Laparoscopic versus open gastrectomy for gastric cancer, a multicenter prospectively randomized controlled trial (LOGICA-trial)

Background

For gastric cancer patients, surgical resection with en-bloc lymphadenectomy is the cornerstone of curative treatment. Open gastrectomy has long been the preferred surgical approach worldwide. However, this procedure is associated with considerable morbidity. Several meta-analyses have shown an advantage in short-term outcomes of laparoscopic gastrectomy compared to open procedures, with similar oncologic outcomes. However, it remains unclear whether the results of these Asian studies can be extrapolated to the Western population. In this trial from the Netherlands, patients with resectable gastric cancer will be randomized to laparoscopic or open gastrectomy.

Methods

The study is a non-blinded, multicenter, prospectively randomized controlled superiority trial. Patients (≥18 years) with histologically proven, surgically resectable (cT1-4a, N0-3b, M0) gastric adenocarcinoma and European Clinical Oncology Group performance status 0, 1 or 2 are eligible to participate in the study after obtaining informed consent. Patients (n = 210) will be included in one of the ten participating Dutch centers and are randomized to either laparoscopic or open gastrectomy. The primary outcome is postoperative hospital stay (days). Secondary outcome parameters include postoperative morbidity and mortality, oncologic outcomes, readmissions, quality of life and cost-effectiveness.

Discussion

In this randomized controlled trial laparoscopic and open gastrectomy are compared in patients with resectable gastric cancer. It is expected that laparoscopic gastrectomy will result in a faster recovery of the patient and a shorter hospital stay. Secondly, it is expected that laparoscopic gastrectomy will be associated with a lower postoperative morbidity, less readmissions, higher cost-effectiveness, better postoperative quality of life, but with similar mortality and oncologic outcomes, compared to open gastrectomy. The study started on 1 December 2014. Inclusion and follow-up will take 3 and 5 years respectively. Short-term results will be analyzed and published after discharge of the last randomized patient.

Trial registration

NCT02248519

Subtotal adrenalectomy for phaeochromocytoma in multiple endocrine neoplasia type 2A

OBJECTIVE

To describe our surgical technique for, and results of, subtotal adrenalectomy for phaeochromocytoma in multiple endocrine neoplasia (MEN) type 2.

DESIGN

Retrospective study.

SETTING

Teaching hospital, The Netherlands.

SUBJECTS

6 patients (four women and 2 men, mean age 35 years, range 31-46) with MEN type 2 who presented between 1993 and 1996.

INTERVENTIONS

Cortical sparing adrenalectomy (n =4) together with contralateral total adrenalectomy in bilateral disease (n = 2).

MAIN OUTCOME MEASURES

Morbidity, mortality, adrenal function postoperatively, and recurrence.

RESULTS

Cortical sparing adrenalectomy leaving adequate adrenal reserve was possible in all cases. There was no operative morbidity or mortality. Mean follow-up was 40 months (range 1347). One patient developed a recurrent phaeochromocytoma 24 months after subtotal adrenalectomy.

CONCLUSIONS

Subtotal adrenalectomy with preservation of adequate adrenal cortical reserve was feasible in all cases. Long term follow-up is necessary to establish its definitive place in the treatment of familial phaeochromocytoma.

Technetium-99m-sestamibi uptake in axillary lymph node metastases in breast cancer patients

In a prospective study the value of technetium-99m-sestamibi scintigraphy (MIBI scintigraphy) in staging axillary lymph node involvement in breast cancer patients was established. The study comprised 36 cases. The results of the staging were compared with physical and histological examination. MIBI scintigraphy had a sensitivity of 91% and a total accuracy of 81%. These percentages demonstrate the potential value of this technique; larger series will be needed to confirm our results.

Intramedullary nailing of open femoral shaft fractures

Twenty-seven patients with 28 open femoral shaft fractures were treated by intramedullary nailing. Ten fractures were Grade I, nine Grade II and nine Grade III according to Gustilo. After debridement and irrigation of the wounds, 26 fractures were nailed immediately, whilst two fractures were stabilized at an early stage. Two infections developed. One occurred before intramedullary nailing during a period of femoral traction. Both infections were treated successfully. The authors conclude that primary intramedullary nailing is safe in open femoral fractures of all grades. If a thorough debridement and irrigation are performed, the postoperative infection rate is low.