Copyright
©The Author(s) 2021.
World J Gastroenterol. Oct 21, 2021; 27(39): 6659-6672
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6659
Published online Oct 21, 2021. doi: 10.3748/wjg.v27.i39.6659
Table 1 Clinicopathological characteristics of the entire cohort
Variables | n = 814 |
Age, yr [IQR] | 68[61-74] |
Sex, n (%) | |
Male | 562 (69.0) |
Female | 252 (31.0) |
BMI, kg/m2 [IQR] | 22.2 [20.0-24.1] |
ASA, n (%) | |
1 | 314 (38.6) |
2 | 396 (48.6) |
3 | 104 (12.8) |
Clinical stage, n (%) | |
I | 558 (68.6) |
II | 125 (15.3) |
III | 121 (14.9) |
IV | 10 (1.2) |
Neoadjuvant chemotherapy, n (%) | 119 (14.6) |
Neoadjuvant radiotherapy, n (%) | 0 (0) |
Approach, n (%) | |
Laparoscopic | 657 (80.7) |
Robotic | 157 (19.3) |
Type of gastrectomy, n (%) | |
Distal | 559 (68.7) |
Total | 238 (29.2) |
Proximal | 16 (2.0) |
Pylorus preserving | 1 (0.1) |
Lymphadenectomy, n (%) | |
D1+ | 378 (46.4) |
D2 | 436 (53.6) |
Dissected nodes, n [IQR] | 38[28-48] |
Tumor size, mm [IQR] | 30[20-50] |
pT, n (%) | |
1 | 469 (57.6) |
2 | 87 (10.7) |
3 | 112 (13.8) |
4 | 138 (17.0) |
CR | 8 (1.0) |
pN, n (%) | |
0 | 559 (68.7) |
1 | 98 (12.0) |
2 | 79 (9.7) |
3 | 78 (9.6) |
pStage, n (%) | |
I | 498 (61.2) |
II | 160 (19.7) |
III | 148 (18.2) |
TCRNany | 8 (1.0) |
WHO histologic type, n (%) | |
Tub/pap | 402 (49.4) |
Por/sig | 352 (43.2) |
Mixed/other | 60 (7.4) |
Lymphovascular invasion, n (%) | 531 (65.2) |
Adjuvant chemotherapy, n (%) | 242 (29.7) |
Adjuvant radiotherapy, n (%) | 0 (0) |
Morbidity (C–D grade ≥ III), n (%) | 72 (8.8) |
Anastomotic leakage | 22 (2.7) |
Pancreatic fistula | 30 (3.7) |
Table 2 Factors associated with overall survival for the entire cohort (n = 814)
Univariate | Multivariate | |||||
HR | 95%CI | P | HR | 95%CI | P | |
Age > 65 yr | 1.46 | 1.04–2.06 | 0.031 | 1.62 | 1.09–2.40 | 0.017 |
Female sex | 0.75 | 0.52–1.09 | 0.129 | |||
BMI > 23 kg/m2 | 0.77 | 0.55–1.07 | 0.123 | |||
ASA | ||||||
1 | 1 | 1 | ||||
2 | 0.96 | 0.68–1.38 | 0.837 | 1.06 | 0.72–1.57 | 0.753 |
3 | 1.97 | 1.27–3.05 | 0.003 | 1.91 | 1.18–3.10 | 0.009 |
Neoadjuvant chemotherapy | 1.84 | 1.27–2.67 | 0.001 | 1.34 | 0.88–2.04 | 0.166 |
Robotic approach | 0.77 | 0.50–1.21 | 0.258 | |||
Type of gastrectomy | ||||||
Distal/pylorus-preserving | 1 | 1 | ||||
Total/proximal | 2.17 | 1.58–2.99 | < 0.001 | 1.45 | 1.03–2.05 | 0.036 |
D2 lymphadenectomy | 1.86 | 1.32–2.61 | < 0.001 | 0.87 | 0.57–1.33 | 0.528 |
