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Abboretti F, Didisheim L, Farinha HT, Schäfer M, Mantziari S. Long-term oncological outcomes of minimally invasive versus open gastrectomy for cancer. Am J Surg 2025; 240:116134. [PMID: 39647246 DOI: 10.1016/j.amjsurg.2024.116134] [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: 08/25/2024] [Revised: 10/30/2024] [Accepted: 12/03/2024] [Indexed: 12/10/2024]
Abstract
BACKGROUND Although laparoscopy is widely used in oncologic digestive surgery, many centers are still reluctant to replace open surgery for gastric cancer treatment, especially in advanced disease. The aim of this study was to assess long-term survival and recurrence in patients after laparoscopic (LG) versus open (OG) oncological gastrectomy, in a tertiary reference center. METHODS All consecutive patients with gastric adenocarcinoma undergoing curative gastrectomy between December 2007 and December 2021 were retrospectively analyzed. Clinico-pathological characteristics, survival and recurrence were compared among LG, OG or converted (CoG) patients. The ×2 test was used for categorical variables and the Mann-Whitney U test for continuous ones. Survival was assessed with the Kaplan-Meier method and log-rank test, as well as a multivariable Cox regression analysis. RESULTS Among 156 included patients, 49 (31.4 %) were in the LG group, 93 (59.6 %) in the OG group, and 14 (9 %) in the CoG group. Baseline demographics were similar among the groups. R0 resection rates were 75.5 % in LG, 80.6 % in OG, and 64.3 % in CoG (p = 0.489). Open surgery was associated with a higher mean lymph node yield (28.4 ± 11.6) compared to LG (22.8 ± 9.7) and CoG (26.5 ± 12.3, p = 0.036). Severe postoperative complications were higher in the CoG group (64.3 % CoG versus 29 % OG, 32.7 % LG, p = 0.035). The CoG group had a significantly inferior disease-free survival (p = 0.012 vs OG, p = 0.003 vs LG; 53.3 % OG, 62.7 % LG and 28.1 % CoG) although overall survival was similar (57.1 % OG, 62.7 % LG and 32.7 % CoG, all p > 0.005). CONCLUSIONS Laparoscopic gastrectomy, while associated with a lower lymph node yield, provides similar overall survival rates compared to open surgery. Conversion to open surgery was associated with higher major postoperative morbidity and inferior disease-free survival.
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Affiliation(s)
- Francesco Abboretti
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Switzerland
| | - Laura Didisheim
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Switzerland
| | - Hugo Teixeira Farinha
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Switzerland
| | - Markus Schäfer
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Switzerland.
| | - Styliani Mantziari
- Department of Visceral Surgery, Lausanne University Hospital, CHUV, Switzerland; Faculty of Biology and Medicine, University of Lausanne (UNIL), Switzerland
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Ajay PS, Mavani PT, Sok CP, Goyal S, Switchenko JM, Gillespie TW, Kooby DA, Kennedy TJ, Shah MM. Comparison of treatment strategies based on clinical and pathological nodal status in resectable gastric adenocarcinoma. J Surg Oncol 2024; 130:1078-1091. [PMID: 39190495 PMCID: PMC11655263 DOI: 10.1002/jso.27835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/17/2024] [Accepted: 08/10/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND To determine the optimal multimodal treatment strategy between perioperative chemotherapy (PEC), postoperative chemoradiation therapy (POCR), and postoperative chemotherapy (POC) in resected gastric cancer (GC) patients based on nodal status. METHODS In this retrospective analysis, the National Cancer Database was used to identify resected non-metastatic GC (2006-2016). Patients were stratified by clinical nodal status-negative (cLN-) and positive (cLN+). In patients with cLN- disease who underwent upfront resection and were upstaged to pathological LN+, overall survival (OS) was compared between POC and POCR. In patients with cLN- and cLN+ disease, OS was compared between PEC, POCR, and POC. Kaplan-Meier survival estimate, log-rank test, and multivariable Cox proportional hazards analysis were performed. RESULTS We identified 7827 patients (cLN- 4828; cLN+ 2999). On multivariable analysis in patients with cLN- disease who underwent upfront resection (n = 4314) and were upstaged to pLN+ disease (70%), POCR (n = 2300, aHR 0.78, 95% CI 0.70-0.87, p < 0.001) was associated with improved OS compared to POC (n = 907). No significant difference was noted between POCR (n = 766, aHR 1.11, 95% CI 0.88-1.40, p = 0.39) and POC (n = 341) in patients with pLN- disease. On multivariable analysis in all patients with cLN- disease, POCR (n = 3066) was significantly associated with improved OS (aHR 0.84, 95% CI 0.75-0.92, p < 0.01) compared to POC (n = 1248). No significant difference was noted between POCR (aHR 1.0, 95% CI 0.70-1.01, p = 0.958) and PEC (n = 514). These results remained consistent in patients with cLN+ disease (POCR = 1602, POC = 720, PEC = 677). CONCLUSION Postoperative chemoradiation is associated with improved survival in GC patients upstaged from clinically node-negative disease to pathologically node-positive disease. Negative clinical nodal disease status is not a reliable indicator of pathological nodal disease.
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Affiliation(s)
- Pranay S. Ajay
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Parit T. Mavani
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Caitlin P. Sok
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Subir Goyal
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffery M. Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Theresa W. Gillespie
- Department of Surgery and Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - David A. Kooby
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy J. Kennedy
- Division of Surgical Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Mihir M. Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Fabbi M, Milani MS, Giacopuzzi S, De Werra C, Roviello F, Santangelo C, Galli F, Benevento A, Rausei S. Adherence to Guidelines for Diagnosis, Staging, and Treatment for Gastric Cancer in Italy According to the View of Surgeons and Patients. J Clin Med 2024; 13:4240. [PMID: 39064280 PMCID: PMC11277783 DOI: 10.3390/jcm13144240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/09/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Despite the strong declining trends in incidence and mortality over the last decades, gastric cancer (GC) is still burdened with high mortality, even in high-income countries. To improve GC prognosis, several guidelines have been increasingly published with indications about the most appropriate GC management. The Italian Society of Digestive System Pathology (SIPAD) and Gastric Cancer Italian Research Group (GIRCG) designed a survey for both surgeons and patients with the purpose of evaluating the degree of application and adherence to guidelines in GC management in Italy. Materials and Methods: Between January and May 2022, a questionnaire has been administered to a sample of Italian surgeons and, in a simplified version, to members of the Patient Association "Vivere Senza Stomaco" (patients surgically treated for GC between 2008 and 2021) to investigate the diagnosis, staging, and treatment issues. Results: The survey has been completed by 125 surgeons and 125 patients. Abdominal CT with gastric hydro-distension before treatment was not widespread in both groups (47% and 42%, respectively). The rate of surgeons stating that they do not usually perform minimally invasive gastrectomy was 15%, but the rate of patients who underwent a minimally invasive approach was 22% (between 2011 and 2022). The percentage of surgeons declaring to perform extended lymphadenectomy (>D2) was 97%, although a limited lymph node dissection rate was observed in about 35% of patients. Conclusions: This survey shows several important discrepancies from surgical attitudes declared by surgeons and real data derived from the reports available to the patients, suggesting heterogeneous management in clinical practice and, thus, a not rigorous adherence to the guidelines.
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Affiliation(s)
- Manrica Fabbi
- Department of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21033 Varese, Italy; (M.S.M.); (S.R.)
| | - Marika Sharmayne Milani
- Department of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21033 Varese, Italy; (M.S.M.); (S.R.)
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, 37134 Verona, Italy;
| | - Carlo De Werra
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy;
| | - Franco Roviello
- Department of Medical Surgical Sciences and Neurosciences, Section of General Surgery and Surgical Oncology, Istituto Toscano Tumori (ITT), University Hospital of Siena, University of Siena, 53100 Siena, Italy;
| | | | - Federica Galli
- Department of General Surgery, Gallarate Hospital, ASST Valle Olona, 21013 Gallarate, Italy; (F.G.); (A.B.)
| | - Angelo Benevento
- Department of General Surgery, Gallarate Hospital, ASST Valle Olona, 21013 Gallarate, Italy; (F.G.); (A.B.)
| | - Stefano Rausei
- Department of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21033 Varese, Italy; (M.S.M.); (S.R.)
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Wang J, Zhang Z, Liang R, Chen W, Li Q, Xu J, Zhao H, Xing D. Targeting lymph nodes for enhanced cancer vaccination: From nanotechnology to tissue engineering. Mater Today Bio 2024; 26:101068. [PMID: 38711936 PMCID: PMC11070719 DOI: 10.1016/j.mtbio.2024.101068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/02/2024] [Accepted: 04/23/2024] [Indexed: 05/08/2024] Open
Abstract
Lymph nodes (LNs) occupy a critical position in initiating and augmenting immune responses, both spatially and functionally. In cancer immunotherapy, tumor-specific vaccines are blooming as a powerful tool to suppress the growth of existing tumors, as well as provide preventative efficacy against tumorigenesis. Delivering these vaccines more efficiently to LNs, where antigen-presenting cells (APCs) and T cells abundantly reside, is under extensive exploration. Formulating vaccines into nanomedicines, optimizing their physiochemical properties, and surface modification to specifically bind molecules expressed on LNs or APCs, are common routes and have brought encouraging outcomes. Alternatively, porous scaffolds can be engineered to attract APCs and provide an environment for them to mature, proliferate and migrate to LNs. A relatively new research direction is inducing the formation of LN-like organoids, which have shown positive relevance to tumor prognosis. Cutting-edge advances in these directions and discussions from a future perspective are given here, from which the up-to-date pattern of cancer vaccination will be drawn to hopefully provide basic guidance to future studies.
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Affiliation(s)
- Jie Wang
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China
| | - Zongying Zhang
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China
| | - Rongxiang Liang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, 266033, China
| | - Wujun Chen
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China
| | - Qian Li
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China
| | - Jiazhen Xu
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China
| | - Hongmei Zhao
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China
| | - Dongming Xing
- Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, 266071, China
- School of Life Sciences, Tsinghua University, Beijing, 100084, China
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Zhu X, Ge B, Wen L, Huang H, Shi X. Analysis of multiple factors influencing the survival of patients with advanced gastric cancer. Aging (Albany NY) 2024; 16:8541-8551. [PMID: 38742950 PMCID: PMC11164492 DOI: 10.18632/aging.205820] [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: 08/31/2023] [Accepted: 04/08/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the main factors influencing the survival of patients with advanced gastric cancer. METHODS The clinicopathological data of 120 patients with advanced gastric cancer were analyzed retrospectively, and clinical and pathological data were collected. Tumor tissue staging and grading were re-evaluated, and 5-year overall survival was followed up. The classified data were described by percentages, and the continuous data were described by standard deviations or medians. Univariate analysis was performed using the χ2 test or rank-sum test, followed by Kaplan-Meier survival analysis to calculate the median survival time and 5-year cumulative survival. A multivariate Cox regression model was used to evaluate the independent risk factors affecting survival. The test level was α = 0.05. RESULTS Patients were followed up for 0 to 60 months, the 5-year overall survival rate was 36.2%, and the median survival time was 53.0 ± 1.461 months. K-M and log-rank test results revealed that tumor location, degree of differentiation, depth of invasion, regional lymph node involvement, and postoperative tumor stage were correlated with a decreased 5-year survival rate (P < 0.05). A multivariate Cox risk regression model was used to analyze the degree of histological differentiation (HR = 1.441; 95% CI = 1.049-1.979; P = 0.024), regional lymph node (HR = 1.626; 95% CI = 1.160-2.279; P = 0.005), and pTNM stage (HR = 2.266; 95% CI = 1.335-3.847; P = 0.002), which are independent risk factors for poor survival. Tumor location (P = 0.191), invasion depth (P = 0.579) and tumor size (P = 0.324) were not found to be independent risk factors. CONCLUSION The degree of tumor differentiation, regional lymph node metastasis and postoperative pathological stage were found to be independent risk factors for 5-year overall survival in patients with advanced gastric cancer. Standardized and reasonable lymph node dissection and accurate postoperative pathological staging were very important.
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Affiliation(s)
- Xinqiang Zhu
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, PR China
| | - Beibei Ge
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
| | - Linchun Wen
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
| | - Hailong Huang
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
| | - Xiaohong Shi
- The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, Jiangsu 223800, PR China
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6
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Kim KY, Hwang J, Park SH, Cho M, Kim YM, Kim HI, Hyung WJ. Superior lymph node harvest by fluorescent lymphography during minimally invasive gastrectomy for gastric cancer patients with high body mass index. Gastric Cancer 2024; 27:622-634. [PMID: 38502275 DOI: 10.1007/s10120-024-01482-w] [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: 10/17/2023] [Accepted: 02/14/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Fluorescent lymphography (FL) using indocyanine green (ICG) allows for the visualization of all draining lymph nodes (LNs), thereby increasing LN retrieval. However, no studies have assessed the efficacy of FL in high body mass index (BMI) gastric cancer patients, even as LN yield decreases with increasing BMI in gastrectomy. This study aimed to investigate the influence of FL on LN retrieval in high BMI gastric cancer patients. METHODS Gastric cancer patients who underwent laparoscopic or robotic gastrectomies from 2013 to 2021 were included. Patients were classified into two groups, with FL (FL group) or without FL (non-FL group). The effect of FL on LN retrieval was assessed by BMI. Inverse probability of treatment weighting (IPTW) was used to ensure comparability between groups. RESULTS Retrieved LN number decreased as BMI increased regardless of FL application (P < 0.001). According to the IPTW analysis, the mean retrieved LN number was significantly higher in the FL group (48.4 ± 18.5) than in the non-FL group (39.8 ± 16.3, P < 0.001), irrespective of BMI. The FL group exhibited a significantly higher proportion of patients with 16 or more LNs (99.5%) than the non-FL group (98.1%, P < 0.001). The FL group also had a significantly higher proportion of patients with 30 or more LNs (86.6%) than the non-FL group (72.2%, P < 0.001). In both the normal and high-BMI patients, the FL group had a significantly larger percentage of patients with a higher nodal classification than the non-FL group. CONCLUSION FL resulted in more LN retrieval, even in high BMI patients. FL ensures accurate staging by maintaining the appropriate retrieved LN number in high BMI gastric cancer patients.
