In the Dutch LOGICA trial reported in the Journal of Clinical Oncology, van der Veen et al found that laparoscopic gastrectomy was not associated with shorter hospital stay vs open gastrectomy in patients with gastric cancer.
Study Details
In the trial, conducted at 10 sites in the Netherlands, 227 patients with resectable (cT1–4aN0–3bM0) gastric adenocarcinoma were randomly assigned between 2015 and 2018 to undergo laparoscopic (n = 115) or open gastrectomy (n = 112). Neoadjuvant chemotherapy was administered to 77 patients (67%) in the laparoscopic group and 87 patients (78%) in the open surgery group. The primary outcome was length of hospital stay. All analyses were performed in the intent-to-treat population, except as specified below.
Hospital Stay and Other Outcomes
Median hospital stay was 7 days (interquartile range [IQR] = 5–9 days) in both the laparoscopic and open surgery groups (probability of shorter stay with laparoscopic approach = .54, P = .34). Mean hospital stay was 9.5 days vs 9.2 days (P = .83). No significant difference in hospital stay between 106 vs 105 patients in the per-protocol population was observed (mean difference = 0.7, 95% confidence interval [CI] = -2 to 3.4 days).
KEY POINTS
- Median hospital stay was 8 days vs 8 days among 48 vs 43 patients undergoing total gastrectomy and 6 days vs 6 days among 59 vs 64 patients undergoing distal gastrectomy.
- Postoperative complications occurred in 44% vs 42% of patients, with anastomotic leakage occurring in 9% vs 10%.
Median hospital stay was 8 days vs 8 days among 48 vs 43 patients undergoing total gastrectomy (P = .82) and 6 days vs 6 days among 59 vs 64 patients undergoing distal gastrectomy (P = .60).
The laparoscopic group had significantly less median blood loss (150 vs 300 mL, P < .001) and significantly longer mean operating time (216 vs 182 minutes, P < .001).
No significant differences were observed in R0 resection rate (95% vs 95%, P = 1.00) or median lymph node yield (29 vs 29, P = .49).
Postoperative complications occurred in 44% vs 42% of patients (P = .91), with anastomotic leakage occurring in 9% vs 10% (P = .92).
No significant differences were observed in 30-day readmission rate (9.6% vs 9.1%, P = 1.00), in-hospital mortality (4% vs 7%, P = .40), or 1-year overall survival (76% vs 78%, P = .74).
There were no significant differences between groups in health-related global quality of life as assessed by the EORTC Quality of Life Questionnaire-C30 at 6 weeks or 3, 6, 9, or 12 months after surgery (mean differences between +1.5 and +3.6 on 1–100 scale across all assessments, with all 95% CIs including 0).
The investigators concluded, “Laparoscopic gastrectomy did not lead to a shorter hospital stay in this Western multicenter randomized trial of patients with predominantly advanced gastric cancer. Postoperative complications and oncological efficacy did not differ between laparoscopic gastrectomy and open gastrectomy.”
Richard van Hillegersberg, MD, PhD, of the Department of Surgery, University Medical Center Utrecht, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was funded by is trial was funded by The Netherlands Organisation for Health Research and Development (ZonMW). For full disclosures of the study authors, visit ascopubs.org.
