Operative mortality after gastric cancer resection and long-term survival differences across Europe

Abstract

Abstract Background Little is known at a population level about operative mortality after surgery for gastric cancer and whether differences between countries can explain differences in long-term survival. This study compared operative mortality recorded by ten cancer registries in seven European countries. Methods Non-conditional logistic regression analysis was performed to estimate the independent effect of the studied factors on mortality within 30 days of surgery. A multivariable survival model was employed with and without operative mortality. Results The overall operative mortality rate in 1611 patients studied was 8·9 (range 5·2–16) per cent. Country of residence was a significant prognostic factor in the multivariable analysis. The likelihood of operative mortality was lower in Italy, France and the UK than in the Netherlands, Spain, Slovenia and Poland. Age, type of gastrectomy and stage at diagnosis were also significant factors. Cancer site was not found to be significant in the multivariable analysis. The overall 5-year relative survival rate varied between 42·0 per cent (Italy) and 24 per cent (Poland); after excluding operative mortality, the 5-year survival rate was 44·3 and 28 per cent respectively. Conclusion Within Europe, the substantial differences in operative mortality after gastrectomy only partly explain marked differences in survival after gastric cancer resection.