M G Schouwenburg1, L A D Busweiler2, N Beck2, D Henneman3, S Amodio4, M I van Berge Henegouwen5, A Cats6, R van Hillegersberg7, J W van Sandick8, B P L Wijnhoven9, M W J Wouters10, G A P Nieuwenhuijzen11. 1. Leiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands. Electronic address: m.g.schouwenburg@lumc.nl. 2. Leiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands. 3. Leiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. 4. Leiden University Medical Centre, Department of Medical Statistics and Bio-informatics, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. 5. Academic Medical Centre, Department of Surgery, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. 6. The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Division of Gastrointestinal Oncology, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 7. University Medical Centre Utrecht, Department of Surgery, Utrecht, The Netherlands. 8. The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Surgery, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 9. Erasmus Medical Centre, Department of Surgery, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. 10. Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands; The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Surgery, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. 11. Catharina Hospital, Department of Surgery, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
Abstract
BACKGROUND: Dutch national guidelines on the diagnosis and treatment of gastric cancer recommend the use of perioperative chemotherapy in patients with resectable gastric cancer. However, adjuvant chemotherapy is often not administered. The aim of this study was to evaluate hospital variation on the probability to receive adjuvant chemotherapy and to identify associated factors with special attention to postoperative complications. METHODS: All patients who received neoadjuvant chemotherapy and underwent an elective surgical resection for stage IB-IVa (M0) gastric adenocarcinoma between 2011 and 2015 were identified from a national database (Dutch Upper GI Cancer Audit). A multivariable linear mixed model was used to evaluate case-mix adjusted hospital variation and to identify factors associated with adjuvant therapy. RESULTS: Of all surgically treated gastric cancer patients who received neoadjuvant chemotherapy (n = 882), 68% received adjuvant chemo(radio)therapy. After adjusting for case-mix and random variation, a large hospital variation in the administration rates for adjuvant was observed (OR range 0.31-7.1). In multivariable analysis, weight loss, a poor health status and failure of neoadjuvant chemotherapy completion were strongly associated with an increased likelihood of adjuvant therapy omission. Patients with severe postoperative complications had a threefold increased likelihood of adjuvant therapy omission (OR 3.07 95% CI 2.04-4.65). CONCLUSION: Despite national guidelines, considerable hospital variation was observed in the probability of receiving adjuvant chemo(radio)therapy. Postoperative complications were strongly associated with adjuvant chemo(radio)therapy omission, underlining the need to further reduce perioperative morbidity in gastric cancer surgery.
BACKGROUND: Dutch national guidelines on the diagnosis and treatment of gastric cancer recommend the use of perioperative chemotherapy in patients with resectable gastric cancer. However, adjuvant chemotherapy is often not administered. The aim of this study was to evaluate hospital variation on the probability to receive adjuvant chemotherapy and to identify associated factors with special attention to postoperative complications. METHODS: All patients who received neoadjuvant chemotherapy and underwent an elective surgical resection for stage IB-IVa (M0) gastric adenocarcinoma between 2011 and 2015 were identified from a national database (Dutch Upper GI Cancer Audit). A multivariable linear mixed model was used to evaluate case-mix adjusted hospital variation and to identify factors associated with adjuvant therapy. RESULTS: Of all surgically treated gastric cancerpatients who received neoadjuvant chemotherapy (n = 882), 68% received adjuvant chemo(radio)therapy. After adjusting for case-mix and random variation, a large hospital variation in the administration rates for adjuvant was observed (OR range 0.31-7.1). In multivariable analysis, weight loss, a poor health status and failure of neoadjuvant chemotherapy completion were strongly associated with an increased likelihood of adjuvant therapy omission. Patients with severe postoperative complications had a threefold increased likelihood of adjuvant therapy omission (OR 3.07 95% CI 2.04-4.65). CONCLUSION: Despite national guidelines, considerable hospital variation was observed in the probability of receiving adjuvant chemo(radio)therapy. Postoperative complications were strongly associated with adjuvant chemo(radio)therapy omission, underlining the need to further reduce perioperative morbidity in gastric cancer surgery.
Authors: Ashika D Maharaj; Jennifer F Holland; Ri O Scarborough; Sue M Evans; Liane J Ioannou; Wendy Brown; Daniel G Croagh; Charles H C Pilgrim; James G Kench; Lara R Lipton; Trevor Leong; John J McNeil; Mehrdad Nikfarjam; Ahmad Aly; Paul R Burton; Paul A Cashin; Julie Chu; Cuong P Duong; Peter Evans; David Goldstein; Andrew Haydon; Michael W Hii; Brett P F Knowles; Neil D Merrett; Michael Michael; Rachel E Neale; Jennifer Philip; Ian W T Porter; Marty Smith; John Spillane; Peter P Tagkalidis; John R Zalcberg Journal: BMJ Open Date: 2019-09-30 Impact factor: 2.692
Authors: L R van der Werf; W J Eshuis; W A Draaisma; B van Etten; S S Gisbertz; E van der Harst; M S L Liem; V E P P Lemmens; B P L Wijnhoven; M G Besselink; M I van Berge Henegouwen Journal: J Gastrointest Surg Date: 2019-02-28 Impact factor: 3.452