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A Multi-institutional Analysis of Open Versus Minimally-Invasive Surgery for Gastric Adenocarcinoma: Results of the US Gastric Cancer Collaborative

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Surgical experience with minimally invasive surgery (MIS) has increased; however, published reports on MIS resection of gastric adenocarcinoma are limited.

Methods

Between 2000 and 2012, 880 patients who underwent surgical resection of gastric adenocarcinoma were identified from a multi-institutional database. Clinicopathological characteristics, operative details, and outcomes were stratified by operative approach (open vs. MIS) and analyzed.

Results

Overall, 70 (8 %) patients had a MIS approach. Patients who underwent a MIS resection were more likely to have a smaller tumor (open 4.5 cm vs. MIS 3.0 cm, p < 0.001). MIS resections were associated with lower estimated blood loss (open 250 cc vs. MIS 150 cc) and longer operative time (open 232 min vs. MIS 271 min) compared with open surgery (both p < 0.05). An R0 resection was achieved in most patients (open 90.9 % vs. MIS 98.6 %, p = 0.03) and median lymph node yield was good in both groups (open 17 vs. MIS 14, p = 0.10). MIS had a similar incidence of complications (open 33.1 % vs. MIS 20 %, p = 0.07) and a similar length of stay (open 9 days vs. MIS 7 days, p = 0.13) compared with open surgery. In the propensity-matched analysis, median recurrence-free and overall were not impacted by operative approach.

Conclusion

An MIS approach to gastric cancer was associated with adequate lymph node retrieval, a high incidence of R0 resection, and comparable long-term oncological outcomes versus open gastrectomy.

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Authors and Affiliations

  1. Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

    Gaya Spolverato, Yuhree Kim, Aslam Ejaz, Vicente Valero III & Timothy M. Pawlik

  2. Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Malcolm H. Squires & Shishir K. Maithel

  3. Department of Surgery, Stanford University, Palo Alto, CA, USA

    George Poultsides

  4. Department of Surgery, Washington University, St. Louis, MO, USA

    Ryan C. Fields

  5. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Mark Bloomston & Carl Schmidt

  6. Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI, USA

    Sharon M. Weber, Alexandra W. Acher & Clifford S. Cho

  7. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Konstantinos Votanopoulos

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  1. Gaya Spolverato
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  2. Yuhree Kim
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Spolverato, G., Kim, Y., Ejaz, A. et al. A Multi-institutional Analysis of Open Versus Minimally-Invasive Surgery for Gastric Adenocarcinoma: Results of the US Gastric Cancer Collaborative. J Gastrointest Surg 18, 1563–1574 (2014). https://doi.org/10.1007/s11605-014-2562-9

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  • DOI: https://doi.org/10.1007/s11605-014-2562-9

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