P82: Short- and Long- Term Outcomes of Minimally Invasive vs Open Gastrectomy after Neoadjuvant Chemotherapy for Gastric cancer.

Friday, March 24, 2023

12:36 PM – 12:41 PM

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

Poster Presenter(s)

Shoji Shimada, MD, PhD (he/him/his)

Research Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.

Author(s)

Shoji Shimada, MD, PhD (he/him/his)

Research Fellow
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Miseker E. Abate, MD, MPH

Research Fellow
Memorial Sloan Kettering Cancer Center, United States

Disclosure(s): No financial relationships to disclose
Harrison M. Drebin, BA

Research Coordinator
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
TF

Teng Fei, PhD

Biostatistician
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
YJ

Yelena Janjigian, MD

Medical Oncologist
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
GK

Geoffrey Ku, MD

Medical Oncologist
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
LT

Laura Tang, MD, PhD

Pathologist
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Daniel G. Coit, MD

Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure information not submitted.
Vivian E. Strong, MD

Iris Cantor Endowed Chair and Attending Surgeon, MSKCC and Professor of Surgery and Associate Dean, Weill Medical College of Cornell University
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure(s): Merck: Speaker (Terminated, November 1, 2022)

Disclosure(s):

Miseker E. Abate, MD, MPH: No financial relationships to disclose

Vivian E. Strong, MD: Merck: Speaker (Terminated, November 1, 2022)

Introduction: Neoadjuvant chemotherapy (NAC) is a standard treatment option for locally advanced gastric cancer (LAGC) in the West; however, the feasibility and oncological safety of minimally invasive surgery (MIS) for LAGC after NAC remains unclear. The aim of this study is to evaluate the perioperative safety and oncological outcomes of MIS for LAGC patients who received NAC.

Methods: We collected data between January 2000 and December 2020 from a prospectively maintained database of patients with gastric adenocarcinoma selected for curative resection after NAC, Patient characteristics, clinicopathologic and operative findings, and postoperative outcomes were compared between open and MIS gastrectomy using hypothesis testing of associations. Long-term outcomes (overall survival, OS, and disease-specific survival, DSS) were compared using multivariate survival analyses.

Results: 527 patients met the criteria. The median follow-up for all patients was 36.8 months. Open and MIS gastrectomy after NAC was adopted in 449 and 78 patients, respectively (Table 1). In the MIS group, 62 (79.5%) patients underwent robotic gastrectomy. The groups did not significantly differ in age, sex or Lauren classification. The frequency of patients who received total gastrectomy was significantly higher in the open group than in the MIS group (51.2 vs. 23.1%; p< 0.001). The groups did not significantly differ in ypT or ypN classification. Postoperative complication (Clavien-Dindo (CD) ≥ I) was higher in the open group compared to the MSI group (32.0 vs. 21%; p=0.04). Postoperative severe morbidity (CD ≥III) and mortality did not differ between the two groups (p=0.6). The length of postoperative hospital stay was significantly shorter in the MIS group than in open group (5.0 vs 7.0 days; p< 0.001). Multivariate survival analyses indicate no significant differences between MIS vs. open gastrectomy in OS (HR=0.9, p=0.6) and DSS (HR=0.7, p=0.3).

Conclusions: MIS gastrectomy for LAGC after NAC results in decreased morbidity and shorter hospital stays with survival that is at least equivalent to open approaches. This suggests that MIS approaches after NAC in well-selected patients is safe, oncological equivalent and provides quicker and less morbid recovery that may facilitate quicker resumption of needed adjuvant treatment.

Learning Objectives:

Upon completion, participants will be able to learn the usefulness of MIS surgery for gastric cancer after neoadjuvant chemotherapy.
Upon completion, participants will be able to know the oncological safety of MIS surgery for gastric cancer after neoadjuvant chemotherapy.
Upon completion, participants will be able to know define the surgical indication of MIS surgery for gastric cancer after neoadjuvant chemotherapy.