# KLASS-01: laparoscopic versus open distal gastrectomy for stage I gastric cancer, long-term survival

Source: https://onco.cc/key-papers/paper-klass-01-kim-jama-oncol-2019/  
OnCo record `paper-klass-01-kim-jama-oncol-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Keyhole removal of the lower stomach for early gastric cancer gave the same five-year survival as open surgery in this large Korean trial, confirming laparoscopic gastrectomy as a standard for stage I disease.

## Summary

Phase 3 non-inferiority trial of 1,416 patients with clinical stage I gastric cancer randomised to laparoscopic or open distal gastrectomy in 13 Korean centres.

Five-year overall survival was 94.2 percent with laparoscopic and 93.3 percent with open surgery, cancer-specific survival 97.1 versus 97.2 percent, with fewer wound complications after laparoscopic surgery as reported earlier.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: JAMA Oncology
- Year: 2019
- DOI: 10.1001/jamaoncol.2018.6727
- Authors: Kim HH, Han SU, Kim MC, et al.
- Findings: Five-year overall survival 94.2 percent vs 93.3 percent (non-inferior).; Five-year cancer-specific survival 97.1 percent vs 97.2 percent.
- What it means: Laparoscopic distal gastrectomy is the standard operation for stage I gastric cancer outside endoscopic criteria in East Asia and increasingly elsewhere.
- Caveats: High-volume Korean surgeons; results may not generalise to low-volume settings.

## Sources

- JAMA Oncol 2019: https://doi.org/10.1001/jamaoncol.2018.6727
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30730546/

## Connected records

- cancers: [Early gastric cancer](https://onco.cc/cancers/early-gastric-cancer/)
- trials: [KLASS-01](https://onco.cc/trials/klass-01/)
- journals: [JAMA Oncology](https://onco.cc/journals/jama-oncology/)

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