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Realis Luc M, de Pascale S, Ascari F, Bonomi AM, Bertani E, Cella CA, Gervaso L, Fumagalli Romario U. Textbook outcome as indicator of surgical quality in a single Western center: results from 300 consecutive gastrectomies. Updates Surg 2024; 76:1357-1364. [PMID: 38145422 DOI: 10.1007/s13304-023-01727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
Textbook outcome (TO) has been proposed as a tool to evaluate surgical quality. Textbook oncological outcome (TOO) adds chemotherapeutic compliance to TO. This study was conducted to analyze the TO and TOO of patients with gastric adenocarcinoma who underwent surgery at our center. Data from a prospective database of patients operated on for gastric adenocarcinoma between September 2018 and September 2022 were analyzed. Postoperative management followed Enhanced Recovery After Surgery guidelines. The Dutch Upper Gastrointestinal Cancer Audit group defined TO as a multidimensional measure (10 items). TOO also considers guideline-accordant chemotherapeutic compliance. Three hundred patients underwent surgery during the study period (167 men, 133 women). One hundred seventy-six (58.7%) reached TO. Achieving TO was influenced by patients' comorbidities, calculated via the Charlson Comorbidity Score (3 vs. 4; p = 0.002) and surgery type (subtotal gastrectomy; p < 0.001), but not by the American Society of Anesthesiologists (ASA) score (p = 0.057) or surgical approach (laparoscopic vs. open; p = 0.208). The analysis of TOO included 213 patients. Of these, 71 (33%) underwent complete adequate systemic treatment. Compared with the non-TOO group, patients who achieved TOO had a lower median age (64 vs. 73 years; p < 0.001) and lower ASA score (p < 0.001) and more frequently underwent preoperative chemotherapy (p < 0.001). Our results represent the experience of a single team at a high-volume Western institute. Patients' comorbidities and surgery type influenced whether TO was achieved. Conversely, younger age, lower ASA score and preoperative chemotherapy were associated with TOO.
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Affiliation(s)
- Marco Realis Luc
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
- University of Milan, Milan, Italy.
| | | | - Filippo Ascari
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Alessandro Michele Bonomi
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
- University of Milan, Milan, Italy
| | - Emilio Bertani
- Digestive Surgery, European Institute of Oncology, IRCCS, Milan, Italy
| | - Chiara Alessandra Cella
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
| | - Lorenzo Gervaso
- Division of Gastrointestinal and Neuroendocrine Tumors, European Institute of Oncology, IRCCS, Milan, Italy
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Ruff SM, Dillhoff ME. Minimally Invasive Techniques for Gastrectomy. Surg Oncol Clin N Am 2024; 33:539-547. [PMID: 38789196 DOI: 10.1016/j.soc.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Gastric adenocarcinoma is an aggressive disease and a leading cause of cancer-related deaths worldwide. Surgery entails either a total or a subtotal gastrectomy. These complex operations carry elevated morbidity and mortality with an extended recovery time. As such, research has focused on minimizing these risks and enhancing postoperative care. Robotic surgery is a newer platform that helps overcome some of the limitations of laparoscopy through three-dimensional vision, better mobility, and improved surgeon dexterity. As such, many surgeons have embraced robotics and advocated for their implementation in cancer surgery. This review will discuss the technical considerations of performing a robotic gastrectomy.
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Affiliation(s)
- Samantha M Ruff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Mary E Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA; Department of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 320 West 10th Avenue, M-256 Starling Loving Hall, Columbus, OH 43210, USA.
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Yang LW, Bai XY, Jing GM. Systematic review and meta-analysis of short-term outcomes: robot-assisted versus laparoscopic surgery for gastric cancer patients with visceral obesity. J Robot Surg 2024; 18:238. [PMID: 38833096 DOI: 10.1007/s11701-024-02002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
The objective of this meta-analysis was to assess the comparative efficacy of robot-assisted and laparoscopic surgery in treating gastric cancer among patients characterized by a high visceral fat area (VFA). In April 2024, we conducted a comprehensive literature review using major international databases, such as PubMed, Embase, and Google Scholar. We restricted our selection to articles written in English, excluding reviews, protocols without published data, conference abstracts, and irrelevant content. Our analysis focused on continuous data using 95% confidence intervals (CIs) and standard mean differences (SMDs), while dichotomous data were assessed with odds ratios (ORs) and 95% CIs. We set the threshold for statistical significance at P < 0.05. Data extraction included baseline characteristics, primary outcomes (such as operative time, major complications, lymph node yield, and anastomotic leakage), and secondary outcomes. The meta-analysis included three cohort studies totaling 970 patients. The robotic-assisted group demonstrated a significantly longer operative time compared to the laparoscopic group, with a weighted mean difference (WMD) of - 55.76 min (95% CI - 74.03 to - 37.50; P < 0.00001). This group also showed a reduction in major complications, with an odds ratio (OR) of 2.48 (95% CI 1.09-5.66; P = 0.03) and fewer occurrences of abdominal infections (OR 3.17, 95% CI 1.41-7.14; P = 0.005), abdominal abscesses (OR 3.83, 95% CI 1.53-9.57; P = 0.004), anastomotic leaks (OR 4.09, 95% CI 1.73-9.65; P = 0.001), and pancreatic leaks (OR 8.93, 95% CI 2.33-34.13; P = 0.001). However, no significant differences were observed between the groups regarding length of hospital stay, overall complications, estimated blood loss, or lymph node yield. Based on our findings, robot-assisted gastric cancer surgery in obese patients with visceral fat appears to be correlated with fewer major complications compared to laparoscopic surgery, while maintaining similar outcomes in other surgical aspects. However, it is important to note that robot-assisted procedures do tend to have longer operative times.
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Affiliation(s)
- Lin-Wen Yang
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Xiang-Yu Bai
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, China
| | - Guo-Min Jing
- Clinical Medicine Department of North Sichuan Medical College, Nanchong, Sichuan Province, China.
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Maalouf H, Saber T, Ghattas S, Meguerian-Bedoyan Z, El Rassi Z. CDH1 gene mutation, a challenging surgical topic: Case report and literature review. Int J Surg Case Rep 2024; 116:109422. [PMID: 38394940 PMCID: PMC10943988 DOI: 10.1016/j.ijscr.2024.109422] [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: 01/12/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Gastric cancer is one of the top 5 cancers worldwide. Most gastric cancers are classified as sporadic with the exception of around 3 % that are associated with specific syndromes or genes. Hereditary diffuse gastric cancer is a very rare type of gastric cancer, associated with loss of function of a tumor suppressor gene CDH1 which has a high penetrance that can reach 90 % over a lifetime. CASE PRESENTATION Here we present the case of a 31 years old male patient carrying the CDH1 gene who presented for prophylactic total gastrectomy and D1 lymphadenectomy followed by a roux en y esophago-jejunostomy for digestive tract reconstruction. The patient had a preoperative negative gastroscopy for gastric cancer. On final pathology, few 2 mm foci of signet ring cells involving the lamina propria (T1a) were identified. CLINICAL DISCUSSION Randomized clinical trial data concerning HDGC is lacking. Individuals who meet the genetic testing criteria developed by the IGCLC, testing should be obtainable from the legal age of consent that range from 16 to 18 years of age. CDH1 is the main gene that is tested. The mainstay treatment of choice for HDGC is total gastrectomy and Roux-en-Y esophago-jejunostomy in asymptomatic patients but should only be undertaken after baseline endoscopy. CONCLUSION Genetic testing for CDH1 should be carried in high-risk populations. Due to its high penetrance, any person carrying the CDH1 gene should be managed by a prophylactic gastrectomy and D1 lymphadenectomy with close follow up for any future breast neoplasm.
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Affiliation(s)
- Hani Maalouf
- Department of General Surgery, University of Balamand, Beirut, Lebanon
| | - Toufic Saber
- Department of General Surgery, University of Balamand, Beirut, Lebanon
| | - Souad Ghattas
- Department of General Surgery, University of Balamand, Beirut, Lebanon.
| | | | - Ziad El Rassi
- Head of General Surgery Department, Saint Georges Hospital University Medical Center, Beirut, Lebanon
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Cai Z, Lin H, Li Z, Zhou J, Chen W, Liu F, Zhao H, Xu Y. The short- and long-term outcomes of laparoscopic D2 lymphadenectomy plus complete mesogastrium excision for lymph node-negative gastric cancer. Surg Endosc 2024; 38:1059-1068. [PMID: 38082018 DOI: 10.1007/s00464-023-10621-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Patients with T1-3N0M0 gastric cancer (GC) who undergo radical gastrectomy maintain a high recurrence rate. The free cancer cells in the mesogastric adipose connective tissue (Metastasis V) maybe the reason for recurrence in these individuals. We aimed to evaluate whether D2 lymphadenectomy plus complete mesogastrium excision (D2 + CME) was superior to D2 lymphadenectomy with regard to safety and oncological efficacy for T1-3N0M0 GC. METHODS Patients with T1-3N0M0 GC who underwent radical resection from January 2014 to July 2018 were retrospectively analyzed; there were 323 patients, of whom 185 were in the D2 + CME group and 138 in the D2 group. The primary endpoint was 5-year disease-free survival (DFS). Secondary endpoints include the 5-year overall survival (OS), recurrence pattern, morbidity, mortality, and surgical outcomes. RESULTS D2 + CME was associated with less intraoperative bleeding loss, a greater number of lymph nodes harvested, and less time to first postoperative flatus, but the postoperative morbidity was similar. The 5-year DFS was 95.6% (95% CI 92.7-98.5%) and 90.4% (95% CI 85.5-95.3%) in the D2 + CME group and the D2 group, respectively, with a hazard ratio (HR) of 0.455 (95% CI 0.188-1.097; p = 0.071). In terms of recurrence patterns, local recurrence was more prone to occur in the D2 group (p = 0.031). Subgroup analysis indicated that for patients with T1b-3N0M0 GC, the 5-year DFS in the D2 + CME group was considerably greater than that in the D2 group (95.3% [95% CI 91.6-99.0%] vs. 87.6% [95% CI 80.7-94.5%], HR 0.369, 95% CI 0.138-0.983; log-rank p = 0.043). CONCLUSION Laparoscopic D2 + CME for T1-3N0M0 GC is safe and feasible. Furthermore, it not only reduces the local recurrence rate but also improves the 5-year DFS in cases of T1b-3N0M0 GC.
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Affiliation(s)
- Zhiming Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Huimei Lin
- Department of Anorectal Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, 361021, Fujian, China
| | - Zhixiong Li
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
| | - Jinfeng Zhou
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Weixiang Chen
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Feng Liu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Hongrui Zhao
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China.
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Takayama T, Tsuji Y. Updated Adjuvant Chemotherapy for Gastric Cancer. J Clin Med 2023; 12:6727. [PMID: 37959193 PMCID: PMC10648766 DOI: 10.3390/jcm12216727] [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: 08/25/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
Surgical resection is currently the best curative approach for gastric cancer (GC); however, the prognosis of patients with advanced GC remains poor even with curative resection. For this reason, perioperative chemotherapy has been combined with surgery to reduce the risk of postoperative recurrence. Standard perioperative chemotherapy for resectable advanced GC varies from region to region. Postoperative S-1 therapy was standardized via the ACTS-GC study in East Asia, perioperative ECF (Epirubicin + Cisplatin + Fluorouracil) was standardized via the MAGIC study in Europe, and postoperative chemoradiotherapy was standardized via the US intergroup study in North America. Since then, more intensive regimens have been developed. In recent years, perioperative therapy using novel agents, such as molecular-targeted drugs and immune checkpoint inhibitors (ICIs), has also been tested and evaluated in the three major regions (East Asia, Europe, and North America) with promising results. Perioperative chemotherapy has become an integral part of many treatment strategies and requires continued research and evaluation.
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Affiliation(s)
- Toshizo Takayama
- Department of Medical Oncology, Tonan Hospital, Sapporo 060-0004, Japan
- Department of Medical Oncology, Daido Hospital, Nagoya 457-8511, Japan
| | - Yasushi Tsuji
- Department of Medical Oncology, Tonan Hospital, Sapporo 060-0004, Japan
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Russo A, Tseng J, DiPeri T, Pletcher E, Lee J, Chen C, Justo M, Razavi A, Gong J, Atkins K, Burch M, Gangi A. Contemporary Cancer Program Practice Profile Report Compliance Rates for Gastric Cancer: A National Cancer Database Analysis. Am Surg 2023; 89:4171-4178. [PMID: 37279501 DOI: 10.1177/00031348231180931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Commission on Cancer (CoC) established quality measures to be reported in National Cancer Database (NCDB) Quality Reporting Tools. Compliance is provided to accredited cancer programs as Cancer Program Practice Profile Reports (CP3R). At the time of this study, the quality metric for gastric cancer (GC) was removal and pathologic examination of 15 regional lymph nodes for resected GC (G15RLN). OBJECTIVE This study evaluates national trends in quality metric compliance for GC based on CoC CP3R. METHODS The National Cancer Database (NCDB) was queried from 2004-2017 to identify patients with stage I-III GC who met criteria for inclusion. National trends in compliance were compared. Overall survival (OS) was compared stage for stage. RESULTS Overall, 42 997 patients with GC qualified. In 2017, 64.5% of patients met compliance with G15RLN compared to 31.4% in 2004. When comparing academic and non-academic institutions, compliance was met 67.0% vs 60.0% of the time in 2017 (P < .01) and 36% vs 30.6% of the time in 2004 (P < .01). On multivariate logistic regression, patients receiving care at academic institutions (OR 1.5, 95% CI 1.4-1.5) and who underwent surgery at institutions in the >75th percentile for case volume (OR 1.5, 95% CI 1.4-1.6) had higher odds of compliance. When stratified by stage, median OS was better across all stages when compliance was met. CONCLUSION Compliance rates with GC quality measures have improved over time. Compliance with the G15RLN metric is associated with improved OS, stage for stage. Continued efforts to improve compliance rates across all institutions are critical.
