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Utilization of Minimally Invasive Surgery and Its Association with Chemotherapy for Locally Advanced Gastric Cancer

  • Rhami Khorfan
  • Cary Jo R. Schlick
  • Anthony D. Yang
  • David D. Odell
  • David J. Bentrem
  • Ryan P. MerkowEmail author
2019 SSAT Plenary Presentation
  • 28 Downloads

Abstract

Background

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.

Methods

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.

Results

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).

Discussion

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.

Keywords

Gastric cancer Minimally invasive surgery Chemotherapy 

Notes

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

References

  1. 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. 2.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA: a cancer journal for clinicians. 2019;69(1):7-34.Google Scholar
  3. 3.
    Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Annals of Surgery. 2010;251(4):640-646.CrossRefGoogle Scholar
  4. 4.
    Choi AH, Kim J, Chao J. Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond. World journal of gastroenterology. 2015;21(24):7343-7348.CrossRefGoogle Scholar
  5. 5.
    Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. The New England journal of medicine. 2006;355(1):11-20.CrossRefGoogle Scholar
  6. 6.
    Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. The New England journal of medicine. 2001;345(10):725-730.CrossRefGoogle Scholar
  7. 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
  8. 8.
    Raigani S, Hardacre JM, Kim J, Ammori JB. Trends in the surgical treatment of gastric adenocarcinoma. Annals of surgical oncology. 2014;21(2):569-574.CrossRefGoogle Scholar
  9. 9.
    Sherman KL, Merkow RP, Bilimoria KY, et al. Treatment trends and predictors of adjuvant and neoadjuvant therapy for gastric adenocarcinoma in the United States. Annals of surgical oncology. 2013;20(2):362-370.CrossRefGoogle Scholar
  10. 10.
    Snyder RA, Penson DF, Ni S, Koyama T, Merchant NB. Trends in the use of evidence-based therapy for resectable gastric cancer. Journal of surgical oncology 2014;110(3):285-290.CrossRefGoogle Scholar
  11. 11.
    Cassidy MR, Gholami S, Strong VE. Minimally Invasive Surgery: The Emerging Role in Gastric Cancer. Surgical Oncology Clinics of North America. 2017;26(2):193-212.CrossRefGoogle Scholar
  12. 12.
    Costantino CL, Mullen JT. Minimally Invasive Gastric Cancer Surgery. Surgical oncology clinics of North America. 2019;28(2):201-213.CrossRefGoogle Scholar
  13. 13.
    Russo A, Strong VE. Minimally invasive surgery for gastric cancer in USA: current status and future perspectives. Translational gastroenterology and hepatology. 2017;2:38.CrossRefGoogle Scholar
  14. 14.
    Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Annals of surgery. 2012;255(3):446-456.CrossRefGoogle Scholar
  15. 15.
    Information Committee of Korean Gastric Cancer Association. Korean Gastric Cancer Association Nationwide Survey on Gastric Cancer in 2014. Journal of Gastric Cancer. 2016;16(3):131-140.CrossRefGoogle Scholar
  16. 16.
    Merkow RP, Bentrem DJ, Mulcahy MF, et al. Effect of postoperative complications on adjuvant chemotherapy use for stage III colon cancer. Annals of surgery. 2013;258(6):847-853.CrossRefGoogle Scholar
  17. 17.
    Merkow RP, Bilimoria KY, Tomlinson JS, et al. Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Annals of Surgery. 2014;260(2):372-377.CrossRefGoogle Scholar
  18. 18.
    Kelly KJ, Selby L, Chou JF, et al. Laparoscopic Versus Open Gastrectomy for Gastric Adenocarcinoma in the West: A Case-Control Study. Annals of Surgical Oncology. 2015;22(11):3590-3596.CrossRefGoogle Scholar
  19. 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. 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. 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. 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
  23. 23.
    Yu J, Huang C, Sun Y, et al. Effect of Laparoscopic vs Open Distal Gastrectomy on 3-Year Disease-Free Survival in Patients With Locally Advanced Gastric Cancer: The CLASS-01 Randomized Clinical Trial. Jama. 2019;321(20):1983-1992.CrossRefGoogle Scholar
  24. 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
  25. 25.
    Bilimoria KY, Bentrem DJ, Nelson H, et al. Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States. Archives of surgery 2008;143(9):832-839; discussion 839-840.CrossRefGoogle Scholar
  26. 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. 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
  28. 28.
    Vicente D, Ikoma N, Chiang YJ, et al. Preoperative Therapy for Gastric Adenocarcinoma is Protective for Poor Oncologic Outcomes in Patients with Complications After Gastrectomy. Annals of surgical oncology. 2018;25(9):2720-2730.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Surgery ServiceJesse Brown VA Medical CenterChicagoUSA
  3. 3.Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

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