Surgical quality and prospective quality control of the D2-gastrectomy for gastric cancer in the multicenter randomized LOGICA-trial.

Autor: de Jongh C; University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands., Triemstra L; University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands., van der Veen A; University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands., Brosens LA; UMC Utrecht, Department of Pathology, Utrecht, the Netherlands., Nieuwenhuijzen GA; Catharina Hospital Eindhoven, Department of Surgery, Eindhoven, the Netherlands., Stoot JH; Zuyderland Medical Center, Department of Surgery, Sittard, the Netherlands., de Steur WO; Leiden UMC, Department of Surgery, Leiden, the Netherlands., Ruurda JP; University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands., van Hillegersberg R; University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands. Electronic address: R.vanHillegersberg@umcutrecht.nl.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2023 Oct; Vol. 49 (10), pp. 107018. Date of Electronic Publication: 2023 Aug 12.
DOI: 10.1016/j.ejso.2023.107018
Abstrakt: Background: Quality of gastric cancer surgery is crucial for favorable prognosis. Generally, prospective trials lack quality control measures. This study assessed surgical quality and a novel D2-lymphadenectomy photo-scoring in the LOGICA-trial.
Methods: The multicenter LOGICA-trial randomized laparoscopic versus open total/distal D2-gastrectomy for resectable gastric cancer (cT1-4aN0-3M0) in 10 Dutch hospitals. During the trial, two reviewers prospectively analyzed intraoperative photographs of dissected nodal stations for quality control, and provided centers weekly feedback on their D2-lymphadenectomy, as continuous quality-enhancing incentive. After the trial, these photographs were reanalyzed to develop a photo-scoring for future trials, rating the D2-lymphadenectomy dissection quality (optimal-good-suboptimal-unevaluable). Interobserver variability was calculated (weighted kappa). Regression analyses related the photo-scoring to nodal yield, recurrence and 5-years survival.
Results: Between 2015 and 2018, 212 patients underwent total/distal D2-gastrectomy (n = 122/n = 90), and 158 (75%) received neoadjuvant chemotherapy. R0-resection rate was 95%. Rate of ≥15 retrieved lymph nodes was 95%. Moderate agreement was obtained in stations 8 + 9 (κ = 0.522), 11p/11d (κ = 0.446) and 12a (κ = 0.441). Consensus was reached for discordant cases (30%). Stations 8 + 9, 11p/11d and 12a were rated 'optimal' in 76%, 63% and 68%. Laparoscopic photographs could be rated better than open (2% versus 12% 'unevaluable'; 73% versus 50% 'optimal'; p = 0.042). The photo-scoring did not show associations with nodal yield (p = 0.214), recurrence (p = 0.406) and survival (p = 0.988).
Conclusions: High radicality and nodal yield demonstrated good quality of D2-gastrectomy. The prospective quality control probably contributed to this. The photo-scoring did not show good performance, but can be refined. Laparoscopic D2-gastrectomy was better suited for standardized surgical photo-evaluation than open surgery.
Competing Interests: Declaration of competing interest Richard van Hillegersberg: Consulting or Advisory Role: Intuitive Surgical, Medtronic. Jelle Ruurda: Consulting or Advisory Role: Intuitive Surgical. Lodewijk Brosens: Advisory Role: Bristol Myers Squibb. Grard Nieuwenhuijzen: Consulting or Advisory Role, Medtronic. Research Funding: Dutch Cancer Foundation. Travel, Accommodations, Expenses: Medtronic.
(© 2023 Published by Elsevier Ltd.)
Databáze: MEDLINE
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