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Comparison of Long- and Short-term Outcomes in 845 Open and Minimally Invasive Gastrectomies for Gastric Cancer in the United States

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Few Western studies have evaluated the long-term oncologic outcomes of minimally invasive surgery (MIS) approaches to gastrectomy for gastric cancer. This study aimed to compare the outcomes between minimally invasive and open gastrectomies and between laparoscopic and robotic gastrectomies at a high-volume cancer center in the United States.

Methods

The study analyzed data for all patients undergoing curative gastrectomy for gastric adenocarcinoma from January 2007 to June 2017. Postoperative complications and disease-specific survival (DSS) were compared between surgical approaches.

Results

The median follow-up period for the 845 patients in this study was 38.5 months. The stage-stratified 5-year DSS did not differ significantly between open surgery (n = 534) and MIS (n = 311). The MIS approach resulted in significantly fewer complications, as confirmed by adjusted comparison (odds ratio [OR], 0.70; range, 0.49–1.00; p = 0.049). After adjustment, the two groups did not differ in terms of DSS (hazard ratio [HR], 0.83; range, 0.55–1.25; p = 0.362). The robotic operations (n = 190) had fewer conversions to open procedure (p = 0.010), a shorter operative time (212 vs 240 min; p < 0.001), more dissected nodes (27 vs 22; p < 0.001), fewer Clavien-Dindo grade ≥3 complications (5.8% vs 13.2%; p = 0.023), and a shorter postoperative stay (5 vs 6 days; p = 0.045) than the laparoscopic operations (n = 121). The DSS rate did not differ between the laparoscopic and robotic groups.

Conclusion

The study findings demonstrated the long-term survival and oncologic equivalency of MIS gastrectomy and the open approach in a Western cohort, supporting the use of MIS at centers that have adequate experience with appropriately selected patients.

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Acknowledgment

This research was supported in part by the NIH/NCI Cancer Center support grant P30 CA008748. We acknowledge Jessica Moore, MS, staff editor at MSK, for editing this report.

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Authors and Affiliations

  1. Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Masaya Nakauchi MD, Elvira Vos MD, Daniel G. Coit MD & Vivian E. Strong MD, FACS

  2. Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Yelena Y. Janjigian MD & Geoffrey Y. Ku MD

  3. Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mark A. Schattner MD & Makoto Nishimura MD

  4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mithat Gonen PhD

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  1. Masaya Nakauchi MD
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Corresponding author

Correspondence to Vivian E. Strong MD, FACS.

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Disclosures

Yelena Y. Janjigian has received research funding provided to the institution for other studies from Rgenix, Boehringer Ingelheim, Bayer, Genentech/Roche, Bristol-Myers Squibb, Eli Lilly, and Merck, and has served on advisory boards for Rgenix, Merck Serono, Bristol-Myers Squibb, Eli Lilly, Pfizer, Bayer, Imugene, Merck, Daiichi-Sankyo, and AstraZeneca. Geoffrey Y. Ku has received research funding provided to the institution for other studies from AROG Pharmaceuticals, AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, Merck, Pieris Pharmaceuticals, and Zymeworks, and has received consulting, speaking, or travel fees from Bristol Myers Squibb, Merck, and Pieris. Mark A. Schattner is a consultant for Boston Scientific. Masaya Nakauchi is a consultant for Lumendi, Boston Scientific, and Olympus. The remaining authors have no conflicts of interest.

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Nakauchi, M., Vos, E., Janjigian, Y.Y. et al. Comparison of Long- and Short-term Outcomes in 845 Open and Minimally Invasive Gastrectomies for Gastric Cancer in the United States. Ann Surg Oncol 28, 3532–3544 (2021). https://doi.org/10.1245/s10434-021-09798-y

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  • DOI: https://doi.org/10.1245/s10434-021-09798-y

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