Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Real-world Nationwide Outcomes of Minimally Invasive Surgery for Advanced Gastric Cancer Based on Korean Gastric Cancer Association-Led Survey

  • Received : 2023.08.24
  • Accepted : 2024.03.11
  • Published : 2024.04.01
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Abstract

Purpose: The study aimed to investigate real-world surgical outcomes of minimally invasive surgery (MIS) for advanced gastric cancer using Korean Gastric Cancer Association (KGCA)-led nationwide data. Materials and Methods: A nationwide survey of patients who underwent surgical treatment for gastric cancer in 2019 was conducted by the KGCA. A total of 14,076 patients from 68 institutions underwent surgery, and 4,953 patients diagnosed with pathological stages IB-III gastric cancer were included. Among them, 1,689 patients who underwent MIS (MIS group) and 1,689 who underwent the open approach (open group) were matched using propensity score in a 1:1 ratio. Surgical outcomes were compared, and multivariate analysis was performed to identify the independent factors for overall morbidity. Results: The MIS group had a lower proportion of D2 lymphadenectomy, total omentectomy, and combined resection. However, the number of harvested lymph nodes was higher in the MIS group. Better surgical outcomes, including less blood loss and shorter hospital stay, were observed in the MIS group, and the overall morbidity rate was significantly lower in the MIS group (17.5% vs. 21.9%, P=0.001). The mortality rates did not differ significantly between the 2 groups. In the multivariate analysis, the minimally invasive approach was a significant protective factor against overall morbidity (odds ratio, 0.799; P=0.006). Conclusions: Based on the Korean nationwide data, MIS for stage IB-III gastric cancer had better short-term outcomes than the open approach, including lower rates of wound complications, intra-abdominal abscesses, and cardiac problems.

Keywords

Acknowledgement

This research was supported by a nationwide survey project of the information committee of the Korean Gastric Cancer Association (study number: KGCA2023IC10).

References

  1. Information Committee of the Korean Gastric Cancer Association. Korean Gastric Cancer Association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer 2021;21:221-235.
  2. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 2016;263:28-35.
  3. Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer: the KLASS-01 randomized clinical trial. JAMA Oncol 2019;5:506-513.
  4. Lee HJ, Hyung WJ, Yang HK, Han SU, Park YK, An JY, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 2019;270:983-991.
  5. Hyung WJ, Yang HK, Park YK, Lee HJ, An JY, Kim W, et al. Long-term outcomes of laparoscopic distal gastrectomy for locally advanced gastric cancer: the KLASS-02-RCT randomized clinical trial. J Clin Oncol 2020;38:3304-3313.
  6. Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, et al. Korean practice guidelines for gastric cancer 2022: an evidence-based, multidisciplinary approach. J Gastric Cancer 2023;23:3-106.
  7. Kim HI, Hur H, Kim YN, Lee HJ, Kim MC, Han SU, et al. Standardization of D2 lymphadenectomy and surgical quality control (KLASS-02-QC): a prospective, observational, multicenter study [NCT01283893]. BMC Cancer 2014;14:209.
  8. Han SU, Hur H, Lee HJ, Cho GS, Kim MC, Park YK, et al. Surgeon quality control and standardization of D2 lymphadenectomy for gastric cancer: a prospective multicenter observational study (KLASS-02-QC). Ann Surg 2021;273:315-324.
  9. Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer 2023;26:1-25.
  10. Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology 2020;76:182-188.
  11. Brierley JD, Gospodarowicz MK, Wittekind C, eds. TNM Classification of Malignant Tumours. 8th ed. Chichester; Hoboken (NJ): Wiley-Blackwell; 2017.
  12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
  13. Korean Health Insurance Review and Assessment Service. Report of the 5th Gastric Cancer Adequacy Evaluation in 2019. Wonju: Korean Health Insurance Review and Assessment Service; 2021.
  14. Etoh T, Ohyama T, Sakuramoto S, Tsuji T, Lee SW, Yoshida K, et al. Five-year survival outcomes of laparoscopy-assisted vs open distal gastrectomy for advanced gastric cancer: the JLSSG0901 randomized clinical trial. JAMA Surg 2023;158:445-454.
  15. Yu J, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA 2019;321:1983-1992.
  16. Chen QY, Xie JW, Zhong Q, Wang JB, Lin JX, Lu J, et al. Safety and efficacy of indocyanine green tracer-guided lymph node dissection during laparoscopic radical gastrectomy in patients with gastric cancer: a randomized clinical trial. JAMA Surg 2020;155:300-311.
  17. Son T, Hyung WJ, Lee JH, Kim YM, Kim HI, An JY, et al. Clinical implication of an insufficient number of examined lymph nodes after curative resection for gastric cancer. Cancer 2012;118:4687-4693.
  18. Gholami S, Janson L, Worhunsky DJ, Tran TB, Squires MH 3rd, Jin LX, et al. Number of lymph nodes removed and survival after gastric cancer resection: an analysis from the US Gastric Cancer Collaborative. J Am Coll Surg 2015;221:291-299.
  19. Macalindong SS, Kim KH, Nam BH, Ryu KW, Kubo N, Kim JY, et al. Effect of total number of harvested lymph nodes on survival outcomes after curative resection for gastric adenocarcinoma: findings from an eastern high-volume gastric cancer center. BMC Cancer 2018;18:73.
  20. Eom SS, Choi W, Eom BW, Park SH, Kim SJ, Kim YI, et al. A comprehensive and comparative review of global gastric cancer treatment guidelines. J Gastric Cancer 2022;22:3-23.
  21. Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Br J Cancer 1999;79:1522-1530.
  22. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 2010;11:439-449.
  23. Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg 2011;253:900-911.
  24. Park DJ, Lee HJ, Kim HH, Yang HK, Lee KU, Choe KJ. Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 2005;92:1099-1102.
  25. Brar SS, Seevaratnam R, Cardoso R, Yohanathan L, Law C, Helyer L, et al. Multivisceral resection for gastric cancer: a systematic review. Gastric Cancer 2012;15 Suppl 1:S100-S107.
  26. Xiao H, Xiao Y, Quan H, Liu W, Pan S, Ouyang Y. Intra-abdominal infection after radical gastrectomy for gastric cancer: incidence, pathogens, risk factors and outcomes. Int J Surg 2017;48:195-200.
  27. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 2015;39:2734-2741.
  28. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 2016;34:1350-1357.
  29. Iwatsuki M, Yamamoto H, Miyata H, Kakeji Y, Yoshida K, Konno H, et al. Association of surgeon and hospital volume with postoperative mortality after total gastrectomy for gastric cancer: data from 71,307 Japanese patients collected from a nationwide web-based data entry system. Gastric Cancer 2021;24:526-534.
  30. Endo S, Yamatsuji T, Fujiwara Y, Higashida M, Kubota H, Matsumoto H, et al. Prognostic factors for elderly gastric cancer patients who underwent gastrectomy. World J Surg Oncol 2022;20:10.