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Affiliation(s)
- Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, and Gastric Cancer Center, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Jawon Hwang
- Department of Surgery, Yonsei University College of Medicine, and Gastric Cancer Center, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, and Gastric Cancer Center, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, and Gastric Cancer Center, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, and Gastric Cancer Center, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, and Gastric Cancer Center, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, and Gastric Cancer Center, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.
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Manara M, Aiolfi A, Sozzi A, Calì M, Grasso F, Rausa E, Bonitta G, Bonavina L, Bona D. Short-Term Outcomes Analysis Comparing Open, Laparoscopic, Laparoscopic-Assisted, and Robotic Distal Gastrectomy for Locally Advanced Gastric Cancer: A Randomized Trials Network Analysis. Cancers (Basel) 2024; 16:1620. [PMID: 38730574 PMCID: PMC11083793 DOI: 10.3390/cancers16091620] [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: 02/26/2024] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Minimally invasive surgery for the treatment of locally advanced gastric cancer (AGC) is debated. The aim of this study was to execute a comprehensive assessment of principal surgical treatments for resectable distal gastric cancer. METHODS Systematic review and randomized controlled trials (RCTs) network meta-analysis. Open (Op-DG), laparoscopic-assisted (LapAs-DG), totally laparoscopic (Lap-DG), and robotic distal gastrectomy (Rob-DG) were compared. Pooled effect-size measures were the risk ratio (RR), the weighted mean difference (WMD), and the 95% credible intervals (CrIs). RESULTS Ten RCTs (3823 patients) were included. Overall, 1012 (26.5%) underwent Lap-DG, 902 (23.6%) LapAs-DG, 1768 (46.2%) Op-DG, and 141 (3.7%) Rob-DG. Anastomotic leak, severe complications (Clavien-Dindo > 3), and in-hospital mortality were comparable. No differences were observed for reoperation rate, pulmonary complications, postoperative bleeding requiring transfusion, surgical-site infection, cardiovascular complications, number of harvested lymph nodes, and tumor-free resection margins. Compared to Op-DG, Lap-DG and LapAs-DG showed a significantly reduced intraoperative blood loss with a trend toward shorter time to first flatus and reduced length of stay. CONCLUSIONS LapAs-DG, Lap-DG, and Rob-DG performed in referral centers by dedicated surgeons have comparable short-term outcomes to Op-DG for locally AGC.
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Affiliation(s)
- Michele Manara
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Matteo Calì
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Federica Grasso
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Emanuele Rausa
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, 20097 Milan, Italy;
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
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8
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Park SH, Han M, Yoon HM, Ryu KW, Kim YW, Eom BW. Real-world Nationwide Outcomes of Minimally Invasive Surgery for Advanced Gastric Cancer Based on Korean Gastric Cancer Association-Led Survey. J Gastric Cancer 2024; 24:210-219. [PMID: 38575513 PMCID: PMC10995831 DOI: 10.5230/jgc.2024.24.e16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/04/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE The study aimed to investigate real-world surgical outcomes of minimally invasive surgery (MIS) for advanced gastric cancer using Korean Gastric Cancer Association (KGCA)-led nationwide data. MATERIALS AND METHODS A nationwide survey of patients who underwent surgical treatment for gastric cancer in 2019 was conducted by the KGCA. A total of 14,076 patients from 68 institutions underwent surgery, and 4,953 patients diagnosed with pathological stages IB-III gastric cancer were included. Among them, 1,689 patients who underwent MIS (MIS group) and 1,689 who underwent the open approach (open group) were matched using propensity score in a 1:1 ratio. Surgical outcomes were compared, and multivariate analysis was performed to identify the independent factors for overall morbidity. RESULTS The MIS group had a lower proportion of D2 lymphadenectomy, total omentectomy, and combined resection. However, the number of harvested lymph nodes was higher in the MIS group. Better surgical outcomes, including less blood loss and shorter hospital stay, were observed in the MIS group, and the overall morbidity rate was significantly lower in the MIS group (17.5% vs. 21.9%, P=0.001). The mortality rates did not differ significantly between the 2 groups. In the multivariate analysis, the minimally invasive approach was a significant protective factor against overall morbidity (odds ratio, 0.799; P=0.006). CONCLUSIONS Based on the Korean nationwide data, MIS for stage IB-III gastric cancer had better short-term outcomes than the open approach, including lower rates of wound complications, intra-abdominal abscesses, and cardiac problems.
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Affiliation(s)
- Sin Hye Park
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Mira Han
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
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Riascos MC, Greenberg JA, Palacardo F, Edelmuth R, Lewis VC, An A, Najah H, Al Asadi H, Safe P, Finnerty BM, Christos PJ, Fahey TJ, Zarnegar R. Timing to Surgery and Lymph Node Upstaging in Gastric Cancer: An NCDB Analysis. Ann Surg Oncol 2024; 31:1714-1724. [PMID: 38006526 DOI: 10.1245/s10434-023-14536-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/19/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Prior studies have shown tumor specificity on the impact of longer time interval from diagnosis to surgery, however in gastric cancer (GC) this remains unclear. We aimed to determine if a longer time interval from diagnosis to surgery had an impact on lymph node (LN) upstaging and overall survival (OS) outcomes among patients with clinically node negative (cN0) GC. PATIENTS AND METHODS Patients diagnosed with cN0 GC undergoing surgery between 2004-2018 were identified in the National Cancer Database (NCDB) and divided into intervals between time of diagnosis and surgery [short interval (SI): ≥ 4 days to < 8 weeks and long interval (LI): ≥ 8 weeks]. Multivariable regression analysis evaluated the independent impact of surgical timing on LN upstaging and a Cox proportional hazards analysis and Kaplan-Meier curves evaluated survival outcomes. RESULTS Of 1824 patients with cN0 GC, 71.8% had a SI to surgery and 28.1% had a LI to surgery. LN upstaging was seen more often in the SI group when compared to LI group (82% versus 76%, p = 0.004). LI to surgery showed to be an independent factor protective against LN upstaging [adjusted odds ratio = 0.62, 95% CI: (0.39-0.99)]. Multivariate Cox regression analysis indicated that time to surgery was not associated with a difference in overall survival [hazard ratio (HR) = 0.91, 95% CI: (0.71-1.17)], however uncontrolled Kaplan-Meier curves showed OS difference between the SI and LI to surgery groups (p = 0.037). CONCLUSION Timing to surgery was not a predictor of LN upstaging or overall survival, suggesting that additional medical optimization in preparation for surgery and careful preoperative staging may be appropriate in patients with node negative early stage GC without affecting outcomes.
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Affiliation(s)
| | | | | | | | - V Colby Lewis
- Department of Population and Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Anjile An
- Department of Population and Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Haythem Najah
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Hala Al Asadi
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Parima Safe
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine, New York, NY, USA.
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10
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Guo Y, Zhang XD, Zhang GT, Song XF, Yuan Y, Zhang P, Song YC. Laparoscopic D2+ lymph node dissection in patients with obesity and gastric cancer: A retrospective study. Oncol Lett 2024; 27:84. [PMID: 38249812 PMCID: PMC10797313 DOI: 10.3892/ol.2024.14218] [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: 06/09/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
D2 lymph node dissection is widely used in laparoscopic radical gastrectomy for gastric cancer, and its efficacy and safety are known for patients with obesity. Currently, D2+ lymph node dissection is also applied to certain patients with gastric cancer of later stages. Due to the high difficulty of D2+ surgery, it is more challenging to perform on patients with obesity. There is currently limited research on the efficacy and safety of D2+ surgery in obese patients with gastric cancer. The present study aimed to retrospectively analyze the clinical data of patients undergoing laparoscopic radical gastrectomy for gastric cancer admitted to a single gastroenterology department. Patients with a body mass index ≥25 kg/m2 were included in the study. A total of 149 patients were selected as the research subjects and divided into two groups. The observation group comprised 74 patients who underwent D2+ lymph node dissection, while the control group comprised 75 patients who underwent standard D2 lymph node dissection. The surgical performance, postoperative recovery and postoperative complications of the two groups were compared. The results showed that the rates of conversion to open surgery in the D2+ and D2 groups were 5.4% (4/74) and 2.7% (2/75), respectively, and were not significantly different. The duration of surgery in the D2+ group (282.55±23.02 min) was significantly longer than that in the D2 group (271.45±20.05 min). The mean number of lymph node dissections in the D2+ group was 28.57±7.19, which was significantly higher than that in the D2 group (25.29±6.41). No statistically significant differences in intraoperative blood loss, time to first flatus, postoperative hospitalization days, total hospitalization expenses or postoperative complications was detected between the two groups. There were no deaths in either group within the 30-day perioperative period. In addition, there was no significant difference in the 3-year overall survival rate between the two groups, while the 5-year overall survival rate of the D2+ group was significantly higher than that of the D2 group. For obese patients with gastric cancer, D2+ surgery may increase the duration of surgery and slightly increase intraoperative blood loss compared with standard D2 radical surgery, but does not increase the incidence of postoperative complications. Moreover, D2+ surgery increases the number of lymph node dissections and improves the 5-year survival rate of patients. Therefore, it may be concluded that laparoscopic D2+ lymph node dissection is safe and feasible for obese patients with gastric cancer.
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Affiliation(s)
- Yu Guo
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Xue Dong Zhang
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Guang Tan Zhang
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Xiao Fei Song
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yuan Yuan
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yu Cheng Song
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
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11
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Díaz Del Arco C, Ortega Medina L, Estrada Muñoz L, Molina Roldán E, García Gómez de Las Heras S, Fernández Aceñero MJ. Prognostic role of the number of resected and negative lymph nodes in Spanish patients with gastric cancer. Ann Diagn Pathol 2023; 67:152209. [PMID: 37689040 DOI: 10.1016/j.anndiagpath.2023.152209] [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: 08/29/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Lymph node (LN) involvement is one of the most critical prognostic factors in resected gastric cancer (GC). Some analyses, mainly conducted in Asian populations, have found that patients with a higher number of total lymph nodes (NTLN) and/or negative lymph nodes (NNLN) have a better prognosis, although other authors have failed to confirm these results. MATERIALS AND METHODS Retrospective study including all patients with GC resected in a tertiary hospital in Spain between 2001 and 2019 (n = 315). Clinicopathological features were collected and patients were categorized according to the NTLN and the NNLN. Statistical analyses were performed. RESULTS Mean NNLN was 17. The NNLN was significantly related to multiple clinicopathological variables, including recurrence and tumor-related death. The classification based on the NNLN (N1: ≥16, N2: 8-15, N3: ≤7) effectively stratified the entire cohort into three distinct prognostic groups and maintained its prognostic value within both the pN0 and pN+ patient subsets. Furthermore, it was an independent prognostic indicator for both overall and disease-free survival. Conversely, the mean NTLN was 21.9. Patients with ≤16 LN retrieved exhibited distinct clinicopathological features compared to those with >16 LN, but no significant differences were observed in terms of recurrence or disease-associated death. The application of alternative cut-off points for NTLN (10, 20, 25, 30, and 40) showed no prognostic significance. CONCLUSIONS In Spanish patients with resected GC the NNLN hold prognostic significance, while the NTLN does not appear to be prognostically significant. Incorporating the NNLN into GC staging may enhance the accuracy of the TNM system.
