Redefining High-Volume Gastric Cancer Centers: The Impact of Operative Volume on Surgical Outcomes

Abstract Background Existing literature suggests deteriorating surgical outcome of esophagogastric surgery as the week progresses. However, these studies were conducted in the pre-centralization and pre-minimally invasive era. In addition, they failed to correct for fixed weekdays of esophagogastric cancer surgery among hospitals. This study aimed to describe the impact of weekday of minimally invasive upper gastrointestinal surgery on short-term surgical outcomes. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit who underwent curative minimally invasive esophageal or gastric carcinoma surgery in 2015–2019, were included in this nationwide cohort study. Using multilevel multivariable logistic regression, the impact of weekday of surgery on 14 short-term surgical outcomes was investigated. To correct for interhospital variance in fixed weekday(s) of surgery multilevel analyses was used. Results were adjusted for patient, tumor, and treatment characteristics using multivariable logistic regression analyses. Results This study included 4,102 patients undergoing minimally invasive upper gastrointestinal surgery (2,968 esophageal cancer and 1,134 gastric cancer patients). Weekday of surgery did not impact postoperative complications, severe postoperative complications, surgical/technical complications, medical complications, anastomotic leakage, complicated postoperative course, failure to rescue, surgical radicality, lymph node yield, 30-day/in-hospital mortality, reinterventions, length of ICU stay, 30-day readmission, and textbook outcome after neither esophageal cancer nor gastric cancer surgery. Conclusions Minimally invasive esophagogastric surgery can be performed safely on all weekdays with respect to short-term surgical outcomes, which is important information for operation room scheduling.

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Delivering esophago-gastric cancer care during the COVID-19 pandemic in the United Kingdom: a surgical perspective

Diseases of the Esophagus ◽

10.1093/dote/doaa091 ◽

2020 ◽

Vol 33 (9) ◽

Author(s):

S Wahed ◽

J Chmelo ◽

M Navidi ◽

N Hayes ◽

A W Phillips ◽

...

Keyword(s):

Gastric Cancer ◽

Surgical Intervention ◽

Clinical Care ◽

High Volume ◽

Good Communication ◽

The United Kingdom ◽

Tertiary Center ◽

High Level ◽

The Impact ◽

Multi Disciplinary Team

Summary Background The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular surgical intervention, in patients with esophago-gastric cancer at a high-volume tertiary center. Methods All patients undergoing potential management for esophago-gastric cancer from 12 March to 22 May 2020 had their outcomes reviewed. Multi-disciplinary team (MDT) decisions, volume of cases, and outcomes following resection were evaluated. Results Overall 191 patients were discussed by the MDT, with a 12% fall from the same period in 2019, including a fall in new referrals from 120 to 83 (P = 0.0322). The majority of patients (80%) had no deviation from the pre-COVID-19 pathway. Sixteen patients had reduced staging investigations, 4 had potential changes to their treatment only, and 10 had a deviation from both investigation and potential treatment. Only one patient had palliation rather than potentially curative treatment. Overall 19 patients underwent surgical resection. Eight patients (41%) developed complications with two (11%) graded Clavien-Dindo 3 or greater. Two patients developed COVID-19 within a month of surgery, one spending 4 weeks in critical care due to respiratory complications; both recovered. Twelve patients underwent endoscopic resections with no complications. Conclusion Care must be taken not to compromise cancer treatment and outcomes during the COVID-19 pandemic. Excellent results can be achieved through meticulous logistical planning, good communication, and maintaining high-level clinical care.

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The Impact of Nerve Involvement on the Prognosis of Gastric Cancer Patients with Curative Gastrectomy: An International Multicenter Analysis

Disease Markers ◽

10.1155/2021/8870562 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Kun Yang ◽

Yu-Qing Dan ◽

Yoon Young Choi ◽

Zong-Guang Zhou ◽

Woo Jin Hyung ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Significance ◽

High Volume ◽

Tumor Location ◽

Lymphatic Invasion ◽

Stage Iii ◽

Curative Gastrectomy ◽

Additional Information ◽

Gastric Cancer Patients ◽

The Impact

Background. Several studies have been conducted to investigate the association between the presence of perineural invasion (PNI) and overall survival (OS) of gastric cancer (GC) patients who underwent curative resection, but no consensus has been reached. This study is aimed at determining the prognostic significance of PNI in gastric cancer. Study Design. The data of 2969 patients with gastric cancer and who had undergone curative gastrectomy from 2006 to 2010 in two high-volume hospitals of China and Korea were retrospectively analyzed. PNI positivity was identified when carcinoma cells were found to infiltrate into the perineurium or neural fascicles. The relationships between PNI and other clinicopathological factors were evaluated, and survival analyses were performed. Results. The presence of PNI was detected in 1055 of the 2969 patients (35.5%). Nationality, age, tumor location, size of tumor, differentiation of the tumor, pT stage, pN stage, lymphatic invasion, and vascular invasion had been associated with PNI positivity. The mean survival time of patients with and without PNI was 62.5 months and 87.3 months, respectively ( P < 0.001 ). However, the presence of PNI was not an independent prognostic factor for gastric cancer, except for patients in stage III ( P = 0.037 , hazard ratio: 1.21, 95% confidence interval: 1.01-1.44). Conclusion. PNI occurs frequently in patients with gastric cancer, and the incidence of PNI increases with the staging of the tumor. The presence of PNI can provide additional information in predicting the survival outcome for those with stage III tumors.

