Clinical audit of gastrectomy for gastric adenocarcinoma: Results of a single institution

Abstract

Aim To study the short- and long-term outcomes of surgical resections for gastric adenocarcinoma. Patients and Methods All patients who had gastric adenocarcinoma who underwent gastrectomy from 2002 to 2012 at Tuen Mun Hospital, Hong Kong, were reviewed. Pathological staging was defined according to 7th edition of the American Joint Committee on Cancer stage manual. D1 lymphadenectomy is the removal of perigastric lymph nodes, and D2 lymphadenectomy is the removal of perigastric and the second tier of regional lymph nodes, according to the Japanese Gastric Cancer Association. Results The clinical outcomes of 354 patients were studied. The median age was 67, and 65.8 per cent of patients were male. A total of 299 operations (84.5 per cent) were performed with curative intent; 167 (47.2 per cent) patients received extended lymphadenectomy (D2). Laparoscopic gastrectomy was started in 2008 and comprised of 7.8 per cent of gastrectomies since then; 44.9 per cent of patients had pathological stage III, 31.1 per cent of patients received adjuvant treatment and 18.8 per cent of patients developed complications, including intra-abdominal collection (3 per cent), duodenal stump leak (2.5 per cent) and anastomotic leak (1.4 per cent). The median postoperative length of stay was 10 days. The 30-day mortality was 2.3 per cent. The overall median survival time was 38.23 months. The 3-year survival rates for D1 and D2 gastrectomies were 45.45 per cent and 58.37 per cent, respectively. The 5-year survival rates for D1 and D2 gastrectomies were 33.49 per cent and 47.78 per cent, respectively (P = 0.0013). The results are comparable to international standards. Conclusion The outcomes of patients undergoing gastrectomy for cancer are reviewed and were found to be comparable to international standards. Many of our patients had advanced disease and were benefitted by more extensive lymph-node dissection.