Faculty Collaboration Database

Minimally invasive gastrectomy for cancer: current utilization in US academic medical centers. Surg Endosc 2015 Dec;29(12):3768-75

Date

03/21/2015

Pubmed ID

25791064

DOI

10.1007/s00464-015-4152-7

Scopus ID

2-s2.0-84947490342 (requires institutional sign-in at Scopus site)   22 Citations

Abstract

BACKGROUND: Internationally, the utilization of minimally invasive techniques for gastric cancer resection has been increasing since first introduced in 1994. In the USA, the feasibility and safety of these techniques for cancer have not yet been demonstrated.

METHODS: The University HealthSystem Consortium database was queried for gastrectomies performed between 2008 and 2013. Any adult patient with an abdominal visceral malignancy that necessitated gastric resection was included in the cohort. Clinicopathological and in-hospital outcome metrics were collected for open, laparoscopic, and robotic procedures.

RESULTS: Open gastrectomies comprised 89.5% of the total study group, while 8.2% of procedures were performed laparoscopically, and 2.3% were performed with robotic assistance. When accounting for disparities in patient severity of illness and risk of mortality subclass designations, there were no significant differences in mean length of stay, 30-day readmission, and in-hospital mortality between the three groups; however, mean total cost was highest in the robotic-assisted group (P = 0.017). Overall, complication rates were also similar; however, there was a higher incidence of superficial infection in the laparoscopic group (P = 0.013) and a higher incidence of venous thromboembolism in the robotic group (P = 0.038).

CONCLUSION: Despite widespread adoption for benign indications, minimally invasive gastrectomy for cancer remains underutilized in the USA. In these patients, laparoscopic and robot-assisted gastrectomies appear to be comparable to open resection with respect to overall complications, length of stay, 30-day readmission, and in-hospital mortality. However, when employing minimally invasive techniques, infection and thromboembolism risk reduction strategies should be emphasized in the operative and postoperative periods.

Author List

Glenn JA, Turaga KK, Gamblin TC, Hohmann SF, Johnston FM

Author

Thomas Clark Gamblin MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Adolescent
Adult
Aged
Aged, 80 and over
Female
Gastrectomy
Humans
Laparoscopy
Male
Middle Aged
Retrospective Studies
Robotic Surgical Procedures
Stomach Neoplasms
Treatment Outcome
United States
Young Adult