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TANIGUCHI KIYOAKI, OTA MASAHO, YAMADA TAKUJI, SERIZAWA AKIKO, KOTAKE SHO, ITO SHUNICHI, SUZUKI KAZUOMI, YAMAMOTO MASALAZU. Tumor Depth Prediction of Gastric Cancer With a T4 Score. CANCER DIAGNOSIS & PROGNOSIS 2022; 2:641-647. [PMID: 36340460 PMCID: PMC9628156 DOI: 10.21873/cdp.10154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIM Peritoneal metastases are often found at surgery of pT4 gastric cancers, preventing R0 resection. In the event of successful R0 resection, distant metastases still occur in a sizeable proportion of patients. Estimation of the depth of invasion has a relatively low accuracy (57%-86%) compared with pathological findings. This study sought to develop a clinical score to distinguish between pathological stage T4 (pT4) and pT1-3 gastric cancer. PATIENTS AND METHODS Reviewing the data of 2,771 patients who had undergone gastrectomy at our hospital from January 1996-December 2016, we assessed demographic factors plus tumor markers, diameter, location, histology, and macroscopic type according to the fifth edition (2019) of the WHO classification. Significant factors on multivariate analysis were used to develop a pT4 gastric cancer depth prediction score (T4 score). RESULTS Multivariate analysis revealed that the clinical factors associated with pT4 disease were CA19-9 elevation, tumor diameter ≥50 mm, poorly cohesive type adenocarcinoma, mucinous adenocarcinoma, and WHO macroscopic types 2-4. The T4 score was obtained by weighing these factors according to the β-coefficient. The optimum cutoff value of the T4 score was 4 points. A total of 79.4% of cases with a T4 score ≥4 points were stage pT4. A total of 93.9% of cases with a T4 score <4 points were stage pT1-3, with 91.1% sensitivity, 85.3% specificity, 79.4% positive predictive value, and 93.9% negative predictive value. CONCLUSION T4 scoring can differentiate pT4 gastric cancer from pT1-3 gastric cancer.
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The prognostic role of tumor size in stage T1 gastric cancer. World J Surg Oncol 2022; 20:135. [PMID: 35477526 PMCID: PMC9044763 DOI: 10.1186/s12957-022-02596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose was to assess the contribution of tumor size to the prognosis of patients with gastric cancer. METHODS Patient data were sourced from the Surveillance, Epidemiology, and End Results program (SEER) database. Cox proportional risk regression was performed to determine the prognostic role of tumor size. Kaplan-Meier curves were conducted to calculate survival curves. Consistency index (c-index) and subject exercise curve (ROC) were utilized to assess the predictive ability of each factor on the prognosis of gastric cancer. RESULTS Tumor size is preferable to other widely accepted prognostic clinical features in forecasting the survival of patients with gastric cancer. CONCLUSIONS The discriminatory ability of tumor size at T1 stage is superior to many other clinical prognostic factors.
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Kinami S, Nakamura N, Tomita Y, Miyata T, Fujita H, Ueda N, Kosaka T. Precision surgical approach with lymph-node dissection in early gastric cancer. World J Gastroenterol 2019; 25:1640-1652. [PMID: 31011251 PMCID: PMC6465935 DOI: 10.3748/wjg.v25.i14.1640] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/09/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
The gravest prognostic factor in early gastric cancer is lymph-node metastasis, with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinic-pathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy, functional symptoms may still result. Physicians must strive to minimize post-gastrectomy symptoms and optimize long-term quality of life after this operation. Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients. Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.
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Affiliation(s)
- Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Naohiko Nakamura
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Yasuto Tomita
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Takashi Miyata
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Hideto Fujita
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Nobuhiko Ueda
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Takeo Kosaka
- Department of Surgical Oncology, Kanazawa Medical University, Ishikawa 920-0293, Japan
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Taniguchi K, Ota M, Yamada T, Serizawa A, Noguchi T, Amano K, Kotake S, Ito S, Ikari N, Omori A, Yamamoto M. Staging of gastric cancer with the Clinical Stage Prediction score. World J Surg Oncol 2019; 17:47. [PMID: 30849974 PMCID: PMC6408856 DOI: 10.1186/s12957-019-1589-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/28/2019] [Indexed: 12/13/2022] Open
Abstract
Background Chemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer. Accordingly, it is important to distinguish between stage III/IV and stage I/II gastric cancer, but clinical staging is less accurate than pathological staging. This study was performed to develop a clinical score that could distinguish stage III/IV gastric cancer from stage I/II gastric cancer. Methods We reviewed 2722 patients who underwent gastrectomy at our hospital from January 1996 to December 2015. As pretreatment factors potentially related to tumor stage, we assessed age, sex, tumor markers, tumor diameter, tumor location, tumor histology, and macroscopic type. Factors showing significance on multivariate analysis were used to develop the Clinical Stage Prediction score (CSP score), and a cutoff value for the score was determined by receiver operating characteristics analysis. Results According to multivariate analysis, clinical factors associated with stage III/IV disease were elevation of the carcinoembryonic antigen level, tumor diameter ≥ 60 mm, circumferential gastric involvement, esophageal infiltration, mucinous adenocarcinoma, and macroscopic types 2–4. The CSP score was obtained by weighting these factors according to the non-standardized β-coefficient. Receiver operating characteristics analysis indicated that the optimum cutoff value of the CSP score was 17 points. Among 1042 patients with a CSP score ≥ 17 points, 820 patients (78.7%) had stage III/IV gastric cancer. Conversely, among 1680 patients with a CSP score < 17 points, 1547 patients (92.1%) had stage I/II gastric cancer. When discrimination of stage III/IV gastric cancer from stage I/II gastric cancer by the CSP score was assessed, the sensitivity was 78.7%, specificity was 92.1%, positive predictive value was 86.0%, and negative predictive value was 87.5%. Conclusions The CSP score can be helpful for differentiating stage III/IV gastric cancer from stage I/II gastric cancer based on pretreatment clinical factors.
