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Bobrzyński Ł, Pach R, Szczepanik A, Kołodziejczyk P, Richter P, Sierzega M. What determines complications and prognosis among patients subject to multivisceral resections for locally advanced gastric cancer? Langenbecks Arch Surg 2023; 408:442. [PMID: 37987850 PMCID: PMC10663187 DOI: 10.1007/s00423-023-03187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/16/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Locally advanced gastric cancer (GC) extending to the surrounding tissues may require a multivisceral resection (MVR) to provide the best chance of cure. However, little is known about how the extent of organ resection affects the risks and benefits of surgery. METHODS An electronic database of patients treated between 1996 and 2020 in an academic surgical centre was reviewed. MVRs were defined as partial or total gastrectomy combined with splenectomy, distal pancreatectomy, or partial colectomy. RESULTS Suspected intraoperative tumour invasion of perigastric organs (cT4b) was found in 298 of 1476 patients with non-metastatic GC, and 218 were subject to MVRs, including the spleen (n = 126), pancreas (n = 51), and colon (n = 41). MVRs were associated with higher proportions of surgical and general complications, but not mortality. A nomogram was developed to predict the risk of major postoperative morbidity (Clavien-Dindo's grade ≥ 3a), and the highest odds ratio for major morbidity identified by logistic regression modelling was found for distal pancreatectomy (2.53, 95% CI 1.23-5.19, P = 0.012) and colectomy (2.29, 95% CI 1.04-5.09, P = 0.035). Margin-positive resections were identified by the Cox proportional hazards model as the most important risk factor for patients' survival (hazard ratio 1.47, 95% CI 1.10-1.97). The extent of organ resection did not affect prognosis, but a MVR was the only factor reducing the risk of margin positivity (OR 0.44, 95% CI 0.21-0.87). CONCLUSIONS The risk of multivisceral resections is associated with the organ being removed, but only MVRs increase the odds of complete tumour clearance for locally advanced gastric cancer.
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Affiliation(s)
- Łukasz Bobrzyński
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, 30-688, Cracow, Poland
| | - Radosław Pach
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, 30-688, Cracow, Poland
| | - Antoni Szczepanik
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, 30-688, Cracow, Poland
| | - Piotr Kołodziejczyk
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, 30-688, Cracow, Poland
| | - Piotr Richter
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, 30-688, Cracow, Poland
| | - Marek Sierzega
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowski Street, 30-688, Cracow, Poland.
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Vladov N, Trichkov T, Mihaylov V, Takorov I, Kostadinov R, Lukanova T. Аre Multivisceral Resections for Gastric Cancer Acceptable: Experience from a High Volume Center and Extended Literature Review? Surg J (N Y) 2023; 9:e28-e35. [PMID: 36742159 PMCID: PMC9897905 DOI: 10.1055/s-0043-1761278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/05/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction Multivisceral resections (MVRs) in gastric cancer are potentially curable in selected patients in whom clear resection margins are possible. However, there are still uncertain data on their feasibility and safety considering short- and long-term results. The study compares survival, morbidity, mortality, and other secondary outcomes between standard and MVRs for gastric cancer. Materials and Methods A monocentric retrospective study in patients with gastric adenocarcinoma, covering 2004 to 2020. Of the 336 operable cases, 101 patients underwent MVRs. The remaining 235 underwent standard gastric resections (SGRs), of which 173 patients were in stage T3/T4. To compare survival, a control group of 101 patients with palliative procedures was used-bypass anastomosis or exploration. Results MVR had a lower survival rate than the SGR but significantly higher than the palliative procedures. The predominant gender in MVR was male (72.3%), with a mean age of 61 years. The perioperative mortality was 3.96% ( n = 4), and the overall median survival was 28.1 months. The most frequently resected organs were the spleen (67.3%), followed by the pancreas (32.7%) and the liver (20.8%). In 56.4% of the cases two organs were resected, in 28.7% three organs, and in 13.9% four organs. The main complication was bleeding (9.9%). The major postoperative complications in the MVR were 14.85%, and in the SGR 6.4% ( p < 0.05). Better long-term results were observed in patients who underwent R0 resections compared with R1. Conclusion Multiorgan resections are characterized by poorer survival and a higher complication rate than gastrectomies. On the other hand, they have better long-term outcomes than palliative procedures. However, MVRs are admissible when performed by an experienced surgical team in high-volume centers.
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Affiliation(s)
- Nikola Vladov
- Department of HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria
| | - Tsvetan Trichkov
- Department of HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria,Address for correspondence Tsvetan Trichkov, MD Department of HPB Surgery and TransplantologyMilitary Medical Academy, Sveti Georgi Sofiyski str. No.3, floor 14, SofiaBulgaria
| | - Vassil Mihaylov
- Department of HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria
| | - Ivelin Takorov
- First Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria
| | - Radoslav Kostadinov
- Department of HPB Surgery and Transplantology, Military Medical Academy, Sofia, Bulgaria
| | - Tsonka Lukanova
- First Department of Abdominal Surgery, Military Medical Academy, Sofia, Bulgaria
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Funaki S, Ose N, Kanou T, Fukui E, Kimura K, Minami M, Okumura M, Shintani Y. Prognostic Impact of Number of Organ Invasions in Patients with Surgically Resected Thymoma. Ann Surg Oncol 2022; 29:4900-4907. [PMID: 35397738 DOI: 10.1245/s10434-022-11698-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2023]
Abstract
PURPOSE This study aimed to explore the clinical implications and prognostic value of the number of organ/structure invasions (NOI) in patients with thymoma after curative surgical resection. METHODS We retrospectively analyzed 306 consecutive Japanese patients with thymoma who underwent curative surgical resection. Tumor invasions of pericardium, mediastinal pleura, phrenic nerve, lung, and venous structures were examined histopathologically. Cases were classified into four subgroups according to NOI: group 0, no tumor invasion; group 1, tumor invasion into single organ/structure; group 2, tumor invasion of two organs/structures; group 3, invasion of three or more organs/structures. Associations with NOI and several clinical characteristics and their prognostic significance were analyzed. RESULTS Pleural invasion was found in 100 cases (32.7%), lung invasion in 48 cases (15.7%), pericardial invasion in 46 cases (15%), phrenic nerve invasion in 29 (9.5%), and venous invasion in 22 cases (7.2%). NOI was classed as group 0 in 201 cases (65.0%), group 1 in 42 cases (13.7%), group 2 in 20 cases (6.5%), and group 3 in 43 cases (14.1%). Cases with higher NOI showed significantly worse relapse-free survival (RFS) and overall survival (OS). Cox's proportional hazard model analysis also identified NOI as a prognostic factor affecting RFS and OS. CONCLUSIONS Cases with higher NOI of thymoma after radical surgical resection showed significantly worse recurrence rates and survival.
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Affiliation(s)
- Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Kimura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- General Thoracic Surgery, Osaka Toneyama Medical Center, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Jin P, Liu H, Ma FH, Ma S, Li Y, Xiong JP, Kang WZ, Hu HT, Tian YT. Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion. World J Clin Cases 2021; 9:8718-8728. [PMID: 34734050 PMCID: PMC8546839 DOI: 10.12998/wjcc.v9.i29.8718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/03/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND For advanced gastric cancer patients with pancreatic head invasion, some studies have suggested that extended multiorgan resections (EMR) improves survival. However, other reports have shown high rates of morbidity and mortality after EMR. EMR for T4b gastric cancer remains controversial.
AIM To evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.
METHODS A total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed. The patients were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group) by comparing the clinicopathological features, surgical outcomes, and prognostic factors of these patients.
RESULTS There were 24 patients (16.8%) in the GP group who had significantly larger lesions (P < 0.001), a higher incidence of advanced N stage (P = 0.030), and less neoadjuvant chemotherapy (P < 0.001) than the GA group had. Postoperative morbidity (33.3% vs 15.3%, P = 0.128) and mortality (4.2% vs 4.8%, P = 1.000) were not significantly different in the GP and GA groups. The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group (47.6%, median 30.3 mo vs 20.4%, median 22.8 mo, P = 0.010). Multivariate analysis identified neoadjuvant chemotherapy [hazard ratio (HR) 0.290, 95% confidence interval (CI): 0.103–0.821, P = 0.020], linitis plastic (HR 2.614, 95% CI: 1.024–6.675, P = 0.033), surgical margin (HR 0.274, 95% CI: 0.102–0.738, P = 0.010), N stage (HR 3.489, 95% CI: 1.334–9.120, P = 0.011), and postoperative chemoradiotherapy (HR 0.369, 95% CI: 0.163–0.836, P = 0.017) as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion.
CONCLUSION Curative resection of the invaded pancreas should be performed to improve survival in selected patients. Invasion of the pancreatic head is not a contraindication for surgery.
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Affiliation(s)
- Peng Jin
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hao Liu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fu-Hai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yang Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jian-Ping Xiong
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wen-Zhe Kang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hai-Tao Hu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Ye Z, Wei S, Zeng Y, Wang Y, Lin Z, Chen S, Xie Y, Zheng Q, Chen L. Prognostic value of preoperative body mass index for diabetic patients with non-metastasis gastric cancer: a single center experience. BMC Surg 2021; 21:320. [PMID: 34372800 PMCID: PMC8351091 DOI: 10.1186/s12893-021-01316-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/02/2021] [Indexed: 12/20/2022] Open
Abstract
Aim This study was designed to investigate the prognostic effect of preoperative body mass index (BMI) for Type 2 diabetes mellitus (T2DM) patients with non-metastasis gastric cancer (GC) who underwent D2 gastrectomy. Methods T2DM patients with pT1–4bN0–3bM0 GC were retrospectively collected in Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital from January, 2000 to December, 2010. These patients underwent D2 radical resection of the stomach combined with regional lymphadenectomy. Chi-square test was used to analyze unordered categorical variables and ranked data, followed by Kaplan–Meier analysis as well as Cox regression models to detect risk factors for survival outcomes. In addition, the cut-off point was determined by the X-tile program. All analyses were carried out using survival package of R and SPSS Software. Results A total of 302 T2DM patients with pT1–4bN0–3bM0 GC were collected and analyzed. The cut-off points of BMI, identified by the X-tile program, was 19 kg/m2. Patients with low BMI (< 19 kg/m2) had a higher percentage of advanced T stage (T4a and T4b), more advanced TNM stage (stage IIIA, IIIB and IIIC), and more elevated level of serum carcinoembryonic antigen (CEA), compared to those with high BMI (> 19 kg/m2) (all P < 0.05). In the low BMI subgroup, the 5-year overall survival rate was 39.02%, which was as high as 58.11% in the high BMI subgroup (P < 0.05). In the multivariate Cox regression model revealed that IIIC stage (OR = 3.101), N3b stage (OR = 3.113) were the most important prognostic indicators, followed by pretreatment BMI (OR = 2.136). Conclusion Low preoperative BMI (< 19 kg/m2) was a poor prognostic marker for T2DM patients with pT1–4bN0–3bM0 GC.
