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Ye L, Yang Q, Xue Y, Jia R, Yang L, Zhong L, Zou L, Xie Y. Impact of robotic and open surgery on patient wound complications in gastric cancer surgery: A meta-analysis. Int Wound J 2023; 20:4262-4271. [PMID: 37496310 PMCID: PMC10681412 DOI: 10.1111/iwj.14328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023] Open
Abstract
This meta-analysis is intended to evaluate the effect of both robotic and open-cut operations on postoperative complications of stomach carcinoma. From the earliest date until June 2023, a full and systemic search has been carried out on four main databases with keywords extracted from 'Robot', 'Gastr' and 'Opene'. The ROBINS-I instrument has been applied to evaluate the risk of bias in nonrandomized controlled trials. In these 11 trials, a total of 16 095 patients had received surgical treatment for stomach cancer and all 11 trials were nonrandomized, controlled trials. Abdominal abscesses were reported in 5 trials, wound infections in 8 trials, haemorrhage in 7 trials, wound dehiscence in 2 trials and total postoperative complications in 4 trials. Meta-analyses revealed no statistically significantly different rates of postoperative abdominal abscesses among patients who had received robotic operations than in those who had received open surgical procedures (OR, 0.91; 95% CI, 0.25, 3.36; p = 0.89). The incidence of bleeding after surgery was not significantly different from that in both groups (OR, 1.37; 95% CI, 0.69, 2.75; p = 0.37). Similarly, there was no significant difference between the two groups (OR, 0.78; 95% CI, 0.52, 1.18; p = 0.24). No significant difference was found between the two groups (OR, 1. 28; 95% CI, 0.75, 2.21; p = 0.36). No significant difference was found between the two groups of patients who had received the robotic operation and those who had received the surgery after the operation (OR, 1.14; 95% CI, 0.78, 1.66; p = 0.49). Generally speaking, this meta-analysis suggests that the use of robotics does not result in a reduction in certain postsurgical complications, including wound infections and abdominal abscesses. Thus, the use of a microinvasive robot for stomach carcinoma operation might not be better than that performed on the surgical site after the operation. This is a valuable guide for the surgeon to select the operative method.
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Affiliation(s)
- Lu Ye
- Department of Medical Oncology of Cancer Center, West China HospitalSichuan UniversityChengduChina
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical CollegeChina National Nuclear Corporation 416 HospitalChengduChina
| | - Qian Yang
- Clinical Medical CollegeChengdu Medical CollegeChengduChina
| | - Yuyu Xue
- School of Preclinical MedicineChengdu UniversityChengduChina
| | - Rong Jia
- Clinical Medical CollegeChengdu Medical CollegeChengduChina
| | - Li Yang
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical CollegeChina National Nuclear Corporation 416 HospitalChengduChina
| | - Lili Zhong
- Department of Oncology, The Second Affiliated Hospital of Chengdu Medical CollegeChina National Nuclear Corporation 416 HospitalChengduChina
| | - Liqun Zou
- Department of Medical Oncology of Cancer Center, West China HospitalSichuan UniversityChengduChina
| | - Yao Xie
- Department of Obstetrics and Gynaecology, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Chinese Academy of Sciences Sichuan Translational Medicine Research HospitalChengduChina
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Mitra S, Simson DK, Gehani M, Barik S, Khurana R, Singh S, Talwar V, Goel V, Khurana H, Mishra M, Dewan A, Mukhi MJ. Survival and Recurrence Patterns in Patients With Stomach Adenocarcinoma Receiving Chemotherapy or Chemoradiotherapy After D2 Gastrectomy in a Tertiary Care Cancer Institute: A Retrospective Real-World Evidence Cohort Study. Adv Radiat Oncol 2023; 8:101280. [PMID: 38047217 PMCID: PMC10692297 DOI: 10.1016/j.adro.2023.101280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/23/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Clinical trials comparing the efficacy of adjuvant chemotherapy (CT) and chemo radiation therapy (CTRT) for stomach adenocarcinoma have reported equivocal results. Hence, the current retrospective cohort study assessed the long-term survival and recurrence outcomes of these therapies, to generate evidence in a real-world scenario. Methods and Materials Pathologically confirmed patients with stomach adenocarcinoma aged ≥18 years who underwent gastrectomy and D2 lymph nodal dissection at a tertiary cancer hospital from January 2010 to October 2017 were enrolled. Hospital-based follow-up was performed until December 2021. Data were gathered from electronic medical records, supplemented by telephonic interviews for patients who could not come for physical follow-up. CT-alone and CTRT cohorts were compared in terms of survival and recurrence outcomes. Results The analysis included 158 patients (mean age, 56.42 years; 63.9% male; CT-alone cohort, 69; CTRT cohort, 89). Patients in the CTRT cohort had significantly worse tumor characteristics at baseline (29.2% had the diffuse type of tumor, 94.4% had stage II or III, 68.5% had lympho-vascular space invasion, and 85.4% had lymph node involvement). Recurrence was observed in 13 (19.7%) of the 76 followed-up patients. Although locoregional recurrence was higher in the CT-alone cohort (7 vs 2), distant metastasis was higher in the CTRT cohort (3 vs 1). The overall 5-year survival was 67.0% (SE, 5.0%) and 5-year recurrence-free survival (RFS) was 75.0% (SE, 5.0%). On multivariate Cox regression, no variable was significantly associated with the overall survival, whereas age, positive lymph nodes without extracapsular extension, and lymph node-negative were significantly associated with RFS. The CTRT cohort had significantly (84.0%) higher RFS (hazard ratio, 0.161; 95% CI, 0.056-0.464; P < .001). Conclusions Patients who received adjuvant CTRT after D2 dissection showed similar overall survival but significantly higher RFS than the CT-alone cohort, despite having worse baseline tumor characteristics.
