Laparoscopic Surgery in Patients With Distal T4a Gastric Cancer

Mini-invasive techniques have become increasingly popular and even routine for gastric cancer (GC) surgery in many centers. In this issue of JAMA Surgery, Dat and colleagues report results from their randomized clinical trial (RCT) comparing laparoscopic distal gastrectomy (LDG) and open distal gastrectomy (ODG) with D2 lymphadenectomy for clinical T4a GC. The protocol of the study was previously published. The study setting is important and clinically relevant. The authors show comparable but not superior short-term outcomes between the operative techniques and recommend LDG to be feasible and safe as an alternative to ODG for qualified and experienced surgeons.