Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population-on behalf of the Italian Research Group for Gastric Cancer.

Humans Stomach Neoplasms / pathology Propensity Score Retrospective Studies Adenocarcinoma / pathology Treatment Outcome Gastrectomy / adverse effects Laparoscopy / adverse effects
Advanced gastric cancer Gastrectomy Laparoscopy Minimally invasive surgery Survival

Journal

Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
ISSN: 1436-3305
Titre abrégé: Gastric Cancer
Pays: Japan
ID NLM: 100886238

Informations de publication

Date de publication:
11 2022
Historique:
received: 05 04 2022
accepted: 05 07 2022
pubmed: 22 7 2022
medline: 26 10 2022
entrez: 21 7 2022
Statut: ppublish

Résumé

Oncologic outcomes after laparoscopic gastrectomy for advanced gastric cancer in the West have been poorly investigated. The aim of the present study was to compare survival outcomes in patients undergoing curative-intent laparoscopic and open gastrectomy for advanced gastric cancer in several centres belonging to the Italian Research Group for Gastric Cancer. Data of patients operated between 2015 and 2018 were retrospectively analysed. Propensity Score Matching was performed to balance baseline characteristics of patients undergoing laparoscopic and open gastrectomy. The primary endpoint was 3-year overall survival. Secondary endpoints were 3-year disease-free survival and short-term outcomes. Multivariable regression analyses for survival were conducted. Data were retrieved from 20 centres. Of the 717 patients included, 438 patients were correctly matched, 219 per group. The 3-year overall survival was 73.6% and 68.7% in the laparoscopic and open group, respectively (p = 0.40). When compared with open gastrectomy, laparoscopic gastrectomy showed comparable 3-year disease-free survival (62.8%, vs 58.9%, p = 0.40), higher rate of return to intended oncologic treatment (56.9% vs 40.2%, p = 0.001), similar 30-day morbidity/mortality. Prognostic factors for survival were ASA Score ≥ 3, age-adjusted Charlson Comorbidity Index ≥ 5, lymph node ratio ≥ 0.15, p/ypTNM Stage III and return to intended oncologic treatment. Laparoscopic gastrectomy for advanced gastric cancer offers similar rates of survival when compared to open gastrectomy, with higher rates of return to intended oncologic treatment. ASA score, age-adjusted Charlson Comorbidity Index, lymph node ratio, return to intended oncologic treatment and p/ypTNM Stage, but not surgical approach, are prognostic factors for survival.

Sections du résumé

BACKGROUND
Oncologic outcomes after laparoscopic gastrectomy for advanced gastric cancer in the West have been poorly investigated. The aim of the present study was to compare survival outcomes in patients undergoing curative-intent laparoscopic and open gastrectomy for advanced gastric cancer in several centres belonging to the Italian Research Group for Gastric Cancer.
METHODS
Data of patients operated between 2015 and 2018 were retrospectively analysed. Propensity Score Matching was performed to balance baseline characteristics of patients undergoing laparoscopic and open gastrectomy. The primary endpoint was 3-year overall survival. Secondary endpoints were 3-year disease-free survival and short-term outcomes. Multivariable regression analyses for survival were conducted.
RESULTS
Data were retrieved from 20 centres. Of the 717 patients included, 438 patients were correctly matched, 219 per group. The 3-year overall survival was 73.6% and 68.7% in the laparoscopic and open group, respectively (p = 0.40). When compared with open gastrectomy, laparoscopic gastrectomy showed comparable 3-year disease-free survival (62.8%, vs 58.9%, p = 0.40), higher rate of return to intended oncologic treatment (56.9% vs 40.2%, p = 0.001), similar 30-day morbidity/mortality. Prognostic factors for survival were ASA Score ≥ 3, age-adjusted Charlson Comorbidity Index ≥ 5, lymph node ratio ≥ 0.15, p/ypTNM Stage III and return to intended oncologic treatment.
CONCLUSIONS
Laparoscopic gastrectomy for advanced gastric cancer offers similar rates of survival when compared to open gastrectomy, with higher rates of return to intended oncologic treatment. ASA score, age-adjusted Charlson Comorbidity Index, lymph node ratio, return to intended oncologic treatment and p/ypTNM Stage, but not surgical approach, are prognostic factors for survival.