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Affiliation(s)
- Cristina Díaz Del Arco
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Luis Ortega Medina
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Lourdes Estrada Muñoz
- Department of Basic Medical Sciences, School of Medicine, Rey Juan Carlos University, Móstoles, Madrid, Spain; Department of Pathology, Rey Juan Carlos Hospital, Móstoles, Madrid, Spain
| | - Elena Molina Roldán
- Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Biobank, Hospital Clínico San Carlos, Madrid, Spain
| | | | - M Jesús Fernández Aceñero
- Pathology Teaching Unit, Department of Legal Medicine, Psychiatry and Pathology, School of Medicine, Complutense University of Madrid, Madrid, Spain; Department of Pathology, Hospital Clínico San Carlos; Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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12
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Zhang S, Zheng L, Zhang Y, Gao Y, Liu L, Jiang Z, Wang L, Ma Z, Wu J, Chen J, Lu Y, Wang D. A web-based prediction model for long-term cancer-specific survival of middle-aged patients with early-stage gastric cancer: a multi-institutional retrospective study. J Cancer Res Clin Oncol 2023; 149:16551-16561. [PMID: 37712958 DOI: 10.1007/s00432-023-05405-7] [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: 06/18/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND This study constructed and validated a prognostic model to evaluate long-term cancer-specific survival (CSS) in middle-aged patients with early gastric cancer (EGC). METHODS We extracted clinicopathological data from relevant patients between 2004 and 2015 from Surveillance, Epidemiology, and End Results (SEER) database, and randomly divided the patients into a training group (N = 688) and a validation group (N = 292). In addition, 102 Chinese patients were enrolled for external validation. Univariate and multivariate Cox regression models were used to screen for independent prognostic factors, and a nomogram was constructed to predict CSS. We used the concordance index (C-index), calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) to evaluate the predictive performance of the model. RESULTS Univariate and multivariate COX regression analyses showed that tumor location, differentiation grade, N stage, chemotherapy, and number of regional nodes examined were independent risk factors for prognosis, and these factors were used to construct the nomogram. The C-index of the model in the training cohort, internal validation cohort, and external validation cohort was 0.749 (95% CI 0.699-0.798), 0.744 (95% CI 0.671-0.818), and 0.807 (95% CI 0.721-0.893), respectively. The calibration curve showed that the model had an excellent fit. The DCA curve showed that the model had good predictive performance and practical clinical value. CONCLUSION This study developed and validated a new nomogram to predict CSS in middle-aged patients with EGC. The prediction model has unique and practical value and can help doctors carry out individualized treatment and judge prognosis.
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Affiliation(s)
- Simeng Zhang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Longbo Zheng
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266400, Shandong, China
| | - Yuxia Zhang
- Department of Rehabilitation Pain, Shanghe County People's Hospital, Jinan, Shandong, China
| | - Yuan Gao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266400, Shandong, China
| | - Lei Liu
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Zinian Jiang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Liang Wang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Zheng Ma
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Jinhui Wu
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| | - Jiansheng Chen
- Department of Gastrointestinal Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Yun Lu
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266400, Shandong, China
| | - Dongsheng Wang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China.
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266400, Shandong, China.
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13
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Liu S, Ai S, Song P, Wang M, Lu X, Guan W. Subserosal Indocyanine Green Plus Submucosal Carbon Nanoparticle Navigated Laparoscopic Gastrectomy (DANCE-01): a Cohort Study. J Gastrointest Surg 2023; 27:2068-2075. [PMID: 37353658 DOI: 10.1007/s11605-023-05756-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: 03/09/2023] [Accepted: 06/03/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Indocyanine green (ICG) and carbon nanoparticle (CN) have been widely used for radical gastrectomy. However, synchronous application of ICG and CN in gastrectomy has not been tried yet. For the first time, we herein reported a novel strategy using dual tracers in laparoscopic radical gastrectomy. METHODS This is a single-center, single-armed, prospective study. For each qualified patient, submucosal CN was injected the day before surgery, and subserosal ICG was injected immediately before surgery. Standard D2 laparoscopic gastrectomy and lymph node examination were subsequently performed. Demographics, lymph nodes (LNs) and postoperative outcome were collected for analysis. To analyze the safety and efficacy of this novel strategy, two contemporary historic control groups using single tracer were established. RESULTS A total of 60 patients underwent dual tracer laparoscopic gastrectomy and were divided into distal (n = 41) and total (n = 19) groups. An average of 53.3 and 62.2 LNs was harvested from two groups, respectively. The average operation duration was 213.3 and 250.0 min, and intra-operative blood loss was 100.2 ml and 94.7 ml. None received combined organ resection. Margin negativity and R0 resection were achieved in all patients. Three (7.3%) complications occurred in distal group. None required second operation or deceased. Postoperative hospitalization was 9.7 and 9.6 days, respectively. Compared to single tracer, more LNs (p < 0.01), shorter operation time (p < 0.01), less blood lost (p < 0.01) and accelerated postoperative recovery (p < 0.01) were observed in dual tracer group. CONCLUSIONS We propose a novel, feasible and safe tracing strategy for laparoscopic gastrectomy. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100051309).
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Affiliation(s)
- Song Liu
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Shichao Ai
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Peng Song
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Meng Wang
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Xiaofeng Lu
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan RD, Nanjing, 210008, China
| | - Wenxian Guan
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan RD, Nanjing, 210008, China.
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14
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Zhang G, Zhang Y, Zhang Y, Zhao W, Xia Y, Song J, Feng Z, Liu L, Shu X, Wu A, Wu Y, Cao Y, Jie Z, Li Z. Global trends in indocyanine green fluorescence navigation in the field of gastric cancer: bibliometrics and knowledge atlas analysis. Quant Imaging Med Surg 2023; 13:7117-7141. [PMID: 37869281 PMCID: PMC10585495 DOI: 10.21037/qims-23-391] [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: 03/25/2023] [Accepted: 08/07/2023] [Indexed: 10/24/2023]
Abstract
Background Indocyanine green (ICG) fluorescence navigation can enhance the visualization of gastric cancer (GC) lesions, increase the lymph node detection rate, and reduce the incidence of anastomotic leakage in the treatment of GC. It thus holds considerable potential for application in GC clinical surgery and has attracted widespread research interest. The purpose of this study was to visualize the current topics and emerging trends in research regarding ICG in GC. Methods We searched the Web of Science Core Collection (WoSCC) for articles relevant to the use of ICG in GC. The resulting information was then analyzed from a bibliometric and knowledge graph analysis perspective using CiteSpace, Scimago Graphica, and R Studio so that the key trends and hot spots in research within this field could be identified and visualized. Results Ultimately, 1,385 papers from 58 countries or regions published from 1991 to 2022 were included in this study. The largest number of publications were from China, followed by Japan and the United States. High-yield institutions were concentrated in Asian countries, especially China. The top publication contributors were Shanghai Jiao Tong University. Li Y and Bang YJ ranked first among the top 10 most productive authors and top 10 most cocited authors, respectively. World Journal of Gastroenterology was the most productive academic journal on ICG in GC, while Cancer Research was the most commonly cocited journal. The keyword "indocyanine green" was among the top 5 keywords, and will likely remain a popular topic in future research. Furthermore, the emerging themes including surgery, biopsy, lymphadenectomy, dissection, and gastrectomy have attracted increasing attention. Conclusions Current research hotspots in this area focus on the clinical implementation of ICG in precision surgery for GC. Given the imaging tracer characteristics of ICG and its utility in GC surgery, the optimization and application of ICG-guided precision surgery techniques for GC will be a research hot spot going forward.
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Affiliation(s)
- Guoyang Zhang
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yujun Zhang
- Jiangxi Medical College of Nanchang University, Nanchang, China
| | - Yiwei Zhang
- Queen Mary College, Nanchang University, Nanchang, China
| | - Wentao Zhao
- The Third Clinical Department, China Medical University, Shenyang, China
| | - Yu Xia
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Jingjing Song
- Jiangxi Medical College of Nanchang University, Nanchang, China
| | - Zongfeng Feng
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
- Medical Innovation Center, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Liu
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xufeng Shu
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ahao Wu
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yukang Wu
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Cao
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhigang Jie
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhengrong Li
- Department of Digestive Surgery, Digestive Disease Hospital, the First Affiliated Hospital of Nanchang University, Nanchang, China
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15
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Fernström A, Kokkola A, Korpela A, Puolakkainen P, Louhimo J. Separating lymph node stations by the surgeon from the gastric cancer specimen improves the quality of nodal status evaluation. World J Surg Oncol 2023; 21:265. [PMID: 37626384 PMCID: PMC10463918 DOI: 10.1186/s12957-023-03146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In gastric cancer (GC), the pN-stage is an important prognostic factor influencing treatment. Along with the depth of invasion of the tumor, the presence of nodal metastases is one of the most important prognostic factors guiding treatment strategies in gastric cancer. Examining a small number of lymph nodes may lead to understaging of the disease; hence, it is essential for the nodal status to be precisely assessed. In this study, we explored whether dissecting lymph node stations into separate samples by the surgeon from the gastric cancer surgical specimen affects the quality of nodal status evaluation and patient outcome. METHODS The clinical data of 130 GC patients treated at the Helsinki University Hospital between 2016 and 2019 was reviewed. The performed operations included 59 total and 71 subtotal gastrectomies. The processing of the surgical specimen before the pathological examination was assessed from the operation records and pathology reports. The association of the number of examined lymph nodes with other variables was assessed, and multivariate survival analysis was performed to explore the independent prognostic factors in disease-specific survival. RESULTS Dissecting lymph node stations into separate specimens before pathological evaluation yielded a significantly greater number of examined lymph nodes compared with a specimen without intervention (median 34.5 vs 21.0, p < 0.001). The pT-stage, the pN-stage, and the extent of lymphadenectomy were identified as independent prognostic factors, whereas dissecting the specimen's lymph node stations did not associate with survival. CONCLUSIONS Dissecting lymph node stations into separate specimens results in a greater number of examined lymph nodes, which has the potential to lead to a more reliable pN-stage assessment.
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Affiliation(s)
- Aleksi Fernström
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland
| | - Arto Kokkola
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland
| | - Akseli Korpela
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland
| | - Pauli Puolakkainen
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland
| | - Johanna Louhimo
- Abdominal Center, Department of Surgery, Helsinki University Hospital and University of Helsinki, Meilahti Hospital, PO Box 440, Stenbäckinkatu 9A, Helsinki, 00029 HUS, Finland.
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16
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Ajay PS, Sok CP, Goyal S, Switchenko JM, Maegawa FB, Gillespie TW, Paulos CM, Lesinski GB, Kooby DA, Kennedy TJ, Shah MM. Impact of nodal status in determining multimodal treatment strategies in non-cardia gastric cancer. J Surg Oncol 2023; 128:242-253. [PMID: 37114465 PMCID: PMC10901235 DOI: 10.1002/jso.27297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Patients with resectable noncardia gastric cancer may be subjected to perioperative chemotherapy (PEC), postoperative chemoradiation (POCR), or postoperative chemotherapy (POC). We analyzed these treatment strategies to determine optimal therapy based on nodal status. METHOD The National Cancer Database was used to identify patients with resected noncardia gastric cancer (2004-2016). Patients were stratified based on clinical nodal status-negative (cLN-), positive (cLN+) and pathological nodal status (pLN-, pLN+). In cLN- patients who underwent upfront resection and were upstaged to pLN+, POC, and POCR were compared. Overall survival (OS) with PEC, POCR, and POC were compared in cLN- and cLN+. RESULTS We identified 6142 patients (cLN-: 3831; cLN+: 2311). In cLN- patients who underwent upfront resection (N = 3423), 69% were upstaged to pLN+ disease (N = 2499; POCR = 1796, POC = 703). On MVA, POCR was associated with significantly improved OS when compared to POC (hazard ratio [HR]: 0.75; p < 0.001). In patients with cLN- disease (PEC = 408; POCR = 2439; POC = 984), PEC(HR: 0.77; p = 0.01) and POCR(HR: 0.81; p < 0.001) were associated with improved OS compared with POC. In cLN+ group (PEC = 452; POCR = 1284; POC = 575), POCR was associated with improved OS compared with POC (HR: 0.81; p < 0.01), and trend towards improved OS was noted when PEC(HR: 0.83; p = 0.055) was compared with POC. CONCLUSION Postoperative chemoradiation may be the preferred treatment strategy over postoperative chemotherapy in non-cardia gastric cancer patients who receive upfront resection and are upstaged from clinically node negative to pathologically node positive disease.
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Affiliation(s)
- Pranay S Ajay
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Caitlin P Sok
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Subir Goyal
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jeffery M Switchenko
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Felipe B Maegawa
- Division of General and Gastrointestinal Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Theresa W Gillespie
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chrystal M Paulos
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gregory B Lesinski
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David A Kooby
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Timothy J Kennedy
- Division of Surgical Oncology, Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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17
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Calcara C, Cocciolillo S, Marten Canavesio Y, Adamo V, Carenzi S, Lucci DI, Premoli A. Endoscopic fluorescent lymphography for gastric cancer. World J Gastrointest Endosc 2023; 15:32-43. [PMID: 36925646 PMCID: PMC10011894 DOI: 10.4253/wjge.v15.i2.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/18/2022] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Lymphography by radioisotope or dye is a well-known technique for visualizing the lymphatic drainage pattern in a neoplastic lesion and it is in use in gastric cancer. Indocyanine green (ICG) more recently has been validated in fluorescent lymphography studies and is under evaluation as a novel tracer agent in gastric cancer. The amount and dilution of ICG injected as well as the site and the time of the injection are not standardized. In our unit, endoscopic submucosal injections of ICG are made as 0.5 mg in 0.5 mL at four peritumoral sites the day before surgery (for a total of 2.0 mg in 2.0 mL). Detection instruments for ICG fluorescence are evolving. Near-infrared systems integrated into laparoscopic or robotic instruments (near-infrared fluorescence imaging) have shown the most promising results. ICG fluorescence recognizes the node that receives lymphatic flow directly from a primary tumor. This is defined as the sentinel lymph node, and it has a high predictive negative value at the cT1 stage, able to reduce the extent of gastrectomy and lymph node dissection. ICG also enhances the number of lymph nodes detected during extended lymphadenectomy for advanced gastric cancer. Nevertheless, the practical effects of ICG use in a single patient are not yet clear. Standardization of the technique and further studies are needed before fluorescent lymphography can be used extensively worldwide. Until then, current guidelines recommend an extensive lymphadenectomy as the standard approach for gastric cancer with suspected metastasis.
