Long term oncologic outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer.
BACKGROUND Laparoscopy assisted gastrectomy is a feasible and safe procedure for treating advanced gastric cancer in terms of short term outcomes. However, concern about long term oncologic outcomes has limited the adoption of laparoscopy assisted gastrectomy for advanced gastric cancer. METHODS We launched a prospective randomized controlled trial comparing laparoscopic and open gastrectomy with D2 lymph node dissection for locally advanced gastric cancer to evaluate long term oncologic feasibility. The 5 year overall survival, disease free survival, and tumor recurrences have been determined on an intention to treat basis. RESULTS Between January 2010 and June 2012, a total of 328 patients with preoperative clinical stage T2 4aN0 3M0 gastric cancer were enrolled in the trial. We excluded 6 patients with unresected tumor, and the remaining 322 patients were randomized to the laparoscopic group (162 patients) or the open group (160 patients) for radical surgery. One patient in laparoscopy assisted gastrectomy and 4 patients in open gastrectomy were lost to follow up immediately after discharge, leaving 317 patients (161 in laparoscopy assisted gastrectomy and 156 in open gastrectomy) eligible for long term analysis. The 5 year overall survival rate was 49.0% in the laparoscopic group and 50.7% in the open group, and the 5 year disease free survival rate was 47.2% and 49.6% in the 2 groups, respectively. Kaplan Meier curves for overall survival and disease free survival showed no differences between the 2 groups. There was no difference in the 5 year tumor recurrence rate between the 2 procedures. CONCLUSION Laparoscopy assisted gastrectomy can provide comparable long term survival without an increase in recurrence and metastasis in treating advanced gastric cancer.
Surgery