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Randomized Controlled Trial
. 2025 Jan 1;111(1):686-696.
doi: 10.1097/JS9.0000000000002062.

Final results of a randomized controlled trial: comparison of the efficacy and safety between totally laparoscopic and laparoscopic-assisted total gastrectomy for advanced Siewert III esophagogastric junction cancer and upper and middle third gastric cancer

Juan Wang  1   2 , Shushang Liu  1 , Haixiang Chen  3 , Jialin Luo  1 , Guanghui Xu  1 , Xiangying Feng  1 , Xuewen Yang  1 , Jianjun Yang  1   2 , Ji Gang  1   2
Affiliations
Randomized Controlled Trial

Final results of a randomized controlled trial: comparison of the efficacy and safety between totally laparoscopic and laparoscopic-assisted total gastrectomy for advanced Siewert III esophagogastric junction cancer and upper and middle third gastric cancer

Juan Wang et al. Int J Surg. .

Abstract

Background: This study aimed to compare the efficacy and safety of TLTG with the overlap technique to LATG in patients with advanced Siewert III Esophagogastric Junction Cancer and upper and middle third gastric cancer.

Methods: This single-center RCT enrolled 292 patients with the mentioned cancers, randomly assigned to TLTG overlap ( n =146) or LATG ( n =146) groups. Data on demographics, pathology, intraoperative variables, postoperative complications, recovery parameters, and 3-year survival were collected. Main outcome: postoperative complications within 30 days. Secondary outcomes: 3-year disease-free and overall survival.

Results: TLTG versus LATG: TLTG had shorter incision, faster flatus/defecation, reduced analgesia, less opioid use, and shorter hospital stay. Similar operation time, anastomosis time, blood loss, and lymph node harvest. TLTG had a lower overall post-op complication rate (P=0.047) and no significant difference in serious complications ( P =0.310). Variances in anastomotic stenosis occurrence at 3 months. No rehospitalization or mortality at 30 days. No significant differences in 3-month disease-free survival ( P =0.058) or overall survival ( P =0.236).

Conclusion: The overlap method for anastomosis in TLTG is safe and feasible for advanced middle-upper-third gastric cancer, with positive short-term outcomes. This technique has the potential to be the preferred esophagojejunostomy approach in TLTG.

Trial registration: This trial has been registered at Chinese Clinical Trial Registry: ChiCTR1900025667 (registration date: 4 September 2019).

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Conflict of interest statement

The authors declare no conflicts of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Flowchart of patient enrollment.
Figure 2
Figure 2
Distribution of different complications in two groups of patients with complications.
Figure 3
Figure 3
The disease-free survival and overall survival of the patients in TLTG and LATG groups. A. Disease-free survival. B. Overall survival.
See this image and copyright information in PMC

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