• Sheraz R Markar, Maurits R Visser, Arjen van der Veen, LuyerMisha D PMDPDepartment of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Grard Nieuwenhuijzen, StootJan H M BJHMBDepartment of Surgery, Zuyderland Medical Center, Heerlen and Sittard-Geleen, The Netherlands., TegelsJuul J WJJWDepartment of Surgery, Zuyderland Medical Center, Heerlen and Sittard-Geleen, The Netherlands., WijnhovenBas P LBPLDepartment of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Sjoerd M Lagarde, Wobbe O de Steur, Henk H Hartgrink, Ewout A Kouwenhoven, Eelco B Wassenaar, Werner A Draaisma, Suzanne S Gisbertz, Mark I van Berge Henehouwen, Donald L van der Peet, Jelle P Ruurda, Richard van Hillegersberg, and LOGICA Study Group, Dutch Upper Gastrointestinal Cancer Audit Group.
• Nuffield Department of Surgery, University of Oxford, UK.
• Ann. Surg. 2024 Mar 1; 279 (3): 394401394-401.

ObjectiveTo examine the influence of the LOGICA RCT (randomized controlled trial) upon the practice and outcomes of laparoscopic gastrectomy within the Netherlands.BackgroundFollowing RCTs the dissemination of complex interventions has been poorly studied. The LOGICA RCT included 10 Dutch centers and compared laparoscopic to open gastrectomy.MethodsData 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.ResultsTwo 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.ConclusionsThe 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.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

20 keywords...

hide…