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Halle-Smith JM, Bage T, Kamarajah SK, Siddaiah-Subramanya M, Pande R, Whiting JL, Griffiths EA. A preoperative predictive tool to assess the need for staging laparoscopy in oesophagogastric cancer patients. Ann R Coll Surg Engl 2024; 106:369-376. [PMID: 37642164 PMCID: PMC10981985 DOI: 10.1308/rcsann.2022.0140] [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] [Accepted: 10/26/2022] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Staging laparoscopy (SL) has become commonplace in the preoperative staging pathway for oesophagogastric (OG) cancer. SL is often performed before curative treatment to examine for macroscopic peritoneal metastases (PM) or positive peritoneal cytology (PPC). The aim of this study was to develop an objective risk scoring system to predict both PM and PPC at SL. METHODS A prospectively collected and maintained database of all OG cancer patients treated between 2006 and 2020 was reviewed. Univariate and multivariate analyses were performed to identify risk factors for both PM and PPC at SL. A risk score was produced for both PM and PPC, and then validated internally. RESULTS Among 968 patients who underwent SL, 96 (9.9%) had PM and 81 (8.4%) had PPC at SL. Tumour site (p < 0.001), computed tomography (CT) T stage (p < 0.001) and N stage (p = 0.029) were significantly associated with PM at SL (p < 0.001). Tumour site (p < 0.001), biopsy histology (p = 0.041), CT T stage (p < 0.001) and N stage (p < 0.001) were significantly associated with PPC. The risk scoring model for PM included cancer site and CT T stage. This was successfully tested on the validation set (area under the receiver operating characteristic [AUROC] = 0.730). The risk scoring model for PPC included cancer site, CT T and N stage. This was successfully tested on the validation set (AUROC = 0.773). CONCLUSIONS The current risk scores are valid tools with which to predict the risk PM and PPC in patients undergoing SL for OG cancer and may help to avoid subjecting patients to unnecessary SL.
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Affiliation(s)
| | - T Bage
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
| | | | | | - R Pande
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
| | - JL Whiting
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
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Lin T, Chen X, Xu Z, Hu Y, Liu H, Yu J, Li G. Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer with intraoperative detection of limited peritoneal metastasis: a Phase II study of CLASS-05 trial. Gastroenterol Rep (Oxf) 2024; 12:goae001. [PMID: 38390578 PMCID: PMC10882263 DOI: 10.1093/gastro/goae001] [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: 05/28/2023] [Revised: 10/05/2023] [Accepted: 12/31/2023] [Indexed: 02/24/2024] Open
Abstract
Background Systemic chemotherapy for gastric cancer with peritoneal metastasis has limited clinical benefit; for those with intraoperative detection of occult peritoneal metastasis, cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is an alternative treatment. However, the feasibility and effects of this modality and criteria for selecting suitable groups remain unclear. This study aimed to explore the safety and efficacy of laparoscopic cytoreductive surgery (L-CRS) followed by HIPEC in gastric cancer with limited peritoneal metastasis, and this study also aimed to determine the optimized cut-off of the peritoneal cancer index. Methods Between March 2017 and November 2019, patients diagnosed with gastric cancer peritoneal metastases by using laparoscopy and the Sugarbaker peritoneal cancer index of ≤12 were eligible for inclusion. All patients received L-CRS (including gastrectomy with D2 lymph node dissection) and resection of visible peritoneal metastasis, followed by post-operative HIPEC, and systemic chemotherapy. The primary end points were median progression-free survival and median survival time, and the secondary outcomes were morbidity and mortality within 30 days after surgery. Results Thirty patients were eligible for analysis, of whom 19 (63.3%) were female, and the overall mean age was 53.0 years. The post-operative morbidity was 20% and the severe complication rate was 10%. The median survival time was 27.0 months with a 2-year overall survival rate of 52.3% and median progression-free survival was 14.0 months with a 2-year progression-free survival of 30.4%. Conclusions L-CRS followed by HIPEC can be safely performed for gastric cancer with limited peritoneal metastasis and potential survival benefits.
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Affiliation(s)
- Tian Lin
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Xinhua Chen
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Zhijun Xu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Yanfeng Hu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Hao Liu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Jiang Yu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Guoxin Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, P. R. China
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Rawicz-Pruszyński K, Erodotou M, Pelc Z, Sędłak K, Polkowski W, Pawlik TM, Wijnhoven BP. Techniques of staging laparoscopy and peritoneal fluid assessment in gastric cancer: a systematic review. Int J Surg 2023; 109:3578-3589. [PMID: 37581636 PMCID: PMC10651295 DOI: 10.1097/js9.0000000000000632] [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: 05/29/2023] [Accepted: 07/13/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Staging laparoscopy for gastric cancer is recommended to assess the tumor's locoregional extension and exclude peritoneal disease. As there is no consensus on optimizing the procedure's diagnostic accuracy, we aimed to systematically review the literature on operative techniques, followed by peritoneal lavage fluid assessment in gastric cancer patients. Specifically, we sought to indicate the most common characteristics of the procedure and cytological evaluation. METHODS This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The protocol for this systematic review was registered on PROSPERO database (CRD: 42022306746). On September 2022, a search was carried out using Embase, Medline ALL, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection. RESULTS The search identified 1632 studies on staging laparoscopy and 2190 studies on peritoneal fluid assessment. Some 212 studies were included. Open Hasson was the method of choice in accessing the peritoneal cavity in 65% of the studies, followed by establishing a pneumoperitoneum at 10-12 mmHg in 52% of reports. Most frequently, the patient was positioned supine (70%), while a 30° scope and three ports were used to assess the peritoneal cavity clockwise (72%, 77%, and 85%, respectively). Right and left upper abdomen quadrants were the predominant area of laparoscopic exploration (both 65%), followed by the primary tumor region (54%), liver and pelvis (both 30%), and small bowel and spleen (19% and 17%, respectively). Regions of peritoneal lavage and aspiration were limited to the pelvis (50%), followed by right and left upper abdomen quadrants (37.5% and 50%, respectively). No studies compared different methods of operative techniques or analysis of ascites/fluid. CONCLUSIONS This study indicates a high heterogeneity in the technique of staging laparoscopy and peritoneal fluid assessment in gastric cancer patients. Further research and initiatives to reach a consensus on the standardization of the procedure are warranted.
