Weekday of gastrectomy for cancer in relation to mortality and oncological outcomes – a Dutch population-based cohort study

Publication date: Available online 29 July 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): E. Visser, H.J.F. Brenkman, R.H.A. Verhoeven, J.P. Ruurda, R.van Hillegersberg
BackgroundSome studies demonstrate that high-complex surgeries performed later in the week are associated with higher postoperative mortality and worse long-term survival. The aim of this cohort study was to determine whether weekday influences outcomes in patients undergoing gastrectomy for cancer.MethodsAll patients who underwent a curative gastrectomy for cancer (2006-2014) were selected from the nationwide population-based Netherlands Cancer Registry. Weekday was analyzed as categorized (Monday-Tuesday versus Wednesday-Friday) and discrete variable (Monday-Friday). The influence of weekday on postoperative 30- and 90-day mortality, and oncological outcomes (lymph node yield, radicality rate and overall survival) was assessed with multivariable logistic and Cox regression analyses.ResultsA total of 3.776 patients were included with a median overall survival of 26.7 months [range 0-120]. The 30- and 90- day mortality were 5% and 8% respectively, median lymph node yield was 13 [range 0-87], and radicality rate was 87%. In multivariable analysis, no influence of weekday was found on postoperative mortality (p>0.05), on R0 resection rates (p>0.05), nor on overall survival (Monday-Friday, HR 1.03, 95%CI 1.01-1.04, p=0.111; Wednesday-Friday vs. Monday-Tuesday, HR 1.05, 95%CI 0.96-1.14, p=0.307). The lymph node yield was significantly lower later in the week compared to earlier (Monday-Friday, OR 0.94, 95%CI 0.89-0.99, p=0.013; Wednesday-Friday vs. Monday-Tuesday OR 0.83, 95%CI 0.71-0.96, p=0.010), which was most apparent in recent years of surgery.ConclusionGastric cancer surgery can be performed safely throughout the week regarding postoperative mortality, radicality and overall survival. A point of concern is a reduced lymph node yield later in the week.



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