Comparison of Laparoscopic Distal Gastrectomy With Open Distal Gastrectomy for Patients With Advanced Gastric Cancer: A Single-Center Analysis From a Community Hospital

Objective: This study is aimed to investigate the safety and efficacy of laparoscopic distal gastrectomy (LDG) at the community hospital. Summary of Background Data: Although various clinical trials have shown that laparoscopic distal gastrectomy was feasible in patients with early gastric cancer, its safety and efficacy for patients with advanced gastric cancer need to be elucidated. Methods: Patients with pathological Stage IB-III gastric cancer who underwent open distal gastrectomy (ODG) or LDG with D1+ or more extended lymph node (LN) dissection between 2007 and 2014 were eligible for this retrospective study. Patient characteristics, clinicopathologic factors, and post-treatment recurrence were recorded. To evaluate the safety of the surgery, surgical outcomes and postoperative complication were investigated. Results: 638 patients underwent gastrectomy for gastric cancer, with 67 patients included in ODG group and 61 included in LDG group. Patients in the ODG group showed significantly more progressive disease than those in the LDG group. Postoperative infectious complications, [≥Clavien-Dindo (C-D) classification grade III] occurred 6% in all patients, and there was no significant difference between groups. Hospital stay (median, range) was (9, 6–45) in ODG and (7, 5–58) in LDG, with significantly shorter stays in the LDG group (<0.001). Conclusions: LDG could be safely performed for advanced gastric cancer in a community hospital. However, long-term outcomes, including types of postoperative recurrence, need further evaluation.

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Oncologic outcomes after laparoscopic and open distal gastrectomy for advanced gastric cancer: A propensity score matching analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.135 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 135-135

Author(s):

Yoona Chung ◽

Sung Il Choi ◽

Kyungpyo Hong ◽

Sanghyun Kim

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Propensity Score Matching ◽

Distal Gastrectomy ◽

Laparoscopic Distal Gastrectomy ◽

Oncologic Outcomes ◽

Open Distal Gastrectomy ◽

Propensity Score Matching Analysis

135 Background: The aim of this study is to investigate the oncologic outcomes as well as short-term outcomes of laparoscopic distal gastrectomy compared with open distal gastrectomy for advanced gastric cancer using propensity-score matching analysis. Methods: A total of 384 patients underwent distal gastrectomy for advanced gastric cancer from July 2006 to November 2016. Data on short- and long-term outcomes were collected prospectively and reviewed. Propensity-score matching was applied at a ratio of 1:1 comparing the laparoscopic distal gastrectomy (LDG) group and open distal gastrectomy (ODG) groups. Results: The LDG group showed longer operative time than the ODG group. However, resumption of diet and length of hospital stay were shorter in the LDG group than in the ODG group (4.7 vs. 5.6 days, p= 0.049 and 9.6 vs. 11.5 days, p= 0.035, respectively).The extent of lymph node dissection in the LDG group was more limited than in the ODG group ( p= 0.002), although there was no difference in the number of retrieved lymph nodes between the two groups. The 3-year overall survival rates were 98% and 86.9% ( p= 0.018), whereas the 3-year recurrence-free survival were 86.3% and 75.3%, p= 0.259) in the LDG and the ODG groups. Conclusions: Laparoscopic distal gastrectomy is safe and feasible for advanced gastric cancer in terms of earlier recovery after surgery and long-term oncologic outcomes.

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Morbidity and mortality of elderly patients with advanced gastric cancer after laparoscopy-assisted or open distal gastrectomy: a randomized–controlled trial

Gastroenterology Report ◽

10.1093/gastro/goy013 ◽

2018 ◽

Vol 6 (4) ◽

pp. 317-319 ◽

Cited By ~ 3

Author(s):

Jun Luo ◽

Yu Zhu ◽

Hao Liu ◽

Yan-Feng Hu ◽

Tuan-Jie Li ◽

...

Keyword(s):

Gastric Cancer ◽

Randomized Controlled Trial ◽

Elderly Patients ◽

Advanced Gastric Cancer ◽

Distal Gastrectomy ◽

Controlled Trial ◽

Morbidity And Mortality ◽

Open Distal Gastrectomy ◽

Randomized Controlled

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Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial

Journal of Clinical Oncology ◽

10.1200/jco.20.01210 ◽

2020 ◽

Vol 38 (28) ◽

pp. 3304-3313 ◽

Cited By ~ 3

Author(s):

Woo Jin Hyung ◽

Han-Kwang Yang ◽

Young-Kyu Park ◽

Hyuk-Joon Lee ◽

Ji Yeong An ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Open Surgery ◽

Distal Gastrectomy ◽

Locally Advanced ◽

Laparoscopic Distal Gastrectomy ◽

D2 Lymphadenectomy ◽

Relapse Free Survival ◽

Free Survival ◽

Locally Advanced Gastric Cancer

PURPOSE It is unclear whether laparoscopic distal gastrectomy for locally advanced gastric cancer is oncologically equivalent to open distal gastrectomy. The noninferiority of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer compared with open surgery in terms of 3-year relapse-free survival rate was evaluated. PATIENTS AND METHODS A phase III, open-label, randomized controlled trial was conducted for patients with histologically proven locally advanced gastric adenocarcinoma suitable for distal subtotal gastrectomy. The primary end point was the 3-year relapse-free survival rate; the upper limit of the hazard ratio (HR) for noninferiority was 1.43 between the laparoscopic and open distal gastrectomy groups. RESULTS From November 2011 to April 2015, 1,050 patients were randomly assigned to laparoscopy (n = 524) or open surgery (n = 526). After exclusions, 492 patients underwent laparoscopic surgery and 482 underwent open surgery and were included in the analysis. The laparoscopy group, compared with the open surgery group, suffered fewer early complications (15.7% v 23.4%, respectively; P = .0027) and late complications (4.7% v 9.5%, respectively; P = .0038), particularly intestinal obstruction (2.0% v 4.4%, respectively; P = .0447). The 3-year relapse-free survival rate was 80.3% (95% CI, 76.0% to 85.0%) for the laparoscopy group and 81.3% (95% CI, 77.0% to 85.0%; log-rank P = .726) for the open group. Cox regression analysis after stratification by the surgeon revealed an HR of 1.035 (95% CI, 0.762 to 1.406; log-rank P = .827; P for noninferiority = .039). When stratified by pathologic stage, the HR was 1.020 (95% CI, 0.751 to 1.385; log-rank P = .900; P for noninferiority = .030). CONCLUSION Laparoscopic distal gastrectomy with D2 lymphadenectomy was comparable to open surgery in terms of relapse-free survival for patients with locally advanced gastric cancer. Laparoscopic distal gastrectomy with D2 lymphadenectomy could be a potential standard treatment option for locally advanced gastric cancer.

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