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Affiliation(s)
- Swarupa Mitra
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - David K. Simson
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Manish Gehani
- Department of Biological Sciences, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, India
| | - Soumitra Barik
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Ruparna Khurana
- Holistic Oncology with Patient Empathy (HOPE) Oncology Clinic, New Delhi, India
| | - Shivendra Singh
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Vineet Talwar
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Varun Goel
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | | | - Manindra Mishra
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - Abhinav Dewan
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
| | - M. Jwala Mukhi
- Rajiv Gandhi Cancer Institute and Research Center, Delhi, India
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Yan W, Yan S, He W. Clinical Efficacy of Laparoscopic Billroth II Subtotal Gastrectomy Plus Lienal Polypeptide Injection for Gastric Cancer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:5162225. [PMID: 35783513 PMCID: PMC9242771 DOI: 10.1155/2022/5162225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/19/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022]
Abstract
Objective To evaluate the clinical efficacy of laparoscopic Billroth II subtotal gastrectomy plus lienal polypeptide injection for gastric cancer. Methods Between May 2018 and January 2021, 110 patients with gastric cancer treated in Jingzhou First People's Hospital were recruited and assigned via the random number table method to either an observation group or a control group, with 55 patients in each group. All patients received laparoscopic Billroth II subtotal gastrectomy, and the observation group additionally received lienal polypeptide injection. Outcome measures include surgical indexes, clinical efficacy, and adverse events. Results The patients in the observation group had significantly less intraoperative hemorrhage volume, smaller surgical wounds, shorter time lapse before passing gas and hospital stay, and longer operation time than those in the control group (P < 0.001). The observation group showed significantly higher efficacy than the control group (P=0.001). The observation group had a significantly lower incidence of toxic side effects and adverse events than the control group (P < 0.05). After treatment, the CD3+ and CD4+ levels were significantly elevated and the CD8+ level was decreased, with higher CD3+ and CD4+ levels and lower CD8+ levels in the observation group than in the control group (P < 0.05). Conclusion In the treatment of patients with gastric cancer, laparoscopic Billroth II subtotal gastrectomy plus lienal polypeptide injection features promising efficacy, improves the immune function of patients, effectively reduces the occurrence of toxic side effects and adverse reactions, with less trauma and rapid recovery, which shows good potential for use in clinical application.
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Affiliation(s)
- Wei Yan
- Department of Oncology, Jingzhou First People's Hospital, Jingzhou 434000, China
| | - Siqi Yan
- Department of Oncology, Jingzhou First People's Hospital, Jingzhou 434000, China
| | - Wu He
- Department of Oncology, Jingzhou First People's Hospital, Jingzhou 434000, China
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Sun F, Liu S, Song P, Zhang C, Liu Z, Guan W, Wang M. Impact of retrieved lymph node count on short-term complications in patients with gastric cancer. World J Surg Oncol 2020; 18:224. [PMID: 32838799 PMCID: PMC7446131 DOI: 10.1186/s12957-020-02000-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is well established that retrieved lymph node (RLN) counts were positively correlated with better overall survival in gastric cancer (GC). But little is known about the relationship between RLN count and short-term complications after radical surgery. METHODS A total of 1487 consecutive GC patients between January 2016 and December 2018 at Nanjing Drum Tower Hospital were retrospectively analyzed. Univariate analyses were performed to elucidate the association between RLN count and postoperative complications. We further identified clinical factors that might affect the RLN count. RESULTS Among all of the patients, postoperative complications occurred in 435 (29.3%) patients. The mean RLN count was 25.1, and 864 (58.1%) patients were diagnosed with lymph node metastasis. Univariate analyses showed no significant difference between RLN count and postoperative complications (both overall and stratified by CDC grade). Univariate and multivariate analyses further revealed that type of resection, tumor invasion, and lymph node metastasis were associated with RLN count. CONCLUSIONS The current study demonstrated that RLN count was not associated with postoperative short-term complications following gastrectomy of GC, which provided a rationale for the determination of a proper RLN count of curative gastrectomy.