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Affiliation(s)
| | - Sila Cocciolillo
- Digestive Endoscopy Unit, Padre Pio Hospital, Vasto 66054, Italy
| | | | - Vincenzo Adamo
- General Surgery Unit, S. Andrea Hospital, Vercelli 13100, Italy
| | - Silvia Carenzi
- Digestive Endoscopy Unit, S. Andrea Hospital, Vercelli 13100, Italy
| | | | - Alberto Premoli
- Digestive Endoscopy Unit, S. Andrea Hospital, Vercelli 13100, Italy
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18
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Zhai J, Jiang H. Two-sample test with g-modeling and its applications. Stat Med 2023; 42:89-104. [PMID: 36412978 PMCID: PMC10099579 DOI: 10.1002/sim.9603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/31/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
Many real data analyses involve two-sample comparisons in location or in distribution. Most existing methods focus on problems where observations are independently and identically distributed in each group. However, in some applications the observed data are not identically distributed but associated with some unobserved parameters which are identically distributed. To address this challenge, we propose a novel two-sample testing procedure as a combination of the g $$ g $$ -modeling density estimation introduced by Efron and the two-sample Kolmogorov-Smirnov test. We also propose efficient bootstrap algorithms to estimate the statistical significance for such tests. We demonstrate the utility of the proposed approach with two biostatistical applications: the analysis of surgical nodes data with binomial model and differential expression analysis of single-cell RNA sequencing data with zero-inflated Poisson model.
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Affiliation(s)
- Jingyi Zhai
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Hui Jiang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
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19
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Kim DH, Yun HY, Ryu DH, Han HS, Han JH, Kim KB, Choi H, Lee TG. Clinical significance of the number of retrieved lymph nodes in early gastric cancer with submucosal invasion. Medicine (Baltimore) 2022; 101:e31721. [PMID: 36401371 PMCID: PMC9678558 DOI: 10.1097/md.0000000000031721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The prognosis of early gastric cancer (EGC) with submucosal invasion is favorable; however, several cases of recurrence have been reported even after curative gastrectomy. This study aimed to investigate risk factors and evaluate the clinical significance of the number of retrieved lymph nodes (LNs) in EGC with submucosal invasion. We retrospectively analyzed the data of 443 patients with gastric cancer with submucosal invasion after curative gastrectomy for recurrent risk factors. Recurrence was observed in 22 of the 443 gastric cancer patients with submucosal invasion. In the univariate analysis, the risk factors for recurrence were the number of retrieved LNs ≤ 25 and node metastasis. In the multivariate analysis, retrieved LNs ≤ 25 (hazard ratio [HR] = 5.754, P-value = .001) and node metastasis (HR = 3.031, P-value = .029) were independent risk factors for recurrence after curative gastrectomy. Body mass index was related to retrieved LNs ≤ 25 in univariate and multivariate analyses (HR = .510, P = .002). The number of retrieved LNs and node metastases were independent risk factors for EGC with submucosal invasion. For EGC with submucosal invasion, retrieved LNs > 25 are necessary for appropriate diagnosis and treatment.
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Affiliation(s)
- Dae Hoon Kim
- Department of Surgery, Chungbuk National University Hospital, Korea
- Department of Surgery, Chungbuk National University College of Medicine, Korea
| | - Hyo Yung Yun
- Department of Surgery, Chungbuk National University Hospital, Korea
- Department of Surgery, Chungbuk National University College of Medicine, Korea
- *Correspondence: Hyo Yung Yun, Department of Surgery, Chungbuk National University College of Medicine, 410, Sungbong-ro, Heungduk-gu, Cheongju 361-763, Korea (e-mail: )
| | - Dong Hee Ryu
- Department of Surgery, Chungbuk National University Hospital, Korea
- Department of Surgery, Chungbuk National University College of Medicine, Korea
| | - Hye Sook Han
- Internal Medicine, Chungbuk National University Hospital, Korea
- Internal Medicine, Chungbuk National University College of Medicine, Korea
| | - Joung-Ho Han
- Department of Surgery, Chungbuk National University Hospital, Korea
- Internal Medicine, Chungbuk National University Hospital, Korea
| | - Ki Bae Kim
- Department of Surgery, Chungbuk National University Hospital, Korea
- Internal Medicine, Chungbuk National University Hospital, Korea
| | - Hanlim Choi
- Department of Surgery, Chungbuk National University Hospital, Korea
- Department of Surgery, Chungbuk National University College of Medicine, Korea
| | - Taek-Gu Lee
- Department of Surgery, Chungbuk National University Hospital, Korea
- Department of Surgery, Chungbuk National University College of Medicine, Korea
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20
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Li H, Lin D, Yu Z, Li H, Zhao S, Hainisayimu T, Liu L, Wang K. A nomogram model based on the number of examined lymph nodes-related signature to predict prognosis and guide clinical therapy in gastric cancer. Front Immunol 2022; 13:947802. [PMID: 36405735 PMCID: PMC9667298 DOI: 10.3389/fimmu.2022.947802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/30/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Increasing evidence suggests that the number of examined lymph nodes (ELNs) is strongly linked to the survivorship of gastric cancer (GC). The goal of this study was to assess the prognostic implications of the ELNs number and to construct an ELNs-based risk signature and nomogram model to predict overall survival (OS) characteristics in GC patients. METHODS This inception cohort study included 19,317 GC patients from the U.S. Surveillance, Epidemiology, and End Results (SEER) database, who were separated into a training group and an internal validation group. The nomogram was built with the training set, then internally verified with SEER data, and externally validated with two different data sets. Based on the RNA-seq data, ELNs-related DERNAs (DElncRNAs, DEmiRNAs, andDEmRNAs) and immune cells were identified. The LASSO-Cox regression analysis was utilized to construct ELNs-related DERNAs and immune cell prognostic signature in The Cancer Genome Atlas (TCGA) cohort. The OS of subgroups with high- and low-ELN signature was compared using the Kaplan-Meier (K-M) analysis. A nomogram was successfully constructed based on the ELNs signature and other clinical characteristics. The concordance index (C-index), calibration plot, receiver operating characteristic curve, and decision curve analysis (DCA) were all used to evaluate the nomogram model. The meta-analysis, the Gene Expression Profiling Interactive Analysis database, and reverse transcription-quantitative PCR (RT-qPCR) were utilized to validate the RNA expression or abundance of prognostic genes and immune cells between GC tissues and normal gastric tissues, respectively. Finally, we analyzed the correlations between immune checkpoints, chemotherapy drug sensitivity, and risk score. RESULTS The multivariate analysis revealed that the high ELNs improved OS compared with low ELNs (hazard ratio [HR] = 0.659, 95% confidence interval [CI]: 0.626-0.694, p < 0.0001). Using the training set, a nomogram incorporating ELNs was built and proven to have good calibration and discrimination (C-index [95% CI], 0.714 [0.710-0.718]), which was validated in the internal validation set (C-index [95% CI], 0.720 [0.714-0.726]), the TCGA set (C-index [95% CI], 0.693 [0.662-0.724]), and the Chinese set (C-index [95% CI], 0.750 [0.720-0.782]). An ELNs-related signature model based on ELNs group, regulatory T cells (Tregs), neutrophils, CDKN2B-AS1, H19, HOTTIP, LINC00643, MIR663AHG, TMEM236, ZNF705A, and hsa-miR-135a-5p was constructed by the LASSO-Cox regression analysis. The result showed that OS was remarkably lower in patients with high-ELNs signature compared with those with low-ELN signature (HR = 2.418, 95% CI: 1.804-3.241, p < 0.001). This signature performed well in predicting 1-, 3-, and 5-year survival (AUC [95% CI] = 0.688 [0.612-0.763], 0.744 [0.659-0.830], and 0.778 [0.647-0.909], respectively). The multivariate Cox analysis illustrated that the risk score was an independent predictor of survival for patients with GC. Moreover, the expression of prognostic genes (LINC00643, TMEM236, and hsa-miR-135a-5p) displayed differences between GC tissues and adjacent non-tumor tissues. The C-index of the nomogram that can be used to predict the OS of GC patients was 0.710 (95% CI: 0.663-0.753). Both the calibration plots and DCA showed that the nomogram has good predictive performance. Moreover, the signature was significantly correlated with the N stage and T stage. According to our analysis, GC patients in the low-ELN signature group may have a better immunotherapy response and OS outcome. CONCLUSIONS We explored the prognostic role of ELNs in GC and successfully constructed an ELNs signature linked to the GC prognosis in TCGA. The findings manifested that the signature is a powerful predictive indicator for patients with GC. The signature might contain potential biomarkers for treatment response prediction for GC patients. Additionally, we identified a novel and robust nomogram combining the characteristics of ELNs and clinical factors for predicting 1-, 3-, and 5-year OS in GC patients, which will facilitate personalized survival prediction and aid clinical decision-making in GC patients.
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Affiliation(s)
- Huling Li
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Dandan Lin
- School of Public Health, Xinjiang Medical University, Urumqi, China
| | - Zhen Yu
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Hui Li
- Central Laboratory of Xinjiang Medical University, Urumqi, China
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tuersun Hainisayimu
- Department of Biochemistry and Molecular Biology, Basic Medicine School, Xinjiang Medical University, Urumqi, China
| | - Lin Liu
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Xinjiang Medical University, Urumqi, China,*Correspondence: Kai Wang, ; Lin Liu,
| | - Kai Wang
- Department of Medical Engineering and Technology, Xinjiang Medical University, Urumqi, China,*Correspondence: Kai Wang, ; Lin Liu,
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21
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Coit DG, Strong VE. Fifty years of progress in gastric cancer. J Surg Oncol 2022; 126:865-871. [PMID: 36087088 PMCID: PMC9469502 DOI: 10.1002/jso.27060] [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: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
As with every human malignancy, the diagnosis, staging, and treatment of patients with gastric cancer have undergone enormous evidence-based change over the last 50 years, largely as a result of increasingly rapid developments in technology and science. Some of the changes in clinical practice have derived from prospective randomized controlled trials (RCTs), whereas others have come from study of meticulously maintained prospective databases, which define the disease's natural history over time, and occasionally from in-depth analysis of a single patient with an unexpectedly good or poor outcome. Herein we summarize the more important changes in gastric cancer management and the data supporting those changes.
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Affiliation(s)
- Daniel G Coit
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivian E Strong
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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22
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Zhu FH, Wang YK, Zhou JL, Meng NL, Wang Y, Jiang B, Wang SN. The Histopathological Types and Distribution Characteristics of Gastric Mixed Tumors. Front Oncol 2022; 12:873005. [PMID: 35785186 PMCID: PMC9247174 DOI: 10.3389/fonc.2022.873005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The present study aimed to investigate the histopathological types and distribution characteristics of gastric mixed tumors. Methods Detailed histological observations, together with related immunohistochemical and genetic tests, were analyzed on 960 surgically resected samples in 6 hospitals with gastric mixed tumors from May 2017 to May 2021 in this retrospective study. Results Epithelial-derived tumors accounted for 80.10% (769/960) of the gastric mixed tumor samples studied, and tumors of different tissue origins accounting for 10.83% (104/960), mesenchymal-derived tumors accounting for 6.25% (60/960), neuroendocrine tumors accounting for 2.40% (23/960), and lymphoma accounting for 0.42% (4/960). The histological types of gastric mixed tumors identified as most commonly were epithelial originated, followed by mixed tumors of different tissue originated, then mixed neuroendocrine, lymphoma, and mesenchymal originated in sequence. The histological number of gastric mixed tumors was ≤ 3 in 83.23% (799/960) of cases and > 4 in 16.77% (161/960) of cases. The mixed histological patterns of gastric mixed tumors were divided into three types: those with tumor cells interspersed with each other, those with incomplete fibrous tissue separation, and those without fibrous tissue separation. The gene target characteristics of gastric mixed tumors were the existence of multi-gene mutation, including human epidermalgrowth factor receptor-2 (HER2) gene amplification, key result areas (K-ras) and platelet-derived growth factor receptor alpha (PDGFRA). Conclusion Gastric mixed tumors should be adequately sampled, each piece of tissue should be involved in the morphological proportional division of the tumor, and any independent histological component should be written into the pathological examination report.
