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Stillman MD, Yoon SS. Open and minimally invasive gastrectomy in Eastern and Western patient populations: A review of the literature and reasons for differences in outcomes. J Surg Oncol 2022; 126:279-291. [PMID: 35416303 PMCID: PMC9276624 DOI: 10.1002/jso.26887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/08/2022]
Abstract
Randomized trials in the East have established minimally invasive gastrectomy as possibly superior for short-term outcomes and noninferior for long-term survival. Smaller randomized studies from Western countries have supported these findings. However, there are marked disparities in morbidity, mortality, and overall survival noted between Eastern and Western studies. In this article, we review the literature comparing open and minimally invasive gastrectomy in the East and West, and describe the possible reasons for differences in outcomes.
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Affiliation(s)
- Mason D Stillman
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Sam S Yoon
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
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Peri-operative Outcomes and Survival Following Palliative Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis. J Gastrointest Cancer 2020; 52:41-56. [PMID: 32959118 PMCID: PMC7900337 DOI: 10.1007/s12029-020-00519-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Many patients with gastric cancer present with late stage disease. Palliative gastrectomy remains a contentious intervention aiming to debulk tumour and prevent or treat complications such as gastric outlet obstruction, perforation and bleeding. METHODS We conducted a systematic review of the literature for all papers describing palliative resections for gastric cancer and reporting peri-operative or survival outcomes. Data from peri-operative and survival outcomes were meta-analysed using random effects modelling. Survival data from patients undergoing palliative resections, non-resective surgery and palliative chemotherapy were also combined. This study was registered with the PROSPERO database (CRD42019159136). RESULTS One hundred and twenty-eight papers which included 58,675 patients contributed data. At 1 year, there was a significantly improved survival in patients who underwent palliative gastrectomy when compared to non-resectional surgery and no treatment. At 2 years following treatment, palliative gastrectomy was associated with significantly improved survival compared to chemotherapy only; however, there was no significant improvement in survival compared to patients who underwent non-resectional surgery after 1 year. Palliative resections were associated with higher rates of overall complications versus non-resectional surgery (OR 2.14; 95% CI, 1.34, 3.46; p < 0.001). However, palliative resections were associated with similar peri-operative mortality rates to non-resectional surgery. CONCLUSION Palliative gastrectomy is associated with a small improvement in survival at 1 year when compared to non-resectional surgery and chemotherapy. However, at 2 and 3 years following treatment, survival benefits are less clear. Any survival benefits come at the expense of increased major and overall complications.
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Gojayev A, Erşen O, Mercan Ü, Yüksel C, Yalkın Ö, Bayar S, Ünal AE, Demirci S. Evaluation of Peroperative and Oncological Results in Laparoscopic Surgery of Gastric Cancer in Elderly Patients: Single-Center Study. J Laparoendosc Adv Surg Tech A 2020; 31:657-664. [PMID: 32924787 DOI: 10.1089/lap.2020.0472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction: Laparoscopic treatment of gastric cancer in elderly patients is still controversial. The aim of this retrospective study is to evaluate the safety and feasibility of laparoscopic gastrectomy in elderly gastric cancer patients based on the long- and short-term results of laparoscopic surgery. Materials and Methods: The data of 163 patients who underwent laparoscopic gastrectomy for gastric cancer. Patients were categorized into two groups by age based on World Health Organization (WHO) criteria: elderly (≥65 years, 80 cases) and nonelderly (<65 years, 83 cases). Patient characteristics and clinicopathological findings, surgical findings, short- and long-term results were compared between the two groups. Results: The patients in the study group were in the age range of 22-87 years and 80 (49%) patients were found out to be 65 years old or older. When all complications were categorized according to Clavien-Dindo (C-D) classification, >3 serious complication rates were similar between groups (P = .421). Although the length of hospital stay and the need for intensive care were higher in the elderly group, the difference was not significant (P = .066; P = .072). There was no significant difference between the two in terms of in-hospital mortality (P = .364). No statistically significant differences were found in the rates of overall survival (nonelderly group; 61.17 ± 3.34, 95% confidence interval [CI]: 54.61-67.74 versus elderly group; 56.48 ± 3.80, 95% CI: 49.03-63.93; P = .176) and disease-specific survival (nonelderly group; 64.24 ± 3.15, 95% CI: 58.06-70.40 versus elderly group; 61.93 ± 3.57, 95% CI: 54.93-68.93; P = .363) between the age groups. Conclusion: In conclusion, although laparoscopic gastrectomy is a feasible and safe method in elderly gastric cancer patients, further randomized prospective studies are needed.
