Long-Term Survivorship After Gastrectomy or Endoscopic Resection for Gastric Cancer Using Nationwide Real-World Data.

Abstract

Background: Nutritional deficiency and weight loss after gastrectomy are major challenges for gastric cancer survivorship, yet appropriate weight reduction may prevent chronic metabolic or cardiovascular diseases. This study evaluates long-term survivorship with chronic diseases in gastric cancer survivors who underwent gastrectomy vs endoscopic resection (ER) in the Korean population.

Methods: Korean National Health Insurance data of gastric cancer patients treated by gastrectomy or ER between 2002 and 2020 were matched 2:1 by age, gender, Charlson Comorbidity Index, insurance premium quartiles, and year of treatment. The 15-year survivorship with major adverse cardiovascular events (MACE) 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 (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 was lower in the gastrectomy group (HR 0.86, P<0.001). Average annual medical expenses for hypertension and diabetes within the first 10 years post-treatment were lower in the gastrectomy group ($90.3 ± 1.9 vs $118.4 ± 2.5, P<0.001).

Conclusion: 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.