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.

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.

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

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]

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

2015 ◽  
Vol 112 (2) ◽  
pp. 195-202 ◽  
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

scholarly journals Two Distinct Etiologies of Gastric Cancer: Infection and Autoimmunity

2021 ◽  
Vol 9 ◽  
Author(s):  
Stella G. Hoft ◽  
Christine N. Noto ◽  
Richard J. DiPaolo
Keyword(s):  
Gastric Cancer ◽  
T Cells ◽  
Gastric Adenocarcinoma ◽  
Inflammatory Diseases ◽  
The United States ◽  
Autoimmune Gastritis ◽  
Gastric Disease ◽  
Increased Risk ◽  
H Pylori ◽  
Gastrointestinal Ulceration

Gastric cancer is a leading cause of mortality worldwide. The risk of developing gastric adenocarcinoma, which comprises &gt;90% of gastric cancers, is multifactorial, but most associated with Helicobacter pylori infection. Autoimmune gastritis is a chronic autoinflammatory syndrome where self-reactive immune cells are activated by gastric epithelial cell autoantigens. This cause of gastritis is more so associated with the development of neuroendocrine tumors. However, in both autoimmune and infection-induced gastritis, high risk metaplastic lesions develop within the gastric mucosa. This warrants concern for carcinogenesis in both inflammatory settings. There are many similarities and differences in disease progression between these two etiologies of chronic gastritis. Both diseases have an increased risk of gastric adenocarcinoma development, but each have their own unique comorbidities. Autoimmune gastritis is a primary cause of pernicious anemia, whereas chronic infection typically causes gastrointestinal ulceration. Both immune responses are driven by T cells, primarily CD4+ T cells of the IFN-γ producing, Th1 phenotype. Neutrophilic infiltrates help clear H. pylori infection, but neutrophils are not necessarily recruited in the autoimmune setting. There have also been hypotheses that infection with H. pylori initiates autoimmune gastritis, but the literature is far from definitive with evidence of infection-independent autoimmune gastric disease. Gastric cancer incidence is increasing among young women in the United States, a population at higher risk of developing autoimmune disease, and H. pylori infection rates are falling. Therefore, a better understanding of these two chronic inflammatory diseases is needed to identify their roles in initiating gastric cancer.

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

2016 ◽  
Vol 113 (7) ◽  
pp. 750-755 ◽  
Author(s):  
Reese W. Randle ◽  
Douglas S. Swords ◽  
Edward A. Levine ◽  
Nora F. Fino ◽  
Malcolm H. Squires ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastric Adenocarcinoma ◽  
The U.S

Outcomes of adjuvant chemoradiotherapy after a radical gastrectomy and D2 node dissection for gastric adenocarcinoma in INEN (Lima, Peru).

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 150-150
Author(s):  
Paola Catherine Montenegro ◽  
Lourdes Lopez ◽  
Shirley Quintana ◽  
Luis Augusto Casanova ◽  
Victor Castro ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Therapy ◽  
Gastric Adenocarcinoma ◽  
Curative Resection ◽  
Standard Treatment ◽  
Adjuvant Chemoradiotherapy ◽  
Rank Test ◽  
D2 Lymphadenectomy ◽  
Risk Of Death ◽  
Node Positive

150 Background: Adjuvant chemoradiotherapy is the standard treatment in Western countries in gastric cancer patients submitted to curative resection. INT 0116 pivotal trial established adyuvant chemoradiation as the standar care for resected high risk adenocarcionoma of the stomach in US however was hampered by suboptimal surgery. There is controversial data about efficacy of this adjuvant therapy in patients who have undergone D2 lymphadenectomy predominantly. In our hospital D2 lymphadenectomy is standar surgery for gastric cancer. Methods: Retrospective study with gastric adenocarcinoma patients stage II to IV M0 who underwent curative resection at Instituto Nacional de enfermedades Neoplasicas Lima- Peru between 2001 and 2006 Standard treatment at institution is D2 lymphadenectomy. Chemoradiotherapy according to INT 0116 was given like adjuvant therapy. Survival curves were calculated according to Kaplan-Meier method and compared with log-rank test. Multivariate analysis of prognostic factors related to survival was performed by Cox proportional hazards model adjusted for age, stage and adjuvant chemoradiotherapy. Results: 84 patients were included 60.3% male and 39.3% female. Median age was 40.5 years old. The patologic stage were T1-T2 (12.3%), T3-T4 ( 50% ), N0-N1 (10.7%), N2-N3 (89.3%). D2 lymphadenectomy was performed in all patients. The 3-year DFS was 17% and 3-year overall survivall was 23.9% years.However when we analized by subgroups the overal survival was significantly longer in group N1 ( 61%) and N2 (58.9%) that N3 (18.3%) and DFS were N1 (60%), N2 (55%) and N3 (16.3%). Conclusions: Adjuvant chemoradiotherapy decreased risk of death and relapse in patients with node positive N1-N2 , who underwent curative resection with D2 lymphadenectomy, but recurrence was most frecuent in N3 node positive, maybe is necesary improve the chemotherapy in this group of patientes for dicrease the rate of relapse.

