RESUMEN
BACKGROUND: Endoscopic submucosal dissection (ESD) for gastric cancer produces an artificial ulcer, and negative effects on the surgical outcomes of additional gastrectomy after ESD are anticipated. The aim of this study is to analyze the effect of ESD on subsequent laparoscopic radical gastrectomy procedures and to compare the surgical results of post-ESD patients with the control group using propensity score (PS) methods. PATIENTS AND METHODS: From 2013 to 2018, 1446 patients underwent totally laparoscopic distal gastrectomy in our center. Among these patients, the clinicopathological factors and short-term surgical outcomes of 107 patients who underwent ESD before surgery (the ESD group) were evaluated. A 1:4 PS matching and inverse probability weighting method was utilized to compare the short-term surgical outcomes of the ESD group with those of a matched control group. RESULTS: A longer operation time was required for the patients who underwent gastrectomy earlier than 24 days after ESD than for the patients who did not. Patients whose ulcer size, due to previous ESD, exceeded 4.6 cm required longer operation times and exhibited more intraoperative blood loss than patients whose ulcer size was small. In the PS matching analysis, patients who underwent distal gastrectomy within 24 days after ESD showed more frequent postoperative morbidity than non-ESD patients. CONCLUSIONS: ESD after laparoscopic distal gastrectomy is largely safe in terms of short-term surgical outcomes, but a short interval between the two procedures and a large ESD scar can make subsequent operation difficult.
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Resección Endoscópica de la Mucosa/efectos adversos , Gastrectomía/métodos , Laparoscopía , Neoplasias Gástricas/cirugía , Anciano , Pérdida de Sangre Quirúrgica , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Puntaje de Propensión , Neoplasias Gástricas/mortalidad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: According to 8th AJCC/UICC TNM criteria, stage IIB includes pT1N3M0, pT2N2M0, pT3N1M0, and pT4aN0M0, which includes not only early gastric cancer but also locally advanced cancer. There are currently no data about whether there is any additional impact of serosal exposed cancer without nodal metastasis (pT4aN0) on patients' survival outcomes compared with other subgroups in IIB. METHODS: Patients who underwent radical gastrectomy for gastric cancer patients were enrolled, including 427 patients in stage IIB; 20 (4.68%), 104 (24.35%), 172 (40.28%), and 131 (30.67%) patients were classified as pT1N3a, pT2N2, pT3N1, and pT4aN0, respectively. Clinicopathological characteristics, recurrence pattern, and survival and recurrence rates were analyzed according to the TNM subgroups. RESULTS: Cancer-specific and relapse-free survival were significantly worse in serosal exposed cancer than in nonserosal exposed cancer in stage IIB (P = 0.019 and P = 0.015). Recurrence rate was highest in the pT4aN0 subgroup (29.0%) in stage IIB, and peritoneal metastasis was the most common pattern. Survival outcomes of the pT4aN0 subgroup were not significantly different from those of the stage IIIA or pT4aN1 subgroups. CONCLUSIONS: Patients with serosal exposed cancer without nodal metastasis shows worse cancer specific and disease-free survival with higher incidence of peritoneal metastasis than other subgroups in stage IIB. Further surveillance studies, including staging laparoscopy and active adjuvant therapy, are required in this subgroup of patients.
