Postoperative mortality after esophageal and gastric cancer surgery: Does age still matter? Results from a nationwide study.

122 Background: More than age, patient comorbidity is increasingly considered as the prominent predictor of postoperative mortality (POM) in esophageal and gastric cancer surgery, leading a growing number of elderly to be operated on. However, the respective impact of age and comorbidity on POM remains to be elucidated. The study objective was to investigate the impact of age on POM according to patient comorbidity. Methods: All consecutive patients who underwent esophageal or gastric cancer surgery between 2010 and 2012 in France were included (n = 11,196). The 30-day POM was compared by age groups (20-39, 40-59, 60-79, ≥ 80) and stratified according to the Charlson score (0, 1-2, ≥ 3). The consistency across esophageal (n = 3286) and gastric (n = 7910) subgroups and variations between 30-day and 90-day POM were analyzed. Results: Patients ≥ 60 years represented 73.8% of cases. A linear increase in 30-day and 90-day POM was observed with increasing age, with rates of 0.9% and 2.1%, 2.4% and 5.4%, 4.8% and 8.8%, and 9.3% and 15.9% in 20-39, 40-59, 60-79, ≥ 80 years age groups, respectively ( P< 0.001). Comparing 20-39 and ≥ 80 years age groups, 30-day POM was 1.0% vs. 7.0% for Charlson 0 ( P< 0.001), 3.1% vs. 11.1% for Charlson1-2 ( P< 0.001) and 0% vs. 19.5% for Charlson ≥ 3 ( P= 0.020) patients. A similar linear increase of POM by growing age groups was observed for 90-day POM and in esophagus and stomach subgroups. By multivariable analysis age groups (OR 1.03 95%CI 1.02-1.04, p < 0.001) and Charlson score (OR 1.56 95%CI 1.43-1.70, p < 0.001) were independent predictors of POM. Conclusions: Age and patient comorbidity have a similar and cumulative impact on POM after esophageal and gastric cancer surgery.

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Effect of hospital volume on postoperative mortality and survival after oesophageal and gastric cancer surgery in the Netherlands between 1989 and 2009

European Journal of Cancer ◽

10.1016/j.ejca.2012.02.064 ◽

2012 ◽

Vol 48 (7) ◽

pp. 1004-1013 ◽

Cited By ~ 88

Author(s):

Johan L. Dikken ◽

Anneriet E. Dassen ◽

Valery E.P. Lemmens ◽

Hein Putter ◽

Pieta Krijnen ◽

...

Keyword(s):

Gastric Cancer ◽

The Netherlands ◽

Hospital Volume ◽

Postoperative Mortality ◽

Cancer Surgery ◽

Gastric Cancer Surgery

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The Impact of COVID-19 on Gastric Cancer Surgery: A Single-center Retrospective Study Based on Real-world Data from China

10.21203/rs.3.rs-35676/v1 ◽

2020 ◽

Author(s):

Yu-xuan Li ◽

Chang-zheng He ◽

Yi-chen Liu ◽

Peng-yue Zhao ◽

Xiao-lei Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Waiting Times ◽

Cancer Surgery ◽

Real World Data ◽

Gastric Cancer Surgery ◽

Patients With Cancer ◽

Study Results ◽

Gastric Cancer Patients ◽

The Impact

Abstract Backgrounds: A respiratory epidemic defined as coronavirus disease 2019 (COVID-19) is becoming unstoppable and has been declared a pandemic. Patients with cancer are more likely to develop COVID-19. Based on our experience during the pandemic period, we propose some surgery strategies for gastric cancer patients under the COVID-19 situation. Methods We defined the ‘COVID-19’ period as occurring between 2020-01-20 and 2020-03-20. All the enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study. Results The waiting times before admission increased by 4 days in CG(PCG:4.5 [IQR: 2, 7.8] vs. CG:8.0 [IQR: 2,20]; P = 0.006). More patients had performed chest CT scan besides abdominal CT before admission during COVID-19 period(PCG:22[32%]vs. CG:30[73%], p = 0.001). After admission, during COVID period, the waiting time before surgery was longer(3[IQR: 2,5] vs. 7[IQR: 5,9]; P < 0.001),more laparoscopic surgery were performed(PCG: 51[75%] vs. CG: 38[92%],p = 0.021), and hospital stay after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11] ; P < 0.001). The total cost of hospitalization increased during COVID period, (9.22[IQR:7.82,10.97] vs. 10.42[IQR:8.99,12.57]; p = 0.006). Conclusion Since no data is available yet on the impact of COVID-19 on gastric cancer patients,our own experience with COVID-19 in gastric cancer surgery has hopefully provided an opportunity for colleagues to reflect on their own service and any contingency plans they have to tackle the crisis.

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Positive association of gastric cancer surgery outcome with surgeon specialization in a Shanghai high-volume general hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.4092 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 4092-4092

Author(s):

Zhenbin Shen ◽

Yihong Sun ◽

Cong Wang ◽

Naiqing Zhao ◽

Weidong Chen ◽

...

