Minimally invasive gastrectomy for gastric cancer: A national perspective on oncologic outcomes and overall survival.

Leung, Kenneth; Sun, Zhifei; Nussbaum, Daniel P; Adam, Mohamed A; Worni, Mathias; Blazer, Dan G (2017). Minimally invasive gastrectomy for gastric cancer: A national perspective on oncologic outcomes and overall survival. Surgical oncology, 26(3), pp. 324-330. Elsevier 10.1016/j.suronc.2017.06.004

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BACKGROUND Minimally invasive (MI) gastrectomy has become increasingly common as a resection technique for gastric cancer; however, data are limited regarding peri-operative morbidity, oncologic outcomes and long-term survival, particularly in the Western patient population. STUDY DESIGN The 2010-2012 National Cancer Data Base was queried for adult patients who underwent gastrectomy for localized, intestinal-type gastric adenocarcinoma. Patients were classified by surgical approach (MI vs. open gastrectomy) on an intent-to-treat basis. Groups were propensity score matched using a 1:1 nearest neighbor algorithm, and outcomes were compared. Survival was estimated using the Kaplan-Meier method. RESULTS Among 5420 patients, 1423 (26%) underwent MI gastrectomy. Following adjustment with propensity matching, all baseline characteristics were highly similar between 1175 patients in each treatment group. Between propensity-matched groups, MI gastrectomy patients had similar rates of margin-negative resections (91 vs. 90%, p = 0.447), median lymph node harvest (16 vs. 15, p = 0.104), and utilization of adjuvant therapies (28 vs. 28%, p = 0.748). MI gastrectomy was associated with shorter hospital stay (8 vs. 9 days, p < 0.001) without an increase in unplanned readmissions (7 vs. 6%, p = 0.456) or 30-day mortality (2 vs. 3%, p = 0.655). There was no difference in 3-year overall survival (50 vs. 55%, p = 0.359). CONCLUSIONS On a national level, MI gastrectomy for gastric cancer appears to be associated with similar perioperative and long-term outcomes compared to the traditional open approach. While prospective studies remain essential, these data provide greater equipoise for ongoing trials and institutional efforts to further implement and evaluate this technique.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Viszeralchirurgie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery

UniBE Contributor:

Worni, Mathias

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0960-7404

Publisher:

Elsevier

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

05 Mar 2018 12:26

Last Modified:

05 Mar 2018 12:30

Publisher DOI:

10.1016/j.suronc.2017.06.004

PubMed ID:

28807254

Uncontrolled Keywords:

Gastrectomy Gastric cancer Laparoscopic gastrectomy Minimally invasive gastrectomy National cancer database Survival

BORIS DOI:

10.7892/boris.109061

URI:

https://boris.unibe.ch/id/eprint/109061

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