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RESEARCH ARTICLE
Short-term Outcome of Laparoscopic vs Open Gastrectomy

for Gastric Cancer: A Randomized Controlled Trial

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Mostafa M Sayed , Mohamed G Taher , Salah I Mohamed , Mostafa A Hamad 4
AbstrAct
Background: Gastric cancer (GC) is a crucial cause of morbidity and mortality worldwide. In Egypt, GC ranked as the 12th most common cancer.
During the last two decades, laparoscopic gastrectomy (LG) has proved to be popular and effective. This study aims to compare the short-term
outcomes of LG vs open gastrectomy (OG) in resectable GC patients.
Patients and methods: This is a randomized controlled trial, where patients presented to Assiut university hospital with resectable GC, in the
period from January 2017 to December 2019, were randomly allocated to OG (group A) or LG (group B).
Results: During the study period, 46 patients were randomized: 23 patients for OG and 23 for LG. Advanced cases after exploration were excluded
from both the groups ended up with a total of 36 patients (20 for OG and 16 for LG). The mean follow-up time was 5 months ranging from
40 days to 10 months. There were no statistically significant differences between the two groups in the baseline clinicopathological data. The
mean operative time was longer in LG (260.6 ± 46.7 vs 191.0 ± 24.7 minutes in OG) with a p-value <0.001. The postoperative hospital stay was
more in OG compared to LG (8.0 ± 4.1 vs 6.9 ± 2.6 days, p-value = 0.361). Postoperative complications were more among OG (4/20) compared
to (2/16) in LG (p-value = 0.549). Just one mortality was reported in the OG.
Conclusion: For GC cases, LG shows comparable outcomes to OG in short-term results, and it is a promising minimally invasive surgery in such
cases.
Keywords: Gastrectomy, Gastric cancer, Laparoscopic surgery.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1451

IntroductIon 1–4 General Surgery Department, Faculty of Medicine, Assiut University,
Gastric cancer (GC) is one of the crucial causes of cancer morbidity Assiut, Egypt
and mortality worldwide. Globally, East Asia (Korea, Mongolia, Corresponding Author: Mohamed G Taher, General Surgery
Japan, and China) represents the highest percentage of cases and Department, Faculty of Medicine, Assiut University, Assiut, Egypt,
deaths from GC. 1 Phone: +2 01091289046, e-mail: mohamedamin022@aun.edu.eg
In Egypt according to the national population-based cancer How to cite this article: Sayed MM, Taher MG, Mohamed SI,
registry program, GC ranked as the 12th most common cancer et al. Short-term Outcome of Laparoscopic vs Open Gastrectomy
representing 1.6% of the total cancers and 2.2% of the total cancer for Gastric Cancer: A Randomized Controlled Trial. World J Lap Surg
deaths. The incidence varies among the different regions of Egypt 2021;14(2):106–110.
( higher in Upper Egypt 2.48% compared to Lower Egypt 0.98%). 2 Source of support: Nil

Surgery is the only cure for GC. According to the resection Conflict of interest: None
extent, gastrectomy is classified into distal gastrectomy, total
gastrectomy, and proximal gastrectomy. Also, the extent of lymph
node (LN) dissection is very important. In general, most studies
report D1 (dissection of the perigastric LNs) or D2 (dissection of This study aims to compare the short-term outcomes of LG vs
the LNs around the big gastric vessels), which means that at least OG in resectable GC patients at our center in Upper Egypt (Assiut
a D1 LN dissection should be done. However, as mentioned in the University Hospital, Egypt).
4th Japanese Gastric Cancer Treatment Guidelines for resectable
GC, D2 LN dissection is strongly recommended and considered as PAtIents And Methods
the standard of care for GC patients. 3 This randomized controlled trial conducted at the Department of
Laparoscopic gastrectomy (LG) for GC, initially introduced General Surgery in the Assiut University Hospital (one of the largest
by Kitano et al. in 1993, has been studied in many countries, and tertiary centers in Egypt that serves most of Upper Egypt patients)
nowadays, it became one of the important procedures for the in the period from January 2017 to December 2019, including all GC
treatment of early GC. Additionally, it has shown comparable short- patients admitted to Assiut university hospital during this period.
and long-term outcomes as open gastrectomy (OG), mainly in Far East The research protocol was approved via the Ethical Review
4,5
countries as Korea and Japan. Furthermore, as surgical experiences Committee of Assiut Faculty of Medicine before starting the study.
increased and with development of instruments, some experts have Written informed consent was obtained from recruited patients,
4,6
extended their use of LG from early GC (EGC) to advanced GC (AGC). and this trial was registered in clinicaltrial.gov (NCT02789826).
However, the implementation of LG in our region is challenging Any adult patient with primary and resectable gastric carcinoma
because of the low number of cases and high cost of the equipment. was eligible for the study. All GC patients have been diagnosed by

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