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Gastrectomía/mortalidad , Recurrencia Local de Neoplasia/patología , Neoplasias Peritoneales/patología , Membrana Serosa/patología , Neoplasias Gástricas/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Neoplasias Peritoneales/cirugía , Pronóstico , Estudios Retrospectivos , Neoplasias Gástricas/cirugía , Tasa de SupervivenciaRESUMEN
BACKGROUND: We sought to assess the prognostic significance of lymph node ratio (LNR) and N stage in patients undergoing D2 gastrectomy and adjuvant chemotherapy, S-1, and XELOX and to compare the efficacy of them according to LNRs and N stages to evaluate the clinical impact of using LNRs compared with using N staging. METHODS: Patients undergoing D2 gastrectomy with adequate lymph node dissection and adjuvant chemotherapy for stage II/III gastric cancer between Mar 2011 and Dec 2016 were analysed. Of the 477 patients enrolled, 331 received S-1 and 146 received XELOX. LNR groups were segregated as 0, 0-0.1, 0.1-0.25, and > 0.25 (LNR0, 1, 2, and 3, respectively). Propensity score matching (PSM) was used to minimise potential selection bias and compare DFS and OS stratified by LNRs and N stages in the two treatment groups. RESULTS: After PSM, the sample size of each group was 110 patients, and variables were well balanced. All patients had more than 15 examined lymph nodes (median 51, range 16~124). In multivariate analysis, LNR (> 0.25) and N stage (N3) showed independent prognostic value in OS and DFS, but LNR (> 0.25) showed better prognostic value. In subgroup analysis, the LNR3 group showed better 5-year DFS (20% vs 54%; HR 0.29; p = 0.004) and 5-year OS (26% vs 67%; HR 0.28; p = 0.020) in the XELOX group. The N3 group showed better 5-year DFS (38% vs 66%; HR 0.40; p = 0.004) and 5-year OS (47% vs 71%; HR 0.45; p = 0.019) in the XELOX group. Stage IIIC showed better 5-year DFS (22% vs 57%; HR 0.32; p = 0.004) and 5-year OS (27% vs 68%; HR 0.32; p = 0.009) in the XELOX group. The LNR3 group within N3 patients showed better 5-year DFS (21% vs 55%; HR 0.31; p = 0.004) and 5-year OS (27% vs 68%; HR 0.34; p = 0.018) in the XELOX group. CONCLUSIONS: LNR showed better prognostic value than N staging. LNR3, N3 and stage IIIC groups showed the superior efficacy of XELOX to that of S-1. And the LNR3 group within N3 patients showed more survival benefit from XELOX. LNR > 0.25, N3 stage and stage IIIC were the discriminant factors for selecting XELOX over S-1. TRIAL REGISTRATION: Not applicable (retrospective study).
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/cirugía , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Adulto , Anciano , Capecitabina/administración & dosificación , Quimioterapia Adyuvante , Combinación de Medicamentos , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Oxaliplatino/administración & dosificación , Ácido Oxónico/administración & dosificación , Estudios Retrospectivos , Neoplasias Gástricas/patología , Tegafur/administración & dosificación , Adulto JovenRESUMEN
BACKGROUND: The prognosis of gastric cancer patients is better in Asia than in the West. Genetic, environmental, and treatment factors have all been implicated. We sought to explore the extent to which the place of birth and the place of treatment influences survival outcomes in Korean and US patients with localized gastric cancer. METHODS: Patients with localized gastric adenocarcinoma undergoing potentially curative gastrectomy from 1989 to 2010 were identified from the SEER registry and two single institution databases from the US and Korea. Patients were categorized into three groups: Koreans born/treated in Korea (KK), Koreans born in Korea/treated in the US (KUS), and White Americans born/treated in the US (W), and disease-specific survival rates compared. RESULTS: We identified 16,622 patients: 3,984 (24.0%) KK, 1,046 (6.3%) KUS, and 11,592 (69.7%) W patients. KK patients had longer unadjusted median (not reached) and 5-year disease-specific survival (81.6%) rates than KUS (87 months, 55.9%) and W (35 months, 39.2%; p < 0.001 for all comparisons) patients. This finding persisted on subset analyses of patients with stage IA tumors, without cardia/GEJ tumors, with > 15 examined lymph nodes, and treated at a US center of excellence. On multivariable analysis, KUS (HR 2.80, p < 0.001) and W (HR 5.79, p < 0.001) patients had an increased risk of mortality compared to KK patients. CONCLUSIONS: Both the place of birth and the place of treatment significantly contribute to the improved prognosis of patients with gastric cancer in Korea relative to those in the US, implicating both nature and nurture in this phenomenon.