Keyword(s):

Gastric Cancer ◽

General Hospital ◽

Surgical Training ◽

Statistical Significance ◽

Postoperative Mortality ◽

High Volume ◽

Cancer Surgery ◽

Specialty Training ◽

Gastric Cancer Surgery ◽

High Volume Hospital

4092 Background: Numerous studies suggest positive relationship between hospital volume and cancer treatment outcomes, the surgeon’s experience and specialty training may also be important. This was examined in a high volume hospital in Shanghai among patients who underwent gastric cancer (GC) surgery. Methods: Data on consecutive patients (pts) undergoing R0 or R1 GC resection in Zhongshan hospital between January 2003 and June 2010 were collected and analyzed. Follow-up on pts who were non-Shanghai residents were less complete therefore excluded. Post-operative mortality, pathologic results and survival outcome for pts treated by surgical training, i.e., sub-specialized vs., non-specialized, were obtained. Survival was calculated by the Kaplan-Meier method and Log-rank test was used to determine statistical significance. To determine whether sub-specialty surgical training was an independent factor for overall survival (OS), univariate and multivariate analyses were performed using Cox proportional hazards regression. Results: Total 5,046 pts underwent R0 or R1 GC resection were identified.1594 pts had complete covariate data, survival information and were included in the study. Of them, the sub-specialized group included 217 cases treated by 3 surgeons, while the non-specialized group included 1377 cases treated by 52 surgeons. 5-year cumulative OS was higher in the sub-specialized group (62.9% vs. 54.6%, p=0.032). Multivariate analysis showed that tumor stage(p<0.001), location of tumor (p=0.003), vascular invasion (p<0.001) and surgeon (HR=1.54, p=0.001) were all associated with OS. The incidence of positive margin was higher in non-specialized group (2.0% vs. 2.7%, p<0.001) and the probability of retrieved lymph nodes less than 15 was more in non-specialized group (25.9% vs. 7.3%, p<0.001). Postoperative mortality was also higher in non-specialized group than in specialized group(1.5% vs. 0.9%, p<0.001). Conclusions: In high volume general hospital, sub-specialty training is desirable in gastric cancer surgery, the quality of gastric cancer surgery can be further improved by sub-specialty training leading to better treatment outcome.

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The effect on glycemic status in type 2 diabetes mellitus after gastric cancer surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20205880 ◽

2020 ◽

Vol 8 (1) ◽

pp. 191

Author(s):

Lakshmi Radhakrishnan ◽

T. V. Haridas

Keyword(s):

Gastric Cancer ◽

Metabolic Surgery ◽

Cancer Surgery ◽

P Value ◽

Glycemic Status ◽

Chi Square ◽

Gastric Cancer Surgery ◽

Type 2 Dm ◽

The Impact

Background: Gastric cancer is a leading cause of cancer death worldwide. With progress in the field of gastric cancer treatment, as indicated by the improved survival rate, postoperative quality of life as well as the appropriate surgical treatment for a cure has become very important. Recently, metabolic surgery has become an appealing treatment option for patients with type 2 DM. Although the purpose of metabolic surgery and gastric cancer surgery is completely different, they are related clinically and technically. Thus organized evaluation of the impact of gastric cancer surgery on diabetes is necessary.Methods: 30 patients with gastric cancer and type 2 DM who underwent curative gastrectomy were selected. Patients were followed up till 12 months, the study population grouped depending upon the glycemic status and results compared using chi square test.Results: Three out of 30 patients had complete remission of diabetes at 12 months, 17 patients improved and 10 patients remained stationary. Short duration (<5 years) had a median reduction in insulin by 8.9 units versus 2.5 units in long duration (>10 years) diabetes. Maximum reduction (>10 U/day) and remission occurred in those who underwent total gastrectomy. The results were compared using chi square test and the p value was 0.048428 (<0.05) proving significant.Conclusions: The glycemic status was found to improve following gastric cancer surgery which was found to be related to the extent of gastrectomy and the diabetes duration and was found to be statistically significant.

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The Impact of COVID-19 on Gastric Cancer Surgery: A Single-center Retrospective Study Based on Real-world Data

10.21203/rs.3.rs-22785/v1 ◽

2020 ◽

Author(s):

