Five-Year Survival Outcomes of Laparoscopy-Assisted vs Open Distal Gastrectomy for Advanced Gastric Cancer: The...

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Minimally Invasive Surgery

Background:

• Evidence for laparoscopic gastrectomy in locally advanced gastric cancer is limited due to short follow-up periods in prior studies.
• Robust data are needed to confirm the noninferiority of laparoscopic techniques compared to open surgery.

Purpose of the Study:

• To compare 5-year survival outcomes between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) for locally advanced gastric cancer.
• To evaluate the noninferiority of LADG versus ODG with D2 lymph node dissection.

Main Methods:

• A multicenter, prospective, randomized clinical trial involving 502 patients with gastric carcinoma.
• Patients were randomized to either ODG or LADG groups, performed by qualified surgeons.
• Primary endpoint was 5-year relapse-free survival; secondary endpoints included 5-year overall survival and safety.

Main Results:

• No significant difference in severe postoperative complications between ODG (4.7%) and LADG (3.5%).
• 5-year relapse-free survival was 73.9% for ODG and 75.7% for LADG (HR 0.96, noninferiority P=0.03).
• Overall survival also showed no significant difference between the groups (HR 0.83).

Conclusions:

• Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection is noninferior to open distal gastrectomy for locally advanced gastric cancer.
• LADG demonstrates comparable long-term survival and safety, suggesting it can be a standard treatment.
• This study provides robust 5-year follow-up data supporting the efficacy of minimally invasive approaches.