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Affiliation(s)
- Feng Sun
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Song Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Peng Song
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chen Zhang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhijian Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Meng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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Mueller JL, Kim DH, Stapleton S, Cauley CE, Chang DC, Park CH, Song KY, Mullen JT. Nature versus nurture: the impact of nativity and site of treatment on survival for gastric cancer. Gastric Cancer 2019; 22:446-455. [PMID: 30167904 DOI: 10.1007/s10120-018-0869-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognosis of gastric cancer patients is better in Asia than in the West. Genetic, environmental, and treatment factors have all been implicated. We sought to explore the extent to which the place of birth and the place of treatment influences survival outcomes in Korean and US patients with localized gastric cancer. METHODS Patients with localized gastric adenocarcinoma undergoing potentially curative gastrectomy from 1989 to 2010 were identified from the SEER registry and two single institution databases from the US and Korea. Patients were categorized into three groups: Koreans born/treated in Korea (KK), Koreans born in Korea/treated in the US (KUS), and White Americans born/treated in the US (W), and disease-specific survival rates compared. RESULTS We identified 16,622 patients: 3,984 (24.0%) KK, 1,046 (6.3%) KUS, and 11,592 (69.7%) W patients. KK patients had longer unadjusted median (not reached) and 5-year disease-specific survival (81.6%) rates than KUS (87 months, 55.9%) and W (35 months, 39.2%; p < 0.001 for all comparisons) patients. This finding persisted on subset analyses of patients with stage IA tumors, without cardia/GEJ tumors, with > 15 examined lymph nodes, and treated at a US center of excellence. On multivariable analysis, KUS (HR 2.80, p < 0.001) and W (HR 5.79, p < 0.001) patients had an increased risk of mortality compared to KK patients. CONCLUSIONS Both the place of birth and the place of treatment significantly contribute to the improved prognosis of patients with gastric cancer in Korea relative to those in the US, implicating both nature and nurture in this phenomenon.
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Affiliation(s)
- Jessica L Mueller
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Danbee H Kim
- Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sahael Stapleton
- Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Christy E Cauley
- Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David C Chang
- Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Cho Hyun Park
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Codman Institute for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA
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Reddavid R, Sofia S, Chiaro P, Colli F, Trapani R, Esposito L, Solej M, Degiuli M. Neoadjuvant chemotherapy for gastric cancer. Is it a must or a fake? World J Gastroenterol 2018; 24:274-289. [PMID: 29375213 PMCID: PMC5768946 DOI: 10.3748/wjg.v24.i2.274] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the neoadjuvant chemotherapy (NAC) effect on the survival of patients with proper stomach cancer submitted to D2 gastrectomy.
METHODS We proceeded to a review of the literature with PubMed, Embase, ASCO and ESMO meeting abstracts as well as computerized use of the Cochrane Library for randomized controlled trials (RCTs) comparing NAC followed by surgery (NAC + S) with surgery alone (SA) for gastric cancer (GC). The primary outcome was the overall survival rate. Secondary outcomes were the site of the primary tumor, extension of node dissection according to Japanese Gastric Cancer Association (JGCA) performed in both arms, disease-specific (DSS) and disease-free survival (DFS) rates, clinical and pathological response rates and resectability rates after perioperative treatment.
RESULTS We identified a total of 16 randomized controlled trials comparing NAC + S (n = 1089) with SA (n = 973) published in the period from January 1993 - March 2017. Only 6 of these studies were well-designed, structured trials in which the type of lymph node (LN) dissection performed or at least suggested in the trial protocol was reported. Two out of three of the RCTs with D2 lymphadenectomy performed in almost all cases failed to show survival benefit in the NAC arm. In the third RCT, the survival rate was not even reported, and the primary end points were the clinical outcomes of surgery with and without NAC. In the remaining three RCTs, D2 lymph node dissection was performed in less than 50% of cases or only recommended in the “Study Treatment” protocol without any description in the results of the procedure really perfomed. In one of the two studies, the benefit of NAC was evident only for esophagogastric junction (EGJ) cancers. In the second study, there was no overall survival benefit of NAC. In the last trial, which documented a survival benefit for the NAC arm, the chemotherapy effect was mostly evident for EGJ cancer, and more than one-fourth of patients did not have a proper stomach cancer. Additionally, several patients did not receive resectional surgery. Furthermore, the survival rates of international reference centers that provide adequate surgery for homogeneous stomach cancer patients’ populations are even higher than the survival rates reported after NAC followed by incomplete surgery.
CONCLUSION NAC for GC has been rapidly introduced in international western guidelines without an evidence-based medicine-related demonstration of its efficacy for a homogeneous population of patients with only stomach tumors submitted to adequate surgery following JGCA guidelines with extended (D2) LN dissection. Additional larger sample-size multicentre RCTs comparing the newer NAC regimens including molecular therapies followed by adequate extended surgery with surgery alone are needed.