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Adenocarcinoma/mortalidad , Emigrantes e Inmigrantes/estadística & datos numéricos , Gastrectomía/mortalidad , Escisión del Ganglio Linfático/mortalidad , Neoplasias Gástricas/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , República de Corea , Programa de VERF , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tasa de Supervivencia , Estados UnidosRESUMEN
BACKGROUND: Our goal was to evaluate changes in PD-L1 expression in primary tumours of metastatic gastric cancer before and after chemotherapy. METHODS: We evaluated the PD-L1 expression of 72 patients with primary gastric cancer, before and after palliative first-line platinum-based chemotherapy, between January 2015 and March 2017. The PD-L1 ratio was defined as pre-chemotherapy PD-L1 expression divided by the post-chemotherapy PD-L1 expression. RESULTS: In 30 patients with PD-L1 negative pre-chemotherapy, 12 (40%) were positive post-chemotherapy; among the 42 patients with PD-L1 positive pre-chemotherapy, 24 (57.1%) were negative post-chemotherapy. The degree of PD-L1 expression decreased from 58.3% before chemotherapy to 41.7% after chemotherapy (P = 0.046). Among patients with complete response/partial response (CR/PR), the degree of PD-L1 expression decreased (P = 0.002), as well as PD-L1 positivity with statistical significance (P = 0.013) after chemotherapy, but not among patients with stable disease/progressive disease (SD/PD). Higher disease control rates (CR/PR/SD) were observed in patients with an elevated PD-L1 ratio (P = 0.043). Patients with a high PD-L1 ratio (> 1) were found to be associated with a better progression-free survival (HR 0.34, 95% CI 0.17-0.67, P = 0.002). CONCLUSIONS: PD-L1 expression can change during chemotherapy. Moreover, changes in patterns of PD-L1 expression might be associated with patient prognosis and response to chemotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Antígeno B7-H1/efectos de los fármacos , Compuestos de Platino/uso terapéutico , Neoplasias Gástricas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Antígeno B7-H1/biosíntesis , Biomarcadores de Tumor/análisis , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/mortalidad , Adulto JovenRESUMEN
BACKGROUND: This study aimed to investigate the clinicopathologic characteristics and outcomes of Borrmann type 1 gastric cancer and evaluate its clinical significance in advanced gastric cancer compared with Borrmann types 2 and 3 cancer. METHODS: Between January 1989 and December 2013, 1949 patients with advanced gastric cancer who underwent curative gastrectomy at our institution were enrolled in the study. RESULTS: Of the 1949 patients, 59 (3%) exhibited Borrmann type 1 cancer, characterized by a large size, rare serosal invasion, lower lymph node involvement, location in the upper third of the stomach, intestinal type, and differentiated histology. The recurrence rate was higher for Borrmann type 1 than for Borrmann types 2 and 3 cancer. In addition, more than half of the Borrmann type 1 recurrences showed a hematogenous pattern. However, overall survival did not differ significantly among the three cancer types. In the multivariate analysis, Borrmann type 1 cancer, with tumor depth, node metastasis, and vascular invasion, was an independent risk factor associated with recurrence. Particularly, Borrmann type 1 cancer showed a worse prognosis in both overall survival and recurrence-free survival than the other Borrmann types in the upper third of the stomach. CONCLUSIONS: Borrmann type 1 gastric cancer is associated with a higher recurrence rate than Borrmann types 2 and 3, but not with a difference in the overall survival rate.
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Gastrectomía/mortalidad , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Neoplasias Gástricas/clasificación , Neoplasias Gástricas/patología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/cirugía , Tasa de SupervivenciaRESUMEN
BACKGROUND: The aim of this study was to evaluate the incidence and clinical characteristics of splenic infarction (SI) in gastric cancer patients who have undergone gastrectomy. METHODS: For this study, the medical records of 1084 patients were reviewed and 877 patients were ultimately enrolled. The times of symptom onset, diagnosis of SI, and complete resolution on CT were calculated from the day of the operation. Based on the wedge shape of the SI in all cases, the total volume of the SI was measured based on that of a corn kernel. RESULTS: Thirty-six patients (4.10%) were diagnosed with SI after gastrectomy; four of these patients (0.45%) developed complications associated with the SI. Total gastrectomy and extended lymph node dissection were risk factors for development of SI. Patients with complications exhibited inflammatory signs between 7 and 10 days after surgery. The mean volume of the SI was 4025.69 mm3. The mean time to complete resolution on the CT scan was 327 days postoperatively. In 30 cases, small branched arteries from the splenic artery that could have caused the SI were retrospectively detected on the preoperative CT scans. CONCLUSION: Although the incidence of the SI was low, large volume of the SI is associated with complication development. Measuring the infarction volume via a CT scan may be useful to decide on the treatment strategy. Preoperative 3-D reconstruction of the splenic artery tributaries may help reduce the risk of inadvertent SI.
