Resultados da gastrectomia D2 para o câncer gástrico: dissecção da cadeia linfática ou ressecção linfonodal múltipla?

Zilberstein, Bruno; Mucerino, Donato Roberto; Yagi, Osmar Kenji; Ribeiro, Ulysses; Lopasso, Fabio Pinatel; Bresciani, Claudio; Jacob, Carlos Eduardo; Coimbra, Brian Guilherme Monteiro Marta; Cecconello, Ivan

doi:10.1590/s0102-67202012000300005

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…In patients with other types of cancer, such as breast or lung cancer, tumor size is still an important predictor. In gastric cancer, however, the prognostic value of tumor size remains controversial 16 , 29 . Some authors showed that tumor size can be an important factor as for aggressiveness 9 , 30 .…”

Section: Discussionmentioning

confidence: 99%

Do Proximal and Distal Gastric Tumours Behave Differently?

Costa

Toneto

Moreira

2016

ABCD, arq. bras. cir. dig.

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Background: Although the incidence of gastric (adenocarcinoma) cancer has been decreasing over time, it is still one of the most common malignancies worldwide, and proximal tumours tend to have a worse prognosis. Aim: To compare surgical outcomes and prognosis between proximal - excluding tumours of the cardia - and distal gastric cancer. Methods: Out of 293 cases reviewed - 209 with distal and 69 with proximal gastric cancer - were compared for clinical and pathological features, stage, surgical outcome, mortality and survival. Results: Statistically, there was no significant difference between patients in both groups regarding mortality (p=0.661), adjuvant chemotherapy (p 0.661), and radiation (p=1.000). However, there was significant difference in the degree of lymph node dissection employed (p=0.002) and the number of positive lymph nodes resected (p=0.038) between the two groups. The odds of death at five years for patients who had a D0 dissection was three times greater (odds ratio 2.78; (95%CI 1.33-5.82) than that for patients who had a D2 dissection, while for patients who had a D1 dissection the odds ratio was only 1.41 (95%CI 0.71-2.83) compared to D2-dissected patients. Conclusion: Although no significant differences were found between proximal and distal gastric cancer, the increased risk of death in D0- and D1-dissected patients clearly suggests an important role of radical D2 lymph node dissection in survival.

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Section: Discussionmentioning

confidence: 99%

Do Proximal and Distal Gastric Tumours Behave Differently?

Costa

Toneto

Moreira

2016

ABCD, arq. bras. cir. dig.

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“…How to make the best choice among the possible treatments for EGC, including EMR/ESD [ 19 ], laparoscopic gastrectom [ 20 ]and traditionalD1 or D2 radical resection [ 21 ], remains debatable. Pre-operative LNM status will certainly be useful information when making a clinical decision.…”

Section: Discussionmentioning

confidence: 99%

Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer

et al. 2015

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BackgroundLymph node metastasis (LNM) has been shown to be related to the prognosis of early gastric cancer (EGC). The choice of optimal treatment depends on an accurate pre-operative assessment of LNM status in EGC patients. However, in China, where EGC cases account for only a small part of gastric cancer (GC) cases, there are not enough data to make an accurate assessment. Therefore, this study, which involved a relatively large number of EGC patients, aimed to explore the relationship between clinicopathological characteristics and LNM in EGC.MethodsClinicopathological data from 205 EGC patients who underwent surgical resection at Sun Yat-Sen University Cancer Center from January 2000 to December 2011 were retrospectively analyzed. Clinicopathological characteristics were assessed to identify effective predictive factors for LNM and overall survival.ResultsLNM occurred in 52 (25.37%) EGC cases; of these cases, 18 occurred in intra-mucosal cancers (13 N1, 4 N2 and 1 N3), and 34 occurred in sub-mucosal cancers (22 N1, 7 N2 and 5 N3). Logistic regression analysis demonstrated that tumor differentiation (P=0.002), depth of tumor infiltration (P=0.004), vessel invasion (P=0.012), tumor size (P=0.020) and gender (P=0.022) were risk factors associated with LNM in EGC, listed in order of priority. The overall survival rate was 90.2%. Kaplan-Meier survival analysis showed that overall survival of EGC patients was significantly correlated with LNM (P=0.001), N staging (P<0.001) and invasion of lymphatic or blood vessels (P=0.010), but it was not correlated with tumor size, depth of tumor infiltration or tumor cell differentiation. Moreover, a multiple Cox regression analysis demonstrated that only N staging (P=0.001) could serve as an independent prognostic predictor in EGC patients.ConclusionsBecause LNM independently predicts the prognosis of EGC, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) and laparoscopic partial gastrectomy should be cautiously used in high-risk EGC patients. A pre-operative assessment of LNM status based on clinicopathological factors may be useful for therapy planning.

