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Gastric Cancer Surgery in the US: a Contemporary Trend Analysis of Lymphadenectomy and the Impact of Minimally Invasive Approaches

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The National Comprehensive Cancer Network guidelines recommend harvesting 16 or more lymph nodes for the adequate staging of gastric adenocarcinoma. This study examines the rate of adequate lymphadenectomy over recent years, its predictors, and its impact on overall survival(OS).

Study design

The National Cancer Database was utilized to identify patients who underwent surgical treatment for gastric adenocarcinoma between 2006–2019. Trend analysis was performed for lymphadenectomy rates during the study period. Logistic regression, Kaplan-Meier survival plots, and Cox proportional hazard regression were utilized.

Results

A total of 57,039 patients who underwent surgical treatment for gastric adenocarcinoma were identified. Only 50.5% of the patients underwent a lymphadenectomy of ≥ 16 nodes. Trend analysis showed that this rate significantly improved over the years, from 35.1% in 2006 to 63.3% in 2019 (p < .0001). The main independent predictors of adequate lymphadenectomy included high-volume facility with ≥ 31 gastrectomies/year (OR: 2.71; 95%CI:2.46–2.99), surgery between 2015–2019 (OR: 1.68; 95%CI: 1.60–1.75), and preoperative chemotherapy (OR:1.49; 95%CI:1.41–1.58). Patients with adequate lymphadenectomy had better OS than patients who did not: median survival: 59 versus 43 months (Log-Rank: p < .0001). Adequate lymphadenectomy was independently associated with improved OS (HR:0.79; 95%CI:0.77–0.81). Laparoscopic and robotic gastrectomies were independently associated with adequate lymphadenectomy compared to open, OR: 1.11, 95%CI:1.05–1.18 and OR: 1.24, 95%CI:1.13–1.35, respectively.

Conclusion

Although the rate of adequate lymphadenectomy improved over the study period, a large number of patients still lacked adequate lymph node dissection, negatively impacting their OS despite multimodality therapy. Laparoscopic and robotic surgeries were associated with a significantly higher rate of lymphadenectomy ≥ 16 nodes.

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Data Availability

The National Cancer Database is available through the American College of Surgeons.

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Author information

Authors and Affiliations

  1. Division of General & GI Surgery, Department of Surgery, Emory University, 5673 Peachtree Dunwoody Rd, Suite 680, Atlanta, GA, 30342, USA

    Felipe B. Maegawa, Ankit D. Patel, Federico J. Serrot, Snehal G. Patel, Jamil L. Stetler, Dipan C. Patel, Juan M. Sarmiento & Edward Lin

  2. Department of Surgery, University of Arizona, Tucson, AZ, USA

    Iman Ghaderi & Chiu-Hsieh Hsu

  3. Saint Vincent Medical Center, Mercy Health, Toledo, OH, USA

    Yazan Ashouri

  4. Division of Surgical Oncology, Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, USA

    Ioannis T. Konstantinidis

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Contributions

Felipe B Maegawa: study design, analysis, interpretation of data, writing the manuscript, approving the final version.

Ankit D. Patel: conception, drafting and approving the final version of the manuscript.

Federico J. Serrot: conception, drafting and approving the final version of the manuscript.

Snehal G. Patel: conception, drafting and approving the final version of the manuscript.

Jamil L. Stetler: conception, drafting and approving the final version of the manuscript.

Dipan C. Patel: conception, drafting and approving the final version of the manuscript.

Iman Ghaderi: conception, drafting and approving the final version of the manuscript.

Chiu-Hsieh Hsu: analysis, interpretation of the data, and approving the final version of the manuscript.

Yazan Ashouri: conception, analysis, and approving the final version of the manuscript.

Juan M. Sarmiento: conception, drafting and approving the final version of the manuscript.

Ioannis T. Konstantinidis: design, acquisition of the data, drafting and approving the final version of the manuscript.

Edward Lin: design, drafting, and approving the final version of the manuscript.

All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Felipe B. Maegawa.

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Meeting presentation

This project was presented as an oral presentation at the Digestive Disease Week in Chicago, IL – May 6-9, 2023

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Maegawa, F.B., Patel, A.D., Serrot, F.J. et al. Gastric Cancer Surgery in the US: a Contemporary Trend Analysis of Lymphadenectomy and the Impact of Minimally Invasive Approaches. J Gastrointest Surg 27, 1825–1836 (2023). https://doi.org/10.1007/s11605-023-05735-4

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  • DOI: https://doi.org/10.1007/s11605-023-05735-4

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