• M G Schouwenburg, BusweilerL A DLADLeiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands., N Beck, D Henneman, S Amodio, M I van Berge Henegouwen, A Cats, R van Hillegersberg, J W van Sandick, WijnhovenB P LBPLErasmus Medical Centre, Department of Surgery, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands., M W J Wouters, NieuwenhuijzenG A PGAPCatharina Hospital, Department of Surgery, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands., and Dutch Upper GI Cancer Audit group.
• Leiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA, Leiden, The Netherlands. Electronic address: m.g.schouwenburg@lumc.nl.
• Eur J Surg Oncol. 2018 Apr 1; 44 (4): 532-538.

BackgroundDutch national guidelines on the diagnosis and treatment of gastric cancer recommend the use of perioperative chemotherapy in patients with resectable gastric cancer. However, adjuvant chemotherapy is often not administered. The aim of this study was to evaluate hospital variation on the probability to receive adjuvant chemotherapy and to identify associated factors with special attention to postoperative complications.MethodsAll patients who received neoadjuvant chemotherapy and underwent an elective surgical resection for stage IB-IVa (M0) gastric adenocarcinoma between 2011 and 2015 were identified from a national database (Dutch Upper GI Cancer Audit). A multivariable linear mixed model was used to evaluate case-mix adjusted hospital variation and to identify factors associated with adjuvant therapy.ResultsOf all surgically treated gastric cancer patients who received neoadjuvant chemotherapy (n = 882), 68% received adjuvant chemo(radio)therapy. After adjusting for case-mix and random variation, a large hospital variation in the administration rates for adjuvant was observed (OR range 0.31-7.1). In multivariable analysis, weight loss, a poor health status and failure of neoadjuvant chemotherapy completion were strongly associated with an increased likelihood of adjuvant therapy omission. Patients with severe postoperative complications had a threefold increased likelihood of adjuvant therapy omission (OR 3.07 95% CI 2.04-4.65).ConclusionDespite national guidelines, considerable hospital variation was observed in the probability of receiving adjuvant chemo(radio)therapy. Postoperative complications were strongly associated with adjuvant chemo(radio)therapy omission, underlining the need to further reduce perioperative morbidity in gastric cancer surgery.Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

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