Distal Gastrectomy for Symptomatic Stage IV Gastric Cancer Contributes to Prognosis with Acceptable Safety Compared to Gastrojejunostomy

Background: The prognostic prolongation effect of reduction surgery for asymptomatic stage IV gastric cancer (GC) is unfavorable; however, its prognostic effect for symptomatic stage IV GC remains unclear. We aimed to compare the prognosis of gastrectomy and gastrojejunostomy for symptomatic stage IV GC. Methods: This multicenter retrospective study analyzed record-based data of patients undergoing palliative surgery for symptomatic stage IV GC in the middle or lower-third regions between January 2015 and December 2019. Patients were divided into distal gastrectomy and gastrojejunostomy groups. We compared clinicopathological features and outcomes after propensity score matching (PSM). Results: Among the 126 patients studied, 46 and 80 underwent distal gastrectomy and gastrojejunostomy, respectively. There was no difference in postoperative complications between the groups. Regarding prognostic factors, surgical procedures and postoperative chemotherapy were significantly different in multivariate analysis. Each group was further subdivided into groups with and without postoperative chemotherapy. After PSM, the data of 21 well-matched patients with postoperative chemotherapy and 8 without postoperative chemotherapy were evaluated. Overall survival was significantly longer in the distal gastrectomy group (p = 0.007 [group with postoperative chemotherapy], p = 0.02 [group without postoperative chemotherapy]). Conclusions: Distal gastrectomy for symptomatic stage IV GC contributes to prognosis with acceptable safety compared to gastrojejunostomy.

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The efficacy of gastrectomy plus chemotherapy for stage IV gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.132 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 132-132 ◽

Cited By ~ 1

Author(s):

Osamu Muto ◽

Hitoshi Kotanagi

Keyword(s):

Gastric Cancer ◽

Statistical Analysis ◽

Survival Rate ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Single Agent ◽

Stage Iv ◽

Palliative Surgery ◽

Stage Iv Gastric Cancer

132 Background: Metastatic gastric adenocarcinoma is an incurable condition. Despite the recently reported benefits of chemotherapies, the prognosis of advanced gastric cancer remains poor. The role of surgical resection is still debatable. Therefore, we investigated the efficacy of gastrectomy plus chemotherapy for stage IV gastric cancer. Methods: We retrospectively evaluated the efficacy of gastrectomy plus chemotherapy for treating stage IV gastric cancer. Among the 753 patients with gastric cancer treated with gastrectomy at our institute between 2003 and 2010, a total of 70 patients classified into stage IV and underwent gastrectomy with perioperative chemotherapy were included in this study. In the analysis, particular attention was paid to the prognostic factors of age, gender, tissue type, metastatic site, pre or postoperative chemotherapy, single agent or combination chemotherapy and the reason for gastrectomy (palliative surgery due to stenosis, bleeding or perforation and reduction surgery). The survival rate was calculated by the Kaplan Meier method and a statistical analysis was performed using the log-rank test. Survival was calculated from the beginning of the treatment until the last follow-up or death from any cause. Results: The median age was 65 years old. Peritoneal, lymph node and liver metastasis were 28, 23, and 13 patients respectively. Fifty-three patients had diffuse type. Gastrectomy followed by chemotherapy and chemotherapy were 53 patients. Single agent chemotherapy were 42 and combination were 28 patients. Thirty-one patients were underwent palliative surgery and 39 patients were reduction surgery. One-year survival rate of all patients was 43% and the median survival time was 19.9 months. In the statistical analysis, only reduction surgery plus chemotherapy demonstrated significant survival benefit. The median survival time was significantly greater in patients undergoing reduction gastrectomy group than in those undergoing palliative gastrectomy (25.3 versus 9.8 months; p=0.005). Conclusions: Long-term survival for patients with stage IV gastric cancer who are managed with reduction surgery and chemotherapy is achievable. Further study with a larger number of patients is warranted.

