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Wang YC, Chen YJ, Shih YH, Wu FH. Assessment of the Relationship Between Positive Radial Margin and Prognosis in Patients with Gastric Adenocarcinoma. Cancers (Basel) 2025; 17:1463. [PMID: 40361390 PMCID: PMC12070839 DOI: 10.3390/cancers17091463] [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: 03/25/2025] [Revised: 04/21/2025] [Accepted: 04/24/2025] [Indexed: 05/15/2025] Open
Abstract
Background/Objectives: Gastrectomy is among the most effective treatments for gastric adenocarcinoma. Margin status can be categorized into three types: proximal, distal, and radial margins. While the relationship between proximal and distal margin involvement in specimens and prognosis has been extensively studied, the impact of a radial margin has not been thoroughly investigated. This study was conducted to determine whether a positive radial margin could affect the prognosis of patients with gastric adenocarcinoma undergoing gastrectomy. Methods: This is a retrospective cohort study of patients with stage II/III gastric adenocarcinoma who received gastrectomy from January 2009 to December 2019 at Taichung Veterans General Hospital, Taiwan. The clinicopathologic features and outcomes were compared between groups. Results: Among the 431 patients who underwent gastrectomy, 94 patients (21.8%) had a positive margin. Radial margin positivity accounted for 16.2%. Factors associated with a positive margin included perineural invasion and advanced cancer stage. The factors related to poor overall survival (OS) and disease-free survival (DFS) included advanced Borrmann type, positive nodal disease, higher nodal burden (≥5), and margin status. In the subgroup analysis, radial margin positivity could negatively impact OS and DFS in the advanced T stage subgroup and nodal-positive subgroup. Conclusions: Aggressive tumor biology may result in a positive margin following gastrectomy. A positive radial margin was correlated with poorer OS and DFS. Future investigations should focus on developing tailored treatment plans for patients with a positive radial margin.
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Affiliation(s)
- Yu-Chih Wang
- Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-C.W.); (Y.-J.C.)
| | - Yi-Ju Chen
- Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-C.W.); (Y.-J.C.)
| | - Yu-Hsuan Shih
- Division of Medical Oncology, Department of Oncology, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Feng-Hsu Wu
- Division of General Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (Y.-C.W.); (Y.-J.C.)
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
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Guha A, Sahewalla A, Killing D, Thakkar M, Das G, Kalita DJ, Talukdar A. Real-World Experience of Clinical Outcomes of Microscopic Margin Positivity After Radical Gastrectomy from a Tertiary Cancer Center in Northeast India. Indian J Surg Oncol 2025; 16:290-295. [PMID: 40114873 PMCID: PMC11920480 DOI: 10.1007/s13193-024-02081-y] [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: 05/29/2024] [Accepted: 08/23/2024] [Indexed: 11/10/2024] Open
Abstract
Surgical resection for gastric adenocarcinoma (GAC) remains the only potentially curative treatment, and the use of neoadjuvant and adjuvant therapy improves survival in patients with advanced gastric cancer. Margin-positive resection is a known poor prognostic factor. A retrospective observational study of patients undergoing radical gastrectomy of any type for GAC was done at a tertiary care cancer center in Northeast India. The study included patients who were operated on from 1 January 2017 to 31 December 2021 (5 years), and they were followed up to 31 March 2024. A total of 172 patients underwent gastrectomy of any type for GAC during the study period of which 13 patients were found to have microscopic positive (R1) histopathological margin (7.6%). The median age of the patients with positive margins was 48 years (range 27 to 69 years). The male-to-female ratio was 9:4. Ten patients (77%) had poorly differentiated or signet-ring cell carcinoma. The distal margin was the most frequent margin which was positive (84.6%). Neoadjuvant chemotherapy was used in only 23.1% patients. At the end of our study period, only 1 patient out of 13 patients was alive. Median disease-free survival (DFS) was 16.2 months (95% confidence interval 1.2 to 31.1 months). Median overall survival (OS) was 20.2 months (95% confidence interval 9.3 to 31.2 months). Patients who have microscopic positive margins after gastrectomy are found to have a high incidence of poorly differentiated or signet-ring cell carcinoma.
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Affiliation(s)
- Akash Guha
- Department of Surgical Oncology, Dr B Borooah Cancer Institute, Room No. 30, Surgical OPD, Gopinathnagar, Guwahati, Assam 781016 India
| | - Ashutosh Sahewalla
- Department of Surgical Oncology, Dr B Borooah Cancer Institute, Room No. 30, Surgical OPD, Gopinathnagar, Guwahati, Assam 781016 India
| | - Dilip Killing
- Department of Surgical Oncology, Dr B Borooah Cancer Institute, Room No. 30, Surgical OPD, Gopinathnagar, Guwahati, Assam 781016 India
| | - Manthan Thakkar
- Department of Surgical Oncology, Dr B Borooah Cancer Institute, Room No. 30, Surgical OPD, Gopinathnagar, Guwahati, Assam 781016 India
| | - Gaurav Das
- Department of Surgical Oncology, Dr B Borooah Cancer Institute, Room No. 30, Surgical OPD, Gopinathnagar, Guwahati, Assam 781016 India
| | - Deep Jyoti Kalita
- Department of Surgical Oncology, Dr B Borooah Cancer Institute, Room No. 30, Surgical OPD, Gopinathnagar, Guwahati, Assam 781016 India
| | - Abhijit Talukdar
- Department of Surgical Oncology, Dr B Borooah Cancer Institute, Room No. 30, Surgical OPD, Gopinathnagar, Guwahati, Assam 781016 India
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Kim IH, Kang SJ, Choi W, Seo AN, Eom BW, Kang B, Kim BJ, Min BH, Tae CH, Choi CI, Lee CK, An HJ, Byun HK, Im HS, Kim HD, Cho JH, Pak K, Kim JJ, Bae JS, Yu JI, Lee JW, Choi J, Kim JH, Choi M, Jung MR, Seo N, Eom SS, Ahn S, Kim SJ, Lee SH, Lim SH, Kim TH, Han HS. Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline). J Gastric Cancer 2025; 25:5-114. [PMID: 39822170 PMCID: PMC11739648 DOI: 10.5230/jgc.2025.25.e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 12/24/2024] [Indexed: 01/19/2025] Open
Abstract
Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area. Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version. Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.
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Affiliation(s)
- In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Wonyoung Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bum Jun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Jung An
- Division of Oncology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Ho Cho
- Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Joon Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jungyoon Choi
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jwa Hoon Kim
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Soo Eom
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Soomin Ahn
- Department of Pathology and Translational Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hee Lim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
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Guo Z, Wang N, Zhao G, Du L, Cui Z, Liu F. Development and validation of a preoperative model for predicting positive proximal margins in adenocarcinoma of the esophagogastric junction and assessing safe margin distance. Front Oncol 2024; 14:1503728. [PMID: 39720570 PMCID: PMC11666492 DOI: 10.3389/fonc.2024.1503728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Accepted: 11/25/2024] [Indexed: 12/26/2024] Open
Abstract
Objective To develop and validate a model for preoperative prediction of positive proximal margins for adenocarcinoma of the esophagogastric junction (AEG) by transabdominal approach, and to analyze the safe margin distances for patients with different risks of positive proximal margins. Materials and methods A retrospective analysis was performed on 284 AEG patients who underwent surgery via the transabdominal approach at Hengshui People's Hospital between January 2017 and December 2023. Patients were divided into a training set (n=201, first five years) and a test set (n=83, last two years). Clinicopathologic factors potentially influencing margin status were collected. The synthetic minority oversampling technique (SMOTE) was applied to address class imbalance in the training set. Two nomogram models were developed: one based on the original training set and the other using the SMOTE dataset. The model's performance was compared using the test set, with the area under the curve (AUC) used to evaluate discrimination and the Hosmer-Lemeshow test used for model fit. The best-performing model was used to calculate total scores for the entire cohort, and the optimal cutoff value was determined via the ROC curve. Patients were classified into low- and high-risk groups based on the total score, and optimal margin distances were determined using Youden's index. Results The model developed using the SMOTE dataset showed superior AUC for predicting positive proximal margins in the test set compared to the model based on the original training set (0.814 vs. 0.780). Independent predictors of positive proximal margins included Borrmann classification, Lauren classification, cT stage, tumor differentiation, and Siewert classification. The Hosmer-Lemeshow test showed a good model fit (χ² = 5.397, P = 0.612). Using a cutoff total score of 206.811, patients were divided into low-risk (score < 206.811) and high-risk (score ≥ 206.811) groups, with an AUC of 0.788. For the low-risk group, a proximal margin distance of 2.75 cm yielded an AUC of 0.824, with a sensitivity of 54.5%, specificity of 97.9%, and a Youden's index of 0.524. For the high-risk group, a margin distance of 3.85 cm provided an AUC of 0.813, sensitivity of 73.1%, specificity of 80.0%, and a Youden's index of 0.531. Conclusions The nomogram may offer a valuable preoperative tool for assessing the risk of positive proximal margins in AEG patients. While it holds the potential to inform surgical decision-making and help determine appropriate margin distances, further validation in larger and more diverse cohorts is needed to confirm its clinical utility.
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Affiliation(s)
- Zhenjiang Guo
- Department of Gastrointestinal, Hengshui People’s Hospital, Hengshui, Hebei, China
| | - Ning Wang
- Department of Respiratory and Critical Care Medicine, Hengshui People’s Hospital, Hengshui, Hebei, China
| | - Guangyuan Zhao
- Department of Gastrointestinal, Hengshui People’s Hospital, Hengshui, Hebei, China
| | - Liqiang Du
- Department of Gastrointestinal, Hengshui People’s Hospital, Hengshui, Hebei, China
| | - Zhaobo Cui
- Department of Respiratory and Critical Care Medicine, Hengshui People’s Hospital, Hengshui, Hebei, China
| | - Fangzhen Liu
- Department of Gastrointestinal, Hengshui People’s Hospital, Hengshui, Hebei, China
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Long VD, Nguyen DT, Thong DQ, Dat TQ, Hai NV, Vuong NL, Bac NH. Laparoscopic versus open total gastrectomy for T4a gastric cancer: a propensity score-matched analysis of long-term outcomes. Updates Surg 2024; 76:1843-1854. [PMID: 38879836 DOI: 10.1007/s13304-024-01910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/03/2024] [Indexed: 10/06/2024]
Abstract
Evidence of implementation of laparoscopic total gastrectomy (LTG) for surgical T4a stage (sT4a) gastric cancer (GC) remains inadequate. This study aimed to compare short- and long-term outcomes of LTG versus open total gastrectomy (OTG) for sT4a GC. This retrospective cohort study was conducted using data from patients with sT4a GC underwent total gastrectomy from 2014 to 2020. Short-term outcomes included operative characteristics and postoperative complications. Long-term oncological outcomes focused on 3-, and 5-year overall survival (OS) and disease-free survival (DFS). Propensity score matching (PSM) was applied to reduce potential biases in baseline characteristics between groups. There was a total of 161 patients, in which 96 underwent LTG and 65 underwent OTG. After PSM, both groups consisted of 51 patients each, with balanced baseline characteristics. There were no significant differences between the two groups regarding blood loss, length of proximal resected margin, postoperative hospital stays, and overall and major postoperative complications. Most of the complications were classified as minor according to the Clavien-Dindo classification. Operating time was significantly longer in the LTG group (mean: 257 min vs. 231 min, p = 0.006). LTG was superior to OTG groups in time to flatus (mean: 3.0 days vs 3.9 days, p < 0.001). Five-year OS and DFS rates were similar between the two groups (44% and 33% vs. 43% and 28% in the LTG and OTG groups, respectively). Our findings indicate that LTG is a feasible and safe technique, exhibiting comparable long-term oncological outcomes to OTG for sT4a GC. LTG may be an acceptable alternative to OTG for the treatment of sT4a GC.
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Affiliation(s)
- Vo Duy Long
- Department of Gastro-Intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam.
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| | - Doan Thuy Nguyen
- Department of Gastro-Intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Dang Quang Thong
- Department of Gastro-Intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Tran Quang Dat
- Department of Gastro-Intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Viet Hai
- Department of Gastro-Intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Bac
- Department of Gastro-Intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Park JY, Yang JY, Park KB, Kwon OK, Lee SS, Chung HY. Prognostic effect of microscopically negative but close resection margin in gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108517. [PMID: 38964223 DOI: 10.1016/j.ejso.2024.108517] [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: 02/12/2024] [Revised: 05/13/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Microscopically positive resection margin (RM) following curative surgery has been linked to disease recurrence in gastric cancer (GC), but the impact of microscopically negative but close RM (CRM) remains unclear. This study aimed to evaluate the prognostic implications of a CRM of ≤0.5 cm in GC patients. METHODS A retrospective review of the institutional GC database identified 1958 patients who underwent curative gastrectomy for pathologically proven GC between January 2011 and December 2015. The patients were categorized into CRM (RM ≤0.5 cm) and sufficient RM (SRM, RM >0.5 cm) groups. The impact of CRM on recurrence-free survival (RFS) and overall survival (OS) was analyzed compared to the SRM group. RESULTS The cohort comprised 1264 patients with early GC (EGC, 64.6%) and 694 with advanced GC (AGC, 35.4%). Forty-four patients (2.2%) had RM of ≤0.5 cm. CRM was associated with worse RFS in AGC (5-year RFS in the CRM vs. SRM groups; 41.6% vs. 68.7%, p = 0.011); however, the effect on OS was not significant (p = 0.159). Multivariate analysis revealed that CRM was an independent prognostic factor for RFS (hazard ratio [HR] 2.035, 95% confidence interval [CI] 1.097-3.776). In AGC, the locoregional recurrence rate was significantly higher in the CRM group than in the SRM group (15.4% vs. 4.9%, p = 0.044). CONCLUSION CRM of ≤0.5 cm was a significant prognostic factor for RFS in GC patients and was associated with a significant increase in locoregional recurrence in AGC.
