Researchers from Korea have reported no differences in morbidity or mortality between patients with Stage I gastric cancer treated with laparoscopic or open distal gastrectomy. The details of this randomized study were published in the March, 2010 issue of Annals of Surgery.[1]

The primary treatment of gastric cancer is total or subtotal gastrectomy with removal of the lymph nodes to determine spread. These procedures are usually performed with “open” surgery, which is considered a major operative procedure. Laparoscopic gastrectomy, in contrast, is a minimally invasive surgical procedure during which a surgeon removes the stomach through a lighted tube. This type of procedure prevents the need for large surgical incisions and may reduce the risk of infection, healing complications, pain, and blood loss. Laparoscopic surgery is being evaluated for a wide variety of surgical conditions. However, as in other cancers, there have been no randomized trials comparing open to laparoscopic surgery, and the benefits of laparoscopic surgery are inferred rather than proven.

A recent study from the Memorial Sloan-Kettering Cancer Center reported that laparoscopic surgery produced a similar rate of recurrence-free survival to traditional open surgery in patients with gastric cancer; laparoscopic surgery was also associated with fewer complications and shorter hospital stays. Researchers from Korea have also reported that laparoscopy-assisted surgery for early gastric cancer results in a 98.8% three-year overall survival in patients with early gastric cancer.

The current study randomly allocated 342 patients with Stage I distal gastric cancer to open versus laparoscopic surgery. The post operative complication rate in the laparoscopic group was 10.5% versus 14.7% for the open group (p=0.137). Re-operations were required in three patients in each group. The postoperative mortality was 1.1% in the laparoscopic group and 0% in the open surgery group.

Comments: This is the only randomized controlled trial of open versus laparoscopic surgery performed for any cancer and should be a model for how to evaluate new procedures.

Reference: