Back to 2016 Annual Meeting Posters
Improved Gastric Cancer Lymph Node Staging Following Multidisciplinary Tumor Board Initiative
*Whitney A Young, *Anne C Granfield, *Rachel E Sargent, *Howard P Safran, Thomas J Miner
Rhode Island Hospital, Providence, RI
Objective: The current UICC/AJCC classification recommends at least 15 lymph nodes (LN) be examined to correctly stage gastric cancer (GC). To improve GC staging, a local multidisciplinary tumor board (MTB) initiative to educate physicians on the requirements of LN retrieval following gastrectomy for GC was undertaken.
Design: Prospective cohort study
Setting: An academic tertiary healthcare organization
Patients: Gastrectomies performed with curative intent for gastric adenocarcinoma between 2003 and 2016.
Interventions: Beginning March 2006, a standardized announcement was made at the weekly MTB reminding participants that 15 LN were required to adequately stage GC.
Main Outcome Measures: Number of LNs obtained and frequency of adequate LN retrieval
Results: Between 2003-2016 121 gastrectomies were performed for gastric adenocarcinoma. Before the MTB initiative, a mean 14 LN were obtained (range 1-32) and an adequate number of LN were obtained in 52% (13/25) of cases. Following the MTB initiative, the number of LN resected (mean 21, range 0-49, p<0.05) and the frequency of adequate LN retrieval (75% (72/96), p<0.05) were significantly increased. MTB attendees retrieved greater LN (mean 24 vs.16, p<0.05) and increased frequency of adequate LN (90%, 46/51 vs. 60%, 9/16, p<0.05). Non-attendees did not exhibit any change LN retrieved.
Conclusions: In the United States, the number of LN resected varies regionally and is frequently inadequate. At our institution, improved GC staging was associated with a simple, cheap, and reproducible MTB initiative emphasizing the importance of evaluating >15 LN. Improved GC staging was achieved for those surgeons who utilized the system wide attention to this measure encouraged by the MTB. The emphasis provided by the MTB may be particularly useful for low volume surgeons and centers.
Back to 2016 Annual Meeting Posters
