Comparison of long- and short-term outcomes in 845 open and minimally invasive gastrectomies for gastric cancer in the United States Journal Article

Authors: Nakauchi, M.; Vos, E.; Janjigian, Y. Y.; Ku, G. Y.; Schattner, M. A.; Nishimura, M.; Gonen, M.; Coit, D. G.; Strong, V. E.
Article Title: Comparison of long- and short-term outcomes in 845 open and minimally invasive gastrectomies for gastric cancer in the United States
Abstract: Background: Few Western studies have evaluated the long-term oncologic outcomes of minimally invasive surgery (MIS) approaches to gastrectomy for gastric cancer. This study aimed to compare the outcomes between minimally invasive and open gastrectomies and between laparoscopic and robotic gastrectomies at a high-volume cancer center in the United States. Methods: The study analyzed data for all patients undergoing curative gastrectomy for gastric adenocarcinoma from January 2007 to June 2017. Postoperative complications and disease-specific survival (DSS) were compared between surgical approaches. Results: The median follow-up period for the 845 patients in this study was 38.5 months. The stage-stratified 5-year DSS did not differ significantly between open surgery (n = 534) and MIS (n = 311). The MIS approach resulted in significantly fewer complications, as confirmed by adjusted comparison (odds ratio [OR], 0.70; range, 0.49–1.00; p = 0.049). After adjustment, the two groups did not differ in terms of DSS (hazard ratio [HR], 0.83; range, 0.55–1.25; p = 0.362). The robotic operations (n = 190) had fewer conversions to open procedure (p = 0.010), a shorter operative time (212 vs 240 min; p < 0.001), more dissected nodes (27 vs 22; p < 0.001), fewer Clavien-Dindo grade ≥3 complications (5.8% vs 13.2%; p = 0.023), and a shorter postoperative stay (5 vs 6 days; p = 0.045) than the laparoscopic operations (n = 121). The DSS rate did not differ between the laparoscopic and robotic groups. Conclusion: The study findings demonstrated the long-term survival and oncologic equivalency of MIS gastrectomy and the open approach in a Western cohort, supporting the use of MIS at centers that have adequate experience with appropriately selected patients. © 2021, Society of Surgical Oncology.
Keywords: adult; controlled study; treatment outcome; aged; retrospective studies; major clinical study; postoperative period; united states; follow up; antineoplastic agent; lymph node dissection; laparoscopy; cohort analysis; retrospective study; postoperative complication; length of stay; operation duration; gastrectomy; minimally invasive surgery; neoadjuvant chemotherapy; epidemiology; stomach adenocarcinoma; adjuvant radiotherapy; stomach neoplasms; disease specific survival; stomach tumor; clinical outcome; open surgery; long term survival; minimally invasive surgical procedures; conversion to open surgery; humans; human; male; female; article; robotic surgical procedures; robot assisted surgery
Journal Title: Annals of Surgical Oncology
Volume: 28
Issue: 7
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2021-07-01
Start Page: 3532
End Page: 3544
Language: English
DOI: 10.1245/s10434-021-09798-y
PUBMED: 33709174
PROVIDER: scopus
Notes: Article -- Export Date: 1 July 2021 -- Source: Scopus
Citation Impact
MSK Authors
  1. Mithat Gonen
    832 Gonen
  2. Geoffrey Yuyat Ku
    151 Ku
  3. Yelena Yuriy Janjigian
    243 Janjigian
  4. Vivian Strong
    194 Strong
  5. Daniel Coit
    498 Coit
  6. Mark Schattner
    122 Schattner
  7. Elvira Lise Vos
    10 Vos