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Affiliation(s)
- Ji Yeon Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.
| | - Jae Yeong Yang
- Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ki Bum Park
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Oh Kyoung Kwon
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Department of Surgery, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Seung Soo Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ho Young Chung
- Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
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Xie S, Zhi Y, Shao C, Zeng B. Comment on 'Association of systemic inflammatory markers and tertiary lymphoid structure with pathological complete response in gastric cancer patients receiving preoperative treatment: a retrospective cohort study'. Int J Surg 2024; 110:4429-4430. [PMID: 38518078 PMCID: PMC11254246 DOI: 10.1097/js9.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/03/2024] [Indexed: 03/24/2024]
Affiliation(s)
| | | | | | - Binfang Zeng
- College of Traditional Chinese Medicine, Xinjiang Medical University, Urumqi, Xinjiang, People’s Republic of China
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Pang T, Nie MM, Fan L, Wang JY, Liu ZR, Qin Y, Yin K. The impact of the length of proximal margin on the prognosis in adenocarcinoma of gastroesophageal junction: A real-world study and strategies. Asian J Surg 2024; 47:2613-2622. [PMID: 38565445 DOI: 10.1016/j.asjsur.2024.03.135] [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: 11/17/2023] [Revised: 01/23/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The optimal proximal margin (PM) length for Siewert II/III adenocarcinoma of the esophagogastric junction (AEJ) remains unclear. This study aimed to determine the optimal PM length using an abdominal approach to guide surgical decision-making. METHODS A prospective study analyzed 304 consecutive patients diagnosed with Siewert II/III AEJ between January 2019 and December 2021. Total gastrectomy was performed via the abdominal approach, and PM length was measured on fixed gross specimens. X-Tile software determined the optimal PM cut-point based on progression-free survival (PFS). Univariate analyses compared baseline characteristics across PM groups, while survival analyses utilized Kaplan-Meier estimation and Cox proportional hazards regression for assessing the impact of margin length on survival. Multivariable analyses were conducted to adjust for confounding variables. RESULTS The study included 264 AEJ cases classified as Siewert II (71.97%) or III (28.03%). The median gross PM length was 1.0 cm (IQR: 0.5 cm-1.5 cm, range: 0 cm-6 cm). PM length ≥1.2 cm was associated with a lower risk of disease progression compared to PM length 0.4 cm on PFS (HR = 0.41, 95% CI 0.20-0.84, P = 0.015). Moreover, PM ≥ 1.2 cm improved prognosis in subgroups of T4 or N3, tumor size <4 cm, Siewert II, and Lauren classification. CONCLUSIONS For Siewert type II/III AEJ, a proximal margin length ≥1.2 cm (1.65 cm in situ) is associated with improved outcomes. These findings offer valuable insights into the association between PM length and outcomes in Siewert II/III AEJ, providing guidance for surgical approaches and aiding clinical decision-making to enhance patient outcomes.
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Affiliation(s)
- Tao Pang
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China.
| | - Ming Ming Nie
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Lei Fan
- General Education Research Office, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Jia Yang Wang
- General Education Research Office, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Zhao Rui Liu
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Yingyi Qin
- Department of Military Health Statistics, Naval Medical University, Shanghai, China.
| | - Kai Yin
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China.
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Hayami M, Ohashi M, Kurihara N, Nunobe S. Adequate gross resection margin length ensuring pathologically complete resection in gastrectomy for gastric cancer: A systematic review and meta-analysis. Ann Gastroenterol Surg 2024; 8:202-213. [PMID: 38455483 PMCID: PMC10914694 DOI: 10.1002/ags3.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 11/12/2023] [Accepted: 11/21/2023] [Indexed: 03/09/2024] Open
Abstract
Aim A positive resection margin (RM) is associated with poor survival after gastrectomy for gastric cancer (GC). However, the adequate RM length to avoid a positive RM remains controversial. We performed a systematic review to examine the RM length required to avoid a positive RM in gastrectomy for GC. Methods This systematic review involved all relevant articles identified in PubMed, the Cochrane Library, Web of Science, and ClinicalTrials.gov until August 2023. The incidence of a positive RM related to the RM length and the possible incidence of a positive RM estimated from the discrepancy between the gross and pathological RM length were evaluated. The Newcastle-Ottawa Scale was used to quantify study quality. Results Thirteen studies involving 8983 patients were analyzed. Investigation of the incidence of a positive RM in relation to the RM length showed that a proximal RM length of 6 cm guaranteed a negative RM in gastrectomy. Analyses of the possible incidence of a positive RM revealed that a negative RM would be guaranteed if the proximal RM length was 6 cm in distal gastrectomy, if the esophageal resection length was 2 cm in total gastrectomy for GC without esophageal invasion and 2.5 cm in total or proximal gastrectomy for GC with esophageal invasion or esophagogastric junction cancer, and if the distal RM length was 4 cm in proximal gastrectomy for early GC. Conclusions The adequate RM lengths to ensure a pathologically negative RM in each type of gastrectomy for GC were herein suggested.
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Affiliation(s)
- Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Nozomi Kurihara
- Department of Clinical Trial Planning and StrategyCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological CenterCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
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10
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De Ruvo N, Fenocchi S, Veronesi L, Missori G, Ricciardolo AA, Rossi EG, Sorrentino L, Cautero N, Serra F, Gelmini R. Prognostic factors in gastric cancer patients: a 10-year mono-institutional experience. Front Surg 2024; 11:1321981. [PMID: 38362460 PMCID: PMC10867173 DOI: 10.3389/fsurg.2024.1321981] [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: 10/15/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Gastric cancer (GC) is one of the main causes of death from cancer globally. Long-term survival, especially in Western countries, remains dismal, with no significant improvements in recent years. Therefore, precise identification of clinical and pathological risk factors is crucial for prognosis, as it allows a better selection of patients suitable for oncologically radical treatments and contributes to longer survivals. Methods We devised a retrospective observational longitudinal study over 10 years of experience with GC patients operated with curative intent. Results Several factors were thoroughly investigated in a multivariate analysis to look for significance as independent risk factors for disease-free survival. Our results showed that only BMI, pTNM, and lymph node ratio expressed hazard ratios with implications for survival in our series of patients. Discussion Although limited by the retrospective nature of the study, this is one of the few cancer reports from Northern Italy showing results over 10 years, which may in our view, have an impact on decision-making processes for multidisciplinary teams dedicated to the care of gastric cancer patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - F. Serra
- General, Oncological and Emergency Surgery Unit, Department of Surgery, AOU Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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11
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Cox KE, Turner MA, Amirfakhri S, Lwin TM, Hosseini M, Ghosh P, Obonyo M, Murakami T, Hoffman RM, Yazaki PJ, Bouvet M. Humanized Anti-Carcinoembryonic Antigen Antibodies Brightly Target and Label Gastric Cancer in Orthotopic Mouse Models. J Surg Res 2024; 293:701-708. [PMID: 37839102 PMCID: PMC11060874 DOI: 10.1016/j.jss.2023.08.038] [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: 12/01/2022] [Revised: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Gastric cancer poses a major therapeutic challenge. Improved visualization of tumor margins at the time of gastrectomy with fluorescent tumor-specific antibodies could improve outcomes. The present report demonstrates the potential of targeting gastric cancer with a humanized anti-carcinoembryonic antigen (CEA) antibody in orthotopic mouse models. METHODS MKN45 cells were injected subcutaneously into nude mice to establish xenograft models. Tumor fragments collected from subcutaneous models were then implanted into the greater curvature of the stomach to establish orthotopic models. For tumor labeling, a humanized anti-CEA antibody (M5A) and IgG as a control, were conjugated with the near-infrared dye IRDye800CW. Time (24-72 h) and dose (50-100 μg) response curves were performed in subcutaneous models. Orthotopic models received 50 μg of M5A-IR800 or 50 μg IgG-IR800 as a control and were imaged after 72 h. Fluorescence imaging was performed on the mice using the LI-COR Pearl Imaging System. RESULTS In subcutaneous models, tumor to background ratios (TBRs) reached 8.85 at 72 h. Median TBRs of orthotopic model primary tumors were 6.25 (interquartile range [IQR] 6.03-7.12) for M5A-IR800 compared to 0.42 (IQR 0.38-0.54) for control. Abdominal wall metastasis median TBRs were 13.52 (IQR 12.79-13.76) for M5A-IR800 and 3.19 (IQR 2.65-3.73) for the control. Immunohistochemistry confirmed CEA expression within tumors. CONCLUSIONS Humanized anti-CEA antibodies conjugated to near-infrared dyes provide specific labeling of gastric cancers in mouse models. Orthotopic models demonstrated bright and specific labeling with TBRs greater than ten times that of control. This tumor-specific fluorescent antibody is a promising potential clinical tool for improving visualization of gastric cancer margins at time of surgical resection.
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Affiliation(s)
- Kristin E Cox
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California
| | - Michael A Turner
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California
| | - Siamak Amirfakhri
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California
| | - Thinzar M Lwin
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California
| | - Mojgan Hosseini
- Department of Pathology, University of California San Diego, La Jolla, California
| | - Pradipta Ghosh
- Department of Cellular and Molecular Medicine, University of California San Diego, La Jolla, California; Department of Medicine, University of California San Diego, La Jolla, California
| | - Marygorret Obonyo
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Takashi Murakami
- Department of Microbiology, Saitama Medical University, Saitama, Japan
| | - Robert M Hoffman
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California; AntiCancer Inc, San Diego, California
| | - Paul J Yazaki
- Department of Immunology & Theranostics, Beckman Research Institute of the City of Hope, Duarte, California
| | - Michael Bouvet
- Department of Surgery, University of California San Diego, La Jolla, California; Department of Surgery, VA San Diego Healthcare System, La Jolla, California.
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12
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Pang T, Nie M, Yin K. The correlation between the margin of resection and prognosis in esophagogastric junction adenocarcinoma. World J Surg Oncol 2023; 21:316. [PMID: 37814242 PMCID: PMC10561513 DOI: 10.1186/s12957-023-03202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023] Open
Abstract
Adenocarcinoma of the gastroesophageal junction (AEG) has become increasingly common in Western and Asian populations. Surgical resection is the mainstay of treatment for AEG; however, determining the distance from the upper edge of the tumor to the esophageal margin (PM) is essential for accurate prognosis. Despite the relevance of these studies, most have been retrospective and vary widely in their conclusions. The PM is now widely accepted to have an impact on patient outcomes but can be masked by TNM at later stages. Extended PM is associated with improved outcomes, but the optimal PM is uncertain. Academics continue to debate the surgical route, extent of lymphadenectomy, preoperative tumor size assessment, intraoperative cryosection, neoadjuvant therapy, and other aspects to further ensure a negative margin in patients with gastroesophageal adenocarcinoma. This review summarizes and evaluates the findings from these studies and suggests that the choice of approach for patients with adenocarcinoma of the esophagogastric junction should take into account the extent of esophagectomy and lymphadenectomy. Although several guidelines and reviews recommend the routine use of intraoperative cryosections to evaluate surgical margins, its generalizability is limited. Furthermore, neoadjuvant chemotherapy and radiotherapy are more likely to increase the R0 resection rate. In particular, intraoperative cryosections and neoadjuvant chemoradiotherapy were found to be more effective for achieving negative resection margins in signet ring cell carcinoma.
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Affiliation(s)
- Tao Pang
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Mingming Nie
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China
| | - Kai Yin
- Department of Gastrointestinal Tract Surgery, First Affiliated Hospital of Naval Military Medical University, Shanghai, China.
