Laparoscopic Versus Open Gastrectomy for Gastric Adenocarcinoma: Long-term Outcomes From a Large Scale Multicenter Study.

Hyung-ho Kim, MD PhD, Hyuk-joon Lee, MD, Gyu Seok Cho, MD, Sang-uk Han, MD, Min-chan Kim, MD, Seung Wan Ryu, MD, Wook Kim, MD, Kyo Young Song, MD, Woo Jin Hyung, MD, Seong Yeob Ryu, MD. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea; Department of Surgery, Seoul National University, Seoul, Korea


INTRODUCTION: Although laparoscopic assisted gastrectomy (LAG) is widely used for the treatment of gastric cancer, large scale study showing the long-term outcome is rare. The aim of this study is to compare laparoscopic versus open surgery for gastric cancer in terms of long-term prognosis and recurrence from multicenter data.

METHODS AND PROCEDURES: A retrospective multicenter data from nine institutions in Korea was used. A total of 3047 patients (laparoscopy: 1483, open: 1562) who underwent curative resection for gastric adenocarcinoma between 1998 and 2005 were included in this study. Patients with T4b disease (n= 40) or stage IV (n=19) were excluded because none or few these patients had received laparoscopic surgery.

RESULTS: According to the AJCC/UICC 7th staging system, the tumor stages in the open group were as follows: stage IA (n= 381, 24.4%); stage IB (n= 167, 11.0%); stage IIA (n=156, 10.2%); stage IIB (n=189, 12.4%); stage IIIA (n= 169, 11.1%); stage IIIB (n= 176, 11.6%); and stage IIIC (n=265, 17.4%).Tumor stages in the LAG group were: stage IA (n=1140, 76.9%); stage IB (n=157, 10.6%); stage IIA (n= 76, 5.1%); stage IIB (n=53, 3.6%); stage IIIA (n= 23, 1.6%); stage IIIB (n= 24, 1.6%); and stage IIIC (n=9, 0.6%). There were no significant differences in 5-year cancer free survival rates between the LAG and the open gastrectomy groups at any tumor stage except for stage IA(stage IA: 98.9% vs. 97.4%, P= 0.031; stage IB: 96.7% vs. 95.6%, P=0.352; stage IIA: 94.4% vs. 88.7%, P=0.150; stage IIB: 77.0% vs. 79.2%, p=0.928; stage IIIA: 71.1% vs. 74.7%, P=0.902; stage IIIB: 39.7% vs. 46.4%, P=0.204; stage IIIC: 22.2% vs. 36.5%, P=0.561). No difference in the 5 year overall survival was also observed when the groups were compared according to tumor stages except for stage IA (stage IA: LAG 95.6% vs. open gastrectomy 91.5%, P= 0.007; stage IB: 91.6% vs. 93.3%, P=0.496; stage IIA: 86.7% vs. 85.6%, P=0.559; stage IIB: 75.2% vs. 77.3%, p=0.789; stage IIIA: 63.3% vs. 69.9%, P=0.711; stage IIIB: 45.8% vs. 49.8%, P=0.512; stage IIIC: 33.3% vs. 30.5%, P=0.607).

CONCLUSIONS: LAG for gastric cancer is a safe oncological procedure with comparable long-term outcomes when compared with open gastrectomy. We are expecting the result of prospective KLASS study.

Session Number: SS12 – Plenary I
Program Number: S068

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