Table 3.

Randomized clinical trials on laparoscopic versus open gastrectomy for gastric cancer.

Authors	Patients	Procedures	Results
Kitano et al., 2002 [59]	28 EGC	Distal gastrectomy	Faster recovery, less pain, and less compromised pulmonary function in the LPS group
Fujii et al., 2003 [60]	20 EGC	Distal gastrectomy	Better preservation of Th1 immune response in the LPS group
Huscher et al., 2005 [61]	59 T1-4 and N0-2 GC	Distal gastrectomy	No difference in terms of mean number of resected lymph nodes, mortality, morbidity, five-year OS and DFS. LPS was associated with lower intraoperative blood loss, earlier resumption of oral intake, and earlier hospital discharge.
Hayashi et al., 2005 [62]	28 EGC	Distal gastrectomy	No difference in terms of oncological radicality. Shorter postoperative epidural anesthesia, lower IL-6 and CRP levels, without major postoperative complications in the LPS group.
Lee et al., 2005 [63]	47 EGC	Distal gastrectomy	Similar oncological outcomes, but fewer pulmonary complications in the LPS group
Kim et al., 2008 [64]	164 EGC	Distal gastrectomy	LPS-related advantages regarding QoL, intraoperative blood loss, analgesic use, and postoperative hospital stay.
Kim et al., 2010 [65]	342 EGC	Distal gastrectomy	No significant difference in morbidity and mortality rate.
Kim et al., 2013 [66]	164 EGC	Distal gastrectomy	Similar overall postoperative morbidity, QoL, five-year OS and DFS. Mild complications were lower in the LPS group.
Sakuramoto et al., 2013 [67]	64 EGC	Distal gastrectomy	LPS resulted in less postoperative pain with similar short-term outcomes than open surgery.
Takiguchi et al., 2013 [68]	40 EGC	Distal gastrectomy	Benefits related to LPS were faster recovery, less intraoperative blood loss, less postoperative pain, smaller wound size, shorter postoperative hospital stay, and better levels of CRP and SaO2.
Hu et al., 2015 [69]	66 stage I-III GC	Distal gastrectomy	LPS was associated with lower morbidity, less intraoperative blood loss, shorter hospital stay, faster recovery and better humoral and cellular immune response.
Hu et al., 2016 [70] CLASS-01 Trial	1056 T2-4a and N0-3 GC	Distal gastrectomy with D2 lymphadenectomy	Similar node-dissection compliance, morbidity and mortality rate.
Kim et al., 2016 KLASS-01 Trial	1416 EGC	Distal gastrectomy with D1+ lymphadenectomy	LPS resulted in lower wound complication rate, comparable overall morbidity and mortality.
Yamashita et al., 2016 [71]	63 EGC	Distal gastrectomy	LPS was associated with less long-term wound pain.
Katai et al., 2017 [72]	921 T1-2 and N0-1 GC non-endoscopically suitable	Distal gastrectomy	LPS was safe as open surgery presenting similar short-term clinical outcomes, with a significantly higher operative time but smaller blood loss.
Park et al., 2018 [73] COACT 1001 trial	204 T2-4a and N0-2 GC	Distal gastrectomy with D2 lymphadenectomy	No significant differences in three-year DFS, morbidity and overall lymphadenectomy noncompliance rate, despite the latter being significantly higher for stage III GC in the LPS group.
Shi et al., 2018 [74]	328 T2-3 and N0-3 GC	Proximal, distal and total gastrectomy with D2 lymphadenectomy	LPS resulted to be safe and feasible procedure in locally advanced GC compared to open surgery.
Shi et al., 2019 [75]	328 T2-3 and N0-3 GC	Proximal, distal and total gastrectomy with D2 lymphadenectomy	No difference in terms of five-year OS, DFS and recurrence rate.
Wang et al., 2019 [76]	446 T2-4a and N0-3	Distal gastrectomy with D2 lymphadenectomy	No difference in terms of 30-day morbidity and mortality, three-year DFS and in compliance rate of D2 lymph node dissection.
Li et al., 2019 [77]	96 T2-4a and N+ GC after neoadjuvant therapy	Distal gastrectomy with D2 lymphadenectomy	LPG gastrectomy resulted in a lower overall complication rate, less pain, similar postoperative recovery, better adjuvant chemotherapy completion rate and comparable mortality.
Lee et al., 2019 [78] KLASS-02 Trial	1050 T2-4a and N0-1 GC	Distal gastrectomy with D2 lymphadenectomy	LPS was significantly associated with faster recovery, lower early morbidity rate, postoperative pain and analgesic use, and shorter hospital stay with no difference in terms of mortality and totally retrieved lymph nodes.
Yu et al., 2019 [79] CLASS-01 Trial	1056 T2-4a and N0-3 GC	Distal gastrectomy with D2 lymphadenectomy	No difference in terms of three-year DFS.
Liu et al., 2020 [80] CLASS-02 trial	227 T1-2 and N0-1 (stage I) GC	Total gastrectomy	No difference in terms of overall postoperative complication rate and mortality.
Hyung et al., 2020 [81] KLASS-02 Trial	1050 T2-4a and N0-1 GC	Distal gastrectomy with D2 lymphadenectomy	No difference in terms of three-year relapse-free survival rate.
Van de Veen et al., 2021 [82] LOGICA Trial	227 T1-4a and N0-3b GC	Total or distal gastrectomy with D2 lymphadenectomy	No difference in terms of postoperative complications, in-hospital mortality, 30-day readmission rate, R0 resections, median lymph node harvested, one-year OS, and one-year global health-related QoL.
Huang et al., 2022 [83] CLASS-01 Trial	1056 T2-4a and N0-3 GC	Distal gastrectomy with D2 lymphadenectomy	Similar five-year OS.
Son et al., 2022 [84] KLASS-02 Trial	1050 T2-4a and N0-1 GC	Distal gastrectomy with D2 lymphadenectomy	Five-year OS and relapse-free survival rates were not significantly different between LPS and open surgery.

EGC, Early Gastric Cancer; LPS, Laparoscopic; GC, Gastric Cancer; OS, Overall Survival; DFS, Disease-Free Survival; QoL, Quality of Life; IL-6, Interleukin-6; CRP, C-Reactive Protein; CLASS-01, Chinese Laparoscopic Gastrointestinal Surgery Study 01; KLASS-01, Korean Laparoendoscopic Gastrointestinal Surgery Study 01; KLASS-02, Korean Laparoendoscopic Gastrointestinal Surgery Study 02; CLASS-02, Chinese Laparoscopic Gastrointestinal Surgery Study 02; LOGICA, Laparoscopic versus Open Gastrectomy for gastrIc Cancer.