Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2016; 22(15): 4041-4048
Published online Apr 21, 2016. doi: 10.3748/wjg.v22.i15.4041
Worldwide practice in gastric cancer surgery
Hylke JF Brenkman, Leonie Haverkamp, Jelle P Ruurda, Richard van Hillegersberg
Hylke JF Brenkman, Leonie Haverkamp, Jelle P Ruurda, Richard van Hillegersberg, Department of Surgery, University Medical Center Utrecht, 3508 GA, Utrecht, The Netherlands
Author contributions: Brenkman HJF and Haverkamp L contributed equally to this work; van Hillegersberg R and Ruurda JP were the guarantors and designed the study; Brenkman HJF and Haverkamp L participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; van Hillegersberg R and Ruurda JP revised the article critically for important intellectual content.
Institutional review board statement: Institutional review board approval was waived.
Informed consent statement: Informed consent was waived.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Richard van Hillegersberg, Professor, Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA, Utrecht, The Netherlands. r.vanhillegersberg@umcutrecht.nl
Telephone: +31-88-7555555 Fax: +31-88-7555459
Received: December 16, 2015
Peer-review started: December 17, 2015
First decision: January 13, 2016
Revised: January 26, 2016
Accepted: February 20, 2016
Article in press: February 22, 2016
Published online: April 21, 2016
Processing time: 108 Days and 21.3 Hours
Abstract

AIM: 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)

CONCLUSION: 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.

Keywords: Gastric cancer; Gastrectomy; Laparoscopy; Neoplasm; Minimally invasive surgery

Core tip: Since surgical techniques might differ over time and between countries, we aimed to evaluate international preferences in gastric cancer surgery by means of a cross-sectional survey. Surgical preferences for gastric cancer surgery vary between surgeons worldwide. Minimally invasive gastrectomy is still not widely adapted, but most popular in Asia to treat patients with early gastric cancer. Neo-adjuvant chemotherapy is used by the majority of surgeons worldwide. A D1+ lymphadenectomy is preferred for early gastric cancer and a D2 lymphadenectomy is preferred for advanced gastric cancer.