Failure to Operate on Resectable Gastric Cancer: Implications for Policy Changes and Regionalization

Abstract Background A significant proportion of patients never receive curative-intent surgery for resectable gastric cancer (GC). The primary aims of this study were to identify disparities and targetable risk factors associated with failure to operate in the context of national trends in surgical...

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Bibliographic Details
Published in:The Journal of surgical research 2017-06, Vol.214, p.229-239
Main Authors: Frohman, Heather A., MD, Martin, Jeremiah T., MBBCh, Le, Anh-Thu, MD, Dineen, Sean P., MD, Tzeng, Ching-Wei D., MD
Format: Article
Language:English
Subjects:
Adenocarcinoma - mortality
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Databases, Factual
Early cancer
Failure to operate
Female
Follow-Up Studies
Gastrectomy
Gastrectomy - statistics & numerical data
Gastric cancer
Health Policy
Healthcare Disparities - statistics & numerical data
Humans
Male
Middle Aged
Multivariate Analysis
Practice Patterns, Physicians' - statistics & numerical data
Proportional Hazards Models
Resectable
Stomach Neoplasms - mortality
Stomach Neoplasms - surgery
Surgery
Survival
Treatment Outcome
United States
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Summary:Abstract Background A significant proportion of patients never receive curative-intent surgery for resectable gastric cancer (GC). The primary aims of this study were to identify disparities and targetable risk factors associated with failure to operate in the context of national trends in surgical rates for resectable GC. Methods The National Cancer Database was used to identify patients with resectable GC (adenocarcinoma, clinical stage IA-IIIC, 2004-2013). Multivariate modeling was used to identify predictors of resection and to analyze the impact of surgery on overall survival (OS). Results Of 46,970 patients with resectable GC, 18,085 (39%) did not receive an appropriate operation. Among unresected patients, 69% had no co-morbidities. Failure to resect was associated with reduced median OS (44.4 vs. 11.8mo, hazard ratio, HR 2.09, p1 (OR-1.17), residing in areas with median income
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2017.03.043