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01.09.2014 | Original Article

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

verfasst von: Gaya Spolverato, Yuhree Kim, Aslam Ejaz, Vicente Valero III, 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

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 9/2014

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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.

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Titel: A Multi-institutional Analysis of Open Versus Minimally-Invasive Surgery for Gastric Adenocarcinoma: Results of the US Gastric Cancer Collaborative
verfasst von: Gaya Spolverato
Yuhree Kim
Aslam Ejaz
Vicente Valero III
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
Publikationsdatum: 01.09.2014
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 9/2014
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2562-9

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