Short-term postoperative outcomes of gastric adenocarcinoma patients treated with curative intent in low-volume centers (original) (raw)
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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)
Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lym...
European Journal of Surgical Oncology (EJSO), 2017
Background: Gastrectomy represents the main treatment for gastric adenocarcinoma. This procedure is associated with substantial morbidity and mortality. The aim of this study was to evaluate the postoperative mortality changes across the study period and to identify predictive factors of 30-day mortality after elective gastrectomy for gastric cancer. Methods: This was a retrospective cohort study of a prospective database from a single centre. Patients treated with an elective gastrectomy from 1996 to 2014 for gastric adenocarcinoma were included. We compared postoperative mortality between four time periods: 1996e2000, 2001e2005, 2006e2010, and 2011e2014. Univariate and multivariate analyses were applied to identify predictors of 30day postoperative mortality. Results: We included 1066 patients (median age 65 years; 67% male). The 30-day mortality rate was 4.7%. Mortality decreased across the four time periods; from 6.5% to 1.8% (P ¼ 0.022). In the univariate analysis, age, ASA score, albumin <3.5, multivisceral resection, splenectomy, intrathoracic esophagojejunal anastomosis, R status, and T status were significantly associated with postoperative mortality. In the multivariate analysis, ASA class 3 (OR 10.06; CI 1.97e51.3; P ¼ 0.005) and multivisceral resection (OR 1.6; CI 1.09e2.36; P ¼ 0.016) were associated with higher postoperative 30-day mortality; surgery between 2011 and 2014 was associated with lower postoperative 30day mortality (OR 0.55; CI 0.33e0.15; P ¼ 0.030). Conclusion: There was a decrease in postoperative 30-day mortality during this 18-year period at our institution. We have identified ASA score and multivisceral resection as predictors of 30-day mortality for elective gastrectomy for cancer.
Determinants of surgical morbidity in gastric cancer treatment
Journal of the American …, 2008
BACKGROUND: The occurrence of early surgical complications after gastrectomy as a treatment for gastric cancer has been reported to have a negative impact on longterm survival. The aim of this study was to identify treatment-related factors that can predict morbidity and mortality in patients undergoing operations for gastric cancer. STUDY DESIGN: The charts of 388 patients who underwent different operations for gastric cancer at A Gemelli , were reviewed. Patients were grouped according to the type of surgical treatment performed.
Polski przeglad chirurgiczny, 2011
The aim of the study was to analyze epidemiologic parameters, treatment-related data and prognostic factors in the management of gastric cancer patients of a university surgical center under conditions of routine clinical care before the onset of the era of multimodal therapies. By analyzing our data in relation with multi-center quality assurance trials [German Gastric Cancer Study - GGCS (1992) and East German Gastric Cancer Study - EGGCS (2004)] we aimed at providing an instrument of internal quality control at our institution as well as a base for comparison with future analyses taking into account the implementation of evolving (multimodal) therapies and their influence on treatment results. Retrospective analysis of prospectively gathered data of gastric cancer patients treated at a single institution during a defined 10-year time period with multivariate analysis of risk factors for early postoperative outcome. From 04/01/1993 through 03/31/2003, a total of 328 gastric cancer...
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.
Journal of Gastrointestinal Cancer, 2020
Background and Aims: Although the number of gastric cancer patients aged !85 years indicated for endoscopic submucosal dissection (ESD) has increased, little is known about the outcomes and prognostic factors. This study aimed to investigate the clinical outcomes and prognostic factors for overall survival (OS) of patients aged !85 years who underwent ESD for gastric cancer. Methods: We retrospectively reviewed 108 patients aged !85 years with 149 gastric cancers treated by ESD between 1999 and 2014 at our institution. The clinical outcomes and prognosis were evaluated. Furthermore, the relationships between patient and lesion characteristics with OS were determined using the Kaplan-Meier method and a Cox proportional hazards model. Results: All patients had Eastern Cooperative Oncology Group performance status (PS) of 0 to 1. En bloc, R0, and curative resections were achieved in 98.0%, 91.3%, and 72.7%, respectively, without severe adverse events requiring surgery. During a median follow-up period of 40.2 months (range, 1.8-108.7 months), 23 patients died, including 2 of gastric cancer. The 3-year (54.3% vs 95.9%) and 5-year (54.3% vs 76.3%) OS rates were significantly lower in patients with a low (<44.6) as opposed to a higher (!44.6) prognostic nutritional index (PNI) (P < .001). The PNI was independently prognostic of OS (hazard ratio, 7.0; 95% confidence interval, 2.2-22.9; P Z .001). Conclusions: ESD is feasible for gastric cancer patients aged !85 years with good PS. However, low PNI was found to be prognostic of reduced OS, indicating the need to evaluate the PNI in determining whether to perform ESD.
