Medical Oncology

, 31:150 | Cite as

Outcomes of surgical treatment for gastric cancer patients: 11-year experience of a Chinese high-volume hospital

  • Wei-Han Zhang
  • Xin-Zu Chen
  • Kai Liu
  • Xiao-Long Chen
  • Kun Yang
  • Bo Zhang
  • Zhi-Xin Chen
  • Jia-Ping Chen
  • Zong-Guang Zhou
  • Jian-Kun HuEmail author
Original Paper


Gastric cancer is one of the leading causes of cancer-related deaths worldwide. We report our experience with surgery-related parameters and survival outcomes at a single Chinese center. This study analyzed patients following gastric resection between 2000 and 2010, and overall survival was the primary end point. In this study, 1,936 patients who underwent gastrectomy were collected from 2000 to 2010. Curative gastrectomy (R0 resection) was performed in 86.6 % of patients. D1/D1+ lymphadenectomy was frequently performed from 2000 to 2005, and the proportion of D2/D2+ lymphadenectomy increased after 2006. The number of harvested lymph nodes was 10.1 ± 6.0 in 2000 and increased to 28.0 ± 10.5 in 2010. Serosa-invasive lesions (pT4) accounted for 67.9 % of all cases. The 1-year overall survival (OS), 2-year OS, and 3-year OS rates were 89, 74, and 63 %, respectively. Multivariate analysis identified R status, tumor location, macroscopic type, and tumor stage (pT stage and pN stage) as the independent risk factors for overall survival. The prognosis of gastric cancer patients in China remains dismal. To improve the survival outcomes, further efforts toward early detection and multi-disciplinary treatment are needed.


Gastric adenocarcinoma Gastrectomy Lymphadenectomy Prognosis 



Authors thank the substantial work of Volunteer Team of Gastric Cancer Surgery (VOLTGA) based on Multidisciplinary Team (MDT) of Gastrointestinal Tumors, West China Hospital, Sichuan University, China. The authors also sincerely appreciate Dr. Zhong Q. Wang from Pennington Biomedical Research Center, Louisiana State University System, USA, for his English language support. The study received domestic support from (1) National Natural Science Foundation of China (No. 81372344) and (2) New Century Excellent Talents in University support program, Ministry of Education of China (2012SCU-NCET-11-0343).

Conflict of interest

All the authors have no conflicts of interest or financial ties to disclose.


