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Milone M, D'Amore A, Baiocchi GL, Cianchi F, De Manzoni G, De Pascale S, Degiuli M, Ercolani G, Ferrari G, Fortuna L, Fumagalli RU, Gualtierotti M, Marchesi F, Peri A, Puccetti F, Luc MR, Reddavid R, Rosati R, Solaini L, Staderini F, Valente M, Viganò J, Elmore U, Giacopuzzi S. Short-term outcomes of minimally invasive gastrectomy in population with obesity versus population without obesity: the obesity paradox. Updates Surg 2025:10.1007/s13304-025-02144-x. [PMID: 40317409 DOI: 10.1007/s13304-025-02144-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Accepted: 02/24/2025] [Indexed: 05/07/2025]
Abstract
This study aims to compare the short-term outcomes after minimally invasive gastrectomy between obese and non-obese population. Our analysis included data of 713 patients from ten departments of surgery. They were divided in non-obese group and obese group with 617 and 96 patients respectively. Significant differences were found in terms of mortality at 90 days (obese: 0 vs non-obese: 27, p = 0.037). Intraoperative data showed no significant differences in terms of conversion (obese: 4 vs non-obese: 43, p = 0.303). About postoperative complications, significant differences between the two groups were found only in terms of surgical infection (obese: 13 vs non-obese: 38, p = 0.009). About oncological outcomes, no differences were found about retrieved lymph nodes (obese: 30.71 ± 18.44 vs non-obese: 32.93 ± 17.62, p = 0.596) and about surgical radicality (R0) (obese:94 vs non-obese:594, p = 0.415). Obesity doesn't worsen postoperative outcomes and minimally invasive gastrectomy in obese patients is related to a lower postoperative mortality.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgery, University of Brescia, Brescia, Italy
| | - Fabio Cianchi
- Digestive Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Giovanni De Manzoni
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | | | - Maurizio Degiuli
- Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna Italy / General and Oncologic Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Giovanni Ferrari
- Minimally-Invasive and Oncological Surgical Department Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | - Laura Fortuna
- Digestive Surgery Unit, Careggi University Hospital, Florence, Italy
| | | | - Monica Gualtierotti
- Minimally-Invasive and Oncological Surgical Department Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3 20162, Milan, Italy
| | | | - Andrea Peri
- General Surgery II, Surgery Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Francesco Puccetti
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Marco Realis Luc
- Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Rossella Reddavid
- Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna Italy / General and Oncologic Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Staderini
- Digestive Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Marina Valente
- Unit of General Surgery, University Hospital of Parma, Parma, Italy
| | - Jacopo Viganò
- General Surgery II, Surgery Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
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Weindelmayer J, Mengardo V, Torroni L, Gervasi MC, Hetoja S, De Pasqual CA, Simion D, Giacopuzzi S. The "Weekday Effect" on Enhanced Recovery after Surgery Protocol for Gastrectomy. Dig Surg 2023; 40:100-107. [PMID: 37399795 DOI: 10.1159/000531022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/14/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION While enhanced recovery after surgery (ERAS) protocol demonstrated to improve outcomes after gastrectomy, some papers evidenced a detrimental effect on postoperative morbidity related to the "weekday effect." We aimed to understand whether the day of gastrectomy could affect postoperative outcomes and compliance with ERAS items. METHODS We included all patients that underwent gastrectomy for cancer between January 2017 and September 2021. Cohort was divided considering the day of surgery: Early group (Monday-Wednesday) and Late group (Thursday-Friday). Compliance with protocol and postoperative outcomes were compared. RESULTS Two hundred twenty-seven patients were included in Early group, while 154 were in Late group. The groups were comparable in preoperative characteristics. No significant difference in pre/intraoperative and postoperative ERAS items' compliance was apparent between Early and Late groups, with most items exceeding the 70% threshold. Median length of stay was 6.5 days and 6 days in Early and Late groups (p = 0.616), respectively. Morbidity was 50% in both groups, with severe complications that occurred in 13% of Early patients and 15% of Late patients. Ninety-day mortality was 2%, and it was similar between the two groups. CONCLUSIONS In a center with a standardized ERAS protocol, the weekday of gastrectomy has no significant impact on the success of each ERAS item and on postoperative surgical and oncological outcomes.
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Affiliation(s)
- Jacopo Weindelmayer
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - Valentina Mengardo
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - Lorena Torroni
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maria Clelia Gervasi
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - Selma Hetoja
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - Carlo Alberto De Pasqual
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
| | - Davide Simion
- Anesthesia and Intensive Care Unit, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Borgo Trento, University of Verona, Verona, Italy
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Milone M, D'Amore A, Alfieri S, Ambrosio MR, Andreuccetti J, Ansaloni L, Antonucci A, Arganini M, Baiocchi G, Barone M, Bencini L, Bencivenga M, Boccia L, Boni L, Braga M, Cianchi F, Cipollari C, Contine A, Cotsoglou C, D'Imporzano S, De Manzoni G, De Pascale S, De Ruvo N, Degiuli M, Donini A, Elmore U, Ercolani G, Ferrari G, Fumagalli RU, Garulli G, Gelmini R, Graziosi L, Gualtierotti M, Guglielmi A, Inama M, Maffeis F, Maione F, Manigrasso M, Marchesi F, Marrelli D, Massobrio A, Moretto G, Moukachar A, Navarra G, Nigri G, Olmi S, Palaia R, Papis D, Parise P, Pedrazzani C, Petri R, Pignata G, Pisano M, Rausei S, Reddavid R, Rocco G, Rosa F, Rosati R, Rossit L, Rottoli M, Roviello F, Santi S, Scabini S, Scaringi S, Solaini L, Staderini F, Taglietti L, Torre B, Ubiali P, Uccelli M, Uggeri F, Vertaldi S, Viganò J, De Palma GD, Giacopuzzi S. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG. Updates Surg 2023; 75:931-940. [PMID: 36571661 DOI: 10.1007/s13304-022-01438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/05/2022] [Indexed: 12/27/2022]
Abstract
Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p = 0.02 and p = 0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Anna D'Amore
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sergio Alfieri
- Chirurgia Digestiva, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Maria Raffaella Ambrosio
- Department of Surgical Pathology and General Surgery, Azienda Sanitaria Toscana Nord Ovest, Pisa, Italy
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128, Bergamo, Italy
| | - Adelmo Antonucci
- UOC Chirurgia Generale Ospedale Sant'Anna Como Asst Lariana, San Fermo della Battaglia, Italy
| | - Marco Arganini
- Department of Surgical Pathology and General Surgery, Azienda Sanitaria Toscana Nord Ovest, Pisa, Italy
| | | | - Mirko Barone
- Department of General and Thoracic Surgery, SS. Annunziata University Hospital, Chieti, Italy
| | - Lapo Bencini
- Chirurgia Generale Azienda Ospedaliero-Universitaria Careggi Firenze, Florence, Italy
| | - Maria Bencivenga
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Luigi Boccia