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Affiliation(s)
- Zaisheng Ye
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, and Fujian Medical University Cancer Hospital, No. 420 Fu-ma Road, Jin-An District, Fuzhou, 350014, China
| | - Shenghong Wei
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, and Fujian Medical University Cancer Hospital, No. 420 Fu-ma Road, Jin-An District, Fuzhou, 350014, China
| | - Yi Zeng
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, and Fujian Medical University Cancer Hospital, No. 420 Fu-ma Road, Jin-An District, Fuzhou, 350014, China
| | - Yi Wang
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, and Fujian Medical University Cancer Hospital, No. 420 Fu-ma Road, Jin-An District, Fuzhou, 350014, China
| | - Zhitao Lin
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, and Fujian Medical University Cancer Hospital, No. 420 Fu-ma Road, Jin-An District, Fuzhou, 350014, China
| | - Shu Chen
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, and Fujian Medical University Cancer Hospital, No. 420 Fu-ma Road, Jin-An District, Fuzhou, 350014, China
| | - Yunqing Xie
- Department of Fujian Provincial Key Laboratory of Tumor Biotherapy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Qiuhong Zheng
- Department of Fujian Provincial Key Laboratory of Tumor Biotherapy, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, 350014, Fujian, China
| | - Luchuan Chen
- Department of Gastrointestinal Surgical Oncology, Fujian Cancer Hospital, and Fujian Medical University Cancer Hospital, No. 420 Fu-ma Road, Jin-An District, Fuzhou, 350014, China.
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Aversa JG, Diggs LP, Hagerty BL, Dominguez DA, Ituarte PHG, Hernandez JM, Davis JL, Blakely AM. Multivisceral Resection for Locally Advanced Gastric Cancer. J Gastrointest Surg 2021; 25:609-622. [PMID: 32705611 PMCID: PMC9274296 DOI: 10.1007/s11605-020-04719-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Locally advanced gastric cancer (LAGC) presents a therapeutic dilemma, particularly as it often involves adjacent organs through desmoplasia or true pathologic invasion. To obtain a margin-negative resection, these tumors require en bloc gastrectomy with multivisceral resection (G+MVR), and contention remains regarding its safety and oncologic benefit. METHODS We used the National Cancer Database to retrospectively evaluate the short- and long-term outcomes of patients with LAGC treated in the USA between 2004 and 2016. Associations with margin status and perioperative outcomes were calculated using logistic regression. Survival was estimated using Cox proportional hazards regression and the Kaplan-Meier method. RESULTS Overall, 785 pathologic stage T4b (pT4b) patients diagnosed with LAGC underwent gastrectomy (n = 438) or G+MVR (n = 347). There was no association between G+MVR and short- or long-term mortality. Positive resection margins (HR 1.68, 95% CI 1.40-2.03), the presence of nodal disease (HRs 1.46-1.50), treatment at a high-volume center (HR 0.76, 95% CI 0.68-0.85), and the receipt of adjuvant chemotherapy (HR 0.64, 95% CI 0.51-0.80) were independently associated with overall survival. Diffuse-type histology was associated with higher rates of an R1 resection (OR 3.60, 95% CI 2.20-5.87). Perioperative and long-term survival metrics were comparable between patients with pT4a and pT4b LAGC who underwent a margin-negative G+MVR. Undergoing a margin-negative G+MVR imparted a 6-month survival benefit over non-curative gastrectomy alone (p < 0.001). CONCLUSIONS Our study demonstrates the safety and long-term feasibility of G+MVR for disease clearance in well-selected patients with LAGC, and we advocate for their referral to high-volume centers for optimal care.
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Affiliation(s)
- John G Aversa
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laurence P Diggs
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brendan L Hagerty
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dana A Dominguez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jonathan M Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew M Blakely
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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Toyota S, Naito H, Motoyoshi S, Nakanishi R, Oki E, Orita H, Korenaga D. Extended total gastrectomy after nivolumab for unresectable multivisceral invasive gastric cancer. Surg Case Rep 2020; 6:298. [PMID: 33237443 PMCID: PMC7688799 DOI: 10.1186/s40792-020-01040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background Chemotherapy has been considered the main treatment for stage IV gastric cancer (GC). However, advances in chemotherapy have provided new clinical approaches, permitting conversion surgery with the aim of R0 resection after resolving unresectability issues. Case presentation A 70-year-old man with gastric cancer invading the pancreatic tail and spleen and with periaortic lymph-node enlargement was admitted to our hospital. After 24 courses of nivolumab as third-line chemotherapy, periaortic lymph-node enlargement was resolved, and conversion surgery was planned. Intraoperatively, we found no peritoneal metastasis, but the distal pancreas, splenic hilum, and transverse colon were adhered to the gastric body. Therefore, we performed D2 total gastrectomy with distal pancreatosplenectomy and partial transverse colectomy. The pathological diagnosis was type III moderately differentiated tubular adenocarcinoma (tub2) with signet ring cells, stage ypT1b (SM), ly0, and v0. The pathological proximal and distal tumor margins were negative. One lymph-node metastasis was observed (No. 4d; 1/23). Postoperatively, no recurrence was observed over 7 months, without adjuvant chemotherapy. Conclusions Nivolumab may allow R0 resection in patients with unresectable gastric cancer. Conversion surgery should be considered even after third-line nivolumab treatment.
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Affiliation(s)
- Satoshi Toyota
- Department of Surgery, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan. .,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hiroshi Naito
- Department of Surgery, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan
| | - Saki Motoyoshi
- Department of Surgery, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hiroyuki Orita
- Department of Surgery, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan
| | - Daisuke Korenaga
- Department of Surgery, Nakatsu Municipal Hospital, Nakatsu, Oita, Japan
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Yang Y, Hu J, Ma Y, Chen G, Liu Y. Multivisceral resection for locally advanced gastric cancer: A retrospective study. Am J Surg 2020; 221:1011-1017. [PMID: 33036727 DOI: 10.1016/j.amjsurg.2020.09.037] [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] [Received: 07/04/2020] [Revised: 09/12/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Multivisceral resection may be the exclusive radical procedure for cT4b gastric cancer patients. However, most surgeons refuse to select surgery because of the theoretical higher mortality, morbidity and poorer prognosis. METHODS We retrospectively reviewed cT4b gastric cancer patients who underwent surgery from January 1,1997 to December 31,2018. The primary endpoint was overall survival. Short-term results and prognostic values of clinical and pathologic factors were also analyzed. RESULTS Patients underwent multivisceral resection had an acceptable mortality and morbidity. The overall 5-year survival rate of multivisceral resection was higher than that of palliative surgery (P < 0.05). And independent prognostic factors of multivisceral resection were R+ resection, extensive lymph node involved (>15), vascular cancer emboli, and postoperative chemotherapy. CONCLUSIONS cT4b gastric cancer patients underwent multivisceral resection experience acceptable mortality and morbidity. The independent prognostic factors for multivisceral resection were completeness of resection, extensive lymph node involvement (>15), vascular cancer emboli, and postoperative chemotherapy.
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Affiliation(s)
- Yanpeng Yang
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Jianwen Hu
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Yongchen Ma
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Guowei Chen
- Department of General Surgery, Peking University First Hospital, Beijing, China.
| | - Yucun Liu
- Department of General Surgery, Peking University First Hospital, Beijing, China.
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Wang GC, Liu YJ, Gao CQ, Wang YC, Lv HF, Chen BB, Nie CY, Chen XB, Luo SX. Surgical outcomes and survival for T4 gastric cancer extending to the transverse colon. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:947. [PMID: 32953747 PMCID: PMC7475396 DOI: 10.21037/atm-20-3377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background For the treatment of locally advanced (T4) gastric cancer, extended multi-organ resection remains controversial. This study aimed to evaluate the surgical outcomes and survival of patients with T4 gastric cancer extending to the transverse colon. Methods A total of 2,652 gastric cancer patients underwent surgery between December 2011 and December 2015. Data from 40 of these patients who underwent curative resection for T4 gastric cancer extending to the transverse colon were obtained. Patient characteristics, related complications, long-term survival, and prognostic factors for T4 gastric cancer were analyzed. Results Postoperative morbidity occurred in 5 (12.5%) patients. All of the patients were cured with conservative treatment. No procedure-related mortality occurred. The 1-, 3-, and 5-year overall survival (OS) rates were 75.0%, 49.2%, and 36.9%, respectively, with a median survival time of 24 months. Univariate analysis revealed tumor size (P=0.049), advanced T stage (P=0.013), and lymph node metastasis (P=0.006) to be poor prognostic factors of OS. Advanced T stage and lymph node metastasis were identified by multivariate analysis as being independent prognostic factors. Further, it was observed that lymph node metastasis grade was associated with poorer OS. Conclusions Patients with T4 gastric cancer extending to the transverse colon might benefit from curative resection with acceptable morbidity and mortality.