Identifiants

DOI: 10.1007/s10120-022-01321-w PMID: 35864239
pubmed: 35864239
doi: 10.1007/s10120-022-01321-w
pii: 10.1007/s10120-022-01321-w
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1105-1116

Investigateurs

A Agnes (A)
S Alfieri (S)
M Alloggio (M)
M Bencivenga (M)
M Benedetti (M)
A Bottari (A)
F Cianchi (F)
E Cocozza (E)
G Dalmonte (G)
P De Martini (P)
S De Pascale (S)
M Desio (M)
G Emiliani (G)
G Ercolani (G)
F Galli (F)
I Garosio (I)
A Giani (A)
M Gualtierotti (M)
L Marano (L)
P Morgagni (P)
A Peri (A)
F Puccetti (F)
R Reddavid (R)
M Uccelli (M)

Informations de copyright

© 2022. The Author(s) under exclusive licence to The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

Références

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.
doi: 10.1002/ijc.29210
Sitarz R, Skierucha M, Mielko J, Offerhaus J, Maciejewski R, Polkowski W. Gastric cancer: epidemiology, prevention, classification, and treatment. Cancer Manag Res. 2018. https://doi.org/10.2147/cmar.s149619 .
doi: 10.2147/cmar.s149619 pubmed: 29445300 pmcid: 5808709
Griffin SM. Gastric cancer in the East: same disease, different patient. Br J Surg. 2005;92:1055–6.
doi: 10.1002/bjs.5121
Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg. 2005;241:27–39.
doi: 10.1097/01.sla.0000149300.28588.23
Al-Batran S-E, Homann N, Pauligk C, Goetze TO, Meiler J, Kasper S, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet Elsevier BV. 2019;393:1948–57.
doi: 10.1016/S0140-6736(18)32557-1
Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.
doi: 10.1056/NEJMoa072252
Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.
pubmed: 8180768
Lee H-J, Hyung WJ, Yang H-K, Han SU, Park Y-K, An JY, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg. 2019;270:983–91.
doi: 10.1097/SLA.0000000000003217
Huang C, Liu H, Hu Y, Sun Y, Su X, Cao H, et al. Laparoscopic vs open distal gastrectomy for locally advanced gastric cancer: five-year outcomes from the CLASS-01 randomized clinical trial. JAMA Surg. 2022;157:9–17.
doi: 10.1001/jamasurg.2021.5104
Kitano S, Shiraishi N, Kakisako K, Yasuda K, Inomata M, Adachi Y. Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years’ experience. Surg Laparosc Endosc Percutan Tech. 2002;12:204–7.
doi: 10.1097/00129689-200206000-00021
van der Wielen N, Straatman J, Daams F, Rosati R, Parise P, Weitz J, et al. Open versus minimally invasive total gastrectomy after neoadjuvant chemotherapy: results of a European randomized trial. Gastric Cancer. 2021;24:258–71.
doi: 10.1007/s10120-020-01109-w
Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z. Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis. PLoS ONE. 2014;9:e88753.
doi: 10.1371/journal.pone.0088753
Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20:699–708.
doi: 10.1007/s10120-016-0646-9
Kim H-H, Han S-U, Kim M-C, Kim W, Lee H-J, Ryu SW, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer: the KLASS-01 randomized clinical trial. JAMA Oncol. 2019;5:506–13.
doi: 10.1001/jamaoncol.2018.6727
Beyer K, Baukloh A-K, Kamphues C, Seeliger H, Heidecke C-D, Kreis ME, et al. Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a systematic review and meta-analysis of randomized controlled studies. World J Surg Oncol. 2019;17:68.
doi: 10.1186/s12957-019-1600-1
De Manzoni G, Roviello F, Siquini W. Surgery in the multimodal management of gastric cancer. Berlin: Springer Science & Business Media; 2012.
doi: 10.1007/978-88-470-2318-5
Institute NC, National Cancer Institute. AJCC cancer staging manual 8th Edition. Definitions. 2020. https://doi.org/10.32388/b30ldk
Claassen YHM, van Sandick JW, Hartgrink HH, Dikken JL, De Steur WO, van Grieken NCT, et al. Association between hospital volume and quality of gastric cancer surgery in the CRITICS trial. Br J Surg. 2018;105:728–35.
doi: 10.1002/bjs.10773
Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007;245:543–52.