- Dip Chirurgico Ortopedico UOC Chirurgia Generale Mininvasiva e d Urgenza ASST, Mantua, Italy
| | - Luigi Boni
- Department of Surgery Fondazione, IRCCS-Ca' Granda-Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Marco Braga
- Università degli Studi di Milano-Bicocca, Ospedale San Gerardo di Monza, Monza, Italy
| | - Fabio Cianchi
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Cipollari
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | - Alessandro Contine
- Department of General Surgery, Città di Castello Hospital, Città di Castello, Perugia, Italy
| | - Christian Cotsoglou
- General Surgery Unit, Vimercate Hospital-ASST Brianza, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy
| | - Simone D'Imporzano
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Medical University of Pisa, 56124, Pisa, Italy
| | - Giovanni De Manzoni
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
| | | | - Nicola De Ruvo
- University of Modena and Reggio Emilia Policlinico of Modena Oncological and Emergency Surgery Unit ID, Modena, Italy
| | - Maurizio Degiuli
- Department of Oncology, University of Turin, San Luigi University Hospital, Turin, Italy
| | - Annibale Donini
- Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy
| | - Ugo Elmore
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Giovanni Ferrari
- Minimally-Invasive and Oncological Surgical Department Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | | | - Gianluca Garulli
- UOC Chirurgia Generale e d'Urgenza-Ospedale di Rimini (Novafeltria, Santarcangelo), Rimini, Italy
| | - Roberta Gelmini
- University of Modena and Reggio Emilia Policlinico of Modena Oncological and Emergency Surgery Unit ID, Modena, Italy
| | - Luigina Graziosi
- Santa Maria della Misericordia Hospital University of Perugia, Perugia, Italy
| | - Monica Gualtierotti
- Minimally-Invasive and Oncological Surgical Department Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University Hospital "G.B. Rossi", Verona, Italy
| | - Marco Inama
- Dipartimento di Chirurgia Generale Ospedale Pederzoli, Peschiera del Garda, VR, Italy
| | - Federica Maffeis
- General Surgical Department St. Mary of Angels Hospital, Pordenone Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | | | - Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Andrea Massobrio
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluigi Moretto
- Dipartimento di Chirurgia Generale Ospedale Pederzoli, Peschiera del Garda, VR, Italy
| | | | - Giuseppe Navarra
- Department of Surgical Sciences, Faculty of Medicine, University of Messina, G. Martino University Hospital, Messina, Italy
| | - Giuseppe Nigri
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome St. Andrea University Hospital, Via di Grottarossa 1037, 00189, Rome, Italy
| | - Stefano Olmi
- Head of General and Oncologic Surgery Center for Minimal Invasive and Laparoscopic Surgery Policlinico San Marco, Zingonia, Italy
| | - Raffaele Palaia
- Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale"-IRCCS-Via Mariano Semmola, 80131, Naples, Italy
| | - Davide Papis
- UOC Chirurgia Generale Ospedale Sant'Anna Como Asst Lariana, San Fermo della Battaglia, Italy
| | - Paolo Parise
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University Hospital "G.B. Rossi", Verona, Italy
| | - Roberto Petri
- Department of General Surgery, Azienda Ospedaliero-Universitaria of Udine Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Giusto Pignata
- General Surgery 2, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Pisano
- General, Emergency and Trauma Surgery, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128, Bergamo, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona Gallarate, Varese, Italy
| | - Rossella Reddavid
- Department of Oncology, University of Turin, San Luigi University Hospital, Turin, Italy
| | - Giuseppe Rocco
- Università di Bologna Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Fausto Rosa
- Chirurgia Digestiva, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Riccardo Rosati
- Division of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Luca Rossit
- Department of General Surgery, Azienda Ospedaliero-Universitaria of Udine Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy
| | - Matteo Rottoli
- Policlinico Sant'Orsola Bologna U.O. Chirurgia Tratto Alimentare, Bologna, Italy
| | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Stefano Santi
- Esophageal Surgery Unit, Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease, Medical University of Pisa, 56124, Pisa, Italy
| | - Stefano Scabini
- General and Oncologic Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefano Scaringi
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Leonardo Solaini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - Fabio Staderini
- Chirurgia dell'Apparato Digerente Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lucio Taglietti
- Department of Surgery, Asst Valcamonica Brescia, Brescia, Italy
| | - Beatrice Torre
- Policlinico Sant'Orsola Bologna U.O. Chirurgia Tratto Alimentare, Bologna, Italy
| | - Paolo Ubiali
- General Surgical Department St. Mary of Angels Hospital, Pordenone Azienda Sanitaria Friuli Occidentale, Pordenone, Italy
| | - Matteo Uccelli
- Head of General and Oncologic Surgery Center for Minimal Invasive and Laparoscopic Surgery Policlinico San Marco, Zingonia, Italy
| | - Fabio Uggeri
- Università degli Studi di Milano-Bicocca, Ospedale San Gerardo di Monza, Monza, Italy
| | - Sara Vertaldi
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Jacopo Viganò
- General Surgery I, Surgery Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Verona, Italy
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Yu P, Hu C, Wang Y, Bao Z, Zhang R, Cao M, Zhang Y, Cheng X, Xu Z. Preoperative chemotherapy combined with para-aortic lymph node dissection has clinical value in the treatment of gastric cancer with para-aortic lymph node metastases. BMC Surg 2022; 22:401. [PMID: 36404297 PMCID: PMC9677899 DOI: 10.1186/s12893-022-01844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/08/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Lymph node metastases often occur in advanced gastric cancer, with some patients presenting with metastases in the para-aortic lymph nodes. There are persistent Controversies about the benefit of para-aortic lymph node dissection (PAND). Our purpose is to probe whether PAND following preoperative chemotherapy had any clinical significance in individuals with PALNs in gastric cancer. MATERIAL AND METHODS To retrospectively analyze the clinical data of 86 gastric cancer patients (40 in the D2 + PAND group and 46 in the D2 group) who attended the abdominal surgery department of Zhejiang Cancer Hospital between September 1, 2008, and July 30, 2018. RESULTS In the D2 + PAND group (40 cases), the average number of lymph nodes cleared per case was 4.3 in group 16 (16a2, 16b1), and the postoperative pathology confirmed lymph node positivity in 16 cases, with a metastasis rate of 40%. The median overall survival times were 63 and 34 months for the patients in the D2 + PAND group and D2 group, respectively. The 3-year overall survival (OS) compared to the D2 group (D2 + PAND 69.1% vs. D2 50%, P = 0.012) and a statistically significant difference in 3-year disease-free survival (DFS) (D2 + PAND 69.6% vs. D2 38.3%, P = 0.007). Lymph node dissection extent and recurrence of para-aortic lymph nodes were independent prognostic variables for the patients. The recurrence rate was reduced in the D2 + PAND group compared to the D2 group (D2 + PAND 7.5% vs. D2 26.1%, p = 0.023). CONCLUSIONS For patients with gastric cancer whose imaging suggests metastasis in the para-aortic lymph nodes, preoperative chemotherapy combined with PAND is an effective and safe treatment that may benefit patient survival.