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Affiliation(s)
- Gang-Cheng Wang
- Department of General Surgery, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ying-Jun Liu
- Department of General Surgery, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Chong-Qing Gao
- Department of General Surgery, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - You-Cai Wang
- Department of General Surgery, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Hui-Fang Lv
- Department of Gastrointestinal Medical Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Bei-Bei Chen
- Department of Gastrointestinal Medical Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Cai-Yun Nie
- Department of Gastrointestinal Medical Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xiao-Bing Chen
- Department of Gastrointestinal Medical Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Su-Xia Luo
- Department of Gastrointestinal Medical Oncology, the Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Dias AR, Pereira MA, Ramos MFKP, Oliveira RJ, Ribeiro U, Zilberstein B, Cecconello I. Prediction scores for complication and recurrence after multivisceral resection in gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1097-1102. [PMID: 31987704 DOI: 10.1016/j.ejso.2020.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/29/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multivisceral resection (MVR) is indicated in T4b gastric cancer (GC) when R0 can be achieved. Patient's selection for MVR is imperative, since it carries an increased risk for postoperative complications (POC) and disease recurrence. This study aims to elaborate prediction scores for POC and recurrence after MVR for cT4b GC. METHODS Patients who underwent MVR with curative intent due to cT4b gastric adenocarcinoma were selected from our prospective database. Scoring models were based on the variables identified as risk factors for the studied outcome. Through binary regression the model that best predicted the outcome was created. RESULTS From 237 MVRs, 58 fulfilled the inclusion criteria. Males were 70.7%, mean age was 61.8 years. A pT4b was confirmed in 34 patients, 29 had 2 or more adjacent organs removed. Major POC occurred in 25.9%, mortality was 8.6%. Overall survival (OS) and disease-free survival (DFS) were similar for pT4b and non-pT4b. DFS was worse for pN+ and when >2 adjacent organs were removed. Scoring models included 5 and 6 parameters for POC and recurrence, respectively, and their accuracy was 80.6% (95%CI = 0.69-0.92) and 78% (95%CI = 0.66-0.90). The POC and recurrence rates in low- and high-score groups were statistically different (p < 0.001 and p = 0.004, respectively). Patients with high-risk for POC had lower OS (p = 0.036) and DFS was worse in the high-recurrence risk group (p = 0.008). CONCLUSION The proposed scoring systems accurately predict POC and recurrence in GC patients undergoing MVR. These models are easy to use and can assist in the adoption of an individualized approach.
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Affiliation(s)
- Andre Roncon Dias
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil.
| | - Marina Alessandra Pereira
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | | | - Rodrigo Jose Oliveira
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Ulysses Ribeiro
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Bruno Zilberstein
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Ivan Cecconello
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
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Dias AR, Pereira MA, Oliveira RJ, Ramos MFKP, Szor DJ, Ribeiro U, Zilberstein B, Cecconello I. Multivisceral resection vs standard gastrectomy for gastric adenocarcinoma. J Surg Oncol 2020; 121:840-847. [PMID: 32003476 DOI: 10.1002/jso.25862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/17/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Multivisceral resection (MVR) is potentially curative for selected gastric cancer patients, supposedly at the cost of increased complications. However, current data comparing MVR to standard gastrectomy (SG) is lacking. OBJECTIVES Compare complications and survival after MVR and SG. METHODS In a retrospective cohort of 1015 patients with gastric adenocarcinoma, 58 underwent MVR and 466 SG. Groups were compared concerning their characteristics, complications, and survival. RESULTS One hundred seventy-six patients had postoperative complications. Major complications were more frequent after MVR (P = .002). Surgical mortality was 8.6% and 4.9% for MVR and SG (P = .221). Older age, higher morbidities, and MVR were independent risk factors for major complications. The odds ratio for major complications was 5.89 for MVR with one or two organs and 38.01 for MVR with three or more organs. The pancreas was the most commonly removed organ and pT4b disease were confirmed in 34 (58.6%) of the MVR cases. Disease-free survival (DFS) was lower in MVR patients (51% vs 77.8%; P < .001), being worse according to the number of organs resected. In pN+ patients, DFS was worse after MVR. DFS was equivalent to pT4b and non-pT4b in the MVR group. CONCLUSIONS Increased morbidity and lower survival are expected for gastric cancer patients undergoing MVR.
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Affiliation(s)
- Andre R Dias
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marina A Pereira
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Rodrigo J Oliveira
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcus F K P Ramos
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniel J Szor
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ulysses Ribeiro
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Zilberstein
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ivan Cecconello
- Gastrointestinal Surgery Division, Department of Gastroenterology, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Acosta-Mérida M, Ortiz-López D, Callejón-Cara M, Rahy-Martín A, Marchena-Gómez J. Gastric adenocarcinoma: Should pancreaticoduodenectomy be associated with intraoperative suspicion of infiltration? REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Nadiradze G, Yurttas C, Königsrainer A, Horvath P. Significance of multivisceral resections in oncologic surgery: A systematic review of the literature. World J Meta-Anal 2019; 7:269-289. [DOI: 10.13105/wjma.v7.i6.269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multivisceral resections (MVR) are often necessary to reach clear resections margins but are associated with relevant morbidity and mortality. Factors associated with favorable oncologic outcomes and elevated morbidity rates are not clearly defined.
AIM To systematically review the literature on oncologic long-term outcomes and morbidity and mortality in cancer surgery a systematic review of the literature was performed.
METHODS PubMed was searched for relevant articles (published from 2000 to 2018). Retrieved abstracts were independently screened for relevance and data were extracted from selected studies by two researchers.
RESULTS Included were 37 studies with 3112 patients receiving MVR for colorectal cancer (1095 for colon cancer, 1357 for rectal cancer, and in 660 patients origin was not specified). The most common resected organs were the small intestine, bladder and reproductive organs. Median postoperative morbidity rate was 37.9% (range: 7% to 76.6%) and median postoperative mortality rate was 1.3% (range: 0% to 10%). The median conversion rate for laparoscopic MVR was 7.9% (range: 4.5% to 33%). The median blood loss was lower after laparoscopic MVR compared to the open approach (60 mL vs 638 mL). Lymph-node harvest after laparoscopic MVR was comparable. Report on survival rates was heterogeneous, but the 5-year overall-survival rate ranged from 36.7% to 90%, being worst in recurrent rectal cancer patients with a median 5-year overall survival of 23%. R0 -resection, primary disease setting and no lymph-node or lymphovascular involvement were the strongest predictors for long-term survival. The presence of true malignant adhesions was not exclusively associated with poorer prognosis.
Included were 16 studies with 1.600 patients receiving MVR for gastric cancer. The rate of morbidity ranged from 11.8% to 59.8%, and the main postoperative complications were pancreatic fistulas and pancreatitis, anastomotic leakage, cardiopulmonary events and post-operative bleedings. Total mortality was between 0% and 13.6% with an R0 -resection achieved in 38.4% to 100% of patients. Patients after R0 resection had 5-year overall survival rates of 24.1% to 37.8%.
CONCLUSION MVR provides, in a selected subset of patients, the possibility for good long-term results with acceptable morbidity rates. Unlikelihood of achieving R0 -status, lymphovascular- and lymph -node involvement, recurrent disease setting and the presence of metastatic disease should be regarded as relative contraindications for MVR.
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Affiliation(s)
- Giorgi Nadiradze
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
| | - Can Yurttas
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
| | - Philipp Horvath
- Department of General, Visceral and Transplant Surgery, University of Tübingen, Comprehensive Cancer Center, Tübingen 72076, Germany
- National Center for Pleura and Peritoneum, Tübingen 72076, Germany
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Extended Gastrectomy for T4b Gastric Adenocarcinoma: Single-Surgeon Experience. J Gastrointest Cancer 2019; 51:135-143. [PMID: 30895429 DOI: 10.1007/s12029-019-00222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE This study reports single-surgeon experience with extended gastrectomy including en-bloc resection of adjacent organs/structures for T4b stage gastric adenocarcinoma. Time-related changes in patient selection criteria and outcomes were also analyzed. METHODS All consecutive gastrectomies for adenocarcinoma performed between May 2004 and December 2017 were extracted from prospectively collected database to study surgical and oncologic results. Time-related changes in outcomes were examined according to three time periods. RESULTS Five hundred eighty-seven gastrectomies were performed throughout the study period including 87 (14.8%) extended resections. The latter most often included pancreatosplenectomy, colon, and liver resections (21, 16, and 11 patients, respectively) resulting in similar postoperative outcomes and survival. Extended gastrectomy was associated with larger tumor size (8.4 vs 5.6 cm), performing total gastrectomy (55.2 vs 35.2%, p < 0.01) and increased blood loss (375 vs 150 ml, p < 0.01) compared with standard gastrectomy. Larger experience in extended gastrectomy allowed for expanding patient selection criteria, considering complex resections and extensive lymphadenectomy. Median and 3-year survival following extended gastrectomy for T4b adenocarcinoma were 14 months and 18%, respectively, which was comparable to standard gastrectomy for T4a adenocarcinoma (p = 0.48). Obesity, nodal stage and type of gastrectomy were associated with survival in T4b adenocarcinoma in the univariable analysis. Obesity and N3a and N3b stages were independent predictors in the multivariable model. CONCLUSIONS Extended gastrectomy for T4b gastric adenocarcinoma provides satisfactory surgical outcomes even with expanded patient selection criteria and regardless of the organ involved. Given its poor prognosis, neoadjuvant therapy should be considered to improve the long-term oncologic results.
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Oter V, Dalgic T, Ozer I, Colakoglu K, Cayci M, Ulas M, B Bostanci E, Musa A. Comparison of Early Postoperative Outcomes after Total Gastrectomy and D2 Lymph Node Dissection with and without Splenectomy. Euroasian J Hepatogastroenterol 2019; 8:108-111. [PMID: 30828550 PMCID: PMC6395487 DOI: 10.5005/jp-journals-10018-1274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/29/2018] [Indexed: 11/23/2022] Open
Abstract
Background A famous prognostic ingredient for gastric cancer is the lymph node metastasis. Previously in the therapy of gastric cancer, splenectomy was considered as a definitive part of lymph node dissection. Currently, preservation of the spleen is the accepted approach during total gastrectomy and routine splenectomy is abandoned. The aim of this study was to estimate the impression of splenectomy for D2 lymph node dissection with total gastrectomy. Methodology Between February 1998 and January 2012, 1531 patients underwent gastric cancer surgery. Of these 257 patients, 205 patients underwent total gastrectomy with splenectomy, and the remaining 52 underwent a spleen-preserving total gastrectomy. Results No statistical difference between these two groups in terms of age, gender, comorbidity, stage and American Society of Anesthesiologists score, surgical complications were detected. A significant difference was not seen in these groups with regard to postoperative mortality too. Conclusion Early postoperative results were similar after TG ± splenectomy. Performing splenectomy did not increase the postoperative morbidity and mortality. How to cite this article: Oter V, Dalgic T, Ozer I, Colakoglu K, Cayci M, Ulas M, Bostanci EB, Akoglu M. Comparison of Early Postoperative Outcomes after Total Gastrectomy and D2 Lymph Node Dissection with and without Splenectomy. Euroasian J Hepatogastroenterol, 2018;8(2):108-111.
