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Long-Term Survival after Minimally Invasive Versus Open Gastrectomy for Gastric Adenocarcinoma: A Propensity Score-Matched Analysis of Patients in the United States and China

Annals of Surgical Oncology volume 27, pages 802–811 (2020)Cite this article

Abstract

Background

This study aimed to compare the long-term survival of patients undergoing minimally invasive gastrectomy and those undergoing open gastrectomy for gastric adenocarcinoma (GA) in the United States and China.

Methods

Data on patients with GA who underwent gastrectomy without neoadjuvant therapy were retrieved from prospectively maintained databases at Memorial Sloan Kettering Cancer Center (MSKCC) and Fujian Medical University Union Hospital (FMUUH). Using propensity score-matching (PSM), equally sized cohorts of patients with similar clinical and pathologic characteristics who underwent minimally invasive versus open gastrectomy were selected. The primary end point of the study was 5-year overall survival (OS).

Results

The study identified 479 patients who underwent gastrectomy at MSKCC between 2000 and 2012 and 2935 patients who underwent gastrectomy at FMUUH between 2006 and 2014. Of the total 3432 patients, 1355 underwent minimally invasive gastrectomy, and 2059 underwent open gastrectomy. All the patients had at least 5 years of potential follow-up evaluation. Before PSM, most patient characteristics differed significantly between the patients undergoing the two types of surgery. After PSM, each cohort included 889 matched patients, and the actual 5-year OS did not differ significantly between the two cohorts, with an OS rate of 54% after minimally invasive gastrectomy and 50.4% after open gastrectomy (p = 0.205). Subgroup analysis confirmed that survival was similar between surgical cohorts among the patients for each stage of GA and for those undergoing distal versus total/proximal gastrectomy. In the multivariable analysis, surgical approach was not an independent prognostic factor.

Conclusions

After PSM of U.S. and Chinese patients with GA undergoing gastrectomy, long-term survival did not differ significantly between the patients undergoing minimally invasive gastrectomy and those undergoing open gastrectomy.

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Acknowledgments

This research was funded in part by a National Institutes of Health/National Cancer Institute Cancer Center Support Grant (P30 CA008748), the National Nature Science Foundation of China (No. 81871899), the Construction Project of Fujian Province Minimally Invasive Medical Centre (No. [2017] 171), and the Natural Science Foundation of Fujian Province (2019J01155). The authors thank Jessica Moore, senior editor at MSKCC, for editing the manuscript.

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Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China

    Jun Lu MD, PhD, Binbin Xu MD, Jianwei Xie MD, PhD, Ping Li MD, PhD, Chaohui Zheng MD, PhD & Changming Huang MD

  2. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jun Lu MD, PhD, Changhwan Yoon PhD & Sam S. Yoon MD

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  1. Jun Lu MD, PhD
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  2. Changhwan Yoon PhD
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  3. Binbin Xu MD
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  4. Jianwei Xie MD, PhD
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  5. Ping Li MD, PhD
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Correspondence to Sam S. Yoon MD.

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Supplementary material 1 (DOCX 18 kb)

Supplementary material 2 (DOCX 15 kb)

Supplementary Figure 1

Flow diagram of study cohort (PDF 108 kb)

Supplementary Figure 2

Comparison of overall survival between patients undergoing minimally invasive or open gastrectomy according to Japanese Gastric Cancer Association stage in the propensity-matched cohort. (A) Early GA and (B) advanced GA. Graphs display the number of patients at risk. Shaded areas represent 95% CI (TIFF 7114 kb)

Supplementary Figure 3

Comparison of overall survival between patients undergoing minimally invasive or open gastrectomy according to resection extent in the propensity-matched cohort. (A) Distal, gastrectomy and (B) total or proximal gastrectomy. Graphs display the number of patients at risk. Shaded areas represent 95% CI (TIFF 7506 kb)

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Lu, J., Yoon, C., Xu, B. et al. Long-Term Survival after Minimally Invasive Versus Open Gastrectomy for Gastric Adenocarcinoma: A Propensity Score-Matched Analysis of Patients in the United States and China. Ann Surg Oncol 27, 802–811 (2020). https://doi.org/10.1245/s10434-019-08170-5

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  • DOI: https://doi.org/10.1245/s10434-019-08170-5