TY - JOUR
T1 - Evolution in Laparoscopic Gastrectomy From a Randomized Controlled Trial Through National Clinical Practice
AU - Markar, Sheraz R.
AU - Visser, Maurits R.
AU - Dutch Upper Gastrointestinal Cancer Audit (DUCA)
AU - Van Der Veen, Arjen
AU - Luyer, Misha D.P.
AU - Nieuwenhuijzen, Grard
AU - Stoot, Jan H.M.B.
AU - Tegels, Juul J.W.
AU - Wijnhoven, Bas P.L.
AU - Lagarde, Sjoerd M.
AU - De Steur, Wobbe O.
AU - Hartgrink, Henk H.
AU - Kouwenhoven, Ewout A.
AU - Wassenaar, Eelco B.
AU - Draaisma, Werner A.
AU - Gisbertz, Suzanne S.
AU - Van Berge Henehouwen, Mark I.
AU - Van Der Peet, Donald L.
AU - Ruurda, Jelle P.
AU - Van Hillegersberg, Richard
N1 - Publisher Copyright:
© 2024 Wolters Kluwer Health. All rights reserved.
PY - 2024/3/1
Y1 - 2024/3/1
N2 - Objective: To examine the influence of the LOGICA RCT (randomized controlled trial) upon the practice and outcomes of laparoscopic gastrectomy within the Netherlands. Background: Following RCTs the dissemination of complex interventions has been poorly studied. The LOGICA RCT included 10 Dutch centers and compared laparoscopic to open gastrectomy. Methods: Data were obtained from the Dutch Upper Gastrointestinal Cancer Audit (DUCA) on all gastrectomies performed in the Netherlands (2012-2021), and the LOGICA RCT from 2015 to 2018. Multilevel multivariable logistic regression analyses were performed to assess the effect of laparoscopic versus open gastrectomy upon clinical outcomes before, during, and after the LOGICA RCT. Results: Two hundred eleven patients from the LOGICA RCT (105 open vs 106 laparoscopic) and 4131 patients from the DUCA data set (1884 open vs 2247 laparoscopic) were included. In 2012, laparoscopic gastrectomy was performed in 6% of patients, increasing to 82% in 2021. No significant effect of laparoscopic gastrectomy on postoperative clinical outcomes was observed within the LOGICA RCT. Nationally within DUCA, a shift toward a beneficial effect of laparoscopic gastrectomy upon complications was observed, reaching a significant reduction in overall [adjusted odds ratio (aOR):0.62; 95% CI: 0.46-0.82], severe (aOR: 0.64; 95% CI: 0.46-0.90) and cardiac complications (aOR: 0.51; 95% CI: 0.30-0.89) after the LOGICA trial. Conclusions: The wider benefits of the LOGICA trial included the safe dissemination of laparoscopic gastrectomy across the Netherlands. The robust surgical quality assurance program in the design of the LOGICA RCT was crucial to facilitate the national dissemination of the technique following the trial and reducing potential patient harm during surgeons learning curve.
AB - Objective: To examine the influence of the LOGICA RCT (randomized controlled trial) upon the practice and outcomes of laparoscopic gastrectomy within the Netherlands. Background: Following RCTs the dissemination of complex interventions has been poorly studied. The LOGICA RCT included 10 Dutch centers and compared laparoscopic to open gastrectomy. Methods: Data were obtained from the Dutch Upper Gastrointestinal Cancer Audit (DUCA) on all gastrectomies performed in the Netherlands (2012-2021), and the LOGICA RCT from 2015 to 2018. Multilevel multivariable logistic regression analyses were performed to assess the effect of laparoscopic versus open gastrectomy upon clinical outcomes before, during, and after the LOGICA RCT. Results: Two hundred eleven patients from the LOGICA RCT (105 open vs 106 laparoscopic) and 4131 patients from the DUCA data set (1884 open vs 2247 laparoscopic) were included. In 2012, laparoscopic gastrectomy was performed in 6% of patients, increasing to 82% in 2021. No significant effect of laparoscopic gastrectomy on postoperative clinical outcomes was observed within the LOGICA RCT. Nationally within DUCA, a shift toward a beneficial effect of laparoscopic gastrectomy upon complications was observed, reaching a significant reduction in overall [adjusted odds ratio (aOR):0.62; 95% CI: 0.46-0.82], severe (aOR: 0.64; 95% CI: 0.46-0.90) and cardiac complications (aOR: 0.51; 95% CI: 0.30-0.89) after the LOGICA trial. Conclusions: The wider benefits of the LOGICA trial included the safe dissemination of laparoscopic gastrectomy across the Netherlands. The robust surgical quality assurance program in the design of the LOGICA RCT was crucial to facilitate the national dissemination of the technique following the trial and reducing potential patient harm during surgeons learning curve.
UR - https://www.scopus.com/pages/publications/85184141474
U2 - 10.1097/SLA.0000000000006162
DO - 10.1097/SLA.0000000000006162
M3 - Article
C2 - 37991188
AN - SCOPUS:85184141474
SN - 0003-4932
VL - 279
SP - 394
EP - 401
JO - Annals of Surgery
JF - Annals of Surgery
IS - 3
ER -
