Stomach cancer

Laparoscopic Versus Open Gastrectomy for Gastric Cancer (LOGICA): A Multicenter Randomized Clinical Trial

In the March 20, 2021 edition of Journal of Clinical Oncology, Arjen van der Veen and colleagues report the results of the LOGICA trial, to determine the clinical efficacy and safety of laparoscopic gastrectomy in a western patient population with advanced gastric cancer undergoing multimodality treatment.

Methods

Patient treated across 10 high-volume centers with experience in upper GI malignancies in the Netherlands were assessed, with resectable (cT1-4aN0-3bM0) gastric adenocarcinoma.  Patients were randomized to either laparoscopic or open gastrectomy.  There was no asking. The primary outcome was hospital stay.  The investigators had hypothesized that laparoscopic gastrectomy would lead to a shorter hospital stay, less complications in the postoperative setting, and equal oncological outcomes.

Results

Between 2015 – 2018, a total of 227 patients were randomized to laparoscopic (n = 115) or open gastrectomy (n = 112).  Patients were given preoperative chemotherapy n=77 patients (67%) in the laparoscopic group and n=87 patients (78%) in the open group. The median hospital stay was 7 days (interquartile range, 5-9) in both groups (P = .34). The median blood loss was less in the laparoscopic group (150 versus  300 mL, P < .001), while mean operating time was longer (216 versus  182 minutes, P < .001). Both groups showed no difference regarding postoperative complications (44% versus 42%, P = .91), in-hospital mortality (4% v 7%, P = .40), 30-day readmission rate (9.6% versus  9.1%, P = 1.00), R0 resection rate (95% versus  95%, P = 1.00), median lymph node yield (29 versus  29 nodes, P = .49), 12-month overall survival (76% versus 78%, P = .74), and global health-related quality of life up to 12 months postoperatively (mean differences between + 1.5 and + 3.6 on a 1-100 scale).

Conclusion

The authors concluded “Laparoscopic gastrectomy did not lead to a shorter hospital stay in this Western multicenter randomized trial of patients with predominantly advanced gastric cancer. Postoperative complications and oncological efficacy did not differ between laparoscopic gastrectomy and open gastrectomy.”

Reference:

Laparoscopic Versus Open Gastrectomy for Gastric Cancer (LOGICA): A Multicenter Randomized Clinical Trial

https://ascopubs.org/doi/full/10.1200/JCO.20.01540

en_USEnglish