Laparoscopic Procedures Provide Better Outcomes in Gastric Cancer

Laparoscopy-assisted distal gastrectomy (LADG) offered better short-term, post-surgical outcomes than open distal gastrectomy (ODG) in a study¹ of patients with locally advanced gastric cancer who were undergoing neoadjuvant chemotherapy. The study will eventually assess 3-year recurrence rates between the 2 procedures.

“Laparoscopic gastrectomy has become the established treatment for early gastric cancer,” wrote study authors led by Ziyu Li, MD, of Peking University Cancer Hospital and Institute in China. “However, the safety and efficacy of the laparoscopic procedure in patients after neoadjuvant chemotherapy are unclear.” They added that tissue losses and profibrotic reactions following chemotherapy present additional technical challenges.    

A total of 95 patients with locally advanced gastric cancer undergoing neoadjuvant chemotherapy were included in the phase II, open-label clinical trial They were analyzed in an as-treated analysis, where 45 patients underwent LADG and 50 underwent ODG, and in a modified intent-to-treat analysis, in which 47 patients were in the LADG group and 48 were in the ODG group. The results were published online ahead of print on September 25 in JAMA Surgery.

 In the analysis, patients in the LADG group had a lower rate of post-operative complications than those in the ODG group (20% vs 46%; P= 0.007). The median visual analog scale score was lower in the LADG group than in the ODG group on postoperative day 2 (P= 0.04) and on day 3 (P= 0.04). 

The protective effect of the laparoscopic procedure on complication rates persisted after adjustment for a number of factors including stage and the interval between chemotherapy and surgery, for an odds ratio (OR) of 0.15 (95% CI, 0.04-0.48; P= 0.001). There were no unplanned re-operations or deaths within 30 days after the procedure in either group.

Patients in the LADG group were more likely to complete adjuvant chemotherapy, with an adjusted OR of 4.39 (95% CI, 1.63-11.80; P= 0.003). They were also less likely to terminate adjuvant chemotherapy because of adverse events (22% vs 42%; P= 0.04). The modified intent-to-treat analysis yielded similar results.

“The results of this study suggest that, for patients with locally advanced gastric cancer who received neoadjuvant chemotherapy, LADG can be safely performed by experienced surgeons and has the benefits of a lower postoperative complication rate and better adjuvant chemotherapy tolerance compared with ODG,” the authors concluded.

In an accompanying editorial, Teviah E. Sachs, MD, MPH, and Jennifer F. Tseng, MD, MPH, both of Boston University School of Medicine, wrote that the adherence to and completion of adjuvant chemotherapy is the new study’s most important contribution. 

“The long-term survival of patients with gastric cancer is far more dependent on the completion of systemic therapy than on the surgical approach for resection,” they wrote. “It will be interesting to see whether a longer-term overall and recurrence-free survival advantage exists between these groups.”

References:

1. Garfall, A., Dancy, E., Cohen, A., Hwang, W., Fraietta, J., Davis, M., Levine, B., Siegel, D., Stadtmauer, E., Vogl, D., Waxman, A., Rapoport, A., Milone, M., June, C. and Melenhorst, J. (2019). T-cell phenotypes associated with effective CAR T-cell therapy in postinduction vs relapsed multiple myeloma. [online] Blood Advances. Available at: http://www.bloodadvances.org/content/3/19/2812?sso-checked=true [Accessed 7 Oct. 2019].