Tumor > 30 mm | 3.23 | 2.20–4.75 | < 0.001 | 1.05 | 0.66–1.69 | 0.832 |
WHO histologic type | ||||||
Tub/pap | 1 | 1 | ||||
Por/sig/mixed/other | 1.54 | 1.12–2.13 | 0.009 | 1.26 | 0.89–1.78 | 0.190 |
Lymphovascular invasion | 4.38 | 2.68–7.17 | < 0.001 | 1.17 | 0.60–2.26 | 0.651 |
pT | ||||||
1 | 1 | 1 | ||||
2 | 2.82 | 1.62–4.91 | < 0.001 | 1.72 | 0.90–3.27 | 0.099 |
3 | 3.03 | 1.82–5.03 | < 0.001 | 1.54 | 0.82–2.91 | 0.184 |
4 | 9.78 | 6.54–14.60 | < 0.001 | 4.31 | 2.37–7.82 | < 0.001 |
CR | 1.67 | 0.23–12.17 | 0.613 | 1.34 | 0.16–10.97 | 0.784 |
pN | ||||||
0 | 1 | 1 | ||||
1 | 2.76 | 1.74–4.39 | < 0.001 | 2.02 | 1.22–3.34 | 0.007 |
2 | 4.05 | 2.56–6.41 | < 0.001 | 1.97 | 1.15–3.36 | 0.013 |
3 | 8.08 | 5.40–12.10 | < 0.001 | 2.92 | 1.79–4.78 | < 0.001 |
Adjuvant chemotherapy | 3.27 | 2.37–4.50 | < 0.001 | 1.21 | 0.80–1.82 | 0.371 |
Morbidity (C-D grade ≥ III) | 1.85 | 1.18–2.91 | 0.008 | 1.27 | 0.79–2.05 | 0.325 |
Table 3 Factors associated with recurrence-free survival for the entire cohort (n = 814)
Univariate | Multivariate | ||||||
HR | 95%CI | P | HR | 95%CI | P | ||
Age > 65 yr | 1.33 | 0.97–1.84 | 0.076 | 1.48 | 1.02–2.14 | 0.038 | |
Female sex | 0.76 | 0.54–1.06 | 0.108 | ||||
BMI > 23 kg/m2 | 0.77 | 0.56–1.05 | 0.100 | ||||
ASA | |||||||
1 | 1 | 1 | |||||
2 | 0.95 | 0.68–1.32 | 0.761 | 1.08 | 0.75–1.55 | 0.692 | |
3 | 1.67 | 1.09–2.55 | 0.018 | 1.62 | 1.02–2.60 | 0.043 | |
Neoadjuvant chemotherapy | 1.91 | 1.34–2.71 | < 0.001 | 1.39 | 0.93–2.08 | 0.104 | |
Robotic approach | 0.69 | 0.45–1.06 | 0.087 | 0.68 | 0.44–1.06 | 0.088 | |
Type of gastrectomy | |||||||
Distal/pylorus-preserving | 1 | 1 | |||||
Total/proximal | 2.24 | 1.66–3.02 | < 0.001 | 1.55 | 1.12–2.15 | 0.009 | |
D2 lymphadenectomy | 2.08 | 1.50–2.86 | < 0.001 | 0.99 | 0.66–1.48 | 0.957 | |
Tumor > 30 mm | 3.19 | 2.23–4.56 | < 0.001 | 0.95 | 0.61–1.48 | 0.827 | |
WHO histologic type | |||||||
Tub/pap | 1 | 1 | |||||
Por/sig/mixed/other | 0.54 | 0.14–2.08 | 0.005 | 1.20 | 0.86–1.66 | 0.284 | |
Lymphovascular invasion | 4.93 | 3.06–7.94 | < 0.001 | 1.29 | 0.69–2.43 | 0.430 | |
pT | |||||||
1 | 1 | 1 | |||||
2 | 2.87 | 1.69–4.85 | < 0.001 | 1.57 | 0.85–2.89 | 0.148 | |
3 | 3.42 | 2.13–5.48 | < 0.001 | 1.60 | 0.89–2.89 | 0.120 | |
4 | 10.62 | 7.26–15.53 | < 0.001 | 4.20 | 2.38–7.41 | < 0.001 | |
CR | 1.41 | 0.19–10.24 | 0.737 | 0.96 | 0.12–7.77 | 0.967 | |
pN | |||||||
0 | 1 | 1 | |||||
1 | 3.08 | 1.99–4.77 | < 0.001 | 2.23 | 1.39–3.58 | 0.001 | |