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Affiliation(s)
- Volkan Oter
- Department of Gastroenterological Surgery, School of Medicine, Sakarya University. Sakarya/Türkiye
| | - Tahsin Dalgic
- Department of Gastroenterological Surgery, Turkiye YuksekIhtisas Teaching and Research, Hospital, Ankara/Türkiye
| | - Ilter Ozer
- Department of Gastroenterological Surgery, School of Medicine, Eskişehir Osmangazi University. Sakarya/Türkiye
| | - Kadri Colakoglu
- Department of Gastroenterological Surgery, School of Medicine, Recep Tayyip Erdoyğan University. Rize/Türkiye
| | - Murat Cayci
- Department of Gastroenterological Surgery, Şevket Yılmaz Teaching and Research, Hospital, Bursa/Türkiye
| | - Murat Ulas
- Department of Gastroenterological Surgery, School of Medicine, Eskişehir Osmangazi University. Sakarya/Türkiye
| | - Erdal B Bostanci
- Department of Gastroenterological Surgery, Turkiye YuksekIhtisas Teaching and Research, Hospital, Ankara/Türkiye
| | - Akoglu Musa
- Department of Gastroenterological Surgery, Turkiye YuksekIhtisas Teaching and Research, Hospital, Ankara/Türkiye
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16
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Molina JC, Al-Hinai A, Gosseling-Tardif A, Bouchard P, Spicer J, Mulder D, Mueller CL, Ferri LE. Multivisceral Resection for Locally Advanced Gastric and Gastroesophageal Junction Cancers-11-Year Experience at a High-Volume North American Center. J Gastrointest Surg 2019; 23:43-50. [PMID: 29663302 DOI: 10.1007/s11605-018-3746-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 03/13/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The oncologic benefit of multivisceral en bloc resections for T4 gastroesophageal tumors has been questioned, given the increased morbidity associated. We thus sought to investigate the surgical and oncologic outcomes of curative-intent en bloc multivisceral resections for T4 gastroesophageal carcinomas. METHODS Between 2005 and 2016, 35 of the 525 patients who had gastric or EGJ carcinomas underwent curative-intent multivisceral resections for direct invasion or adhesion to adjacent organs. RESULTS Postoperative complications occurred in 16(46%), 10 of which were Clavien-Dindo ≥ 3 (29%). Ninety-day mortality was 3%. The R0 resection rate was 94% (33). Direct organ invasion (pT4b) was confirmed on pathological analysis in 14 (40%) and did not affect survival. The majority (28, 80%) had lymph node involvement with a high nodal disease burden and was associated with decreased survival. Overall 5-year survival rate was 34%, and the vast majority of recurrences were distant/peritoneal (81%). On multivariate analysis, positive lymph nodes (H.R. 21.2; 95%CI 2.34-192) and R1 resection (H.R. 5.6; 95%CI 1.02-30.9) were predictors of survival. CONCLUSION Multivisceral resections for T4 gastric and GEJ adenocarcinomas, in combination with effective systemic therapy, result in prolonged long-term survival with acceptable morbidity. Complete resection to negative margins should remain a mainstay of curative-intent treatment in carefully selected patients.
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Affiliation(s)
- J C Molina
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada.
| | - A Al-Hinai
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - A Gosseling-Tardif
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - P Bouchard
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - J Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - D Mulder
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - C L Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - L E Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Centre, Montreal, QC, Canada
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Surgery for Locally Advanced GIT Cancers Has Potentially Good Postoperative Outcomes in a Tertiary Hospital. J Gastrointest Cancer 2018; 51:23-29. [DOI: 10.1007/s12029-018-0181-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
BACKGROUND Multivisceral resections seem to be naturally associated with an elevated morbidity rate. Data regarding the impact of multivisceral resections on progression-free and overall survival are only available in insufficient quantities. OBJECTIVE Data on multivisceral resections in cancer surgery are presented exemplified by gastric cancer, colorectal cancer and peritoneal metastases, focusing on overall and progression-free survival as well as morbidity and mortality. MATERIAL AND METHODS A PubMed search was carried out including the following terms: multivisceral resection, peritoneal metastases, cytoreduction, morbidity, HIPEC (hyperthermic intraperitoneal chemotherapy) RESULTS: Multivisceral resections should only be performed if an R0 status can be achieved for all tumor entities. Preoperative performance of an FDG-PET-CT scan (fluorodeoxyglucose positron emission tomography computed tomography scan) can help in the selection of appropriate patients. In gastric cancer, extensive lymphatic metastases are associated with a poor overall survival despite multivisceral resection. Recurrent rectal cancer shows elevated morbidity rates and also decreased overall survival rates. Maximum cytoreductive surgery can be conducted for peritoneal metastasized appendiceal neoplasms and colorectal cancer with acceptable morbidity and without an increased risk for reduced overall survival. CONCLUSION After adequate patient selection and exclusion of stage IV distant metastatic disease, multivisceral resections can be offered to patients with the goal of an R0 resection.
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Affiliation(s)
- P Horvath
- Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - A Königsrainer
- Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
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19
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Acosta-Mérida MA, Ortiz-López D, Callejón-Cara MM, Rahy-Martín A, Marchena-Gómez J. Gastric adenocarcinoma: Should pancreaticoduodenectomy be associated with intraoperative suspicion of infiltration? REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2018; 84:405-407. [PMID: 30119967 DOI: 10.1016/j.rgmx.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/21/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Affiliation(s)
- M A Acosta-Mérida
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España.
| | - D Ortiz-López
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - M M Callejón-Cara
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - A Rahy-Martín
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
| | - J Marchena-Gómez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
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Li Z, Bai B, Zhao Y, Yu D, Lian B, Liu Y, Zhao Q. Severity of complications and long-term survival after laparoscopic total gastrectomy with D2 lymph node dissection for advanced gastric cancer: A propensity score-matched, case-control study. Int J Surg 2018; 54:62-69. [PMID: 29698790 DOI: 10.1016/j.ijsu.2018.04.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/11/2018] [Accepted: 04/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increasing numbers of studies have shown that postoperative complication is a negative predictor of long-term survival outcomes in various malignancies. However, the impact of severity of complications on long-term survival for patients with gastric cancer still remains unclear. This study aimed to explore the relationship between the severity of complications and long-term survival outcomes after laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC). METHODS The study analyzed 571 patients with AGC who underwent LTG in a single institution between April 2008 and June 2015. Patients were divided into two groups based on the occurrence or absence of postoperative complications which were recorded using the Clavien-Dindo (C-D) classification. Long-term survival outcomes were compared between groups in the propensity score-matched cohort. RESULTS The groups were well balanced after the propensity score matched. The complication (C) group was associated with decreased 5-year cancer-specific survival (CSS) (65.1% vs. 76.2%, P=0.049). Subgroup analysis showed that the severe complication (C-D grade > II) group was associated with decreased 5-year overall survival (OS) (46.3% vs. 65.9%, P = 0.042) and cancer-specific survival (CSS) (53.7% vs. 74.4%, P = 0.030). However, a comparative analysis of 5-year OS and CCS showed no significant differences between the minor complication (C-D grade II) group and matched NC group (68.9% vs. 72.2%, P = 0.578; 75.6% vs. 77.8%, P = 0.649; respectively). Multivariate analysis confirmed severe complication was an independent risk factor for decreased OS. Further analysis showed that older age, lower body mass index (BMI), and combined resection were independent risk factor for the occurrence of severe complications. CONCLUSIONS Severe complications adversely affected long-term survival outcomes after LTG with D2 lymph node dissection for AGC. More attention should be paid to patients at high risk for severe complications in preoperative assessment and postoperative management.
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Affiliation(s)
- Zhengyan Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China.
| | - Bin Bai
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China
| | - Yan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China
| | - Deliang Yu
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China
| | - Bo Lian
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China
| | - Yezhou Liu
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China
| | - Qingchuan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xian 710032, China.
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Mita K, Ito H, Katsube T, Tsuboi A, Yamazaki N, Asakawa H, Hayashi T, Fujino K. Prognostic Factors Affecting Survival After Multivisceral Resection in Patients with Clinical T4b Gastric Cancer. J Gastrointest Surg 2017; 21:1993-1999. [PMID: 28940122 DOI: 10.1007/s11605-017-3559-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/21/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognosis and survival of patients with advanced gastric cancer is poor. Although completeness of resection (R0) is one of the most important factors affecting survival, multivisceral resection (MVR) for locally advanced (clinical T4b, cT4b) gastric cancer remains controversial. The aim of this study was to evaluate the factors affecting prognosis and survival after MVR in patients with cT4b gastric cancer. METHODS Between 2005 and 2015, we retrospectively reviewed the medical records of 103 patients who underwent MVR for cT4b gastric cancer with suspected direct invasion to adjacent organs. Patient characteristics, related complications, long-term survival, and prognostic factors of cT4b gastric cancer were analyzed. RESULTS Postoperative mortality and morbidity rates of patients after MVR were 1.0 and 37.9%, respectively. R0 resection was achieved in 82.5% patients, all of whom had a significantly improved survival rate. Overall survival rates at 1 and 3 years were 78.3 and 47.7% for R0 resection and 46.6 and 14.3% for R1 resection, respectively (R0 vs. R1, P < 0.002). Multivariate analysis revealed that completeness of resection (R0) was an independent prognostic factor associated with longer survival. CONCLUSIONS In patients with cT4b gastric cancer, gastrectomy with MVR to achieve an R0 resection can be performed with acceptable postoperative morbidity and mortality rates and can have a positive impact on long-term survival.
