title: Surgical techniques, open versus minimally invasive gastrectomy after chemotherapy (STOMACH trial): study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Laparoscopic surgery has been shown to provide important advantages in comparison with open procedures in the treatment of several malignant diseases, such as less perioperative blood loss and faster patient recovery. It also maintains similar results with regard to tumor resection margins and oncological long-term survival. In gastric cancer the role of laparoscopic surgery remains unclear. Current recommended treatment for gastric cancer consists of radical resection of the stomach, with a free margin of 5 to 6 cm from the tumor, combined with a lymphadenectomy. The extent of the lymphadenectomy is considered a marker for radicality of surgery and quality of care. Therefore, it is imperative that a novel surgical technique, such as minimally invasive total gastrectomy, should be non-inferior with regard to radicality of surgery and lymph node yield.
  
  
  METHODS
  The Surgical Techniques, Open versus Minimally invasive gastrectomy After CHemotherapy (STOMACH) study is a randomized, clinical multicenter trial. All adult patients with primary carcinoma of the stomach, in which the tumor is considered surgically resectable (T1-3, N0-1, M0) after neo-adjuvant chemotherapy, are eligible for inclusion and randomization. The primary endpoint is quality of oncological resection, measured by radicality of surgery and number of retrieved lymph nodes. The pathologist is blinded towards patient allocation. Secondary outcomes include patient-reported outcomes measures (PROMs) regarding quality of life, postoperative complications and cost-effectiveness. Based on a non-inferiority model for lymph node yield, with an average lymph node yield of 20, a non-inferiority margin of -4 and a 90% power to detect non-inferiority, a total of 168 patients are to be included.
  
  
  CONCLUSIONS
  The STOMACH trial is a prospective, multicenter, parallel randomized study to define the optimal surgical strategy in patients with proximal or central gastric cancer after neo-adjuvant therapy: the conventional 'open' approach or minimally invasive total gastrectomy.
  
  
  BACKGROUND
  This trial was registered on 28 April 2014 at Clinicaltrials.gov with the identifier NCT02130726 .
authors: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, NL, Netherlands. je.straatman@vumc.nl.
authors: Jennifer
authors: J
authors: Straatman
authors: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, NL, Netherlands. ni.vanderwielen@vumc.nl.
authors: Nicole
authors: N
authors: van der Wielen
authors: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, NL, Netherlands. ma.cuesta@vumc.nl.
authors: Miguel A
authors: MA
authors: Cuesta
authors: Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, NL, Netherlands. s.s.gisbertz@amc.uva.nl.
authors: Suzanne S
authors: SS
authors: Gisbertz
authors: Department of Surgery, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, NL, Netherlands. k.hartemink@nki.nl.
authors: Koen J
authors: KJ
authors: Hartemink
authors: Department of Surgery, Hospital Universitario del Sureste, Ronda del Sur 10, Arganda del Rey, 28500, Madrid, ES, Spain. alfredo.alonsop@salud.madrid.org.
authors: Alfredo
authors: A
authors: Alonso Poza
authors: Department of Surgery, Uniklinikum Dresden, Fetscherstraße 74, 01307, Dresden, DE, Germany. Juergen.Weitz@uniklinikum-dresden.de.
authors: Jürgen
authors: J
authors: Weitz
authors: Department of Surgery, Hospital Jerez de la Frontera, Ronda de Circunvalación, 11407, Cadiz, ES, Spain. fasismateo@gmail.com.
authors: Fransico
authors: F
authors: Mateo Vallejo
authors: Department of Surgery, Salford Royal NHS Foundation Trust, Stott lane, Salford, M6 8HD, UK. khurshid.akhtar@srft.nhs.uk.
authors: Khurshid
authors: K
authors: Ahktar
authors: Department of Surgery, Hospital Universitario Basurto, Montevideo Etorbidea 18, 48013, Bilbao, Spain. ismael.diezdelval@osakidetza.net.
authors: Ismael
authors: I
authors: Diez Del Val
authors: Department of Surgery, Hospital Universitario de Josep Trueta, Avenida França, 17007, Girona, ES, Spain. jroigg@ono.com.
authors: Josep
authors: J
authors: Roig Garcia
authors: Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, NL, Netherlands. d.vdpeet@vumc.nl.
authors: Donald L
authors: DL
authors: van der Peet
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008197:Lymph Node Excision; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*