Evolution in Laparoscopic Gastrectomy From a Randomized Controlled Trial Through National Clinical Practice.

Autor:	Markar SR; Nuffield Department of Surgery, University of Oxford, UK.; Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands., Visser MR; Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands.; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands., van der Veen A; Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands., Luyer MDP; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Nieuwenhuijzen G; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Stoot JHMB; Department of Surgery, Zuyderland Medical Center, Heerlen and Sittard-Geleen, The Netherlands., Tegels JJW; Department of Surgery, Zuyderland Medical Center, Heerlen and Sittard-Geleen, The Netherlands., Wijnhoven BPL; Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Lagarde SM; Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., de Steur WO; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Hartgrink HH; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Kouwenhoven EA; Department of Surgery, ZGT Hospitals, Almelo, The Netherlands., Wassenaar EB; Department of Surgery, Gelre Hospitals, Apeldoorn, The Netherlands., Draaisma WA; Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands., Gisbertz SS; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.; Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands., van Berge Henehouwen MI; Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.; Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands., van der Peet DL; Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands., Ruurda JP; Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands., van Hillegersberg R; Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Mar 01; Vol. 279 (3), pp. 394-401. Date of Electronic Publication: 2023 Nov 23.
DOI:	10.1097/SLA.0000000000006162
Abstrakt:	Objective: To examine the influence of the LOGICA RCT (randomized controlled trial) upon the practice and outcomes of laparoscopic gastrectomy within the Netherlands. Background: Following RCTs the dissemination of complex interventions has been poorly studied. The LOGICA RCT included 10 Dutch centers and compared laparoscopic to open gastrectomy. Methods: Data were obtained from the Dutch Upper Gastrointestinal Cancer Audit (DUCA) on all gastrectomies performed in the Netherlands (2012-2021), and the LOGICA RCT from 2015 to 2018. Multilevel multivariable logistic regression analyses were performed to assess the effect of laparoscopic versus open gastrectomy upon clinical outcomes before, during, and after the LOGICA RCT. Results: Two hundred eleven patients from the LOGICA RCT (105 open vs 106 laparoscopic) and 4131 patients from the DUCA data set (1884 open vs 2247 laparoscopic) were included. In 2012, laparoscopic gastrectomy was performed in 6% of patients, increasing to 82% in 2021. No significant effect of laparoscopic gastrectomy on postoperative clinical outcomes was observed within the LOGICA RCT. Nationally within DUCA, a shift toward a beneficial effect of laparoscopic gastrectomy upon complications was observed, reaching a significant reduction in overall [adjusted odds ratio (aOR):0.62; 95% CI: 0.46-0.82], severe (aOR: 0.64; 95% CI: 0.46-0.90) and cardiac complications (aOR: 0.51; 95% CI: 0.30-0.89) after the LOGICA trial. Conclusions: The wider benefits of the LOGICA trial included the safe dissemination of laparoscopic gastrectomy across the Netherlands. The robust surgical quality assurance program in the design of the LOGICA RCT was crucial to facilitate the national dissemination of the technique following the trial and reducing potential patient harm during surgeons learning curve. Competing Interests: The authors report no conflicts of interest. (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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