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Affiliation(s)
- Kazuhito Mita
- Department of Surgery, New Tokyo Hospital, 1271 Wanagaya, Matudo, Chiba, Japan.
| | - Hideto Ito
- Department of Surgery, New Tokyo Hospital, 1271 Wanagaya, Matudo, Chiba, Japan
| | - Toshio Katsube
- Department of Surgery, New Tokyo Hospital, 1271 Wanagaya, Matudo, Chiba, Japan
| | - Ayaka Tsuboi
- Department of Surgery, New Tokyo Hospital, 1271 Wanagaya, Matudo, Chiba, Japan
| | - Nobuyoshi Yamazaki
- Department of Surgery, New Tokyo Hospital, 1271 Wanagaya, Matudo, Chiba, Japan
| | - Hideki Asakawa
- Department of Surgery, New Tokyo Hospital, 1271 Wanagaya, Matudo, Chiba, Japan
| | - Takashi Hayashi
- Department of Surgery, New Tokyo Hospital, 1271 Wanagaya, Matudo, Chiba, Japan
| | - Keiichi Fujino
- Department of Surgery, New Tokyo Hospital, 1271 Wanagaya, Matudo, Chiba, Japan
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Xiao H, Ma M, Xiao Y, Ouyang Y, Tang M, Zhou K, Hong Y, Tang B, Zuo C. Incomplete resection and linitis plastica are factors for poor survival after extended multiorgan resection in gastric cancer patients. Sci Rep 2017; 7:15800. [PMID: 29150634 PMCID: PMC5694005 DOI: 10.1038/s41598-017-16078-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/07/2017] [Indexed: 12/12/2022] Open
Abstract
The aim of this retrospective study was to analyze the morbidity, mortality, and survival rates of extended multiorgan resection (EMR) for locally advanced gastric cancer patients compared to gastrectomy alone and a palliative operation. 893 locally advanced gastric cancer patients without distant metastasis had surgery including gastrectomy alone (GA group, n = 798), EMR resection (EMR group, n = 75), and palliative operation (palliative gastrectomy or gastrojejunostomy (PO group, n = 20)). Postoperative mortality and complication rates in the EMR group were significantly higher than in the GA group (2.7% vs 0.4%, P = 0.010 and 25.3% vs 8.1%, P < 0.001, respectively), but similar in the PO group. The median survival time of the EMR group was significantly longer than in the PO group (27 months vs 11 months, P = 0.020), but significantly worse (P = 0.020) than in the GA group (44 months). Incompleteness of resection (R1) and linitis plastica were independent prognostic factors for survival in the EMR group. Three different gastric cancer surgeries led to different postoperative mortality and complication rates. EMR had a better survival rate compared with PO while GA had the longest survival time with the lowest mortality and complication rates.
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Affiliation(s)
- Hua Xiao
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Min Ma
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Yanping Xiao
- Department of Admissions and Employment, Changsha Health Vocational College, Changsha, 410010, China
| | - Yongzhong Ouyang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Ming Tang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Kunyan Zhou
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Yuan Hong
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Bo Tang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Chaohui Zuo
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China.
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Marano L, Polom K, Bartoli A, Spaziani A, De Luca R, Lorenzon L, Di Martino N, Marrelli D, Roviello F, Castagnoli G. Oncologic Effectiveness and Safety of Bursectomy in Patients with Advanced Gastric Cancer: A Systematic Review and Updated Meta-Analysis. J INVEST SURG 2017; 31:529-538. [DOI: 10.1080/08941939.2017.1355942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Luigi Marano
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, “San Matteo degli Infermi Hospital”—ASL Umbria 2, Spoleto (PG), Italy
| | - Karol Polom
- Department of Medical, Surgical and Neuroscience; Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci, Italy
| | - Alberto Bartoli
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, “San Matteo degli Infermi Hospital”—ASL Umbria 2, Spoleto (PG), Italy
| | - Alessandro Spaziani
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, “San Matteo degli Infermi Hospital”—ASL Umbria 2, Spoleto (PG), Italy
| | - Raffaele De Luca
- Department of Surgical Oncology, National Cancer Research Centre—Istituto Tumori “G. Paolo II”, Bari, Italy
| | - Laura Lorenzon
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Natale Di Martino
- Department of Surgical Sciences, Second University of Naples, Naples, Italy
| | - Daniele Marrelli
- Department of Medical, Surgical and Neuroscience; Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci, Italy
| | - Franco Roviello
- Department of Medical, Surgical and Neuroscience; Unit of General and Minimally Invasive Surgery, University of Siena, Viale Bracci, Italy
| | - Giampaolo Castagnoli
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, “San Matteo degli Infermi Hospital”—ASL Umbria 2, Spoleto (PG), Italy
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Zu G, Zhang T, Li W, Sun Y, Zhang X. Impact of clinicopathological parameters on survival after multiorgan resection among patients with T4 gastric carcinoma: a systematic review and meta-analysis. Clin Transl Oncol 2017; 19:750-760. [PMID: 28054321 DOI: 10.1007/s12094-016-1600-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/16/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND The prognostic factors which can improve the overall survival (OS) of patients with T4 gastric carcinoma (GC) are still controversial: a meta-analysis was conducted to analyze the impact of clinicopathological parameters on survival after MOR among patients with T4 GC. METHODS A systematic search was performed. Odd risks (ORs) of patients with T4 GC were used to calculate the relationship between clinicopathological parameters and OS. RESULTS Nine studies involving 941 patients with T4 GC were identified. Well-moderate differentiation led to increased 1-, 3-, 5-year OS with an OR of 2.63, 1.58 and 1.45. Borrmann type I-II led to increased 1-, 3-year OS with an OR of 1.67 and 2.08. No lymph node metastasis led to increased 1-, 3-, 5-year OS with an OR of 7.16, 3.18 and 3.71. Total gastrectomy led to increased 1-, 3-year OS with an OR of 2.01 and 1.79. ≥2 Organs resected led to increased 1-, 3-year OS with an OR of 2.19 and 2.19. TNM stage II-III led to increased 1-, 3-year OS with an OR of 3.68 and 5.75. Curative resection led to increased 1-, 3-, 5-year OS with an OR of 4.46, 5.80 and 5.98. CONCLUSION Well-moderate differentiation, Borrmann type I-II, no lymph node metastasis, total gastrectomy, ≥2 organs resected, TNM stage II-III and curative resection were positive prognostic factors for OS of patients with T4 GC.
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Affiliation(s)
- G Zu
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China.
| | - T Zhang
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China
| | - W Li
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China
| | - Y Sun
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China
| | - X Zhang
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China.
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Ntutumu R, Liu H, Zhen L, Hu YF, Mou TY, Lin T, I BA, Yu J, Li GX. Risk factors for pulmonary complications following laparoscopic gastrectomy: A single-center study. Medicine (Baltimore) 2016; 95:e4567. [PMID: 27512884 PMCID: PMC4985339 DOI: 10.1097/md.0000000000004567] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The risk factors associated with postoperative pulmonary complications (PPCs) following laparoscopic gastrectomy have not been well studied. We sought to identify the risk factors for PPCs following gastric cancer surgery.A retrospective analysis was performed on all gastric cancer patients in a prospective database who underwent a laparoscopic gastrectomy from 2004 to 2014. The potential risk factors for PPCs were evaluated.PPCs occurred in 6.8% (83/1205) of patients and included pneumonia in 56 (67.5%) patients, pleural effusion in 26 (31.3%) patients, and pulmonary embolism in 1 (1.2%) patient. The multivariate analysis identified the following significant risk factors for PPCs: advanced age (odds ratio [OR] = 1.043, 95% confidence interval [CI] = 1.021%, 1.066%), chronic obstructive pulmonary disease (COPD) (OR = 17.788, 95% CI = 2.618%, 120.838%), total gastrectomy (OR = 2.781, 95% CI = 1.726%, 4.480%), time to first diet (OR = 1.175, 95% CI = 1.060%, 1.302%), and postoperative hospital stay (OR = 1.015, 95% CI = 1.002%, 1.028%). The risk factors for pneumonia included advanced age (OR = 1.036, 95% CI = 1.010%, 1.063%), total gastrectomy (OR = 3.420, 95% CI = 1.960%, 5.969%), and time to first diet (OR = 1.207, 95% CI = 1.703%, 1.358%). Only pancreatectomy was a risk factor for pleural effusion (OR = 9.082, 95% CI = 2.412%, 34.206%).The frequency of PPCs in patients with gastric cancer who underwent laparoscopic surgery was relatively high. Patients with cardiac and pulmonary comorbidities and those who undergo total gastrectomy and combined resection should be considered at high risk.
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Hasselgren K, Sandström P, Gasslander T, Björnsson B. Multivisceral Resection in Patients with Advanced Abdominal Tumors. Scand J Surg 2016; 105:147-52. [PMID: 26929293 DOI: 10.1177/1457496915622128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Multivisceral resection for advanced tumors can result in prolonged survival but may also increase the risk of postoperative morbidity and mortality. The primary aim of this study was to investigate whether extensive resections increase the severity of postoperative complications. MATERIALS AND METHODS A retrospective study was conducted between 2009 and 2014 at the Linköping University Hospital surgical department. All patients with a confirmed or presumed malignant disease who underwent a non-standardized surgical procedure requiring a multivisceral resection were included. The primary endpoint was 90-day complications according to the Clavien-Dindo score. RESULTS Forty-eight patients were included, with an age range of 17-77 years. A median of three organs was resected. The most common diagnoses were neuroendocrine tumor (n = 8), gastric cancer (n = 7), and gastrointestinal stromal tumor (n = 6). One patient died during surgery. Complications ⩾ grade 3b according to Clavien-Dindo score occurred in 10 patients. R0 resection was achieved in 32 patients. No correlation was observed between the number of anastomoses, perioperative blood loss, operative time, and complications. Only postoperative blood transfusion was correlated with severe complications (p = 0.046); however, a tendency toward more complications with an increasing number of resected organs was observed (p = 0.06). CONCLUSION Multivisceral resection can result in R0, potentially curing patients with advanced tumors. Here, no correlation between extensive resections and complications was observed. Only postoperative blood transfusion was correlated with severe complications.
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Affiliation(s)
- K Hasselgren
- Department of Surgery, Linköping University, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - P Sandström
- Department of Surgery, Linköping University, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - T Gasslander
- Department of Surgery, Linköping University, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - B Björnsson
- Department of Surgery, Linköping University, Linköping, Sweden Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Surgical management of advanced gastric cancer: An evolving issue. Eur J Surg Oncol 2015; 42:18-27. [PMID: 26632080 DOI: 10.1016/j.ejso.2015.10.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/30/2015] [Indexed: 01/01/2023] Open
Abstract
Worldwide, gastric cancer represents the fifth most common cancer and the third leading cause of cancer deaths. Although the overall 5-year survival for resectable disease was more than 70% in Japan due to the implementation of screening programs resulting in detection of disease at earlier stages, in Western countries more than two thirds of gastric cancers are usually diagnosed in advanced stages reporting a 5-year survival rate of only 25.7%. Anyway surgical resection with extended lymph node dissection remains the only curative therapy for non-metastatic advanced gastric cancer, while neoadjuvant and adjuvant chemotherapies can improve the outcomes aimed at the reduction of recurrence and extension of survival. High-quality research and advances in technologies have contributed to well define the oncological outcomes and have stimulated many clinical studies testing multimodality managements in the advanced disease setting. This review article aims to outline and discuss open issues in current surgical management of advanced gastric cancer.
