Latest Update from KLASS Study Group

Speaker

Hyuk Joon LEE Professor Department of Surgery Seoul National University Hospital, South Korea

Hyuk Joon LEE
Professor
Department of Surgery
Seoul National University Hospital, South Korea

Talk Abstract

Korean Laparoendoscopic Gastrointestinal Surgery Study Group, named KLASS, was launched in 2004, and conducted lots of important clinical trials focusing on the safety and efficacy of laparoscopic gastrectomy for gastric cancer for the last 20 years.

KLASS-01 and KLASS-02 were a large scale randomized controlled trials comparing laparoscopic versus open distal gastrectomy for clinical stage I and stage II/III gastric cancers, respectively. Both RCTs successfully showed the significant less complications of laparoscopic surgery without compromising long term survivals.

KLASS-03 was a single arm prospective observational study focusing on the safety of laparoscopic total gastrectomy for EGC, and showed a comparable complication rate compared to historical controls.

KLASS-04 is a RCT comparing laparoscopic pylorus preserving gastrectomy (LPPG) versus laparoscopic distal gastrectomy (LDG) for middle third EGC. LPPG group showed the benefits of lower incidence of gallstone formation, bile reflux gastritis, postoperative anemia, and hypoalbuminemia. However, LPPG also had demerits of higher incidences of delayed gastric emptying and reflux esophagitis. There were no significant differences of the incidence of dumping syndrome (primary endpoint) as well as postoperative quality of life and body weight.

KLASS-05 was a RCT comparing Laparoscopic Proximal Gastrectomy with Double Tract Reconstruction (LPG-DT) versus laparoscopic total gastrectomy for upper third EGC. LPG-DT group showed a benefit for preserving vitamin B12 level compared to LTG, but no differences for the incidence of anemia.

KLASS-06 is a RCT comparing LTG versus open TG for advanced gastric cancer to reveal the safety and benefit of LTG. The enrollment is almost finished (753/772, 97.5% on April 8th 2024), and we have to wait for 3 years to conform the oncologic safety of LTG for AGC.

KLASS-07 is a RCT comparing extracorporeal and intracorporeal anastomosis after LDG. The enrollment was finished and the final outcome was not opened yet. KLASS-08 is a RCT comparing laparoscopic versus open gastrectomy after neoadjuvant chemotherapy for AGC, and the enrollment is still on-going. KLASS-09 is a RCT comparing long limb versus conventional Roux-en-Y GJstomy in LDG for obese diabetic patients with EGC to see the efficacy of long limb RY for diabetic remission. The enrollment was finished and the final results was not opened yet. KLASS-12 is a RCT comparing reduced port versus conventional multiport LDG for EGC. The The enrollment was finished and the final results was not opened yet.

We have recently launched KLASS-9, 10, 13, and 14, and I will briefly present all of KLASS trials and their current status.