Patient Characteristics and Evolution of Surgical Management of Gastric/ Gastro-esophageal Junction (GOJ) Adenocarcinoma From 1998 to 2018: Experience From a Single Gastrointestinal Surgical Unit in a Resource Limited Setting

Abstract

Introduction: Gastric/gastro-oesopageal junctional adenocarcinoma/ (GC/GOJ CA) is the fourth commonly diagnosed cancer and the second commonest cancer related cause of death worldwide. Curative therapy for GC involves surgical resection with an accompanying lymphadenectomy. Yet, most of the GC/GOJ tumours are inoperable at presentation and has a poor prognosis in our setup probably due to the absence of screening programme. The objective of this study was to describe the operability and curative resection rate and outcomes of gastric/GOJ adenocarcinoma in Sri Lankan setting from 1998 to 2018.Methodology- In a retrospective analysis of prospectively maintained data from, surgery for GCs in a tertiary care center over a period of 21 years. All patients underwent surgery for GC/GOJ adenocarcinoma by single gastrointestinal surgeon. Results: There were 153 patients with mean age of 57.4(22 to 84) years. The majority (n=109) were Males (Male: Female was 2.3 : 1) . There were 88(56.4%) distal, 60(39.2%) proximal and 5(3.2%) diffuse cancers. Only 82 (53.6 %) patients underwent curative resection. Only 3 patients underwent palliative major resection (total gastrectomy(n=1), distal gastrectomy(n=2) Among curative resections,51(62.2%) had distal gastrectomy and 17(20.7%) had total gastrectomy.R0 resection was performed in 75 (91.5%), and 6 (7.3%) had microscopic positive margins (R1). Resectability of the proximal GCs (48.3%, n=29) was lower (63.4%, n=54) than the distal GCs (p= 0.117). Further, resectability among patients with GCs has not increased significantly over the past 21 years.Conclusions: Majority of the patients especially with proximal GC are inoperable at presentation. Despite the availability of endoscopes the operability has not changed significantly over the years. Given the low incidence, screening for GC is not seemingly feasible in Sri Lanka. Therefore an attempt has to be made to identify those with high risk factors during diagnostic endoscopic procedures.