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Markar SR, Visser MR, van der Veen A, Luyer MD, Nieuwenhuijzen G, Stoot JH, Tegels JJ, Wijnhoven BP, Lagarde SM, de Steur WO, Hartgrink HH, Kouwenhoven EA, Wassenaar EB, Draaisma WA, Gisbertz SS, van Berge Henehouwen MI, van der Peet DL, Ruurda JP, van Hillegersberg R. Evolution in Laparoscopic Gastrectomy From a Randomized Controlled Trial Through National Clinical Practice. Ann Surg 2024; 279:394-401. [PMID: 37991188 PMCID: PMC10829898 DOI: 10.1097/sla.0000000000006162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
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.
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Affiliation(s)
- Sheraz R. Markar
- Nuffield Department of Surgery, University of Oxford, UK
- Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands
| | - Maurits R. Visser
- Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Arjen van der Veen
- Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands
| | - Misha D.P. Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Jan H.M.B. Stoot
- Department of Surgery, Zuyderland Medical Center, Heerlen and Sittard-Geleen, The Netherlands
| | - Juul J.W. Tegels
- Department of Surgery, Zuyderland Medical Center, Heerlen and Sittard-Geleen, The Netherlands
| | - Bas P.L. Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sjoerd M. Lagarde
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wobbe O. de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk H. Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Werner A. Draaisma
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Suzanne S. Gisbertz
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mark I. van Berge Henehouwen
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Donald L. van der Peet
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
| | - Jelle P. Ruurda
- Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, The Netherlands
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Ehlers AP, Dimick JB. Comment on: Assurance of surgical quality within multicenter randomized controlled trials for bariatric and metabolic surgery: a systematic review. Surg Obes Relat Dis 2021; 18:132-133. [PMID: 34742651 DOI: 10.1016/j.soard.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/10/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Anne P Ehlers
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Justin B Dimick
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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