Predictors of Conversion During Minimally Invasive Gastrectomy for Malignancy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Minimally invasive gastrectomy (MIG) is increasingly used for gastric cancer.
• Risk factors for conversion to open surgery during laparoscopic and robotic gastrectomy are not well understood.

Purpose of the Study:

• To identify risk factors for conversion to open surgery during minimally invasive gastrectomy.
• To assess the impact of conversion on patient outcomes.

Main Methods:

• Analysis of the National Cancer Database (NCDB) for patients with clinical stage I-III gastric cancer (2010-2017).
• Comparison of laparoscopic versus robotic gastrectomy using chi-squared and t-tests.
• Multivariable logistic regression with propensity score weighting to identify predictors of conversion.

Main Results:

• Robotic-assisted gastrectomy had a lower conversion rate (7.8%) compared to laparoscopic (14.7%).
• Factors predicting conversion included larger tumor size (>5 cm), total gastrectomy, and tumors in the antrum/pylorus or body.
• Conversion was associated with longer hospital stays and higher rates of positive surgical margins.

Conclusions:

• Robotic gastrectomy is associated with a lower likelihood of conversion compared to laparoscopic gastrectomy.
• Conversion to open surgery negatively impacts hospital length of stay and surgical margin status.
• Identifying risk factors for conversion is crucial for selecting the optimal surgical modality.