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13
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Chung JH, Im DW, Ryu DG, Choi CW, Kim SJ, Hwang SH, Lee SH. Clinical strategies for securing negative proximal margin in early gastric cancer. Medicine (Baltimore) 2023; 102:e35393. [PMID: 37800787 PMCID: PMC10552986 DOI: 10.1097/md.0000000000035393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
Securing an appropriate proximal resection margin (PRM) is crucial for oncological safety in treating gastric cancer. This study investigated the clinicopathological characteristics of patients with incomplete PRM length of <2 cm in early gastric cancer. Clinicopathological data of 1,493 patients who underwent subtotal gastrectomy for early gastric cancer in 2012 to 2021 were retrospectively reviewed. Patients were divided into the PRM length of <2 cm and ≥2 cm groups based on pathological results. Univariate and multivariate analyses evaluated factors for incomplete PRM length. Factors related to patients with a relative PRM positive were also analyzed. The proportion of patients with a PRM length of <2 cm was 17.9% (267/1,493). Multivariate regression analysis revealed that age <50, preoperative endoscopic size of ≥3 cm, size discrepancy of ≥2 cm, and midbody tumor with a lesser curvature significantly contributed to the PRM length of <2 cm. Twenty-four patients had a relative PRM positive (24/1493, 1.6%). An incomplete PRM was the only risk factor for a positive relative PRM. Surgical treatment for early gastric cancer requires an accurate preoperative endoscopic tumor size and location evaluation. A more aggressive resection is recommended for patients with age <50, preoperative endoscopic size of ≥3 cm, size discrepancy of ≥2 cm, and midbody tumor with a lesser curvature.
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Affiliation(s)
- Jae Hun Chung
- Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong Won Im
- Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dae-Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sun-Hwi Hwang
- Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Si-Hak Lee
- Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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14
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Kumar S P, Kalayarasan R, Senthil G, Pottakkat B, Rajeswari M. Risk factor analysis for duodenal margin positivity following gastrectomy for resectable gastric cancer. Asia Pac J Clin Oncol 2023; 19:e300-e304. [PMID: 36575564 DOI: 10.1111/ajco.13910] [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: 01/13/2022] [Revised: 05/28/2022] [Accepted: 11/30/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Duodenal margin positivity is a poor prognostic factor following gastrectomy for resectable gastric cancer. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time- and resource-consuming. Hence resection is usually performed based on surgeon's judgment and palpation. AIM OF STUDY To determine risk factors for duodenal resection margin (RM) positivity following gastrectomy for resectable gastric cancer. MATERIALS AND METHODS We retrospectively analyzed prospectively maintained data of 376 patients admitted with diagnosis of gastric cancer from August 2011 to January 2020 in JIPMER, a tertiary center in Puducherry, India. Of these, 146 patients underwent gastric resection with curative intent and were the subject of this study. RM status was assessed by definitive histopathology examination. The potential risk factors were compared between patients with positive margin on definitive histopathology examination and a control cohort of similar patients with negative margins. RESULTS Of the 146 patients, 16 patients (10.9%), 11 men and 5 women, had positive duodenal margin. The mean age of study group was 59 years. None of the patient characteristics like age, sex, comorbidities, or addictions were statistically significant with regard to duodenal margin positivity. Among tumor characteristics, locally advanced tumors and pyloroantral tumors were found more frequently in the margin-positive group. High-risk features for duodenal margin positivity were extensive nodal disease, oligometastatic disease, lymphovascular invasion, and perineural invasion. Neoadjuvant chemotherapy and types of surgical access did not have significant impact on RM. Interestingly, both proximal and circumferential resection margin positivity had a linear association with distal margin positivity suggesting that tumor biology may have a significant role in margin positivity. However, none of these factors were statistically significant on multivariate analysis using logistic regression model. Among oligometastatic patients, survival was dependent on R0 resection and was not different from patients without metastases though our study was not powered for survival analysis (mean survival of 11.040 months) and expectedly, duodenal margin positive patients had lower overall survival compared to margin negative patients (mean survival of 5.188 vs. 11.763 months, p = 0.12). CONCLUSIONS Locally advanced tumors and pyloroantral tumors are associated with an increased risk of duodenal margin positivity after gastrectomy for carcinoma stomach and may benefit from intraoperative frozen section analysis as survival is negatively affected by positive RM. Patients with high-risk features like extensive nodal and oligometastatic disease have a greater propensity for positive duodenal margin. A prospective study with a large sample size is needed to further validate these results.
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Affiliation(s)
- Pradeep Kumar S
- Department of Surgical Gastroenterology, JIPMER, Puducherry, India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, JIPMER, Puducherry, India
| | | | - Biju Pottakkat
- Department of Surgical Gastroenterology, JIPMER, Puducherry, India
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15
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de Jongh C, van der Veen A, Brosens LAA, Nieuwenhuijzen GAP, Stoot JHMB, Ruurda JP, van Hillegersberg R. Distal Versus Total D2-Gastrectomy for Gastric Cancer: a Secondary Analysis of Surgical and Oncological Outcomes Including Quality of Life in the Multicenter Randomized LOGICA-Trial. J Gastrointest Surg 2023; 27:1812-1824. [PMID: 37340107 PMCID: PMC10511620 DOI: 10.1007/s11605-023-05683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/10/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Distal gastrectomy (DG) for gastric cancer can cause less morbidity than total gastrectomy (TG), but may compromise radicality. No prospective studies administered neoadjuvant chemotherapy, and few assessed quality of life (QoL). METHODS The multicenter LOGICA-trial randomized laparoscopic versus open D2-gastrectomy for resectable gastric adenocarcinoma (cT1-4aN0-3bM0) in 10 Dutch hospitals. This secondary LOGICA-analysis compared surgical and oncological outcomes after DG versus TG. DG was performed for non-proximal tumors if R0-resection was deemed achievable, TG for other tumors. Postoperative complications, mortality, hospitalization, radicality, nodal yield, 1-year survival, and EORTC-QoL-questionnaires were analyzed using Χ2-/Fisher's exact tests and regression analyses. RESULTS Between 2015 and 2018, 211 patients underwent DG (n = 122) or TG (n = 89), and 75% of patients underwent neoadjuvant chemotherapy. DG-patients were older, had more comorbidities, less diffuse type tumors, and lower cT-stage than TG-patients (p < 0.05). DG-patients experienced fewer overall complications (34% versus 57%; p < 0.001), also after correcting for baseline differences, lower anastomotic leakage (3% versus 19%), pneumonia (4% versus 22%), atrial fibrillation (3% versus 14%), and Clavien-Dindo grading compared to TG-patients (p < 0.05), and demonstrated shorter median hospital stay (6 versus 8 days; p < 0.001). QoL was better after DG (statistically significant and clinically relevant) in most 1-year postoperative time points. DG-patients showed 98% R0-resections, and similar 30-/90-day mortality, nodal yield (28 versus 30 nodes; p = 0.490), and 1-year survival after correcting for baseline differences (p = 0.084) compared to TG-patients. CONCLUSIONS If oncologically feasible, DG should be preferred over TG due to less complications, faster postoperative recovery, and better QoL while achieving equivalent oncological effectiveness. Distal D2-gastrectomy for gastric cancer resulted in less complications, shorter hospitalization, quicker recovery and better quality of life compared to total D2-gastrectomy, whereas radicality, nodal yield and survival were similar.
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Affiliation(s)
- Cas de Jongh
- Department of Surgery, University Medical Center (UMC) Utrecht, G04.228, 3508 GA Utrecht, The Netherlands
| | - Arjen van der Veen
- Department of Surgery, University Medical Center (UMC) Utrecht, G04.228, 3508 GA Utrecht, The Netherlands
| | | | | | - Jan H. M. B. Stoot
- Department of Surgery, Zuyderland Medical Center, Sittard, The Netherlands
| | - Jelle P. Ruurda
- Department of Surgery, University Medical Center (UMC) Utrecht, G04.228, 3508 GA Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center (UMC) Utrecht, G04.228, 3508 GA Utrecht, The Netherlands
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16
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Koterazawa Y, Ohashi M, Hayami M, Makuuchi R, Ida S, Kumagai K, Sano T, Nunobe S. Oncological impact of unexpected horizontal tumor spread in gastric cancer that requires total gastrectomy. Gastric Cancer 2023; 26:823-832. [PMID: 37247037 DOI: 10.1007/s10120-023-01401-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Gastric cancer often exhibits discrepancies between the gross and pathological tumor boundaries, and the degree of discrepancy may be a tumor characteristic. However, whether these discrepancies influence oncological outcomes remains unclear. METHODS The data of patients who underwent total gastrectomy for gastric cancer from 2005 to 2018 were collected. A new parameter, ΔPM, which corresponds to the length of the discrepancy between the gross and pathological proximal boundaries, was calculated and the patients were divided into two groups: patients with long ΔPM and those with short ΔPM. Oncological outcomes were compared between the two groups. RESULTS A length of 8 mm was determined as the cutoff value for long or short ΔPM. Tumor size, growth pattern, pathological type, depth, and esophageal invasion were associated with ΔPM > 8 mm. Overall survival of the ΔPM > 8 mm group was significantly worse than that of the ΔPM ≤ 8 mm group (5-year overall survival: 58% vs 78%; p < 0.0001). Multivariate analysis revealed that ΔPM > 8 mm was an independent risk factor for poor survival and peritoneal metastasis. The likelihood ratio test revealed a significant interaction between pT status and ΔPM (p = 0.0007). Circumferential involvement and gross esophageal invasion were poorer survival factors in the ΔPM > 8 mm group. CONCLUSIONS ΔPM > 8 mm is related to several clinicopathological characteristics and is an independent risk factor for poorer survival and peritoneal metastasis but not local recurrence. ΔPM > 8 mm combined with circumferential involvement or esophageal invasion is associated with relatively poor survival outcomes.
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Affiliation(s)
- Yasufumi Koterazawa
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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17
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Hirata Y, Agnes A, Estrella JS, Blum Murphy M, Das P, Minsky BD, Ajani JA, Badgwell BD, Mansfield P, Ikoma N. Clinical Impact of Positive Surgical Margins in Gastric Adenocarcinoma in the Era of Preoperative Therapy. Ann Surg Oncol 2023; 30:4936-4945. [PMID: 37106276 DOI: 10.1245/s10434-023-13495-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Microscopically positive (R1) surgical margins after gastrectomy increase gastric cancer recurrence risk, but optimal management after R1 gastrectomy is controversial. We sought to identify the impact of R1 margins on recurrence patterns and survival in the era of preoperative therapy for gastric cancer. METHODS Patients who underwent gastrectomy for adenocarcinoma during 1998-2017 at a major cancer center were enrolled. Clinicopathologic factors associated with positive margins were examined, and incidence, sites, and timing of recurrence and survival outcomes were compared between patients with positive and negative margins. RESULTS Of 688 patients, 432 (63%) received preoperative therapy. Thirty-four patients (5%) had R1 margins. Compared with patients with negative margins, patients with R1 margins more frequently had aggressive clinicopathologic features, such as linitis plastica (odds ratio [OR] 7.79, p < 0.001) and failure to achieve cT downstaging with preoperative treatment (OR 5.20, p = 0.005). The 5 year overall survival (OS) rate was lower in patients with R1 margins (6% vs 60%; p < 0.001), and R1 margins independently predicted worse OS (hazard ratio 2.37, 95% CI 1.51-3.75, p < 0.001). Most patients with R1 margins (58%) experienced peritoneal recurrence, and locoregional recurrence was relatively rare in this group (14%). Median time to recurrence was 8.5 months for peritoneal dissemination and 15.7 months for locoregional recurrence. CONCLUSION R1 margins after gastrectomy were associated with aggressive tumor biology, high incidence of peritoneal recurrence after a short interval, and poor OS. In patients with R1 margins, re-resection to achieve microscopically negative margins has to be considered with caution.
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Affiliation(s)
- Yuki Hirata
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Annamaria Agnes
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeannelyn S Estrella
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mariela Blum Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prajnan Das
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bruce D Minsky
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul Mansfield
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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18
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Costa T, Nogueiro J, Ribeiro D, Viegas P, Santos-Sousa H. Impact of serum albumin concentration and neutrophil-lymphocyte ratio score on gastric cancer prognosis. Langenbecks Arch Surg 2023; 408:57. [PMID: 36689025 DOI: 10.1007/s00423-023-02799-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023]
Abstract
INTRODUCTION/AIM Serum albumin concentration (COA) and neutrophil-lymphocyte ratio (NLR) could reflect immunological and nutritional status. We aim to evaluate the impact of COA-NLR score on the prognosis of gastric cancer (GC). MATERIAL AND METHODS We perform a retrospective analysis on a database of 637 GC cases, between January 2010 and December 2017. In 396 patients, the inclusion criteria for this study were met (non-resectional or palliative surgery were excluded). Analytic data was only available in 203 patients. COA-NLR score was defined as follows: COA under 35 g/L and NLR value of 2.585 or higher, score 2; one of these conditions, score 1; and neither, score 0. RESULTS In our population (n = 203), 87 patients were classified as score 0, 82 as score 1 and 34 as score 2. COA-NLR score was significantly associated with DFS (HR 1.674; CI 95% 1.115-2.513; p = 0.013) and with OS (HR 2.072; CI 95% 1.531-2.805; p < 0.001). Kaplan-Meier curve analysis (log rank test) revealed that a higher score of COA-NLR predicted a worse OS (p < 0.001) and DFS (p = 0.03). COA-NLR was an independent prognostic factor for OS when adjusted to pStage and age (adjusted HR 1.566; CI 95% 1.145-2.143; p = 0.005). CONCLUSIONS Preoperative COA-NLR score was significantly associated with worse OS and DFS and, in this way, with worse prognosis on GC patients submitted to curative-intent resectional surgery.
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Affiliation(s)
- Teresa Costa
- Faculty of Medicine, University of Porto, Porto, Portugal.
