Introduction of minimally invasive surgery for distal and total gastrectomy: a population-based study |
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| Institution: | 1. Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;2. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;1. University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands;2. Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Medical Oncology, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands;3. Netherlands Cancer Institute, Antoni van Leeuwenhoek, Department of Surgical Oncology, Plesmanlaan 121, 1066, CX, Amsterdam, the Netherlands;4. Leiden University Medical Center, Department of Medical Oncology, P.O. Box 9600, 2300, RC, Leiden, the Netherlands;5. Erasmus MC – Cancer Institute, Department of Surgical Oncology, s Gravendijkwal 230, 3015, CE, Rotterdam, the Netherlands;6. Radboud University Medical Center, Department of Medical Oncology, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands;7. Radboud University Medical Center, Department of Surgical Oncology, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands;8. University of Groningen, University Medical Center Groningen, Department of Surgical Oncology, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands;1. Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK;2. Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Hills Road, Cambridge, UK;3. Department of Oesophago-Gastric Surgery, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK;4. Department of Oesophago-Gastric Surgery, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK;1. Peritoneal Surface Malignancies Unit, Istituto Nazionale dei Tumori, Milan, Italy;2. Department of Surgery A, Tel- Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel;3. Department of Surgical Oncology, Centre Hospitalier Lyon Sud, Pierre-Benite, France;4. Charles Nicolle University Hospital, Rouen, France;5. L''Archet II, University Hospital, Nice, France;6. Gustave Roussy Institute, Villejuif, France;1. Department of Surgery, City of Hope National Medical Center, Duarte, CA;2. Department of Surgery, Kaiser Permanente, Los Angeles, CA;3. Department of Surgery, Severence Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea |
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| Abstract: | BackgroundMinimally invasive gastrectomy has been introduced in Western populations during the last decade. As minimally invasive distal gastrectomy (MIDG) versus total gastrectomy (MITG) are procedures with a different complexity, outcomes may differ. The aim of this population-based cohort study was to evaluate the safety of MIDG and MITG.Materials and methodsAll patients who underwent potentially curative gastrectomy for gastric adenocarcinoma were included from the Dutch Upper GI Cancer Audit (2011–2016). Propensity score matching was applied to create comparable groups of patients receiving open distal gastrectomy (ODG) versus MIDG and open total gastrectomy (OTG) versus MITG, using patient and tumor characteristics. Postoperative outcomes and short-term oncological outcomes were appraised.ResultsOf the 1970 eligible patients, 1138 underwent distal gastrectomy and 832 underwent total gastrectomy. For distal gastrectomy, 390 ODG were matched to 288 MIDG patients. Although overall postoperative morbidity and mortality were similar, patients who underwent MIDG encountered less intra-abdominal abscesses (4% vs. 1%, p = 0.039) and wound complications (6% vs. 2%, p = 0.021). The median hospital stay was shorter after MIDGs (9 vs. 7 days, p < 0.001). For total gastrectomy, 323 OTG patients were matched to 258 MITG patients. Overall postoperative morbidity, mortality and hospital stay were similar, whereas the anastomotic leakage rate was higher after MITGs (11% vs. 17%, p = 0.030). Short-term oncological outcomes between both groups were equal for distal and total gastrectomy.ConclusionBenefits of MIG during the early introduction were demonstrated for distal gastrectomy but not for total gastrectomy. An increased anastomotic leakage rate was encountered for MITG. |
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| Keywords: | Gastric cancer Gastrectomy Morbidity Population-based |
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