title: Treatment results of curative gastric resection from a specialist Australian unit: low volume with satisfactory outcomes.
abstract: BACKGROUND
  The incidence of gastric cancer is decreasing in Australia, yet it remains a common cause of cancer-related mortality. Surgical resection remains the cornerstone of curative treatment. High-volume specialized units have reported superior perioperative and oncological outcomes. The role of D2 lymphadenectomy has been controversial as a result of concerns over increased morbidity. Our aim is to report the perioperative and oncological outcomes of curative gastric resection from a specialist Australian upper GI unit.
  
  
  METHODS
  Data from a prospectively maintained database were reviewed for all patients undergoing curative resection for gastric adenocarcinoma from a single unit during a 12-year period. Perioperative and long-term outcomes were compiled.
  
  
  RESULTS
  There were 255 curative gastric resections during 12 years. An R0 resection was performed in 96 % with a perioperative mortality rate of 1.6 %. A D2 dissection was performed in 85 % of cases in the past 6 years, with no increase in perioperative morbidity or mortality detected. The 5-year overall survival was 53 %.
  
  
  CONCLUSIONS
  Our results demonstrate that both short- and long-term outcomes of surgical resection in gastric cancer patients, comparable to international high-volume centers, can be achieved in an Australian upper GI unit. A D2 lymph node dissection can be performed safely without any increase in perioperative risk in a specialist unit that has the necessary training but also the perioperative support structures to manage these complex patients.
authors.affiliation: Upper Gastrointestinal and Soft Tissue Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia, i.thomson@uq.edu.au.
authors.forename: Iain G
authors.initials: IG
authors.lastname: Thomson
authors.forename: David C
authors.initials: DC
authors.lastname: Gotley
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Barbour
authors.forename: Ian
authors.initials: I
authors.lastname: Martin
authors.forename: Neil
authors.initials: N
authors.lastname: Jayasuria
authors.forename: Janine
authors.initials: J
authors.lastname: Thomas
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Smithers
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods / Q000401:mortality*; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult