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

Abstract

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. 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. 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). 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.