Worldwide practice in gastric cancer surgery.
OBJECTIVE
To evaluate the current status of gastric cancer surgery worldwide.


METHODS
An international cross-sectional survey on gastric cancer surgery was performed amongst international upper gastro-intestinal surgeons. All surgical members of the International Gastric Cancer Association were invited by e-mail to participate. An English web-based survey had to be filled in with regard to their surgical preferences. Questions asked included hospital volume, the use of neoadjuvant treatment, preferred surgical approach, extent of the lymphadenectomy and preferred anastomotic technique. The invitations were sent in September 2013 and the survey was closed in January 2014.


RESULTS
The corresponding specific response rate was 227/615 (37%). The majority of respondents: originated from Asia (54%), performed > 21 gastrectomies per year (79%) and used neoadjuvant chemotherapy (73%). An open surgical procedure was performed by the majority of surgeons for distal gastrectomy for advanced cancer (91%) and total gastrectomy for both early and advanced cancer (52% and 94%). A minimally invasive procedure was preferred for distal gastrectomy for early cancer (65%). In Asia surgeons preferred a minimally invasive procedure for total gastrectomy for early cancer also (63%). A D1+ lymphadenectomy was preferred in early gastric cancer (52% for distal, 54% for total gastrectomy) and a D2 lymphadenectomy was preferred in advanced gastric cancer (93% for distal, 92% for total gastrectomy)


CONCLUSIONS
Surgical preferences for gastric cancer surgery vary between surgeons worldwide. Although the majority of surgeons use neoadjuvant chemotherapy, minimally invasive techniques are still not widely adapted.
Hylke JF Brenkman, Leonie Haverkamp, Jelle P Ruurda, Richard van Hillegersberg, Department of Surgery, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands.
Hylke J F
HJ
Brenkman
Hylke JF Brenkman, Leonie Haverkamp, Jelle P Ruurda, Richard van Hillegersberg, Department of Surgery, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands.
Leonie
L
Haverkamp
Hylke JF Brenkman, Leonie Haverkamp, Jelle P Ruurda, Richard van Hillegersberg, Department of Surgery, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands.
Jelle P
JP
Ruurda
Hylke JF Brenkman, Leonie Haverkamp, Jelle P Ruurda, Richard van Hillegersberg, Department of Surgery, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands.
Richard
R
van Hillegersberg
D017024:Chemotherapy, Adjuvant / Q000639:trends; D003430:Cross-Sectional Studies; D005743:Gastrectomy / Q000639:trends*; D019538:Health Care Surveys; D061847:Hospitals, High-Volume / Q000639:trends; D061846:Hospitals, Low-Volume / Q000639:trends; D006801:Humans; D008197:Lymph Node Excision / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000639:trends; D020360:Neoadjuvant Therapy / Q000639:trends; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000639:trends*; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*
Gastrectomy; Gastric cancer; Laparoscopy; Minimally invasive surgery; Neoplasm