- Surgery Department, Guarda Local Health Unit, Guarda, Portugal.
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto, Porto, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Daniel Ribeiro
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Viegas
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, Porto, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
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19
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Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, Kim BJ, Min BH, Choi CI, Shin CM, Tae CH, Gong CS, Kim DJ, Cho AEH, Gong EJ, Song GJ, Im HS, Ahn HS, Lim H, Kim HD, Kim JJ, Yu JI, Lee JW, Park JY, Kim JH, Song KD, Jung M, Jung MR, Son SY, Park SH, Kim SJ, Lee SH, Kim TY, Bae WK, Koom WS, Jee Y, Kim YM, Kwak Y, Park YS, Han HS, Nam SY, Kong SH. Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach. J Gastric Cancer 2023; 23:3-106. [PMID: 36750993 PMCID: PMC9911619 DOI: 10.5230/jgc.2023.23.e11] [Citation(s) in RCA: 155] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.
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Affiliation(s)
- Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center Seoul, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Pusan, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seungnam, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Woman's University College of Medicine, Seoul, Korea
| | - Chung Sik Gong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University, Cheonan, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Lim
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Ji Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jwa Hoon Kim
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Shin-Hoo Park
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeseob Jee
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Yoo Min Kim
- Department of Surgery, Severance Hospital, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Su Youn Nam
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
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20
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Watanabe A, Adamson H, Lim H, McFadden AF, McConnell YJ, Hamilton TD. Intraoperative frozen section analysis of margin status as a quality indicator in gastric cancer surgery. J Surg Oncol 2023; 127:66-72. [PMID: 36177786 DOI: 10.1002/jso.27107] [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: 05/18/2022] [Revised: 08/12/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Positive pathologic margins following gastric cancer (GC) resection carries a poor prognosis. We evaluated intraoperative frozen section (IFS) analysis of resection margins (RMs) as a quality indicator in GC surgery. METHODS Patients referred to a provincial cancer agency with surgically resected non-metastatic GC between 2004 and 2012 were included. Associations between IFS analysis, other baseline characteristics, RMs, and overall survival (OS) were assessed using logistic regression, Kaplan-Meier analyses, and Cox proportional hazards modeling. RESULTS Among 377 patients, median age was 67 years, 68% were male, and 16% had +RMs. Thirty-four percent of patients underwent IFS analysis, which protected against +RMs (odds ratio [OR]: 0.34, 95% confidence interval [CI]: 0.16-0.73, p = 0.006) and improved OS (hazards ratio [HR]: 0.72, 95% CI: 0.54-0.98, p = 0.037). OS following re-resection of IFS positive patients was similar to IFS negative patients (69 vs. 54 months, p = 0.317). Stage III disease (OR: 12.8, 95% CI: 3.00-55.0, p = 0.001) and gastroesophageal junction tumors (OR: 2.25, 95% CI: 1.05-4.78, p = 0.036) predicted +RMs. Stage III disease led to worse OS (HR: 2.89, 95% CI: 1.92-4.34, p < 0.001) while intestinal histology improved OS (HR: 0.67, 95% CI: 0.50-0.90, p = 0.007). CONCLUSIONS IFS analysis reduce +RMs and improve OS and should be incorporated in curative intent GC surgery for patients with locally advanced GC.
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Affiliation(s)
- Akie Watanabe
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hannah Adamson
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Howard Lim
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew F McFadden
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Trevor D Hamilton
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Lu H, Sun Y, Zhu Z, Yao J, Xu H, Huang R, Huang B. Effect of Chemoradiotherapy on the Survival of Resectable Gastric Cancer Patients: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2022; 29:6962-6975. [PMID: 35723792 DOI: 10.1245/s10434-022-12005-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adjuvant chemotherapy (CT) and chemoradiotherapy (CRT) after surgery are necessary to reduce the risk of metastasis and recurrence for resectable gastric cancer (GC) patients. Adjuvant CT and CRT have been proven to significantly improve the prognosis for GC patients, when compared with surgery only. However, it is still unclear whether radiotherapy offers additional survival benefits to advanced gastric cancer (AGC) patients. METHODS PubMed, Cochrane Library, and Embase databases were systematically searched for eligible studies that compared survival benefits between CRT and CT. The endpoints of this meta-analysis were measured as HR for OS or DFS and 95% CI using fixed- or random-effect models. Additionally, side effects, completed rate, and metastatic risk, were calculated as OR. Subgroup analyses according to clinicopathological factors were presented. RESULTS A total of 28 eligible studies involving 20,220 patients were included in our study. Of these, 17 studies evaluated the survival benefits of additional radiotherapy on overall survival (OS) of gastric cancer patients, ten reported the impact of CRT on disease-free survival (DFS), and 26 studies showed long-term survival rate. The pooled results were significant (HR for OS 0.84, 95% CI 0.71-0.99; HR for DFS 0.76, 95% CI 0.66-0.89). The subgroup analysis showed that adjuvant CRT increased OS for patients without preoperative treatment; showed similar nausea/vomiting, but an increased risk of neutropenia; reduced the risk of locoregional recurrence; failed to improve OS for lymph node (LN)-positive GC patients; and significantly improved prognosis for R1-treated patients. Of note, DFS was improved in all the subgroups via decreasing the locoregional recurrence. CONCLUSION Compared with CT, adjuvant CRT can improve survival for advanced gastric cancer patients, with similar nausea/vomiting, but increased risk of neutropenia. Patients without preoperative treatment or with positive surgical margins should be strongly recommended to undergo CRT. Treatment regimens should be carefully decided by doctors based on patients' tolerance, physical status, and reaction to treatment. Moreover, CRT improves the DFS for patients regardless of subgroups, because it significantly reduced the risk of locoregional recurrence.
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Affiliation(s)
- Huiwen Lu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, No.155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Yimeng Sun
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, No.155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Zirui Zhu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, No.155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Junqiao Yao
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, No.155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Huimian Xu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, No.155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China
| | - Rui Huang
- Department of Clinical Medicine of year 2017, Dalian Medical University, Dalian, People's Republic of China
| | - Baojun Huang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, No.155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China.
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22
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Liu L, Wang C, Li F, Zhang X, Cheng X, Lin S, Liu Y, Yang C, Li W. The safety and efficacy of laparoscopic gastrectomy for patients with locally advanced gastric cancer following neoadjuvant chemotherapy. Sci Rep 2022; 12:10384. [PMID: 35726012 PMCID: PMC9209419 DOI: 10.1038/s41598-022-14717-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 06/10/2022] [Indexed: 12/12/2022] Open
Abstract
Limited researches focused on the application of laparoscopic gastrectomy (LG) in locally advanced gastric cancer (LAGC) patients following neoadjuvant chemotherapy (NACT). In this study, we aimed at illustrating the surgical and survival outcome of LG in LAGC patients following NACT. We performed a retrospective study of patients with LAGC who received either LG following NACT or upfront LG at Fujian Provincial Hospital between March 2013 and October 2018. Perioperative parameters, short-term and long-term outcomes were compared. The Kaplan–Meier estimator was used to describe the survival curves, and the differences were examined by the log-rank test. In total, 76 consecutive patients were enrolled into the NACT-LG (41 patients) and LG (35 patients) group. The postoperative hospital stay was significantly longer for LG than for NACT-LG (11.0 vs. 12.0 day, P = 0.031). Significant difference was found in Grade ≥ III severe postoperative complications in two groups (0 vs. 17.1%, P = 0.001). No patient died of postoperative complications in the NACT-LG group, and one patient (1/35, 2.9%) died of postoperative complications in the LG group. A forest plot revealed that most subgroups of LG group were at great risks of postoperative complications. Compared with the LG group, the NACT-LG group had a significantly better DFS (14.4% vs. 5.7%, P = 0.0299) and better OS (34.1% vs. 8.6%, P = 0.0061) at 3 years. NACT increased the safety of LG for patients with LAGC and offer better disease-free and overall survival. For patients with LAGC, LG following NACT should be the priority treatment.
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Affiliation(s)
- Lihang Liu
- Shengli Clinical Medical College, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Chuandong Wang
- Shengli Clinical Medical College, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Feng Li
- Shengli Clinical Medical College, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, China.,Department of Pathology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, 350001, China
| | - Xuefei Cheng
- Shengli Clinical Medical College, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Shengtao Lin
- Shengli Clinical Medical College, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yi Liu
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, People's Republic of China
| | - Changshun Yang
- Shengli Clinical Medical College, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Weihua Li
- Shengli Clinical Medical College, Fujian Medical University, No. 134, East Street, Fuzhou, 350001, China. .,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China.
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23
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Ikeda K, Nagai H, Miyake H, Yoshioka Y, Katayama M, Yuasa N, Marukawa T, Ito M, Fujino M, Murakami H, Kiriyama A. Superficial spreading type of early gastric cancer with diagnostic difficulty and positive surgical margin: a case report. Clin J Gastroenterol 2022; 15:537-546. [PMID: 35226301 DOI: 10.1007/s12328-022-01610-y] [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: 08/03/2021] [Accepted: 02/12/2022] [Indexed: 10/19/2022]
Abstract
An 83-year-old man visited our hospital because of difficulty swallowing. Gastroscopy revealed multiple ulcers and a reddish depression in the lesser curvature of the middle stomach. The initial biopsy showed regenerative atypia, so a gastroscopy was repeated every 3 months thereafter because of suspected malignancy. A biopsy performed 12 months after the initial gastroscopy revealed a well-differentiated adenocarcinoma. After determination of the planned oral resection line by two negative biopsies, laparoscopic distal gastrectomy was performed. The resected specimen showed a 0 - IIa + IIc lesion composed of well-to-moderately differentiated tubular adenocarcinoma, including hand-shaking-type gastric cancer. The oral resection margin was positive due to widespread mucosal extension; therefore, an additional total gastrectomy was needed. Cases of well-differentiated adenocarcinoma and its superficial extension may be difficult to diagnose via endoscopy and biopsy.
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Affiliation(s)
- Koyo Ikeda
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hidemasa Nagai
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Yuichiro Yoshioka
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Mika Katayama
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
| | - Takahiro Marukawa
- Department of Gastroenterlogy, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Masafumi Ito
- Department of Pathology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Masahiko Fujino
- Department of Pathology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Hideki Murakami
- Department of Pathology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
| | - Ayami Kiriyama
- Department of Pathology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan
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24
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Levy J, Gupta V, Amirazodi E, Allen-Ayodabo C, Jivraj N, Jeong Y, Davis LE, Mahar AL, De Mestral C, Saarela O, Coburn NG. Textbook Outcome and Survival in Patients With Gastric Cancer: An Analysis of the Population Registry of Esophageal and Stomach Tumours in Ontario (PRESTO). Ann Surg 2022; 275:140-148. [PMID: 32149825 DOI: 10.1097/sla.0000000000003849] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between Textbook Outcome (TO)-a new composite quality measurement-and long-term survival in gastric cancer surgery. BACKGROUND Single-quality indicators do not sufficiently reflect the complex and multifaceted nature of perioperative care in patients with gastric adenocarcinoma. METHODS All patients undergoing gastrectomy for nonmetastatic gastric adenocarcinoma registered in the Population Registry of Esophageal and Stomach Tumours of Ontario (PRESTO) between 2004 and 2015 were included. TO was defined according to negative margins; >15 lymph nodes sampled; no severe complications; no re-interventions; no unplanned ICU admission; length of stay ≤21 days; no 30-day readmission; and no 30-day mortality. Three-year survival was estimated using the Kaplan-Meier method. A marginal multivariable Cox proportional-hazards model was used to estimate the association between achieving TO metrics and long-term survival. E-value methodology was used to assess for risk of residual confounding. RESULTS Of the 1836 patients included in this study, 402 (22%) achieved all TO metrics. TO patients had a higher 3-year survival rate compared to non-TO patients (75% vs 55%, log-rank P < 0.001). After adjustments for covariates and clustering within hospitals, TO was associated with a 41% reduction in mortality (adjusted hazards ratio 0.59, 95% confidence interval 0.48, 0.72, P < 0.001). These results were robust to potential residual confounding. CONCLUSIONS Achieving TO is strongly associated with improved long-term survival in gastric cancer patients and merits further focus in surgical quality improvement efforts.
