Outcomes of Minimally Invasive Surgery for Early Gastric Cancer Is Comparable to Open Surgery – Analysis of 1,013 MIS at a Single Institute

Seung-Young Oh, MD, Sebastianus Kwon, MD, Yun-Suhk Suh, MD, MS, Hwi-Nyeong Choe, RN, Seong-Ho Kong, MD, MS, Hyuk-Joon Lee, MD, PhD, Woo Ho Kim, MD, PhD, Han-Kwang Yang, MD, PhD

Seoul National University Hospital

Introduction The aim of this study was to compare short and long-term results of minimally invasive surgery (MIS) and open surgery for primary early gastric cancer (EGC) at a single high-volume institute.

Methods and procedures Clinicopathologic and survival data of primary gastric cancer patients who underwent a minimally invasive radical gastrectomy at Seoul National University Hospital from December 2003 to January 2012 were retrospectively analyzed. For comparison of short-term outcomes, data on 1,112 patients who underwent a radical open gastrectomy from 2007 to 2011 were collected. For long-term outcome analysis, data on 1,214 patients who underwent a radical open gastrectomy from 2004 to 2006 were collected. Because MIS was performed in EGC patients, only patients who were deemed to have EGC by endoscopy and/or endoscopic ultrasound were included in order to match the surgical indications of these two control groups to the MIS group.

Results Review of our database identified 1,013 patients who underwent MIS for gastric cancer; 942 laparoscopic gastrectomies and 71 robotic gastrectomies. The number of MIS increased from 27 cases in 2004 upto 40.6% of all operations for gastric cancer in 2011. 749 distal gastrectomies (DG), 19 total gastrectomies (TG), 36 proximal gastrectomies (PG), and 209 pylorus preserving gastrectomies (PPG) were performed. In the short-term outcome analysis, MIS group showed statistically better result than open group in the post-operative hospital stay (8.7 days vs. 11.3 days, P<0.001), the estimate blood loss (75.4cc vs. 142.3cc, P<0.001), and the complication rate (17.5% vs. 24.4%, P<0.001). In the subanalysis of TG and PG groups, the complication rates were not significant different between two groups but much higher than DG and PPG groups. Univariate analysis revealed that age, sex, several comorbidities, surgical approach, type of gastrectomy and whether there was any combined resection or not were the significant influencing factors on the complication rate. Multivariate analysis showed that not only surgical approach but also age, chronic liver disease, chronic renal disease and whether there was any combined resection or not had significant effect. In the long-term outcome analysis, there was no significant difference between two groups in the 5-year survival rate.

Conclusions MIS for EGC showed better operative results, fewer complication rate and comparable 5-year survival rate. But TG and PG in MIS group were associated with higher complication rate than open group, so caution seems to be needed to overcome the learning-curve.

Session: Podium Presentation

Program Number: S064