Outcomes Following Laparoscopic vs Open Surgery for Gastric Cancer

Open surgery and laparoscopic distal gastrectomy with D2 lymphadenectomy were found to have similar long-term prognoses among patients with gastric cancer. These findings, from a phase 3, multicenter, open-label, randomized, controlled trial, were published in the Journal of Clinical Oncology.

Patients (N=974) with locally advanced gastric cancer who were suitable for curative resection by distal subtotal gastrectomy were recruited from 13 tertiary hospitals in South Korea between 2011 and 2015. The patients were randomly assigned 1:1 to undergo laparoscopic (n=492) or open (n=482) surgery. The procedures were performed by 20 surgeons who had previously performed at least 50 of each type of surgery. Clinical outcomes and mortality up to 3 years were assessed.

Patients were aged mean 59.8±11.0 and 59.4±11.5 years, and 71.3% and 69.5% were men in the laparoscopy and open surgery groups, respectively. The cohorts were well balanced for baseline clinical characteristics.

The laparoscopy group had a significantly higher instance of gastrojejunostomy (P <.001) and longer operation durations (P <.001), but patients recovered more quickly (3.5 vs 3.7 days; P =.0431) and spent fewer days in the hospital (8.0 vs 9.1 days; P =.0047).

The laparoscopy group experienced fewer early postoperative complications compared with the open surgery group (15.7% vs 23.4%; P =.0027); they also reported fewer  postoperative complications during follow-up (4.7% vs 9.5%; P =.0038).

Mortality rates were similar between the groups. At a median follow-up of 36.3 months, 9.1% of the laparoscopy and 9.3% of the open cohorts had died. These totals equated to survival rates of 90.6% (95% CI, 88.0-93.2) for those undergoing laparoscopy and 90.3% (95% CI, 87.6-93.0; P =.961) for those undergoing open surgery.

Death and recurrence rates were also similar (laparoscopy: 17.3%, open: 16.6%). The 3-year relapse-free survival for the laparoscopy (80.3%; 95% CI, 76.0-85.0) and open (81.3%; 95% CI, 77.0-85.0; P =.726) cohorts did not differ significantly.

This study may have been limited by including a high proportion of patients with stage I cancer (35%), and it remains unclear whether similar clinical outcomes would be observed among a patient population with more progressive disease.

The results from this trial indicate that laparoscopic surgery had similar clinical outcomes as open surgery but resulted in decreased postoperative complications and hospital stays. Laparoscopic distal gastrectomy with D2 lymphadenectomy may be a viable option for the treatment of advanced gastric cancer.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry.  In addition, this study was sponsored by the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Hyung WJ, Yang H-K, Park Y-K, et al; on behalf of the Korean Laparoendoscopic Gastrointestinal Surgery Study Group. Long-term outcomes of laparoscopic distal gastrectomy for locally advanced gastric cancer: the KLASS-02-RCT randomized clinical trial. J Clin Oncol. 2020;38(28):3304-3313. doi:10.1200/JCO.20.01210