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Affiliation(s)
- Ashley Russo
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Tseng
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Timothy DiPeri
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eric Pletcher
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jaewon Lee
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Courtney Chen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Monica Justo
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Allen Razavi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jun Gong
- Department of Medicine, Cedars-Sinai Medical Oncology, Los Angeles, CA, USA
| | - Kaitlyn Atkins
- Department of Radiation Oncology, Cedars-Sinai Medical Oncology, Los Angeles, CA, USA
| | - Miguel Burch
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexandra Gangi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Zhao L, Zhang F, Jiao F, Zhou X, Niu P, Han X, Wang W, Luan X, He M, Guan Q, Li Y, Zhao D, Gao J, Chen Y. The minimum number of examined lymph nodes was 24 for optimal survival of pathological T2-4 gastric cancer: a multi-center, hospital-based study covering 20 years of data. BMC Cancer 2023; 23:892. [PMID: 37735628 PMCID: PMC10512540 DOI: 10.1186/s12885-023-11138-0] [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: 04/27/2023] [Accepted: 06/30/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION The current National Comprehensive Cancer Network (NCCN) guidelines recommend that at least 16 lymph nodes should be examined for gastric cancer patients to reduce staging migration. However, there is still debate regarding the optimal management of examined lymph nodes (ELNs) for gastric cancer patients. In this study, we aimed to develop and test the minimum number of ELNs that should be retrieved during gastrectomy for optimal survival in patients with gastric cancer. METHODS We used the restricted cubic spline (RCS) to identify the optimal threshold of ELNs that should be retrieved during gastrectomy based on the China National Cancer Center Gastric Cancer (NCCGC) database. Northwest cohort, which sourced from the highest gastric cancer incidence areas in China, was used to verify the optimal cutoff value. Survival analysis was performed via Kaplan-Meier estimates and Cox proportional hazards models. RESULTS In this study, 12,670 gastrectomy patients were included in the NCCGC cohort and 4941 patients in the Northwest cohort. During 1999-2019, the average number of ELNs increased from 17.88 to 34.45 nodes in the NCCGC cohort, while the number of positive lymph nodes remained stable (5-6 nodes). The RCS model showed a U-curved association between ELNs and the risk of all-cause mortality, and the optimal threshold of ELNs was 24 [Hazard ratio (HR) = 1.00]. The ELN ≥ 24 group had a better overall survival (OS) than the ELN < 24 group clearly (P = 0.003), however, with respect to the threshold of 16 ELNs, there was no significantly difference between the two groups (P = 0.101). In the multivariate analysis, ELN ≥ 24 group was associated with improved survival outcomes in total gastrectomy patients [HR = 0.787, 95% confidence interval (CI): 0.711-0.870, P < 0.001], as well as the subgroup analysis of T2 patients (HR = 0.621, 95%CI: 0.399-0.966, P = 0.035), T3 patients (HR = 0.787, 95%CI: 0.659-0.940, P = 0.008) and T4 patients (HR = 0.775, 95%CI: 0.675-0.888, P < 0.001). CONCLUSION In conclusion, the minimum number of ELNs for optimal survival of gastric cancer with pathological T2-4 was 24.
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Affiliation(s)
- Lulu Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Zhang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Fuzhi Jiao
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiadong Zhou
- Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Penghui Niu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Han
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyi Luan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingyan He
- Gansu Provincial Cancer Hospital, Lanzhou, China.
| | - Quanlin Guan
- The First Hospital of Lanzhou University, Lanzhou, China.
| | - Yumin Li
- Lanzhou University Second Hospital, Lanzhou, China.
| | - Dongbing Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jidong Gao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union College, Shenzhen, China.
| | - Yingtai Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Fernström A, Kokkola A, Korpela A, Puolakkainen P, Louhimo J. Separating lymph node stations by the surgeon from the gastric cancer specimen improves the quality of nodal status evaluation. World J Surg Oncol 2023; 21:265. [PMID: 37626384 PMCID: PMC10463918 DOI: 10.1186/s12957-023-03146-y] [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: 05/30/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In gastric cancer (GC), the pN-stage is an important prognostic factor influencing treatment. Along with the depth of invasion of the tumor, the presence of nodal metastases is one of the most important prognostic factors guiding treatment strategies in gastric cancer. Examining a small number of lymph nodes may lead to understaging of the disease; hence, it is essential for the nodal status to be precisely assessed. In this study, we explored whether dissecting lymph node stations into separate samples by the surgeon from the gastric cancer surgical specimen affects the quality of nodal status evaluation and patient outcome. METHODS The clinical data of 130 GC patients treated at the Helsinki University Hospital between 2016 and 2019 was reviewed. The performed operations included 59 total and 71 subtotal gastrectomies. The processing of the surgical specimen before the pathological examination was assessed from the operation records and pathology reports. The association of the number of examined lymph nodes with other variables was assessed, and multivariate survival analysis was performed to explore the independent prognostic factors in disease-specific survival. RESULTS Dissecting lymph node stations into separate specimens before pathological evaluation yielded a significantly greater number of examined lymph nodes compared with a specimen without intervention (median 34.5 vs 21.0, p < 0.001). The pT-stage, the pN-stage, and the extent of lymphadenectomy were identified as independent prognostic factors, whereas dissecting the specimen's lymph node stations did not associate with survival. CONCLUSIONS Dissecting lymph node stations into separate specimens results in a greater number of examined lymph nodes, which has the potential to lead to a more reliable pN-stage assessment.
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Affiliation(s)
- Aleksi Fernström
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland
| | - Arto Kokkola
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland
| | - Akseli Korpela
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland
| | - Pauli Puolakkainen
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland
| | - Johanna Louhimo
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland.
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10
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Aydin D, Kefeli U, Ozcelik M, Erdem GU, Sendur MA, Yildirim ME, Oven BB, Bilici A, Gumus M. The Prognostic Utility of the Metastatic Lymph Node Ratio and the Number of Regional Lymph Nodes Removed from Patients with Small Bowel Adenocarcinomas. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1472. [PMID: 37629761 PMCID: PMC10456871 DOI: 10.3390/medicina59081472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Small bowel adenocarcinomas (SBAs) are rare tumors of the gastrointestinal system. Lymph node metastasis in patients with curatively resected SBAs is associated with poor prognosis. In this study, we determined the prognostic utility of the number of removed lymph nodes and the metastatic lymph node ratio (the N ratio). Materials and Methods: The data of 97 patients who underwent curative SBA resection in nine hospitals of Turkey were retrospectively evaluated. Univariate and multivariate analyses of potentially prognostic factors including the N ratio and the numbers of regional lymph nodes removed were evaluated. Results: Univariate analysis showed that perineural and vascular invasion, metastatic lymph nodes, advanced TNM stage, and a high N ratio were significant predictors of poor survival. Multivariate analysis revealed that the N ratio was a significant independent predictor of disease-specific survival (DSS). The group with the lowest N ratio exhibited the longest disease-free survival (DFS) and DSS; these decreased significantly as the N ratio increased (both, p < 0.001). There was no significant difference in either DFS or DSS between groups with low and high numbers of dissected lymph nodes (i.e., <13 and ≥13) (both, p = 0.075). Conclusions: We found that the N ratio was independently prognostic of DSS in patients with radically resected SBAs. The N ratio is a convenient and accurate measure of the severity of lymph node metastasis.
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Affiliation(s)
- Dincer Aydin
- Department of Medical Oncology, University of Health Sciences, Derince Training and Research Hospital, Kocaeli 41900, Turkey
| | - Umut Kefeli
- Department of Medical Oncology, Faculty of Medicine, Kocaeli University, Kocaeli 41100, Turkey;
| | - Melike Ozcelik
- Department of Medical Oncology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul 34764, Turkey;
| | - Gokmen Umut Erdem
- Department of Medical Oncology, University of Health Sciences, Cam and Sakura City Hospital, Istanbul 34480, Turkey;
| | - Mehmet Ali Sendur
- Department of Medical Oncology, University of Health Sciences, Ankara City Hospital, Ankara 06800, Turkey;
| | - Mahmut Emre Yildirim
- Department of Medical Oncology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul 34865, Turkey;
| | - Basak Bala Oven
- Department of Medical Oncology, Faculty of Medicine, Yeditepe University, Istanbul 34752, Turkey;
| | - Ahmet Bilici
- Department of Medical Oncology, Faculty of Medicine, Medipol University, Istanbul 34214, Turkey;
| | - Mahmut Gumus
- Department of Medical Oncology, Faculty of Medicine, Medeniyet University, Istanbul 34722, Turkey;
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11
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Li Y, Wu G, Liu J, Zhang Y, Yang W, Wang X, Duan L, Niu L, Chen J, Zhou W, Han W, Wang J, Zhong H, Ji G, Fan D, Hong L. Log odds of positive lymph nodes as a novel prognostic predictor for gastric cancer: a systematic review and meta-analysis. BMC Cancer 2023; 23:523. [PMID: 37291493 DOI: 10.1186/s12885-023-10805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 04/03/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to summarize the predictive and prognostic ability of the log odds of positive lymph nodes (LODDS) staging system and compare it with pathological N (pN) classification and the ratio-based lymph node system (rN) for the overall survival (OS) of gastric cancer (GC). METHODS Through a systematic review till March 7, 2022, we identified population-based studies that reported the prognostic effects of LODDS in patients with GC. We compare the predictive effectiveness of the LODDS staging system with that of the rN and pN classification systems for the OS of GC. RESULTS Twelve studies comprising 20,312 patients were included in this systematic review and meta-analysis. The results showed that LODDS1, LODDS2, LODDS3, and LODDS4 in GC patients were correlated with poor OS compared with LODDS0 (LODDS1 vs. LODDS0: HR = 1.62, 95% CI (1.42, 1.85); LODDS2 vs. LODDS0: HR = 2.47, 95% CI (2.02, 3.03); LODDS3 vs. LODDS0: HR = 3.15, 95% CI (2.50, 3.97); LODDS4 vs. LODDS0: HR = 4.55, 95% CI (3.29, 6.29)). Additionally, significant differences in survival were observed among patients with different LODDS classifications (all P-values were < 0.001) with the same rN and pN classifications. Meanwhile, for patients with different pN or rN classifications with the same LODDS classification, prognosis was highly similar. CONCLUSION The findings show that LODDS is correlated with the prognosis of GC patients and is superior to the pN and rN classifications for prognostic assessment.
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Affiliation(s)
- Yiding Li
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Guiling Wu
- School of Aerospace Medicine, Fourth Military Medical University, Xi'an, 710032, China
| | - Jinqiang Liu
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Yujie Zhang
- Department of Histology and Embryology, School of Basic Medicine, Xi'an Medical University, Xi'an, 710021, China
| | - Wanli Yang
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Xiaoqian Wang
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Lili Duan
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Liaoran Niu
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Junfeng Chen
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Wei Zhou
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Weili Han
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Jing Wang
- Department of Immunology, Fourth Military Medical University, Xi'an, 710032, China
| | - Helun Zhong
- Treatment Centre for Traumatic Injures, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, 510630, China
| | - Gang Ji
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Daiming Fan
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China
| | - Liu Hong
- Department of Digestive Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, Shaanxi Province, 710032, China.
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12
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Li Z, Wu H, Lin H, Li J, Guo Z, Pan G, Guo Y, Zheng P, Cai Z, Ren J, Zhou J, Ye J, Xu Y. The short- and long-term effect of membrane anatomy-guided laparoscopic D2 lymphadenectomy plus regional complete mesogastrium excision for locally advanced gastric cancer. Surg Endosc 2023:10.1007/s00464-023-10089-8. [PMID: 37157036 DOI: 10.1007/s00464-023-10089-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Retrospectively analyzed the short- and long-term efficacy between laparoscopic D2 lymphadenectomy plus regional complete mesogastrium excision (D2 + rCME) and traditional laparoscopic D2 in the treatment of patients with locally advanced gastric cancer (LAGC), in order to obtain more evidence for D2 + rCME gastrectomy. METHODS A total of 599 LAGC patients who underwent laparoscopy-assisted radical gastrectomy from January 2014 to December 2019, including 367 cases in the D2 + rCME group and 232 cases in the D2 group. Intraoperative and postoperative clinicopathological parameters, postoperative complications and long-term survival in the two groups were statistically analyzed. RESULTS No significant differences in the positive rate of mesogastric tumor deposits, the number of positive lymph nodes and postoperative length of stay were found between the two groups (P > 0.05). In the D2 + rCME group, intraoperative blood loss was significantly reduced (84.20 ± 57.64 ml vs. 148.47 ± 76.97 ml, P < 0.001), the time to first postoperative flatus and first liquid diet intake were significantly shortened (3[2-3] days vs. 3[3-3] days, P < 0.001; 7[7-8] days vs. 8[7-8] days, P < 0.001), and the number of lymph nodes dissected was greater (43.57 ± 16.52 pieces vs. 36.72 ± 13.83 pieces, P < 0.001). The incidence of complications did not significantly differ between the D2 + rCME group (20.7%) and D2 group (19.4%) (P > 0.05). Although there was no statistically difference in 3-year OS and DFS between the two groups. However, the trend was better in D2 + rCME group. In subgroup analysis, patients with positive tumor deposits (TDs) in the D2 + rCME group had significantly better 3-year DFS compared With D2 group (P < 0.05). CONCLUSION Laparoscopic D2 + rCME is safe and feasible for the treatment of LAGC and is characterized by less bleeding, greater lymph node dissection and rapid recovery, without increasing postoperative complications. D2 + rCME group showed a better trend of long-term efficacy, especially significant beneficial for LAGC patients who with positive TDs.
