Intraoperative assessment of the curative potential to predict survival after gastric cancer resection: A national cohort study

Gustav Linder; Richard J McGregor; Mats Lindblad

doi:10.1177/14574969231216594

Intraoperative assessment of the curative potential to predict survival after gastric cancer resection: A national cohort study

Scand J Surg. 2023 Dec 16:14574969231216594. doi: 10.1177/14574969231216594. Online ahead of print.

Authors

Gustav Linder¹, Richard J McGregor², Mats Lindblad³

Affiliations

¹ Department of Surgical Sciences Uppsala University Ingång 70, 1 tr SE-751 85 Uppsala Sweden.
² Clinical Surgery, The University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
³ Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.

PMID: 38102973
DOI: 10.1177/14574969231216594

Abstract

Background: The surgeon's intraoperative assessment of the curative potential of tumor resection following gastrectomy adds new information that could help clinicians and patients by predicting survival.

Methods: All patients in Sweden undergoing gastric cancer resection between 2006 and 2018 were grouped according to a prospectively registered variable; the surgeon's intraoperative assessment of the curative potential of surgery: curative, borderline curative, or palliative. Factors affecting group allocation were analyzed with multivariable logistic regression, while survival was analyzed using multivariable Cox regression and the Kaplan-Meier method. Positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results: Of 2341 patients undergoing gastric cancer resection, 1547 (71%) were deemed curative, 340 (15%) borderline curative, and 314 (14%) palliative (140 missing assessments). Advanced stage increased the risk of borderline curative resection (Stage III, odds ratio (OR) = 6.04, 95% confidence interval (CI) = 3.92-9.31), as did emergency surgery OR = 3.31 (1.74-6.31) and blood loss >500 mL; OR = 1.63 (1.06-2.49). Neoadjuvant chemotherapy and multidisciplinary team (MDT) discussion both decreased the risk of borderline curative resection, OR = 0.58 (0.39-0.87) and 0.57 (0.40-0.80), respectively. In multivariable Cox regression, the surgeon's assessment independently predicted worse survival for borderline curative (hazard ratio (HR) = 1.54, 95% CI = 1.29-1.83) and palliative resections (HR = 1.76, 95% CI = 1.45-2.19), compared to curative resections. The sensitivity of the surgeon's assessment of long-term survival was 96.7%. The PPV was 50.7% and the NPV was 92.1%.

Conclusion: The surgeon's intraoperative assessment of the curative potential of gastric cancer surgery may independently aid survival prediction and is analogous to prognostication by pathologic Staging. Advanced disease, emergency surgery, and a high intraoperative blood loss, increases the risk of a borderline curative or palliative resection. Conversely, neoadjuvant treatment and MDT discussion reduce the risk of borderline curative or palliative resection.

Keywords: Gastric cancer; surgeon’s assessment; survival prediction.