Improved survival after resectable non-cardia gastric cancer in The Netherlands: the importance of surgical training and quality control.
BACKGROUND
In The Netherlands, standardised limited D1 and extended D2 lymph node dissections in the treatment of resectable gastric cancer were introduced nationwide within the framework of the Dutch D1-D2 Gastric Cancer Trial between 1989 and 1993. In a population-based study, we evaluated whether the survival of patients with resectable gastric cancer improved over time on a regional level.


METHODS
We compared 5-year overall and relative survival of patients with curatively resected non-cardia gastric cancer in the regional cancer registry of the Comprehensive Cancer Centre West in The Netherlands before the Dutch D1-D2 trial (1986 to mid 1989; n = 273), during the trial period (mid 1989 to mid 1993; n = 255), and after the trial (mid 1993 to 1999; n = 219), adjusting for prognostic variables.


RESULTS
Unadjusted survival was highest in the post-trial period: 5-year overall and relative survival were 42% and 52%, respectively, compared to 34% and 41% in the pre-trial period, and 39% and 46% in the trial period (p = 0.31 and p = 0.06, respectively). After adjustment for age, gender, tumour site, pT-stage, nodal status and hospital volume, the effect of period on survival was more apparent (p = 0.009). Compared to the pre-trial period, the hazard ratio was 0.83 (95% confidence interval, 0.68-1.02) for the trial period, and 0.72 (0.58-0.89) after the trial. Less than 1% of the patients received adjuvant therapy.


CONCLUSIONS
Survival of patients with curatively resected non-cardia gastric cancer has improved. Standardisation and surgical training in D1 and D2 lymph node dissection are the most likely explanation for this improvement.
Krijnen
P
P
Leiden Cancer Registry, Comprehensive Cancer Centre West (IKW), Leiden, The Netherlands. p.krijnen@ikw.nl
den Dulk
M
M
Meershoek-Klein Kranenbarg
E
E
Jansen-Landheer
M L E A
ML
van de Velde
C J H
CJ
D000368:Aged; D004493:Education / Q000592:standards; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D005743:Gastrectomy / Q000193:education / Q000592:standards; D013502:General Surgery / Q000193:education / Q000592:standards; D006801:Humans; D008197:Lymph Node Excision / Q000193:education / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011786:Quality Control; D012042:Registries; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome