Journal of Gastrointestinal Surgery

, Volume 23, Issue 11, pp 2119–2128 | Cite as

Evaluating Dissemination of Adequate Lymphadenectomy for Gastric Cancer in the USA

  • Anthony M. Villano
  • Alexander Zeymo
  • James McDermott
  • Andrew Crocker
  • Jay Zeck
  • Kitty S. Chan
  • Nawar Shara
  • Sunnie Kim
  • Waddah B. Al-RefaieEmail author
Original Article



Adequate lymphadenectomy (AL) of 15+ lymph nodes comprises an important component of gastric cancer surgical therapy. Despite endorsement by the National Comprehensive Cancer Network and the Committee on Cancer, initial adoption of this paradigm has been relatively slow. The current analysis sought to perform an adjusted time-trend evaluation of the factors associated with AL and its dissemination.


Utilizing the 2004–2015 National Cancer Database, 28,985 patients were identified who underwent gastrectomy for adenocarcinoma. An adjusted time-trend analysis was performed to estimate the adoption of AL overall. Multivariable logistic regression was utilized to assess factors associated with these observed trends. Interactions and stratified models determined disparate effects in vulnerable populations (older adults, ethnic minorities, low socioeconomic status).


The adjusted time-trend analysis demonstrated an overall 30% increase (28.8 to 58.7%) in receipt of AL (OR 1.10 increase/year; 95%CI 1.09–1.10) from 2004 to 2015. This trend persisted even after stratifying the models by age, race/ethnicity, and income (OR 1.07–1.12; p < 0.05). Slowest rates of adoption were seen amongst hospitals in the Midwest census region (OR 1.08, CI 1.06–1.90) and comprehensive community hospitals (OR 1.08, CI 1.06–1.91) and with African-American patients (OR 1.09, CI 1.06–1.11) (all p < 0.05).


This multi-center evaluation demonstrates increased adoption of AL during gastric cancer surgery in the USA overall and amongst vulnerable populations, although regional and racial disparities were observed. Future studies are needed to investigate reasons underlying racial and regional differences in receipt of AL.


Gastric Cancer Lymphadenectomy Outcomes Disparity Volume 



The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

Author Contributions

Villano: conception and design, acquisition/analysis/interpretation of the data, drafting/revision, final approval; Zeymo: conception and design, acquisition/analysis/interpretation of the data, drafting/revision, final approval; McDermott: interpretation of the data, drafting/revision, final approval; Crocker: interpretation of the data, drafting/revision, final approval; Zeck: interpretation of the data, drafting/revision, final approval; Chan: analysis/interpretation of the data, drafting/revision, final approval; Shara: analysis/interpretation of the data, drafting/revision, final approval; Kim: analysis/interpretation of the data, drafting/revision, final approval; Al-Refaie: conception and design, acquisition/analysis/interpretation of the data, drafting/revision, final approval.


This work was supported by a grant from the Georgetown-Howard Universities Center for Clinical and Translational Science and The Lee Folger Foundation

Supplementary material

11605_2019_4138_MOESM1_ESM.docx (30 kb)
ESM 1 (DOCX 29 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Anthony M. Villano
    • 1
    • 2
  • Alexander Zeymo
    • 1
    • 3
  • James McDermott
    • 1
  • Andrew Crocker
    • 1
  • Jay Zeck
    • 4
  • Kitty S. Chan
    • 1
    • 3
  • Nawar Shara
    • 5
    • 6
  • Sunnie Kim
    • 7
  • Waddah B. Al-Refaie
    • 1
    • 2
    • 3
    • 8
    Email author
  1. 1.MedStar-Georgetown Surgical Outcomes Research CenterWashingtonUSA
  2. 2.Department of SurgeryMedStar-Georgetown University HospitalWashingtonUSA
  3. 3.MedStar Health Research InstituteHyattsvilleUSA
  4. 4.Department of PathologyMedStar-Georgetown University HospitalWashingtonUSA
  5. 5.Department of Biostatistics, Bioinformatics and BiomathematicsGeorgetown UniversityWashingtonUSA
  6. 6.Georgetown-Howard Universities Center for Clinical and Translational ScienceWashingtonUSA
  7. 7.Department of Hematology-OncologyMedStar-Georgetown University HospitalWashingtonUSA
  8. 8.Department of SurgeryMedStar Georgetown University Hospital and Georgetown Lombardi Comprehensive Cancer CenterWashingtonUSA

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