Survival following operative management of gastric linitis plastica compared with non-operative management

INTRODUCTION Linitis plastica (LP) is a particular subtype of diffuse gastric cancer and is thought to have a very poor prognosis. The operative approach in patients with LP has historically been questioned because of the poor outcomes. The aim of this study was to determine the current outcomes in LP patients who undergo radical resection. METHODS Patients with a new diagnosis of diffuse gastric adenocarcinoma between 2006 and 2010 were identified from a regional pathology database. LP was diagnosed based on histological, radiological and endoscopic findings. The patients’ health records were analysed retrospectively and mortality data obtained from a regional cancer registry. The primary outcome assessed was overall survival. RESULTS Overall, 273 patients with diffuse gastric cancer were identified; 54 of these were diagnosed with LP. In the LP cohort, 17 patients underwent resection compared with 95 of the 219 patients in the non-LP group. The median survival following resection in patients with LP was 16.7 months (95% confidence interval [CI]: 8.3–25.1) while in LP patients who did not have surgery it was 3.6 months (95% CI: 2.2–4.9 months) (p<0.001). There was no significant difference in survival following resection between those with LP and those with non-LP diffuse gastric adenocarcinoma (median: 23.9 months, 95% CI: 15.8–32.1 months) (p=0.331). CONCLUSIONS Survival following resection in patients with LP is not significantly different to that in those with non-LP diffuse gastric cancer. A preoperative diagnosis of LP should not be a reason for denying radical treatment and such individuals should be managed in the same way as any other patient with diffuse gastric cancer.

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Linitis Plastica of The Stomach: A Review

Journal of Surgical Sciences ◽

10.3329/jss.v22i2.44231 ◽

2020 ◽

Vol 22 (2) ◽

pp. 125-138

Author(s):

Md Mizanur Rahman

Keyword(s):

Gastric Cancer ◽

Treatment Outcome ◽

Surgical Resection ◽

Linitis Plastica ◽

Diffuse Gastric Cancer ◽

Biological Behaviour ◽

Desmoplastic Reaction ◽

The Poor ◽

Diagnostic Approaches ◽

Poor Outcomes

Linitis plastica (LP) is a particular subtype of diffuse gastric cancer and is thought to have a separate entity in respect with its biological behaviour, pathology, presentation and treatment outcome. The poor prognosis of LP gastric cancer is due primarily to its advanced stage at diagnosis. The characteristic histopathological feature of this entity is cellular spread to the submucosa and stroma with minimal mucosal alterations accompanied by an excessive desmoplastic reaction. Despite recent research on alternative therapies, surgical resection appears the only potentially curative approach. Patient selection and multidisciplinary management are paramount when considering surgical resection in patients with gastric LP. The operative approach in patients with LP has historically been questioned because of the poor outcomes. The aim of this review is to highlight different dimension of linitis plastica stomach in respect to its definition, classification, clinico-pathological characters, diagnostic approaches and treatment outcome. Journal of Surgical Sciences (2018) Vol. 22 (2) : 125-138

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A cohort study and meta-analysis of the evidence for consideration of Lauren subtype when prescribing adjuvant or palliative chemotherapy for gastric cancer

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920930359 ◽

2020 ◽

Vol 12 ◽

pp. 175883592093035 ◽

Cited By ~ 1

Author(s):

Kunning Wang ◽

Enxiao Li ◽

Rita A. Busuttil ◽

Joseph C. Kong ◽

Sharon Pattison ◽

...

Keyword(s):

