In stage I gastric cancer, laparoscopic total gastrectomy looks safe

  • Liu F & al.
  • JAMA Oncol
  • 20 Aug 2020

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • An open-label, randomized trial shows no difference between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) with respect to mortality or complications in stage I gastric cancer.

Why this matters

  • Laparoscopic total gastrectomy has been widely adopted, but its safety had not been proven in a randomized trial.

Study design

  • Prospective, randomized, open-label noninferiority trail of LTG or OTG (N=214).
  • Funding: Clinical Trial Fund of Zhongshan Hospital; Johnson & Johnson Medical Ltd.

Key results

  • Overall morbidity and mortality rates were similar between the 2 groups:
    • 19.1% LTG vs 20.2% OTG.
    • Rate difference, −1.1% (95% CI, −11.8% to 9.6%).
  • Intraoperative complication rate was similar:
    • 2.9% LTG vs 3.7% OTG.
    • Rate difference, −0.8% (95% CI, −6.5% to 4.9%).
  • The overall postoperative complication rate was also similar:
    • 18.1% LTG vs 17.4% OTG.
    • Rate difference, 0.7% (95% CI, −9.6% to 11.0%).
  • Mortality was similar: rate difference, 1.0% (95% CI, −2.5% to 5.2%).
  • There was a higher rate of severe complications in the LTG group according to the Clavien-Dindo classification system, but this did not reach statistical significance (7.6% vs 3.8%; P=.52).
    • The difference may have resulted from surgeon inexperience.

Limitations

  • Open label.