Improving Outcomes After Gastroesophageal Cancer Resection Can Japanese Results Be Reproduced in Western Centers?

Hypothesis: Extended lymphadenectomy in gastroesphageal cancer leads to improved long-term survival without compromising postoperative outcomes in Western patients to attain the standard achieved in Japanese centers. Design: Cohort study comparing postoperative outcomes and long-term survival with data from the National Cancer Center (NCC) of Tokyo, Japan. Outcomes were also compared with data from the UK National Oesophago-Gastric Cancer Audit (NOGCA) and a representative cohort from southeast England. Prospectively collected data were independently audited. Setting: University medical center. Patients: From 2003 to 2010, 100 patients underwent gastrectomy and 109 underwent esophagectomy. Main Outcome Measures: Postoperative mortality and morbidity and long-term overall survival. Lymph node count was used as a measure for the extent of lymphad-enectomy. Results: One death occurred after esophagectomy and none after gastrectomy. Anastomotic leak rate was approximately 2% in both cohorts. Kaplan-Meier estimates of 5-year overall survival after gastrectomy and esophagectomy were 58.4% and 47.8%, respectively. Postoperative mortality and technical complications for gastric and esophageal cancer resections were similar to NCC rates (P=. 20). Stage for stage 5-year survival rates in patients with esophageal cancer and stages II and III gastric cancer were similar to outcomes in the NCC. The 5-year survival for patients with gastric cancer was worse for those with stage I (P < .001) and better for those with stage IV (P < .001) disease compared with NCC rates. Postoperative outcomes and long-term survival were significantly better than those reported by the NOGCA and the data from the southeast of England (P < .05). Conclusions: This study demonstrates that postoperative outcomes and long-term survival after gastroesophageal cancer resection can be improved in Western patients to the highest standard achieved in Japan.