Gastric Cancer ◽

Systemic Chemotherapy ◽

Meta Analysis ◽

Sensitivity Analyses ◽

Diffuse Gastric Cancer ◽

Lauren Classification ◽

Significant Difference ◽

Laurén Classification ◽

Better Than

Background: The association between the survival or efficacy of chemotherapy and the Lauren subtype of gastric cancer (GC) remains unclear. We aimed to clarify whether patients with different Lauren subtypes have different survival after treatment with systemic chemotherapy: intestinal gastric cancer (IGC) patients survived better than patients with mixed type gastric cancer (MGC) or diffuse gastric cancer (DGC) after treatment with systemic chemotherapy. Patients & methods: Relevant studies for the meta-analysis were identified through searching Pubmed, Embase, Cochrane and Ovid up to March 2020. We also included our own prospectively collected cohort of patients that were followed over a 10-year period. Sub-group and sensitivity analyses were also performed. Results: In our prospective cohort, the overall survival (OS) of IGC patients receiving systemic chemotherapy (chemoIGC) [median OS 5.01 years, interquartile range (IQR) 2.63–6.71] was significantly higher than that of DGC patients receiving the same chemotherapy (chemoDGC) (median OS 1.33 years, IQR 0.78–3.33, p = 0.0001). After adjusting for age, gender and cancer stage, there was a significant difference in OS in patients treated with chemotherapy based on the Lauren classification of GC {hazard ratio (HR) for OS of the IGC versus DGC 0.33, [95% confidence interval (CI), 0.17–0.65; p < 0.001]}. In the IGC patients, the adjusted HR associated with chemotherapy was 0.26 (95% CI, 0.12–0.56; p = 0.001), whereas the association was 0.64 (95% CI, 0.30–1.33; p = 0.23) in the DGC patient group. In our meta-analysis, 33 studies comprising 10,246 patients treated with systemic chemotherapy (chemoIGC n = 4888, chemoDGC n = 5358) met all the selection criteria. While we accounted for much of the heterogeneity in these studies, we found that chemoIGC patients showed significantly improved OS [HR, 0.76 (95% CI, 0.71–0.82); p < 0.00001] when compared with similarly treated chemoDGC patients. Conclusion: Our results support the consideration of Lauren subtype when prescribing systemic chemotherapy for GC, particularly for MGC or DGC, which may not benefit from chemotherapy. Lauren classification should be considered to stratify chemotherapy regimens to GC patients in future clinical trials, with particular relevance to MGC or DGC, which is more difficult to treat with current regimens.

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Postoperative Morbidity and Failure to Rescue in Surgery for Gastric Cancer: A Single Center Retrospective Cohort Study of 1107 Patients from 1972 to 2014

Cancers ◽

10.3390/cancers12071953 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1953

Author(s):

Christian Galata ◽

Ulrich Ronellenfitsch ◽

Susanne Blank ◽

Christoph Reißfelder ◽

Julia Hardt

Keyword(s):

Gastric Cancer ◽

Surgical Complications ◽

Postoperative Morbidity ◽

Postoperative Mortality ◽

Radical Resection ◽

Failure To Rescue ◽

Surgical Morbidity ◽

Significant Difference ◽

Lethal Complications ◽

Early Cohort

Background: The aim of this study was to evaluate postoperative morbidity, mortality, and failure to rescue following complications after radical resection for gastric cancer. Methods: A retrospective analysis of the surgical database of patients with gastroesophageal malignancies at our institution was performed. All consecutive patients undergoing R0 gastrectomy for pT1–4 M0 gastric adenocarcinoma between October 1972 and February 2014 were eligible for this analysis. Patients were divided into two groups according to the date of surgery: an early cohort operated on from 1972–1992 and a late cohort operated on from 1993–2014. Both groups were compared regarding patient characteristics and surgical outcomes. Results: A total of 1107 patients were included. Postoperative mortality was more than twice as high in patients operated on from 1972–1992 compared to patients operated on from 1993–2014 (6.8% vs. 3.2%, p = 0.017). Between both groups, no significant difference in failure to rescue after major surgical complications was observed (20.8% vs. 20.5%, p = 1.000). Failure to rescue after other surgical and non-surgical complications was 37.8% in the early cohort compared to 3.2% in the late cohort (p < 0.001). Non-surgical complications accounted for 71.2% of lethal complications between 1972 and 1992, but only for 18.2% of lethal complications between 1993 and 2014 (p = 0.002). Conclusion: In the course of four decades, postoperative mortality after radical resection for gastric cancer has more than halved. In this cohort, the reason for this decrease was reduced mortality due to non-surgical complications. Major surgical morbidity after gastrectomy remains challenging.