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Affiliation(s)
- Pengcheng Yu
- grid.268505.c0000 0000 8744 8924The First Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, 310053 China
| | - Can Hu
- grid.268505.c0000 0000 8744 8924The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, 310053 China
| | - Yi Wang
- grid.268505.c0000 0000 8744 8924The First Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, 310053 China
| | - Zhehan Bao
- grid.268505.c0000 0000 8744 8924The First Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, 310053 China
| | - Ruolan Zhang
- grid.268505.c0000 0000 8744 8924The Second Clinical Medical College of Zhejiang, Chinese Medical University, Hangzhou, 310053 China
| | - Mengxuan Cao
- grid.268099.c0000 0001 0348 3990Wenzhou Medical University, Wenzhou, 325035 China
| | - Yanqiang Zhang
- grid.9227.e0000000119573309The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Banshan Road 1#, Hangzhou, 310022 China
| | - Xiangdong Cheng
- grid.9227.e0000000119573309The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Banshan Road 1#, Hangzhou, 310022 China
| | - Zhiyuan Xu
- grid.9227.e0000000119573309The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institutes of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Banshan Road 1#, Hangzhou, 310022 China
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5
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Bracale U, Merola G, Pignata G, Andreuccetti J, Dolce P, Boni L, Cassinotti E, Olmi S, Uccelli M, Gualtierotti M, Ferrari G, De Martini P, Bjelović M, Gunjić D, Silvestri V, Pontecorvi E, Peltrini R, Pirozzi F, Cuccurullo D, Sciuto A, Corcione F. Laparoscopic gastrectomy for stage II and III advanced gastric cancer: long‑term follow‑up data from a Western multicenter retrospective study. Surg Endosc 2022; 36:2300-2311. [PMID: 33877411 PMCID: PMC8921054 DOI: 10.1007/s00464-021-08505-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/07/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There has been an increasing interest for the laparoscopic treatment of early gastric cancer, especially among Eastern surgeons. However, the oncological effectiveness of Laparoscopic Gastrectomy (LG) for Advanced Gastric Cancer (AGC) remains a subject of debate, especially in Western countries where limited reports have been published. The aim of this paper is to retrospectively analyze short- and long-term results of LG for AGC in a real-life Western practice. MATERIALS AND METHODS All consecutive cases of LG with D2 lymphadenectomy for AGC performed from January 2005 to December 2019 at seven different surgical departments were analyzed retrospectively. The primary outcome was diseases-free survival (DFS). Secondary outcomes were overall survival (OS), number of retrieved lymph nodes, postoperative morbidity and conversion rate. RESULTS A total of 366 patients with stage II and III AGC underwent either total or subtotal LG. The mean number of harvested lymph nodes was 25 ± 14. The mean hospital stay was 13 ± 10 days and overall postoperative morbidity rate 27.32%, with severe complications (grade ≥ III) accounting for 9.29%. The median follow-up was 36 ± 16 months during which 90 deaths occurred, all due to disease progression. The DFS and OS probability was equal to 0.85 (95% CI 0.81-0.89) and 0.94 (95% CI 0.92-0.97) at 1 year, 0.62 (95% CI 0.55-0.69) and 0.63 (95% CI 0.56-0.71) at 5 years, respectively. CONCLUSION Our study has led us to conclude that LG for AGC is feasible and safe in the general practice of Western institutions when performed by trained surgeons.
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Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy.
| | - Giovanni Merola
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili of Brescia, Brescia, Italy
| | - Jacopo Andreuccetti
- Department of General and Mininvasive Surgery, San Camillo Hospital of Trento, Trento, Italy
| | - Pasquale Dolce
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Olmi
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, BG, Italy
| | - Matteo Uccelli
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, BG, Italy
| | - Monica Gualtierotti
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo De Martini
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Miloš Bjelović
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Gunjić
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vania Silvestri
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Roberto Peltrini
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, NA, Italy
| | - Diego Cuccurullo
- Department of General, Mini-Invasive and Robotic Surgery, Monaldi Hospital, Naples, NA, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, NA, Italy
| | - Francesco Corcione
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
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Brisinda G, Chiarello MM, Crocco A, Adams NJ, Fransvea P, Vanella S. Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study. World J Gastroenterol 2022; 28:381-398. [PMID: 35110956 PMCID: PMC8771610 DOI: 10.3748/wjg.v28.i3.381] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/09/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory. Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant. AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer. METHODS A retrospective analysis of clinical data and pathological characteristics (age, sex, primary site of the tumor, Lauren histotype, number of positive lymph nodes resected, number of negative lymph nodes resected, and depth of invasion as defined by the standard nomenclature) was conducted in patients with gastric cancer. For each patient we calculated the Kattan's score. We arbitrarily divided the study population of patients into two groups based on the nomogram score (< 100 points or ≥ 100 points). Prespecified subgroups in these analyses were defined according to age (≤ 65 years or > 65 years), and number of lymph nodes retrieved (≤ 35 lymph nodes or > 35 lymph nodes). Uni- and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity. RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy. Perioperative mortality rate was 3.8% (7 patients); a higher mortality rate was observed in patients aged > 65 years (P = 0.002) and in N+ patients (P = 0.04). Following univariate analysis, mortality was related to a Kattan's score ≥ 100 points (P = 0.04) and the presence of advanced gastric cancer (P = 0.03). Morbidity rate was 21.0% (40 patients). Surgical complications were observed in 17 patients (9.1%). A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested (P = 0.0005). CONCLUSION Mortality and morbidity rate are higher in N+ and advanced gastric cancer patients. The removal of more than 35 lymph nodes does not lead to an increase in mortality.
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Affiliation(s)
- Giuseppe Brisinda
- Abdominal Surgery, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
- Department of Medical and Surgical Sciences, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Michela Chiarello
- General Surgery Operative Unit, Azienda Sanitaria Provinciale di Crotone, Ospedale San Giovanni di Dio, Crotone 88900, Italy
| | - Anna Crocco
- Endocrine Surgery Operative Unit, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Napoli 80100, Italy
| | - Neill James Adams
- Health Sciences, Clinical Microbiology Unit, Magna Grecia University, Catanzaro 88100, Italy
| | - Pietro Fransvea
- Department of Emergency Surgery and Trauma Center, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome 00168, Italy
| | - Serafino Vanella
- Department of General and Oncological Surgery, Azienda Ospedaliera San Giuseppe Moscati, Avellino 83100, Italy
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7
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Bracale U, Corcione F, Pignata G, Andreuccetti J, Dolce P, Boni L, Cassinotti E, Olmi S, Uccelli M, Gualtierotti M, Ferrari G, De Martini P, Bjelović M, Gunjić D, Cuccurullo D, Sciuto A, Pirozzi F, Peltrini R. Impact of neoadjuvant therapy followed by laparoscopic radical gastrectomy with D2 lymph node dissection in Western population: A multi-institutional propensity score-matched study. J Surg Oncol 2021; 124:1338-1346. [PMID: 34432291 PMCID: PMC9291045 DOI: 10.1002/jso.26657] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/20/2021] [Accepted: 08/14/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES In the setting of a minimally invasive approach, we aimed to compare short and long-term postoperative outcomes of patients treated with neoadjuvant therapy (NAT) + surgery or upfront surgery in Western population. METHODS All consecutive patients from six Italian and one Serbian center with locally advanced gastric cancer who had undergone laparoscopic gastrectomy with D2 lymph node dissection were selected between 2005 and 2019. After propensity score-matching, postoperative morbidity and oncologic outcomes were investigated. RESULTS After matching, 97 patients were allocated in each cohort with a mean age of 69.4 and 70.5 years. The two groups showed no difference in operative details except for a higher conversion rate in the NAT group (p = 0.038). The overall postoperative complications rate significantly differed between NAT + surgery (38.1%) and US (21.6%) group (p = 0.019). NAT was found to be related to a higher risk of postoperative morbidity in patients older than 60 years old (p = 0.013) but not in patients younger (p = 0.620). Conversely, no difference in overall survival (p = 0.41) and disease-free-survival (p = 0.34) was found between groups. CONCLUSIONS NAT appears to be related to a higher postoperative complication rate and equivalent oncological outcomes when compared with surgery alone. However, poor short-term outcomes are more evident in patients over 60 years old receiving NAT.
