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Treatment of Gastric Adenocarcinoma based on Institution Type/Approvals Category in the United States
Kaye M. Reid1, Lina Patel3, Jaffer Ajani2,3, John H. Donohue1,3, Members of the Gastric PCE Project The3; 1General Surgery, Mayo Clinic - Rochester, Rochester, MN; 2GI Medical Oncology, M.D. Anderson, Houston, TX; 3American College of Surgeons, Commission on Cancer , Chicago, IL

INTRODUCTION: The concept that high risk surgical procedures should be performed in high volume centers in order to improve both surgical morbidity and mortality is becoming widely accepted. Our aim was to determine if there is a difference in treatment of gastric cancer among hospitals categorized as community cancer centers, comprehensive community cancer centers, teaching/research centers as defined by the American College of Surgeons, Commission on Cancer (CoC). METHODS: Data from the National Cancer Data Base (NCDB) 2001 Gastric Cancer Patient Care Evaluation (PCE) Study were analyzed. The data for patients diagnosed with gastric adenocarcinomas in 2001 were voluntarily submitted by 711 CoC-approved cancer programs. Proportional differences were based on two-sided chi-square test with a significant level of 0.05. Tests were adjusted for all pairwise comparisons using the Bonferroni correction at a 0.05 level. RESULTS: Of the 6042 with adenocarcinoma, 3151(52%)were treated surgically. The mean number of patients treated at teaching hospitals was higher than community centers (Table 1). The utilization of laparoscopy and endoscopic ultrasound (EUS) were highest at research centers (p<0.001 for both). More than 15 nodes were pathologically evaluated in 21.5 % of the resection specimen at community centers and 30% at research centers (p=<0.001).A D1 lymphadenectomy was most frequently preformed (mean of 59 % at all centers). Post-operative wound infections and bleeding occurred at all institutions with similar frequency. Adjusted to cancer stage, chemotherapy and radiation therapy were utilized with equal frequency at all types of treatment centers (p =0.62, p=0.82 respectively). The 30-day post-operative mortality was lowest at research centers compared to community cancer centers (p = ≤0.001) and comprehensive cancer centers (p = ≤0.01). There were no differences between both types of community treatment centers (p=≤0.20). CONCLUSION:Thirty day mortality for gastric cancer operations is significantly less at research centers which supports established data that rare diseases treated at higher volume centers have more favorable outcomes. There is no difference by the category of institution in the frequency of post operative hemorrhage, wound infection, or use of either chemotherapy or radiation therapy. Because only a third of patients have >15 nodes assessed, the staging and subsequent adjuvant therapy are likely compromised in the United States .

 

Community Cancer Center

Comprehensive Cancer Center

Teaching/Research

Mean Cases/year

5

9

14

>15 Lymph nodes, %

21

22

31

30 Day Mortality, % (long term data not available)

9

7

5


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