Department of Surgery, Duke University, Durham, North Carolina.
Department of Surgery, University of Iowa, Iowa City, Iowa.
J Surg Oncol. 2020 Mar;121(3):486-493. doi: 10.1002/jso.25834. Epub 2020 Jan 9.
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.
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.
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 initiation of 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.
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.
化疗可改善可切除胃癌患者的预后。微创胃切除术（MIS）的比例正在增加，但 MIS 对术后化疗的影响仍不确定。本研究探讨了 MIS 与开腹胃切除术（OG）对高危胃癌辅助化疗应用的影响。
纳入 2010 年至 2015 年间在国家癌症数据库中接受高危胃腺癌切除术的患者。根据手术方式（MIS 与 OG）对患者进行分层，并采用多变量回归模型进行分析。主要终点是辅助化疗的应用和起始时间。
共纳入 23071 例患者；16595 例（71.9%）接受 OG，6476 例（28.1%）接受 MIS。调整患者和肿瘤特征后，MIS 与辅助化疗的应用增加无关（比值比 [OR]：1.027，95%置信区间 [CI]：0.95 至 1.11，P=0.50），化疗起始时间也相似（变化-2%，95%CI：-5%至+1%，P=0.27）。MIS 与较短的住院时间相关（-1 天）。两组的 30 天再入院率、90 天死亡率和总生存率相似。
在这项研究中，虽然胃腺癌的 MIS 与较短的住院时间和相似的生存相关，但与辅助化疗的应用改善或起始时间的改善无关。