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EPR19-075: Geographic Region and Race/Ethnicity Are Associated With Treatment and Survival for Gastric Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7157 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. EPR19-075

Author(s):

Mark Ulanja ◽

Mohit Rishi ◽

Bryce Beutler ◽

Santhosh Ambika

Keyword(s):

Gastric Cancer ◽

Gastric Adenocarcinoma ◽

Cox Regression ◽

Treatment Guidelines ◽

Univariate Analysis ◽

Geographic Region ◽

Adjusted Analysis ◽

Significant Difference ◽

Race Ethnicity ◽

The Impact

Introduction: Gastric adenocarcinoma (GAC) remains a lethal disease. Evidence suggests that there is increased incidence of gastric cancer among ethnic minorities as compared to whites. In addition, survival and treatment recommendations may vary based on geographic regions. Objectives: We sought to assess the impact of geographic region and race/ethnicity on treatment and survival for GAC. Methods: Data from SEER registry was used to identify patients with potentially resectable gastric adenocarcinoma (AJCC I–III) diagnosed 2004 to 2015. Exposures of interest were geographic region of diagnosis: Western (West), Midwestern (MW), Southern (SO) or North Eastern (NE), and race. The endpoints were: (1) recommendation of no surgery by the provider, (2) utilization of surgery, and (3) gastric cancer-specific survival (GCS). Multivariable logistic and Cox regression models were used to identify associations. Results: 15,991 patients were included in the analysis (West, 56.3%; NE, 16.3%; MW, 7.8%; and SO, 19.7%). On univariate analysis, the likelihood of no recommendation for surgery was highest in SO (OR: 1.35; P<.001;] West, referent). In adjusted analysis, it was lowest in NE and MW (NE aOR: 0.78; P<.001; MW aOR: 0.78; P=.002). The likelihood of no recommendation for surgery was lowest in Asians (AS) on univariate analysis (OR: AS, 0.47; P<.001); American Indian (AI) 0.59 (P=.027); Hispanic (HS) 0.85 (P=.018); whites (W) 1.01 (P=.884); Black (B) ref]. The adjusted analysis for W is (aOR: 0.86; P=.029; B-ref) and persisted for the rest of ethnicity. Patients diagnosed in NE were independently more likely to undergo surgery as compared to those in other regions (aOR: 1.25; P<.001); black individuals were less likely to undergo surgery as compared to whites, Asians, and Hispanics (P<.05 for all). Overall, a diagnosis of gastric cancer in the NE region was independently associated with superior GCS (HR=0.85; P<.001) (Table 1). Among patients who underwent surgery, those in the NE (HR=0.85; P=.001) exhibited superior GCS, but poor GCS in SO (HR=1.17; P=.001; West-ref). AS who underwent surgical intervention demonstrated superior GCS as compared to all other ethnic groups (HR=0.76; P<.001). Conclusion: There is significant difference in treatment and survival for GAC based on geographic region and race/ethnicity. Adherence to treatment guidelines and recommendations is essential to optimize outcomes for all patients.

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Prognostic effect of high pretreatment neutrophil to lymphocyte ratio on survival of patients with gastric adenocarcinoma in China

The International Journal of Biological Markers ◽

10.5301/jbm.5000123 ◽

2015 ◽

Vol 30 (1) ◽

pp. 96-103 ◽

Cited By ~ 5

Author(s):

Miaozhen Qiu ◽

Yixin Zhou ◽

Ying Jin ◽

Xiao-li Wei ◽

De-shen Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Gastric Adenocarcinoma ◽