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Affiliation(s)
- Zhixiong Li
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Haiyan Wu
- Department of Pathology, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Huimei Lin
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Junpeng Li
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Zipei Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Guofeng Pan
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Yihong Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Peng Zheng
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Zhiming Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jie Ren
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jinfeng Zhou
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jianxin Ye
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China.
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China.
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China.
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Ghukasyan R, Banerjee S, Childers C, Labora A, McClintick D, Girgis M, Varley P, Dann A, Donahue T. Higher Numbers of Examined Lymph Nodes Are Associated with Increased Survival in Resected, Treatment-Naïve, Node-Positive Esophageal, Gastric, Pancreatic, and Colon Cancers. J Gastrointest Surg 2023:10.1007/s11605-023-05617-9. [PMID: 36854990 DOI: 10.1007/s11605-023-05617-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/22/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND OR PURPOSE The role of extended lymphadenectomy as part of resection for lymph node (LN)-positive gastrointestinal (GI) malignancies remains controversial with no clear clinical guidance. The purpose of this retrospective study is to determine whether the number of LNs examined as part of GI malignancy resections affects overall survival (OS) among patients with node-positive esophageal, gastric, pancreatic, and colon cancers. METHODS Participants with LN-positive GI cancers who were diagnosed between 2004 and 2015 and underwent oncologic resections were selected from National Cancer Database (NCDB). The primary predictor was the number of examined LNs categorized in tertiles. The effect on OS was measured by hazard ratio (HR) derived from multivariate Cox regression analyses. RESULTS From 2004 to 2015, 1877, 10,086, 18,193, and 102,500 patients with LN-positive esophageal, gastric, pancreatic, and colon adenocarcinomas who did not receive neoadjuvant treatment and underwent oncologic tumor resection were registered in the NCDB. Using multivariate Cox proportional hazard modeling, greater LNs examined in surgically resected LN-positive GI cancers were found to be associated with increased OS for all histologies. This association was the strongest (as compared to the lowest tertile) for gastric cancer (middle tertile: HR = 0.91, 95% CI, 0.86-0.96, p = 0.001; highest tertile: HR = 0.73, 95% CI, 0.69-0.78, p < 0.001), followed by colon (highest tertile: HR = 0.86, 95% CI, 0.84-0.88, p < 0.001), esophageal (highest tertile: HR = 0.83, 95% CI, 0.72-0.95, p = 0.01), and pancreatic (highest tertile: HR = 0.93, 95% CI, 0.89-0.98, p = 0.002) cancers. DISCUSSION AND CONCLUSION In patients with surgically resected node-positive GI malignancies who did not receive neoadjuvant systemic therapy, a higher number of examined LNs is associated with increased OS. This association is the strongest for gastric cancer, followed by colon, esophageal, and pancreatic cancers respectively.
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Affiliation(s)
- Razmik Ghukasyan
- Department of Surgery, David Geffen School of Medicine, University of California, 54-117 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Sudeep Banerjee
- Department of Surgery, David Geffen School of Medicine, University of California, 54-117 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
- Division of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Childers
- Department of Surgery, David Geffen School of Medicine, University of California, 54-117 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Amanda Labora
- Department of Surgery, David Geffen School of Medicine, University of California, 54-117 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Daniel McClintick
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mark Girgis
- Department of Surgery, David Geffen School of Medicine, University of California, 54-117 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Patrick Varley
- Department of Surgery, University of Wisconsin School of Medicine, Madison, WI, USA
| | - Amanda Dann
- Department of Surgery, David Geffen School of Medicine, University of California, 54-117 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
- Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy Donahue
- Department of Surgery, David Geffen School of Medicine, University of California, 54-117 CHS, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
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14
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Survival Outcome of Gastric Signet Ring Cell Carcinoma Based on the Optimal Number of Examined Lymph Nodes: A Nomogram- and Machine-Learning-Based Approach. J Clin Med 2023; 12:jcm12031160. [PMID: 36769809 PMCID: PMC9918112 DOI: 10.3390/jcm12031160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
The optimal number of examined lymph nodes (ELNs) for gastric signet ring cell carcinoma recommended by National Comprehensive Cancer Network guidelines remains unclear. This study aimed to determine the optimal number of ELNs and investigate its prognostic significance. In this study, we included 1723 patients diagnosed with gastric signet ring cell carcinoma in the Surveillance, Epidemiology, and End Results database. X-tile software was used to calculate the cutoff value of ELNs, and the optimal number of ELNs was found to be 32 for adequate nodal staging. In addition, we performed propensity score matching (PSM) analysis to compare the 1-, 3-, and 5-year survival rates; 1-, 3-, and 5-year survival rates for total examined lymph nodes (ELNs < 32 vs. ELNs ≥ 32) were 71.7% vs. 80.1% (p = 0.008), 41.8% vs. 51.2% (p = 0.009), and 27% vs. 30.2% (p = 0.032), respectively. Furthermore, a predictive model based on 32 ELNs was developed and displayed as a nomogram. The model showed good predictive ability performance, and machine learning validated the importance of the optimal number of ELNs in predicting prognosis.
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15
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Hou C, Yin F, Liu Y. Developing and validating nomograms for predicting the survival in patients with clinical local-advanced gastric cancer. Front Oncol 2022; 12:1039498. [PMID: 36387146 PMCID: PMC9644132 DOI: 10.3389/fonc.2022.1039498] [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: 09/08/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Many patients with gastric cancer are at a locally advanced stage during initial diagnosis. TNM staging is inaccurate in predicting survival. This study aims to develop two more accurate survival prediction models for patients with locally advanced gastric cancer (LAGC) and guide clinical decision-making. Methods We recruited 2794 patients diagnosed with LAGC (2010–2015) from the Surveillance, Epidemiology, and End Results (SEER) database and performed external validation using data from 115 patients with LAGC at Yantai Affiliated Hospital of Binzhou Medical University. Univariate and multifactorial survival analyses were screened for meaningful independent prognostic factors and were used to build survival prediction models. Concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were evaluated for nomograms. Finally, the differences and relationships of survival and prognosis between the three different risk groups were described using the Kaplan–Meier method. Results Cox proportional risk regression model analysis identified independent prognostic factors for patients with LAGC, and variables associated with overall survival (OS) included age, race, marital status, T-stage, N-stage, grade, histologic type, surgery, and chemotherapy. Variables associated with cancer-specific survival (CSS) included age, race, T-stage, N-stage, grade, histological type, surgery, and chemotherapy. In the training cohort, C-index of nomogram for predicting OS was 0.722 (95% confidence interval [95% CI]: 0.708–0.736] and CSS was 0.728 (95% CI: 0.713–0.743). In the external validation cohort, C-index of nomogram for predicted OS was 0.728 (95% CI:0.672–0.784) and CSS was 0.727 (95% CI:0.668–0.786). The calibration curves showed good concordance between the predicted and actual results. C-index, ROC, and DCA results indicated that our nomograms could more accurately predict OS and CSS than TNM staging and had a higher clinical benefit. Finally, to facilitate clinical use, we set up two web servers based on nomograms. Conclusion The nomograms established in this study have better risk assessment ability than the clinical staging system, which can help clinicians predict the individual survival of LAGC patients more accurately and thus develop appropriate treatment strategies.
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Affiliation(s)
- Chong Hou
- Department of Gastroenterology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Fangxu Yin
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Yipin Liu
- Department of Gastroenterology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
- *Correspondence: Yipin Liu,
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16
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Yang W, Lu S, Ge F, Hua Y, Chen X. Prognostic and Predictive Model of the Log Odds of the Negative Lymph Node/T Stage Ratio in Resectable Gastric Adenocarcinoma Patients. J Gastrointest Surg 2022; 26:1743-1756. [PMID: 35831692 DOI: 10.1007/s11605-022-05408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/24/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE There are few reports on disease-specific survival (DSS) prediction systems for resected gastric cancer (GC) patients. The aim of this study was to create a nomogram based on the log odds of the negative lymph node/T stage ratio (LONT) for individual risk prediction. METHODS We applied the Surveillance, Epidemiology, and End Results (SEER) Program database released in 2021 to screen GC patients from 2010 to 2015. Using a competitive risk model, we plotted the cumulative risk curve of variables for gastric cancer-specific death and death from other causes at each time point. According to the minimum BIC, we constructed and assessed a nomogram for the 12-month, 36-month, and 60-month cumulative mortality probabilities assessed by time-dependent ROC curves (time-AUCs), the C-index, Brier scores, decision curve analysis (DCA), and calibration curves. RESULTS A total of 3895 patients were ultimately included and randomly assigned to two sets: the training set (n = 2726, 70%) and the validation set (n = 1169, 30%). The LONT was a remarkable independent predictor of gastric cancer-specific death (high versus low: 0.705, 95% CI 0.524-0.95, p = 0.021). The variables selected based on the minimum BIC were as follows: location, AJCC, AJCC.T, AJCC.N, radiotherapy, LONT.cat, and chemotherapy. According to the time-AUC, C-index, Brier score, DCA, and calibration curves, the nomogram risk score had excellent survival prediction ability for DSS. CONCLUSIONS A low LONT was associated with a high cumulative incidence of DSS. A prognostic nomogram model based on the LONT could effectively predict DSS for resectable GC patients.
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Affiliation(s)
- Wei Yang
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Rd, Zhengzhou, 450008, Henan, China
| | - Shuaibing Lu
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Rd, Zhengzhou, 450008, Henan, China
| | - Fusheng Ge
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Rd, Zhengzhou, 450008, Henan, China
| | - Yawei Hua
- Department of General Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Rd, Zhengzhou, 450008, Henan, China.
| | - Xiaobing Chen
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China. .,Zhengzhou Key Laboratory for Precision Therapy of Gastrointestinal Cancer, No. 127 Dongming Rd, Zhengzhou, 450008, China.
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17
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Wang W, Yang YJ, Zhang RH, Deng JY, Sun Z, Seeruttun SR, Wang ZN, Xu HM, Liang H, Zhou ZW. Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data. Mil Med Res 2022; 9:15. [PMID: 35387671 PMCID: PMC8988371 DOI: 10.1186/s40779-022-00375-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Currently, there is no formal consensus regarding a standard classification for gastric cancer (GC) patients with < 16 retrieved lymph nodes (rLNs). Here, this study aimed to validate a practical lymph node (LN) staging strategy to homogenize the nodal classification of GC cohorts comprising of both < 16 (Limited set) and ≥ 16 (Adequate set) rLNs. METHODS All patients in this study underwent R0 gastrectomy. The overall survival (OS) difference between the Limited and Adequate set from a large Chinese multicenter dataset was analyzed. Using the 8th American Joint Committee on Cancer (AJCC) pathological nodal classification (pN) for GC as base, a modified nodal classification (N') resembling similar analogy as the 8th AJCC pN classification was developed. The performance of the proposed and 8th AJCC GC subgroups was compared and validated using the Surveillance, Epidemiology, and End Results (SEER) dataset comprising of 10,208 multi-ethnic GC cases. RESULTS Significant difference in OS between the Limited and Adequate set (corresponding N0-N3a) using the 8th AJCC system was observed but the OS of N0limited vs. N1adequate, N1limited vs. N2adequate, N2limited vs. N3aadequate, and N3alimited vs. N3badequate subgroups was almost similar in the Chinese dataset. Therefore, we formulated an N' classification whereby only the nodal subgroups of the Limited set, except for pT1N0M0 cases as they underwent less extensive surgeries (D1 or D1 + gastrectomy), were re-classified to one higher nodal subgroup, while those of the Adequate set remained unchanged (N'0 = N0adequate + pT1N0M0limited, N'1 = N1adequate + N0limited (excluding pT1N0M0limited), N'2 = N2adequate + N1limited, N'3a = N3aadequate + N2limited, and N'3b = N3badequate + N3alimited). This N' classification demonstrated less heterogeneity in OS between the Limited and Adequate subgroups. Further analyses demonstrated superior statistical performance of the pTN'M system over the 8th AJCC edition and was successfully validated using the SEER dataset. CONCLUSION The proposed nodal staging strategy was successfully validated in large multi-ethnic GC datasets and represents a practical approach for homogenizing the classification of GC cohorts comprising of patients with < 16 and ≥ 16 rLNs.