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The feasibility and safety conversion surgery in stage IV gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.164 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 164-164

Author(s):

Tsutomu Sato ◽

Ken Nishimura ◽

Norisuke Nakayama ◽

Osamu Motohashi ◽

Kenki Segami ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Median Duration ◽

Regional Lymph Node ◽

Stage Iv ◽

Operation Time ◽

Conversion Surgery ◽

Period Range ◽

Stage Iv Gastric Cancer ◽

Nodal Dissection

164 Background: Conversion surgery could be an option for stage IV gastric cancer when distant metastasis (M1) is disappeared by palliative chemotherapy, however, feasibility, safety and efficacy of surgery after long-term chemotherapy remains unclear. Methods: This retrospective study examined 21 gastric cancer patients who underwent curative conversion surgery between 2001 and 2013. Postoperative complications were evaluated according to the Clavien-Dindo classification. Overall survival (OS) was estimated by Kaplan-Meier method. Results: Median follow-up period (range) was 43.9 months (7.2-72.1 months). The number of M1 factors was one in 17 patients and two in 4, including metastases to non-regional lymph node in 11, peritoneum in 11, and liver in 3. The regimen of chemotherapy was S-1/CDDP in 11 patients, S-1/docetaxel/CDDP in 5, S-1/docetaxel in 2, 5FU/leucovorin/paclitaxel in 1, CPT/CDDP in 1, and S-1 monotherapy in 1. The median duration from initiation of chemotherapy to disappearance of M1 factor was 3.5 months and the median duration from initiation of chemotherapy to the operation was 7.5 months. A total of 19 patients (90.4%) underwent over D2 lymphadenectomy including modified D2 in 2 patients, D2 in 16, and D2 plus para-aortic nodal dissection in 3. M1 tumor was not resected except para-aortic nodal dissection in 3 patients. The median operation time and bleeding were 205 minutes and 228 ml, respectively. Grade 2/3/4 morbidities were observed in 5 patients (23.8%); 2 pancreatic fistula (grade 2), 2 abdominal abscess (grade 2 and 3), and 1 anastomotic leakage (grade 3). No mortality was observed. Pathological response of the primary tumor, defined as disappearance of more than two third of the tumor cells, was 66.7% including 19.0% of complete response. The overall survival (OS) after initiation of chemotherapy was 90.5% at 1-year, 85.7% at 2-year, and 75.9% at 3-year with median survival time (MST) of 52.9 months, while OS after surgery was 90.5% at 1 year, 76.2% at 2-year, and 64.5% at 3-year with MST of 40.9 months. Conclusions: Curative conversion gastrectomy for stage IV gastric cancer was feasible and safe. Considering excellent survival, conversion surgery has a value to be evaluated in prospective studies.

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Survival analysis of patients with stage IV gastric cancer following palliative surgery based on inflammation-based prognostic score

Gastroenterology Hepatology and Endoscopy ◽

10.15761/ghe.1000132 ◽

2017 ◽

Vol 2 (1) ◽

Author(s):

Takeshi Matsubara ◽

Noriyuki Hirahara ◽

Toshihiro Takanashi ◽

Shuichi Ishibashi ◽

Yoshitsugu Tajima

Keyword(s):

Gastric Cancer ◽

Survival Analysis ◽

Prognostic Score ◽

Stage Iv ◽

Palliative Surgery ◽

Stage Iv Gastric Cancer

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A case report of curative distal gastrectomy for stage IV gastric cancer after chemoradiotherapy in a patient with a gastrojejunal gastric bypass

Surgical Case Reports ◽

10.1186/s40792-016-0259-x ◽

2016 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Masataka Shimonosono ◽

Sumiya Ishigami ◽

Takaaki Arigami ◽

Yoshikazu Uenosono ◽

Yasuto Uchikado ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Bypass ◽

Case Report ◽

Distal Gastrectomy ◽

Stage Iv ◽

Stage Iv Gastric Cancer

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Surgery for stage IV gastric cancer: An Italian perspective.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.403 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 403-403

Author(s):

Maria Bencivenga ◽

Silvia Ministrini ◽

Leonardo Solaini ◽

Elisabetta Marino ◽

Alessia d’Ignazio ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Lymph Nodes ◽

