Surgical treatment of gastric cancer: A single center's 15-year experience

The treatment of Gastric Cancer (GC) has evolved with advances in multimodal therapy and minimally invasive surgery. This study aimed to provide an overview of the current treatment and survival outcomes of GC at a public high-volume cancer center during 15 years.

Patients with gastric adenocarcinoma who underwent any surgical procedure between January 2009 and December 2023 were retrospectively included. To investigate temporal differences in patient characteristics and therapeutic approaches, the case cohort was divided into two time periods: Period I (2009-2016) and II (2016-2023).

A total of 1406 patients were included: 741 (52.7 %) were treated in Period I, and 665 (47.3 %) in Period II. The proportion of curative-intent surgeries remained stable (65.2% vs. 65.1), but diagnostic procedures increased (7.3 % vs. 12.2). Overall, 804 (57.2 %) patients underwent potentially curative gastrectomy. In Period II, patients had advanced ASA scores, more advanced clinical staging, and more frequent D1 lymphadenectomy (all p < 0.05). The use of minimally invasive surgery and the number of resected lymph nodes increased (both p < 0.001). Multimodal treatment became more frequent, with increased use of preoperative chemotherapy (p = 0.03). There were no significant differences in postoperative complications or 30- and 90-day mortality rates between the two periods. In multivariable analysis, advanced age, ASA III/IV, total gastrectomy, D1 lymphadenectomy, diffuse/mixed histology, advanced pT stage, and lymph node metastasis were independent factors associated with worse survival (all p < 0.05).

Over 15 years, treatment evolved toward increased use of minimally invasive and multimodal approaches, with no impact on short-term surgical outcomes.