Optimal extent of lymphadenectomy for gastric adenocarcinoma: A 7-institution study of the U.S. gastric cancer collaborative

80 Background: Lymph node (LN) status is a predictor of recurrence after gastrectomy for gastric adenocarcinoma. Clinicopathologic predictors of recurrence in patients with node-negative disease are less well established. Methods: Patients who underwent surgery with curative intent for gastric adenocarcinoma from between 2000-2012 from participating institutions of the U.S. Gastric Cancer Collaborative were analyzed. Patients who died within 30 days of surgery were excluded. Univariate (UV) and multivariate (MV) analysis of clinicopathologic factors was associated with recurrence was performed. Results: Nine-hundred sixty-five patients from seven institutions were included in the analysis. Three-hundred forty-five (36%) had LN- disease, of whom 63 (18%) had disease recurrence after a median follow-up of 24 months. The most common patterns of recurrence were: peritoneal alone (44%), liver (22%), or combined liver/peritoneal (9%). This distribution did not differ significantly from LN+ disease. UV analysis identified tumor size, linitis plastica, diffuse histology, poor differentiation, signet ring histology, T stage ≥3, perineural invasion, and lymphvascular invasion as risk factors for recurrence (Table). On MV analysis, T stage≥3 (OR 3.6, 95% CI=1.7-7.5) and poorly differentiated histology (OR 2.4, 95% CI=1.2-4.9) were independent predictors of recurrence. Conclusions: Despite the presence of negative lymph nodes, patients with T stage ≥3 and poorly differentiated histology are at high risk of recurrence after gastrectomy for adenocarcinoma of the stomach. These factors, along with other patient and treatment-related variables, may be used to select patients who may benefit from more aggressive adjuvant therapy and to guide subsequent monitoring for disease recurrence. [Table: see text]

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Value of peritoneal drain placement after total gastrectomy for gastric adenocarcinoma: A multi-institutional analysis from the U.S. Gastric Cancer Collaborative.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.131 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 131-131

Author(s):

Gregory C. Dann ◽

Malcolm Hart Squires ◽

Lauren McLendon Postlewait ◽

David A. Kooby ◽

George A. Poultsides ◽

...

Keyword(s):

Gastric Cancer ◽

Anastomotic Leak ◽

Total Gastrectomy ◽

Gastric Adenocarcinoma ◽

Multivariate Analyses ◽

Major Complication ◽

Postoperative Outcomes ◽

Drain Placement ◽

The U.S

131 Background: A recent randomized trial of peritoneal drain (PD) placement after pancreaticoduodenectomy concluded that placement of PDs decreased the frequency and severity of complications. The role of PD placement after total gastrectomy for gastric adenocarcinoma (GAC) is not well-established. Methods: Patients who underwent total gastrectomy for GAC at 7 institutions from the U.S. Gastric Cancer Collaborative from 2000-2012 were identified. Univariate and multivariate analyses were performed to evaluate the association of PD placement with postoperative outcomes. Results: 344 patients were identified and anastomotic leak rate was 9%.253 (74%) patients received a PD. Those with PD placed had similar ASA class, tumor size, TNM stage, and need for additional organ resection when compared to their counterparts with no PD. No difference was observed in the rate of any complication (54% vs. 48%;p=0.45), major complication (25% vs. 24%;p=0.90), or 30-day mortality (7% vs. 4%;p=0.51) between the two groups. In addition, no difference in anastomotic leak (9% vs. 10%;p=0.90), need for secondary drainage (10% vs. 9%;p=0.92), or reoperation (13% vs. 8%;p=0.28) was identified. On multivariate analysis, PD placement was not associated with a decrease in frequency or severity of postoperative complications. Subset analysis of patients stratified by whether they underwent concomitant pancreatectomy similarly demonstrated no association of PD placement with reduced complications or mortality. In patients who experienced an anastomotic leak (n=31), placement of PD was similarly not associated with a decrease in complications, need for secondary drainage, or mortality. Conclusions: Peritoneal drain placement after total gastrectomy for adenocarcinoma, regardless of concomitant pancreatectomy, is not associated with a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, or decrease in the need for secondary drainage procedures or reoperation. Routine use of peritoneal drains is not warranted.

