Survival Outcomes Between Minimally Invasive and Open Gastrectomy in Early and Locally Advanced Gastric Adenocarcinoma in a Western Center.

Abstract

Purpose: While minimally invasive gastrectomy (MIS) is well-utilized in Asia, its adoption in the West to treat gastric adenocarcinoma has been slower. We compare survival outcomes between open gastrectomy and MIS in a high-volume Western US center.

Methods: In this retrospective review, demographic and clinical characteristics of gastric adenocarcinoma patients who underwent curative-intent MIS (robotic or laparoscopic approaches) or open surgery were compared via descriptive statistics. Multivariable Cox hazard regression models were constructed to assess the effects of gastrectomy type on overall survival (OS) and recurrence-free survival (RFS) in the overall cohort and a locally advanced subgroup (pathologic stage 2-3 patients).

Results: A total of 135 gastric adenocarcinoma patients were studied; 67% underwent MIS. Open patients experienced lower lymph node retrieval (p = 0.004) and neoadjuvant chemotherapy administration (p = 0.037) than MIS. OS (p = 0.18) and RFS (p = 0.74) were not different between MIS and open over a 5-year period. In multivariable survival models, gastrectomy type was not associated with OS (open hazard ratio (HR) = 1.78, p = 0.8 (compared to MIS)) or RFS (HR = 1.46, p = 0.7), while positive nodes (HR = 21.7, p = 0.003) and pathologic stage 3 (HR = 1.6, p = 0.025) were associated with poorer OS. Within the locally advanced cohort (N = 66, 67% MIS), OS (p = 0.43) and RFS (p = 0.72) were similarly not different between MIS and open patients.

Conclusions: This study contributes to the growing body of evidence supporting the efficacy of MIS to manage gastric cancer within Western populations. Importantly, these data highlight the utility of MIS as a treatment option for locally advanced disease where uptake has been slowest.