Related Experiment Video
Updated: Jun 21, 2025
Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma
Published on: August 9, 2016
1657 Resected Gastric Adenocarcinomas at a Single Institution: Outcomes and Trends over 17 Years
Swati Batra1, Manish S Bhandare1, Vikram Chaudhari1
1Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India.
Background:
Outside of clinical trials, real-world data of advanced gastric cancers (AGCs) managed with perioperative or adjuvant chemotherapy with a backbone of D2 lymphadenectomy is limited.
Patients And Methods:
Curative resections for gastric adenocarcinoma between January 2003 and January 2020 at the Tata Memorial Centre were analyzed, comparing three time periods marking major increments in annual gastric resections (GRs).
Results:
1657 radical gastric resections were performed with a morbidity and mortality rate of 34.9% and 1.4%, respectively. Over three consecutive periods, the number of annual GRs increased from 56/year to 97/year to 156/year (P < 0.001) with a significant escalation in surgical magnitude and complexity. Improvement in surgical quality indicators (median lymph node yield from 15 to 25, P < 0.001 and margin negativity from 8.2 to 5.5%, P = 0.002) was observed with no corresponding increase in severe complications (6.9%) or mortality (1.4%). The proportion of distal and signet ring cancers was found to decrease over time, with an increase in proximal cancers and younger age at presentation. Overall, 90% of GRs were for AGCs with a median overall survival (OS) of 4.4 years (± 6 months), and 5-year OS rate of 47.6% (± 1.9%).
Conclusions:
Change in pattern of tumor characteristics was observed. Aggressive treatment options for AGC were employed progressively with excellent survival. With increase in volumes, improvements in surgical quality indicators, and a relative improvement in postoperative mortality was observed. These results provide a roadmap for developing dedicated gastric cancer centers.
Insights
Real-world data on advanced gastric cancers (AGCs) treated with D2 lymphadenectomy shows increasing surgical volumes and complexity. Improvements in quality indicators and survival were observed without increased mortality, highlighting the need for dedicated gastric cancer centers.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Real-World Evidence
Background:
- Limited real-world data exists for advanced gastric cancers (AGCs) treated with perioperative or adjuvant chemotherapy and D2 lymphadenectomy.
- This study analyzes outcomes from a high-volume cancer center.
Purpose of the Study:
- To evaluate the impact of increasing surgical volume on outcomes for gastric adenocarcinoma.
- To assess changes in tumor characteristics and surgical quality over time.
Main Methods:
- Retrospective analysis of 1657 radical gastric resections performed between January 2003 and January 2020.
- Comparison of outcomes across three distinct time periods with increasing annual gastric resections (GRs).
Main Results:
- Annual GRs increased significantly from 56 to 156 (P < 0.001).
- Surgical quality improved, evidenced by increased lymph node yield (15 to 25, P < 0.001) and margin negativity (8.2% to 5.5%, P = 0.002).
- Median overall survival was 4.4 years, with a 5-year OS rate of 47.6%; mortality remained stable at 1.4% despite increased complexity.
Conclusions:
- Increasing surgical volume in gastric cancer care is associated with improved quality indicators and survival.
- Shifting tumor characteristics, including more proximal cancers and younger patients, were observed.
- These findings support the development of specialized gastric cancer centers for optimal patient outcomes.
