Western population-based study of oncologic surgical quality and outcomes of laparoscopic versus open gastrectomy for ga
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and Other Interventional Techniques
2020 SAGES ORAL
Western population‑based study of oncologic surgical quality and outcomes of laparoscopic versus open gastrectomy for gastric adenocarcinoma Omid Salehi1 · Eduardo A. Vega1 · Onur C. Kutlu2 · Daria James1 · Sylvia V. Alarcon3 · Beth Herrick4 · Olga Kozyreva3 · Claudius Conrad1,5 Received: 21 April 2020 / Accepted: 27 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
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 shortterm 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. Keywords Laparoscopic gastrectomy · Open gastrectomy · Gastric adenocarcinoma · Oncologic outcomes · NCDB Today, the short-term benefits of laparoscopic gastrectomy (LG) are well established [1]. These short-term benefits Oral presentation: 2020 The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting, Cleveland, OH. * Claudius Conrad [email protected] 1
Department of Surgery, St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston, MA, USA
2
Department of Surgery, University of Miami Health System, Miller School of Medicine, Miami, FL, USA
3
Department of Medical Oncology, Dana‑Farber Cancer Institute at St. Elizabeth’s Medical Center, Harvard Medical School, Boston, MA, USA
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