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Affiliation(s)
- Rossella Reddavid
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Silvia Sofia
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Paolo Chiaro
- Department of Surgical Sciences, Digestive and Oncological Surgery, University of Turin, Molinette Hospital, Turin 10126, Italy
| | - Fabio Colli
- Department of Surgical Sciences, Digestive and Oncological Surgery, University of Turin, Molinette Hospital, Turin 10126, Italy
| | - Renza Trapani
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Laura Esposito
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Mario Solej
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
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Evolution in the surgical management of gastric cancer: is extended lymph node dissection back in vogue in the USA? World J Surg Oncol 2017; 15:135. [PMID: 28716043 PMCID: PMC5514466 DOI: 10.1186/s12957-017-1204-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/08/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastric cancer remains a formidable treatment challenge. For decades, treatment consisted mostly of surgical intervention for this deadly disease. With improvements in the multi-disciplinary management of solid organ malignancies, the approach to this disease is being stepwise refined. MAIN BODY One of the prevalent controversies in the surgical management of gastric cancer rests on the need for adequate harvesting of lymph nodes. For decades, lymph node dissection is regarded as a staging technique useful in only upstaging the disease. The adoption of D2 lymphadenectomy has been particularly slow to mature. But with prevailing data from Asia consistently demonstrating a survival benefit from lymphadenectomy, it calls into question the notion of lymphadenectomy as being solely a staging procedure. CONCLUSIONS As gastric resection techniques are being better defined in western countries and surgical morbidities lowered on its execution, D2 lymphadenectomy is becoming more accepted as the new standard in the management of gastric cancer.
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Zhang S, Wu L, Wang X, Ding X, Liang H. Satisfactory surgical outcome of T2 gastric cancer after modified D2 lymphadenectomy. Chin J Cancer Res 2017; 29:100-108. [PMID: 28536488 PMCID: PMC5422411 DOI: 10.21147/j.issn.1000-9604.2017.02.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Though D2 lymphadenectomy has been increasingly regarded as standard surgical procedure for advanced gastric cancer (GC), the modified D2 (D1 + 7, 8a and 9) lymphadenectomy may be more suitable than D2 dissection for T2 stage GC. The purpose of this study is to elucidate whether the surgical outcome of modified D2 lymphadenectomy was comparable to that of standard D2 dissection in T2 stage GC patients. Methods A retrospective cohort study with 77 cases and 77 controls matched for baseline characteristics was conducted. Patients were categorized into two groups according to the extent of lymphadenectomy: the modified D2 group (mD2) and the standard D2 group (D2). Surgical outcome and recurrence date were compared between the two groups. Results The 5-year overall survival (OS) rate was 71.4% for patients accepted mD2 lymphadenectomy and 70.1% for those accepted standard D2, respectively, and the difference was not statistically significant. Multivariate survival analysis revealed that curability, tumor size, TNM stage and postoperative complications were independently prognostic factors for T2 stage GC patients. Patients in the mD2 group tended to have less intraoperative blood loss (P=0.001) and shorter operation time (P<0.001) than those in the D2 group. While there were no significant differences in recurrence rate and types, especially lymph node recurrence, between the two groups. Conclusions The surgical outcome of mD2 lymphadenectomy was equal to that of standard D2, and the use of mD2 instead of standard D2 can be a better option for T2 stage GC.
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Affiliation(s)
- Shupeng Zhang
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Liangliang Wu
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Xiaona Wang
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Xuewei Ding
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, China
| | - Han Liang
- Department of General Surgery, the Fifth Central Hospital of Tianjin, Tianjin 300450, China
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Dolan JP, McLaren PJ, Diggs BS, Schipper PH, Tieu BH, Sheppard BC, Gilbert EW, Conroy MA, Hunter JG. Evolution in the Treatment of Esophageal Disease at a Single Academic Institution: 2004-2013. J Laparoendosc Adv Surg Tech A 2017; 27:915-923. [PMID: 28486000 DOI: 10.1089/lap.2017.0069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Management of benign and malignant esophageal disease has changed rapidly over the past decade. The aim of this study was to analyze evolution in surgical management of esophageal disease at a single academic medical center during this period. MATERIALS AND METHODS We reviewed a retrospective cohort of patients who underwent esophagectomy between 2004 and 2013. Patient, institutional, treatment, and outcomes variables were reviewed. RESULTS 317 patients were analyzed. Median age was 63.5 years; 80% were male. Average inhospital mortality rate was 3.8%. Operative indications changed significantly from 2004 to 2013, with more operations performed for invasive malignancy (77% vs. 95%) and fewer for high-grade dysplasia (12% vs. 3%, P = .008). In 2004, Ivor Lewis esophagectomy was the most common surgical technique, but the three-field technique was the operation of choice in 2013. A minimally invasive approach was used in 19% of cases in 2004 and 100% of cases in 2013 (P < .001). Anastomotic leak ranged from 0% to 21% with no significant difference over the study period (P = .18). Median lymph node harvest increased from seven to 18 nodes from 2004 to 2013 (P = .001). Hospital length of stay decreased from 15 to 8 days (P = .001). In 2013, 79% of patients were discharged to home, compared to 73% in 2004 (P = .04). DISCUSSION Over the last decade, our treatment of esophageal disease has evolved from a predominantly open Ivor Lewis to a minimally invasive three-field approach. Operations for malignancy have also increased dramatically. Postoperative complications and mortality were not significantly changed, but were consistently low during the latter years of the study.