doi: 10.1097/01.sla.0000250423.43436.e1
Lombardi PM, Mazzola M, Achilli P, Aquilano MC, De Martini P, Curaba A, et al. Prognostic value of pathological tumor regression grade in locally advanced gastric cancer: new perspectives from a single-center experience. J Surg Oncol. 2021. https://doi.org/10.1002/jso.26391 .
doi: 10.1002/jso.26391 pubmed: 33497471
De Manzoni G, Marrelli D, Baiocchi GL, Morgagni P, Saragoni L, Degiuli M, et al. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer. 2017;20:20–30.
doi: 10.1007/s10120-016-0615-3
Ajani J, D’Amico T, Bentrem D, Chao J, Corvera C, Al PD et al. NCCN Clinical Practice Guidelines in Oncology Gastric Cancer. 2020.
Association JGC, Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021. https://doi.org/10.1007/s10120-020-01042-y
Aloia TA, Zimmitti G, Conrad C, Gottumukalla V, Kopetz S, Vauthey J-N. Return to intended oncologic treatment (RIOT): a novel metric for evaluating the quality of oncosurgical therapy for malignancy. J Surg Oncol. 2014;110:107–14.
doi: 10.1002/jso.23626
Baiocchi GL, Giacopuzzi S, Marrelli D, Reim D, Piessen G, Matosda Costa P, et al. International consensus on a complications list after gastrectomy for cancer. Gastric Cancer. 2019;22:172–89.
doi: 10.1007/s10120-018-0839-5
Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28:3083–107.
doi: 10.1002/sim.3697
de Manzoni G, Roviello F. Gastric cancer: the 25-year R-evolution. Springer Nature; 2021.
Yoshida K, Yamaguchi K, Okumura N, Tanahashi T, Kodera Y. Is conversion therapy possible in stage IV gastric cancer: the proposal of new biological categories of classification. Gastric Cancer. 2016;19:329–38.
doi: 10.1007/s10120-015-0575-z
Song JH, Lee S, Choi S, Cho M, Kwon IG, Kim YM, et al. Adverse prognostic impact of postoperative complications after gastrectomy for patients with stage II/III gastric cancer: analysis of prospectively collected real-world data. Front Oncol Front. 2021. https://doi.org/10.3389/fonc.2021.611510 .
doi: 10.3389/fonc.2021.611510
Mazzola M, Giani A, Crippa J, Morini L, Zironda A, Bertoglio CL, et al. Totally laparoscopic pancreaticoduodenectomy: comparison between early and late phase of an initial single-center learning curve. Indian J Surg Oncol. 2021;12:688–98.
doi: 10.1007/s13193-021-01422-5
Liu F, Huang C, Xu Z, Su X, Zhao G, Ye J, et al. Morbidity and mortality of laparoscopic vs open total gastrectomy for clinical stage I gastric cancer: the CLASS02 multicenter randomized clinical trial. JAMA Oncol. 2020;6:1590–7.
doi: 10.1001/jamaoncol.2020.3152
Hyung WJ, Yang H-K, Han S-U, Lee Y-J, Park J-M, Kim JJ, et al. A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer. 2019. https://doi.org/10.1007/s10120-018-0864-4 .
doi: 10.1007/s10120-018-0864-4 pubmed: 30830639
Hyung WJ, Yang H-K, Park Y-K, Lee H-J, An JY, Kim W, et al. Long-term outcomes of laparoscopic distal gastrectomy for locally advanced gastric cancer: the KLASS-02-RCT randomized clinical trial. J Clin Oncol. 2020;38:3304–13.
doi: 10.1200/JCO.20.01210
Cai J, Wei D, Gao CF, Zhang CS, Zhang H, Zhao T. A Prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. DSU Karger Publishers. 2011;28:331–7.
Bracale U, Merola G, Pignata G, Andreuccetti J, Dolce P, Boni L, et al. Laparoscopic gastrectomy for stage II and III advanced gastric cancer: long-term follow-up data from a Western multicenter retrospective study. Surg Endosc. 2021. https://doi.org/10.1007/s00464-021-08505-y .
doi: 10.1007/s00464-021-08505-y pubmed: 33877411 pmcid: 8921054
van der Veen A, Brenkman HJF, Seesing MFJ, Haverkamp L, Luyer MDP, Nieuwenhuijzen GAP, et al. Laparoscopic versus open gastrectomy for gastric cancer (LOGICA): a multicenter randomized clinical trial. J Clin Oncol. 2021;39:978–89.
doi: 10.1200/JCO.20.01540
Lombardo F, Aiolfi A, Cavalli M, Mini E, Lastraioli C, Panizzo V, et al. Techniques for reconstruction after distal gastrectomy for cancer: updated network meta-analysis of randomized controlled trials. Langenbecks Arch Surg. 2022. https://doi.org/10.1007/s00423-021-02411-6 .
