#VisualAbstract: Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced Gastric Cancer

1. In this randomized clinical trial, three-year disease-free survival rates were similar for patients with locally advanced gastric cancer treated with laparoscopic vs. open distal gastrectomy.

2. Overall survival and cumulative incidence of recurrence rates over the 3-year period did not differ between the two groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Surgery for locally advanced gastric cancer, defined as T2, T3, or T4a tumor lacking metastatic disease or bulky lymph nodes, is technically challenging to perform due to required resection of D2 lymph nodes. While evidence suggests that laparoscopic approaches yield shorter hospital stays and faster recovery, it is unclear if they are as effective as open approaches. In this multicenter clinical trial, three-year disease-free survival rates were similar for patients with locally advanced gastric cancer treated with laparoscopic and open distal gastrectomy. Further, overall survival and cumulative incidence of recurrence rates over the 3-year period did not differ between the two groups.

Overall, the study suggests that laparoscopic distal gastrectomy is non-inferior to open distal gastrectomy in patients with locally advanced gastric cancer. Limitations of the study include non-availability of patient-centered outcomes as well as limited importance to Western settings where a proximal gastrectomy is a more common operation that a distal gastrectomy.

Click to read the study in JAMA

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