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Affiliation(s)
- Kiyoaki Taniguchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Masaho Ota
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takuji Yamada
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akiko Serizawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takeharu Noguchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kunihiko Amano
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Sho Kotake
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shunichi Ito
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Naoki Ikari
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Akiko Omori
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Marano L, Petrillo M, Pezzella M, Patriti A, Braccio B, Esposito G, Grassia M, Romano A, Torelli F, De Luca R, Fabozzi A, Falco G, Di Martino N. Applicability of the Proposed Japanese Model for the Classification of Gastric Cancer Location: The "PROTRADIST" Retrospective Study. J INVEST SURG 2016; 30:210-216. [PMID: 27690693 DOI: 10.1080/08941939.2016.1230248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The extension of lymphadenectomy for surgical treatment of gastric cancer remains discordant among European and Japanese surgeons. Kinami et al. (Kinami S, Fujimura T, Ojima E, et al. PTD classification: proposal for a new classification of gastric cancer location based on physiological lymphatic flow. Int. J. Clin. Oncol. 2008;13:320-329) proposed a new experimental classification, the "Proximal zone, Transitional zone, Distal zone" (PTD) classification, based on the physiological lymphatic flow of gastric cancer site. The aim of the present retrospective study is to assess the applicability of PTD Japanese model in gastric cancer patients of our Western surgical department. METHODS Two groups of patients with histologically documented adenocarcinoma of the stomach were retrospectively obtained: In the first group were categorized 89 patients with T1a-T1b tumor invasion; and in the second group were 157 patients with T2-T3 category. The data collected were then categorized according to the PTD classification. RESULTS In the T1a-T1b group there were no lymph node metastases within the r-GA or r-GEA compartments for tumors located in the P portion, and similarly there were no lymphatic metastases within the l-GEA or p-GA compartments for tumors located in the D portion. On the contrary, in the T2-T3 group the lymph node metastases presented a diffused spreading with no statistical significance between the two classification models. CONCLUSIONS Our results show that the PTD classification based on physiological lymphatic flow of the gastric cancer site is a more physiological and clinical version than the Upper, Medium And Lower classification. It represents a valuable and applicable model of cancer location that could be a guide to a tailored surgical approach in Italian patients with neoplasm confined to submucosa. Nevertheless, in order to confirm our findings, larger and prospective studies are needed.
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Affiliation(s)
- Luigi Marano
- a Division of Multidisciplinary Robotic Surgery , Department of Surgery , "San Matteo degli Infermi" Hospital - ASL Umbria 2 , Via Loreto 3, Spoleto (PG) , Italy
| | - Marianna Petrillo
- b 8th General and Gastrointestinal Surgery - Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine , Second University of Naples , Piazza Miraglia 2, Naples , Italy
| | - Modestino Pezzella
- b 8th General and Gastrointestinal Surgery - Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine , Second University of Naples , Piazza Miraglia 2, Naples , Italy
| | - Alberto Patriti
- a Division of Multidisciplinary Robotic Surgery , Department of Surgery , "San Matteo degli Infermi" Hospital - ASL Umbria 2 , Via Loreto 3, Spoleto (PG) , Italy
| | - Bartolomeo Braccio
- b 8th General and Gastrointestinal Surgery - Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine , Second University of Naples , Piazza Miraglia 2, Naples , Italy
| | - Giuseppe Esposito
- b 8th General and Gastrointestinal Surgery - Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine , Second University of Naples , Piazza Miraglia 2, Naples , Italy
| | - Michele Grassia
- b 8th General and Gastrointestinal Surgery - Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine , Second University of Naples , Piazza Miraglia 2, Naples , Italy
| | - Angela Romano
- b 8th General and Gastrointestinal Surgery - Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine , Second University of Naples , Piazza Miraglia 2, Naples , Italy
| | - Francesco Torelli
- b 8th General and Gastrointestinal Surgery - Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine , Second University of Naples , Piazza Miraglia 2, Naples , Italy
| | - Raffaele De Luca
- c Department of Surgical Oncology , National Cancer Research Centre, Istituto Tumori "G. Paolo II ," Bari , Italy
| | - Alessio Fabozzi
- d Department of Clinical Pathology , Fatebenefratelli Hospital , Benevento , Italy
| | - Giuseppe Falco
- e Breast Surgery Unit , IRCCS-Arcispedale Santa Maria Nuova , Viale Risorgimento 80, Reggio Emilia , Italy
| | - Natale Di Martino
- b 8th General and Gastrointestinal Surgery - Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine , Second University of Naples , Piazza Miraglia 2, Naples , Italy
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Nomura E, Okajima K. Function-preserving gastrectomy for gastric cancer in Japan. World J Gastroenterol 2016; 22:5888-5895. [PMID: 27468183 PMCID: PMC4948261 DOI: 10.3748/wjg.v22.i26.5888] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/30/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy if curability of the gastric cancer can still be achieved. However, if we preserve a wider residual stomach in function-preserving gastrectomy, we should pay attention to the development of metachronous gastric cancer.
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Jagric T, Gorenjak M, Goropevsek A. Could the immune response in the sentinel lymph nodes of gastric cancer patients be the key to tailored surgery? Surgery 2016; 160:613-22. [PMID: 27233636 DOI: 10.1016/j.surg.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/27/2016] [Accepted: 04/08/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Precise detection of downstream, nonsentinel lymph node metastases is the key to implementation of the sentinel lymph node concept in gastric cancer. To overcome the problem of complex lymphatic drainage, micrometastases, and skip metastases, we investigated the feasibility of tumor cell detection in sentinel lymph nodes, using flow cytometry as well as studied immune suppression in the sentinel lymph node as a potential marker of downstream lymph node metastases. METHODS In 21 patients with gastric cancer, the sentinel lymph nodes extracted during operation subjected to frozen sections and flow cytometry. The tumor cells were defined with the cell surface markers CEACAM and EpCAM. Simultaneously, the cell densities of different subsets of T cells were determined. RESULTS The sensitivity and specificity of the determination of nodal status with flow cytometry for tumor cell detection was 100% and 63%, respectively, as seen in frozen sections. Correlations with nonsentinel lymph node metastases were seen for CD127(low)CD25(high) and CD45(neg)CD127(low)CD25(high) cell densities, relative proportion of CD45RA(neg)CD127(low)CD25(high) cells, frozen sections results, lymphangial invasion, and tumor size (P ≤ .043 each). Multivariate analysis identified the relative proportions of CD45RA(neg)CD127(low)CD25(high) cells as the only significant predictor for downstream nonsentinel lymph node metastases (P = .028; 95% confidence interval, 1.107-5.780). The predictive value of combined detection of flow cytometry tumor cells and the relative proportion of CD45RA(neg)CD127(low)CD25(high) cells for nodal stage determination was 91%. CONCLUSION Combined detection of tumor cells and CD45RA(neg)CD127(low)CD25(high) cells in sentinel lymph nodes with flow cytometry predicts accurately nonsentinel lymph node metastases.