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Affiliation(s)
- Fang-Heng Zhu
- Department of Pathology, Xinxiang Central Hospital, Xinxiang, China
| | - Yang-Kun Wang
- Department of Pathology, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, China
| | - Jun-Ling Zhou
- Shenzhen Nanshan District People’s Hospital, Shenzhen, China
| | - Nian-Long Meng
- Department of Pathology, The 989th Hospital of the Joint Logistics Support Force of The Chinese People’s Liberation Army, Luoyang, China
| | - Yue Wang
- Shenzhen Hezheng Hospital, Shenzhen, China
| | - Bo Jiang
- Department of Pathology, People’s Liberation Army Joint Logistic Support Force 990th Hospital, Zhumadian, China
| | - Su-Nan Wang
- Shenzhen Polytechnic, Shenzhen, China
- *Correspondence: Su-Nan Wang,
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Tsao MW, Kahl MS, Deneve JL, Yakoub D, Glazer ES, Shibata D, Jain R, Clark I, Dickson PV. The Association of Race With Adequate Lymph Node Evaluation for Gastric Cancer. Am Surg 2022; 88:2280-2288. [PMID: 35570820 DOI: 10.1177/00031348221101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND National studies have reported racial and socioeconomic disparities in gastric cancer (GC) care. The current study evaluated adequate lymph node (LN) assessment (≥16 LNs) during resection for GC within a healthcare system servicing a socioeconomically disparate, mostly non-White population in the Southeast United States. METHODS A retrospective cohort study of patients undergoing resection for GC between 2003-2019 was performed. Factors associated with adequate LN assessment including patient and tumor characteristics were analyzed. RESULTS Among 202 patients, adequate LN assessment was performed in 97 (48%) patients. On univariable analysis, younger age, non-White race, lower Charlson Comorbidity Index (CCI), Medicaid or no insurance, D1+/D2 lymphadenectomy, clinical evidence of regional LN metastases, total gastrectomy, and receipt of neoadjuvant therapy were associated with adequate LN assessment. On multivariable analysis, non-White race (OR 2.79, 95% CI 1.38-5.65), CCI <4 (OR 2.14, 95% CI 1.15-3.96), and D1+/D2 lymphadenectomy (OR 3.63, 95% CI 1.96-6.74) were the only factors independently associated with adequate LN evaluation. CONCLUSIONS In the current study, non-White race, independent of socioeconomics, was significantly associated with adequate LN assessment. Future work is necessary to improve standardization and achieve higher rates of adequate LN assessment for all patients during resection for GC.
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Affiliation(s)
- Miriam W Tsao
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Madison S Kahl
- College of Medicine, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Evan S Glazer
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Shibata
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
| | - Richa Jain
- Department of Pathology, 5416Methodist LeBonheur Healthcare, Memphis, TN, USA
| | - Ian Clark
- Department of Pathology, 5416Methodist LeBonheur Healthcare, Memphis, TN, USA
| | - Paxton V Dickson
- Department of Surgery, Division of Surgical Oncology, 12326University of Tennessee Health Science Center, Memphis, TN, USA
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Crimì F, Bao QR, Mari V, Zanon C, Cabrelle G, Spolverato G, Pucciarelli S, Quaia E. Predictors of Metastatic Lymph Nodes at Preoperative Staging CT in Gastric Adenocarcinoma. Tomography 2022; 8:1196-1207. [PMID: 35645384 PMCID: PMC9149869 DOI: 10.3390/tomography8030098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background. The aim of this study was to identify the most accurate computed-tomography (CT) dimensional criteria of loco-regional lymph nodes (LNs) for detecting nodal metastases in gastric cancer (GC) patients. Methods. Staging CTs of surgically resected GC were jointly reviewed by two radiologists, considering only loco-regional LNs with a long axis (LA) ≥ 5 mm. For each nodal group, the short axis (SA), volume and SA/LA ratio of the largest LN, the sum of the SAs of all LNs, and the mean of the SA/LA ratios were plotted in ROC curves, taking the presence/absence of metastases at histopathology for reference. On a per-patient basis, the sums of the SAs of all LNs, and the sums of the SAs, volumes, and SA/LA ratios of the largest LNs in all nodal groups were also plotted, taking the presence/absence of metastatic LNs in each patient for reference. Results. Four hundred and forty-three nodal groups were harvested during surgery from 107 patients with GC, and 173 (39.1%) were metastatic at histopathology. By nodal group, the sum of the SAs showed the best Area Under the Curve (AUC), with a sensitivity/specificity of 62.4/72.6% using Youden’s index with a >8 mm cutoff. In the per-patient analysis, the sum of the SAs of all LNs in the loco-regional nodal groups showed the best AUC with a sensitivity/specificity of 65.6%/83.7%, using Youden’s index with a >39 mm cutoff. Conclusion. In patients with GC, the sum of the SAs of all the LNs at staging CT is the best predictor among dimensional LNs criteria of both metastatic invasion of the nodal group and the presence of metastatic LNs.
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Affiliation(s)
- Filippo Crimì
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (F.C.); (C.Z.); (G.C.); (E.Q.)
| | - Quoc Riccardo Bao
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences-DISCOG, University of Padova, 35128 Padova, Italy; (Q.R.B.); (V.M.); (S.P.)
| | - Valentina Mari
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences-DISCOG, University of Padova, 35128 Padova, Italy; (Q.R.B.); (V.M.); (S.P.)
| | - Chiara Zanon
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (F.C.); (C.Z.); (G.C.); (E.Q.)
| | - Giulio Cabrelle
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (F.C.); (C.Z.); (G.C.); (E.Q.)
| | - Gaya Spolverato
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences-DISCOG, University of Padova, 35128 Padova, Italy; (Q.R.B.); (V.M.); (S.P.)
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences-DISCOG, University of Padova, 35128 Padova, Italy; (Q.R.B.); (V.M.); (S.P.)
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (F.C.); (C.Z.); (G.C.); (E.Q.)
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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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The type of gastrectomy affects skeletal muscle loss and the long-term outcomes of elderly patients with gastric cancer: a retrospective study using computed tomography images. Surg Today 2021; 52:812-821. [PMID: 34837102 DOI: 10.1007/s00595-021-02414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Sarcopenia is common in elderly gastrectomized patients and a known risk factor for postoperative complications and poor overall survival. However, the long-term outcomes of skeletal muscle loss after gastrectomy and the differences in outcomes of different gastrectomy procedures remain unclear. METHODS The subjects of this retrospective study were 136 patients who underwent various gastrectomy procedures for early gastric cancer, namely: total gastrectomy (TG; n = 20), proximal gastrectomy (PG; n = 16), distal gastrectomy (DG; n = 60), and pylorus-preserving gastrectomy (PPG; n = 40). Skeletal muscle volume (SMV), calculated as the skeletal muscle index (SMI), was measured using cross-sectional computed tomography (CT) scans preoperatively and then 1, 2, and 3 years after gastrectomy. RESULTS Sarcopenia developed from 2 years onwards in all the patients who underwent TG. The SMI and sarcopenia prevalence after gastrectomy deteriorated over time. Multivariate analysis revealed that TG and PG were significant risk factors for skeletal muscle loss in postoperative years 1 and 3. A decrease in the SMI after TG or PG was most remarkable in elderly patients. CONCLUSIONS The type of gastrectomy affects skeletal muscle loss in the long term. Elderly patients who undergo TG or PG are at high risk of severe skeletal muscle loss.
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27
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Zhu X, Zhou G, Ma M, Hou D, Huang H, Jiang X, Xing PhD C. Clinicopathological Analysis and Prognostic Assessment of TCN1 in Patients with Gastric Cancer. Surg Innov 2021; 29:557-565. [PMID: 34549663 DOI: 10.1177/15533506211045318] [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] [Indexed: 01/21/2023]
Abstract
BACKGROUND Stomach cancer is the fourth most common type of cancer worldwide. TCN1 mainly encodes the vitamin B12 transporter, transcobalamin. TCN1 is a marker of gastrointestinal tumor progression, but the impact of TCN1 on survival is unclear. MATERIAL/METHODS Gastrointestinal tumor records were reviewed and analyzed, clinicopathological data were summarized, immunohistochemical detection of TCN1 was performed again, and the protein expression in tumor tissue, non-tumor tissue, and lymph nodes was semi-quantitatively analyzed. Patients were followed up for 5 years to determine the 5-year survival rates. RESULTS The strong immune reactivity of the TCN1 protein was significantly correlated with tumor invasion depth, regional lymph nodes, and a tumor diameter of >5 cm (Z = -2.531 and P = .016; Z = 3.785 and P < .001; Z = 2.541 and P = .049). Kaplan-Meier survival analysis showed that the total survival time of patients in the low-expression TCN1 group was significantly longer than that in the high-expression TCN1 group (P = .001; Table 2 and Figure 5). The mean survival time of all patients was 49.774 months (95% CI: 47.871-51.676; Table 4) and the 5-year overall survival rates were 73.3, 50.8, and 34.0%, respectively. Multivariate analysis revealed that regional lymph nodes (HR = 1.253; 95% CI: 1.031-1.747, P = .012), TCN1 immune expression status (HR = 2.707; 95% CI: 1.068-1.886, P = .016), and pTNM staging (HR = 2.293; 95% CI: 1.583-3.321; P = .001) were independent risk factors for poor survival. CONCLUSION The high expression of TCN1 in gastric tumor tissues was found to be associated with the clinicopathological factors of patients, and the high expression of TCN1 was shown to indicate a poor clinical prognosis.
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Affiliation(s)
- Xinqiang Zhu
- Department of General Surgery, 105860The Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Gang Zhou
- Department of Gastroenteropancreatic Surgery, 579164The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Meimei Ma
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Daorong Hou
- Key Laboratory of Animal Research Affiliated to Nanjing Medical University, Nanjing, China
| | - Hailong Huang
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Xuetong Jiang
- Department of General Surgery, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Chungen Xing PhD
- Department of General Surgery, 105860The Second Affiliated Hospital of Soochow University, Suzhou, China
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Teh SH, Uong S, Lin TY, Shiraga S, Li Y, Gong IY, Herrinton LJ, Li RA. Clinical Outcomes Following Regionalization of Gastric Cancer Care in a US Integrated Health Care System. J Clin Oncol 2021; 39:3364-3376. [PMID: 34339289 DOI: 10.1200/jco.21.00480] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In 2016, Kaiser Permanente Northern California regionalized gastric cancer care, introducing a regional comprehensive multidisciplinary care team, standardizing staging and chemotherapy, and implementing laparoscopic gastrectomy and D2 lymphadenectomy for patients eligible for curative-intent surgery. This study evaluated the effect of regionalization on outcomes. METHODS The retrospective cohort study included gastric cancer cases diagnosed from January 2010 to May 2018. Information was obtained from the electronic medical record, cancer registry, state vital statistics, and chart review. Overall survival was compared in patients with all stages of disease, stage I-III disease, and curative-intent gastrectomy patients using annual inception cohorts. For the latter, the surgical approach and surgical outcomes were also compared. RESULTS Among 1,429 eligible patients with gastric cancer with all stages of disease, one third were treated after regionalization, 650 had stage I-III disease, and 394 underwent curative-intent surgery. Among surgical patients, neoadjuvant chemotherapy utilization increased from 35% to 66% (P < .0001), laparoscopic gastrectomy increased from 18% to 92% (P < .0001), and D2 lymphadenectomy increased from 2% to 80% (P < .0001). Dissection of ≥ 15 lymph nodes increased from 61% to 95% (P < .0001). Surgical complication rates did not appear to increase after regionalization. Length of hospitalization decreased from 7 to 3 days (P < .001). Overall survival at 2 years was as follows: all stages, 32.8% pre and 37.3% post (P = .20); stage I-III cases with or without surgery, 55.6% and 61.1%, respectively (P = .25); and among surgery patients, 72.7% and 85.5%, respectively (P < .03). CONCLUSION Regionalization of gastric cancer care within an integrated system allowed comprehensive multidisciplinary care, conversion to laparoscopic gastrectomy and D2 lymphadenectomy, increased overall survival among surgery patients, and no increase in surgical complications.
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Affiliation(s)
- Swee H Teh
- The Permanente Medical Group, Gastric Surgery, Northern California, Oakland, CA
| | - Stephen Uong
- Division of Research, Kaiser Permanente, Oakland, CA
| | - Teresa Y Lin
- Division of Research, Kaiser Permanente, Oakland, CA
| | - Sharon Shiraga
- The Permanente Medical Group, Gastric Surgery, Northern California, Oakland, CA
| | - Yan Li
- The Permanente Medical Group, Gastrointestinal Oncology, Northern California, Oakland, CA
| | - I-Yeh Gong
- The Permanente Medical Group, Gastrointestinal Oncology, Northern California, Oakland, CA
| | | | - Robert A Li
- The Permanente Medical Group, Gastric Surgery, Northern California, Oakland, CA
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Aiolfi A, Lombardo F, Matsushima K, Sozzi A, Cavalli M, Panizzo V, Bonitta G, Bona D. Systematic review and updated network meta-analysis of randomized controlled trials comparing open, laparoscopic-assisted, and robotic distal gastrectomy for early and locally advanced gastric cancer. Surgery 2021; 170:942-951. [PMID: 34023140 DOI: 10.1016/j.surg.2021.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/15/2021] [Accepted: 04/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of minimally invasive surgery for the treatment of early and locally advanced gastric cancer remains controversial. The purpose of this study was to perform a comprehensive evaluation of major surgical approaches for operable distal gastric cancer. METHODS Systematic review and network meta-analyses of randomized controlled trials were performed to compare open distal gastrectomy, laparoscopic-assisted distal gastrectomy, and robotic distal gastrectomy. Risk ratio, weighted mean difference, and 95% credible intervals were used as pooled effect size measures. RESULTS Seventeen randomized controlled trials (5,909 patients) were included. Overall, 2,776 (46.8%) underwent open distal gastrectomy, 2,964 (50.1%) laparoscopic-assisted distal gastrectomy, and 141 (3.1%) robotic distal gastrectomy. Among these 3 groups, there were no significant differences in 30-day mortality, anastomotic leak, and overall complications. Compared to open distal gastrectomy, laparoscopic-assisted distal gastrectomy was associated with significantly reduced intraoperative blood loss, early postoperative pain, time to first flatus, and hospital length of stay. Similarly, robotic distal gastrectomy was associated with significantly reduced blood loss and time to first flatus compared to open distal gastrectomy. No differences were found in the total number of harvested lymph nodes, tumor-free resection margins, 5-year overall, and disease-free survival. The subgroup analysis in locally advanced gastric cancer showed trends toward reduced blood loss, time to first flatus, and hospital length of stay with minimally invasive approaches but similar overall and disease-free survival. CONCLUSION Laparoscopic-assisted distal gastrectomy and robotic distal gastrectomy performed by well-trained experienced surgeons, even in the setting of locally advanced gastric cancer, seem associated with improved short-term outcomes with similar overall and disease-free survival compared with open distal gastrectomy.
