W. Jones1,2, K.R. Bates1, D.J. Vitello1, J.E. Sanchez1, R.C. Jacobs1, D.J. Bentrem1,2 1Feinberg School Of Medicine – Northwestern University, Surgery, Chicago, IL, USA 2Jesse Brown VA Medical Center, Surgery, Chicago, IL, USA
Introduction:
Gastric adenocarcinoma (GA) is a leading cause of cancer death throughout the world. Surgery remains an integral part of the multimodal treatment of GA. Minimally invasive surgery has been used increasingly to decrease the associated morbidity and mortality. This study sought to compare postoperative risk of complication of open surgery versus minimally invasive surgical resection of GA and identify predictors of surgical approach.
Methods:
A retrospective observation cohort study was performed by identifying patients with GA by International Classification of Diseases (ICD) codes in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database years 2016 – 2020. Those with metastatic disease, requiring emergent surgery, withdrawing from care, or who expired were excluded. Patients were compared based on receipt of open versus laparoscopic gastrectomy using Current Procedural Terminology (CPT) codes. The primary outcome of interest was surgical approach with the secondary outcome of interest being risk of experiencing a complication. Predictors of receiving laparoscopic gastrectomy were identified using multivariable Poisson regression. Differences in complication rates were determined using modified multivariable Poisson regressions with robust variance. Relative risk of experiencing complications was assessed using multivariable Poisson regressions.
Results:
3,206 patients were included in the analysis. 85.2% of patients underwent open gastrectomy compared to 14.8% of patients who underwent laparoscopic gastrectomy. Patients undergoing laparoscopic gastrectomy had a decreased risk of experiencing a major complication (RR 0.7, 95% CI 0.5-0.9) or any complication (RR 0.7, 95% CI 0.5-0.8) compared to patients undergoing open gastrectomy. Specifically, more patients who underwent open gastrectomy compared to laparoscopic gastrectomy experienced a deep incisional or organ space infection (7.2% versus 3.6%, p<0.01), a bleeding transfusion (10.2% versus 6.3%, p=0.01), pneumonia (5.4% versus 2.5%, p=0.01), unplanned intubation (3.3% versus 1.5%, p=0.03), and unplanned readmission (11.8% versus 7.8%, p=0.03). Women were more likely than men to receive laparoscopic gastrectomy (OR 1.4, 95% CI 1.1-1.7), whereas non-Hispanic black patients were less likely to receive laparoscopic gastrectomy than non-Hispanic white patients (OR 0.6, 95% CI 0.4-0.8).
Conclusion:
Laparoscopic gastrectomy is associated with lower rates of postoperative complications and decreased risk of experiencing complications compared to open gastrectomy for GA treatment. Sociodemographic predictors of receipt of laparoscopic gastrectomy indicate that there may be disparities regarding who has access to certain treatments and surgical approaches.