J Gastric Cancer.  2022 Jun;22(2):94-106. 10.5230/jgc.2022.22.e8.

Short-Term Outcomes of Laparoscopic Proximal Gastrectomy With DoubleTract Reconstruction Versus Laparoscopic Total Gastrectomy for Upper Early Gastric Cancer: A KLASS 05 Randomized Clinical Trial

  • 1Department of Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 2Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) Group, Seoul, Korea
  • 3Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
  • 5Department of Surgery, Yonsei University Severance Hospital, Seoul, Korea
  • 6Department of Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
  • 7Center for Gastric Center, National Cancer Center, Goyang, Korea
  • 8Department of Surgery, Catholic University of Seoul St. Mary's Hospital, Seoul, Korea
  • 9Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
  • 10Department of Surgery, Chonnam National University Medical School, Hwasun, Korea
  • 11Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
  • 12Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea


Laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) is a function-preserving procedure performed for treating upper early gastric cancer (EGC). However, few studies have compared the outcomes of LPG-DTR with those of laparoscopic total gastrectomy (LTG). This study aimed at comparing the short-term outcomes of LPGDTR between LTG and upper EGC.
Materials and Methods
For upper-third EGC, a multicenter, prospective, randomized trial was performed to compare those who underwent LPG-DTR with those who underwent LTG. Short-term outcomes, including clinicopathologic results, morbidity, mortality, and postoperative courses, were evaluated using a full analysis set based on the intention-to-treat principle and the per-protocol set.
Of the patients, 138 who fulfilled the criteria were randomized to each group. One patient in the LPG-DTR group withdrew consent. Sixty-eight patients underwent LPGDTR and 69 underwent LTG. The operative time (LPG-DTR=219.4 minutes; LTG=201.8 minutes; P=0.085), estimated blood loss (LPG-DTR=76.0 mL; LTG=66.1 mL; P=0.413), and the morbidity rate (LPG-DTR=23.5%; LTG=17.4%; P=0.373) between the groups were not significantly different. No mortality occurred in either of the study groups. Two weeks post operation, the Visick scores for postprandial symptoms, including reflux symptoms, were not significantly different between the groups (P=0.749). Laboratory findings on postoperative day 5 were not significantly different between the groups.
The short-term outcomes of LPG-DTR for upper EGC were comparable to those of LTG. Trial Registration: ClinicalTrials.gov Identifier: NCT02892643


Surgery; Treatment; Laparoscopy; Diagnosis
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