Laparoscopic gastrectomy outcome comparable to open surgery

By David Douglas

NEW YORK (Reuters Health) - 13/2/2019

Patients with stage I gastric cancer who undergo laparoscopic distal gastrectomy have long-term-survival rates similar to those who have open distal gastrectomy, according to a clinical trial from South Korea.

In a paper online February 7 in JAMA Oncology, Dr. Woo Jin Hyung of Yonsei University College of Medicine, in Seoul, and colleagues note that the laparoscopic approach offers better short-term postoperative outcome. Because of a lack of studies, however, its oncological safety has remained controversial.

To shed more light on the matter, between 2006 and 2010, the researchers conducted an open-label randomized trial of the techniques in more than 1,400 patients with histologically proven, preoperative clinical stage I gastric adenocarcinoma.

The study involved 15 surgeons from 13 centers, and trial quality was maintained by "using hospitals' and surgeons' case volumes as eligibility criteria as well as evaluation of surgeons' technical proficiency," the team notes.

Patient survival and recurrence status was determined at the end of 2016. The five-year overall survival rate was 94.2% in the laparoscopic group and 93.3% in the open-surgery group. Cancer-specific survival was also similar, at 97.1% and 97.2%, respectively.

Eighty-five patients crossed over and received a procedure to which they had not been randomized, but per-protocol analysis results were consistent with those using intention-to-treat analysis.

The researchers also note that, as was standard practice at the time, they used extracorporeal anastomosis in the laparoscopic group, "although intracorporeal anastomosis has now become the standard technique."

They conclude that the trial "supports the use of laparoscopic distal gastrectomy as a standard treatment option for clinical stage I distal gastric cancer when it can be performed by surgeons with sufficient experience."

Dr. Anthony D. Yang of Northwestern University Feinberg School of Medicine, in Chicago, told Reuters Health by email that the study is important "in that it adds to the body of literature that minimally invasive surgery for stage I gastric cancer does not compromise important oncologic factors such as time to chemotherapy after surgery, recurrence patterns, and, most importantly, survival, and is safe in experienced hands. Laparoscopic gastrectomy offers several advantages such as reducing length of stay, reduced blood loss, and reduced complications."

However, Dr. Yang, who is associate professor of surgical oncology, added, "we should be cautious about advocating widespread use of laparoscopic gastrectomy for stage I gastric cancer given that this study came from what is probably the most experienced group in the world with this procedure."

Dr. Yang observed, "Less experienced surgeons performing laparoscopic gastrectomy may not have as good surgical and/or cancer-related outcomes as in this study, and this could harm patients. The authors, themselves, advocate referral to high-volume, experienced centers for all patients with gastric cancer."

Dr. Hyung did not respond to requests for comments.

SOURCE: JAMA Oncol 2019.

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