Distal Versus Total D2-Gastrectomy for Gastric Cancer: a Secondary Analysis of Surgical and Oncological Outcomes Including Quality of Life in the Multicenter Randomized LOGICA-Trial
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Published:2023-06-20
Issue:9
Volume:27
Page:1812-1824
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ISSN:1091-255X
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Container-title:Journal of Gastrointestinal Surgery
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language:en
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Short-container-title:J Gastrointest Surg
Author:
de Jongh CasORCID, van der Veen Arjen, Brosens Lodewijk A. A., Nieuwenhuijzen Grard A. P., Stoot Jan H. M. B., Ruurda Jelle P., van Hillegersberg Richard, Brenkman Hylke J. F., Seesing Maarten F. J., Luyer Misha D. P., Ponten Jeroen E. H., Tegels Juul J. W., Hulsewe Karel W. E., Wijnhoven Bas P. L., Lagarde Sjoerd M., de Steur Wobbe O., Hartgrink Henk H., Kouwenhoven Ewout A., van Det Marc J., Wassenaar Eelco, van Duijvendijk P., Draaisma Werner A., Broeders Ivo A. M. J., Gisbertz Susanne S., van der Peet Donald L., van Laarhoven Hanneke W. M.,
Abstract
Abstract
Background
Distal gastrectomy (DG) for gastric cancer can cause less morbidity than total gastrectomy (TG), but may compromise radicality. No prospective studies administered neoadjuvant chemotherapy, and few assessed quality of life (QoL).
Methods
The multicenter LOGICA-trial randomized laparoscopic versus open D2-gastrectomy for resectable gastric adenocarcinoma (cT1–4aN0–3bM0) in 10 Dutch hospitals. This secondary LOGICA-analysis compared surgical and oncological outcomes after DG versus TG. DG was performed for non-proximal tumors if R0-resection was deemed achievable, TG for other tumors. Postoperative complications, mortality, hospitalization, radicality, nodal yield, 1-year survival, and EORTC-QoL-questionnaires were analyzed using Χ2-/Fisher’s exact tests and regression analyses.
Results
Between 2015 and 2018, 211 patients underwent DG (n = 122) or TG (n = 89), and 75% of patients underwent neoadjuvant chemotherapy. DG-patients were older, had more comorbidities, less diffuse type tumors, and lower cT-stage than TG-patients (p < 0.05). DG-patients experienced fewer overall complications (34% versus 57%; p < 0.001), also after correcting for baseline differences, lower anastomotic leakage (3% versus 19%), pneumonia (4% versus 22%), atrial fibrillation (3% versus 14%), and Clavien-Dindo grading compared to TG-patients (p < 0.05), and demonstrated shorter median hospital stay (6 versus 8 days; p < 0.001). QoL was better after DG (statistically significant and clinically relevant) in most 1-year postoperative time points. DG-patients showed 98% R0-resections, and similar 30-/90-day mortality, nodal yield (28 versus 30 nodes; p = 0.490), and 1-year survival after correcting for baseline differences (p = 0.084) compared to TG-patients.
Conclusions
If oncologically feasible, DG should be preferred over TG due to less complications, faster postoperative recovery, and better QoL while achieving equivalent oncological effectiveness.
Mini-abstract
Distal D2-gastrectomy for gastric cancer resulted in less complications, shorter hospitalization, quicker recovery and better quality of life compared to total D2-gastrectomy, whereas radicality, nodal yield and survival were similar.
Subject
Gastroenterology,Surgery
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