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Fiebre/etiología , Gastrectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Infarto del Bazo/etiología , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Infarto del Bazo/diagnóstico por imagenRESUMEN
ABASTRACT: BACKGROUND: Despite the development of newer treatments, the prognosis for patients with stage IV gastric cancer remains grave. This study evaluated the efficacy of gastrectomy following response to chemotherapy in patients with stage IV gastric cancer. METHODS: A total of 419 patients who were diagnosed with stage IV gastric cancer were identified from the multi-institutional Catholic Gastric Cancer Study Group database. The patients were divided into four groups: 212 were in the chemotherapy only (CTx) group, 124 were in the chemotherapy after palliative gastrectomy (G-CTx) group, 23 were in the radical gastrectomy after chemotherapy (CTx-G) group, and 60 were in the best supportive care group. To compensate for the effects of chemotherapy, cases of chemotherapy responsive were analyzed separately. To identify factors affecting survival rates, cure rates for surgery in the surgery group were analyzed. RESULTS: The 3-year survival rate of the CTx-G group was significantly higher than that of the CTx group (42.8 vs. 12.0%, p = 0.001). Moreover, the CTx-G group's 3-year survival rate was greater than that of the G-CTx group (42.8 vs. 37.1%, p = 0.207). Chemotherapy-responsive patients in the CTx-G group had a better 3-year survival rate than those in the G-CTx group (46.1 vs. 18.4%, respectively, p = 0.011). In the surgery group, R0 resection led to a significantly better 3-year survival rate than palliative gastrectomy (61.1 vs. 16.2%, p = 0.003). CONCLUSIONS: Adjuvant surgery might improve the survival rate of patients with stage IV gastric cancer, particularly in R0 resection cases.
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Gastrectomía , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Anciano , Terapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Cuidados Paliativos , Pronóstico , Neoplasias Gástricas/mortalidad , Tasa de SupervivenciaRESUMEN
BACKGROUND: The prognosis of gastric cancer is generally determined by tumor depth and lymph node metastasis, while the effect of cross-sectional tumor location on prognosis remains unclear. METHODS: This study recruited patients who had been diagnosed with gastric cancer and who underwent gastrectomy from 1989 to 2012. The cross-sectional locations of the gastric cancers were classified into four regions: the lesser (LC) and greater curvatures (GC), and anterior (AW) and posterior walls (PW). RESULTS: Overall, 4820 patients were enrolled in this study. The most common site of gastric cancer among the four cross-sectional locations was the LC (46.4%), while the proportions of PW (19.9%), AW (18.4%), and GC (15.4%) were similar. Overall survival differed statistically (p = 0.013) according to the cross-sectional location, and the 5-year overall survival of those with tumors with a GC location was significantly worse (p = 0.003) than for the other three locations. In subgroup multivariate analysis, GC location was an independent prognostic indicator for a worse clinical outcome at T stage 3-4b (hazard ratio 1.365, 95% confidence interval 1.150-1.620, p < 0.001). In addition, a GC gastric cancer had a higher recurrence rate in terms of peritoneal seeding compared with other locations. CONCLUSIONS: The cross-sectional location of gastric cancer is associated with long-term survival. A GC location predicts a worse prognosis, especially in gastric cancer patients with deeper T stages.
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Adenocarcinoma/mortalidad , Gastrectomía/mortalidad , Escisión del Ganglio Linfático/mortalidad , Neoplasias Gástricas/mortalidad , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Metástasis Linfática , Masculino , Invasividad Neoplásica , Pronóstico , Estudios Retrospectivos , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tasa de SupervivenciaRESUMEN
BACKGROUND: The purpose of this retrospective study was to determine whether RFA could provide an alternative treatment modality for selected patients who are not candidates for hepatic resection. METHODS: A total of 18 consecutive patients with liver metastases alone from gastric cancer treated with radiofrequency ablation (RFA, n = 11) or hepatic resection (HR, n = 7) at Seoul St. Mary's Hospital, Korea, between January 2000 and September 2014, were enrolled. RESULTS: The median OS and DFS in the RFA group were 40.5 ± 22.3 and 10.3 ± 1.07 months, respectively. There was no significant difference between the RFA and HR groups in terms of baseline characteristics except for performance status. Mean survival and DFS times of all patients were 60.1 ± 9.4 and 40.9 ± 10.2 months, respectively. Mean OS times in the HR and RFA groups were 67.5 ± 15.4 and 51.1 ± 9.8 months (P = 0.671), respectively, and the mean DFS time in the HR group (74.1 ± 14.2 months) was longer than that in the RFA group (26.9 ± 9.2 months), but the difference was not significant (P = 0.076). CONCLUSIONS: In patients who are not candidates for surgical treatment, RFA may be an alternative to HR.