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“…Moreover, D2 lymphadenectomy, which allows for clearance of the nodal stations likely harboring metastatic disease and increased number of nodes for evaluation, is now internationally accepted as the standard procedure with demonstrated decreased regional recurrence and improved long-term survival for patients undergoing curative surgery (9–13). Thus, many guidelines (Italian Gastric Cancer Study Group, the German Gastric Carcinoma Study Group, the Brazilian Gastric Cancer Association and the Chinese Gastric Cancer Association) support D2 lymphadenectomy as the optimum extent of lymph node dissection (14–16). While D2 lymph node dissection has long been advocated as the surgical standard for radical gastrectomy in Japan and South Korea by the Japanese Research Society for Gastric Cancer and Korean Gastric Cancer Association (17, 18), D2 lymphadenectomy in Western studies has until recently been associated with forbidding morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Lymphadenectomy with Optimum of 29 Lymph Nodes Retrieved Associated with Improved Survival in Advanced Gastric Cancer: A 25,000-Patient International Database Study

Woo

Goldner

Ituarte

et al. 2017

Journal of the American College of Surgeons

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Background Gastric adenocarcinoma is an aggressive disease with frequent lymph node (LN) metastases for which lymphadenectomy results in a survival benefit. In the United States, the NCCN guidelines recommend D2 lymphadenectomy or a minimum of 15 LNs retrieved. However, retrieval of only 15 LNs is considered by most international guidelines as inadequate. We seek to evaluate the survival benefits associated with a more complete lymphadenectomy. Study Design An international database was constructed by combining gastric cancer cases from the SEER database (n=13,932) and the Yonsei University Gastric Cancer database (n=11,358)(total n=25,289). Kaplan-Meier survival analysis was performed along with Joinpoint analysis to obtain the optimal number of LNs to retrieve based upon survival. Prognostic significance of number of nodes retrieved was then confirmed with uni- and multivariate analyses. Results Analysis for both mean and median survival yielded 29 LNs removed as the Joinpoint. This was further confirmed with multivariate analysis, where 15 retrieved LNs cutoff fell out of the model while 29 retrieved LNs remained intact with an hazard ratio (HR): 0.799(95%CI 0.759–0.842, p<0.001). Stage-stratified Kaplan- Meier analysis for a cutoff point of 29 also demonstrated a statistically significant improvement in survival. Conclusion Joinpoint analysis has allowed for the creation of a model demonstrating the point at which additional dissection would not provide further benefit. Thus, this large international dataset analysis demonstrates that the maximal survival advantage is seen by performing a lymphadenectomy with a minimum of 29 LNs retrieved.

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Resultados da gastrectomia D2 para o câncer gástrico: dissecção da cadeia linfática ou ressecção linfonodal múltipla?

Cited by 12 publications

References 17 publications

Do Proximal and Distal Gastric Tumours Behave Differently?

Do Proximal and Distal Gastric Tumours Behave Differently?

Lymph Node Metastasis, a Unique Independent Prognostic Factor in Early Gastric Cancer

Lymphadenectomy with Optimum of 29 Lymph Nodes Retrieved Associated with Improved Survival in Advanced Gastric Cancer: A 25,000-Patient International Database Study

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