Surgical quality and prospective quality control of the D2-gastrectomy for gastric cancer in the multicenter randomized LOGICA-trial

Cas de Jongh; Lianne Triemstra; Arjen van der Veen; Lodewijk Aa Brosens; Grard Ap Nieuwenhuijzen; Jan Hmb Stoot; Wobbe O de Steur; Jelle P Ruurda; Richard van Hillegersberg; LOGICA Study Group

doi:10.1016/j.ejso.2023.107018

Surgical quality and prospective quality control of the D2-gastrectomy for gastric cancer in the multicenter randomized LOGICA-trial

Eur J Surg Oncol. 2023 Oct;49(10):107018. doi: 10.1016/j.ejso.2023.107018. Epub 2023 Aug 12.

Authors

Cas de Jongh¹, Lianne Triemstra¹, Arjen van der Veen¹, Lodewijk Aa Brosens², Grard Ap Nieuwenhuijzen³, Jan Hmb Stoot⁴, Wobbe O de Steur⁵, Jelle P Ruurda¹, Richard van Hillegersberg⁶; LOGICA Study Group

Collaborators

LOGICA Study Group:
Hylke Jf Brenkman¹, Maarten F J Seesing¹, Misha Dp Luyer³, Jeroen Eh Ponten³, Juul Jw Tegels⁴, Karel We Hulsewe⁴, Henk H Hartgrink⁵, Bas Pl Wijnhoven⁷, Sjoerd M Lagarde⁷, Ewout A Kouwenhoven⁸, Marc J van Det⁸, Eelco B Wassenaar⁹, P van Duijvendijk⁹, Werner A Draaisma¹⁰, Ivo Amj Broeders¹⁰, Donald L van der Peet¹¹, Suzanne S Gisbertz¹²

Affiliations

¹ University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands.
² UMC Utrecht, Department of Pathology, Utrecht, the Netherlands.
³ Catharina Hospital Eindhoven, Department of Surgery, Eindhoven, the Netherlands.
⁴ Zuyderland Medical Center, Department of Surgery, Sittard, the Netherlands.
⁵ Leiden UMC, Department of Surgery, Leiden, the Netherlands.
⁶ University Medical Center (UMC) Utrecht, Department of Surgery, Utrecht, the Netherlands. Electronic address: R.vanHillegersberg@umcutrecht.nl.
⁷ Erasmus UMC, Department of Surgery, Rotterdam, the Netherlands.
⁸ ZGT Almelo, Department of Surgery, Almelo, the Netherlands.
⁹ Gelre Hospitals Apeldoorn, Department of Surgery, Apeldoorn, the Netherlands.
¹⁰ Meander Medical Center, Department of Surgery, Amersfoort, the Netherlands.
¹¹ Amsterdam UMC, Location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Treatment and Quality of Life, Cancer Center Amsterdam, the Netherlands.
¹² Cancer Treatment and Quality of Life, Cancer Center Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije University, Department of Surgery, Amsterdam, the Netherlands.

PMID: 37651889
DOI: 10.1016/j.ejso.2023.107018

Abstract

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.

Keywords: Gastric cancer; Laparoscopic surgery; Quality indicator; Scoring system; Surgical compliance; Surgical quality.

Publication types

Multicenter Study

MeSH terms

Gastrectomy
Humans
Laparoscopy*
Lymph Node Excision
Prospective Studies
Quality Control
Stomach Neoplasms* / pathology
Stomach Neoplasms* / surgery