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Affiliation(s)
- Tomaz Jagric
- Department of Abdominal and General Surgery, University Clinical Centre Maribor, Maribor, Slovenia.
| | - M Gorenjak
- Department for Laboratory Diagnostics, University Clinical Centre Maribor, Maribor, Slovenia
| | - A Goropevsek
- Department for Laboratory Diagnostics, University Clinical Centre Maribor, Maribor, Slovenia
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Jagric T, Potrc S, Mis K, Plankl M, Mars T. CA19-9 serum levels predict micrometastases in patients with gastric cancer. Radiol Oncol 2016; 50:204-11. [PMID: 27247553 PMCID: PMC4852963 DOI: 10.1515/raon-2015-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 05/09/2015] [Indexed: 12/12/2022] Open
Abstract
Background We explored the prognostic value of the up-regulated carbohydrate antigen (CA19-9) in node-negative patients with gastric cancer as a surrogate marker for micrometastases. Patients and methods Micrometastases were determined using reverse transcription quantitative polymerase chain reaction (RT-qPCR) for a subgroup of 30 node-negative patients. This group was used to determine the cut-off for preoperative CA19-9 serum levels as a surrogate marker for micrometastases. Then 187 node-negative T1 to T4 patients were selected to validate the predictive value of this CA19-9 threshold. Results Patients with micrometastases had significantly higher preoperative CA19-9 serum levels compared to patients without micrometastases (p = 0.046). CA19-9 serum levels were significantly correlated with tumour site, tumour diameter, and perineural invasion. Although not reaching significance, subgroup analysis showed better five-year survival rates for patients with CA19-9 serum levels below the threshold, compared to patients with CA19-9 serum levels above the cut-off. The cumulative survival for T2 to T4 node-negative patients was significantly better with CA19-9 serum levels below the cut-off (p = 0.04). Conclusions Preoperative CA19-9 serum levels can be used to predict higher risk for haematogenous spread and micrometastases in node-negative patients. However, CA19-9 serum levels lack the necessary sensitivity and specificity to reliably predict micrometastases.
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Affiliation(s)
- Tomaz Jagric
- Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Sloveni
| | - Stojan Potrc
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Katarina Mis
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Plankl
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tomaz Mars
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Robot-assisted gastrectomy for early gastric cancer: is it beneficial in viscerally obese patients compared to laparoscopic gastrectomy? World J Surg 2016; 39:1789-97. [PMID: 25670040 DOI: 10.1007/s00268-015-2998-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The adoption of robotic systems for gastric cancer surgery has been proven feasible and safe; however, a benefit over the laparoscopic approach has not yet been well-documented. We aimed to investigate the surgical outcomes of robotic versus laparoscopic gastrectomy for gastric cancer, according to the extent of surgery and patients' obesity status. METHODS Between January 2009 and July 2011, 770 patients were enrolled in this retrospective analysis. All had stage IA/IB gastric cancer preoperatively and underwent either laparoscopic (n = 622) or robotic (n = 148) gastrectomy. Patients were classified into obese and non-obese groups on the basis of visceral fat area (VFA). The extent of surgery was defined by whether patients underwent distal or total gastrectomy. RESULTS The surgical outcomes following distal gastrectomy were similar between the robotic and laparoscopic groups regardless of the obesity status. After total gastrectomy, the number of total and N2-area lymph nodes were significantly higher in the robotic group than in the laparoscopic group in non-obese patients with VFA < 100 cm(2) (total, 38.8 vs. 46.5; p = 0.018; N2 area, 9.0 vs. 12.4; p = 0.041), but no significant differences were observed in obese population. Robotic group developed less severe complications after total gastrectomy compared to laparoscopic group in non-obese patients (p = 0.036). CONCLUSION Robotic assistance did not improve surgical outcomes over the laparoscopic approach in obese patients undergoing distal gastrectomy. However, non-obese patients with low VFA may benefit from robotic assistance during total gastrectomy in terms of radical D2 lymphadenectomy with fewer serious complications.
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Kong F, Qi Y, Liu H, Gao F, Yang P, Li Y, Jia Y. Surgery combined with chemotherapy for recurrent gastric cancer achieves better long-term prognosis. Clin Transl Oncol 2015; 17:917-24. [PMID: 26088414 DOI: 10.1007/s12094-015-1327-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/09/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUNDS Recurrence is the most important factor associated with death of gastric cancer patients after surgery. The aim of this study was to explore the prognosis factors and the effective therapy for recurrent gastric cancer (RGC) patients after radical resection. METHODS The clinical data of 144 RGC patients who underwent radical resection from January 1999 to March 2004 were reviewed. The 15 clinicopathological factors and treatment modalities on the survival were analyzed. Univariate and multivariate analyses were performed to investigate the prognostic significance of these factors for RGC. RESULTS The early recurrence (<2 years) was found in 90 patients, while late recurrence (≥2 years) occurred in 54 patients. The 2-year cumulative survival rates were 23.8 % for recurrent patients receiving chemotherapy plus surgery vs. 1.2 % in patients having chemotherapy only (p < 0.001), while the median survival time was 11.0 months vs. 6.0 months (p < 0.001). Multivariate analysis indicated TNM stage after the first operation (p = 0.048), iASPP overexpression (p = 0.013), time to recurrence (p < 0.001) and treatment of recurrence (p < 0.001) as independent prognostic factors. CONCLUSIONS Surgery combined with chemotherapy for recurrent gastric cancer patients achieves ideal long-term prognosis, which should perform actively.
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Affiliation(s)
- F Kong
- Department of Oncology, First Teaching Hospital of Tianjin University of TCM, Anshanxi Road, Nankai District, Tianjin, 300193, China.
| | - Y Qi
- Department of Hematology, Tianjin First Center Hospital, Fukang Road, Tianjin, 300192, China
| | - H Liu
- Department of Oncology, First Teaching Hospital of Tianjin University of TCM, Anshanxi Road, Nankai District, Tianjin, 300193, China
| | - F Gao
- Department of Pediatrics, Tianjin Medical University General Hospital, Anshan Road, Tianjin, 300052, China
| | - P Yang
- Department of Oncology, First Teaching Hospital of Tianjin University of TCM, Anshanxi Road, Nankai District, Tianjin, 300193, China
| | - Y Li
- Department of Hematology, Tianjin First Center Hospital, Fukang Road, Tianjin, 300192, China.
| | - Y Jia
- Department of Oncology, First Teaching Hospital of Tianjin University of TCM, Anshanxi Road, Nankai District, Tianjin, 300193, China.
