key papersKey paper
KLASS-01: laparoscopic versus open distal gastrectomy for stage I gastric cancer, long-term survival
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.
Overview
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.
Randomised controlled trialChanged practice1,416 participants
Authors
Kim HH, Han SU, Kim MC, et al.
Published
JAMA Oncology, 2019
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.