Morbidity and Mortality of Laparoscopic vs Open Total Gastrectomy for Clinical Stage I Gastric Cancer

Abstract

IMPORTANCEThe safety of laparoscopic total gastrectomy (LTG) for the treatment of gastric cancer remains uncertain given the lack of high-level clinical evidence.OBJECTIVE To compare the safety of LTG for clinical stage I gastric cancer with that of conventional open total gastrectomy (OTG). DESIGN, SETTING, AND PARTICIPANTSThe Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group CLASS02 study was a prospective, multicenter, open-label, noninferiority, randomized clinical trial that compared the safety of LTG vs OTG with lymphadenectomy for patients with clinical stage I gastric cancer. From January 2017 to September 2018, a total of 227 patients were enrolled. Final follow-up was in October 2018. INTERVENTIONS Eligible patients were randomized to LTG (n = 113) or OTG (n = 114) by an interactive web response system. MAIN OUTCOMES AND MEASURESThe primary outcome was the morbidity and mortality within 30 days following surgeries between LTG and OTG with a noninferiority margin of 10%. The secondary outcomes were recovery courses and postoperative hospital stays.RESULTS A total of 214 patients were analyzed for morbidity and mortality (105 patients in the LTG group and 109 patients in the OTG group). The mean (SD) age was 59.8 (9.4) years in the LTG group and 59.4 (9.2) years in the OTG group, and most were male (LTG group, 75 of 105 [71.4%]; OTG group, 80 of 109 [73.4%]). The overall morbidity and mortality rates were not significantly different between the groups (rate difference, −1.1%; 95% CI, −11.8% to 9.6%). Intraoperative complications occurred in 3 patients (2.9%) in the LTG group and 4 patients (3.7%) in the OTG group (rate difference, −0.8%; 95% CI, −6.5% to 4.9%). In addition, there was no significant difference in the overall postoperative complication rate of 18.1% in the LTG group and 17.4% in the OTG group (rate difference, 0.7%; 95% CI, −9.6% to 11.0%). One patient in the LTG group died from intra-abdominal bleeding secondary to splenic artery hemorrhage. However, there was no significant difference in mortality between the LTG group and the OTG group (rate difference, 1.0%; 95% CI, −2.5% to 5.2%), and the distribution of complication severity was similar between the 2 groups. CONCLUSIONS AND RELEVANCEThe results of the CLASS02 trial showed that the safety of LTG with lymphadenectomy by experienced surgeons for clinical stage I gastric cancer was comparable to that of OTG.

Laparoscopic gastrectomy plus D2 lymphadenectomy is as effective as open surgery in terms of long-term survival: a single-institution study on gastric cancer

“…It was reported by the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) group that laparoscopic gastrectomy was related with much better short-term outcomes such as less blood loss, less severe postoperative pain, faster recovery, and much shorter hospital stay and similar long-term oncological outcomes [ 7 ]. In a multicenter randomized clinical trial published in 2020, similar conclusions were drawn [ 5 ]. Thus, as far as we are concerned, in most guidelines and multicenter clinical trial, laparoscopic gastrectomy is recommended as the treatment of choice for early-stage GC.…”

“…Oncological safety of laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer (most were stages II and III) has previously been proven by a few large randomized clinical trials [ 9 , 12 , 20 ]. In these studies and other reports, it was reported that in comparison with open surgery, laparoscopic gastrectomy plus D2 lymphadenectomy was related with significantly lower intraoperative and postoperative complication rates and quicker recovery [ 5 , 7 , 9 , 12 , 20 ]. However, for stage I GC, a D2 lymphadenectomy is not always indicated and concerns about risks and benefits of laparoscopic gastrectomy plus D2 lymphadenectomy have not been fully resolved [ 5 , 7 , 21 ].…”

“…A few clinical trials have confirmed the safety of laparoscopic gastrectomy plus D2 lymphadenectomy in treating GC [ 12 , 18 , 19 ]. The short-term advantages and oncological safety of laparoscopic surgery for stage I GC has recently been confirmed by one Korean randomized trial and Chinese clinical study, demonstrating decreased morbidity rates and at least non-inferior long-term outcomes related with laparoscopic approach [ 5 , 7 ]. Oncological safety of laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer (most were stages II and III) has previously been proven by a few large randomized clinical trials [ 9 , 12 , 20 ].…”

Effects of Clavien-Dindo classification on long-term survival of patients with advanced gastric cancer after radical resection:A propensity score-matched study

“…Radical resection of gastric cancer lesions combined with adequate lymph node dissection is key to treatment of gastric cancer. However, radical resection of gastric cancer is still technically di cult the incidence of postoperative complications (POCs) of gastric cancer was reported to be 12.9 24.4% [3][4][5].The most common POCs are anastomotic problems, obstruction, infectious complications such as pneumonia, abdominal abscess, urinary tract infection, incision infection, etc.…”

The Novel Role of Circular RNA ST3GAL6 on Blocking GC Malignant Behaviors Through Autophagy Regulated by the FOXP2/MET/Mtor Axis

“…East Asia, including China, has a high incidence of gastric cancer 1,2 . Although much progress has been made in improving the quality of life of gastric cancer patients [3][4][5] , the overall survival of GC patients has remained unsatisfactory in recent years 6 . Therefore, it is valuable to explore the potential mechanism and identify possible clinical therapeutic targets.…”