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Western population-based study of oncologic surgical quality and outcomes of laparoscopic versus open gastrectomy for gastric adenocarcinoma

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

While studies have reported improved morbidity of laparoscopic (LG) compared with open gastrectomy (OG), it remains unclear whether comparable oncologic outcomes can be achieved. This study aims at comparing not only short-term outcomes, including 30- and 90-day mortality, but also survival of LG vs OG.

Methods

The National Cancer Database was searched for adult patients with histologically proven gastric cancer and complete information regarding M0 disease, tumor size, differentiation grade, T stage, nodal status, comorbidities, type of hospital, hospital stay, type of surgery, oncological treatment and survival data were included. Logistic regression analyses were performed to analyze margin status, 30- and 90-day mortality, and 30-day re-admission rate. Linear regression was performed for length of hospital stay and lymph node yield. Kaplan–Meier survival analyses were performed to evaluate median survival. Cox multivariable regression models were created to correct for confounders and identify factors affecting survival.

Results

A query of the National Cancer Database identified 13,538 patients with complete dataset. A significant regression equation favoring LG for lymph node yield, hospital stay, and unplanned re-admission rate was identified. There was no significant effect of surgical approach on R1 margin rate, 30-day mortality, or 90-day mortality. Median survival was comparable between LG and OG (44.8 vs 40.2 months, p = 0.804).

Conclusion

LG offers a safe surgical approach to gastric cancer with shorter hospital stay and lower re-admission rates than OG, and also similar and sometimes improved operative oncologic quality parameters (margin, lymph node yield). More importantly, this Western series demonstrates that equivalent long-term outcomes of LG vs. OG are being achieved.

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Acknowledgements

We would like to thank Laurie MacDougall, MS, CTR for her valuable editorial support.

Funding

This research did not receive any specific funding from agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Omid Salehi, Eduardo A. Vega, Daria James & Claudius Conrad

  2. Department of Surgery, University of Miami Health System, Miller School of Medicine, Miami, FL, USA

    Onur C. Kutlu

  3. Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth’s Medical Center, Harvard Medical School, Boston, MA, USA

    Sylvia V. Alarcon & Olga Kozyreva

  4. Department of Radiation Oncology, St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Beth Herrick

  5. General Surgery and Surgical Oncology, Hepato-Pancreato-Biliary Surgery, St. Elizabeth’s Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA

    Claudius Conrad

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  1. Omid Salehi
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  2. Eduardo A. Vega
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  8. Claudius Conrad
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Correspondence to Claudius Conrad.

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Disclosures

Drs. Salehi, Vega, Kutlu, De La Cruz Munoz, Herrick, Kozyreva, Alarcon Velasco, Conrad and Daria James CTR have no conflicts of interest or financial ties to disclose.

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Salehi, O., Vega, E.A., Kutlu, O.C. et al. Western population-based study of oncologic surgical quality and outcomes of laparoscopic versus open gastrectomy for gastric adenocarcinoma. Surg Endosc 35, 4786–4793 (2021). https://doi.org/10.1007/s00464-020-07959-w

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  • DOI: https://doi.org/10.1007/s00464-020-07959-w

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