Prognostic value of resection-line involvement in patients undergoing curative resections for gastric cancer

Songun, Ilfet; Jj, Bonenkamp; Hermans, J.; Jh, van Krieken; Cj, van de Velde

doi:10.1016/0959-8049(95)00591-9

Cited by 90 publications

(85 citation statements)

References 9 publications

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“…This result is concordant with a previous French retrospective and single-center study of 180 patients [5], and is also in line with an Asian study that used multivariate analysis and found that the SRC type was associated with a poorer prognosis, albeit not statistically significantly so [35]. In contrast, among the five multivariate studies available [39][40][41][42][43][44] on the prognostic impact of SRC type in gastric adenocarcinoma, the single Western study did not find any impact of SRC type on survival [23], but Taghavi et al acknowledged that although radicality of surgery (R0 or R1-R2) and extent of lymphadenectomy were found to be prognostic factors for overall survival in the literature (and in our multivariate analysis) [39][40][41][42][43][44], these factors were neither controlled nor recorded in their retrospective analysis of the large SEER database [23]. Among the prognostic factors for poor survival found in our study, three are characteristics of patients: patient older than 60 years (HR = 1.33; p = 0.001), high ASA score (HR = 1.265; p \ 0.001), and preoperative malnutrition (HR = 1.432; p \ 0.001).…”

Section: Discussionsupporting

confidence: 65%

Is signet-ring cell carcinoma a specific entity among gastric cancers?

et al. 2015

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Background The prognosis and chemoresistance of signet-ring cell (SRC) gastric adenocarcinoma have been reported and debated, and the utility of perioperative chemotherapy for such a tumor has been questioned. This study was performed to assess the impact of the SRC type on survival following resection of gastric adenocarcinoma, and to assess whether the prognostic factors (including perioperative chemotherapy) for non-SRC adenocarcinoma differed from those for SRC adenocarcinoma. Methods 1799 cases of adenocarcinoma that were consecutively treated from 1997 to 2010 in 19 French centers by subtotal or total gastrectomy were included in a retrospective study. A D2 lymphadenectomy was performed for antropyloric tumors, and a modified D2 for upper tumors. SRC adenocarcinoma was diagnosed based on the presence of isolated carcinoma cells containing mucin. Results A total gastrectomy was performed in 979 (54.4 %) patients. SRC adenocarcinoma was diagnosed in 899 (50 %) patients. Patients with an SRC tumor were more frequently female, younger, and malnourished, had lower ASA scores, and had larger tumors than non-SRC patients. Median survival in patients with non-SRC carcinoma was 51 months, as compared to 26 months in patients with SRC carcinoma (p \ 0.001). At multivariate analysis, SRC type remained an independent adverse prognostic factor (HR = 1.182). Factors that were prognostic in the SRC subgroup but not in the non-SRC subgroup were age [60 years, linitis, and involvement of adjacent organs. In contrast to non-SRC tumors, pre-and postoperative chemotherapy did not significantly impact on survival following resection of SRC adenocarcinoma. On behalf of the FREGAT (French Eso-GAstric Tumours) working group-FRENCH (Fédération de Recherche en Chirurgie).Electronic supplementary material The online version of this article (doi:10.1007/s10120-015-0564-2) contains supplementary material, which is available to authorized users. Conclusion In comparison to non-SRC adenocarcinoma, the SRC type has a worse prognosis, different prognostic factors, and is only poorly sensitive to perioperative chemotherapy. Non-SRC and SRC adenocarcinomas should be considered different entities in future therapeutic trials.

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Section: Discussionsupporting

confidence: 65%

Is signet-ring cell carcinoma a specific entity among gastric cancers?

et al. 2015

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“…Resection line involvement was reported in literature in about 1-10 % of patients [39,40] and is generally considered as a cause of high surgical morbidity [41]. In our series, despite of what is referred in literature, we found no correlation between resection line involvement and DSF development.…”

Section: Discussioncontrasting

confidence: 56%

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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Background Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy. Methods All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications. Results Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p \ 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p \ 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p \ 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p \ 0.001), liver cirrhosis (OR 13.2; p \ 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses [300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p \ 0.001) were found to be independent risk factors for DSF development. Conclusions Duodenal stump fistula still remains a lifethreatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.

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“…Despite the fact that the real prognostic impact of positive RMs is still a matter of discussion, most authors [1,2,4,21,22] suggest that, in the case of R1 resection, a surgical retreatment of the patient aiming to achieve radical resection (if possible) should always be considered, in order to ensure optimal prognostic results. Lee et al [23] showed that the OS rate and the recurrence rate are not changed if R0 resection is achieved by performing additional resection for positive RMs.…”

Section: Discussionmentioning

confidence: 99%

Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study

et al. 2016

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Background Resection margin (RM) involvement is associated with negative prognosis after gastrectomy. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is timeconsuming and resource-consuming. The aim of this study was to assess risk factors associated with RM involvement to identify patients who would benefit from IFS analysis. Methods We retrospectively analyzed patients who underwent gastrectomy with curative intent for gastric or esophagogastric junction (EGJ) cancer from 2000 to 2014 in six Italian hospitals. RM status was assessed by IFS analysis and/or definitive histopathology examination. A set of 21 potential risk factors were compared in a multivariate analysis between patients with positive RMs on IFS analysis or definitive histopathology examination and a control cohort of similar patients with negative RMs, with the samples stratified into three subgroups (T1, T2-T4 Lauren intestinal pattern, T2-T4 Lauren diffuse/mixed pattern). Results One hundred forty-five patients had positive RMs. Survival was significantly worse in positive RM patients than in negative RM patients (89.5 months vs 28.9 months). Multivariate analysis showed that in T1 cancers a margin distance of less than 2 cm is a risk factor for RM involvement (odds ratio 15.7), in T2-T4 intestinal pattern cancers, serosa invasion (odds ratio 6.0), EGJ location (odds ratio 4.1), and a margin distance of less than 3 cm (odds ratio 4.0) are independent risk factors, and in T2-T4 diffuse/mixed pattern cancers, lymphatic infiltration (odds ratio 4.2), tumor diameter greater than 4 cm (odds ratio 3.5), EGJ location (odds ratio 2.8), and serosa invasion (odds ratio 2.2) are independent risk factors. Conclusions Survival after gastrectomy is negatively affected by positive RMs. IFS analysis should be routinely used in patients with a high risk of positive RMs, especially in diffuse pattern cancers.

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Prognostic value of resection-line involvement in patients undergoing curative resections for gastric cancer

Cited by 90 publications

References 9 publications

Is signet-ring cell carcinoma a specific entity among gastric cancers?

Is signet-ring cell carcinoma a specific entity among gastric cancers?

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

Risk factor analysis for involvement of resection margins in gastric and esophagogastric junction cancer: an Italian multicenter study

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