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Affiliation(s)
- Alberto Aiolfi
- Department of Biomedical Science for Health, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy.
| | - Francesca Lombardo
- Department of Biomedical Science for Health, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA
| | - Andrea Sozzi
- Department of Biomedical Science for Health, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Marta Cavalli
- Department of Biomedical Science for Health, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Valerio Panizzo
- Department of Biomedical Science for Health, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, University of Milan, Istitituto Clinico Sant'Ambrogio, Milan, Italy
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The development and external validation of a nomogram predicting overall survival of gastric cancer patients with inadequate lymph nodes based on an international database. Int J Clin Oncol 2021; 26:867-874. [PMID: 33788042 DOI: 10.1007/s10147-021-01875-2] [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: 05/28/2020] [Accepted: 01/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inadequate sampling of lymph nodes could lead to stage migration and indicate a poor prognosis for gastric cancer after curative surgery. Some emerging novel predictors and the application of a nomogram could increase the accuracy of survival prediction. METHODS An international database regarding gastric cancer was employed as the primary cohort. The patients with inadequate (< 30) lymph nodes (LN) were analyzed by Cox proportional hazards regression. Based on the selected model, a nomogram was plotted and calibrated against an external validation database. RESULTS A total of 1109 patients were included in the primary cohort, and there were 6584 patients in the validation cohort. There were significant differences regarding the clinical characteristics between the two cohorts. The model containing age, T stages, N stages, metastatic lymph nodes (mLN), and the number of total LN retrieved (TLN) showed superiority over the conventional TNM stages. Harrell's concordance index of the nomogram and TNM stages was 0.744 and 0.717, respectively. The external validation demonstrated a good concordance with the nomogram-predicted survival. CONCLUSIONS The nomogram including age, T stages, N stages, mLN, and TLN had a better accuracy than the conventional TNM staging system in predicting overall survival for gastric cancer patients with inadequate (< 30) LN.
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31
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Zhao RS, Liu YN, Dai WG, Chen SL, Ye JN, Zhai ET, Cai SR, Chen JH. A Substage Increase in The AJCC Classification System Improves Prognostic Prediction in Stage III Gastric Cancer With Insufficient Lymph Nodes Removed. Front Oncol 2021; 11:624413. [PMID: 33763360 PMCID: PMC7982898 DOI: 10.3389/fonc.2021.624413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/11/2021] [Indexed: 01/03/2023] Open
Abstract
Background The impact of lymph nodes (LNs) removed on the survivals of patients with stage III gastric cancer, especially on that of those who undergo the adjuvant chemotherapy as a compensation for a possibly insufficient lymphadenectomy, is still unclear. Methods Consecutive patients (n = 488) with stage III gastric cancer under R0 curative resection followed by adjuvant chemotherapy were analyzed. The overall survival (OS) was compared between patients with insufficient LNs removed (ILNr, <16 LNs) and sufficient LNs removed (SLNr, ≥16 LNs). Performance of the prediction systems was evaluated using the Likelihood ratio χ2 test, Akaike information criterion (AIC), Harrell’s concordance index (C-index), and area under the receiver operating characteristic curves (AUC). Results The OS of patients were significantly longer in those with SLNr relative to those with ILNr (for stage IIIA, 68.2 vs. 43.2 months, P = 0.042; for stage IIIB, 43.7 vs. 24.9 months, P < 0.001; for stage IIIC, 23.9 vs. 8.3 months, P < 0.001; and for total stage III, 37.7 vs. 21.7 months, P < 0.001). However, the OS were similar between stage IIIA patients with ILNr and stage IIIB patients with SLNr (P = 0.928), between IIIB patients with ILNr and IIIC patients with SLNr (P = 0.962), and IIIC patients with ILNr and stage IV (P = 0.668), respectively. A substage increase in the AJCC classification system, from IIIA to IIIB, from IIIB to IIIC, and from IIIC to IV in patients with ILNr, enhanced the accuracy of prognostic prediction in patients with stage III gastric cancer compared to the current TNM system (Likelihood ratio χ2, 188.6 vs. 184.8; AIC, 4336.4 vs. 4340.6; C-index, 0.695 vs. 0.679, P = 0.002). The ROC curves revealed that the performance of prognostic prediction was better in the new prediction system (AUC = 0.699) compared with the current TNM system (AUC = 0.676). Conclusions ILNr (LNs <16) impairs the long-term outcomes of stage III gastric cancer underwent adjuvant chemotherapy. The status of LNs removal adds values to the current TNM system in prognostic prediction of stage III gastric cancer.
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Affiliation(s)
- Ri-Sheng Zhao
- Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yi-Nan Liu
- Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Wei-Gang Dai
- Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Si-Le Chen
- Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Jin-Ning Ye
- Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Er-Tao Zhai
- Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Shi-Rong Cai
- Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Jian-Hui Chen
- Division of Gastrointestinal Surgery Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Gastric Cancer Center, Sun Yat-sen University, Guangzhou, China
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Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection. Sci Rep 2021; 11:2022. [PMID: 33479327 PMCID: PMC7820341 DOI: 10.1038/s41598-021-81663-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/18/2020] [Indexed: 12/28/2022] Open
Abstract
The staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. The patients were divided into four groups on the basis of the NR cutoffs: rN0: 0; rN1: > 0 and ≤ 1/6; rN2: > 1/6 and ≤ 1/2; and rN3: > 1/2. The 5-year overall survival (OS) rates for rN0, rN1, rN2, and rN3 were 84.3%, 64.7%, 31.5%, and 12.7%, respectively. Multivariable analyses revealed that tumor size (p = 0.005), lymphovascular invasion (p = 0.023), and NR (p < 0.001), but not pN stage (p = 0.682), were independent factors for OS. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, thus predicting the prognosis of RGC patients more accurately.
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33
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Huang L, Zhang X, Wei Z, Xu A. Importance of Examined Lymph Node Number in Accurate Staging and Enhanced Survival in Resected Gastric Adenocarcinoma-The More, the Better? A Cohort Study of 8,696 Cases From the US and China, 2010-2016. Front Oncol 2021; 10:539030. [PMID: 33585181 PMCID: PMC7874152 DOI: 10.3389/fonc.2020.539030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 11/23/2020] [Indexed: 01/19/2023] Open
Abstract
Background While most guidelines advocate D2 lymphadenectomy for non-metastatic gastric adenocarcinoma (nmGaC), it is not always performed as standard of care outside East Asia. The recommended minimal examined lymph node (ELN) count in nmGaC to stage cancer accurately varies largely across guidelines, and the optimal count to satisfactorily stratify patient survival has yet to be determined. This large cohort study aimed at robustly defining the minimal and optimal thresholds of examined lymph node (ELN) number in non-metastatic gastric adenocarcinoma (nmGaC). Methods Data on nmGaC patients operated in 2010–2016 and surviving ≥3 months were retrieved from the US SEER-18 Program and a Chinese multi-institutional gastric cancer database (MIGC). The correlation of ELN count with stage migration and patient survival were quantified with the use of the multivariable-adjusted logistic and proportional hazards Cox models, respectively. The sequences of odds ratios (ORs) and hazard ratios (HRs) for each additional ELN were smoothed, and the structural breakpoints were determined. Results Together 7,228 patients from the US and 1,468 from China were analyzed, encompassing 23,114 person-years of follow-up. The mean ELN count was 20 in the US and 30 in China. With more ELNs, both cohorts significantly showed proportional increases from lower to higher nodal stage (ORSEER = 1.03, 95%-CI = 1.03–1.04; ORMIGC = 1.02, 95%-CI = 1.02–1.03) and sequential enhancements in postoperative survival (HRSEER = 0.97, 95%-CI = 0.97–0.97; HRMIGC = 0.98, 95%-CI = 0.97–0.99). Correlations for both stage migration and survival were still significant in most subgroups by patient, cancer, and management factors. Breakpoint analyses revealed a minimum threshold ELN count of 17 and an optimum count of 33, which were validated in both cohorts with good efficacy to differentiate probabilities of both stage migration and survival. Conclusion In resected nmGaC patients with anticipated survival ≥3 months, more ELNs are correlated with more accurate staging, which may partly explain the survival correlation. This observational investigation does not indicate causality. Our findings robustly conclude 17 ELNs as the minimum and propose 33 ELNs as the optimum thresholds, to assess the quality of lymph node examination and to stratify postsurgical survival.
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Affiliation(s)
- Lei Huang
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyue Zhang
- Department of Academic Research, Hefei City First People's Hospital, Hefei, China
| | - Zhijian Wei
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Aman Xu
- Department of General Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China
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Narayan RR, Poultsides GA. Advances in the surgical management of gastric and gastroesophageal junction cancer. Transl Gastroenterol Hepatol 2021; 6:16. [PMID: 33409410 DOI: 10.21037/tgh.2020.02.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/15/2020] [Indexed: 12/21/2022] Open
Abstract
Since Theodore Billroth and Cesar Roux perfected the methods of post-gastrectomy reconstruction in the late 19th century, surgical management of gastric and gastroesophageal cancer has made incremental progress. The majority of patients with localized disease are treated with perioperative combination chemotherapy or neoadjuvant chemoradiation. Staging laparoscopy before initiation of treatment or before surgical resection has improved staging accuracy and can drastically inform treatment decisions. The longstanding and contentious debate on the optimal extent of lymph node dissection for gastric cancer appears to have settled in favor of D2 dissection with the recently published 15-year follow-up of the Dutch randomized trial. Minimally invasive gastric and gastroesophageal resections are performed routinely in most centers affording faster recovery and equivalent oncologic outcomes. Pylorus-preserving distal (central) gastrectomy has emerged as a less invasive, function-preserving option for T1N0 middle-third gastric cancers, while randomized data on its oncologic adequacy are pending. Multi-visceral resections and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy has been utilized selectively for patients with locally advanced tumors who have demonstrated disease control on preoperative chemotherapy. This review summarizes the current standard of surgical care for gastroesophageal junction and gastric cancer as well as highlights recent and upcoming advances to the field.
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Affiliation(s)
- Raja R Narayan
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - George A Poultsides
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Moslim MA, Minarich MJ, Deng M, Handorf E, Greco SH, Reddy SS, Farma JM. Treatment at an Academic Cancer Center Confers Better Survival by Stage for Signet-Ring Cell and Non-signet-Ring Cell Gastric Cancer. Ann Surg Oncol 2021; 28:4423-4432. [PMID: 33393048 DOI: 10.1245/s10434-020-09424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/10/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND The literature lacks large-scale population studies comparing survival outcomes between signet-ring cell gastric carcinoma (SRGC) and non-SRGC (NSRGC) when treatment is delivered at academic versus community cancer centers. METHODS The National Cancer Database (NCDB) from 2004 to 2016 was queried to examine the association between treatment facility category and overall survival of patients who underwent gastrectomy for resectable gastric adenocarcinoma (GAC). RESULTS The study investigated 22,871 patients. Upstaging of resectable GAC to pathologic stage 4 was more evident at community centers (3.5%) than at academic centers (2.8%) for the NSRGC variant (p = 0.211), whereas it was comparable between the two facility categories for the SRGC variant (5.9% vs 6%, respectively). Patients with pathologic stage 1 or 3 NSRGC who underwent gastrectomy at academic programs had better overall survival (OS) (hazard ratio [HR], 0.68; p < 0.0001) than those who underwent gastrectomy at community centers (HR, 0.79; p < 0.0065). Similarly, patients with stage 2 SRGC had better OS when treated at academic versus community centers (HR, 0.54; p = 0.0019). No statistically significant improvement in OS was observed between patients with stage 2 NSRGC (HR, 0.84; p = 0.083) and those with stage 3 SRGC (HR, 0.78; p = 0.054) who were treated at academic centers. No survival benefit was demonstrated for stage 1 SRGC when academic and community centers were compared (p = 0.56). CONCLUSIONS This is the first study based on a large-scale database in the Western population that addressed the overall survival-by-stage of two distinct GAC histologic variants. Treatment at academic centers was associated with significant improvements in OS.
