A prospective randomized clinical trial comparing D2 dissection in laparoscopic and open gastrectomy for gastric cancer

Abstract

Laparoscopic surgery is an acceptable alternative to open surgery in colorectal cancer treatment. However, in gastric cancer, there is not much scientific evidence. Here, we proposed a prospective randomized clinical trial to evaluate the radicalness and safety of laparoscopic D2 dissection for gastric cancer. From October 2010 to September 2012, 300 patients with gastric cancer were randomized to undergo either laparoscopy-assisted gastrectomy (LAG) or conventional open gastrectomy (OG) with D2 dissection. Clinicopathological parameters, recovery and complications were compared between these two groups. Thirty cases were excluded because of refusing to be involved in the trial, having peritoneal seeding metastasis or LAG conversed to OG, and finally 270 cases were analyzed (128 in LAG and 142 in OG). No significant differences were observed in gender, age, body mass index, stages and types of radical resection [radical proximal gastrectomy (PG + D2), radical distal gastrectomy (DG + D2) and radical total gastrectomy (TG + D2)] (P > 0.05). The number of harvested lymph nodes (HLNs) was similar (29.3 ± 11.8 in LAG vs. 30.1 ± 11.4 in OG, P = 0.574). And in the same type of radical resection, no significant difference was found in the number of HLNs between the two groups (PG + D2, P = 0.770; DG + D2, P = 0.500; TG + D2, P = 0.993). The morbidity of the LAG group (21.8 %) was also comparable to the OG group (19.0 %, P = 0.560). However, the LAG group had significantly less blood loss and faster recovery, and a longer operation time (P < 0.05). Laparoscopic D2 dissection is feasible, safe and capable of fulfilling oncologic criteria for the treatment of gastric cancer.

Laparoscopic‐assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta‐analysis, and trial sequential analysis of randomized controlled trials

“…Also, we checked the references of relevant reviews, published meta‐analyses and possible included studies. Finally, 14 RCTs totaling 2,307 gastric cancer survivors (1,163 laparoscopic and 1,144 open) were included in present meta‐analysis .…”

“…Although blinding was seldom described in most studies, outcomes of interest seemed to be difficult to be influenced by the lack of blinding. Overall, two trials were categorized as at low risk of bias and twelve as at unclear risk of bias .…”

“…Now, new evidence from longer follow‐up RCTs with inconsistent results was reported . Therefore, an updated meta‐analysis of randomized controlled trials was conducted to compare the safety and efficacy of LAG with OG for resectable gastric cancer, including relevant data on hospital costs, patient satisfaction and quality of life.…”

Ongoing clinical studies of minimally invasive surgery for gastric cancer in Japan

“…In East Asia, large-scale, multicenter RCTs are currently ongoing not only in Japan, but also in Korea (KLASS 02: NCT01456598) and China (CLASS 01: NCT01609309). Regarding to short-term outcome from the Chinese trials including CLASS01 study, favorable outcome in LADG as well as ODG for AGC has been demonstrated (30,31). These data in combination will be beneficial for determining the role of LAG.…”

Laparoscopic Total Gastrectomy with D2 Lymphadenectomy and Side-to-Side Stapled Esophagojejunostomy

“…8 Several other series of single institution experiences have been reported from Asia and Western Europe. In addition, two recent prospective randomized trials have shown technical safety of laparoscopic-assisted distal gastrectomy in Japan 9 and laparoscopic-assisted gastrectomy in China, 10 including 42 total gastrectomies with D2 lymphadenectomy. Both trials showed safety and feasibility of a laparoscopic approach, albeit these trials compared laparoscopicassisted and not totally laparoscopic gastrectomy.…”