Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced...

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Minimally Invasive Surgery

Background:

• Laparoscopic distal gastrectomy is established for early-stage gastric cancer.
• Efficacy of laparoscopic distal gastrectomy for locally advanced gastric cancer remains unclear.

Purpose of the Study:

• To compare 3-year disease-free survival between laparoscopic and open distal gastrectomy in locally advanced gastric cancer.
• To assess overall survival and recurrence patterns as secondary outcomes.

Main Methods:

• A randomized clinical trial involving 1056 patients with locally advanced gastric cancer (stages T2-T4a).
• Patients were randomized to undergo either laparoscopic distal gastrectomy (n=528) or open distal gastrectomy (n=528) with D2 lymphadenectomy.
• The primary endpoint was 3-year disease-free survival, with a noninferiority margin of -10% for the laparoscopic approach.

Main Results:

• Three-year disease-free survival was 76.5% for laparoscopic and 77.8% for open gastrectomy (absolute difference -1.3%, not crossing the noninferiority margin).
• No significant differences were observed in 3-year overall survival (83.1% vs 85.2%) or recurrence patterns (18.8% vs 16.5%) between the groups.
• The study met its primary noninferiority endpoint for disease-free survival.

Conclusions:

• Laparoscopic distal gastrectomy is noninferior to open distal gastrectomy in terms of 3-year disease-free survival for locally advanced gastric cancer.
• The findings support the use of laparoscopic distal gastrectomy as a viable alternative to open surgery for this patient population.
• Further research may explore long-term oncological outcomes and quality of life.