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Affiliation(s)
- Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Maria Erodotou
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Bas P.L. Wijnhoven
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Schena CA, Laterza V, De Sio D, Quero G, Fiorillo C, Gunawardena G, Strippoli A, Tondolo V, de'Angelis N, Alfieri S, Rosa F. The Role of Staging Laparoscopy for Gastric Cancer Patients: Current Evidence and Future Perspectives. Cancers (Basel) 2023; 15:3425. [PMID: 37444535 DOI: 10.3390/cancers15133425] [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: 05/13/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
A significant proportion of patients diagnosed with gastric cancer is discovered with peritoneal metastases at laparotomy. Despite the continuous improvement in the performance of radiological imaging, the preoperative recognition of such an advanced disease is still challenging during the diagnostic work-up, since the sensitivity of CT scans to peritoneal carcinomatosis is not always adequate. Staging laparoscopy offers the chance to significantly increase the rate of promptly diagnosed peritoneal metastases, thus reducing the number of unnecessary laparotomies and modifying the initial treatment strategy of gastric cancer. The aim of this review was to provide a comprehensive summary of the current literature regarding the role of staging laparoscopy in the management of gastric cancer. Indications, techniques, accuracy, advantages, and limitations of staging laparoscopy and peritoneal cytology were discussed. Furthermore, a focus on current evidence regarding the application of artificial intelligence and image-guided surgery in staging laparoscopy was included in order to provide a picture of the future perspectives of this technique and its integration with modern tools in the preoperative management of gastric cancer.
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Affiliation(s)
- Carlo Alberto Schena
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Vito Laterza
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Davide De Sio
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gayani Gunawardena
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonia Strippoli
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Vincenzo Tondolo
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Nicola de'Angelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, 92110 Paris, France
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Fausto Rosa
- Department of Digestive Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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SAKAMOTO E, RAMOS MFKP, PEREIRA MA, DIAS AR, RIBEIRO U, ZILBERSTEIN B, NAHAS SC. STAGING LAPAROSCOPY IS STILL A VALUABLE TOOL FOR OPTIMAL GASTRIC CANCER MANAGEMENT. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 35:e1700. [PMID: 36629683 PMCID: PMC9830676 DOI: 10.1590/0102-672020220002e1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Complete surgical resection is the main determining factor in the survival of advanced gastric cancer patients, but is not indicated in metastatic disease. The peritoneum is a common site of metastasis and preoperative imaging techniques still fail to detect it. AIM The aim of this study was to evaluate the role of staging laparoscopy in the staging of advanced gastric cancer patients in a Western tertiary cancer center. METHODS A total of 130 patients with gastric adenocarcinoma who underwent staging laparoscopy from 2009 to 2020 were evaluated from a prospective database. Clinicopathological characteristics were analyzed to identify factors associated with the presence of peritoneal metastasis and were also evaluated the accuracy and strength of agreement between computed tomography and staging laparoscopy in detecting peritoneal metastasis and the change in treatment strategy after the procedure. RESULTS The peritoneal metastasis was identified in 66 (50.76%) patients. The sensitivity, specificity, and accuracy of computed tomography in detecting peritoneal metastasis were 51.5, 87.5, and 69.2%, respectively. According to the Kappa coefficient, the concordance between staging laparoscopy and computed tomography was 38.8%. In multivariate analysis, ascites (p=0.001) and suspected peritoneal metastasis on computed tomography (p=0.007) were statistically correlated with peritoneal metastasis. In 40 (30.8%) patients, staging and treatment plans changed after staging laparoscopy (32 patients avoided unnecessary laparotomy, and 8 patients, who were previously considered stage IVb by computed tomography, were referred to surgical treatment). CONCLUSION The staging laparoscopy demonstrated an important role in the diagnosis of peritoneal metastasis, even with current advances in imaging techniques.
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Affiliation(s)
- Erica SAKAMOTO
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | | | - Marina Alessandra PEREIRA
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | - André Roncon DIAS
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | - Ulysses RIBEIRO
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | - Bruno ZILBERSTEIN
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
| | - Sergio Carlos NAHAS
- Universidade de São Paulo, University Hospital, Department of Gastroenterology of Faculty of Medicine – São Paulo (SP), Brazil
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Guan G, Li Z, Wang Q, Ying X, Shan F, Li Z. Risk factors associated with peritoneal carcinomatosis of gastric cancer in staging laparoscopy: A systematic review and meta-analysis. Front Oncol 2022; 12:955181. [PMID: 36387230 PMCID: PMC9650136 DOI: 10.3389/fonc.2022.955181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background The optimal indications of staging laparoscopy in gastric cancer to detect peritoneal carcinomatosis are still controversial. We performed this systematic review and meta-analysis to quantify the relevance of the preoperative factors with peritoneal carcinomatosis to explore the indications of staging laparoscopy. Materials and methods Systematic searches were conducted using Medline, Embase, and the Cochrane Library in December 2021. On the basis of calculating the odds ratio (OR) of each factor, we quantified the association between the risk factors and peritoneal carcinomatosis such as clinical T/N stage, Borrmann type, and tumor markers, using meta-analysis with a random-effects model. Results A total of 21 case-control studies and one cohort study were obtained. T stage, N stage, and differentiation degree were most widely studied, with OR values of 2.96 (95% CI: 1.87–4.69), 1.22 (95% CI: 0.86–1.73), and 1.91 (95% CI: 1.42–2.56), respectively. Among all the factors, elevated CA125 (OR = 19.45, 95% CI: 4.71–80.30), Borrmann type IV (OR = 7.68, 95% CI: 3.62–16.27), and large tumor diameter (OR = 5.12, 95% CI: 2.55–10.31) had the highest OR. In particular, CA125 had the best predictability for peritoneal carcinomatosis but was only mentioned by three articles. Conclusions There was a cognitive gap between the awareness and importance of risk factors for peritoneal carcinomatosis. In addition to T4 stage, patients with factors with high OR, such as Borrmann type IV, large tumor diameter, and elevated CA125, should undergo staging laparoscopy.
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Leder Macek AJ, Wang A, Turgeon MK, Lee RM, Russell MC, Porembka MR, Alterio R, Ju M, Kronenfeld J, Goel N, Datta J, Maker AV, Fernandez M, Richter H, Berman RS, Correa-Gallego C, Lee AY. Diagnostic laparoscopy is underutilized in the staging of gastric adenocarcinoma regardless of hospital type: An US safety net collaborative analysis. J Surg Oncol 2022; 126:649-657. [PMID: 35699351 PMCID: PMC10029827 DOI: 10.1002/jso.26972] [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: 02/09/2022] [Revised: 05/12/2022] [Accepted: 05/22/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diagnostic laparoscopy (DL) is a key component of staging for locally advanced gastric adenocarcinoma (GA). We hypothesized that utilization of DL varied between safety net (SNH) and affiliated tertiary referral centers (TRCs). METHODS Patients diagnosed with primary GA eligible for DL were identified from the US Safety Net Collaborative database (2012-2014). Clinicopathologic factors were analyzed for association with use of DL and findings on DL. Overall survival (OS) was analyzed by Kaplan-Meier method. RESULTS Among 233 eligible patients, 69 (30%) received DL, of which 24 (35%) were positive for metastatic disease. Forty percent of eligible SNH patients underwent DL compared to 21.5% at TRCs. Lack of insurance was significantly associated with decreased use of DL (OR 0.48, p < 0.01), while African American (OR 6.87, p = 0.02) and Asian race (OR 3.12, p ≤ 0.01), signet ring cells on biopsy (OR 3.14, p < 0.01), and distal tumors (OR 1.62, p < 0.01) were associated with increased use. Median OS of patients with a negative DL was better than those without DL or a positive DL (not reached vs. 32 vs. 12 months, p < 0.005, Figure 1). CONCLUSIONS Results from DL are a strong predictor of OS in GA; however, the procedure is underutilized. Patients from racial minority groups were more likely to undergo DL, which likely accounts for higher DL rates among SNH patients.
