Complete mesogastric excision for locally advanced gastric cancer: short-term outcomes of a randomized clinical trial

Cell Rep Med. 2021 Mar 16;2(3):100217. doi: 10.1016/j.xcrm.2021.100217.

Abstract

Implementation of complete mesogastric excision in gastric cancer surgery, named D2 lymphadenectomy plus complete mesogastric excision (D2+CME), has recently been proposed as an optimal procedure. However, the safety and efficacy of D2+CME remain uncertain. In this randomized controlled trial, patients receiving D2+CME exhibit less intraoperative blood loss, more lymph node harvesting, and earlier postoperative flatus than patients receiving conventional D2 radical surgery. Univariate Cox regression analysis reveals that the risk ratio for postoperative flatus in D2+CME group is 1.247 (p = 0.044). Overall postoperative complications are comparable between the two groups, but complications are significantly less severe in the D2+CME group than the D2 group (Clavien-Dindo classification grade ≥ IIIa: 4 D2+CME patients [11.8%] versus 9 D2 patients [33.3%]; p = 0.041). In conclusion, our work shows that D2+CME is associated with better short-term outcomes and surgical safety than conventional D2 dissection for patients with advanced gastric cancer.

Trial registration: ClinicalTrials.gov NCT01978444.

Keywords: complete mesogastric excision; gastric cancer; randomized clinical trial; short-term outcomes.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Loss, Surgical / physiopathology
  • Blood Loss, Surgical / prevention & control
  • Disease Progression
  • Female
  • Flatulence / diagnosis
  • Flatulence / etiology
  • Flatulence / physiopathology
  • Gastrectomy / methods*
  • Humans
  • Lymph Node Excision / methods*
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery*
  • Male
  • Mesentery / pathology
  • Mesentery / surgery*
  • Middle Aged
  • Odds Ratio
  • Patient Safety
  • Postoperative Complications / diagnosis
  • Postoperative Complications / physiopathology
  • Stomach / pathology
  • Stomach / surgery*
  • Stomach Neoplasms / mortality
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / surgery*
  • Survival Analysis
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT01978444