MS O04 - OGC Outcomes following gastrectomy for cancer: A 15-Year Retrospective Study examining the impact of regional service centralisation, benchmarking against international standards

Abstract Background Gastrectomy remains the cornerstone of curative treatment for gastric cancer but is associated with significant risks of complications. This study aimed to explore the impact of service centralisation in Greater Manchester on outcomes following gastrectomy for cancer. Outcomes were compared against international benchmarks to evaluate impact of centralisation and identify areas for improvement. Method This was a retrospective study of all patients undergoing gastrectomy (total gastrectomy TG; partial gastrectomy PG) for cancer at a tertiary OG cancer centre between 2007-2022. Patients were allocated to three time periods (2007-2012; 2013-2018; 2018-2022). Regional centralisation took place in August 2018. Outcome selection was guided by a core outcome set for gastrectomy and international benchmarks including the GastroData consortium and the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Results 379 patients undergoing gastrectomy (TG; 201, PG; 172) were included. Median length of stay shortened (p=0.023) and median lymph node yield improved (p<0.001) following centralisation. This was consistent with findings from the DUCA audit. There was no difference in R0 resection rates (p=0.668), surgical reinterventions (p=0.717) or readmissions within 90-days (p=0.428) after centralisation. Whilst post-operative mortality improved (30-day 4.5% versus 0%; 90-day 5.4% versus 1.2%), this was not statistically significant (p=0.09). Conclusion Centralisation of surgical OG cancer services in our region resulted in improved short-term outcomes for patients undergoing gastrectomy. This may reflect a greater emphasis on standardised peri-operative surgical and pathology protocols. These findings were partly consistent with international benchmarks. Further evaluation of the impact on longer-term outcomes is required.