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Affiliation(s)
- Umberto Bracale
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | | | - Giusto Pignata
- Department of General Surgery IISpedali Civili of BresciaBresciaItaly
| | - Jacopo Andreuccetti
- Department of General and Mininvasive surgerySan Camillo HospitalTrentoItaly
| | - Pasquale Dolce
- Department of Public HealthUniversity of Naples Federico IINaplesItaly
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, UniversityMilanoItaly
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' GrandaOspedale Maggiore Policlinico, UniversityMilanoItaly
| | - Stefano Olmi
- Department of General and Oncologic SurgerySan Marco Hospital GSDZingoniaItaly
| | - Matteo Uccelli
- Department of General and Oncologic SurgerySan Marco Hospital GSDZingoniaItaly
| | - Monica Gualtierotti
- Department of Minimally Invasive Oncologic Surgery, Niguarda HospitalASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Giovanni Ferrari
- Department of Minimally Invasive Oncologic Surgery, Niguarda HospitalASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Paolo De Martini
- Department of Minimally Invasive Oncologic Surgery, Niguarda HospitalASST Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Miloš Bjelović
- Department of Minimally Invasive Upper Digestive Surgery, Hospital for Digestive SurgeryClinical Center of SerbiaBelgradeSerbia
| | - Dragan Gunjić
- Department of Minimally Invasive Upper Digestive Surgery, Hospital for Digestive SurgeryClinical Center of SerbiaBelgradeSerbia
| | - Diego Cuccurullo
- Department of General, Mini‐Invasive and Robotic SurgeryMonaldi HospitalNaplesItaly
| | - Antonio Sciuto
- Department of General SurgerySanta Maria delle Grazie HospitalPozzuoliNaplesItaly
| | - Felice Pirozzi
- Department of General SurgerySanta Maria delle Grazie HospitalPozzuoliNaplesItaly
| | - Roberto Peltrini
- Department of Public HealthUniversity of Naples Federico IINaplesItaly
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Hu Y, Yoon SS. Extent of gastrectomy and lymphadenectomy for gastric adenocarcinoma. Surg Oncol 2021; 40:101689. [PMID: 34839198 DOI: 10.1016/j.suronc.2021.101689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 12/18/2022]
Abstract
Gastric adenocarcinoma is one of the most common and lethal cancers worldwide and is associated with a high frequency of nodal metastasis. The value of multimodality therapy is well-established, but gastric resection and locoregional lymph node dissection are important mainstays in potentially curative therapy. However, there has been considerable regional variation in surgical approach and debate regarding the ideal extent of gastric resection, gastric reconstruction, and extent of lymphadenectomy. This chapter outlines the current evidence in the surgical management of gastric adenocarcinoma. The advent of minimally invasive approaches to gastric operations is also discussed.
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Affiliation(s)
- Yinin Hu
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, MD, USA.
| | - Sam S Yoon
- Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
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9
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Assessment on the Prognostic Validity of Dissected and Positive Lymph Node Counts and Lymph Node Ratio in Patients with Gastric Cancer: A Multi-central Cohort Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.114118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Adequate treatment for all resectable early gastric cancers (EGCs) is gastrectomy with regional lymphadenectomy. The number of positive resected lymph nodes during lymphadenectomy can be a reliable predictor of survival of GC. Objectives: We aimed at assessing the prognostic significance of Dissected Lymph Node Count (DLNC), positive LNC (PLNC), and Lymph Node Ratio (LNR) in patients with EGC. Methods: In the current retrospective cohort, 201 patients with resectable EGC were included. Demographic variables, clinicopathological characteristics of tumors (including numbers of total dissected nodes and positive, negative nodes), history of receiving adjuvant cancer therapies, and 1- and 5-year survivals were noted. Results: DLNC, PLNC, and LNR were associated with differentiation and depth of tumor, lymph node status, and risk of death (P-value for all < 0.05). There was no correlation between either of these measures with preoperative symptoms, lymphovascular invasion, and recurrence. DLNC, PLNC, and LNR showed prognostic significance only in patients, who did not receive comprehensive therapy (P-value < 0.001 for all). A significantly higher LNR was seen in patients with more than 1-year survival compared to others (P-value = 0.011). A significantly lower DLNC and higher PLNC were seen in patients, who survived over 5 years (P-value of 0.002 and 0.047, respectively). Conclusions: LNR, DLNC, and PLNC are significant prognostic factors for EGC. According to our findings, choosing the optimal approach, through which fewer negative lymph nodes are dissected, is crucial in increasing overall survival and extended lymphadenectomy cannot necessarily benefit patients.
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10
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Isobe T, Murakami N, Minami T, Tanaka Y, Kaku H, Umetani Y, Kizaki J, Aoyagi K, Fujita F, Akagi Y. Robotic versus laparoscopic distal gastrectomy in patients with gastric cancer: a propensity score-matched analysis. BMC Surg 2021; 21:203. [PMID: 33882906 PMCID: PMC8059032 DOI: 10.1186/s12893-021-01212-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background Robotic distal gastrectomy (RDG) has been increasingly used for the treatment of gastric cancer (GC). However, whether RDG has a clinical advantage over laparoscopic distal gastrectomy (LDG) is yet to be determined. Thus, this study aimed to assess the feasibility and safety of RDG for the treatment of GC as compared with LDG. Methods In total, 157 patients were enrolled between February 2018 and August 2020 in this retrospective study. We then compared the surgical outcomes between RDG and LDG using propensity score-matching (PSM) analysis to reduce the confounding differences. Results After PSM, a clinicopathologically well-balanced cohort of 100 patients (50 in each group) was analyzed. The operation time for the RDG group (350.1 ± 58.1 min) was determined to be significantly longer than that for the LDG group (257.5 ± 63.7 min; P < 0.0001). Of interest, there was a decreased incidence of pancreatic fistulas and severe complications after RDG as compared with LDG (P = 0.092 and P = 0.061, respectively). In addition, postoperative hospital stay was statistically slightly shorter in the RDG group as compared with the LDG group (12.0 ± 5.6 vs. 13.0 ± 12.3 days; P = 0.038). Conclusions Our study confirmed that RDG is a feasible and safe procedure for GC in terms of short-term surgical outcomes. A surgical robot might reduce postoperative severe complications and length of hospital stay.