doi: 10.1007/s00423-021-02411-6 pubmed: 36242619
Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol. 2016;34:1350–7.
doi: 10.1200/JCO.2015.63.7215
Kelly KJ, Selby L, Chou JF, Dukleska K, Capanu M, Coit DG, et al. Laparoscopic versus open gastrectomy for gastric adenocarcinoma in the west: a case–control study. Ann Surg Oncol. 2015. https://doi.org/10.1245/s10434-015-4381-y .
doi: 10.1245/s10434-015-4381-y pubmed: 26678406 pmcid: 5841914
Russo A, Strong VE. Minimally invasive surgery for gastric cancer in USA: current status and future perspectives. Transl Gastroenterol Hepatol. 2017;2:38.
doi: 10.21037/tgh.2017.03.14
Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, et al. A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg. 2015;39:2734–41.
doi: 10.1007/s00268-015-3160-z
Best LMJ, Mughal M, Gurusamy KS. Laparoscopic versus open gastrectomy for gastric cancer. Cochrane Database Syst Rev. 2016;3:1CD011389.
Yu J, Huang C, Sun Y, Su X, Cao H, Hu J, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the CLASS-01 randomized clinical trial. JAMA. 2019;321:1983–92.
doi: 10.1001/jama.2019.5359
Trastulli S, Desiderio J, Lin J-X, Reim D, Zheng C-H, Borghi F, et al. Laparoscopic compared with open D2 gastrectomy on perioperative and long-term, stage-stratified oncological outcomes for gastric cancer: a propensity score-matched analysis of the IMIGASTRIC database. Cancers. 2021. https://doi.org/10.3390/cancers13184526 .
doi: 10.3390/cancers13184526 pubmed: 34572753 pmcid: 8465518
Garbarino GM, Costa G, Laracca GG, Castagnola G, Mercantini P, Di Paola M, et al. Laparoscopic versus open distal gastrectomy for locally advanced gastric cancer in middle-low-volume centers in Western countries: a propensity score matching analysis. Langenbecks Arch Surg. 2020;405:797–807.
doi: 10.1007/s00423-020-01951-7
Orsenigo E, Di Palo S, Tamburini A, Staudacher C. Laparoscopy-assisted gastrectomy versus open gastrectomy for gastric cancer: a monoinstitutional Western center experience. Surg Endosc. 2011;25:140–5.
doi: 10.1007/s00464-010-1147-2
Rosa F, Tortorelli AP, Quero G, Galiandro F, Fiorillo C, Sollazzi L, et al. The impact of preoperative ASA-physical status on postoperative complications and long-term survival outcomes in gastric cancer patients. Eur Rev Med Pharmacol Sci. 2019;23:7383–90.
pubmed: 31539125
GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, Burzykowski T, Michiels S, Ohashi Y, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA. 2010;303:1729–37.
doi: 10.1001/jama.2010.534
Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer. Cochrane Database Syst Rev. 2015;CD009944.
Kim SH, Kim JJ, Lee JS, Kim SH, Kim BS, Maeng YH, et al. Preoperative N staging of gastric cancer by stomach protocol computed tomography. J Gastric Cancer. 2013;13:149–56.
doi: 10.5230/jgc.2013.13.3.149
Ramos MFKP, Pereira MA, Dias AR, Ribeiro U Jr, Zilberstein B, Nahas SC. Laparoscopic gastrectomy for early and advanced gastric cancer in a western center: a propensity score-matched analysis. Updates Surg. 2021;73:1867–77.
doi: 10.1007/s13304-021-01097-1
Obama K, Kim Y-M, Kang DR, Son T, Kim H-I, Noh SH, et al. Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer. 2018;21:285–95.
doi: 10.1007/s10120-017-0740-7
Klompmaker S, van Hilst J, Wellner UF, Busch OR, Coratti A, D’Hondt M, et al. Outcomes after minimally-invasive versus open pancreatoduodenectomy: a pan-european propensity score matched study. Ann Surg. 2020;271:356–63.
doi: 10.1097/SLA.0000000000002850
van der Poel MJ, Barkhatov L, Fuks D, Berardi G, Cipriani F, Aljaiuossi A, et al. Multicentre propensity score-matched study of laparoscopic versus open repeat liver resection for colorectal liver metastases. Br J Surg Oxf Acad. 2019;106:783–9.