Surgical Outcomes and Early Postoperative Complications in Locally Advanced Gastric Cancer
Acta Oncologica Turcica, 2011
Batı ülkelerinde saptanan mide kanserlerinin %60-65'i tanı anında lokal ileri evrededirler. Bu hastalara uygulanan genişletilmiş rezeksiyonlar komplikasyon riskini arttırabilir. Bu çalışmanın amacı lokal ileri evre mide kanserlerinde rezektabilite, erken dönem mortalite ve morbidite oranlarını saptamaktır. Hastalar ve Yöntem: Ocak 2002 ile Eylül 2006 tarihleri arasında rezeksiyon uygulanan non-metastatik, lokal ileri evre mide kanserli hastalarımız geriye dönük olarak incelendi. Bulgular: Komşu organ invazyonu nedeni ile 110 hastaya (%49.8) ek organ rezeksiyonu uygulanmıştı. Yüz seksen bir hastaya (%82) R0, 29 hastaya (%13) R1 ve 11 hastaya (%5) R2 rezeksiyon yapılabilmişti. Tüm serinin morbidite ve mortalite oranları sırasıyla %21.7 ve %4.5 olarak bulundu. İkiden fazla ek organ rezeksiyonu (p=0.001), 2 üniteden fazla kan transfüzyonu (p=0.001) ve düşük protein seviyeleri (p=0.008) multivaryant analizlerde komplikasyon oranlarını arttıran parametreler olarak saptandı. İki veya daha fazla ek organ rezeksiyonu (p=0.001), kardiyovasküler ve respiratuar komorbidite (p=0.002) ve total gastrektomi uygulanması (p=0.028) mortaliteyi arttıran faktörler olarak bulundu. Sonuç: Neo-adjuvan tedavi uygulanmayan lokal ileri evre mide kanserli hastalarda ek organ rezeksiyonu oranları yüksektir ve bu durum morbidite ve mortalite oranlarını arttırır. Total gastrektomi mortaliteyi arttıran bir faktör olarak belirlenmiş ancak D2 diseksiyonun bu hastalarda güvenle uygulanabileceği sonucuna varılmıştır. Anahtar kelimeler: Komplikasyon; Lokal ileri evre mide kanseri; Morbidite; Mortalite ABSTRACT Objective: In Western world, 60 to 65% of the gastric cancer cases are in locally advanced stage at the time of diagnosis. Extended resections may increase the risk of complications in these patients. The aim of this study was to investigate the resectability, early morbidity and mortality rates for locally advanced gastric cancer. Patients and Methods: Non-metastatic locally advanced gastric cancer patients who underwent resection between January 2002 and September 2006 were analyzed retrospectively. Results: One hundred and ten patients (49.8%) had additional organ resection due to adjacent organ involvement. R0 resection was performed in 181 patients (82%), R1 resection in 29 patients (13%), and R2 resection in 11 patients (5%). The morbidity and mortality rates of the all series were 21.7% and 4.5% respectively. According to multivariate analysis more than two additional organ resections (p=0.001), erythrocyte transfusions of more than 2 units (p=0.001) and low total protein levels (p=0.008) were determined as the parameters that increase complication rates. The parameters that increase mortality rates were as follows; having two or more additional organ resections (p=0.001), cardiovascular and respiratory comorbidities (p=0.002) and total gastrectomy (p=0.028). Conclusion: Additional organ resection rate of the patients with locally advanced gastric cancers that not given neo-adjuvant treatment is high and this occurrence increases the morbidity and mortality rates. Although total gastrectomy has been found to be a factor for increased mortality in locally advanced gastric cancer, D2 dissection is safe for these patients
Quality of surgery determinant for the outcome of patient with gastric cancer
Annals of Surgical Oncology, 2002
Curative surgery, the complete removal of the tumor (R0 resection), has long been considered the treatment of choice and the only treatment modality able to provide cure in localized gastric cancer. But until now, the optimal extent of this surgical resection still remains highly debated. Several factors, including tumor stage and difficulties in accurate pre-or intraoperative staging prediction, surgical complications, risks of residual disease and recurrence, as well as quality of life (QOL) differentially influence and complicate the selection of the appropriate extent of surgery.
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