P70: Does Minimally Invasive Gastrectomy Impact Return to Intended Oncologic Therapy for Gastric Cancer?

We analyzed 105 patients meeting our inclusion criteria. Sixty-nine (65.7%) patients underwent OG, and 36 (34.3%) underwent MIG. The median age was 65 years (18-85). The majority of patients were male (58.1%), and 35/105 (33.3%) were white. Sixty-five (61.9%) patients received neoadjuvant chemotherapy. There were no differences in demographics, performance status, comorbid conditions, or type of gastric resection between patients undergoing OG vs. MIG. Patients undergoing MIG were more likely to receive neoadjuvant chemotherapy (p=0.013), have Roux-en-Y reconstruction (p=0.007), and have lower blood loss (p=0.001) compared to patients undergoing OG. Eighty-seven (82.9%) patients were eligible for adjuvant chemotherapy, and remaining patients had upfront resection with pathological T1 disease. The overall RIOT rate was 71.3% (62/88). The RIOT rate for OG (60.7%) was significantly lower than for MIG (90.3%, p=0.003). On UVA, other factors associated with higher RIOT rate were age < 65, intraoperative blood loss < 150mL, Clavien-Dindo (CD) complication grade < 3, reoperation during index hospitalization, and readmission within 30 days (p < 0.05). On MVA, minimally invasive approach was independently associated with higher odds of RIOT (OR: 13.1, 95%CI: 2.3-74.3, p=0.004). The odds of RIOT were significantly reduced with age >65 years (OR: 0.26, 95%CI: 0.08-0.8, p=0.023) and major postoperative complication (CD grade ≥ 3) (OR: 0.06, 95%CI: 0.01-0.4, p=0.001). 

Conclusions: Minimally invasive gastrectomy impacts receipt of postoperative chemotherapy in patients with gastric cancer. We report a higher rate of return to adjuvant chemotherapy compared to published data, supporting minimally invasive gastrectomy over open gastrectomy.