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Affiliation(s)
- Afig Gojayev
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ogün Erşen
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ümit Mercan
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Cemil Yüksel
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ömer Yalkın
- Department of General Surgery, Bursa City Hospital, Bursa, Turkey
| | - Sancar Bayar
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ali Ekrem Ünal
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Salim Demirci
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
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Shan F, Gao C, Li XL, Li ZY, Ying XJ, Wang YK, Li SX, Ji X, Ji JF. Short- and Long-Term Outcomes after Laparoscopic Versus Open Gastrectomy for Elderly Gastric Cancer Patients: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2020; 30:713-722. [PMID: 32471317 DOI: 10.1089/lap.2019.0778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: With the rapid aging of global population, the number of elderly patients with gastric cancer is increasing. This study aimed to evaluate short- and long-term outcomes after laparoscopic gastrectomy (LG) versus open gastrectomy (OG) in elderly gastric cancer patients. Materials and Methods: We searched PubMed, EMBASE, and the Cochrane library databases from January 1994 to May 2019. Surgical safety, postoperative complications, number of harvested lymph nodes, and overall survival rate were included and analyzed. The qualities of the included studies were evaluated by Newcastle-Ottawa Quality Assessment Scale. The evidence of outcomes was evaluated using the GRADE approach. The Review Manager® 5.3 (Cochrane, London, UK) and Stata® 14.0 (StataCorp., College Station, Texas) were used to analyze the outcomes. Results: Thirteen studies containing 4768 elderly patients with gastric cancer were included in this meta-analysis. LG was more favorable than OG in terms of overall postoperative morbidity (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; P < .00001), the postoperative stay (standardized mean difference [SMD]: -0.56; 95% CI: -0.76 to (-0.37); P < .00001), and the number of harvested lymph nodes (SMD: 0.19; 95% CI: 0.09 to 0.29; P = .0003). No significant difference was found in anastomotic leakage rate (OR: 0.82; 95% CI: 0.59 to 1.12; P = .21), mental disease (OR: 0.79; 95% CI: 0.44 to 1.44; P = .44), or overall survival rate (P = .62) between two groups. However, in the subgroup with a cutoff age of 80 years, the anastomotic leakage rate was higher in LG (OR: 10.27; 95% CI: 1.31 to 80.35; P = .03). Conclusions: LG was more favorable than OG in the elderly patients <80 years old with gastric cancer.
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Affiliation(s)
- Fei Shan
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chao Gao
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiao-Long Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zi-Yu Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang-Ji Ying
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yin-Kui Wang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shuang-Xi Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xin Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jia-Fu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
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Li Z, Shan F, Ying X, Xue K, Ji J. Laparoscopic versus open gastrectomy for elderly local advanced gastric cancer patients: study protocol of a phase II randomized controlled trial. BMC Cancer 2018; 18:1118. [PMID: 30445943 PMCID: PMC6240197 DOI: 10.1186/s12885-018-5041-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/05/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gastric cancer is one of the most common malignant tumors worldwide. With the rapid aging of global population, the number of elderly patients with local advanced gastric cancer is increasing. Surgery is the essential treatment for local advanced gastric cancer. However, elderly patients are at high risk of postoperative complications due to reduced functional reserve and increased comorbidities. Laparoscopic gastrectomy may be a promising surgery approach for elderly patients but its benefits remain controversial. We therefore proposed this randomized trial to evaluate the safety and efficacy of laparoscopic versus open gastrectomy for local advanced gastric cancer in patients aged 70 and above. METHODS The current study has a randomized, parallel controlled, single-center, open-label, superiority design with two arms. A sample of 180 local advanced gastric cancer patients aged 70 and above will be recruited in Peking University Cancer Hospital and Institute. Participants will be randomized to either receive open or laparoscopic gastrectomy. The primary outcome is surgical safety, including complication rate, reoperation rate, readmission rate, and mortality rate within 30 days after surgery. The secondary endpoints include postoperative rehabilitation status, one-year postoperative life quality, three-year overall and disease-free survival. Assessments will take place at baseline (before random assignment), at 30 days, one-year, and three-year after the surgery. The study has been approved by an ethical review board. DISCUSSION We hypothesized that laparoscopic gastrectomy is superior to open gastrectomy in terms of perioperative safety for local advanced gastric cancer patients aged 70 and above. If this hypothesis is statistically proved, the rational introduction of minimally invasive surgery technique in traditional gastrectomy can help improve the surgical safety for elderly patients, reduce patient financial burden, shorten hospital stay, and improve hospital beds turnover rate. Our research data will also provide high quality clinical evidence and data support for the conduction of multicenter phase III clinical trials. TRIAL REGISTRATION The study has been prospectively registered in ClinicalTrial.gov ( NCT03564834 ).