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Affiliation(s)
- Aleeza J. Leder Macek
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Annie Wang
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Michael K. Turgeon
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Rachel M. Lee
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Maria C. Russell
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Matthew R. Porembka
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Rodrigo Alterio
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Michelle Ju
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Joshua Kronenfeld
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Neha Goel
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Jashodeep Datta
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Ajay V. Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Manuel Fernandez
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Harry Richter
- Department of Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Russell S. Berman
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Camilo Correa-Gallego
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Ann Y. Lee
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
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Li Z, Guan G, Liu Z, Li J, Ying X, Shan F, Li Z. Predicting peritoneal carcinomatosis of gastric cancer: A simple model to exempt low-risk patients from unnecessary staging laparoscopy. Front Surg 2022; 9:916001. [PMID: 35937608 PMCID: PMC9349356 DOI: 10.3389/fsurg.2022.916001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background Peritoneal carcinomatosis (PC) of gastric cancer indicates a poor outcome and is mainly diagnosed by staging laparoscopy (SL). This study was designed to develop a risk stratification model based on the number of risk factors to exempt low-risk patients from unnecessary SL. Methods This was a retrospective cohort study based on a single institution between January 2015 and December 2019. SL is indicated for patients of advanced locoregional stage, and clinicopathologic characteristics of 535 consecutive patients were included. PC-associated variables were identified by logistic regression analysis. A risk stratification model based on the number of risk factors was constructed, and we defined its predictive value with a receiver operating characteristic (ROC) curve and negative predictive value. Results In total, 15.9% of included patients were found to have PC during SL. Borrmann type IV, elevated CA125, and tumour diameter ≥5 cm were independent risk factors of PC. These three factors combined with cT4 were selected as predictive factors, and the number of predictive variables was significantly related to the possibility of PC (2.0%, 12.8%, 20.0%, 54.2%, and 100%, respectively). When the cutoff value is more than one predictive factor, the negative predictive value is 98.0%, with an area under the curve of 0.780. This model could exempt 29.8% of unnecessary SL compared to the indication of the current NCCN guideline. Conclusions We constructed a simple model to predict the probability of PC using the number of predictive factors. It is recommended that patients without any of these factors should be exempt from SL.
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A population-based study on treatment and outcomes in patients with gastric adenocarcinoma diagnosed with distant interval metastases. Eur J Surg Oncol 2022; 48:1964-1971. [DOI: 10.1016/j.ejso.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/06/2022] [Accepted: 03/04/2022] [Indexed: 12/20/2022] Open
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Solaini L, Bencivenga M, D'ignazio A, Milone M, Marino E, De Pascale S, Rosa F, Sacco M, Romario UF, Graziosi L, De Palma G, Marrelli D, Morgagni P, Ercolani G. Which gastric cancer patients could benefit from staging laparoscopy? A GIRCG multicenter cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1778-1784. [PMID: 35101316 DOI: 10.1016/j.ejso.2022.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/29/2021] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
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The Burden of Peritoneal Metastases from Gastric Cancer: A Systematic Review on the Incidence, Risk Factors and Survival. J Clin Med 2021; 10:jcm10214882. [PMID: 34768402 PMCID: PMC8584453 DOI: 10.3390/jcm10214882] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/22/2022] Open
Abstract
The peritoneum is a common metastatic site in gastric cancer. This systematic review provides an overview of the incidence, risk factors and survival of synchronous peritoneal metastases from gastric cancer. A systematic search was performed to identify studies wherein the incidence, risk factors and survival of gastric cancer with peritoneal metastases were investigated. Of all 38 potentially eligible studies, 17 studies were included based on the eligibility criteria. The incidence of synchronous gastric peritoneal metastases was reviewed for population-based studies (10–21%), for observational cohort studies (2–15%) and for surgical cohort studies (13–40%). Potential risk factors for synchronous gastric peritoneal metastases were younger age, non-cardia gastric cancer, female sex, signet ring cell carcinoma, diffuse type histology or linitis plastica, T4 stage, Hispanic ethnicity and more than one metastatic location. Synchronous peritoneal metastases are commonly diagnosed in patients with gastric cancer with an incidence up to 21% in recent population-based studies. Furthermore, prognosis of patients with gastric peritoneal metastases is poor with median overall survival ranging from 2 to 9 months. The high incidence and poor prognosis require intensive research on diagnostic features and effective treatment options to improve survival.
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12
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Staging laparoscopy in patients with advanced gastric cancer: A single center cohort study. Eur J Surg Oncol 2021; 48:362-369. [PMID: 34384656 DOI: 10.1016/j.ejso.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/29/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Most studies exploring the role of staging laparoscopy in gastric cancer are limited by low sample size and are predominantly conducted in Asian countries. This study sets out to determine the value of staging laparoscopy in patients with advanced gastric cancer in a Western population. METHODS All patients with gastric cancer from a tertiary referral center without definite evidence of non-curable disease after initial staging, and who underwent staging laparoscopy between 2013 and 2020, were identified from a prospectively maintained database. The proportion of patients in whom metastases or locoregional non-resectability was detected during staging laparoscopy was established. Secondary outcomes included the avoidable surgery rate (detection of non-curable disease during gastrectomy with curative intent) and diagnostic accuracy (sensitivity, specificity, accuracy, negative and positive predictive value). RESULTS A total of 216 patients were included. Staging laparoscopy revealed metastatic disease in 46 (21.3 %) patients and a non-resectable tumor in three (1.4 %) patients. During intended gastrectomy, non-curable disease was revealed in 13 (8.6 %) patients. Overall sensitivity, specificity and diagnostic accuracy were 76.6 %, 100 % and 92.6 %, respectively. The positive predictive value was 100 % and the negative predictive value was 90.3 %. CONCLUSION Staging laparoscopy is valuable in the staging process of gastric cancer with a high accuracy in detecting non-curable disease, thereby preventing futile treatment and its associated burden.
