Who Can Perform Adjuvant Chemotherapy Treatment for Gastric Cancer? A Multicenter Retrospective Overview of the Current Status in Korea

Treatment options for advanced gastric cancer with peritoneal metastasis: experience from a single institution in Korea

Purpose

This study aimed to compare treatment options and outcomes based on peritoneal cancer index (PCI) among patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC).

Methods

Between January 2016 and July 2019, clinicopathological data of patients with AGC diagnosed with PM were reviewed. Different treatment methods were performed according to the PCI score: (1) group A (PCI ≤ 13) received cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) with postoperative intraperitoneal (IP) and systemic chemotherapy (n = 29), while (2) group B (PCI > 13) received IP chemotherapy with systemic chemotherapy (n = 22).

Results

Clinical outcomes of 51 patients at the Dankook University Hospital were reviewed. Group A had a significantly lower mean PCI score (9.8 ± 6.9 vs. 32.6 ± 7.1, P < 0.01) than group B, with 25 patients (86.2%) achieving complete cytoreduction. Complications occurred in 16 patients (31.4%), none of who suffered mortality (group A: 11 patients, 37.9% vs. group B: 5 patients, 22.7%; P = 0.25). Among the morbidity, 5 cases (17.2%) and 2 cases (9.1%) exhibited a Clavien-Dindo grade greater than III in groups A and B, respectively (P = 0.04). Groups A and B had an overall median survival time of 34.0 and 16.0 months, respectively (P = 0.03).

Conclusion

Patients with PM of AGC received different treatments according to their PCI score. When accompanied with careful patient selection, our approach may be considered an acceptable option for the treatment of PM of AGC.

Facilitated completion of 1-year adjuvant S-1 monotherapy for pathological stage II or III gastric cancer by medical oncologists

PURPOSE

Several factors are known to be significantly associated with a low completion rate of 1-year adjuvant S-1 monotherapy for gastric cancer. The present study investigated whether or not the specialties of physicians conducting adjuvant S-1 monotherapy affect the completion rate.

METHODS

A total of 437 patients who underwent curative gastrectomy followed by adjuvant S-1 monotherapy for pathological stage II or III gastric cancer between 2008 and 2013 were retrospectively analyzed. Factors affecting completion of adjuvant S-1 monotherapy, including the physicians (medical oncologists or surgeons) administering S-1, were evaluated by a multivariate analysis. The relationship between patient factors and physicians was analyzed regarding the cumulative incidence of discontinuation. The number of times the dose was reduced, the schedule changed, or administration was suspended or delayed in patients completing adjuvant S-1 monotherapy was also counted.

RESULTS

The multivariate analysis showed that old age (≥ 65 years old), excess body weight loss (≥ 15%), and surgeons were independently associated with discontinuation. In older patients, the cumulative incidence of discontinuation by medical oncologists was significantly lower than that by surgeons. Medical oncologists ensured that older patients continued S-1 by frequent suspension or a delay in each course.

CONCLUSIONS

Medical oncologists may facilitate completion of adjuvant S-1 monotherapy.

How Does Combined Resection Affect the Clinical Outcomes After Laparoscopic Surgery for Serosa-Positive Gastric Cancer?: A Retrospective Cohort Study to Investigate the Short-Term Outcomes of Laparoscopic Combined Resection in Patients With T4b Gastric Cancer

Background: Only few surgeons have tried to perform laparoscopic combined resection for T4b gastric cancer. The purpose of this study was to investigate the feasibility of laparoscopic combined resection through a comparison of the clinical outcomes between cT4a and cT4b cases. Methods: We reviewed the medical charts of patients who underwent laparoscopic gastrectomy for clinically T4 gastric cancer from May 2014 and July 2018. During this period, 62 patients with serosa-positive gastric cancer underwent laparoscopic curative surgery. The patients were divided into the following groups: patients who underwent gastrectomy and combined resection for the invaded organs (combined resection group) and those who did not undergo combined organ surgery (gastrectomy only group). Clinical outcomes were compared between the gastrectomy only and combined resection groups. Results: Of 62 patients included in this study, 43 and 19 patients were included in the gastrectomy only and combined resection groups, respectively. The operation time was significantly longer in the combined resection group (364.6 ± 102.5 vs. 247.7 ± 66.1 min; p < 0.001). The incidence of grade ≥ III complications was comparable between the groups (26.3% vs. 11.6%; p = 0.147). The time from the first operation to the initiation of adjuvant chemotherapy showed no statistically significant difference between the groups (48.1 ± 45.4 days vs. 31.6 ± 9.2; p = 0.134). Conclusions: Focusing on the high quality of image and new devices of laparoscopic surgery, it is necessary to re-evaluate the oncologic outcomes of combined resection for T4b gastric cancer.