Prognostic factors in patients with advanced gastric cancer with macroscopic invasion to adjacent organs treated with radical surgery

Isozaki, Hiroshi; Tanaka, Noriaki; Tanigawa, N; Okajima, Kunio

doi:10.1007/pl00011718

Cited by 50 publications

(46 citation statements)

References 13 publications

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“…In this way, 38 to 56% of the patients with additional organ resection were seen pathologically to be in T4 stage (22,23). In our series, 61 of 110 patients (55%) with additional organ resection were seen pathologically to be in T4 stage.…”

Section: Discussionsupporting

confidence: 51%

Surgical Outcomes and Early Postoperative Complications in Locally Advanced Gastric Cancer

Doğan¹,

Karaman²,

Hüseyinova³

et al. 2011

Acta Oncol Tur.

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ÖZET Amaç: Batı ülkelerinde saptanan mide kanserlerinin %60-65'i tanı anında lokal ileri evrededirler. Bu hastalara uygulanan genişletilmiş rezeksiyonlar komplikasyon riskini arttırabilir. Bu çalışmanın amacı lokal ileri evre mide kanserlerinde rezektabilite, erken dönem mortalite ve morbidite oranlarını saptamaktır. Hastalar ve Yöntem: Ocak 2002 ile Eylül 2006 tarihleri arasında rezeksiyon uygulanan non-metastatik, lokal ileri evre mide kanserli hastalarımız geriye dönük olarak incelendi. Bulgular: Komşu organ invazyonu nedeni ile 110 hastaya (%49.8) ek organ rezeksiyonu uygulanmıştı. Yüz seksen bir hastaya (%82) R0, 29 hastaya (%13) R1 ve 11 hastaya (%5) R2 rezeksiyon yapılabilmişti. Tüm serinin morbidite ve mortalite oranları sırasıyla %21.7 ve %4.5 olarak bulundu. İkiden fazla ek organ rezeksiyonu (p=0.001), 2 üniteden fazla kan transfüzyonu (p=0.001) ve düşük protein seviyeleri (p=0.008) multivaryant analizlerde komplikasyon oranlarını arttıran parametreler olarak saptandı. İki veya daha fazla ek organ rezeksiyonu (p=0.001), kardiyovasküler ve respiratuar komorbidite (p=0.002) ve total gastrektomi uygulanması (p=0.028) mortaliteyi arttıran faktörler olarak bulundu. Sonuç: Neo-adjuvan tedavi uygulanmayan lokal ileri evre mide kanserli hastalarda ek organ rezeksiyonu oranları yüksektir ve bu durum morbidite ve mortalite oranlarını arttırır. Total gastrektomi mortaliteyi arttıran bir faktör olarak belirlenmiş ancak D2 diseksiyonun bu hastalarda güvenle uygulanabileceği sonucuna varılmıştır. Anahtar kelimeler: Komplikasyon; Lokal ileri evre mide kanseri; Morbidite; Mortalite ABSTRACT Objective: In Western world, 60 to 65% of the gastric cancer cases are in locally advanced stage at the time of diagnosis. Extended resections may increase the risk of complications in these patients. The aim of this study was to investigate the resectability, early morbidity and mortality rates for locally advanced gastric cancer. Patients and Methods: Non-metastatic locally advanced gastric cancer patients who underwent resection between January 2002 and September 2006 were analyzed retrospectively. Results: One hundred and ten patients (49.8%) had additional organ resection due to adjacent organ involvement. R0 resection was performed in 181 patients (82%), R1 resection in 29 patients (13%), and R2 resection in 11 patients (5%). The morbidity and mortality rates of the all series were 21.7% and 4.5% respectively. According to multivariate analysis more than two additional organ resections (p=0.001), erythrocyte transfusions of more than 2 units (p=0.001) and low total protein levels (p=0.008) were determined as the parameters that increase complication rates. The parameters that increase mortality rates were as follows; having two or more additional organ resections (p=0.001), cardiovascular and respiratory comorbidities (p=0.002) and total gastrectomy (p=0.028). Conclusion: Additional organ resection rate of the patients with locally advanced gastric cancers that not given neo-adjuvant treatment is high and this occurrence incr...

