University of Oulu

Junttila, A., Helminen, O., Kairaluoma, V. et al. Implementation of Multimodality Therapy and Minimally Invasive Surgery: Short- and Long-term Outcomes of Gastric Cancer Surgery in Medium-Volume Center. J Gastrointest Surg 26, 2061–2069 (2022).

Implementation of multimodality therapy and minimally invasive surgery : short- and long-term outcomes of gastric cancer surgery in medium-volume center

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Author: Junttila, Anna1,2; Helminen, Olli1,3; Kairaluoma, Valtteri1;
Organizations: 1Department of Surgery, Central Finland Central Hospital, Keskussairaalantie 19 40620, Jyväskylä, Finland
2Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
3Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: Springer Nature, 2022
Publish Date: 2023-06-09


Background: Multimodal treatment of gastric cancer includes careful preoperative staging, perioperative oncological treatment, and selective minimally invasive approach. The aim was to evaluate whether this approach improves short- and long-term outcomes in operable gastric cancer.

Methods: This study included 181 gastric cancer patients who underwent curative intent surgery in Central Finland Central Hospital between years 2005 and 2021 for gastric or esophagogastric junction adenocarcinoma. Those 65 patients in group 1 operated between years 2005–2010 had open surgery with possible adjuvant therapy. During the second period including 58 patients (2011–2015), perioperative chemotherapy and minimally invasive surgery were implemented. The period, when these treatments were standard practise, was years 2016–2021 including 58 patients (group 3). Outcomes were lymph node yield, major complications and 1- and 3-year survival rates.

Results: Median lymph node yield increased from 17 in group 1 and 20 in group 2 to 23 in group 3 (p < 0.001). Major complication rates in groups 1–3 were 12.3%, 32.8%, and 15.5% (group 1 vs. group 2, p = 0.007; group 2 vs. group 3, p = 0.018), respectively. Overall 1-year survival rates between study groups 1–3 were 78.5% vs. 69.0% vs. 90.2% (p = 0.018) and 3-year rates 44.6% vs. 44.8% vs. 68.1% (p = 0.016), respectively. For overall 3-year mortality, adjusted hazard ratio (HR) was 1.02 (95%CI 0.63–1.66) in group 2 and HR 0.37 (95%CI 0.20–0.68) in group 3 compared to group 1.

Conclusions: In medium-volume center, modern multimodal therapy in operable gastric cancer combined with minimally invasive surgery increased lymph node yield and improved long-term survival without increasing postoperative morbidity.

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Series: Journal of gastrointestinal surgery
ISSN: 1091-255X
ISSN-E: 1873-4626
ISSN-L: 1091-255X
Volume: 26
Issue: 10
Pages: 2061 - 2069
DOI: 10.1007/s11605-022-05437-3
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
Funding: Open Access funding provided by University of Turku (UTU) including Turku University Central Hospital. This work was supported Instrumentarium Science Foundation (OH), Mary and Georg C. Ehrnrooth Foundation (OH), Finnish State Research Funding (OH), Turku University Foundation (AJ), Finnish-Norwegian Medical Foundation (AJ) and Finnish Cultural Foundation (AJ).
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