Auteurs

Pietro Maria Lombardi (PM)

Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy. pietrom.lombardi@gmail.com.
IRCCS Humanitas Research Hospital, Unit of Foregut Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy. pietrom.lombardi@gmail.com.
ORCID: 0000-0002-2633-7977

D Bernasconi (D)

Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Functional Department for Higher Education, Research, and Development, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

G L Baiocchi (GL)

General Surgery, ASST Cremona, Cremona, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

M Berselli (M)

Unit of General Surgery, Ospedale di Circolo e Fondazione Macchi, ASST Settelaghi, Varese, Italy.

A Biondi (A)

Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli n. 8, 00168, Rome, Italy.
Università Cattolica del Sacro Cuore, Largo F. Vito n.1, 00168, Rome, Italy.

C Castoro (C)

IRCCS Humanitas Research Hospital, Unit of Foregut Surgery, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.

M Catarci (M)

General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Rome, Italy.

M Degiuli (M)

Department of Oncology, University of Torino, Turin, Italy.
Surgical Oncology and Digestive Surgery Unit, San Luigi University Hospital, Orbassano, TO, Italy.

U Fumagalli Romario (U)

Digestive Surgery, European Institute of Oncology, IRCCS, 20141, Milan, Italy.

S Giacopuzzi (S)

Department of General and Upper G.I. Surgery, University of Verona, Verona, Italy.

F Marchesi (F)

Unit of General Surgery, Parma University Hospital, Parma, Italy.
ORCID: 0000-0001-8236-3224

D Marrelli (D)

Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.

M Mazzola (M)

Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.

S Molfino (S)

Department of Clinical and Experimental Sciences, University of Brescia and Third Division of General Surgery, Brescia Civili Hospital, Brescia, Italy.

S Olmi (S)

Head of General and Oncologic Surgery. Center for Minimal Invasive and Laparoscopic Surgery, Policlinico San Marco, Senior Research Vita-Salute University San Raffaele Milan (UNISR), Zingonia, Italy.

S Rausei (S)

Department of Surgery, ASST Valle Olona, Gallarate, Italy.

F Rosa (F)

Digestive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

R Rosati (R)

Department of Gastrointestinal Surgery, San Raffaele Research Hospital, 20132, Milan, Italy.
Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132, Milan, Italy.

F Roviello (F)

Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.

S Santi (S)

Division of Esophageal Surgery Regional Referral Center "Mauro Rossi" for Diagnosis and Treatment of Diseases of Esophagus, Azienda Ospedaliero-Universitaria Pisana (AOUP), Via Paradisa 2, 56010, Pisa, Italy.

L Solaini (L)

Department of Medical and Surgical Sciences, University of Bologna, Morgagni-Pierantoni Hospital, Forlì, Italy.

F Staderini (F)

Digestive Surgery Unit, Department of Clinical and Experimental Medicine, Careggi University Hospital of Florence, Florence, Italy.

J Viganò (J)

General Surgery. Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

G Ferrari (G)

Division of Minimally-Invasive Surgical Oncology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Open versus laparoscopic gastrectomy for...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies de l'estomac › Tumeurs de l'estomac › Open versus laparoscopic gastrectomy for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Score de propension › Open versus laparoscopic gastrectomy for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Open versus laparoscopic gastrectomy for...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Carcinomes › Adénocarcinome › Open versus laparoscopic gastrectomy for...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Open versus laparoscopic gastrectomy for...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Gastrectomie › Open versus laparoscopic gastrectomy for...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Laparoscopie › Open versus laparoscopic gastrectomy for...