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Affiliation(s)
- James P Dolan
- 1 Division of Gastrointestinal & General Surgery, Department of Surgery, the Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon
| | - Patrick J McLaren
- 1 Division of Gastrointestinal & General Surgery, Department of Surgery, the Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon
| | - Brian S Diggs
- 1 Division of Gastrointestinal & General Surgery, Department of Surgery, the Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon
| | - Paul H Schipper
- 2 Division of Cardiothoracic Surgery, Section of General Thoracic Surgery, Department of Surgery, Oregon Health & Science University , Portland, Oregon
| | - Brandon H Tieu
- 2 Division of Cardiothoracic Surgery, Section of General Thoracic Surgery, Department of Surgery, Oregon Health & Science University , Portland, Oregon
| | - Brett C Sheppard
- 1 Division of Gastrointestinal & General Surgery, Department of Surgery, the Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon
| | - Erin W Gilbert
- 1 Division of Gastrointestinal & General Surgery, Department of Surgery, the Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon
| | - Molly A Conroy
- 1 Division of Gastrointestinal & General Surgery, Department of Surgery, the Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon
| | - John G Hunter
- 1 Division of Gastrointestinal & General Surgery, Department of Surgery, the Knight Cancer Institute, Oregon Health & Science University , Portland, Oregon
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Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, Yu B, Min Z. Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer 2016. [PMID: 26216579 DOI: 10.1007/s10120-015-0516-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. METHODS Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. RESULTS Overall, 26 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P < 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P < 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P < 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P < 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P < 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. CONCLUSIONS For AGCs, LG appeared comparable with OG in short- and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.
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Affiliation(s)
- Yingjun Quan
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ao Huang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Min Ye
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ming Xu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Biao Zhuang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Bo Yu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Zhijun Min
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
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Dolan JP, Kaur T, Diggs BS, Luna RA, Sheppard BC, Schipper PH, Tieu BH, Bakis G, Vaccaro GM, Holland JM, Gatter KM, Conroy MA, Thomas CA, Hunter JG. Significant understaging is seen in clinically staged T2N0 esophageal cancer patients undergoing esophagectomy. Dis Esophagus 2016; 29:320-5. [PMID: 25707341 DOI: 10.1111/dote.12334] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This study aimed to determine the impact of preoperative staging on the treatment of clinical T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy. We reviewed a retrospective cohort of 27 patients treated at a single institution between 1999 and 2011. Clinical staging was performed with computed tomography, positron emission tomography, and endoscopic ultrasound. Patients were separated into two groups: neoadjuvant therapy followed by surgery (NEOSURG) and surgery alone (SURG). There were 11 patients (41%) in the NEOSURG group and 16 patients (59%) in the SURG group. In the NEOSURG group, three of 11 patients (27%) had a pathological complete response and eight (73%) were partial or nonresponders after neoadjuvant therapy. In the SURG group, nine of 16 patients (56%) were understaged, 6 (38%) were overstaged, and 1 (6%) was correctly staged. In the entire cohort, despite being clinically node negative, 14 of 27 patients (52%) had node-positive disease (5/11 [45%] in the NEOSURG group, and 9/16 [56%] in the SURG group). Overall survival rate was not statistically significant between the two groups (P = 0.96). Many cT2N0 patients are clinically understaged and show no preoperative evidence of node-positive disease. Consequently, neoadjuvant therapy may have a beneficial role in treatment.
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Affiliation(s)
- J P Dolan
- Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - T Kaur
- Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - B S Diggs
- Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - R A Luna
- Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - B C Sheppard
- Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - P H Schipper
- Department of Surgery, Division of Cardiothoracic Surgery & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - B H Tieu
- Department of Surgery, Division of Cardiothoracic Surgery & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - G Bakis
- Department of Medicine, Division of Gastroenterology & the Digestive Health Center, Oregon Health and Science University, Portland, Oregon, USA
| | - G M Vaccaro
- Department of Medicine, Division of Hematology & Medical Oncology, Oregon Health and Science University, Portland, Oregon, USA
| | - J M Holland
- Department of Radiation Medicine & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - K M Gatter
- Department of Pathology, Oregon Health and Science University, Portland, Oregon, USA
| | - M A Conroy
- Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - C A Thomas
- Department of Radiation Medicine & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - J G Hunter
- Department of Surgery, Digestive Health Center & the Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon, USA
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Degiuli M, De Manzoni G, Di Leo A, D’Ugo D, Galasso E, Marrelli D, Petrioli R, Polom K, Roviello F, Santullo F, Morino M. Gastric cancer: Current status of lymph node dissection. World J Gastroenterol 2016; 22:2875-2893. [PMID: 26973384 PMCID: PMC4779911 DOI: 10.3748/wjg.v22.i10.2875] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/09/2015] [Accepted: 01/18/2016] [Indexed: 02/06/2023] Open
Abstract
D2 procedure has been accepted in Far East as the standard treatment for both early (EGC) and advanced gastric cancer (AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials (RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council (MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recurrence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC.
