Should Gastric Cancer Surgery be Performed in Community Hospitals?

Once the most common solid tumor malignancy in the United States, stomach cancer now ranks about 14th in incidence, with approximately 21,860 cases of adenocarcinoma of the stomach diagnosed annually. Gastrectomy for cancer is thus an infrequent operation, and indeed, the number of surgical residents completing 5-year training programs with an adequate number of gastrectomies is steadily shrinking. As time passes and experience with gastric surgery continues to diminish, questions concerning who and where gastric cancer surgery should be performed become increasingly relevant. For patients in major metropolitan areas, locating a high-volume hospital or surgeon is usually not an issue, but for a large portion of the country this may represent a major burden. Moreover, adding this additional volume of patients to an already overburdened system of a busy hospital may not be practical. A significant number of Americans continue to receive their care in low-volume hospitals. The majority of Americans receive their medical care locally and would much prefer a solution that would improve the medical care in their own back yard without altering their support system.