Outcome of gastric cancer surgery in Sweden

Gastric cancer worldwide is the fifth most common cancer and has the third highest cancer related mortality. Curative treatment includes surgical resection but comes with risk of complications and the optimal surgery including extent of lymphadenectomy has evolved over time. This thesis aims to assess the impact of surgical treatment and lymphadenectomy in gastric cancer and its postoperative short-term outcomes and long-term survival effects. It also examines the decision-making process and impact of the variation of different proportion of the population that is offered curative treatment for gastric cancer.

Paper I is a single center retrospective study examining the incidence of postoperative pancreatic fistula following gastrectomy with D2 lymphadenectomy and bursectomy. The results show that there is an acceptable general complication rate and the risk of postoperative pancreatic fistula is low when no concomitant pancreatic resection is carried out. Paper II and III are national register-based studies using the National Register of Oesophageal and Gastric Cancer (NREV) quality register. The studies examine the impact of different extent of lymphadenectomy on postoperative morbidity, mortality and long-term survival. The results show that extensive lymphadenectomy, D1+/D2, can be performed with acceptable and low postoperative complication rate and mortality and offers a survival advantage compared to limited, D0/D1, lymphadenectomy. Paper IV is a NREV study examining the different rates of curative gastric cancer resection across geographical regions in Sweden and its impact on survival. The results show that the rate of resection varies greatly across different regions and years in Sweden indicative of room for improvement in the decision-making process. A higher rate of curative resection is accompanied with improved survival for the entire population of gastric cancer.

List of scientific papers

I. Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients. Kung CH, Lindblad M, Nilsson M, Rouvelas I, Kumagai K, Lundell L, Tsai JA. Gastric Cancer. 2014;17(3):571-7.
https://doi.org/10.1007/s10120-013-0307-1

II. Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden. Kung CH, Song H, Ye W, Nilsson M, Johansson J, Rouvelas I, Irino T, Lundell L, Tsai JA, Lindblad M. Chin J Cancer Res. 2017 Aug;29(4):313-322.
https://doi.org/10.21147/j.issn.1000-9604.2017.04.04

III. Nationwide study of the impact of D2 lymphadenectomy on survival after gastric cancer surgery. Kung CH, Tsai JA, Lundell L, Johansson J, Nilsson M, Lindblad M. BJS Open. 2020 Mar 4.
https://doi.org/10.1002/bjs5.50270

IV. Impact of rate of surgical resection on survival in gastric cancer patients. Nationwide register study from the Swedish National Register of Oesophageal and Gastric Cancer – NREV. Kung CH, Jestin C, Linder G, Johansson J, Nilsson M, Hedberg J, Lindblad M. [Manuscript]