Long-term outcome of laparoscopic versus open total gastrectomy for advanced gastric cancer: A propensity score-matched analysis.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 77-77
Author(s):  
Hayemin Lee ◽  
Junhyun Lee
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Term Survival ◽  
Long Term Outcome ◽  
Open Total Gastrectomy

77 Background: Laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC) is technically and oncologically challenging procedure for surgeons. The aim of this study is to compare technical safety and long-term oncologic feasibility of LTG for AGC patients compared to open total gastrectomy (OTG) using propensity score (PS)-matched analysis. Methods: Between 2004 and 2014, 185 patients (OTG: 127, LTG: 58) underwent total gastrectomy due to advanced gastric cancer. PS-matching was done using patients’ age, sex, American Society of Anesthesiologist (ASA) physical status, extent of lymph node dissection, presence of combined resection and pathological stage of gastric cancer. Comparisons were made based on surgical outcomes and long-term survival rates. Results: After PS-matching, 102 patients, respectively 51 patients for each group, were enrolled. LTG had longer tumor-free proximal resection margin (OTG 2.5 cm vs. LTG 3.0 cm, p = 0.008). Total number of retrieved lymph node and metastasized lymph node was similar in both groups. The retrieved number of lymph nodes around splenic hilum (#10 and #11d) was similar in both groups (p = 0.105). Longer operation time was required in LTG (OTG 240 min. vs. LTG 320 min, p = 0.002) but less intraoperative bleeding was observed in LTG (OTG 390 cc vs. LTG 276 cc, p < 0.001). Patients of LTG were discharged earlier than OTG (OTG 12 days vs. LTG 10 days, p = 0.043). Overall morbidity and mortality of both group was similar. Between two groups, there was not a difference in 5-year overall survival rate (OTG 56.3% vs. LTG 56.5%, p = 0.597) or disease free survival rate (OTG 59.0% vs. LTG 67.6%, p = 0.455). Conclusions: For treating proximal AGC, LTG may be a technically and oncologically safe and feasible method.

Long-Term Outcomes of Laparoscopic versus Open Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score-Matched Analysis

2019 ◽  
Vol 37 (3) ◽  
pp. 220-228 ◽  
Author(s):  
Hayemin Lee ◽  
Wook Kim ◽  
Junhyun Lee
Keyword(s):  
Gastric Cancer ◽  
Survival Rate ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Total Gastrectomy ◽  
Disease Free Survival ◽  
Term Survival ◽  
Open Total Gastrectomy

Background: Laparoscopic total gastrectomy (LTG) for advanced gastric cancer (AGC) is a technically and oncologically challenging procedure for surgeons. Objectives: The aim of this study was to compare the technical safety and long-term oncological feasibility between LTG and open total gastrectomy (OTG) for patients with AGC using a propensity score (PS)-matched analysis. Methods: Between 2004 and 2014, 185 patients (OTG: 127, LTG: 58) underwent curative total gastrectomy for AGC. PS matching was performed using the patients’ clinicopathological factors, and comparisons were made based on surgical outcomes and long-term survival rates. Results: After PS matching, 102 patients (51 patients in each group) were enrolled. The total numbers of retrieved lymph nodes were similar in both groups. The numbers of retrieved lymph nodes around the splenic hilum were similar in both groups. A longer operation time was required for the LTG group than for the OTG group, but less intraoperative bleeding was observed in the LTG group. The overall morbidity and mortality rates of both groups were similar. Between the 2 groups, there was no difference in the 5-year overall survival rate or disease-free survival rate. Conclusions: For treating proximal AGC, LTG may be a technically and an oncologically safe and feasible method.

Long-term outcome of preoperative docetaxel with cisplatin plus S-1 therapy for advanced gastric cancer with extensive nodal metastasis (JCOG1002).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 141-141 ◽  
Author(s):  
Shinji Morita ◽  
Seiji Ito ◽  
Takeshi Sano ◽  
Daisuke Takahari ◽  
Hiroshi Katayama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Response Rate ◽  
Nodal Metastasis ◽  
Clinical Response Rate ◽  
R0 Resection ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome

