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. 2023 Oct;23(4):535-548.
doi: 10.5230/jgc.2023.23.e32.

Real-World Compliance of Surgical Treatment According to the Korean Gastric Cancer Guideline 2018: Evaluation From the Nationwide Survey Data 2019 in Korea

Sang Soo Eom  1   2 , Sin Hye Park  1 , Bang Wool Eom  1 , Hong Man Yoon  1 , Young-Woo Kim  1 , Keun Won Ryu  3
Affiliations

Real-World Compliance of Surgical Treatment According to the Korean Gastric Cancer Guideline 2018: Evaluation From the Nationwide Survey Data 2019 in Korea

Sang Soo Eom et al. J Gastric Cancer. 2023 Oct.

Abstract

Purpose: This study evaluated real-world compliance with surgical treatment according to Korea's gastric cancer treatment guidelines.

Materials and methods: The 2018 Korean Gastric Cancer Treatment Guidelines were evaluated using the 2019 national survey data for surgically treated gastric cancer based on postoperative pathological results in Korea. In addition, the changes in surgical treatments in 2019 were compared with those in the 2014 national survey data implemented before the publication of the guidelines in 2018. The compliance rate was evaluated according to the algorithm recommended in the 2018 Korean guidelines.

Results: The overall compliance rates in 2019 were 83% for gastric resection extent, 87% for lymph node dissection, 100% for surgical approach, and 83% for adjuvant chemotherapy, similar to 2014. Among patients with pathologic stages IB, II, and III disease who underwent total gastrectomy, the incidence of splenectomy was 8.08%, a practice not recommended by the guidelines. The survey findings revealed that 48.66% of the patients who underwent gastrectomy had pathological stage IV disease, which was not recommended by the 2019 guidelines. Compared to that in 2014, the rate of gastrectomy in stage IV patients was 54.53% in 2014. Compliance rates were similar across all regions of Korea, except for gastrectomy in patients with stage IV disease.

Conclusions: Real-world compliance with gastric cancer treatment guidelines was relatively high in Korea.

Keywords: Compliance; Guideline; Stomach neoplasm.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. pStage of surgically treated gastric cancer in 2019.
pStage = pathological stage.
Fig. 2
Fig. 2. Guideline compliance in pStage Ia. (A) Gastric resection in pStage Ia, (B) LND in pStage Ia. Percentages in parentheses are the proportions of subgroups. (C) Surgical approach in pStage Ia. Laparoscopic surgery include robot surgery.
pStage = pathological stage; DG = distal gastrectomy; PPG = pylorus-preserving gastrectomy; TG = total gastrectomy; PG = proximal gastrectomy; LND = lymph node dissection.
Fig. 3
Fig. 3. Guideline compliance in pStage Ib, II, III. (A) Gastric resection in pStage Ib, II, III and (B) LND in pStage Ib, II, III. Percentages in parentheses are the proportions of subgroups. (B) In pStage Ib, II, III, splenectomy was performed in 134 patients (8.08%) among the TG cases (n=1,658). (C) Surgical approach in pStage Ib, II, III. Laparoscopic surgery include robot surgery.
pStage = pathological stage; DG = distal gastrectomy; PPG = pylorus-preserving gastrectomy; TG = total gastrectomy; PG = proximal gastrectomy; LND = lymph node dissection.
Fig. 4
Fig. 4. Surgically treated gastric cancer in pStage IV.
pStage = pathological stage.
Fig. 5
Fig. 5. Adjuvant chemotherapy after surgical resection of gastric cancer.
pStage = pathological stage.
Fig. 6
Fig. 6. Preoperative chemotherapy before surgery for gastric cancer. Percentages in parentheses are the proportions of subgroups.
Fig. 7
Fig. 7. Compliance rate in 2019.
Fig. 8
Fig. 8. Comparison of compliance rates between 2019 and 2014.
pStage = pathological stage.
Fig. 9
Fig. 9. Regional compliance rate. (A) Regional distribution of enrolled patients, (B) Extent of gastric resection in each regions, (C) Lymph node dissection in each regions, (D) Surgical approach in each regions, (E) Adjuvant chemotherapy in each regions, (F) Splenectomy in each regions, and (G) Gastrectomy of stage IV in each regions.
See this image and copyright information in PMC

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