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Urgent Surgery for Gastric Adenocarcinoma: A Study of the National Cancer Database.
J Surg Res 2019; 245:619-628JS

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.

Authors+Show Affiliations

Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.Department of Surgery, Geisinger Medical Center, Danville, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31522035

Citation

Fisher, Benjamin W., et al. "Urgent Surgery for Gastric Adenocarcinoma: a Study of the National Cancer Database." The Journal of Surgical Research, vol. 245, 2019, pp. 619-628.
Fisher BW, Fluck M, Young K, et al. Urgent Surgery for Gastric Adenocarcinoma: A Study of the National Cancer Database. J Surg Res. 2019;245:619-628.
Fisher, B. W., Fluck, M., Young, K., Shabahang, M., Blansfield, J., & Arora, T. K. (2019). Urgent Surgery for Gastric Adenocarcinoma: A Study of the National Cancer Database. The Journal of Surgical Research, 245, pp. 619-628. doi:10.1016/j.jss.2019.07.073.
Fisher BW, et al. Urgent Surgery for Gastric Adenocarcinoma: a Study of the National Cancer Database. J Surg Res. 2019 Sep 12;245:619-628. PubMed PMID: 31522035.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Urgent Surgery for Gastric Adenocarcinoma: A Study of the National Cancer Database. AU - Fisher,Benjamin W, AU - Fluck,Marcus, AU - Young,Katelyn, AU - Shabahang,Mohsen, AU - Blansfield,Joseph, AU - Arora,Tania K, Y1 - 2019/09/12/ PY - 2019/03/04/received PY - 2019/07/13/revised PY - 2019/07/19/accepted PY - 2019/9/16/pubmed PY - 2019/9/16/medline PY - 2019/9/16/entrez KW - Emergent surgery KW - Gastric adenocarcinoma KW - Gastric cancer KW - NCDB KW - National Cancer Database KW - Urgent surgery SP - 619 EP - 628 JF - The Journal of surgical research JO - J. Surg. Res. VL - 245 N2 - 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. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/31522035/Urgent_Surgery_for_Gastric_Adenocarcinoma:_A Study_of_the_National_Cancer_Database L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(19)30567-0 DB - PRIME DP - Unbound Medicine ER -