Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT)

Hyuk Joon Lee, Woo Jin Hyung, Han Kwang Yang, Sang Uk Han, Young Kyu Park, Ji Yeong An, Wook Kim, Hyoung Il Kim, Hyung Ho Kim, Seung Wan Ryu, Hoon Hur, Seong Ho Kong, Gyu Seok Cho, Jin Jo Kim, Do Joong Park, Keun Won Ryu, Young Woo Kim, Jong Won Kim, Joo Ho Lee, Min Chan Kim

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Abstract

Objective: The aim of the study was to evaluate the short-term outcomes of KLASS-02-RCT, a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy (LDG) with D2 lymphadenectomy with open distal gastrectomy (ODG). Summary Background Data: Although several benefits of laparoscopic gastric cancer surgery have been reported, strong evidence is still limited, especially in locally advanced gastric cancer which requires extensive lymph node dissection. Methods: Enrollment criteria included histologically confirmed cT2-4a and N0-1 gastric adenocarcinoma. Thirty-day morbidity, 90-day mortality, postoperative pain, and recovery were compared between LDG and ODG groups. Results: A total of 1050 patients were randomly assigned to LDG (n ¼ 526) or ODG group (n ¼ 524) between November 2011 and April 2015. After excluding patients who received bypass or no surgery, 1011 patients were analyzed as actual treatment group. Mean number of totally retrieved lymph nodes was similar in both groups (LDG ¼ 46.6 vs ODG ¼ 47.4, P ¼ 0.451). Early morbidity rate was significantly lower after LDG (16.6%) than after ODG (24.1%; P ¼ 0.003). Postoperative analgesics use and patients’ reported pain score were significantly lower after LDG. First day of flatus was earlier after LDG (3.5 vs 3.7 d, P ¼ 0.025) and postoperative hospital stay was shorter in LDG group (8.1 vs 9.3 d, P ¼ 0.005). Ninety days’ mortality rate was similar in both groups (LDG ¼ 0.4% vs ODG ¼ 0.6%, P ¼ 0.682). Conclusions: Laparoscopic distal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer shows benefits in terms of lower complication rate, faster recovery, and less pain compared with open surgery.

Original languageEnglish
Pages (from-to)983-991
Number of pages9
JournalAnnals of surgery
Volume270
Issue number6
DOIs
Publication statusPublished - 2019 Dec 1

All Science Journal Classification (ASJC) codes

  • Surgery

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    Lee, H. J., Hyung, W. J., Yang, H. K., Han, S. U., Park, Y. K., An, J. Y., Kim, W., Kim, H. I., Kim, H. H., Ryu, S. W., Hur, H., Kong, S. H., Cho, G. S., Kim, J. J., Park, D. J., Ryu, K. W., Kim, Y. W., Kim, J. W., Lee, J. H., & Kim, M. C. (2019). Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Annals of surgery, 270(6), 983-991. https://doi.org/10.1097/SLA.0000000000003217