141 Background: Neoadjuvant chemotherapy (NAC) with cisplatin plus S-1 (CS) followed by gastrectomy with D2 plus para-aortic lymph node (PAN) dissection is regarded as a standard treatment in Japan for advanced gastric cancer with bulky lymph node (BN) and/or PAN metastasis based on the results of JCOG0405. In JCOG1002, we added docetaxel to CS (DCS) to further improve the long-term outcome. However the primary endpoint, clinical response rate (RR), did not meet the expected level (Ito S, Gastric Cancer. 2017). Herein we report the long-term survival. Methods: Patients with BN and/or PAN metastasis received two or three cycles of DCS therapy (docetaxel at 40 mg/m2 and cisplatin at 60 mg/m2 on day 1, S-1 at 40 mg/m2 twice daily for 2 weeks, were administered every four weeks) followed by gastrectomy with D2 plus PAN dissection and postoperative S-1 for 1 year. Results: Between July 2011 and May 2013, 53 patients were enrolled. Clinically, 17.0% of patients had both PAN and BN metastasis, and remaining patients had either PAN (26.4%) or BN (56.6%) metastasis. The clinical response rate (RR) was 57.7 % as assessed by RECIST v1.0, and the R0 resection rate was 84.6%, which did not exceed those in JCOG0405 (64.7% and 82.3%, respectively). The pathological RR defined as residual tumor corresponding to less than one-third the size of the original tumor was 34.6% in 52 eligible patients, which was slightly higher than in JCOG0405 (28.6%). Among all eligible patients, 5-year overall survival was 54.9% (95% confidence interval 40.3–67.3%) at the date cut-off of May 2018. Among 44 eligible patients with R0 resection, 5-year progression-free survival was 47.7% (95% confidence interval 32.5–61.5%). These were similar to the results of JCOG0405 (52.8% and 50.0%). Twenty patients developed cancer recurrence. The most frequent site of recurrence was lymph nodes (50.0% of all recurrences). Conclusions: Adding docetaxel to CS in NAC for extensive lymph node metastasis did not improve not only short-term outcomes but also long-term survival. NAC with CS followed by D2 + PAN dissection and postoperative S-1 remains standard for patients with extensive nodal metastasis. Clinical trial information: UMIN000006069.

scholarly journals Long-Term Outcomes of Laparoscopic Versus Open Gastrectomy With D2 Lymph Node Dissection for Advanced Gastric Cancer

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 225s-225s
Author(s):  
Z. Li
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Lymph Node Dissection ◽  
Node Dissection ◽  
Long Term Outcomes ◽  
D2 Lymph Node Dissection

Background: Technical safety and short-term surgical outcomes of laparoscopy-assisted gastrectomy (LAG) for advanced gastric cancer (AGC) have been investigated in many clinical trials. However, studies with large sample size and sufficient follow-up comparing LAG and open gastrectomy (OG) for AGC have seldom been reported. Aim: The purpose of this study was to compare the long-term outcomes of LAG vs open OG for AGC using a propensity score matching analysis. Methods: We retrospectively evaluated 459 and 856 patients who underwent LG or OG with D2 lymph node dissection, respectively, for AGC between June 2007 and June 2012. One-to-one propensity score matching was performed to compensate for heterogeneity between groups. We compared long-term outcomes between the 2 groups after propensity score matching. Results: In the propensity score-matched cohort, no significant differences were observed in 5-year overall survival (OS) (52.0% vs 53.4%; P = 0.805) and disease-free survival (DFS) (46.8% vs 47.3%; P = 0.963) between the LAG group and OG group. Stratified analysis showed that the 5-year OS and DFS rates were comparable between the 2 groups in each tumor stage ( P > 0.05). Multivariate analysis revealed that the operation method was not an independent prognostic factor for OS or DFS. Further analysis showed that the recurrence pattern was similar between the LAG group the OG group ( P > 0.05). Conclusion: LAG is a feasible surgical procedure for AGC in comparison with OG in terms of long-term prognosis, although the results should be confirmed by the ongoing randomized controlled trials.

scholarly journals Short- and long-term outcomes of laparoscopy-assisted versus open total gastrectomy for gastric cancer: a propensity score-matched analysis

Oncotarget ◽  
2017 ◽  
Vol 8 (45) ◽  
pp. 80029-80038 ◽  
Author(s):  
Jian-Xian Lin ◽  
Ju-Li Lin ◽  
Chao-Hui Zheng ◽  
Ping Li ◽  
Jian-Wei Xie ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Total Gastrectomy ◽  
Long Term Outcomes ◽  
Open Total Gastrectomy ◽  
Short And Long Term

scholarly journals Preoperative Versus Postoperative Chemo-Radiotherapy For Locally Advanced Gastric Cancer: A Propensity Score-Matched Analysis