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Shimada H, Fukagawa T, Haga Y, Okazumi S, Oba K. Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature. Ann Gastroenterol Surg 2021; 5:404-418. [PMID: 34337289 PMCID: PMC8316742 DOI: 10.1002/ags3.12444] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
AIM Clinical staging is vital for selecting appropriate candidates and designing neoadjuvant treatment strategies for advanced tumors. The aim of this review was to evaluate diagnostic abilities of clinical TNM staging for gastrointestinal, gastrointestinal cancers. METHODS We conducted a systematic review of recent publications to evaluate the accuracy of diagnostic modalities on gastrointestinal cancers. A systematic literature search was performed in PubMed/MEDLINE using the keywords "TNM staging," "T4 staging," "distant metastases," "esophageal cancer," "gastric cancer," and "colorectal cancer," and the search terms used in Cochrane Reviews between January 2005 to July 2020. Articles focusing on preoperative diagnosis of: (a) depth of invasion; (b) lymph node metastases; and (c) distant metastases were selected. RESULTS After a full-text search, a final set of 55 studies (17 esophageal cancer studies, 26 gastric cancer studies, and 12 colorectal cancer studies) were used to evaluate the accuracy of clinical TNM staging. Positron emission tomography-computed tomography (PET-CT) and/or magnetic resonance imaging (MRI) were the best modalities to assess distant metastases. Fat and fiber mode of CT may be useful for T4 staging of esophageal cancer, CT was a partially reliable modality for lymph node staging in gastric cancer, and CT combined with MRI was the most reliable modality for liver metastases from colorectal cancer. CONCLUSION The most reliable diagnostic modality differed among gastrointestinal cancers depending on the type of cancer. Therefore, we propose diagnostic algorithms for clinical staging for each type of cancer.
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Affiliation(s)
- Hideaki Shimada
- Department of Gastroenterological SurgeryToho University Graduate School of MedicineTokyoJapan
| | - Takeo Fukagawa
- Department of SurgeryTeikyo University School of MedicineTokyoJapan
| | - Yoshio Haga
- Department of SurgeryJapan Community Healthcare Organization Amakusa Central General HospitalAmakusaJapan
| | - Shin‐ichi Okazumi
- Department of Gastroenterological SurgeryToho University Graduate School of MedicineTokyoJapan
- Department of SurgeryToho University Sakura Medical CenterSakuraJapan
| | - Koji Oba
- Department of BiostatisticsSchool of Public HealthGraduate School of MedicineThe University of TokyoTokyoJapan
- Interfaculty Initiative in Information StudiesGraduate School of Interdisciplinary Information StudiesThe University of TokyoTokyoJapan
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14
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Potential survival benefits of open over laparoscopic radical gastrectomy for gastric cancer patients beyond three years after surgery: result from multicenter in-depth analysis based on propensity matching. Surg Endosc 2021; 36:1456-1465. [PMID: 34085095 PMCID: PMC8758649 DOI: 10.1007/s00464-021-08430-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The oncologic efficacy of laparoscopic versus open surgery for advanced distal gastric cancer (ADGC) beyond 3 years after surgery remain obscure. METHODS A total of 1256 patients with ADGC at two teaching institutions in China from April 2007 to December 2014 were enrolled. The general data of the two groups were identified to enable rigorous estimation of propensity scores. Restricted mean survival time (RMST) and Landmark analysis was used to compare survival. RESULTS After matching 461 patients each in the open distal gastrectomy (ODG) and laparoscopic distal gastrectomy (LDG) groups, they were included into analysis. The 3- and 5-year overall survival (OS) and disease-free survival were comparable in two groups. RMST-stratified analysis showed that the 3-year RMST of ODG group was similar to that of LDG group in patients with cT4a (- 1.38 years, p = 0.163) or with cT4a and tumor size > 5 cm, whereas the 5-year RMST had significant differences between groups in cT4a patients(- 8.36 years, P = 0.005) or cT4a and tumor size > 5 cm patients(4.67 years, P = 0.042). In patients with cT4a and tumors > 5 cm, the number of peritoneal recurrences was significantly fewer in the ODG group than in the LDG group (4 vs. 17, P = 0.033), and the peritoneal recurrence time and multiple-site recurrence time were both later in the ODG group. CONCLUSION By reducing recurrence, ODG achieves a better survival for GC patients with serous infiltration and tumors larger than 5 cm beyond 3 years after surgery. The present findings can serve as a reference for surgical options and the setting of follow-up time point for clinical studies.
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15
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Dineen SP, Pimiento JM. The Landmark Series: Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) for Treatment of Gastric Cancer Metastatic to Peritoneum. Ann Surg Oncol 2021; 28:4130-4137. [PMID: 33856601 DOI: 10.1245/s10434-021-09927-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 12/24/2022]
Abstract
Gastric cancer (GC) is a common cancer worldwide, with patients developing isolated peritoneal metastases (PM) in approximately 30% of cases. In patients with PM, prognosis is quite poor, and long-term survival is almost zero. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been demonstrated to be an effective treatment in many peritoneal malignancies, including appendiceal and ovarian cancers and in peritoneal mesothelioma. In this educational review, we summarize many of the seminal studies addressing the potential benefit of CRS/HIPEC for patients with gastric cancer and peritoneal metastases (GC/PM).
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Affiliation(s)
- Sean P Dineen
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA. .,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Jose M Pimiento
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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16
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He Q, Zhu J, Wang A, Ji K, Ji X, Zhang J, Wu X, Li X, Bu Z, Ji J. A decision analysis comparing three strategies for peritoneal lavage cytology testing in staging of gastric cancer in China. Cancer Med 2020; 9:8940-8949. [PMID: 33047873 PMCID: PMC7724308 DOI: 10.1002/cam4.3518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Positive peritoneal cytology (PCY) indicates metastasis (M1) in gastric cancer (GC) patients; both the American and Chinese guidelines recommend laparoscopic peritoneal lavage (LPL) for cytology. However, relatively high costs impair the widespread use of LPL in some resource-limited regions in China, and the cost-effectiveness of PCY testing remains unclear. Therefore, we performed a decision analysis to evaluate the cost-effectiveness of PCY testing by comparing the guideline-recommended intraoperative LPL, a newly proposed preoperative percutaneous peritoneal lavage (PPL), and a third strategy of exploratory laparotomy with no cytology testing (ELNC) among GC patients. METHODS We developed a decision-analytic Markov model of the aforementioned three strategies for a hypothetical cohort of GC patients with curative intent after initial imaging, from the perspective of Chinese society. We estimated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) as primary outcomes; we also conducted one-way and probabilistic sensitivity analyses to investigate the model's robustness. RESULTS We found that ELNC was dominated (i.e., more expensive and less effective) by PPL and LPL. LPL was the most cost-effective method with an ICER of US$17,200/QALY compared to PPL, which was below the Chinese willingness-to-pay (WTP) threshold of US$29,313 per QALY gained. In sensitivity analyses, PPL was more likely to be cost-effective with a lower WTP threshold. CONCLUSIONS Cytology testing through either LPL or PPL was less expensive and more effective than ELNC among GC patients. Moreover, LPL was the most cost-effective modality at the current WTP threshold, while PPL could potentially be cost-effective in lower-income areas.
