Decreased Morbidity of Laparoscopic Distal Gastrectomy Compared With Open Distal Gastrectomy for Stage I Gastric Cancer: Short-term Outcomes From a Multicenter Randomized Controlled Trial (KLASS-01)

Kim, Wook MD, PhD^*; Kim, Hyung-Ho MD, PhD^†; Han, Sang-Uk MD, PhD^‡; Kim, Min-Chan MD, PhD^§; Hyung, Woo Jin MD, PhD^¶; Ryu, Seung Wan MD, PhD^||; Cho, Gyu Seok MD, PhD^**; Kim, Chan Young MD, PhD^††; Yang, Han-Kwang MD, PhD^‡‡; Park, Do Joong MD, PhD^†; Song, Kyo Young MD, PhD^§§; Lee, Sang Il MD, PhD^¶¶; Ryu, Seung Yub MD, PhD^||||; Lee, Joo-Ho MD, PhD^***; Lee, Hyuk-Joon MD, PhD^‡‡; on behalf of the Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group

Annals of Surgery: January 2016 - Volume 263 - Issue 1 - p 28–35

doi: 10.1097/SLA.0000000000001346

Randomized Controlled Trials

Objective: To determine the safety of laparoscopy-assisted distal gastrectomy (LADG) compared with open distal gastrectomy (ODG) in patients with clinical stage I gastric cancer in Korea.

Background: There is still a lack of large-scale, multicenter randomized trials regarding the safety of LADG.

Methods: A large-scale, phase 3, multicenter, prospective randomized controlled trial was conducted. The primary end point was 5-year overall survival. Morbidity within 30 postoperative days and surgical mortality were compared to evaluate the safety of LADG as a secondary end point

Results: A total of 1416 patients were randomly assigned to the LADG group (n = 705) or the ODG group (n = 711) between February 1, 2006, and August 31, 2010, and 1384 patients were analyzed for modified intention-to-treat analysis (ITT) and 1256 were eligible for per protocol (PP) analysis (644 and 612, respectively). In the PP analysis, 6 patients (0.9%) needed open conversion in the LADG group. The overall complication rate was significantly lower in the LADG group (LADG vs ODG; 13.0% vs 19.9%, P = 0.001). In detail, the wound complication rate of the LADG group was significantly lower than that of the ODG group (3.1% vs 7.7%, P < 0.001). The major intra-abdominal complication (7.6% vs 10.3%, P = 0.095) and mortality rates (0.6% vs 0.3%, P = 0.687) were similar between the 2 groups. Modified ITT analysis showed similar results with PP analysis.

Conclusions: LADG for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complication compared with conventional ODG.

http://journals.lww.com/annalsofsurgery/Abstract/2016/01000/Decreased_Morbidity_of_Laparoscopic_Distal.6.aspx

Changes of Esophagogastric Junctional Adenocarcinoma and Gastroesophageal Reflux Disease Among Surgical Patients During 19882012: A Single-institution, High-volume Experience in China

Liu, Kai MD^*; Yang, Kun MD^*; Zhang, Weihan MD^*; Chen, Xiaolong MD^*; Chen, Xinzu MD^*; Zhang, Bo MD, PhD^*; Chen, Zhixin MD^*; Chen, Jiaping MD^*; Zhao, Yongfan MD^†; Zhou, Zongguang MD, PhD, FACS^*; Chen, Longqi MD, PhD^†; Hu, Jiankun MD, PhD^*

Annals of Surgery: January 2016 - Volume 263 - Issue 1 - p 88–95

doi: 10.1097/SLA.0000000000001148

Original Articles

Objective: To evaluate the changes of esophagogastric junctional adenocarcinoma (EGJA) and gastroesophageal reflux disease (GERD) among surgical patients from 1988 to 2012 in a Chinese high-volume hospital.

Background: The incidence of EGJA in Western countries has rapidly increased in recent decades. However, recent data from China remain sparse.

Conclusions: An increasing trend of EGJA is observed during the past 25 years in West China Hospital. The prevalence of GERD among EGJA had showed a gradually increased trend. However, the causality between GERD and EGJA still needs to be researched further. Total gastrectomy is becoming more preferred procedure in patients with EGJA.

http://journals.lww.com/annalsofsurgery/Fulltext/2016/01000/Changes_of_Esophagogastric_Junctional.15.aspx

Cumulative Metformin Use and Its Impact on Survival in Gastric Cancer Patients After Gastrectomy

Lee, Choong-kun MD^*; Jung, Minkyu MD^*; Jung, Inkyung PhD^†; Heo, Su Jin MD^*; Jeong, Yong Hyu MD^‡; An, Ji Yeong MD, PhD^§; Kim, Hyoung-Il MD^§; Cheong, Jae-Ho MD, PhD^§; Hyung, Woo Jin MD, PhD^§; Noh, Sung Hoon MD, PhD^§; Kim, Hyo Song MD^*; Rha, Sun Young MD, PhD^*; Chung, Hyun Cheol MD, PhD^*

Annals of Surgery: January 2016 - Volume 263 - Issue 1 - p 96–102

doi: 10.1097/SLA.0000000000001086

Original Articles

Objective: The aim of this study was to evaluate the association between metformin and survival of gastric cancer (GC) patients.

Background: Metformin has recently received attention as a potential anticancer treatment. However, no study has shown the survival benefit of metformin for GC patients.

Methods: A total of 1974 GC patients who underwent curative gastrectomy were compared for survival according to groups; 132 diabetic patients treated with metformin, 194 diabetic patients without metformin, and 1648 non-diabetic patients.

Conclusions: The increased cumulative duration of metformin use decreased the recurrence, all-cause mortality, and cancer-specific mortality rates among GC patients with diabetes who underwent gastrectomy.

http://journals.lww.com/annalsofsurgery/Abstract/2016/01000/Cumulative_Metformin_Use_and_Its_Impact_on.16.aspx

Multicenter Prospective Comparative Study of Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma

Kim, Hyoung-Il MD^*,†,‡; Han, Sang-Uk MD^§; Yang, Han-Kwang MD^¶; Kim, Young-Woo MD^||; Lee, Hyuk-Joon MD^¶; Ryu, Keun Won MD^||; Park, Joong-Min MD^**; An, Ji Yeong MD^*,†,‡; Kim, Min-Chan MD^††; Park, Sungsoo MD^‡‡; Song, Kyo Young MD^§§; Oh, Sung Jin MD^¶¶; Kong, Seong-Ho MD^¶; Suh, Byoung Jo MD^¶¶; Yang, Dae Hyun MD^||||; Ha, Tae Kyung MD^***; Kim, Youn Nam PhD^†††; Hyung, Woo Jin MD, PhD^*,†,‡

Annals of Surgery: January 2016 - Volume 263 - Issue 1 - p 103–109

doi: 10.1097/SLA.0000000000001249

Original Articles

Objective: To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy.

Background: Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy.

Conclusions: The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256

http://journals.lww.com/annalsofsurgery/Abstract/2016/01000/Multicenter_Prospective_Comparative_Study_of.17.aspx