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Inadequate documentation and resection for gastric cancer in the United States: a preliminary report
N C Estes1, J S MacDonald, K Touijer
1Department of Surgery, Kansas University School of Medicine, Kansas City, USA.
Abstract:
Patients entered into Southwest Oncology Group gastric adjuvant protocol INT 0016 (SWOG 9008) after a "curative" gastric resection were assessed to determine practice patterns of more than 300 surgeons nationwide who performed "curative" gastric resections for 453 gastric cancer patients. The most common gastric resection performed was distal in 256 patients, proximal in 118, and total in 79. Extragastric organs resected were omentum (285), spleen (59), pancreas (18), and bowel (17). The extent of lymphadenectomy as staged by Japanese rules was 246 (54.2%) D0 resections, 173 (38.1%) D1 resections, 28 (6.2%) D2 resections, and 7 (1.5%) D3 resections. Staging of the cancer was poorly documented, with no statement made regarding the status of the primary cancer in 6 per cent, liver in 10 per cent, lymph nodes in 17 per cent, and omentum in 17 per cent. The greater the lymph node clearance, the greater the chance of resecting to a level of negative lymphatics, given that 45 per cent of nodes were involved when 10 or less were removed, whereas only 17 per cent were positive when more than 40 were cleared. The lack of adequate clearance of lymph nodes and poor documentation of tumor stage suggests that a more regimented surgical approach to this uncommon cancer is required.
Insights
Surgical practices for gastric cancer resection varied nationwide. Inadequate lymph node clearance and poor staging documentation highlight the need for standardized surgical approaches in treating this uncommon malignancy.
Area of Science:
- Surgical Oncology
- Gastrointestinal Cancer Research
- Clinical Practice Patterns
Background:
- Gastric cancer resection is a critical component of treatment.
- Surgical practice patterns can significantly influence patient outcomes.
- Standardization in surgical procedures is often lacking in uncommon cancers.
Purpose of the Study:
- To assess nationwide surgical practice patterns for gastric cancer resection.
- To evaluate the extent of resection and lymphadenectomy performed.
- To identify deficiencies in tumor staging documentation.
Main Methods:
- Analysis of data from Southwest Oncology Group (SWOG) protocol INT 0016 (SWOG 9008).
- Review of surgical procedures for 453 gastric cancer patients undergoing "curative" resection.
- Assessment of extragastric organ resection and lymphadenectomy extent (Japanese rules).
Main Results:
- Distal resection was most common (256 patients), followed by proximal (118) and total (79).
- Lymphadenectomy extent was predominantly D0 (54.2%) and D1 (38.1%), with limited D2 (6.2%) and D3 (1.5%) dissections.
- Tumor staging was poorly documented; inadequate lymph node clearance correlated with higher positive node rates.
Conclusions:
- Significant variation exists in surgical approaches to gastric cancer.
- Limited lymph node dissection and poor staging documentation are prevalent.
- A more regimented surgical approach is necessary for improved gastric cancer treatment outcomes.