2021 ◽  
Author(s):  
Ning Li ◽  
Xiaoyong Xiang ◽  
Dongbin Zhao ◽  
Xin Wang ◽  
Yuan Tang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Postoperative Treatment ◽  
Long Term Outcome ◽  
Free Survival ◽  
Locally Advanced Gastric Cancer

Abstract Background: peri-operative chemo-radiotherapy played important role in locally advanced gastric cancer. Whether preoperative strategy can improve the long-term prognosis compared with postoperative treatment is unclear. The study purpose to compare long-term oncologic outcomes in locally advanced gastric cancer patients treated with preoperative chemo-radiotherapy (pre-CRT) and postoperative chemo-radiotherapy (post-CRT). Methods: From January 2009 to April 2019, 222 patients from 2 centers with stage T3/4 and/or N positive gastric cancer who received pre-CRT and post-CRT were included. After propensity score matching (PSM), comparisons of local regional control (LC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) were performed using Kaplan-Meier analysis and log-rank test between pre- and post-CRT groups.Results: The median follow-up period was 30 months. 120 matched cases were generated for analysis. Three-year LC, DMFS, DFS and OS for pre- vs. post-CRT groups were 93.8% vs. 97.2% (p=0.244), 78.7% vs. 65.7% (p=0.017), 74.9% vs. 65.3% (p=0.042) and 74.4% vs. 61.2% (p=0.055), respectively. Pre-CRT were significantly associated with DFS in uni- and multi-variate analysis. Conclusion: Preoperative CRT showed advantages of long-term outcome compared with postoperative CRT. Trial registration: ClinicalTrial.gov NCT01291407, NCT03427684 and NCT04062058, date of registration: Feb 8, 2011

scholarly journals Multiorgan resection in patients with gastric cancer

2004 ◽  
Vol 57 (9-10) ◽  
pp. 480-486 ◽  
Author(s):  
Dragan Radovanovic ◽  
Dejan Stevanovic ◽  
Ivan Pavlovic ◽  
Aleksandar Bajec ◽  
Berislav Vekic ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Advanced Gastric Cancer ◽  
Subtotal Gastrectomy ◽  
Postoperative Mortality ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
Systematic Lymphadenectomy

Introduction Multiorgan resection for a malignancy is a very comlicated procedure, but there is always the question: does it work? In everyday clinical practice gastric cancer in phases III and IV is rather frequent. Unfortunately, our patients are under the age of 55 years. D2 lymphadenectomy is not as extensive as D2 %/ or D3, so one must ask himself if multiorgan resection is worth the risk. Material and methods We evaluated two groups of patients: group I consisted of 34 patients who underwent total or subtotal gastrectomy, systematic lymphadenectomy and resection of one or more organs; group II (control) consisted of 167 patients who underwent total or subtotal gastrectomy and systematic lymphadenectomy. These two groups of patients were analzyed in regard to: Bormann's classification, histopathologic type, early mortality, early postoperative complications, lymph node dissection and long-term survival. Results According to Bormann's classification the most common type of carcinoma in both groups was ulcerovegetativ tumor (70.6% in I and 58% in II). In the first group of patients a great number of patients had poorly differentiated adenocarcinomas (47%), while in the second group the most common histologic type was well differentiated intestinal carcinoma (28%). Patients with multiorgan resections had higher rates of early postoperative mortality and morbiditiy (mortality - 14.7% and complications - 26.5%) than patients in control group (mortality - 4.8% and complications - 11.4%). The most frequent causes of postopertive mortality and morbidity were anastomotic leakage and wound infections in both groups. Metastatic lymph node invelvement was higher in the first group (41%), than in the second (28%). Long-term survival was best in the control group (38.5 months). Patients with multiorgan resection had better survival (25.4 months) than inoperable cases (only 5 months). Discussion Patients undergoing multiorgan resection usually have advanced gastric cancer with tumor infiltration in surrounding structures. Only these cases are absolute indications for this radical operation, because patients have better chances fo survival. Conclusion Multiorgan resections are extensive procedures with high rates of postoperative mortality and morbiditiy, but represent the only way for better survival of patients with advanced gastric cancer.

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