Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial

Nicole van der Wielen, Jennifer Straatman, Freek Daams, Riccardo Rosati, Paolo Parise, Jürgen Weitz, Christoph Reissfelder, Ismael Diez del Val, Carlos Loureiro, Purificación Parada-González, Elena Pintos-Martínez, Francisco Mateo Vallejo, Carlos Medina Achirica, Andrés Sánchez-Pernaute, Adriana Ruano Campos, Luigi Bonavina, Emanuele L.G. Asti, Alfredo Alonso Poza, Carlos Gilsanz, Magnus NilssonMats Lindblad, Suzanne S. Gisbertz, Mark I. van Berge Henegouwen, Uberto Fumagalli Romario, Stefano De Pascale, Khurshid Akhtar, H. Jaap Bonjer, Miguel A. Cuesta, Donald L. van der Peet, Christoph Reiβfelder

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50 Citations (Scopus)


Background: Surgical resection with adequate lymphadenectomy is regarded the only curative option for gastric cancer. Regarding minimally invasive techniques, mainly Asian studies showed comparable oncological and short-term postoperative outcomes. The incidence of gastric cancer is lower in the Western population and patients often present with more advanced stages of disease. Therefore, the reproducibility of these Asian results in the Western population remains to be investigated. Methods: A randomized trial was performed in thirteen hospitals in Europe. Patients with an indication for total gastrectomy who received neoadjuvant chemotherapy were eligible for inclusion and randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG). Primary outcome was oncological safety, measured as the number of resected lymph nodes and radicality. Secondary outcomes were postoperative complications, recovery and 1-year survival. Results: Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. The mean number of resected lymph nodes was 43.4 ± 17.3 in OTG and 41.7 ± 16.1 in MITG (p = 0.612). Forty-eight patients in the OTG group had a R0 resection and 44 patients in the MITG group (p = 0.617). One-year survival was 90.4% in OTG and 85.5% in MITG (p = 0.701). No significant differences were found regarding postoperative complications and recovery. Conclusion: These findings provide evidence that MITG after neoadjuvant therapy is not inferior regarding oncological quality of resection in comparison to OTG in Western patients with resectable gastric cancer. In addition, no differences in postoperative complications and recovery were seen.

Original languageEnglish
Pages (from-to)258-271
Number of pages14
JournalGastric cancer
Issue number1
Early online date2020
Publication statusPublished - Jan 2021


  • Minimally invasive total gastrectomy
  • Neoadjuvant chemotherapy

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