Comparison of Gastric Cancer Survival Following R0 Resection in the United States and Korea Using an Internationally Validated Nomogram

Strong, Vivian E.; Song, Kyo Young; Park, Cho Hyun; Jacks, Lindsay M.; Gönen, Mithat; Shah, Manish A.; Coit, Daniel G.; Brennan, Murray F.

doi:10.1097/sla.0b013e3181d3d29b

Cited by 329 publications

(297 citation statements)

References 34 publications

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“…The overall operative mortality rate of 1.6 % compares favorably with data from large contemporary audits, with the 2010 esophagogastric cancer audit of England and Welsh hospitals reporting an in-hospital mortality rate of 6 % for patients undergoing curative gastric resection [31]. The operative mortality rate of 2.5 % for our patients selected to have a D2 resection is comparable to the results published from internationally renowned centers [9,17,18,20] and is significantly less than the mortality rates reported from two of the published randomized trials of D1 versus D2 resection [11,32,33]. It is worth noting that we have performed far fewer resections involving the pancreas and the spleen, which was a major source of morbidity in the Dutch study [11].…”

Section: Discussionsupporting

confidence: 73%

“…It is worth noting that we have performed far fewer resections involving the pancreas and the spleen, which was a major source of morbidity in the Dutch study [11]. The pattern of morbidity we have reported is similar to other series involving ''Western'' patients [20], with a high incidence of cardiac and respiratory complications. The reasons for our results are likely related to the surgery occurring in a unit that includes surgeons who have undergone training and education in gastric surgery and who also perform a large number of esophageal resections.…”

Section: Discussionsupporting

confidence: 66%

“…This result has led to a shift from routine resection of the distal pancreas and spleen to a much more selective approach [13][14][15][16]. A more recent randomized study from a Western surgical center was able to demonstrate no increase in morbidity or mortality rates with D2 lymphadenectomy [17]; this has also been reported in numerous nonrandomized studies from specialized units with an interest in gastric cancer, demonstrating that a D2 lymph node dissection can be performed safely with good outcomes [10,15,[18][19][20][21].…”

Section: Introductionmentioning

confidence: 57%

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Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

et al. 2013

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Background The incidence of gastric cancer is decreasing in Australia, yet it remains a common cause of cancerrelated mortality. Surgical resection remains the cornerstone of curative treatment. High-volume specialized units have reported superior perioperative and oncological outcomes. The role of D2 lymphadenectomy has been controversial as a result of concerns over increased morbidity. Our aim is to report the perioperative and oncological outcomes of curative gastric resection from a specialist Australian upper GI unit. Methods Data from a prospectively maintained database were reviewed for all patients undergoing curative resection for gastric adenocarcinoma from a single unit during a 12-year period. Perioperative and long-term outcomes were compiled. Results There were 255 curative gastric resections during 12 years. An R0 resection was performed in 96 % with a perioperative mortality rate of 1.6 %. A D2 dissection was performed in 85 % of cases in the past 6 years, with no increase in perioperative morbidity or mortality detected. The 5-year overall survival was 53 %. Conclusion Our results demonstrate that both short-and long-term outcomes of surgical resection in gastric cancer patients, comparable to international high-volume centers, can be achieved in an Australian upper GI unit. A D2 lymph node dissection can be performed safely without any increase in perioperative risk in a specialist unit that has the necessary training but also the perioperative support structures to manage these complex patients.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 57%

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Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

et al. 2013

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“…Previous cohort studies have highlighted the survival difference in patients with resectable GC between Western and Eastern countries [6][7][8][9][10][11][12][13][14]. Noguchi et al [6] reported a survival difference between high-volume centers in the USA and Japan that was no longer apparent after adjusting for tumor location.…”

Section: Introductionmentioning

confidence: 97%

“…Bollschweiler et al [8] compared the survival of Japanese and German GC patients and concluded that the country itself was a prognostic factor. Strong et al [9] calculated the diseasespecific survival of GC patients by considering the risk of individual patients using a nomogram and demonstrated that the survival probability was different between a Korean and US high-volume center.…”

