Prospective randomized controlled trial (phase III) to comparing laparoscopic distal gastrectomy with open distal gastrectomy for gastric adenocarcinoma (KLASS 01)

Kim, Hyung‐Ho; Han, Sang‐Uk; Kim, Min-Chan; Hyung, Woo Jin; Kim, Wook; Lee, Hyuk-Joon; Ryu, Seung Wan; Cho, Gyu Seok; Kim, Chan Young; Yang, Han–Kwang; Park, Do Joong; Song, Kyo Young; Lee, Sang IL; Ryu, Seong Yeob; Lee, Joo Ho

doi:10.4174/jkss.2013.84.2.123

Cited by 93 publications

(69 citation statements)

References 22 publications

(23 reference statements)

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“…Laparoscopic gastrectomy has long been used to treat EGC, and in the past decade, attention has been paid to the feasibility and safety of LG for AGC. Although several clinical trials have been initiated to evaluate the effectiveness of LG [9,10,56,57], currently we do not have enough evidence to support this surgical procedure in AGC management. To this end, we conducted this meta-analysis trying to find some clues.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to OG, LG is associated with less blood loss, fewer surgical complications, faster bowel function recovery, shorter hospital stay, and an equivalent rate of postoperative tumor recurrence [6][7][8]. Although the long-term oncological effects of LG for EGC still need to be validated by two ongoing phase III trials [9,10], laparoscopic surgery for EGC is largely accepted and increasingly used in East Asia (China, Japan, and Korea).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Quan

Huang

et al. 2015

Gastric Cancer

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Background Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. Methods Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. Results Overall, 26 studies were included in this metaanalysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P \ 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P \ 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P \ 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P \ 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P \ 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. Conclusions For AGCs, LG appeared comparable with OG in short-and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Quan

Huang

et al. 2015

Gastric Cancer

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Section: Editorialmentioning

confidence: 95%

“…The short and long term results regarding the safety and efficacy of oncological outcomes of laparoscopic gastrectomy in early gastric cancer have already been established and are considered unequivocal. 3,4 We are expecting such results in advanced gastric cancer.Obese patients with gastric cancer have shown poor surgical outcomes in open and laparoscopic surgery compared with normal weight patients. A longer operation time, more intraoperative blood loss, and less lymph node retrievals were reported and more evident in cases of open surgery.…”

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confidence: 95%

Improved Surgical Outcomes of Laparoscopic Gastrectomy Compared with Conventional Open Gastrectomy for Gastric Adenocarcinoma in Obese Patients

Choi

2017

J Minim Invasive Surg

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EDITORIALLaparoscopic abdominal surgery including gastrectomy in obese patients is challenging. Obesity has been increasing and more and more patients we encounter in the surgical clinic are obese as well. 1 Although the incidence of gastric cancer has been on the decline, it is still one of most common cancers in Asian countries. 2 Minimally invasive surgery for gastric cancer is being practiced more often with the development of new instruments and improvement in devices. The short and long term results regarding the safety and efficacy of oncological outcomes of laparoscopic gastrectomy in early gastric cancer have already been established and are considered unequivocal. 3,4 We are expecting such results in advanced gastric cancer.Obese patients with gastric cancer have shown poor surgical outcomes in open and laparoscopic surgery compared with normal weight patients. A longer operation time, more intraoperative blood loss, and less lymph node retrievals were reported and more evident in cases of open surgery. 5 A high level of surgical technique is required in every process in obese gastric cancer patients, from inserting the trocars, performing gastrectomy with adequate lymph node dissection and completing reconstruction. Excessive fat makes anatomical dissection difficult during omentectomy, lymph node dissection around major vessels and in conducting a tension-free reconstruction.Short term outcomes of laparoscopic surgery in obese patients such as operation time, open conversion rate, postoperative complications and mortality are concerning issues for the surgeon. Furthermore, long term results including cancer recurrence and incisional hernia are of interest.In this article, the author divided the patients into two groups according to their BMI. However, the extent of visceral obesity could be of more importance in abdominal surgery because BMI may not accurately reflect the amount of intraabdominal fat, which makes laparoscopic procedures more difficult. 6 The results of this study might differ if data were reanalyzed according to visceral fat.The patients in the open gastrectomy group had slightly larger tumors and had received more aggressive lymph node dissection than in the laparoscopic group even though all patients were diagnosed with early gastric cancer. This is one of the reasons why the laparoscopic group had more favorable results. Surprisingly, the operation time was shorter in the laparoscopic group, which was probably because of the well trained and highly qualified participating operators. This article helps readers consider the advantages of laparoscopic

