Improved Survival after Implementation of Multidisciplinary Team Meetings, Perioperative Chemotherapy, Extended Lymphnode Dissection and Laparoscopic Surgery in the Treatment of Advanced Gastric Cancer

摘要

Aims style="font-family:;" "=""> style="font-family:Verdana;">: The treatment of gastric cancer has changed in the western countries during the last decade. This includes multidisciplinary team (MDT) meetings, style="font-family:Verdana;">perioperative chemotherapy, extended lymph node dissection, and laparo style="font-family:Verdana;">scopic surgery, all of which were gradually implemented at our department from 2008. The aim of the present study was to determine the effect of these changes on morbidity and survival. style="font-family:Verdana;">Material and Methods style="font-family:Verdana;">: 185 patients with gastric cancer were operated with curative intent from 2000 until 2016 style="font-family:;" "=""> style="font-family:Verdana;">in this retrospective, observational, follow-up study style="font-family:Verdana;">; style="font-family:Verdana;">83 before implementation of modern principles in 2008 (period 1) and 102 were treated after style="font-family:;" "=""> style="font-family:;" "=""> style="font-family:Verdana;">2008 (period 2). style="font-family:Verdana;">Results style="font-family:Verdana;">: The resection rate (94% vs 92.8%) and mortality rates (4.8% vs 2.9%) did not differ between the two periods. In period 2, 48 patients (47.1%), received neoadjuvant chemotherapy. In 36 patients (35.3%), laparoscopic surgery with D2 lymphadenectomy was performed. There was a significantly higher yield in style="font-family:Verdana;">the style="font-family:Verdana;">number of lymph nodes in period 2 compared to period 1 style="font-family:;" "=""> style="font-family:Verdana;">(14 vs 8, p < 0.001). This is also a style="font-family:Verdana;">p style="font-family:Verdana;">parent between laparoscopic and open surgery style="font-family:Verdana;"> in the second period (32 vs 10, p < 0.001). style="font-family:;" "=""> style="font-family:;" "=""> style="font-family:Verdana;">The five-year survival rate was significantly improved after the change in treatment principles with an estimated improvement from 30% to 40% between the periods (p = 0.033). style="font-family:Verdana;">Conclusion style="font-family:Verdana;">: The combined effect of MDT meetings, neoadjuvant chemotherapy, extended lymphnode dissection and laparoscopy has improved the prognosis of gastric cancer patients.