Yu-xuan Li ◽

Chang-zheng He ◽

Yi-chen Liu ◽

Peng-yue Zhao ◽

Xiao-lei Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Real World ◽

Cancer Surgery ◽

Real World Data ◽

Gastric Cancer Surgery ◽

World Data ◽

Study Results ◽

Gastric Cancer Patients ◽

The Impact

Abstract Background ： A respiratory epidemic defined as coronavirus disease 2019 ( COVID-19 ) is becoming unstoppable and has been declared a pandemic. Patients with cancer are more likely to develop COVID-19. Based on our experience during the pandemic period, we propose some surgery strategies for gastric cancer patients under the COVID-19 situation. Methods ： We defined the ‘COVID-19’ period as occurring between 2020-01-20 and 2020-03-20. All the enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study. Results ： The waiting times before admission increased by 4 days in CG(PCG:4.5 [IQR: 2, 7.8] vs. CG:8.0 [IQR: 2,20]; P = 0.006). More patients had performed chest CT scan besides abdominal CT before admission during COVID-19 period(PCG:22[32%]vs. CG:30[73%], p=0.001). After admission, during COVID period, the waiting time before surgery was longer(3[IQR: 2,5] vs. 7[IQR: 5,9]; P < 0.001),more laparoscopic surgery were performed(PCG: 51[75%] vs. CG: 38[92%],p=0.021), and hospital stay after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11] ; P < 0.001). The total cost of hospitalization increased during COVID period, (9.22[IQR:7.82,10.97] vs. 10.42[IQR:8.99,12.57]; p=0.006). Conclusion ： Since no data is available yet on the impact of COVID-19 on gastric cancer patients,our own experience with COVID-19 in gastric cancer surgery has hopefully provided an opportunity for colleagues to reflect on their own service and any contingency plans they have to tackle the crisis. Keywords: gastric cancer; coronavirus disease 2019; COVID-19; retrospective analysis; real-world data.

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Exploring the impact of regional variation on outcome prioritisation in core outcome set development: a case study in the field of gastric cancer surgery

10.21203/rs.3.rs-140027/v1 ◽

2021 ◽

Author(s):

Bilal Alkhaffaf ◽

Aleksandra Metryka ◽

Jane M Blazeby ◽

Anne-Marie Glenny ◽

Paula R Williamson ◽

...

Keyword(s):

Gastric Cancer ◽

Stakeholder Participation ◽

Core Outcome Set ◽

Cancer Surgery ◽

Core Outcome ◽

Middle Income ◽

Gastric Cancer Surgery ◽

Middle Income Countries ◽

Stakeholder Groups ◽

The Impact

Abstract BackgroundInternational stakeholder participation is important in the development of core outcome sets (COS). Stakeholders, however, may value health outcomes differently when regional differences are considered. Here, we explore how region, health income and participant characteristics influence prioritisation of outcomes during development of a COS for gastric cancer surgery trials (the GASTROS study).Methods952 participants from 55 countries participating in a Delphi survey during COS development were eligible for inclusion. Recruits were grouped according to region (East or West), country income classification (high and low-to-middle income) and other characteristics (e.g. patients; age, sex, time since surgery, mode of treatment, surgical approach and healthcare professionals; clinical experience). Groups were compared with respect to how they categorised outcomes (‘consensus in’, ‘consensus out’, ‘no consensus’). Outcomes categorised as ‘consensus in’ or ‘consensus out’ by all 3 stakeholder groups would be automatically included in or excluded from the COS respectively.ResultsIn total, 13 outcomes were categorised ‘consensus in’, 13 ‘consensus out’ and 31 ‘no consensus’. There was little variation in prioritisation of outcomes by stakeholders from Eastern or Western countries and high or low-to-middle income countries. There was little variation in outcome prioritisation within either health professional or patient groups.ConclusionOur study suggests that there is little variation in opinion within stakeholder groups when participant region and other characteristics are considered. This finding may help COS developers when designing their Delphi surveys and recruitment strategies. Further work across other clinical fields is needed before broad recommendations can be made.

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Risk factors for persistent elevation of perioperative lactate levels in gastric cancer surgery

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i5.29743 ◽

2020 ◽

Vol 11 (5) ◽

pp. 24-28

Author(s):

Selcuk Gulmez ◽

Orhan Uzun ◽

Aziz Serkan Senger ◽

Zehra Zeynep Keklikkiran ◽

Hilmi Bozkurt ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Operative Time ◽

Multivariate Logistic Regression Analysis ◽

Perioperative Period ◽

Cancer Surgery ◽

Gastric Cancer Surgery ◽

Icu Stay ◽

Lactate Levels ◽

The Impact

Background: The impact of high-risk surgery on tissue perfusion can be indirectly assessed by measuring lactate levels during surgery and intensive care unit (ICU) stay. While consistently high values are associated with poor prognosis, transient elevations do not mean poor clinical outcomes. Therefore, intraoperative and early postoperative blood lactate monitoring is essential for cancer patients. Aims and Objective: This study aimed to determine the risk factors of persistently elevated lactate levels in the intraoperative and postoperative period in patients with elective gastric cancer surgery. Materials and Methods: We retrospectively enrolled 293 patients who underwent curative resection for gastric cancer. Lactate values of all patients were examined during surgery and ICU-stay at 3rd, 6th, 12th, and 18th hours. All lactate values above 2 mmol/L were considered elevated. The patients were divided into two groups as those with perioperative persistently increased lactate levels and those without. Results: Of the 293 patients, 60 (20.5%) had higher lactate levels in the perioperative period. According to multivariate logistic regression analysis, the operative time had the highest significance rate (p = 0.020) out of two significant variables, followed by the BMI ≥ 30 kg/m2 (p = 0.048). Besides, patients with perioperative hyperlactatemia had prolonged hospital stays (p = 0.034). Conclusions: Operative time and obesity (BMI ≥ 30 kg/m2) were independent risk factors for persistent lactate elevation in the perioperative period. Also, perioperative hyperlactatemia extended the length of hospital stay.

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