PO-11 Venous thromboembolism in patients receiving preoperative chemotherapy for gastric cancer

IntroductionVenous thromboembolism (VTE) is a serious life-threatening complication in patients with gastric cancer. Abnormal coagulation function and tumour-related treatment may contribute to the occurrence of VTE. Many guidelines considered that surgical treatment would put patients with cancer at high risk of VTE, so positive prevention is needed. However, there are no studies that have systematically reviewed the postoperative risk and distribution of VTE in patients with gastric cancer. We thus conduct this systematic review to determine the risk of VTE in patients with gastric cancer undergoing surgery and provide some evidence for clinical decision-making.Methods and analysisStudies reporting the incidence of VTE after gastric cancer surgery will be included. Primary studies of randomised controlled trials, cohort studies, population-based surveys and cross-sectional studies are eligible for this review and only studies published in Chinese and English will be included. We will search the Medline, Embase, Web of Science, CBM, CNKI and Wanfang data from their inception to November 2019. Two reviewers will independently select studies and extract data. The quality of each included study will be assessed with tools corresponding to their study design. Meta-analysis will be used to pool the incidence data from included studies. Heterogeneity of the estimates across studies will be assessed, if necessary, a subgroup analysis will be performed to explore the source of heterogeneity. The Grades of Recommendation, Assessment, Development and Evaluation method is applied to assess the level of evidence obtained from this systematic review.Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, and thus ethical approval is not required. The results of this review will be sought for publication.PROSPERO registration numberCRD42019144562

Download Full-text

A Prospective Multicenter Observational Study of Venous Thromboembolism after Gastric Cancer Surgery (SHISA-1601)

European Surgical Research ◽

10.1159/000514309 ◽

2021 ◽

pp. 1-10

Author(s):

Sachiko Kaida ◽

Toru Miyake ◽

Satoshi Murata ◽

Tsuyoshi Yamaguchi ◽

Takeshi Tatsuta ◽

...

Keyword(s):

Gastric Cancer ◽

Venous Thromboembolism ◽

Blood Transfusion ◽

Observational Study ◽

Characteristic Curve ◽

Cancer Surgery ◽

Gastric Cancer Surgery ◽

Multicenter Observational Study ◽

Prospective Multicenter Observational Study ◽

D Dimer

Introduction: This study aimed to clarify the frequency and risk factors of intercurrent venous thromboembolism (VTE) in patients undergoing major curative gastric cancer surgery. Methods: This prospective, multicenter, observational study included patients with gastric cancer who underwent radical gastrectomy at 5 hospitals between June 2016 and May 2018. Patients who were preoperatively administered anticoagulants were excluded. Results: A total of 126 patients were eligible to participate. VTE occurred within 9 days postoperatively in 5 cases (4.0%; 2 symptomatic and 3 asymptomatic). Postoperative day (POD) 1 plasma D-dimer and soluble fibrin (SF) levels were significantly higher in the VTE group than in the non-VTE group. Receiver-operating characteristic curve (ROC) analysis indicated a statistically significant ability of POD 1 D-dimer and SF levels to predict postoperative VTE development after gastrectomy; this finding was reflected by an area under the curve (AUC) of 0.97 (95% CI 0.92–1.0) and 0.87 (95% CI 0.74–1.0), respectively. Cutoff values of D-dimer (24.6 µg/mL) and SF (64.1 µg/mL) were determined. Intraoperative blood transfusion (odds ratio [OR] 7.86), POD 1 D-dimer ≥24.6 µg/mL (OR 17.35), and POD 1 SF ≥64.1 µg/mL (OR 19.5) were independent predictive factors for postoperative VTE (p < 0.05). Conclusion: VTE occurred in 4.0% patients (1.6% symptomatic and 2.4% asymptomatic) after gastric cancer surgery; however, with an early diagnosis and anticoagulant therapy, no patients experienced progression. Careful observation of patients with a high risk for VTE, including intraoperative blood transfusion and high POD 1 D-dimer or SF levels, would contribute to the early detection of VTE.

Download Full-text

What is the most useful body composition parameter for predicting toxicities of preoperative chemotherapy for gastric cancer?

Surgery Today ◽

10.1007/s00595-019-01915-5 ◽

2019 ◽

Vol 50 (5) ◽

pp. 509-515 ◽

Cited By ~ 1

Author(s):

Tadayoshi Hashimoto ◽

Yukinori Kurokawa ◽

Tsuyoshi Takahashi ◽

Takuro Saito ◽

Kotaro Yamashita ◽

...

