Results of specialization in the surgical treatment of gastric cancer in Peru

Background. The best results in the surgical treatment of gastric cancer are those obtained by the Japanese surgical school that emphasizes D2 lymphadenectomy as a fundamental principle for obtaining better local control of the disease. However, this technique has not gained wide acceptance in the West, owing to the fact that the results of Japanese studies have not been reproduced frequently in Western countries. In recent years, a series of studies have recommended the centralization of gastric cancer treatment in specialized surgical units in order to obtain results similar to those achieved by Japanese centers. The objective of this study was to describe the specialization process and to show the short-term results obtained in the surgical treatment of gastric cancer in the Specialized Unit of the Rebagliati National Hospital, the largest general referral hospital in Lima, Peru. Methods. In the year 2000 a specialized service was created for the surgical treatment of gastric cancer, initiating a process that included the establishment of surgical treatment guidelines, training in the Japanese surgical technique, and progress along the learning curve for D2 lymphadenectomy. Clinical, surgical, and pathological data were recorded prospectively in a fixed format, considering that strict documentation of cases was also an important step within this process. Results. Between January 1, 2004, and December 31, 2005, 243 consecutive patients with a proven diagnosis of gastric adenocarcinoma were admitted to the operating theater for surgical treatment. During this study period, morbidity was 22.7% and hospital mortality, 2.8%. The numbers (mean ± SD) of resected lymph nodes for distal gastrectomy and total gastrectomy were 37.3 ± 12.4 and 45.3 ± 14.5, respectively. Hospital stay was 13 days for distal gastrectomy as well as for total gastrectomy. Conclusion. According to our results, adequate training in the Japanese surgical technique, progress along the learning curve for D2 lymphadenectomy, and the establishment of specialized units are highly recommended for the surgical treatment of gastric cancer in Western referral hospitals.