title: A multi-institutional analysis of open versus minimally-invasive surgery for gastric adenocarcinoma: results of the US gastric cancer collaborative.
abstract: BACKGROUND
  Surgical experience with minimally invasive surgery (MIS) has increased; however, published reports on MIS resection of gastric adenocarcinoma are limited.
  
  
  METHODS
  Between 2000 and 2012, 880 patients who underwent surgical resection of gastric adenocarcinoma were identified from a multi-institutional database. Clinicopathological characteristics, operative details, and outcomes were stratified by operative approach (open vs. MIS) and analyzed.
  
  
  RESULTS
  Overall, 70 (8 %) patients had a MIS approach. Patients who underwent a MIS resection were more likely to have a smaller tumor (open 4.5 cm vs. MIS 3.0 cm, p < 0.001). MIS resections were associated with lower estimated blood loss (open 250 cc vs. MIS 150 cc) and longer operative time (open 232 min vs. MIS 271 min) compared with open surgery (both p < 0.05). An R0 resection was achieved in most patients (open 90.9 % vs. MIS 98.6 %, p = 0.03) and median lymph node yield was good in both groups (open 17 vs. MIS 14, p = 0.10). MIS had a similar incidence of complications (open 33.1 % vs. MIS 20 %, p = 0.07) and a similar length of stay (open 9 days vs. MIS 7 days, p = 0.13) compared with open surgery. In the propensity-matched analysis, median recurrence-free and overall were not impacted by operative approach.
  
  
  CONCLUSIONS
  An MIS approach to gastric cancer was associated with adequate lymph node retrieval, a high incidence of R0 resection, and comparable long-term oncological outcomes versus open gastrectomy.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.forename: Yuhree
authors.initials: Y
authors.lastname: Kim
authors.forename: Aslam
authors.initials: A
authors.lastname: Ejaz
authors.forename: Vicente
authors.initials: V
authors.lastname: Valero
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Squires
authors.forename: George
authors.initials: G
authors.lastname: Poultsides
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.forename: Alexandra W
authors.initials: AW
authors.lastname: Acher
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Votanopoulos
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; D018572:Disease-Free Survival; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D018365:Neoplasm, Residual; D061646:Operative Time; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D047368:Tumor Burden; D014481:United States