Refining the Role of Laparoscopic Gastrectomy for T4a Disease

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The UMC-UPPERGI-01 trial provides prospective data on laparoscopic distal gastrectomy for clinical T4a gastric cancer, a previously underrepresented group.
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Preoperative staging accuracy was limited as it relied solely on computed tomography, lacking staging laparoscopy and cytology.
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No clear superiority in postoperative outcomes was observed, raising questions about the benefits of minimally invasive surgery for T4a disease.
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Exclusion of patients receiving perioperative chemotherapy limits the external validity of the trial's findings in contemporary oncologic practice.
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Short-term safety findings are reassuring but insufficient for establishing oncologic equivalence; long-term outcomes are needed for broader LDG adoption.

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