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Affiliation(s)
- Ziyu Li
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Fei Shan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Xiangji Ying
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Kan Xue
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
| | - Jiafu Ji
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142 China
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Lin JX, Yi BC, Yoon C, Li P, Zheng CH, Huang CM, Yoon SS. Comparison of Outcomes for Elderly Gastric Cancer Patients at Least 80 Years of Age Following Gastrectomy in the United States and China. Ann Surg Oncol 2018; 25:3629-3638. [PMID: 30218243 DOI: 10.1245/s10434-018-6757-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare gastric cancer (GC) patients aged 80 years or older undergoing gastrectomy at two high-volume cancer centers in the US and China. METHODS Patients aged ≥ 80 years who underwent R0 resection at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, USA (n = 159), and Fujian Medical University Union Hospital (FMUUH) in Fujian, China (n = 118) from January 2000 to December 2013 were included. Demographic, surgical, and pathologic variables were compared, and factors associated with survival were determined via multivariate analysis. RESULTS The number of patients increased annually in the FMUUH cohort but not in the MSKCC cohort. Patients at MSKCC were slightly older (mean age 83.7 vs. 82.7 years), more commonly female (38 vs. 19%), and had higher average body mass index (BMI; 26 vs. 23). Treatment at FMUUH more frequently employed total gastrectomy (59 vs. 20%) and laparoscopic surgery (65 vs. 7%), and less frequently included adjuvant therapy (11 vs. 18%). In addition, FMUUH patients had larger tumors of more advanced T, N, and TNM stage. Morbidity (35 vs. 25%, p = 0.08) and 30-day mortality (2.5 vs. 3.3%, p = 0.67) were similar between the cohorts. For each TNM stage, there was no significant difference between MSKCC and FMUUH patients in 5-year overall survival and disease-specific survival (DSS). TNM stage was the only independent predictor of DSS for both cohorts. CONCLUSIONS Patients ≥ 80 years of age selected for gastrectomy for GC at MSKCC and FMUUH had acceptable morbidity and mortality, and DSS was primarily dependent on TNM stage.
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Affiliation(s)
- Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Brendan C Yi
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Changhwan Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
| | - Sam S Yoon
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Lee JH, Kim HG, Ryu SY, Kim DY. The Benefits of Resection for Gastric Carcinoma Patients with Non-curative Factors. Chonnam Med J 2018; 54:36-40. [PMID: 29399564 PMCID: PMC5794477 DOI: 10.4068/cmj.2018.54.1.36] [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: 11/06/2017] [Revised: 12/20/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022] Open
Abstract
The benefits of resection for gastric carcinoma patients with non-curative factors remain controversial. Thus, we evaluated the survival benefits of resection in these gastric carcinoma patients. We reviewed the hospital records of 467 gastric carcinoma patients with non-curative factors who had resection (n=305) and compared their clinicopathological findings with individuals (n=162) who underwent bypass or exploration from 1996 to 2010. The 3-year survival rate of patients who had resection was higher than was that of patients who did not (13.2 vs. 7.2%, respectively p<0.001). Cox's proportional hazard regression analysis revealed that only one factor was an independent, statistically significant prognostic parameter: the presence of peritoneal dissemination (risk ratio, 1.37; 95% confidence interval, 1.04–1.79; p<0.05). The 3-year survival rate of patients with peritoneal dissemination was higher in individuals who underwent resection compared with those who did not (9.5 vs. 4.7%, respectively; p<0.001). The current results highlight the improved survival rates of gastric carcinoma patients with non-curative factors who underwent surgery compared with those who did not. Although resection is not curative in this group of patients, we still recommend performing the procedure.
