Laparoscopy-assisted versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: Results From a Randomized Phase II Multicenter Clinical Trial (COACT 1001).

OBJECTIVE: This randomized, phase II, multicenter clinical trial was conducted to evaluate the feasibility of laparoscopy-assisted distal gastrectomy (LADG) with D2 lymph node dissection compared with open distal gastrectomy (ODG) for the treatment of advanced gastric cancer (AGC). SUMMARY OF BACKGROUND DATA: D2 lymph node dissection has been accepted as standard treatment for AGC. Although LADG is widely performed in early gastric cancer (EGC), the feasibility of LADG in AGC has not been proven yet. METHODS: Patients with cT2-T4a and cN0-2 (AJCC 7 staging system) distal gastric cancer were randomly but not blindingly assigned to LADG or ODG groups using fixed block sizes with a 1:1 allocation ratio. The primary endpoint was the noncompliance rate of the lymph node dissection, which was used to evaluate feasibility. Secondary endpoints included 3-year disease-free survival (DFS), 5-year overall survival, complications, and surgical stress response. RESULTS: Between June 2010 and October 2011, 204 patients enrolled and underwent either LADG (n = 105) or ODG (n = 99). Of these, 196 patients (100 in LADG and 96 in ODG) were included in the intention-to-treat analysis. There were no significant differences in the overall noncompliance rate of lymph node dissection between LADG and ODG groups (47.0% and 43.2%, respectively; P = 0.648). In the subgroup analysis, the noncompliance rate in the LADG group was significantly higher than the ODG group for clinical stage III disease (52.0% vs 25.0%, P = 0.043). No difference was found in the 3-year DFS rate between the groups (LADG, 80.1%; ODG, 81.9%; P = 0.448). Differences in postoperative complication rates and surgical stress response were found to be insignificant between the 2 arms. CONCLUSIONS: LADG was feasible for AGC treatment based on the noncompliance rate of D2 lymph node dissection. Subgroups analysis data suggest that further studies are needed for stage III gastric cancer.

Handsewn versus stapled gastroduodenostomy in patients with gastric cancer: long-term follow-up of a randomized clinical trial.

BACKGROUND: The role of circular staplers in gastroduodenostomy during subtotal gastrectomy for gastric cancer has not been defined clearly. METHODS: A randomized clinical trial included patients with gastric cancer who underwent subtotal gastrectomy with either stapled (99 patients) or handsewn gastroduodenostomy (98 patients). The anastomosis time and postoperative outcomes in the two groups were compared. RESULTS: Performance of stapled gastroduodenostomy was significantly quicker than handsewn gastroduodenostomy. There were no significant differences between the groups in postoperative course, morbidity and mortality rates, survival rate, and recurrence pattern. CONCLUSIONS: Stapled gastroduodenostomy with a circular stapler can reduce the anastomosis time with relative safety.

Localization of gastric cancer by CT gastrography: a prospective study.

BACKGROUND/AIMS: We evaluated the usefulness of CT gastrography in preoperative localization of gastric cancer. METHODOLOGY: CT gastrographic images of 213 patients with gastric cancer were evaluated for localization of tumor. For the precise localization we developed a software module to measure the shortest distances from tumor to the esophagogastric junction and to the pylorus on the images. After gastrectomy, these were compared with the shortest distances on surgical specimen. RESULTS: The localization rates of advanced and early gastric cancer were 100.0% and 88.8%, respectively. There were significantly linear relationship between the shortest distances measured on CT gastrographic images and those on surgical specimen. CONCLUSION: CT gastrography could be a useful preoperative localization tool.