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Annals of Surgery:
doi: 10.1097/SLA.0b013e318288dd2b
Original Articles

Optimal Management of Gastric Cancer: Results From an International RAND/UCLA Expert Panel

Coburn, Natalie MD, MPH*,‡,§,‖; Seevaratnam, Rajini MSc; Paszat, Lawrence MD, MSc‡,§; Helyer, Lucy MD, MSc; Law, Calvin MD, MPH*,‡,§,‖; Swallow, Carol MD, PhD*; Cardosa, Roberta RN, PhD; Mahar, Alyson MSc†,‖; Lourenco, Laercio Gomes MD**; Dixon, Matthew MD‖,††; Bekaii-Saab, Tanios MD‡‡; Chau, Ian MD§§; Church, Neal MD¶¶; Coit, Daniel MD‖‖; Crane, Christopher H. MD***; Earle, Craig MD, MSc§,†††; Mansfield, Paul MD‡‡‡; Marcon, Norman MD†††; Miner, Thomas MD§§§; Noh, Sung Hoon MD, PhD¶¶¶; Porter, Geoff MD, MSc; Posner, Mitchell C. MD‖‖‖; Prachand, Vivek MD‖‖‖; Sano, Takeshi MD****; van de Velde, Cornelis MD, PhD††††; Wong, Sandra MD‡‡‡‡; McLeod, Robin MD*

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Objective: Defining processes of care, which are appropriate and necessary for management of gastric cancer (GC), is an important step toward improving outcomes.

Methods: Using a RAND/UCLA Appropriateness Method, an international multidisciplinary expert panel created 22 statements reflecting optimal management. All statements were scored for appropriateness and necessity.

Results: The following tenets were scored appropriate and necessary: (1) preoperative staging by computed tomography of abdomen/pelvis; (2) positron-emission tomographic scans not routinely indicated; (3) consideration for adjuvant therapy; (4) further clinical trials; (5) multidisciplinary decision making; (6) sufficient support at hospitals; (7) assessment of 16 or more lymph nodes (LNs); (8) in metastatic disease, surgery only for palliation of major symptoms; (9) surgeons experienced in GC management; (10) and surgeons experienced in both GC management and advanced laparoscopic surgery for laparoscopic resection. The following were scored appropriate, but of indeterminate necessity: (1) diagnostic laparoscopy before treatment; (2) a multidisciplinary approach to linitis plastica; (3) genetic assessment for diffuse GC and family history, or age less than 45 years; (4) endoscopic removal of select T1aN0 lesions; (5) D2 LN dissection in curative intent cases; (6) D1 LN dissection for early GC or patients with comorbidities; (7) frozen section analysis of margins; (8) nonemergent cases performed in a hospital with a volume of more than 15 resections per year; and (9) by a surgeon with more than 6 resection per year.

Conclusions: The expert panel has created 22 statements for the perioperative management of GC patients, to provide guidance to clinicians and improve the care received by patients.

© 2014 by Lippincott Williams & Wilkins.


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