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Effect of Surgical Approach on Node Harvest in Gastrectomy: Analysis of the National Cancer Database

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Abstract

Background

Gastrectomy is the cornerstone of treatment for gastric cancer. Recent studies demonstrated significant surgical outcome advantages for patients undergoing minimally invasive versus open gastrectomy. Lymph node harvest is an indicator of adequate surgical resection, and greater harvest is associated with improved staging and patient outcomes. This study evaluated lymph node harvest based on surgical approach.

Methods

Gastric adenocarcinoma patients were identified from NCDB who underwent gastrectomy between 2010 and 2016. Patients were classified by surgical approach into three cohorts: robotic, laparoscopic, or open gastrectomy. Clinical and demographic data were collected. Lymph node harvest was compared with univariate analysis and multivariable generalized linear mixed model. Univariate analysis with propensity matching was also performed to control for differences in patient population across cohorts.

Results

We identified 10,690 patients that underwent gastrectomy for gastric adenocarcinoma, with 68% males and median age of 66 (IQR 5774) years. 7161 (67%) underwent open, 2841 (26.6%) laparoscopic, and 688 (6.4%) robotic gastrectomy. Multivariable analysis revealed robotic was associated with a significantly higher median node harvest (18, IQR 1326) compared to laparoscopic (17, IQR 1125) and open gastrectomy (16, IQR 1023). Laparoscopic was also associated with significantly higher node harvest then open gastrectomy. Propensity-matched analysis (6950 patients) showed robotic gastrectomy was still associated with significantly higher node harvest (18, IQR 1226) compared to laparoscopic (17, IQR 1125) and open (17, IQR 1124); however, laparoscopic and open were not significantly different.

Conclusion

Robotic approach is associated with increased node harvest compared to laparoscopic and open approach in gastrectomy patients.

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Acknowledgements

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA

    Michael D. Watson, Joshua S. Hill & Jonathan C. Salo

  2. Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA

    Sally Trufan

  3. LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA

    Jennifer H. Benbow & Nicole L. Gower

Authors
  1. Michael D. Watson
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  2. Sally Trufan
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  3. Jennifer H. Benbow
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  4. Nicole L. Gower
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  5. Joshua S. Hill
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  6. Jonathan C. Salo
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Correspondence to Jonathan C. Salo.

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Watson, M.D., Trufan, S., Benbow, J.H. et al. Effect of Surgical Approach on Node Harvest in Gastrectomy: Analysis of the National Cancer Database. World J Surg 44, 3061–3069 (2020). https://doi.org/10.1007/s00268-020-05590-3

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