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2011 | 83 | 3 | 123-134

Article title

Epidemiology, Surgical Management and Early Postoperative Outcome in a Cohort of Gastric Cancer Patients of a Tertiary Referral Center in Relation to Multi-Center Quality Assurance Studies


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The aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study - GGCS (1992) and East German Gastric Cancer Study - EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results.Material and methods. Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome.Results. From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer patients were treated. In comparison with the EGGCS cohort there was a larger proportion of patients with locally advanced and proximally located tumors. 272 patients (82.9%) underwent surgery with curative intent; in 88.4% of these an R0 resection was achieved (EGGCS/GGCS: 82.5%/71.5%). 68.2% of patients underwent preoperative endoluminal ultrasound (EUS) (EGGCS: 27.4%); the proportion of patients undergoing EUS increased over the study period. Diagnostic accuracy of EUS for T stage was 50.6% (EGGCS: 42.6%). 77.2% of operated patients with curative intent underwent gastrectomy (EGGCS/GGCS: 79.8%/71.1%). Anastomotic leaks at the esophagojejunostomy occurred slightly more frequently (8.8%) than in the EGGCS (5.9%) and GGCS (7.2%); however, postoperative morbidity (36.1%) and early postoperative mortality (5.3%) were not increased compared to the multi-center quality assurance study results (EGGCS morbidity, 45%); EGGCS/GGCS mortality, 8%/8.9%). D2 lymphadenectomy was performed in 72.6% of cases (EGGCS: 70.9%). Multivariate analysis revealed splenectomy as an independent risk factor for postoperative morbidity and ASA status 3 or 4 as an independent risk factor for early postoperative mortality. The rate of splenectomies performed during gastric cancer surgery decreased substantially during the study period.Conclusions. Preoperative diagnostics were able to accurately predict resectability in almost 90% of patients which is substantially more than the corresponding results of both the EGGCS and the GGCS. In the future, more wide-spread use of EUS will play an increasing role as stage-dependent differentiation of therapeutic concepts gains acceptance. However, diagnostic accuracy of EUS needs to be improved. Our early postoperative outcome data demonstrate that the quality standard of gastric cancer care established by the EGGCS is being fulfilled at our institution in spite of distinct characteristics placing our patients at higher surgical risk. Besides being a valuable instrument of internal quality control, our study provides a good base for comparison with ongoing analyses on future developments in gastric cancer therapy.









Physical description


1 - 3 - 2011
2 - 5 - 2011


  • Department of General, Abdominal, and Vascular Surgery, University Hospital Magdeburg, Germany
  • Department of General, Abdominal, and Vascular Surgery, University Hospital Magdeburg, Germany
  • Department of Biometrics and Medical Informatics, University Hospital Magdeburg, Germany
  • Department of General, Abdominal, and Vascular Surgery, University Hospital Magdeburg, Germany
  • Department of General, Abdominal, and Vascular Surgery, University Hospital Magdeburg, Germany


