[Contribution] What’s the appropriate time between diagnosis and surgery of stomach cancer?

One of the biggest issues in Korea these days is the conflict between the government and doctors over increasing the number of medical school students. Hit hardest in this process are cancer patients. When people are diagnosed with cancer, they become impatient and want to get treatment as soon as possible.

The real harm comes in the form of delays in surgery or chemotherapy and results in fear of progression or recurrence of the disease. So, what is a safe time between diagnosis and surgery, and should you just wait it out?

The answer to the question of how much time is appropriate between diagnosis and surgery for stomach cancer depends on many factors.

The most important factor is the stage of the disease at the time of diagnosis. Still, other factors, including the patient’s age, general condition, and underlying medical conditions, should also be considered. Another factor to consider is the medical team's and hospital's preparedness. If there are many surgeries, the wait can be long, or the hospital may not be in a good situation.

While it's impossible to take all of these factors into account, studies and recommendations on the appropriate time from diagnosis to surgery, represented by the Cancer Appropriateness Assessment, exist. The Gastric Cancer Appropriateness Assessment, offered by the Health Insurance Review and Assessment Service (HIRA), selects a set of indices to evaluate specific hospitals that treat stomach cancer and periodically grade their performances.

One metric commonly applied to stomach and colorectal cancer is the "percentage of patients who had surgery within 30 days of cancer diagnosis." The recommendation is to have surgery within a month of diagnosis.

So, will it be a problem if you have surgery more than a month after diagnosis?

The effects of delayed surgery are likely to be greater in advanced gastric cancer than in early gastric cancer. It usually takes two to three years for early stomach cancer to develop into advanced stomach cancer. So, patients shouldn't be afraid that their cancer will progress significantly if they wait two to three months after diagnosis.

On the contrary, they should focus on thoroughly examining themselves and choosing the best treatment for them. There are several treatments to choose from, including laparoscopic surgery, robotic surgery, and endoscopic resection.

It is known that badly differentiated cancers, such as seminoma and gastric cancer in younger patients, progress more quickly. Still, there is no need to rush into treatment if they have early-stage gastric cancer. The reason why badly differentiated cancers progress quickly is because they are usually highly staged at diagnosis.

In other words, it is thought to progress quickly because it is detected at a very advanced stage. So, if it is detected early, it is no different from a well-differentiated cancer.

However, in advanced gastric cancer, they should try to shorten the time to surgery as much as possible. In most cases, surgical treatment is necessary, and adjuvant anticancer therapy should be started as early as possible after surgery. In addition, the longer the time passes, the more likely it is that the cancer will progress and develop complications, including bleeding, obstruction, or perforation.

Still, precise staging, including distant metastases, is essential, so no test should be missed. Suppose the cancer is advanced and bleeding obstruction is present. In that case, it is important to realize that preoperative treatment, such as adequate nutritional therapy, is important in reducing the frequency of postoperative complications rather than immediate surgery.

If the patient is elderly or has multiple medical conditions, rushing into surgery can make it difficult to prepare for postoperative complications. For very elderly patients, cardiopulmonary function tests should be performed thoroughly, and related departments, such as cardiology and respiratory medicine, should be consulted to identify and deal with problems that may occur during or after surgery early.

As the number of elderly patients has increased in recent years, many have multiple underlying medical conditions, including diabetes, hypertension, and asthma. These conditions are not usually a problem, but they can become a problem after general anesthesia, so it is necessary to have a thorough examination and treatment before surgery.

Another consideration is the level of preparedness of the hospital and medical staff. At the Big Five hospitals, the waiting time for surgery is not uncommon for more than four weeks. Still, other hospitals, such as university hospitals and local hospitals, do not have long waiting times. There is no need to choose a large university hospital if the wait is too long.

If patients are diagnosed with stage 2 or 3 stomach cancer after surgery, they will need additional chemotherapy or adjuvant chemotherapy. It’s appropriate to start adjuvant therapy early after surgery. The Cancer Appropriateness Assessment recommends starting it within eight weeks, or two months, after surgery. It should be started as soon as possible after the patient has recovered from surgery and can eat.