E. M. Groh1, N. Hyun2, D. Check2, H. Chinnasamy3, J. M. Hernandez1, B. I. Graubard2, J. L. Davis1 1National Cancer Institute,Thoracic And Gastrointestinal Oncology Branch,Bethesda, MD, USA 2National Cancer Institute,Division Of Cancer Epidemiology And Genetics,Bethesda, MD, USA 3National Cancer Institute,Surgery Branch,Bethesda, MD, USA
Introduction: The incidence of gastric cancer has declined in the United States over the last few decades, however race-specific trends in gastrectomy remain undefined. The goals of this study were to evaluate the annual rates and outcomes of gastrectomy for cancer stratified by race during a time of a changing US population.
Methods: Data was queried from the Nationwide Inpatient Sample (NIS) from 1993 to 2013. All patients undergoing gastrectomy for cancer as defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) procedure and diagnostic codes were identified. Multivariate analyses were performed on common covariates including sex, race, type of gastrectomy, comorbidity score and hospital characteristics. SAS® 9.4 Software was used for statistical analysis.
Results: We identified a significant decline in the rates of gastrectomy for cancer between 1993 and 2013 (p<0.0001). In 1993, there were 9,879 gastric resections for cancer whereas in 2013, there were 7,270, representing a 26.4% decrease. Despite the decreasing frequency of operations undertaken for gastric cancer in the US, we identified a concomitant decrease in the rates of in-hospital mortality during the study period (p=0.0002). Not surprisingly, in-hospital mortality was significantly lower at urban teaching hospitals as compared to rural or urban nonteaching hospitals (p=0.0217), where most resections were undertaken. In analyzing the rates of gastrectomy for cancer stratified by race, we identified a 32.5% decrease in operations undertaken in white patients, whereas a 39.5% increase in operations was observed in Hispanic patients. During this same time period the percent Hispanic U.S. population more than doubled. Multivariate analysis of patients undergoing gastrectomy for cancer revealed that Asian patients had significantly lower in-hospital mortality rates when compared to Whites (p=0.0041). However, there was no difference in in-hospital mortality when comparing African-American (AA) and Hispanic patients to White patients.
Conclusion: The annual rate of gastrectomy for cancer is declining in the U.S. in general, although race-specific changes may reflect changes in the population over the study period. Despite decreasing frequency of gastrectomy, mortality rates have also declined for patients undergoing gastrectomy for cancer. Rates of in-hospital mortality were worse in AA, Hispanic and White patients as compared to Asian patients for reasons that remained ill-defined.
