Epidemiology, Surgical Management and Early Postoperative Outcome in a Cohort of Gastric Cancer Patients of a Tertiary Referral Center in Relation to Multi-Center Quality Assurance Studies

Abstract

the aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study -GGCS (1992) and East German Gastric Cancer Study -EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results. material and methods. Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome. results. From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer patients were treated. In comparison with the EGGCS cohort there was a larger proportion of patients with locally advanced and proximally located tumors. 272 patients (82.9%) underwent surgery with curative intent; in 88.4% of these an R0 resection was achieved (EGGCS/GGCS: 82.5%/71.5%). 68.2% of patients underwent preoperative endoluminal ultrasound (EUS) (EGGCS: 27.4%); the proportion of patients undergoing EUS increased over the study period. Diagnostic accuracy of EUS for T stage was 50.6% (EGGCS: 42.6%). 77.2% of operated patients with curative intent underwent gastrectomy (EGGCS/GGCS: 79.8%/71.1%). Anastomotic leaks at the esophagojejunostomy occurred slightly more frequently (8.8%) than in the EGGCS (5.9%) and GGCS (7.2%); however, postoperative morbidity (36.1%) and early postoperative mortality (5.3%) were not increased compared to the multi-center quality assurance study results (EGGCS morbidity, 45%); EGGCS/GGCS mortality, 8%/8.9%). D2 lymphadenectomy was performed in 72.6% of cases (EGGCS: 70.9%). Multivariate analysis revealed splenectomy as an independent risk factor for postoperative morbidity and ASA status 3 or 4 as an independent risk factor for early postoperative mortality. The rate of splenectomies performed during gastric cancer surgery decreased substantially during the study period. conclusions. Preoperative diagnostics were able to accurately predict resectability in almost 90% of patients which is substantially more than the corresponding results of both the EGGCS and the GGCS. In the future, more wide-spread use of EUS will play an increasing role as stage-dependent differentiation of therapeutic concepts gains acceptance. However, diagnostic accuracy of EUS needs to be improved. Our early postoperative outcome data demonstrate that the quality standard of gastric cancer care established by the EGGCS is being fulfilled at our institution in spite of distinct characteristics placing our patients at higher surgical risk. Besides being a valuable instrument of internal quality con...

Dynamic expression of Lgr6 in the developing and mature mouse cochlea

“…In other organs, including the skin, taste buds, and lungs, Lgr6 has been identified as a stem cell marker (Snippert et al, 2010 ; Oeztuerk-Winder et al, 2012 ; Ren et al, 2014 ), and these Lgr6-positive stem cells have been reported to be involved in wound repair and hair follicle development (Barker and Clevers, 2010 ; Snippert et al, 2010 ; Leushacke and Barker, 2012 ). Lgr6 expression is sometimes up-regulated in gastric cancer, and Lgr6 expression is significantly correlated with patient survival; patients with Lgr6-positive tumors tend to live longer than patients with Lgr6-negative tumors (Krejs, 2010 ; Garlipp et al, 2011 ).…”

Accuracy of Endoscopic Ultrasonography for Determination of Tumor Invasion Depth in Gastric Cancer

“…In this context, accurate preoperative determination of the GC stage is essential in the selection of an appropriate therapeutic mode. Previously, precise preoperative staging was not essential because the exact stage did not alter treatment plans (Garlipp et al, 2011). Endoscopic ultrasonography (EUS), which is considered to be the method of choice for locoregional staging, was commonly used for the differentiation of mucosal from submucosal lesions (Ganpathi et al, 2006;Jurgensen et al, 2013;Karimi et al, 2014).…”