Stomach cancer: laparoscopic gastrectomy shows advantage after NACT

  • Li Z & al.
  • JAMA Surg
  • 25 Sep 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Laparoscopy-assisted distal gastrectomy (LADG) leads to fewer complications and better rates of adjuvant chemotherapy completion than open distal gastrectomy (ODG) in patients who have undergone neoadjuvant chemotherapy (NACT) for locally advanced gastric cancer.

Why this matters

  • Advantages of LADG over ODG in postoperative complications may be more substantial in the neoadjuvant setting.
  • Fibrosis and scarring that accompany successful NACT may include surgical risk.

Study design

  • Open-label, phase 2 trial of 96 patients treated with NACT and then randomly assigned to LADG or ODG, with D2 lymphadenectomy.
  • Funding: Beijing Municipal Science and Technology Commission.

Key results

  • An as-treated analysis showed a lower frequency of 30-day postoperative complications in the LADG group (20% vs 46%; P=.007). This effect remained after adjustment (OR, 0.15; P=.001).
  • Postoperative pain was lower in the LADG group, as measured by the postoperative visual analog scale score for pain (1.2 units lower; P=.008).
  • The LADG group was more likely to complete more than 1 cycle of adjuvant chemotherapy (aOR, 4.39; P=.003).
  • The LADG group was less likely to stop adjuvant chemotherapy because of adverse events (22% vs 42%; P=.04).

Limitations

  • Monocentric design.
  • Chinese population.