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Tran TB, Worhunsky DJ, Norton JA, Squires MH, Jin LX, Spolverato G, Votanopoulos KI, Schmidt C, Weber S, Bloomston M, Cho CS, Levine EA, Fields RC, Pawlik TM, Maithel SK, Poultsides GA. Multivisceral Resection for Gastric Cancer: Results from the US Gastric Cancer Collaborative. Ann Surg Oncol 2015; 22 Suppl 3:S840-7. [PMID: 26148757 DOI: 10.1245/s10434-015-4694-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Resection of an adjacent organ during gastrectomy for gastric cancer is occasionally necessary to achieve margin clearance. The short- and long-term outcomes of this approach remain unclear. METHODS Patients who underwent gastric cancer resection in seven U.S. academic institutions from 2000 to 2012 were evaluated to compare perioperative morbidity, mortality, and survival outcomes, stratified by the need for and type of multivisceral resection (MVR). RESULTS Of 835 patients undergoing curative-intent gastrectomy, 159 (19 %) had MVR. The most common adjacent organs resected were the spleen (48 %), pancreas (27 %), liver segments 2/3 (14 %), and colon (13 %). As extent of resection increased (gastrectomy only, n = 676; MVR without pancreatectomy, n = 116; and MVR with pancreatectomy, n = 43), perioperative morbidity was higher: any complication (45, 60, 59 %, p = 0.012), major complication (17, 31, 33 %, p = 0.001), anastomotic leak (5, 11, 19 %, p < 0.001), and respiratory failure (9, 15, 22 %, p = 0.012). However, perioperative mortality did not significantly increase (30-day: 3, 4, 2 %, p = 0.74; 90-day: 6, 8, 9 %, p = 0.61). Overall survival after resection decreased as extent of resection increased (5-year: 42, 28, 6 %). After controlling for age, race, T stage, N stage, grade, margin status, perineural invasion, adjuvant therapy, and blood transfusion, MVR with pancreatectomy (HR 1.67, p = 0.044), but not MVR without pancreatectomy (HR 0.97, p = 0.759), remained an independent predictor of poor survival. CONCLUSION In this modern, multi-institutional cohort of gastric cancer patients, multivisceral resection was associated with higher perioperative morbidity but not significantly higher perioperative mortality. If concomitant pancreatectomy is anticipated, patients should be selected with extreme caution because long-term survival remains poor.
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Affiliation(s)
- Thuy B Tran
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - David J Worhunsky
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Jeffrey A Norton
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Malcolm Hart Squires
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Linda X Jin
- Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University, St. Louis, MO, USA
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Carl Schmidt
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Sharon Weber
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Mark Bloomston
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Clifford S Cho
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Edward A Levine
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Ryan C Fields
- Department of Surgery, Barnes Jewish Hospital and The Alvin J. Siteman Cancer Center, Washington University, St. Louis, MO, USA
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Shishir K Maithel
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - George A Poultsides
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
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Zhou J, Yu P, Shi Y, Tang B, Hao Y, Zhao Y, Qian F. Evaluation of Clavien-Dindo classification in patients undergoing total gastrectomy for gastric cancer. Med Oncol 2015; 32:120. [PMID: 25788033 DOI: 10.1007/s12032-015-0573-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 03/13/2015] [Indexed: 12/24/2022]
Abstract
The Clavien-Dindo classification for postoperative complications has been established as a standardized system and applied in many fields of surgery. The aim of our study was to assess the complications after total gastrectomy using the Clavien-Dindo classification and identify risk factors related to them. Four hundred and fifteen patients who underwent total gastrectomy for gastric cancer between April 2009 and September 2014 were enrolled in this study. Postoperative complications were graded, and possible risk factors related to complications were analyzed. The overall complication rate was 13.3 %, with the severe complications classified as grade III or above accounting for 3.1 %. Age of 65 years old or more, higher TNM staging, and open surgery were identified as independent risk factors for overall complications. Age of 65 years old or more, ASA score of 3 or more, multiorgan resection, and retrieved lymph nodes of 30 or more were identified as independent risk factors for severe complications. The Clavien-Dindo system has a broad applicability and facilitates the assessment on the incidence and severity of complications. Large-scaled, prospective clinical trials using the classification are necessary to evaluate the postoperative complications of total gastrectomy for gastric cancer.
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Affiliation(s)
- Junfeng Zhou
- Department of General Surgery and Center of Minimal Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Gaotanyan Street 30, Shapingba District, Chongqing, 400038, China
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Hu X, Cao L, Yu Y. Prognostic prediction in gastric cancer patients without serosal invasion: comparative study between UICC 7(th) edition and JCGS 13(th) edition N-classification systems. Chin J Cancer Res 2014; 26:596-601. [PMID: 25400426 DOI: 10.3978/j.issn.1000-9604.2014.10.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 10/09/2014] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE T-stage and N-stage have been proven to be the most important factors influencing survival in gastric cancer patients, and have been accepted for use in the Japanese Classification of Gastric Carcinoma (JCGC) and the Union International Cancer Control (UICC-TNM) staging systems. The purpose of this study was to compare the prognostic values of the different N classification systems in gastric cancer patients without serosal invasion. METHODS We retrospectively compared the clinicopathological results of 1,115 patients with primary gastric cancer who underwent curative gastric resection. RESULTS Serosal invasion was identified in 212 of 1,115 patients (19.0%), and it was associated with lymph node metastasis according to the JCGC(13th) (P<0.001) and TNM(7th) (P<0.001) systems. The 5-year survival rate for the serosal invasion-negative patients (78.2%) was significantly higher than that for the serosal invasion-positive patients (31.1%) (P<0.001). Multivariate Cox regression survival analysis showed that depth of invasion (P=0.013), 13(th) JCGC PN stage (P<0.001), and 7(th) TNM PN stage (P<0.001) were independent prognostic factors for serosal invasion-negative gastric cancer patients. CONCLUSIONS The prognosis of gastric cancer patients with serosal invasion is very poor. Both the 13(th) JCGC and 7(th) TNM N-staging systems were able to accurately estimate the prognosis of gastric cancer patients, but the 7(th) TNM system was simpler and easier to use.
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Affiliation(s)
- Xiang Hu
- Department of General Surgery, The First Affiliated Hospital, Dalian Medical University, Dalian 116011, China
| | - Liang Cao
- Department of General Surgery, The First Affiliated Hospital, Dalian Medical University, Dalian 116011, China
| | - Yi Yu
- Department of General Surgery, The First Affiliated Hospital, Dalian Medical University, Dalian 116011, China
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Lee JH, Kim JG, Jung HK, Kim JH, Jeong WK, Jeon TJ, Kim JM, Kim YI, Ryu KW, Kong SH, Kim HI, Jung HY, Kim YS, Zang DY, Cho JY, Park JO, Lim DH, Jung ES, Ahn HS, Kim HJ. [Synopsis on clinical practice guideline of gastric cancer in Korea: an evidence-based approach]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:66-81. [PMID: 24561693 DOI: 10.4166/kjg.2014.63.2.66] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Although, gastric cancer is quite common in Korea, the treatment outcome is relatively favorable compared to that of Western countries. However, there is no Korean multidisciplinary guideline for gastric cancer and thus, a guideline adequate for domestic circumstances is required. Experts from related societies developed 22 recommendation statements for the diagnosis (n=9) and treatment (n=13) based on relevant key questions. Evidence levels based on systematic review of literatures were classified as five levels from A to E, and recommendation grades were classified as either strong or weak. The topics of this guideline cover diagnostic modalities (endoscopy, endoscopic ultrasound, radiologic diagnosis), treatment modalities (surgery, therapeutic endoscopy, chemotherapy, radiotherapy) and pathologic evaluation. External review of the guideline was conducted at the finalization phase.
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Affiliation(s)
- Jun Haeng Lee
- Department of Gastroenterology, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul 156-861, Korea
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Li MZ, Deng L, Wang JJ, Xiao LB, Wu WH, Yang SB, Li WF. Surgical outcomes and prognostic factors of T4 gastric cancer patients without distant metastasis. PLoS One 2014; 9:e107061. [PMID: 25211331 PMCID: PMC4161379 DOI: 10.1371/journal.pone.0107061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/05/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate surgical outcomes and prognostic factors for T4 gastric cancer treated with curative resection. Methods Between January 1994 and December 2008, 94 patients diagnosed with histological T4 gastric carcinoma and treated with curative resection were recruited. Patient characteristics, surgical complications, survival, and prognostic factors were analyzed. Results Postoperative morbidity and mortality were 18.1% and 2.1%, respectively. Multivariate analysis indicated lymph node metastasis (hazard ratio, 2.496; 95% confidence interval, 1.218–5.115; p = 0.012) was independent prognostic factor. Conclusions For patients with T4 gastric cancer, lymph node metastasis was associated with poorer survival. Neoadjuvant chemotherapy or aggressive adjuvant chemotherapy after radical resection was strongly recommended for these patients.
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Affiliation(s)
- Ming-zhe Li
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Deng
- Department of General Surgery I, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-jing Wang
- Department of laboratory, Hexian Memory Hospital of Panyu District, Guangzhou, China
| | - Long-bin Xiao
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail:
| | - Wen-hui Wu
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shi-bin Yang
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen-feng Li
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lee KG, Lee HJ, Yang JY, Oh SY, Bard S, Suh YS, Kong SH, Yang HK. Risk factors associated with complication following gastrectomy for gastric cancer: retrospective analysis of prospectively collected data based on the Clavien-Dindo system. J Gastrointest Surg 2014; 18:1269-77. [PMID: 24820136 DOI: 10.1007/s11605-014-2525-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most studies about complication after gastric cancer surgery have been performed without consideration of the severity of each complication. The purposes of this study were to prospectively analyze all postgastrectomy complications according to severity using Clavien-Dindo classification and to identify risk factors related to postoperative complications. METHODS Complication data were collected prospectively through weekly conferences with all gastric adenocarcinoma patients who underwent gastrectomy between March 2011 and February 2012 at Seoul National University Hospital. Complications were categorized according to the Clavien-Dindo classification. RESULTS Out of the 881 patients who underwent gastrectomy, there were 254 events in 197 patients (22.4%). The numbers of grade I, II, IIIa, IIIb, IVa, and V complications according to the Clavien-Dindo classification were 71 (8.1%), 58 (6.6%), 108 (12.3%), 8 (0.9%), 5 (0.6%), and 4 (0.5%), respectively. Extended gastrectomy (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.96-7.82, p < 0.001), total gastrectomy (OR, 1.97; 95% CI, 1.24-3.14, p = 0.004), and age of 60 years or more (OR, 1.66; 95% CI, 1.15-2.38, p = 0.007) were found to be significant independent risk factors for overall complications of gastrectomy. These three factors were also risk factors for the complications of grade IIIa or over and local and systemic complications. In addition, ASA 3 or 4 and moderate or severe malnutrition as well as those three factors were risk factors for systemic complications. CONCLUSION Age and the extent of gastrectomy were revealed as the prognostic factors for overall complications and the complications of grade IIIa or over according to the Clavien-Dindo classification following gastrectomy for gastric cancer.
