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Kubo N, Cho H, Lee D, Yang H, Kim Y, Khalayleh H, Yoon HM, Ryu KW, Hanna GB, Coit DG, Hakamada K, Kim YW. Risk prediction model of peritoneal seeding in advanced gastric cancer: A decision tool for diagnostic laparoscopy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:853-861. [PMID: 36586786 DOI: 10.1016/j.ejso.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/07/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Selective diagnostic laparoscopy in gastric cancer patients at high risk of peritoneal metastasis is essential for optimal treatment planning. In this study available clinicopathologic factors predictive of peritoneal seeding in advanced gastric cancer (AGC) were identified, and this information was translated into a clinically useful tool. METHODS Totally 2833 patients underwent surgery for AGC between 2003 and 2013. The study identified clinicopathologic factors associated with the risk of peritoneal seeding for constructing nomograms using a multivariate logistic regression model with backward elimination. A nomogram was constructed to generate a numerical value indicating risk. Accuracy was validated using bootstrapping and cross-validation. RESULTS The proportion of seeding positive was 12.7% in females and 9.6% in males. Of 2833 patients who underwent surgery for AGC, 300 (10.6%) were intraoperatively identified with peritoneal seeding. Multivariate analysis revealed the following factors associated with peritoneal seeding: high American Society of Anesthesiologists score, fibrinogen, Borrmann type 3 or 4 tumors, the involvement of the middle, anterior, and greater curvature, cT3 or cT4cN1 or cN2 or cN3, cM1, and the presence of ascites or peritoneal thickening or plaque or a nodule on the peritoneal wall on computed tomography. The bootstrap analysis revealed a robust concordance between mean and final parameter estimates. The area under the ROC curve for the final model was 0.856 (95% CI, 0.835-0.877), which implies good performance. CONCLUSIONS This nomogram provides effective risk estimates of peritoneal seeding from gastric cancer and can facilitate individualized decision-making regarding the selective use of diagnostic laparoscopy.
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Affiliation(s)
- Norihito Kubo
- Center for Gastric Cancer, National Cancer Center, Korea; Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan
| | - Hyunsoon Cho
- Department of Cancer Control and Population Science, Graduate School of Cancer Science and Policy, National Cancer Center, Korea
| | - Dahhay Lee
- Department of Cancer Control and Population Science, Graduate School of Cancer Science and Policy, National Cancer Center, Korea
| | - Hannah Yang
- Center for Gastric Cancer, National Cancer Center, Korea; Division of Biology and Biological Engineering, California Institute of Technology Pasadena, California, 91125, USA
| | - Youngsook Kim
- Center for Gastric Cancer, National Cancer Center, Korea
| | - Harbi Khalayleh
- Center for Gastric Cancer, National Cancer Center, Korea; Faculty of Medicine, Hebrew University of Jerusalem, Israel; The Department of Surgery, Kaplan Medical Center, Israel
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Korea
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College of London, United Kingdom
| | - Daniel G Coit
- Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, USA
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Korea; Department of Cancer Control and Population Science, Graduate School of Cancer Science and Policy, National Cancer Center, Korea.
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Yüksel C, Erşen O, Basceken SI, Mercan Ü, Yalkın Ö, Culcu S, Bakırarar B, Bayar S, Ünal AE, Demirci S. The role of laparoscopic staging for the management of gastric cancer. POLISH JOURNAL OF SURGERY 2021; 93:1-8. [PMID: 33949319 DOI: 10.5604/01.3001.0014.7360] [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: 11/13/2022]
Abstract
AİM Staging laparoscopy enables us to perform palliative treatment, neo-adjuvant therapy for curative resection or direct curative resection and making a decision with minimal morbidity by avoiding from unnecessary laparotomies. In the present study, the importance of staging lapafoscopy was retrospectively investigated by using clinical and pathologic data. METHODS Data of 70 out of 350 patients who underwent diagnostic laparoscopy due to gastric cancer at Surgical Oncology department between August 2013 and January 2020 were retrospectively analyzed. RESULTS Peritoneal biopsy was positive for malignity in 41 (58.5%) and negative in 29 (41.5%) of the patients who underwent SL. Peritoneal cytology (PC) results were negative in 32 (45.7%) patients and positive in 38 (54.3%) patients. Peritoneal biopsy and cytology results were concurrently positive in 35 patients and concurrently negative in 26 patients. CONCLUSİONS In conclusion, even the most developed imaging methods cannot provide 100% staging, therefore SL plays an important role in treatment of gastric cancer and laparoscopic staging is essential as a simple, inexpensive, safe and well tolerated method in patients who have the suspicion of peritoneal disease and who cannot be clearly evaluated with pre-operative methods.
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Affiliation(s)
- Cemil Yüksel
- University of Health Science, Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital
| | - Ogün Erşen
- Ankara University School of Medicine Department of Surgical Oncology
| | | | - Ümit Mercan
- Ankara University School of Medicine, Department of Surgical Oncology
| | - Ömer Yalkın
- Bursa State Hospital Surgical Oncology Clinic
| | - Serdar Culcu
- University of Health Science, Ankara Abdurrahman Yurtaslan Oncology Training and Research Hospital
| | | | - Sancar Bayar
- Ankara University School of Medicine, Department of Surgical Oncology
| | - Ali Ekrem Ünal
- Ankara University School of Medicine Department of Surgical Oncology
| | - Salim Demirci
- Ankara University School of Medicine, Department of Surgical Oncology
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Yepuri N, Bahary N, Jain A, Dhir M. Review and Update on the Role of Peritoneal Cytology in the Treatment of Gastric Cancer. J Surg Res 2018; 235:607-614. [PMID: 30691849 DOI: 10.1016/j.jss.2018.10.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/12/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Positive peritoneal cytology (Cyt+) even in the absence of macroscopic disease is associated with poor prognosis in patients with gastric cancer and deemed as M1 disease. Recent years have seen advancements in the evaluation strategies for peritoneal washings and management of patients with Cyt+. The aim of this review was to describe the newest paradigms in the management of patients with gastric cancer who have Cyt+ without macroscopic peritoneal metastases. METHODS A comprehensive literature review was performed to identify studies on the management of gastric cancer and thereby to summarize relevant information on the accuracy of various diagnostic tests and controversies involved in the treatment of patients with Cyt+. RESULTS Although conventional cytology remains the standard technique for assessment of peritoneal washings, it is limited by low sensitivity. The role of immunohistochemistry and molecular techniques for the assessment of peritoneal washings is evolving. Although systemic chemotherapy remains the standard of care for patients with Cyt+ disease, the role of gastrectomy, intraperitoneal chemotherapy, extensive intraperitoneal saline lavage, and hyperthermic intraperitoneal chemotherapy is being evaluated. CONCLUSIONS Clinical decision-making in patients with Cyt+ remains controversial given the seemingly technical resectable albeit biologically unresectable or aggressive disease that portends an overall poor prognosis. Current management strategies are evolving, and further studies are needed to develop an optimal treatment strategy for these patients.
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Affiliation(s)
- Natesh Yepuri
- Division of Surgical Oncology, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Nathan Bahary
- Division of Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ajay Jain
- Division of Surgical Oncology, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Mashaal Dhir
- Division of Surgical Oncology, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York.
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Saklani A, Sugoor P, Chaturvedi A, Bhamre R, Jatal S, Ostwal V, Engineer R. Clinical Utility of Staging Laparoscopy for Advanced Obstructing Rectal Adenocarcinoma: Emerging Tool. Indian J Surg Oncol 2018; 9:488-494. [PMID: 30538377 DOI: 10.1007/s13193-018-0803-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/17/2018] [Indexed: 02/07/2023] Open
Abstract
The multimodal treatment for advanced rectal adenocarcinoma mandates accurate preoperative staging with contrast-enhanced computed tomography (CECT) of the thorax, abdomen, and pelvis, and magnetic resonance imaging (MRI) of the pelvis. Unlike gastric cancer, the role of staging laparoscopy (SL) in advanced colorectal cancer has not been evaluated. This study aims to evaluate the clinical value of SL in treatment decision-making for advanced rectal cancer (RC) with near or complete obstructing tumors. Observational review of colorectal database at Tata Memorial Hospital from January 2013 to December 2016 identified 562 patients diagnosed and treated for advanced RC. Of the 562 cases, 48.7% (274) were clinically and radiologically diagnosed of near or complete obstructing advanced RC. Medical records of 34% (94/274) who underwent SL with diversion stoma (DS) were analyzed. In the absence of ascites, extensive peritoneal deposits, and unresectable liver metastases on SL, a curative treatment was offered, which entailed neoadjuvant chemoradiation (NACTRT), whereas the cohort of patients with extensive peritoneal disease received palliative therapy. Of the 94 patients with advanced RC, conventional imaging studies staged 73.5% (69/94) cohort as non-metastatic locally advanced and 26.5% (25/94) had potentially resectable metastatic RC. Pre-therapeutic SL upstaged the disease by 26% (18/69) and 8% (2/25) in locally advanced and potentially resectable metastatic RC cohorts, respectively. Treatment decision changed in 21.2% (20/94) of the patients, and midline laparotomy was thus avoided. In our observational study, SL was found to be a safe and effective staging modality in RC; it detected occult peritoneal disease and prevented midline laparotomy in 21.2% of the cohort, which was of value to determine treatment strategy in patients with advanced RC before initiating NACTRT. SL and laparoscopic-assisted de-functioning stoma were associated with minimal morbidity and led to early initiation of NACTRT.
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Affiliation(s)
- Avanish Saklani
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - P Sugoor
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - A Chaturvedi
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - R Bhamre
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - S Jatal
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - V Ostwal
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India.,2Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - R Engineer
- 1Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
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DA Silva AM. Multiorganic resections in gastric cancer. ACTA ACUST UNITED AC 2017; 44:549-552. [PMID: 29267550 DOI: 10.1590/0100-69912017006012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- André Maciel DA Silva
- - Head, General Surgery Service, Federal Hospital of Andaraí MS/RJ; Oncologic Surgeon, Service of Abdominal-Pelvic Surgery, National Cancer Institute, Rio de Janeiro, RJ, Brazil
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Abdelaziem S, El-Bakary TA, Allah HSA. Short Term Outcomes of Laparoscopic versus Open Distal Gastrectomy with D2 Lymph Nodes Dissection for Gastric Cancer: A Prospective Study. SURGICAL SCIENCE 2017; 08:334-347. [DOI: 10.4236/ss.2017.88037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Kunisaki C, Makino H, Kimura J, Takagawa R, Kanazawa A, Ota M, Kosaka T, Ono HA, Akiyama H, Endo I. Impact of S-1 plus Cisplatin Neoadjuvant Chemotherapy on Scirrhous Gastric Cancer. Oncology 2015; 88:281-8. [PMID: 25591954 DOI: 10.1159/000369497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 10/30/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This retrospective study aimed to address the therapeutic outcome for scirrhous gastric cancer patients by evaluating the effect of neoadjuvant chemotherapy prior to gastrectomy. METHODS Two cycles of a 3-week regimen of fluoropyrimidine S-1 (40 mg/m(2), orally, twice daily), together with cisplatin (60 mg/m(2), intravenously, day 8), were administered to patients, separated by a 2-week rest period. Surgery was performed 3 weeks later in the neoadjuvant group (n = 27). We retrospectively evaluated overall survival and prognostic factors in these patients. RESULTS Univariate analysis showed that positive lavage cytology indicated significantly worse prognoses. In the 15 patients who also underwent curative gastrectomies after S-1 plus cisplatin chemotherapy, the pathological response grade was a significant prognostic factor for 5-year survival. Additionally, lymph node metastasis tended to be an adverse prognostic factor. CONCLUSION After S-1 plus cisplatin neoadjuvant chemotherapy, a grade 2-3 pathological response may predict favorable outcomes in scirrhous gastric cancer patients receiving curative gastrectomy, but further studies are needed to confirm these results.
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Affiliation(s)
- Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
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Abstract
INTRODUCTION Gastric cancer is the fourth most common cancer and the second leading cause of death from cancer. Only complete resection of all gross disease with negative microscopic margins (R0 resection) provides a long-term survival benefit, and the overall 5-year relative survival rate is approximately 20%. To improve survival and quality of life, new therapeutic approaches have been introduced. MATERIAL AND METHODS A total of 277 patients (171 men, 106 women) were included in this analysis. The results from the preoperative EUS and MDCT were compared to the postoperative pathological findings. A radial scanning ultrasonic endoscope was used. In patients with early gastric cancer, especially in cases confined to mucosa, endoscopic resection is performed to avoid unnecessary surgical procedures. To achieve R0 resection for locally-advanced gastric cancer, neoadjuvant treatments have been investigated. RESULTS AND DISCUSSION Laparoscopic surgery has been shown to improve quality of life for both early and locally advanced gastric cancer. Endoscopic ultrasonography (EUS), which is considered to be the most precise method for locoregional staging, was commonly used for differentiating mucosal lesions from submucosal lesions. By contrast, computed tomography (CT) was used to detect the presence of distant metastasis. The difference in accuracy between the < or = 20-mm group and other groups was statistically significant for both EUS and MDCT (P = 0.026 and P = 0.044, respectively). CONCLUSION However, recent technological advances with the helical and multi-detector scanners have provided better CT performance.
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Affiliation(s)
- Amila Mehmedović
- Clinic for Gastroenterology and Hepatology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Corresponding author: Amila Mehmedovic, MD. E-mail:
| | - Rusmir Mesihović
- Clinic for Gastroenterology and Hepatology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Aida Saray
- Clinic for Gastroenterology and Hepatology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nenad Vanis
- Clinic for Gastroenterology and Hepatology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Kikuchi H, Kamiya K, Hiramatsu Y, Miyazaki S, Yamamoto M, Ohta M, Baba S, Konno H. Laparoscopic narrow-band imaging for the diagnosis of peritoneal metastasis in gastric cancer. Ann Surg Oncol 2014; 21:3954-62. [PMID: 24859934 DOI: 10.1245/s10434-014-3781-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Staging laparoscopy (SL) is often used to diagnose peritoneal metastasis in patients with advanced gastric cancer, but accurate detection of metastasis can be difficult. We evaluated the usefulness of laparoscopic narrow-band imaging (NBI) versus conventional laparoscopic white-light imaging (WLI) for the diagnosis of peritoneal metastasis. METHODS We excised 37 white nodules from the parietal peritoneum of 26 patients with gastric cancer and suspected peritoneal metastasis. The WLI and NBI findings were compared with the pathological findings. All the peritoneal lesions examined were observed as white nodules on WLI. Intranodular vessels were evaluated by WLI and NBI for (1) vessel dilatation, (2) vessel tortuousness, (3) vessel heterogeneity, and (4) brown spots. RESULTS Each individual abnormal finding had a diagnostic accuracy of less than 79 % with or without NBI. Detection of any one abnormal finding had a sensitivity, specificity, and accuracy of 47.8, 85.7, and 62.2 %, respectively, on WLI and 91.3, 71.4, and 83.8 %, respectively, on NBI, for detection of peritoneal metastasis. Detection of any one abnormal finding on NBI plus clear demarcation of the nodule on WLI had a sensitivity of 91.3 %, specificity of 92.9 %, and accuracy of 91.9 % for detection of peritoneal metastasis. Pathological examination showed that a brown spot detected on NBI correlated with dilated vessels around cancer cells. Vascular endothelial growth factor was expressed in 76.2 % of peritoneal metastases. CONCLUSIONS NBI was more sensitive for the detection of dilated vessels than WLI. NBI could be a useful tool for the diagnosis of peritoneal metastasis during SL.
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Affiliation(s)
- Hirotoshi Kikuchi
- Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan,
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Park SS, Min JS, Lee KJ, Jin SH, Park S, Bang HY, Yu HJ, Lee JI. Risk stratification for serosal invasion using preoperative predictors in patients with advanced gastric cancer. J Gastric Cancer 2012; 12:149-55. [PMID: 23094226 PMCID: PMC3473221 DOI: 10.5230/jgc.2012.12.3.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/09/2012] [Accepted: 06/21/2012] [Indexed: 12/26/2022] Open
Abstract
Purpose Although serosal invasion is a critical predisposing factor for peritoneal dissemination in advanced gastric cancer, the accuracy of preoperative assessment using routine imaging studies is unsatisfactory. This study was conducted to identify high-risk group for serosal invasion using preoperative factors in patients with advanced gastric cancer. Materials and Methods We retrospectively analyzed clinicopathological features of 3,529 advanced gastric cancer patients with Borrmann type I/II/III who underwent gastrectomy at Korea Cancer Center Hospital between 1991 and 2005. We stratified patients into low- (≤40%), intermediate- (40~70%), and high-risk (>70%) groups, according to the probability of serosal invasion. Results Borrmann type, size, longitudinal and circumferential location, and histology of tumors were independent risk factors for serosal invasion. Most tumors of whole stomach location or encircling type had serosal invasion, so they belonged to high-risk group. Patients were subdivided into 12 subgroups in combination of Borrmann type, size, and histology. A subgroup with Borrmann type II, large size (≥7 cm), and undifferentiated histology and 2 subgroups with Borrmann type III, large size, and regardless of histology belonged to high-risk group and corresponded to 25% of eligible patients. Conclusions This study have documented high-risk group for serosal invasion using preoperative predictors. And risk stratification for serosal invasion through the combination with imaging studies may collaboratively improve the accuracy of preoperative assessment, reduce the number of eligible patients for further staging laparoscopy, and optimize therapeutic strategy for each individual patient prior to surgery.
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Affiliation(s)
- Sung-Sil Park
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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Lee SR, Kim HO, Yoo CH. Clinical outcomes of TS-1 chemotherapy for advanced and recurrent gastric cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:163-8. [PMID: 22066117 PMCID: PMC3204544 DOI: 10.4174/jkss.2011.81.3.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 07/07/2011] [Accepted: 07/19/2011] [Indexed: 11/30/2022]
Abstract
Purpose Titanium silicate (TS)-1 chemotherapy has been widely used against gastric cancer in Japan. The aim of the present study was to assess the efficacy and hematological safety of TS-1 as treatment for advanced and recurrent gastric cancer. Methods From September 2006 to February 2011, 51 advanced or recurrent gastric cancers were treated with TS-1. One course of treatment consisted of 40, 50, or 60 mg/m2 of TS-1 twice a day for 28 days, followed by withdrawal for two weeks. The primary end point was progression-free survival (PFS), and the secondary end point was overall survival (OS). Results The disease control rate was 39.2% (complete response, 0/51; partial response, 6/51; stable disease, 14/51; progressive disease, 23/51; not evaluable, 8/51). The median PFS was 4.0 months (95% confidence interval [CI], 2.2 to 5.7); the median PFS of the advanced group was 6.0 months (95% CI, 2.8 to 9.1), and the median PFS of the recurrent group was 3.0 months (95% CI, 1.8 to 4.1). The median OS was 11.0 months (95% CI, 6.3 to 15.6); the median OS of the advanced group was 10.0 months (95% CI, 4.9 to 15.0), and the median OS of the recurrent group was 14.0 months (95% CI, 4.1 to 23.8). Grade 3 or 4 hematological toxicity occurred in three patients (5.9%), anemia occurred in two patients (3.9%), and thrombocytopenia occurred in one patient (2%). Conclusion TS-1 chemotherapy was safe and effective, with relatively long PFS and OS in patients with advanced and recurrent gastric cancers.
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Affiliation(s)
- Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Mahadevan D, Sudirman A, Kandasami P, Ramesh G. Laparoscopic staging in gastric cancer: An essential step in its management. J Minim Access Surg 2011; 6:111-3. [PMID: 21120068 PMCID: PMC2992659 DOI: 10.4103/0972-9941.72597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 10/01/2010] [Indexed: 01/13/2023] Open
Abstract
AIM: The role of laparoscopy in staging of gastric cancer is widely accepted; however, in Malaysia its usage has been limited. Patients can be classified as resectable or unresectable, which helps in avoiding an unwanted laparotomy and the morbidities associated with it. The aim of this study was to assess the value of laparoscopy in staging of gastric cancer in comparison with CT scan. MATERIALS AND METHODS: Patients with carcinoma of the stomach after a complete preoperative work-up underwent laparoscopy prior to surgical exploration. TNM staging was used to compare laparoscopy with CT, with the histopathological report used as the gold standard. RESULTS: Forty cases were included in this study. The sensitivity of laparoscopy for T3 tumours appears to be significant when compared to that of CT. Laparoscopy detected 90.3% of the cases as against the 58% detected with CT. There was not much difference in the N factor. With regard to M factor, the sensitivity was 100% for laparoscopy in comparison with CT. CONCLUSIONS: Laparoscopy has been shown to be sensitive in detecting metastasis in gastric cancer in comparison to CT, thus helping in avoiding unwanted laparotomy and thus providing a more systemic approach in managing gastric cancers.
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Affiliation(s)
- D Mahadevan
- Department of Surgery, Division of Upper GI Surgery, Tuanku Jaafar Hospital, Seremban, Malaysia
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Brancato S, Miner TJ. Surgical management of gastric cancer: review and consideration for total care of the gastric cancer patient. ACTA ACUST UNITED AC 2011; 11:109-18. [PMID: 18321438 DOI: 10.1007/s11938-008-0023-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Surgical therapy remains the most effective modality in the treatment of gastric cancer. Staging laparoscopy with laparoscopic ultrasound may increase the accuracy of staging and prevent patients with unresectable gastric cancer from undergoing unnecessary operations. Resection of proximal and distal gastric cancer is best accomplished with an appropriate gastrectomy that ensures adequate resection margins. A D2 lymphadenectomy can be performed safely and facilitates the resection of the minimum 15 lymph nodes required for adequate staging. Adjacent organ resection should be used only in highly selected patients with R0 resection as the goal. Palliative operations offer improved quality of life and symptom relief in patients with metastatic disease. Appreciation of postoperative quality of life after gastric resection facilitates appropriate and effective preoperative counseling. Surgical outcomes may be influenced by hospital volume and rate of adequate lymph node assessment.
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Affiliation(s)
- Samielle Brancato
- Thomas J. Miner, MD Department of Surgery, The Warren Alpert School of Medicine of Brown University, 593 Eddy Street, APC 443, Providence, RI 02903, USA.