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Ablación por Catéter/métodos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Gástricas/cirugía , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Hepatectomía , Humanos , Masculino , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: Slug is a transcription factor that activates the epithelial-mesenchymal transition (EMT) process in cancer progression. The aim of our study was to evaluate the clinical significance of Slug expression in gastric cancer. METHODS: The expression of Slug in gastric cancer tissues of 456 patients who underwent gastrectomy was evaluated by immunohistochemistry using tissue microarrays. Slug expression level was defined by the composite score determined by multiplying the tumor staining scores for intensity and extent. The associations of Slug expression with clinicopathological characteristics and overall and recurrence-free survival were analyzed. RESULTS: Patients were divided into three groups according to Slug composite score (≤4, 6, and 9). Low, mid, and high expression of Slug was observed in 104 (22.7%), 130 (28.3%), and 225 (49.0%) of cases, respectively. Overall survival and recurrence-free survival progressively increased from high to low Slug expression. In terms of lymph node metastasis, the rate of positive lymph node metastasis was 38/104 (36.5%), 79/130 (60.8%), and 178/225 (79.1%) in low, mid, and high Slug expression groups, respectively, displaying a tendency to increase with higher Slug expression. In a multivariate analysis adjusting for patient age, tumor size, tumor depth, and histology, high Slug expression was associated with a high rate of positive lymph node metastasis compared with low Slug expression (odds ratio 3.42; 95% confidence interval, 1.74-6.69). In a subgroup analysis of T1 cancer, patients with negative Slug expression (defined as <5% positive tumor cells or no/weak staining) showed no lymph node metastasis (0/13), whereas those with positive Slug expression showed 15.9% (17/107) lymph node metastasis, with a negative predictive value of 100%. CONCLUSIONS: High expression of Slug in gastric cancer tissue was associated with lymph node metastasis and poor survival. Evaluation of Slug would be useful for discriminating patients at high risk of lymph node metastasis in early gastric cancer.
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Biomarcadores de Tumor/genética , Metástasis Linfática/genética , Factores de Transcripción de la Familia Snail/genética , Neoplasias Gástricas/genética , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Detección Precoz del Cáncer , Transición Epitelial-Mesenquimal/genética , Femenino , Gastrectomía , Regulación Neoplásica de la Expresión Génica , Humanos , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Pronóstico , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Análisis de Matrices TisularesRESUMEN
BACKGROUND: The clinical outcomes for postoperative complications (PCs) after gastrectomy depend on early diagnosis and intensive treatment. The aim of this study was to investigate the role of C-reactive protein (CRP) as an early predictor of PCs after gastrectomy for gastric cancer. METHODS: A total of 334 consecutive patients who underwent gastrectomy for gastric cancer in 2014 were enrolled in this study. Blood samples were obtained preoperatively, and at postoperative days 1 and 4 for the measurement of inflammatory markers (white blood cell, neutrophil, and platelet counts, and CRP). Patients were classified into groups of major and minor/no PCs, which were defined as patients with PCs of more than grade III and those with grade I/II or without PCs, respectively, according to the Clavien-Dindo classification. RESULTS: Twenty-five patients developed major PCs. The CRP on postoperative day 4 provided superior diagnostic accuracy in predicting major PCs compared to the other systematic inflammatory markers. Multivariate analysis identified a CRP level of 16.8 mg/dl or greater on postoperative day 4 as a significant predictive factor for major PCs. CONCLUSIONS: Among the various systemic inflammatory markers, CRP on postoperative day 4 is the most reliable predictor of PCs after gastrectomy for gastric cancer.
