Long-term outcomes of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG0703)

Abstract

Background Laparoscopic gastrectomy has become a common surgical treatment for gastric cancer in eastern Asian countries. However, a large-scale prospective study to investigate the benefit of laparoscopy-assisted distal gastrectomy (LADG) regarding long-term outcomes has never been reported. We have already reported the shortterm outcomes of this study. Here we report long-term outcomes as the secondary endpoints of this study after a 5-year follow-up period. Methods This study comprised patients with clinical stage I gastric cancer who were able to undergo a distal gastrectomy. LADG with D1 plus suprapancreatic lymph node dissection was performed by credentialed gastric surgeons who had each conducted at least 30 LADG and 30 open gastrectomy procedures. The primary endpoint was the proportion of patients who developed either anastomotic leakage or pancreatic fistula. The secondary endpoints included overall survival and relapse-free survival. Results From November 2007 to September 2008, 176 eligible patients were enrolled, comprising 140 patients with pathological stage IA disease, 23 patients with pathological stage IB disease, 9 patients with pathological stage II disease, and 4 patients with pathological stage IIIA disease. No patients had recurrent disease, and three of the patients died within the follow-up period. The 5-year overall survival was 98.2% (95% confidence interval 94.4-99.4%) and the 5-year relapse-free survival was 98.2% (95% confidence interval 94.4-99.4%). Conclusions The long-term outcomes of stage I gastric cancer patients undergoing LADG seem comparable to those of patients undergoing an open procedure, although this result should be confirmed by a randomized control trial. We have already completed accrual of 921 patients for a multicenter randomized phase III trial (JCOG0912) to confirm the noninferiority of LADG compared with open gastrectomy in terms of relapse-free survival.

Feasibility and Effectiveness of Gastrectomy for Elderly Gastric Cancer Patients

“…Since, younger patients have less comorbidities and longer expectancy than elderly, fine classification of patients is needed to compare the surgical short-and long-term outcomes, as in our study. The JCOG0703 study in which the majority of the patients were pathological Stage I, has shown that no patients had recurrent disease and the 5-year OS and RFS were both 98.2% (17). Although, in that study the median age was 59 years old, a similar result was obtained in the current study: no patients had recurrent disease in pathological Stage I.…”

Prospective feasibility study for single-tracer sentinel node mapping by ICG (indocyanine green) fluorescence and OSNA (one-step nucleic acid amplification) assay in laparoscopic gastric cancer surgery

“…Laparoscopic gastrectomy (LG) with lymphadenectomy is increasingly performed to manage early gastric cancer in Asian countries because of its reduced invasiveness compared with conventional open gastrectomy [1][2][3][4][5][6]. However, because the incidence of lymph node (LN) metastasis is low in early gastric cancer, LN dissection during LG may be overly invasive for patients with pathological N0 disease.…”

Short-term surgical outcomes of laparoscopy-assisted versus open D2 distal gastrectomy for locally advanced gastric cancer in North China: a multicenter randomized controlled trial

“…Some well-designed multicenter randomized controlled trials (RCTs) from Japan (JCOG0912 [5]) and Korea (KLASS-01 [6]) revealed that LADG was just as safe as conventional ODG in terms of short-term clinical outcomes for stage I gastric cancer, even with significantly lower overall complication rate [6]. Furthermore, the long-term outcomes of EGC patients undergoing LADG were proven comparable to those of patients treated by ODG from a single-arm, multi-institutional clinical trial (JCOG0703 [7]).…”