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

Cas de Jongh; Lianne Triemstra; LOGICA Study Group; Arjen van der Veen; Lodewijk AA Brosens; Grard AP Nieuwenhuijzen; Jan HMB Stoot; Wobbe O. de Steur; Jelle P. Ruurda; Richard van Hillegersberg; Hylke JF Brenkman; Maarten F.J. Seesing; Misha DP Luyer; Jeroen EH Ponten; Juul JW Tegels; Karel WE Hulsewe; Henk H. Hartgrink; Bas PL Wijnhoven; Sjoerd M. Lagarde; Ewout A. Kouwenhoven; Marc J. van Det; Eelco B. Wassenaar; P. van Duijvendijk; Werner A. Draaisma; Ivo AMJ Broeders; Donald L. van der Peet; Suzanne S. Gisbertz

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

Cas de Jongh
, Lianne Triemstra
, LOGICA Study Group
, Arjen van der Veen
, Lodewijk AA Brosens
, Grard AP Nieuwenhuijzen
, Jan HMB Stoot
, Wobbe O. de Steur
, Jelle P. Ruurda
, Richard van Hillegersberg^*
, Hylke JF Brenkman
, Maarten F.J. Seesing
, Misha DP Luyer
, Jeroen EH Ponten
, Juul JW Tegels
, Karel WE Hulsewe
, Henk H. Hartgrink
, Bas PL Wijnhoven
, Sjoerd M. Lagarde
, Ewout A. Kouwenhoven

Marc J. van Det, Eelco B. Wassenaar, P. van Duijvendijk, Werner A. Draaisma, Ivo AMJ Broeders, Donald L. van der Peet, Suzanne S. Gisbertz

^*Corresponding author for this work

Surgery

Utrecht University
Catharina Hospital
Zuyderland Medical Center (Sittard-Geleen)
Leiden University Medical Centre
Ziekenhuisgroep Twente (Almelo)
Gelre Ziekenhuizen
Meander Medical Center
University of Amsterdam
Amsterdam UMC
Amsterdam UMC, Locatie VUmc
University Medical Centre Utrecht

Research output: Contribution to journal › Article › Academic › peer-review

3 Citations (Scopus)

87 Downloads (Pure)

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.

Original language	English
Article number	107018
Journal	European Journal of Surgical Oncology
Volume	49
Issue number	10
DOIs	https://doi.org/10.1016/j.ejso.2023.107018
Publication status	Published - Oct 2023

Bibliographical note

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

UN SDGs

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SDG 3 Good Health and Well-being

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Cite this

de Jongh, C., Triemstra, L., LOGICA Study Group, van der Veen, A., Brosens, L. AA., Nieuwenhuijzen, G. AP., Stoot, J. HMB., de Steur, W. O., Ruurda, J. P., van Hillegersberg, R., Brenkman, H. JF., Seesing, M. F. J., Luyer, M. DP., Ponten, J. EH., Tegels, J. JW., Hulsewe, K. WE., Hartgrink, H. H., Wijnhoven, B. PL., Lagarde, S. M., ... Gisbertz, S. S. (2023). Surgical quality and prospective quality control of the D2-gastrectomy for gastric cancer in the multicenter randomized LOGICA-trial. European Journal of Surgical Oncology, 49(10), Article 107018. https://doi.org/10.1016/j.ejso.2023.107018

@article{be76e5b933924102a8e48b8980ce8964,

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

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 {\textquoteleft}optimal{\textquoteright} in 76\%, 63\% and 68\%. Laparoscopic photographs could be rated better than open (2\% versus 12\% {\textquoteleft}unevaluable{\textquoteright}; 73\% versus 50\% {\textquoteleft}optimal{\textquoteright}; 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.",

author = "\{de Jongh\}, Cas and Lianne Triemstra and \{LOGICA Study Group\} and \{van der Veen\}, Arjen and Brosens, \{Lodewijk AA\} and Nieuwenhuijzen, \{Grard AP\} and Stoot, \{Jan HMB\} and \{de Steur\}, \{Wobbe O.\} and Ruurda, \{Jelle P.\} and \{van Hillegersberg\}, Richard and Brenkman, \{Hylke JF\} and Seesing, \{Maarten F.J.\} and Luyer, \{Misha DP\} and Ponten, \{Jeroen EH\} and Tegels, \{Juul JW\} and Hulsewe, \{Karel WE\} and Hartgrink, \{Henk H.\} and Wijnhoven, \{Bas PL\} and Lagarde, \{Sjoerd M.\} and Kouwenhoven, \{Ewout A.\} and \{van Det\}, \{Marc J.\} and Wassenaar, \{Eelco B.\} and \{van Duijvendijk\}, P. and Draaisma, \{Werner A.\} and Broeders, \{Ivo AMJ\} and \{van der Peet\}, \{Donald L.\} and Gisbertz, \{Suzanne S.\}",

note = "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: {\textcopyright} 2023 The Authors",

year = "2023",

month = oct,

doi = "10.1016/j.ejso.2023.107018",

language = "English",

volume = "49",

journal = "European Journal of Surgical Oncology",

issn = "0748-7983",

number = "10",

}

de Jongh, C, Triemstra, L, LOGICA Study Group, van der Veen, A, Brosens, LAA, Nieuwenhuijzen, GAP, Stoot, JHMB, de Steur, WO, Ruurda, JP, van Hillegersberg, R, Brenkman, HJF, Seesing, MFJ, Luyer, MDP, Ponten, JEH, Tegels, JJW, Hulsewe, KWE, Hartgrink, HH, Wijnhoven, BPL , Lagarde, SM, Kouwenhoven, EA, van Det, MJ, Wassenaar, EB, van Duijvendijk, P, Draaisma, WA, Broeders, IAMJ, van der Peet, DL & Gisbertz, SS 2023, 'Surgical quality and prospective quality control of the D2-gastrectomy for gastric cancer in the multicenter randomized LOGICA-trial', European Journal of Surgical Oncology, vol. 49, no. 10, 107018. https://doi.org/10.1016/j.ejso.2023.107018

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 - LOGICA Study Group

AU - van der Veen, Arjen

AU - Brosens, Lodewijk AA

AU - Nieuwenhuijzen, Grard AP

AU - Stoot, Jan HMB

AU - de Steur, Wobbe O.

AU - Ruurda, Jelle P.

AU - van Hillegersberg, Richard

AU - Brenkman, Hylke JF

AU - Seesing, Maarten F.J.

AU - Luyer, Misha DP

AU - Ponten, Jeroen EH

AU - Tegels, Juul JW

AU - Hulsewe, Karel WE

AU - Hartgrink, Henk H.

AU - Wijnhoven, Bas PL

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 AMJ

AU - van der Peet, Donald L.

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.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

Y1 - 2023/10

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.

UR - https://www.scopus.com/pages/publications/85169024874

U2 - 10.1016/j.ejso.2023.107018

DO - 10.1016/j.ejso.2023.107018

M3 - Article

AN - SCOPUS:85169024874

SN - 0748-7983

VL - 49

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

IS - 10

M1 - 107018

ER -

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

Abstract

Bibliographical note

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