Short-term surgical outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer
- 564 Downloads
Laparoscopy-assisted gastrectomy (LAG) has gained acceptance as one of the best treatments for early gastric cancer. However, the application of LAG with D2 lymph node dissection in patients with locally advanced gastric cancer (AGC) remains controversial.
We launched a prospective randomized controlled trial comparing laparoscopic and open gastrectomy with D2 lymph node dissection for locally AGC to evaluate technical safety and oncologic feasibility. The postoperative morbidity and mortality rates were based on the modified intention-to-treat analysis.
Between January 2010 and June 2012, a total of 328 patients with preoperative clinical stage T2–3N0–3M0 gastric cancer were enrolled in the trial. Six patients with unresected AGC were excluded, and the remaining 322 patients were randomized to the laparoscopic group (162 patients) or the open group (160 patients) for radical surgery. All patients underwent D2 lymph node dissection including 18 (5.59%) proximal gastrectomies, 196 (60.87%) distal gastrectomies, and 108 (33.54%) total gastrectomies. Six patients (3.70%) in the LAG group were converted to open procedures. The overall complication rate was 11.72% in the LAG group and 14.38% in the open group (P = 0.512). No mortality occurred in either group.
The short-term results of the current study suggest that LAG with D2 lymph node dissection is a safe and feasible procedure in treating patients with locally AGC in experienced centers.
KeywordsAdvanced gastric cancer Laparoscopy-assisted gastrectomy Morbidity Mortality D2 lymph node dissection
The authors thank Dong Yi for the statistical analyses. The authors also thank Pingang Li, Yingjie Wan, and Xiao Luo for data collection and management, and Xiaoqing Zhan for language editing.
This study was supported by the Chongqing Science and Technology Commission, China (No. CSTC, 2009AB5035).
Compliance with ethical standards
Drs. Yan Shi, Xianhui Xu, Yongliang Zhao, Feng Qian, Bo Tang, Yingxue Hao, Huaxing Luo, Jun Chen, and Peiwu Yu have no conflicts of interest or financial ties to disclose.
- 4.Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Lee HJ, Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage i gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRefPubMedGoogle Scholar
- 5.Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, Terashima M, Misawa K, Teshima S, Koeda K, Nunobe S, Fukushima N, Yasuda T, Asao Y, Fujiwara Y, Sasako M (2017) Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer 20:699–708CrossRefPubMedGoogle Scholar
- 9.Hu Y, Ying M, Huang C, Wei H, Jiang Z, Peng X, Hu J, Du X, Wang B, Lin F, Xu J, Dong G, Mou T, Li G; Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group (2014) Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China. Surg Endosc 28:2048–2056CrossRefPubMedGoogle Scholar
- 11.Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357CrossRefPubMedGoogle Scholar
- 12.Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A Multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741CrossRefPubMedGoogle Scholar