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Investigation of the recurrence patterns of gastric cancer following a curative resection. Surg Today 2011; 41:210-5. [PMID: 21264756 DOI: 10.1007/s00595-009-4251-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 11/05/2009] [Indexed: 12/11/2022]
Abstract
PURPOSE The goal of this study was to investigate the recurrence patterns of gastric cancer and determine the predictive information of recurrence patterns of gastric cancer following a curative resection. METHODS This study retrospectively analyzed the data of 308 gastric cancer patients who underwent a curative resection, to identify the factors associated with the recurrence patterns. RESULTS One hundred and sixty-nine gastric cancer patients had recurrence following curative resection. One hundred and twenty-six patients were observed for 3 years after the operation. Locoregional recurrence formed part of the recurrence pattern in 107 patients, peritoneal dissemination was observed in 98 patients, and distant metastasis occurred in 22 patients. A multivariate analysis revealed that locoregional recurrence was only associated with the Lauren classification (P = 0.003); peritoneal dissemination was only associated with N stage (P < 0.001); and distant metastasis was only associated with the Lauren classification (P = 0.016). CONCLUSIONS Locoregional recurrence, peritoneal dissemination, and distant metastasis were the most common recurrence patterns of gastric cancer following a curative resection. Each recurrence pattern is associated with specific clinicopathological factors.
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Survival of patients treated by an autonomic nerve-preserving gastrectomy for early gastric cancer. Surg Today 2010; 40:444-50. [DOI: 10.1007/s00595-009-4067-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 06/30/2009] [Indexed: 10/19/2022]
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Hondo FY, Maluf-Filho F, Kishi HS, Uemura RS, Okawa L, Cecconello I, Sakai P. Predictive factors for local recurrence and incomplete resection of early gastric cancer treated by endoscopic resection: a Western experience. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:357-63. [PMID: 19440567 PMCID: PMC2706749 DOI: 10.1155/2009/986495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 10/05/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early gastric cancer (EGC) is defined as adenocarcinoma limited to the mucosa or submucosa regardless of lymph node involvement. Local EGC recurrence rates have been described in up to 6% of cases. OBJECTIVES To evaluate predictive factors for incomplete resection and local recurrence of EGC treated by endoscopic mucosal resection (EMR) that was followed up for at least one year. METHODS From June 1994 to December 2005, 46 patients with EGC underwent EMR. Possible predictive factors for incomplete endoscopic resection and local recurrence were identified by medical chart analysis. Demographic, endoscopic and histopathological data were retrospectively evaluated. EMR was considered complete or incomplete. Patients from the complete resection group were divided into subgroups (with and without local EGC recurrence). RESULTS Complete resection was possible in 36 cases (76.6%). Predictive factors for incomplete resection were tumour location (P=0.035), histological type (P=0.021), lesion size (P=0.022) and number of resected fragments (P=0.013). On multivariate analysis, undifferentiated histological type (OR 0.8; 95% CI 0.036 to 0.897) and number of resected fragments (OR 7.34; 95% CI 1.266 to 42.629) were independent predictive factors for incomplete resection. In the complete resection group, a larger lesion size was associated with a higher the number of resected fragments (P=0.018). Local recurrence occurred in nine cases (25%). Use of the cap technique was the only predictive factor for local recurrence in five of seven cases (71.4%) (P=0.006). CONCLUSIONS A larger lesion size was associated with a higher number of resected fragments. Undifferentiated adenocarcinoma and piecemeal resection were predictive factors for incomplete resection. Technique type was a predictive factor for local EGC recurrence.
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Affiliation(s)
- Fábio Y Hondo
- Gastrointestinal Endoscopy Unit, Sao Paulo University Medical School, Sao Paulo, Brazil.
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14
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Prognosis of gastric cancer patients with node-negative metastasis following curative resection: outcomes of the survival and recurrence. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 22:835-9. [PMID: 18925308 DOI: 10.1155/2008/761821] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND The purpose of the present study was to provide valuable prognostic information on lymph node-negative gastric cancer patients following curative resection. METHODS Data from 112 lymph node-negative gastric cancer patients who underwent curative resection were reviewed to identify the independent factors of overall survival and recurrence. RESULTS The five-year survival rate of lymph node-negative gastric cancer patients was 85.7%, and recurrence was identified in 25 patients after curative surgery. The five-year survival rate of lymph node-negative gastric cancer patients was higher than that of lymph node-positive gastric cancer patients (P<0.001). Recurrence in lymph node-negative gastric cancer patients was less than that of lymph node-positive gastric cancer patients (P=0.001). The median survival after recurrence of lymph node-negative gastric cancer patients was longer than that of lymph node-positive gastric cancer patients (P=0.021). Using multivariate analyses, the following results were determined for lymph node-negative gastric cancer patients: sex, operative type and the presence of serosal involvement were independent factors of overall survival; and lymphadenectomy, number of dissected nodes and the presence of serosal involvement were independent factors of recurrence. CONCLUSIONS The prognosis of lymph node-negative gastric cancer patients was better than that of lymph node-positive gastric cancer patients. Male sex, subtotal gastrectomy and nonserosal involvement should be considered to be the favourable predictors of postoperative long-term survival of lymph node-negative gastric cancer patients. Conversely, limited lymphadenectomy, few dissected nodes and serosal involvement should be considered to be risk factors of postoperative recurrence of lymph node-negative gastric cancer patients.
