Kalavacherla Sandhya, Neel Nicholas, Jagadeesh Vasan, Bouvet Michael, Lowy Andrew, Horgan Santiago, Mehtsun Winta T, Kelly Kaitlyn J
Department of Surgery, Division of Surgical Oncology, UC San Diego School of Medicine, 3855 Health Sciences Drive, # 0987, La Jolla, San Diego, CA, 92093, USA.
Department of Surgery, Division of Surgical Oncology, University of Wisconsin School of Medicine, Madison, WI, USA.
J Gastrointest Cancer. 2025 Feb 20;56(1):68. doi: 10.1007/s12029-024-01163-y.
While minimally invasive gastrectomy (MIS) is well-utilized in Asia, its adoption in the West to treat gastric adenocarcinoma has been slower. We compare survival outcomes between open gastrectomy and MIS in a high-volume Western US center.
In this retrospective review, demographic and clinical characteristics of gastric adenocarcinoma patients who underwent curative-intent MIS (robotic or laparoscopic approaches) or open surgery were compared via descriptive statistics. Multivariable Cox hazard regression models were constructed to assess the effects of gastrectomy type on overall survival (OS) and recurrence-free survival (RFS) in the overall cohort and a locally advanced subgroup (pathologic stage 2-3 patients).
A total of 135 gastric adenocarcinoma patients were studied; 67% underwent MIS. Open patients experienced lower lymph node retrieval (p = 0.004) and neoadjuvant chemotherapy administration (p = 0.037) than MIS. OS (p = 0.18) and RFS (p = 0.74) were not different between MIS and open over a 5-year period. In multivariable survival models, gastrectomy type was not associated with OS (open hazard ratio (HR) = 1.78, p = 0.8 (compared to MIS)) or RFS (HR = 1.46, p = 0.7), while positive nodes (HR = 21.7, p = 0.003) and pathologic stage 3 (HR = 1.6, p = 0.025) were associated with poorer OS. Within the locally advanced cohort (N = 66, 67% MIS), OS (p = 0.43) and RFS (p = 0.72) were similarly not different between MIS and open patients.
This study contributes to the growing body of evidence supporting the efficacy of MIS to manage gastric cancer within Western populations. Importantly, these data highlight the utility of MIS as a treatment option for locally advanced disease where uptake has been slowest.
虽然微创胃切除术（MIS）在亚洲得到了广泛应用，但在西方用于治疗胃腺癌的情况则较为缓慢。我们在美国西部一个大型中心比较了开放胃切除术和MIS的生存结果。
在这项回顾性研究中，通过描述性统计比较了接受根治性MIS（机器人或腹腔镜手术）或开放手术的胃腺癌患者的人口统计学和临床特征。构建多变量Cox风险回归模型，以评估胃切除术类型对整个队列以及局部晚期亚组（病理分期为2 - 3期的患者）的总生存期（OS）和无复发生存期（RFS）的影响。
共研究了135例胃腺癌患者；67%接受了MIS。与MIS相比，开放手术患者的淋巴结清扫数量较少（p = 0.004）且新辅助化疗的应用较少（p = 0.037）。在5年期间，MIS和开放手术之间的OS（p = 0.18）和RFS（p = 0.74）没有差异。在多变量生存模型中，胃切除术类型与OS（开放手术风险比（HR）= 1.78，p = 0.8（与MIS相比））或RFS（HR = 1.46，p = 0.7）无关，而阳性淋巴结（HR = 21.7，p = 0.003）和病理分期3期（HR = 1.6，p = 0.025）与较差的OS相关。在局部晚期队列（N = 66，67%为MIS）中，MIS和开放手术患者之间的OS（p = 0.43）和RFS（p = 0.72）同样没有差异。
本研究为支持MIS在西方人群中治疗胃癌有效性的越来越多的证据做出了贡献。重要的是，这些数据突出了MIS作为局部晚期疾病治疗选择的效用，而在局部晚期疾病中MIS的应用一直最为缓慢。