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Abstract
A more differentiated therapy regimen for gastric carcinoma requires more precise preoperative staging. In patients with early gastric cancer (EGC), especially in cases with carcinoma confined to mucosa, endoscopic resection (ER) is usually performed to avoid unnecessary surgical procedures. To achieve R0 resection for locally advanced gastric cancer (AGC), neoadjuvant treatments have been investigated. Clinical staging of gastric cancer has been greatly improved by advances in imaging techniques, such as endoscopic ultrasonography (EUS), transabdominal ultrasonography (TAUS), multi-slice spiral CT (MSCT), magnetic resonance imaging (MRI), positron emission tomography (PET), combined PET-CT scans, and laparoscopic staging. This paper aims to summarize the recent advances in preoperative staging of gastric cancer.
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Hur H, Lee HH, Jung H, Song KY, Jeon HM, Park CH. Predicting factors of unexpected peritoneal seeding in locally advanced gastric cancer: indications for staging laparoscopy. J Surg Oncol 2011; 102:753-7. [PMID: 20812349 DOI: 10.1002/jso.21685] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study is to investigate predictive factors for unexpected peritoneal seeding from clinically resectable advanced gastric cancers to suggest the indications for staging laparoscopy (SL). METHODS A total of consecutive 589 gastric cancer patients who were clinically diagnosed with advanced gastric cancer with no metastatic disease underwent operations at Seoul St. Mary's Hospital. RESULTS A total of 72 patients (including 35 patients with seeding to distant peritoneum) were surgically diagnosed with peritoneal seeding. Borrmann type 3 (OR: 4.475) or type 4 (OR: 8.243) cancer, tumor invasion of T3 (OR: 2.794) or T4 (OR: 6.841) and tumor size (4 cm ≤ tumor size < 8 cm; OR: 3.723 and 8 cm ≤ tumor size; OR: 6.971) were predictive factors for overall peritoneal seeding. Borrmann type 3 (OR: 3.524) or 4 (OR: 4.695) cancer, tumor invasion of T3 (OR: 4.378) or T4 (OR: 15.817), and tumors involving the anterior wall (OR: 2.762) also turned out to be predictive factors for distant peritoneal seeding. CONCLUSIONS If SL were performed by these predictive factors, this should have been performed in 42.4% of advanced gastric cancers and the detection rates for overall peritoneal seeding would have been 24.0%.
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Affiliation(s)
- Hoon Hur
- Department of Surgery, Ajou University, School of Medicine, Suwon, Korea
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Potential utility of HOP homeobox gene promoter methylation as a marker of tumor aggressiveness in gastric cancer. Oncogene 2010; 29:3263-75. [PMID: 20228841 DOI: 10.1038/onc.2010.76] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
HOP homeobox (HOPX) is an unusual homeobox gene encoding three spliced transcript variants, among which the only HOPX-beta promoter harbors CpG islands. The characteristics of its promoter methylation was analyzed using bisulfite sequencing and quantitative-methylation-specific polymerase chain reaction (Q-MSP), and the effects of HOPX expression were also examined. HOPX-beta expression was silenced in all gastric cancer cell lines tested; its expression could be restored by treatment with demethylating agent. On Q-MSP, HOPX-beta hypermethylation (cut-off value of 3.55) was found in 84% (67 out of 80) of primary tumor tissues and 10% (8 out of 80) of the corresponding normal tissues and could discriminate normal from tumor tissues (P<0.0001). The prognosis of the advanced cases with HOPX-beta hypermethylation was as poor as those with stage IV disease when cut-off value was set at 11.28. This finding was validated in an independent cohort of 90 advanced gastric cancers. The HOPX-beta hypermethylation was also an independent prognostic factor (P=0.029) on multivariate analysis. Exogenous HOPX expression significantly inhibited cell proliferation, colony formation and invasion as well as enhanced apoptosis. Taken together, HOPX-beta promoter methylation is a frequent and cancer-specific event in gastric cancer. Quantitative assessment of HOPX-beta methylation has great clinical potential as a marker of tumor aggressiveness.
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Hwang SW, Lee DH, Lee SH, Park YS, Hwang JH, Kim JW, Jung SH, Kim NY, Kim YH, Lee KH, Kim HH, Park DJ, Lee HS, Jung HC, Song IS. Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector-row computed tomography. J Gastroenterol Hepatol 2010; 25:512-8. [PMID: 20370729 DOI: 10.1111/j.1440-1746.2009.06106.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The aim of this study was to determine the accuracy of endoscopic ultrasonography (EUS) and multidetector-row computed tomography (MDCT) for the locoregional staging of gastric cancer. EUS and computed tomography (CT) are valuable tools for the preoperative evaluation of gastric cancer. With the introduction of new therapeutic options and the recent improvements in CT technology, further evaluation of the diagnostic accuracy of EUS and MDCT is needed. METHODS In total, 277 patients who underwent EUS and MDCT, followed by gastrectomy or endoscopic resection at Bundang Hospital, Seoul National University, from July 2006 to April 2008, were analyzed. The results from the preoperative EUS and MDCT were compared to the postoperative pathological findings. RESULTS Among the 277 patients, the overall accuracy of EUS and MDCT for T staging was 74.7% and 76.9%, respectively. Among the 141 patients with visualized primary lesions on MDCT, the overall accuracy of EUS and MDCT for T staging was 61.7% and 63.8%, respectively. The overall accuracy for N staging was 66% and 62.8%, respectively. The performance of EUS and MDCT for large lesions and lesions at the cardia and angle had significantly lower accuracy than that of other groups. For EUS, the early gastric cancer lesions with ulcerative changes had significantly lower accuracy than those without ulcerative changes. CONCLUSIONS For the preoperative assessment of individual T and N staging in patients with gastric cancer, the accuracy of MDCT was close to that of EUS. Both EUS and MDCT are useful complementary modalities for the locoregional staging of gastric cancer.
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Affiliation(s)
- Sung Wook Hwang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Biffi R, Fazio N, Luca F, Chiappa A, Andreoni B, Zampino MG, Roth A, Schuller JC, Fiori G, Orsi F, Bonomo G, Crosta C, Huber O. Surgical outcome after docetaxel-based neoadjuvant chemotherapy in locally-advanced gastric cancer. World J Gastroenterol 2010; 16:868-74. [PMID: 20143466 PMCID: PMC2825334 DOI: 10.3748/wjg.v16.i7.868] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate feasibility, morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.
METHODS: Patients suffering from locally-advanced (T3-4 any N M0 or any T N1-3 M0) gastric carcinoma, staged with endoscopic ultrasound, bone scan, computed tomography, and laparoscopy, were assigned to receive four 21 d/cycles of TCF (docetaxel 75 mg/m2 day 1, cisplatin 75 mg/m2 day 1, and fluorouracil 300 mg/m2 per day for days 1-14), either before (Arm A) or after (Arm B) gastrectomy. Operative morbidity, overall mortality, and severe adverse events were compared by intention-to-treat analysis.
RESULTS: From November 1999 to November 2005, 70 patients were treated. After preoperative TCF (Arm A), thirty-two (94%) resections were performed, 85% of which were R0. Pathological response was complete in 4 patients (11.7%), and partial in 18 (55%). No surgical mortality and 28.5% morbidity rate were observed, similar to those of immediate surgery arm (P = 0.86). Serious chemotherapy adverse events tended to be more frequent in arm B (23% vs 11%, P = 0.07), with a single death per arm.
CONCLUSION: Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.
