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

Yunni Jeong MD, Alyson L. Mahar PhD, Natalie G. Coburn MD, MPH, Christopher J. Wallis MD, MSC, Raj Satkunasivam MD, MSc, Kaitlyn Beyfuss MSc(c), Paul J. Karanicolas MD, PhD, Calvin H. L. Law MD, MPH, Julie Hallet MD, MSc
Gastrointestinal Oncology
Volume 25, Issue 13 / December , 2018

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.

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