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Jiang L, Yao Z, Zhang Y, Hu J, Zhao D, Zhai H, Wang X, Zhang Z, Wang D. Comparison of lymph node number and prognosis in gastric cancer patients with perigastric lymph nodes retrieved by surgeons and pathologists. Chin J Cancer Res 2016; 28:511-518. [PMID: 27877010 PMCID: PMC5101225 DOI: 10.21147/j.issn.1000-9604.2016.05.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To compare the numbers of positive and total lymph nodes and prognosis in gastric cancer patients whose perigastric lymph node retrieval was performed by surgeons and pathologists. Methods We conducted a retrospective analysis of clinical and follow-up data from 1, 056 patients who underwent gastric cancer D2 radical lymph node resection between January 2008 and December 2010 in the Gastrointestinal Surgery Department of Yantai Yuhuangding Hospital. The follow-up ended in December 2015. Patients were divided into two groups according to the specialty of physicians who performed the postoperative perigastric lymph node retrieval: the surgeon group (475 cases) and the pathologist group (581 cases). The numbers of positive and total perigastric lymph nodes and the 3- and 5-year survival were compared between gastric cancer patients in the two groups overall and stratified by TNM stage (the 7th Edition of the American Joint Committee on Cancer). Results Overall, the numbers of positive and total lymph nodes were significantly higher in the surgeon group than in the pathologist group (6.53±4.07 vs. 4.09±3.70, P=0.021; 29.64±11.50 vs. 20.71±8.56, P<0.001). Further analysis showed that the total number of lymph nodes in stage I patients (19.40±9.62 vs. 15.45±8.59, P=0.011) and the numbers of positive and total lymph nodes in stage II (1.38±1.08 vs. 0.87±1.55, P=0.031; 25.35±10.80 vs. 16.75±8.56, P<0.001) and stage III patients (8.11±6.91 vs. 6.66±5.12, P=0.026; 32.34±12.55 vs. 25.45±8.31, P<0.001) were significantly higher in the surgeon group than in the pathologist group. The survival analysis showed that the 3- and 5-year survival of stage II and III patients was significantly higher in the surgeon group than in the pathologist group (82.0% vs. 73.1%, 69.5% vs. 61.2%, P=0.038; 49.2% vs. 38.9%, 36.3% vs. 28.0%; P=0.045). Conclusions Compared with retrieval performed by pathologists, postoperative perigastric lymph node retrieval performed by surgeons was associated with significant increase in the total lymph node number of stage I patients, the numbers of positive and total lymph nodes of stage II and III patients, and the survival of stage II and stage III gastric cancer patients.
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Affiliation(s)
- Lixin Jiang
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Zengwu Yao
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Yifei Zhang
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Jinchen Hu
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Dawei Zhao
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Huiyuan Zhai
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Xixun Wang
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Zhenbin Zhang
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
| | - Dong Wang
- Gastrointestinal Surgery Ward I, Yantai Yuhuangding Hospital, the Affiliated Hospital of Qingdao University, Yantai 264000, China
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Cravo M, Fidalgo C, Garrido R, Rodrigues T, Luz G, Palmela C, Santos M, Lopes F, Maio R. Towards curative therapy in gastric cancer: Faraway, so close! World J Gastroenterol 2015; 21:11609-11620. [PMID: 26556990 PMCID: PMC4631964 DOI: 10.3748/wjg.v21.i41.11609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/14/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023] Open
Abstract
Although recent diagnostic and therapeutic advances have substantially improved the survival of patients with gastric cancer (GC), the overall prognosis is still poor. Surgery is the only curative treatment and should be performed in experienced centers. Due to high relapse following surgery, complementary and systemic treatment aimed at eradicating micrometastasis should be performed in most cases. Cytotoxic treatments are effective in downstaging locally advanced cancer, but different sensitivities and toxicities probably exist in different GC subtypes. Current treatment protocols are based primarily on clinical data and histological features, but molecular biomarkers that would allow for the prediction of treatment responses are urgently needed. Understanding how host factors are responsible for inter-individual variability of drug response or toxicity will also contribute to the development of more effective and less toxic treatments.