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Affiliation(s)
- Kyung-Goo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Lee JH, Kim JG, Jung HK, Kim JH, Jeong WK, Jeon TJ, Kim JM, Kim YI, Ryu KW, Kong SH, Kim HI, Jung HY, Kim YS, Zang DY, Cho JY, Park JO, Lim DH, Jung ES, Ahn HS, Kim HJ. Clinical practice guidelines for gastric cancer in Korea: an evidence-based approach. J Gastric Cancer 2014; 14:87-104. [PMID: 25061536 PMCID: PMC4105383 DOI: 10.5230/jgc.2014.14.2.87] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 06/26/2014] [Indexed: 12/13/2022] Open
Abstract
Although gastric cancer is quite common in Korea, the treatment outcome is relatively favorable compared to those in western countries. However, there are currently no Korean multidisciplinary guidelines for gastric cancer. Experts from related societies developed guidelines de novo to meet Korean circumstances and requirements, including 23 recommendation statements for diagnosis (n=9) and treatment (n=14) based on relevant key questions. The quality of the evidence was rated according to the GRADE evidence evaluation framework: the evidence levels were based on a systematic review of the literature, and the recommendation grades were classified as either strong or weak. The applicability of the guidelines was considered to meet patients' view and preferences in the context of Korea. The topics of the guidelines cover diagnostic modalities (endoscopy, endoscopic ultrasound, and radiologic diagnosis), treatment modalities (surgery, therapeutic endoscopy, chemotherapy, and radiotherapy), and pathologic evaluation. An external review of the guidelines was conducted during the finalization phase.
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Affiliation(s)
- Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae G. Kim
- Department of Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye-Kyung Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University, College of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Mee Kim
- Department of Pathology, Inha University School of Medicine, Incheon, Korea
| | - Young Il Kim
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sik Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Jae Yong Cho
- Department of Medical Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Oh Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sun Jung
- Department of Pathology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Xiao L, Li M, Xu F, Ye H, Wu W, Long S, Li W, He Y. Extended multi-organ resection for cT4 gastric carcinoma: A retrospective analysis. Pak J Med Sci 2013; 29:581-5. [PMID: 24353581 PMCID: PMC3809257 DOI: 10.12669/pjms.292.2898] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 12/24/2012] [Accepted: 02/26/2013] [Indexed: 12/29/2022] Open
Abstract
Objective: Combined resection for locally advanced (T4) gastric cancer may result in high morbidity and mortality. The aim of this study was to evaluate the clinicopathologic characteristics to determine the prognostic factors for T4 gastric cancers. Methodology: A total of 463 consecutive patients with gastric cancers were enrolled in this study. Among them, 63 patients received combined resections. Various clinicopathologic factors influencing survival rates were evaluated. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors were evaluated by the univariate and multivariate analysis. Results: Thirty-one patients (49.2%) received one additional organ resection and 32 patients (50.8%) received two or more additional organ resections. Curative resection was performed in 49 patients (77.8%). Multivariate analysis identified curative resection (hazard ratio 0.330; 95 percent confidence interval, 0.139-0.784; P = 0.012) and tumor diameter (> 7 cm) (hazard ratio, 3.589; the 95 percent confidence interval, 1.425-9.037; P = 0.007) as independent prognostic factor for patients with T4 gastric cancer undergoing combined resection. Conclusions: The use of aggressive multi-organ resection was recommended for patients with T4 gastric carcinoma, with tumor diameter as a useful indicator. Patients with relatively small tumor diameter (≤ 7cm) could benefit from multi-organ resections.
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Affiliation(s)
- Longbin Xiao
- Longbin Xiao, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700
| | - Mingzhe Li
- Mingzhe Li, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700
| | - Fengfeng Xu
- Fengfeng Xu, Department of General Surgery I, Huangpu Division of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, 510700
| | - Huishao Ye
- Huishao Ye, Department of Pharmacy, Huangpu Division of the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, 510700
| | - Wenhui Wu
- Wenhui Wu, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700
| | - Shuo Long
- Shuo Long, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700
| | - Wenfeng Li
- Wenfeng Li, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700
| | - Yulong He
- Yulong He, Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, 510700
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Favacho BC, Costa CDS, Magalhães TC, Assumpção PPD, Ishak G. Adenocarcinoma gástrico T4b: experiência de 12 anos em Hospital Universitário. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2013; 26:268-73. [DOI: 10.1590/s0102-67202013000400004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 08/19/2013] [Indexed: 11/21/2022]
Abstract
A neoplasia gástrica é doença heterogênea e multifatorial, com incidência e mortalidade variando geograficamente. Aproximadamente 60% dos diagnósticos em pacientes de países ocidentais ocorrem nos estádios III ou IV. Nestes doentes, o melhor tratamento consiste na realização de procedimento cirúrgico. OBJETIVO: Identificar os aspectos epidemiológicos de pacientes diagnosticados com adenocarcinoma gástrico T4b. MÉTODOS: Estudo observacional, transversal, retrospectivo, de fonte secundária, dos pacientes diagnosticados com adenocarcinoma gástrico T4b através de estadiamento patológico. Foram analisados 815 prontuários, sendo 27 pacientes estudados. As variáveis investigadas foram: aspectos demográficos, principais queixas, fatores de risco, acesso ao serviço de saúde, aspectos cirúrgicos, morbidade, mortalidade e sobrevida. RESULTADOS: Vinte e dois eram homens (81,5%) e cinco mulheres (18,5%) com idade variando de 38 a 87 e média de 58,78 anos. O tempo de acesso ao serviço, em meses, variou de 1 a 120, com média de 12,5. Os sinais e sintomas mais prevalentes foram: perda de peso 23 (85,2%), epigastralgia 22 (81,5%), vômitos 16 (59,3%) e plenitude gástrica 12 (44,4%). A frequência de acometimento das estruturas adjacentes foi: pâncreas oito (29,6%), fígado sete (25,9%), cólon transverso seis (22,2%), intestino delgado seis (22,2%), mesocólon três (11,1%), baço um (3,7%) e vesícula biliar um (3,7%). Morbidades pós-operatórias ocorreram em 51,85% dos pacientes. Houve associação significativa entre mortalidade cirúrgica e ocorrência de fístula/deiscência, choque séptico e sangramento. A sobrevida ao final de seis meses foi de 63,27%. CONCLUSÃO: A média do tempo entre início dos sintomas e acesso ao serviço de saúde especializado foi elevada. Mais da metade dos pacientes apresentaram morbidades pós-operatórias. Os pacientes que apresentaram fístula/deiscência, sangramentos e choque séptico tiveram associação significativa com mortalidade cirúrgica. A sobrevida ao final de seis meses foi de 63,27%.
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Lee CM, Rao J, Son SY, Ahn SH, Lee JH, Park DJ, Kim HH. Laparoscopic gastrectomy for gastric cancer with simultaneous organ resection. J Laparoendosc Adv Surg Tech A 2013; 23:861-5. [PMID: 23968253 DOI: 10.1089/lap.2013.0081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Simultaneous organ resection is performed in 10% of laparoscopic gastrectomies for gastric cancer. The purpose of this study is to investigate the feasibility and safety of simultaneous organ resection with laparoscopic gastrectomy for gastric cancer. SUBJECTS AND METHODS We retrospectively reviewed the medical records from a prospectively collected database of patients who underwent laparoscopic gastrectomy from May 2003 to April 2012 in a single center. The patients were classified into three groups: a gastrectomy-only (no simultaneous resection [NS]) group as a control, a combined resection (CB) group characterized by additional resection due to tumor invasion and extensive lymphadenectomy, and a concomitant resection (CC) group, including patients with other pathologic conditions. The clinical outcomes, in particular morbidity and mortality, were compared among the three groups. RESULTS The NS, CB, and CC groups included 1883 (90.1%), 66 (3.2%), and 140 (6.7%) patients, respectively. Mean operation time was longer in CB and CC patients than in NS patients (233.0 ± 59.3, 227.4 ± 100.9, and 180.1 ± 54.0 minutes, respectively; P<.001), and mean hospital stay was longer in the CB and CC groups than in the NS group (9.6 ± 5.2, 8.3 ± 4.7, and 6.9 ± 4.4 days, respectively; P<.001). However, there were no statistically significant differences among the groups in the incidence of complications (P=.185), complications more severe than grade II (P=.077), and mortality (P=1.000). CONCLUSIONS Laparoscopic simultaneous organ resection during laparoscopic gastrectomy for gastric cancer prolonged the operation time and hospital stay but did not increase morbidity and mortality.
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Affiliation(s)
- Chang Min Lee
- 1 Department of Surgery, Seoul National University Bundang Hospital , Seongnam, South Korea
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Brar SS, Seevaratnam R, Cardoso R, Yohanathan L, Law C, Helyer L, Coburn NG. Multivisceral resection for gastric cancer: a systematic review. Gastric Cancer 2012; 15 Suppl 1:S100-7. [PMID: 21785926 DOI: 10.1007/s10120-011-0074-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 06/26/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The overall prognosis and survival of patients with advanced gastric cancer is generally poor. One of the most powerful predictors of outcomes in gastric cancer surgery is an R0 resection. However, the extent of the required surgical resection and the additional benefit of multivisceral resection (MVR) are controversial. METHODS Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from January 1, 1998 to December 31, 2009. All search titles and abstracts were independently rated for relevance by a minimum of two reviewers. RESULTS Seventeen studies were included in this review. Among the 1343 patients who underwent MVR, overall complication rates ranged from 11.8 to 90.5%. Perioperative mortality was found to be 0-15%. Pathological T4 disease was confirmed in 28.8-89% of patients. R0 resection and extent of nodal involvement were important predictors of survival in patients undergoing MVR. Patient outcomes may also be affected by the number of organs resected. CONCLUSIONS Gastrectomy with MVR can be safely pursued in patients with locally advanced gastric cancer to achieve an R0 resection. MVR may not be beneficial in patients with extensive nodal disease.