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Affiliation(s)
- Jae Hyuk Lee
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Gun Kim
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Yeob Ryu
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Yi Kim
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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Choe YR, Joh JY, Kim YP. Association between frailty and readmission within one year after gastrectomy in older patients with gastric cancer. J Geriatr Oncol 2017; 8:185-189. [PMID: 28259489 DOI: 10.1016/j.jgo.2017.02.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/25/2016] [Accepted: 02/07/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The incidence of gastric cancer in older people is increasing. Because older patients are at increased risk of postoperative complications and mortality, preoperative risk assessment in this population is important. This study explored whether preoperative assessment of frailty could be useful for predicting the postoperative outcome in patients with gastric cancer. MATERIALS AND METHODS We investigated 223 patients (136 men and 87 women) over 65years of age who underwent gastric cancer surgery from April 2012 to March 2015 at a single institution in Korea. Frailty was assessed using the Study of Osteoporotic Fractures (SOF) frailty index. Logistic regression was used to identify factors predicting readmission within one year of discharge following gastrectomy. RESULTS Twenty six (11.7%) patients were readmitted within one year after gastrectomy. Patients in the "robust" and "pre-frail and frail" group had a readmission rate of 6.7% and 19.1%, respectively. After adjusting age, gender, Eastern Cooperative Oncology Group performance status (ECOG PS) (score≥1), histological type and stage (III, IV), frailty (pre-frail and frail) was a predictive factor for readmission within one year of discharge after gastrectomy (Odds Ratio, 5.74, 95%; Confidence Interval, 1.78-18.48; p=0.003). CONCLUSIONS Preoperative risk assessment including frailty evaluation can predict the readmission within one year of discharge after gastrectomy. Frailty assessment can help physicians to identify the risk and inform patients and their families of the risk, which should improve decision making in gastric cancer treatment.
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Affiliation(s)
- Yu-Ri Choe
- Department of Family Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Chonnam, South Korea.
| | - Ju-Youn Joh
- Department of Family Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Chonnam, South Korea.
| | - Yeon-Pyo Kim
- Department of Family Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro, Hwasun-eup, Hwasun-gun, Chonnam, South Korea; Chonnam National University School of Medicine, 160, Baekseo-ro, Dong-gu, Gwangju, South Korea.
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Solaini L, Ministrini S, Coniglio A, Cavallari S, Molteni B, Baiocchi GL, Portolani N, Tiberio GAM. How could we identify the 'old' patient in gastric cancer surgery? A single centre cohort study. Int J Surg 2016; 34:174-179. [PMID: 27613126 DOI: 10.1016/j.ijsu.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze the population submitted to gastric cancer surgery in our Institution in order to find those characteristics which could help in the identification of the elderly high-risk patient. METHODS In a cohort of 263 patients (>65 y) we selectively investigated the risk factors for medical and surgical complications and postoperative mortality, focusing on the variable "age". All the significant variables were used to find predictors of complications with Clavien-Dindo>2. RESULTS Age>75 (AUC 0.61; 95% 0.55-0.67, p = 0.003) and ASA score >2 (AUC 0.60; 95% CI 0.54-0.67, p = 0.01) were significantly associated with an increased risk of medical complications. Operative time >330 min (OR 1.00; 95% CI 1.00-1.01; p = 0.0001- AUC 0.62, 95% CI 0.56-0.68, p = 0.01) was the only significant predictor of surgical complications. In-hospital mortality (6/263 patients) was significantly associated with preoperative albumin ≤2.95 g/dl (OR 0.15; 95% CI 0.04-0.93, p = 0.041 - AUC 0.74 95% CI 0.68-0.80; p = 0.003) and additional procedures (OR 7.05; 1.23-40.32, p = 0.03). Stepwise multivariate analysis showed that albumin ≤2.95 g/dl (OR 3.43; 95% CI 1.06-11.13 p = 0.033), ASA>2 (OR 9.51; 95% CI 1.23-72.97; p = 0.042) and additional resections (OR 3.39; 95% CI 1.36-8.45; p = 0.045) were independent risk factors for complications Clavien Dindo >2. CONCLUSIONS Our work demonstrated that, in our institution, 75 years of age could identify the elderly in gastric surgery as those patients were at higher risk of medical complications. ASA >2, preoperative serum albumin ≤2.95 g/dl and the need of additional procedures could increase the risk of severe postoperative adverse events.
