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ROBOTIC GASTRECTOMY FOR GASTRIC TUMORS: A SINGLE INSTITUTION COMPARED TO THE NATIONAL CANCER DATABASE
Alona Bilik
*, Garnet Vanterpool, Iswanto Sucandy, Melanie Mendez, Paola Piascik, Kristina Milivojev Covilo, Sharona B. Ross
Digestive Health Institute, Advent Health Tampa, Tampa, FL
Background: Gastric cancer remains the fourth leading cause of cancer-related deaths globally. Robotic gastrectomy has emerged as a new innovative surgical approach for the treatment of gastric cancer and other gastric tumors. Limited literature comparing postoperative outcomes of patients who had robotic gastrectomy for gastric tumors. This study aims to conduct a comparative analysis of patients undergoing robotic gastrectomy by one team at a single institution with reported data in the National Cancer Database (NCDB).
Methods: With Institutional Review Board (IRB) approval, a retrospective analysis was performed on 113 patients from our institution and 5,913 patients from the NCDB who underwent robotic gastrectomy between 2013 and 2024. The data was compared with the NCDB from 2011 to 2020. Patients with missing variables in the NCDB were excluded. Using 1:1 propensity score matching (PSM), the balance between the two groups was controlled, resulting in 40 matched patients. The PSM factors used were demographic data (age, sex, Charlson Comorbidity Score); Tumor (histology, grade, size, AJCC staging); Postoperative (length of stay, readmission, 30 and 90 days mortality, overall survival). Limitations of the NCDB included a lack of intraoperative and postoperative complications. Data are presented as median (mean ± SD). Statistical significance was accepted at p ? 0.05.
Results: The median patient age was 63 years and 53% were women. The median length of stay at our institution was 3 days, compared to 8 days reported in the NCDB cohort (p-value= <0.001). All patients at our institution achieved R0 resection status, compared to 33 patients (83%) in the NCDB (p-value=0.01). The NCDB 30-day readmission rate was 30%, substantially higher than 7% at our institution (p-value=0.005). The 30-day mortality rate for our institution was 0% compared to 13% reported in the NCDB cohort (p-value=0.04). The 90-day mortality rate for our institution was 0% compared to 20% reported in the NCDB (p-value=0.002). Follow-up time for gastrointestinal stromal tumors was 70 months at our institution vs 60 months in NCDB (p-value=0.01). For neuroendocrine tumors, follow-up time was 70 months at our institution vs 51 months in NCDB (p-value=0.02). For adenocarcinoma, follow-up time was 68 months at our institution vs 60 months in NCDB (p-value=0.03).
Conclusion: Robotic gastrectomy for gastric cancer performed in a single institution by one team is safe and shows improved short and long-term outcomes and better survival rates compared to the NCDB. Emphasizing the importance of the learning curve of a surgeon and the importance of developing centers of excellence for treating gastric cancer.
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