Short-Term Outcomes of Laparoscopic Distal Gastrectomy versus Open Gastrectomy for T4a Gastric Cancer: A Randomized Controlled Trial

Authors
Tran Quang Dat, Dang Quang Thong, Nguyen Viet Hai, Doan Thuy Nguyen, Vo Duy Long

Affiliations
Department of Gastro-Intestinal Surgery, University Medical Center, Ho Chi Minh City, Vietnam

Background
Laparoscopic gastrectomy for serosal invasion (T4a) gastric cancer (GC) is still controversial. This RCT was aimed to compare short-term outcomes of laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) for T4a GC.

Methods
A prospective, randomized, controlled trial compared LDG with ODG. Enrollment criteria included cT4aN0-3M0 gastric adenocarcinoma at the middle or lower third of the stomach. Intraoperative characteristics and postoperative morbidity, mortality, and recovery were compared between LDG and ODG groups.

Results
220 patients were randomly assigned to LDG or ODG with a 1:1 ratio. After excluding patients who received paliative or total gastrectomy, 205 patients were analyzed. Mean number of retrieved lymph nodes was comparable (35.6 in LDG vs 37.4 in ODG, P = 0.541). The LDG group had a longer operating time (180 vs 160 min, p = 0.001) but less blood loss (50 vs 100 ml, p = 0.001). The total morbidity rate was similar between groups regarding both minor (15.6% in LDG vs. 14.5% in ODG; P = 0.612) and major complications (2.1% in LDG vs. 1.8% in ODG; P = 0.780). Pain score was significantly lower after LDG. First day of flatus and postoperative hospital stay were earlier after LDG (2.8 vs 3.8, and 7.9 vs 9.2 days, p < 0.001, respectively). There was no death in both groups.

Conclusion
LDG with D2 lymphadenectomy for T4a GC shows benefits in terms of comparable complication rate, faster recovery, and less pain compared with open surgery.