Laparoscopy-Assisted vs. Open Gastrectomy in Advanced Gastric Cancer

The use of minimally invasive laparoscopy and robotically assisted surgery in patients with gastric cancer is increasing, given reports of equivalent oncologic outcomes compared to conventional open gastrectomy.

Investigators report updated 5-year survival from a randomized trial of laparoscopy-assisted versus open distal gastrectomy for locally advanced gastric cancer. Of the 507 patients treated at 37 Japanese centers between 2009 and 2016, 67% were male, 53% had clinical stage N0 disease, and 52% had clinical stage II or III disease.

At a median follow up of 67.9 months, 5-year overall survival for the open and laparoscopy-assisted gastrectomy groups was similar (79.8% and 81.7%; hazard ratio, 0.83; P=0.34). The primary endpoint — 5-year relapse-free survival — was also similar in the two groups (73.9% and 75.7%, respectively; HR, 0.96; noninferiority 1-sided P=0.03). The operating time for laparoscopy-assisted surgery was longer than for open surgery (median, 291 vs. 205 minutes), but there was no difference in intraoperative complications or the need for reoperation, and laparoscopy-assisted surgery led to less blood loss (median, 30 vs. 141 mL).