Utvärdering av operationsresultat för övre GI-cancer

Projekt: Forskning

Projektinformation

Beskrivning

“Background:
Approximately 1100 individuals are diagnosed with oesophageal or gastric cancer annually in Sweden. The 5-year survival rate for these patients does not surpass 20%. Surgery and/or oncological therapy is the mainstay of modern cancer treatment regimens for these tumours. The aims of this project were twofold: 1. To evaluate current trends in Swedish oesophagogastric (OG) cancer treatment in a national (2007-16) and international context (2012-14); 2. To investigate the potential benefit of the three-stage thoracoabdominal gastrectomy with resection of the distal two-thirds of the oesophagus and anastomosis with a long Roux-en-Y limb at the level of vena azygos (THX-ABD) for Siewert type II & III tumours at the gastrooesophageal junction (GOJ).

Methods:
Data were derived from the national quality registers for OG cancer in Sweden, the Swedish National Register for Oesophageal and Gastric cancer (NREV) and the Netherlands, the Dutch Upper GI Cancer Audit (DUCA). The second project was based on a separate retrospective cohort of patients with OG cancer operated on at Skåne University Hospital 1986-2011.

Results:
Neoadjuvant treatment before surgery became increasingly prevalent, surgical procedures for OG cancer were centralized to fewer hospitals and there was a significant improvement in short-term mortality after gastric surgery in Sweden 2007-16. Lower annual hospital volumes of OG cancer surgery were observed in Sweden compared to the Netherlands. Neoadjuvant treatment rates were significantly lower in Sweden for both oesophageal and gastric cancer and Sweden had lower adjusted 30 and/or in-hospital mortality after gastrectomy than the Netherlands. After THX-ABD the in-hospital mortality was 2.4%, the R0-resection rate was 84% and overall 5-year survival was 27%. Additional thoracic lymph node dissection did not not seem to improve long-term survival.

Conclusion:
The results from NREV 2007-16 show significant improvements in several important quality indicators of care for patients with OG cancers in Sweden. Well-maintained national quality registers allow for international comparisons where significant differences in patient and treatment characteristics were evident between Sweden and the Netherlands. The THX-ABD can be performed with high rates of R0-resections and low in-hospital mortality. Long-term prognosis is not superior to other less extensive procedures for tumours in the same locations.”
StatusSlutfört
Gällande start-/slutdatum2018/10/262020/12/30

Finansiering

  • Erik och Angelica Sparres forskningsstift.