Minimally invasive gastrectomy: time to change practice?
Mené au Japon sur 921 patients atteints d'un cancer gastrique de stade IA ou IB (âge : 20 à 80 ans), cet essai multicentrique de phase III évalue la non infériorité, du point de vue de la survie sans récidive à 5 ans, d'une gastrectomie distale laparoscopique par rapport à une gastrectomie distale par voie ouverte avec curage ganglionnaire
The year 2019 represents a turning point in the field of evidence-based minimally invasive gastrectomy for gastric cancer. In The Lancet Gastroenterology & Hepatology, Hitoshi Katai and colleagues 1present the phase 3 JCOG0912 trial, in which 921 patients with early gastric cancer were randomly assigned to receive open distal gastrectomy (ODG; n=459) or laparoscopic-assisted distal gastrectomy (LADG; n=462). LADG was non-inferior to ODG with regard to the primary outcome of 5-year relapse-free survival (95·1% [95% CI 92·7–96·8] for LADG vs 94·0% [91·4–95·9] for ODG; HR 0·84 [0·56–1·27], p=0·008). These findings are congruent with those of the similarly designed South Korean randomised controlled trial, KLASS-01, that was published with 5-year results earlier in 2019. 2
The standard of gastric cancer treatment in Japan and South Korea, especially in surgery, is particularly good because of a high incidence of gastric cancer in both countries that would otherwise result in a considerable burden if it was not treated effectively. Japan was the first country to show that screening was effective in reducing gastric cancer mortality, resulting in earlier detection and increased awareness in the population. 3In 1999, South Korea initiated a gastric cancer screening programme with endoscopy every 2 years starting at the age of 40 years, which substantially reduced mortality compared with a non-screened group and led to most patients being diagnosed in clinical stage I. 4The pioneer of laparoscopic cancer gastrectomy, the Japanese surgeon Seigo Kitano, performed the procedure in 1991 and first described his techniques in 1995.
The Lancet Gastroenterology & Hepatology , commentaire, 2018