AB87. Impact of surgeons’ specialization on survival after surgery for gastric cancer

Objectives: The purpose of this study was to evaluate the prognostic value of surgeons’ specialization, and then to emphasize the importance of specialist training in gastric surgery.

Methods: A total of 1,137 patients with gastric cancer who underwent gastrectomy in our central were enrolled. Patients were categorized into two groups: specialized group (those treated by specialized surgeons) and non-specialized group (those treated by non-specialized surgeons).

Results: Of the 1,137 patients, 817 patients (71.9%) were treated by non-specialized surgeons, and 320 patients (28.1%) were treated by specialized surgeons. The patients treated by specialized surgeons demonstrated a significantly higher survival rate than those treated by non-specialized surgeons [5-year overall survival rate (5-YSR): 46.6% vs. 34%, P=0.004]. In multivariable analysis, surgeons’ specialization was an independent prognostic factor for gastric cancer after surgery (hazard ratio: 1.315, P=0.005). By stratification analysis, between two groups, the significant prognostic differences were only observed in patients at TNM_II-IIIB or pN_1-2 stages. In subgroup analysis, chemotherapy played a more important role in non-specialized group when compared with specialized group (P=0.006 and P=0.037 respectively). D2 resection performed by specialized surgeons demonstrated a better prognosis than that performed by non-specialized surgeon though the difference was not statistically significant (5-YSR: 49.8% vs. 42.9%, P=0.165).

Conclusions: Surgeons’ specialization was an independent prognostic factor for gastric cancer after surgery. Patients treated by specialized surgeons tended to have better prognosis and longer survival periods. Gastric cancer should be treated by specialized surgeon in large-volume center. Specialist training especially standard lymphadenectomy is necessary for gastric surgeons.

Keywords: Gastric cancer; prognosis; surgeons; specialization