Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer
Authors: Son Sang-Yong , Hur Hoon , Hyung Woo Jin , Park Young-Kyu , Lee Hyuk-Joon , An Ji Yeong , Kim Wook , Kim Hyoung-Il , Kim Hyung-Ho , Ryu Seung Wan , Kim Min-Chan , Kong Seong-Ho , Cho Gyu Seok , Kim Jin-Jo , Park Do Joong , Ryu Keun Won , Kim Young Woo , Kim Jong Won , Lee Joo-Ho , Yang Han-Kwang , Han Sang-Uk ,   Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) Group, Ahn HyeSeong , Ahn Sang-Hoon , Bae Jae-Moon , Bae Jung Min , Bae Sung Joon , Byun Cheul Su , Chang Yeon Soo , Cho Hyunjin , Cho In , Cho Minah , Choi Chang In , Choi Kyeong-Woon , Choi Seohee , Choi Seung-Ho , Choi Sung Il , Choi Yun-Suck , Chung Ho-Young , Chung Joo Won , Chung Jung Kee , Eom Bang Wool , Eom Sang Soo , Ha Dongyeop , Ha Man Ho , Ha Taekyung , Han Dong-Seok , Han Sang-Moon , Han Se Wung , Huh Yeon-Ju , Hwang Sun-Hwi , Jang You-Jin , Jee Ye Seob , Jeon Chul Hyo , Jeong Gui-Ae , Jeong Inho , Jeong Oh , Jeong Sang-Ho , Jin Sung-Ho , Jo Ji Hoon , Jun Kyong Hwa , Jung Bong Soo , Jung Do Hyun , Jung Mi-Ran , Jung Yoonju , Kang Dongbaek , Kang Ji Hoon , Kang So Hyun , Kim Amy , Kim Beom Su , Kim Chan Young , Kim Chang Hyun , Kim Chee Young , Kim Dae Hoon , Kim Dong Jin , Kim Dong -Wook , Kim Eun Young , Kim Ho-Goon , Kim Hyun Il , Kim In Ho , Kim Ji Hoon , Kim Jong-Han , Kim Jun Young , Kim Kap-Jung , Kim Ki Han , Kim Kwang Hee , Kim Kyoung Hwan , Kim Min Gyu , Kim Sa-Hong , Kim Sang Woon , Kim Se Won , Kim Seong-Gon , Kim Su Mi , Kim Sung , Kim Sung Geun , Kim Sung Soo , Kim Tae Han , Kim Yong Ho , Kim Yongil , Kim Yoo Min , Kim You Na , Ko Jeong Hyun , Kong Sung Chan , Kwon In Gyu , Kwon Ji Hyoung , Kwon Oh Kyoung , Lee Chang Min , Lee Han Hong , Lee Joong Ho , Lee Jun Ho , Lee Jun Hyun , Lee In Seob , Lee Kyung-Goo , Lee Moon-Soo , Lee Myung Jae , Lee Sang Eok , Lee Sang Ho , Lee Sang-Il , Lee Si Hak , Lee Se Youl , Lee Seung Soo , Lee Sol , Lee Yoontaek , Lim Seung Hyun , Lim Man-Sup , Min Jae Seok , Mok Woo-Kyun , Mok Young-Jae , Nam Yoon-Hwan , Oh Seung Jong , Oh Sung Don , Oh Sung Eun , Oh Sung Jin , Park Cho Hyung , Park Dong Jin , Park Ji Ho , Park Ji Yeon , Park Ji Hyun , Park Jong-Min , Park Joong-Min , Park Ki Bum , Park Seong-Heum , Park Sungsoo , Park Yong Eun , Park Young Suk , Roh Chulkyu , Roh Kun Ho , Ryu Hoon , Ryu Seong Yeop , Seo Ho Seok , Seo Jeong Eun , Seo Kyung Won , Seo Sang Hyuk , Seo Won Jun , Seon Jang Won , Shin Dong Gue , Shin Dong Woo , Shin Ho-Jung , Sohn Tae Sung , Son Myoung Won , Son Taeil , Son Young-Gil , Song Geum Jong , Song Jeong Ho , Song Kyo Young , Song Sun-Kyo , Suh Byoung Jo , Suh Yun-Suhk , Sul Ji-Young , Sung Choon Kyung , Yang Jun Young , Yoo Han Mo , Yoo Moon-Won , Yook Jeong-Hwan , Yoon Hong Man , Yoon Ki Young , Youn Sang Il , Yu Wansik 
Published: July 2022

Importance

The long-term safety of laparoscopic distal gastrectomy for locally advanced gastric cancer (AGC) remains uncertain given the lack of 5-year follow-up results.

Objective

To compare the 5-year follow-up results in patients with clinically AGC enrolled in the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-02 randomized clinical trial who underwent laparoscopic or open distal gastrectomy.

Design, Setting, and Participants

The KLASS-02, a multicenter randomized clinical trial, showed that laparoscopic surgery was noninferior to open surgery for patients with locally AGC. The present study assessed the 5-year follow-up results, including 5-year overall survival (OS) and relapse-free survival (RFS) rates and long-term complications, in patients enrolled in KLASS-02. From November 21, 2011, to April 29, 2015, patients aged 20 to 80 years diagnosed preoperatively with locally AGC were enrolled. Final follow-up was on June 15, 2021. Data were analyzed June 24 to September 9, 2021.

Interventions

Patients were treated with R0 resection either by laparoscopic gastrectomy or open gastrectomy as the full analysis set of the KLASS-02 trial.

Main Outcomes and Measures

Five-year OS and RFS rates, recurrence patterns, and long-term surgical complications were evaluated.

Results

This study enrolled a total of 1050 patients. A total of 974 patients were treated with R0 resection; 492 (50.5%) in the laparoscopic gastrectomy group (mean [SD] age, 59.8 [11.0] years; 351 men [71.3%]) and 482 (49.5%) in the open gastrectomy group (mean [SD] age, 59.4 [11.5] years; 335 men [69.5%]). In patients who underwent laparoscopic and open distal gastrectomy, the 5-year OS (88.9% vs 88.7%) and RFS (79.5% vs 81.1%) rates did not differ significantly. The most common types of recurrence were peritoneal carcinomatosis (73 of 173 [42.1%]), hematogenous metastases (36 of 173 [20.8%]), and locoregional recurrence (23 of 173 [13.2%]), with no between-group differences in types of recurrence at each cancer stage. The correlation between 3-year RFS and 5-year OS at the individual level was highest in patients with stage III gastric cancer (ρ = 0.720). The late complication rate was significantly lower in the laparoscopic than in the open surgery group (32 of 492 [6.5%] vs 53 of 482 [11.0%]). The most common type of complication in both groups was intestinal obstruction (13 of 492 [2.6%] vs 24 of 482 [5.0%]).

Conclusions and Relevance

The 5-year outcomes of the KLASS-02 trial support the 3-year results, which is the noninferiority of laparoscopic surgery compared with open gastrectomy for locally AGC. The laparoscopic approach can be recommended in patients with locally AGC to achieve the benefit of low incidence of late complications.

Trial Registration

ClinicalTrials.gov Identifier: NCT01456598