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 lymphadenectomy. 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.