  • Jemal A, Siegel R, Ward E, et al.: Cancer statistics, 2006. CA Cancer J Clin 2006; 56: 106-30.
  • Parkin DM, Bray F, Ferlay J, et al.: Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74-108.
  • Cunningham D, Allum WH, Stenning SP, et al.: Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355: 11-20.
  • Macdonald JS, Smalley SR, Benedetti J, et al.: Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001; 345: 725-30.
  • Bozzetti F, Marubini E, Bonfanti G, et al.: Subtotal versus total gastrectomy for gastric cancer: Five-year survival rates in a multicenter randomised Italian trial. Ann Surg 1999; 230: 170-78.
  • Bonenkamp JJ, Hermans J, Sasako M, et al.: Extended lymph node dissection for gastric cancer. N Engl J Med 1999; 340: 908-914.
  • Cuschieri A, Weeden S, Fielding J, et al.: Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999; 79: 1522-30.
  • Siewert JR, Böttcher K, Stein HJ, et al.: Relevant prognostic factors in gastric cancer. Ten-year results of the German Gastric Cancer Study. Ann Surg 1998; 228: 449-61.
  • Wanebo HJ, Kennedy BJ, Chmiel J, et al.: Cancer of the stomach: A patients care study by the American College of Surgeons. Ann Surg 1993; 218: 583-92.
  • Meyer L, Steinert R, Nowak L, et al.: Prospective multicenter trial of gastric cancer surgery - a contribution to clinical research on quality control. Zentralbl Chir 2005; 130: 97-105.
  • Pedrazzani C, Marrelli D, Rampone B, et al.: Postoperative complications and functional results after subtotal gastrectomy with Billroth II reconstruction for primary gastric cancer. Dig Dis Sci 2007; 52: 1757-63.[WoS]
  • Ichikawa D, Kurioka H, Yamaguchi T, et al.: Postoperative complications following gastrectomy for gastric cancer during the last decade. Hepatogastroenterology 2004; 51: 613-17.
  • Park D, Lee H, Kim H, et al.: Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 2005; 92: 1099-1102.
  • Siewert JR, Stein H, Bartels H: Anastomotic leaks in the upper gastrointestinal tract. Chirurg 2004; 75: 1063-70.[WoS]
  • Willis S, Truong S, Gribnitz S, et al.: Endoscopic ultrasonography in the preoperative staging of gastric cancer. Accuracy and impact on surgical therapy. Surg Endosc 2000; 14: 951-54.
  • Böttcher K, Roder JD, Busch R, et al.: The epidemiology of stomach carcinoma from the surgical viewpoint. The results of the German Stomach Carcinoma Study 1992. The German Stomach Carcinoma Study Group. Dtsch Med Wochenschr 1993; 118: 729-36.
  • Puli SR, Reddy JB, Bechtold ML, et al.: How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review. World J Gastroenterol 2008; 14: 4011-19.
  • Bösing N, Schumacher B, Frieling T, et al.: Endoscopic ultrasound in routine clinical practice for staging adenocarcinomas of the stomach and distal esophagus. Chirurg 2003; 74: 214-23.
  • Schwartz JY: Endosonographie des Magenkarzinoms in der klinischen Routine - Was leistet die Methode wirklich? Dissertation. Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf; 2005.
  • Yasuda K, Shiraishi N, Adachi Y, et al.: Risk factors for complications following resection of large gastric cancer. Br J Surg 2001; 88: 873-77.
  • Isgüder AS, Nazli O, Tansug T, et al.: Total gastrectomy for gastric carcinoma. Hepatogastroenterology 2005; 52: 302-04.
  • Schuhmacher C, Novotny A, Ott K, et al.: Lymphadenectomy with tumors of the upper gastrointestinal tract. Chirurg 2007; 78: 203-16.[PubMed][WoS][Crossref]
  • Hartgrink HH, van de Velde CJH, Putter H, et al.: Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004; 22: 2069-77.
  • Kodera Y, Schwarz RE, Nakao A: Extended lymph node dissection in gastric carcinoma: where do we stand after the Dutch and British randomized trials? J Am Coll Surg 2002; 195: 855-64.
  • Mönig SP, Collet PH, Baldus SE, et al.: Splenectomy in proximal gastric cancer: frequency of lymph node metastasis to the splenic hilus. J Surg Oncol 2001; 76: 89-92.
  • Mönig SP, Bollschweiler E, Hölscher AH: Lymphadenectomy for Gastric Carcinoma. Viszeralchirurgie 2005; 40: 272-78.
  • Siewert JR, Böttcher K, Roder JD, et al.: Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg 1993; 80: 1015-18.
  • Sendler A, Etter M, Böttcher K, et al.: Extent of resection in surgery of stomach carcinoma. Chirurg 2002; 73: 316-24.
  • Sendler A: Tumors of the upper gastro-intestinal tract. Chirurg 2010; 81: 103-10.[WoS]
  • Cuschieri A, Weeden S, Fielding J, et al.: Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer 1999; 79: 1522-30.
  • Meyer L, Meyer F, Dralle H, et al.: Insufficiency risk of esophagojejunal anastomosis after total abdominal gastrectomy for gastric carcinoma. Langenbecks Arch Surg 2005; 390: 510-16.

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