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Aim & Methods: By means of a systematic multicenter prospective observational study, quality of surgical care for a representative group of patients with gastric cancer in daily clinical practice was investigated after inauguration of neoadjuvant therapeutic concepts (QCGC'07/09) and compared to former data obtained in a study with similar design (EGGCS'02) but no neoadjuvant treatment arm.
Results: - From 01/01/2007-12/31/2009, 2,897 patients from 141 hospitals were enrolled in the study with the following rates (QCGC'07/09 [EGGCS'02: n=1,139 patients]): Resection (91.2[87.1]%), gastrectomy (74.5[79.8]%), R0-resection (82.8[82.3]%) explorative laparotomy (4.9[6.3]%), UICC-III/IV (45.2[41.8]%), hospital lethality (6.0[8.3]%) & esophagojejunal anastomotic insufficiency (6.0[5.8]%).
- After inauguration of multimodal procedures (n=498; 18%)
i) the proportion of patients with no or only palliative surgical intervention decreased considerably - palliative rate (no R0-resection, i.e., palliative or no operation: In 2002 [40%] vs. 2007-2009 [24.5%]);
ii) hospital lethality (overall, 6%/with neoadjuvant chemotherapy, 3.4%) and peri- & postoperative morbidity did not increase;
iii) 4.4% (n=23/521) of patients with neoadjuvant treatment could not be resected.
- There were no changes of the distribution of tumor sites and stages (according to UICC classification), in particular, no reduction of advanced tumor stages.
- Gastrectomy rate decreased from 79.8 to 74.5% - the supposed reduction of radicality at the primary tumor lesion was associated with an extension of lymphadenectomy compared with 2002 - D1: 11.9% (n=245/2,052 resected patients with curative intention); D2: 79.5%; D3/4: 5.7/2.8%.
- Two trends continued: Predominating esophagojejunal stapler anastomosis, 96% (pouch: Approx. 20%).
- A hospital-volume effect could not be observed.
- A postoperative adjuvant chemotherapy (only patients without neoadjuvant treatment) received 15.8% of the patients (n=327).
- The 5-year survival rate of the whole patient group (including curative & palliative intention) increased from 40.0% up to 48.5% but, in particular, in stage II - in stage IV: Increase from 3.5 to 11.3%).
Conclusion: After inauguration of multimodal concepts, there was an effective improval of the overall survival without increased perioperative risk in the daily clinical care of gastric cancer; however, patients undergoing endoscopic tumor ablation & exclusively palliative chemotherapy were not included.