Locally advanced gastric cancer: minimally invasive surgery linked to better outcome

  • Khorfan R & al.
  • J Gastrointest Surg
  • 20 Nov 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Minimally invasive surgery (MIS) is associated with better survival in gastric cancer, possibly due to more frequent adjuvant chemotherapy.

Why this matters

  • Although chemotherapy has been shown to extend survival in gastric cancer, postsurgical utilization has remained low.
  • MIS has fewer postoperative complications, which may increase use of adjuvant chemotherapy.

Study design

  • Retrospective analysis of surgical data from the National Cancer Database (2010-2015; n=21,872).
  • Funding: NIH; American Cancer Society.

Key results

  • 28.0% of patients underwent MIS, and the proportion increased from 18.0% in 2010 to 36.9% in 2015 (P<.01>
  • Factors associated with MIS were high-volume hospitals (34.2% vs 19.9%; OR, 1.63; 95% CI, 1.17-2.27) and Charlson comorbidity score >2 (OR, 1.36; 95% CI, 1.01-1.82).
  • MIS was associated with better survival than open surgery (HR, 0.83; P=.01).
  • Postoperative chemotherapy was also associated with better survival (HR, 0.54; P<.01 but mis was not associated with survival after correcting for postoperative chemotherapy p=".08).</li">

Limitations

  • Retrospective analysis.
  • Study examined initiation of chemotherapy but not completion.