Multimodal treatment of gastric cancer in the west: Where are we going?

Marrelli, Daniele; Połom, Karol; Manzoni, Giovanni De; Morgagni, Paolo; Baiocchi, Gian Luca; Roviello, Franco

doi:10.3748/wjg.v21.i26.7954

Cited by 59 publications

(38 citation statements)

References 107 publications

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“…Gastric cancer is common condition world wide, although with an incidence rate lower than those of lung, breast and colorectal cancer (1). Symptoms of gastric cancer include anemia, weigh loss, appetite loss, easy fatigability and non-specific symptoms such as abdominal pain (2).…”

Section: Introductionmentioning

confidence: 99%

“…Symptoms of gastric cancer include anemia, weigh loss, appetite loss, easy fatigability and non-specific symptoms such as abdominal pain (2). Treatment options for gastric cancer include endoscopic treatment, surgery, chemotherapy and radiation (1,3,4). Key types of endoscopic treatment include endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) (5,6).…”

Section: Introductionmentioning

confidence: 99%

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Detection of gastric cancer using transabdominal ultrasonography is associated with tumor diameter and depth of invasion

Tomizawa

Shinozaki

Fugo

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Gastric cancer is occasionally diagnosed using transabdominal ultrasonography (US) during screening or investigation of patients with abdominal symptoms. Therefore, the present study analyzed the association of the tumor diameter, pathological T (pT) staging and depth of invasion with the detection of gastric cancer using US. Patient records were analyzed retrospectively and 13 patients were enrolled, who underwent US screening prior to endoscopic mucosal resection, endoscopic submucosal dissection or surgery. In total, 5 patients were diagnosed with gastric cancer using US (positive detection group), while US was unable to detect the gastric cancer in 8 patients (negative detection group). The tumor diameter and depth of invasion were determined by pathologists. One-way analysis of variance or the χ 2 test was performed. Wall thickness in gastric cancer cases ranged between 7 and 20 mm (mean, 12.2±5.9 mm), as measured using abdominal US. The hemoglobin level was significantly lower in the positive detection patients compared with the negative detection patients (P=0.0455). In addition, the diameters of the gastric wall in the negative and positive detection patients were 24.5±16.4 and 54.4±26.2 mm, respectively (P=0.0266). These results indicate that gastric cancer in the positive detection patients were at a more advanced-stage compared with that in the negative detection patients. Furthermore, gastric cancer with a stage over pT2 was diagnosed using abdominal US (P=0.0242), whereas stage pT1a gastric cancer was not detected by abdominal US. Gastric tumors invading deeper than the submucosa were diagnosed using US (P=0.0242). However, the gastric cancer cases limited to the mucosa remained undetected. In conclusion, the detection of gastric cancer correlated well with the tumor diameter, pT staging and depth of invasion.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detection of gastric cancer using transabdominal ultrasonography is associated with tumor diameter and depth of invasion

Tomizawa

Shinozaki

Fugo

et al. 2015

Experimental and Therapeutic Medicine

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“…Recent studies reported very good long-term survival rates in patients with extensive or bulky lymph node metastases submitted to neoadjuvant chemotherapy and D2 plus lymphadenectomy (31,57). This is particularly true in Western series, where the rate of diffuse type tumors, associated with a high propensity to spread to regional and distant nodes, is increasing with time (26,56).…”

Section: Long-term Resultsmentioning

confidence: 99%

“…When analysing long-term results in Western large series, it is evident that survival rates at advanced pT (serosal involvement) and pN stages (N3a and N3b) are unsatisfactory, even when submitting patients to extended lymphadenectomy (55). As such, in these stages a multidisciplinary approach is advisable, with possible integrated approach including neoadjuvant treatments or intraperitoneal chemotherapy (56). Recent studies reported very good long-term survival rates in patients with extensive or bulky lymph node metastases submitted to neoadjuvant chemotherapy and D2 plus lymphadenectomy (31,57).…”

Section: Long-term Resultsmentioning

confidence: 99%

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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“…Interventions using a combination of chemotherapy, gene-targeted therapy, or radiotherapy have been widely applied, effectively prolonging the survival of patients with advanced gastric cancer [2][3][4] . However, the side effects of chemotherapy can worsen a patient's quality of life, possibly even hindering continuation of treatment and rendering the patient vulnerable to disease progression and death.…”

Section: Introductionmentioning

confidence: 99%