Skip to main content

Advertisement

SpringerLink
Log in

The Impact of Minimally Invasive Gastrectomy on Survival in the USA

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Minimally invasive surgical approaches for gastric adenocarcinoma are increasing in prevalence. Although recent studies suggest such approaches are associated with improvements in short-term outcomes, long-term outcomes have not been well studied. This study aimed to evaluate the impact of minimally invasive gastrectomy on long-term survival.

Methods

The National Cancer Database (NCDB) was used to identify patients who underwent gastrectomy for adenocarcinoma between 2010 and 2015. Patient characteristics were stratified by open and minimally invasive approaches and compared using chi-square and t tests. Unadjusted survival functions were estimated using Kaplan-Meier methodology. Multivariable modeling of risks factors for survival was analyzed with Cox proportional hazard models. Covariate imbalance was controlled using propensity score matching.

Results

The study included 17,449 patients who underwent gastrectomy. Cox proportional hazard modeling demonstrated that minimally invasive surgery improved survival (hazard ratio = 0.86, P < 0.0001). Predictors of worsened survival included community facility type, comorbidities, tumor size, extent of gastrectomy, clinical T and N staging (P < 0.0060 for all). After propensity score matching, minimally invasive surgery had a significantly improved survival at 5 years compared to an open approach, 51.9% versus 47.7% (P < 0.0001). Survival was not significantly different between propensity score-matched patients who received laparoscopic and robotic approaches (P = 0.2611).

Conclusions

Minimally invasive approaches for gastric carcinoma are associated with improved long-term survival. There was no significant difference in survival when comparing laparoscopic to robotic gastrectomy. The mechanisms that drive these improvements deserve further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-E386.

    Article  CAS  Google Scholar 

  2. Neugut AI, Hayek M, Howe G. Epidemiology of gastric cancer. Semin Oncol 1996;23:281–291.

    CAS  PubMed  Google Scholar 

  3. Anderson WF, Camargo MC, Fraumeni JF, Jr., Correa P, Rosenberg PS, Rabkin CS. Age-specific trends in incidence of noncardia gastric cancer in US adults. JAMA 2010;303:1723–1728.

    Article  CAS  Google Scholar 

  4. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7–30.

    Article  Google Scholar 

  5. American Cancer Society. Stomach Cancer Survival Rates. 2018. Available at: https://www.cancer.org/cancer/stomach-cancer/detection-diagnosis-staging/survival-rates.html?_ga=2.16129717.2054514864.1542726330-364917192.1542726330. Accessed October 10, 2018.

  6. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146–148.

    CAS  PubMed  Google Scholar 

  7. Hashizume M, Sugimachi K. Robot-assisted gastric surgery. Surg Clin North Am 2003;83:1429–1444.

    Article  Google Scholar 

  8. Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G. Robotics in general surgery: personal experience in a large community hospital. Arch Surg 2003;138:777–784.

    Article  Google Scholar 

  9. Jiang L, Yang KH, Guan QL, Cao N, Chen Y, Zhao P, Chen YL, Yao L. Laparoscopy-assisted gastrectomy versus open gastrectomy for resectable gastric cancer: an update meta-analysis based on randomized controlled trials. Surg Endosc 2013;27:2466–2480.

    Article  Google Scholar 

  10. Goh PM, Alponat A, Mak K, Kum CK. Early international results of laparoscopic gastrectomies. Surg Endosc 1997;11:650–652.

    Article  CAS  Google Scholar 

  11. Wei Y, Yu D, Li Y, Fan C, Li G. Laparoscopic versus open gastrectomy for advanced gastric cancer: a meta-analysis based on high-quality retrospective studies and clinical randomized trials. Clin Res Hepatol Gastroenterol 2018 Aug 23.

  12. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 2008;248:721–727.

    Article  Google Scholar 

  13. Greenleaf EK, Sun SX, Hollenbeak CS, Wong J. Minimally invasive surgery for gastric cancer: the American experience. Gastric Cancer 2017;20:368–378.

    Article  Google Scholar 

  14. Marano A, Choi YY, Hyung WJ, Kim YM, Kim J, Noh SH. Robotic versus laparoscopic versus open gastrectomy: a meta-analysis. J Gastric Cancer 2013;13:136–148.

    Article  Google Scholar 

  15. Son T, Hyung WJ. Robotic gastrectomy for gastric cancer. J Surg Oncol 2015;112:271–278.

    Article  Google Scholar 

  16. Obama K, Kim YM, Kang DR, Son T, Kim HI, Noh SH1, Hyung WJ. Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer 2018;21:285–295.

