OGC P52 Short and long-term outcomes of minimally versus open gastrectomy for cancer; a retrospective analysis over 15 years

Abstract

Abstract Background Minimally invasive gastrectomy (MIG) is a well-established approach for the management of gastric cancer. However, much of the evidence base has come from the Far East where patient characteristics are significantly different and therefore not necessarily applicable to Western practice. In the UK (NOGCA 2022), less than 20% of gastrectomy is undertaken using a MIG approach with limited information regarding the distribution between total or partial MIG. This area therefore urgently requires further exploration. Our study aimed to review short and long-term outcomes of patients undergoing open and MIG over a 15-year period. Methods This was a retrospective analysis of all consecutive patients who underwent MIG and open gastrectomy (OG) for cancer between 2007 to 2022. The setting was a regional tertiary oesophago-gastric centre in the North-West of England serving a population of over 3.5 million people. Patients were further subcategorised into total (TG) or partial resections (PG -defined as sub-total or distal gastrectomy). Patient demographics and co-morbidities, peri-operative treatments, disease-related data, in addition to short and long-term outcomes were collected. Outcome choice was informed by the GASTROS core outcome set for surgical studies in gastric cancer. Results 372 patients were included (OG 245; LG 105; LG converted 22). 166 underwent PG (MIG = 39.8%) and TG 187 (MIG = 18%). No difference in patient co-morbidities, staging or peri-operative chemotherapy rates between groups was found. LOS was 15.2 days for OG and 14.4 days for LG (p = 0.220). Median lymph nodes resected was 20 for OG and 21 for LG (p = <0.004). R0 rates were 90% for OG and 94% for LG (p=0.441). Overall survival was similar (1075 days for OG vs 1114 days for LG (p=<0.751)). No differences were found in TG or PG. Conclusions Outcomes following MIG in this study were not statistically different to OG. This was mirrored in a sub-group analysis of total and partial gastrectomy. This data suggests that MIG is an appropriately safe alternative to open gastrectomy. Further multi-centre studies are required to validate these findings. A randomised control trial may be challenging to recruit to due to limited uptake of MIG across the UK.