Minimally invasive gastrectomy for gastric adenocarcinoma in the United States: Utilization and short-term oncologic outcomes

作者：Ecker Brett L; Datta Jashodeep; McMillan Matthew T; Poe Sarah Lucy C; Drebin Jeffrey A; Fraker Douglas L; Dempsey Daniel T; Karakousis Giorgos C; Roses Robert E^*

来源：Journal of Surgical Oncology, 2015, 112(6): 616-621.

DOI：10.1002/jso.24052

• gastrectomy
• gastric cancer
• gastric adenocarcinoma
• minimally invasive surgery
• laparoscopy
• laparoscopic gastrectomy

Background and ObjectivesWhen performed at select centers, minimally invasive gastrectomy (MIG) for gastric adenocarcinoma is associated with reduced perioperative morbidity, and similar oncologic outcomes as compared to open gastrectomy (OG). Utilization of, and outcomes associated with, MIG in the United States have not been characterized.
MethodsThe National Cancer Database (2010-2011) was queried for AJCC pStage IB-IIIC patients who underwent curative-intent OG (n=2,303) or MIG (n=331). Multivariable models identified factors associated with MIG utilization, R0 resection rates, and adequate lymph node staging (LNS).
ResultsMIG was more frequently utilized for T1/T2 (P<0.001), N0 (P=0.022), and stage IB (P=0.001) tumors. MIG was associated with shorter hospital stay (P<0.001), equivalent lymph node examination (P=0.337) and superior rates of R0 resection (P=0.011) compared with OG. In patients undergoing MIG, R0 resection was associated with performance of near-total/total gastrectomy (OR 3.90, 95%CI 1.10-13.9) and tumors <5cm (OR 2.78, 95%CI 1.07-7.26). Adequate LNS was associated with surgery at academic (OR 1.99, 95%CI 1.19-3.32) or high-volume facilities (OR 2.97, 95%CI 1.59-5.54), tumor size 5cm (OR 1.85, 95%CI 1.10-3.11), and node positivity (OR 1.75, 95%CI 1.04-2.93).
ConclusionsMIG is selectively utilized in cases with favorable tumor characteristics. In such cases, short-term oncologic outcomes are equivalent to those achieved with OG. Worse oncologic outcomes in specific subgroups underscore opportunities for quality improvement. J. Surg. Oncol. 2015;112:616-621.

• 出版日期2015-11-1