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Affiliation(s)
- Jordan Levy
- Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Vaibhav Gupta
- Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Elmira Amirazodi
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Naheed Jivraj
- Department of Anesthesia and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yunni Jeong
- Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Laura E Davis
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Manitoba Centre for Health Policy and Department of Community Health Sciences, University of Manitoba, Canada
| | - Charles De Mestral
- Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute and St. Michael's Hospital, Toronto, Ontario, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natalie G Coburn
- Division of General Surgery, Department of Surgery and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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25
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Kalff MC, Wagner AD, Verhoeven RHA, Lemmens VEPP, van Laarhoven HWM, Gisbertz SS, van Berge Henegouwen MI, the Dutch Upper GI Cancer Audit group. Sex differences in tumor characteristics, treatment, and outcomes of gastric and esophageal cancer surgery: nationwide cohort data from the Dutch Upper GI Cancer Audit. Gastric Cancer 2022; 25:22-32. [PMID: 34365540 PMCID: PMC8732809 DOI: 10.1007/s10120-021-01225-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sex differences in clinicopathological characteristics, treatment, and postoperative outcomes of gastric and esophageal cancer are largely undefined. This study aimed to compare tumor and treatment characteristics and outcomes of gastric and esophageal cancer surgery between male and female patients. METHODS Patients after elective surgery for primary esophageal (EAC) or gastric adenocarcinoma (GAC) registered in the Dutch Upper GI Cancer Audit between 2011 and 2016 were included. The primary endpoint, 5-year relative survival with relative excess risk (RER), i.e., adjusted for the normal life expectancy, was compared between male and female patients with EAC and GAC. RESULTS In total, 4937 patients were included (75% male) with a mean age of 66 years. cT and cN-stages showed a similar distribution in male and female patients. In females, antrum GAC was more frequent (47% vs. 38%, p < 0.001). Female patients with EAC less frequently received neo-adjuvant treatment (OR = 0.60, 95% CI 0.38-0.96, p = 0.033). For GAC, less postoperative morbidity (33% vs. 38% p = 0.017) and less re-interventions (12% vs. 16%, p = 0.008) were observed in females, although they had inferior 5-year relative survival (49% vs. 56%, RER = 1.31, 95% CI 1.09-1.58, p = 0.004). No differences in relative survival of EAC were observed. CONCLUSIONS In addition to significant sex differences in tumor location, female patients with esophageal adenocarcinoma less frequently received neo-adjuvant therapy, and female patients with gastric adenocarcinoma had inferior relative survival. Further consideration and exploration of sex differences in surgical treatment and outcomes are necessary to improve tailored treatment and outcomes.
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Affiliation(s)
- Marianne C. Kalff
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anna D. Wagner
- Department of Oncology, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Rob H. A. Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands ,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Valery E. P. P. Lemmens
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands ,Department of Public Health, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Hanneke W. M. van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Suzanne S. Gisbertz
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mark I. van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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26
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Xie FN, Chen J, Li ZY, Bai B, Song D, Xu S, Song XT, Ji G. Impact of Laparoscopic Converted to Open Gastrectomy on Short- and Long-Term Outcomes of Patients with Locally Advanced Gastric Cancer: A Propensity Score-Matched Analysis. J Gastrointest Surg 2021; 25:2484-2494. [PMID: 33821415 DOI: 10.1007/s11605-021-04975-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/03/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND It remains unclear whether laparoscopic conversation to open gastrectomy causes higher morbidity and has an adverse effect on the long-term survival outcomes of patients with gastric cancer. This study was designed to evaluate the impact of the conversion on short and long-term outcomes of patients with locally advanced gastric cancer (AGC). METHODS We retrospectively investigated 871 patients who initially underwent laparoscopic gastrectomy (LG) for pathologically confirmed diagnosis of AGC between February 2009 and April 2018. The patients were grouped as the conversion (CONV) group and completed laparoscopic (LAP) group. The 1:2 propensity score matching was performed to reduce the effect of bias due to the imbalanced baseline features between the two groups. Multivariate analyses were performed to identify risk factors for conversion and poor survival. RESULTS After propensity-score matching, 168 patients (56 in the CONV group and 112 in the LAP group) were studied. The CONV group was associated with significantly longer operation time (252.4 vs. 216.7 min, P < 0.001) and greater estimated blood loss (234.8 vs. 171.2 ml, P < 0.001) as compared with the LAP group. The time to first flatus (3.8 vs. 3.3 days, P = 0.043), time to start a liquid diet (4.1 vs. 3.5 days, P = 0.021), and postoperative hospital stay (8.7 vs. 7.6 days, P = 0.020) were significantly longer in the CONV group than that in the LAP group. The overall complication rate did not differ significantly between the CONV group and the LAP group (16.1% vs. 12.5%, P = 0.692). Both 5-year overall survival (OS) and 5-year disease-free survival (DFS) did not differ significantly between the CONV group and the LAP group (P = 0.805, P = 0.945, respectively). Multivariate analysis showed that lymphovascular invasion and stage III were independent prognostic factors for poor OS and DFS, whereas conversion was not. CONCLUSIONS The conversion from laparoscopic to open gastrectomy had no negative impact on morbidity and long-term survival outcomes for patients with locally AGC.
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Affiliation(s)
- Feng-Ni Xie
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi'an, China
| | - Jie Chen
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi'an, China
| | - Zheng-Yan Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi'an, China
| | - Bin Bai
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi'an, China
| | - Dan Song
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi'an, China
| | - Shuai Xu
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi'an, China
| | - Xiao-Tian Song
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi'an, China
| | - Gang Ji
- Department of Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No. 127 Changle West Road, 710032, Xi'an, China.
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Muneoka Y, Ohashi M, Kurihara N, Fujisaki J, Makuuchi R, Ida S, Kumagai K, Sano T, Nunobe S. Short- and long-term oncological outcomes of totally laparoscopic gastrectomy versus laparoscopy-assisted gastrectomy for clinical stage I gastric cancer. Gastric Cancer 2021; 24:1140-1149. [PMID: 33723719 DOI: 10.1007/s10120-021-01181-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Totally laparoscopic gastrectomy (TLG), which involves a complete intracorporeal gastric transection and the creation of an anastomosis, has been gradually adopted. However, a potential limitation of intracorporeal transection is the lack of tactile feedback, and whether this limitation influences oncological outcomes is unclear. The aim of this study is to evaluate the short- and long-term oncological safety of TLG using endoscopy-guided intracorporeal gastric transection for clinical stage (cStage) I gastric cancer. METHODS A total of 1875 consecutive patients who underwent laparoscopic gastrectomy for cStage I gastric cancer between January 2007 and March 2015 were enrolled in this study. Marking clips were preoperatively placed and a transection line was determined by perceiving it tactually in laparoscopy-assisted gastrectomy (LAG) or endoscopically in TLG. After propensity score matching, 1366 patients (683 each for LAG and TLG groups) were selected to primarily test the non-inferiority of TLG to that of LAG for relapse-free survival (RFS). RESULTS In the propensity-matched population, the 5-year RFS rates of the LAG and TLG groups were 94.3% (95% confidence interval (CI) 92.2-95.8%), and 95.6% (95% CI 93.8-96.9%), respectively. The hazard ratio (TLG/LAG) was 0.77 (95% CI 0.48-1.24, P for non-inferiority < 0.01). There were no significant differences in the recurrence profiles. The incidence of the remnant of marking clips or tumor tissue did not differ (LAG: 1.0% vs. TLG: 1.9%, P = 0.177). CONCLUSIONS TLG using preoperative markings and intraoperative endoscopic guidance provides cStage I gastric cancer patients with comparable oncological outcomes to the conventional method.
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Affiliation(s)
- Yusuke Muneoka
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Nozomi Kurihara
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Prognostic impact of a microscopic positive margin in patients undergoing gastrectomy for gastric cancer: a propensity score‑matched analysis of a multi‑institutional dataset. Surg Today 2021; 52:559-566. [PMID: 34436686 DOI: 10.1007/s00595-021-02365-8] [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: 03/15/2021] [Accepted: 07/03/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE We analyzed the effect of a microscopic positive margin on survival outcomes after gastrectomy for gastric cancer METHODS: We analyzed a multi-institutional dataset to study patients who underwent gastrectomy with curative intent between 2010 and 2014. We used propensity score matching to strictly balance the patients' oncological features, backgrounds, and postoperative treatment to compare the survival outcomes of those with microscopic positive margins and those with negative margins. RESULTS Among 3029 patients, 32 (1.1%) had positive margins. After matching, we enrolled 128 patients in this retrospective analysis: 32 with a positive margin and 96 with a negative margin. The recurrence-free survival of the positive-margin group was significantly shorter than that of the negative-margin group (hazard ratio [HR], 1.62, 95% confidence interval, 1.00-2.63, p = 0.0485). Consistent results were observed for patients with pStages I-III disease (HR, 1.65, p = 0.0835), whereas the survival curves overlapped in those with pStage IV disease (HR, 1.29, p = 0.5934). The prevalence of overall recurrence in the positive-margin group was higher than that in the negative-margin group (75% vs 58%, p = 0.0917). This trend was consistent with locoregional recurrence (9% vs 3%) and distant recurrence (69% vs 55%). CONCLUSIONS The survival of patients after curative gastrectomy for gastric cancer was worse in those with microscopic positive margins than in those with negative margins.
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Lin JX, Xu YC, Lin W, Xue FQ, Ye JX, Zang WD, Cai LS, You J, Xu JH, Cai JC, Tang YH, Xie JW, Li P, Zheng CH, Huang CM. Effectiveness and Safety of Apatinib Plus Chemotherapy as Neoadjuvant Treatment for Locally Advanced Gastric Cancer: A Nonrandomized Controlled Trial. JAMA Netw Open 2021; 4:e2116240. [PMID: 34241629 PMCID: PMC8271357 DOI: 10.1001/jamanetworkopen.2021.16240] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/03/2021] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Apatinib is a novel treatment option for chemotherapy-refractory advanced gastric cancer (GC), but it has not been evaluated in patients with locally advanced GC. OBJECTIVE To investigate the effectiveness and safety of apatinib combined with S-1 plus oxaliplatin (SOX) as a neoadjuvant treatment for locally advanced GC. DESIGN, SETTING, AND PARTICIPANTS This multicenter, prospective, single-group, open-label, phase 2 nonrandomized controlled trial was conducted in 10 centers in southern China. Patients with M0 and either clinical T2 to T4 or N+ disease were enrolled between July 1, 2017, and June 30, 2019. Statistical analysis was performed from December 1, 2019, to January 31, 2020. INTERVENTIONS Eligible patients received apatinib (500 mg orally once daily on days 1 to 21 and discontinued in the last cycle) plus SOX (S-1: 40-60 mg orally twice daily on days 1 to 14; oxaliplatin: 130 mg/m2 intravenously on day 1) every 3 weeks for 2 to 5 cycles. A D2 gastrectomy was performed 2 to 4 weeks after the last cycle. MAIN OUTCOMES AND MEASURES The primary end point was R0 resection rate. Secondary end points were the response rate, toxic effects, and surgical outcome. RESULTS A total of 48 patients (mean [SD] age, 63.2 [8.2] years; 37 men [77.1%]) were enrolled in this study. Forty patients underwent surgery (38 had gastrectomy, and 2 had exploratory laparotomy), with an R0 resection rate of 75.0% (95% CI, 60.4%-86.4%). The radiologic response rate was 75.0%, and T downstaging was observed in 16 of 44 patients (36.4%). The pathological response rate was 54.2% (95% CI, 39.2%-68.6%); moreover, this rate was significantly higher in patients who achieved a radiologic response compared with those who did not (12 [80.0%] vs 1 [20.0%]; P = .03) and in those who had an Eastern Cooperative Oncology Group Performance Status score of 0 (20 [76.9%] vs 10 [45.5%]; P = .03) or had tumors located in the upper one-third of the stomach (16 [61.5%] vs 7 [31.8%]; P = .04). Patients who achieved a pathological response (vs those who did not) had significantly less blood loss (median [range]: 60 [10-200] mL vs 80 [20-300] mL; P = .04) and significantly more lymph nodes harvested (median [range]: 40 [24-67] vs 32 [19-51]; P = .04) during surgery. Postoperative complications were observed in 7 of 38 patients (18.4%). Grade 3 toxic effects occurred in 16 of 48 patients (33.3%), and no grade 4 toxic effects or preoperative deaths were observed. CONCLUSIONS AND RELEVANCE This nonrandomized controlled trial found that apatinib combined with SOX was effective and had an acceptable safety profile as a neoadjuvant treatment for locally advanced GC. A large-scale randomized clinical trial may be needed to confirm the findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03192735.