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Affiliation(s)
- Wei Wang
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Yu-Jie Yang
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Ri-Hong Zhang
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Jing-Yu Deng
- Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300000, China
| | - Zhe Sun
- Department of Surgical Oncology, the First Hospital of China Medical University, Shenyang, 110000, China
| | - Sharvesh Raj Seeruttun
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Zhen-Ning Wang
- Department of Surgical Oncology, the First Hospital of China Medical University, Shenyang, 110000, China.
| | - Hui-Mian Xu
- Department of Surgical Oncology, the First Hospital of China Medical University, Shenyang, 110000, China.
| | - Han Liang
- Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300000, China.
| | - Zhi-Wei Zhou
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China. .,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
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18
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AL-Magedi AA, Wu R, Tao Q. Comparison of postoperative pancreatic fistula between open and laparoscopic surgery in patients with gastric cancer: A meta-analysis. Ann Med Surg (Lond) 2022; 76:103558. [PMID: 35495375 PMCID: PMC9052230 DOI: 10.1016/j.amsu.2022.103558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Open gastrectomy"OG" compared with laparoscopic gastrectomy"LG" in patients with gastric cancer"GC" has been widely discussed over the past years. However, the lack of comparative analysis in postoperative pancreatic fistula "POPF" hinders its severity as surgical procedures developed rapidly. Therefore, there are still moot on whether one of these surgical options is superior in POPF. Objective To compare the incidence of POPF in patients undergoing OG and LG for gastric cancer "GC". Methods Articles from January 2011 to August 2021 that compared LG and OG for GC were reviewed. Cohort studies were included in our study. The quality of enrolled studies was evaluated. Outcomes regarding POPF complication and relative operation results were analyzed. Statistical analysis portrayed the Weighted mean difference"WMD"and the odds ratio"OR"with a 95% confidence interval "CI". The curative effect was analyzed using RevMan 5.4.1 software. Results Totally 7 articles met the inclusion criteria, including 3194 patients with treatment of gastrectomy surgeries for gastric cancer "GC". There was no significant difference observed in POPF incidence (OR, 95% CI = 1.04 [0.74,1.46], P = 0.81) between OG group and LG group in patients undergoing GC gastrectomy. Conclusion We stringently explored the current incidence of POPF after GC gastrectomy, comparing its incidence during LG and OG, there was no significant difference between OG and LG in the incidence of POPF, and surgeons should give more concern for improvement in surgical techniques. Further research is still needed to explore the risk of causes and surgical techniques should be considered cautiously in a clinical procedure.
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Key Words
- CI, Confidence interval
- GC, Gastric cancer
- Gastric cancer
- HR, Hazard ratio
- LG, Laparoscopic gastrectomy
- LN, Lymph nodes
- Laparoscopic gastrectomy
- MD, Mean difference
- OG, Open gastrectomy
- OR, odds ratio
- Open gastrectomy
- POPF, Postoperative Pancreatic Fistula
- PSM, Propensity score matching
- Postoperative complication
- Postoperative pancreatic fistula
- RCT, Randomized controlled trials
- WMD, Weighted mean difference
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Affiliation(s)
- Ahmed A.S. AL-Magedi
- Department of General Surgery, Affiliated Zhongda Hospital, School of Medicine, Southeast University, No. 87 dingjiaqiao, Nanjing, Jiangsu 210093, China
| | - Rong Wu
- Department of General Surgery, Affiliated Zhongda Hospital, School of Medicine, Southeast University, No. 87 dingjiaqiao, Nanjing, Jiangsu 210093, China
| | - Qingsong Tao
- Department of General Surgery, Affiliated Zhongda Hospital, School of Medicine, Southeast University, No. 87 dingjiaqiao, Nanjing, Jiangsu 210093, China
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Wang YF, Yin X, Fang TY, Wang YM, Zhang DX, Zhang Y, Wang XB, Wang H, Xue YW. Nomograms predicting prognosis of patients with pathological stages T1N2-3 and T3N0 gastric cancer. World J Gastrointest Surg 2022; 14:143-160. [PMID: 35317546 PMCID: PMC8908342 DOI: 10.4240/wjgs.v14.i2.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/24/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with pathological stages T1N2-3 (pT1N2-3) and pT3N0 gastric cancer (GC) have not been routinely included in the target population for postoperative chemotherapy according to the Japanese Gastric Cancer Treatment Guideline, and their prognosis is significantly different.
AIM To identify the high-risk patients after radical surgery by analyzing biomarkers and clinicopathological features and construct prognostic models for them.
METHODS A total of 459 patients with pT1N2-3/pT3N0 GC were retrospectively selected for the study. The Chi-square test was used to analyze the differences in the clinicopathological features between the pT1N2-3 and pT3N0 groups. The Kaplan–Meier analysis and log-rank test were used to analyze overall survival (OS). The independent risk factors for patient prognosis were analyzed by univariate and multivariate analyses based on the Cox proportional hazards regression model. The cutoff values of continuous variables were identified by receiver operating characteristic curve. The nomogram models were constructed with R studio.
RESULTS There was no statistically significant difference in OS between the pT1N2-3 and pT3N0 groups (P = 0.374). Prealbumin (P = 0.040), carcino-embryonic antigen (CEA) (P = 0.021), and metastatic lymph node ratio (mLNR) (P = 0.035) were independent risk factors for prognosis in the pT1N2-3 group. Age (P = 0.039), body mass index (BMI) (P = 0.002), and gastrectomy (P < 0.001) were independent risk factors for prognosis in the pT3N0 group. The area under the curve values of the nomogram models for predicting the 5-year prognosis of the pT1N2-3 group and pT3N0 group were 0.765 and 0.699, respectively.
CONCLUSION Nomogram model combining prealbumin, CEA, and mLNR levels can be used to predict the prognosis of pT1N2-3 GC. Nomogram model combining age, BMI, and gastrectomy can be used to predict the prognosis of pT3N0 GC.
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Affiliation(s)
- Yu-Fei Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Xin Yin
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Tian-Yi Fang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Yi-Min Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Dao-Xu Zhang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Yao Zhang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Xi-Bo Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Hao Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Ying-Wei Xue
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
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Zhao K, Shan BQ, Gao YP, Xu JY. Role of carbon nanotracers in lymph node dissection of advanced gastric cancer and the selection of preoperative labeling time. World J Clin Cases 2022; 10:870-881. [PMID: 35127902 PMCID: PMC8790434 DOI: 10.12998/wjcc.v10.i3.870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/19/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of gastric cancer is high. The number of dissected lymph nodes was an independent factor affecting prognosis. Although preoperative labeling is helpful in lymph nodes resection, there are no guidelines for when to perform preoperative labeling.
AIM To investigate the role of nanocarbon in lymph node dissection during gastrectomy, and to discuss the relationship between the timing of preoperative injection of carbon nanoparticles and the extent of lymph node dissection.
METHODS A prospective analysis was performed on the clinical data of 307 patients with advanced gastric cancer who underwent laparoscopic surgery in the General Surgery Department of Weifang People’s Hospital between June 2018 and February 2021. The patients were randomly divided into experimental group and control group based on whether they received preoperative nanocarbon injection or not. The experimental group was divided into different groups according to the preoperative labeling time. The number of dissected lymph nodes and the number of lymph nodes with black staining were compared in each group after surgery, and the role of nanocarbon in the number of dissected lymph nodes, pathological staging, and the relationship with prognosis were discussed.
RESULTS The average number of dissected lymph nodes in the experimental group was higher than that in the control group. In the experimental group, the number of lymph node dissections and number of black-staining lymph nodes in the nanocarbon-labeling group at 2 d and 1 d before surgery were higher than in the labeling group on the day before surgery (P < 0.05).
CONCLUSION Preoperative nanocarbon labeling can safely and effectively guide lymph node dissection. To improve the detection rate of lymph nodes is conducive to subsequent comprehensive anti-tumor therapy.
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Affiliation(s)
- Kai Zhao
- Department of General Surgery, WFPH, Weifang 261400, Shandong Province, China
| | - Bao-Qiang Shan
- Department of General Surgery, WFPH, Weifang 261400, Shandong Province, China
| | - Yan-Peng Gao
- Department of General Surgery, WFPH, Weifang 261400, Shandong Province, China
| | - Jia-You Xu
- Department of General Surgery, WFPH, Weifang 261400, Shandong Province, China
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21
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Spolverato G, Paro A, Capelli G, Dalmacy D, Poultsides GA, Fields RC, Weber SM, Votanopoulos KI, He J, Maithel SK, Pucciarelli S, Pawlik TM. Surgical treatment of gastric adenocarcinoma: Are we achieving textbook oncologic outcomes for our patients? J Surg Oncol 2021; 125:621-630. [PMID: 34964983 DOI: 10.1002/jso.26778] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/28/2021] [Accepted: 11/30/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Composite measures are increasingly used to assess quality of care in surgical oncology. We sought to define the incidence of "textbook oncologic outcome" (TOO) following resection of gastric adenocarcinoma among a large, international cohort of patients. METHODS Gastric adenocarcinoma patients undergoing resection between 2000 and 2020 were identified from an international database. TOO was defined as margin-negative resection, examination of ≥16 lymph nodes, no prolonged length-of-stay (LOS), no 30-day mortality, and stage-appropriate receipt of chemotherapy. RESULTS Among a total of 910 patients, 321 patients (35.3%) achieved a postoperative TOO. While failure to evaluate ≥16 lymph nodes (n = 591, 65.0%) and receipt of chemotherapy (n = 651, 71.5%) had the greatest negative impact on the ability to obtain a TOO, no 30-day mortality (n = 880, 96.7%), margin-negative resection (n = 831, 91.3%), and no extended LOS (n = 706, 77.6%) were more commonly achieved. No postoperative complications (OR: 0.44; 95% CI: 0.31-0.63) and T1a/T1b-stage disease (OR: 2.87; 95% CI: 1.59-5.18) were independently associated with achieving a TOO (p < 0.05). The odds of achieving a TOO improved over time (p-trend < 0.05), which was largely attributable to improved odds of evaluating ≥16 lymph nodes (2010-2014 vs. 2000-2004: OR, 5.21; 95% CI: 3.22-8.45). CONCLUSIONS Only about one in three patients achieved a TOO following resection of gastric adenocarcinoma. Odds of TOO increased over time, largely due to improved lymph node evaluation.
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Affiliation(s)
- Gaya Spolverato
- Department of Surgical Oncological and Gastrointestinal Science, University of Padova, Padova, Italy
| | - Alessandro Paro
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | - Giulia Capelli
- Department of Surgical Oncological and Gastrointestinal Science, University of Padova, Padova, Italy
| | - Djhenne Dalmacy
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
| | | | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Sharon M Weber
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Jin He
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Salvatore Pucciarelli
- Department of Surgical Oncological and Gastrointestinal Science, University of Padova, Padova, Italy
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio, USA
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22
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Zhang C, Zhao S, Wang X. A Prognostic Nomogram for T3N0 Rectal Cancer After Total Mesorectal Excision to Help Select Patients for Adjuvant Therapy. Front Oncol 2021; 11:698866. [PMID: 34900666 PMCID: PMC8654784 DOI: 10.3389/fonc.2021.698866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background The recurrence rate of T3N0 rectal cancer after total mesorectal excision (TME) is relatively low, meaning that not all patients need adjuvant therapy (AT) (radiotherapy, chemotherapy, or chemoradiotherapy). Methods Patients diagnosed with pT3N0M0 rectal cancer after TME were analyzed using the SEER database, of which 4367 did not receive AT and 2794 received AT. Propensity score matching was used to balance the two groups in terms of confounding factors. Cox proportional hazards regression analysis was used to screen independent prognostic factors, which were then used to establish a nomogram. The patients were then divided into three groups with X-tile software according to their risk scores. We enrolled 334 patients as external validation. Results The C-index of the model was 0.725 (95% confidence interval: 0.694–0.756). We divided the patients into three different risk layers based on the nomogram prediction scores, and found that AT did not improve the prognosis of low- and moderate-risk patients, while high-risk patients benefited from AT. External validation data also support the above conclusions. Conclusion This study developed a nomogram that effectively and comprehensively evaluates the prognosis of T3N0 rectal cancer patients after TME. After using the nomogram, we recommend AT for high-risk patients, but not for low- and moderate-risk patients.
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Affiliation(s)
- Chao Zhang
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Shutao Zhao
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Xudong Wang
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun, China
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23
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Spolverato G, Azzolina D, Paro A, Lorenzoni G, Gregori D, Poultsides G, Fields RC, Weber SM, Votanopoulos K, Maithel SK, Pucciarelli S, Pawlik TM. Dynamic Prediction of Survival after Curative Resection of Gastric Adenocarcinoma: A landmarking-based analysis. Eur J Surg Oncol 2021; 48:1025-1032. [PMID: 34895773 DOI: 10.1016/j.ejso.2021.11.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Accurate estimation of survival and recurrence are important to inform decisions regarding therapy and surveillance. We sought to design and validate a dynamic prognostic model for patients undergoing resection for gastric adenocarcinoma. METHODS Patients who underwent curative-intent surgery for gastric adenocarcinoma between 2000 and 2020 were identified using a multi-institutional database. Landmark analysis was used to create dynamic OS and DFS prediction models. Model performance was internally cross-validated via bootstrap resampling. RESULTS Among 895 patients, 507 (57.2%) patients underwent partial gastrectomy (n = 507, 57.2%) while 380 (42.8%) had total gastrectomy. Median tumor size was 40 mm (IQR: 25-65), most tumors were located in the antrum (n = 344, 39.5%) and infiltrated the subserosa (T3 tumors: n = 283, 31.9%) or serosa (T4 tumors: n = 253, 28.5%); lymph node metastasis occurred in 528 (59.1%) patients. Median OS and DFS were 17.5 (IQR: 7.5-42.8) and 14.3 months (IQR: 6.5-39.9), respectively. The impact of age, sex, preoperative comorbidities, tumor size and location, extent of lymphadenectomy and total number of lymph nodes examined, Lauren class, T and N category, postoperative complications, and tumor recurrence varied over time (all p < 0.05). An online tool to predict dynamic OS and DFS based on patient survival relative to time survived was developed and made available for clinical use. Discrimination ability of OS and DFS was excellent (C-index: 0.84 and 0.86, respectively) and calibration plots revealed good prediction. CONCLUSIONS An online dynamic prognostic tool was developed and validated to predict OS and DFS following resection of gastric adenocarcinoma. Landmark analysis to predict long-term outcomes based on follow-up time may be helpful to surgeons and patients.