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Affiliation(s)
- Maitham A Moslim
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Michael J Minarich
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Mengying Deng
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Handorf
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Stephanie H Greco
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Sanjay S Reddy
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
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36
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Wang WA, Dong P, Zhang A, Wang WJ, Guo CA, Wang J, Liu HB. Artificial intelligence: A new budding star in gastric cancer. Artif Intell Gastroenterol 2020; 1:60-70. [DOI: 10.35712/aig.v1.i4.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/01/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023] Open
Abstract
The pursuit of health has always been the driving force for the advancement of human society, and social development will be profoundly affected by every breakthrough in the medical industry. With the arrival of the information technology revolution era, artificial intelligence (AI) technology has been rapidly developed. AI has been combined with medicine but it has been less studied with gastric cancer (GC). AI is a new budding star in GC, and its contribution to GC is mainly focused on diagnosis and treatment. For early GC, AI’s impact is not only reflected in its high accuracy but also its ability to quickly train primary doctors, improve the diagnosis rate of early GC, and reduce missed cases. At the same time, it will also reduce the possibility of missed diagnosis of advanced GC in cardia. Furthermore, it is used to assist imaging doctors to determine the location of lymph nodes and, more importantly, it can more effectively judge the lymph node metastasis of GC, which is conducive to the prognosis of patients. In surgical treatment of GC, it also has great potential. Robotic surgery is the latest technology in GC surgery. It is a bright star for minimally invasive treatment of GC, and together with laparoscopic surgery, it has become a common treatment for GC. Through machine learning, robotic systems can reduce operator errors and trauma of patients, and can predict the prognosis of GC patients. Throughout the centuries of development of surgery, the history gradually changes from traumatic to minimally invasive. In the future, AI will help GC patients reduce surgical trauma and further improve the efficiency of minimally invasive treatment of GC.
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Affiliation(s)
- Wen-An Wang
- Graduate School, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, Gansu Province, China
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Peng Dong
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730000, Gansu Province, China
| | - An Zhang
- Graduate School, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, Gansu Province, China
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Wen-Jie Wang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730000, Gansu Province, China
| | - Chang-An Guo
- Department of Emergency Medicine, Lanzhou University Second Hospital, Lanzhou 730000, Gansu Province, China
| | - Jing Wang
- Graduate School, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, Gansu Province, China
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Hong-Bin Liu
- Department of General Surgery, The 940th Hospital of Joint Logistics Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
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Cheng Y, Zhou X, Xu K, Huang J, Huang Q. Very low risk of lymph node metastasis in Epstein-Barr virus-associated early gastric carcinoma with lymphoid stroma. BMC Gastroenterol 2020; 20:273. [PMID: 32807085 PMCID: PMC7433105 DOI: 10.1186/s12876-020-01422-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
Background Epstein-Barr virus-associated early gastric carcinoma with lymphoid stroma (EBV-GCLS) is a rare variant of early gastric carcinomas. Clinicopathological features of this variant remain obscure, especially in Chinese patients. Therefore, we collected EBV-GCLS cases and studied clinicopathology and prognosis. Methods By a retrospective review of 595 consecutive radical gastrectomies for early gastric carcinoma from 2006 to 2018, we identified 8 (1.3%, 8/595) EBV-GCLS cases. Clinicopathologic characteristics were compared between EBV-GCLSs and 109 conventional early gastric carcinomas, which were divided into intramucosal, SM1, and SM2 subgroups. The latter 2 subgroups were classified according to the submucosal invasion depth below or over 500 μm. Results All 8 EBV-GCLSs occurred in male patients and invaded deep submucosa (SM2) without lymph node metastasis (LNM), four (50%) of which had synchronous non-gastric malignant tumors (3 gastric gastrointestinal stromal tumors and 1 primary clear cell renal cell carcinoma), and four (50%) arose in the proximal stomach. Compared to conventional early gastric carcinomas, EBV-GCLS was significantly more frequent with SM2 invasion, poor differentiation, and synchronous non-gastric carcinoma tumor, but not with age, gender, macroscopic type, location, size, perineural invasion, lymphovascular invasion, and pathologic stage. In invasion-depth stratified comparisons in the SM2 subgroup, the frequency of LNM in EBV-GCLS was significantly lower than that in conventional early gastric carcinomas (p < 0.05) and the 5-year survival rate of patients with EBV-GCLS was better than that with conventional early gastric carcinomas in 3 subgroups (100% vs 91.5, 85.7, 83.9%, respectively), although the differences did not reach a statistically significant level due to the small sample size. Significant differences among 4 subgroups were found in tumor grade, lymphovascular invasion, LNM, pathological stage, and synchronous tumor, but not in age, gender, macroscopic type, tumor size, location, perineural invasion. Conclusions Even with poor differentiation and SM2 invasion, EBV-GCLS showed very low risk of LNM and may be a candidate for endoscopic therapy such as endoscopic submucosal dissection.
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Affiliation(s)
- Yuqing Cheng
- Department of Pathology of the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Xiaoli Zhou
- Department of Pathology of the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Kequn Xu
- Department of Oncology of the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jin Huang
- Department of Gastroenterology of the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Qin Huang
- Department of Pathology of the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China. .,Department of Pathology and Laboratory Medicine of Veterans Affairs Boston Healthcare System, Harvard Medical School and Brigham and Women's Hospital, 1400 VFW Parkway, West Roxbury, MA, 02132, USA.
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Acevedo JJ, Restrepo J, Hernandez D, Oliveros R, Pinilla R. Treatment Alternatives for Recurrent Esophagogastric Junction Adenocarcinoma: Case Report of an Ileocolonic Reconstruction and Literature Review. Cureus 2020; 12:e9504. [PMID: 32879826 PMCID: PMC7458707 DOI: 10.7759/cureus.9504] [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] [Indexed: 11/05/2022] Open
Abstract
Esophagogastric junction tumors are a challenging pathology for surgeons and the best treatment depends on an adequate initial localization and stadification. Approximately half of patients relapse after curative surgery during the first two years. Surgical resection could increase the survival of these patients, but the esophageal reconstruction is a surgical challenge for which there are multiple reconstruction techniques described with different organs. In this report, we present the case of a patient with an esophagogastric junction tumor treated initially with total gastrectomy and esophageal margin. The patient presented an anastomotic recurrence that was taken to surgical resection, but a second recurrence required a residual esophagectomy with ileocolonic reconstruction, to achieve adequate oncologic treatment.
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Affiliation(s)
- Juan Javier Acevedo
- Gastrointestinal Surgery, Instituto Nacional De Cancerología, Universidad Militar Nueva Granada, Bogota, COL
| | - Juliana Restrepo
- Surgical Oncology, Instituto Nacional de Cancerología, Bogota, COL.,Surgical Oncology, Universidad Militar Nueva Granada, Bogota, COL
| | - Dary Hernandez
- Surgical Oncology, Instituto Nacional de Cancerología, Bogota, COL.,Oncologic Surgery, Universidad Militar Nueva Granada, Bogota, COL
| | - Ricardo Oliveros
- Gastrointestinal Surgery, Instituto Nacional de Cancerología, Bogota, COL
| | - Raúl Pinilla
- Gastrointestinal Surgery, Instituto Nacional de Cancerología, Bogota, COL
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Wang P, Deng J, Sun Z, Wang W, Wang Z, Xu H, Zhou Z, Liang H. Proposal of a novel subclassification of pN3b for improvement the prognostic discrimination ability of gastric cancer patients. Eur J Surg Oncol 2020; 46:e20-e26. [PMID: 32713746 DOI: 10.1016/j.ejso.2020.06.033] [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: 02/23/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In the recent edition of TNM staging system, pN3b gastric cancer were separated into the staging system for better prognosis accuracy. The definition of pN3b contains a large range of metastasis lymph nodes (mLNs). However, few studies have evaluated the prognosis of pN3b patients and it remains unknown whether these patients were reasonably assigned into the same substage. MATERIALS AND METHODS A total of 642 pN3b patients from a multi-institutional cohort in China were included. Disease-specific survival (DSS) was estimated using the Kaplan-Meier method and the Cox proportional hazards regression analysis was used to identify the independent prognostic factors. Restricted cubic spine model was used to specify the association between the continuous variables and the logarithm Hazard ratios (HRs). The optimal cut-off value of mLNs for DSS was identified using the X-tile software. RESULTS The 5-year DSS rate of total pN3b cohort was 15.4%. The smooth curves showed a non-linear association between the mLNs and the logarithm HRs. All pN3b gastric cancer patients were divided into two subclassifications (pN3b1: 16-24 mLNs, pN3b2: ≥25 mLNs). Significant survival difference was observed between two subclassifications (P = 0.048). Additionally, more LNs examined could decrease the death risk of pN3b patients and bring survival benefit only in pN3b1 patients, but not in pN3b2 patients. CONCLUSIONS We proposed a novel subclassification of pN3b patients, which assigned patients into two subclassifications with significant survival difference. Future study should explore the prognosis value based on this novel subclassification in TNM staging system.
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Affiliation(s)
- Pengliang Wang
- Affiliated Cancer Hospital & Institution of Guangzhou Medical University, Guangzhou, 510060, China
| | - Jingyu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Zhe Sun
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Wei Wang
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Zhenning Wang
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Huimian Xu
- Department of Surgical Oncology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China.
| | - Zhiwei Zhou
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Han Liang
- Affiliated Cancer Hospital & Institution of Guangzhou Medical University, Guangzhou, 510060, China; Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, 300060, China.
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Patti MG, Herbella FA. Indocyanine Green Tracer-Guided Lymph Node Retrieval During Radical Dissection in Gastric Cancer Surgery. JAMA Surg 2020; 155:312. [DOI: 10.1001/jamasurg.2019.6034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Marco G. Patti
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Lin JX, Desiderio J, Lin JP, Wang W, Tu RH, Li P, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Zheng CH, Zhou ZW, Parisi A, Huang CM. Multicenter Validation Study of the American Joint Commission on Cancer (8th Edition) for Gastric Cancer: Proposal for a Simplified and Improved TNM Staging System. J Cancer 2020; 11:3483-3491. [PMID: 32284744 PMCID: PMC7150461 DOI: 10.7150/jca.36891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/05/2020] [Indexed: 12/13/2022] Open
Abstract
Objective: To evaluate the prognostic significance of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging classification for gastric cancer. Methods: Prospective databases were reviewed to identify patients who underwent radical gastrectomy at two specialized eastern centers. The prognostic value of the eighth edition TNM classification was estimated and compared with that of the seventh edition. Additional external validation was performed using a dataset from a Western population. Results: Significant differences in 5-year overall survival (OS) rates were observed for each TNM stage when using the eighth edition system, and smaller Akaike information criteria (AIC) values and a higher c-statistic were observed relative to those of the seventh edition. However, the OS rates in each subgroup of stage III patients based on the eighth edition were significantly different. Patients with the same pN stage, namely, the pT4a and pT4b groups, showed similar 5-year OS (P>0.05). Based on the survival data, we propose a simplified staging system. In the improved TNM (iTNM) staging system, the subgroups of a given TNM stage do not show statistically significant differences in OS. The iTNM staging exhibits superior prognostic stratification, with lower AIC values and a higher c-statistic than the eighth edition TNM classification. Similar results were obtained with the external validation dataset from the IMIGASTRIC database. Conclusion: The prognostic prediction of the eighth edition of the AJCC TNM classification is superior to that of the seventh edition. However, it remains associated with some stage migration. The iTNM staging system permits simplification and slightly better prognostic prediction.
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Affiliation(s)
- Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jacopo Desiderio
- Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy
| | - Jun-Peng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Wei Wang
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhi-Wei Zhou
- Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Amilcare Parisi
- Department of Digestive Surgery, St. Mary's Hospital, University of Perugia, Terni, Italy
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
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Ma F, Li Y, Li W, Kang W, Liu H, Ma S, Wang B, Xie Y, Zhong Y, Chen Y, Xue L, Tian Y. Is subtotal gastrectomy feasible for the treatment of gastric stump cancer located at the anastomotic site after distal gastrectomy for benign lesions? World J Surg Oncol 2020; 18:43. [PMID: 32106866 PMCID: PMC7047362 DOI: 10.1186/s12957-020-01821-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
Background Total gastrectomy (TG) is a widely accepted procedure for treating gastric stump cancer (GSC). However, subtotal gastrectomy (SG) would benefit elective patients with GSC. The aim of this study was to clarify the safety and long-term prognosis of SG in treating GSC after distal gastrectomy for benign lesions. Methods A total of 53 patients with GSC located at the anastomotic site or gastric body between May 1999 and December 2018 at our hospital were included. In total, 21 patients underwent SG, and the remaining 24 patients underwent TG. Clinicopathological data, operative data, and overall survival (OS) were compared. Results The operative duration, estimated blood loss volume, and length of hospital stay were similar between the SG and TG groups. The postoperative complications were similar between the two groups, but no cases of anastomotic leakage were noted in the SG group. TG was associated with significantly more retrieved lymph nodes than SG (18.5 ± 11.5 vs. 10.7 ± 9.2; p = 0.017), while the number of metastatic lymph nodes did not differ between the groups (2.9 ± 3.5 vs. 1.9 ± 3.6; p = 0.329). The median survival time in the SG group was 81.0 months (95% confidence interval (CI), 68.906 to 93.094 months), which was similar to the 45.0 months (95% CI, 15.920 to 74.080 months) observed in the TG group (p = 0.236). Both univariate and multivariate analyses showed that tumor location and histological type were prognostic factors, while surgery type was not a prognostic factor. Further stratified analyses according to tumor location revealed that OS was not significantly different between the two groups among patients with tumors located at the anastomotic site, while OS in the TG group was significantly better than that in the SG group among patients with tumors located in the gastric body (p = 0.046). Conclusions The results of the current study indicate that SG is a suitable alternative surgical procedure for GSC located at the anastomotic site after distal gastrectomy for benign lesions. The short-term outcomes and long-term prognoses of SG are comparable with those of TG.
