Preoperative Chemoradiation Therapy Does not Increase Risk of Anastomotic Leak in Gastric Cancer Patients

Ikoma, Naruhiko; Blum, Mariela; Estrella, Jeannelyn S.; Fournier, Keith F.; Mansfield, P. F.; Ajani, Jaffer A.; Badgwell, Brian

doi:10.1016/s0016-5085(17)34048-9

Cited by 7 publications

(10 citation statements)

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“…We analyzed data from patients with gastric cancer, who underwent SL and PC at our institution from July 1, 1995 to July 1, 2018. Patient selection and variables collected were similar to those in a previous study by our group [5,16,17]. Only patients with pathologically diagnosed adenocarcinoma of the stomach who underwent SL and PC were included.…”

Section: Methodsmentioning

confidence: 99%

“…Patients considered to be potentially resectable (negative SL/PC) underwent induction chemotherapy, followed by chemoradiation, restaging, and then attempted resection. Preoperative chemotherapy and chemoradiation techniques at our institution have been previously described [5,16,17]. Following resection, our standard surveillance practice is to perform 4-6 month follow-up with imaging.…”

Section: Methodsmentioning

confidence: 99%

“…At times, patients with T1 lesions will undergo SL and PC if there are high-risk features, or at the time of laparotomy and attempted resection. SL and PC were performed prior to any definitive treatment with the standard technique used at our institution, as previously described [5,6,[16][17][18][19][20]. The peritoneal cavity was inspected for gross evidence of metastasis.…”

Section: Methodsmentioning

confidence: 99%

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Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma

et al. 2020

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Background: Staging laparoscopy and peritoneal cytology can detect occult metastatic disease prior to treatment of gastric cancer. The yield of peritoneal staging in patients with early stage disease is lacking. We assess the yield of peritoneal staging in early stage gastric cancer and its impact on survival. Methods: Data were obtained from a prospective database of patients who underwent staging laparoscopy and peritoneal cytology for gastric cancer at our institution between July 1995 and July 2018. Clinical stage was determined by endoscopic ultrasound, and early stage was defined as cT1-2 and cN0. Rates of positive cytology and carcinomatosis at time of laparoscopy were obtained. Univariate analyses were used to compare groups, and Kaplan-Meier survival analyses were used to assess survival outcomes. Results: Eight hundred sixty-seven patients underwent staging laparoscopy and peritoneal cytology; 56 were defined as early stage. Age was 61 ± 12 years, 66.4% were male, and 62.3% were white. Of the patients with early stage disease, 17.9% had either gross carcinomatosis (10.7%) and/or positive peritoneal cytology (10.9%). All cases of peritoneal disease were in patients with cT2 disease. There were no differences in age, gender, or race based on peritoneal disease (all p > 0.05). The presence of carcinomatosis or positive cytology significantly affected overall survival (p < 0.001), regardless of clinical T or N stage. Conclusions: Peritoneal staging identifies metastatic disease in a significant number of patients with early stage disease. Given its poor prognosis and alternate therapy options, independent staging laparoscopy and peritoneal cytology should be considered in patients with early stage gastric adenocarcinoma.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma

et al. 2020

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“…Patient selection and variables collected were similar to those in a previous study by our group. 10,14,15 The patient and tumor characteristics collected were age, sex, race/ethnicity, primary tumor location, cT category, cN status, and final stage were defined according to the 8th edition of the American Joint Committee on Cancer staging manual. cT and cN status were determined mainly via endoscopic ultrasound performed by experienced endoscopists at our facility.…”

Section: Methodsmentioning

confidence: 99%

“…We analyzed data from patients who had undergone SL and PC for gastric and GE cancer at our institution from 1 July, 1995 to 1 July, 2018. Patient selection and variables collected were similar to those in a previous study by our group . The patient and tumor characteristics collected were age, sex, race/ethnicity, primary tumor location, cT category, cN status, and final stage were defined according to the 8th edition of the American Joint Committee on Cancer staging manual.…”

Section: Methodsmentioning

confidence: 99%

Yield of peritoneal cytology in staging patients with gastric and gastroesophageal cancer

Allen

Newhook

Vreeland

et al. 2019

Journal of Surgical Oncology

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Background Guidelines for gastric and gastroesophageal (GE) cancer recommend staging laparoscopy (SL) with peritoneal cytology (PC). However, the reliability of PC is unknown. The primary purpose of this study was to determine the sensitivity of PC. Methods We analyzed a prospectively maintained database of patients who underwent SL and PC for gastric and GE cancer. Test sensitivity of PC for detecting peritoneal disease was assessed. Survival analyses were used to examine the implication of PC. Results There were 1186 patients that underwent SL and PC; 282 (24%) were found with carcinomatosis. PC was analyzed in 214 (76%) of these patients and 77 (36%) were found to have no malignant cells. In this setting, PC had a sensitivity of 64% for confirming peritoneal disease. Those with peritoneal disease had a poorer 5‐year overall survival (5.8% vs 37.7%; P < .001). Those with positive PC without carcinomatosis had a similar survival to those with gross disease with and without cytological confirmation (both P > .05). Conclusions PC has limited sensitivity for detecting peritoneal disease. Positive PC alone carries a similar poor survival as in patients with gross carcinomatosis. Improvements in the identification of microscopic disease in peritoneal washings are needed.

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Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer

Stark

Estrella

Chiang

et al. 2020

Journal of Surgical Oncology

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Background and Objectives It is unknown whether the degree of response to preoperative therapy correlates with locoregional recurrence (LR) or distant recurrence (DR) after resection of gastric cancer. Methods Patients who underwent resection of gastric adenocarcinoma following chemotherapy and chemoradiation (1995‐2015) were reviewed. The tumor regression grade (TRG) was defined by the percentage of viable tumor cells in the specimen (TRG0 = 0%; TRG1 = 1%‐2%; TRG2 = 3%‐50%; TRG3 ≥ 50%). The relationships among TRG, recurrence‐free survival (RFS), LR, and DR were examined. Results Two hundred forty‐seven patients met the inclusion criteria (TRG0, 52 [21%]; TRG1, 49 [20%]; TRG2, 98 [40%]; TRG3, 48 [19%]). LR and DR occurred in 6.1% and 32.0% of patients, respectively. No patient with TRG0 experienced LR. R1 resection (6%‐15%) and LR (6%‐8%) rates were similar among TRG1‐3 patients. R1 resection was associated with LR (hazard ratio [HR], 17.85; P < .001). ypN status (HR, 2.44; P = .004) and linitis plastica (HR, 2.90; P < .001) were associated with DR. TRG was not independently associated with RFS, LR, or DR. Conclusions TRG0 imparted excellent local control. However, TRG1‐3 patients had similar R1 resection rates and therefore similar LR. DR is associated with ypN status and linitis plastica, not TRG.

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Preoperative Chemoradiation Therapy Does not Increase Risk of Anastomotic Leak in Gastric Cancer Patients

Cited by 7 publications

References 0 publications

Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma

Staging laparoscopy and peritoneal cytology in patients with early stage gastric adenocarcinoma

Yield of peritoneal cytology in staging patients with gastric and gastroesophageal cancer

Impact of tumor regression grade on recurrence after preoperative chemoradiation and gastrectomy for gastric cancer

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