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15
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16
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Kinami S, Fujimura T, Ojima E, Fushida S, Ojima T, Funaki H, Fujita H, Takamura H, Ninomiya I, Nishimura G, Kayahara M, Ohta T, Yoh Z. PTD classification: proposal for a new classification of gastric cancer location based on physiological lymphatic flow. Int J Clin Oncol 2008; 13:320-9. [PMID: 18704632 DOI: 10.1007/s10147-007-0755-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 12/17/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND We propose a new classification for the location of gastric cancer - the PTD classification (i.e., zones P, T, and D; see below), with the zones classified according to the physiological lymphatic flow. METHODS Three hundred and thirty-six patients with T1 or small T2 gastric cancer who underwent sentinel node mapping at our hospital were enrolled. The relationship between the location of the gastric cancer and the physiological lymphatic flow derived from sentinel node mapping was investigated. Lymphatic basins were defined as lymphatic zones divided by the stream of stained lymphatic canals. RESULTS One hundred and forty-six patients underwent standard gastrectomy with more than D2 dissection and the other 190 patients underwent function-preserving gastrectomy with the omission of lymph node dissection outside the lymphatic basin. In the former group, the progression pattern of lymph node metastasis was observed; nodal metastasis occurred in sentinel nodes first, and rarely extended outside the lymphatic basin. In the latter group, none of the patients have had a recurrence. The PTD classification we propose is as follows: the dividing line between the proximal region (zone P) and the transitional region (zone T) is the line that links the point of the watershed between the left gastroepiploic artery and right gastroepiploic artery, to the point that is the inflow point of the first descending branch of the left gastric artery; and the dividing line between zone T and the distal region (zone D) is an arc at a radius of 8 cm from the pylorus. There were no lymphatic basins within the right gastric artery area for tumors located in zone T. CONCLUSION The advantage of the PTD classification is that if the PTD classification were to be used as a guide for gastric resection procedures, preservation of the pylorus would become possible without diminishing the prognosis in patients with cT1N0 cancer located in zone T.
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Affiliation(s)
- Shinichi Kinami
- Department of Gastroenterologic Surgery, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa, Japan.
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17
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Fujiwara M, Kodera Y, Misawa K, Kinoshita M, Kinoshita T, Miura S, Ohashi N, Nakayama G, Koike M, Nakao A. Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery. J Am Coll Surg 2007; 206:138-43. [PMID: 18155579 DOI: 10.1016/j.jamcollsurg.2007.07.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 06/18/2007] [Accepted: 07/11/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopy-assisted approaches have become popular for dissecting early-stage gastric cancer in Japan, but the outcomes after 5 years of followup have not been reported. STUDY DESIGN Between January 1998 and March 2002, 94 patients with histologically proved early-stage gastric carcinoma participated in clinical studies and underwent gastrectomy with regional lymphadenectomy to evaluate feasibility and safety of the laparoscopy-assisted approach. Outcomes and pattern of disease failure during followup up to 5 years were evaluated in all patients. Multivariable analysis was performed to identify relevant prognostic factors. RESULTS Conversion to open procedures occurred in three patients. Median blood loss was 90 mL (interquartile range, 160 mL), and duration of operation was 230 minutes (interquartile range, 60 minutes). Operative morbidity and mortality were 22.3% and 0%, respectively. Nine patients died during the course of followup, for an overall 5-year survival rate of 90%. Two patients died of recurrent disease, and 2 other patients have been diagnosed with recurrences, for a 5-year recurrence-free survival of 95.6%. Three patients with recurrent cancer, including 1 with port-site recurrence, had stage IA disease (pT1pN0) at operation. Diabetes mellitus as a comorbidity was prominent as a prognostic factor. CONCLUSIONS Outcomes of patients with a preoperative diagnosis of early-stage cancer were excellent when treated with a laparoscopy-assisted approach, although rare patterns of disease failure were observed.
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Affiliation(s)
- Michitaka Fujiwara
- Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Japan
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18
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Campoli PMDO, Ejima FH, Cardoso DMM, Mota ED, Fraga Jr. AC, Mota OMD. Endoscopic mucosal resection of early gastric cancer: initial experience with two technical variants. ARQUIVOS DE GASTROENTEROLOGIA 2007; 44:250-6. [DOI: 10.1590/s0004-28032007000300014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 03/02/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND: When performed in carefully selected cases, the endoscopic treatment of early gastric cancer yields results which are comparable to the conventional surgical treatment, but with lower morbidity and mortality and better quality of life. Several technical options to perform endoscopic mucosal resection have been described and there is a large amount of accumulated experience with this procedure in eastern countries. In western countries, particularly in Brazil, technical limitations associated with the small number of cases of early gastric cancer reflect the little experience with this therapeutic mode. AIM: This study was carried out in order to assess the indications, pathological results and morbidity of a series of endoscopic mucosal resections using two technical variants in addition to investigating the safety and feasibility of the method. METHODS: Individuals with well-differentiated early gastric adenocarcinomas with up to 30 mm in diameter without scar or ulcer underwent endoscopic treatment. Two variants of the strip biopsy technique were used. The pathological study assessed the depth of the vertical invasion, lateral and basal margins as well as angio-lymphatic invasion. RESULTS: Thirteen tumors in 12 patients were resected between June 2002 and August 2005. The most common macroscopic types were IIa and IIa + IIc. Tumor size ranged from 10 to 30 mm (mean = 16.5 mm). En bloc resection was carried out in nine patients. Angio-lymphatic invasion was not observed; however, submucosal invasion was found in two cases. In four cases, the lateral margin was involved. Perforation occurred in two patients who then received conservative treatment. CONCLUSION: The relatively small series presented here suggests that the method is safe and feasible. Appropriate patient selection is the most important criteria. Long follow-up is required after treatment due to the risk of relapse.
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Choi WH, Kim S, Shen J, Cheong JH, Hyung WJ, Kim YI, Choi SH, Noh SH, Park CI. Prognostic significance of perinodal extension in gastric cancer. J Surg Oncol 2007; 95:540-5. [PMID: 17252555 DOI: 10.1002/jso.20734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The grouping of patients who have a poor prognosis is important in determining a treatment strategy. The aim of this study was to investigate the clinicopathologic features and prognosis in patients with perinodal extension, with a focus on the difference of survival between homogenous groups. METHODS This study included a total of 1,092 patients who underwent curative gastrectomy for gastric adenocarcinoma from 1997 to 2004 at the Department of Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine. RESULTS One hundred sixty-one patients had perinodal extension. The incidence of perinodal extension was positively correlated for T and N stages. Perinodal extension was identified as an independent prognostic factor and had more influence on survival than T and N stages. Patients who had nodal metastasis without serosal exposure and who had serosal exposure without nodal metastasis were selected as homogenous groups, and there was no difference of survival between these groups. However, when the nodal metastasis group was subdivided according to the perinodal extension, perinodal extension subgroup had significant poorer prognosis than no perinodal extension subgroup. CONCLUSIONS The perinodal extension was the most important independent prognostic factor in gastric cancer, and should be included in the TNM gastric cancer staging system.