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Affiliation(s)
- Gaya Spolverato
- Department of Surgical Oncological and Gastrointestinal Sciences, University of Padova, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Paro
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Giulia Lorenzoni
- Department of Surgical Oncological and Gastrointestinal Sciences, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Ryan C Fields
- Department of Surgery, Washington University, St. Louis, MO, USA
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | | | | | - Salvatore Pucciarelli
- Department of Surgical Oncological and Gastrointestinal Sciences, University of Padova, Padova, Italy
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA.
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Girnyi S, Ekman M, Marano L, Roviello F, Połom K. Complete Mesogastric Excisions Involving Anatomically Based Concepts and Embryological-Based Surgeries: Current Knowledge and Future Challenges. Curr Oncol 2021; 28:4929-4937. [PMID: 34898586 PMCID: PMC8628739 DOI: 10.3390/curroncol28060413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022] Open
Abstract
Surgeries for gastrointestinal tract malignancies are based on the paradigm that we should remove the tumour together with its lymphatic drainage in one block. This concept was initially proposed in rectal surgery and called a total mesorectal excision. This procedure gained much interest and has improved oncological results in rectal cancer surgery. The same idea for mesogastric and complete mesogastric excisions was proposed but, because of the complexity of the gastric mesentery, it has not become a standard technique. In this review, we analysed anatomical and embryological factors, proposed technical aspects of this operation and incorporated the available initial results of this concept. We also discussed analogies to other gastrointestinal organs, as well as challenges to this concept.
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Affiliation(s)
- Sergii Girnyi
- Department of Surgical Oncology, Medical University of Gdansk, 80-070 Gdansk, Poland; (S.G.); (M.E.); (K.P.)
| | - Marcin Ekman
- Department of Surgical Oncology, Medical University of Gdansk, 80-070 Gdansk, Poland; (S.G.); (M.E.); (K.P.)
| | - Luigi Marano
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
- Correspondence:
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Karol Połom
- Department of Surgical Oncology, Medical University of Gdansk, 80-070 Gdansk, Poland; (S.G.); (M.E.); (K.P.)
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Yang P, Tian Y, Tan B, Ding P, Guo H, Liu Y, Zhang Z, Li Y, Zhao Q. Clinical application of nano-carbon to improve the accuracy of lymph node staging in patients with advanced gastric cancer receiving neoadjuvant chemotherapy: a prospective randomized controlled trial. J Gastrointest Oncol 2021; 12:2052-2060. [PMID: 34790373 DOI: 10.21037/jgo-21-457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/27/2021] [Indexed: 11/06/2022] Open
Abstract
Background The significance of nano-carbon for lymph node staging in radical gastrectomy for gastric cancer (GC) has been confirmed, but studies on its application for GC patients treated with neoadjuvant chemotherapy (NCT) are rare. The purpose of this study was to explore the clinical value of using carbon nanoparticles suspension injections (CNS) to improve the accuracy of lymph node staging (N staging) of NCT for advanced GC. Methods 160 advanced GC patients receiving preoperative NCT were enrolled, according to the random number generated by computer, the enrolled patients were randomly divided into two groups: experimental group (n=80) and control group (n=80). The experimental group received endoscopic injection of CNS within 24 hours prior to NCT, while the control group received this within 24 hours post NCT and before D2 radical resection. SOX [oxaliplatin: 130 mg/(body surface area, BSA): m2, first day + S-1: (BSA: <1.25 m2, 40 mg each time; ≥1.25 to <1.5 m2, 50 mg each time; ≥1.5 m2, 60 mg each time), 2 times a day, for 2 weeks] was chosen as the NCT regimen, repeat every 3 weeks, 4 cycles were performed preoperative. Surgery was performed 3 weeks after the end of the 4 cycles of chemotherapy. The staining rate, metastasis rate, metastasis rate of stained lymph nodes, postoperative complication rate, and N staging of the two groups were analyzed and compared. Results A total of 3,197 lymph nodes were harvested in the experimental group, including 384 metastatic lymph nodes, 1,424 stained lymph nodes, and 210 metastatic stained lymph nodes. The total number of lymph nodes harvested in the control group was 2,565, including 244 metastatic lymph nodes, 796 stained lymph nodes, and 94 metastatic stained lymph nodes. Compared with the control group, a higher rate of stained lymph nodes, a higher total number of lymph nodes, and an increased number of metastatic lymph nodes were detected in the experimental group. Conclusions The application of CNS before NCT in patients with advanced GC can minimize lymph node staging bias after NCT and improve its accuracy. Trial Registration Chinese Clinical Trial Registry ChiCTR2100047407.
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Affiliation(s)
- Peigang Yang
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Tian
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Bibo Tan
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pingan Ding
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Honghai Guo
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yang Liu
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhidong Zhang
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Li
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qun Zhao
- Department of Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Yang J, Wang Z, Dong K, Zhang R, Xiao K, Shang L, Li L. Safety and efficacy of indocyanine green fluorescence imaging-guided radical gastrectomy: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:1319-1328. [PMID: 34488515 DOI: 10.1080/17474124.2021.1970530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND The clinical value of indocyanine green (ICG) in laparoscopic radical gastrectomy remains controversial. We performed this meta-analysis to investigate the safety and efficacy of ICG fluorescence imaging-guided radical gastrectomy. METHODS All relevant studies published until 30 October 2020 were retrieved from several databases. Fixed- and random-effects models were used to analyze the results based on different heterogeneity levels. Data were expressed as odds ratios or weighted mean differences along with 95% confidence intervals. The Grading of Recommendations, Assessment, Development, and Evaluation system scale was used for quality of evidence evaluation. RESULTS This meta-analysis included six cohort studies that investigated 622 patients. Compared with conventional radical gastrectomy, ICG fluorescence imaging-guided gastrectomy facilitates complete lymph node dissection, reduces intraoperative blood loss, and shortens the length of postoperative hospitalization. Moreover, we observed no significant intergroup differences in the operative time, first exhaust time, and postoperative complications. CONCLUSION ICG fluorescence imaging-guided radical gastrectomy scores over conventional gastrectomy and appears to be a promising approach in patients who require radical gastrectomy. However, further research is warranted to explore the potential long-term survival benefit of ICG fluorescence imaging in patients with gastric cancer.
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Affiliation(s)
- Jianqiao Yang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zixiao Wang
- Department of Basic Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kangdi Dong
- Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Ronghua Zhang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Kun Xiao
- Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Liang Shang
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Key Laboratory of Engineering of Shandong Province, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Leping Li
- Department of Gastroenterological Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Gastroenterological Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Key Laboratory of Engineering of Shandong Province, Shandong Provincial Hospital, Jinan, Shandong, China
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27
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Erstad DJ, Blum M, Estrella JS, Das P, Minsky BD, Ajani JA, Mansfield PF, Ikoma N, Badgwell BD. Navigating Nodal Metrics for Node-Positive Gastric Cancer in the United States: An NCDB-Based Study and Validation of AJCC Guidelines. J Natl Compr Canc Netw 2021; 19:1-12. [PMID: 34678759 DOI: 10.6004/jnccn.2021.7038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The optimal number of examined lymph nodes (ELNs) and the positive lymph node ratio (LNR) for potentially curable gastric cancer are not established. We sought to determine clinical benchmarks for these values using a large national database. METHODS Demographic, clinicopathologic, and treatment-related data from patients treated using an R0, curative-intent gastrectomy registered in the National Cancer Database during 2004 to 2016 were evaluated. Patients with node-positive (pTxN+M0) disease were considered for analysis. RESULTS A total of 22,018 patients met the inclusion criteria, with a median follow-up of 2.2 years. Mean age at diagnosis was 65.6 years, 66% were male, 68% were White, 33% of tumors were located near the gastroesophageal junction, and 29% of patients had undergone preoperative therapy. Most primary tumors (62%) were category pT3-4, 67% had a poor or anaplastic grade, and 19% had signet features. Clinical nodal staging was inaccurate compared with staging at final pathology. The mean [SD] number of nodes examined was 19 [11]. On multivariable analysis, the pN category, ELNs, and LNR were independently associated with survival (all P<.0001). Using receiver operating characteristic (ROC) analysis, an optimal ELN threshold of ≥30 was established for patients with pN3b disease and was applied to the entire cohort. Node positivity and LNR had minimal change beyond 30 examined nodes. Stage-specific LNR thresholds calculated by ROC analysis were 11% for pN1, 28% for pN2, 58% for pN3a, 64% for pN3b, 30% for total combined. By using an ELN threshold of ≥30, prognostically advantageous stage-specific LNR values could be determined for 96% of evaluated patients. CONCLUSIONS Using a large national cancer registry, we determined that an ELN threshold of ≥30 allowed for prognostically advantageous LNRs to be achieved in 96% of patients. Therefore, ≥30 examined nodes should be considered a clinical benchmark for practice in the United States.
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Affiliation(s)
| | - Mariela Blum
- 2Department of Gastrointestinal Medical Oncology
| | | | - Prajnan Das
- 4Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruce D Minsky
- 4Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Ozmen MM, Zulfikaroglu B, Ozmen F, Moran M, Ozalp N, Seckin S. D2 vs D2 Plus Para-aortic Lymph Node Dissection for Advanced Gastric Cancer. Turk J Surg 2021; 37:49-58. [PMID: 34585094 DOI: 10.47717/turkjsurg.2020.4931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
Objectives Gastric cancer is a common malignancy worldwide. Effective treatment by interdisciplinary cooperation is important, and surgery still plays an important role. Material and Methods In a ten-year period, 355 patients were diagnosed to have gastric cancer. One hundred and sixty-two patients with a median (range) age of 58 (23-83) years were eligible for the study. There were 107 patients in D2 and 55 patients in D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection group. The two groups were compared in terms of complications, morbidity, mortality and long-term survival. Results Length of stay was 12 (8-34) days for D2 and 14 (8-42) days for D2 plus PALND. Total number of operative mortality was 8/162 (5%), and it was not different between the groups. Twenty patients (18%) had complications in D2 group and 9 (17%) patients in D2 plus PALND group. Overall survival was also similar between the groups, but patients with T3-T4 tumors, patients with stage IIIA and IIIB disease had better survival with D2 plus PALN dissection. We found that the depth of invasion, PLN, ratio (PLN/TLN), stage and LND were all prognostic variables. Conclusion This study showed that D2 plus PALN dissection for advanced gastric cancer can be performed as safely as a standard D2 dissection by experienced surgeons without increasing postoperative morbidity and mortality. D2 plus PALN dissection should be preferred in the advanced stage of the disease (IIIA-IIIB) as it increases the rate of survival.
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Affiliation(s)
- Mehmet Mahir Ozmen
- Department of Surgery, Medical School, Istinye University, Istanbul, Turkey.,General Surgery, Liv Hospital, Ankara, Turkey.,General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Baris Zulfikaroglu
- General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Fusun Ozmen
- Department of Basic Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey.,Medical Oncology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Munevver Moran
- General Surgery, Liv Hospital, Ankara, Turkey.,General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Necdet Ozalp
- General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Selda Seckin
- Pathology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
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Liao XL, Liang XW, Pang HY, Yang K, Chen XZ, Chen XL, Liu K, Zhao LY, Zhang WH, Hu JK. Safety and Efficacy of Laparoscopic Versus Open Gastrectomy in Patients With Advanced Gastric Cancer Following Neoadjuvant Chemotherapy: A Meta-Analysis. Front Oncol 2021; 11:704244. [PMID: 34422658 PMCID: PMC8377369 DOI: 10.3389/fonc.2021.704244] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/19/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Given the expanding clinical applications of laparoscopic surgery and neoadjuvant chemotherapy in advanced gastric cancer treatment, there is an emerging need to summarize the few evidences that evaluated the safety and efficacy of laparoscopic versus open gastrectomy in patients with advanced gastric cancer (AGC) following neoadjuvant chemotherapy (NAC). METHODS From January 1 to 2, 2021, we searched Ovid Embase, PubMed, Cochrane central register Trials (Ovid), and web of science to find relevant studies published in English, and two authors independently performed literature screening, quality assessment of the included studies, data extraction, and data analysis. This study was registered with PROSPERO (CRD42021228845). RESULTS The initial search retrieved 1567 articles, and 6 studies were finally included in the meta-analysis review, which comprised 2 randomized control trials and 4 observational studies involving 288 laparoscopic gastrectomy (LG) and 416 open gastrectomy (OG) AGC patients treated with NAC. For intraoperative conditions, R0 resection rate, blood transfusion, intraoperative blood loss, number of lymph nodes dissected, proximal margin, and distal margin were comparable between LG group and open OG group. For postoperative short-term clinical outcomes, LG has significantly less postoperative complications (OR = 0.65, 95%CI: 0.42-1.00, p = 0.05) and shorter postoperative time to first aerofluxus (WMD = -0.57d, 95%CI: -0.89-0.25, p = 0.0004) than OG, and anastomotic leakage, pulmonary infection, pleural effusion, surgical site infection, thrombosis, intestinal obstruction, peritoneal effusion or abscess formation, postoperative time to first defecation, postoperative time to first liquid diet, and postoperative length of stay were comparable between the two groups. For postoperative survival outcomes, there were no significant differences in disease-free survival (DFS) and overall survival (OS) between the two groups. CONCLUSION The available evidences indicated that LG is an effective and feasible technology for the treatment of AGC patients treated with NAC, and LG patients have much less postoperative complications and faster bowel function recovery than OG patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO database (identifier, CRD42021228845).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jian-Kun Hu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, China
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Abstract
We investigated potential disparities in the diagnosis, treatment, and survival of gastric cancer (GC) patients with and without disabilities.
