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

Author:

Hu Yanfeng1,Huang Changming1,Sun Yihong1,Su Xiangqian1,Cao Hui1,Hu Jiankun1,Xue Yingwei1,Suo Jian1,Tao Kaixiong1,He Xianli1,Wei Hongbo1,Ying Mingang1,Hu Weiguo1,Du Xiaohui1,Chen Pingyan1,Liu Hao1,Zheng Chaohui1,Liu Fenglin1,Yu Jiang1,Li Ziyu1,Zhao Gang1,Chen Xinzu1,Wang Kuan1,Li Ping1,Xing Jiadi1,Li Guoxin1

Affiliation:

1. Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of...

Abstract

Purpose 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. Patients and Methods 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. Results 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). Conclusion Experienced surgeons can safely perform LG with D2 lymphadenectomy for AGC.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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