Prognostic Value ◽

Neutrophil To Lymphocyte Ratio ◽

Healthy Individuals ◽

Poor Survival ◽

Lymphocyte Ratio ◽

Significant Difference ◽

Gastric Cancer Patients

Background A high neutrophil to lymphocyte ratio (NLR) is a strong predictor of poor survival in patients with colorectal, breast, pancreatic and lung cancers, while the prognostic value of NLR in gastric cancer is still controversial. The aim of our study was to determine the prognostic value of pretreatment NLR in a Chinese population of patients with gastric adenocarcinoma. Methods Our retrospective study used an unselected cohort of gastric adenocarcinoma patients treated in the Cancer Center of Sun Yat-sen University between January 2001 and December 2008. We used the data from 341 healthy individuals as controls to understand the difference of NLR between the gastric cancer patients and normal individuals. A total of 706 patients had a complete blood count (CBC) record prior to treatment. Cox regression analysis was used to evaluate the prognostic value of NLR. Results Gastric adenocarcinoma patients had a significantly higher NLR as well as neutrophilic granulocyte and lower lymphocyte counts compared with healthy individuals. By combining the nearby groups of NLR whose survival had no significant difference, we got a cutoff value for NLR of 3. Patients with a high NLR had a significantly lower survival rate than patients with a low NLR. On multivariate analysis, after adjusting for tumor stage and other clinicopathologic factors, high NLR turned out to be an independent risk factor for poor survival (p=0.016). Conclusions Gastric cancer patients had a significantly higher incidence rate of high NLR compared with healthy individuals. High pretreatment NLR in gastric cancer was an independent prognostic factor.

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A Distinct Clinicopathological Feature and Prognosis of Young Gastric Cancer Patients Aged ≤ 45 Years Old

Frontiers in Oncology ◽

10.3389/fonc.2021.674224 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qian Huang ◽

Xiufeng Zheng ◽

Yang Jiao ◽

Yanna Lei ◽

Xiaoying Li ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Late Onset ◽

Radical Resection ◽

Palliative Surgery ◽

Clinicopathological Feature ◽

Kaplan Meier ◽

Significant Difference ◽

Differentiation Degree ◽

Gastric Cancer Patients

PurposeThe aim of this retrospective study was to probe into clinicopathological features and prognosis of early-onset gastric cancer (EOGC) patients aged ≤ 45 years old.MethodsThis study selected 154 young gastric cancer patients aged ≤ 45 years old and 158 elderly gastric cancer patients aged > 50 years old admitted to West China Hospital of Sichuan University in 2009-2019 as the research object. These patients were further divided into two groups according to whether tumor can be resected radically. The following parameters were analyzed: age, gender, helicobacter pylori (HP) infection status, Her-2 status, pathological type and stage, chemotherapy, tumor differentiation degree, overall survival (OS).ResultsMore than 3,000 patients with gastric carcinoma were screened, and 154 young gastric cancer patients aged ≤ 45 years old were identified as EOGC. Among them, the number of female patients in EOGC group was significantly higher than that of males, accounting for 63.6%. In addition, EOGC were associated with diffuse Laur´en type and poorly differentiated tumors. Interestingly, the Kaplan–Meier method showed that the OS of unresectable EOGC group was significantly lower than that of unresectable LOGC group (P = 0.0005) and chemotherapy containing paclitaxel tended to be more effective in the young people (P = 0.0511). Nevertheless, there was no significant difference in OS between young and elderly patients with gastric cancer in the radical resection group (P = 0.3881).ConclusionEOGC patients have a worse prognosis than late-onset gastric cancer (LOGC) patients with advanced unresectable gastric cancer. Palliative surgery or chemotherapy containing paclitaxel may improve the OS of unresectable young individuals with gastric cancer. Additional randomized controlled trials are required for guiding clinical practice.

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Pathological Diversity of Gastric Cancer from the Viewpoint of Background Condition

Digestion ◽

10.1159/000519337 ◽

2021 ◽

pp. 1-9

Author(s):

Hiroyuki Abe ◽

Tetsuo Ushiku

Keyword(s):

