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.

Identifying locoregional gastric cancer patients who are at high risk for relapse after resection could facilitate early intervention. By detecting molecular residual disease (MRD), circulating tumor DNA (ctDNA) has been shown to predict post-operative relapse in several cancers. Here, we aim to evaluate MRD detection by ctDNA and its association with clinical outcome in resected gastric cancer. This prospective cohort study enrolled 46 patients with stage I–III gastric cancer that underwent resection with curative intent. Sixty resected tumor samples and 296 plasma samples were obtained for targeted deep sequencing and longitudinal ctDNA profiling. ctDNA detection was correlated with clinicopathologic features and post-operative disease-free (DFS) and overall survival (OS). ctDNA was detected in 45% of treatment-naïve plasma samples. Primary tumor extent (T stage) was independently associated with pre-operative ctDNA positivity (p = 0.006). All patients with detectable ctDNA in the immediate post-operative period eventually experienced recurrence. ctDNA positivity at any time during longitudinal post-operative follow-up was associated with worse DFS and OS (HR = 14.78, 95%CI, 7.991–61.29, p < 0.0001 and HR = 7.664, 95% CI, 2.916–21.06, p = 0.002, respectively), and preceded radiographic recurrence by a median of 6 months. In locoregional gastric cancer patients treated with curative intent, these results indicate that ctDNA-detected MRD identifies patients at high risk for recurrence and can facilitate novel treatment intensification studies in the adjuvant setting to improve survival.

Background Laparoscopically assisted gastric surgery has become an option for the treatment of early gastric cancer. However, the feasibility and safety of laparoscopically assisted gastrectomy for advanced gastric cancer has rarely been studied. This study evaluated the short-and long-term outcomes of laparoscopically assisted distal gastrectomy (LADG) for advanced gastric cancer. Methods The study retrospectively analyzed the clinical and follow-up data for 346 cases after LADG and for 313 cases after conventional open distal gastrectomy (ODG) used to treat advanced gastric cancer from January 2004 to June 2009 at the authors' hospital. The surgical safety, postoperative complications, survival rate, and recurrence and metastasis of cancer were compared between the LADG and ODG groups. Results The average time for the LADG and ODG procedures did not differ significantly (211 ± 56 vs 204 ± 41 min), but bleeding during the operation and incision length in the LADG group were significantly less than in the ODG group. The proximal and distal margins of tumors were, respectively, 6.25 ± 2.04 and 5.68 ± 1.71 cm in the LADG group compared with 6.29 ± 2.11 and 5.62 ± 1.59 cm in the ODG group. Neither intergroup difference was significant. The number of lymph node dissections also was similar in the two groups: 33.2 ± 12.5 in the LADG group and 32.8 ± 15.6 in the ODG group. The incidence of postoperative complications in the LADG group (6.7%) was significantly lower than in the ODG group (13.1%). During the follow-up period of 6 to 72 months (average, 37 months), the survival rates were 87.2% at 1 year, 57.2% at 3 years, and 50.30% at 5 years in the LADG group compared with 87.1% at 1 year, 54.1% at 3 years, and 49.2% at 5 years in the ODG group (all similar between the groups). The differences in recurrence and metastasis between the two groups were not statistically significant. Conclusion Laparoscopically assisted gastrectomy for advanced gastric cancer is safe and effective. In this study, it did not differ significantly from open surgery in terms of survival rate or recurrence after surgery based on long-term follow-up evaluation. It can achieve the same beneficial effects as open surgery, and it has the advantages of a small operation wound, less bleeding, good safety, rapid postoperative recovery, and fewer complications.Keywords Advanced gastric cancer Á Distal subtotal gastrectomy Á Laparoscopic surgery Á Lymph node dissection Laparoscopically assisted gastrectomy for early gastric cancer has gradually matured technically since its development more than 10 years ago. Many reports indicate that laparoscopic treatment for early gastric cancer can achieve the same benefit as open surgery with quite good short-and long-term efficacy [1][2][3]. Additionally, it has the advantages of rapid recovery and fewer complications [4][5][6]. It also has been accepted as one of the standard approaches for