A new randomized clinical trial published in *JAMA Surgery* by Hyung et al. has shown that laparoscopic distal gastrectomy (LDG) is a safe and feasible surgical option for patients with serosa-invasive (cT4a) gastric cancer when conducted by experienced surgeons. The study provides critical evidence addressing a long-standing question in oncologic surgery—whether minimally invasive techniques can maintain safety and efficacy in advanced gastric tumors. The results demonstrated that LDG achieved comparable short-term surgical outcomes to open distal gastrectomy (ODG), including similar postoperative recovery and complication rates, establishing its potential as a valid alternative for selected patients.
The trial emphasized the importance of surgical expertise and strict procedural standardization. All operations were performed by surgeons with extensive laparoscopic experience, ensuring consistency in technique and patient safety. Researchers found that LDG offered several practical advantages, such as smaller incisions, faster recovery, and reduced surgical trauma, which may contribute to improved postoperative comfort and quicker return to normal function. However, the study authors noted that while LDG appears technically feasible and safe in the short term, its long-term oncologic efficacy—particularly regarding overall and disease-free survival—remains to be confirmed through ongoing follow-up analyses.
These findings hold substantial implications for surgical oncology, particularly in regions where gastric cancer remains prevalent. The study suggests that, under rigorous surgical standards, minimally invasive approaches can extend beyond early-stage cancers and potentially redefine the standard of care for advanced cases. Further research will determine whether LDG’s oncologic outcomes can match or surpass those of ODG, paving the way for broader adoption in clinical practice. Until then, careful patient selection and surgeon proficiency remain key to achieving optimal results in this complex surgical setting.
Keywords: laparoscopic distal gastrectomy, serosa-invasive gastric cancer, minimally invasive surgery, open distal gastrectomy, oncologic safety, JAMA Surgery
Reference: Hyung, W. J., Kim, H. I., Yang, H. K., Park, D. J., Kim, H. H., Han, S. U., et al. (2025). Laparoscopic vs open distal gastrectomy for serosa-invasive gastric cancer: A randomized clinical trial. *JAMA Surgery, 160*(11), e2841298. [https://doi.org/10.1001/jamasurgery.2025.41298](https://doi.org/10.1001/jamasurgery.2025.41298)
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