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Absceso Abdominal/metabolismo , Fuga Anastomótica/metabolismo , Proteína C-Reactiva/metabolismo , Gastrectomía , Ileus/metabolismo , Obstrucción Intestinal/metabolismo , Complicaciones Posoperatorias/metabolismo , Neoplasias Gástricas/cirugía , Absceso Abdominal/epidemiología , Anciano , Fuga Anastomótica/epidemiología , Biomarcadores , Femenino , Humanos , Ileus/epidemiología , Obstrucción Intestinal/epidemiología , Escisión del Ganglio Linfático , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Complicaciones Posoperatorias/epidemiología , Periodo Posoperatorio , Pronóstico , Estudios Retrospectivos , Neoplasias Gástricas/patologíaRESUMEN
BACKGROUND: Laparoscopic gastrectomy (LG) in gastric cancer patients with liver cirrhosis (LC) has rarely been reported. In this study, we aimed to elucidate the feasibility of LG compared with that of open gastrectomy (OG) for LC patients. METHODS: Of the 75 LC patients who underwent radical gastrectomy for gastric cancer between April 2005 and March 2014, 36 patients who underwent LG were compared with 39 patients who underwent OG. Comparisons were based on clinicopathologic characteristics, surgical outcomes, and long-term survival rates. RESULTS: Comparison of LG and OG revealed no significant differences in the clinicopathologic characteristics. Five patients in the LG group and eight in the OG group showed a Child-Turcotte-Pugh score (CTPs) over A. In surgical outcomes, we observed shorter operation times (191.4 ± 63.9 vs. 225.9 ± 77.1 min, p = 0.039), reduced estimated blood loss (175.5 ± 214.1 vs. 396.9 ± 514.8 ml, p = 0.021), and shorter hospital stays (10.4 ± 4.6 vs. 13.7 ± 5.8 days, p = 0.008) in LG than OG. Regarding postoperative morbidity, 7 (19.4%) and 10 (25.6%) complications were observed in the LG and OG groups, respectively. There was no difference in complications between the two groups regardless of the CTPs. One patient with a CTPs of C succumbed to hepatic failure following LG. Long-term survival and overall and recurrence-free survival rates did not differ between the two groups. CONCLUSIONS: Even in cases with CTPs B, LG with lymph node dissection for gastric cancer patient was safer and acceptable than OG was. Therefore, LG can be considered an alternative surgical approach in gastric cancer with LC.
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Gastrectomía/efectos adversos , Laparoscopía/efectos adversos , Cirrosis Hepática/cirugía , Neoplasias Gástricas/cirugía , Adulto , Anciano , Estudios de Factibilidad , Femenino , Gastrectomía/métodos , Humanos , Laparoscopía/métodos , Tiempo de Internación/estadística & datos numéricos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Estómago/patología , Estómago/cirugía , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/mortalidad , Tasa de SupervivenciaRESUMEN
BACKGROUND: Chemotherapy is the standard of care for incurable advanced gastric cancer. Whether the addition of gastrectomy to chemotherapy improves survival for patients with advanced gastric cancer with a single non-curable factor remains controversial. We aimed to investigate the superiority of gastrectomy followed by chemotherapy versus chemotherapy alone with respect to overall survival in these patients. METHODS: We did an open-label, randomised, phase 3 trial at 44 centres or hospitals in Japan, South Korea, and Singapore. Patients aged 20-75 years with advanced gastric cancer with a single non-curable factor confined to either the liver (H1), peritoneum (P1), or para-aortic lymph nodes (16a1/b2) were randomly assigned (1:1) in each country to chemotherapy alone or gastrectomy followed by chemotherapy by a minimisation method with biased-coin assignment to balance the groups according to institution, clinical nodal status, and non-curable factor. Patients, treating physicians, and individuals who assessed outcomes and analysed data were not masked to treatment assignment. Chemotherapy consisted of oral S-1 80 mg/m(2) per day on days 1-21 and cisplatin 60 mg/m(2) on day 8 of every 5-week cycle. Gastrectomy was restricted to D1 lymphadenectomy without any resection of metastatic lesions. The primary endpoint was overall survival, analysed by intention to treat. This study is registered with UMIN-CTR, number UMIN000001012. FINDINGS: Between Feb 4, 2008, and Sept 17, 2013, 175 patients were randomly assigned to chemotherapy alone (86 patients) or gastrectomy followed by chemotherapy (89 patients). After the first interim analysis on Sept 14, 2013, the predictive probability of overall survival being significantly higher in the gastrectomy plus chemotherapy group than in the chemotherapy alone group at the final analysis was only 13·2%, so the study was closed on the basis of futility. Overall survival at 2 years for all randomly assigned patients was 31·7% (95% CI 21·7-42·2) for patients assigned to chemotherapy alone compared with 25·1% (16·2-34·9) for those assigned to gastrectomy plus chemotherapy. Median overall survival was 16·6 months (95% CI 13·7-19·8) for patients assigned to chemotherapy alone and 14·3 months (11·8-16·3) for those assigned to gastrectomy plus chemotherapy (hazard ratio 1·09, 95% CI 0·78-1·52; one-sided p=0·70). The incidence of the following grade 3 or 4 chemotherapy-associated adverse events was higher in patients assigned to gastrectomy plus chemotherapy than in those assigned to chemotherapy alone: leucopenia (14 patients [18%] vs two [3%]), anorexia (22 [29%] vs nine [12%]), nausea (11 [15%] vs four [5%]), and hyponatraemia (seven [9%] vs four [5%]). One treatment-related death occurred in a patient assigned to chemotherapy alone (sudden cardiopulmonary arrest of unknown cause during the second cycle of chemotherapy) and one occurred in a patient assigned to chemotherapy plus gastrectomy (rapid growth of peritoneal metastasis after discharge 12 days after surgery). INTERPRETATION: Since gastrectomy followed by chemotherapy did not show any survival benefit compared with chemotherapy alone in advanced gastric cancer with a single non-curable factor, gastrectomy cannot be justified for treatment of patients with these tumours. FUNDING: The Ministry of Health, Labour and Welfare of Japan and the Korean Gastric Cancer Association.