Is laparoscopy superior to open surgery for locally advanced gastric cancer?

South Korea: The Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-02 trial's 5-year results confirm the 3-year findings, which show that laparoscopic surgery for locally advanced gastric cancer (AGC) is not inferior to open gastrectomy. The findings of this study were published in the Journal of American Medical Association Surgery.

Given the absence of 5-year follow-up data, the long-term safety of laparoscopic distal gastrectomy for locally advanced gastric cancer is still unknown. As a consequence, the researcher's team from South Korea led by Sang-Yong Son compared the 5-year follow-up outcomes in patients with symptomatic AGC who underwent laparoscopic or open distal gastrectomy and were participating in the KLASS-02 randomized clinical trial.

Laparoscopic surgery for patients with locally present AGC was shown to be non-inferior to open surgery in the KLASS-02, a randomized multicenter clinical study. The current study evaluated the 5-year follow-up outcomes in patients participating in KLASS-02, including 5-year overall survival (OS), 5-year relapse-free survival (RFS), and long-term problems rates.

Patients diagnosed with locally prevalent AGC prior to surgery and aged 20 to 80 were included between November 21, 2011, and April 29, 2015. The last check-in took place on June 15, 2021. Data from June 24 through September 9, 2021, were examined. In the KLASS-02 trial's entire analysis set, patients were given R0 resection by either laparoscopic or open gastrectomy. The key outcomes included long-term surgical complications, recurrence patterns, and five-year OS and RFS rates.

The key findings of this study were as follows:

1. There were 1050 patients altogether in this research.

2. 974 patients in total received R0 resection; 492 underwent laparoscopic gastrectomy and 482 underwent open gastrectomy.

3. The 5-year OS and RFS rates were comparable in individuals who underwent laparoscopic and open distal gastrectomy.

4. Peritoneal carcinomatosis, hematogenous metastases, and locoregional recurrence were the most prevalent kinds of recurrence, with no between-group differences in these types of recurrence at any stage of malignancy.

5. Patients with stage III gastric cancer had the strongest individual connection between 3-year RFS and 5-year OS.

6. The laparoscopic surgery group experienced considerably fewer late complications than the open surgery group.

7. Intestinal obstruction was the most common problem in both groups.

In concussion, this study suggests that the laparoscopic method should take the place of traditional open surgery for patients with locally advanced GISTs due to the low complication rate of laparoscopic surgery.

Reference:

Son S, Hur H, Hyung WJ, et al. Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer: 5-Year Outcomes of the KLASS-02 Randomized Clinical Trial. JAMA Surg. Published online July 20, 2022. doi:10.1001/jamasurg.2022.2749