Laparoscopic Gastrectomy for Gastric Cancer
Mené au Japon entre 2009 et 2016 sur 507 patients atteints d'un cancer gastrique de stade localement avancé (âge médian : 67 ans ; 66 % d'hommes), cet essai randomisé multicentrique évalue la non-infériorité, du point de vue de la survie sans récidive à 5 ans, d'une gastrectomie distale assistée par laparoscopie par rapport à une gastrectomie distale par voie ouverte
Randomized clinical trials (RCTs) comparing laparoscopic with open surgery for gastric cancer show similar short-term goals (R0 resection, adequate lymph node sampling, safety) and long-term outcomes. In JAMA Surgery, Etoh et al report results of a multicenter RCT comparing 5-year outcomes between open distal gastrectomy and laparoscopy-assisted distal gastrectomy for locally advanced distal gastric cancers showing similar long-term outcomes.Several caveats must be considered before applying these results to Western populations. First, the median body mass index of 22.5 (calculated as weight in kilograms divided by height in meters squared) and exclusion of patients with a body mass index of 30 or higher means the study population is less overweight than those published in Western series. Second, Western practice preferentially gives neoadjuvant chemotherapy to patients with locally advanced gastric adenocarcinomas, whereas in this study, patients were exclusively given adjuvant chemotherapy. On the other hand, the fact that no one received neoadjuvant chemotherapy means there was closer alignment between preoperative clinical stage and pathological stage, making findings simpler to interpret. Finally, the authors thoroughly controlled for differences in skills and experience by requiring all surgeons participating in the trial to have certification with additional training in both approaches. This likely produced optimal study results, which may not reflect the reality of gastric cancer care in Western countries, where lower gastric cancer incidence and a lack of centralization of gastrectomies to high-volume centers limit individual surgeon experience.
JAMA Surgery , éditorial, 2022