The overall and relapse-free survival at 5 years were comparable in patients with locally advanced gastric cancer who underwent a laparoscopic or open gastrectomy, according to a new study from South Korea reported in JAMA Surgery.¹

To evaluate the 5-year outcomes, 1050 participants with locally advanced gastric cancer from the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-02 randomized clinical trial were enrolled for the present study from November 21, 2011 to April 29, 2015. The final follow-up was carried out on June 15, 2021. The 5-year overall survival (OS) and relapse-free survival (RFS) rates, recurrence patterns and long-term complications were compared among 492 patients who underwent laparoscopic gastrectomy and 482 who underwent open distal gastrectomy.

Results showed that at around 70 months, both groups had comparable 5-year relapse-free survival (RFS) rates. Patients in the laparoscopic surgery group had a 5-year RFS rate of 79.5%, while the RFS rate at 5 years in the open surgery group was 81%. The 5-year overall survival (OS) rates in the two groups were also commensurate with each other; 88.9% in the laparoscopy group vs 88.7% in the open surgery group.

The most common type of recurrence was peritoneal carcinomatosis (42.1%). Hematogenous metastases occurred in 20.8%, while 13.2% had locoregional recurrence. Around 10% had distal lymph node metastases. Most of these recurrences occurred within the first three years after the surgery. No differences between the two groups were observed with regard to the types of recurrence. The number of deaths or recurrences at 5 years was comparable in both groups. There were 108 (21.9%) deaths or recurrences in the laparoscopy group compared to 101 (20.9%) in the open group.

Patients who underwent laparoscopic surgery had a considerably lower late complication rate at 6.5% compared to those who underwent open surgery (11.0%). The most common complication in both groups was intestinal obstruction. The intestinal obstruction rate was 2.6% vs 5.0%, respectively. The chronic wound complication rate was 0.6% vs 1.9%, respectively. Although the complication rates were lower in the laparoscopy group, this difference was non-significant.

The multicenter randomized clinical trial, KLASS-02, published in 2020 had concluded that the relapse-free survival was comparable for laparoscopic distal gastrectomy with D2 lymphadenectomy and open surgery in patients with locally advanced gastric cancer. However, the primary end point of this trial was 3-year relapse-free survival.² Further corroborating these results, the current study has again shown the non-inferiority of laparoscopic distal gastrectomy compared to open surgery as evident by the 5-year survival rates. The lower complication rates with laparoscopic surgery were an added benefit. Hence, laparoscopic surgery may be a clinically feasible option for patients with locally advanced gastric cancers.

References

1. Sang-Yong Son, et al; Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) Group. Laparoscopic vs open distal gastrectomy for locally advanced gastric cancer: 5-year outcomes of the KLASS-02 randomized clinical trial. JAMA Surg. 2022 Jul 20. doi: 10.1001/jamasurg.2022.2749.
2. Woo Jin Hyung 1, et al; Korean Laparoendoscopic Gastrointestinal Surgery Study Group. Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial. J Clin Oncol. 2020 Oct 1;38(28):3304-3313.