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Affiliation(s)
- Won Hyuk Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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20
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Kopp R, Diebold J, Dreier I, Cramer C, Glas J, Baretton G, Jauch KW. Prognostic relevance of p53 and bcl-2 immunoreactivity for early invasive pT1/pT2 gastric carcinomas: indicators for limited gastric resections? Surg Endosc 2005; 19:1507-12. [PMID: 16177872 DOI: 10.1007/s00464-005-0043-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Accepted: 04/24/2005] [Indexed: 01/28/2023]
Abstract
BACKGROUND Laparoscopic or endoscopic limited resection is intended to be an additional therapeutic option for the treatment of early gastric cancer. However, tumorbiologic markers to predict the outcome for patients after limited resections are missing. This study therefore investigated the prognostic relevance of p53 and bcl-2 immunoreactivity as well as the percentage of apoptotic tumor cells in early invasive pT1/pT2 tumors managed with standard operations for gastric adenocarcinoma. METHODS Histologic slides of 65 pT1/pT2 gastric carcinomas were investigated for bcl-2 and p53 immunoreactivity. For 35 patients, DNA fragmentation of tumor cell nuclei was determined by the terminal uridine 5'-triphosphate (UTP) nick end-labeling (TUNEL) method. Follow-up evaluation of the patients was prospectively documented for 53.4 +/- 4.1 months. RESULTS Findings showed that bcl-2 immunoreactivity was associated with tumors of the intestinal type according to Lauren s classification (p = 0.042), and that p53 immunoreactivity was increased in more invasive tumors (pT1 vs pT2 tumors; p = 0.047). Mean survival time was significantly longer for patients with bcl-2-negative tumors (74.3 +/- 6.8 months) than for patients with bcl-2-positive tumors (50.8 +/- 7.6 months; p = 0.024). The percentage of apoptotic tumor cell nuclei did not have prognostic relevance in the population studied and was not associated with several histopathologic parameters or bcl-2 and p53 immunoreactivity. Subgroup analysis indicated that the survival of patients with differentiated G2 and bcl-2-negative/p53-negative tumors was significantly longer (82 +/- 6 months) than the survival of patients with G2 bcl-2- and/or p53-positive tumors (41.8 +/- 12.5 months; p = 0.005), with independent prognostic relevance determined by multivariate analysis (p = 0.024). CONCLUSION The data reported indicate that the analysis of bcl-2 and p53 immunoreactivity seems to have prognostic implications for early invasive (pT1/pT2) gastric adenocarcinomas and may subclassify patients for minimally invasive laparoscopic or endoscopic gastric resections.
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Affiliation(s)
- R Kopp
- Department of Surgery, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, D-81377 Munich, Germany
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21
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Meyer HJ. The influence of case load and the extent of resection on the quality of treatment outcome in gastric cancer. Eur J Surg Oncol 2005; 31:595-604. [PMID: 15919174 DOI: 10.1016/j.ejso.2005.03.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 03/08/2005] [Indexed: 01/13/2023] Open
Abstract
AIMS The background was to analyse the influence of hospital- and surgeon volume and of the extent of resective procedures on the quality of early and late treatment results in gastric cancer. METHODS The literature was reviewed by searching the databases of Medline, Cancerlit, Pubmed and the Cochran register. RESULTS The levels of evidence showed wide variations. The influence of hospital volume was more important for the outcome than the case load of the individual surgeon. The extent of surgical resection should be adapted to histology--or stage. The value of systematic lymph node dissection is still under discussion. CONCLUSIONS We have found that the best treatment results were seen in high volume hospitals with experienced surgeons, even taking into account extended surgical procedures. Further studies are needed to define the optimal number of operations necessary to be carried out each year.
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Affiliation(s)
- H-J Meyer
- Department of General and Visceral Surgery, Städtisches Klinikum Solingen, 42653 Solingen, Germany.
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Abstract
The rate of detection of early gastric cancer has increased because of the development of diagnostic techniques, such as endoscopy, biopsy, and endoscopic ultrasonography. Recently, minimally invasive surgical procedures for benign gastric conditions have been advocated, and the laparoscopic approach is noted as a technique that increases the quality of life. However, the development of laparoscopic gastric resections and laparoscopically assisted gastric operations for malignancy still deserve a word of caution. Laparoscopic local resection of the stomach is used to treat mucosal cancer without lymph node metastasis, and laparoscopy-assisted distal gastrectomy is used to treat early gastric cancer with lymph node metastasis in the perigastric portion. According to short-term results reported by a small group of surgeons, laparoscopic approaches for gastric cancer result in a minimally invasive approach, early recovery, and decreased morbidity and mortality. However, the longterm results of these less invasive treatments are not known in advanced gastric cancer. If the results of randomized controlled studies for advanced gastric cancer are confirmed, the use of these techniques will spread worldwide and may become a standard technique for the resection of gastric cancer.
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Affiliation(s)
- Koji Otsuka
- Department of Surgery, Division of General & Gastroenterological Surgery, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
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Bando E, Kojima N, Kawamura T, Takahashi S, Fukushima N, Yonemura Y. Prognostic value of age and sex in early gastric cancer. Br J Surg 2004; 91:1197-1201. [PMID: 15449274 DOI: 10.1002/bjs.4541] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The need for lymph node dissection in early gastric cancer (EGC) is controversial. The present study investigated the possibility of planning treatment for EGC according to age and sex rather than node status. METHODS Overall survival rate and cause of death were analysed according to age (5-year increments) and sex in 4231 patients with EGC. Cox proportional hazard regression analyses were used to identify the most valuable predictor. RESULTS In patients with EGC 5- and 10-year cancer-specific survival rates were 98.4 and 96.3 per cent respectively, whereas corresponding overall survival rates were 90.2 and 80.9 per cent. The critical age for determining prognosis was 70 years for men (chi2 = 131.34, P < 0.001) and 75 years for women (chi2 = 64.35, P < 0.001). For both sexes, the 10-year overall survival rate was less than 30 per cent in patients over 80 years old. Multivariate Cox stepwise regression analysis identified age as the most powerful prognostic indicator in EGC. The rate of death from causes unrelated to the tumour increased significantly with age, whereas that from recurrence was not affected by age. CONCLUSION Age is a better prognostic indicator than node status in both men and women with EGC. Age and sex should be taken into account as well as conventional clinicopathological variables related to lymph node metastases when determining appropriate therapy for EGC.
