NSQIP Outcomes for Open and Minimally Invasive Gastrectomy for Malignancy

ACS-NSQIP began capturing operative approach in 2022. With increased adoption of minimally invasive (MIS) techniques for malignancy, a contemporary review of benchmark outcomes for open, laparoscopic and robotic gastrectomy is warranted.

We performed a retrospective cohort study of adults in ACS-NSQIP (2022-2024) undergoing partial or total gastrectomy (CPT 43631-4 and 43620-2) for cancer. Outcomes included operative time, length of stay (LOS), unplanned conversion-to-open, and 30-day morbidity, mortality, and readmission. Multivariable logistic regression evaluated patient and operative factors associated with morbidity.

Among 1,459 patients (median age 66, 60.4% male), 66.8% underwent partial gastrectomy and 33.2% total gastrectomy. Approaches were 61.2% open, 19.5% laparoscopic, and 19.3% robotic. Thirty-day mortality (1.8%), major complications (18.2%), and readmissions (10.3%) did not differ by approach. Unplanned conversion-to-open occurred in 14.0% of MIS. Robotic had longer median operative time of +1.2 and +1.7 h than laparoscopic and open and median -1 and -2 days shorter LOS respectively (p < 0.001). Hypoalbuminemia (OR 3.10), CKD ≥ 3 (OR 1.75), and anemia (OR 1.48) were independently associated with major complications (p < 0.05).

Operative approach influences operative time and LOS but not short-term morbidity and mortality. The newly available ACS-NSQIP operative approach variable enables approach-specific benchmarks for cancer-related gastrectomy.