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Is It Time to Abandon the 5-cm Margin Rule During Resection of Distal Gastric Adenocarcinoma? A Multi-Institution Study of the U.S. Gastric Cancer Collaborative

Annals of Surgical Oncology ◽

10.1245/s10434-014-4138-z ◽

2014 ◽

Vol 22 (4) ◽

pp. 1243-1251 ◽

Cited By ~ 17

Author(s):

Malcolm H. Squires III ◽

David A. Kooby ◽

George A. Poultsides ◽

Timothy M. Pawlik ◽

Sharon M. Weber ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Adenocarcinoma ◽

The U.S

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An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: A seven-institution analysis of 837 patients from the U.S. Gastric Cancer Collaborative.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.120 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 120-120

Author(s):

Gregory C. Dann ◽

Malcolm Hart Squires ◽

Lauren McLendon Postlewait ◽

David A. Kooby ◽

George A. Poultsides ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Therapy ◽

Gastric Adenocarcinoma ◽

Subtotal Gastrectomy ◽

Surgical Site Infections ◽

Infectious Complications ◽

Tube Placement ◽

Increased Risk ◽

Abdominal Infections ◽

The U.S

120 Background: A recent single institutional study demonstrated that jejunostomy feeding tubes (J-tubes) placed during resection of gastric adenocarcinoma (GAC) are associated with increased complications and no change in receipt of adjuvant therapy. Our aim was to validate these findings in a large multi-institutional cohort. Methods: All patients who underwent resection for GAC at 7 institutions participating in the U.S. Gastric Cancer Collaborative from 2000-2012 were identified. Patients with metastatic disease were excluded. Univariate and multivariate logistic regression were performed to assess the association of J-tubes with postoperative complications and receipt of adjuvant therapy. Subset analysis of patients who underwent total vs subtotal gastrectomy was also performed. Results: Of 965 patients, 837 were included for analysis, of whom 265 (32%) received a J-tube. Patients receiving J-tubes demonstrated greater incidence of preoperative weight loss, lower BMI, greater extent of resection, and more advanced TNM stage. J-tube placement was associated with increased infectious complications (36% vs 19%;p<0.001), including surgical site infections (14% vs 6%;p<0.001) and deep intra-abdominal infections (11% vs 4%;p<0.001). On multivariate analysis, J-tubes remained independently associated with increased risk of infectious complications (HR=1.93;p=0.001), surgical site infections (HR=2.85;p=0.001), and deep intra-abdominal infections (HR=2.13;p=0.04). J-tubes were not associated with increased receipt of adjuvant therapy (HR=0.82;p=0.34). Subset analysis of patients undergoing total and subtotal gastrectomy similarly demonstrated an association of J-tubes with increased risk of infectious outcomes andno association with increased receipt of adjuvant therapy. Conclusions: J-tubes placed during resection of gastric adenocarcinoma are independently associated with increased postoperative infections and are not associated with increased receipt of adjuvant therapy, despite being placed in patients with advanced TNM stage tumors. Selective use of J-tubes is recommended.

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Interaction of Postoperative Morbidity and Receipt of Adjuvant Therapy on Long-Term Survival After Resection for Gastric Adenocarcinoma: Results From the U.S. Gastric Cancer Collaborative

Annals of Surgical Oncology ◽

10.1245/s10434-016-5121-7 ◽

2016 ◽

Vol 23 (8) ◽

pp. 2398-2408 ◽

Cited By ~ 34

Author(s):

Linda X. Jin ◽

Dominic E. Sanford ◽

Malcolm Hart Squires ◽

Lindsey E. Moses ◽

Yan Yan ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Therapy ◽

Gastric Adenocarcinoma ◽

Postoperative Morbidity ◽

Term Survival ◽

Long Term Survival ◽

The U.S

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The effect of postoperative morbidity on survival after resection for gastric adenocarcinoma: Results from the U.S. Gastric Cancer Collaborative.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.5 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 5-5

Author(s):