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Affiliation(s)
- Qifei He
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Jinyi Zhu
- Center for Health Decision ScienceHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Anqiang Wang
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Ke Ji
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Xin Ji
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Ji Zhang
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Xiaojiang Wu
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Xia Li
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Zhaode Bu
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
| | - Jiafu Ji
- Department of Gastrointestinal SurgeryKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital & InstituteBeijingChina
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17
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Borgstein ABJ, van Berge Henegouwen MI, Lameris W, Eshuis WJ, Gisbertz SS. Staging laparoscopy in gastric cancer surgery. A population-based cohort study in patients undergoing gastrectomy with curative intent. Eur J Surg Oncol 2020; 47:1441-1448. [PMID: 33234483 DOI: 10.1016/j.ejso.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/02/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Studies on the value of a staging laparoscopy in detecting metastases in gastric cancer patients show great variation. This study investigates the avoidable surgery rate in patients with and without a staging laparoscopy scheduled for surgery with curative intent. METHODS This population-based cohort study included all patients with an intentional resection for a potentially curable gastric adenocarcinoma, between 2011 and 2016, registered in the Dutch Upper GI Cancer audit. Patients with and without a staging laparoscopy were compared. The primary outcome was the avoidable surgery rate (detection of metastases and/or locoregional non-resectable tumor during intentional gastrectomy). Secondary outcomes were the negative predictive value, postoperative morbidity and pathology parameters. RESULTS 2849 patients who underwent an intentional gastrectomy were included. 414 of 2849 (14.5%) patients underwent a staging laparoscopy before initiation of treatment. The avoidable surgery rate was 16.2% in the staging laparoscopy group, compared to 8.5% in the non-staging group (P < 0.001), resulting in a negative predictive value of 83.8%. The avoidable surgery rate remained significantly different after correction for possible confounders. The main reason for not executing the gastrectomy was the presence of distant metastasis in both groups. cT and cN stage were significantly higher in patients who underwent a staging laparoscopy. CONCLUSIONS The staging laparoscopy group had a higher cTN and pTN stage, implicating selection of patients with more advanced disease for a staging laparoscopy. Despite the staging laparoscopy, a higher rate of avoidable surgery was found, suggesting a low sensitivity for detecting metastases or locoregional non-resectability in this patient group.
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Affiliation(s)
- Alexander B J Borgstein
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands.
| | | | - Wytze Lameris
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
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- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, the Netherlands
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18
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Berlet M, Hartwig R, Feussner H, Neumann PA, Wilhelm D. New insights in diagnostic laparoscopy. CURRENT DIRECTIONS IN BIOMEDICAL ENGINEERING 2020. [DOI: 10.1515/cdbme-2020-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The basic concept of Diagnostic Laparoscopy (DL) is old but not old-fashioned. – Before the rise of tomography and ultrasound there was just the direct look into the abdomen and onto the affected organ available. As open surgery comes along with trauma, blood loss and infection, every effort have been made to improve the access strategies. Finally, due to innovation in optics, video technology and computer science, the look into the abdomen through a “keyhole” is a standard procedure today. – In this review we give an overview of history, implications and cost-effectiveness of DL, attempting an extrapolation of its future role.
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Affiliation(s)
- Maximilian Berlet
- Department of Surgery, Technical University of Munich , Munich , Germany
| | - Regine Hartwig
- Department of Surgery, Technical University of Munich , Munich , Germany
| | - Hubertus Feussner
- Department of Surgery, Technical University of Munich , Munich , Germany
| | | | - Dirk Wilhelm
- Department of Surgery, Technical University of Munich , Munich , Germany
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19
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Abstract
Neoadjuvant or perioperative therapy with radical surgery is a meaningful approach to improve the prognosis of gastric cancer. The FLOT regimen (5-fluorouracil, leucovorin, oxaliplatin, docetaxel) has been established as a perioperative concept in Germany and is also increasingly being used internationally. The prognostic significance of neoadjuvant chemoradiotherapy has to be awaited based on the results of currently active studies. The microsatellite instability (MSI) status has increasingly gained in importance with respect to decision-making processes in the interdisciplinary tumor board as patients with MSI tumors probably do not benefit from neoadjuvant therapy. Patients with only initial stages of locally advanced MSI tumors (cT2, N0) and those with comorbidities could be spared from neoadjuvant therapy. This article critically deals with the current state of the art concepts as well as with ongoing studies with respect to neoadjuvant and perioperative treatment of gastric cancer. For this purpose, the essential already published and the active studies are presented.
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20
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Wang Y, Zhang S, Wang H, Cui Y, Wang Z, Cheng X, Li W, Hou J, Ji Y, Liu T. High Level of Legumain Was Correlated With Worse Prognosis and Peritoneal Metastasis in Gastric Cancer Patients. Front Oncol 2020; 10:966. [PMID: 32766126 PMCID: PMC7378441 DOI: 10.3389/fonc.2020.00966] [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: 03/17/2020] [Accepted: 05/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background: Accumulating evidence has demonstrated that legumain (LGMN) is abnormally expressed in several malignancies and functions as an oncogene. However, the association between LGMN and gastric cancer (GC) has not yet been fully elucidated. In this study, we performed a comprehensive analysis of the role of LGMN in clinicopathologic characteristics and survival of GC patients. Methods: The study had two patient cohorts, The Cancer Genome Atlas (TCGA) cohort and the Zhongshan Hospital cohort, both of which were used to analyze the role of LGMN in GC samples. The relationship between LGMN and clinicopathologic characteristics was determined by the Chi-square test and logistic regression analysis. The Kaplan–Meier method and Cox proportional hazards regression analysis were conducted to investigate the prognostic role of LGMN in GC patients. Moreover, a nomogram was constructed based on the factors that were independently associated with peritoneal metastasis. Finally, the gene set enrichment analysis (GSEA) was conducted to explore the underlying pathways through which LGMN was involved in GC progression. Results: The mRNA and protein levels of LGMN were significantly upregulated in GC tissues, especially for diffuse-type GC. High level of LGMN was independently associated with poor prognosis in both TCGA and Zhongshan cohorts. Further analysis showed that increased protein level of LGMN was related to peritoneal metastasis in GC patients. In a nomogram model, the LGMN expression could help predict the possibility of peritoneal metastasis in GC patients. LGMN was a strong determinant for prediction of peritoneal metastasis. GC patients with high LGMN expression tended to have worse survival together with more frequent diffuse-type tumors and increased risk of peritoneal metastasis. The GSEA results showed that focal adhesion, ecm receptor interaction, cell adhesion molecules cams, TGF-β signaling pathway, JAK-STAT signaling pathway, gap junction, etc. were differentially enriched in the phenotype with high LGMN expression. Conclusion: LGMN was an independent prognostic factor for OS in GC patients. Increased expression of LGMN was significantly associated with peritoneal metastasis. The nomogram based on LGMN might guide the clinical decisions for patients with GC.