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Affiliation(s)
- Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yan-Chang Xu
- Department of Gastrointestinal Surgery, The First Hospital of Putian, Putian, Fujian Province, China
| | - Wei Lin
- Department of Gastrointestinal Surgery and Gastrointestinal Surgery Research Institute, The Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Fang-Qin Xue
- Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Fuzhou, Fujian Province, China
| | - Jian-Xin Ye
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Wei-Dong Zang
- Department of Gastrointestinal Surgery, Fujian Provincial Cancer Hospital, Fuzhou, Fujian Province, China
| | - Li-Sheng Cai
- Department of General Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, China
| | - Jun You
- Department of Gastrointestinal Oncology Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, China
| | - Jian-Hua Xu
- Department of Oncology Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Jian-Chun Cai
- Department of Gastrointestinal Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, China
| | - Yi-Hui Tang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
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30
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Juez LD, Barranquero AG, Priego P, Cuadrado M, Blázquez L, Sánchez-Picot S, Fernández-Cebrián JM, Galindo J. Influence of positive margins on tumour recurrence and overall survival after gastrectomy for gastric cancer. ANZ J Surg 2021; 91:E465-E473. [PMID: 34013576 DOI: 10.1111/ans.16937] [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: 12/20/2020] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Incidence of positive surgical margins after curative gastrectomy ranges from 1% to 20%. It has been suggested that positive surgical margin is an adverse prognosis factor, with a higher local recurrence and worse overall survival (OS). However, the management of these patients remains unclear. METHODS A total of 267 patients who underwent gastrectomy with curative intent between January 2010 and December 2018 in our centre were enrolled in this study. Post-operative histological analysis revealed positive resection margins in 18 patients (8%). Clinicopathological features and outcome of patients undergoing gastrectomy with negative and positive margins were compared. RESULTS Patients with positive margins were associated with higher American Joint Committee on Cancer (AJCC) stage, T stage, N stage, median number of positive nodes, diffuse Lauren type, whole stomach involved and poorly differentiated tumours. Local recurrence was described in 50% of cases with positive margins. The multivariate analysis demonstrated that the TNM stage was the only independent prognostic factor associated with recurrence. OS for positive margins at 1, 3 and 5 years was 75%, 57% and 26%, respectively. The median survival in patients with positive margins was 38.33 versus 81.17 months for R0 patients (p = 0.027). Multivariate analysis showed that age (hazard ratio [HR] 1.041, 95% confidence interval [CI] 1.02-1.07, sex (HR 2.00, 95% CI 1.22-3.30) and TNM stage (p < 0.001) were independent factors of OS. CONCLUSION Positive resection margin was an indication of advanced and more aggressive disease rather than an independent prognosis factor for OS or recurrence in gastric cancer.
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Affiliation(s)
- Luz Divina Juez
- Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Alberto G Barranquero
- Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Pablo Priego
- Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Marta Cuadrado
- Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Luis Blázquez
- Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Silvia Sánchez-Picot
- Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - José María Fernández-Cebrián
- Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - Julio Galindo
- Division of Esophagogastric and Bariatric Surgery, Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain
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31
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Aversa JG, Diggs LP, Hagerty BL, Dominguez DA, Ituarte PHG, Hernandez JM, Davis JL, Blakely AM. Multivisceral Resection for Locally Advanced Gastric Cancer. J Gastrointest Surg 2021; 25:609-622. [PMID: 32705611 PMCID: PMC9274296 DOI: 10.1007/s11605-020-04719-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/28/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Locally advanced gastric cancer (LAGC) presents a therapeutic dilemma, particularly as it often involves adjacent organs through desmoplasia or true pathologic invasion. To obtain a margin-negative resection, these tumors require en bloc gastrectomy with multivisceral resection (G+MVR), and contention remains regarding its safety and oncologic benefit. METHODS We used the National Cancer Database to retrospectively evaluate the short- and long-term outcomes of patients with LAGC treated in the USA between 2004 and 2016. Associations with margin status and perioperative outcomes were calculated using logistic regression. Survival was estimated using Cox proportional hazards regression and the Kaplan-Meier method. RESULTS Overall, 785 pathologic stage T4b (pT4b) patients diagnosed with LAGC underwent gastrectomy (n = 438) or G+MVR (n = 347). There was no association between G+MVR and short- or long-term mortality. Positive resection margins (HR 1.68, 95% CI 1.40-2.03), the presence of nodal disease (HRs 1.46-1.50), treatment at a high-volume center (HR 0.76, 95% CI 0.68-0.85), and the receipt of adjuvant chemotherapy (HR 0.64, 95% CI 0.51-0.80) were independently associated with overall survival. Diffuse-type histology was associated with higher rates of an R1 resection (OR 3.60, 95% CI 2.20-5.87). Perioperative and long-term survival metrics were comparable between patients with pT4a and pT4b LAGC who underwent a margin-negative G+MVR. Undergoing a margin-negative G+MVR imparted a 6-month survival benefit over non-curative gastrectomy alone (p < 0.001). CONCLUSIONS Our study demonstrates the safety and long-term feasibility of G+MVR for disease clearance in well-selected patients with LAGC, and we advocate for their referral to high-volume centers for optimal care.
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Affiliation(s)
- John G Aversa
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laurence P Diggs
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brendan L Hagerty
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dana A Dominguez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Jonathan M Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew M Blakely
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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32
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Hayami M, Ohashi M, Ishizuka N, Hiki N, Kumagai K, Ida S, Sano T, Nunobe S. Oncological Impact of Gross Proximal Margin Length in Distal Gastrectomy for Gastric Cancer: Is the Japanese Recommendation Valid? ANNALS OF SURGERY OPEN 2021; 2:e036. [PMID: 37638234 PMCID: PMC10455052 DOI: 10.1097/as9.0000000000000036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Abstract
Objective To identify an oncological impact of gross proximal margin (PM) length in distal gastrectomy for cancer. Summary background data In Japan, to obtain pathologically negative PMs in gastrectomy for cancer, the Gastric Cancer Treatment Guidelines (GCTGs) recommend maintaining the PM length to at least 2 cm for cT1, 3 cm for the expansive growth type (Exp), and 5 cm for the infiltrative growth type (Inf) of cT2-4. The GCTGs also recommend confirming pathologically negative PMs by intraoperative frozen section analyses when the gross PMs are shorter than the recommendations. However, whether they are valid is unknown. Methods Patients who intended to undergo curative distal gastrectomy were included. They were divided into groups A (adherence to the GCTGs) and NA (nonadherence) according to the PM length. The incidence of pathologically positive PMs and survival outcomes were compared between the groups. Propensity scores (PSs) were used in comparisons of survival outcomes to eliminate potential confounders. Results A total of 1036 patients were eligible. Pathologically positive PMs were identified in group NA with cT1 and Inf, and the incidence was 1.6% and 3.1%, respectively. Adjusted analysis using the PSs showed comparable survival outcomes between the groups. However, the hazard ratios according to the PSs presented a possible survival advantage in maintaining the recommended gross PM lengths except for cT1 and Exp located in the lower stomach. Conclusion Surgeons should maintain the gross PM lengths recommended in the GCTGs to both obtain pathologically negative PMs and avoid survival disadvantages.
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Affiliation(s)
- Masaru Hayami
- From the Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Manabu Ohashi
- From the Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Ishizuka
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koshi Kumagai
- From the Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Ida
- From the Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- From the Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Souya Nunobe
- From the Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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33
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Jiang Z, Liu C, Cai Z, Shen C, Yin Y, Yin X, Zhao Z, Mu M, Yin Y, Zhang B. Impact of Surgical Margin Status on Survival in Gastric Cancer: A Systematic Review and Meta-Analysis. Cancer Control 2021; 28:10732748211043665. [PMID: 34569315 PMCID: PMC8482729 DOI: 10.1177/10732748211043665] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is inconclusive whether R1 margin determined by postoperative pathological examination indicates worse long-term survival in gastric cancer (GC) patients after curative intent resection (CIR). Hence, we aimed to systematically pool the conflicting evidence to fill this gap. METHODS The present study was performed according to the published protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Published studies examining the impact of microscopic margin status on overall survival (OS) and 5-year OS rate in GC were systematically searched in PubMed, Embase, and Cochrane Library databases. RevMan 5.3 was used to conduct statistical analysis, and the Grading of Recommendations, Assessment, Development, and Evaluations approach was used to assess the certainty of evidence for each outcome. RESULTS Twenty-three retrospective cohort studies including 19 992 patients were analyzed. The pooled hazard ratio for OS of 14 studies was 2.06 (95% confidence interval [CI]: 1.61-2.65, low certainty), indicating that R1 margin predicted inferior OS. Subgroup and sensitivity analyses upheld the statistical stability of this finding. The pooled odds ratio (OR) of 14 studies was .21 (95% CI: .17-.26, moderate certainty), demonstrating that the presence of R1 margins was associated with a poorer 5-year OS rate. Sensitivity analyses and most of the subgroup analyses confirmed this finding, except the "esophagogastric junction (EGJ) cancers" subgroup, which included two studies with a pooled OR of .41 (95% CI: .10-1.61). CONCLUSION R1 margin detected by pathological examination might exhibit a high correlation with poorer OS and 5-year OS rate in GC (except EGJ cancers) patients who underwent CIR. To figure out the effect of R1 margin on survival of different stages and histological types need prospective studies with large sample sizes and standardized methods. What is the best treatment for R1 margin patients also need more in-depth and special research.
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Affiliation(s)
- Zhiyuan Jiang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyu Liu
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
- Ministry of Education, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, China
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaonan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Mingchun Mu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqiong Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Jiao X, Wang Y, Wang F, Wang X. Recurrence pattern and its predictors for advanced gastric cancer after total gastrectomy. Medicine (Baltimore) 2020; 99:e23795. [PMID: 33371151 PMCID: PMC7748337 DOI: 10.1097/md.0000000000023795] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/15/2020] [Indexed: 12/24/2022] Open
Abstract
This study aimed to investigate the recurrence patterns of advanced gastric cancer (AGC) after curative total gastrectomy and further explore predictors for each pattern of recurrence.Data of 299 AGC patients between 2010 and 2014 were retrospectively analyzed to investigate the clinicopathologic factors affecting the recurrence pattern of AGC patients underwent curative total gastrectomy.Sixty-eight (22.7%) AGC patients had recurrence after total gastrectomy. Distant metastasis (DM) was the most prevalent pattern with 29 (42.6%) cases, followed by peritoneal recurrence (PR) with 25 (36.8%) patients, and locoregional recurrence (LR) occurred in 23 (33.8%) patients. The recurrence rates within 2 and 5 years were 77.9% and 97.1%. Extent of lymphadenectomy (P < .001, χ2 = 17.366), depth of tumor invasion (P < .001, χ2 = 21.638), lymph node metastasis (P = .046, χ2 = 9.707), and number of negative lymph nodes (P = .017, χ2 = 2.406) were associated with tumor recurrence by univariate analysis. Multivariate analyses revealed that the extent of lymphadenectomy (P = .034, 95% CI: 1.074-6.414) and T4b status (P = .015, 95% CI: 0.108-0.785) were independent predictors for LR; histological type (P = .041, 95% CI: 0.016-0.920) and T4b status (P = .007, 95% CI: 0.102-0.690) for PR; and pN status (P = .032) for DM.In AGC patients following total gastrectomy, recurrent predictors various among locoregional, peritoneal, and distant recurrence. Recurrent predictors of tumor invasion, lymph node metastasis, and histological type could guide follow-up and risk-oriented adjuvant treatment, extended lymphadenectomy was considered to reduce LR of AGC patients after curative total gastrectomy.
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Affiliation(s)
| | - Yu Wang
- Department of Information Network Management, Weifang People's Hospital; Weifang, Shandong, P.R. China
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Jiang Z, Cai Z, Yin Y, Shen C, Huang J, Yin Y, Zhang B. Impact of surgical margin status on the survival outcome after surgical resection of gastric cancer: a protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e040282. [PMID: 33148760 PMCID: PMC7643516 DOI: 10.1136/bmjopen-2020-040282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Generally, complete resection with cancer cell negative (R0) margin has been accepted as the most effective treatment of gastric cancer and positive resection (R1/R2) margin has been associated with decreased survival to varied degrees. However, the independent impact of microscopical positive (R1) margin on long-term survival may be confounded. No meta-analysis has worked at the association between R1 margin and outcomes of gastric cancer and the available evidence are scant. Therefore, we plan to conduct a systematic review and meta-analysis to quantitatively explore the role of R1 margin on gastric (including oesophagogastric junction) cancer survival after curative intent resection. METHODS AND ANALYSIS The protocol was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A systematic search of PubMed, Embase and the Cochrane Central Register of Controlled Trials databases will be performed from their inceptions to 30 April 2020 to identify randomised controlled trials (RCTs), cohort studies and case-control studies focusing on the impact of R1 margin on survival of gastric cancer after curative intent resection. The primary outcome will be the overall survival (OS) and disease-free survival (DFS) and the secondary outcomes will be 5-year OS rate and 5-year DFS rate. The Cochrane tool for bias assessment in randomised trials and Risk Of Bias In Non-randomised Studies-I for the assessment of bias in non-randomised studies (NRS) will be used. Statistical heterogeneity will be assessed by visual inspection of forest plots and measured using the I2 statistics. A fixed-effect model will be used when heterogeneity is low, otherwise, a random-effect model will be chosen. Publication bias will be assessed by funnel plots, subgroup analysis and sensitivity analysis will be performed in the right context. For each outcome, we will perform data synthesis separately for RCTs and NRS using Rev Man V.5.3 software and compile 'summary of findings' tables separately for RCTs and NRS using GRADEpro software. Grading of Recommendations, Assessment, Development and Evaluations considerations will also be used to make an overall assessment of the quality of evidence. ETHICS AND DISSEMINATION There is no requirement for ethics approval because no patient data will be collected at an individual level in this systematic review and meta-analysis.The results of this systematic review will be published in a peer-reviewed journal and presented at relevant conferences, any deviations from the protocol will be clearly documented and explained in its final report. PROSPERO REGISTRATION NUMBER CRD42020165110.
