TY - JOUR
T1 - Distal Versus Total D2-Gastrectomy for Gastric Cancer
T2 - a Secondary Analysis of Surgical and Oncological Outcomes Including Quality of Life in the Multicenter Randomized LOGICA-Trial
AU - de Jongh, Cas
AU - van der Veen, Arjen
AU - Brosens, Lodewijk A. A.
AU - Nieuwenhuijzen, Grard A. P.
AU - Stoot, Jan H. M. B.
AU - Ruurda, Jelle P.
AU - van Hillegersberg, Richard
AU - LOGICA Study Group
AU - Brenkman, Hylke J. F.
AU - Seesing, Maarten F. J.
AU - Luyer, Misha D. P.
AU - Ponten, Jeroen E. H.
AU - Tegels, Juul J. W.
AU - Hulsewe, Karel W. E.
AU - Wijnhoven, Bas P. L.
AU - Lagarde, Sjoerd M.
AU - de Steur, Wobbe O.
AU - Hartgrink, Henk H.
AU - Kouwenhoven, Ewout A.
AU - van Det, Marc J.
AU - Wassenaar, Eelco
AU - van Duijvendijk, P.
AU - Draaisma, Werner A.
AU - Broeders, Ivo A. M. J.
AU - Gisbertz, Susanne S.
AU - van der Peet, Donald L.
AU - van Laarhoven, Hanneke W. M.
N1 - Funding Information: The LOGICA-trial (NCT02248519) was funded by ZonMw (The Netherlands Organization for Health Research and Development), project number 837002502. Funding Information: The authors would like to thank all LOGICA-patients and everyone from the participating hospitals who contributed in including patients, completing the data collection or locally coordinating the LOGICA-trial. For providing an unrestricted educational grant to enable proctoring of laparoscopic gastrectomy in participating centers before starting the LOGICA-trial, the authors thank Johnson & Johnson. COLLABORATORS (LOGICA Study Group): Hylke JF Brenkman1, Maarten F.J. Seesing1, Misha DP Luyer2, Jeroen EH Ponten2, Juul JW Tegels3, Karel WE Hulsewe3, Bas PL Wijnhoven4, Sjoerd M Lagarde4, Wobbe O de Steur5, Henk H Hartgrink5, Ewout A Kouwenhoven6, Marc J van Det6, Eelco Wassenaar7, P. van Duijvendijk7, Werner A Draaisma8, Ivo AMJ Broeders8, Susanne S Gisbertz9, Donald L van der Peet10, Hanneke WM van Laarhoven10*.1*UMC Utrecht, Department of Pathology, Utrecht, The Netherlands.2Catharina Hospital Eindhoven, Department of Surgery, Eindhoven, The Netherlands.3Zuyderland Medical Center, Department of Surgery, Sittard, The Netherlands.4Erasmus UMC, Department of Surgery, Rotterdam, The Netherlands.5Leiden UMC, Department of Surgery, Leiden, The Netherlands.6ZGT Almelo, Department of Surgery, Almelo, The Netherlands.7Gelre Hospitals Apeldoorn, Department of Surgery, Apeldoorn, The Netherlands.8Meander Medical Center, Department of Surgery, Amersfoort, The Netherlands.9Amsterdam UMC, Location VUmc, Department of Surgery, Amsterdam, The Netherlands.10Amsterdam UMC, location AMC, Department of Surgery, Amsterdam, The Netherlands.10*Amsterdam UMC, Location AMC, Department of Medical Oncology, Amsterdam, Netherlands Publisher Copyright: © 2023, The Author(s).
