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

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

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.

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Authors and Affiliations

  1. Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, 633 N St Clair Street, 20th Floor, Chicago, IL, 60611, USA

    Rhami Khorfan, Cary Jo R. Schlick, Anthony D. Yang, David D. Odell, David J. Bentrem & Ryan P. Merkow

  2. Surgery Service, Jesse Brown VA Medical Center, Chicago, IL, USA

    David J. Bentrem

  3. Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER Onc), Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Ryan P. Merkow

Authors
  1. Rhami Khorfan
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  2. Cary Jo R. Schlick
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  3. Anthony D. Yang
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  5. David J. Bentrem
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  6. Ryan P. Merkow
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Correspondence to Ryan P. Merkow.

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Presentation: This paper was presented as a plenary presentation at the 60th Annual Meeting of The Society for Surgery of the Alimentary Tract in San Diego, CA on May 20, 2019.

Appendix

Appendix

Table 6 Cox proportional hazard models predicting survival after surgery for locally advanced gastric cancer
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Khorfan, R., Schlick, C.J.R., Yang, A.D. et al. Utilization of Minimally Invasive Surgery and Its Association with Chemotherapy for Locally Advanced Gastric Cancer. J Gastrointest Surg 24, 243–252 (2020). https://doi.org/10.1007/s11605-019-04410-x

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  • DOI: https://doi.org/10.1007/s11605-019-04410-x

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