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Long-term results after radical resection for gastric adenocarcinoma


Authors: F. Pazdírek 1;  J. Leffler 1;  L. Štěpánek 2;  D. Kostrouch 1;  J. Votava 1;  M. Šimša 3
Authors‘ workplace: Chirurgická klinika 2. LF UK a FN v Motole, Praha 1;  Fakulta biomedicínského inženýrství ČVUT v Praze 2;  Chirurgická klinika 1. LF UK a Thomayerova nemocnice, Praha 3
Published in: Gastroent Hepatol 2016; 70(5): 402-407
Category: Gastrointestinal Oncology: Original Article
doi: https://doi.org/10.14735/amgh2016402

Overview

Background:
Gastric cancer is a serious disease with a generally poor prognosis. Because systemic anticancer treatment is not sufficiently effective, only complete removal of the tumor gives patients a chance of a cure.

Aim:
The study evaluated the long-term treatment outcomes of patients after radical resections for gastric adenocarcinoma.

Methods:
The study group included 48 patients who had undergone radical gastrectomy for adenocarcinoma. The results of statistical analyses of prospectively collected data were evaluated for 30-day overall patient survival (OS) and disease free survival (DFS), and 90-day postoperative mortality and morbidity. Further, the study evaluated the relationship between survival of patients in different clinical stages and the extent of lymphadenectomy, adjuvant effect of cancer treatment on survival and DFS, and the potential impact of early postoperative complications on OS.

Results:
Twenty-one patients (43.8%) survived five years. Postoperative surgical complications occurred in 12.5% of patients and non-surgical complications occurred in 12.5% of patients. The extent of lymphadenectomy D1 vs. D2 did not affect survival of patients neither overall nor in individual stages of the disease (p = 0.189). Conversely, a significant difference in long-term survival was found in cases where the number of histologically negative nodes among the total number of examined lymph nodes was greater than 60% (p < 0.0001). The extent of gastric resection or postoperative complications in our cohort had no impact on OS (p = 0.625; p = 0.268). Adjuvant therapy did not extend the OS of patients but prolonged DFS (FUFA combination with radiotherapy; p < 0.033).

Conclusion:
Gastric adenocarcinoma remains a serious disease with a prognosis that depends mainly on the stage of disease at the time of diagnosis. In our group, we did not find a positive effect of D2 lymphadenectomy on OS. A statistically significant difference in long-term survival was found in cases where the number of histologically negative nodes among the total number of examined lymph nodes was greater than 60%. Adjuvant cancer treatment had no effect on OS but prolonged DFS.

Key words:
carcinoma – stomach – treatment – prognosis – survival

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
4. 8. 2016

Accepted:
18. 9. 2016


Sources

1. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010; 17 (12): 3077–3079. doi: 10.1245/s10434-010-1362-z.

2. Ono H, Kondo H, Gotoda T et al. Endoscopic mucosal resection for treatment of early gastric cancer. Gut 2001; 48 (2): 225–229.

3. Soetikno R, Kaltenbach T, Yeh R et al. Endoscopic mucosal resection for early cancers of the upper gastrointestinal tract. J Clin Oncol 2005; 23 (20): 4490–4498.

4. Tanaka M, Ono H, Hasuike N et al. Endoscopic submucosal dissection of early gastric cancer. Digestion 2008; 77 (Suppl 1): 23–28. doi: 10.1159/000111484.

5. Cheng Q, Pang TC, Hollands MJ et al. Systematic review and meta-analysis of laparoscopic versus open distal gastrectomy. J Gastrointest Surg 2014; 18 (6): 1087–1099. doi: 10.1007/s11605-014-2519-z.

6. Xiong JJ, Nunes QM, Huang W et al. Laparoscopic vs open total gastrectomy for gastric cancer: a meta-analysis. World J Gastroenterol 2013; 19 (44): 8114–8132. doi: 10.3748/wjg.v19.i44.8114.

7. Songun I, Putter H, Kranenbarg EM et al. Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol 2010; 11 (5): 439–449. doi: 10.1016/ S1470-2045 (10) 70070-X.

8. Šimša J, Smejkal P. Chirurgická léčba karcinomu žaludku. Rozhl Chir 2012; 91 (8): 446–448.

9. Orditura M, Galizia G, Sforza V et al. Treatment of gastric cancer. World J Gastroenterol 2014; 20 (7): 1635–1649. doi: 10.3748/wjg.v20.i7.1635.

10. Siewert JR, Böttcher K, Stein HJ et al. Relevant prognostic factor in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998; 228 (4): 449–461.

11. Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol 2007; 14 (2): 317–328.

12. McCulloch P, Nita ME, Kazi H et al. Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database Syst Rev 2012; 1: CD001964. doi: 10.1002/146 51858.CD001964.pub3.

13. Mocellin S, Nitti D. Lymphadenectomy extent and survival of patients with gastric carcinoma: a systematic review and meta-analysis of time-to-event data from randomized trials. Cancer Treat Rev 2015; 41 (5): 448–454. doi: 10.1016/j.ctrv.2015.03.003.

14. Yu W, Choi GS, Chung HY. Randomized clinical trial of splenectomy versus splenic preservation in patients with proximal gastric cancer. Br J Surg 2006; 93 (5): 559–563.

15. Bartlett EK, Rose RE, Kelz RR et al. Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database. Surgery 2014; 156 (2): 298–304. doi: 10.1016/j.surg.2014.03. 022.

16. Li QG, Li P, Tang D, Chen J et al. Impact of postoperative complications on long-term survival after radical resection for gastric cancer. World J Gastroenterol 2013; 19 (25): 4060–4065.

17. Liao Y, Yang ZL, Peng JS et al. Neoadjuvant chemotherapy for gastric cancor. a meta-analysis of randomized, controlled trials. J Gastroenterol Hepatol 2013; 28 (5): 777–782. doi: 10.1111/jgh.12152.

18. Macdonald JS, Smalley SR, Benedetti J et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001; 345 (10): 725–730.

19. Bang YE, Kim YW, Yang HK et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012; 379 (9813): 315–321. doi: 10.1016/S0140-6736 (11) 61 873-4.

20. Xu AM, Huang L, Liu W et al. Neoadjuvant chemotherapy followed by surgery versus surgery alone for gastric carcinoma: systematic review and meta-analysis of randomized controlled trials. Plos One 2014; 9 (1): e86941. doi: 10.1371/journal.pone.0086941.

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Paediatric gastroenterology Gastroenterology and hepatology Surgery

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