A Multi-institutional Analysis of Open Versus Minimally-Invasive Surgery for Gastric Adenocarcinoma: Results of the US Gastric Cancer Collaborative

Gaya Spolverato, Yuhree Kim, Aslam Ejaz, Vicente Valero, Malcolm H. Squires, George Poultsides, Ryan C. Fields, Mark Bloomston, Sharon M. Weber, Alexandra W. Acher, Konstantinos Votanopoulos, Carl Schmidt, Clifford S. Cho, Shishir K. Maithel, Timothy M. Pawlik

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: Surgical experience with minimally invasive surgery (MIS) has increased; however, published reports on MIS resection of gastric adenocarcinoma are limited. Methods: Between 2000 and 2012, 880 patients who underwent surgical resection of gastric adenocarcinoma were identified from a multi-institutional database. Clinicopathological characteristics, operative details, and outcomes were stratified by operative approach (open vs. MIS) and analyzed. Results: Overall, 70 (8 %) patients had a MIS approach. Patients who underwent a MIS resection were more likely to have a smaller tumor (open 4.5 cm vs. MIS 3.0 cm, p <0.001). MIS resections were associated with lower estimated blood loss (open 250 cc vs. MIS 150 cc) and longer operative time (open 232 min vs. MIS 271 min) compared with open surgery (both p <0.05). An R0 resection was achieved in most patients (open 90.9 % vs. MIS 98.6 %, p = 0.03) and median lymph node yield was good in both groups (open 17 vs. MIS 14, p = 0.10). MIS had a similar incidence of complications (open 33.1 % vs. MIS 20 %, p = 0.07) and a similar length of stay (open 9 days vs. MIS 7 days, p = 0.13) compared with open surgery. In the propensity-matched analysis, median recurrence-free and overall were not impacted by operative approach. Conclusion: An MIS approach to gastric cancer was associated with adequate lymph node retrieval, a high incidence of R0 resection, and comparable long-term oncological outcomes versus open gastrectomy.

Original languageEnglish (US)
Pages (from-to)1563-1574
Number of pages12
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number9
DOIs
StatePublished - Sep 1 2014

Keywords

  • Gastric cancer
  • Gastric cancer outcomes
  • Laparoscopic gastrectomy
  • Open gastrectomy
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology
  • General Medicine

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