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/administración & dosificación , Gastrectomía/métodos , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Adulto , Anciano , Quimioterapia Adyuvante , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Japón , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , República de Corea , Medición de Riesgo , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Endoscopic submucosal dissection (ESD) is an alternative to surgical resection for treating early gastric cancer (EGC). However, there have been limited reports on the long-term outcome of ESD compared to that of surgical resection. The aim of this study was to evaluate the immediate and long-term clinical and oncologic outcomes of ESD compared to surgical resection. METHOD: We retrospectively reviewed data of patients in five centers who were treated with ESD or surgical resection for EGC within expanded criteria for ESD from 2006 to 2008. RESULT: ESD group had significantly shorter procedure times, shorter fasting period, and shorter hospital stay than the surgical resection group. Immediate complications in the surgical resection group were more common compared to those in the ESD group. Five-year cancer recurrence rate of the ESD group was 12.3 % and significantly higher than 2.1 % of the surgical resection group (P = 0.001). Five-year disease-free survival rate of the surgical resection group was 97 %, which was significantly higher than 85 % of the ESD group (P = 0.001). Metachronous lesions were equally found every year during the follow-up period in the ESD group. Five-year overall survival rates were 100 % for both groups. CONCLUSION: ESD might be an acceptable and effective treatment for EGC considering overall survival rates with fewer early complication rates and shorter duration of hospital stay compared to surgical resection. However, intensive and persistent endoscopic surveillance should be performed after ESD for early detection of metachronous lesions.
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Resección Endoscópica de la Mucosa/métodos , Gastrectomía/métodos , Neoplasias Gástricas/cirugía , Anciano , Disección/métodos , Detección Precoz del Cáncer , Resección Endoscópica de la Mucosa/efectos adversos , Resección Endoscópica de la Mucosa/mortalidad , Femenino , Gastrectomía/efectos adversos , Mucosa Gástrica/cirugía , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Complicaciones Posoperatorias , Estudios Retrospectivos , Neoplasias Gástricas/mortalidad , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND: As indicators of the systemic inflammatory response, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been proposed to predict the clinical outcome in some cancers. The purpose of this study was to investigate the impact of NLR and PLR on the prognosis of gastric cancer. METHODS: From 2000 to 2009, 1986 consecutive patients who underwent curative surgery for gastric cancer were enrolled. The optimal cutoff value of PLR and NLR was determined according to receiver operating characteristic analysis. We categorized the patients into the high or low PLR and NLR group based on the cutoff value, and the clinical features of these two groups were comparatively analyzed. RESULTS: The high NLR and PLR groups were significantly associated with poor prognosis. The NLR was an independent prognostic factor for overall survival [hazard ratio (HR) = 1.403; p = 0.023]; however, the PLR was not (p = 0.788). CONCLUSIONS: Although both the PLR and NLR can reflect the prognosis, the NLR is more predictive of overall survival than the PLR.
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Adenocarcinoma/secundario , Plaquetas/patología , Linfocitos/patología , Neutrófilos/patología , Neoplasias Gástricas/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/cirugía , Tasa de Supervivencia , Adulto JovenRESUMEN
BACKGROUND: Conditional survival (CS) measures the probability that patients will survive an additional number of years given that they have already survived for a certain period of time. METHODS: In total, 2935 gastric cancer patients who had undergone curative gastrectomy between 1995 and 2011 were enrolled. The Cox proportional hazard regression model was used to evaluate the factors associated with overall survival (OS). Three-year CS estimates at 't' years after surgery were calculated as follows: CS(t) = S(t + 3)/S(t). RESULTS: The 1-, 2-, 3-, 4- and 5-year OS rates of the 2935 patients were 96.6 %, 92.0 %, 88.7 %, 85.6 and 82.7 %, respectively. The probability of surviving an additional 3 years on the condition of having already survived 1, 2, 3, 4 and 5 years after surgery were 88.6 %, 89.9 %, 91.0 %, 92.2 % and 93.2 %, respectively. Patients with a higher risk at baseline showed a greater increase in CS over time. CONCLUSIONS: CS estimates provide important information about dynamic prognostic changes over time for Korean gastric cancer patients, and as such, can be used to guide long-term follow-up strategies.