Gastric Cancer ◽

Gastric Carcinoma ◽

Atrophic Gastritis ◽

Gastric Adenocarcinoma ◽

Chronic Atrophic Gastritis ◽

Signet Ring Cell ◽

Diffuse Gastric Cancer ◽

Fundic Gland ◽

Histological Characteristics ◽

H Pylori

Background: The prevalence of Helicobacter pylori infection and chronic atrophic gastritis is decreasing in Japan, which has led to a decline in the incidence of gastric cancer. However, there are various subtypes of gastric cancer that arise from the background mucosa without H. pylori infection, and their histological characteristics are distinct from those of gastric cancer with chronic atrophic gastritis. Summary: In this review, after a brief overview of conventional gastric carcinoma with H. pylori infection, including its molecular classification, histological characteristics of gastric cancer after eradicating H. pylori are described. The clinicopathological characteristics of gastric cancer independent of H. pylori infection are then explained. Autoimmune gastritis (type A gastritis) increases the risk of gastric adenocarcinoma and neuroendocrine tumors. Gastric carcinoma without H. pylori infection has various histological subtypes, including fundic gland-type adenocarcinoma (oxyntic gland adenoma), foveolar-type adenocarcinoma/adenoma, signet ring cell carcinoma, and adenocarcinoma of the esophagogastric junction. In addition, some familial gastric cancer syndromes, including hereditary diffuse gastric cancer, familial adenomatous polyposis, and gastric adenocarcinoma and proximal polyposis of the stomach, are also discussed. Key Messages: Although the incidence of gastric cancer will decrease in the near future, the diversity of gastric cancer pathology will be enhanced because H. pylori-negative gastric cancer will have a significant impact on the clinical practice guidelines for gastric cancer. Gastroenterologists and pathologists should be aware of the morphological diversity of H. pylori-negative gastric cancer, and attention should be paid to the status of the background gastric mucosa while examining gastric cancer.

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PCF chemotherapy combined with surgical treatment of advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.113 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 113-113

Author(s):

Cheng Xiangdong

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Surgical Resection ◽

Distant Metastasis ◽

Metastatic Tumor ◽

Radical Resection ◽

R0 Resection ◽

Significant Difference ◽

Local Advanced ◽

Single Organ

113 Background: Local advanced gastric cancer that could not receive R0 resection or gastric cancer with distant metastasis usually received palliative chemotherapy or entered into a number of clinical trials, and surgery usually roled as a symptomatic treatment. This study is to investigate the efficacy and safety of PCF chemotherapy combined with surgery in the treatment of these patients. Methods: From July 2008 to February 2011, 72 cases of local advanced gastric cancer that cannot be treated with R0 resection (T4N2~3M0) or gastric cancer with single organ metastases (M1) were prospectively analysed. Patients received 2-4 cycles of PCF chemotherapy (PTX 150mg/m2, d1, CDDP 25mg/m2, d1-3, CF 250 mg/m2, d1-3,5-FU 750 mg/m2, d1-3, repeated every 3 weeks), then the primary and metastatic tumor were treated with cytoreductive surgery: mainly treated with radical resection of gastric tumor, combined with D3 and D4 lymph node dissection, pancreaticoduodenal resection, colon resection, ovariectomy, peritoneal resection, liver resection, and tumor radio frequency, followed with another 2-4 cycles of PCF chemotherapy. The treatment completion rate, patients’ tolerance, and overall survival (OS) time were analyzed. Results: 50 patients (69.4%) accomplished chemotherapy and surgical resection as planned. 42 cases had R0 resection (58.3%). The postoperative complication rate was 6.0%. Grade 3/4 toxic effects included bone marrow suppression (30.6%) and gastrointestinal reaction (40.3%), the overall response rate (CR+PR) was 72.2%. Survival analysis: the median survival time was 23.5 months. 1-year and 2-year survival rate was 67.0% and 47.0%. The OS of patients with surgical resection was much longer than that of the non-surgery group. (30.2 vs. 8.9 months) (p <0.01). The OS of local advanced group was 30.3 months, and was significantly longer than 17.6 months of the distant metastasis group (p <0.01); however, it had no significant difference compared to 28.2 months of the distant metastasis group with R0 resection. Conclusions: PCF chemotherapy combined with surgical resection were safe and effective, and can make survival benefits for patients with local advanced gastric cancer or gastric cancer with single organ metastasis.