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Shimizu H, Imamura H, Ohta K, Miyazaki Y, Kishimoto T, Fukunaga M, Ohzato H, Tatsuta M, Furukawa H. Usefulness of staging laparoscopy for advanced gastric cancer. Surg Today 2010; 40:119-24. [PMID: 20107950 DOI: 10.1007/s00595-009-4017-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/24/2009] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of this study was to clarify the usefulness of staging laparoscopy for planning the treatment strategy in patients with advanced gastric cancer. METHODS This was a retrospective study of patients with gastric cancer who underwent staging laparoscopy. The patients were divided into three groups according to the presence/absence of peritoneal metastasis (P) and positive peritoneal cytology (CY): P negative (0) CY0, P0CY positive (1), and P1CY1. The treatment strategy after staging laparoscopy was as follows: (1) surgery for the P0CY0 group, (2) surgery with neoadjuvant chemotherapy (NAC) for the P0CY1 group, and (3) chemotherapy for the P1CY1 group. Survival was estimated by the Kaplan-Meier method and statistical differences were analyzed by the log-rank test. RESULTS Thirty-four patients were included in this study: 11 in the P0CY0 group, 13 in the P0CY1 group, and 10 in the P1CY1 group. A gastrectomy was done in 11, 10, and no patients, respectively. The survival rate of the P0CY0 patients was significantly better than that of the P0CY1 or P1CY1 patients (P = 0.0106 and 0.0031, respectively). CONCLUSION Staging laparoscopy is useful for planning the treatment strategy and estimating the prognosis of patients with advanced gastric cancer.
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Affiliation(s)
- Hiroki Shimizu
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, Japan
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Dassen AE, Lips DJ, Hoekstra CJ, Pruijt JFM, Bosscha K. FDG-PET has no definite role in preoperative imaging in gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2009; 35:449-55. [PMID: 19147324 DOI: 10.1016/j.ejso.2008.11.010] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/18/2008] [Accepted: 11/24/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gastric cancer is fourth on the incidence list of cancers worldwide with a high disease-related mortality rate. Curation can only be achieved by a radical resection including an adequate lymphadenectomy. However, prognosis remains poor and cancer recurrence rates are high, also due to lymph node metastases. To improve outcome, (neo)adjuvant treatment strategies with chemo- and/or radiotherapy regimes are employed. AIMS Accurate staging of gastric cancer at primary diagnosis is essential for adequate treatment. In this non-systematic review the role 18-F-Fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) in preoperative staging is investigated. Furthermore, the results of neoadjuvant chemotherapy-induced tumour response monitoring by FDG-PET are discussed. RESULTS AND CONCLUSION It is concluded that currently FDG-PET has no role in the primary detection of gastric cancer due to its low sensitivity. FDG-PET shows, however, slightly better results in the evaluation of lymph node metastases in gastric cancer compared to CT and could have therefore a role in the preoperative staging. Improvement in accuracy could be achieved by using PET/CT or other PET tracers than FDG, but these modalities need further investigation. FDG-PET, however, adequately detects therapy responders at an early stage following neoadjuvant chemotherapy.
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Affiliation(s)
- A E Dassen
- Department of Surgery, Jeroen Bosch Hospital, PO Box 90153, 5200 ME, 's-Hertogenbosch, The Netherlands
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Power DG, Schattner MA, Gerdes H, Brenner B, Markowitz AJ, Capanu M, Coit DG, Brennan M, Kelsen DP, Shah MA. Endoscopic ultrasound can improve the selection for laparoscopy in patients with localized gastric cancer. J Am Coll Surg 2008; 208:173-8. [PMID: 19228527 DOI: 10.1016/j.jamcollsurg.2008.10.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 10/20/2008] [Accepted: 10/27/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND The majority of newly diagnosed patients with gastric cancer have disease that is not resectable because of local extension or metastatic (M1) disease. Laparoscopy is a recommended staging evaluation to identify occult peritoneal metastatic disease. We determined if endoscopic ultrasound (EUS) could improve the selection of patients for laparoscopy. STUDY DESIGN Gastric cancer patients being screened for a preoperative chemotherapy clinical trial were prospectively examined. Patients underwent standard preoperative assessment. Those without obvious metastatic disease were referred for EUS and laparoscopy. EUS divided patients into risk categories for metastatic disease: low risk (T1-2, N0) and high risk (T3-4, N+, or both). Laparoscopy categories were M1 and M0. The ability of EUS to predict subradiographic peritoneal metastatic disease was evaluated. RESULTS Ninety-four patients were studied. The majority were EUS high risk (72%). Occult metastatic disease was identified in 19 patients, 18 of whom had high-risk EUS stage. The yields of identifying M1 disease by laparoscopy in EUS high- and low-risk patients were 25% (95% CI, 15% to 37%) and 4% (95% CI, 0.1% to 20%), respectively. The negative predictive value of low-risk EUS for laparoscopy and pathologic M0 was 96% (exact 95% CI, 80% to 100%). CONCLUSIONS This study suggested that laparoscopy can be avoided in patients with EUS early-stage gastric cancer. Patients with more advanced disease are at higher risk of occult peritoneal disease and require laparoscopy. Validation with greater numbers is warranted, but, based on these data, we propose a new staging algorithm allowing EUS low-risk patients to proceed directly to resection.
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Affiliation(s)
- Derek G Power
- Gastrointestinal Oncology Service, Memorial Sloan-Kettering Cancer Center, and the Department of Medicine, Weil Cornell Medical College of Cornell University, New York, NY, USA
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Osorio J, Rodríguez-Santiago J, Muñoz E, Camps J, Veloso E, Marco C. Outcome of unresected gastric cancer after laparoscopic diagnosis of peritoneal carcinomatosis. Clin Transl Oncol 2008; 10:294-7. [PMID: 18490247 DOI: 10.1007/s12094-008-0200-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Most gastric adenocarcinomas in western countries are locally advanced, and these tumours are often associated with metastatic spread at the time of diagnosis. It is controversial whether palliative surgery can improve symptom control in gastric cancer patients with peritoneal carcinomatosis. OBJECTIVE To determine the need of palliative procedures and survival in patients affected by gastric cancer with peritoneal carcinomatosis managed without resection. Methods and materials After standard preoperative staging, 160 patients were diagnosed with resectable gastric adenocarcinoma. Laparoscopy was performed in 107 patients (66.9%), finding peritoneal spread in 22 of them (21%). Seventeen of these patients were not submitted to any additional surgical procedure. Data regarding postoperative morbidity and mortality, need of endoscopic, percutaneous or surgical procedures to palliate symptoms, hospital stay and survival were collected. The same data were collected for the 6 non-resected patients who were diagnosed with carcinomatosis by laparotomy. RESULTS In the "laparoscopy alone" group, there were 2 minor complications and no postoperative mortality. Mean postoperative stay was 6 days. Eight patients had to be readmitted to hospital for symptoms derived from tumour progression, and 10 palliative endoscopic procedures were performed. Surgical interventions were not needed in any case. Mean survival was 11.5 months. Patients submitted only to laparotomy presented higher morbidity and mortality rates, with a longer postoperative stay and survival of less than 5 months. CONCLUSIONS Laparoscopic staging of gastric cancer can help to avoid unnecessary laparotomies. In patients with peritoneal carcinomatosis diagnosed by laparoscopy, nonsurgical treatment has low morbidity and mortality and permits good symptom relief with no shortening of survival.
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Affiliation(s)
- J Osorio
- Service of General and Digestive Surgery, Hospital Mutua de Terrassa, Universitat de Barcelona, Terrassa, Spain.
