Changing clinical and pathological features of gastric cancer over time

Marrelli, Daniele; Pedrazzani, Corrado; Morgagni, Paolo; Manzoni, Giovanni De; Pacelli, Fabio; Coniglio, Arianna; Marchet, Alberto; Saragoni, Luca; Giacopuzzi, Simone; Roviello, Franco

doi:10.1002/bjs.7528

Cited by 69 publications

(50 citation statements)

References 34 publications

(59 reference statements)

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“…An essential condition is that good early postoperative results in terms of morbidity and mortality should be ensured. This is consistent with the reports of observational non-randomized studies from specialized centers (6)(7)(8)(9)18,(26)(27)(28).…”

Section: Lymphadenectomy For Advanced Formssupporting

confidence: 92%

“…It is also worthy of note that in the British trial resection of spleen and pancreas were found to have a significant negative influence on overall survival (5). In the GIRCG experience, data collected from a prospective database of 2,822 patients, most of which submitted to extended lymphadenectomy (>15 removed nodes in 78% of cases, >25 nodes in 53%) postoperative mortality was 3.5%, even when including aged patients, advanced stages and so on (26). These data indicate that extended lymphadenectomy can be performed safely in Western patients when adopting correct criteria and with an adequate surgical volume.…”

Section: Early Resultsmentioning

confidence: 86%

“…The correct procedure of extended lymphadenectomy requires specialized experience in gastro esophageal surgery with an appropriate learning curve; indeed, the complication and mortality rates reported in the specialized Western centers are limited, generally overlapping or slightly higher than those reported by the Japanese authors (6)(7)(8)(9)18,(26)(27)(28)42,43). Furthermore, it is particularly important to limit the use of splenopancreatic resection to only selected cases.…”

Section: Early Resultsmentioning

confidence: 99%

“…In particular, some studies reported that with the implementation of lymphadenectomy procedures with time, a progressive reduction of locoregional recurrences has been observed (26). However, it should be emphasized that when comparing long-term results from Eastern and Western series, a significant better outcome at the same stage is observed in the former, suggesting potential biological differences related to the tumor, to the ethnicity or to the immunological system (50)(51)(52)(53)(54).…”

Section: Long-term Resultsmentioning

confidence: 99%

“…If we look at survival curves of this study, it is evident that after 2-3 years from operation the cumulative risk of death due to GC is increased in the D1 group, and several long-term tumor-related deaths even after 5 years of follow-up are observed. In the GIRCG experience, a reduction of locoregional recurrence has been observed with time, with a parallel increase in the quality of lymphadenectomy and the number of removed lymph nodes (26).…”

Section: Reduction Of Gc Recurrencementioning

confidence: 97%

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Lymphadenectomy: state of the art

Marrelli

Franco

Iudici

et al. 2017

Transl. Gastroenterol. Hepatol.

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The extent of lymphadenectomy in gastric cancer (GC) surgery has been for long time a matter of debate. Randomized trials performed in the West reported worse results of D2 dissection, in terms of postoperative complications and long-term survival benefit, than Eastern series and observational studies from specialized Western centers. However, long-term re-evaluation of such trials and in depth-analysis of other experiences demonstrated the potential benefit of D2 in reducing the probability of cancer-related death and the safety of this procedure when avoiding unnecessary spleno-pancreatectomy and in centers with ad adequate surgical volume. Nowadays, the D2 is considered the standard treatment in most guidelines all over the world. More limited procedures (D1, D1 plus) may be adequate in selected cases, and more extended dissections (D2 plus) could be indicated in advanced forms with high risk of metastases to distant nodes, but in specialized centers or in the setting of clinical studies. The integration with neoadjuvant therapies and multimodality approach could offer a chance of cure in groups of patients with poor results when approached with standard treatment.

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Section: Lymphadenectomy For Advanced Formssupporting

confidence: 92%

Section: Early Resultsmentioning

confidence: 86%

Section: Early Resultsmentioning

confidence: 99%

Section: Long-term Resultsmentioning

confidence: 99%

Section: Reduction Of Gc Recurrencementioning

confidence: 97%

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Lymphadenectomy: state of the art

Marrelli

Franco

Iudici

et al. 2017

Transl. Gastroenterol. Hepatol.

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Meta-analysis of microsatellite instability in relation to clinicopathological characteristics and overall survival in gastric cancer

Połom

Marano

Marrelli

et al. 2017

British Journal of Surgery

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195

143

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Critical number of lymph node involvement in esophageal and gastric cancer and its impact on long‐term survival—A single‐center 8‐year study

Askari

Munster

Jambulingam

et al. 2020

Journal of Surgical Oncology

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Background: Nodal disease in esophageal and gastric cancer is associated with poor survival. Objectives: To determine the critical level of lymph node involvement where survival becomes significantly compromised. Methods: Survival analyses using multivariable Cox regression and receiver operator characteristics (ROC) were undertaken to determine what number of positive lymph nodes were most sensitive and specific in predicting survival. Results: A total of 317 patients underwent esophagectomy (n = 190, 59.9%) and gastrectomy (n = 127, 40.1%) for adenocarcinoma. At multivariable analyses, four nodes positivity (irrespective of T-category) was associated with nearly a fivefold increased risk of mortality when compared to node-negative patients (hazard ratio [HR], 4.9; interquartile range 2.0-11.5; P < .001). A positive ratio of up to 50.0% was not associated with worse survival than having four nodes positive (HR, 4.6; 95% confidence interval, 2.6-8.1; P < .001). ROC analysis demonstrated four lymph nodes positive to have a sensitivity of 80.5%, a specificity of 60.1%, and an accuracy of 77.8 (P < .001). Conclusion: The absolute number of nodes positive for cancer is more important than the proportion of positive nodes in predicting survival in esophageal/gastric cancer. Four positive lymph nodes are associated with a fivefold increase in mortality. Beyond this, increasing numbers of positive lymph nodes make no appreciable difference to survival.

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Changing clinical and pathological features of gastric cancer over time

Abstract: Overall and disease-free survival rates after R0 resection of GC were unchanged over time.

Cited by 69 publications

References 34 publications

Lymphadenectomy: state of the art

Lymphadenectomy: state of the art

Meta-analysis of microsatellite instability in relation to clinicopathological characteristics and overall survival in gastric cancer

Critical number of lymph node involvement in esophageal and gastric cancer and its impact on long‐term survival—A single‐center 8‐year study

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