scholarly journals Evidence Based Surgical Approach to Locally Advanced Gastric Cancer

2019 ◽  
Vol 17 (2) ◽  
pp. 133-140
Author(s):  
Binay Thakur ◽  
Mukti Devkota ◽  
Amit Sharma ◽  
Manish Chaudhary
Keyword(s):  
Gastric Cancer ◽  
Soviet Union ◽  
Advanced Gastric Cancer ◽  
Former Soviet Union ◽  
Locally Advanced ◽  
Population Level ◽  
Multimodality Treatment ◽  
Current Evidence ◽  
Curative Surgery ◽  
Locally Advanced Gastric Cancer

Gastric cancer is endemic in China, Japan, Korea, Brazil and Former Soviet Union. Patients are diagnosed usually in locally advanced stage. Endoscopy, Positron Emission Therapy- Computed Tomography, Endoscopic ultrasound and staging laparoscopy are the tools for proper evaluation of such patients. Locally advanced gastric cancer (T2-4N0 or TanyN+) requires multimodality treatment including surgery. Resection is the cornerstone of cure for gastric adenocarcinoma; however, several aspects of surgical intervention remain controversial or are suboptimally applied at a population level. Current evidence shows a D2 gastrectomy has got the best survival results. At least 15 lymph nodes should be assessed for adequate staging. Laparoscopic resections should be performed to the same standards as those for for open resections, by surgeons who are experienced in both advanced laparoscopic surgery and gastric cancer management.Keywords: Curative surgery; gastrectomy; stomach neoplasms.

scholarly journals Surgical strategy for locally advanced gastric cancer

2018 ◽  
Vol 2 (1) ◽  
pp. 10-18
Author(s):  
Thakur Binay ◽  
Devkota Mukti ◽  
Bishal Sapkota
Keyword(s):  
Gastric Cancer ◽  
Soviet Union ◽  
Advanced Gastric Cancer ◽  
Former Soviet Union ◽  
Locally Advanced ◽  
Multimodality Treatment ◽  
Surgical Strategy ◽  
Locally Advanced Gastric Cancer ◽  
Pet Ct ◽  
Nodal Dissection

Gastric cancer is endemic in China, Japan, Korea, Brazil and Former Soviet Union. Patients are diagnosed usually in locally advanced stage. Endoscopy, PET-CT, Endoscopic ultrasound and staging laparoscopy are the tools for proper evaluation of such patients. Locally advanced gastric cancer (T2-4N0 or T any N+) requires multimodality treatment including surgery. Surgical strategy requires gastrectomy with D2 nodal dissection.

scholarly journals Phase II trial of prophylactic hyperthermic intraperitoneal chemotherapy in patients with locally advanced gastric cancer after curative surgery

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Biao Fan ◽  
Zhaode Bu ◽  
Ji Zhang ◽  
Xianglong Zong ◽  
Xin Ji ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Advanced Gastric Cancer ◽  
Phase Ii Trial ◽  
Locally Advanced ◽  
Control Group ◽  
Radical Gastrectomy ◽  
Curative Surgery ◽  
Locally Advanced Gastric Cancer ◽  
Experimental Group

Abstract Background HIPEC is an emerging procedure to treat peritoneal metastasis of gastric cancer. Data about HIPEC in locally advanced gastric cancer is scarce. The purpose of this trial is to evaluate the safety and toxicity of prophylactic HIPEC with cisplatin for patients with locally advanced gastric cancer. Methods From March 2015 to November 2016, a prospective, randomized phase II trial was conducted. After radical gastrectomy, patients in the experimental group underwent HIPEC with cisplatin followed by adjuvant chemotherapy with SOX regime. Patients in the other group were treated with SOX regime alone. Postoperative complications and patient survival were compared. Results In total, 50 patients were eligible for analyses. No significant difference was found in the incidence of postoperative complications including anastomotic/intestinal leakage, liver dysfunction, bone marrow suppression, wound infection and ileus (P > 0.05). Mean duration of hospitalization after radical gastrectomy was 11.7 days. 12.2 days in experimental group and 10.8 days in control group respectively (P = 0.255). The percentage of patients with elevated tumor markers was 12.1% in experimental group, which was significantly lower than 41.2% in control group (P = 0.02). 3-year RFS of patients who treated with or without prophylactic HIPEC were 84.8 and 88.2% respectively (P = 0.986). In the multivariate analysis, pathological T stage was the only independent risk factor for the RFS of patients (P = 0.012, HR =15.071). Conclusion Additional intraoperative HIPEC with cisplatin did not increase postoperative complications for locally advanced gastric cancer after curative surgery. Prophylactic HIPEC with cisplatin was safe and tolerable, while it did not reduce the risk of peritoneal recurrence in this trial, supporting further studies to validate the efficacy of it. Trial registration Chinese Clinical Trial Registry, ChiCTR2000038331. Registered 18 September 2020 - Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=59692.

