Colon Cancer

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

Whether or not laparoscopic versus open gastrectomy results in better outcomes for patients with locally advanced gastric cancer, remains an unanswered question.  In the peer-reviewed clinical trial, authors reviewed data from 10 experienced upper-GI centers in the Netherlands in patients with gastric adenocarcinoma, (cT1-4a N0-3bM0) who were randomly assigned to either laparoscopic or open gastrectomy.  The primary endpoint was hospital stay.  

The initial hypothesis was that patients who underwent laparoscopic gastrectomy would have shorter hospital stays as well as less postoperative complications without compromising oncology outcomes.  Data was collected between 2015 and 2018.  227 patients were randomly assigned to each group.  115 in the laparoscopic arm and 112 in the open gastrectomy arm.  77 patients and 87 patients received preoperative chemo and the laparoscopic versus open group, respectively.  

The median hospital stay was 7 days in both groups, P-value = 0.34.  The median blood loss was less than in the laparoscopically resected group, 150 versus 300 mL, p-value < 0.001.  The median operating time was longer in the laparoscopic group, 216 versus 182 minutes, p-value < 0.001.  Postoperative complications showed no difference, 44% versus 42%, P = 0.91.  In-hospital mortality was 4% versus 7%, P- value = 0.40.  30-day readmission rate was 9.6 vs  9.1%, P-value = 1.00.  R0 resection rate was 95% for both.  The median lymph node yield was equal, 29 in both arms.  1-year overall survival was 76 vs 78%, P-value = 0.74.  

The authors concluded that laparoscopic gastrectomy did not lead to the shorter hospital stay in patients with locally advanced gastric cancer with similar postoperative complications as well as oncologic efficacy.

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

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