72325 - Centralisation of gastric cancer surgery- impact on treatment strategies and survival - a national population-based cohort study

Abstract Introduction Centralised surgery care improves results of curative resection in rare malignancies. Less is known of secondary effects of such centralisation on all patients, including patients receiving palliative or no tumour treatment. This population-based cohort study aimed to evaluate effects of centralisation on survival and treatment decision in all gastric cancer patients in Sweden between 2006-2016. Method All patients diagnosed with non-cardia gastric cancer were identified using National Registry for Oesophageal and Gastric Cancer (NREV) in Sweden. Patients cared by a local hospital performing low-volume curative gastric cancer surgery before centralisation were compared to patients in the same communities after curative cases were referred elsewhere. Survival differences were plotted in logistic regression models. Result Of 49 hospitals, 28 stopped performing curative gastric cancer surgery during the study period. After centralisation, 8 hospitals remained performing curative gastric cancer surgery. 4562 patients were included, and the median overall survival increased from 7.9 to 9.2 months. Resection rates fell from 36% to 30%. Treatment recommendation made at multidisciplinary cancer conference increased from 36% to 87%, where active tumour treatment increased from 66% to 72%. No significant difference in treatment strategy or time to surgery was found between the groups. No difference in overall survival was found between the groups. Discussion During the centralisation of gastric cancer surgery, survival, multidisciplinary treatment decisions and active treatment increased, with no detrimental effects on populations outside the major centres’ primary uptake areas.