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Section: Discussionsupporting

confidence: 51%

Surgical Outcomes and Early Postoperative Complications in Locally Advanced Gastric Cancer

Doğan¹,

Karaman²,

Hüseyinova³

et al. 2011

Acta Oncol Tur.

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“…After removal of duplicates and screening for relevant titles and abstracts, a total of 142 articles were submitted for a full-text review. Seventeen studies involving 1343 patients met our inclusion criteria and were included in this review [1,2,[4][5][6][8][9][10][11][12][13][14][15][16][17][18][19][20] (Fig. 1).…”

Section: Literature Searchmentioning

confidence: 99%

“…Table 5 lists the studies that reported survival based on the number of organs involved or resected. Two of four studies showed in multivariate analysis that an increasing number of organs involved or resected was associated with decreased survival at 5 years [10,17]. However, an R0 resection resulted in 5-year survival of 32-35% for patients undergoing MVR, even when two or more organs were resected.…”

Section: Literature Searchmentioning

confidence: 99%

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Multivisceral resection for gastric cancer: a systematic review

et al. 2011

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Background The overall prognosis and survival of patients with advanced gastric cancer is generally poor. One of the most powerful predictors of outcomes in gastric cancer surgery is an R0 resection. However, the extent of the required surgical resection and the additional benefit of multivisceral resection (MVR) are controversial. Methods Electronic literature searches were conducted using Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from

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“…In the 3rd and 4th editions of the UICC/AJCC guidelines, hepatoduodenal metastases were considered as M1 disease, while the 5th and 6th editions re-classify them as regional lymph nodes and not distant metastases [24]. The prognostic importance of lymph node involvement has been examined in many series of multivisceral resections (other than PD) for gastric cancer [6,21,[25][26][27][28], with most finding no survival benefit for extended resections in patients with extensive lymph node involvement. However, in a few series [29], even in patients with advanced nodal disease, a benefit was found for multivisceral resection.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer

et al. 2011

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Background The purpose of this study was to identify and synthesize findings from all articles on surgical and longterm outcomes in patients with gastric cancer undergoing gastrectomy combined with pancreaticoduodenectomy (PD). Methods Electronic literature searches were conducted using Medline, EMBASE, and Cochrane databases from January 1, 1985, to December 31, 2009. Results Eight retrospective case series were included, with 132 patients having PD combined with gastrectomy. PD was combined with total gastrectomy in 27 patients, and subtotal gastrectomy in 81 patients; 24 patients had undocumented gastric resection type. Clinical stage was available for 92 patients (4 stage I, 7 stage II, 26 stage III, and 55 stage IV). Five studies (98 patients having PD combined with gastrectomy) compared PD and gastrectomy to gastrectomy alone. In the four studies reporting morbidity, PD had a higher morbidity. The pooled pancreatic anastomotic leak rate was 24.5% for the seven studies in which complications were reported; however, there were no peri-operative deaths. Long-term survival (37.3% at 5 years) in gastric cancer patients with PD combined with gastrectomy was described; however, survival was poor in the setting of incurable factors. Due to heterogeneity of patients and staging techniques in the case series no recommendations can be made on the appropriate selection criteria for patients undergoing PD and gastrectomy. Conclusion PD for gastric cancer invading the pancreas is associated with a higher morbidity; given the heterogeneous data, defining exact selection criteria is difficult.

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Prognostic factors in patients with advanced gastric cancer with macroscopic invasion to adjacent organs treated with radical surgery

Cited by 50 publications

References 13 publications

Surgical Outcomes and Early Postoperative Complications in Locally Advanced Gastric Cancer

Surgical Outcomes and Early Postoperative Complications in Locally Advanced Gastric Cancer

Multivisceral resection for gastric cancer: a systematic review

Systematic review of pancreaticoduodenectomy for locally advanced gastric cancer

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