A prospective study for safety margins during laparoscopic distal gastrectomy for advanced gastric cancer

Background: It has not been evaluated so far whether laparoscopic distal gastrectomy (LDG) could secure the safety surgical margin as open distal gastrectomy (ODG) for advanced gastric cancer.
Patients and Methods: This study was a single-arm prospective study in a single institution. The subjects were gastric cancer patients with cT1N2-3, cT2N0-3, cT3N0, cT4aN0 that could be curatively resected by distal gastrectomy. The primary endpoint was the proportion of cases with a surgical proximal margin (sPM) of less than 20 mm, the percentage of cases with an sPM of less than 20 mm was set to be less than 13.5%, not considered to be inferior to ODG.
Results: From November 2017 to November 2021, 130 patients were enrolled. Of these, a total of 5 cases, which included 2 cases of cT4b, 1 case of peritoneal dissemination, 1 case of positive lavage cytopathology, and 1 case of laparotomy transition due to the appearance of allergic symptoms, were excluded, and 125 cases were eligible for registration. Two cases (1.6%) had positive margins as a result of intraoperative margins. The total number of cases with sPM less than 20 mm was 2 (1.6%).
Conclusions: It was confirmed that LDG for advanced gastric cancer could secure a sufficient surgical margin.