Long-term outcomes of laparoscopic radical gastrectomy for highly advanced gastric cancer

This is the final report evaluating the long-term outcomes of a phase 2 clinical trial that demonstrated the short-term efficacy of laparoscopic gastrectomy (LG) for highly advanced gastric cancer (AGC). 73 patients with histologically confirmed gastric adenocarcinoma, diagnosed with clinical stage II or higher, who potentially underwent curative resection between Aug 2009 and Nov 2014, were prospectively enrolled. Long-term outcomes with 5-year PFS (5-PFS) and 5-year OS (5-OS) were evaluated according to clinical or pathological stages. Recurrence and progression patterns were also investigated. The median observation period of all surviving patients was 75.1 months. The 5-PFS and 5-OS of all patients were 47.4% and 54.4%, respectively. Clinical stage-specific 5-PFS and 5-OS were 75.0, 69.1, 53.9, 39.4, 40.0, 9.1, 75.0, 68.8, 61.5, 45.0, 60.0, and 27.3 in stages IIA, IIB, IIIA, IIIB, IIIC, and IV, respectively. Pathological stage-specific 5-PFS and 5-OS, including ypStage with preoperative chemotherapy, were 100, 80.0, 100, 62.5, 80.0, 51.3, 16.7, 22.2, 12.5, and 100, 80.0, 100, 75.0, 80.0, 64.2, 25.0, 33.3, and 12.5, respectively, in stage X (no residual tumor with preoperative chemotherapy), IA, IB, IIA, IIB, IIIA, IIIB, IIIC, and IV, respectively. Recurrence or progression was observed in 30 patients (41.1%). LG for highly AGC performed by experienced surgeons is safe and oncologically acceptable.