B. Fisher1, M. Fluck1, M. Hunsinger1, J. Blansfield1, M. Shabahang1, T. Arora1 1Geisinger Health System,Department Of Surgery,Danville, PA, USA
Introduction: Gastric adenocarcinoma is the 2nd leading cause of cancer death in the world, and 16th most common in the United States. Gastric cancer can present emergently as an upper GI bleed or perforation. No large studies have examined how urgent surgery for gastric cancer effects patient outcomes. The aim of this study is to examine outcomes of urgent vs elective surgery for gastric cancer.
Methods: Patients from the National Cancer Database (NCDB) with gastric adenocarcinoma from 2004 to 2015 were examined retrospectively. Patients with metastatic disease or incomplete data were excluded. Urgent surgery was defined as definitive surgery within 4 days of diagnosis. Univariate and multivariate analysis of surgical and oncologic outcomes were performed, in addition to patient factors. All p-values <0.01
Results: Of 26,116 total patients, 2648 had urgent surgery and 23,468 had elective surgery. Patients in the urgent surgery cohort were significantly older, male, non-white, had higher pathologic stage, and were treated at a low volume center. Urgent surgery was associated with decreased quality lymph node harvest (OR 0.68 95%CI [0.62,0.74]), positive surgical margin (OR 1.48, 95%CI [1.32,1.65]), increased 30-day mortality (OR 1.38, 95%CI [1.16,1.65]), increased 90-day mortality (OR 1.30, 95%CI [1.14,1.49]), and decreased overall survival (HR 1.21 95%CI [1.15-1.27]).
Conclusion: Urgent surgery for gastric cancer is associated with significantly worse surgical and oncologic outcomes. Stable patients requiring urgent surgical resection for gastric masses may benefit from referral to a high-volume center for resection by an experienced surgeon. In addition, surgeons should maintain a high level of suspicion for gastric cancer in any patient with perforation or upper GI bleed.