Differences in quality of surgery for advanced gastric cancer between institutions

Gastric cancer is one of the most common diseases in Japan, and surgery for gastric cancer is conducted in many general hospitals. However, there has been little investigation of the differences between institutions in terms of postoperative results in gastric cancer patients. This study aimed to compare the quality of treatment for gastric cancer between university hospital and general hospital.

We previously performed a multicenter trial in patients with stage II or III gastric cancer who underwent curative surgery followed by adjuvant S-1 chemotherapy. We selected 39 patients with similar backgrounds from this cohort: 16 from the Tottori University Hospital and 23 from a general hospital (Tottori Prefectural Central Hospital). Quality of surgery, postoperative patient nutrition and immunity, relapse-free survival, and overall survival were compared between the two groups.

Operation time was significantly longer, but postoperative hospital stay was significantly shorter in the university group. Postoperative neutrophil/lymphocyte ratio and prognostic nutritional index improved significantly in the university group but remained unchanged in the general-hospital group. Relapse-free survival and overall survival both were better in the university group compared with the general-hospital group, although the difference in relapse-free survival was not significant.

Surgery and follow-up for advanced gastric cancer should be conducted by trained surgeons and gastric cancer specialists.