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Affiliation(s)
- Leonardo Solaini
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy.
| | - Silvia Ministrini
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Arianna Coniglio
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Sara Cavallari
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Beatrice Molteni
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Gian Luca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
| | - Nazario Portolani
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, 25123 Brescia, Italy
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Zhang XL, Shi HJ, Wang JP, Tang HS, Wu YB, Fang ZY, Cui SZ, Wang LT. MicroRNA-218 is upregulated in gastric cancer after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and increases chemosensitivity to cisplatin. World J Gastroenterol 2014; 20:11347-11355. [PMID: 25170221 PMCID: PMC4145775 DOI: 10.3748/wjg.v20.i32.11347] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/09/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the molecular mechanisms of miRNA in advanced gastric cancers (AGCs) before and after cytoreductive surgery (CRS) + hyperthermic intraperitoneal chemotherapy (HIPEC).
METHODS: A miRNA microarray containing human mature and precursor miRNA sequences was used to compare expression profiles in serum samples of 5 patients with AGC before and after CRS + HIPEC. The upregulation of miR-218 was confirmed by real-time reverse transcription polymerase chain reaction and its expression was analyzed in SGC7901 gastric cancer cells.
RESULTS: miRNA microarray chip analysis found that the level of miR-218 expression was upregulated more than 8 fold after CRS + HIPEC. Furthermore, miR-218 increased gastric cancer cell chemosensitivity to cisplatin in vitro and inhibited gastric cell tumor growth in nude mice in vivo (0.5 vs 0.78, P < 0.05).
CONCLUSION: Our results indicated that targeting miR-218 may provide a strategy for blocking the development of gastric cancer and reverse the multi-drug resistance of gastric cell lines.
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He MM, Zhang DS, Wang F, Wang ZQ, Luo HY, Jin Y, Wei XL, Xu RH. The role of non-curative surgery in incurable, asymptomatic advanced gastric cancer. PLoS One 2013; 8:e83921. [PMID: 24358318 PMCID: PMC3865283 DOI: 10.1371/journal.pone.0083921] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 11/11/2013] [Indexed: 12/22/2022] Open
Abstract
Background Although general agreement exists on palliative surgery with intent of symptom palliation in advanced gastric cancer (AGC), the role of non-curative surgery for incurable, asymptomatic AGC is hotly debated. We aim to clarify the role of non-curative surgery in patients with incurable, asymptomatic AGC under the first-line chemotherapy. Methods A total of 737 patients with incurable, asymptomatic advanced gastric adenocarcinoma between January 2008 and May 2012 at the Sun Yat-sen University Cancer Center were retrospectively analyzed, comprising 414 patients with non-curative surgery plus first-line chemotherapy, and 323 patients with first-line chemotherapy only. The clinicopathologic data, survival, and prognosis were evaluated, with propensity score adjustment for selection bias. Results The median overall survival (OS) outcomes significantly favored non-curative surgery group over first-line chemotherapy only group in entire population (28.00 versus 10.37 months, P = 0.000), stage 4 patients (23.87 versus 10.37 months, P = 0.000), young patients (28.70 versus 10.37 months, P = 0.000) and elderly patients (23.07 versus 10.27 months, P = 0.031). The median OS advantages of non-curative surgery over first-line chemotherapy only were also maintained when the analyses were restricted to single organ metastasis (P = 0.001), distant lymph node metastasis (P = 0.002), peritoneal metastasis (P = 0.000), and multi-organ metastasis (P = 0.010). Significant OS advantages of non-curative surgery over chemotherapy only were confirmed solid by multivariate analyses before and after adjustment on propensity score (P = 0.000). Small subsets of patients with surgery of single metastatic lesion after previous curative gastrectomy, and with surgery of both primary and single metastatic sites showed sound median OS. Conclusions There is a role for non-curative surgery plus first-line chemotherapy for incurable, asymptomatic AGC, in terms of survival. Randomized controlled trials are warranted to fill a gap in knowledge about the value of metastectomy and patient selection strategies.
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Affiliation(s)
- Ming-ming He
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dong-sheng Zhang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Feng Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-qiang Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui-yan Luo
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ying Jin
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-li Wei
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui-hua Xu
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- * E-mail:
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