• Hyuk-Joon Lee, Woo Jin Hyung, Han-Kwang Yang, Sang Uk Han, Young-Kyu Park, Ji Yeong An, Wook Kim, Hyoung-Il Kim, Hyung-Ho Kim, Seung Wan Ryu, Hoon Hur, Seong-Ho Kong, Gyu Seok Cho, Jin-Jo Kim, Park Do Joong DJ Department of Surgery, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi., Keun Won Ryu, Young Woo Kim, Kim Jong Won JW Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul. Department o, Joo-Ho Lee, Min-Chan Kim, and Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group.
• Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul.
• Ann. Surg. 2019 Dec 1; 270 (6): 983-991.

ObjectiveThe aim of the study was to evaluate the short-term outcomes of KLASS-02-RCT, a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy (LDG) with D2 lymphadenectomy with open distal gastrectomy (ODG).Summary Background DataAlthough several benefits of laparoscopic gastric cancer surgery have been reported, strong evidence is still limited, especially in locally advanced gastric cancer which requires extensive lymph node dissection.MethodsEnrollment criteria included histologically confirmed cT2-4a and N0-1 gastric adenocarcinoma. Thirty-day morbidity, 90-day mortality, postoperative pain, and recovery were compared between LDG and ODG groups.ResultsA total of 1050 patients were randomly assigned to LDG (n = 526) or ODG group (n = 524) between November 2011 and April 2015. After excluding patients who received bypass or no surgery, 1011 patients were analyzed as actual treatment group. Mean number of totally retrieved lymph nodes was similar in both groups (LDG = 46.6 vs ODG = 47.4, P = 0.451). Early morbidity rate was significantly lower after LDG (16.6%) than after ODG (24.1%; P = 0.003). Postoperative analgesics use and patients' reported pain score were significantly lower after LDG. First day of flatus was earlier after LDG (3.5 vs 3.7 d, P = 0.025) and postoperative hospital stay was shorter in LDG group (8.1 vs 9.3 d, P = 0.005). Ninety days' mortality rate was similar in both groups (LDG = 0.4% vs ODG = 0.6%, P = 0.682).ConclusionsLaparoscopic distal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer shows benefits in terms of lower complication rate, faster recovery, and less pain compared with open surgery.

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