Adjuvant Chemoradiotherapy After Subtotal or Total Gastrectomy and D2 Limphadenectomy Increases Survival in Advanced Gastric Cancer?

Background: The octogenarian population is expanding worldwide and demand for gastrectomy due to gastric cancer in this population is expected to grow. However, the outcomes of surgery with curative intent in this age group are poorly reported and it is unclear what matters most to survival: age, clinical status, disease´s stage, or the extent of the surgery performed. Aim: Evaluate the results of gastrectomy in octogenarians with gastric cancer and to verify the factors related to survival. Methods: From prospective database, patients aged 80 years or older with histologically confirmed adenocarcinoma who had undergone gastrectomy with curative intent were selected. Factors related to postoperative complications and survival were studied. Results: Fifty-one patients fulfilled the inclusion criteria. A total of 70.5% received subtotal gastrectomy and in 72.5% D1 lymphadenectomy was performed. Twenty-five (49%) had complications, in eleven major complications occurred (seven of these were clinical complications). Hospital length of stay was longer (8.5 vs. 17.8 days, p=0.002), and overall survival shorter (median of 1.4 vs. 20.5 months, p=0.009) for those with complications. D2 lymphadenectomy and the presence of postoperative complications were independent factors for worse overall survival. Conclusion: Octogenarians undergoing gastrectomy with curative intent have high risk for postoperative clinical complications. D1 lymphadenectomy should be the standard of care in these patients.

Section: Discussionsupporting

confidence: 90%

Gastrectomy in Octogenarians With Gastric Cancer: Is It Feasible?

Silva

Pereira

Ramos

et al. 2020

“…Laparoscopic surgery has proved to be safe and effective with less pain, less bleeding and a shorter recovery time. The randomized studies during the last decade have shown excellent results in terms of complication rates, which are very similar to open surgery 1,2,20,21,28,29 .…”

mentioning

confidence: 79%

“…In terms of oncological safety, the number of lymph nodes and resected lymph nodal barriers do not differ in any way from open surgery 1,24 . Moreover, it is possible that lymph node dissection becomes more precise and less difficult with 3D laparoscopic or robotic surgery (R0 oncological surgery with better survival) 22,24,30 .…”

mentioning

confidence: 95%

Lessons Learned Analyzing Complications After Laparoscopic Total Gastrectomy for Gastric Cancer

Braghetto

Lanzarini

Musleh

et al. 2020

Background: Laparoscopic surgery has been gradually accepted as an option for the surgical treatment ofgastric cancer. There are still points that are controversial or situations that are eventually associated with intra-operative difficulties or postoperative complications. Aim: To establish the relationship between the difficulties during the execution of total gastrectomy and the occurrence of eventual postoperative complications. Method: The operative protocols and postoperative evolution of 74 patients operated for gastriccancer, who were subjected to laparoscopic total gastrectomy (inclusion criteria) were reviewed. The intraoperative difficulties recorded in the operative protocol and postoperative complications of a surgical nature wereanalyzed (inclusion criteria). Postoperative medical complications were excluded (exclusion criteria). For the discussion, an extensive bibliographical review was carried out. Results: Intra-operative difficulties or complications reported correspond to 33/74 and of these; 18 events (54.5%) were related to postoperative complications and six were absolutely unexpected. The more frequent were leaks of the anastomosis and leaks of the duodenal stump; however, other rare complications were observed. Seven were managed with conservative measures and 17 (22.9%) required surgical re-exploration, with a postoperative mortality of two patients (2.7%). Conclusion: We have learned that there are infrequent and unexpected complications; the treating team must be mindful of and, in front of suspicion of complications, anappropriate decision must be done which includes early re-exploration. Finally, after the experience reported, some complications should be avoided.

“…G astric cancer (GC) has high prevalence worldwide and is a major cause of cancer-related death 2,10,20 . Lymph node metastasis is the most important prognostic factor 18,23,29 ; however, nearly 10% of pN0 patients who underwent gastrectomy have disease recurrence 18,22,23,29 .…”

Section: Introductionmentioning

confidence: 99%

Recurrence in Pn0 Gastric Cancer: Risk Factors in the Occident

Nobre¹,

Pereira

Ramos

et al. 2021

Background: Nearly 10% of node negative gastric cancer patients who underwent curative surgery have disease recurrence. Western data is extremely poor on this matter and identifying the risk factors that associate with relapse may allow new strategies to improve survival. Aim: Verify the clinical and pathological characteristics that correlate with recurrence in node negative gastric cancer. Methods: All gastric cancer patients submitted to gastrectomy between 2009 and 2019 at our institution and pathologically classified as N0 were considered. Their data were available in a prospective database. Inclusion criteria were: gastric adenocarcinoma, node negative, gastrectomy with curative intent, R0 resection. Main outcomes studied were: disease-free survival and overall survival. Results: A total of 270 patients fulfilled the inclusion criteria. Mean age was 63-year-old and 155 were males. Subtotal gastrectomy and D2 lymphadenectomy were performed in 64% and 74.4%, respectively. Mean lymph node yield was 37.6. Early GC was present in 54.1% of the cases. Mean follow-up was 40.8 months and 19 (7%) patients relapsed. Disease-free survival and overall survival were 90.9% and 74.6%, respectively. Independent risk factors for worse disease-free survival were: total gastrectomy, lesion size ≥3.4 cm, higher pT status and <16 lymph nodes resected. Conclusion: In western gastric cancer pN0 patients submitted to gastrectomy, lymph node count <16, pT3-4 status, tumor size ≥3.4 cm, total gastrectomy and presence of lymphatic invasion, are all risk factors for disease relapse.