Adequate lymph node (LN) assessment and R0 resection are critical to the staging and management of gastric cancer. The American Joint Committee on Cancer/International Union Against Cancer recommend at least 15 LN be assessed, and the literature suggests a gross disease-free margin of 5-6 cm be achieved. Results of an Ontario general surgeons' survey indicated these standards were not widely known. Because disease management is highly collaborative, we surveyed pathologists to assess their knowledge of LN assessment and margins for processing gastric cancer specimens.
Pathologists were identified by the College of Physicians and Surgeons of Ontario and MD Select databases. Participants were surveyed online or by mail.
Pathologists indicated a goal of assessing 20 LN (11%). Most self-reported an actual assessment of 5-10 LN (49%), with 88% reporting a number below current standards. Additionally, 54% of responding pathologists identified >1 cm as an adequate gross margin, and 89% of pathologists indicated a response below current standards. Ninety-four percent of pathologists agreed that more education on gastric cancer is valuable.
To improve the quality of gastric cancer management, our findings suggest the need for clear, consistent guidelines for adequate gross margin resection length. Furthermore, there is a critical need for education aimed at closing the knowledge gap among practicing pathologists and surgeons regarding current recommended guidelines for LN assessment and adequate margin length.
Gastric cancer survival in the West is inferior to that achieved in Asian centers. While differences in tumor biology may play a role, poor quality surgery likely contributes to understaging. We hypothesize that the majority of surgeons performing gastric cancer surgery in North America are unaware of the recommended standards.
Using the Ontario College of Physicians and Surgeons registry, surgeons who potentially included gastric cancer surgery in their scope of practice were identified. A questionnaire was mailed to 559; of those, 206 surgeons reported managing gastric cancer. Results were evaluated by chi(2) and logistic regression; P