Implementation of the recommendations of the II Brazilian Consensus On Gastric Cancer in clinical practice: a multicenter study of the Brazilian Gastric Cancer Association.

BACKGROUND

Gastric cancer (GC) remains a major global health problem. Despite a decline in its incidence, GC is still the third most lethal cancer worldwide.

BACKGROUND

Multimodal treatment approaches are employed, including chemotherapy (CMT), radiotherapy (RDT), surgery, expanded criteria for endoscopic resection, and increased use of minimally invasive surgery.

BACKGROUND

The development of clinical guidelines and consensus recommendations to update and guide healthcare professionals involved in GC treatment has gained increasing prominence.

BACKGROUND

Preoperative nutritional therapy, indication of D2 lymphadenectomy, and the use of minimally invasive surgery for distal EGC, was notably strong.

BACKGROUND

Greater attention is warranted regarding the broader implementation of diagnostic laparoscopy and ensuring the retrieval of an adequate number of lymph nodes during D2 lymphadenectomy to optimize staging and outcomes.

BACKGROUND

The development of consensus statements and clinical guidelines supports decision-making in clinical practice. However, recommendations formulated by experts may not always reflect real-world clinical practice. In this study, 21 key statements from the 2nd Brazilian Consensus on Gastric Cancer were evaluated across multiple cancer reference centers. It was found that, in 10 of these statements, current clinical practice diverged from the consensus recommendations.

BACKGROUND

Some consensus statements may be revised in future editions to better reflect the realities of clinical practice in the national context. To enhance adherence to the recommendations, broad dissemination of the study results is essential, alongside the implementation of educational initiatives and institutional policies aimed at promoting guideline compliance. These measures may contribute to closing the gap between consensus recommendations and everyday clinical practice, ultimately improving patient outcomes.

BACKGROUND

The management of gastric cancer has become increasingly complex, highlighting the importance of clinical guidelines to ensure standardized care. The Second Brazilian Consensus on Gastric Cancer was developed to guide clinical practice across the country.

AIMS

The aim of this study was to evaluate the degree of implementation of the 2nd Brazilian Consensus recommendations in cancer reference centers in Brazil.

METHODS

This multicenter study involved 18 cancer centers that prospectively collected data over a one-year period. Notably, 21 key statements from the Consensus were assessed. Adherence was defined as following the recommendation in more than 80% of applicable cases.

RESULTS

Of the 21 statements, 11 (52.4%) met the predefined adherence threshold. The selective use of endoscopic ultrasound and PET-CT was consistent with the recommendations. However, diagnostic laparoscopy was underutilized, performed in only 24.7% of patients. Preoperative nutritional therapy, another key recommendation, was provided in just 42% of cases. D2 lymphadenectomy was performed in 79.8% of surgeries, but only 63.3% of specimens included ≥25 lymph nodes, the recommended minimum for adequate staging. Minimally invasive surgery (MIS) was performed in approximately 25% of early distal tumors but was rarely used in advanced proximal tumors. Despite not being recommended for early stage tumors, omentectomy and bursectomy were still performed in a significant number of T1/T2 cases. Preoperative chemotherapy was used in 35.4% of distal tumors ≥IB and 54.3% of proximal tumors, showing partial adherence to this recommendation.

CONCLUSIONS

Just over half of the II Brazilian Consensus recommendations were implemented in routine practice. There was strong adherence to D2 lymphadenectomy and MIS for early distal tumors. However, there is still room for improvement in areas such as diagnostic laparoscopy, nutritional support, adequate lymph node retrieval, and using more neoadjuvant chemotherapy to enhance care and follow national guidelines.