Skip to main content

Outcomes of Non-curative Gastrectomy for Gastric Cancer: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)

Annals of Surgical Oncology volume 25, pages 3943–3949 (2018)Cite this article

Abstract

Background

The surgical care of patients with metastatic gastric cancer (GC) remains debated. Despite level 1 evidence showing lack of survival benefit, surgery may be used for symptoms prevention or palliation. This study examined short-term postoperative outcomes of non-curative gastrectomy performed for metastatic GC.

Methods

A multi-institutional retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) registry, including gastrectomies for GC (2007–2015). The primary outcome was 30-day major morbidity. Multivariable analysis examined the association between metastatic status and outcomes adjusted for relevant demographic and clinical covariates.

Results

Of 5341 patients, 377 (7.1%) had metastases. Major morbidity was more common with metastases (29.4 vs. 19.6%; p < 0.001), driven by a higher rate of respiratory events. Prolonged hospital length of stay (beyond the 75th percentile: 11 days) was more likely with metastases than with no metastases (41.9 vs. 28.3%; p < 0.001). After adjustment, metastatic status was associated with major morbidity (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.16–1.90). This association remained for respiratory events (OR, 1.58; 95% CI, 1.07–2.33), 30-day mortality (OR, 2.19; 95% CI, 1.38–3.48), and prolonged hospital stay (OR, 1.65; 95% CI, 1.31–2.07).

Conclusion

Non-curative gastrectomy for metastatic GC was associated with significant major morbidity and mortality as well as a prolonged hospital stay, longer than expected for gastrectomy for non-metastatic GC. These data can inform decision making regarding non-curative gastrectomy, helping surgeons to weigh the risks of morbidity against the potential benefits and alternative therapeutic options.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Mahar AL, Coburn NG, Singh S, Law C, Helyer LK. A systematic review of surgery for non-curative gastric cancer. Gastric Cancer. 2012;15:S125–37.

    Article  Google Scholar 

  2. Schmidt B, Look-Hong N, Maduekwe UN, Chang K, Hong TS, Kwak EL, et al. Non-curative gastrectomy for gastric adenocarcinoma should only be performed in highly selected patients. Ann Surg Oncol. 2013;20:3512–8.

    Article  Google Scholar 

  3. Sherman KL, Merkow RP, Shah AM, Wang CE, Bilimoria KY, Bentrem DJ. Assessment of advanced gastric cancer management in the United States. Ann Surg Oncol. 2013;20:2124–31.

    Article  Google Scholar 

  4. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition—response assessment of chemotherapy and radiotherapy for gastric carcinoma: clinical criteria. Gastric Cancer. 2001;4:1–8.

    Article  Google Scholar 

  5. Ajani JA, Bentrem DJ, DAmico TA, Das P, Denlinger C, Fakih MG, et al. NCCN Clinical practice guidelines in oncology: gastric cancer (version 2.2013). Retrieved 19 February 2018 http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

  6. Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2016;27:v38–v49.

    CAS  Article  Google Scholar 

  7. Brar SS, Mahar AL, Helyer LK, Swallow C, Law C, Paszat L, et al. Processes of care in the multidisciplinary treatment of gastric cancer. JAMA Surg. 2014;149:18–25.

    Article  Google Scholar 

  8. Fujitani K, Yang H-K, Mizusawa J, Kim Y-W, Terashima M, Han S-U, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single noncurable factor (REGATTA): a phase 3 randomised controlled trial. Lancet Oncol. 2016;17:309–18.

    CAS  Article  Google Scholar 

  9. Haider AH, Bilimoria KY, Kibbe MR. A checklist to elevate the science of surgical database research. JAMA Surg. 2018;153:505–7.

    Article  Google Scholar 

  10. Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med. 2015 6;12:e1001885–22.

    Google Scholar 

  11. Shiloach M, Frencher SK, Steeger JE, Rowell KS, Bartzokis K, Tomeh MG, et al. Toward robust information: data quality and interrater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210:6–16.

