Laparoscopic Versus Open Distal Gastrectomy for Gastric Cancer

Viñuela, Eduardo; Gönen, Mithat; Brennan, Murray F.; Coit, Daniel G.; Strong, Vivian E.

doi:10.1097/sla.0b013e31824682f4

Cited by 327 publications

(144 citation statements)

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“…Significant reductions in the use of analgesics and narcotics, more rapid recovery of intestinal movement, and faster return to normal diet in LAG group together contribute to a reduction in hospital stay, although local hospital policies are different worldwide. These results concur with previous published analyses (Hosono et al, 2006;Liang et al, 2011;Ding et al, 2012;Vinuela et al, 2012), making the meta-analysis of short-term outcomes unnecessary. This study (815 patients) focused on the surgical safety and oncologic results for LAG with extended lymphadenectomy of seven studies comparing laparoscopic with open surgery for mainly AGC; and confirmed that LAG for AGC achieved equivalent morbidity rates.…”

Section: Discussionsupporting

confidence: 82%

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Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Liu

et al. 2013

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The study compared laparoscopy-assisted gastrectomy (LAG) with open gastrectomy (OG) in the management of advanced gastric cancer (AGC). Methods: Literature search was performed in the Medline, Embase, and Cochrane Library databases to identify control studies that compared LAG and OG for AGC. A meta-analysis was conducted to examine the surgical safety and oncologic adequacy, using the random-effect model. Results: Seven eligible studies including 815 patients were analyzed. LAG was associated with less blood loss, less use of analgesics, shorter time of flatus and periods of hospital stay, but longer time of operation. The incidence of most complications was similar between the two groups. However, LAG was associated with a lower rate of pulmonary infection (odds ratio (OR) 0.19; 95% confidence interval (CI) 0.05 to 0.68; P<0.05). No significant differences were noted in terms of the number of harvested lymph nodes (weighted mean difference (WMD) 1.165; 95% CI −2.000 to 4.311; P>0.05), overall mortality (OR 0.65; 95% CI 0.39 to 1.10; P>0.05), cancer-related mortality (OR 0.64; 95% CI 0.32 to 1.25; P>0.05), or recurrence (OR 0.62; 95% CI 0.33 to 1.16; P>0.05). Conclusions: LAG could be performed safely for AGC with adequate lymphadenectomy and has several short-term advantages compared with conventional OG. No differences were found in long-term outcomes. However, these results should be validated in large randomized controlled studies (RCTs) with sufficient follow-up.

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Section: Discussionsupporting

confidence: 82%

“…There are few reports related to the efficacy of LAG in the management for AGC. Regarding the inclusion criteria used to select studies, the recent reports (Hosono et al, 2006;Liang et al, 2011;Ding et al, 2012;Vinuela et al, 2012) included patients with EGC. AGC has rarely been evaluated rigorously in a study.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Liu

et al. 2013

J. Zhejiang Univ. Sci. B

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“…However, the majority of patients had EGC and therefore comparison to a Western population case-mix is difficult. Results further showed additional benefits of fewer overall and minor complications, shorter lengthof-stay (weighted mean difference, 3.6 d) and less blood loss [59] . Also, longer operation time and lower number of harvested lymph nodes was reported for laparoscopic gastrectomy.…”

Section: Laparoscopic Surgerymentioning

confidence: 92%

“…Also, longer operation time and lower number of harvested lymph nodes was reported for laparoscopic gastrectomy. Several other reviews and meta-analyses have been published on this subject since (Table 3) [59][60][61][62][63] . The general conclusion of these studies is that laparoscopic approach offers improved recovery after surgery at no compromise of morbidity and mortality.…”

Section: Laparoscopic Surgerymentioning

confidence: 99%

“…There were no significant differences in operation time, number of harvested lymph nodes and postoperative complications [57,58] . A review and meta-analysis evaluating randomized controlled trials (RCT's) and high quality non-randomized controlled trials on laparoscopic vs open approach for distal gastrectomy for cancer showed that major complications and mortality rates were similar between procedures and concluded that the laparoscopic approach is safe [59] . However, the majority of patients had EGC and therefore comparison to a Western population case-mix is difficult.…”

Section: Laparoscopic Surgerymentioning

confidence: 99%

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Improving the outcomes in gastric cancer surgery

Tegels¹,

Maat²,

Hulsewé³

et al. 2014

WJG

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Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced Gastric Cancer

Huang

Sun

et al. 2019

JAMA

544

407

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IMPORTANCE Laparoscopic distal gastrectomy is accepted as a more effective approach to conventional open distal gastrectomy for early-stage gastric cancer. However, efficacy for locally advanced gastric cancer remains uncertain. OBJECTIVE To compare 3-year disease-free survival for patients with locally advanced gastric cancer after laparoscopic distal gastrectomy or open distal gastrectomy. DESIGN, SETTING, AND PATIENTS The study was a noninferiority, open-label, randomized clinical trial at 14 centers in China. A total of 1056 eligible patients with clinical stage T2, T3, or T4a gastric cancer without bulky nodes or distant metastases were enrolled from September 2012 to December 2014. Final follow-up was on December 31, 2017. INTERVENTIONS Participants were randomized in a 1:1 ratio after stratification by site, age, cancer stage, and histology to undergo either laparoscopic distal gastrectomy (n = 528) or open distal gastrectomy (n = 528) with D2 lymphadenectomy. MAIN OUTCOMES AND MEASURESThe primary end point was 3-year disease-free survival with a noninferiority margin of −10% to compare laparoscopic distal gastrectomy with open distal gastrectomy. Secondary end points of 3-year overall survival and recurrence patterns were tested for superiority. RESULTS Among 1056 patients, 1039 (98.4%; mean age, 56.2 years; 313 [30.1%] women) had surgery (laparoscopic distal gastrectomy [n=519] vs open distal gastrectomy [n=520]), and 999 (94.6%) completed the study. Three-year disease-free survival rate was 76.5% in the laparoscopic distal gastrectomy group and 77.8% in the open distal gastrectomy group, absolute difference of −1.3% and a 1-sided 97.5% CI of −6.5% to ϱ, not crossing the prespecified noninferiority margin. Three-year overall survival rate (laparoscopic distal gastrectomy vs open distal gastrectomy: 83.1% vs 85.2%; adjusted hazard ratio, 1.19; 95% CI, 0.87 to 1.64; P = .28) and cumulative incidence of recurrence over the 3-year period (laparoscopic distal gastrectomy vs open distal gastrectomy: 18.8% vs 16.5%; subhazard ratio, 1.15; 95% CI, 0.86 to 1.54; P = .35) did not significantly differ between laparoscopic distal gastrectomy and open distal gastrectomy groups.CONCLUSIONS AND RELEVANCE Among patients with a preoperative clinical stage indicating locally advanced gastric cancer, laparoscopic distal gastrectomy, compared with open distal gastrectomy, did not result in inferior disease-free survival at 3 years.

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Laparoscopic Versus Open Distal Gastrectomy for Gastric Cancer

Cited by 327 publications

References 100 publications

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Improving the outcomes in gastric cancer surgery

Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced Gastric Cancer

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