KLASS-01
KLASS-01 showed that removing an early stomach cancer through keyhole surgery is as safe for long-term survival as open surgery and causes fewer wound complications, which made laparoscopic gastrectomy the standard for early gastric cancer in Korea and beyond.
Overview
KLASS-01 was a multicentre non-inferiority trial run by the Korean Laparoendoscopic Gastrointestinal Surgery Study group in patients with clinical stage I gastric adenocarcinoma. Patients were randomised to laparoscopy-assisted or open distal gastrectomy with standard lymph node dissection.
The short-term report found fewer wound complications and similar mortality with the laparoscopic approach. The primary analysis, published in JAMA Oncology in 2019, showed that five-year overall survival after laparoscopic surgery was non-inferior to open surgery. With the Japanese JCOG0912 trial it settled the question for early distal gastric cancer; the follow-on KLASS-02 addressed locally advanced disease.
Together with KLASS-01, this trial makes laparoscopic distal gastrectomy the standard for early gastric cancer needing surgery.
Laparoscopic distal gastrectomy is the standard operation for stage I gastric cancer outside endoscopic criteria in East Asia and increasingly elsewhere.
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