PY - 2023/9
Y1 - 2023/9
N2 - Background: Distal gastrectomy (DG) for gastric cancer can cause less morbidity than total gastrectomy (TG), but may compromise radicality. No prospective studies administered neoadjuvant chemotherapy, and few assessed quality of life (QoL). Methods: The multicenter LOGICA-trial randomized laparoscopic versus open D2-gastrectomy for resectable gastric adenocarcinoma (cT1–4aN0–3bM0) in 10 Dutch hospitals. This secondary LOGICA-analysis compared surgical and oncological outcomes after DG versus TG. DG was performed for non-proximal tumors if R0-resection was deemed achievable, TG for other tumors. Postoperative complications, mortality, hospitalization, radicality, nodal yield, 1-year survival, and EORTC-QoL-questionnaires were analyzed using Χ 2-/Fisher’s exact tests and regression analyses. Results: Between 2015 and 2018, 211 patients underwent DG (n = 122) or TG (n = 89), and 75% of patients underwent neoadjuvant chemotherapy. DG-patients were older, had more comorbidities, less diffuse type tumors, and lower cT-stage than TG-patients (p < 0.05). DG-patients experienced fewer overall complications (34% versus 57%; p < 0.001), also after correcting for baseline differences, lower anastomotic leakage (3% versus 19%), pneumonia (4% versus 22%), atrial fibrillation (3% versus 14%), and Clavien-Dindo grading compared to TG-patients (p < 0.05), and demonstrated shorter median hospital stay (6 versus 8 days; p < 0.001). QoL was better after DG (statistically significant and clinically relevant) in most 1-year postoperative time points. DG-patients showed 98% R0-resections, and similar 30-/90-day mortality, nodal yield (28 versus 30 nodes; p = 0.490), and 1-year survival after correcting for baseline differences (p = 0.084) compared to TG-patients. Conclusions: If oncologically feasible, DG should be preferred over TG due to less complications, faster postoperative recovery, and better QoL while achieving equivalent oncological effectiveness. Mini-abstract: Distal D2-gastrectomy for gastric cancer resulted in less complications, shorter hospitalization, quicker recovery and better quality of life compared to total D2-gastrectomy, whereas radicality, nodal yield and survival were similar.
AB - Background: Distal gastrectomy (DG) for gastric cancer can cause less morbidity than total gastrectomy (TG), but may compromise radicality. No prospective studies administered neoadjuvant chemotherapy, and few assessed quality of life (QoL). Methods: The multicenter LOGICA-trial randomized laparoscopic versus open D2-gastrectomy for resectable gastric adenocarcinoma (cT1–4aN0–3bM0) in 10 Dutch hospitals. This secondary LOGICA-analysis compared surgical and oncological outcomes after DG versus TG. DG was performed for non-proximal tumors if R0-resection was deemed achievable, TG for other tumors. Postoperative complications, mortality, hospitalization, radicality, nodal yield, 1-year survival, and EORTC-QoL-questionnaires were analyzed using Χ 2-/Fisher’s exact tests and regression analyses. Results: Between 2015 and 2018, 211 patients underwent DG (n = 122) or TG (n = 89), and 75% of patients underwent neoadjuvant chemotherapy. DG-patients were older, had more comorbidities, less diffuse type tumors, and lower cT-stage than TG-patients (p < 0.05). DG-patients experienced fewer overall complications (34% versus 57%; p < 0.001), also after correcting for baseline differences, lower anastomotic leakage (3% versus 19%), pneumonia (4% versus 22%), atrial fibrillation (3% versus 14%), and Clavien-Dindo grading compared to TG-patients (p < 0.05), and demonstrated shorter median hospital stay (6 versus 8 days; p < 0.001). QoL was better after DG (statistically significant and clinically relevant) in most 1-year postoperative time points. DG-patients showed 98% R0-resections, and similar 30-/90-day mortality, nodal yield (28 versus 30 nodes; p = 0.490), and 1-year survival after correcting for baseline differences (p = 0.084) compared to TG-patients. Conclusions: If oncologically feasible, DG should be preferred over TG due to less complications, faster postoperative recovery, and better QoL while achieving equivalent oncological effectiveness. Mini-abstract: Distal D2-gastrectomy for gastric cancer resulted in less complications, shorter hospitalization, quicker recovery and better quality of life compared to total D2-gastrectomy, whereas radicality, nodal yield and survival were similar.
KW - Gastrectomy
KW - Gastric cancer
KW - Patient selection
KW - Postoperative complications
KW - Quality of life
UR - http://www.scopus.com/inward/record.url?scp=85162665839&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s11605-023-05683-z
DO - https://doi.org/10.1007/s11605-023-05683-z
M3 - Article
C2 - 37340107
SN - 1091-255X
VL - 27
SP - 1812
EP - 1824
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 9
ER -