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Affiliation(s)
- Fuhai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Yang Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Weikun Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Wenzhe Kang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Hao Liu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Shuai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yibin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Yuxin Zhong
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Yingtai Chen
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yantao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing, 100021, China.
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The relationship between the number of examined lymph nodes and the efficacy of chemotherapy for gastric cancer. Surg Today 2019; 50:585-596. [PMID: 31811459 DOI: 10.1007/s00595-019-01925-3] [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: 10/02/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The purpose of this research was to investigate the relationship between the number of examined lymph nodes (eLNs) and the prognosis. METHODS A retrospective examination of reports and studies carried out at two institutions was conducted. According to TNM stages, the relationship between the number of eLNs and the prognosis was analyzed. RESULTS The 5-year disease-specific survival (DSS) of all enrolled patients was 66.3%. A multivariate analysis showed the type of gastrectomy, histologic type, perineural invasion, pT stage, pN stage, chemotherapy and eLNs to be independent prognostic markers. Additionally, with the exception of patients with stage I disease, the 5-year DSS of patients who had < 25 eLNs removed had a higher risk of having a worst prognosis compared to patients who had ≥ 25 eLNs removed. Through this study, a hypothetical TNM staging system was obtained for predicting the prognosis according to the number of eLNs. Chemotherapy was able to improve the prognosis of patients with stage III and < 25 eLNs in stage II. CONCLUSIONS Extended lymphadenectomy with a new goal of dissecting 25 LNs for the evaluation of stage II-III cancer cases is recommended. Our hypothetical TNM staging system may be able to stratify the risk more accurately compared to the current AJCC 8th system. Chemotherapy can improve the prognosis in advanced gastric cancer, but its benefit may be affected by the surgical quality.
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Gao Y, Zhang ZD, Li S, Guo YT, Wu QY, Liu SH, Yang SJ, Ding L, Zhao BC, Li S, Lu Y. Deep neural network-assisted computed tomography diagnosis of metastatic lymph nodes from gastric cancer. Chin Med J (Engl) 2019; 132:2804-2811. [PMID: 31856051 PMCID: PMC6940067 DOI: 10.1097/cm9.0000000000000532] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Artificial intelligence-assisted image recognition technology is currently able to detect the target area of an image and fetch information to make classifications according to target features. This study aimed to use deep neural networks for computed tomography (CT) diagnosis of perigastric metastatic lymph nodes (PGMLNs) to simulate the recognition of lymph nodes by radiologists, and to acquire more accurate identification results. METHODS A total of 1371 images of suspected lymph node metastasis from enhanced abdominal CT scans were identified and labeled by radiologists and were used with 18,780 original images for faster region-based convolutional neural networks (FR-CNN) deep learning. The identification results of 6000 random CT images from 100 gastric cancer patients by the FR-CNN were compared with results obtained from radiologists in terms of their identification accuracy. Similarly, 1004 CT images with metastatic lymph nodes that had been post-operatively confirmed by pathological examination and 11,340 original images were used in the identification and learning processes described above. The same 6000 gastric cancer CT images were used for the verification, according to which the diagnosis results were analyzed. RESULTS In the initial group, precision-recall curves were generated based on the precision rates, the recall rates of nodule classes of the training set and the validation set; the mean average precision (mAP) value was 0.5019. To verify the results of the initial learning group, the receiver operating characteristic curves was generated, and the corresponding area under the curve (AUC) value was calculated as 0.8995. After the second phase of precise learning, all the indicators were improved, and the mAP and AUC values were 0.7801 and 0.9541, respectively. CONCLUSION Through deep learning, FR-CNN achieved high judgment effectiveness and recognition accuracy for CT diagnosis of PGMLNs. TRIAL REGISTRATION Chinese Clinical Trial Registry, No. ChiCTR1800016787; http://www.chictr.org.cn/showproj.aspx?proj=28515.
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Affiliation(s)
- Yuan Gao
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Zheng-Dong Zhang
- Beihang University Qingdao Research Institute, Qingdao, Shandong 266100, China
| | - Shuo Li
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Yu-Ting Guo
- Beihang University Qingdao Research Institute, Qingdao, Shandong 266100, China
| | - Qing-Yao Wu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Shu-Hao Liu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Shu-Jian Yang
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Lei Ding
- Department of Medical Administration, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Bao-Chun Zhao
- Department of Follow-up Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
| | - Shuai Li
- Beihang University Qingdao Research Institute, Qingdao, Shandong 266100, China
| | - Yun Lu
- Department of General Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266555, China
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, Qingdao, Shandong 266555, China
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Rausei S, Galli F, Lianos G, Rosa F, Cossu A, Biondi A, Martignoni F, Cananzi FCM, Fumagalli U, Alfieri S, Persiani R, Quagliuolo V, D'Ugo D, Rosati R. How Should We Measure the Quality of Lymphadenectomy for Gastric Cancer? Anatomical Versus Numerical Criterion. J Gastrointest Cancer 2019; 51:887-892. [PMID: 31691087 DOI: 10.1007/s12029-019-00321-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To compare anatomical with numerical criterion to measure the quality of lymphadenectomy for gastric cancer. PATIENTS AND METHODS We analyzed 447 gastric cancer patients with resectable tumor stage (R0 resection) with at least 16 examined lymph nodes. RESULTS Of 447 patients, 82.6% underwent D2 lymphadenectomy for a median of total examined lymph nodes of 28. The 7-year disease-specific survival rate for the whole sample was 71.4%. Survival was significantly different between patients treated with D2 and D1 lymphadenectomy (77.4% versus 44.3%; p < 0.001) and between patients with total examined lymph nodes ≥ 28 and < 28 (74.5% versus 62.3%; p = 0.041). Anatomical criterion significantly differentiated 7-year survival in patients stratified according to a numerical parameter. CONCLUSION We should still consider the anatomical criterion as the best item to measure the quality of lymphadenectomy for gastric cancer.
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Affiliation(s)
- Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, VA, Italy
| | - Federica Galli
- Department of Surgery, University of Insubria, Varese, Italy
| | - Georgios Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, Greece.
| | - Fausto Rosa
- Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | - Andrea Cossu
- Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Biondi
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | | | | | | | - Sergio Alfieri
- Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | - Roberto Persiani
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | - Vittorio Quagliuolo
- Division of Surgical Oncology, Humanitas Clinical and Research Center, Rozzano, MI, Italy
| | - Domenico D'Ugo
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | - Riccardo Rosati
- Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy
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Villano AM, Zeymo A, McDermott J, Crocker A, Zeck J, Chan KS, Shara N, Kim S, Al-Refaie WB. Evaluating Dissemination of Adequate Lymphadenectomy for Gastric Cancer in the USA. J Gastrointest Surg 2019; 23:2119-2128. [PMID: 30788715 DOI: 10.1007/s11605-019-04138-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/23/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Adequate lymphadenectomy (AL) of 15+ lymph nodes comprises an important component of gastric cancer surgical therapy. Despite endorsement by the National Comprehensive Cancer Network and the Committee on Cancer, initial adoption of this paradigm has been relatively slow. The current analysis sought to perform an adjusted time-trend evaluation of the factors associated with AL and its dissemination. METHODS Utilizing the 2004-2015 National Cancer Database, 28,985 patients were identified who underwent gastrectomy for adenocarcinoma. An adjusted time-trend analysis was performed to estimate the adoption of AL overall. Multivariable logistic regression was utilized to assess factors associated with these observed trends. Interactions and stratified models determined disparate effects in vulnerable populations (older adults, ethnic minorities, low socioeconomic status). RESULTS The adjusted time-trend analysis demonstrated an overall 30% increase (28.8 to 58.7%) in receipt of AL (OR 1.10 increase/year; 95%CI 1.09-1.10) from 2004 to 2015. This trend persisted even after stratifying the models by age, race/ethnicity, and income (OR 1.07-1.12; p < 0.05). Slowest rates of adoption were seen amongst hospitals in the Midwest census region (OR 1.08, CI 1.06-1.90) and comprehensive community hospitals (OR 1.08, CI 1.06-1.91) and with African-American patients (OR 1.09, CI 1.06-1.11) (all p < 0.05). CONCLUSION This multi-center evaluation demonstrates increased adoption of AL during gastric cancer surgery in the USA overall and amongst vulnerable populations, although regional and racial disparities were observed. Future studies are needed to investigate reasons underlying racial and regional differences in receipt of AL.
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Affiliation(s)
- Anthony M Villano
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA.,Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC, USA
| | - Alexander Zeymo
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA.,MedStar Health Research Institute, Hyattsville, MD, USA
| | - James McDermott
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA
| | - Andrew Crocker
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA
| | - Jay Zeck
- Department of Pathology, MedStar-Georgetown University Hospital, Washington, DC, USA
| | - Kitty S Chan
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA.,MedStar Health Research Institute, Hyattsville, MD, USA
| | - Nawar Shara
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC, USA.,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC, USA
| | - Sunnie Kim
- Department of Hematology-Oncology, MedStar-Georgetown University Hospital, Washington, DC, USA
| | - Waddah B Al-Refaie
- MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC, USA. .,Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC, USA. .,MedStar Health Research Institute, Hyattsville, MD, USA. .,Department of Surgery, MedStar Georgetown University Hospital and Georgetown Lombardi Comprehensive Cancer Center, 3800 Reservoir Rd., NW, PHC Building, 4th Floor, Washington, DC, 20007, USA.
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Khanjani N, Mirzaei S, Nasrolahi H, Hamedi SH, Mosalaei A, Omidvari S, Ahmadloo N, Ansari M, Sobhani F, Mohammadianpanah M. Insufficient lymph node assessment in gastric adenocarcinoma. J Egypt Natl Canc Inst 2019; 31:2. [PMID: 32372269 DOI: 10.1186/s43046-019-0004-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study aimed to investigate the sufficient (≥ 16) lymph node assessment in 449 patients with gastric adenocarcinoma and literature review. METHODS Four hundred and forty-nine patients with pathologically confirmed locoregional invasive gastric adenocarcinoma from 2004 to 2013 were included. A standard surgical resection was performed for all the patients with (n = 16) or without (n = 433) neoadjuvant treatment. RESULTS In this study, 301 men and 148 women with a median age of 58 (range 21-88) years were included. The median total numbers of examined lymph nodes were 9 (range 0-55). Ninety-five patients (21.2%) had adequate (≥ 16) lymph node examination, and 70 patients (15.6%) had no examined lymph nodes. In univariate analysis, total or near total gastrectomy (P < 0.001), advanced node stage (P < 0.001), primary tumor size > 6 cm (P < 0.001), and the presence of perineural invasion (P = 0.039) were associated with more average number of examined lymph nodes. On multivariate analysis, node stage (P < 0.001) and type of surgery (P = 0.008) were independent predictive factors. CONCLUSION In this study, approximately one in five patients with gastric adenocarcinoma had sufficient lymph node assessment. More studies are suggested for identifying a true inadequate lymph node dissection from insufficient lymph node assessment.
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Affiliation(s)
- Nezhat Khanjani
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepideh Mirzaei
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nasrolahi
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hasan Hamedi
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Mosalaei
- Shiraz Institute for Cancer Research, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shapour Omidvari
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Ahmadloo
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansour Ansari
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Sobhani
- Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
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Gao Y, Hu J, Zhang X, Zhang M, Wang D, Zheng X, Liu S, Lu Y. Use of Hisense Computer-Assisted Surgery System Enhances Infrapyloric Lymph Node Dissection for Gastric Cancer. J Surg Res 2019; 242:31-39. [DOI: 10.1016/j.jss.2019.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 12/20/2022]
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Li S, Gu L, Shen Z, Mao D, Khadaroo PA, Su H. A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer. BMC Surg 2019; 19:117. [PMID: 31438918 PMCID: PMC6704512 DOI: 10.1186/s12893-019-0584-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/14/2019] [Indexed: 12/11/2022] Open
Abstract
Background In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial. Methods The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library. Results The results showed no significant difference in the anastomotic stenosis (OR = 0.91, 95%CI = 0.33–2.50, p = 0.85) and reflux esophagitis (OR = 1.87, 95%CI = 0.62–5.65, p = 0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR = 0.06, 95%Cl = 0.01–0.59, p = 0.02). Conclusions Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis. Electronic supplementary material The online version of this article (10.1186/s12893-019-0584-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shengnan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, Zhejiang, 315010, China
| | - Zefeng Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
| | - Parikshit A Khadaroo
- Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Hui Su
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Northwest Street 41, Haishu District, Ningbo, Zhejiang, 315010, China. .,Department of General Surgery, The first Affiliated Hospital of Jinan University, Huangpu Road West 613, Tianhe District, Guangzhou, 510630, Guangdong, China.
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50
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Ali H, Sharif M, Yasmin M, Rehmani MH, Riaz F. A survey of feature extraction and fusion of deep learning for detection of abnormalities in video endoscopy of gastrointestinal-tract. Artif Intell Rev 2019. [DOI: 10.1007/s10462-019-09743-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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