Patrick J Sweigert, MD1, Emanuel Eguia, MD, MHA1, Marc H Nelson, MD1, Haroon Janjua, MS2, Gerard J Abood, MD, FACS1, Bipan Chand, MD, FACS, FASMBS, FASGE1, Paul C Kuo, MD, MS, MBA, FACS2, Marshall S Baker, MD, MS, MBA1. 1Loyola University Medical Center, 2University of South Florida
Introduction: Laparoscopic (LG) approaches to gastrectomy for gastrointestinal stromal tumors (GIST) have been shown to provide clinical outcomes similar to open (OG) approaches. The safety and oncologic efficacy of robotic-assisted gastrectomy (RG) in the treatment of GIST has not been well studied.
Methods: We queried the National Cancer Database to identify patients undergoing gastrectomy for GIST between 2010 and 2015. Patients with metastatic disease and tumor invasion into adjacent organs were excluded. Patients were stratified into OG, LG and RG cohorts in an intention-to-treat fashion. Multivariable logistic regression was used to compare margin status, 90-day mortality, 30-day readmission rate and length of stay (LOS) while controlling for patient age, sex, race, comorbidity score, tumor size and pathologic stage, cancer facility type and gastric resection type. Kaplan-Meier (KM) survival functions and multivariable cox proportional hazard models were used to compare rates of overall survival (OS).
Results: 22,665 (51.2%) patients under went OG; 2,192 (42.1%) LG, and 350 (6.7%) RG. On univariate analysis, RG was more likely to be performed at Academic/Integrated Cancer Centers than either LG or OG (61.7% vs 55.6%, p=0.01; vs 52.4% p<0.01). Patients undergoing RG and LG were more likely than those undergoing OG to have low grade/small tumors with 94.6% of RG, 89.8% of LG and 78.2% of OG cases done for stage I-II disease (p<0.01). The extent of resection was most often a partial gastrectomy (93.7% vs 98.0% vs 98.3%, p<0.01). RG was associated with a lower rate of conversion to OG than LG (5.1% vs 10.8%, p<0.01). Unadjusted KM analysis (Figure 1) demonstrated a survival advantage for RG and LG relative to OG (p<0.01, p<0.01) but no difference in OS between RG and LG (p=0.14). On adjusted analysis, patients undergoing RG had increased risk of having a margin positive resection than those undergoing either LG (OR 1.74; 95% CI[1.07-2.82]), or OG (OR 1.69; 95% CI[1.02-2.78]). RG (OR 0.32; 95% CI[0.23-0.43], p<0.01) and LG (OR 0.31; 95% CI[0.26-0.36], p<0.01) were associated with lower risk of prolonged LOS and LG with lower risk of readmission compared to OG (OR 0.69; 95% CI[0.49-0.97], p<0.05 ). There were no differences in adjusted OS.
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Conclusion: Compared to the OG, robotic-assisted partial gastrectomy for nonmetastatic GIST is associated with increased risk of margin positive resection that is independent of tumor size and grade but affords a lower risk of prolonged hospitalization and similar patterns of overall survival.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94587
Program Number: P473
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster