Rodriguez M Juanita, Ore Ana Sofia, Schawkat Khoschy, Kennedy Kevin, Bullock Andrea, Pleskow Douglas K, Critchlow Jonathan, Moser A James
Pancreas and Liver Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Ann Transl Med. 2021 Sep;9(18):1408. doi: 10.21037/atm-21-1054.
This study compares standard of care (SOC) open and robotic D2-gastrectomy for locally advanced gastric cancer (LAGC) in the Western context of low disease prevalence, reduced surgical volume, and neoadjuvant chemotherapy (NAC). We hypothesized that robotic gastrectomy (RG) after NAC reduces treatment burden for LAGC across multiple outcome domains SOC.
Single institution, interrupted time series comparing SOC (2008-2013) for LAGC (T2-4Nany/TanyN+) NAC + RG (2013-2018). Treatment burden was a composite metric of narcotic consumption, oncologic efficacy, cumulative morbidity, and 90-day resource utilization. Predictors were evaluated via multivariate modeling. Learning curve analysis was done using CUSUM.
After exclusions, 87 subjects with equivalent baseline characteristics, aside from male sex, were treated via SOC (n=55) or NAC + RG (n=32). All four domains of treatment burden were significantly reduced in the NAC + RG cohort compared to SOC (P=0.003). The odds ratio for excess treatment burden in the NAC/RG was 0.23 (95% CI: 0.07-0.72, P=0.0117) SOC upon multivariable modeling, whereas the extent of resection (total/subtotal), tumor size, T-stage, sex, and early learning curve had no effect. Differences in treatment burden persisted in subgroup analysis for NAC (n=51).
NAC + RG was associated with decreased treatment burden relative to SOC for LAGC. Frequencies of unfavorable hospitalization, adverse oncological outcomes, major morbidity, and narcotic consumption all decreased in this interrupted time series.
本研究比较了在西方疾病患病率低、手术量减少且采用新辅助化疗（NAC）的情况下，标准治疗（SOC）开放性和机器人辅助D2胃切除术治疗局部晚期胃癌（LAGC）的效果。我们假设NAC后行机器人胃切除术（RG）可在多个结局领域减轻LAGC的治疗负担。
单中心、间断时间序列研究，比较LAGC（T2 - 4Nany/TanyN +）的SOC（2008 - 2013年）与NAC + RG（2013 - 2018年）。治疗负担是一个综合指标，包括麻醉药物消耗、肿瘤学疗效、累积发病率和90天资源利用情况。通过多变量建模评估预测因素。使用累积和分析（CUSUM）进行学习曲线分析。
排除后，87例除性别外基线特征相当的受试者接受了SOC治疗（n = 55）或NAC + RG治疗（n = 32）。与SOC相比，NAC + RG队列的治疗负担所有四个领域均显著降低（P = 0.003）。多变量建模时，NAC/RG组出现过度治疗负担的优势比为0.23（95%CI：0.07 - 0.72，P = 0.0117），而SOC组则无此情况，切除范围（全胃/次全胃）、肿瘤大小、T分期、性别和早期学习曲线均无影响。在NAC亚组分析（n = 51）中，治疗负担差异仍然存在。
对于LAGC，NAC + RG与SOC相比治疗负担降低。在这个间断时间序列中，不良住院频率、不良肿瘤学结局、主要发病率和麻醉药物消耗均有所下降。