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Affiliation(s)
- Taro Isobe
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Naotaka Murakami
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Taizan Minami
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yuya Tanaka
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hideaki Kaku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yuki Umetani
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Junya Kizaki
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Keishiro Aoyagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Alarcón I, Yang T, Balla A, Morales-Conde S. Single/reduced port surgery vs. conventional laparoscopic gastrectomy: systematic review and meta-analysis. MINIM INVASIV THER 2021; 31:515-524. [PMID: 33600291 DOI: 10.1080/13645706.2021.1884571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim is to compare single port surgery (SPS)/reduced port surgery (RPS) versus conventional laparoscopy (CL) for gastrectomy for gastric cancer in terms of intra- and postoperative outcomes. MATERIAL AND METHODS After a search in Pubmed and Embase, six articles were included. Pooled analysis was used to evaluate the statistically significance for each variable. RESULTS Two hundred and thirty-three and 230 patients underwent SPS/RPS and CL, respectively. One hundred and eighty-eight patients and 45 patients underwent subtotal and total gastrectomy, respectively, using the SPS/RPS approach. One hundred and eighty-five patients and 45 patients underwent subtotal and total gastrectomy, respectively, by CL. In 85 patients, an extra trocar was systematically placed at the end of surgery. Statistically significant differences were not observed about preoperative staging. The pooled analysis regarding operative time, blood loss, postoperative complications, number of harvested lymph nodes and postoperative hospital stay showed that the only statistically significant difference between the two approaches is the shorter hospital stay in case of SPS/RPS. CONCLUSIONS SPS/RPS total or subtotal gastrectomy shows a lower postoperative hospital stay, with comparable operative time, blood loss, early postoperative complication rate and number of harvested lymph nodes in comparison to CL, provided extensive experience in minimally invasive gastrectomy is present. Abbreviations: AGC: advanced gastric cancer; BMI: body mass index; CI: confidence interval; CL: conventional laparoscopy; LESS: laparoendoscopic single site; MD: mean difference; NOS: Newcastle-Ottawa Scale; OR: odds ratio; PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis; ROBIN-I: Risk Of Bias In Non-randomised Studies - of Interventions; RPS: reduced port surgery; RR: risk ratio; SILS: single incision laparoscopic surgery; SPS: single port surgery; WMD: weighted mean differences.
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Affiliation(s)
- Isaias Alarcón
- Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain
| | - Tao Yang
- Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain
| | - Andrea Balla
- Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain.,Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Salvador Morales-Conde
- Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain.,Unit of General and Digestive Surgery, Hospital QuironSalud Sagrado Corazón, Seville, Spain
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12
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Baiocchi GL, Gheza F, Molfino S, Arru L, Vaira M, Giacopuzzi S. Indocyanine green fluorescence-guided intraoperative detection of peritoneal carcinomatosis: systematic review. BMC Surg 2020; 20:158. [PMID: 32680492 PMCID: PMC7367360 DOI: 10.1186/s12893-020-00821-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To review the available clinical data about the value of Indocyanine Green (ICG) fluorescence imaging for intraoperative detection of peritoneal carcinomatosis. METHODS We conducted a systematic review, according to the PRISMA guidelines, for clinical series investigating the possible role of ICG fluorescence imaging in detecting peritoneal carcinomatosis during surgical treatment of abdominal malignancies. With the aim to analyze actual application in the daily clinical practice, papers including trials with fluorophores other than ICG, in vitro and animals series were excluded. Data on patients and cancer features, timing, dose and modality of ICG administration, sensitivity, specificity and accuracy of fluorescence diagnosis of peritoneal nodules were extracted and analyzed. RESULTS Out of 192 screened papers, we finally retrieved 7 series reporting ICG-guided detection of peritoneal carcinomatosis. Two papers reported the same cases, thus only 6 series were analyzed, for a total of 71 patients and 353 peritoneal nodules. The investigated tumors were colorectal carcinomas in 28 cases, hepatocellular carcinoma in 16 cases, ovarian cancer in 26 cases and endometrial cancer in 1 case. In all but 4 cases, the clinical setting was an elective intervention in patients known as having peritoneal carcinomatosis. No series reported a laparoscopic procedure. Technical data of ICG management were consistent across the studies. Overall, 353 lesions were harvested and singularly evaluated. Sensitivity varied from 72.4 to 100%, specificity from 54.2 to 100%. Two series reported that planned intervention changed in 25 and 29% of patients, respectively. CONCLUSION Indocyanine Green based fluorescence of peritoneal carcinomatosis is a promising intraoperative tool for detection and characterization of peritoneal nodules in patients with colorectal, hepatocellular, ovarian carcinomas. Further prospective studies are needed to fix its actual diagnostic value on these and other abdominal malignancies with frequent spread to peritoneum.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- Oncoteam Peritoneal Surface Malignancies, SICO (Italian Society of Surgical Oncology), Brescia, Italy.
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Luca Arru
- Centre Hospitalier de Luxembourg, Service de Chirurgie Generale, Luxemborg City, Luxembourg
| | - Marco Vaira
- Oncoteam Peritoneal Surface Malignancies, SICO (Italian Society of Surgical Oncology), Brescia, Italy
- Surgical Oncology Unit, Candiolo Cancer Institute, FPO - IRCCS, Str. Prov.le 142, km. 3,95, 10060, Candiolo, TO, Italy
| | - Simone Giacopuzzi
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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13
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Molfino S, Ballarini Z, Gheza F, Portolani N, Baiocchi GL. Is there a role for treatment-oriented surgery in stage IV gastric cancer? A systematic review. Updates Surg 2019; 71:21-27. [PMID: 30039281 DOI: 10.1007/s13304-018-0571-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 06/30/2018] [Indexed: 12/19/2022]
Abstract
To analyze the available evidence on the role of treatment-oriented surgery in stage IV gastric cancer (metastatic disease), a systematic literature search was undertaken using Medline, Embase, Cochrane, and Web-of-Science libraries. The search was not restricted to articles published within a given year range. Articles written in English language (or with abstracts written in English) were considered. All references in the chosen articles were further screened to find additional relevant publications. Both clinical series and literature reviews were included. Stage IV gastric cancer is classified into four subcategories: positive peritoneal cytology without clear macroscopic peritoneal involvement (surgery is usually performed in these cases); gross appearance peritoneal carcinomatosis [surgery, eventually with hyperthermic intraoperative peritoneal chemotherapy (HIPEC) may be considered in very selected cases with limited PCI]; nodal metastases outside the loco-regional nodes (surgery may not be denied for metastatic nodes in stations 13 and 16); and hematogenous metastases (surgery should be performed in selected cases with liver metastases suitable to R0 resection). The analysis incorporated the new biological classification of stage IV gastric cancer recently proposed by Japanese researchers (Yoshida et al. in Gastric Cancer 19:329-338. https://doi.org/10.1007/s10120-015-0575-z , 2015) into the four aforementioned subcategories to make the comparison of the issues discussed meaningful. The take home message from the existing literature is that treatment-oriented surgery may be performed in a significant proportion of patients with stage IV gastric cancer.
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Affiliation(s)
- Sarah Molfino
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Zeno Ballarini
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
- Chirurgia Generale 3, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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14
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Mariette C, Carneiro F, Grabsch HI, van der Post RS, Allum W, de Manzoni G. Consensus on the pathological definition and classification of poorly cohesive gastric carcinoma. Gastric Cancer 2019; 22:1-9. [PMID: 30167905 DOI: 10.1007/s10120-018-0868-0] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Clinicopathological characteristics of gastric cancer (GC) are changing, especially in the West with a decreasing incidence of distal, intestinal-type tumours and the corresponding increasing proportion of tumours with Laurén diffuse or WHO poorly cohesive (PC) including signet ring cell (SRC) histology. To accurately assess the behaviour and the prognosis of these GC subtypes, the standardization of pathological definitions is needed. METHODS A multidisciplinary expert team belonging to the European Chapter of International Gastric Cancer Association (IGCA) identified 11 topics on pathological classifications used for PC and SRC GC. The topics were debated during a dedicated Workshop held in Verona in March 2017. Then, through a Delphi method, consensus statements for each topic were elaborated. RESULTS A consensus was reached on the need to classify gastric carcinoma according to the most recent edition of the WHO classification which is currently WHO 2010. Moreover, to standardize the definition of SRC carcinomas, the proposal that only WHO PC carcinomas with more than 90% poorly cohesive cells having signet ring cell morphology have to be classified as SRC carcinomas was made. All other PC non-SRC types have to be further subdivided into PC carcinomas with SRC component (< 90% but > 10% SRCs) and PC carcinomas not otherwise specified (< 10% SRCs). CONCLUSION The reported statements clarify some debated topics on pathological classifications used for PC and SRC GC. As such, this consensus classification would allow the generation of evidence on biological and prognostic differences between these GC subtypes.
