Laparoscopic Gastrectomy May Be Preferable After Gastric-Cancer Chemo

By David Douglas

October 07, 2019

NEW YORK (Reuters Health) - In patients with locally advanced gastric cancer, laparoscopy-assisted distal gastrectomy (LADG) after neoadjuvant chemotherapy appears to offer more short-term benefits than does open gastrectomy, according to Chinese researchers.

Specifically, Dr. Jiafu Ji told Reuters Health by email, LADG is effective "in reducing 30-day postoperative complications incidence and increasing completion of postoperative chemotherapy."

In a September 25 online paper in JAMA Surgery, Dr. Li of Peking University Cancer Hospital and Institute, in Beijing, and colleagues note that as part of an ongoing investigation they sought to determine the short-term noninferiority of minimally invasive LADG compared with the open technique.

The researchers enrolled 96 patients aged between 18 and 60 years of age who were receiving neoadjuvant chemotherapy into an open-label study. They were randomized to undergo either LADG or open distal gastrectomy, both with D2 lymphadenectomy.

In as-treated analyses in 95 patients, at 30 days postoperative complications in the LADG group (20%) were significantly lower than for the open group (46%).

Postoperative pain intensity measured within 72 hours after the procedure by a visual analogue scale showed that on postoperative day 2 the measure was a significant 1.2 units lower in the LADG group.

Patients in the LADG group also had significantly better adjuvant chemotherapy completion rates (adjusted odds ratio, 4.39). They were also significantly less likely to terminate adjuvant chemotherapy because of adverse effects (22% vs. 42%).

Modified intention-to-treat analyses showed similar results to as-treated analyses.

"This outcome," Dr. Ji concluded, "suggests that LADG is a safer surgical approach than open distal gastrectomy for patients of advanced gastric cancer receiving preoperative chemotherapy."

He added, "The long-term therapeutic efficacy (3-year recurrence-free survival rate) is under investigation and will be reported in 2 years."

Dr. Teviah E. Sachs of Boston Medical Center, co-author of an accompanying editorial, told Reuters Health by email that the study "shows similar short-term outcomes of laparoscopic and open distal gastrectomy in patients with locally advanced . . . distal gastric cancer."

"More importantly, perhaps," he added, "is their finding that laparoscopic patients had better rates of adherence to and completion of their adjuvant therapy. If future investigation can show longer-term overall and recurrence-free survival advantage with laparoscopic surgery, then that will have even greater impact on this devastating disease."


JAMA Surg 2019.