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Mocellin S, McCulloch P, Kazi H, Gama‐Rodrigues JJ, Yuan Y, Nitti D. Extent of lymph node dissection for adenocarcinoma of the stomach. Cochrane Database Syst Rev 2015; 2015:CD001964. [PMID: 26267122 PMCID: PMC7263417 DOI: 10.1002/14651858.cd001964.pub4] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The impact of lymphadenectomy extent on the survival of patients with primary resectable gastric carcinoma is debated. OBJECTIVES We aimed to systematically review and meta-analyze the evidence on the impact of the three main types of progressively more extended lymph node dissection (that is, D1, D2 and D3 lymphadenectomy) on the clinical outcome of patients with primary resectable carcinoma of the stomach. The primary objective was to assess the impact of lymphadenectomy extent on survival (overall survival [OS], disease specific survival [DSS] and disease free survival [DFS]). The secondary aim was to assess the impact of lymphadenectomy on post-operative mortality. SEARCH METHODS We searched CENTRAL, MEDLINE and EMBASE until 2001, including references from relevant articles and conference proceedings. We also contacted known researchers in the field. For the updated review, CENTRAL, MEDLINE and EMBASE were searched from 2001 to February 2015. SELECTION CRITERIA We considered randomized controlled trials (RCTs) comparing the three main types of lymph node dissection (i.e., D1, D2 and D3 lymphadenectomy) in patients with primary non-metastatic resectable carcinoma of the stomach. DATA COLLECTION AND ANALYSIS Two authors independently extracted data from the included studies. Hazard ratios (HR) and relative risks (RR) along with their 95% confidence intervals (CI) were used to measure differences in survival and mortality rates between trial arms, respectively. Potential sources of between-study heterogeneity were investigated by means of subgroup and sensitivity analyses. The same two authors independently assessed the risk of bias of eligible studies according to the standards of the Cochrane Collaboration and the quality of the overall evidence based on the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria. MAIN RESULTS Eight RCTs (enrolling 2515 patients) met the inclusion criteria. Three RCTs (all performed in Asian countries) compared D3 with D2 lymphadenectomy: data suggested no significant difference in OS between these two types of lymph node dissection (HR 0.99, 95% CI 0.81 to 1.21), with no significant difference in postoperative mortality (RR 1.67, 95% CI 0.41 to 6.73). Data for DFS were available only from one trial and for no trial were DSS data available. Five RCTs (n = 3 European; n = 2 Asian) compared D2 to D1 lymphadenectomy: OS (n = 5; HR 0.91, 95% CI 0.71 to 1.17) and DFS (n=3; HR 0.95, 95% CI 0.84 to 1.07) findings suggested no significant difference between these two types of lymph node dissection. In contrast, D2 lymphadenectomy was associated with a significantly better DSS compared to D1 lymphadenectomy (HR 0.81, 95% CI 0.71 to 0.92), the quality of the body of evidence being moderate; however, D2 lymphadenectomy was also associated with a higher postoperative mortality rate (RR 2.02, 95% CI 1.34 to 3.04). AUTHORS' CONCLUSIONS D2 lymphadenectomy can improve DSS in patients with resectable carcinoma of the stomach, although the increased incidence of postoperative mortality reduces its therapeutic benefit.
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Affiliation(s)
- Simone Mocellin
- University of PadovaMeta‐Analysis Unit, Department of Surgery, Oncology and GastroenterologyVia Giustiniani 2PadovaVenetoItaly35128
| | - Peter McCulloch
- John Radcliffe HospitalNuffield Department of Surgery6th floorHeadingtonOxfordUKOX3 9DU
| | - Hussain Kazi
- University of LiverpoolAcademic DepartmentLiverpoolUK
| | - Joaquin J Gama‐Rodrigues
- Hospital de ClinicasDepartment of Digestive SurgeryRua Manuel da Nobrega, 1564Sao PauloSao PauloBrazil04001005
| | - Yuhong Yuan
- McMaster UniversityDepartment of Medicine, Division of Gastroenterology1280 Main Street WestRoom HSC 4N50HamiltonONCanadaL8S 4K1
| | - Donato Nitti
- University of PadovaClinica Chirurgica IIVia Giustiniani 2PadovaItaly35128
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Luna RA, Dolan JP, Diggs BS, Bronson NW, Sheppard BC, Schipper PH, Tieu BH, Feeney BT, Gatter KM, Vaccaro GM, Thomas CR, Hunter JG. Lymph Node Harvest During Esophagectomy Is Not Influenced by Use of Neoadjuvant Therapy or Clinical Disease Stage. J Gastrointest Surg 2015; 19:1201-7. [PMID: 25910454 DOI: 10.1007/s11605-015-2821-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 04/07/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effects of neoadjuvant therapy on lymph node harvest (LNH), lymph node ratio (LNR), and overall survival rates after esophagectomy. METHODS A retrospective analysis of 111 patients who underwent esophagectomy for esophageal adenocarcinoma from 2001 to 2010 was performed. Patients were divided into two groups: neoadjuvant chemoradiotherapy prior to surgery (NEOSURG) versus surgery alone (SURG). RESULTS There were 83 patients (75%) in the NEOSURG group and 28 (25%) in the SURG group with a mean age of 66 and 67 years, respectively. The median LNH in the NEOSURG group and SURG group was 16.0 and 15.5, respectively (p = 0.57). Within the NEOSURG group, the median LNH was 16 for complete responders, 14 for partial responders, 16 for nonresponders, and 18 in those who were pathologically upstaged (p = 0.434). The median LNR was 0, 0, 0.1, and 0.2, respectively (p < 0.001). Complete response after neoadjuvant therapy demonstrated a trend toward improved survival (p = 0.056). CONCLUSION The LNH was not significantly influenced by neoadjuvant treatment or pathologic response. The LNR was inversely related to pathologic response after neoadjuvant therapy. Complete pathologic response to neoadjuvant therapy trends to improve survival rates.
