Gastric Cancer Surgery: Morbidity and Mortality Results From a Prospective Randomized Controlled Trial Comparing D2 and Extended Para-Aortic Lymphadenectomy—Japan Clinical Oncology Group Study 9501

Sano, Takeshi; Sasako, Mitsuru; Yamamoto, Seiichiro; Nashimoto, Atsushi; Kurita, Akira; Hiratsuka, Masahiro; Tsujinaka, T.; Kinoshita, Taira; Arai, Kuniyashi; Yamamura, Yoshitaka; Okajima, Kunio

doi:10.1200/jco.2004.10.184

Cited by 627 publications

(463 citation statements)

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“…Although 5·8 per cent of the patients (6 of 104) died in hospital from disease progression during the primary admission, none died from postoperative complications. The 30‐day postoperative mortality rate of 1·9 per cent was acceptable in comparison with the rate of 0·8 per cent associated with elective potentially curative surgical oncology procedures for advanced gastric cancer in Japan32. Given the low rates of postoperative morbidity and mortality in the present study, the extent to which QoL was impaired by the operation is likely to have been small.…”

Section: Discussionmentioning

confidence: 59%

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Fujitani¹,

Ando

Sakamaki

et al. 2017

BJS Open

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BackgroundQuality of life (QoL) is a key component in decision‐making for surgical palliation, but QoL data in association with surgical palliation in advanced gastric cancer are scarce. The aim of this multicentre observational study was to examine the impact of surgical palliation on QoL in advanced gastric cancer.MethodsThe study included patients with gastric outlet obstruction caused by incurable advanced primary gastric cancer who had no oral intake or liquid intake only. Patients underwent palliative distal/total gastrectomy or bypass surgery at the physician's discretion. The primary endpoint was change in QoL assessed at baseline, 14 days, 1 month and 3 months following surgical palliation by means of the EuroQoL Five Dimensions (EQ‐5D™) questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ‐STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.ResultsSome 104 patients (23 distal gastrectomy, 9 total gastrectomy, 70 gastrojejunostomy, 2 exploratory laparotomy) were enrolled from 35 institutions. The mean EQ‐5D™ utility index scores remained consistent, with a baseline score of 0·74 and the change from baseline within ± 0·05. Gastric‐specific symptoms showed statistically significant improvement from baseline. The majority of patients were able to eat solid food 2 weeks after surgery and tolerated it thereafter. The rate of overall morbidity of grade III or more according to the Clavien–Dindo classification was 9·6 per cent (10 patients) and the 30‐day postoperative mortality rate was 1·9 per cent (2 patients).ConclusionIn patients with gastric outlet obstruction caused by advanced gastric cancer, surgical palliation maintained QoL while improving solid food intake, with acceptable morbidity for at least the first 3 months after surgery. Registration number 000023494 (UMIN Clinical Trials Registry).

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Section: Discussionmentioning

confidence: 59%

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Fujitani¹,

Ando

Sakamaki

et al. 2017

BJS Open

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“…40 In recent years, there have been advances in the surgical approach with combining gastrectomy with limited lymphadenectomy in a Western setting 41 and D2 lymphadenectomy in an Asian setting 42 and the use of preoperative chemotherapy to increase the R0 resection rate. 43 It has also been shown that combination chemotherapy significantly improves survival compared to single agent 5-fluorouracil, however, at the expensive of increased toxicity.…”

Section: Presence Of Metastases (M)mentioning

confidence: 99%

Clinicopathologic factors associated with HER2‐positive gastric cancer and its impact on survival outcomes—A systematic review

