Utilization of Minimally Invasive Surgery and Its Association with Chemotherapy for Locally Advanced Gastric Cancer
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Minimally invasive surgery (MIS) is increasingly used to treat gastric cancer in the USA. A potential benefit of MIS is increased likelihood of receiving adjuvant chemotherapy. Our objectives were (1) to assess trends and predictors of MIS for gastric cancer, (2) to evaluate the association between MIS and postoperative chemotherapy, and (3) to investigate the relationship between MIS and survival.
Patients with T3 or greater and/or N+ gastric adenocarcinoma were identified from the National Cancer Database from 2010 to 2015. Patients aged ≥ 85, with metastatic disease, treated with only preoperative chemotherapy, or with contraindications to chemotherapy were excluded. Hierarchical logistic regression and Cox proportional hazards were used to assess associations between MIS and postoperative chemotherapy and survival.
Of 21,872 gastric resections, 6083 (27.8%) were MIS and 15,789 (72.2%) open. The majority were partial/subtotal (68.3%). Utilization of MIS increased from 18 to 37% from 2010 to 2015 (p < 0.01). Predictors of MIS were Asian race, any insurance coverage, and treatment at high-volume centers. Among 7540 patients with locally advanced disease, MIS was associated with receiving postoperative chemotherapy compared to open surgery (77.7% vs. 71.9%; OR 1.31, 95% CI 1.11–1.54). MIS was associated with improved survival before adjusting for postoperative chemotherapy (HR 0.83; 95% CI 0.72–0.97) but not after (HR 0.87, 95% CI 0.75–1.01).
Utilization of MIS for locally advanced gastric cancer approximately doubled during the study period. Compared to open surgery patients, MIS patients were more likely to receive postoperative chemotherapy. The increased utilization of postoperative chemotherapy may explain the associated survival advantage observed with MIS.
KeywordsGastric cancer Minimally invasive surgery Chemotherapy
Compliance with ethical standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
- 1.Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. 2018; https://gco.iarc.fr/today. Accessed 5/14/2019, 2019.
- 2.Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA: a cancer journal for clinicians. 2019;69(1):7-34.Google Scholar
- 7.Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2012;30(19):2327-2333.CrossRefGoogle Scholar
- 19.Commission on Cancer. CoC Quality of Care Measures. 2018; https://www.facs.org/quality-programs/cancer/ncdb/qualitymeasures. Accessed 5/14/2019, 2019.
- 20.Kim HH, Han SU, Kim MC, et al. Effect of Laparoscopic Distal Gastrectomy vs Open Distal Gastrectomy on Long-term Survival Among Patients With Stage I Gastric Cancer: The KLASS-01 Randomized Clinical Trial. JAMA oncology. 2019.Google Scholar
- 21.Lee HJ, Hyung WJ, Yang HK, et al. Short-term Outcomes of a Multicenter Randomized Controlled Trial Comparing Laparoscopic Distal Gastrectomy With D2 Lymphadenectomy to Open Distal Gastrectomy for Locally Advanced Gastric Cancer (KLASS-02-RCT). Annals of surgery. 2019.Google Scholar
- 22.Hu Y, Huang C, Sun Y, et al. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2016;34(12):1350-1357.CrossRefGoogle Scholar
- 24.Jin LX, Sanford DE, Squires MH, 3rd, et al. Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative. Annals of surgical oncology. 2016;23(8):2398-2408.CrossRefGoogle Scholar
- 26.Skancke M, Schoolfield C, Umapathi B, Amdur R, Brody F, Obias V. Minimally Invasive Surgery for Rectal Adenocarcinoma Shows Promising Outcomes Compared to Laparotomy, a National Cancer Database Observational Analysis. Journal of laparoendoscopic & advanced surgical techniques. Part A 2019;29(2):218-224.CrossRefGoogle Scholar
- 27.Eto K, Hiki N, Kumagai K, et al. Prophylactic effect of neoadjuvant chemotherapy in gastric cancer patients with postoperative complications. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2018;21(4):703-709.CrossRefGoogle Scholar