Radical gastrectomy for gastric cancer at Tata Memorial Hospital

Aim: Tata Memorial Hospital is one of the high-volume tertiary care referral centers for gastric cancer (GC) in India. We aimed to analyze the outcomes after surgery for GC. Patients and Methods: Data were collected from the prospective database maintained by the Gastrointestinal and Hepato-Pancreato-Biliary Division of the Department of Surgical Oncology at Tata Memorial Hospital, Mumbai, Maharashtra, India. All consecutive patients who underwent curative resection for adenocarcinoma of the stomach from January 2010 to December 2015 were included. Results: A total of 580 patients underwent curative resection for adenocarcinoma of the stomach in the above mentioned time span. Distal tumors were more common and the tumor epicenter was at the distal body/antrum in 435 (75%) patients. One hundred eighty-two (31.3%) patients underwent upfront surgery and 398 patients (68.6%) were operated after receiving neoadjuvant chemotherapy. Surgical procedures included 371 distal/subtotal gastrectomies, 78 proximal, and 131 total gastrectomies. Overall median blood loss was 500 mL and intraoperative blood transfusion was required only in 10.5%. Median hospital stay was 8 days (range, 3-44). Postoperative major morbidity (Clavein-Dindo grade III/IV) was 8.9% and mortality was 1.5%. Median lymph node yield was 18 (range, 2-76). When perioperative outcomes were compared in the initial half of the study period (Period 1, 2010-2012) versus the later half (Period 2, 2013-2015), the median lymph node yield was found to be better in the later half (17 vs. 19) along with reduction in the median hospital stay (16 vs. 11 days). At a median follow-up of 36 months (range, 3-225 months), overall 5-year survival was 51.9%. The disease-free survival at 5 years was 46.9%. Conclusion: Results from our study indicate that, with increasing hospital volumes, the median lymph node yield after D2 gastrectomy improves and the median hospital stay is reduced. Surgery for GCs in high-volume centers might result in improved perioperative outcomes.