Gastric Cancer

Lawson, Joshua D.; Sicklick, Jason K.; Fanta, Paul T.

doi:10.1016/j.currproblcancer.2011.03.001

Cited by 9 publications

(5 citation statements)

References 138 publications

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“…Lymph nodes involvement and local spread is one of the main features of gastric cancer and nodal invasion is mainly influenced by tumor depth [ 54 ]. Nodal spread gradually takes place radiating from the primary site [ 55 ] and nodal involvement is one of the most important prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Central vascular ligation and mesentery based abdominal surgery

et al. 2021

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In the nineteenth century the idea of a correct surgical approach in oncologic surgery moved towards a good lymphadenectomy. In colon cancer the segment is removed with adjacent mesentery, in gastric cancer or pancreatic cancer a good oncologic resection is obtained with adequate lymphadenectomy. Many guidelines propose a minimal lymph node count that the surgeon must obtain. Therefore, it is essential to understand the adequate extent of lymphadenectomy to be performed in cancer surgery. In this review of the current literature, the focus is on “central vascular ligation”, understood as radical lymphadenectomy in upper and lower gastrointestinal cancer, the evolution of this approach during the years and the improvement of laparoscopic techniques. For what concerns laparoscopic surgery, the main goal is to minimize post-operative trauma introducing the “less is more” concept whilst preserving attention for oncological outcomes. This review will demonstrate the importance of a scientifically based standardization of oncologic gastrointestinal surgery, especially in relation to the expansion of minimally invasive surgery and underlines the importance to further investigate through new randomized trials the role of extended lymphadenectomy in the new era of a multimodal approach, and most importantly, an era where minimally invasive techniques and the idea of “less is more” are becoming the standard thought for the surgical approach.

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Section: Discussionmentioning

confidence: 99%

Central vascular ligation and mesentery based abdominal surgery

et al. 2021

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“…Overall, the more invasive the tumor depth is, the more extensive the LN involving is. 30 , 31 However, due to tumour heterogeneity, some T3-4 patients may have no LN metastasis, while some T1a-1b patients may confront extensive LN metastasis. Of course, the stage T3-4N0 GC are distinguished from the subgroup of biologically LN metastasis-active GC (T1a-1bN+) and could be conformed to our study demanding.…”

Section: Discussionmentioning

confidence: 99%

“…27 After preoperative chemotherapy, 372 (95%) of 393 patients in the chemotherapy subgroup and 369 (93%) of 395 patients in the chemoradiotherapy subgroup proceeded to surgery. With a median follow-up of 61.4 months (IQR 43.3-82.8), mOS was 43 months (95% CI 31-57) in the chemotherapy subgroup and 37 months (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48) in the chemoradiotherapy subgroup (HR 1.01, 95% CI 0.84 -1.22; p ¼ 0.90). This result supported our hypothesis and finding in our study that the survival benefit of chemoradiotherapy in Western practices may be attributed primarily to chemotherapy rather than to radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Distinguish the Role of Radiotherapy From Chemoradiotherapy for Gastric Cancer With Behavior of Metastasis-Indolent in Lymph Node

Zhi

Lin

et al. 2020

Technol Cancer Res Treat

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Background: Although the landmark INT-0116 trial and National Comprehensive Cancer Network (NCCN) guidelines recommended pT3-4Nx gastric cancer (GC) patients to receive chemoradiotherapy, the role of radiotherapy has not been distinguished from chemoradiotherapy. Methods: GC with behavior of metastasis-indolent in lymph node (MILN) being confirmed with more than 15 examined LNs after gastrectomy were identified using the Surveillance, Epidemiology and End Result (SEER) database. The cancer-specific survival (CSS) of subgroups for radiotherapy, chemotherapy, chemoradiotherapy and non-adjuvant-treatment were compared. Propensity score matching (PSM) was performed between radiotherapy and non-radiotherapy subgroups to further distinguish the role of radiotherapy from chemoradiotherapy. Cox regression was performed to identify whether radiotherapy or chemotherapy could independently improve prognosis. Results: We identified 690 MILN GC patients in SEER database. 5-year CSS was 71.9% in radiotherapy subgroup and 75.1% in non-radiotherapy subgroup(HR = 1.013, 95% CI = 0.714-1.438, p = 0.940), 75.6% in chemotherapy subgroup and 68.5% in non-chemotherapy subgroup(HR = 0.616, 95% CI = 0.430-0.884, p = 0.008), 52.5% in radiotherapy-alone subgroup and 71.9% in non-adjuvant treatment group (HR = 1.604, 95% CI = 0.575-4.471, p = 0.360), 72.9% in chemoradiotherapy subgroup and 79.5% in chemotherapy-alone subgroup (HR = 1.365, 95% CI = 0.859-2.172, p = 0.185), respectively. Further, PSM markedly improved balance of variables between radiotherapy subgroup and non-radiotherapy subgroup. After PSM, the role of the variables of radiotherapy and chemotherapy in contributing to improving CSS are consistent with that before PSM. Cox regression showed chemotherapy, tumor size, tumor invasiveness and Lauren classification were independent prognostic factors, but not including radiotherapy. Conclusions: Chemoradiotherapy confers superior prognosis to MILN GC patients compared with surgery alone might only be attributed to chemotherapy rather than radiotherapy.

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“…However, some T4 tumors were unresectable, forming the T status of surgery for incurable gastric cancer. The risk of regional nodal involvement increases with deep penetration through the gastric wall [ 22 ], and the nodal extension of the cancer occurs gradually, radiating from the primary location via the lymphatic system [ 23 , 24 ]. Nodal metastases are observed in 3–5 % of gastric carcinomas limited to the mucosa.…”

Section: Discussionmentioning

confidence: 99%

Analysis of surgery for incurable gastric cancer

et al. 2015

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BackgroundIt is important to evaluate the curability of and avoid unnecessary exploratory surgery for gastric cancer preoperatively. However, no related research has been reported until now. The aim of this study was to evaluate the factors influencing surgery for incurable gastric cancer.Methods310 cases of T3–4 gastric cancer patients were analyzed retrospectively, including 141 cases with radical surgery and 169 with surgery for incurable gastric cancer. The incurable factors were categorized as T status (unresectable T4 tumor), N status (unresectable lymph node), peritoneal metastasis, and distant metastasis. χ2 test and logistic regression were performed to analyze the associations between curability, T status, N status, peritoneal metastasis, or distant metastasis and clinicopathological data.ResultsEsophageal involvement and T grade were associated with curability. Cardia involvement and Borrmann type were associated with T status. Esophageal involvement and T grade were associated with N status. Gastric body involvement, esophageal involvement, and T grade were associated with peritoneal metastasis. Gastric antrum involvement was associated with distant metastasis.ConclusionsThe influencing factors of surgery for incurable gastric cancer should be analyzed preoperatively. Resectability should be evaluated according to these influencing factors combined with imaging analysis.

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Gastric Cancer

Cited by 9 publications

References 138 publications

Central vascular ligation and mesentery based abdominal surgery

Central vascular ligation and mesentery based abdominal surgery

Distinguish the Role of Radiotherapy From Chemoradiotherapy for Gastric Cancer With Behavior of Metastasis-Indolent in Lymph Node

Analysis of surgery for incurable gastric cancer

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