Factors associated with recurrence in lymph node-negative gastric adenocarcinoma: Results from the U.S. Gastric Cancer Collaborative.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 80-80 ◽  
Author(s):  
Linda X. Jin ◽  
Malcolm Hart Squires ◽  
George A. Poultsides ◽  
Konstantinos Ioannis Votanopoulos ◽  
Sharon M. Weber ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Gastric Adenocarcinoma ◽  
Disease Recurrence ◽  
Curative Intent ◽  
Node Negative ◽  
T Stage ◽  
Predictors Of Recurrence ◽  
Poorly Differentiated ◽  
The U.S

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]

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

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.

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

2014 ◽  
Vol 22 (4) ◽  
pp. 1243-1251 ◽  
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

NESC multicenter phase II trial in the preoperative treatment of gastric adenocarcinoma with chemotherapy (docetaxel-cisplatin-5FU + lenograstim) followed by chemoradiation (RTCT) based 5FU and oxaliplatin and surgery.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 95-95
Author(s):  
Laurent Mineur ◽  
Gael Deplanque ◽  
Francoise Desseigne ◽  
Laurence Moureau-Zabotto ◽  
Olivier Boulat ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Continuous Infusion ◽  
Total Gastrectomy ◽  
Gastric Adenocarcinoma ◽  
Response Rate ◽  
Subtotal Gastrectomy ◽  
High Response Rate ◽  
Phase Iii ◽  
R0 Resection ◽  
Preoperative Treatment

95 Background: Perioperative chemotherapy is a standard treatment. The combination of Docetaxel- cddp-5FU(DCF) is a treatment in metastatic gastric cancer with high response rate. Preoperative RTCT is expected to increase the rate of curative resections and complete histological response. We investigate the efficacy of an optimal chemotherapy with DCF + lenograstim then preoperative RTCT with oxaliplatin - 5FU in gastric adk. Methods: Between 2009 and 2014, 33 patients with gastric adenocarcinoma(adk) were included. Inclusion criteria adk of stomach, cardia, Siewert II, III, according to staging classification T2bT3T4anyNM0 optional laparoscopy. Treatment consisted of 2 cycles docetaxel 75 mg/m2 I.V. day 1, cddp 75 mg/ m2 I.V. day 1, 5-FU 750 mg/m2 continuous infusion for 120 h, every 3 weeks and lenograstim followed by RTCT delivered in 25 daily fractions of 1.8 Gy in 5 weeks with 5Fu 250mg/m2 continuous infusion per day on days 1 to 35 and oxaliplatin 85mg/m2 day 1-14-28. Surgery was performed 4-6 weeks after RTCT. The primary endpoints were pathological response rate and secondary PFS, overall survival, morbidity and post operative mortality, toxicity. Results: 33 patients were included, 1patient progressive disease(PD) after 2 cycles of DCF, 32 patients received RTCT and 2 patients PD after RTCT, 1 patient refused surgery. 29 patients were operated and 3 non resected (peritoneal metastasis). 26 patients underwent surgery after RTCT (total gastrectomy n = 12, total gastrectomy and diaphragm surgery n = 1 lewis santy n = 11, subtotal gastrectomy n = 1, Enlarged gastrectomy transverse colectomy and partial pancreatic n = 1 D1 (n = 5) and D2 (n = 21) R0 resection rate was n = 26/26. Postoperative morbidity (n = 12) and mortality (n = 2), histology mean nods examined and involved respectively 16 and 2,5. pT0pN0 23% pT1pN0 19% pTpN2N3 20% others 38%. < 10% residual tumor 27% histologic complete response 23%. Conclusions: Promising results from trials involving preoperative chemoradiation followed by surgery in gastric cancer need to be further evaluated in a Phase III and compared with perioperative CT. Clinical trial information: NCT01565109.

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