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Towards the goal of r0 resection in locally advanced gastriccancer through the path of neoadjuvant chemotherapy e impact of tumour downstaging on survival in a single series.
No full textBackground: Long term survival after R0 resection in locally advanced gastric cancer
(LAGC) remains poor, suggesting that a true curative treatment is seldom performed. Preoperative treatment protocols have been proven to be effective in LAGC by large-scale
randomized trials; this theoretically happens through an increased control on both distant
and loco-regional recurrencies. Aim of this study is the evaluation of the effects on the
primary tumour, along with its lymphatic basin, induced by preoperative chemotherapy
and the survival impact on a single series of locally advanced gastric carcinomas.
Methods: 47 patients with LAGC, staged by laparoscopy, underwent D2-gastrectomy after
preoperative chemotherapy. The effects of preoperative treatment were evaluated by a quantitative analysis , which determined the percentage of residual vital tumour cells in the surgical specimens, and by a qualitative analysis , which evaluated the achievement of
8 ABSTRACTStumour-downstaging (T/dwn) induced by any grade of pathologic response. T/dwn after preoperative chemotherapy was assessed comparing pre-treatment clinical and laparoscopic
staging with post-operative pathologic staging. The c2 test was used to evaluate the significance of statistical differences among sub-groups. Survival was calculated by Kaplane
Meier method and the prognostic significance of prognostic factors was determined by
means of univariate analysis (log-rank test). Multivariate analysis was performed using the
Cox proportional hazard model in backward stepwise regression.
Results: "Quantitative analysis" of pathologic response was unable to show a clear
prognostic significance. T/dwn was obtained in 25 out of 47 patients. T/dwn was
associated with a smaller tumour diameter (34 mm. mean-diameter in T/dwn group
versus 55 mm.mean-diameter in non-T/dwn group, p1⁄40.002) and a higher R0-resection rate (96% in T/dwn group versus 72% in no-T/dwn group, p1⁄40.04). Overall survival at 5 years was 55%. In those patients who benefited from a R0-resection (40/47
patients: R0-resection rate 1⁄4 85%) overall survival reached up to 63%. At univariate
and multivariate analysis, R0-resection was found to be an independent prognostic
factor (R1-2/R0: HR 6.250/1, p1⁄40.002).
Conclusions: In this study, R0-resection was the most important prognostic factor for
LAGC selected to be treated by preoperative chemotherapy.
Patients who obtained T/dwn had a definitely better chance of cure, mainly through
the achievement of a true R0-resection
The Road to Curative Surgery in Gastric Cancer Treatment: A Different Path in the Elderly?
Full text linkBACKGROUND:
The aim of this study was to evaluate the possibility of a different path to achieve curative surgery in patients older than age 70 years and affected by resectable gastric cancer.
STUDY DESIGN:
This is a multicentric retrospective study based on an analysis of 1,465 patients with gastric adenocarcinoma who underwent surgery with curative intent. Patients were divided into 2 age groups (younger than 70 years vs older than 70 years) and were evaluated with respect to postoperative morbidity and mortality and survival.
RESULTS:
Postoperative morbidity and mortality in elderly and nonelderly groups were 24.8% vs 20.6% and 2.6% vs 3.7%, respectively (p = NS). In the elderly group, multivisceral resection was independently associated with surgical complications (hazard ratio [HR] = 1.988; 95% CI, 1.124-3.516; p = 0.018), total gastrectomy with medical complications (HR = 2.007; 95% CI, 1.165-3.459; p = 0.012), and higher postoperative mortality (HR = 4.319; 95% CI, 1.571-11.873; p = 0.005); D1 lymph node dissection was predictive of a lower postoperative mortality rate (HR = 0.219; 95% CI, 0.080-0.603; p = 0.003). Five-year overall survival rates differed significantly in young and elderly patients (58.9% vs 38.9%; p < 0.001), and 5-year cancer-specific survival did not show any significant difference.
CONCLUSIONS:
Age should not be considered as a factor in the selection of treatment for gastric cancer patients. Curative surgery can be performed as safely in elderly patients as in younger patients, with comparable postoperative results and long-term survival rates, although the life expectancy of elderly patients is shorter
Ratio of metastatic lymph nodes: impact on staging and survival of gastric cancer
No full textNo consensus exists on the level and number of lymph nodes to be dissected and examined for accurate staging of patients with resectable gastric cancer. The aim of this study was to examine the prognostic value and staging accuracy of the metastatic lymph nodes ratio (NR)
Preoperative chemotherapy in gastric cancer: expanding the indications, limiting the overuse
Full text linkPreoperative chemotherapy in gastric cancer: expanding the indications, limiting the overuse
Surgical issues after neoadjuvant treatment for gastric cancer
No full textGastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior depends on the metastatic potential of the tumour. Particularly, lymphatic metastasis is one of the main predictor of tumour recurrence and survival and current pathologic staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients resected with curative intent. This is deducted by the observation that two thirds of gastric cancers in the western world present at an advanced stage, with nearly 85% of tumors accompanied by lymph node metastasis at diagnosis. To date most therapeutic efforts are directed toward individualization of therapeutic protocols, tailoring the extent of resection integrated by the administration of preoperative and postoperative treatment. The goal of such strategies is to improve prognosis towards the achievement of a curative resection (R0-resection) with minimal morbidity and mortality, with better postoperative quality of life. A brief review of literature about preoperative therapy for gastric carcinoma will be herein illustrated. The rationale and the general drawbacks of preoperative treatments will be both discussed in order to demonstrate its value in terms of safety and efficacy
7-Year survival results of perioperative chemotherapy with epidoxorubicin, etoposide, and cisplatin (EEP) in locally advanced resectable gastric cancer: up-to-date analysis of a phase-II study
No full textPerioperative chemotherapy is considered an effective treatment option for patients with gastric carcinoma. We report the results after a 7-year follow-up of a study aimed at evaluating a perioperative chemotherapy protocol in a group of patients with locally advanced gastric cancer (LAGC)
R0 resection in the treatment of gastric cancer: room for improvement
No full textGastric carcinoma is one of the most frequent malignancies in the world and its clinical behavior especially depends on the metastatic potential of the tumor. In particular, lymphatic metastasis is one of the main predictors of tumor recurrence and survival, and current pathological staging systems reflect the concept that lymphatic spread is the most relevant prognostic factor in patients undergoing curative resection. This is compounded by the observation that two-thirds of gastric cancer in the Western world presents at an advanced stage, with lymph node metastasis at diagnosis. All current therapeutic efforts in gastric cancer are directed toward individualization of therapeutic protocols, tailoring the extent of resection and the administration of preoperative and postoperative treatment. The goals of all these strategies are to improve prognosis towards the achievement of a curative resection (R0 resection) with minimal morbidity and mortality, and better postoperative quality of life
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