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Affiliation(s)
- Yan Wang
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Haiwei Wang
- Maternity and Children's Hospital of Fujian Province, Fujian Medical University, Fuzhou, China
| | - Yuehong Cui
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhiming Wang
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xi Cheng
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Li
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianshu Liu
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.,Center of Evidence-Based Medicine, Fudan University, Shanghai, China
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21
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Kim M, Jeong WK, Lim S, Sohn TS, Bae JM, Sohn IS. Gastric cancer: development and validation of a CT-based model to predict peritoneal metastasis. Acta Radiol 2020; 61:732-742. [PMID: 31653185 DOI: 10.1177/0284185119882662] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The sensitivity of computed tomography (CT) for the detection of peritoneal metastasis (PM) of advanced gastric cancer (AGC) is relatively low. PURPOSE To develop a predictive model to improve the sensitivity of PM detection and to externally validate this model. MATERIAL AND METHODS We analyzed data from 78 patients with PM, who had undergone preoperative CT and subsequent surgery between January 2012 and December 2014, and 101 controls to form a derivation set, retrospectively. The following CT findings were evaluated: tumor size; Bormann type 4; enlarged lymph node; indirect findings of PM (peritoneal thickening, fat stranding, plaques or nodules on the peritoneum, and ascites); and definitive findings of PM (omental cake and rectal shelf). A predictive model was created using multivariate logistic regression. Receiver operating characteristic (ROC) analyses were performed to assess the diagnostic performance of the model. The accuracy was externally validated at other hospitals on 31 patients with PM and 48 patients without PM. RESULTS Tumor size >5.2 cm, Bormann type 4, enlarged lymph node, peritoneal plaques or nodules, and ascites were independently associated with PM. It was able to predict PM with a higher area under the ROC curve (AUC) and sensitivity than definitive findings of PM (AUC 0.903 vs. 0.647, sensitivity 92.3% vs. 38.3%). External validation confirmed the predictive power with good inter-observer agreement. CONCLUSION The CT-driven model shows higher AUC and sensitivity for prediction of PM and may help decision-making with the aim of improving care for patients with AGC.
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Affiliation(s)
- Mimi Kim
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sanghyeok Lim
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - In Suk Sohn
- Biostatistics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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The Chicago Consensus on peritoneal surface malignancies: Management of gastric metastases. Cancer 2020; 126:2541-2546. [PMID: 32282074 DOI: 10.1002/cncr.32868] [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: 06/28/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 12/29/2022]
Abstract
The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of gastric cancer specifically as it relates to the management of peritoneal surface malignancy. These guidelines are developed with input from leading experts, including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness of the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.
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Affiliation(s)
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- Chicago Consensus Working Group, Chicago, Illinois
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23
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The Chicago Consensus on Peritoneal Surface Malignancies: Management of Gastric Metastases. Ann Surg Oncol 2020; 27:1768-1773. [PMID: 32285269 DOI: 10.1245/s10434-020-08320-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Indexed: 01/08/2023]
Abstract
The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of gastric cancer specifically as it relates to the management of peritoneal surface malignancy. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness of the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence.
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Gastric Cancer with Radiographically Occult Metastatic Disease: Biology, Challenges, and Diagnostic Approaches. Cancers (Basel) 2020; 12:cancers12030592. [PMID: 32150838 PMCID: PMC7139817 DOI: 10.3390/cancers12030592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/13/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022] Open
Abstract
Gastric adenocarcinoma is an aggressive cancer that demonstrates heterogeneous biology depending on patient ethnicity, tumor location, tumor type, and genetic profile. It remains the third leading cause of cancer deaths worldwide and was estimated to result in 782,000 deaths in 2018. Challenges exist in accurately assessing the disease burden, as available radiological staging often underestimates metastatic disease. This diagnostic handicap, along with the poor understanding of the heterogeneous biology of gastric cancer, has hindered the development of effective therapeutic solutions and thus halted improvement in patient outcomes over the last few decades. The management of occult peritoneal disease is complicated, as most patients are understaged by standard imaging studies and therefore thought to have local diseases. In this article, we systematically review recent literature on the limitations that are associated with standard radiographic staging, discuss recent molecular biology advances to better identify and diagnose occult peritoneal disease, and propose possible management strategies to approach this complicated clinical problem.
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Genomewide Expression Profiling Identifies a Novel miRNA-Based Signature for the Detection of Peritoneal Metastasis in Patients With Gastric Cancer. Ann Surg 2019; 274:e425-e434. [PMID: 31663973 DOI: 10.1097/sla.0000000000003647] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aimed to conduct a genomewide transcriptomic profiling to develop a microRNA (miRNA)-based signature for the identification of peritoneal metastasis (PM) in patients with gastric cancer (GC). SUMMARY BACKGROUND DATA Even though PM in patients with GC has long been recognized to associate with poor prognosis, currently there is lack of availability of molecular biomarkers for its robust diagnosis. METHODS We performed a systematic biomarker discovery by analyzing miRNA expression profiles in primary tumors from GC patients with and without PM, and subsequently validated the expression of candidate miRNA biomarkers in 3 independent clinical cohorts of 354 patients with advanced GC. RESULTS Five miRNAs (miR-30a-5p, -134-5p, -337-3p, -659-3p, and -3917) were identified during the initial discovery phase; three of which (miR-30a-5p, -659-3p, and -3917) were significantly overexpressed in the primary tumors from PM-positive patients in the testing cohort (P = 0.002, 0.04, and 0.007, respectively), and distinguished patients with versus without peritoneal metastasis with the value of area under the curve (AUC) of 0.82. Furthermore, high expression of these miRNAs also associated with poor prognosis (hazard ratio = 2.18, P = 0.04). The efficacy of the combination miRNA signature was subsequently validated in an independent validation cohort (AUC = 0.74). Finally, our miRNA signature when combined together with the macroscopic Borrmann's type score offered a much superior diagnostic in all 3 cohorts (AUC = 0.87, 0.76, and 0.79, respectively). CONCLUSIONS We have established an miRNA-based signature that have a potential to identify peritoneal metastasis in GC patients.
