Impact of minimally invasive gastrectomy on use of and time to adjuvant chemotherapy for gastric adenocarcinoma

Abstract

Background: Chemotherapy improves outcomes in patients with resectable gastric cancer. Minimally invasive gastrectomy (MIS) rates are increasing, though the impact of MIS on postoperative chemotherapy remains uncertain. This study examines the impact of MIS vs open gastrectomy (OG) on utilization of adjuvant chemotherapy for high-risk gastric cancer. Methods: Patients in the National Cancer Database who underwent resection for high-risk gastric adenocarcinoma between 2010 and 2015 were included. Patients were stratified by surgical approach (MIS vs OG) and analyzed using multivariable regression modeling. Primary endpoints were utilization of and time to initiation of adjuvant chemotherapy. Results: Overall, 23 071 patients were included; 16 595 (71.9%) underwent OG and 6476 (28.1%) underwent MIS. After adjusting for patient and tumor characteristics, MIS was not associated with increased use of adjuvant chemotherapy (odds ratio [OR]: 1.027, 95% confidence interval [CI]: 0.95 to 1.11, P = .50), and time to initiationof chemotherapy was similar (−2% change, 95% CI: −5% to +1%, P = .27). MIS was associated with shorter hospital stays (−1 day). Thirty-day readmission rates, 90-day mortality, and overall survival were similar between groups.Conclusions: In this study, while MIS for gastric adenocarcinoma was associated with shorter hospital stays and comparable survival, it was not associated with improved utilization or time to initiation of adjuvant chemotherapy.

Disparities in Utilization and Outcomes of Minimally Invasive Techniques for Gastric Cancer Surgery in the United States

“…13 Most recently, two studies utilizing the National Cancer Database (NCDB) analyzing survival following MIG presented opposing conclusions despite using the same time period with one study finding improved short-term and long-term survival with MIG. 14,15 These studies also had conflicting findings regarding socioeconomic utilization of MIG. Notably, as the NCDB only includes data from hospitals approved by the committee on cancer, it is thought to inherently bias the database toward better oncologic outcomes and underrepresentation of socioeconomic disparities.…”

Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection

“…Postoperative mortality rates are similarly low, often <1%, across RCT LG and OG cohorts. Reviews of the National Cancer Database (NCDB) reported lower rates of 30‐day and 90‐day mortality for patients undergoing MIG versus OG 44,45 . One of those studies 45 demonstrated a persistent mortality benefit after MIG using propensity‐matching analysis.…”

“…51,52 Results are similarly mixed for postoperative mortality; however, overall, RG appears to be noninferior to OG. 49,50 Authors of national database analyses concluded that MIG was associated with improved rates of 30-day 53 and 90-day mortality, 44 but the proportion of MIG cases that were performed robotically is unclear.…”

“…Reviews of the National Cancer Database (NCDB) reported lower rates of 30‐day and 90‐day mortality for patients undergoing MIG versus OG. 44 , 45 One of those studies 45 demonstrated a persistent mortality benefit after MIG using propensity‐matching analysis. However, Farrow et al 44 did not adjust for the overrepresentation of early stage cancer in the minimally invasive surgery group, and these results should be interpreted with caution.…”

“…Adjuvant treatment rates rose to 60% for each cohort in the KLASS 02 trial 37 for locally advanced disease. From a Western perspective, the review of the NCDB by Farrow et al 44 demonstrated no difference in the receipt of adjuvant chemotherapy for patients who underwent MIG versus OG (odds ratio, 1.03; p = .50). Importantly, although some studies reported no impact of surgical approach on the time from surgery to adjuvant chemotherapy induction, 31 , 38 Li et al, 38 whose patients had received NAC, observed that those who underwent LG were able to complete more cycles of adjuvant chemotherapy (odds ratio, 4.39; p = .003) and had improved tolerance of the regimen (22% vs. 42% termination; p = .04) compared with those who underwent OG.…”