Surgical treatment of gastric adenocarcinoma: Are we achieving textbook oncologic outcomes for our patients?. Issue 4 (29th December 2021)

• Record Type: Journal Article
• Authors: Spolverato, Gaya; Paro, Alessandro; Capelli, Giulia; Dalmacy, Djhenne; Poultsides, George A.; Fields, Ryan C.; Weber, Sharon M.; Votanopoulos, Konstantinos I.; He, Jin; Maithel, Shishir K.; Pucciarelli, Salvatore; Pawlik, Timothy M.
• Is Part Of: Journal of surgical oncology. Volume 125:Issue 4(2022)
• Page Start: 621
• Page End: 630
• Publication Date: 2021-12-29
• Subjects: gastric cancer -- surgical oncology -- textbook oncologic outcome; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.26778
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background and objectives: Composite measures are increasingly used to assess quality of care in surgical oncology. We sought to define the incidence of "textbook oncologic outcome" (TOO) following resection of gastric adenocarcinoma among a large, international cohort of patients. Methods: Gastric adenocarcinoma patients undergoing resection between 2000 and 2020 were identified from an international database. TOO was defined as margin‐negative resection, examination of ≥16 lymph nodes, no prolonged length‐of‐stay (LOS), no 30‐day mortality, and stage‐appropriate receipt of chemotherapy. Results: Among a total of 910 patients, 321 patients (35.3%) achieved a postoperative TOO. While failure to evaluate ≥16 lymph nodes ( n = 591, 65.0%) and receipt of chemotherapy ( n = 651, 71.5%) had the greatest negative impact on the ability to obtain a TOO, no 30‐day mortality ( n = 880, 96.7%), margin‐negative resection ( n = 831, 91.3%), and no extended LOS ( n = 706, 77.6%) were more commonly achieved. No postoperative complications (OR: 0.44; 95% CI: 0.31−0.63) and T1a/T1b‐stage disease (OR: 2.87; 95% CI: 1.59−5.18) were independently associated with achieving a TOO ( p < 0.05). The odds of achieving a TOO improved over time ( p ‐trend < 0.05), which was largely attributable to improved odds of evaluating ≥16 lymph nodes (2010−2014 vs. 2000−2004: OR, 5.21; 95% CI: 3.22−8.45). Conclusions: Only about one in three patients achieved a TOO following resection of gastric adenocarcinoma. Odds of TOO increased over time, largely due to improved lymph node evaluation.