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“…They reported that the LADG and ODG groups showed similar survival (5-year disease-free survival: 98.8% in LADG vs 97.6% in ODG, P = 0.514; 5-year overall survival: 97.6% in LADG vs 96.3% in ODG, P = 0.721) with reductions in mild complications observed with LADG (23.2% in LADG vs 41.5% in ODG, P = 0.012). In relation to patient quality of life, LADG showed better short-term functional and symptom scores, but no long-term advantages.Currently, two large-scale multicenter RCTs are underway to elucidate the long-term oncological results of laparoscopic gastrectomy: The Korean Laparoscopic Gastrointestinal Surgery Study (KLASS)-01 and Japanese Clinical Oncology Group (JCOG) 0912 trials ( [43] . In 2010, the JCOG also started a multicenter RCT to compare ODG and LADG in 920 patients with stage Ⅰ gastric cancer accrued from 33 institutions.…”

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confidence: 99%

Minimally Invasive Surgery of Gastric Cancer

Güner

Hyung

2017

Minimally Invasive Surgery for Upper Abdominal Cancer

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Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short-and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Gastric cancer; Minimally invasive surgery; Laparoscopic gastrectomyCore tip: Minimally invasive surgery has become an alternative modality for the treatment of gastric cancer.Son SY, Kim HH. Minimally invasive surgery in gastric cancer. World J Gastroenterol 2014; 20(39): 14132-14141 Available from: URL: http://www.wjgnet.com/1007-9327/full/ v20/i39/14132.htm DOI: http://dx.doi.org/10.3748/wjg.v20. tano et al [9] and Nagai et al [10] reported the success of laparoscopy-assisted distal gastrectomy (LADG) for EGC in 1994 and 1995. In the early 2000s, robot-assisted surgery emerged as one of the treatment modalities for EGC, and the first robot-assisted gastrectomy (RAG) for EGC was reported by Hashizume et al [11] in 2003. In 2011, singleincision laparoscopic surgery was described for EGC [12] . MIS has revolutionized the surgical approach to gastric cancer for the past two decades, leading to improvements in patients' quality of life by producing less pain, less blood loss, earlier postoperative recovery, and a shorter hospital stay [13][14][15][16][17][18][19] .Currently, MIS is evolving in two major directions [20] . First, MIS techniques are being used in more radical but less invasive procedures, such as totally laparoscopic distal gastrectomy or laparoscopic total gastrectomy with D1+ or D2 lymphadenectomy. These procedures are comparable to conventional open surgery and can be performed even in patients with advanced gastric cancer (AGC) [21][22][23] . Second, MIS is being employed for function-preserving surgery, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy, and limited gastrectomy with sentinel node navigation surgery. These procedures can assist in improving patients' late postoperative function and quality of life [20,[24][25][26] . RECENT ADVANCES IN LAPAROSCOPIC GASTRECTOMYAs advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Totally laparoscopic gastrectomy (TLG) is one example. TLG has gained popularity since Kanaya et al [27] reported the first delta-shaped anastomosis. A recent meta-analysis (five studies, 652 patients) showed that totally laparoscopic distal gastrectomy has less bleeding, shorter time to first flatus, and lower rates of postoperative complicat...

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Prospective randomized controlled trial (phase III) to comparing laparoscopic distal gastrectomy with open distal gastrectomy for gastric adenocarcinoma (KLASS 01)

Cited by 93 publications

References 22 publications

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis

Improved Surgical Outcomes of Laparoscopic Gastrectomy Compared with Conventional Open Gastrectomy for Gastric Adenocarcinoma in Obese Patients

Minimally Invasive Surgery of Gastric Cancer

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