Annals of Surgical Oncology

, Volume 16, Issue 7, pp 1883–1889 | Cite as

Quality Indicators for Gastric Cancer Surgery: A Survey of Practicing Pathologists in Ontario

  • Alia P. Qureshi
  • C. Andrea Ottensmeyer
  • Alyson L. Mahar
  • Runjan Chetty
  • Aaron Pollett
  • Frances C. Wright
  • Natalie G. Coburn
Gastrointestinal Oncology



Adequate lymph node (LN) assessment and R0 resection are critical to the staging and management of gastric cancer. The American Joint Committee on Cancer/International Union Against Cancer recommend at least 15 LN be assessed, and the literature suggests a gross disease-free margin of 5–6 cm be achieved. Results of an Ontario general surgeons’ survey indicated these standards were not widely known. Because disease management is highly collaborative, we surveyed pathologists to assess their knowledge of LN assessment and margins for processing gastric cancer specimens.


Pathologists were identified by the College of Physicians and Surgeons of Ontario and MD Select databases. Participants were surveyed online or by mail.


Pathologists indicated a goal of assessing <5 LN (2%), 5–10 LN (27%), 10–15 LN (40%), 15–20 LN (20%), or >20 LN (11%). Most self-reported an actual assessment of 5–10 LN (49%), with 88% reporting a number below current standards. Additionally, 54% of responding pathologists identified >1 cm as an adequate gross margin, and 89% of pathologists indicated a response below current standards. Ninety-four percent of pathologists agreed that more education on gastric cancer is valuable.


To improve the quality of gastric cancer management, our findings suggest the need for clear, consistent guidelines for adequate gross margin resection length. Furthermore, there is a critical need for education aimed at closing the knowledge gap among practicing pathologists and surgeons regarding current recommended guidelines for LN assessment and adequate margin length.


Gastric Cancer Gastric Cancer Patient Advanced Gastric Cancer Negative Margin Freeze Section Analysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr. Coburn is supported by the Ministry of Health and Long Term Care Career Scientist Award. We would like to thanks Seana Rossi for her help with editing and formatting this manuscript.

Supplementary material

10434_2009_468_MOESM1_ESM.doc (59 kb)
(DOC 59 kb)


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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Alia P. Qureshi
    • 1
  • C. Andrea Ottensmeyer
    • 2
  • Alyson L. Mahar
    • 2
  • Runjan Chetty
    • 3
  • Aaron Pollett
    • 4
  • Frances C. Wright
    • 1
    • 5
  • Natalie G. Coburn
    • 1
    • 2
    • 5
  1. 1.Division of General SurgeryUniversity of TorontoTorontoCanada
  2. 2.Centre for Health Services SciencesSunnybrook Health Sciences CentreTorontoCanada
  3. 3.Department of PathologyUniversity Health NetworkTorontoCanada
  4. 4.Department of PathologyMount Sinai HospitalTorontoCanada
  5. 5.Division of Surgical OncologyOdette Cancer CentreTorontoCanada

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