The impact of the extent of surgical resection on survival of gastric cancer patients (original) (raw)
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European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2015
We assessed the impact of complications on recurrence and survival after curative gastric cancer resection. Patients undergoing R0 resections between 1990 and 2009 were identified in a prospectively maintained database and were categorized by presence of any complication Clavien-Dindo (CD) ≥ II, sepsis or intra-abdominal sepsis. Cox regression analyses to relate complications and clinico-pathological variables to time to recurrence (TTR) and overall survival (OS) were performed. A total of 271 patients were included with a median follow-up of 149.9 months (range 140.1-159.9). Complications CD ≥ II occurred in 162 (59.8%) patients, sepsis in 66 (22.5%), and intra-abdominal sepsis in 37 (13.6%). Recurrence developed in 88 (32.4%) patients. Independent predictors of short TTR were pTNM stage (IIIB-IIIC vs. IA-IIA) (hazard ratio [HR] = 37.55, 95% confidence interval [CI] 17.57-80.24; p < 0.001), D1 lymphadenectomy (HR = 3.14, 95% CI 1.94-5.07; p < 0.001), and male gender (HR = 1.6...
Langenbeck's Archives of Surgery, 2005
Recent results from long-term follow-up of a large number of patients who have undergone gastric resection for early gastric cancer (EGC) have not yet been fully evaluated. Patients and methods: A total of 848 patients who had undergone gastric resection for EGC (262 female, 586 male; mean age 58.0 years; range 20-86 years) were studied with respect to surgical technique, long-term survival and prognostic factors on the basis of current TNM classification. Results: Death related to recurrence occurred in only eight patients (0.9%). Hematogenous metastasis to the liver or bone represented the most common pattern of recurrence, developing in six of the eight recurrences (75%). The 5-year and 10-year cancer-related survival rates were 98.6% and 94.8%, respectively. The 5-year and 10-year overall survival rates were 95.2% and 85.0%, respectively. Lymph node metastasis represented an independent prognostic factor when analyzed on the basis of cancer-related survival. Conclusion: The present findings indicate that long-term survival of patients who undergo gastric resection for EGC is extremely good and that lymph node metastasis represents an independent prognostic factor when analyzed according to cancer-related survival. Future developments for the treatment of EGC are expected to improve quality of life for patients after gastric resection.
Influence of Surgery on Outcomes in Gastric Cancer
Surgical Oncology Clinics of North America, 2000
Gastric cancer is one of the most frequently occurring malignancies in the world, and in Japan it even is the most frequent malignancy. Although the incidence has declined, it still remains one of the most mortal forms of cancer in Western countries. Surgery is the only possible curative treatment, and fortunately results of gastrectomy have improved throughout the years with respect to survival, morbidity, and postoperative mortality.2,54 One of the main reasons for this improved outcome is that the identification of prognostic factors has allowed a better understanding of which patients benefit from surgery. Studies, however, on prognostic factors also have increased controversies in gastric cancer surgery. There is an ongoing discussion whether extended lymph node dissections should be performed, whether the stomach should be removed subtotally or totally, and whether pancreaticosplenectomy should be performed. With more studies at hand, the surgeon must make more decisions in order to obtain optimal results, which means an extra challenge in the surgical treatment of gastric cancer. In this article the authors present some historical data of gastric cancer treatment, and address the influence of surgery on outcomes of D1-D2 dissections, total versus subtotal gastric resection, pancreas and spleen resection, and stage and stage migration. Furthermore, the authors address the influence of patient selection, the surgeon as a prognostic factor, and learning curves on outcomes in gastric surgery. Finally the authors discuss noncurative resections and chemotherapy.
Follow-up after curative resection for gastric cancer: Is it time to tailor it?
World journal of gastroenterology, 2017
There is still no consensus on the follow-up frequency and regimen after curative resection for gastric cancer. Moreover, controversy exists regarding the utility of follow-up in improving survival, and the recommendations of experts and societies vary considerably. The main reason to establish surveillance programs is to diagnose tumor recurrence or metachronous cancers early and to thereby provide prompt treatment and prolong survival. In the setting of gastric malignancies, other reasons have been put forth: (1) the detection of adverse effects of a previous surgery, such as malnutrition or digestive sequelae; (2) the collection of data; and (3) the identification of psychological and/or social problems and provision of appropriate support to the patients. No randomized controlled trials on the role of follow-up after curative resection of gastric carcinoma have been published. Herein, the primary retrospective series and systematic reviews on this subject are analyzed and discus...