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Thompson AM, Rapson T, Gilbert FJ, Park KGM. Hospital volume does not influence long-term survival of patients undergoing surgery for oesophageal or gastric cancer. Br J Surg 2007; 94:578-84. [PMID: 17410636 DOI: 10.1002/bjs.5729] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Guidelines suggest that surgery for oesophageal and gastric cancer should be conducted in large cancer centres. This national study examined the relationship between hospital volume and outcome in Scotland. METHODS This was a prospective, population-based study of 3293 consecutive patients with oesophageal or gastric cancer diagnosed between 1997 and 1999. Some 1302 patients underwent surgery and were followed for 5 years after operation. RESULTS The 5-year adjusted overall survival rate for the 3293 patients was 18.7 (95 per cent confidence interval (c.i.) 17.2 to 20.2) per cent and that after surgical resection was 39.6 (95 per cent c.i. 36.3 to 43.0) per cent. Death within 1 year after surgical resection was associated with a postoperative complication (odds ratio (OR) 2.5 (95 per cent c.i. 1.6 to 3.8); P < 0.001) or resection margin involvement by tumour (OR 7.2 (95 per cent c.i. 1.1 to 47.5); P = 0.042) after adjustment for age, sex and tumour location. There was no relationship between hospital volume and postoperative morbidity or mortality, nor between survival and volume of patients either for hospital of diagnosis or hospital of surgery. CONCLUSION This population-based study of oesophageal and gastric cancer suggests that the link between hospital volume and long-term survival for patients undergoing surgery requires re-evaluation.
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Affiliation(s)
- A M Thompson
- Department of Surgery and Molecular Oncology, University of Dundee, Dundee, UK
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Kim HJ, D'Angelica M, Hiotis SP, Shoup M, Weber SM. Laparoscopic staging for liver, biliary, pancreas, and gastric cancer. Curr Probl Surg 2007; 44:228-69. [PMID: 17467404 DOI: 10.1067/j.cpsurg.2007.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hong Jin Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, USA
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Jensen EH, Tuttle TM. Preoperative Staging and Postoperative Surveillance for Gastric Cancer. Surg Oncol Clin N Am 2007; 16:329-42. [PMID: 17560516 DOI: 10.1016/j.soc.2007.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Physicians must consider multiple factors when determining the most appropriate preoperative imaging strategy for gastric cancer. Health care resources are not unlimited, and the use of multiple expensive imaging techniques that do not alter treatment decisions is not recommended. With this in mind, EGD and CT scan alone should form the basis for preoperative evaluation, with further imaging considered only in selected cases. Based on the reviewed literature, we do not recommend routine surveillance imaging after curative surgery for gastric cancer. We agree with current NCCN guidelines that recommend history and physical examination every 4 to 6 months for 3 years, followed by yearly examinations. Imaging studies and endoscopy should be selectively performed in symptomatic patients.
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Affiliation(s)
- Eric H Jensen
- Division of Surgical Oncology, University of Minnesota Medical Center, MMC 195, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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de Graaf GW, Ayantunde AA, Parsons SL, Duffy JP, Welch NT. The role of staging laparoscopy in oesophagogastric cancers. Eur J Surg Oncol 2007; 33:988-92. [PMID: 17344017 DOI: 10.1016/j.ejso.2007.01.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Accepted: 01/08/2007] [Indexed: 01/12/2023] Open
Abstract
AIMS Selection of patients for treatment of oesophagogastric cancers rests on accurate staging. Laparoscopy has become a safe and effective staging tool in upper gastrointestinal cancers because of its ability to detect small peritoneal and liver metastases missed by imaging techniques. The aim of this study was to evaluate the role of staging laparoscopy (SL) in determining resectability of oesophagogastric cancers. METHODS A review of 511 patients with oesophagogastric cancers referred to our centre during a 7-year period was performed. Four hundred and sixteen of them assessed to have resectable tumours after preoperative staging with CT and/or ultrasound underwent SL. The main outcome measure was the number of patients in whom laparoscopy changed treatment decision. RESULTS Staging laparoscopy changed treatment decision in 84 cases (20.2%): locally advanced disease in 17, extensive lymph node disease in four and distant metastases (liver and peritoneum) in 63 cases. The sensitivity of laparoscopy for resectability was 88%. Eighty-one percent of patients who had combined CT scan and EUS were resectable at surgery compared with 65% of those who had CT scan alone (statistically significant with P-value<0.05). Of those patients deemed resectable by SL 8.1% were found to be unresectable at laparotomy, 16 with locally advanced disease and 11 with metastases. CONCLUSION Staging laparoscopy avoided unnecessary laparotomy in 20.2% of our patients and was most useful in adenocarcinoma, distal oesophageal, GOJ and gastric cancers and probably not necessary in lesions of the upper two-third of the oesophagus.
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Affiliation(s)
- G W de Graaf
- Department of Surgery, Nottingham City Hospital, Hucknall Road, Nottingham, UK
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Gretschel S, Siegel R, Estévez-Schwarz L, Hünerbein M, Schneider U, Schlag PM. Surgical strategies for gastric cancer with synchronous peritoneal carcinomatosis. Br J Surg 2007; 93:1530-5. [PMID: 17051604 DOI: 10.1002/bjs.5513] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gastric cancer frequently spreads to the peritoneal cavity. Whether laparoscopy is useful in planning therapy remains controversial. The aim of this study was to investigate the value of laparoscopy and to develop a therapeutic algorithm. METHODS Six hundred and sixty consecutive patients with gastric cancer were included in this prospective observational study. The sensitivity of abdominal ultrasonography, computed tomography (CT) and laparoscopy for detecting peritoneal carcinomatosis was compared. The lesions were biopsied and classified as P1, P2 or P3 according to the recommendations of the Japanese Research Society for Gastric Cancer. Prognosis was determined according to the stage of peritoneal carcinomatosis and therapeutic procedure adopted. RESULTS One hundred and ten (16.7 per cent) of 660 patients presented with synchronous peritoneal carcinomatosis. The sensitivity for detecting peritoneal carcinomatosis was 85 per cent for laparoscopy compared with 19 per cent for ultrasonography and 28 per cent for CT. Patients with P3 disease did not benefit from additional surgery compared with chemotherapy alone. Those with P1 carcinomatosis had improved survival rates after complete resection followed by chemotherapy. CONCLUSION Laparoscopy improves the detection and classification of peritoneal carcinomatosis, and offers patients with gastric cancer a more individualized and effective therapy.
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Affiliation(s)
- S Gretschel
- Department of Surgery and Surgical Oncology, Charité-Universitatsmedizin Berlin, Campus Buch, Robert-Rössle-Klinik im Helios-Klinikum Berlin Buch, Berlin, Germany
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Abstract
The availability of more treatment options for gastrointestinal cancer requires precise and reliable pretherapeutic staging. Despite impressive technical progress in modern imaging procedures, this high level of staging quality is not yet warranted in all instances. Visual exploration of the abdominal cavity in extended diagnostic laparoscopy (EDL), including surgical dissection of areas which are primarily inaccessible, biopsy retrieval, and laparoscopic ultrasound, is superior in the diagnostic workup of early peritoneal carcinomatosis and (small) liver metastases. It is helpful to evaluate lymph node infliction and local resectability. In esophageal carcinoma, pretherapeutic EDL is valuable in case of advanced adenocarcinoma of the distal esophagus (AEG I according to Siewert), whereas the incidence of abdominal tumor manifestations in squamous cell carcinoma is too low to perform staging laparoscopy. In advanced gastric cancer, EDL yields relevant additional information in up to 20% of cases. If a multimodal therapeutic strategy is considered, EDL should be obligatory at least in prospective therapeutic studies. In carcinoma of the pancreas, EDL is in general not recommended by the majority of centers. Selective use (in particular in advanced cancer with a high probability of local irresectability) is gaining importance. In hepatobiliary malignancy including colorectal metastases, the high yield of additional information by EDL was confirmed in recent studies.
