Hyuk-Joon Lee1, Woo Jin Hyung2, Han-Kwang Yang1, Sang Uk Han3, Young-Kyu Park4, Ji Yeong An2, Wook Kim5, Hyoung-Il Kim2, Hyung-Ho Kim6, Seung Wan Ryu7, Hoon Hur3, Seong-Ho Kong1, Gyu Seok Cho8, Jin-Jo Kim9, Do Joong Park6, Keun Won Ryu10, Young Woo Kim10, Jong Won Kim11,12, Joo-Ho Lee13, Min-Chan Kim14. 1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul. 2. Department of Surgery Yonsei University Severance Hospital, Seoul. 3. Department of Surgery, Ajou University Hospital, Suwon, Gyeonggi. 4. Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Jeonnam. 5. Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul. 6. Department of Surgery, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi. 7. Department of Surgery, Keimyung University Dongsan Medical Center, Daegu. 8. Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi. 9. Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon. 10. Center for Gastric Center, National Cancer Center, Goyang, Gyeonggi. 11. Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul. 12. Department of Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea. 13. Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul. 14. Department of Surgery, Dong-A University Hospital, Busan.
Abstract
OBJECTIVE: The aim of the study was to evaluate the short-term outcomes of KLASS-02-RCT, a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy (LDG) with D2 lymphadenectomy with open distal gastrectomy (ODG). SUMMARY BACKGROUND DATA: Although several benefits of laparoscopic gastric cancer surgery have been reported, strong evidence is still limited, especially in locally advanced gastric cancer which requires extensive lymph node dissection. METHODS: Enrollment criteria included histologically confirmed cT2-4a and N0-1 gastric adenocarcinoma. Thirty-day morbidity, 90-day mortality, postoperative pain, and recovery were compared between LDG and ODG groups. RESULTS:A total of 1050 patients were randomly assigned to LDG (n = 526) or ODGgroup (n = 524) between November 2011 and April 2015. After excluding patients who received bypass or no surgery, 1011 patients were analyzed as actual treatment group. Mean number of totally retrieved lymph nodes was similar in both groups (LDG = 46.6 vs ODG = 47.4, P = 0.451). Early morbidity rate was significantly lower after LDG (16.6%) than after ODG (24.1%; P = 0.003). Postoperative analgesics use and patients' reported pain score were significantly lower after LDG. First day of flatus was earlier after LDG (3.5 vs 3.7 d, P = 0.025) and postoperative hospital stay was shorter in LDG group (8.1 vs 9.3 d, P = 0.005). Ninety days' mortality rate was similar in both groups (LDG = 0.4% vs ODG = 0.6%, P = 0.682). CONCLUSIONS:Laparoscopic distal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer shows benefits in terms of lower complication rate, faster recovery, and less pain compared with open surgery.
RCT Entities:
OBJECTIVE: The aim of the study was to evaluate the short-term outcomes of KLASS-02-RCT, a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy (LDG) with D2 lymphadenectomy with open distal gastrectomy (ODG). SUMMARY BACKGROUND DATA: Although several benefits of laparoscopic gastric cancer surgery have been reported, strong evidence is still limited, especially in locally advanced gastric cancer which requires extensive lymph node dissection. METHODS: Enrollment criteria included histologically confirmed cT2-4a and N0-1 gastric adenocarcinoma. Thirty-day morbidity, 90-day mortality, postoperative pain, and recovery were compared between LDG and ODG groups. RESULTS: A total of 1050 patients were randomly assigned to LDG (n = 526) or ODG group (n = 524) between November 2011 and April 2015. After excluding patients who received bypass or no surgery, 1011 patients were analyzed as actual treatment group. Mean number of totally retrieved lymph nodes was similar in both groups (LDG = 46.6 vs ODG = 47.4, P = 0.451). Early morbidity rate was significantly lower after LDG (16.6%) than after ODG (24.1%; P = 0.003). Postoperative analgesics use and patients' reported pain score were significantly lower after LDG. First day of flatus was earlier after LDG (3.5 vs 3.7 d, P = 0.025) and postoperative hospital stay was shorter in LDG group (8.1 vs 9.3 d, P = 0.005). Ninety days' mortality rate was similar in both groups (LDG = 0.4% vs ODG = 0.6%, P = 0.682). CONCLUSIONS: Laparoscopic distal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer shows benefits in terms of lower complication rate, faster recovery, and less pain compared with open surgery.
Authors: Marcus Fernando Kodama Pertille Ramos; Leandro Cardoso Barchi; Antonio Carlos Weston; Bruno Zilberstein Journal: Arq Bras Cir Dig Date: 2019-12-20
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