Linda X. Jin ◽

Lindsey E. Moses ◽

Yan Yan ◽

Malcolm Hart Squires ◽

Sharon M. Weber ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Therapy ◽

Gastric Adenocarcinoma ◽

Negative Impact ◽

Perioperative Complications ◽

Disease Free Survival ◽

Oncologic Outcomes ◽

Rank Test ◽

Curative Intent ◽

The U.S

5 Background: The negative impact of postoperative complications (POCs) on survival is well documented for many cancer types, but has not been well described in gastric cancer. Here, we evaluated the effect of POCs on survival after surgery for gastric cancer in a cohort of patients from a multi-institutional database. Methods: Patients who underwent surgery with curative intent for gastric adenocarcinoma between 2000-2012 from participating institutions of the U.S. Gastric Cancer Collaborative were analyzed. Patients who died within 30 days of surgery were excluded. Ninety-day postoperative complication data were collected. Survival probabilities were estimated by Kaplan-Meier analysis and compared using the log-rank test. Results: A total of 853 patients from seven institutions met inclusion criteria. Median follow-up was 32 months. The overall complication rate was 40% (n=344). The most frequent complications were: infectious (25%, including surgical site infection [8%]), and anastomotic leak (6%). 7% of patients underwent reoperation during the same hospitalization. Five-year overall survival (OS) for patients without perioperative complications was 54%, compared with 39% for patients with POCs (p=0.001). Disease free survival (DFS) at five years was 61% for patients without POCs compared to 49% in patients with POCs (p=0.002). Patients without POCs were significantly more likely to receive adjuvant therapy (55% vs 42%; p<0.001). Conclusions: In a large, multi-institutional cohort, POCs were associated with decreased survival in patients undergoing surgery for gastric adenocarcinoma. This may be due, in part, to the negative impact of complications on the receipt of adjuvant therapy. Efforts aimed at reducing perioperative morbidity are important not only for short-term surgical outcomes, but also for enhancing long-term oncologic outcomes in patients with gastric cancer. [Table: see text]

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An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: A seven-institution analysis of 837 patients from the U.S. gastric cancer collaborative

Journal of Surgical Oncology ◽

10.1002/jso.23983 ◽

2015 ◽

Vol 112 (2) ◽

pp. 195-202 ◽

Cited By ~ 13

Author(s):

Gregory C. Dann ◽

Malcolm H. Squires ◽

Lauren M. Postlewait ◽

David A. Kooby ◽

George A. Poultsides ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Adenocarcinoma ◽

Tube Placement ◽

Jejunostomy Tube ◽

Feeding Jejunostomy ◽

The U.S

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Clinicopathological and Endoscopic Features of Raspberry-Shaped Gastric Cancer in Helicobacter pylori-Uninfected Patients

Digestion ◽

10.1159/000511907 ◽

2020 ◽

pp. 1-8

Author(s):

Noboru Yatagai ◽

Hiroya Ueyama ◽

Muneo Ikemura ◽

Ryota Uchida ◽

Hisanori Utsunomiya ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Adenocarcinoma ◽

Submucosal Tumor ◽

Clinicopathological Characteristics ◽

Fundic Gland ◽

Histopathological Classification ◽

Histological Characteristics ◽

Greater Curvature ◽

H Pylori ◽

Tumor Shape

Background: Gastric adenocarcinoma of foveolar type (GA-FV) is a raspberry-shaped gastric cancer (RSGC) and garners much attention as H. pylori (Hp)-uninfected gastric cancer. However, the classification and clinicopathological and endoscopic features of RSGCs in Hp-uninfected patients are poorly defined. We designed a new histopathological classification of RSGC and compared them via endoscopic and clinicopathological characteristics. Summary: From 996 patients with early gastric cancers resected by endoscopy in our hospital, we studied 24 RSGC lesions from 21 (2.4%) Hp-uninfected patients. RSGCs were classified into 3 histological types as follows: GA-FV (n = 19), gastric adenocarcinoma of fundic gland type (GA-FG, n = 2), and gastric adenocarcinoma of fundic gland mucosa type (GA-FGM, n = 3). Most of the lesions were found at the greater curvature of the upper or middle third of the stomach. GA-FV lesions were homogeneously reddish and frequently accompanied with a whitish area around the tumor and an irregular microvascular (MV) pattern; these features were confirmed histopathologically by the presence of homogeneous neoplastic foveolar epithelium with foveolar hyperplasia around the tumors. GA-FG lesions might be heterogeneously reddish with a submucosal tumor shape and regular MV pattern; these were confirmed by the presence of covered or mixed nonneoplastic epithelium on deeper regions of tumors. GA-FGM lesions might be homogeneously reddish and occasionally had a submucosal tumor shape and irregular MV pattern; these were confirmed by the presence of homogeneous neoplastic foveolar epithelium on deeper regions of the tumors. Key Messages: RSGCs in Hp-uninfected patients are classified into 3 histopathological types. For accurate diagnosis of RSGCs, it may be necessary to fully understand endoscopic features of these lesions based on these histological characteristics and to take a precise biopsy.

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