2 | 5.01 | 3.29–7.62 | < 0.001 | 2.24 | 1.36–3.70 | 0.002 | |
3 | 8.92 | 6.07–13.11 | < 0.001 | 3.32 | 2.06–5.34 | < 0.001 | |
Adjuvant chemotherapy | 3.53 | 2.62–4.77 | < 0.001 | 1.18 | 0.80–1.73 | 0.410 | |
Morbidity (C-D grade ≥ III) | 1.69 | 1.09–2.62 | 0.019 | 1.04 | 0.65–1.67 | 0.868 |
Table 4 Factors associated with recurrence-free survival for patients with pathological stage II/III disease (n = 308)
Univariate | Multivariate | |||||
HR | 95%CI | P | HR | 95%CI | P | |
Age > 65 yr | 1.04 | 0.73–1.48 | 0.848 | |||
Female sex | 1.08 | 0.75–1.58 | 0.673 | |||
BMI > 23 kg/m2 | 0.69 | 0.47–1.00 | 0.052 | 0.92 | 0.62–1.35 | 0.657 |
ASA | ||||||
1 | 1 | |||||
2 | 0.82 | 0.56–1.19 | 0.297 | |||
3 | 1.07 | 0.63–1.80 | 0.809 | |||
Neoadjuvant chemotherapy | 1.37 | 0.93–2.01 | 0.114 | |||
Robotic approach | 0.50 | 0.30–0.83 | 0.007 | 0.56 | 0.33–0.96 | 0.035 |
Type of gastrectomy | ||||||
Distal/pylorus-preserving | 1 | 1 | ||||
Total/proximal | 1.67 | 1.18–2.37 | 0.004 | 1.32 | 0.91–1.90 | 0.145 |
D2 lymphadenectomy | 1.26 | 0.80–2.00 | 0.320 | |||
Tumor > 30 mm | 2.17 | 1.17–4.03 | 0.014 | 1.34 | 0.69–2.60 | 0.303 |
WHO histologic type | ||||||
Tub/pap | 1 | 1 | ||||
Por/sig/mixed/other | 1.38 | 0.95–2.00 | 0.089 | 1.29 | 0.88–1.90 | 0.197 |
pT | ||||||
1 | 1 | 1 | ||||
2 | 1.82 | 0.60–5.53 | 0.292 | 1.33 | 0.42–4.23 | 0.628 |
3 | 1.32 | 0.47–3.75 | 0.6 | 1.45 | 0.49–4.30 | 0.505 |
4 | 3.96 | 1.45–10.83 | 0.007 | 3.52 | 1.23–10.07 | 0.019 |
pN | ||||||
0 | 1 | 1 | ||||
1 | 2.07 | 1.16–3.69 | 0.014 | 2.86 | 1.57–5.24 | 0.001 |
2 | 2.24 | 1.29–3.90 | 0.004 | 2.45 | 1.38–4.34 | 0.002 |
3 | 3.74 | 2.21–6.32 | < 0.001 | 3.25 | 1.88–5.61 | < 0.001 |
Adjuvant chemotherapy | 1.37 | 0.92–2.04 | 0.119 | |||
Morbidity (C-D grade ≥ III) | 1.58 | 0.97–2.58 | 0.066 | 1.22 | 0.73–2.05 | 0.453 |
Table 5 Clinicopathological characteristics of pStage II/III patients in the pre- and postmatched cohort
Prematched | Postmatched | |||||||
Lap (n = 241) | Robotic (n = 67) | P | ASD | Lap (n = 61) | Robotic (n = 61) | P | ASD | |
Sex, n (%) | 0.132 | 0.204 | 0.580 | 0.100 | ||||
Male | 174 (72.2) | 42 (62.7) | 35 (57.4) | 38 (62.3) | ||||
Female | 67 (27.8) | 25 (37.3) | 26 (42.6) | 23 (37.7) | ||||
Age, yr [IQR] | 69 [61–75] | 65 [60–77] | 0.134 | 0.235 | 68 [61–75] | 65 [60–77] | 0.824 | 0.042 |
BMI, kg/m2 [IQR] | 21.6 [19.2–23.7] | 23.1 [20.0–24.8] | 0.008 | 0.329 | 22.6 [20.4–24.9] | 23.0 [20.0–24.9] | 0.810 | 0.007 |