Final results of a phase II multicenter study of neoadjuvant S-1 and irinotecan in patients with locally advanced gastric cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 65-65
Author(s):  
Masanori Terashima ◽  
Zenichiro Saze ◽  
Ryo Hosotani ◽  
Masahiro Takahashi ◽  
Akinori Takagane ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Gastric Cancer ◽  
Combination Chemotherapy ◽  
Tumor Response ◽  
Locally Advanced ◽  
R0 Resection ◽  
Curative Surgery ◽  
Term Survival ◽  
Locally Advanced Gastric Cancer

65 Background: Combination chemotherapy involving S-1 and irinotecan (IRI-S) has failed to demonstrate a survival benefit over S-1 alone in metastatic gastric cancer. However, the tumor response rate was significantly higher with I-RIS. Therefore, we evaluated the effect of I-RIS as neoadjuvant chemotherapy for locally advanced gastric cancer. Methods: Patients with locally advanced gastric adenocarcinoma, T3-4, N0-3, M0, for whom curative surgery was planned after neoadjuvant chemotherapy, PS 0-1, with adequate organ function were enrolled in this study. Patients received irinotecan 80 mg/m2 on days 1 and 15 and oral S-1 80 mg/m2/day on days 1 to 21. Treatment was repeated every 28 days for 2 courses. Patients then underwent gastrectomy with lymphadenectomy. After surgery, patients resumed treatment with S-1 alone for 1 year. Results: Of the 39 patients enrolled, 37 were eligible. Two cycles of chemotherapy were completed in 34 patients, and surgery was performed in 33 patients. Of 27 RECIST-evaluable patients, 16 (59%) had a partial response and 9 (33%) had stable disease. Major grade 3 toxicities were neutropenia in 6, anorexia in 4, nausea in 3, diarrhea in 2, and fatigue in 2. Resection was performed in 32 (86%) patients and R0 resection was possible in 20 (54%) patients. The reason for R1/R2 were cy+ in 6, M1(LYM) in 5, M1(PER) in 4, M1(HEP) in 1 and PM+ in 2. Postoperative complications were observed in 13 (39%) patients. There were no treatment-related deaths. Pathological response was observed in 13 of 32 patients (41%); 2 patients had pathological CR. Median survival time was 15.9M and median progression-free survival (PFS) was 5.9M. Overall survival and PFS were significantly better in patients underwent R0 resection (p < 0.0001). Neither objective tumor response nor pathologic response predicted the survival. Conclusions: These results show that neoadjuvant S-1 and irinotecan combination chemotherapy was active and feasible for treating locally advanced gastric cancer. R0 resection is essential to achieve long-term survival. Therefore, careful diagnosis with staging laparoscopy before surgery is mandatory to avoid non-curative operation. Clinical trial information: NCT00134095.

CPT-11/Cisplatin neoadjuvant therapy downstages locally advanced gastric cancer

2001 ◽  
Vol 120 (5) ◽  
pp. A129-A129
Author(s):  
E NEWMAN ◽  
S MARCUS ◽  
M POTMESIL ◽  
H HOCHSTER ◽  
H YEE ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Therapy ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Locally Advanced Gastric Cancer
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