Chua

Merrett

2011

Intl Journal of Cancer

163

111

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With the availability of a therapeutic target and an effective agent in trastuzumab, a systematic examination of the literature to investigate the role of human epidermal growth factor 2 (HER2) as a prognostic factor for survival and its association with clinicopathologic markers may improve treatment. An electronic search of the MEDLINE and PubMed databases (January 1990 to January 2011) was undertaken to identify translational studies that correlated HER2 with clinicopathologic markers and/or survival outcome. This review included 49 studies totaling 11,337 patients. Forty-four percent of patients had Stage I/II, and 56% had Stage III/IV disease. Immunohistochemistry was most commonly used to assess HER2 expression, identifying a median rate of 18% (range, 4-53%) of gastric cancer demonstrating HER2 overexpression. In patients with and without HER2 overexpression, the median 3-year disease-free survival rate was 58% (range, 50-88%) and 86% (range, 62-97%), respectively. Of the 35 studies reporting the impact of HER2 overexpression on survival, 20 studies (57%) reported no difference in overall survival, two studies (6%) reported significantly longer overall survival in patients with HER2 overexpression and 13 studies (37%) reported significantly poorer overall survival in patients with HER2 overexpression. The median overall survival and 5-year survival rate was 21 (range, 10-57) months and 42%, and 33 (range, 13-80) months and 52% in patients with and without HER2 overexpression, respectively. HER2 overexpression appears to be associated with poorer survival and with intestinal-type gastric cancer in this group of patients for whom majority undergone curative gastrectomy.On a global scale, gastric cancer remains the second most common cause of cancer-related death with an estimated 930,000 new cases diagnosed each year albeit an overall decline in incidence. 1 Noncardia gastric cancers have steadily declined. However, it has been observed that proximal gastric cancers (cardia and oesophago-gastric tumors) are increasing at a rate of up to 10% per year, far exceeding that of any other type of cancer. Metastatic or advanced unresectable gastric cancer is an aggressive malignancy with a poor prognosis despite chemotherapy treatment with median survival of 7.5 to 12 months and a median survival of 3 to 5 months if managed by best supportive care. 2 Gastric cancer is a chemosensitive disease where a range of chemotherapy agents may achieve response rates of 30 to 40%; however, in the advanced setting, the disease is limited by a low complete response rate and the response duration is protracted often leading to disease progression and treatment related toxicities. 3 Combination chemotherapy with a Japanese standard doublet of fluoropyrimidine and platinum or western triplet regimens has shown better response rates and outcomes over single agent chemotherapy. However, there remains no established global standard for treatment.The human epidermal growth factor 2 (HER2) gene is a proto-oncogene where high amplifica...

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“…Albeit recent advancements in surgical techniques and perioperative care, the postoperative morbidity rate is as high as approximately 40% after esophageal cancer surgery,1, 2 and 20–30% after both gastric cancer surgery3, 4, 5 and colorectal surgery 6, 7, 8. Various reports have shown that such postoperative complications frequently reduce the overall survival (OS) as well as cancer‐specific survival after major surgery for cancer 9.…”

Section: Introductionmentioning

confidence: 99%

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

Shimada

Fukagawa

Haga

et al. 2017

Annals of Gastroent Surgery

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PurposeThe impact of postoperative complications on survival after radical surgery for esophageal, gastric, and colorectal cancers remains controversial. We conducted a systematic review of recent publications to examine the effect of postoperative complications on oncological outcome.MethodsA literature search of PubMed/MEDLINE was performed using the keywords “esophageal cancer,” “gastric cancer,” and “colorectal cancer,” obtaining 27 reports published online up until the end of April 2016. Articles focusing on (i) postoperative morbidity and oncological outcome; and (ii) body mass index (BMI), postoperative morbidity, and oncological outcome, were selected. Univariate and multivariate analyses (Cox proportional hazards model) were performed.ResultsPatients with postoperative complications had significantly poorer long‐term survival than those without complications. Complications were associated with impaired oncological outcomes. The hazard ratios for overall survival were 1.67 (95% confidence interval [CI], 1.31‐2.12), 1.59 (95% CI, 1.13‐2.24), and 1.55 (95% CI, 1.28‐1.87) in esophageal, gastric, and colorectal cancers, respectively. High BMI was associated with postoperative morbidity rate but not with poor oncological outcome. Low BMI was significantly associated with inferior oncological outcome.ConclusionsComplications after radical surgery for esophageal, gastric, and colorectal cancers are associated with patient prognosis. Avoiding such complications might improve the outcomes.

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Gastric Cancer Surgery: Morbidity and Mortality Results From a Prospective Randomized Controlled Trial Comparing D2 and Extended Para-Aortic Lymphadenectomy—Japan Clinical Oncology Group Study 9501

Abstract: Specialized surgeons could safely perform gastrectomy with D2 lymphadenectomy in patients with low operative risks. Para-aortic lymphadenectomy could be added without increasing major surgical complications in this setting.

Cited by 627 publications

References 20 publications

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Clinicopathologic factors associated with HER2‐positive gastric cancer and its impact on survival outcomes—A systematic review

Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature

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