  17. Shahian DM, Nordberg P, Meyer GS, Blanchfield BB, Mort EA, Torchiana DF, Normand SL. Contemporary performance of U.S. teaching and nonteaching hospitals. Acad Med 2012;87:701–708.

    Article  Google Scholar 

  18. Burke L, Khullar D, Orav EJ, Zheng J, Frakt A, Jha AK. Do academic medical centers disproportionately benefit the sickest patients? Health Aff (Millwood) 2018;37:864–872.

    Article  Google Scholar 

  19. Etoh T, Inomata M, Shiraishi N, Kitano S. Minimally invasive approaches for gastric cancer-Japanese experiences. J Surg Oncol 2013;107:282–288.

    Article  Google Scholar 

  20. Lianos GD, Hasemaki N, Glantzounis GK, Mitsis M, Rausei S. Assessing safety and feasibility of “pure” laparoscopic total gastrectomy for advanced gastric cancer in the West. Review article. Int J Surg 2018;53:275–278.

    Article  Google Scholar 

  21. Greenleaf EK, Hollenbeak CS, Wong J. Trends in the use and impact of neoadjuvant chemotherapy on perioperative outcomes for resected gastric cancer: Evidence from the American College of Surgeons National Cancer Database. Surgery. 2016;159(4):1099–1112.

    Article  Google Scholar 

  22. Oehrlein EM, Graff JS, Perfetto EM, Mullins CD, Dubois RW, Anyanwu C, Onukwugha E. Peer-reviewed journal editors’ views on real-world evidence. Int J Technol Assess Health Care 2018;34:111–119.

    Article  Google Scholar 

  23. Zou ZH, Zhao LY, Mou TY, Hu YF, Yu J, Liu H, Chen H, Wu JM, An SL, Li GX. Laparoscopic vs open D2 gastrectomy for locally advanced gastric cancer: a meta-analysis. World J Gastroenterol 2014;20:16750–16764.

    Article  Google Scholar 

  24. Cassidy MR, Gholami S, Strong VE. Minimally invasive surgery: the emerging role in gastric cancer. Surg Oncol Clin N Am 2017;26:193–212.

    Article  Google Scholar 

  25. Shu ZB, Cao HP, Li YC, Sun LB. Influences of laparoscopic-assisted gastrectomy and open gastrectomy on serum interleukin-6 levels in patients with gastric cancer among Asian populations: a systematic review. BMC Gastroenterol. 2015;15:52.

    Article  Google Scholar 

  26. Okholm C, Goetze JP, Svendsen LB, Achiam MP. Inflammatory response in laparoscopic vs. open surgery for gastric cancer. Scand J Gastroenterol. 2014;49(9):1027–1034.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, 17033-0850, USA

    Brandon S. Hendriksen, Ashton J. Brooks, Christopher S. Hollenbeak, Matthew D. Taylor, Michael F. Reed & David I. Soybel

  2. Department of Health Policy and Administration, The Pennsylvania State University, University Park, State College, PA, USA

    Christopher S. Hollenbeak

  3. Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    Christopher S. Hollenbeak

Authors
  1. Brandon S. Hendriksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashton J. Brooks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christopher S. Hollenbeak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew D. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael F. Reed
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David I. Soybel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design: Hendriksen, Hollenbeak, Reed, Soybel

Acquisition and analysis of data: Hendriksen, Brooks, Hollenbeak, Taylor, Reed, Soybel

Interpretation of data: Hendriksen, Brooks, Hollenbeak, Taylor, Reed, Soybel

Drafting of the manuscript: Hendriksen, Brooks, Hollenbeak, Soybel

Critical revision of the manuscript for important intellectual content: All authors

Study supervision: Hendriksen, Hollenbeak, Soybel

Corresponding author

Correspondence to David I. Soybel.

Ethics declarations

NCDB Disclaimer

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This was an oral presentation at the American College of Surgeons Clinical Congress, Boston, MA, October 21–25, 2018.

Electronic Supplementary Material

ESM 1

(DOCX 17 kb)

ESM 2

(DOCX 14 kb)

ESM 3

(DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hendriksen, B.S., Brooks, A.J., Hollenbeak, C.S. et al. The Impact of Minimally Invasive Gastrectomy on Survival in the USA. J Gastrointest Surg 24, 1000–1009 (2020). https://doi.org/10.1007/s11605-019-04263-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-019-04263-4

Keywords

Search

Navigation