Urgent Surgery for Gastric Adenocarcinoma: A Study of the National Cancer Database

Benjamin W Fisher, Marcus Fluck, Katelyn Young, Mohsen Shabahang, Joseph Blansfield, Tania K Arora

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

BACKGROUND: Gastric adenocarcinoma is a leading cause of cancer death worldwide and, in the United States, can present emergently with upper GI hemorrhage, obstruction, or perforation. No large studies have examined how urgent surgery affects patient outcomes. This study examines the outcomes of urgent versus elective surgery for gastric cancer.

MATERIALS AND METHODS: Patients with gastric adenocarcinoma from the National Cancer Database from 2004 to 2015 were examined retrospectively. Patients with metastatic disease or incomplete data were excluded. Urgent surgery was defined as definitive surgery within 3 d of diagnosis. Univariate and multivariate analysis of patient factors, surgical outcomes, and oncologic data was performed. P-values <0.05 were statistically significant.

RESULTS: Of 26,116 total patients, 2964 had urgent surgery and 23,468 had elective surgery. Urgent surgery patients were significantly older, were female, were nonwhite, had higher pathologic stage, and were treated at a low-volume center. Urgent surgery was associated with decreased quality lymph node harvest (odds ratio [OR] 0.68 95% confidence interval {CI} [0.62, 0.74]), increased positive surgical margin (OR 1.48, 95% CI [1.32, 1.65]), increased 30-d mortality (OR 1.38, 95% CI [1.16, 1.65]), increased 90-d mortality (OR 1.30, 95% CI [1.14, 1.49]), and decreased overall survival (hazard ratio 1.21, 95% CI [1.15, 1.27]).

CONCLUSIONS: Urgent surgery for gastric cancer is associated with significantly worse outcomes than elective surgery. Stable patients requiring urgent surgical resection for gastric cancer may benefit from referral to a high-volume center for resection by an experienced surgeon. Patients undergoing urgent resection for gastric cancer should be referred to surgical and medical oncologists to ensure they receive appropriate adjuvant therapy and surveillance.

Original languageEnglish (US)
Pages (from-to)619-628
Number of pages10
JournalJournal of Surgical Research
Volume245
DOIs
StatePublished - Jan 2020
Externally publishedYes

Keywords

  • Adenocarcinoma/mortality
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Databases, Factual/statistics & numerical data
  • Elective Surgical Procedures/adverse effects
  • Female
  • Gastrectomy/adverse effects
  • Hospital Mortality
  • Humans
  • Lymph Node Excision
  • Male
  • Margins of Excision
  • Middle Aged
  • Postoperative Complications/etiology
  • Retrospective Studies
  • Stomach Neoplasms/mortality
  • Survival Analysis
  • Time Factors
  • Time-to-Treatment
  • Treatment Outcome
  • United States/epidemiology
  • Young Adult

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