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Affiliation(s)
- C Mariette
- Department of Surgery, Hôpital Claude-Huriez, Lille, France
| | - F Carneiro
- Departments of Pathology, Centro Hospitalar São João, Faculty of Medicine of Porto University and Institute for Research and Innovation in Health (i3S), Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
| | - H I Grabsch
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - R S van der Post
- Department of Pathology, Radboud university medical center, Nijmegen, The Netherlands
| | - W Allum
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
| | - Giovanni de Manzoni
- General and Upper GI Surgery Division, Department of Surgery, University of Verona, Piazzale Stefani 1, 37126, Verona, Italy.
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Morgagni P, La Barba G, Colciago E, Vittimberga G, Ercolani G. Resection line involvement after gastric cancer treatment: handle with care. Updates Surg 2018; 70:213-223. [DOI: 10.1007/s13304-018-0552-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/01/2018] [Indexed: 02/06/2023]
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16
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Tailored treatment for signet ring cell gastric cancer. Updates Surg 2018; 70:167-171. [PMID: 29948660 DOI: 10.1007/s13304-018-0550-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 05/13/2018] [Indexed: 02/08/2023]
Abstract
Gastric cancer with Laurèn diffuse types is increasing in the West. The raising trend is more evident when considering signet ring cells (SRC) histology. However, to control the biologic potential of this GC subtype, some hypotheses of tailored therapeutic strategies for SRC cancers have been made. A review of the literature was performed using the key words "signet ring cells" AND "gastric cancer". Results of literature review were descriptively reported. Endoscopic submucosal dissection (ESD), according to the Japanese extended criteria, could be a therapeutic option for early SRC tumours. However, according to the evidences from more recent studies, indications for ESD to these tumours types should be carefully considered. Concerning the optimal surgical treatment, considering the high lymphotropism and infiltrating behaviour of SRC histotype, the extension of gastric resection should be wider than for intestinal type cancer and laparoscopic surgery should be performed carefully. Moreover, D3 lymphadenectomy could provide a benefit in diffuse-type and SRC histology. The role of surgery in gastric cancer with peritoneal carcinomatosis is still debated and studies on this topic should stratify the good results according to GC histotype. Finally, despite the evidences of chemoresistance in SRC, ongoing randomized trials suggest that multimodal therapy could be the best treatment. Based on the assumption that SRC tumours have specific features, they deserve a specific multimodal treatment. However, a preliminary step to generate strong evidences in this field is the standardization of terminology used to define signet ring cells carcinoma.
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17
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Mengardo V, Bencivenga M, Weindelmayer J, Pavarana M, Giacopuzzi S, de Manzoni G. Para-aortic lymphadenectomy in surgery for gastric cancer: current indications and future perspectives. Updates Surg 2018; 70:207-211. [PMID: 29846892 DOI: 10.1007/s13304-018-0549-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 05/13/2018] [Indexed: 12/20/2022]
Abstract
Involvement of para-aortic nodes (PAN) has been detected at pathological examination in 10-25% of locally advanced gastric cancer. Based on these data of nodal diffusion, the lymphadenectomy of para-aortic stations would be desirable in locally advanced gastric cancer. However, the debate on the oncological benefit of para-aortic nodes dissection is still not solved. A review of the literature was performed and papers reporting either the rate of para-aortic nodal metastases or the long-term survival outcomes after D2+ para-aortic nodes dissection (PAND) or D3 lymphadenectomy were descriptively reported. The literature survey yielded 14 studies. Most of the papers show the outcome of series of advanced gastric cancer treated with surgery alone, while starting from 2012, 3 articles report the outcomes of D2 + PAND or D3 lymphadenectomy after preoperative chemotherapy. The rate of PAN metastases ranges between 8.5 and 28% in surgical series. Survival outcomes largely improved in series of patients treated with multimodal approach compared to those of surgery alone. In patients with clinically detected para-aortic nodal metastases, preoperative chemotherapy followed by PAND is indicated. More data are needed to clarify the indication to prophylactic PAND in the era of multimodal treatment, anyway super-extended lymphadenectomies have to be performed by experienced surgeons in dedicated centres.
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Affiliation(s)
- Valentina Mengardo
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Maria Bencivenga
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Jacopo Weindelmayer
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Michele Pavarana
- Department of Medical Oncology, Ospedale Civile Maggiore of Verona, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Giovanni de Manzoni
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
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18
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Baiocchi GL, Giacopuzzi S, Marrelli D, Bencivenga M, Morgagni P, Rosa F, Berselli M, Orsenigo E, Cananzi F, Tiberio G, Rausei S, Cozzaglio L, Degiuli M, Di Leo A, Fumagalli U, Portolani N, Rosati R, Roviello F, De Manzoni G. Complications after gastrectomy for cancer: Italian perspective. Updates Surg 2017; 69:285-288. [PMID: 28710718 DOI: 10.1007/s13304-017-0478-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/10/2017] [Indexed: 10/19/2022]
Abstract
Surgery for gastric cancer is associated with significant major morbidity and an estimated mortality rate of about 5%. A reliable comparison of post-operative outcomes is hampered by the lack of a clear, universally recognized, definition of the most frequent complications. This paper reports the final results of a project launched by the Italian Research Group for Gastric Cancer in September 2015, whose goal was to propose a comprehensive list of surgical-related, gastric cancer-specific complications, with their definitions. The project was carried out through a multicentric, mainly web-based, consensus of experts. The proposed list, following assessment and validation by a group of experts of the European Chapter of the International Gastric Cancer Association, will form the basis for implementing a "Complications Recording Sheet" that can be disseminated worldwide for proper and reliable post-operative assessment.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy.
