Methods: The Netherlands Cancer Registry identified all patients with gastric adenocarcinoma that underwent gastrectomy with curative intent between 2010-2014. Multivariable analysis was performed to compare MIG and OG on lymph node yield (≥15)， R0 resection rate， and 1-year overall survival. The pooled learning curve per center of MIG was evaluated by groups of 5 subsequent procedures.

 

Results: Between 2010-2014， a total of 277 (14%) patients underwent MIG and 1633 (86%) patients underwent OG. During this period， the use of MIG increased from 4% to 39% (p<0.001)， the median lymph node yield increased from 12 to 20 (p<0.001)， and the R0 resection rate remained stable from 86% to 91% (p=0.080). MIG and OG had a comparable lymph node yield (OR 1.01， 95% CI [0.75–1.36])， R0 resection rate (OR 0.86， 95% CI [0.54–1.37]) and 1-year overall survival (HR 0.99， 95% CI [0.75 – 1.32]). A pooled learning curve of 10 procedures was demonstrated for MIG after which the conversion rate (13% to 2%， p=0.001) and lymph node yield were at a desired level (18 to 21， p=0.045). 

 

Conclusion: With a proctoring program， minimally invasive gastrectomy can be safely introduced in Western countries regarding short-term oncological outcomes.