Journal of the American College of Surgeons · 2025
Long-Term Survivorship after Gastrectomy or Endoscopic Resection for Gastric Cancer Using Nationwide Real-World Data.
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Woo Hyeong-Taek, Kang So Hyun, Baek Ji Yoon, Yoo Mira, Park Young Suk, Kim Nayoung, Lee Dong Ho, Kim Hyung-Ho, Shin Aesun, Suh Yun-Suhk
Аннотация
BACKGROUND: Nutritional deficiency and weight loss after gastrectomy are major challenges for gastric cancer survivorship, yet appropriate weight reduction can prevent chronic metabolic or cardiovascular diseases. This study evaluated long-term survivorship with chronic diseases in gastric cancer survivors who underwent gastrectomy vs endoscopic resection (ER) in the Korean population.
STUDY DESIGN: Korean National Health Insurance data of patients with gastric cancer treated by gastrectomy or ER between 2002 and 2020 were matched 2:1 by age, sex, Charlson Comorbidity Index, insurance premium quartiles, and year of treatment. The 15-year survivorship with major adverse cardiovascular events (MACEs) and chronic diseases was compared.
RESULTS: A total of 74,367 gastric cancer survivors were matched (gastrectomy 49,578; ER 24,789). The gastrectomy group had lower incidence of hypertension (hazard ratio [HR] 0.53, p < 0.001; 11,757 events), ischemic heart disease (HR 0.80, p < 0.001; 4,740 events), heart failure (HR 0.77, p < 0.001; 5,580 events), cerebrovascular diseases (HR 0.78, p < 0.001; 6,013 events), and obesity-related cancers (HR 0.74, p < 0.001; 1,500 events). They also showed lower risk of death from obesity-related cancers (HR 0.74, p < 0.001) but higher risk of death by respiratory diseases (HR 1.37, p < 0.001). MACE-3 and MACE-6 were lower in the gastrectomy group (HR 0.86, p < 0.001). Average annual medical expenses for hypertension and diabetes within the first 10 years posttreatment were lower in the gastrectomy group ($90.3 ± 1.9 vs $118.4 ± 2.5, p < 0.001).
CONCLUSIONS: The gastrectomy group exhibited lower risk of MACE, reduced incidence and mortality of obesity-related cancers, and lower medical expenses for diabetes or hypertension compared with the ER group, despite higher risk of respiratory disease-related death.
STUDY DESIGN: Korean National Health Insurance data of patients with gastric cancer treated by gastrectomy or ER between 2002 and 2020 were matched 2:1 by age, sex, Charlson Comorbidity Index, insurance premium quartiles, and year of treatment. The 15-year survivorship with major adverse cardiovascular events (MACEs) and chronic diseases was compared.
RESULTS: A total of 74,367 gastric cancer survivors were matched (gastrectomy 49,578; ER 24,789). The gastrectomy group had lower incidence of hypertension (hazard ratio [HR] 0.53, p < 0.001; 11,757 events), ischemic heart disease (HR 0.80, p < 0.001; 4,740 events), heart failure (HR 0.77, p < 0.001; 5,580 events), cerebrovascular diseases (HR 0.78, p < 0.001; 6,013 events), and obesity-related cancers (HR 0.74, p < 0.001; 1,500 events). They also showed lower risk of death from obesity-related cancers (HR 0.74, p < 0.001) but higher risk of death by respiratory diseases (HR 1.37, p < 0.001). MACE-3 and MACE-6 were lower in the gastrectomy group (HR 0.86, p < 0.001). Average annual medical expenses for hypertension and diabetes within the first 10 years posttreatment were lower in the gastrectomy group ($90.3 ± 1.9 vs $118.4 ± 2.5, p < 0.001).
CONCLUSIONS: The gastrectomy group exhibited lower risk of MACE, reduced incidence and mortality of obesity-related cancers, and lower medical expenses for diabetes or hypertension compared with the ER group, despite higher risk of respiratory disease-related death.