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Affiliation(s)
- H Feussner
- Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TUM, Ismaninger Strasse 22, 81675 München, Deutschland.
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Abstract
This paper provides an overview of the current status of laparoscopic resection for early gastric cancer. According to many case-control studies, laparoscopic gastrectomy is feasible and safe, and in comparison with conventional open gastrectomy is associated with less pain, a quicker recovery of gastrointestinal function, and a better postoperative quality of life, with no negative influence on survival. Large randomized controlled trials of laparoscopic versus open gastrectomy are needed to establish the future role of laparoscopic surgery in the treatment of patients with gastric cancer.
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Affiliation(s)
- Seigo Kitano
- Department of Gastroenterological Surgery, Oita University Faculty of Medicine, Japan.
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Mortensen MB, Fristrup CW, Ainsworth AP, Pless T, Nielsen HO, Hovendal C. Combined preoperative endoscopic and laparoscopic ultrasonography for prediction of R0 resection in upper gastrointestinal tract cancer. Br J Surg 2006; 93:720-5. [PMID: 16671064 DOI: 10.1002/bjs.5342] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study evaluated the ability of combined endoscopic and laparoscopic ultrasonography to predict R0 resection and avoid unnecessary surgery in patients with upper gastrointestinal tract cancer (UGIC). METHODS A total of 411 consecutive patients with UGIC (182 pancreatic cancers, 134 gastric cancers and 95 oesophageal cancers) treated between January 2002 and May 2004 were analysed prospectively. The allocation of patients into resectability groups by endoscopic ultrasonography (EUS) and laparoscopic ultrasonography (LUS) was compared with the treatment actually undertaken. RESULTS The combination of EUS and LUS correctly predicted R0 resection in 90.6 per cent, R1-R2 in 91 per cent and irresectability in 91.4 per cent of patients. Ten patients (2.4 per cent) had explorative laparotomy only. There were no complications associated with the EUS and LUS procedures. CONCLUSION The routine use of EUS and LUS before surgery predicted R0 resection in nine of ten patients and reduced the number of unnecessary laparotomies to less than 3 per cent.
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Affiliation(s)
- M B Mortensen
- Department of Surgical Gastroenterology, Centre for Surgical Ultrasound, Odense University Hospital, DK-5000 Odense C, Denmark.
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Sarela AI, Lefkowitz R, Brennan MF, Karpeh MS. Selection of patients with gastric adenocarcinoma for laparoscopic staging. Am J Surg 2006; 191:134-8. [PMID: 16399124 DOI: 10.1016/j.amjsurg.2005.10.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 06/28/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND To refine selection criteria for laparoscopic staging of gastric adenocarcinoma, preoperatively available clinical and radiologic factors that may predict the risk of M1 disease were investigated. METHODS During 1993-2002, laparoscopy was performed if patients had minimal symptoms and there was no definite M1 disease at computed tomography (CT) scanning. High-quality, spiral, CT scans were reviewed in detail for 65 recent patients. RESULTS Laparoscopy was conducted for 657 patients and M1 was detected in 31%. M1 was significantly more prevalent with tumor location at the gastroesophageal junction (GEJ; M1 in 42%) or whole stomach (66%), poor differentiation (36%) or age < or = 70 years (34%). On spiral CT scan, lymphadenopathy > or = 1 cm (49%) or T3/T4 tumors (63%) were associated with significantly higher prevalence of M1. On multivariate analyses, only tumor location (GEJ or whole stomach) and lymphadenopathy were independently significant and M1 was not detected in any patient with neither risk factor. CONCLUSIONS With spiral CT staging, laparoscopy may be avoided if the primary tumor is not at the GEJ or whole stomach and there is no lymphadenopathy.
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Affiliation(s)
- Abeezar I Sarela
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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Sarela AI, Miner TJ, Karpeh MS, Coit DG, Jaques DP, Brennan MF. Clinical outcomes with laparoscopic stage M1, unresected gastric adenocarcinoma. Ann Surg 2006; 243:189-95. [PMID: 16432351 PMCID: PMC1448917 DOI: 10.1097/01.sla.0000197382.43208.a5] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE For patients with laparoscopic stage M1 gastric adenocarcinoma, no resection of the primary tumor, and systemic chemotherapy, this study investigated the incidence of subsequent palliative intervention and survival. SUMMARY BACKGROUND DATA Laparoscopy was performed for patients with computed tomography scan stage M0 disease and no significant obstruction or bleeding. METHODS A prospectively maintained database for 1993 to 2002 was used to identify 165 patients (median age, 63 years) with laparoscopic M1 disease in the peritoneum (P1, adjacent to stomach, 9%; P2, few distant sites, 35%; or P3, disseminated, 30%) or liver (10%) or both (16%). Functional performance status (FPS, Eastern Cooperative Oncology Group) was 0 to 1 (84%) or 2 (16%). RESULTS Subsequent intervention was performed on 50% of patients, at median interval of 4 months (range, 1-35 months) after laparoscopy. Intervention was performed on the stomach for obstruction (33%), bleeding (8%), or perforation (1%) or on a distant site for a metastasis-related complication (20%). More than one intervention (maximum, 4) was performed in 21%. Laparotomy was necessary in 12%; the remainder had endoscopic or radiologic procedures or radiation therapy only. There was one intervention-related death. Median survival was 10 months, with 1-year survival of 39%. On multivariate analysis, better FPS (0-1; odds ratio, 4; P=0.001) and limited peritoneal metastasis (P1 or P2; 2; P=0.01) were independently associated with improved survival. CONCLUSIONS The incidence of subsequent intervention was 50%, but few patients had laparotomy. Intervention-related mortality was minimal. The burden of metastatic disease and functional performance status were important prognostic factors.
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Affiliation(s)
- Abeezar I Sarela
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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Zöpf T, Schneider ARJ, Weickert U, Riemann JF, Arnold JC. Improved preoperative tumor staging by 5-aminolevulinic acid induced fluorescence laparoscopy. Gastrointest Endosc 2005; 62:763-7. [PMID: 16246693 DOI: 10.1016/j.gie.2005.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 05/12/2005] [Indexed: 01/04/2023]
Abstract
BACKGROUND We report our data in 35 patients who underwent preoperative conventional and fluorescence-based staging laparoscopy. We use the data to address the questions of whether fluorescence examination increases the yield of metastatic lesions and alters treatment intervention. METHODS Fluorescence laparoscopy was successfully performed in 30 patients with GI malignancies. After sensitization with 5-aminolevulinic acid, conventional white-light mode and fluorescence-light laparoscopies were sequentially performed. A suspected malignancy was biopsied. OBSERVATIONS In 5 patients, examinations were incomplete because of adhesions. In 9 of 10 patients, hepatic or peritoneal metastases were detected by white-light examination. In 4 of these 9, blue-light examination yielded more metastatic lesions. In one patient with no lesions by white- or blue-light examination, surgery revealed hepatic metastasis in a location not accessible to laparoscopic examination. In 18 patients, surgery confirmed the absence of metastatic lesions. CONCLUSIONS A fluorescence, blue-light examination yielded more lesions than the conventional white-light examination but did not alter treatment intervention and did not enhance yield when metastatic lesion is in an inaccessible location. Continued research should focus on whether treatment intervention will be altered by the fluorescence examination.