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26
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Fukagawa T. Role of staging laparoscopy for gastric cancer patients. Ann Gastroenterol Surg 2019; 3:496-505. [PMID: 31549009 PMCID: PMC6749947 DOI: 10.1002/ags3.12283] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022] Open
Abstract
Staging laparoscopy (SL) is frequently carried out in patients with advanced gastric cancer. However, some clinical questions are being debated and consensus must be obtained. With this aim, a literature search of PubMed/MEDLINE was carried out using the keywords "gastric cancer," "SL," and "diagnostic laparoscopy". Articles published online up to February 2019 were analyzed, focusing on the following questions. (i) What is an adequate indication for SL? (ii) How do you carry out SL? (iii) Does SL provide accurate information about peritoneal dissemination? (iv) Is the yield of SL different by tumor location? (v) Is SL a safe procedure? (vi) Is "repeat SL" needed? (vii) Does SL provide oncological benefit? Results provided the following responses: (i) In Western countries, clinically resectable advanced tumor is an indication for SL. Terms to be introduced for adequate indication include "location," "type 4 (linitis feature)," "large tumor," "equivocal computed tomography (CT] findings," and "lymph node swelling". (ii) Exploration of the entire peritoneal cavity is preferable. (iii) Detection rate of peritoneal disease is 43%-52% in Japanese institutions and 7.8%-40% in other countries. False-negative findings during SL were 0%-17%, and 10%-13% when limited to cytology. (iv) Yield of SL was higher in gastric cancer compared with esophagogastric junctional tumor. (v) SL-related complications were estimated to occur in 0.4%. (vi) Repeat SL is important after treatment. (vii) If the efficacy of neoadjuvant chemotherapy for patients with P0CY1 is established, SL can provide oncological benefit. SL can be carried out safely and effectively. Considering the prevalence of neoadjuvant treatment, the role of SL will become more important.
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Affiliation(s)
- Takeo Fukagawa
- Department of SurgerySchool of MedicineTeikyo UniversityTokyoJapan
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27
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Sanjeevaiah A, Cheedella N, Hester C, Porembka MR. Gastric Cancer: Recent Molecular Classification Advances, Racial Disparity, and Management Implications. J Oncol Pract 2019; 14:217-224. [PMID: 29641950 DOI: 10.1200/jop.17.00025] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gastric adenocarcinoma remains an aggressive and poorly understood malignancy with a heterogeneous presentation and tumor biology. The current histologic and anatomic classification has been ineffective in guiding therapy, with only marginal improvement in outcome over time. Furthermore, the variation in presentation and disease among racial and ethnic groups amplifies the complexity of this cancer. An understanding of the clinical and molecular variability is important for effective treatment. Recent advances in molecular biology have better defined gastric cancer subtypes. We systematically review recent literature on the molecular classification of gastric adenocarcinoma and the associated management implications, with an emphasis on Hispanic and Native American populations.
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Affiliation(s)
| | - Naga Cheedella
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Caitlin Hester
- The University of Texas Southwestern Medical Center, Dallas, TX
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A Novel Selection Model of Surgical Treatments for Early Gastric Cancer Patients Based on Heterogeneous Multicriteria Group Decision-Making. Symmetry (Basel) 2018. [DOI: 10.3390/sym10060223] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Brenkman HJF, Gertsen EC, Vegt E, van Hillegersberg R, van Berge Henegouwen MI, Gisbertz SS, Luyer MDP, Nieuwenhuijzen GAP, van Lanschot JJB, Lagarde SM, de Steur WO, Hartgrink HH, Stoot JHMB, Hulsewe KWE, Spillenaar Bilgen EJ, van Det MJ, Kouwenhoven EA, van der Peet DL, Daams F, van Sandick JW, van Grieken NCT, Heisterkamp J, van Etten B, Haveman JW, Pierie JP, Jonker F, Thijssen AY, Belt EJT, van Duijvendijk P, Wassenaar E, van Laarhoven HWM, Wessels FJ, Haj Mohammad N, van Stel HF, Frederix GWJ, Siersema PD, Ruurda JP. Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study). BMC Cancer 2018; 18:450. [PMID: 29678145 PMCID: PMC5910577 DOI: 10.1186/s12885-018-4367-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 04/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3–4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. Methods This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3–4b, N0–3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. Discussion In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. Trial registration NCT03208621. This trial was registered prospectively on June 30, 2017.
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Affiliation(s)
- H J F Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E C Gertsen
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - E Vegt
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - S S Gisbertz
- Academic Medical Center, Amsterdam, The Netherlands
| | - M D P Luyer
- Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - S M Lagarde
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - W O de Steur
- Leiden University Medical Center, Leiden, The Netherlands
| | - H H Hartgrink
- Leiden University Medical Center, Leiden, The Netherlands
| | - J H M B Stoot
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - K W E Hulsewe
- Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | | | | | | | | | - F Daams
- VU University Medical Center, Amsterdam, The Netherlands
| | - J W van Sandick
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - J Heisterkamp
- Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands
| | - B van Etten
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J W Haveman
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J P Pierie
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - F Jonker
- Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A Y Thijssen
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - E J T Belt
- Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - E Wassenaar
- Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - H W M van Laarhoven
- Academic Medical Center, Amsterdam, The Netherlands.,Propsective Observational Cohort study of Oesophageal-gastric cancer Patients (POCOP) of the Dutch Upper GI Cancer Group (DUCG), Amsterdam, The Netherlands
| | - F J Wessels
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - N Haj Mohammad
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H F van Stel
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - G W J Frederix
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P D Siersema
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Label-free imaging for T staging of gastric carcinoma by multiphoton microscopy. Lasers Med Sci 2018; 33:871-882. [DOI: 10.1007/s10103-018-2442-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
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López-Ramírez M, Lever-Rosas C, Motta-Ramírez G, Rebollo-Hurtado V, Guzmán-Bárcenas J, Fonseca-Morales J, Carreño-Lomeli M. Correlation between preoperative tomographic staging and definitive histopathologic results in gastric cancer at the Hospital Central Militar. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2017.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Nassour I, Fullington H, Hynan LS, Yopp AC, Augustine MM, Polanco PM, Choti MA, Mansour JC, Wang SC, Porembka MR. The Yield of Staging Laparoscopy in Gastric Cancer is Affected by Racial and Ethnic Differences in Disease Presentation. Ann Surg Oncol 2017; 24:1787-1794. [PMID: 28194592 PMCID: PMC5608608 DOI: 10.1245/s10434-017-5805-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Gastric cancer is a heterogeneous disease with variable presentation between racial and ethnic groups. Staging laparoscopy (SL) detects occult metastases not visible on cross-sectional imaging and therefore improves staging. It remains unclear how differences in race and ethnicity affect disease presentation and the yield of SL. METHODS We performed a retrospective review of a prospectively maintained database to identify patients with gastric cancer treated with curative intent at our institutions from 2008 to 2015. RESULTS Hispanic patients presented at an earlier mean age (55.5 ± 11.9 years) compared with Asian (59.8 ± 13.9 years), African American (61.0 ± 10.0 years), and white patients (61.7 ± 12.5 years; p = 0.046) and with more locally advanced disease (clinical stage T3/T4 or node positive; Hispanic 87%; African American 79%; white 68%, Asian 55%; p = 0.03). SL identified 42 patients (34%) with occult metastatic disease. Hispanics were more likely to have a positive SL (44%) than white patients (21%; p = 0.04). On univariate analysis, Hispanic ethnicity, clinical T3/T4, positive nodal disease, signet ring cells, and poor differentiation were predictors of a positive SL. On multivariable analysis, clinical T3/T4, signet ring cells, and poor differentiation independently predicted radiographically occult disease. CONCLUSIONS Hispanic patients presented with more locally advanced disease and were more likely to have occult disease found on SL compared with white patients. Laparoscopy should be used routinely as part of the pretreatment staging evaluation for patients with locally advanced disease as it alters the management in a significant proportion of patients.
