Pattern of gastric cancer resection in the Memphis metropolitan area (MMA).

Abstract

e14633 Background: Quality of cancer surgery impacts patient outcomes. We evaluated the pattern and quality of gastric cancer resections and correlated them with postoperative and long term survival in the MMA. Methods: Institutional review of all curative-intent gastric cancer resections from 1999-2008 excluding those who received preoperative therapy. Good quality resection (GQR) was defined as R0 with ≥ 15 lymph nodes (LN) examined. Log rank test for survival comparisons, Wilcoxon Mann Whitney for comparison between medians and proportional hazard models were employed. Results: Table: Cohort characteristics (N=112). GQR rate: 26%. Only 6% of patients had preoperative endoscopic ultrasound (EUS) or laparoscopic staging. Unexpected metastatic disease was discovered intraoperatively in 25% of the patients. R-status (p< 0.001), but not number of LN examined, correlated with survival. Tumor stage independently predicted survival on univariate analysis, while GQR, age, and number of comorbidities did not. Conclusions: R0 resection was associated with better survival in our MMA gastric resection cohort. The proportion of patients who had ≥ 15 LN examined was low. Increased utilization of preoperative staging modalities like EUS and laparoscopy, and emphasis on more thorough pathological examination of resection specimens can improve GQR rates. (%) P value Median age 66 (25-93) Sex Female 43 Male 57 Race Black 63 White 30 Other 7 Stage I 24 II 22 III 30 IV 22 Preoperative staging CT 71 EUS 3 Laparoscopy 3 Not reported 23 Gastrectomy Proximal 5 Distal 66 Total 28 R status R0 72 R1/R2 28 Median margin distance (mm) 10 (0-340) LN status Nx 4 N0 29 N1-3 66 Median LN examined Overall 14 (0-55) LN-negative patients 9 (1-43) p < 0.01 LN-positive patients 15 (0-55) # LN examined 0 5 < 15 54 ≥15 41 GQR p = 0.61 Overall 26 Stage I 20 Stage II 30 Stage III 28 Stage IV 25 60-day postoperative survival rate (%) 93 5-year survival rates (%) Overall 44 Stage p <0.01 I 74 II 35 III 39 IV 21 R status p < 0.001 R0 55 R1/R2 17 LN examined p = 0.61 < 15 49 ≥ 15 38 GQR p = 0.51 Yes 42 No 51 No significant financial relationships to disclose.