The influence of surgery quality on the longtime results of gastric cancer combination therapy

Introduction. The aim of this study was to analyze the influence of surgical center experience on the long term survival of patients with locoregionally advanced gastric adenocarcinoma undergoing primary surgery, followed by complementary chemoradiotherapy according to MacDonald regimen. Material and methods. 154 patients treated surgically, including 75 (48.7%) at the Maria Sklodowska-Curie National Research Institute of Oncology (NIO-PIB) in Warsaw, and 79 (51.3%) outside this center. Both groups were retrospectively analyzed. The compared groups were statistically homogeneous. The following parameters were analyzed: age, gender, tumor differentiation, TNM VII (2010) staging, nodal index, radicality of surgical treatment, tumor type according to the Lauren classification, clinical stage, presence of prognostic factors, overall survival time. Results. Among those patients operated on at NIO-PIB, 71 (94.7%) patients underwent radical resection, 4 (5.3%) cases were microscopically non-radical resection had. There were no macroscopically non-radical resections (0%). For patients operated on outside NIO-PIB, 60 (75.9%) R0 resections, 15 (19%) R1 resections and 4 (5.1%) R2 resections were performed. The percentage of radical resections was significantly higher at NIO-PIB (p = 0.001). In 77% of patients operated on at NIO-PIB, disease progression in terms of feature could be established. This percentage for patients operated on outside the NIO-PIB was 54% and was significantly lower (p = 0.001). The probability of 5-year survival was 41.6% in total, with 45.3% for the group of patients operated on in the NIO-PIB and 38.0% for the group of patients operated on outside the NIO-PIB, respectively (p = 0.628). Conclusions. The quality of surgical treatment was significantly higher in NIO-PIB. The difference in 5-year overall survival (OS) between the compared groups is not statistically significant. Complementary treatment with chemoradiotherapy (CRT) according to MacDonald regimen reduces the shortcomings in the quality of surgical treatment in locoregionally advanced gastric adenocarcinoma.