A Critical Evaluation of Subtotal Gastrectomy for the Cure of Cancer of the Stomach

McNeer, Gordon; VandenBerg, Henry J.; Donn, Frederick Y.; Bowden, Lemuel

doi:10.1097/00000658-195107000-00002

Cited by 137 publications

(33 citation statements)

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“…Studies outlining the patterns of failure after surgery for gastric cancer have shown a high rate of locoregional recurrence after surgical resection for gastric cancer. 1,2,3 In the University of Minnesota reoperation series of 86 patients, 87.8% of patients were found to have a locoregional recurrence (including isolated peritoneal recurrence). 2 In the Massachusetts General Hospital series, the locoregional recurrence rate was 38% in 130 patients who had undergone curative resection.…”

Section: Discussionmentioning

confidence: 99%

“…1 Furthermore, an autopsy series demonstrated an 80.4% locoregional recurrence rate in 92 patients after curative subtotal gastrectomy. 3 The high rates of recurrence have been attributed to the abundant lymphatic channels within the gastric wall, providing channels for mucosal skip lesions and numerous potential pathways of lymphatic drainage away from the stomach. The 13% actuarial incidence of any locoregional recurrence at 3 years in the current study compares favorably with that of previous series of surgery alone.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,3 Various adjuvant treatment strategies have been used to address this risk. In a recent prospective randomized trial, postoperative chemoradiotherapy has been shown to improve locoregional control rate and overall survival time.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, Natural History, and Patterns of Locoregional Recurrence in Gastric Cancer Patients Treated With Preoperative Chemoradiotherapy

Reed

Krishnan

Mansfield

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To retrospectively determine the incidence and patterns (in-field, marginal, or out-offield) of locoregional recurrence of gastric cancer in patients who received preoperative chemoradiotherapy and to determine the outcome in these patients. 1994 and 2004, 149 patients with gastric carcinoma were treated on institutional protocols with preoperative chemoradiation. Ultimately, 105 patients had an R0 resection. Sixty-five of these patients received preoperative chemotherapy followed by chemoradiotherapy and 40 patients received preoperative chemoradiotherapy. Most (96%) of these patients received 5-fluorouracil-based chemotherapy during radiation, and the median dose of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Methods and Materials-Between HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript radiation administered was 45 Gy. We retrospectively identified and classified the patterns of locoregional recurrences.Results-The 3-year actuarial incidence of locoregional recurrence was 13%, with locoregional disease recurring as any part of the failure pattern in 14 patients. The majority (64%) of evaluable locoregional recurrences were in-field. Two of the four patients with marginal recurrence had inadequate coverage of regional nodal volumes on their oblique fields. The pathologic complete response rate was 23%. A pathologic complete response was the only statistically significant predictor of locoregional control.Conclusions-Patients with gastric cancer who received preoperative chemoradiotherapy had low rates of locoregional recurrence. This strategy merits prospective multi-institutional and randomized evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence, Natural History, and Patterns of Locoregional Recurrence in Gastric Cancer Patients Treated With Preoperative Chemoradiotherapy

Reed

Krishnan

Mansfield

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…McNeer found that of 92 patients undergoing 'curative sub-total gastrectomy' 80.4% were found to have evidence of recurrence at post-mortem (McNeer et al, 1951). Among these the great majority were local recurrences; 65.2% had recurrence in the gastric remnant, gastroenterostomy or duodenum while 52.2% had recurrence in peri-gastric nodes and stomach bed, 30% had peritoneal seedlings and 40% had haematogenous recurrence.…”

Section: Discussionmentioning

confidence: 99%

The pattern of recurrence of adenocarcinoma of the oesophago-gastric junction

et al. 2002

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Knowledge of the pattern of recurrence of surgically treated cases of adenocarcinoma of the oesophago-gastric junction is important both for better understanding of their biological nature and for future strategic planning of therapy. The aim of this study is to demonstrate and compare the pattern of dissemination and recurrence in patients with Type I and Type II adenocarcinoma of oesophago-gastric junction. A prospective audit of the clinico-pathological features of patients who had undergone surgery with curative intent for adenocarcinoma of oesophago-gastric junction between 1991 and 1996 was undertaken. Patients were followed up by regular clinical examination. Clinical evaluation was supported by ultrasound, computerised tomography, radio-isotope bone scan, endoscopy and laparotomy each with biopsy and histology where appropriate. One hundred and sixty-nine patients with oesophago-gastric junction tumours (94 Type I and 75 Type II) have been followed up for a median of 75.3 (57 -133) months. One hundred and three patients developed proven recurrent disease. The median time to recurrence was 23.3 (14.2 -32.4) months for Type I and 20.5 (11.6 -29.4) for Type II cancers. The most frequent type of recurrence was haematogenous (56% of Type I recurrences and 54% of Type II) of which 56% were detected within 1 year of surgery. The most frequent sites were to liver (27%), bone (18%) brain (11%) and lung (11%). Local recurrence occurred in 33% of Type I cancer and 29% of Type II recurrences. Nodal recurrence occurred in 18 and 25% of Type I and Type II cancer recurrences, most frequently to coeliac or porta hepatis nodes (64%). Only 7% of Type I and 15% of Type II cancer recurrences were by peritoneal dissemination. Type I and Type II adenocarcinoma of the oesophago-gastric junction have a predominantly early, haematogenous pattern of recurrence. There is a need to better identify the group of patients with small metastases at the time of diagnosis who are destined to develop recurrent disease in order that they may be spared surgery and those with micro metastases in order that they can be offered multi-modality therapy including early post operative or neo-adjuvant chemotherapy.