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Carcinoma/mortalidad , Gastrectomía , Neoplasias Gástricas/mortalidad , Adulto , Anciano , Carcinoma/cirugía , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Pronóstico , Modelos de Riesgos Proporcionales , Factores de Riesgo , Neoplasias Gástricas/cirugía , Factores de TiempoRESUMEN
BACKGROUND: To compare the incidences of postoperative pancreatic fistula (POPF) between robot-assisted distal gastrectomy (RADG) and laparoscopy-assisted distal gastrectomy (LADG). MATERIALS AND METHODS: A total of 40 patients with gastric cancer who underwent RADG were compared with 40 initial patients who underwent LADG by a single surgeon. We evaluated and compared the clinicopathologic characteristics, surgical outcomes, and operative complications including POPF in two groups. RESULTS: The POPF was observed more frequently in the LADG group than in the RADG group (22.5% versus 10%, P < 0.001). Although the serum amylase levels in the 20 first-half cases did not statistically differ between LADG and RADG (P = 0.32), those in the 20 latter-half cases were significantly lower in the RADG group (P < 0.05). Univariate and multivariate analyses identified laparoscopic surgery and visceral fat area as POPF-associated risk factors. CONCLUSIONS: RADG is feasible and safe for distal gastrectomy in terms of POPF.
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Gastrectomía/efectos adversos , Gastrectomía/métodos , Fístula Pancreática/etiología , Complicaciones Posoperatorias/etiología , Robótica , Femenino , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
BACKGROUND: Previous comparisons of gastric cancer between the West and the East have focused predominantly on Japan and Korea, where early gastric cancer is prevalent, and have not included the Chinese experience, which accounts for approximately half the world's gastric cancer. METHODS: Patient characteristics, surgical procedures, pathologic information, and survival were compared among gastric cancer patients who underwent curative intent gastrectomy at two large volume cancer centers in China and the US between 1995 and 2005. RESULTS: Median age and body mass index were significantly higher in US patients. The proportion of proximal gastric cancer was comparable. Gastric cancer patients in China had larger tumors and a later stage at presentation. The median number of positive lymph nodes was higher (5 vs 4, P < 0.02) despite a lower lymph node retrieval (16 vs 22, P < 0.001) in Chinese patients. The probability of death due to gastric cancer in Chinese patients was 1.7 fold of that in the US (P < 0.0001) after adjusting for important prognostic factors. CONCLUSIONS: Even after adjusting for important prognostic factors Chinese gastric cancer patients have a worse outcome than US gastric cancer patients. The differences between Chinese and US gastric cancer are a potential resource for understanding the disease.
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Adenocarcinoma/mortalidad , Gastrectomía/mortalidad , Neoplasias Gástricas/mortalidad , Adenocarcinoma/epidemiología , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , China/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tasa de Supervivencia , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: We investigated the changes of lipid profiles after radical gastrectomy. METHODS: We analyzed the lipid-profile changes after radical gastrectomy in 144 patients with gastric cancer. Their lipid profiles, including total cholesterol (TC), triglyceride (TG), LDL-cholesterol (LDL), and HDL-cholesterol (HDL), were evaluated preoperatively as well as 6 and 12 months postoperatively. We compared the changes of lipid profile according to the reconstruction type and resection extent. RESULTS: The TC level had decreased 6 months after surgery, and remained unchanged thereafter. The LDL level also had decreased 6 months after surgery, but had increased again after 12 months after surgery. The HDL level had increased 12 months after surgery, whereas the TG level was unchanged. In a comparison of the lipid levels according to the reconstruction type or resection extent, the HDL level significantly differed by reconstruction type 12 months after surgery: it was markedly higher in the total gastrectomy than in the subtotal gastrectomy group both 6 months and 12 months after surgery. Both the male gender and total gastrectomy were associated with probability of normalization of LDL after surgery. CONCLUSIONS: The lipid profiles including the TC, LDL and HDL levels were changed after radical gastrectomy; therefore, after this procedure, the lipid profiles of patients with hyperlipidemia should be evaluated.