Adherence with operative standards in the treatment of gastric cancer in the United States

Background Despite multiple clinical trials and practice guidelines for the treatment of gastric cancer, oncologic outcomes have not improved in the United States. One potential reason could be differences in the quality of surgery as performed in a controlled trial versus in practice. Methods Using...

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Bibliographic Details
Published in:Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2020-05, Vol.23 (3), p.550-560
Main Authors: Zhao, Beiqun, Blair, Sarah L., Katz, Matthew H. G., Lowy, Andrew M., Kelly, Kaitlyn J.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adenocarcinoma
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Cancer Research
Clinical trials
Female
Follow-Up Studies
Gastrectomy
Gastrectomy - mortality
Gastric cancer
Gastroenterology
Guideline Adherence
Humans
Lymph Node Excision - mortality
Lymph nodes
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Original Article
Patients
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Prognosis
Retrospective Studies
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgery
Surgical Oncology
Survival Rate
Young Adult
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Summary:Background Despite multiple clinical trials and practice guidelines for the treatment of gastric cancer, oncologic outcomes have not improved in the United States. One potential reason could be differences in the quality of surgery as performed in a controlled trial versus in practice. Methods Using the National Cancer Database, rates of adherence with operative standards for gastrectomy for cancer were analyzed. Of the numerous evidence-based operative standards outlined in the manual, two were reliably measured in the NCDB: (1) achieving and R0 resection, and (2) having > 16 lymph nodes examined. Univariable and multivariable Cox proportional hazard modeling and logistic regression were performed. Results A total of 28,705 patients with gastric adenocarcinoma who underwent curative-intent gastrectomy during 2004–2014 were identified. Only 36.5% of stage 0/I patients, and 41.8% of stage II/III patients, met minimum standards. Predictors for meeting standards included age 
ISSN:1436-3291
1436-3305
DOI:10.1007/s10120-019-01028-5