    Article  Google Scholar 

  12. Henderson WG, Daley J. Design and statistical methodology of the National Surgical Quality Improvement Program: why is it what it is? Am J Surg. 2009;198:S19–27.

    Article  Google Scholar 

  13. Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X, et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg. 2013;217:336–46.

    Article  Google Scholar 

  14. Davenport DL, Holsapple CW, Conigliaro J. Assessing surgical quality using administrative and clinical data sets: a direct comparison of the University HealthSystem Consortium Clinical Database and the National Surgical Quality Improvement Program data set. Am J Med Qual. 2009;24:395–402.

    Article  Google Scholar 

  15. Merkow RP, Kmiecik TE, Bentrem DJ, Winchester DP, Stewart AK, Ko CY, et al. Effect of including cancer-specific variables on models examining short-term outcomes. Cancer. 2013;119:1412–9.

    Article  Google Scholar 

  16. Elmi M, Mahar A, Kagedan D, Law CHL, Karanicolas PJ, Lin Y, et al. The impact of blood transfusion on perioperative outcomes following gastric cancer resection: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Can J Surg. 2016;59:322–9.

    Article  Google Scholar 

  17. Hallet J, Mahar AL, Tsang ME, Lin Y, Callum J, Coburn NG, et al. The impact of perioperative blood transfusions on post-pancreatectomy short-term outcomes: an analysis from the American College of Surgeons National Surgical Quality Improvement Program. HPB. 2015;17:975–82.

    Article  Google Scholar 

  18. Hamilton TD, Mahar AL, Haas B, Beyfuss K, Law CHL, Karanicolas PJ, et al. The impact of advanced age on short-term outcomes following gastric cancer resection: an ACS-NSQIP analysis. Gastric Cancer. 2017;294:1255.

    Google Scholar 

  19. The World Health Organization. Obesity: preventing and managing the global epidemic. WHO Technical Report Series, Geneva, 2000, 268 p.

    Google Scholar 

  20. Raval MV, Pawlik TM. Practical guide to surgical data sets: national surgical quality improvement program (NSQIP) and pediatric NSQIP. JAMA Surg. 2018;153:764–5.

    Article  Google Scholar 

  21. Coburn N, Seevaratnam R, Paszat L, Helyer L, Law C, Swallow C, et al. Optimal management of gastric cancer: results from an international RAND/UCLA expert panel. Ann Surg. 2014;259:102–8.

    Article  Google Scholar 

  22. Brar SS, Mahar AL, Helyer LK, Swallow C, Law C, Paszat L, et al. Processes of care in the multidisciplinary treatment of gastric cancer: results of a RAND/UCLA expert panel. JAMA Surg. 2014;149:18–25.

    Article  Google Scholar 

  23. Coburn NG, Lourenco LG, Rossi SE, Gunraj N, Mahar AL, Helyer LK, et al. Management of gastric cancer in Ontario. J Surg Oncol. 2010;102:54–63.

    Article  Google Scholar 

  24. Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJH, Dutch Gastric Cancer Group. Value of palliative resection in gastric cancer. Br J Surg. 2002;89:1438–43.

    CAS  Article  Google Scholar 

  25. Bonenkamp JJ, Sasako M, Hermans J, van de Velde CJ. Tumor load and surgical palliation in gastric cancer. Hepatogastroenterology. 2001;48:1219–21.

    CAS  PubMed  Google Scholar 

  26. Jeong O, Park YK, Choi WY, Ryu SY. Prognostic significance of non-curative gastrectomy for incurable gastric carcinoma. Ann Surg Oncol. 2014;21:2587–93.

    Article  Google Scholar 

  27. Tokunaga M, Terashima M, Tanizawa Y, Bando E, Kawamura T, Yasui H, et al. Survival benefit of palliative gastrectomy in gastric cancer patients with peritoneal metastasis. World J Surg. 2012;36:2637–43.

    Article  Google Scholar 

  28. Chang YR, Han DS, Kong S-H, Lee H-J, Kim SH, Kim WH, et al. The value of palliative gastrectomy in gastric cancer with distant metastasis. Ann Surg Oncol. 2011;19:1231–9.

