Improving Outcomes After Gastroesophageal Cancer Resection

Abstract

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.

Trends in clinical features, postoperative outcomes, and long-term survival for gastric cancer: a Western experience with 1,278 patients over 30 years

“…The mean age and male predominance of the patients in our series are similar to those in other reports [13,15,16]. …”

“…Usually, postoperative outcomes in Western centers have been explained by the difference in age, weight, and comorbidity, whereas the poor long-term survival has been attributed to tumor stage and location [16,17]. …”

Using textbook outcome as a measure of quality of care in oesophagogastric cancer surgery

“…The rate of complications of grade II and above was higher in the present series than in the nationwide cohort: 32·9 per cent after oesophagectomy (DUCA 17·0 per cent) and 32·3 per cent after gastrectomy (DUCA 11·7 per cent). Pulmonary complications were most frequent, similar to previous findings. Pulmonary complications are less common after minimally invasive procedures than after open surgery.…”

Different survival outcomes after curative R0-resection for Eastern Asian and European gastric cancer

“…[ 20 ] Meta-analyses for Western data on this issue are not conclusive to this date [ 21 ] but experienced centers may have excellent results. [ 22 ] Surgical strategies were different between the cohorts. Almost two-thirds of the patients received subtotal gastrectomies in the Korean group whereas most of the patients in the German group received total or even extended gastrectomies.…”