• Hylke J F Brenkman, Suzanne S Gisbertz, Annelijn E Slaman, Lucas Goense, Jelle P Ruurda, Mark I van Berge Henegouwen, Richard van Hillegersberg, and Dutch Upper Gastrointestinal Cancer Audit (DUCA) group.
• *Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands †Department of Surgery, Amsterdam Medical Center, Amsterdam, the Netherlands ‡Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
• Ann. Surg. 2017 Nov 1; 266 (5): 831-838.

ObjectiveTo compare postoperative outcomes of minimally invasive gastrectomy (MIG) to open gastrectomy (OG) for cancer during the introduction of MIG in the Netherlands.BackgroundBetween 2011 and 2015, the use of MIG increased from 4% to 53% in the Netherlands.MethodsThis population-based cohort study included all patients with curable gastric adenocarcinoma that underwent gastrectomy between 2011 and 2015, registered in the Dutch Upper GI Cancer Audit. Patients with missing preoperative data, and patients in whom no lymphadenectomy or reconstruction was performed were excluded. Propensity score matching was applied to create comparable groups between patients receiving MIG or OG, using year of surgery and other potential confounders. Morbidity, mortality, and hospital stay were evaluated.ResultsOf the 1697 eligible patients, 813 were discarded after propensity score matching; 442 and 442 patients who underwent MIG and OG, respectively, remained. Conversions occurred in 10% of the patients during MIG. Although the overall postoperative morbidity (37% vs 40%, P = 0.489) and mortality rates (6% vs 4%, P = 0.214) were comparable between the 2 groups, patients who underwent MIG experienced less wound complications (2% vs 5%, P = 0.006). Anastomotic leakage occurred in 8% of the patients after MIG, and in 7% after OG (P = 0.525). The median hospital stay declined over the years for both procedures (11 to 8 days, P < 0.001). Overall, hospital stay was shorter after MIG compared with OG (8 vs 10 days, P < 0.001).ConclusionsMIG was safely introduced in the Netherlands, with overall morbidity and mortality comparable with OG, less wound complications and shorter hospitalization.

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