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Affiliation(s)
- Zhiyuan Jiang
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Zhaolun Cai
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Chaoyong Shen
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Jinming Huang
- Department of Rehabilitation Medicine, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Yiqiong Yin
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Huguet F, Rivin Del Campo E, Labidi M, Ménard J, Sergent G, Durand B, Quéro L. Cancers gastriques et pancréatiques : la (chimio)radiothérapie néoadjuvante remplacera-t-elle la chimioradiothérapie adjuvante ? Cancer Radiother 2020; 24:493-500. [DOI: 10.1016/j.canrad.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/24/2022]
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What are the important prognostic factors in gastric cancer with positive duodenal margins? A multi-institutional analysis. Surg Today 2020; 51:561-567. [PMID: 32797287 DOI: 10.1007/s00595-020-02110-7] [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: 05/19/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Positive margins are reported in from 4.8 to 9.5% of all gastric cancer surgeries and they have a negative impact on the overall survival. Few cases with positive duodenal margins have been included in previous studies regarding the prognosis. METHODS This multi-institutional retrospective study included 115 gastric cancer patients with positive duodenal margins following gastrectomy between January 2002 and December 2017. The association between clinicopathological factors and the overall survival was evaluated by univariate and multivariate analyses. RESULTS The three-year overall survival was 22% and the median survival was 13 months. A multivariate analysis found that distant metastasis, no postoperative chemotherapy, and non-Type 4 disease were significantly associated with a poor survival. Patients without distant metastasis who received postoperative chemotherapy had a 3-year overall survival of 56% and a median survival of 44 months. CONCLUSION The patients who underwent post-operative chemotherapy showed a significantly better OS compared with those who did not undergo post-operative chemotherapy, regardless of the existence of distant metastasis. Postoperative chemotherapy may, therefore, improve the prognosis of surgically treated gastric cancer patients with positive duodenal margins.
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Yamazaki Y, Kanaji S, Takiguchi G, Urakawa N, Hasegawa H, Yamamoto M, Matsuda Y, Yamashita K, Matsuda T, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y. Preoperative endoscopic tattooing using India ink to determine the resection margins during totally laparoscopic distal gastrectomy for gastric cancer. Surg Today 2020; 51:111-117. [PMID: 32594250 DOI: 10.1007/s00595-020-02057-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was conducted to determine whether establishing the proximal resection line using India ink tattooing can ensure safe resection margins during totally laparoscopic distal gastrectomy. METHODS This retrospective study included 81 patients who underwent totally laparoscopic distal gastrectomy for gastric cancer on the lower two-thirds of the stomach. The proximal resection margins were analyzed with respect to the macroscopic type and clinical T stage, and the intraoperative appearance of the stain on the serosa was classified by reviewing surgical videos. RESULTS R0 resection was performed in all patients. The rates of the intended margins were 89.2% in patients without a frozen section diagnosis and 84.2% in patients with differentiated type lesions who underwent a frozen section diagnosis; however, most patients with undifferentiated advanced lesions failed to achieve the intended resection margins. Intraoperative appearance revealed that 85.2% of patients had localized type stains, whereas 11.1% had widespread-type stains. CONCLUSIONS Our procedure to determine the proximal resection line in totally laparoscopic distal gastrectomy is oncologically safe. However, careful observation of the resected specimen and a frozen section analysis should be performed for undifferentiated advanced lesions.
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Affiliation(s)
- Yuta Yamazaki
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan.
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Gosuke Takiguchi
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Naoki Urakawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Masashi Yamamoto
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Yoshiko Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Takeru Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Satoshi Suzuki
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, KobeHyogo, 650-0017, Japan
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Risk factors analysis and stratification for microscopically positive resection margin in gastric cancer patients. BMC Surg 2020; 20:95. [PMID: 32380979 PMCID: PMC7204060 DOI: 10.1186/s12893-020-00744-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background Cancer cells are often found postoperatively at surgical resection margins (RM) in patients with gastric cancer because of submucosal infiltration or hesitation to secure adequate RM. This study was designed to evaluate risk factors for microscopic positive RM and to clarify which patients should undergo intraoperative frozen section diagnosis (IFSD). Methods Patients who underwent R0/1 gastrectomy for gastric adenocarcinoma between 2000 and 2018 in a single cancer center in Japan were studied. We divided the patients into a positive RM group and negative RM group according to the results of definitive histopathological examinations. We performed multivariate analysis to analyze risk factors for positive RM by and used the identified risk factors to risk stratify the patients. Results A total of 2757 patients were studied, including 49 (1.8%) in the positive RM group. The risk factors significantly associated with positive RM were remnant gastric cancer (odds ratio [OR] 4.7), esophageal invasion (OR 6.3), tumor size ≥80 mm (OR 3.9), and a histopathological diagnosis of undifferentiated type (OR 3.6), macroscopic type 4 (OR 3.7), or pT4 disease (OR 4.6). On risk stratification analysis, the incidence of positive RM was 0.1% without any risk factors, increasing to 0.4% with one risk factor, 3.1% with two risk factors, 5.3% with three risk factors, 21.3% with four risk factors, and 85.7% with five risk factors. Conclusions The risk of macroscopically positive RM increased in patients who have risk factors. IFSD should be performed in patients who have four or more risk factors.
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Fiorillo C, Laterza V, Quero G, Menghi R, Cina C, Rosa F, Tortorelli AP, Boskoski I, Alfieri S. From biology to surgery: One step beyond histology for tailored surgical treatments of gastric cancer. Surg Oncol 2020; 34:86-95. [PMID: 32891359 DOI: 10.1016/j.suronc.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/06/2020] [Accepted: 04/02/2020] [Indexed: 02/07/2023]
Abstract
Gastric cancer is the third most common cause of cancer related death. Although its incidence is globally declined, prognosis remains dismal in the Western hemisphere, while better outcomes are evidenced in Asian countries. Endoscopic or surgical resection with or without lymphadenectomy represents the only chance of cure, with limited improvements of the prognosis in case of associated chemotherapy in a neoadjuvant or adjuvant setting. This could be mainly attributed to the uniform fashion of treatment of gastric cancer, mainly based on the histological features, that usually do not reflect the complexity of the disease. With the recent introduction of genomic technologies and new generation sequencing techniques, gastric cancer biology is now investigated in great details. This has brought to the publication of three main molecular classifications, based on the underlying molecular biology of gastric cancer. Although only few clinical reports are currently present in literature, the identification of gastric cancer molecular subtypes has shown interesting findings that may pave the way to a tailored clinical and surgical management. The aim of this review is, thus, to give a comprehensive overview of the current molecular classifications as compared to the available histopathological ones, also focusing on the potential clinical and surgical benefits and the future perspectives for a more personalized treatment of gastric cancer.
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Affiliation(s)
- Claudio Fiorillo
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Vito Laterza
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore di Roma, Italy.
| | - Roberta Menghi
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Caterina Cina
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Fausto Rosa
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonio Pio Tortorelli
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Ivo Boskoski
- Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Sergio Alfieri
- Digestive Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore di Roma, Italy
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Zhu X, Bledsoe JR. Frozen section diagnosis of gastrointestinal poorly cohesive and signet-ring cell adenocarcinoma: useful morphologic features to avoid misdiagnosis. Virchows Arch 2020; 477:497-506. [PMID: 32215719 DOI: 10.1007/s00428-020-02799-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/25/2020] [Accepted: 03/17/2020] [Indexed: 01/01/2023]
Abstract
Frozen section examination of adenocarcinomas with poorly cohesive growth, including signet-ring cell carcinoma, is challenging. Due to their diffuse morphology, the tumor cells may be indistinct and difficult to distinguish from inflammatory or stromal cells. Misdiagnosis may result in significant adverse clinical outcome. We performed a detailed retrospective analysis of such cases to identify features that are helpful to avoid misdiagnosis at the time of frozen section. We reviewed the original frozen section slides from 50 patients with poorly cohesive carcinoma (PCC) including 32 with positive and 18 with negative frozen section slides. Tumor cells and inflammatory cells were evaluated for 17 distinct cytologic and nine architectural or stromal features. Features with 100% specificity and positive predictive value (PPV) for carcinoma included the presence of cells with a single distinct cytoplasmic mucin vacuole, focal gland formation, and perineural invasion. Features with high specificity, sensitivity, PPV, and negative predictive value (NPV) (all > 75%) included irregular nuclear contours, large nuclear size with many nuclei > 4× the size of a small lymphocyte, and disruption/obliteration of normal structures. Other features with high specificity and PPV (both ≥ 85%) but relatively low sensitivity and NPV-included crescent-shaped/indented nuclei, prominent nucleoli, anisonucleosis (> 4:1 difference in nuclear size), multinucleation, and the presence of mitotic figures. We characterized useful histologic features of poorly cohesive carcinoma that may serve to distinguish carcinoma cells from benign inflammatory or stroma cells. Knowledge of the relatively specific features in particular may help surgical pathologists avoid false-negative interpretation resulting in significant clinical morbidity.
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Affiliation(s)
- Xiaoqin Zhu
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts, One Innovation Drive, Biotech 3, Worcester, MA, 01605, USA
| | - Jacob R Bledsoe
- Department of Pathology, UMass Memorial Medical Center, University of Massachusetts, One Innovation Drive, Biotech 3, Worcester, MA, 01605, USA.
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Zhao B, Lu H, Bao S, Luo R, Mei D, Xu H, Huang B. Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer. J Clin Pathol 2019; 73:470-475. [PMID: 31879270 DOI: 10.1136/jclinpath-2019-206305] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/26/2022]
Abstract
AIM The aim of this study was to evaluate the risk factors for proximal resection margin involvement and its impact on survival outcome in patients with proximal gastric cancer. METHODS A total of 488 patients who underwent potentially curative resection for proximal gastric cancer were retrospectively reviewed. Clinicopathological characteristics and survival differences between patients with positive and negative resection margins were compared and prognostic factors were determined by Cox multivariate analysis. RESULTS In this study, 7.6% (37/488) of patients with proximal gastric cancer had a positive proximal resection margin after postoperative histopathological examination. Positive resection margins were significantly associated with advanced tumour stage and more aggressive biological features including larger tumour size, serosal invasion and lymphovascular invasion. Serosal invasion (OR 4.543, 95% CI 2.201 to 9.380, p<0.001) and lymphovascular invasion (OR 2.279, 95% CI 1.129 to 4.600, p<0.05) were independent risk factors for positive proximal resection margins. In terms of survival outcome, positive resection margins had an adverse impact on the prognosis of patients with proximal gastric cancer (median DFS: 20.7 vs 30.2 months, p<0.001). The multivariate analysis indicated that positive resection margins (HR 1.494, 95% CI 1.042 to 2.142, p=0.029), T stage (T3-T4, HR 2.264, 95% CI 1.484 to 3.454, p<0.001) and N stage (N1-N2 stage, HR 1.696, 95% CI 1.279 to 2.248, p<0.001; N3 stage, HR 2.691, 95% CI 1.967 to 3.681, p<0.001) were independent prognostic factors for patients with proximal gastric cancer. CONCLUSION Proximal resection margin involvement was an indicator of more aggressive tumours and an independent prognostic factor for patients with proximal gastric cancer. Aggressive efforts should be made to achieve a negative resection margin if gastric cancer was deemed to be potentially resectable.
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Affiliation(s)
- Bochao Zhao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.,Department of General Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China
| | - Huiwen Lu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shiyang Bao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Rui Luo
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Di Mei
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Huimian Xu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Baojun Huang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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Andreollo NA, Drizlionoks E, Tercioti-Junior V, Coelho-Neto JDS, Ferrer JAP, Carvalheira JBC, Lopes LR. ADJUVANT CHEMORADIOTHERAPY AFTER SUBTOTAL OR TOTAL GASTRECTOMY AND D2 LIMPHADENECTOMY INCREASES SURVIVAL IN ADVANCED GASTRIC CANCER? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2019; 32:e1464. [PMID: 31859917 PMCID: PMC6918727 DOI: 10.1590/0102-672020190001e1464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The treatment of advanced gastric cancer with curative intent is essentially surgical and chemoradiotherapy is indicated as neo or adjuvant to control the disease and prolong survival. AIM To assess the survival of patients undergoing subtotal or total gastrectomy with D2 lymphadenectomy followed by adjuvant chemoradiotherapy. METHODS Were retrospectively analyzed 87 gastrectomized patients with advanced gastric adenocarcinoma, considered stages IB to IIIC and submitted to adjuvant chemoradiotherapy (protocol INT 0116). Tumors of the esophagogastric junction, with peritoneal implants, distant metastases, and those that had a compromised surgical margin or early death after surgery were excluded. They were separated according to the extention of the gastrectomy and analyzed for tumor site and histopathology, lymph node invasion, staging, morbidity and survival. RESULTS The total number of patients who successfully completed the adjuvant treatment was 45 (51.7%). Those who started treatment and discontinued due to toxicity, tumor-related worsening, or loss of follow-up were 10 (11.5%) and reported as incomplete adjuvant. The number of patients who refused or did not start adjuvant treatment was 33 (48.3%). Subtotal gastrectomy was indicated in 60 (68.9%) and total in 27 (31.1%) and this had a shorter survival. The mean resected lymph nodes was 30.8. Staging and number of lymph nodes affected were predictors of worse survival and the more advanced the tumor. Patients undergoing adjuvant therapy with complete chemoradiotherapy showed a longer survival when compared to those who did it incompletely or underwent exclusive surgery. On the other hand, comparing the T4b (IIIB + IIIC) staging patients who had complete adjuvance with those who underwent the exclusive operation or who did not complete the adjuvant, there was a significant difference in survival. CONCLUSION Adjuvant chemoradiotherapy presents survival gain for T4b patients undergoing surgical treatment with curative intent.