ASA, n (%) | 0.074 | 0.315 | 0.959 | 0.052 | ||||
1 | 89 (36.9) | 35 (52.2) | 31 (50.8) | 30 (49.2) | ||||
2 | 118 (49.0) | 24 (35.8) | 23 (37.7) | 23 (37.7) | ||||
3 | 34 (14.1) | 8 (11.9) | 7 (11.5) | 8 (13.1) | ||||
Neoadjuvant chemotherapy, n (%) | 61 (25.3) | 11 (16.4) | 0.128 | 0.220 | 10 (16.4) | 11 (18.0) | 0.810 | 0.043 |
Type of gastrectomy, n (%) | 0.075 | 0.329 | 1 | < 0.001 | ||||
Distal | 136 (56.4) | 48 (71.6) | 42 (68.9) | 42 (68.9) | ||||
Total | 104 (43.2) | 19 (28.4) | 19 (31.1) | 19 (31.1) | ||||
Proximal | 1 (0.4) | 0 (0) | 0 (0) | 0 (0) | ||||
Tumor size, mm [IQR] | 50[35-70] | 40[30-63] | 0.026 | 0.265 | 50 [35–77] | 43 [30–65] | 0.192 | 0.187 |
pT, n (%) | 0.042 | 0.391 | 0.860 | 0.158 | ||||
1 | 11 (4.6) | 8 (11.9) | 4 (6.6) | 6 (9.8) | ||||
2 | 35 (14.5) | 4 (6.0) | 4 (6.6) | 4 (6.6) | ||||
3 | 85 (35.3) | 27 (40.3) | 21 (34.4) | 23 (37.7) | ||||
4 | 110 (45.6) | 28 (41.8) | 32 (52.5) | 28 (45.9) | ||||
pN, n (%) | 0.15 | 0.338 | 0.617 | 0.244 | ||||
0 | 65 (27.0) | 24 (35.8) | 16 (26.2) | 22 (36.1) | ||||
1 | 48 (19.9) | 15 (22.4) | 17 (27.9) | 13 (21.3) | ||||
2 | 68 (28.2) | 10 (14.9) | 9 (14.8) | 10 (16.4) | ||||
3 | 60 (24.9) | 18 (26.9) | 19 (31.1) | 16 (26.2) | ||||
pStage, n (%) | 0.246 | 0.716 | ||||||
II | 121 (50.2) | 39 (58.2) | 32 (52.5) | 34 (55.7) | ||||
III | 120 (49.8) | 28 (41.8) | 29 (47.5) | 27 (44.3) | ||||
Dissected nodes, n [IQR] | 44 [35–53] | 43 [35–51] | 0.858 | 45 [35–54] | 43 [30-65] | 0.556 | ||
WHO histological type, n (%) | 0.667 | 0.229 | ||||||
Tub/pap | 88 (36.5) | 27 (41.8) | 17 (27.9) | 26 (42.6) | ||||
Por/sig | 129 (53.5) | 34 (50.7) | 37 (60.7) | 30 (49.2) | ||||
Mixed/other | 24 (10.0) | 5 (7.5) | 7 (11.5) | 5 (8.2) | ||||
Lymphovascular invasion, n (%) | 241 (100) | 66 (98.5) | 0.218 | 61 (100) | 60 (98.4) | 0.5 | ||
Adjuvant chemotherapy, n (%) | 161 (66.8) | 47 (70.1) | 0.605 | 38 (62.3) | 43 (70.5) | 0.338 | ||
Morbidity (C-D grade ≥ III), n (%) | 31 (12.9) | 3 (4.5) | 0.053 | 10 (16.4) | 3 (4.9) | 0.04 |
- Citation: Nakauchi M, Suda K, Shibasaki S, Nakamura K, Kadoya S, Kikuchi K, Inaba K, Uyama I. Prognostic factors of minimally invasive surgery for gastric cancer: Does robotic gastrectomy bring oncological benefit? World J Gastroenterol 2021; 27(39): 6659-6672
- URL: https://www.wjgnet.com/1007-9327/full/v27/i39/6659.htm
- DOI: https://dx.doi.org/10.3748/wjg.v27.i39.6659