Section: Introductionmentioning

confidence: 99%

The survival difference between gastric cancer patients from the UK and Japan remains after weighted propensity score analysis considering all background factors

et al. 2015

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Background Previous studies comparing survival between gastric cancer (GC) patients from the West and the East were based on the assumption that background factors and prognostic factors were identical. The aim of the current study was to compare the survival of GC patients from the UK and Japan using weighted propensity score analysis after identifying all different background factors. Methods Data from 464 patients from the Leeds Teaching Hospital NHS Trust, Leeds, UK (LTHT), and 465 patients from the Kanagawa Cancer Center Hospital, Yokohama, Japan (KCCH), who had surgery for GC were analyzed. Prognostic factors for overall survival (OS) and cancer-specific survival (CSS) were identified by univariate and multivariate analyses. Survival was compared by propensity score weighting after adjusting for all significantly different background factors. Results Most background factors were different between LTHT and KCCH patients. Unadjusted stage-specific OS and CSS were significantly better in KCCH. Independent prognostic factors for unadjusted OS and CSS were pT and pN in KCCH and in addition tumor location, pancreatectomy, resection margin status and number of examined lymph nodes in LTHT. Even after adjusting for all background characteristics, survival remained better in KCCH. Conclusions These results suggest that differences in background factors are unable to fully explain the survival difference of GC patients between UK and Japan. Comprehensive studies into the biology of GC and/or host factors are needed to fully understand the survival difference.

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Improving Outcomes After Gastroesophageal Cancer Resection

Hanna¹,

Boshier²,

Knaggs³

et al. 2012

Arch Surg

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Hypothesis: Extended lymphadenectomy in gastroesphageal cancer leads to improved long-term survival without compromising postoperative outcomes in Western patients to attain the standard achieved in Japanese centers. Design: Cohort study comparing postoperative outcomes and long-term survival with data from the National Cancer Center (NCC) of Tokyo, Japan. Outcomes were also compared with data from the UK National Oesophago-Gastric Cancer Audit (NOGCA) and a representative cohort from southeast England. Prospectively collected data were independently audited. Setting: University medical center. Patients: From 2003 to 2010, 100 patients underwent gastrectomy and 109 underwent esophagectomy. Main Outcome Measures: Postoperative mortality and morbidity and long-term overall survival. Lymph node count was used as a measure for the extent of lymphadenectomy. Results: One death occurred after esophagectomy and none after gastrectomy. Anastomotic leak rate was approximately 2% in both cohorts. Kaplan-Meier estimates of 5-year overall survival after gastrectomy and esophagectomy were 58.4% and 47.8%, respectively. Postoperative mortality and technical complications for gastric and esophageal cancer resections were similar to NCC rates (P =.20). Stage for stage 5-year survival rates in patients with esophageal cancer and stages II and III gastric cancer were similar to outcomes in the NCC. The 5-year survival for patients with gastric cancer was worse for those with stage I (PϽ.001) and better for those with stage IV (P Ͻ .001) disease compared with NCC rates. Postoperative outcomes and long-term survival were significantly better than those reported by the NOGCA and the data from the southeast of England (P Ͻ .05). Conclusions: This study demonstrates that postoperative outcomes and long-term survival after gastroesophageal cancer resection can be improved in Western patients to the highest standard achieved in Japan.

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Comparison of Gastric Cancer Survival Following R0 Resection in the United States and Korea Using an Internationally Validated Nomogram

Abstract: This study demonstrates better survival for GC patients in Korea compared with the US as determined by multivariate analysis with a validated gastric cancer nomogram. Multiple possibilities can explain this difference.

Cited by 329 publications

References 34 publications

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes

The survival difference between gastric cancer patients from the UK and Japan remains after weighted propensity score analysis considering all background factors

Improving Outcomes After Gastroesophageal Cancer Resection

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