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Evolution of gastrectomy for cancer over 30-years: Changes in presentation, management, and outcomes

Lookup NU author(s): Professor Michael Griffin, Maziar Navidi, Shajahan Wahed, Arul Immanuel, Nick Hayes, Professor Alexander PhillipsORCiD

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Abstract

© 2021 Elsevier Inc.Background: Gastric cancer has seen a considerable change in management, and outcomes for the past 30 years. Historically, the overall prognosis has been regarded as poor. However, the use of multimodal treatment, and integration of enhanced recovery pathways have improved short and long-term outcomes. The aim of this study was to evaluate the changing trends in presentation, management, and outcomes for patients undergoing surgical treatment for gastric cancers over 30 years. Methods: Data from consecutive patients undergoing gastrectomy with curative intent for gastric adenocarcinoma between 1989 and 2018 from a single-center, high-volume unit were reviewed. Presentation method, management strategies and outcomes were reviewed. Patients were grouped into successive 5-year cohorts for comparison and evaluation of changing trends. Results: Between 1989 and 2018, 1,162 patients underwent gastrectomy with curative intent for cancer. Median age was 71 years (interquartile range, 63−76 years) and 763 (66%) were male. Patient presentation changed with epigastric discomfort now the most common presentation (67%). An improvement in overall complications from 54% to 35% (P =.006) and mortality from 8% to 1% (P <.001) was seen over the time period and overall survival improved from 28 months to 53 months (P <.001). Conclusion: Both short-term and long-term outcomes have significantly improved over the 30 years studied. The reasons for this are multifactorial and include the use of perioperative chemotherapy, the introduction of an enhanced recovery pathway, and improved preoperative assessment of patients through a multidisciplinary input.

Publication metadata

Author(s): Griffin SM, Kamarajah SK, Navidi M, Wahed S, Immanuel A, Hayes N, Phillips AW

Publication type: Article

Publication status: Published

Journal: Surgery

Year: 2021

Volume: 170

Issue: 1

Pages: 2-10

Online publication date: 02/03/2021

Acceptance date: 25/01/2021

ISSN (print): 0039-6060

ISSN (electronic): 1532-7361

Publisher: Mosby Inc.

URL: https://doi.org/10.1016/j.surg.2021.01.040

DOI: 10.1016/j.surg.2021.01.040

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