| | - Simone Giacopuzzi
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - Daniele Marrelli
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Maria Bencivenga
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - Paolo Morgagni
- G.B. Morgagni-L Pierantoni Surgical Department, Forlì, Italy
| | - Fausto Rosa
- Department of Digestive Surgery, Policlinico Gemelli, Rome, Italy
| | - Mattia Berselli
- Division of General Surgery, Azienda Ospedaliera Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Elena Orsenigo
- Department of General and Emergency Surgery, San Raffaele Hospital, Milan, Italy
| | - Ferdinando Cananzi
- Division of General and Oncological Surgery, Humanitas Hospital, Milan, Italy
| | - Guido Tiberio
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Stefano Rausei
- Division of General Surgery, Azienda Ospedaliera Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - Luca Cozzaglio
- Division of General and Oncological Surgery, Humanitas Hospital, Milan, Italy
| | - Maurizio Degiuli
- Department of Oncology, Head, Digestive and Surgical Oncology, University of Torino, San Luigi University Hospital, Orbassano, Italy
| | - Alberto Di Leo
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | | | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Riccardo Rosati
- Department of G.I. Surgery, San Raffaele Hospital, Milan, Italy
| | - Franco Roviello
- Department of Medicine, Surgery, and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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19
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Badgwell B, Das P, Ajani J. Treatment of localized gastric and gastroesophageal adenocarcinoma: the role of accurate staging and preoperative therapy. J Hematol Oncol 2017; 10:149. [PMID: 28810883 PMCID: PMC5558742 DOI: 10.1186/s13045-017-0517-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/09/2017] [Indexed: 01/11/2023] Open
Abstract
Gastric cancer is the third most common cause of cancer death worldwide, although it is not in the top 10 causes of cancer death in Northern America. Due to clear differences in incidence, screening, risk factors, tumor biology, and treatment between gastric cancers from Eastern and Western countries, our treatment is primarily guided by trials from Western countries. Patients undergo an extensive staging evaluation including high-quality CT imaging, endoscopic ultrasound, and diagnostic laparoscopy with peritoneal washings for cytology. Patients are presented in multidisciplinary conference with input from medical, radiation, and surgical oncology, in addition to further evaluation of existing studies and biopsy results by diagnostic radiology and pathology colleagues. Due to the well-documented difficulty in tolerating postoperative therapy, patients are frequently treated with preoperative chemotherapy and chemoradiotherapy. Extended lymph node (D2) dissection is routinely performed during subtotal or total gastrectomy. Ongoing trials in Western populations comparing preoperative chemotherapy to chemoradiotherapy will help inform the decision regarding the optimal treatment for patients with resectable gastric cancer. Additional studies are needed to identify predictors of treatment response to identify the optimal preoperative or perioperative approach. As peritoneal disease is the most common site of recurrence, studies are also urgently needed for more accurate methods of detecting peritoneal disease at diagnosis, and also investigating potential treatment modalities such as hyperthermic intraperitoneal chemotherapy.
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Affiliation(s)
- Brian Badgwell
- Department of Surgical Oncology, The University of Texas, Unit 1484, MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
| | - Prajnan Das
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaffer Ajani
- Departments of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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20
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Chiari D, Orsenigo E, Guarneri G, Baiocchi GL, Mazza E, Albarello L, Bissolati M, Molfino S, Staudacher C. Effect of neoadjuvant chemotherapy on HER-2 expression in surgically treated gastric and oesophagogastric junction carcinoma: a multicentre Italian study. Updates Surg 2017; 69:35-43. [PMID: 28276033 DOI: 10.1007/s13304-017-0423-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/21/2017] [Indexed: 12/22/2022]
Abstract
Predictors of response to neoadjuvant chemotherapy are not available for gastric and oesophago-gastric junction carcinoma. HER-2 over-expression in breast cancer correlates with poor prognosis and high incidence of recurrence. First aim of this study was to evaluate if the HER-2 expression/amplification is predictive of response to neoadjuvant chemotherapy in terms of pathologic regression. Secondary aim was to evaluate if HER-2 expression varies after neoadjuvant treatment. Thirty-five patients with locally advanced gastric or oesophago-gastric junction carcinoma underwent preoperative chemotherapy and surgical resection at San Raffaele Scientific Institute and Spedali Civili of Brescia. HER-2 expression/amplification was evaluated on every biopsy at diagnosis time and on every surgical sample after neoadjuvant chemotherapy. Pathologic response to chemotherapy was evaluated according to TNM classification (ypT status and ypN status) and Mandard's tumour regression grade classification. In our series 10 patients (28.6%) showed a reduction in HER-2 overexpression and in 6 of them (17.1%) HER-2 expression completely disappeared. Only three of the six patients with HER-2 disappearance had a complete pathological response to neoadjuvant chemotherapy. There was a strong correlation between HER-2 negativity on biopsy and absence of lymph node metastasis in surgical samples after neoadjuvant chemotherapy, irrespective of nodal status before chemotherapy. A direct correlation between HER-2 reduction after neoadjuvant chemotherapy and pathologic regression (primary tumour and lymph nodes) in surgical samples was found. HER-2 negativity may represent a predictor of pathologic response to neoadjuvant chemotherapy for gastric and oesophago-gastric junction adenocarcinoma. Neoadjuvant treatment can reduce HER-2 overexpression.
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Affiliation(s)
- Damiano Chiari
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy.
| | - Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Guarneri
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Gian Luca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Elena Mazza
- Department of Oncology, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Albarello
- Department of Pathology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Sarah Molfino
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Carlo Staudacher
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
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21
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Baiocchi GL, Celotti A, Molfino S, Baggi P, Tarasconi A, Baronio G, Arru L, Gheza F, Tiberio G, Portolani N. Distant nodal metastasis: is it always an unresectable disease? Transl Gastroenterol Hepatol 2017; 2:1. [PMID: 28217751 PMCID: PMC5313284 DOI: 10.21037/tgh.2016.12.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/24/2016] [Indexed: 12/27/2022] Open
Abstract
This article aims at analyzing the published literature concerning the treatment of patients with gastric cancer and distant nodal metastases, actually considered metastatic disease. A systematic search was undertaken using Medline, Embase, Cochrane and Web-of-Science libraries. No specific restriction on year of publication was used; preference was given to English papers. Both clinical series and literature reviews were selected. Only 11 papers address the issue of surgery for nodal basins outside the D2 dissection area. From these papers, in selected cases extended surgery may prove useful in prolonging survival, when a comprehensive therapeutic pathway including chemotherapy is scheduled. In conclusion, in presence of nodal metastases outside the loco-regional nodes, surgery may be considered for metastatic nodes in stations 13 and 16, in selected cases.
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Affiliation(s)
- Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Andrea Celotti
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Sarah Molfino
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Paolo Baggi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Antonio Tarasconi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Gianluca Baronio
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Luca Arru
- Department of General and Minimally Invasive Surgery, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Guido Tiberio
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
| | - Nazario Portolani
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, Brescia, Italy
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22
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De Manzoni G, Marrelli D, Baiocchi GL, Morgagni P, Saragoni L, Degiuli M, Donini A, Fumagalli U, Mazzei MA, Pacelli F, Tomezzoli A, Berselli M, Catalano F, Di Leo A, Framarini M, Giacopuzzi S, Graziosi L, Marchet A, Marini M, Milandri C, Mura G, Orsenigo E, Quagliuolo V, Rausei S, Ricci R, Rosa F, Roviello G, Sansonetti A, Sgroi G, Tiberio GAM, Verlato G, Vindigni C, Rosati R, Roviello F. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer 2017; 20:20-30. [PMID: 27255288 DOI: 10.1007/s10120-016-0615-3] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/01/2016] [Indexed: 02/07/2023]
Abstract
This article reports the guidelines for gastric cancer staging and treatment developed by the GIRCG, and contains comprehensive indications for clinical management, including radiological, endoscopic, surgical, pathological, and oncological paths.
