Laparoscopic Versus Open Gastrectomy for Gastric Cancer (LOGICA): A Multicenter Randomized Clinical Trial

Abstract

BACKGROUND The oncological efficacy and safety of laparoscopic gastrectomy are under debate for the Western population with predominantly advanced gastric cancer undergoing multimodality treatment. METHODS In 10 experienced upper GI centers in the Netherlands, patients with resectable (cT1-4aN0-3bM0) gastric adenocarcinoma were randomly assigned to either laparoscopic or open gastrectomy. No masking was performed. The primary outcome was hospital stay. Analyses were performed by intention to treat. It was hypothesized that laparoscopic gastrectomy leads to shorter hospital stay, less postoperative complications, and equal oncological outcomes. RESULTS Between 2015 and 2018, a total of 227 patients were randomly assigned to laparoscopic (n = 115) or open gastrectomy (n = 112). Preoperative chemotherapy was administered to 77 patients (67%) in the laparoscopic group and 87 patients (78%) in the open group. Median hospital stay was 7 days (interquartile range, 5-9) in both groups ( P = .34). Median blood loss was less in the laparoscopic group (150 v 300 mL, P < .001), whereas mean operating time was longer (216 v 182 minutes, P < .001). Both groups did not differ regarding postoperative complications (44% v 42%, P = .91), in-hospital mortality (4% v 7%, P = .40), 30-day readmission rate (9.6% v 9.1%, P = 1.00), R0 resection rate (95% v 95%, P = 1.00), median lymph node yield (29 v 29 nodes, P = .49), 1-year overall survival (76% v 78%, P = .74), and global health-related quality of life up to 1 year postoperatively (mean differences between + 1.5 and + 3.6 on a 1-100 scale; 95% CIs include zero). CONCLUSION Laparoscopic gastrectomy did not lead to a shorter hospital stay in this Western multicenter randomized trial of patients with predominantly advanced gastric cancer. Postoperative complications and oncological efficacy did not differ between laparoscopic gastrectomy and open gastrectomy.

Worldwide Practice in Gastric Cancer Surgery: A 6-Year Update

“…In this enumeration, level 1 evidence reporting on laparoscopic total gastrectomy for advanced cancer is lacking. However, a Dutch multicenter randomized controlled trial (LOGICA trial [NCT02248519]) recently reported laparoscopic total gastrectomy for patients with predominantly advanced cancer to be safe and feasible [18]. In addition, no differences regarding postoperative morbidity, short-term oncological outcomes, and quality of life were reported, although laparoscopic gastrectomy was associated with less blood loss.…”

The Comparison of Short- and Long-Term Outcomes for Laparoscopic Versus Open Gastrectomy for Patients With Advanced Gastric Cancer: A Meta-Analysis of Randomized Controlled Trials

“…Recently, the CLASS-01 ( 11 ) and KLASS-02 trials ( 12 ) updated their results of long-term outcomes, indicating that locally AGC patients with LDG had similar long-term survival rates compared to open distal gastrectomy. Moreover, the LOGICA trial ( 13 ), which compared the LG with OG for treatment of AGC in the Western population, reported comparable outcomes including postoperative complications, length of hospital stay, R0 resection rate, lymph node yield, and 1-year overall survival (OS) rate. Therefore, in order to summarize the current high-quality evidence, we performed this meta-analysis of RCTs to compared the short- and long-term outcomes of LG versus OG for patients with AGC.…”

Everything, in Retrospect, is Obvious

“…3 Due to the well-established differences in tumor biology and adverse prognostic factors between gastric adenocarcinoma from Eastern and Western countries, I will limit the discussion to the one Western RCT available. 4 In the Laparoscopic Versus Open Gastrectomy for Gastric Cancer (LOGICA) trial, investigators from ten experienced upper gastrointestinal centers in the Netherlands reported short-term outcomes of 227 patients. 4 In summary, laparoscopic and open gastrectomy were the same with no differences in hospital length of stay, postoperative complications, and lymph node evaluation.…”

“…4 In the Laparoscopic Versus Open Gastrectomy for Gastric Cancer (LOGICA) trial, investigators from ten experienced upper gastrointestinal centers in the Netherlands reported short-term outcomes of 227 patients. 4 In summary, laparoscopic and open gastrectomy were the same with no differences in hospital length of stay, postoperative complications, and lymph node evaluation. Interestingly, there was also no difference in quality of life between MIS and open surgery.…”