Comparison of Outcomes for Elderly Gastric Cancer Patients at Least 80 Years of Age Following Gastrectomy in the United States and China

Ji, Lin; Yi, Brendan C.; Yoon, Changhwan; Li, Ping; Zheng, Chao‐Hui; Huang, Chang‐Ming; Yoon, Sam S.

doi:10.1245/s10434-018-6757-2

Cited by 9 publications

(5 citation statements)

References 36 publications

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“…Second, while neoadjuvant therapy is currently one of the significant methods for GC treatment, it is not universally beneficial to all patients . The acceptance of neoadjuvant therapy is relatively low in Eastern countries, with most patients opting for up-front surgery . Moreover, considering that neoadjuvant therapy may influence the tumor’s infiltration depth, LN metastasis status, and the patient’s postoperative outcome, our study was designed without including patients who received neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…33,34 The acceptance of neoadjuvant therapy is relatively low in Eastern countries, with most patients opting for up-front surgery. 35,36 Moreover, considering that neoadjuvant therapy may influence the tumor's infiltration depth, LN metastasis status, and the patient's postoperative outcome, [37][38][39] our study was designed without including patients who received neoadjuvant therapy. This choice was made to better comprehend the worth of splenic hilar lymphadenectomy for patients with APGC, thus providing evidence-based medical substantiation for splenic hilar lymphadenectomy for patients with APGC opting for up-front surgery.…”

Section: Limitationsmentioning

confidence: 99%

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Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

Lin,

Xu,

Zheng

et al. 2024

JAMA Surg

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ImportanceSplenic hilar lymphadenectomy has been recommended for locally advanced proximal gastric cancer (APGC) involving the greater curvature. However, it is unclear whether laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) is associated with a long-term survival benefit for APGC without greater curvature invasion.ObjectiveTo present the 5-year follow-up data from a randomized clinical trial that compared laparoscopic total gastrectomy (D2 group) with D2 plus LSPSHL (D2 + No. 10 group) among patients with resectable APGC.Design, Setting, and ParticipantsThis is a post hoc secondary analysis of a randomized clinical trial that enrolled 536 patients with potentially resectable APGC (cT2-4a, N0 or N+, and M0) without greater curvature invasion from January 5, 2015, to October 10, 2018. All patients were tracked for at least 5 years. The final follow-up was on October 30, 2023.InterventionsPatients were randomly assigned in a 1:1 ratio to the D2 + No. 10 or D2 groups.Main Outcomes and MeasuresThe 5-year disease-free survival (DFS) and overall survival (OS) rates were measured. Recurrence patterns and causes of death were compared.ResultsA total of 526 patients (392 men [74.5%]; mean [SD] age, 60.6 [9.6] years) were included in the modified intent-to-treat analysis, with 263 patients in each group. The 5-year DFS rate was 63.9% (95% CI, 58.1%-69.7%) for the D2 + No. 10 group and 55.1% (95% CI, 49.1%-61.1%) for the D2 group (log-rank P = .04). A statistically significant difference was observed in the 5-year OS between the D2 + No. 10 group and the D2 group (66.2% [95% CI, 60.4%-71.9%] vs 57.4% [95% CI, 51.4%-63.4%]; log-rank P = .03). The No. 10 lymph node exhibited a therapeutic value index (TVI) of 6.5, surpassing that of Nos. 8a (TVI, 3.0), 11 (TVI, 5.8), and 12a (TVI, 0.8). A total of 86 patients in the D2 + No. 10 group (cumulative incidence, 32.7%) and 111 patients in the D2 group (cumulative incidence, 42.2%) experienced recurrence (hazard ratio, 0.72; 95% CI, 0.54-0.95; P = .02). The multivariable competing risk regression model demonstrated that D2 + No. 10 remained an independent protective factor for a lower 5-year cumulative recurrence rate after surgery (hazard ratio, 0.75; 95% CI, 0.56-1.00; P = .05). There was a significant difference in the 5-year cumulative recurrence rate at the No. 10 lymph node area between the 2 groups (D2 + No. 10 group vs D2 group: 0% vs 2.3% [n = 6]; P = .01).ConclusionsThis post hoc secondary analysis of a randomized clinical trial found that laparoscopic total gastrectomy with LSPSHL can improve the prognosis and reduce recurrence for APGC without greater curvature invasion. Future multicenter studies are warranted to validate these findings.Trial RegistrationClinicalTrials.gov Identifier: NCT02333721

