Quick Take: Assessment of laparoscopic distal gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer

1. Patients undergoing laparoscopic distal gastrectomy for locally advanced gastric cancer have better postoperative outcomes when compared to those undergoing traditional open distal gastrectomy.

Evidence Rating Level: 1 (Excellent)

The use of multiple treatment modalities, including surgery, forms the current standard of care in the management of locally advanced gastric cancer. Over the last 20 years, the surgical approach to management has evolved from open gastrectomy to more minimally invasive techniques, including laparoscopic gastrectomy. While previous studies have shown that laparoscopy-assisted distal gastrectomy (LADG) is safe and offers faster postoperative recovery when compared to open distal gastrectomy (ODG), the safety and efficacy of this procedure in patients after the receipt of neoadjuvant chemotherapy has not been well studied. In this randomized clinical trial, 96 patients with locally advanced gastric cancer receiving neoadjuvant chemotherapy were randomized to undergo either LADG with D2 lymphadenectomy or ODG with D2 lymphadenectomy to evaluate the short-term outcomes of patients undergoing either procedure. Of note, in the per-protocol study population, the LADG group had significantly later ypN stage compared to the ODG group p=0.02). Nonetheless, researchers found that the LADG group had a significantly decreased postoperative complication rate (20% vs. 46%, p=0.007). Postoperative pain, as measured using a visual analog scale, was also lower in the LADG group (p=0.008), though significant findings were limited to postoperative day 2 only. Researchers also found that LADG patients demonstrated improved adjuvant chemotherapy completion (OR 4.39, 95% CI 1.63 to 11.80, p=0.003), with a decreased likelihood of terminating adjuvant chemotherapy due to adverse effects (p=0.04). This study therefore shows that patients undergoing LADG for locally advanced gastric cancer have better postoperative outcomes when compared to those undergoing traditional ODG. The decreased morbidity conferred through a laparoscopic approach may also improve tolerance to other treatment modalities such as adjuvant chemotherapy.

Click to read the study in JAMA Surgery

Image: PD

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