Laparoscopic gastrectomy could become ‘standard treatment’ for advanced gastric cancer
Click Here to Manage Email Alerts
Key takeaways:
- No significant difference in 5-year relapse-free and overall survival between laparoscopic and open gastrectomy groups.
- Laparoscopic gastrectomy could become a standard treatment for advanced gastric cancer.
Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection was noninferior to open distal gastrectomy in patients with locally advanced gastric cancer, according to 5-year follow-up data published in JAMA Surgery.
“For advanced gastric cancer (AGC), laparoscopic gastrectomy is considered technically difficult owing to the large tumor size and lymph node metastasis. To clarify the safety and effectiveness of laparoscopy-assisted distal gastrectomy (LADG) with D2 lymph node dissection for AGC, outcomes of several prospective studies have been reported recently,” Tsuyoshi Etoh, MD, of the department of gastroenterological and pediatric surgery at Oita University in Japan, and colleagues wrote. “Although these secondary analyses seem informative for clinical practice, a primary endpoint on a longer follow-up period is clearly more robust for verifying noninferiority of LADG for locally AGC.”
In a multicenter, open-label, phase 2/3 trial, Etoh and colleagues in the Japanese Laparoscopic Surgery Study Group evaluated 502 patients with ACG who underwent open distal gastrectomy (ODG) or LADG to determine relapse-free and overall survival at 5 years. Included in analysis were 254 patients in the ODG group (median age, 67 years; 66.1% men) and 248 in the LADG group (median age, 64 years; 68.1% men).
Postoperative complications occurred in 10.7% of patients in the ODG group and 11.5% in the LADG group, with grade 3 or higher complications reported in 4.7% and 3.5%, respectively.
After a median follow-up of 67.9 months, 5-year relapse-free survival was 73.9% (95% CI, 68.7-79.5) in the ODG group and 75.7% (95% CI, 70.5-81.2) in the LADG group (HR = 0.96; 90% CI, 0.72-1.26). Researchers observed no “significant difference” in overall survival time between groups (HR = 0.83; 95% CI, 0.57-1.21) and similar patterns of recurrence following curative resection (18.1% vs. 17.7%).
“Findings of this randomized controlled trial reveal that LADG with D2 LND for locally AGC was safely performed by trained and qualified surgeons without major surgical complications, and noninferiority of this procedure compared with ODG concerning the 5-year RFS was established,” Etoh and colleagues added. “We conclude that a laparoscopic approach could become the standard treatment for locally AGC.”
Collapse
Read more about
Click Here to Manage Email Alerts