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 T2-4a N0-3 M0 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.