Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial

TLDR

The safety and efficacy of radical laparoscopic distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer remain controversial. This randomized controlled trial compared laparoscopic versus conventional open distal gastrectomy with D2 lymph node dissections in patients with advanced gastric cancer. One thousand fifty‑six eligible patients were randomized 1:1 to laparoscopic or open surgery, performed by 15 experienced surgeons across 14 Chinese institutions, and 30‑day morbidity, mortality, and D2 lymphadenectomy compliance were assessed. The study found no significant difference in 30‑day morbidity (15.2% vs 12.9%) or mortality (0.4% vs 0%) between the groups, with comparable D2 lymphadenectomy compliance and similar complication severity, indicating that laparoscopic surgery can be safely performed for advanced gastric cancer.

Abstract

The safety and efficacy of radical laparoscopic distal gastrectomy (LG) with D2 lymphadenectomy for the treatment of advanced gastric cancer (AGC) remain controversial. We conducted a randomized controlled trial to compare laparoscopic and conventional open distal gastrectomy with D2 lymph node dissections for AGC.Between September 2012 and December 2014, 1,056 patients with clinical stage T2-4aN0-3M0 gastric cancer were eligible for inclusion. They were randomly assigned to either the LG with D2 lymphadenectomy group (n = 528) or the open gastrectomy (OG) with D2 lymphadenectomy group (n = 528). Fifteen experienced surgeons from 14 institutions in China participated in the study. The morbidity and mortality within 30 days after surgery between the LG (n = 519) and the OG (n = 520) groups were compared on the basis of the modified intention-to-treat principle. Postoperative complications were stratified according to the Clavien-Dindo classification.The compliance rates of D2 lymphadenectomy were similar between the LG and OG groups (99.4% v 99.6%; P = .845). The postoperative morbidity was 15.2% in the LG group and 12.9% in OG group with no significant difference (difference, 2.3%; 95% CI, -1.9 to 6.6; P = .285). The mortality rate was 0.4% for the LG group and zero for the OG group (difference, 0.4%; 95% CI, -0.4 to 1.4; P = .249). The distribution of severity was similar between the two groups (P = .314).Experienced surgeons can safely perform LG with D2 lymphadenectomy for AGC.