Short-term postoperative outcomes of gastric adenocarcinoma patients treated with curative intent in low-volume centers
Por:
Lacueva F, Escrig-Sos J, Marti-Obiol R, Zaragoza C, Mingol F, Oviedo M, Peris N, Civera J and Roig A
Publicada:
17 oct 2022
Ahead of Print:
17 oct 2022
Resumen:
Background Quality standards in postoperative outcomes have not yet been defined for gastric cancer surgery. Also, the effect of centralization of gastric cancer surgery on the improvement of postoperative outcomes continues to be debated. Short-term postoperative outcomes in gastric carcinoma patients in centers with low-volume of annual gastrectomies were assessed. The effect of age on major postoperative morbidity and mortality was also analyzed. Methods Patients with gastric or gastroesophageal junction Siewert III type carcinomas who underwent surgical treatment with curative intent between January 2013 and December 2016 were included. Data were obtained from the population-based surgical registry Esophagogastric Carcinoma Registry of the Comunitat Valenciana (RECEG-CV). The RECEG-CV gathers information on demographic characteristics and comorbidity, preoperative study and neoadjuvant treatment, surgical procedure, pathological study, postoperative outcomes, and follow-up. Seventeen hospitals belonging to the public network participated in this registry. Results Data from 591 patients were analyzed. Postoperative major morbidity occurred in 154 (26.1%) patients. Overall 30-day or in-hospital mortality, and 90-day postoperative mortality rates were 8.6% and 10.1% respectively. Failure-to-rescue was 39% and it was significantly higher in patients aged 75 years or older in comparison with younger patients (55.3% vs 23.1% p < 0.001). In the multivariable analysis, age >= 75 years (p = 0.029), laparoscopic approach (p = 0.005), and total gastrectomy (p = 0.005) were associated with major postoperative morbidity. Age >= 75 years (p = 0.027), pulmonary complications (p = 0.001), cardiac complications (p = 0.001), leakage (p = 0.003), and hemorrhage (p = 0.013) were associated with postoperative mortality. Conclusions Centralization of gastric adenocarcinoma treatment in centers with higher annual caseload should be considered to improve the short-term postoperative outcomes in low-volume centers. Patients aged 75 or older had a significantly increased risk of major postoperative morbidity and mortality, and higher failure-to-rescue.
Filiaciones:
Lacueva F:
Hospital General Universitario de Elche, Elche, Spain.
:
Hospital General Universitario de Castellón, Castellón de la Plana, Spain
Marti-Obiol R:
Hospital Clínico Universitario de Valencia, Valencia, Spain
Zaragoza C:
Hospital General Universitario de Alicante, Alicante, Spain
Mingol F:
Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
Oviedo M:
Hospital General Universitario de Valencia, Valencia, Spain
:
Hospital Universitario Doctor Peset de Valencia, Valencia, Spain
:
Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
:
Hospital Lluís Alcanyís de Xàtiva, Valencia, Spain
Green Published, gold
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