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

Lin,

Xu,

Zheng

et al. 2024

JAMA Surg

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“…Although neoadjuvant therapy is one of the important methods for the treatment of GC, not all patients with GC could benefit from neoadjuvant therapy . Some patients would prefer surgical treatment over neoadjuvant therapy . Additionally, neoadjuvant therapy may affect the depth of tumor invasion, LN metastasis, and surgical outcomes .…”

Section: Discussionmentioning

confidence: 99%

Assessment of Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Invasion Into the Greater Curvature

Lin

Wang

et al. 2023

JAMA Surg

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ImportanceThe survival benefit of laparoscopic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy (LSTG) for locally advanced proximal gastric cancer (APGC) without invasion into the greater curvature remains uncertain.ObjectiveTo compare the long-term and short-term efficacy of LSTG (D2 + No. 10 group) and conventional laparoscopic total gastrectomy (D2 group) for patients with APGC that has not invaded the greater curvature.Design, Setting, and ParticipantsIn this open-label, prospective randomized clinical trial, a total of 536 patients with clinical stage cT2 to 4a/N0 to 3/M0 APGC without invasion into the greater curvature were enrolled from January 2015 to October 2018. The final follow-up was on October 31, 2021. Data were analyzed from December 2021 to February 2022.InterventionsEligible patients were randomized to the D2 + No. 10 group or the D2 group.Main Outcomes and MeasuresThe primary outcome was 3-year disease-free survival (DFS). The secondary outcomes were 3-year overall survival (OS) and morbidity and mortality within 30 days after surgery.ResultsOf 526 included patients, 392 (74.5%) were men, and the mean (SD) age was 60.6 (9.6) years. A total of 263 patients were included in the D2 + No. 10 group, and 263 were included in the D2 group. The 3-year DFS was 70.3% (95% CI, 64.8-75.8) for the D2 + No. 10 group and 64.3% (95% CI, 58.4-70.2; P = .11) for the D2 group, and the 3-year OS in the D2 + No. 10 group was better than that in the D2 group (75.7% [95% CI, 70.6-80.8] vs 66.5% [95% CI, 60.8-72.2]; P = .02). Multivariate analysis revealed that splenic hilar lymphadenectomy was not an independent protective factor for DFS (hazard ratio [HR], 0.86; 95% CI, 0.63-1.16) or OS (HR, 0.81; 95% CI, 0.59-1.12). Stratification analysis showed that patients with advanced posterior gastric cancer in the D2 + No. 10 group had better 3-year DFS (92.9% vs 39.3%; P &lt; .001) and OS (92.9% vs 42.9%; P &lt; .001) than those in the D2 group. Multivariate analysis confirmed that patients with advanced posterior gastric cancer could have the survival benefit from No. 10 lymph node dissection (DFS: HR, 0.10; 95% CI, 0.02-0.46; OS: HR, 0.12; 95% CI, 0.03-0.52).Conclusions and RelevanceAlthough LSTG could not significantly improve the 3-year DFS of patients with APGC without invasion into the greater curvature, patients with APGC located posterior gastric wall may benefit from LSTG.Trial RegistrationClinicalTrials.gov Identifier: NCT02333721

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“…Clavien-Dindo IV/V complication rate (West) (total number of pts) tend to be older, 12,15-17 have higher BMI, 15,16,69,70 and have more comorbidities 17 compared to their Eastern counterparts. While the effect of age and BMI on outcomes is controversial, [71][72][73] their presence correlates with greater comorbidities which have been demonstrated to predict worse outcomes for gastrectomy patients.…”

Section: Author Year Countrymentioning

confidence: 99%

Open and minimally invasive gastrectomy in Eastern and Western patient populations: A review of the literature and reasons for differences in outcomes

Stillman

Yoon

2022

Journal of Surgical Oncology

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Randomized trials in the East have established minimally invasive gastrectomy as possibly superior for short-term outcomes and noninferior for long-term survival. Smaller randomized studies from Western countries have supported these findings. However, there are marked disparities in morbidity, mortality, and overall survival noted between Eastern and Western studies. In this article, we review the literature comparing open and minimally invasive gastrectomy in the East and West, and describe the possible reasons for differences in outcomes.

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Comparison of Outcomes for Elderly Gastric Cancer Patients at Least 80 Years of Age Following Gastrectomy in the United States and China

Abstract: Patients ≥ 80 years of age selected for gastrectomy for GC at MSKCC and FMUUH had acceptable morbidity and mortality, and DSS was primarily dependent on TNM stage.

Cited by 9 publications

References 36 publications

Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion

Assessment of Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Invasion Into the Greater Curvature

Open and minimally invasive gastrectomy in Eastern and Western patient populations: A review of the literature and reasons for differences in outcomes

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