Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, 17033-0850, USA.
Department of Health Policy and Administration, The Pennsylvania State University, University Park, State College, PA, USA.
J Gastrointest Surg. 2020 May;24(5):1000-1009. doi: 10.1007/s11605-019-04263-4. Epub 2019 May 31.
Minimally invasive surgical approaches for gastric adenocarcinoma are increasing in prevalence. Although recent studies suggest such approaches are associated with improvements in short-term outcomes, long-term outcomes have not been well studied. This study aimed to evaluate the impact of minimally invasive gastrectomy on long-term survival.
The National Cancer Database (NCDB) was used to identify patients who underwent gastrectomy for adenocarcinoma between 2010 and 2015. Patient characteristics were stratified by open and minimally invasive approaches and compared using chi-square and t tests. Unadjusted survival functions were estimated using Kaplan-Meier methodology. Multivariable modeling of risks factors for survival was analyzed with Cox proportional hazard models. Covariate imbalance was controlled using propensity score matching.
The study included 17,449 patients who underwent gastrectomy. Cox proportional hazard modeling demonstrated that minimally invasive surgery improved survival (hazard ratio = 0.86, P < 0.0001). Predictors of worsened survival included community facility type, comorbidities, tumor size, extent of gastrectomy, clinical T and N staging (P < 0.0060 for all). After propensity score matching, minimally invasive surgery had a significantly improved survival at 5 years compared to an open approach, 51.9% versus 47.7% (P < 0.0001). Survival was not significantly different between propensity score-matched patients who received laparoscopic and robotic approaches (P = 0.2611).
Minimally invasive approaches for gastric carcinoma are associated with improved long-term survival. There was no significant difference in survival when comparing laparoscopic to robotic gastrectomy. The mechanisms that drive these improvements deserve further investigation.
微创外科方法治疗胃腺癌的应用越来越广泛。尽管最近的研究表明这些方法与短期结果的改善相关，但长期结果尚未得到很好的研究。本研究旨在评估微创胃切除术对长期生存的影响。
使用国家癌症数据库（NCDB）确定 2010 年至 2015 年间接受胃腺癌切除术的患者。根据开放性和微创性方法对患者特征进行分层，并使用卡方检验和 t 检验进行比较。使用 Kaplan-Meier 方法估计未调整的生存函数。使用 Cox 比例风险模型分析生存风险因素的多变量建模。使用倾向评分匹配控制协变量失衡。
本研究纳入了 17449 例接受胃切除术的患者。Cox 比例风险模型表明微创手术改善了生存（风险比=0.86，P<0.0001）。生存恶化的预测因素包括社区医疗机构类型、合并症、肿瘤大小、胃切除术范围、临床 T 和 N 分期（P<0.0060 ）。经过倾向评分匹配后，与开放性手术相比，微创手术在 5 年时的生存率显著提高，分别为 51.9%和 47.7%（P<0.0001）。接受腹腔镜和机器人手术的倾向评分匹配患者的生存率无显著差异（P=0.2611）。
胃腺癌的微创方法与长期生存的改善相关。比较腹腔镜与机器人胃切除术，生存率无显著差异。推动这些改善的机制值得进一步研究。
