Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group study JCOG1401

Katai, Hitoshi; Mizusawa, Junki; Katayama, Hiroshi; Kunisaki, Chikara; Sakuramoto, Shinichi; Inaki, Noriyuki; Kinoshita, Takahiro; Iwasaki, Yoshiaki; Misawa, Kazunari; Takiguchi, Nobuhiro; Kaji, Masahide; Okitsu, Hiroshi; Yoshikawa, Takaki; Terashima, Masanori

doi:10.1007/s10120-019-00929-9

Cited by 144 publications

(82 citation statements)

References 19 publications

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“…Both meta-analyses have emphasized the need for a prospective randomized trial comparing MITG and OTG [25,26]. In a single arm confirmatory trial the safety of LATG was further emphasized [27].…”

Section: Discussionmentioning

confidence: 99%

Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial

et al. 2020

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Background Surgical resection with adequate lymphadenectomy is regarded the only curative option for gastric cancer. Regarding minimally invasive techniques, mainly Asian studies showed comparable oncological and short-term postoperative outcomes. The incidence of gastric cancer is lower in the Western population and patients often present with more advanced stages of disease. Therefore, the reproducibility of these Asian results in the Western population remains to be investigated. Methods A randomized trial was performed in thirteen hospitals in Europe. Patients with an indication for total gastrectomy who received neoadjuvant chemotherapy were eligible for inclusion and randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG). Primary outcome was oncological safety, measured as the number of resected lymph nodes and radicality. Secondary outcomes were postoperative complications, recovery and 1-year survival. Results Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. The mean number of resected lymph nodes was 43.4 ± 17.3 in OTG and 41.7 ± 16.1 in MITG (p = 0.612). Forty-eight patients in the OTG group had a R0 resection and 44 patients in the MITG group (p = 0.617). One-year survival was 90.4% in OTG and 85.5% in MITG (p = 0.701). No significant differences were found regarding postoperative complications and recovery. Conclusion These findings provide evidence that MITG after neoadjuvant therapy is not inferior regarding oncological quality of resection in comparison to OTG in Western patients with resectable gastric cancer. In addition, no differences in postoperative complications and recovery were seen.

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Section: Discussionmentioning

confidence: 99%

Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial

et al. 2020

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“…**Regarding the safety issue of laparoscopy-assisted total or proximal gastrectomy, evidence from a single-arm (JCOG1401) is now available. In this trial, incidence of the Grade 2-4 esophagojejunal anastomotic leakage was 2.5% (6/244, 95% CI 0.9-5.3) and met the required level of safety [15].…”

Section: Laparoscopic Surgerymentioning

confidence: 78%

Japanese gastric cancer treatment guidelines 2018 (5th edition)

2020

Gastric Cancer

1,347

943

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Background: The majority of patients with type 4 gastric cancer have distant metastases with extremely poor prognosis. Consequently, considering a therapeutic strategy that improves the prognosis of these patients is clinically important. The present study aimed to assess the clinical indication and prognostic impact of surgery in patients with type 4 gastric cancer who underwent chemotherapy. Methods: A total of 67 patients with type 4 gastric cancer who underwent chemotherapy were retrospectively enrolled. All patients were grouped into progressive disease (PD) and non-PD groups by tumor response to chemotherapy. Results: Distant metastases occurred in 58 patients. With regard to tumor response, 16 and 51 patients had PD and non-PD, respectively. The prognosis was signi cantly poorer in patients with PD than in those with non-PD (p < 0.0001). Among 23 patients who underwent surgery after chemotherapy, 21 had a R0 resection. The presence or absence of surgery was signi cantly correlated with age, rst-line chemotherapeutic regimen, lymph node metastasis, clinical stage, number of distant metastatic sites, peritoneal dissemination, and tumor response (p = 0.0412, p = 0.0096, p = 0.0024, p = 0.0059, p = 0.0128, p = 0.0020, and p = 0.0066, respectively). Multivariate analysis selected tumor response and surgery as an independent prognostic factor (p = 0.0001 and p = 0.0009, respectively). Moreover, multivariate analysis for the surgery group demonstrated that metastatic nodal status (N0-1 vs. N2-3) and residual tumor status (R0 vs. R1-2) were signi cant independent prognostic factors (p = 0.0258 and p = 0.0458, respectively). Conclusions: Our retrospective study suggests that surgery after chemotherapy for type 4 gastric cancer may improve the prognosis of responders with N0-1 status and a curative R0 resection.

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“…Anastomotic leakage is the most common and serious PCs after gastrectomy. According to a recent large-scare cohort study and multicenter phase II studies, the prevalence of esophagojejunal anastomotic leakage (EJAL) for laparoscopic total gastrectomy range from 1.7 to 5.7% [27][28][29]. In this study, the incidence of EJAL was 11.4% (95% CI 5.6-17.2%), higher than data reported by former research.…”

Section: Discussionmentioning

confidence: 49%

The variation tendency of serum C-reactive protein is a good marker to predict postoperative complications after laparoscopic gastrectomy for adenocarcinoma of esophagogastric junction

Luo¹,

Liao²,

Zheng³

et al. 2020

Preprint

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Background: Postoperative complications (PCs) after laparoscopic gastrectomy with mediastinal lymph nodes resection for adenocarcinoma of esophagogastric junction (AEG) prolonged the time of hospitalization and increased mortality rate. Early diagnosis of PCs was of great importance. This retrospective study aimed to investigate whether the variation tendency of serum C-reactive protein can be used as an early marker to predict major postoperative complications after laparoscopic gastrectomy for AEG.Methods: Data for patients underwent laparoscopic gastrectomy for AEG, from January 2015 to March 2020, were retrospectively analyzed. The area under the receiver operating characteristic (ROC) curve (AUC) was used to determine diagnostic accuracy of inflammatory markers. The optimal cutoff values were calculated by maximizing Youden’s index. Univariate and multivariate logistic regression analyses were performed to identify risk factors for PCs of grade III or more，according to the Clavien-Dindo classification. Results: A total of 114 patients were analyzed, of whom 21 (18.4%, 95% CI 11.4-25.4 %) developed major PCs, including anastomotic leakage in 13. The ratio of CRP level on postoperative day 3 to day 2 (POD3/2 CRP) provided the best diagnostic accuracy (AUC 0.903, 95% CI 0.814-0.993, p＜0.001). Proximal gastrectomy (OR 8.224, 95% CI 1.976-34.234, p=0.004) and operation time ≥360 minutes (OR 6.753, 95% CI 2.037-22.395, p=0.002) were identified as significant independent risk factors for major PCs.Conclusions: The POD3/2 CRP was the best marker to predict PCs after laparoscopic gastrectomy for AEG.

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Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group study JCOG1401

Cited by 144 publications

References 19 publications

Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial

Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial

Japanese gastric cancer treatment guidelines 2018 (5th edition)

The variation tendency of serum C-reactive protein is a good marker to predict postoperative complications after laparoscopic gastrectomy for adenocarcinoma of esophagogastric junction

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