Surgical treatment and prognosis of gastric cancer in 2 613 patients

Abstract

AIM:To analyze the factors influencing the prognosis of patients with gastric cancer after surgical treatment, in order to optimize the surgical procedures. METHODS:A retrospective study of 2 613 consecutive patients with gastric cancer was performed. Of these patients, 2 301 (88.1%) received operations; 196 explorative laparotomy (EL), 130 by-pass procedure (BPP), and 1 975 surgical resection of the tumors (891 palliative resection and 1 084 curative resection). The survival rate was calculated by the actuarial life table method, and the prognostic factors were evaluated using the Cox regression proportional hazard model. RESULTS:Of the patients, 2 450 (93.8%) were followed-up. The median survival period was 4.6 mo for patients without operation, 5.2 mo for EL, 6.4 mo for BPP, and 15.2 mo for palliative resection (P = 0.0001). Of the patients with surgical resection of the tumors, the overall 1, 3 and 5-year survival rates after were 82.7%, 46.3% and 31.1%, respectively, with the 5-year survival rate being 51.2% in patients with curative resection, and 7.8% for those with palliative resection. The 5-year survival rate was 32.5% for patients with total gastrectomy, and 28.3% for those with total gastrectomy plus resection of the adjacent organs. The factors that independently correlated with poor survival included advanced stage, upper third location, palliative resection, poor differentiation, type IV of Borrmann classification, tumor metastasis (N 3 ), tumor invasion into the serosa and contiguous structure, proximal subtotal gastrectomy for upper third carcinoma and D 1 lymphadenectomy after curative treatment. CONCLUSION:The primary lesion should be resected as long as the local condition permitted for stage III and IV tumors, in order to prolong the patients' survival and improve their quality of life after operation. Total gastrectomy is indicated for carcinomas in the cardia and fundus, and gastric cancer involving the adjacent organs without distant metastasis requires gastrectomy with resection of the involved organs.

Diagnostic utility of endoscopic brush cytology in upper gastrointestinal lesions and its correlation with biopsy.

“…In India, according to the National Cancer Registry, esophageal and gastric cancers are the most common cancers found in men, while esophageal cancer ranks third among women after the carcinoma of breast and cervix. [1,2,3] In recent years evaluation of endoscopically obtained brush cytology samples has placed the cytopathologist at the forefront of the patient management team in decisions about the treatment of GIT lesions. [4] The diagnostic value of upper GIT biopsy is well established but the value of brush cytology is still a subject of controversy.…”

Imaging in assessing lymph node status in gastric cancer

“…Lymph node (LN) status is an important prognostic factor regarding long-term survival [2,3]; in patients with N0 gastric cancer, the 5-year survival rate (after surgical treatment) is 86.1%, whereas in patients with N1, N2, and N3 gastric cancer, survival rates dramatically decrease to 58.1%, 23.3%, and 5.9% [3]. Patients with T1 tumors have a low risk of LN metastasis: 2.2% in T1a (mucosal) and 17.9% in T1b (submucosal) cancer [4].…”

A prospective analysis of management of carcinoma stomach

“…In a study conducted by Zhang et al the incidence of T1, T2, T3, T4 and M1 disease was 7.3%, 17.6%, 49.5%, 25% and 0% respectively. 9 The status of lymph nodes in this study was 3.85% had N0 status, 42.31% had N1 status, 34.62% had N2 status and 19.23% had N3 status. In a similar study done by Zhang et al 10.5% patients had N0 status, 17.4% had N1 status, 47.4% were N2 and 24.7% had N3 status.…”

“…In a similar study done by Zhang et al 10.5% patients had N0 status, 17.4% had N1 status, 47.4% were N2 and 24.7% had N3 status. 9 In the present study 61.54% of the patients underwent distal gastrectomy with Billroth II procedure and 25% of the patients underwent a palliative procedure. Chaudhary et al recorded that only 51% of the patients underwent distal gastrectomy with Billroth II procedure and 37.7% of the patients underwent a palliative procedure.…”