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Affiliation(s)
- Thomas Zöpf
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
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Carboni F, Lepiane P, Santoro R, Lorusso R, Mancini P, Sperduti I, Carlini M, Santoro E. Extended multiorgan resection for T4 gastric carcinoma: 25-year experience. J Surg Oncol 2005; 90:95-100. [PMID: 15844189 DOI: 10.1002/jso.20244] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND OBJECTIVES In locally advanced gastric carcinoma infiltrating adjacent organs, an extended resection including invaded organs is required to improve the prognosis. We retrospectively analyzed our experience with extended multiorgan resection (EMR) in patients with advanced gastric cancer. METHODS Between December 1979 and April 2004, 65 patients were resected for extended gastric carcinoma macroscopically invading other organs. Various clinicopathologic factors influencing early and late results were evaluated. Survival rates were calculated according to the Kaplan-Meier method. Prognostic factors were evaluated by univariate and multivariate analysis. RESULTS The majority of patients (61.5%) did receive a R0 curative resection. In 52 (80%) of the 65 presumed T4 cancers, histologic final analysis confirmed invasion. Postoperative morbidity and mortality was 27.7% and 12.3%, respectively. Actuarial 5-year overall survival (OS) rate was 21.8%. It was significantly better in R0 versus R+ (30.6% vs. 0%, P = 0.001). Multivariate analysis identified curative resection as the strongest predictor of survival (P = 0.002). CONCLUSIONS Patients with locally advanced gastric carcinoma invading adjacent organs can benefit from aggressive surgical treatment with acceptable morbidity and mortality. However, curative resection is mandatory to improve prognosis.
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Affiliation(s)
- Fabio Carboni
- Department of Digestive Surgery and Liver Transplantation, Regina Elena Cancer Institute, Rome, Italy.
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Rau B, Hünerbein M. Diagnostische Laparoskopie bei malignen Tumoren. Visc Med 2005. [DOI: 10.1159/000083235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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36
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La utilidad de la laparoscopia en el manejo de pacientes con carcinoma gástrico. Clin Transl Oncol 2004. [DOI: 10.1007/bf02711832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lordick F, Stein HJ, Peschel C, Siewert JR. Neoadjuvant therapy for oesophagogastric cancer. Br J Surg 2004; 91:540-51. [PMID: 15122603 DOI: 10.1002/bjs.4575] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The prognosis after surgery for oesophagogastric cancer remains poor. METHODS This review clarifies current indications for neoadjuvant therapy for oesophageal and gastric cancer. A systematic literature research and evaluation of data from international cancer meetings were carried out. RESULTS Recently published results of large randomized phase III trials underscore the potential value of neoadjuvant treatment for oesophagogastric cancer. However, it remains uncertain which subgroups of patients should routinely undergo preoperative therapy. Metabolic response evaluation during neoadjuvant treatment is a promising tool for the selection of responding patients. CONCLUSION Neoadjuvant chemotherapy is a valid option for locally advanced oesophageal and gastric cancer. In the future, more effective and better tolerated treatment strategies, tailored to the specific tumour characteristics of each individual, should be possible.
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Affiliation(s)
- F Lordick
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, D-81675 Munich, Germany.
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Rau B, Hünerbein M. Diagnostic laparoscopy: indications and benefits. Langenbecks Arch Surg 2004; 390:187-96. [PMID: 15156319 DOI: 10.1007/s00423-004-0483-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Accepted: 03/11/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND The increased availability of treatment options for gastrointestinal cancer, necessitates precise preoperative staging. Laparoscopy can be useful for establishing the diagnosis and staging of cancer. However, there is an ongoing discussion as to whether staging laparoscopy provides additional results despite newly developed imaging tools. METHODS A systematic review of relevant literature was undertaken. The strength of evidence was classified according to the North of England Evidence Based Guidelines Development Project. Medline and manual searches were carried out to identify all published manuscripts of clinical trials that dealt with staging laparoscopy. Systematic quality review of those publications was used to verify staging accuracy, complications and trocar metastases. RESULTS Only one randomized trial was performed in gynaecological cancer. In cervical cancer, as a result of this study, staging laparoscopy remains unproven. In gastrointestinal cancer (oesophageal, gastric, pancreatic, liver and colorectal cancers) only prospective and retrospective observational studies are available with an evidence-based level of grade B. As a result of these trials, staging laparoscopy, in a well-defined group of patients with locally advanced cancer, is recommended. CONCLUSION The effects of surgical staging in gynaecological cancer must be kept in mind but cannot be transferred to gastrointestinal cancer in general. Further studies are required to answer those questions.
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Affiliation(s)
- Beate Rau
- Charité, Campus Berlin Buch, Klinik für Chirurgie und chirurgische Onkologie, Robert Rössle Klinik im Helios-Klinikum Berlin, Universitätsmedizin Berlin, 13122, Berlin, Germany.
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Lang BHH, Poon RTP, Fan ST, Wong J. Influence of laparoscopy on postoperative recurrence and survival in patients with ruptured hepatocellular carcinoma undergoing hepatic resection. Br J Surg 2004; 91:444-9. [PMID: 15048744 DOI: 10.1002/bjs.4450] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Use of laparoscopy in patients with gastrointestinal cancer has been associated with port-site and peritoneal tumour metastases. The effect of laparoscopy on tumour recurrence and long-term survival in patients undergoing resection of ruptured hepatocellular carcinoma (HCC) remains unknown.
Methods
Between June 1994 and December 2001, 59 patients with ruptured HCC underwent surgical exploration with a view to hepatic resection. Laparoscopy with laparoscopic ultrasonography was performed in 33 patients; the other 26 patients underwent exploratory laparotomy without laparoscopy. Perioperative and long-term outcomes were compared between the two groups.
Results
Exploratory laparotomy was avoided in 12 of 13 patients with irresectable HCC who had a laparoscopy. The hospital stay of these 12 patients was significantly shorter than that of eight patients found to have irresectable HCC at exploratory laparotomy (median 11 versus 15 days; P = 0·043). Twenty patients had a laparoscopy followed by open resection of HCC, whereas 18 patients underwent laparotomy and resection without laparoscopy. There were no significant differences in disease-free (16 versus 19 per cent; P = 0·525) and overall (32 versus 48 per cent; P = 0·176) survival at 3 years between the two groups. The tumour recurrence pattern was similar between the two groups, and there were no port-site or wound metastases.
Conclusion
Use of diagnostic laparoscopy in patients with ruptured HCC helps avoid unnecessary exploratory laparotomy. The present data suggest that laparoscopy does not have an adverse effect on tumour recurrence or survival in patients who undergo resection.
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Affiliation(s)
- B H H Lang
- Department of Surgery, University of Hong Kong, Pokfulam, Hong Kong, China
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Lee JH, Ryu KW, Kim YW, Bae JM. Staging laparoscopy in gastric cancer: a single port method. J Surg Oncol 2003; 84:50-2. [PMID: 12949992 DOI: 10.1002/jso.10289] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jun Ho Lee
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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D'Ugo DM, Pende V, Persiani R, Rausei S, Picciocchi A. Laparoscopic staging of gastric cancer: an overview. J Am Coll Surg 2003; 196:965-74. [PMID: 12788435 DOI: 10.1016/s1072-7515(03)00126-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Domenico M D'Ugo
- Department of Surgical Sciences, Catholic University of Rome, A Gemelli Medical School, Italy
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