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Affiliation(s)
| | - Eric Drizlionoks
- Digestive Diseases Surgical Unit and Gastrocenter, Campinas, SP, Brazil
| | | | | | | | - José Barreto Campello Carvalheira
- Division of Oncology, Department of Surgery and Internal Medicine, School of Medical Sciences, State University of Campinas - UNICAMP, Campinas, SP, Brazil
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Tu RH, Lin JX, Wang W, Li P, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Zheng CH, Zhou ZW, Huang CM. Pathological features and survival analysis of gastric cancer patients with positive surgical margins: A large multicenter cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:2457-2464. [PMID: 31362841 DOI: 10.1016/j.ejso.2019.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/26/2019] [Accepted: 06/18/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To investigate the factors related to positive surgical margins of gastric cancer and their correlation with the prognosis of these patients. METHODS The clinicopathological data of gastric cancer patients undergoing gastrectomy were collected, and the relationship between surgical margins status and patient outcome was analyzed. RESULTS A total of 10080 patients were included, among which 311 (3.1%) had positive surgical margins. pT3-4, pN+ and M1 were independent risk factors for positive margins, and a tumor in the middle of the stomach was a protective factor (p < 0.05). The 5-year overall survival (OS) rates of the patients with positive and negative margins after propensity score matching (PSM) were 24.2% and 36.8%, respectively (p < 0.001). For M0 patients, the 5-year OS of the margin-positive patients was lower than that of the margin-negative patients, and was higher than that of patients with M1. For the M1 patients, no statistically significant difference in 5-year OS was noted between patients with positive and negative margins. Age, positive margins, tumor location, pN+, and M1 were independent prognostic factors for OS in patients undergoing gastrectomy, and pN2-3 and M1 stages were independent prognostic factors for patients with positive surgical margins. Postoperative chemotherapy could improve the 5-year OS in pN2-3 and M1 margin-positive patients (p < 0.05). CONCLUSION The prognosis of M0 gastric cancer patients with positive surgical margins is poor, and it is recommended that these patients should undergo routine intraoperative frozen-section pathological examination to reduce the risk of positive surgical margins.
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Affiliation(s)
- Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wei Wang
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Caner Center, Guangzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Zhi-Wei Zhou
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Caner Center, Guangzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Clinical usefulness of extending the proximal margin in total gastrectomies for gastric adenocarcinoma. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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46
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Nakanishi K, Morita S, Taniguchi H, Otsuki S, Fukagawa T, Katai H. Diagnostic Accuracy and Usefulness of Intraoperative Margin Assessment by Frozen Section in Gastric Cancer. Ann Surg Oncol 2019; 26:1787-1794. [DOI: 10.1245/s10434-019-07302-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Indexed: 12/16/2022]
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47
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Pereira AL, Magalhães L, Moreira FC, Reis-das-Mercês L, Vidal AF, Ribeiro-Dos-Santos AM, Demachki S, Anaissi AKM, Burbano RMR, Albuquerque P, Dos Santos SEB, de Assumpção PP, Ribeiro-Dos-Santos ÂKC. Epigenetic Field Cancerization in Gastric Cancer: microRNAs as Promising Biomarkers. J Cancer 2019; 10:1560-1569. [PMID: 31031866 PMCID: PMC6485221 DOI: 10.7150/jca.27457] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022] Open
Abstract
Background: The biological role of microRNAs (miRNAs) in field cancerization is unknown. To investigate the involvement of miRNAs in gastric field cancerization, we evaluated the expression profile of ten miRNAs and their diagnostic value. Methods: We used three groups of FFPE gastric samples: non-cancer (NC), cancer adjacent (ADJ) and gastric cancer (GC). The expression profiles of hsa-miR-10a, -miR-21, -miR-29c, -miR-135b, -miR-148a, -miR-150, -miR-204, -miR-215, -miR-483 and -miR-664a were investigated using qRT-PCR. The results obtained by qRT-PCR were validated in Small RNA-Seq data from the TCGA database. The search for target genes of the studied miRNAs was performed in the miRTarBase public database and miRTargetLink tool, using experimentally validated interactions. In addition, we also performed the functional analysis of these genes using enrichment in KEGG pathways. The potential as biomarker was evaluated using a receiver operating characteristic (ROC) curve and the derived area under the curve (AUC>0.85) analysis. Results: The miRNAs hsa-miR-10a, -miR-21, -miR-135b, hsa-miR-148a, -miR-150, -miR-215, -miR-204, -miR-483 and -miR-664a were up-regulated in ADJ and GC compared to NC (P<0.03); and hsa-miR-21 and -miR-135b were up-regulated in GC compared to ADJ (P<0.01). Hsa-miR-148a, -miR-150, -miR-215, -miR-483 and -miR-664a were not differentially expressed between GC and ADJ, suggesting that both share similar changes (P>0.1). The TS-miR hsa-miR-29c was up-regulated in ADJ compared to NC and GC (P<0.01); we did not observe a significant difference in the expression of this miRNA between NC and GC. This feature may be an antitumor mechanism used by cancer-adjacent tissue because this miRNA regulates the BCL-2, CDC42 and DMNT3A oncogenes. The expression level of hsa-miR-204 was associated with Helicobacter pylori infection status (P<0.05). Functional analysis using the genes regulated by the studied miRNAs showed that they are involved in biological pathways and cellular processes that are critical for the establishment of H. pylori infection and for the onset, development and progression of GC. hsa-miR-10a, -miR-21, -miR-135b, -miR-148a, -miR-150, -miR-215, -miR-483 and -miR-664a were able to discriminate NC from other tissues with great accuracy (AUC>0.85). Conclusion: The studied miRNAs are closely related to field cancerization, regulate genes important for gastric carcinogenesis and can be potentially useful as biomarkers in GC.
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Affiliation(s)
- Adenilson Leão Pereira
- Laboratory of Human and Medical Genetics, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa Avenue, 66075-110, Belém, Pará, Brazil
| | - Leandro Magalhães
- Laboratory of Human and Medical Genetics, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa Avenue, 66075-110, Belém, Pará, Brazil
| | - Fabiano Cordeiro Moreira
- Research Center on Oncology, Institute of Health Sciences, Federal University of Pará, Mundurucus Street, 66073-000, Belém, Pará, Brazil
| | - Laís Reis-das-Mercês
- Laboratory of Human and Medical Genetics, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa Avenue, 66075-110, Belém, Pará, Brazil
| | - Amanda Ferreira Vidal
- Laboratory of Human and Medical Genetics, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa Avenue, 66075-110, Belém, Pará, Brazil
| | - André Maurício Ribeiro-Dos-Santos
- Laboratory of Human and Medical Genetics, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa Avenue, 66075-110, Belém, Pará, Brazil
| | - Samia Demachki
- Research Center on Oncology, Institute of Health Sciences, Federal University of Pará, Mundurucus Street, 66073-000, Belém, Pará, Brazil
| | - Ana Karyssa Mendes Anaissi
- Research Center on Oncology, Institute of Health Sciences, Federal University of Pará, Mundurucus Street, 66073-000, Belém, Pará, Brazil
| | - Rommel Mario Rodríguez Burbano
- Research Center on Oncology, Institute of Health Sciences, Federal University of Pará, Mundurucus Street, 66073-000, Belém, Pará, Brazil
| | - Paulo Albuquerque
- São Camilo and São Luís Hospital, Dr. Marcello Cândia Street, 68901-901, Macapá, Amapá, Brazil
| | - Sidney Emanuel Batista Dos Santos
- Laboratory of Human and Medical Genetics, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa Avenue, 66075-110, Belém, Pará, Brazil.,Research Center on Oncology, Institute of Health Sciences, Federal University of Pará, Mundurucus Street, 66073-000, Belém, Pará, Brazil
| | - Paulo Pimentel de Assumpção
- Research Center on Oncology, Institute of Health Sciences, Federal University of Pará, Mundurucus Street, 66073-000, Belém, Pará, Brazil
| | - Ândrea Kely Campos Ribeiro-Dos-Santos
- Laboratory of Human and Medical Genetics, Institute of Biological Sciences, Federal University of Pará, Augusto Corrêa Avenue, 66075-110, Belém, Pará, Brazil.,Research Center on Oncology, Institute of Health Sciences, Federal University of Pará, Mundurucus Street, 66073-000, Belém, Pará, Brazil
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48
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Sachs TE, Tseng JF. Frozen Sections in Gastric Cancer: How Negative Is the False-Negative? JAMA Surg 2019; 154:132-133. [PMID: 30422233 DOI: 10.1001/jamasurg.2018.3864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Teviah E Sachs
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jennifer F Tseng
- Department of Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
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49
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Celli R, Barbieri AL, Colunga M, Sinard J, Gibson JA. Optimal Intraoperative Assessment of Gastric Margins. Am J Clin Pathol 2018; 150:353-363. [PMID: 30020407 DOI: 10.1093/ajcp/aqy062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Intraoperative pathology consultation (IOC) to assess margins is frequently requested during surgery of the stomach and gastroesophageal junction. METHODS We studied 110 consecutive patients undergoing gastrectomy with IOC margin assessment. RESULTS Gastric margins at IOC utilized the most blocks but were least often positive. In 64% of patients, the entire gastric margin was examined using average six blocks; representative sections were examined in 25% of patients using two blocks. There was no difference in patient outcome between those who had entire vs representative sections of margin examined. Gross variables showing strongest associations with positive margins were tumor size and tumor distance to margin. Tumors sized greater than 2.3 cm had significantly increased risk of positive margin, and tumor distance greater than 4.5 cm to margin was associated with negative margins. CONCLUSIONS We conclude representative sections of the closest gastric margin are sufficient to ensure R0 resection in the majority of cases.
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Affiliation(s)
- Romulo Celli
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Andrea L Barbieri
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | | | - John Sinard
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Joanna A Gibson
- Department of Pathology, Yale University School of Medicine, New Haven, CT
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50
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Zhou ML, Li GC, Yang W, Deng WJ, Hu R, Wang Y, Long ZW, Liu XW, Wang YN, Zhang Z. Adjuvant chemoradiotherapy versus adjuvant chemotherapy for R1 resected gastric cancer: a retrospective cohort study. Br J Radiol 2018; 91:20180276. [PMID: 29906235 DOI: 10.1259/bjr.20180276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the effects of adjuvant chemoradiotherapy (CRT) and adjuvant chemotherapy (ChT) on the survival of locally advanced gastric cancer (LAGC) patients treated with R1 resection. METHODS The patients with LAGC and microscopically positive margins after a potentially curative gastrectomy in Fudan University Shanghai Cancer Centre were retrospectively identified. The patients who were referred to our hospital for adjuvant CRT after an R1 resection elsewhere were also included. The patients were divided into either the CRT group or ChT group according to the treatment strategy. We, then, examined the patient survival results and patterns of recurrence for each group. RESULTS There were 114 LAGC patients treated with an R1 resection identified (CRT, n = 33; ChT, n = 81). The baseline characteristics between the two groups were not different. The estimated 3 year recurrence-free survival and overall survival in the CRT and ChT groups were 45.1% vs 31.8% (p = 0.09) and 49.6% vs 39.4% (p = 0.20), respectively. The results indicated that only nodal status was an independent prognostic factor (hazard ratio 4.04, 95% confidence interval 2.06-7.93). The risk of locoregional recurrence was increased in the ChT group. The subgroup analysis revealed that patients with pN0-2 GC showed a better recurrence-free survival due to adjuvant CRT (hazard ratio 0.19, 95% confidence interval 0.04-0.90; p = 0.022). CONCLUSION Adjuvant CRT improves locoregional control and may benefit patients with pN0-2 GC after R1 resection. The nodal status may be the most important predictor for patient selection. Advances in knowledge: Nodal status may be the most important predictor for patient selection. Compared with adjuvant ChT, LAGC patients with pN0-2 disease may further benefit from additional radiotherapy after R1 resection.
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Affiliation(s)
- Meng-Long Zhou
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China
| | - Gui-Chao Li
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China
| | - Wang Yang
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China
| | - Wei-Juan Deng
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China
| | - Ran Hu
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China
| | - Yan Wang
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China
| | - Zi-Wen Long
- 2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China.,3 Department of Gastric Surgery, Fudan University Shanghai Cancer Center , Shangha , PR China
| | - Xiao-Wen Liu
- 2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China.,3 Department of Gastric Surgery, Fudan University Shanghai Cancer Center , Shangha , PR China
| | - Ya-Nong Wang
- 2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China.,3 Department of Gastric Surgery, Fudan University Shanghai Cancer Center , Shangha , PR China
| | - Zhen Zhang
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center , Shanghai , PR China.,2 Department of Oncology, Shanghai Medical College, Fudan University , Shanghai , PR China
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