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Affiliation(s)
- E Bando
- Gastric Surgery and Digestive Surgery Division, Shizuoka Cancer Centre, Shizuoka, Japan
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24
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Karube T, Ochiai T, Shimada H, Nikaidou T, Hayashi H. Detection of sentinel lymph nodes in gastric cancers based on immunohistochemical analysis of micrometastases. J Surg Oncol 2004; 87:32-8. [PMID: 15221917 DOI: 10.1002/jso.20077] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES The sentinel lymph node (SN) theory has the potential to change the trend of surgery for gastric cancer that is based on wide resection of the stomach with dissection of regional lymph nodes. However, feasibility tests of SN mapping procedures in gastric cancers with analysis of micrometastasis are rare. This study aimed to estimate the clinical usefulness of SN mapping using a dual procedure with dye- and gamma probe-guided techniques for gastric cancers, based on immunohistochemical staining (IHC) analysis. METHODS SN mapping procedures were performed on 41 patients with T1-T2 gastric cancer, and gastrectomy with D2 lymphadenectomy followed. All SNs and non-SNs obtained from the patients were tested by IHC analysis using anti-cytokeratin antibodies. RESULTS Using the dual mapping procedure, SNs were detected in all patients (100%). SN was positive in all patients with lymph node metastasis except in one with non-solid type poorly differentiated adenocarcinoma with marked lymphatic permeation, thus achieving an accuracy rate of 98%. CONCLUSIONS The method was accurate in predicting nodal status and could be an indicator for less invasive treatment in patients with gastric cancer.
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Affiliation(s)
- Tomoaki Karube
- Department of Academic Surgery (M9), Graduate School of Medicine, Chiba University, Chiba, Japan
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25
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Yuasa N, Nimura Y. Survival after surgical treatment of early gastric cancer, surgical techniques, and long-term survival. Langenbecks Arch Surg 2004; 390:286-93. [PMID: 15133674 DOI: 10.1007/s00423-004-0482-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Accepted: 03/11/2004] [Indexed: 02/06/2023]
Abstract
Early gastric cancer (EGC) is well accepted as having a favorable prognosis after surgical treatment. Difference in treatment strategies for EGC between Japan and western countries indicates a need for current information to be evaluated with regard to long-term survival rates of EGC patients throughout the world. To analyze survival rates and recurrence after resection of EGC, we investigated 51 reports in English that each included more than 50 cases of EGC treated by gastrectomy and had been published during the past 12 years (1992-2003). Prevalence of EGC among all gastric cancers was 45%-51% in Japan, but only 7%-28% in western countries. Mean age at diagnosis was less than 60 years in Japan and Korea, but was more than 60 in most of the Western countries. Actuarial and disease-specific 5-year survival rates for EGC were 72%-95.8% and 88%-98.3%, respectively. Those for EGC that were invading the submucosal layer were 71.6%-94.1% and 82%-96.6%, respectively. Those for EGC with lymph node metastasis were 57%-89.1% and 72%-93.5%, respectively. Prevalence of recurrence ranged from 1.0% to 13.8%. Larger clinical series with more EGC cases showed a lower prevalence of recurrence (P=0.531, P=0.0026). Liver and blood-borne distant metastasis represented the predominant pattern of relapse, accounting for over half (54%). Local recurrence and peritoneal dissemination represented 20% and 18% of all recurrences, respectively. Clinicopathological studies have shown lymph node metastasis to be closely related to depth of invasion, size of lesion, histological type, presence of ulcer or ulcer scar, and vessel involvement. Information on these factors is the key to successful treatment of EGC. When sufficient information has been assessed preoperatively, surgeons can select patients for whom less-invasive surgery should not increase the risk of recurrence.
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Affiliation(s)
- Norihiro Yuasa
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
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Kikuchi S, Katada N, Sakuramoto S, Kobayashi N, Shimao H, Watanabe M, Hiki Y. Survival after surgical treatment of early gastric cancer: surgical techniques and long-term survival. Langenbecks Arch Surg 2004; 389:69-74. [PMID: 14985987 DOI: 10.1007/s00423-004-0462-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 01/15/2004] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Recent results from long-term follow-up of a large number of patients who have undergone gastric resection for early gastric cancer (EGC) have not yet been fully evaluated. PATIENTS AND METHODS A total of 848 patients who had undergone gastric resection for EGC (262 female, 586 male; mean age 58.0 years; range 20-86 years) were studied with respect to surgical technique, long-term survival and prognostic factors on the basis of current TNM classification. RESULTS Death related to recurrence occurred in only eight patients (0.9%). Hematogenous metastasis to the liver or bone represented the most common pattern of recurrence, developing in six of the eight recurrences (75%). The 5-year and 10-year cancer-related survival rates were 98.6% and 94.8%, respectively. The 5-year and 10-year overall survival rates were 95.2% and 85.0%, respectively. Lymph node metastasis represented an independent prognostic factor when analyzed on the basis of cancer-related survival. CONCLUSION The present findings indicate that long-term survival of patients who undergo gastric resection for EGC is extremely good and that lymph node metastasis represents an independent prognostic factor when analyzed according to cancer-related survival. Future developments for the treatment of EGC are expected to improve quality of life for patients after gastric resection.
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Affiliation(s)
- Shiro Kikuchi
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Sagamihara-shi, 228 Kanagawa, Japan.
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Bando E, Kawamura T, Kinoshita K, Takahashi S, Maeda A, Osada S, Tsubosa Y, Yamaguchi S, Uesaka K, Yonemura Y. Magnitude of serosal changes predicts peritoneal recurrence of gastric cancer. J Am Coll Surg 2003; 197:212-22. [PMID: 12892799 DOI: 10.1016/s1072-7515(03)00539-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peritoneal dissemination is the most frequent mode of recurrence in patients with gastric cancer. We tried to identify factors that predict peritoneal recurrence with high sensitivity. STUDY DESIGN Clinical and pathologic data from 587 consecutive patients with gastric cancer were reviewed retrospectively. The stepwise Cox proportional hazards regression model was used to assess the prognostic significance of the magnitude of serosal changes. Multiple stepwise logistic regression analysis was used to determine factors associated with peritoneal recurrence in 375 patients who underwent curative resection. RESULTS The 5-year survival rate of patients with S2 disease (greatest dimension of macroscopic serosal changes >/= 2.5 cm) was 18%, which was worse than S0 (no serosal changes) and S1 disease (macroscopic serosal changes < 2.5 cm)(p < 0.001). Patients with S0 tumors who underwent curative resection had the best 5-year survival rate. Multivariate analyses indicated that the magnitude of serosal changes was an independent prognostic factor for survival both overall and after curative resection. Logistic regression analysis showed that peritoneal recurrence was more than four times as likely with S2 than with S0 or S1 tumors. The sensitivity for predicting peritoneal recurrence was 79%; the sensitivity of cytologic examination was 38%. CONCLUSIONS Magnitude of serosal changes is easy to measure intraoperatively and predicts peritoneal recurrence of gastric cancer with greater sensitivity than conventional peritoneal lavage cytology.
