Laparoscopic D2 distal gastrectomy for advanced gastric cancer: a myth or a reality?

Dr. Hu and associates (1) have published a randomized controlled trial (RCT) analyzing the safety and efficacy of radical laparoscopic and open distal gastrectomy (LG) with D2 lymphadenectomy for the treatment of advanced gastric cancer (AGC). The trial was conducted between September 2012 and December 2014 recruiting 1,056 patients with clinical stage T2-4N0-3M0. There were 528 patients in both groups. There were 15 experienced Chinese surgeons who participated in the RCT. The primary end points were morbidity and mortality within 30 postoperative days. The only complication that almost reached statistical significance in favor of open procedure was that of anastomotic leakage. Based on Clavien-Dindo classification, both groups were equivalent in their outcome. If one looks at the operating time, this was significantly longer in the laparoscopic group; however the blood loss was significantly less in the laparoscopic group. Postoperative variables such as time to first liquid intake and hospital stay favored the laparoscopic group but not by a large margin. The authors concluded that these results attest to the safety of LG with D2 lymphadenectomy for AGC by experienced gastric surgeons at high volume tertiary referral centers.