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Che K, Wang Y, Wu N, Liu Q, Yang J, Liu B, Wei J. Prognostic Nomograms Based on Three Lymph Node Classification Systems for Resected Gastric Adenocarcinoma: A Large Population-Based Cohort Study and External Validation. Ann Surg Oncol 2021; 28:8937-8949. [PMID: 34241748 DOI: 10.1245/s10434-021-10299-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUNDS The optimal lymph node classification system for prognostic assessment in gastric adenocarcinoma (GAC) patients who undergo lymph node dissection remains unclear. Therefore, this study aimed to compare prognostic nomograms based on AJCC N stage, lymph node ratio (LNR), and log odds of metastatic lymph nodes (LODDS) to evaluate the prognosis and differentiate risk subgroups of patients with resected GAC. PATIENTS AND METHODS We collected 4633 patients with resected stage I-III GAC receiving chemotherapy from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Independent prognostic factors were selected by Cox regression analyses, based on which nomograms were constructed. External validation was performed in 228 cases from Nanjing Drum Tower Hospital. Kaplan-Meier survival analysis was used to evaluate the effect of postoperative radiotherapy (PORT) for different lymph node classifications. RESULTS Multivariate analysis indicated that age, grade, primary site, T stage, N stage, LNR, LODDS, and radiotherapy were independent predictors. Good discrimination power and high consistency of calibration plots were obtained from the LODDS system nomogram. The LODDS classification could more precisely differentiate risk subgroups and improve the discrimination of the resected GAC prognosis. A user-friendly webserver of LODDS system was built based on the nomogram for convenient clinical application. CONCLUSIONS The LODDS seems to be the most reliable lymph node classification in predicting the prognosis of patients with resected GAC and should be recommended in clinical prognostic assessment. Incorporating LODDS into the staging system will enable clinicians to more accurately predict prognosis and guide radiotherapy regimen decisions.
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Affiliation(s)
- Keying Che
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School & Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Yue Wang
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School & Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Nandie Wu
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School & Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Qin Liu
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School & Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Ju Yang
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School & Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Baorui Liu
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School & Clinical Cancer Institute of Nanjing University, Nanjing, China
| | - Jia Wei
- The Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School & Clinical Cancer Institute of Nanjing University, Nanjing, China.
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Mocan L. Surgical Management of Gastric Cancer: A Systematic Review. J Clin Med 2021; 10:jcm10122557. [PMID: 34207898 PMCID: PMC8227314 DOI: 10.3390/jcm10122557] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 05/30/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is the fifth most common cancer worldwide, and it is responsible for 7.7% of all cancer deaths. Despite advances in the field of oncology, where radiotherapy, neo and adjuvant chemotherapy may improve the outcome, the only treatment with curative intent is represented by surgery as part of a multimodal therapy. Two concepts may be adopted in appropriate cases, neoadjuvant treatment before gastrectomy (G) or primary surgical resection followed by chemotherapy. Such an approach, combined with early detection and better screening, has led to a decrease in the overall incidence of gastric cancer. Unfortunately, malignant tumors of the stomach are often diagnosed in locally advanced or metastatic stages when the median overall survival remains poor. Surgical care in these cases must be provided by a multidisciplinary team in a high-volume center. Important surgical aspects such as optimum resection margins, surgical technique, and number of harvested lymph nodes are important factors for patient outcomes. The standardization of surgical treatment of gastric cancer in accordance with the patient’s profile is of decisive importance for a better outcome. This review aims to summarize the current standards in the surgical treatment of gastric cancer.
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Affiliation(s)
- Lucian Mocan
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, RO-400012 Cluj-Napoca, Romania; or ; Tel.: +40-745-362-345
- Regional Institute of Gastroenterology and Hepatology, 19-21 Croitorilor Street, RO-400162 Cluj-Napoca, Romania
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Optimal care and survival for signet-ring cell and non-signet-ring cell gastric cancer are more achievable at academic cancer centers. Am J Surg 2021; 222:969-975. [PMID: 34045068 DOI: 10.1016/j.amjsurg.2021.05.007] [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: 04/15/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Western literature lacks large-scale population studies comparing the influence of academic and high-volume (HV) versus low-volume (LV) cancer centers on gastric cancer oncologic outcomes. METHODS The National Cancer Database from 2004 to 2016 was used. RESULTS 22871 patients were studied. Patients with stage III signet-ring cell gastric carcinoma (SRGC) received neoadjuvant treatment (NAT) more frequently at academic and HV comprehensive cancer centers (OR: 4.27 and 2.42; p < 0.0001 and 0.009) compared to community centers. Patients with stage III non-SRGC (NSRGC) had a 2.4 times higher odds of receiving NAT at academic centers. The R1 resection rate for NSRGC was lower at academic centers (OR: 0.67; p = 0.0018). Lymph node harvest ≥15 nodes was 1.6 and 1.9 times higher at academic centers for NSRGC and SRGC, respectively. Patients treated at academic centers had a significantly improved overall survival (OS). CONCLUSIONS Treatment at academic centers is associated with significant improvements in oncologic metrics and OS.
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Xie J, Pang Y, Li X, Wu X. The log odds of negative lymph nodes/T stage: a new prognostic and predictive tool for resected gastric cancer patients. J Cancer Res Clin Oncol 2021; 147:2259-2269. [PMID: 34003367 PMCID: PMC8236481 DOI: 10.1007/s00432-021-03654-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/27/2021] [Indexed: 02/08/2023]
Abstract
Purpose When only the TNM classification is used to predict survival in gastric cancer (GC) patients, the impact of the degree of lymphadenectomy on the prognosis is neglected. This study aimed to establish a more effective nomogram based on the log odds of negative lymph nodes/T stage ratio (LONT) to predict survival in surgically treated GC patients. Methods The data of resected GC patients were extracted from the Surveillance, Epidemiology, and End Results Program (SEER) database. Univariate and multivariate Cox regression analyses were used to identify the significant prognostic factors. The prognostic performance was assessed using a calibration plot, concordance index (C-index), and area under the (time-dependent receiver operating characteristic) curve (AUC) to compare the predicted survival probability based on the nomogram score groups. Results The results showed LONT as an independent prognostic factor for cancer-specific survival (CSS) and overall survival (OS), independent of clinicopathological factors. After removing potential redundancy, only LONT, T stage, N stage, location and age were used in the final nomogram model. The model had a higher C-index (0.736 ± 0.012) and AUC (0.798) than the TNM staging system (0.685 ± 0.012 and 0.744). The nomogram score could predict a significant survival difference between any two adjacent groups in terms of CSS and OS. Conclusion High LONT is associated with improved survival of gastric cancer patients, independent of other clinicopathological factors. The prognostic nomogram model based on LONT could effectively predict CSS and OS for resectable GC patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03654-y.
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Affiliation(s)
- Jiebin Xie
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yueshan Pang
- Department of Geriatrics, The Second Clinical Medical College of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Xun Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xiaoting Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Ko CS, Choi NR, Kim BS, Yook JH, Kim MJ, Kim BS. Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy: A comparative study. World J Gastroenterol 2021; 27:2193-2204. [PMID: 34025073 PMCID: PMC8117731 DOI: 10.3748/wjg.v27.i18.2193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/21/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although several methods of totally laparoscopic total gastrectomy (TLTG) have been reported. The best anastomosis technique for LTG has not been established.
AIM To investigate the effectiveness and surgical outcomes of TLTG using the modified overlap method compared with open total gastrectomy (OTG) using the circular stapled method.
METHODS We performed 151 and 131 surgeries using TLTG with the modified overlap method and OTG for gastric cancer between March 2012 and December 2018. Surgical and oncological outcomes were compared between groups using propensity score matching. In addition, we analyzed the risk factors associated with postoperative complications.
RESULTS Patients who underwent TLTG were discharged earlier than those who underwent OTG [TLTG (9.62 ± 5.32) vs OTG (13.51 ± 10.67), P < 0.05]. Time to first flatus and soft diet were significantly shorter in TLTG group. The pain scores at all postoperative periods and administration of opioids were significantly lower in the TLTG group than in the OTG group. No significant difference in early, late and esophagojejunostomy (EJ)-related complications or 5-year recurrence free and overall survival between groups. Multivariate analysis demonstrated that body mass index [odds ratio (OR), 1.824; 95% confidence interval (CI): 1.029-3.234, P = 0.040] and American Society of Anaesthesiologists (ASA) score (OR, 3.154; 95%CI: 1.084-9.174, P = 0.035) were independent risk factors of early complications. Additionally, age was associated with ≥ 3 Clavien-Dindo classification and EJ-related complications.
CONCLUSION Although TLTG with the modified overlap method showed similar complication rate and oncological outcome with OTG, it yields lower pain score, earlier bowel recovery, and discharge. Surgeons should perform total gastrectomy cautiously and delicately in patients with obesity, high ASA scores, and older ages.
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Affiliation(s)
- Chang Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Nam Ryong Choi
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Byung Sik Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jeong Hwan Yook
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Beom Su Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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Fuchs S, Ashkenazi I. Retrospective Evaluation of Factors Affecting Lymph Node Retrieval Following Gastrectomies with Oncologic Intent. Rambam Maimonides Med J 2021; 12:RMMJ.10434. [PMID: 33938799 PMCID: PMC8092954 DOI: 10.5041/rmmj.10434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adequate lymphadenectomy is an important factor affecting survival in gastric cancer patients. Retrieval and examination of at least 15 lymph nodes is recommended in order to properly stage gastric malignancies. The objectives of this study were to evaluate the proportion of patients undergoing inadequate lymphadenectomies and possible risk factors for inadequate surgery. METHODS This was a retrospective study that included patients, 18 years and older, who underwent gastrectomies with oncologic intent in the Hillel Yaffe Medical Center. We analyzed the association of demographic, clinical, and pathological variables with adequate number of lymph nodes. RESULTS The retrieval of less than 15 lymph nodes was reported in 51% (53/104) patients undergoing gastrectomies with oncologic intent. The extent of surgery was the only variable associated with inadequate lymphadenectomy on univariate analysis: subtotal/proximal versus total gastrectomy (P=0.047). Differences observed for previous surgery (P=0.193), T stage (P=0.053), N stage (P=0.051), and lymphovascular invasion (P=0.14) did not reach significance. Subtotal/proximal gastrectomy resulted in inadequate resection of lymph nodes in 56% of the patients, while this occurred in only 30% of the patients undergoing total gastrectomy (relative risk 1.865; 95% CI 0.93, 3.741). Logistic regression confirmed that only subtotal/proximal versus total gastrectomy was associated with inadequate number of lymph nodes resected (P=0.043). DISCUSSION AND CONCLUSION In this study we analyzed the association of patient, tumor, and surgery-related factors on adequate lymphadenectomy in patients undergoing gastrectomies for possible gastric cancer. Larger extent of the surgery (total, rather than subtotal/proximal gastrectomy) was revealed to be the only indicator positively associated with adequate lymphadenectomy.
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Affiliation(s)
- Steven Fuchs
- Surgery Department, The Brooklyn Hospital Center, New York, NY, USA
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Itamar Ashkenazi
- The Ruth & Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
- Department of General Surgery, Hillel Yaffe Medical Center, Hadera, Israel (former affiliation)
- To whom correspondence should be addressed. E-mail:
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Cai Z, Ma J, Li S, Fingerhut A, Sun J, Zang L, Yan C, Liu W, Zhu Z, Zheng M. Impact of microsatellite status on negative lymph node count and prognostic relevance after curative gastrectomy. J Surg Oncol 2021; 123 Suppl 1:S15-S24. [PMID: 33650696 DOI: 10.1002/jso.26325] [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: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The impact of microsatellite instability-high (MSI-H) phenotype on lymph node yield after lymphadenectomy has never been discussed in gastric cancer (GC). In this study, we aimed to assess the association of microsatellite status with negative lymph node count (NLNC) as well as its prognostic value. METHODS We retrospectively analyzed 1491 GC patients and divided them into two groups: MSI-HGC (n = 141 [9.5%]) and microsatellite stability (MSSGC ) (n = 1350 [90.5%]). The NLNC and survival data were compared between the two groups. The log odds of positive lymph nodes (LNs) to negative LNs and the target lymph node examined threshold (TLNT) were calculated in both groups. RESULTS A statistically significant difference was found in median NLNC (26 vs. 23, p < .001) between MSI-HGC and MSSGC patients. MSI status was an independent factor for NLNC (p < .001). NLNC showed positive prognostic value for cases with metastatic lymph node (LN+ ) in both MSI-HGC and MSSGC groups. The TLNT(90%) for MSI-HGC and MSSGC were 33 and 26, respectively. CONCLUSIONS MSI-HGC was associated with higher NLNC in GC patients and this was independent of the presence of LN+ . However, more LNs are needed during pathological examination to capture LN+ cases in MSI-HGC.
