Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial
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ORIGINAL ARTICLE
Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial Nicole van der Wielen1 · Jennifer Straatman1,2 · Freek Daams1 · Riccardo Rosati3 · Paolo Parise3 · Jürgen Weitz4 · Christoph Reiβfelder5 · Ismael Diez del Val6 · Carlos Loureiro6 · Purificación Parada‑González7 · Elena Pintos‑Martínez7 · Francisco Mateo Vallejo8 · Carlos Medina Achirica8 · Andrés Sánchez‑Pernaute9 · Adriana Ruano Campos9 · Luigi Bonavina10 · Emanuele L. G. Asti10 · Alfredo Alonso Poza11 · Carlos Gilsanz11 · Magnus Nilsson12 · Mats Lindblad12 · Suzanne S. Gisbertz13 · Mark I. van Berge Henegouwen13 · Uberto Fumagalli Romario14 · Stefano De Pascale14 · Khurshid Akhtar15 · H. Jaap Bonjer1 · Miguel A. Cuesta1 · Donald L. van der Peet1 Received: 2 April 2020 / Accepted: 17 July 2020 © The Author(s) 2020
Abstract 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). Oneyear 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. Keywords Minimally invasive total gastrectomy · Neoadjuvant chemotherapy
Introduction Gastric cancer remains one of the most common cancers worldwide, but its incidence varies widely. A high incidence is observed in East-Asia with an incidence of up to 60 patients per 100.000 inhabitants in Korea, whereas the incidence in Northwestern Europe and North America is low, with an incidence of around 5.8 per 100.000 [1]. Based * N
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