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Affiliation(s)
- Ibrahim Nassour
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hannah Fullington
- Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Adam C Yopp
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mathew M Augustine
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Choti
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John C Mansour
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sam C Wang
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew R Porembka
- Division of Surgical Oncology, Department of Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Correlación entre la estadificación tomográfica preoperatoria con los resultados histopatológicos definitivos en cáncer gástrico en el Hospital Central Militar. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:210-216. [DOI: 10.1016/j.rgmx.2016.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/16/2016] [Accepted: 10/06/2016] [Indexed: 12/24/2022]
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Huang J, Luo H, Zhou C, Zhan J, Rao X, Zhao G, Zhu Z. Yield of Staging Laparoscopy for Incurable Factors in Chinese Patients with Advanced Gastric Cancer. J Laparoendosc Adv Surg Tech A 2017. [PMID: 28650730 DOI: 10.1089/lap.2017.0170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although the role of staging laparoscopy (SL) in detecting radiologically occult M1 disease has been widely recognized, it is seldom used in China and its clinical value based on Chinese population has been rarely reported. The aim of this study is to identify the yield of SL for Chinese patients with advanced gastric cancer (AGC) and determine the proportions of patients in whom treatment plan is altered. MATERIALS AND METHODS The clinical data were retrospectively collected from 879 AGC patients who underwent SL without any definite signs of disseminated disease on imaging examination. The primary outcomes were the proportions of patients whose laparoscopy identified incurable factors (including M1 diseases and unresectable T4b diseases), and who had their treatment plan altered. RESULTS SL revealed incurable factors in 130 (14.8%) patients, including macroscopic peritoneal metastasis (n = 92), positive peritoneal cytology (n = 10), liver metastasis (n = 12), para-aortic lymph node metastasis (n = 1), and unresectable T4b tumor (n = 18). After SL, treatment plans were altered in 123 (14.0%) patients, among which 82 (63.1%) patients were not offered any further procedure and referred for chemotherapy. Among 749 M0 patients who immediately proceeded to radical gastrectomy after SL, new incurable factors were found at subsequent operations in 21 (2.8%) patients. Multivariate analysis showed that tumor size ≥8 cm, Borrmann type III and IV, and tumor invasion of T4a and T4b in preoperative imaging examination were the predictive factors for peritoneal metastasis. CONCLUSIONS SL detects additional incurable factors in Chinese AGC patients with potentially resectable disease and optimizes their treatments. A systematic and painstaking inspection of the whole abdominal cavity, including routine entry into the bursa omentalis, is necessary for improving the yield of SL.
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Affiliation(s)
- Jun Huang
- 1 Department of Gastrointestinal Surgery, Nanchang University Second Affiliated Hospital , Nanchang, Jiangxi, China
| | - Hongliang Luo
- 1 Department of Gastrointestinal Surgery, Nanchang University Second Affiliated Hospital , Nanchang, Jiangxi, China
| | - Chengliang Zhou
- 2 Department of General Surgery, Fengxin County Hospital of Traditional Chinese Medicine , Fengxin, Jiangxi, China
| | - Jianjun Zhan
- 1 Department of Gastrointestinal Surgery, Nanchang University Second Affiliated Hospital , Nanchang, Jiangxi, China
| | - Xionghui Rao
- 1 Department of Gastrointestinal Surgery, Nanchang University Second Affiliated Hospital , Nanchang, Jiangxi, China
| | - Gang Zhao
- 1 Department of Gastrointestinal Surgery, Nanchang University Second Affiliated Hospital , Nanchang, Jiangxi, China
| | - Zhengming Zhu
- 1 Department of Gastrointestinal Surgery, Nanchang University Second Affiliated Hospital , Nanchang, Jiangxi, China
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Ikari N, Taniguchi K, Serizawa A, Yamada T, Yamamoto M, Furukawa T. A primary tumor of mixed histological type is a novel poor prognostic factor for patients undergoing resection of liver metastasis from gastric cancer. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 24:281-288. [PMID: 28273395 DOI: 10.1002/jhbp.445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical resection can be an option for the treatment of metastatic liver tumors originating from gastric cancer; however, its prognostic impact is controversial. The aim of this study was to identify prognostic factors in patients with surgical resection of liver metastasis from gastric cancer. METHODS We retrospectively analyzed the clinicopathological features of 38 consecutive patients undergoing hepatectomy for metastatic tumors from gastric cancer in our institution between 1990 and 2014. RESULTS The median overall survival of the patients was 28 months. The 5-year survival rate was 33.9%. Primary tumors of a mixed histological type, and residual tumors during the course of treatment were identified as significant independent poor prognostic factors. CONCLUSIONS Histological evaluation of primary tumors may aid to identify patients suitable for undergoing surgical resection of liver metastasis from gastric cancer.
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Affiliation(s)
- Naoki Ikari
- Department of Gastroenterological Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Institute for Integrated Medical Sciences, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kiyoaki Taniguchi
- Department of Gastroenterological Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Serizawa
- Department of Gastroenterological Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takuji Yamada
- Department of Gastroenterological Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Gastroenterological Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toru Furukawa
- Department of Gastroenterological Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Institute for Integrated Medical Sciences, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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