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Affiliation(s)
- Savtaj S Brar
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Suite T2-60, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
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Roberts P, Seevaratnam R, Cardoso R, Law C, Helyer L, Coburn N. Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer. Gastric Cancer 2012; 15 Suppl 1:S108-15. [PMID: 21870150 DOI: 10.1007/s10120-011-0086-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/29/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to identify and synthesize findings from all articles on surgical and long-term outcomes in patients with gastric cancer undergoing gastrectomy combined with pancreaticoduodenectomy (PD). METHODS Electronic literature searches were conducted using Medline, EMBASE, and Cochrane databases from January 1, 1985, to December 31, 2009. RESULTS Eight retrospective case series were included, with 132 patients having PD combined with gastrectomy. PD was combined with total gastrectomy in 27 patients, and subtotal gastrectomy in 81 patients; 24 patients had undocumented gastric resection type. Clinical stage was available for 92 patients (4 stage I, 7 stage II, 26 stage III, and 55 stage IV). Five studies (98 patients having PD combined with gastrectomy) compared PD and gastrectomy to gastrectomy alone. In the four studies reporting morbidity, PD had a higher morbidity. The pooled pancreatic anastomotic leak rate was 24.5% for the seven studies in which complications were reported; however, there were no peri-operative deaths. Long-term survival (37.3% at 5 years) in gastric cancer patients with PD combined with gastrectomy was described; however, survival was poor in the setting of incurable factors. Due to heterogeneity of patients and staging techniques in the case series no recommendations can be made on the appropriate selection criteria for patients undergoing PD and gastrectomy. CONCLUSION PD for gastric cancer invading the pancreas is associated with a higher morbidity; given the heterogeneous data, defining exact selection criteria is difficult.
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Affiliation(s)
- Patrick Roberts
- Division of General Surgery, University of Toronto, Toronto, Canada
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Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival. Gastric Cancer 2012; 15 Suppl 1:S116-24. [PMID: 22138928 DOI: 10.1007/s10120-011-0112-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 10/19/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Complete resection is the only definitive treatment available for gastric cancer. Factors associated with positive margins and their survival effects have been the subject of many studies, but the appropriate management for these patients is still debated. The objective of this review is to examine positive margins after gastric cancer resections by exploring predictive factors, impact on survival, and optimal strategies for re-resection. METHODS A systematic electronic literature search was conducted using Medline and EMBASE from January 1, 1998, to December 31, 2009. Studies on gastric or gastroesophageal junction adenocarcinoma that either investigated the predictors for positive margin or employed multivariate methods to analyze the survival effects of positive margins were selected. RESULTS Twenty-two studies incorporating 19355 patients were included in this review. Positive margins were associated with larger tumor size, deeper wall penetration, more extensive gastric involvement, greater nodal involvement, higher stage, diffuse histology, higher Borrmann type, lymphatic vessel involvement, and total gastrectomy. Patient survival was independently associated with margin status, and this survival effect was more prominent in early cancers in most studies that performed subgroup analyses. CONCLUSIONS The probability of acquiring positive margins is highly dependent on the biology and the extent of the tumor. There is a significant negative effect on survival, which is more prominent in cancers at early stages, making re-resection or a second operation important. Patients with more advanced disease can be offered more extensive surgery to remove disease, but this should be balanced against the risks of more extensive resections.
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Ren X, Zheng N, Gao Y, Chen T, Lu W. Biodegradable three-dimension micro-device delivering 5-fluorouracil in tumor bearing mice. Drug Deliv 2012; 19:36-44. [DOI: 10.3109/10717544.2011.635720] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mita K, Ito H, Fukumoto M, Murabayashi R, Koizumi K, Hayashi T, Kikuchi H. Surgical outcomes and survival after extended multiorgan resection for T4 gastric cancer. Am J Surg 2011; 203:107-11. [PMID: 21474116 DOI: 10.1016/j.amjsurg.2010.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 12/07/2010] [Accepted: 12/07/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Extended multiorgan resection (EMR) for locally advanced (T4) gastric cancer remains controversial. The aim of this study was to evaluate the effectiveness of this approach with regard to morbidity, mortality, and survival. METHODS Between 2005 and 2009, 41 patients underwent aggressive surgery for clinical T4 gastric cancer. Univariate and multivariate analyses were used to identify prognostic factors for surgical outcomes and survival in these patients. RESULTS Curative resection was performed in 29 patients (70.7%); postoperative morbidity and mortality rates were 17.1% and 4.9%, respectively. The survival rate in R0 resection patients was significantly longer than that in patients undergoing R1 or R2 resection. Multivariate analysis identified resectability and tumor size (≥10 cm) as independent prognostic factor for patients with T4 gastric cancer undergoing combined resection. CONCLUSIONS EMR should be performed for patients with T4 gastric cancer in whom curative resection can be used.
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Affiliation(s)
- Kazuhito Mita
- Department of Surgery, Shin-Tokyo Hospital, Chiba, Japan.
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Cheng CT, Tsai CY, Hsu JT, Vinayak R, Liu KH, Yeh CN, Yeh TS, Hwang TL, Jan YY. Aggressive surgical approach for patients with T4 gastric carcinoma: promise or myth? Ann Surg Oncol 2011; 18:1606-14. [PMID: 21222167 DOI: 10.1245/s10434-010-1534-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical outcomes of multiorgan resection (MOR) for T4 gastric carcinoma reported in the literature are widely variable. We herein report a large surgical series of T4 gastric carcinoma. METHODS One hundred seventy-nine patients with cT4 gastric carcinoma were recruited onto the study. Patient characteristics, surgical strategy and related complications, long-term survival, and prognostic factors of T4 gastric carcinoma were analyzed. RESULTS Of 179 cT4 gastric carcinoma, there were 57 cT4 (pT3) with MOR, 91 pT4 with MOR, and 31 cT4 without MOR. pT4 with MOR were more likely to be associated with nodal metastasis, cellular dedifferentiation, and lymphoperineural infiltration compared to those of pT0-3 (P < 0.01 for all). For 91 pT4 with MOR, their surgical mortality and morbidity rates were 4.4 and 28.6%, respectively; their 1-, 3-, and 5-year overall survival rates were 55.2, 22.4, and 12.2%, respectively. The long-term survival of cT4 (pT3) with MOR was superior to pT4 with MOR (P = 0.006) and cT4 without MOR (P = 0.004). There was a striking difference between pT4 with MOR, R0 and pT4 with MOR, and R1 or R2 (P = 0.007). By means of multivariate analysis, lymph node status, liver invasion, and positive surgical margin were independent prognostic factors. CONCLUSIONS Aggressive surgical management of pT4 gastric carcinoma should be limited to patients without adverse prognostic factors such as advanced nodal involvement and pancreatic invasion.
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Affiliation(s)
- Chi-Tung Cheng
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taipei, Taiwan
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Gastric cancer: Patterns of disease spread via the perigastric ligaments shown by CT. AJR Am J Roentgenol 2010; 195:398-404. [PMID: 20651196 DOI: 10.2214/ajr.09.3070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The stomach is suspended in the abdominal cavity by perigastric ligaments, which are derived from the dorsal and ventral mesogastrium. These ligaments provide a direct contiguous pathway for the peritoneal spread of gastric cancer. In this article, we discuss the embryology and anatomy of the stomach and describe the specific ligamentous routes along which gastric cancers may spread by direct invasion. CONCLUSION Extragastric disease alters the prognosis and treatment options available to patients with gastric cancer. Familiarity with the stomach's embryology will help the radiologist understand its anatomy and, therefore, the patterns of regional spread of gastric cancer. The location of the primary tumor can predict involvement of specific perigastric ligaments because locoregional spread of gastric cancer occurs along the arteries, veins, nerves, and lymphatic channels within those ligaments. Thus, identifying the location of the primary tumor can potentially improve patient outcomes.
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Ozer I, Bostanci EB, Koc U, Karaman K, Ercan M, Ulas M, Ozogul YB, Dalgic T, Akoglu M. Surgical treatment for gastric cancer in Turkish patients over age 70: early postoperative results and risk factors for mortality. Langenbecks Arch Surg 2010; 395:1101-6. [PMID: 20217119 DOI: 10.1007/s00423-010-0625-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 02/17/2010] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study was to evaluate the effects of advanced age on early postoperative results and to investigate risk factors for mortality in Turkish gastric cancer patients. METHODS From 2002 to 2007, 549 patients who underwent gastrectomy for gastric cancer were divided into two groups as patients younger than 70 years and patients aged 70 years or older. RESULTS There were 387 patients in the younger group and 162 in the older group. Morbidity rates were similar (25.1% vs. 29.0%). Mortality was higher among the elderly patients (2.6% vs. 9.9%). Advanced age, albumin levels lower than 3 mg/dl, higher American Society of Anesthesiologists score, palliative resections and resection of two or more additional organs were independent risk factors for mortality. CONCLUSION Age alone should not preclude gastric resection in elderly patients. However, for patients with multiple risk factors, more limited surgery should be considered.
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Affiliation(s)
- Ilter Ozer
- Gastrointestinal Surgery, Türkiye Yüksek İhtisas Hospital, Ankara, Turkey.
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Song YJ, Jeong SH, Lee YJ, Park ST, Choi SK, Hong SC, Jung EJ, Joo YT, Jeong CY, Ha WS. The Clinical Outcome of Combined Organ Resection during Radical Gastrectomy. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.5.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yu-Jeong Song
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
| | - Sang-Ho Jeong
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Young-Joon Lee
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Soon-Tae Park
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Sang-Kyung Choi
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Soon-Chan Hong
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Eun-Jung Jung
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Young-tae Joo
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Chi-Young Jeong
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Woo-Song Ha
- Department of Surgery, Postgraduate School of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongnam Regional Cancer Center, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Jinju, Korea
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