Surgical treatment of gastric cancer: a 10-year experience in a high-volume university hospital

Oliveira

et al. 2020

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Introduction Multivisceral resection (MVR) is potentially curative for selected gastric cancer patients, supposedly at the cost of increased complications. However, current data comparing MVR to standard gastrectomy (SG) is lacking. Objectives Compare complications and survival after MVR and SG. Methods In a retrospective cohort of 1015 patients with gastric adenocarcinoma, 58 underwent MVR and 466 SG. Groups were compared concerning their characteristics, complications, and survival. Results One hundred seventy‐six patients had postoperative complications. Major complications were more frequent after MVR (P = .002). Surgical mortality was 8.6% and 4.9% for MVR and SG (P = .221). Older age, higher morbidities, and MVR were independent risk factors for major complications. The odds ratio for major complications was 5.89 for MVR with one or two organs and 38.01 for MVR with three or more organs. The pancreas was the most commonly removed organ and pT4b disease were confirmed in 34 (58.6%) of the MVR cases. Disease‐free survival (DFS) was lower in MVR patients (51% vs 77.8%; P < .001), being worse according to the number of organs resected. In pN+ patients, DFS was worse after MVR. DFS was equivalent to pT4b and non‐pT4b in the MVR group. Conclusions Increased morbidity and lower survival are expected for gastric cancer patients undergoing MVR.

“…Lymph node yield was high and similar in both groups, being equivalent to our previous reports 14,20,22,23 . R0 resection was harder to obtain in the MVR group: 87.9% vs 98.5%; P < .001.…”

Section: Discussionsupporting

confidence: 86%

Multivisceral resection vs standard gastrectomy for gastric adenocarcinoma

Dias

Oliveira

et al. 2020

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“…Patients were matched with the use of a 1:1 protocol, without replacement (nearest algorithm), for the following factors: gender, age (<70 or ≥70; American Society of Anesthesiologists Classification [ASA]) (I/II or III/IV), histological type (intestine × diffuse/mixed), gastrectomy type (total or subtotal), N clinical assessment (negative or positive), T clinical assessment (T1/T2, T3/T4a, or T4b) and type of lymphadenectomy (D1 or D2). These factors were chosen since they have all been previously observed as independent risk factors for poor prognosis in our institution 5 …”

Section: Methodsmentioning

confidence: 99%

“…Since the disease is usually discovered in its advanced form, gastrectomy with D2 lymphadenectomy is the recommended treatment 2‐4 . Nevertheless, even with the best surgical option, 5‐year‐survival rates reach only 60% 5 . It is clear that a multimodality approach is necessary.…”

Section: Introductionmentioning

confidence: 99%

“…However, both studies had methodology issues, such as a mixture of tumors with different biological behaviors (esophagus, esophagus‐gastric junction [EGJ] and stomach) and inadequate lymphadenectomy. When compared with specialized centers worldwide, both groups from these studies had low survival rates 5,8‐10 . Additionally, Schuhmacher et al 11 failed to demonstrate the benefit of NACT vs D2‐gastrectomy alone.…”

Section: Introductionmentioning

confidence: 99%

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Impact of neoadjuvant chemotherapy on surgical and pathological results of gastric cancer patients: A case‐control study

Charruf

Ramos

et al. 2020

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Background and Objective Neoadjuvant chemotherapy (NACT) followed by radical surgery represents a treatment option for patients with advanced gastric cancer (GC). This case‐control study aimed to evaluate the clinicopathological characteristics and surgical outcomes of GC patients who received NACT, and its impact on survival. Methods We retrospectively reviewed all patients with GC who underwent gastrectomy. A total of 45 cases with NACT were matched with consecutive 45 patients who underwent upfront gastrectomy for the following characteristics: gender, age, gastrectomy type, lymphadenectomy extent, American Society of Anesthesiologists class, histological type, cT and cN. Results NACT group had smaller tumors (4.9 vs 6.8 cm P = .006), lower lymphatic invasion rate (40% vs 73.3%, P = .001), lower venous invasion rate (18% vs 46.7%, P = .003) and lower perineural invasion rate (35% vs 77.8%, P < .0001). The ypTNM stage was lower in patients treated with NACT (P < .001). The major postoperative complication (POC) rate was lower in NACT patients (6.7% vs 24.4%, P = .02), as was hospital length of stay (10.8 vs 17 days, P = .005). Conclusions NACT allowed nodal and tumor downstaging. In addition, patients who underwent NACT had fewer POC and shorter length of hospital stay.

“…As nearly half of the patients is unable to tolerate adjuvant therapy after surgery, exclusive nCMT is also a good option …”

Section: Introductionmentioning

confidence: 99%

Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer

Ramos

Dias

et al. 2019

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Background and Objective Neoadjuvant chemotherapy (nCMT) has been increasingly used in advanced gastric cancer (GC). However, the prognostic impact of tumor response remains unclear. This study aimed to evaluate if tumor response at the primary site and lymph nodes (LN) correlate with survival in GC patients after nCMT. Methods Patients with gastric adenocarcinoma treated with nCMT followed by gastrectomy were evaluated. Residual tumor was graded from 0% to 100%, defining two groups: poor (PR) and major response (MR). LN regression rate (LNRR) was determined based on tumor/fibrosis examination at each LN and a cutoff value established by receiver operating characteristic curve. Results Among 62 cases, 20 (32.2%) had MR and 42 (67.7%) PR. Smaller size, diffuse histology, lower ypT status and less advanced stage were associated with the MR group. Based on cutoff value of 57, 45.6% and 54.4% patients were classified as low‐LNRR and high‐LNRR. High‐LNRR correlated with absence of venous, lymphatic and perineural invasion, and less advanced stage. Survival was equivalent between MR and PR (P = .956). High‐LNRR had better disease‐free survival (DFS) than low‐LNRR (P < .001). In multivariate analysis, only LNRR associated with DFS. Conclusion High‐LNRR associates with DFS in GC treated with nCMT. Response at the primary site does not correlate with survival.