Natural History of Gastric Cancer: Observational Study of Gastric Cancer Patients Not Treated During Follow-Up

Oh, Seung Young; Lee, Jeong‐Hwan; Lee, Hyuk Joon; Kim, Tae Han; Huh, Yeon Ju; Ahn, Hye Young; Suh, Yun Suhk; Kong, Seong Ho; Kim, Ga Hee; Ahn, Su Joa; Kim, Se Hyung; Choi, Yunhee; Yang, Han Kwang

doi:10.1245/s10434-019-07455-z

Cited by 45 publications

(30 citation statements)

References 17 publications

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“…For comparison, the patients were divided into 2 groups: patients who died within 3 years after ESD (short-term survival group, Group S) and the others as controls (Group C). The length was based on reports on the general course of gastric cancers from which it was concluded that the average period from EGC detection to its progression to advanced cancer was estimated to be 2.7–3.7 years [22, 23].…”

Section: Methodsmentioning

confidence: 99%

Predictive Factors for Short-Term Survival after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer

et al. 2020

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Background/Aims: For early gastric cancer (EGC) treated using endoscopic submucosal dissection (ESD) with poor curability defined by the Japanese Guidelines (non-curative EGC, N-EGC), additional gastrectomy has been recommended. However, N-EGC patients without additional gastrectomy often die of other diseases within a relatively short interval after ESD. It has been unclear whether additional gastrectomy is beneficial or not for such patients. The aim of this study was to clarify predictors for short-term survival of N-EGC patients without additional gastrectomy after ESD. Methods: One hundred six N-EGC patients without additional gastrectomy were included in this study. Factors related to short-term survival, defined as death within 3 years after ESD, were evaluated using uni- and multivariate analyses by comparing patients with and without short-term survival (Groups S and C, respectively). Results: During the mean follow-up period of 89 months, 39 patients died (14 patients died within 3 years, being Group S). The cause of death was gastric cancer for only 1 patient in the Group C. The 3- and 5-year overall survival rates were 86.8 and 81.8%, respectively, and the 3- and 5-years disease-specific survival rates were 100 and 98.9%, respectively. Univariate analyses showed that short-term survival was statistically associated with elevated morphology, high-risk status for lymph node metastases as defined by the eCura system, severe comorbidity (Charlson Comorbidity Index [CCI] ≥3), low level of activity in daily living (being unable to go out by oneself), habitation (a nursing home), and several poor nutritional prognostic indices (neutrophil to lymphocyte ratio ≥2.5, geriatric nutritional risk index <92, C-reactive protein ≥1.0). In the multivariate analysis, a high CCI (≥3) was the independent predictor for short-term survival after ESD (odds ratio, 8.1; 95% confidence interval, 1.53–43.0; p = 0.014). Conclusions: Severe comorbidity indicated by a high CCI score (≥3) was the independent predictor for short-term survival for EGC patients without additional gastrectomy after non-curative ESD. Since the cause of death for most patients was not gastric cancer, observational follow-ups without additional gastrectomy might be a reasonable option for patients with a poor general status indicated by a CCI ≥3.

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Section: Methodsmentioning

confidence: 99%

Predictive Factors for Short-Term Survival after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer

et al. 2020

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“…The average progression time from localized to locally evolved or metastatic is 34-44 months, based on Asian literature data. The doubling time of a locally advanced gastric cancer is 6.2 months [17,18]. The epidemiology of oesogastric cancers in France and in Europe are different, so that these data need to be analysed with some clinical circumspection.…”

Section: Oncological Impact Of Deferralmentioning

confidence: 99%

Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic

Tuech

Gangloff

Fiore

et al. 2020

Journal of Visceral Surgery

132

145

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Introduction: The Coronavirus disease-2019 (COVID-19) pandemic is a global health crisis and surgeons are at increased occupational risk of contracting COVID-19. The impact of the disease on prevalent general surgical practice is uncertain and continues to evolve. Aims/Objectives: To study the impact of COVID-19 on general surgical practice in India and the future implications of the pandemic. Methods: A survey questionnaire was designed and electronically circulated one month after India entered a national lockdown during covid-19 pandemic, among members of Indian Association of Gastro-intestinal Endosurgeons (IAGES), a surgical association with nearly eight thousand members. Survey questions pertaining to pre-COVID era surgical practices, impact on current practice and nancial implications were asked. Responses were collected and statistically analyzed. Results: 153 surgeons completed the survey, of which only 9.2% were females. 41% surgeons were more than 20 years into practice. 36.6% were into private practice at multiple hospitals (free-lancers). 41.8% had mainly laparoscopic practice with mean outpatient consultation of 26 patients/day and elective surgeries of 43 cases /month prior to lockdown. Post lock-down, daily outpatient consults reduced to 4 patients/day and 77% had not performed even a single elective procedure. 52% were taking hydroxychloroquine (HCQ) as chemoprophylaxis. 56.9% stated they are using personal protective equipment for all cases while 71.5% stated there are insu cient guidelines for future surgical practice in terms of safety. 52% surgeons stated a drop of more than 75% of their monthly income while 22% faced 50-75% reduction. 33% of respondents own a hospital and are expecting a monthly nancial liability of 2.25 Million rupees (nearly 30,000 US dollars). Conclusion: COVID 19 has led to a drastic reduction in outpatient and elective surgical practices. There is a de nite need for guidelines regarding safety for future surgical practices and solutions to overcome the nancial liabilities in the near future.

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“…The doubling time of a locally advanced GC is 6.2 months. 41,42 Since these data come from Asian countries, they need to be interpreted with caution in other parts of the world.…”

Section: Strategy For the Treatment Of Gc During The Covid-19 Pandemicmentioning

confidence: 99%

Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable

Polkowski¹,

Sędłak²,

Rawicz‐Pruszyński³

2020

CMAR

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The outbreak of the COVID-19 is currently the biggest international concern. Treatment of gastric cancer (GC) patients in the pandemic era with high hospital burden and under severe oncological/surgical resource constraints should implicate a need for resource reallocation with a new "pandemic" GC treatment algorithm. The neoadjuvant/perioperative (radio-)chemotherapy is applied in the majority of advanced GC cases with poor postoperative therapy compliance. In the East, radical surgery is frequently used in the first instance, with adjuvant chemotherapy reserved for patients with a high risk of recurrence. Moreover, the elderly population might be effectively treated by surgery alone, thus saving oncological resources for younger people who need a more aggressive approach. In this framework, prioritization is a key concept based on the severity of symptoms and the need for urgent (surgical) intervention. High-risk and marginally effective surgery should be replaced with definitive radio-and/or chemotherapy. The pandemic framework to provide optimal care for GC patients must be based on multidisciplinary decision-making and include all anti-cancer treatment options: surgery, systemic therapy, and radiotherapy. The priority and staffing dictate adherence to the new algorithm. We believe that these priorities may improve the delivery of care to all, including elderly GC patients.

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Natural History of Gastric Cancer: Observational Study of Gastric Cancer Patients Not Treated During Follow-Up

Cited by 45 publications

References 17 publications

Predictive Factors for Short-Term Survival after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer

Predictive Factors for Short-Term Survival after Non-Curative Endoscopic Submucosal Dissection for Early Gastric Cancer

Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

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