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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2021

01-08-2021 | Gastric Cancer | Gastrointestinal Oncology

Failure to Cure in Patients Undergoing Surgery for Gastric Cancer: A Nationwide Cohort Study

Authors: Daan M. Voeten, MD, Leonie R. van der Werf, MD, PhD, Janneke A. Wilschut, MD, PhD, Linde A. D. Busweiler, MD, PhD, Johanna W. van Sandick, MD, PhD, Richard van Hillegersberg, MD, PhD, Mark I. van Berge Henegouwen, MD, PhD, on behalf of the Dutch Upper Gastrointestinal Cancer Audit Group

Published in: Annals of Surgical Oncology | Issue 8/2021

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Abstract

Background

This study aimed to describe the incidence of failure to cure (a composite outcome measure defined as surgery not meeting its initial aim), and the impact of hospital variation in the administration of neoadjuvant therapy on this outcome measure.

Methods

All patients in the Dutch Upper Gastrointestinal Cancer Audit undergoing curatively intended gastric cancer surgery in 2011–2019 were included. Failure to cure was defined as (1) ‘open-close’ surgery; (2) irradical surgery (R1/R2); or (3) 30-day/in-hospital mortality. Case-mix-corrected funnel plots, based on multivariable logistic regression analyses, investigated hospital variation. The impact of a hospital’s tendency to administer neoadjuvant chemotherapy on the heterogeneity in failure to cure between hospitals was assessed based on median odds ratios and multilevel logistic regression analyses.

Results

Some 3862 patients from 28 hospitals were included. Failure to cure was noted in 22.3% (hospital variation: 14.5–34.8%). After case-mix correction, two hospitals had significantly higher-than-expected failure to cure rates, and one hospital had a lower-than-expected rate. The failure to cure rate was significantly higher in hospitals with a low tendency to administer neoadjuvant chemotherapy. Approximately 29% of hospital variation in failure to cure could be attributed to different hospital policies regarding neoadjuvant therapy.

Conclusions

Failure to cure has an incidence of 22% in patients undergoing gastric cancer surgery. Higher failure to cure rates were seen in centers administering less neoadjuvant chemotherapy, which confirms the Dutch guideline recommendation on the administration of neoadjuvant chemotherapy. Failure to cure provides short loop feedback and can be used as a quality indicator in surgical audits.
Appendix
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Metadata
Title
Failure to Cure in Patients Undergoing Surgery for Gastric Cancer: A Nationwide Cohort Study
Authors
Daan M. Voeten, MD
Leonie R. van der Werf, MD, PhD
Janneke A. Wilschut, MD, PhD
Linde A. D. Busweiler, MD, PhD
Johanna W. van Sandick, MD, PhD
Richard van Hillegersberg, MD, PhD
Mark I. van Berge Henegouwen, MD, PhD
on behalf of the Dutch Upper Gastrointestinal Cancer Audit Group
Publication date
01-08-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-09510-6

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