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Affiliation(s)
- Renato A Luna
- Department of Surgery, the Digestive Health Center and the Knight Cancer Institute, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail code L223A, Portland, OR, 97239, USA
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Glenn JA, Turaga KK, Gamblin TC, Hohmann SF, Johnston FM. Minimally invasive gastrectomy for cancer: current utilization in US academic medical centers. Surg Endosc 2015; 29:3768-75. [PMID: 25791064 DOI: 10.1007/s00464-015-4152-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internationally, the utilization of minimally invasive techniques for gastric cancer resection has been increasing since first introduced in 1994. In the USA, the feasibility and safety of these techniques for cancer have not yet been demonstrated. METHODS The University HealthSystem Consortium database was queried for gastrectomies performed between 2008 and 2013. Any adult patient with an abdominal visceral malignancy that necessitated gastric resection was included in the cohort. Clinicopathological and in-hospital outcome metrics were collected for open, laparoscopic, and robotic procedures. RESULTS Open gastrectomies comprised 89.5% of the total study group, while 8.2% of procedures were performed laparoscopically, and 2.3% were performed with robotic assistance. When accounting for disparities in patient severity of illness and risk of mortality subclass designations, there were no significant differences in mean length of stay, 30-day readmission, and in-hospital mortality between the three groups; however, mean total cost was highest in the robotic-assisted group (P = 0.017). Overall, complication rates were also similar; however, there was a higher incidence of superficial infection in the laparoscopic group (P = 0.013) and a higher incidence of venous thromboembolism in the robotic group (P = 0.038). CONCLUSION Despite widespread adoption for benign indications, minimally invasive gastrectomy for cancer remains underutilized in the USA. In these patients, laparoscopic and robot-assisted gastrectomies appear to be comparable to open resection with respect to overall complications, length of stay, 30-day readmission, and in-hospital mortality. However, when employing minimally invasive techniques, infection and thromboembolism risk reduction strategies should be emphasized in the operative and postoperative periods.
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Affiliation(s)
- Jason A Glenn
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Kiran K Turaga
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Samuel F Hohmann
- University HealthSystem Consortium, 155 N Upper Wacker Dr, Chicago, IL, 60606, USA
| | - Fabian M Johnston
- Division of Surgical Oncology, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA.
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de Manzoni G, Marrelli D, Verlato G, Morgagni P, Roviello F. Western Perspective and Epidemiology of Gastric Cancer. Gastric Cancer 2015. [DOI: 10.1007/978-3-319-15826-6_7] [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: 02/16/2023]
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Antonakis PT, Ashrafian H, Isla AM. Laparoscopic gastric surgery for cancer: Where do we stand? World J Gastroenterol 2014; 20:14280-14291. [PMID: 25339815 PMCID: PMC4202357 DOI: 10.3748/wjg.v20.i39.14280] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/06/2014] [Accepted: 05/29/2014] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.
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20
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Verlato G, Giacopuzzi S, Bencivenga M, Morgagni P, Manzoni GD. Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer. World J Gastroenterol 2014; 20:12883-12891. [PMID: 25278685 PMCID: PMC4177470 DOI: 10.3748/wjg.v20.i36.12883] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/06/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard of care for advanced gastric cancer by Japanese National Guidelines since 1981 and was adopted as the standard procedure by the Italian Research Group for Gastric Cancer since the Nineties. D2 is now indicated as the standard of surgical treatment with curative intent by the German, British and ESMO-ESSO-ESTRO guidelines. At variance American NCCN guidelines recommend a D1+ or a modified D2 lymph node dissection. In conclusion, D2 lymphadenectomy, originally developed by Eastern surgeons, is now becoming the procedure of choice also in the West. In gastric cancer surgery EBM is lagging behind national guidelines, rather than preceding and orienting them. To eliminate this lag, EBM should value to a larger extent Eastern Asian literature and should evaluate not only the quality of the study design but also the quality of surgical procedures.
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Lin WL, Sun JL, Chang SC, Wu PH, Huang WT, Tsao CJ. Factors Predicting Survival of Patients with Gastric Cancer. Asian Pac J Cancer Prev 2014; 15:5835-8. [DOI: 10.7314/apjcp.2014.15.14.5835] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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