Research Shows Laparoscopic and Open Gastrectomy Outcomes Are Similar

Patients with gastric cancer who undergo laparoscopic distal gastrectomy have long-term survival rates comparable to those who undergo open gastrectomy, according to a new study.

Researchers at Seoul National University Bundang Hospital (Seongnam, South Korea), Yonsei University College of Medicine (Seoul, South Korea), and 11 other institutions in Korea conducted a study involving 1,416 patients (mean age, 57.3 years; 66.4% male) with stage I gastric cancer to examine if the surgical approach affected long-term survival. Participants were randomly assigned to laparoscopic distal gastrectomy (705 patients) or open distal gastrectomy (711 patients). The main outcome was the difference in five year overall survival between the two groups.

The resulted showed five year overall survival rates were 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. An intention-to-treat analysis confirmed the non-inferiority of the laparoscopic approach to the open approach. During the course of the study, 85 patients received a surgical approach opposite the one to which they were randomized, but per-protocol analysis results remained consistent with those using the intention-to-treat analysis. The study was published on February 7, 2019, in JAMA Oncology.

“Laparoscopic distal gastrectomy is gaining popularity over open distal gastrectomy for gastric cancer because of better early postoperative outcomes. However, to our knowledge, no studies have proved if laparoscopic distal gastrectomy is oncologically equivalent to open distal gastrectomy,” concluded lead author Woo Jin Hyung, MD, of Yonsei University College of Medicine, and colleagues. “The trial revealed similar overall and cancer-specific survival rates between patients. Laparoscopic distal gastrectomy is an oncologically safe alternative to open surgery for stage I gastric cancer.”

Five layers of tissue make up the stomach wall – the mucosa, submucosa, muscle, connective tissue (subserosa), and serosa. Gastric cancer begins in the mucosa and spreads through the outer layers as it grows. Treatment options for stage I gastric cancer (as examined in the study) includes total or subtotal gastrectomy, followed by optional chemotherapy. Other modalities include radiation therapy, targeted therapy, and immunotherapy.

Related Links:
Seoul National University Bundang Hospital
Yonsei University College of Medicine