Abstract
BackgroundA steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. However it is still not clear if this trend applies to Eastern Europe where high incidence rate of gastric cancer is observed.MethodsThis was a retrospective non-randomized, single center, cohort study. During the study period 557 consecutive patients diagnosed with gastric cancer in which curative operation was performed met the inclusion criteria. The study population was divided into two groups according to two equal time periods: 01-01-1994 – 31-12-2000 (Group I – 273 patients) and 01-01-2001 – 31-12-2007 (Group II – 284 patients). Primary (five-year survival rate) and secondary (postoperative complications, 30-day mortality rate and length of hospital stay) endpoints were evaluated and compared.ResultsRate of postoperative complications was similar between the groups, except for Grade III (Clavien-Dindo grading system for the classification of surgical complications) complications that were observed at significantly lower rates in Group II (26 (9.5%) vs. 11 (3.9%), p = 0.02). Length of hospital stay was significantly (p = 0.001) shorter (22.6 ± 28.9 vs. 16.2 ± 17.01 days) and 30-day mortality was significantly (p = 0.02) lower (15 (5.5%) vs. 4 (1.4%)) in Group II. Similar rates of gastric cancer related mortality were observed in both groups (92.3% vs. 90.7%). However survival analysis revealed significantly (p = 0.02) better overall 5-year survival rate in Group II (35.6%, 101 of 284) than in Group I (23.4%, 64 of 273). There was no difference in 5-year survival rate when comparing different TNM stages.ConclusionsGastric cancer treatment results remain poor despite decreasing early postoperative mortality rates, shortening hospital stay and improved overall survival over the time. Prognosis of treatment of gastric cancer depends mainly on the stage of the disease. Absence of screening programs and lack of clinical symptoms in early stages of gastric cancer lead to circumstances when most of the patients presenting with advanced stage of the disease can expect a median survival of less than 30 months even after surgery with curative intent.
Highlights
A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe
Five hundred fifty seven consecutive patients were included in the study according to the following inclusion criteria: (1) histologically proven gastric adenocarcinoma; (2) diagnosis based on the UICC TNM staging classification; (3) curative D1 or D2 gastrectomy performed; (4) available complete medical record; (5) postoperative follow-up
The gastric cancer- related survival, rates of postoperative complications, the length of hospital stay and 30-day mortality rate were considered as secondary outcomes
Summary
A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. Previous studies have shown that age, lymph node and liver metastasis, disease stage and tumour size are important predictive factors for survival in patients with resectable gastric cancer [9,10,11]. It is not certainly clear if these predictive factors are the same in all regions and why incidence rates of gastric cancer are still high in the region of Eastern Europe. The aim of this single centre study was to compare the clinical course and outcomes, such as postoperative complications, the length of hospital stay and mortality rate, over two distinctive time periods
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