    Article  Google Scholar 

  29. Yamada N, Akai A, Nomura Y, Tanaka N. The impact and optimal indication of non-curative gastric resection for stage IV advanced gastric cancer diagnosed during surgery: 10 years of experience at a single institute. World J Surg Oncol. 2016;14:79. https://doi.org/10.1186/s12957-016-0790-z.

  30. Kokkola A, Louhimo J, Puolakkainen P. Does non-curative gastrectomy improve survival in patients with metastatic gastric cancer? J Surg Oncol. 2012;106:193–6.

    Article  Google Scholar 

  31. Kim MM, Rana V, Janjan NA, Das P, Phan AT, Delclos ME, et al. Clinical benefit of palliative radiation therapy in advanced gastric cancer. Acta Oncol. 2008;47:421–7.

    Article  Google Scholar 

  32. Ojima T, Nakamori M, Nakamura M, Katsuda M, Hayata K, Yamaue H. Laparoscopic gastrojejunostomy for patients with unresectable gastric cancer with gastric outlet obstruction. J Gastrointest Surg. 2017;21:1220–5.

    Article  Google Scholar 

  33. Jeurnink SM, Steyerberg EW, van Hooft JE, van Eijck CHJ, Schwartz MP, Vleggaar FP, et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc. 2010;71:490–9.

    Article  Google Scholar 

  34. Tey J, Back MF, Shakespeare TP, Mukherjee RK, Lu JJ, Lee KM, et al. The role of palliative radiation therapy in symptomatic locally advanced gastric cancer. Int J Radiat Oncol Biol Phys. 2007;67:385–8.

    Article  Google Scholar 

  35. Kondoh C, Shitara K, Nomura M, Takahari D, Ura T, Tachibana H, et al. Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study. BMC Palliat Care. 2015;14:37.

    Article  Google Scholar 

  36. Parsons HM, Henderson WG, Ziegenfuss JY, Davern M, Al-Refaie WB. Missing data and interpretation of cancer surgery outcomes at the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2011;213:379–91.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department or Surgery, University of Toronto, Toronto, ON, Canada

    Yunni Jeong MD, Natalie G. Coburn MD, MPH, Christopher J. Wallis MD, MSC, Paul J. Karanicolas MD, PhD, Calvin H. L. Law MD, MPH & Julie Hallet MD, MSc

  2. Sunnybrook Research Institute, Toronto, ON, Canada

    Yunni Jeong MD, Natalie G. Coburn MD, MPH, Kaitlyn Beyfuss MSc(c), Paul J. Karanicolas MD, PhD, Calvin H. L. Law MD, MPH & Julie Hallet MD, MSc

  3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Yunni Jeong MD, Natalie G. Coburn MD, MPH & Paul J. Karanicolas MD, PhD

  4. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada

    Alyson L. Mahar PhD

  5. Division of General Surgery, Odette Cancer Centre–Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Natalie G. Coburn MD, MPH, Paul J. Karanicolas MD, PhD, Calvin H. L. Law MD, MPH & Julie Hallet MD, MSc

  6. Division of Urology, Houston Methodist, Houston, TX, USA

    Raj Satkunasivam MD, MSc

Authors
  1. Yunni Jeong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alyson L. Mahar PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natalie G. Coburn MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christopher J. Wallis MD, MSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raj Satkunasivam MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kaitlyn Beyfuss MSc(c)
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul J. Karanicolas MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Calvin H. L. Law MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Julie Hallet MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julie Hallet MD, MSc.

Ethics declarations

NSQIP disclosure

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and the hospitals participating in the ACS-NSQIP are the source of the data used in this report. They have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 11

 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jeong, Y., Mahar, A.L., Coburn, N.G. et al. Outcomes of Non-curative Gastrectomy for Gastric Cancer: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Ann Surg Oncol 25, 3943–3949 (2018). https://doi.org/10.1245/s10434-018-6824-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6824-8

Keywords

  • National Surgical Quality Improvement Program
  • Gastric Cancer
  • Prolonged Hospital Length
  • Major Morbidity
  • Short-term Postoperative Outcomes