Weekday of gastrectomy for cancer in relation to mortality and oncological outcomes – A Dutch population-based cohort study

Abstract

BackgroundSome studies demonstrate that high-complex surgeries performed later in the week are associated with higher postoperative mortality and worse long-term survival. The aim of this cohort study was to determine whether weekday influences outcomes in patients undergoing gastrectomy for cancer. MethodsAll patients who underwent a curative gastrectomy for cancer (2006–2014) were selected from the nationwide population-based Netherlands Cancer Registry. Weekday was analyzed as categorized (Monday–Tuesday versus Wednesday–Friday) and discrete variable (Monday–Friday). The influence of weekday on postoperative 30- and 90-day mortality, and oncological outcomes (lymph node yield, radicality rate and overall survival) was assessed with multivariable logistic and Cox regression analyses. ResultsA total of 3.776 patients were included with a median overall survival of 26.7 months [range 0–120]. The 30- and 90-day mortality were 5% and 8% respectively, median lymph node yield was 13 [range 0–87], and radicality rate was 87%. In multivariable analysis, no influence of weekday was found on postoperative mortality (p > 0.05), on R0 resection rates (p > 0.05), nor on overall survival (Monday–Friday, HR 1.03, 95%CI 1.01–1.04, p = 0.111; Wednesday–Friday vs. Monday–Tuesday, HR 1.05, 95%CI 0.96–1.14, p = 0.307). The lymph node yield was significantly lower later in the week compared to earlier (Monday–Friday, OR 0.94, 95%CI 0.89–0.99, p = 0.013; Wednesday–Friday vs. Monday–Tuesday OR 0.83, 95%CI 0.71–0.96, p = 0.010), which was most apparent in recent years of surgery. ConclusionGastric cancer surgery can be performed safely throughout the week regarding postoperative mortality, radicality and overall survival. A point of concern is a reduced lymph node yield later in the week.