Perioperative,short-, and long-term outcomes of gastric cancer surgery: Propensity score-matched analysis of patients with or without prior solid organ transplantation |
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| Institution: | 1. Transplantation Center, Department of Transplantation Surgery, Wonju Severance Christian Hospital, Wonju, South Korea;2. Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea;3. Department of Surgery, Korea University College of Medicine, Seoul, South Korea;4. Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea;5. Gastric Cancer Center, Yonsei Cancer Center, Seoul, South Korea;6. Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea;7. The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, South Korea;1. Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands;2. Department of Cardiothoracic Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands;3. Department of pulmonary diseases, Amsterdam University Medical Center, Amsterdam, The Netherlands;4. Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, the Netherlands;5. Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands;6. Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands;7. Department of Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands;1. Surgical Outcomes Research Centre (SOuRCe), University of Sydney & Sydney Local Health District, New South Wales, Australia;2. Data Analysis Surgical Outcomes Unit (DASO), Royal North Shore Hospital, Sydney, New South Wales, Australia;3. The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, New South Wales, Australia;4. The Institute of Academic Surgery at RPA, Sydney Local Health District, Sydney, New South Wales, Australia;5. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia;1. Department of Head and Neck, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India;2. Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India;1. Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China;2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China;1. Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada;2. Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada;3. Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada |
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| Abstract: | BackgroundDetails of perioperative outcomes and survival after gastric cancer surgery in prior transplant recipients have received minimal research attention.MethodsWe performed an observational cohort study using the database of 20,147 gastric cancer patients who underwent gastrectomy at a single gastric cancer center in Korea. Forty-one solid organ recipients kidney (n = 35), liver (n = 5), or heart (n = 1)] were matched with 205 controls using propensity score matching.ResultsOperation time, blood loss, and postoperative pain were similar between groups. Short-term complication rates were similar between transplantation and control groups (22.0% vs. 20.1%, P = 0.777). Transplantation group patients with stage 1 gastric cancer experienced no recurrence, while those with stage 2/3 cancer had significantly higher recurrence risk compared to the controls (P = 0.049). For patients with stage 1 cancer, the transplantation group had a significantly higher rate of non-gastric cancer-related deaths compared to the controls (19.2% vs. 1.4%, P = 0.001). For those with stage 2/3 cancer, significantly lower proportion of the transplantation group received adjuvant chemotherapy compared to the control group (26.7% vs. 80.3%, P < 0.001). The transplantation group had a higher (albeit not statistically significant) rate of gastric cancer-related deaths compared to the controls (40.0% vs. 18.0%, P = 0.087).ConclusionTransplant recipients and non-transplant recipients exhibited similar perioperative and short-term outcomes after gastric cancer surgery. From long-term outcome analyses, we suggest active surveillance for non-gastric cancer-related deaths in patients with early gastric cancer, as well as strict oncologic care in patients with advanced cancer, as effective strategies for transplant recipients. |
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| Keywords: | Organ transplantation Transplant recipients Gastric cancer GC"} {"#name":"keyword" "$":{"id":"kwrd0030"} "$$":[{"#name":"text" "_":"gastric cancer BMI"} {"#name":"keyword" "$":{"id":"kwrd0040"} "$$":[{"#name":"text" "_":"body mass index DM"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"diabetes mellitus (DM) POD"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"postoperative day (POD) CNI"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"calcineurin inhibitor (CNI) MMF"} {"#name":"keyword" "$":{"id":"kwrd0080"} "$$":[{"#name":"text" "_":"mycophenolate mofetil (MMF) IV"} {"#name":"keyword" "$":{"id":"kwrd0090"} "$$":[{"#name":"text" "_":"intravenous (IV) |
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