  1. 1.
    Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12(3):354–62.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.PubMedCrossRefGoogle Scholar
  4. 4.
    Zheng L, Wu C, Xi P, Zhu M, et al. The survival and the long-term trends of patients with gastric cancer in Shanghai, China. BMC Cancer. 2014;14(1):300.PubMedCrossRefGoogle Scholar
  5. 5.
    Ding YB, Xia TS, Wu JD, et al. Surgical outcomes for gastric cancer of a single institute in southeast China. Am J Surg. 2012;203(2):217–21.PubMedCrossRefGoogle Scholar
  6. 6.
    Jézéquel J, Bessaguet C, Verveur C, et al. Trends in incidence, management, and survival of gastric and cardia carcinomas in the area of Finistere (France) between 1984 and 2003. Eur J Gastroenterol Hepatol. 2010;22(12):1412–9.PubMedGoogle Scholar
  7. 7.
    Strong VE, Song KY, Park CH, et al. Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 2010;251(4):640–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Nashimoto A, Akazawa K, Isobe Y, et al. Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer. 2013;16(1):1–27.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Theuer CP, Kurosaki T, Ziogas A, et al. Asian patients with gastric carcinoma in the United States exhibit unique clinical features and superior overall and cancer specific survival rates. Cancer. 2000;89(9):1883–92.PubMedCrossRefGoogle Scholar
  10. 10.
    Chen Y, Haveman JW, Apostolou C, et al. Asian gastric cancer patients show superior survival: the experiences of a single Australian center. Gastric Cancer. 2014. doi: 10.1007/s10120-014-0383-x.
  11. 11.
    Brenner H, Francisci S, de Angelis R, et al. Long-term survival expectations of cancer patients in Europe in 2000–2002. Eur J Cancer. 2009;45(6):1028–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Sant M, Aareleid T, Berrino F, et al. EUROCARE-3: survival of cancer patients diagnosed 1990–94—results and commentary. Ann Oncol. 2003;14(Suppl 5):v61–118.PubMedCrossRefGoogle Scholar
  13. 13.
    Brenner H, Gondos A, Arndt V. Recent major progress in long-term cancer patient survival disclosed by modeled period analysis. J Clin Oncol. 2007;25(22):3274–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Shin A, Kim J, Park S. Gastric cancer epidemiology in Korea. J Gastric Cancer. 2011;11(3):135–40.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Inoue M, Tsugane S. Epidemiology of gastric cancer in Japan. Postgrad Med J. 2005;81(957):419–24.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Tsukuma H, Ajiki W, Ioka A, et al. Survival of cancer patients diagnosed between 1993 and 1996: a collaborative study of population-based cancer registries in Japan. Jpn J Clin Oncol. 2006;36(9):602–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual. 7th ed. New York: Springer; 2009.Google Scholar
  18. 18.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.CrossRefGoogle Scholar
  19. 19.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.CrossRefGoogle Scholar
  20. 20.
    Chen W, Zheng R, Zhang S, et al. Annual report on status of cancer in China, 2010. China J Cancer Res. 2014;26(1):48–58.Google Scholar
  21. 21.
    Bouvier AM, Sant M, Verdecchia A, et al. What reasons lie behind long-term survival differences for gastric cancer within Europe? Eur J Cancer. 2010;46(6):1086–92.PubMedCrossRefGoogle Scholar
  22. 22.
    Fayçal J, Bessaguet C, Nousbaum JB, et al. Epidemiology and long term survival of gastric carcinoma in the French district of Finistere between 1984 and 1995. Gastroenterol Clin Biol. 2005;29(1):23–32.PubMedCrossRefGoogle Scholar
  23. 23.
    Wanebo HJ, Kennedy BJ, Chmiel J, Steele G Jr, Winchester D, Osteen R. Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg. 1993;218(5):583–92.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Allum WH, Powell DJ, McConkey CC, Fielding JW. Gastric cancer: a 25-year review. Br J Surg. 1989;76(6):535–40.PubMedCrossRefGoogle Scholar
  25. 25.
    Jeong O, Park YK. Clinicopathological features and surgical treatment of gastric cancer in South Korea: the results of 2009 nationwide survey on surgically treated gastric cancer patients. J Gastric Cancer. 2011;11(2):69–77.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Sano H, Goto R, Hamashima C. What is the most effective strategy for improving the cancer screening rate in Japan? Asian Pac J Cancer Prev. 2014;15(6):2607–12.PubMedCrossRefGoogle Scholar
  27. 27.
    Lee KJ, Inoue M, Otani T, et al. Gastric cancer screening and subsequent risk of gastric cancer: a large-scale population-based cohort study, with a 13-year follow-up in Japan. Int J Cancer. 2006;118(9):2315–21.PubMedCrossRefGoogle Scholar
  28. 28.
    Choi KS, Jun JK, Lee HY, et al. Performance of gastric cancer screening by endoscopy testing through the National Cancer Screening Program of Korea. Cancer Sci. 2011;102(8):1559–64.PubMedCrossRefGoogle Scholar
  29. 29.
    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(9–10):1522–30.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Hartgrink HH, van de Velde CJ, 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(11):2069–77.PubMedCrossRefGoogle Scholar
  31. 31.
    Songun I, Putter H, Kranenbarg EM, et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49.PubMedCrossRefGoogle Scholar
  32. 32.
    Hyung WJ, Kim SS, Choi WH, et al. Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution. Yonsei Med J. 2008;49(3):409–15.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    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(4):449–61.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Bando E, Yonemura Y, Taniguchi K, et al. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol. 2002;9(8):775–84.PubMedCrossRefGoogle Scholar
  35. 35.
    Seto Y, Nagawa H, Muto T. Impact of lymph node metastasis on survival with early gastric cancer. World J Surg. 1997;21(2):186–90.PubMedCrossRefGoogle Scholar
  36. 36.
    NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Gastric Cancer. Version 2. 2013. Scholar
  37. 37.
    Coburn NG, Swallow CJ, Kiss A, et al. Significant regional variation in adequacy of lymph node assessment and survival in gastric cancer. Cancer. 2006;107(9):2143–51.PubMedCrossRefGoogle Scholar
  38. 38.
    Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2007;14(2):317–28.PubMedCrossRefGoogle Scholar
  39. 39.
    Biffi R, Botteri E, Cenciarelli S, et al. Impact on survival of the number of lymph nodes removed in patients with node-negative gastric cancer submitted to extended lymph node dissection. Eur J Surg Oncol. 2011;37(4):305–11.PubMedCrossRefGoogle Scholar
  40. 40.
    Luna A, Rebasa P, Montmany S, et al. Learning curve for d2 lymphadenectomy in gastric cancer. ISRN Surg. 2013;2013:508719.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Wei-Han Zhang
    • 1
  • Xin-Zu Chen
    • 1
  • Kai Liu
    • 1
  • Xiao-Long Chen
    • 1
  • Kun Yang
    • 1
  • Bo Zhang
    • 1
  • Zhi-Xin Chen
    • 1
  • Jia-Ping Chen
    • 1
  • Zong-Guang Zhou
    • 1
  • Jian-Kun Hu
    • 1
    Email author
  1. 1.Department of Gastrointestinal Surgery, West China HospitalSichuan UniversityChengduChina

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