Has there been any improvement in the staging of gastric cancer?. Findings from the German gastric cancer TNM study group

Abstract

This multicenter observational study examined the survival of 1420 patients with histologically proven carcinoma of the stomach. From April 1982 through October 1984, 1360 (95%) patients underwent surgery, 988 (72%) had resections, and 372 (28%) minor surgical procedures. The percentage of patients who have been followed until death or 3 to 5 years was 99.4%. Patients were staged preoperatively and intraoperatively and by pathologists using the old (1978) and new (1987) TNM stage groupings and 5-year survival was analyzed. Subgroups of patients who changed their stage group according to the new stage definitions were analyzed separately. Only age was an important prognostic factor for survival in Stage IA (P less than 0.05) and Stage IB (P less than 0.01). Residual tumor after surgery was most important for survival in Stage II (P less than 0.01) and Stage IIIA (P less than 0.001). This indicates that improvements of stage definitions for individual prognosis can only be achieved by adding data concerning the presence or absence of residual tumor (R classification).

Classification of Lymph Node Metastases from Carcinoma of the Stomach: Comparison of the Old (1987) and New (1997) TNM Systems

“…b Nonregional nodes are retropancreatic (13), mesenteric (14), and paraaortic (16) lymph nodes. c No patients alive after 13 months.…”

Selection of locally advanced gastric carcinoma by preoperative staging laparoscopy

“…It has also been stated [1,6,14,15] that more than 25% of newly diagnosed gastric cancer patients will be found (at subsequent laparotomy) to have been understaged, with severe ethical, economic, and quality-of-life implications. Perioperative complications occur in 12-23% of unresectable patients, with a reported mortality ranging up to 21.1%; patients who do not undergo a surgical exploration have a longer mean survival than those who have laparotomy or bypass [7,18].…”

“…These cases are often understaged by a conventional preoperative workup based on ultrasonography (US) and computed tomography (CT) [6,14,17], which implies a high percentage of unhelpful exploratory laparotomies. The value of preoperative video-laparoscopy in the prevention of unnecessary surgical exploration has been evidenced by previous reports [1,3,5,7,11,17], but to date an even more crucial task has been given to preoperative laparoscopy.…”

Does endoscopic ultrasound staging already allow individual treatment regimens in gastric cancer

“…Two gastroenterologists from the Department of Gastroenterology and Endoscopy took all the EUS images. Depth of tumor infiltration throughout the gastric wall was assessed according to EUS criteria using TNM classification as recommended by the UICC [12,19,20], and expressed by the values EUS T1-T4. Similarly the lymph nodes were assessed according to EUS criteria and expressed as EUS N-(lymph nodes without metastasis) and EUS N+ (lymph nodes with metastasis).…”