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IMPACT OF AGING IN THE SURGICAL OUTCOMES OF GASTRIC CANCER PATIENTS

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.202100000-16 ◽

2021 ◽

Vol 58 (1) ◽

pp. 93-99

Author(s):

Andre Roncon DIAS ◽

Marina Alessandra PEREIRA ◽

Marcus Fernando Kodama Pertille RAMOS ◽

Ulysses RIBEIRO JR ◽

Bruno ZILBERSTEIN ◽

...

Keyword(s):

Gastric Cancer ◽

Surgical Outcomes ◽

Surgical Complications ◽

Postoperative Mortality ◽

Disease Free Survival ◽

D2 Lymphadenectomy ◽

Curative Intent ◽

Clinical Complications ◽

Gastric Cancer Patients ◽

The Impact

ABSTRACT BACKGROUND: As age advances, a higher burden of comorbidities and less functional reserve are expected, however, the impact of aging in the surgical outcomes of gastric cancer (GC) patients is unknown. OBJECTIVE: The aim of this study is to evaluate surgical outcomes of GC patients according to their age group. METHODS: Patients submitted to gastrectomy with curative intent due to gastric adenocarcinoma were divided in quartiles. Each group had 150 patients and age limits were: ≤54.8, 54.9-63.7, 63.8-72, >72. The outcomes assessed were: postoperative complications (POC), 90-day postoperative mortality, disease-free survival (DFS) and overall survival (OS). RESULTS: Major surgical complications were 2.7% in the younger quartile vs 12% for the others (P=0.007). Major clinical complications raised according to the age quartile: 0.7% vs 4.7% vs 5.3% vs 7.3% (P<0.042). ASA score and age were independent risk factors for major POC. The 90-day mortality progressively increased according to the age quartile: 1.3% vs 6.0% vs 7.3% vs 14% (P<0.001). DFS was equivalent among quartile groups, while OS was significantly worse for those >72-year-old. D2 lymphadenectomy only improved OS in the three younger quartiles. Age >72 was an independent risk factor for worse OS (hazard ratio of 1.72). CONCLUSION: Patients <55-year-old have less surgical complications. As age progresses, clinical complications and 90-day mortality gradually rise. OS is worse for those above age 72, and D2 lymphadenectomy should be individualized after this age.

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P-OGC23 Significance of neoadjuvant downstaging in gastric adenocarcinoma

British Journal of Surgery ◽

10.1093/bjs/znab430.151 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Pooja Prasad ◽

Ashwin Sivaharan ◽

Shajahan Wahed ◽

Alexander Phillips

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Neoadjuvant Chemotherapy ◽

Clinical Outcomes ◽

Gastric Adenocarcinoma ◽

Clinical Stage ◽

Neoadjuvant Treatment ◽

High Volume ◽

Recurrence Rates ◽

The Impact

Abstract Background Neoadjuvant chemotherapy is established in the treatment of gastric adenocarcinoma. Histopathological regression as a result of neoadjuvant treatment can potentially have important prognostic implications in gastric cancer. There is little data comparing the clinical outcomes of patients with gastric adenocarcinoma at the same pathological stage with and without neoadjuvant treatment. The aim of this study is to determine the impact of neoadjuvant chemotherapy upon the prognosis of patients being treated for gastric adenocarcinoma. Methods Consecutive patients with gastric cancer treated in a single, tertiary high-volume centre between 2007 and 2017 were evaluated. All patients with gastric adenocarcinoma were treated with either a subtotal or total gastrectomy with D2 lymphadenectomy. A stage-by-stage comparison of the extent of pathological downstaging was conducted for patients who received neoadjuvant treatment (ypTNM) and those that did not (pTNM). The pTNM and ypTNM stages were defined as per the TNM 8th Edition. Results Among 384 patients undergoing gastrectomy for gastric adenocarcinoma, 141 patients received neoadjuvant chemotherapy. Of them, 86 patients (58.1%) benefitted from a downstaging effect. Patients with downstaged disease had improved overall survival compared to patients who did not respond to neoadjuvant chemotherapy (NR vs 66 months, p < 0.001). Downstaging by > 3 stages was the strongest independant predictor of overall survival (hazard ratio: 0.17; 95% Confidence Interval (CI) 0.062-0.44). Overall survival was significantly better when a stage-by-stage comparison was performed between patients in the ypTNM and pTNM groups. Conclusions Pathological staging following neoadjuvant chemotherapy is a more accurate predictor of prognosis compared to pre-neoadjuvant chemotherapy clinical stage with downstaged patients benefitting from lower recurrence rates and improved overall survival. Patients downstaged due to neoadjuvant chemotherapy receipt can potentially have more favourable clinical outcomes compared to stage-matched patients who did not receive this.

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