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A public hospital experience with young gastric cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.30 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 30-30

Author(s):

Bryan S. Goldner ◽

Jonathan Velasquez ◽

Bruce E. Stabile ◽

Steven L. Chen ◽

Joseph Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Adenocarcinoma ◽

Older Patients ◽

Young Patients ◽

The United States ◽

Public Institution ◽

Rank Test ◽

Mortality Data ◽

R0 Resection ◽

One Year

30 Background: Recent literature has reported an increased incidence in the United States of node positive and metastatic disease in young patients with gastric adenocarcinoma. The purpose of this study was to investigate the effect of age (≤40 years) on patients with gastric adenocarcinoma at a large urban public institution. Methods: A total of 520 cases of gastric adenocarcinoma treated between 1995 and 2012 were identified. Information was gathered from the medical record including age at presentation, stage at presentation, pathological type of GC, treatment received, and mortality data. Descriptive statistics were used to analyze the data. Survival was analyzed using the Kaplan-Meier method. Comparisons were made using the log-rank test. Results: The mean age at diagnosis was 56 years. 64 patients (12%) were identified as ≤40 years old. 57 of 64 (89%) of the young age group presented with stage III or IV disease, compared with 75% of patients >40 years of age (p=0.014). For patients ≤40 years old, 38% underwent an operation with curative intent, which was comparable to 39% in patients >40 years old. Of patients who underwent surgery, only 33% (10 of 30) ≤40 years old received an R0 resection compared to 110 of 184 (60%) in those >40 years old (p=0.007). The overall median survival was 5 months with one-year survival of 24% for the young patients and a median of 7.8 months with 39% one-year survival for the older patients (p=0.016). Conclusions: There is a decreased awareness and therefore suspicion of the diagnosis of gastric cancer in young patients (≤40 years of age). For this reason, young patients with gastric adenocarcinoma may present with more advanced disease than older patients. Surgical exploration was often futile, and survival was especially poor in young patients likely due to the more advanced nature of their disease at diagnosis.

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Is linitis plastica a contraindication for surgical resection? A 7-institution study of the U.S. Gastric Cancer Collaborative.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.118 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 118-118

Author(s):

Aaron Udell Blackham ◽

Doug S. Swords ◽

Edward Allen Levine ◽

Nora Fitzgerald ◽

Malcolm Hart Squires ◽

...

Keyword(s):

Gastric Cancer ◽

Surgical Resection ◽

Gastric Adenocarcinoma ◽

Poor Prognosis ◽

Disease Patient ◽

Linitis Plastica ◽

Stage Iii ◽

Disease Stage ◽

Advanced Stage ◽

Term Survival

118 Background: Linitis plastica (LP) describes a diffusively infiltrative gastric adenocarcinoma that portends poor prognosis. Current treatment guidelines do not differentiate between LP and non-LP cancers and it is not known if the same staging system should be applied to both situations. Methods: Using the multi-institutional U.S. Gastric Cancer Collaborative database, 869 patients with gastric adenocarcinoma who underwent resection between 2000-2012 were identified. Clinicopathologic, perioperative and survival outcomes of the 58 patients with LP were compared to the 811 patients without LP. Results: Advanced disease (stage III/IV) at presentation was more common in patients with LP compared to non-LP patients (90 vs 44%, p<0.01). Despite the fact that most LP patients underwent total gastrectomy (88% vs 57%, p<0.01), positive margins were more common in LP patients (33 vs 7%, p<0.01). There was no difference in perioperative complications (48 vs 43%, p=0.45) or mortality (7 vs 3%, p=0.12) between LP and non-LP patients. While survival correlated with stage in non-LP patients, there was no difference in median overall survival (OS) of LP patients based on stage (I/II, 17.3 mos; III, 10.6 mos; IV, 12.0 mos; p=0.46). Median OS was significantly worse in patients with LP (11.6 vs 37.8 months, p<0.01) when margin status and extent of lymphadenectomy were not factored in the analysis. However, when analyzing only patients with optimal resections (R0, D2 lymphadenectomy), the median OS for stage III LP (n=22) and non-LP (n=185) patients was nearly identical (26.8 vs 25.3 mos, p=0.69). There were no independent prognostic factors identified to predict survival in LP patients undergoing curative resection. Conclusions: The poor prognosis of LP gastric cancer is due primarily to its advanced stage at diagnosis. However, LP patients who undergo optimal resections can expect similar long term survival compared to optimally resected non-LP patients with advanced stage disease. Patient selection and multidisciplinary management are paramount when considering surgical resection in patients with gastric LP.

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