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Affiliation(s)
- Etsuro Bando
- Shizuoka Cancer Center, Gastric Surgery Division, Shizuoka, Japan
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Kodera Y, Schwarz RE, Nakao A. Extended lymph node dissection in gastric carcinoma: where do we stand after the Dutch and British randomized trials? J Am Coll Surg 2002; 195:855-64. [PMID: 12495318 DOI: 10.1016/s1072-7515(02)01496-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Yasuhiro Kodera
- Department of Surgery II, Nagoya University School of Medicine, Nagoya, Japan
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29
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Bando E, Yonemura Y, Taniguchi K, Fushida S, Fujimura T, Miwa K. Outcome of ratio of lymph node metastasis in gastric carcinoma. Ann Surg Oncol 2002; 9:775-84. [PMID: 12374661 DOI: 10.1007/bf02574500] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The purpose of this study was to clarify the outcome of the ratio of the metastatic lymph nodes (RML) in gastric cancer patients. METHODS The postoperative survival of 650 patients with gastric cancer who underwent D2 curative gastrectomy was analyzed with regard to the RML. The location, number, and RML in the N1 station and in all (N1 and N2) stations were analyzed. These data were compared from the viewpoints of staging accuracy and patient survival. RESULTS The RML was classified as follows: RML 0, no involvement; RML 1, 0 to.1; RML 2,.1 to.25; and RML 3, >or=.25. The 5-year survival rates stratified by RML were RML 0, 86%; RML 1, 68%; RML 2, 35%; and RML 3, 16%. Cox model identified all methods of classifying lymph node metastases as independent prognostic indicators in each calculation. However, a second Cox regression revealed that RML was the only independent prognostic factor among the three methods (P <.001). Stage migration was present in 35 cases (15%) when the number was considered. However, only 15 cases (7%) were underdiagnosed when RML was used. CONCLUSIONS RML is a useful classification of patients with gastric cancer. It may prevent the phenomenon of stage migration.
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Affiliation(s)
- Etsuro Bando
- Gastric Surgery Division, Shizuoka Cancer Center, Shizuoka, Japan
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Samel S, Singal A, Becker H, Post S. Problems with intraoperative hyperthermic peritoneal chemotherapy for advanced gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2000; 26:222-6. [PMID: 10753533 DOI: 10.1053/ejso.1999.0780] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Intraoperative hyperthermic peritoneal chemotherapy (IHPC) after total gastrectomy for advanced, serosa-penetrating gastric cancer has been demonstrated in several studies to reduce the incidence of peritoneal carcinosis and to prolong survival. METHODS In a prospective pilot study, nine patients with advanced gastric cancer were selected to receive IHPC with Mitomycin and Cisplatin after total gastrectomy and systematic lymphadenectomy. RESULTS All patients had nodal, and four patients distant, metastases. Six patients (66%) suffered from post-operative complications including renal failure, pancreatitis, pancreatic fistula and anastomotic dehiscence. Thirty-day mortality was zero. Six patients died within 3-10 months after surgery. Five of these deaths were related to peritoneal carcinosis and one patient died from cardiac failure 3 months after surgery. Three patients, respectively, have been alive for 12, 20 and 24 months at present, with suspected peritoneal tumour in the last patient. The 2-year probability of survival among our patients receiving IHPC is 29%. CONCLUSION Intraoperative hyperthermic peritoneal chemotherapy carries a high risk of peri-operative complications and was not able to prevent or delay peritoneal tumour recurrence in patients with advanced gastric cancer.
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Affiliation(s)
- S Samel
- Department of Surgery, University Hospital Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer, Mannheim, D-68135, Germany.
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Abstract
Complete tumor removal with margins of clearance at the resection lines must be the aim of today's surgical treatment of gastric cancer, and this must be applied even in lymph node dissection. But, over the last few decades, the extent and impact of lymphadenectomy remains controversial. Whereas Japanese centers advocate extensive lymph node dissection as the base of their excellent results, many Western surgeons, supported by actual randomized trials, believe that the potential benefit of such procedures cannot outweigh the risk of increased postoperative morbidity and mortality. However, if lymphadenectomy is restricted to the removal of nodes only, it does not influence the operative risk. Further, the lymph node ratio and number of lymph nodes involved are relevant prognostic parameters. Survival improvement can be achieved in a moderate degree of metastatic involvement of the nodes (pN0,1). Therefore, systematic lymph node dissection should be an integral part of the curative resection sought. Limited or no lymphadenectomy might be indicated in noncurative surgery or in special types of mucosal early gastric cancer, respectively.
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Affiliation(s)
- H J Meyer
- Klinik für Allgemein- und Visceralchirurgie, Städtisches Klinikum Solingen, Solingen, Germany
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Abstract
We reviewed the literature concerning the effect of extended lymph node dissection on survival in patients with gastrointestinal cancer. Most retrospective and/or prospective nonrandomized comparative studies have claimed that extended lymph node dissection significantly improves survival rate in patients with esophageal cancer, gastric cancer, and colorectal cancer. However, it is difficult to interpret these results since specialized care provided in trials may itself improve survival. In gastric cancer, several prospective randomized trials have failed to demonstrate a survival advantage of extended dissection, while there are few well-done prospective randomized trials in esophageal or colorectal cancer. Therefore, the therapeutic value of extended lymph node dissection remains to be determined in gastrointestinal cancer. Randomized prospective studies within the bounds of the ethical treatment of patients can and should be done.
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Affiliation(s)
- M Noguchi
- Operation Center, Kanazawa University Hospital, School of Medicine, Kanazawa University, Japan
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