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Affiliation(s)
- Zhenghao Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Shuchun Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China.,Department of Surgery, Section for Surgical Research, Medical University of Graz, Graz, Austria
| | - Jing Sun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Chao Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wentao Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenggang Zhu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
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Significance of Lymph Node Resection After Neoadjuvant Therapy in Pancreatic, Gastric, and Rectal Cancers. Ann Surg 2021; 272:438-446. [PMID: 32740236 DOI: 10.1097/sla.0000000000004181] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Gastrointestinal cancers are increasingly being treated with NAT before surgical resection. Currently, quality metrics are linked to the number of LNs resected to determine subsequent treatment and prognosis. We hypothesize that NAT decreases LN metastasis, downstages patients, and decreases overall lymph node yields (LNY) compared to initial surgical resection. With increasing use of NAT, this brings into question the validity of quality metrics. METHODS Gastric (stage II/III), pancreatic (stage I/II/III), and rectal cancers (stage II/III) (2010-2015) treated with surgery with/without NAT were identified in National Cancer Database. We evaluated total LNY and LN metastasis with/without NAT and clinical and pathological stage to evaluate rates of downstaging. RESULTS A total of 7934 gastric, 15,908 pancreatic, and 21,354 rectal cancer patients were included of which 61.1%, 21.2%, and 85.7% received NAT, respectively. NAT patients were more likely to be downstaged (39.9% vs 11.1% gastric P< 0.001, 30.6% vs 3.2% pancreatic P< 0.001, 52.0% vs 16.3% rectal P< 0.001), have lower LNYs (18.8 vs 19.1 gastric P = 0.239, 18.4 vs 17.5 pancreatic P< 0.001, 15.7 vs 20.0 rectal P< 0.001) and have N0 pathologic disease (43.6% vs 26.7% gastric P< 0.001, 51.1% vs 30.9% pancreatic P< 0.001, 65.9% vs 49.4% rectal P< 0.001) when compared to initial surgical resection. CONCLUSION NAT for gastrointestinal cancers results in overall lower LN yields, lower LN metastases, and significant downstaging of tumors. As all patients undergoing NAT receive multimodality therapy, LN yield recommendations may not be true quality metric changing.
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Watson MD, Trufan S, Benbow JH, Gower NL, Hill JS, Salo JC. Effect of Surgical Approach on Node Harvest in Gastrectomy: Analysis of the National Cancer Database. World J Surg 2021; 44:3061-3069. [PMID: 32474624 DOI: 10.1007/s00268-020-05590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gastrectomy is the cornerstone of treatment for gastric cancer. Recent studies demonstrated significant surgical outcome advantages for patients undergoing minimally invasive versus open gastrectomy. Lymph node harvest is an indicator of adequate surgical resection, and greater harvest is associated with improved staging and patient outcomes. This study evaluated lymph node harvest based on surgical approach. METHODS Gastric adenocarcinoma patients were identified from NCDB who underwent gastrectomy between 2010 and 2016. Patients were classified by surgical approach into three cohorts: robotic, laparoscopic, or open gastrectomy. Clinical and demographic data were collected. Lymph node harvest was compared with univariate analysis and multivariable generalized linear mixed model. Univariate analysis with propensity matching was also performed to control for differences in patient population across cohorts. RESULTS We identified 10,690 patients that underwent gastrectomy for gastric adenocarcinoma, with 68% males and median age of 66 (IQR 5774) years. 7161 (67%) underwent open, 2841 (26.6%) laparoscopic, and 688 (6.4%) robotic gastrectomy. Multivariable analysis revealed robotic was associated with a significantly higher median node harvest (18, IQR 1326) compared to laparoscopic (17, IQR 1125) and open gastrectomy (16, IQR 1023). Laparoscopic was also associated with significantly higher node harvest then open gastrectomy. Propensity-matched analysis (6950 patients) showed robotic gastrectomy was still associated with significantly higher node harvest (18, IQR 1226) compared to laparoscopic (17, IQR 1125) and open (17, IQR 1124); however, laparoscopic and open were not significantly different. CONCLUSION Robotic approach is associated with increased node harvest compared to laparoscopic and open approach in gastrectomy patients.
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Affiliation(s)
- Michael D Watson
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Sally Trufan
- Department of Biostatistics, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Jennifer H Benbow
- LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Nicole L Gower
- LCI Research Support, Clinical Trials Office, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Joshua S Hill
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA
| | - Jonathan C Salo
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Carolinas Medical Center, Atrium Health, 1021 Morehead Medical Drive, Charlotte, NC, 28204, USA.
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Identifying Outlier Hospitals in Gastric Cancer Lymph Node Yield Using the National Cancer Database. J Surg Res 2021; 261:196-204. [PMID: 33450628 DOI: 10.1016/j.jss.2020.11.046] [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: 06/30/2020] [Revised: 10/06/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lymph node (LN) yield is a key quality indicator that is associated with improved staging in surgically resected gastric cancer. The National Comprehensive Cancer Network recommends a yield of ≥15 LNs for proper staging, yet most facilities in the United States fail to achieve this number. The present study aimed to identify factors that could affect LN yield on a facility level and identify outlier hospitals. METHODS This was a retrospective review of adults (aged ≥18 y) with gastric cancer (Tumor-Node-Metastasis Stages I-III) who underwent gastrectomy. Data were analyzed from the National Cancer Database (2004-2016). Multivariate analysis identified patient and tumor characteristics, whereas an observed-to-expected ratio of identified outlier hospitals. Facility factors were compared between high and low outliers. RESULTS A total of 26,590 patients were included in this study. Of these patients, only 50.3% had an LN yield ≥15. The multivariate model of patient and tumor characteristics demonstrated a concordance index was 0.684. A total of 1245 facilities were included. There were 198 low outlier LN yield hospitals and 135 high outlier LN yield hospitals (observed-to-expected ratio of 0.42 ± 0.24 versus 1.38 ± 0.19, P < 0.0001). There was a difference in facility type between low and high outliers (P < 0.0001). High LN yield hospitals had a larger surgical volume than low LN yield hospitals (median 8.4 [4.9, 13.5] versus 3.5 [2.4, 5.2]; P < 0.0001). CONCLUSIONS Nearly half of the population exhibited low compliance to National Comprehensive Cancer Network recommendations. Facility-level disparities exist as high yearly surgical volume and academic facility status distinguished high-performing outlier hospitals.
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Huang L, Zhang X, Wei Z, Xu A. Importance of Examined Lymph Node Number in Accurate Staging and Enhanced Survival in Resected Gastric Adenocarcinoma-The More, the Better? A Cohort Study of 8,696 Cases From the US and China, 2010-2016. Front Oncol 2021; 10:539030. [PMID: 33585181 PMCID: PMC7874152 DOI: 10.3389/fonc.2020.539030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
Abstract
Background While most guidelines advocate D2 lymphadenectomy for non-metastatic gastric adenocarcinoma (nmGaC), it is not always performed as standard of care outside East Asia. The recommended minimal examined lymph node (ELN) count in nmGaC to stage cancer accurately varies largely across guidelines, and the optimal count to satisfactorily stratify patient survival has yet to be determined. This large cohort study aimed at robustly defining the minimal and optimal thresholds of examined lymph node (ELN) number in non-metastatic gastric adenocarcinoma (nmGaC). Methods Data on nmGaC patients operated in 2010–2016 and surviving ≥3 months were retrieved from the US SEER-18 Program and a Chinese multi-institutional gastric cancer database (MIGC). The correlation of ELN count with stage migration and patient survival were quantified with the use of the multivariable-adjusted logistic and proportional hazards Cox models, respectively. The sequences of odds ratios (ORs) and hazard ratios (HRs) for each additional ELN were smoothed, and the structural breakpoints were determined. Results Together 7,228 patients from the US and 1,468 from China were analyzed, encompassing 23,114 person-years of follow-up. The mean ELN count was 20 in the US and 30 in China. With more ELNs, both cohorts significantly showed proportional increases from lower to higher nodal stage (ORSEER = 1.03, 95%-CI = 1.03–1.04; ORMIGC = 1.02, 95%-CI = 1.02–1.03) and sequential enhancements in postoperative survival (HRSEER = 0.97, 95%-CI = 0.97–0.97; HRMIGC = 0.98, 95%-CI = 0.97–0.99). Correlations for both stage migration and survival were still significant in most subgroups by patient, cancer, and management factors. Breakpoint analyses revealed a minimum threshold ELN count of 17 and an optimum count of 33, which were validated in both cohorts with good efficacy to differentiate probabilities of both stage migration and survival. Conclusion In resected nmGaC patients with anticipated survival ≥3 months, more ELNs are correlated with more accurate staging, which may partly explain the survival correlation. This observational investigation does not indicate causality. Our findings robustly conclude 17 ELNs as the minimum and propose 33 ELNs as the optimum thresholds, to assess the quality of lymph node examination and to stratify postsurgical survival.
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Affiliation(s)
- Lei Huang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyue Zhang
- Department of Academic Research, Hefei City First People's Hospital, Hefei, China
| | - Zhijian Wei
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Aman Xu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Hoang T, Dayyani F, Alfaro A, Huynh J, Ji J, Ko AH, Cho M, Hiyama D. Variability in multimodality treatment influences survival in non-metastatic gastric cancer patients. J Gastrointest Oncol 2020; 11:952-963. [PMID: 33209490 DOI: 10.21037/jgo-20-212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background While gastric cancer is a leading cause of cancer-related mortality in Eastern Europe and Asia, it is less common in the USA. Recommendations regarding optimal treatment of non-metastatic gastric cancer (nmGC) with regard to type and extent of surgery, choice and sequence of chemotherapeutic agents, and use of radiation therapy vary across geographic locations. To determine how variability in treatment practices affects patient outcomes, we conducted a retrospective study to evaluate clinical outcomes in nmGC patients treated at four high-volume academic institutions. Methods California Cancer Registry data were collected for nmGC patients who underwent gastrectomy with curative intent from 2010 to 2018. We conducted chart reviews of the patients' electronic health records to validate clinical factors and outcomes. We performed multivariable Cox regressions to determine prognostic factors for outcomes. Results Demographics of study cohort (n=326): mean age 66 years; 64% male; 44% Caucasian, 35% Asian, 16% Latino. Tumor stage: 48% loco-regional (pT4 or pN1+) vs. 52% localized (pT1-3, pN0). Histology: 47% intestinal, 30% diffuse, 8% mixed, 15% unknown. Surgery: 34% open gastrectomy, 48% laparoscopic, 18% unknown; number of recovered lymph nodes varied from 0 to 60 in any tumor stage. Chemotherapy: 20% neoadjuvant alone, 25% adjuvant alone, 16% perioperative, 39% none. Multimodality therapy: 44% surgery only, 31% chemotherapy, 25% chemotherapy and radiation. With a median post-surgical follow-up of 6 years, 24% of patients developed recurrence and 40% had died. Compared to open surgery, laparoscopic surgeries were associated with fewer recovered lymph nodes (mean =18 vs. 25, P=0.0042). Fewer recovered lymph nodes were associated with a significant decrease in 5-year overall survival [hazard ratio (HR) =1.9, 95% confidence interval (CI): 1.3-2.8]. Timing of chemotherapy and addition of radiation therapy to chemotherapy did not confer further improvements in survival; in contrast, greater lymph node recovery plus chemotherapy were associated with a significant increase in survival (HR =0.3, 95% CI: 0.1-0.6). Conclusions This study highlights major practice differences in the management of nmGC patients across providers and institutions. Further efforts should be made to standardize the use of chemotherapy and adequate recovery and assessment of lymph nodes in this patient population.
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Affiliation(s)
- Tuyen Hoang
- Institute for Clinical and Translational Science, University of California in Irvine, Irvine, USA
| | - Farshid Dayyani
- Division of Hematology and Oncology, Department of Medicine, University of California in Irvine, Irvine, USA
| | - Ariceli Alfaro
- Gastrointestinal Oncology Program, University of California in San Francisco, San Francisco, USA
| | - Jasmine Huynh
- School of Medicine, University of California in Davis, Davis, USA
| | - Jingran Ji
- School of Medicine, University of California in Davis, Davis, USA
| | - Andrew H Ko
- Gastrointestinal Oncology Program, University of California in San Francisco, San Francisco, USA
| | - May Cho
- Division of Hematology and Oncology, Department of Medicine, University of California in Davis, Davis, USA
| | - Darryl Hiyama
- Department of General Surgery, University of California in Los Angeles, Los Angeles, USA
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Elmessiry MM, El-Fayoumi TA, Fayed HM, Gebaly AA, Mohamed EAE. Operative and Oncological Outcomes After D2 Versus D1 Gastrectomy of Operable Gastric Cancer: an Observational Study. J Gastrointest Cancer 2020; 53:91-98. [PMID: 33188500 DOI: 10.1007/s12029-020-00548-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The optimal surgery for operable gastric carcinoma is still controversial. The aim of the current study was to assess the outcomes of D2 compared with D1 gastrectomy. STUDY This observational study included 80 patients with operable gastric cancer treated by D2 gastrectomy at Alexandria University Hospital between January 2010 and January 2016. Another 68 patients treated by D1 gastrectomy during the same period were included. Both groups were compared regarding operative mortality, morbidities, tumor recurrence, and 5-year survival rates. RESULTS D2 gastrectomy had a significantly higher postoperative mortality and morbidity rates compared with D1 group (19.4% and 41.9% versus 6.3% and 18.8%). Mean number of LNs retrieved was statistically increased in D2 compared with D1 group with more frequency of adequate lymphadenectomy (LN retrieved > 15). D2 gastrectomy demonstrated significant lower recurrence and cancer-specific mortality rates compared with D1 group (18.6% and 14.5% versus 34.9% and 30.8%) with no significant difference in DFS and OS rates. Spleen-saving D2 gastrectomy showed no significant difference in early postoperative mortality with significant increase in DFS and OS compared with D1 gastrectomy (78.7% and 82% versus 61.5% and 64.6%). CONCLUSIONS D2 gastrectomy had a lower recurrence and cancer-specific mortality rates than D1 gastrectomy but it had higher postoperative mortality and morbidity rates that resulted in no overall survival benefit of D2 compared with D1 gastrectomy. Spleen-saving D2 gastrectomy can be done safely in selected patients by expert surgeons without increased morbidity and mortality and better survival outcomes.
