TY - JOUR
T1 - Surgical quality and prospective quality control of the D2-gastrectomy for gastric cancer in the multicenter randomized LOGICA-trial
AU - de Jongh, Cas
AU - Triemstra, Lianne
AU - van der Veen, Arjen
AU - Brosens, Lodewijk A. A.
AU - Nieuwenhuijzen, Grard A. P.
AU - Stoot, Jan H. MB.
AU - de Steur, Wobbe O.
AU - Ruurda, Jelle P.
AU - van Hillegersberg, Richard
AU - Brenkman, Hylke J. F.
AU - Seesing, Maarten F. J.
AU - Luyer, Misha D. P.
AU - Ponten, Jeroen E. H.
AU - Tegels, Juul J. W.
AU - Hulsewe, Karel W. E.
AU - Hartgrink, Henk H.
AU - Wijnhoven, Bas P. L.
AU - Lagarde, Sjoerd M.
AU - Kouwenhoven, Ewout A.
AU - van Det, Marc J.
AU - Wassenaar, Eelco B.
AU - van Duijvendijk, P.
AU - Draaisma, Werner A.
AU - Broeders, Ivo A. MJ.
AU - van der Peet, Donald L.
AU - LOGICA Study Group
AU - Gisbertz, Suzanne S.
N1 - Funding Information: No funding was received nor requested for the current study. The LOGICA-trial (NCT02248519) was funded by ZonMw ( The Netherlands Organization for Health Research and Development ), project number 837002502 . The funder had no active role for the study or manuscript. Funding Information: The authors would like to thank all patients who participated in the LOGICA-trial and everyone in the participating hospitals who contributed in the data collection and local coordination of the LOGICA-trial. In addition, the authors would like to thank ZonMw , The Netherlands Organization for Health Research and Development , for supporting the LOGICA-trial financially under project number 837002502 . Moreover, the authors would like to thank PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, for acquiring the pathology reports. Funding Information: No funding was received nor requested for the current study. The LOGICA-trial (NCT02248519) was funded by ZonMw (The Netherlands Organization for Health Research and Development), project number 837002502. The funder had no active role for the study or manuscript.Richard van Hillegersberg: Consulting or Advisory Role: Intuitive Surgical, Medtronic. Jelle Ruurda: Consulting or Advisory Role: Intuitive Surgical. Lodewijk Brosens: Advisory Role: Bristol Myers Squibb. Grard Nieuwenhuijzen: Consulting or Advisory Role, Medtronic. Research Funding: Dutch Cancer Foundation. Travel, Accommodations, Expenses: Medtronic.The authors would like to thank all patients who participated in the LOGICA-trial and everyone in the participating hospitals who contributed in the data collection and local coordination of the LOGICA-trial. In addition, the authors would like to thank ZonMw, The Netherlands Organization for Health Research and Development, for supporting the LOGICA-trial financially under project number 837002502. Moreover, the authors would like to thank PALGA, the nationwide network and registry of histo- and cytopathology in the Netherlands, for acquiring the pathology reports. Publisher Copyright: © 2023 The Authors
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Background: Quality of gastric cancer surgery is crucial for favorable prognosis. Generally, prospective trials lack quality control measures. This study assessed surgical quality and a novel D2-lymphadenectomy photo-scoring in the LOGICA-trial. Methods: The multicenter LOGICA-trial randomized laparoscopic versus open total/distal D2-gastrectomy for resectable gastric cancer (cT1-4aN0-3M0) in 10 Dutch hospitals. During the trial, two reviewers prospectively analyzed intraoperative photographs of dissected nodal stations for quality control, and provided centers weekly feedback on their D2-lymphadenectomy, as continuous quality-enhancing incentive. After the trial, these photographs were reanalyzed to develop a photo-scoring for future trials, rating the D2-lymphadenectomy dissection quality (optimal-good-suboptimal-unevaluable). Interobserver variability was calculated (weighted kappa). Regression analyses related the photo-scoring to nodal yield, recurrence and 5-years survival. Results: Between 2015 and 2018, 212 patients underwent total/distal D2-gastrectomy (n = 122/n = 90), and 158 (75%) received neoadjuvant chemotherapy. R0-resection rate was 95%. Rate of ≥15 retrieved lymph nodes was 95%. Moderate agreement was obtained in stations 8 + 9 (κ = 0.522), 11p/11d (κ = 0.446) and 12a (κ = 0.441). Consensus was reached for discordant cases (30%). Stations 8 + 9, 11p/11d and 12a were rated ‘optimal’ in 76%, 63% and 68%. Laparoscopic photographs could be rated better than open (2% versus 12% ‘unevaluable’; 73% versus 50% ‘optimal’; p = 0.042). The photo-scoring did not show associations with nodal yield (p = 0.214), recurrence (p = 0.406) and survival (p = 0.988). Conclusions: High radicality and nodal yield demonstrated good quality of D2-gastrectomy. The prospective quality control probably contributed to this. The photo-scoring did not show good performance, but can be refined. Laparoscopic D2-gastrectomy was better suited for standardized surgical photo-evaluation than open surgery.
AB - Background: Quality of gastric cancer surgery is crucial for favorable prognosis. Generally, prospective trials lack quality control measures. This study assessed surgical quality and a novel D2-lymphadenectomy photo-scoring in the LOGICA-trial. Methods: The multicenter LOGICA-trial randomized laparoscopic versus open total/distal D2-gastrectomy for resectable gastric cancer (cT1-4aN0-3M0) in 10 Dutch hospitals. During the trial, two reviewers prospectively analyzed intraoperative photographs of dissected nodal stations for quality control, and provided centers weekly feedback on their D2-lymphadenectomy, as continuous quality-enhancing incentive. After the trial, these photographs were reanalyzed to develop a photo-scoring for future trials, rating the D2-lymphadenectomy dissection quality (optimal-good-suboptimal-unevaluable). Interobserver variability was calculated (weighted kappa). Regression analyses related the photo-scoring to nodal yield, recurrence and 5-years survival. Results: Between 2015 and 2018, 212 patients underwent total/distal D2-gastrectomy (n = 122/n = 90), and 158 (75%) received neoadjuvant chemotherapy. R0-resection rate was 95%. Rate of ≥15 retrieved lymph nodes was 95%. Moderate agreement was obtained in stations 8 + 9 (κ = 0.522), 11p/11d (κ = 0.446) and 12a (κ = 0.441). Consensus was reached for discordant cases (30%). Stations 8 + 9, 11p/11d and 12a were rated ‘optimal’ in 76%, 63% and 68%. Laparoscopic photographs could be rated better than open (2% versus 12% ‘unevaluable’; 73% versus 50% ‘optimal’; p = 0.042). The photo-scoring did not show associations with nodal yield (p = 0.214), recurrence (p = 0.406) and survival (p = 0.988). Conclusions: High radicality and nodal yield demonstrated good quality of D2-gastrectomy. The prospective quality control probably contributed to this. The photo-scoring did not show good performance, but can be refined. Laparoscopic D2-gastrectomy was better suited for standardized surgical photo-evaluation than open surgery.
KW - Gastric cancer
KW - Laparoscopic surgery
KW - Quality indicator
KW - Scoring system
KW - Surgical compliance
KW - Surgical quality
UR - http://www.scopus.com/inward/record.url?scp=85169024874&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ejso.2023.107018
DO - https://doi.org/10.1016/j.ejso.2023.107018
M3 - Article
C2 - 37651889
SN - 0748-7983
VL - 49
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 10
M1 - 107018
ER -