Management of gastroesophageal cancer: A perspective from Catalonia

Abstract

The territory in Spain is administratively organized within 17 autonomous communities. National health system is then composed of 17 independent regional health systems that hold primary jurisdiction on health care planning and organization within each region. Catalonia (7 million inhabitants) has its own structure, organization, and databases that allow us to assess the relationship between volume and surgical outcomes in subjects with esophageal and gastric cancer. Similar to other European regions, the incidence trends in Catalonia have shown a decrease in gastric cancer and an increase in the occurrence of esophageal cancer and gastric cardia adenocarcinoma. Moreover, a declining trend in mortality rate was also detected. No clinical guidelines for the diagnosis and treatment of esophago-gastric cancer or audits have been implemented in Catalonia, but retrospective and prospective data obtained for the 1996–2005 period confirmed a spontaneous centralization of high-risk surgical procedures, such as esophageal cancer resection in a limited number of centers. In early 2012, health care authorities approved centralization of esophageal and gastric cancer surgery into 7 and 15 hospitals, respectively. However, this process should be considered as a first step to be expanded in the forthcoming years. It would be desirable to carry out this process in a transparent manner, using not only data on morbidity and mortality rates, but also data on quality of life as well as teaching or research as quality of care measures. The present review based on local available data and data recorded from the literature allows the authors to present their personal perspective on the current multidisciplinary approach in themanagement of patients with esophago-gastric cancer.