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GASTRIC CANCER(CA) IN SURGICAL PRACTICE OF THE LAST DECADE - DATA OBTAINED IN A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY CONDUCTED BY A SINGLE STUDY GROUP OF RESEARCH ON CLINICAL CARE IN GERMANY
Ingo Gastinger2, Frank Meyer*1
1Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital, Magdeburg, Germany; 2Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
Introduction: Gastric Ca is a challenging tumor disease with regard to substantially improve the outcome.
Aim & Methods: To investigate the factors (with an impact onto i) peri- & early postop. outcome & ii) oncological long-term results in consecutive patients with histological diagnosis of gastric Ca from I-XII/2002 & 2007-2009 (inauguration of multimodal treatment concepts) by means of a prospective multicenter observational study.
Results (corner points): - Overall, neoadjuvant treatment has increased up to 18 %.
- There is an improvement of the 5-year overall survival rate (all tumor stages: from 40.0 up to 48.5%, in particular, in stage II/IV) with no associated increased periop. risk (no increase of the postop. morbidity/lethality) after inauguration of multimodal concepts & based on a higher D2-lymphadenectomy rate (from 71 up to 83.3%) over the years.
- There was an increased acceptance (but further benefitial potential) of using EUS (27.4 up to 40.4%).
- Dysphagia & gastric stenosis (characteristics of a disturbed passage of the upper GI tract by tumor-induced obstruction as well as advanced tumor growth & catabolic status of the patient), obesity & periop. risk according to ASA classification were identified as independent factors with an impact onto the healing of the esophagojejunal anastomosis.
- Therapeutic results & prognosis of AEG-tumor lesions are significantly worse than gastric Ca of other tumor sites.
- "Hospital-volume" effects can only be found in the treatment of AEG tumor lesions.
- A lower rate of palliative surgical interventions was sobserved (from 40% down to 24.5%). - Radical tumor resection with palliative intention (if possible from the perspective of surgical technique) resulted in better median survival by 3 months vs. non-resecting procedures in case of good physical status of the patient & possible palliative chemotherapy postoperatively. In addition, palliative gastrectomy provided a significant prolongation of survival time by 5 months compared with limited resecting procedures (6 vs. 11 months).
- Currently, laparoscopic resections play only a minor role in gastric-Ca surgery in Germany.
Conclusion: To further improve early postop. & oncological long-term outcome, in particular, i) a greater portion of neoadj. treatment in gastric Ca, ii) centralisation of patients with proximal gastric Ca, & iii) palliative resection with low risk (with regard to ASA, exclusion of tumor stenosis/dysphagia) are recommendable.
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