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Objective:To compare the outcomes of minimally invasive (MIS) versus open gastric resections for adenocarcinoma.
Design: Retrospective cohort study.
Setting:National Cancer Database queried 2010-2013.
Patients:Adults, with gastric adenocarcinoma. Patients with unknown surgical approach, resection margin, number of lymph nodes examined, or tumor size were excluded.
Interventions:MIS versus open surgery based on Intention to treat. Propensity score matching used to adjust for selection bias.
Main Outcome Measures:Overall survival, resection margins, and number of lymph nodes harvested.
Results: of 17,299 patients identified, 4094 (23.7%) underwent MIS, of which 572 (14%) were robotic. Before matching, and compared to those with open procedures, patients who underwent MIS were more likely to be male (67.6% vs 64.4%), treated at an academic center (57.4% vs 43.1%), have a tumor size<40mm (48.2 vs 41.3%) be at clinical stage I or II (28.1% and 24.6% vs 23.0% and 22.2%, respectively), receive neoadjuvant chemotherapy (27.7% vs 23.2%), neoadjuvant radiotherapy (20.7 vs 15.0%), have private insurance (36.5% vs 34.2%), and be younger (age≥73; 32.2% vs 34.5%) (all p-values<0.05). After matching all baseline differences disappeared. After matching, patients who underwent MIS vs open were more likely to have negative margins (89.3% vs 87.0%; p-value=0.0012). They were also more likely to have >15 lymph nodes examined (51.3% vs 48.0%; p-value=0.0023) as well as a better median overall survival (49.4 vs 44.1 months; log-rank p-value=0.0075). There were no differences in 30- and 90-day mortality rates (3.3% vs 3.9% and 6.9% vs 7.8% with P-values of 0.20 and 0.47; respectively).
Conclusions:MIS is safe and effective for surgical management of gastric adenocarcinoma.