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Affiliation(s)
- Giovanni De Manzoni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Daniele Marrelli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy.
| | - Gian Luca Baiocchi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Paolo Morgagni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Luca Saragoni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Maurizio Degiuli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Annibale Donini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Uberto Fumagalli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Maria Antonietta Mazzei
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Fabio Pacelli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Anna Tomezzoli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Mattia Berselli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Filippo Catalano
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Alberto Di Leo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Massimo Framarini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Simone Giacopuzzi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Luigina Graziosi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Alberto Marchet
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Mario Marini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Carlo Milandri
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Gianni Mura
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Elena Orsenigo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Vittorio Quagliuolo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Stefano Rausei
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Riccardo Ricci
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Fausto Rosa
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giandomenico Roviello
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Andrea Sansonetti
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giovanni Sgroi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Guido Alberto Massimo Tiberio
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giuseppe Verlato
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Carla Vindigni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Riccardo Rosati
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Franco Roviello
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
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23
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Yarema R, de Manzoni G, Fetsych T, Ohorchak M, Pliatsko M, Bencivenga M. On the road to standardization of D2 lymph node dissection in a European population of patients with gastric cancer. World J Gastrointest Oncol 2016; 8:489-497. [PMID: 27326318 PMCID: PMC4909450 DOI: 10.4251/wjgo.v8.i6.489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/24/2016] [Accepted: 04/14/2016] [Indexed: 02/05/2023] Open
Abstract
The amount of lymph node dissection (LD) required during surgical treatment of gastric cancer surgery has been quite controversial. In the 1970s and 1980s, Japanese surgeons developed a doctrine of aggressive preventive gastric cancer surgery that was based on extended (D2) LD volumes. The West has relatively lower incidence rates of gastric cancer, and in Europe and the United States the most common LD volume was D0-1. This eventually caused a scientific conflict between the Eastern and Western schools of surgical thought: Japanese surgeons determinedly used D2 LD in surgical practice, whereas European surgeons insisted on repetitive clinical trials in the European patient population. Today, however, one can observe the results of this complex evolution of views. The D2 LD is regarded as an unambiguous standard of gastric cancer surgical treatment in specialized European centers. Such a consensus of the Eastern and Western surgical schools became possible due to the longstanding scientific and practical search for methods that would help improve the results of gastric cancer surgeries using evidence-based medicine. Today, we can claim that D2 LD could improve the prognosis in European populations of patients with gastric cancer, but only when the surgical quality of LD execution is adequate.
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24
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Degiuli M, De Manzoni G, Di Leo A, D’Ugo D, Galasso E, Marrelli D, Petrioli R, Polom K, Roviello F, Santullo F, Morino M. Gastric cancer: Current status of lymph node dissection. World J Gastroenterol 2016; 22:2875-2893. [PMID: 26973384 PMCID: PMC4779911 DOI: 10.3748/wjg.v22.i10.2875] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/09/2015] [Accepted: 01/18/2016] [Indexed: 02/06/2023] Open
Abstract
D2 procedure has been accepted in Far East as the standard treatment for both early (EGC) and advanced gastric cancer (AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials (RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council (MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recurrence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC.
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25
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Marrelli D, Polom K, de Manzoni G, Morgagni P, Baiocchi GL, Roviello F. Multimodal treatment of gastric cancer in the west: Where are we going? World J Gastroenterol 2015; 21:7954-7969. [PMID: 26185368 PMCID: PMC4499339 DOI: 10.3748/wjg.v21.i26.7954] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/25/2015] [Accepted: 05/02/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (III and IV), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed.
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Laparoscopy assisted distal gastrectomy for T1 to T2 stage gastric cancer: a pilot study of three ports technique. Updates Surg 2015; 67:69-74. [PMID: 25663585 DOI: 10.1007/s13304-015-0279-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/22/2015] [Indexed: 12/15/2022]
Abstract
Laparoscopy assisted distal gastrectomy (LADG) was first reported in 1994. Since then, it has gradually gained maturity. This procedure is less invasive than conventional open gastrectomy, and the oncologic outcomes are comparable. Recently, single-incision laparoscopic surgery (SILS) has been developed, which seems to be less invasive than conventional laparoscopic surgery. However, SILS technique is characterized by a limited working area, crowding and crossing of instruments which make it difficult to be applied for oncologic gastrectomy. In a trial to overcome SILS difficulties, the authors report their initial clinical experience of LADG with D1 lymphadenectomy using a novel 3-ports technique. Twenty-one patients have been enrolled for 3-ports laparoscopic gastrectomy. The patient's demographic and perioperative data have been collected prospectively. The mean operative time in the first ten cases was 170 min and for the last eleven cases was 140 min (P = 0.01). The mean estimated blood loss was 65 ml. There was no use for additional ports or conversion to open surgery. There were no intra-operative major complications. The mean time for hospital stay was 9 days. One case of pneumonia and one death were the postoperative complications. The mean number of retrieved lymph nodes was 21 and all the cases had free surgical margin. Three-ports LADG with D1 lymphadenectomy could be a safe and oncologically feasible procedure; however, a prospective randomized controlled trial comparing three ports LADG with conventional multi-ports LADG is required. It is a step towards three-port total laparoscopic distal gastrectomy.
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de Manzoni G, Verlato G, Bencivenga M, Marrelli D, Di Leo A, Giacopuzzi S, Cipollari C, Roviello F. Impact of super-extended lymphadenectomy on relapse in advanced gastric cancer. Eur J Surg Oncol 2015; 41:534-40. [PMID: 25707350 DOI: 10.1016/j.ejso.2015.01.023] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In gastric cancer the incidence of loco-regional recurrences decreases when lymphadenectomy is expanded from D1 to D2. The present study aimed at evaluating whether the pattern of recurrence in advanced gastric cancer (AGC) is further modified when lymphadenectomy is expanded from D2 to D3. METHODS 568 patients undergoing curative gastrectomy for AGC (274 D2 and 294 D3) were considered; none of them received preoperative chemotherapy. MantelHaenszel test of homogeneity was used to verify whether the relation between extension of lymphadenectomy and recurrence varied as a function of each risk factor considered. The impact of D2 and D3 on relapse was further investigated by multivariable logistic regression model. RESULTS Cumulative incidence of recurrence did not significantly differ after D2 and after D3 in the whole series (45.3% vs 46.3%; p = 0.866). However, the association between recurrence and extension of lymphadenectomy was significantly affected by histology (Mantel-Haenszel test of homogeneity: p = 0.007). The risk of recurrence was higher after D3 than after D2 (45.1% vs 35.3%) in the intestinal histotype while the pattern was reversed in the mixed/diffuse histotype (48.3% vs 61.5%). This pattern was confirmed in multivariable logistic regression: the interaction between histology and extension of lymphadenectomy was highly significant (p = 0.004). In particular, cumulative incidence of locoregional recurrences was higher in the diffuse histotype after D2, while being higher in the intestinal histotype after D3. CONCLUSIONS D3 reverses the negative impact of diffuse histotype on relapses, especially on locoregional recurrences. Therefore D3 could be considered a valid therapeutic option in histotype-oriented tailored treatment of AGC.
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Affiliation(s)
- G de Manzoni
- Dept. of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy.
| | - G Verlato
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - M Bencivenga
- Dept. of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - D Marrelli
- Dept. of Human Pathology and Oncology, Section of General Surgery and Surgical Oncology, Translational Research Laboratory, University of Siena, Siena, Italy
| | - A Di Leo
- Unit of General Surgery, Rovereto Hospital, APSS of Trento, Trento, Italy
| | - S Giacopuzzi
- Dept. of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - C Cipollari
- Dept. of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - F Roviello
- Dept. of Human Pathology and Oncology, Section of General Surgery and Surgical Oncology, Translational Research Laboratory, University of Siena, Siena, Italy
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de Manzoni G, Marrelli D, Verlato G, Morgagni P, Roviello F. Western Perspective and Epidemiology of Gastric Cancer. Gastric Cancer 2015. [DOI: 10.1007/978-3-319-15826-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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