Keyword(s):

Gastric Cancer ◽

Body Composition ◽

Preoperative Chemotherapy ◽

Composition Parameter ◽

Body Composition Parameter

Download Full-text

Commentary on: Efficacy and safety of short-term (3 days) enoxaparin in preventing venous thromboembolism after gastric cancer surgery: A single-center, prospective cohort study [Int J Surg 021 Epub ahead of Print]

International Journal of Surgery ◽

10.1016/j.ijsu.2021.106026 ◽

2021 ◽

pp. 106026

Author(s):

Marcus JW. Chong ◽

Carolyn Chiam

Keyword(s):

Gastric Cancer ◽

Cohort Study ◽

Venous Thromboembolism ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Cancer Surgery ◽

Efficacy And Safety ◽

Single Center ◽

Short Term ◽

Gastric Cancer Surgery

Download Full-text

Comparison between better and poorly differentiated locally advanced gastric cancer in preoperative chemotherapy: a retrospective, comparative study at a single tertiary care institute

World Journal of Surgical Oncology ◽

10.1186/1477-7819-12-280 ◽

2014 ◽

Vol 12 (1) ◽

pp. 280 ◽

Cited By ~ 9

Author(s):

Li-Bo Sun ◽

Guo-Jie Zhao ◽

Da-Yong Ding ◽

Bin Song ◽

Rui-Zhi Hou ◽

...

Keyword(s):

Gastric Cancer ◽

Comparative Study ◽

Advanced Gastric Cancer ◽

Preoperative Chemotherapy ◽

Tertiary Care ◽

Locally Advanced ◽

Locally Advanced Gastric Cancer ◽

Care Institute ◽

Poorly Differentiated ◽

Retrospective Comparative Study

Download Full-text

Neoadjuvant Chemotherapy Compared With Surgery Alone for Locally Advanced Cancer of the Stomach and Cardia: European Organisation for Research and Treatment of Cancer Randomized Trial 40954

Journal of Clinical Oncology ◽

10.1200/jco.2009.26.6114 ◽

2010 ◽

Vol 28 (35) ◽

pp. 5210-5218 ◽

Cited By ~ 356

Author(s):

Christoph Schuhmacher ◽

Stephan Gretschel ◽

Florian Lordick ◽

Peter Reichardt ◽

Werner Hohenberger ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Preoperative Chemotherapy ◽

Survival Benefit ◽

Locally Advanced ◽

Postoperative Chemotherapy ◽

Phase Iii ◽

R0 Resection ◽

Resection Rate

PurposePatients with locally advanced gastric cancer benefit from combined pre- and postoperative chemotherapy, although fewer than 50% could receive postoperative chemotherapy. We examined the value of purely preoperative chemotherapy in a phase III trial with strict preoperative staging and surgical resection guidelines.Patients and MethodsPatients with locally advanced adenocarcinoma of the stomach or esophagogastric junction (AEG II and III) were randomly assigned to preoperative chemotherapy followed by surgery or to surgery alone. To detect with 80% power an improvement in median survival from 17 months with surgery alone to 24 months with neoadjuvant, 282 events were required.ResultsThis trial was stopped for poor accrual after 144 patients were randomly assigned (72:72); 52.8% patients had tumors located in the proximal third of the stomach, including AEG type II and III. The International Union Against Cancer R0 resection rate was 81.9% after neoadjuvant chemotherapy as compared with 66.7% with surgery alone (P = .036). The surgery-only group had more lymph node metastases than the neoadjuvant group (76.5% v 61.4%; P = .018). Postoperative complications were more frequent in the neoadjuvant arm (27.1% v 16.2%; P = .09). After a median follow-up of 4.4 years and 67 deaths, a survival benefit could not be shown (hazard ratio, 0.84; 95% CI, 0.52 to 1.35; P = .466).ConclusionThis trial showed a significantly increased R0 resection rate but failed to demonstrate a survival benefit. Possible explanations are low statistical power, a high rate of proximal gastric cancer including AEG and/or a better outcome than expected after radical surgery alone due to the high quality of surgery with resections of regional lymph nodes outside the perigastic area (celiac trunc, hepatic ligament, lymph node at a. lienalis; D2).

Download Full-text