P84: Outcomes After Minimally Invasive Gastrectomy for Locally Advanced Gastric Cancer

Friday, March 24, 2023

12:46 PM – 12:51 PM

Location: SSO HUB Pan-Tumor Zone: CRS, HPB, Pan-Tumor & Upper GI

Poster Presenter(s)

EeeLN Buckarma, MD (she/her/hers)

Resident Physician
Mayo Clinic Dept Surgery
Rochester, Minnesota, United States

Disclosure information not submitted.

Author(s)

EeeLN Buckarma, MD (she/her/hers)

Resident Physician
Mayo Clinic Dept Surgery
Rochester, Minnesota, United States

Disclosure information not submitted.
Amro M. Abdelrahman, MBBS MS (he/him/his)

Research Fellow
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
NS

Nizamuddin Shaikh, MBBS

Surgery Resident
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
MK

Michael Kendrick, MD

Professor
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, United States

Disclosure information not submitted.
Mark J. Truty, MD, MSc

Practice Chair
Mayo Clinic Rochester
Rochester, Minnesota, United States

Disclosure information not submitted.
CT

Cornelius A. Thiels, DO, MBA

Assistant Professor
Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, United States

Disclosure information not submitted.
Travis E. Grotz, MD

Assistant Professor
Mayo Clinic
Rochester, Minnesota, United States

Disclosure(s): No financial relationships to disclose

Disclosure(s):

Travis E. Grotz, MD: No financial relationships to disclose

Introduction: Minimally Invasive Surgery (MIS) approaches are being increasingly utilized for gastric cancer. Significant data is available supporting MIS distal gastrectomy and early gastric cancer, however there is limited data in locally advanced gastric cancer.

Methods: Consecutive patients with locally advanced gastric cancer ( >T2 or N+) undergoing MIS gastrectomy from 2003 - 2022 were included. Descriptive statistics were utilized, and the Kaplan-Meier method and log-rank test were used to assess for recurrence free (RFS) and overall survival (OS).

Results: One hundred-four patients underwent MIS gastrectomy, including 65 (62.5%) laparoscopic and 39 (37.5%) robotic. Total, subtotal and distal gastrectomies comprised 54 (51.9%), 36 (34.6%) and 14 (13.4%). Conversion to open occurred in 4 % of cases. 11% of procedures required a multi visceral resection. The mean (SD) operative time was 467.79 ± 105.81mins with a median estimated blood loss of 150 ml (IQR 75 - 250). R0 resection occurred in 94% of cases. The mean (SD) number of lymph nodes retrieved was 28.40 ± 14.66. The median length of stay was 5.5 days (IQR 4 - 8). Major (Clavien-Dindo grade >= 3) occurred in 3%. Median time to adjuvant therapy was 7 weeks (IQR 6-8). The median follow up is 23.4 (20.66 – 26.13) months. The 1, 3 and 5-year recurrence-free survival rates were 75, 68 and 60%. Overall survival rates at 1, 3 and 5 years were 80,69 and 56%, for the entire cohort without significant difference between the two MIS approaches (p=0.56). According to pathologic stage defined by AJCC 8^th edition, 5-year RFS were 76 and 24% for stage I and III (stage II, inadequate sample size). 5-year stage-specific overall survival were 78 and 37% for stage I and III (stage II, inadequate sample size).

Conclusions: MIS gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer is safe and feasible. Perioperative and oncologic outcomes are favorable to previously published data for open gastrectomy. Additional prospective investigations are necessary to support the conclusion that MIS gastrectomy can improve perioperative outcomes while maintaining oncologic outcomes.

Learning Objectives:

understand the latest outcome in MIS gastrectomy for locally advanced gastric cancer
Define advance gastric cancer
understand OS and RFS in gastrectomy by pathologic stage