Oncologie

, Volume 15, Issue 3–4, pp 181–188

Management of gastroesophageal cancer: A perspective from Catalonia

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Abstract

The territory in Spain is administratively organized within 17 autonomous communities. National health system is then composed of 17 independent regional health systems that hold primary jurisdiction on health care planning and organization within each region. Catalonia (7 million inhabitants) has its own structure, organization, and databases that allow us to assess the relationship between volume and surgical outcomes in subjects with esophageal and gastric cancer. Similar to other European regions, the incidence trends in Catalonia have shown a decrease in gastric cancer and an increase in the occurrence of esophageal cancer and gastric cardia adenocarcinoma. Moreover, a declining trend in mortality rate was also detected. No clinical guidelines for the diagnosis and treatment of esophago-gastric cancer or audits have been implemented in Catalonia, but retrospective and prospective data obtained for the 1996–2005 period confirmed a spontaneous centralization of high-risk surgical procedures, such as esophageal cancer resection in a limited number of centers. In early 2012, health care authorities approved centralization of esophageal and gastric cancer surgery into 7 and 15 hospitals, respectively. However, this process should be considered as a first step to be expanded in the forthcoming years. It would be desirable to carry out this process in a transparent manner, using not only data on morbidity and mortality rates, but also data on quality of life as well as teaching or research as quality of care measures. The present review based on local available data and data recorded from the literature allows the authors to present their personal perspective on the current multidisciplinary approach in themanagement of patients with esophago-gastric cancer.

Keywords

Gastric cancer Esophageal cancer Staging Surgical outcomes Volumeoutcomes Multimodal treatment 

Prise en charge des cancers oesogastriques : une perspective depuis la Catalogne

Résumé

D’un point de vue administratif, le territoire espagnol est divisé en 17 communautés autonomes. Le système national de santé est composé de 17 systèmes de santé régionaux indépendants détenant la compétence principale en matière de planification et d’organisation des soins dans chaque région. La Catalogne (7 millions d’habitants) dispose d’une structure, d’une organisation et de bases de données qui lui sont propres et qui nous permettent d’évaluer la relation entre le volume et les résultats chirurgicaux sur des sujets atteints de cancer de l’oesophage et de l’estomac. Tout comme dans d’autres régions européennes, les tendances d’incidence en Catalogne ont affiché une baisse des cancers de l’estomac et une augmentation des cas de cancer de l’oesophage et d’adénocarcinome du cardia gastrique. En outre, une tendance à la baisse du taux de mortalité a été constatée. En Catalogne, aucune directive ou vérification relative au diagnostic et au traitement du cancer oesophagogastrique n’a été mise en place, mais des données rétrospectives et prospectives obtenues entre 1996 et 2005 ont confirmé une centralisation spontanée des procédures chirurgicales à haut risque, telles que la résection du cancer de l’oesophage dans un nombre limité de centres. Début 2012, les autorités de santé ont approuvé la centralisation de la chirurgie du cancer de l’oesophage et de l’estomac dans 7 et 15 hôpitaux, respectivement. Cependant, ce processus devrait être considéré comme un premier pas à développer dans les années à venir. Il serait souhaitable d’exécuter ce processus de manière transparente, à l’aide de données relatives aux taux de morbidité et de mortalité, mais également à l’aide d’informations concernant la qualité de vie ainsi que l’enseignement ou la recherche, en tant que mesure de la qualité des soins. La présente analyse, basée sur les données locales disponibles et sur les données recueillies dans la littérature, permet à ses auteurs de présenter leur point de vue personnel sur l’approche multidisciplinaire actuelle dans la gestion des patients atteints d’un cancer oesophagogastrique.

Mots clés

Cancer de l’estomac Cancer de l’oesophage Phase Résultats chirurgicaux Volumerésultats Traitement multimodal 

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Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Section of Gastrointestinal Surgery, Hospital Universitario del Mar, IMIM (Institut Hospital del Mar d’Investigacions Mèdiques)Universitat Autònoma de BarcelonaBarcelonaSpain
  2. 2.Service of Medical Oncology. Hospital ClinicUniversitat de BarcelonaBarcelonaSpain

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