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“…Complete tumour removal with sufficient resection margin plus extended lymph node dissection is considered to be the most important factor in terms of reduced locoregional recurrence and improved survival. Although the incidence of early gastric cancer is increasing, most patients still present with an advanced stage, and, even after complete resection, 38 -94% of patients developed locoregional recurrence (McNeer et al, 1951;Gunderson and Sosin, 1982;Wisbeck et al, 1986;Landry et al, 1990), which translates into 33 -69% of all recurrences (Gunderson and Sosin, 1982;Landry et al, 1990;Maehara et al, 2000;Yoo et al, 2000). However, high recurrence rates may be reduced by adjuvant treatment, so postoperative adjuvant radiotherapy and/or chemotherapy is generally performed.…”

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confidence: 99%

Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view

et al. 2004

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The risk of locoregional recurrence in resected gastric adenocarcinoma is high, but the benefit of adjuvant treatment remains controversial. In particular, after extended lymph node dissection, the role of radiotherapy is questionable. Since 1995, we started a clinical protocol of adjuvant chemoradiotherapy after D2 gastrectomy and analysed the patterns of failure for 291 patients. Adjuvant chemotherapy consisted of five cycles of fluorouracil and leucovorin, and concurrent radiotherapy was given with 4500 cGy from the second cycle of chemotherapy. With a median follow-up of 48 months, 114 patients (39%) showed any type of failure, and the local and regional failures were seen in 7% (20 out of 291) and 12% (35 out of 291), respectively. When the recurrent site was analysed with respect to the radiation field, in-field recurrence was 16% and represented 35% of all recurrences. Our results suggest that adjuvant chemoradiotherapy has a potential effect on reducing locoregional recurrence. Moreover, low locoregional recurrence rates could give a clue as to which subset of patients could be helped by radiotherapy after D2 gastrectomy. However, in order to draw a conclusion on the role of adjuvant radiotherapy, a randomised study is needed. Gastric cancer is the most common cancer in Korea (Shin et al, 2002). Complete tumour removal with sufficient resection margin plus extended lymph node dissection is considered to be the most important factor in terms of reduced locoregional recurrence and improved survival. Although the incidence of early gastric cancer is increasing, most patients still present with an advanced stage, and, even after complete resection, 38 -94% of patients developed locoregional recurrence (McNeer et al, 1951;Gunderson and Sosin, 1982;Wisbeck et al, 1986;Landry et al, 1990), which translates into 33 -69% of all recurrences (Gunderson and Sosin, 1982;Landry et al, 1990;Maehara et al, 2000;Yoo et al, 2000). However, high recurrence rates may be reduced by adjuvant treatment, so postoperative adjuvant radiotherapy and/or chemotherapy is generally performed.There were several studies (GITSG, 1982;Moertel et al, 1984;Allum et al, 1989;Regine and Mohiuddin, 1992) showing positive effects of radiotherapy and/or chemotherapy in patients with locally advanced or unresectable gastric adenocarcinoma, but the benefit of adjuvant treatment after curative resection remains controversial. Intergroup trial (MacDonald et al, 2001) showed that adjuvant chemoradiotherapy reduced recurrences and increased survival of patients with gastric adenocarcinoma. However, after extended lymph node dissection with R0 gastrectomy, there are no data regarding whether adjuvant radiotherapy could reduce locoregional recurrence and increase survival.The purpose of this study was to analyse the patterns of failure in patients with gastric adenocarcinoma after gastrectomy with D2 lymph node dissection plus postoperative chemoradiotherapy, and to evaluate any effect of adjuvant radiotherapy on locoregional recurrence reduction and su...

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A Critical Evaluation of Subtotal Gastrectomy for the Cure of Cancer of the Stomach

Cited by 137 publications

References 2 publications

Incidence, Natural History, and Patterns of Locoregional Recurrence in Gastric Cancer Patients Treated With Preoperative Chemoradiotherapy

Incidence, Natural History, and Patterns of Locoregional Recurrence in Gastric Cancer Patients Treated With Preoperative Chemoradiotherapy

The pattern of recurrence of adenocarcinoma of the oesophago-gastric junction

Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view

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