Annals of Surgical Oncology, 2014
Background. Advanced gastric cancer in the upper or middle third of the stomach is routinely treated with a total gastrectomy, albeit in some cases with higher morbidity and mortality. The aim of this study was to describe the morbimortality and survival results in total gastrectomy in a single center. Methods. This retrospective study included patients with gastric adenocarcinoma treated with a total gastrectomy at a single Brazilian cancer center between January 1988 and December 2011. Clinical, surgical, and pathology information were analyzed through time, with three 8-year intervals being established. Prognostic factors for survival were evaluated only among the patients treated with curative intent. Results. The study comprised 413 individuals. Most were male and their median age was 59 years. The majority of patients had weight loss and were classified as American Society of Anesthesiologists 2. A curative resection was performed in 336 subjects and a palliative resection was performed in 77 subjects. Overall morbidity was 37.3 % and 60-day mortality was 6.5 %. Temporal analysis identified more advanced tumors in the first 8-year period along with differences in the surgical procedure, with more limited lymph node dissections. In addition, a significant decrease in mortality was observed, from 13 to 4 %. With a median follow-up of 74 months among living patients, median survival was 56 months, and 5-year overall survival was 49.2 %. Weight loss, lymphadenectomy, tumor
Outcome of gastric cancer patients after successful gastrectomy
Cancer, 2006
BACKGROUND. The effect of the location of disease recurrence after curative (R0) gastrectomy on patient survival has not been elucidated. The authors hypothesized that the location of recurrence would have a significant influence on survival. METHODS. Medical records of all patients who received treatment for gastric cancer at The University of Texas M. D. Anderson Cancer Center between 1985 and 1998 were reviewed. Patients who underwent R0 resection for gastric cancer and subsequently developed localized (anastomotic) recurrence (LR), lymph node (regional) recurrence (NR), or distant metastases (DM) were analyzed for overall survival (OS). All study factors were entered into a Cox proportional hazards model to provide multivariate hazard ratios. The model was adjusted for the effects of primary site of recurrence, histologic grade, patient age, and location of the primary tumor. RESULTS. This retrospective analysis included 227 consecutive patients. The median survival of patients who developed NR (11 months) was similar to that of patients who developed LR (10 months), but both groups had significantly longer median survival compared with patients who developed DM (7 months; log-rank P ¼ .03). Patients who had well differentiated or moderately differentiated tumors had a longer OS (11 months) than patients who had poorly differentiated tumors (8 months; logrank P ¼.02). In this cohort, location of the primary cancer and age at recurrence had no significant impact on OS. CONCLUSIONS. The data from this study suggested that, among patients who undergo R0 gastrectomy for gastric cancer, LR and NR versus DM should be considered a valid stratification factor for randomized trials based on significant differences in survival. Determining whether this stratification should apply to histologic differentiation will require further investigation in a larger multicenter cohort.
Primary Tumor Resection and Survival in Patients with Stage IV Gastric Cancer
Journal of Gastric Cancer, 2016
The aim of this study was to determine whether surgical resection of the primary tumor contributes to survival in patients with metastatic gastric cancer. Materials and Methods: A total of 288 patients with metastatic gastric cancer from the Akdeniz University, Antalya Training and Research Hospital, and the Meram University of Konya database were retrospectively analyzed. The effect of primary tumor resection on survival of patients with metastatic gastric cancer was investigated using the log-rank test. Kaplan-Meier survival estimates were calculated. Multivariate analysis was performed using Cox proportional hazards regression modeling. Results: The median overall survival was 12.0 months (95% confidence intewrval [CI], 10.4~13.6 months) and 7.8 months (95% CI, 5.5~10.0 months) for patients with and without primary tumor resection, respectively (P<0.001). The median progression-free survival was 8.3 months (95% CI, 7.1~9.5 months) and 6.2 months (95% CI, 5.8~6.7 months) for patients with and without primary tumor resection, respectively (P=0.002). Conclusions: Non-curative gastrectomy in patients with metastatic gastric cancer might increase their survival rate regardless of the occurrence of life-threatening tumor-related complications.
European Journal of Cancer, 2001
Carcinoma of the stomach remains a major cause of death in most Western countries. The only proven effective therapy is surgery, but overall 5-year survival rates remain low after resection. In 1981, the Japanese Society for Research in Gastric Cancer (JSRGC) standardized the gastric resections and the extent of regional lymphadenectomy in accordance with specific rules (updated over the years) based on the location of the tumour and the respective regional node drainage (Kajitani, 1981). Large retrospective series from Japan of radical gastrectomy with level-2 extended lymphadenectomy (D 2 resections) have shown impressive 5-year survival rates, certainly much higher than experienced in the West (