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Affiliation(s)
| | - Tarek A El-Fayoumi
- Department of Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Haytham M Fayed
- Department of Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ahmed A Gebaly
- Department of Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Eman A E Mohamed
- Department of Internal Medicine, Alexandria Faculty of Medicine, Alexandria, Egypt
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Zhi Y, Lin Z, Ma J, Mou W, Chen X. Distinguish the Role of Radiotherapy From Chemoradiotherapy for Gastric Cancer With Behavior of Metastasis-Indolent in Lymph Node. Technol Cancer Res Treat 2020; 19:1533033820959400. [PMID: 33148125 PMCID: PMC7653296 DOI: 10.1177/1533033820959400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Although the landmark INT-0116 trial and National Comprehensive Cancer Network (NCCN) guidelines recommended pT3-4Nx gastric cancer (GC) patients to receive chemoradiotherapy, the role of radiotherapy has not been distinguished from chemoradiotherapy. METHODS GC with behavior of metastasis-indolent in lymph node (MILN) being confirmed with more than 15 examined LNs after gastrectomy were identified using the Surveillance, Epidemiology and End Result (SEER) database. The cancer-specific survival (CSS) of subgroups for radiotherapy, chemotherapy, chemoradiotherapy and non-adjuvant-treatment were compared. Propensity score matching (PSM) was performed between radiotherapy and non-radiotherapy subgroups to further distinguish the role of radiotherapy from chemoradiotherapy. Cox regression was performed to identify whether radiotherapy or chemotherapy could independently improve prognosis. RESULTS We identified 690 MILN GC patients in SEER database. 5-year CSS was 71.9% in radiotherapy subgroup and 75.1% in non-radiotherapy subgroup(HR = 1.013, 95% CI = 0.714-1.438, p = 0.940), 75.6% in chemotherapy subgroup and 68.5% in non-chemotherapy subgroup(HR = 0.616, 95% CI = 0.430-0.884, p = 0.008), 52.5% in radiotherapy-alone subgroup and 71.9% in non-adjuvant treatment group (HR = 1.604, 95% CI = 0.575-4.471, p = 0.360), 72.9% in chemoradiotherapy subgroup and 79.5% in chemotherapy-alone subgroup (HR = 1.365, 95% CI = 0.859-2.172, p = 0.185), respectively. Further, PSM markedly improved balance of variables between radiotherapy subgroup and non-radiotherapy subgroup. After PSM, the role of the variables of radiotherapy and chemotherapy in contributing to improving CSS are consistent with that before PSM. Cox regression showed chemotherapy, tumor size, tumor invasiveness and Lauren classification were independent prognostic factors, but not including radiotherapy. CONCLUSIONS Chemoradiotherapy confers superior prognosis to MILN GC patients compared with surgery alone might only be attributed to chemotherapy rather than radiotherapy.
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Affiliation(s)
- Yunfei Zhi
- The First Clinical Medical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhousheng Lin
- The First Clinical Medical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Jinyuan Ma
- The Second Clinical Medical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Weiming Mou
- The First Clinical Medical School, Southern Medical University, Guangzhou, Guangdong, China
| | - Xinhua Chen
- The First Clinical Medical School, Southern Medical University, Guangzhou, Guangdong, China
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Peyroteo M, Martins PC, Canotilho R, Correia AM, Baía C, Sousa A, Brito D, Videira JF, Santos LL, de Sousa A. Impact of the 8th edition of the AJCC TNM classification on gastric cancer prognosis-study of a western cohort. Ecancermedicalscience 2020; 14:1124. [PMID: 33209115 PMCID: PMC7652425 DOI: 10.3332/ecancer.2020.1124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction The 8th edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer introduced changes, mainly in stage III, with the incorporation of the pN3 sub-classification in the final staging group. The goal was to compare the 7th and 8th editions to evaluate the discriminative capacity of the new edition. Methods This study was a retrospective review of patients with gastric cancer treated with surgery in 2013 and 2014. Results We analysed 310 patients, with a median age of 66 years and out of which 55.5% were male. The most commonly performed surgery was subtotal gastrectomy (n = 158; 51%), with a median of 30 lymph nodes removed. With a median follow-up of 39.5 months, the 1- and 3-year overall survival (OS) was 82% and 59%, respectively. In stage III (n = 115), there was stage migration in 40 cases (34.8%), with upstage in 11 cases and downstage in 29 cases. In this group, there was a statistically significant difference in OS between N3a and N3b patients (p = 0.002), as well as a statistically significant difference in OS between stages IIIA, IIIB and IIIC when the 8th edition was applied (p = 0.001), which was not verified with the 7th edition (p = 0.057). In multivariate analysis, both extracapsular extension and N classification from TNM were independent prognostic factors (p = 0.033 and p = 0.024, respectively). Conclusion The 8th edition of the AJCC TNM classification allows for a better prognostic refinement, namely in the new stage III groups after the stratification of lymph node disease in N3a and N3b. Factors that evaluate the biological behaviour of the disease remain excluded from this edition, such as extracapsular extension, which had a prognostic impact in our series.
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Affiliation(s)
- Mariana Peyroteo
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal.,https://orcid.org/0000-0002-0941-2533
| | - Pedro Carvalho Martins
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
| | - Rita Canotilho
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
| | - Ana Margarida Correia
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
| | - Catarina Baía
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
| | - Alexandre Sousa
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
| | - Donzília Brito
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
| | - José Flávio Videira
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
| | - Lúcio Lara Santos
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal.,Experimental Pathology and Therapeutics Group, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
| | - Abreu de Sousa
- Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal
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Iyer P, Moslim M, Farma JM, Denlinger CS. Diffuse gastric cancer: histologic, molecular, and genetic basis of disease. Transl Gastroenterol Hepatol 2020; 5:52. [PMID: 33073047 DOI: 10.21037/tgh.2020.01.02] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/15/2020] [Indexed: 12/24/2022] Open
Abstract
Diffuse gastric cancer (DGC) is a distinct histopathologic and molecular disease, characterized by mutations in CDH1, RHOA, and others. In addition, DGC is associated with familial syndromes, including hereditary DGC and germline mutation in CDH1. Clinically, this subtype of gastric adenocarcinoma is associated with a poor prognosis and possible resistance to available systemic therapies. An understanding of the genetic and molecular underpinnings of DGC may help inform of its clinical behavior and aid in screening, diagnosis, and response to treatment. In this review, we will review the current histologic, molecular, and genetic landscape of DGC and its relevance to clinical practice.
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Affiliation(s)
- Pritish Iyer
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Maitham Moslim
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Crystal S Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Hu Y, McMurry TL, Goudreau B, Leick KM, Le TM, Zaydfudim VM. Comparative Effectiveness of Lymphadenectomy Strategies During Curative Resection for Gastric Adenocarcinoma. J Gastrointest Surg 2020; 24:2212-2218. [PMID: 31515762 PMCID: PMC7065947 DOI: 10.1007/s11605-019-04393-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of this study was to compare the long-term effectiveness of three lymphadenectomy strategies in patients with gastric cancer. We hypothesized that, compared with the traditional standard (D2) lymph node dissection strategy, the less aggressive modified standard (mD2) lymphadenectomy may offer superior effectiveness due to reduced operative morbidity and comparable long-term recurrence-free survival. METHODS A Markov decision analysis model was created to simulate 5-year outcomes across three lymphadenectomy approaches for gastric cancer: limited regional (D1), traditional standard (D2), and modified standard (mD2). The primary outcome was discounted quality-adjusted life-years (dQALY). Model variable estimates were derived from outcomes data and quality of life estimates published in Europe and America within the last 15 years. One-way and probabilistic sensitivity analyses were performed for clinically relevant variables. RESULTS The mD2 lymphadenectomy offered 3.03 dQALY over 5 years, outperforming D2 (2.62 dQALY) and D1 (2.37 dQALY). Monte Carlo simulations indicated that both mD2 and D2 lymph node dissection strategies outperformed D1 in 94.9% of simulations. Sensitivity analyses demonstrated that the mD2 approach would be less effective than D2 if the perioperative mortality rate of mD2 was greater than 6.9% (3.2% baseline). CONCLUSIONS Across modern series, the modified standard mD2 lymphadenectomy is an effective alternative to the traditional D2 lymphadenectomy for patients with gastric cancer. A D1-limited regional lymphadenectomy is not recommended during gastric cancer resection.
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Affiliation(s)
- Yinin Hu
- Division of Surgical Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy L. McMurry
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA,Surgical Outcomes Research Center, University of Virginia School of Medicine, Charlottesville, VA
| | - Bernadette Goudreau
- Division of Surgical Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Katie M. Leick
- Division of Surgical Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Tri M. Le
- Division of Hematology and Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - Victor M. Zaydfudim
- Division of Surgical Oncology, University of Virginia School of Medicine, Charlottesville, VA,Surgical Outcomes Research Center, University of Virginia School of Medicine, Charlottesville, VA
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Zhong Q, Chen QY, Parisi A, Ma YB, Lin GT, Desiderio J, Yan S, Xie JW, Wang JB, Hou JF, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Huang ZN, Lin JL, Liu ZY, Que SJ, Li P, Zheng CH, Huang CM. Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi-Institutional Study. Oncologist 2020; 26:e99-e110. [PMID: 32864840 DOI: 10.1634/theoncologist.2020-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/23/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging. PATIENTS AND METHODS Clinicopathological data of 1,791 patients who underwent curative-intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy. RESULTS In the development cohort, the 5-year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C-index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi-square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time-dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation (n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05). CONCLUSION We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy. IMPLICATIONS FOR PRACTICE The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi-institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Amilcare Parisi
- Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy
| | - Yu-Bin Ma
- Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, People's Republic of China
| | - Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jacopo Desiderio
- Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy
| | - Su Yan
- Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, People's Republic of China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jun-Fang Hou
- Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, People's Republic of China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Si-Jin Que
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, People's Republic of China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, People's Republic of China
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Superiority of log odds of positive lymph nodes (LODDS) for prognostic prediction after gastric cancer surgery: a multi-institutional analysis of 7620 patients in China. Surg Today 2020; 51:101-110. [PMID: 32754844 DOI: 10.1007/s00595-020-02091-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare the 8th pN system with ratio-based and Log odds of positive lymph nodes (LODDS) staging systems for predicting the overall survival (OS) of gastric cancer (GC) patients after curative gastric resection. METHODS We analyzed, retrospectively, clinicopathologic and prognostic data from three Chinese medical centers, on 7620 patients who underwent curative surgery for GC. We established a hypothetical tumor-LODDS-metastasis (TLM) and tumor-ratio-metastasis (TRM) staging system. The relative discriminative abilities of the different staging systems were assessed using Akaike's Information Criterion (AIC), a linear trend chi-square test, and a likelihood ratio chi-square test. RESULTS The cut-off points of the LODDS were set as: ≤ - 1.5, - 1.5 to - 1.0, - 1.0 to - 0.5, - 0.5 to 0, and > 0. There were significant differences in the survival of patients in different LODDS classifications for each pN or LNR group. When stratified by the LODDS classification, the prognosis was more homologous according to the pN or lymph-node ratio (LNR) classifications. The modified TLM staging system had better discriminatory ability and better optimistic prognostic stratification than the 8th TNM or the TRM staging systems for predicting the prognosis of patients with GC. CONCLUSIONS The LODDS staging system was superior to other lymph-node classifications for predicting the prognosis of patients undergoing gastrectomy GC. LODDS may be incorporated into a GC staging system if these results are confirmed by other studies.
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50
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Deschner BW, Stiles ZE, DeLozier OM, Drake JA, Tsao M, Glazer ES, Deneve JL, Yakoub D, Dickson PV. Critical analysis of lymph node examination in patients undergoing curative-intent resection for adrenocortical carcinoma. J Surg Oncol 2020; 122:1152-1162. [PMID: 32705677 DOI: 10.1002/jso.26138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is a rare tumor and the role of lymph node dissection remains ill-defined. This study evaluates the effect of nodal examination on prognosis and survival in patients undergoing curative-intent resection of ACC. METHODS The National Cancer Database (2004-2015) was queried for patients undergoing margin-negative resection for ACC. Patients with distant metastases, neoadjuvant therapy, multivisceral resection and T4 tumors were excluded. RESULTS Among 897 patients, 147 (16.4%) had lymph nodes examined. Factors associated with lymph node examination included increasing tumor size (P < .001), extra-adrenal extension (P < .001), open operation (P < .001), and resection at an academic facility (P = .003). Lymph node metastasis was significantly associated with extra-adrenal tumor extension (P = .04). Lymph node harvest, regardless of the number of nodes examined, was not associated with a survival benefit. Median overall survival was incrementally worse with increasing number of positive lymph nodes (88.2 months for N0, 34.9 months for 1-3 positive nodes, and 15.6 months for ≥4 positive nodes, P < .001). CONCLUSIONS Lymph node harvest and lymph node metastasis were associated with more advanced tumors. Although nodal harvest did not offer a survival advantage, stratifying the nodal staging classification may provide important prognostic information.
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Affiliation(s)
- Benjamin W Deschner
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Zachary E Stiles
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Olivia M DeLozier
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Justin A Drake
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Miriam Tsao
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Evan S Glazer
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jeremiah L Deneve
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Danny Yakoub
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Paxton V Dickson
- Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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