Hepatic Metastases ◽

Stage Iv ◽

Stage Iv Gastric Cancer ◽

Cancer Metastases ◽

Metastatic Sites ◽

Survival Differences

403 Background: Surgical approach to gastric cancer with hepatic metastases is becoming more and more accepted but few information exist concerning the surgical management of gastric cancer with extra-hepatic metastases. With this retrospective study we evaluated if the prognosis is influenced by different metastatic sites and we looked for the presence of prognostic factors. Methods: We analysed 282 patients with gastric cancer and synchronous metastases treated at our Institutions from 2010 to January 2017. We investigated survival performances after surgery according to the site of metastases: peritoneal, haematogenous, hepatic, distant lymph nodes and more than one site. Furthermore, we investigated how survival was influenced by patient-, gastric cancer-, metastases- and treatment-related prognostic factors. Results: Median overall survival was 10.9 months. We found no survival differences according to the site of metastases: median survival was 11.2, 11.6, 9.8, 21.4, 7.0 months for peritoneal, hepatic, lymph-nodal, haematogenous and more than1 site of metastases, respectively (p = 0.797). In all subgroups we observed an interesting number of long-term survivors (peritoneal 14.3% ≥36 months, 7.6% ≥60 months; hepatic 13.0% ≥36 months, 2.2% ≥60 months; lymph nodes 12.5% ≥36 months, 3.1% ≥60 months; > 1 site 18.7% ≥36 months, 1.6% ≥60 months). At multivariate analysis the factors that influenced survival were: number of resected lymph-nodes (p = 0.013), extension of lymphadenectomy (p < 0.001), pN (p = 0.003), curativity (p = 0.032) and histology (p = 0.028). Conclusions: We showed that no differences in overall survival according to site of metastases exist and we suggest that patients in whom a curative resection is possible, should be treated by resection of both gastric cancer and metastases.

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Anlotinib combined with SOX regimen (S1 (tegafur, gimeracil and oteracil porassium capsules) + oxaliplatin) in treating stage IV gastric cancer: study protocol for a single-armed and single-centred clinical trial

BMJ Open ◽

10.1136/bmjopen-2019-034685 ◽

2020 ◽

Vol 10 (6) ◽

pp. e034685 ◽

Cited By ~ 1

Author(s):

Juan Wang ◽

Dong Xue Wu ◽

Lu Meng ◽

Gang Ji

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Kinase Inhibitor ◽

Objective Response ◽

Disease Free Survival ◽

Stage Iv ◽

Progression Free Survival ◽

Free Survival ◽

Stage Iv Gastric Cancer ◽

Before And After

IntroductionAnlotinib hydrochloride is a multi-targeted receptor tyrosine kinase inhibitor that targets angiogenesis-related kinases and has already showed good safety and efficacy in some solid tumours. However, evidence on the safety and feasibility of anlotinib in patients with stage IV gastric cancer is scarce.Methods and analysisThis study is a single-armed and single-centred clinical study being designed to include 150 patients of stage IV gastric cancer. The patients’ demographics, pathological characteristics, test results of blood, biochemistry and tumour markers before and after medication, disease-free survival and overall survival will be collected and analysed. The primary and main efficacy outcomes are objective response rate, progression-free survival, disease control rate and overall survival. The secondary efficacy outcome is safety indicator including the incidence of adverse drug reactions and adverse events after administration.Ethics and disseminationEthics approval has been obtained from the Ethics Committee at the First Affiliated Hospital (Xijing Hospital) of Fourth Military Medical University (KY20192111-F-1). The results of this study will be disseminated at several research conferences and as published articles in peer-reviewed journals.Trial registration numberChiCTR1900026291 (registration date: 29 September 2019).

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Recent Strategies for Treating Stage IV Gastric Cancer: Roles of Palliative Gastrectomy, Chemotherapy, and Radiotherapy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.251.rv2 ◽

2016 ◽

Vol 25 (1) ◽

pp. 87-94 ◽

Cited By ~ 31

Author(s):

Kunihiko Izuishi ◽

Hirohito Mori

Keyword(s):

Gastric Cancer ◽

Performance Status ◽

Locally Advanced ◽

Growth Factor Receptor ◽

Stage Iv ◽

Stage Iv Gastric Cancer ◽

Palliative Gastrectomy ◽

Advanced Tumor ◽

Esophagogastric Cancer ◽

Previously Treated

Recently, many strategies have been reported for the effective treatment of gastric cancer. However, the strategy for treating stage IV gastric cancer remains controversial. Conducting a prospective phase III study in stage IV cancer patients is difficult because of heterogeneous performance status, age, and degree of cancer metastasis or extension. Due to poor prognosis, the variance in physical status, and severe symptoms, it is important to determine the optimal strategy for treating each individual stage IV patient. In the past decade, many reports have addressed topics related to stage IV gastric cancer: the 7th Union for International Cancer Control (UICC) TNM staging system has altered its stage IV classification; new chemotherapy regimens have been developed through the randomized ECF for advanced and locally advanced esophagogastric cancer (REAL)-II, S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer (SPIRITS), trastuzumab for gastric cancer (ToGA), ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD), and ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW) trials; and the survival efficacy of palliative gastrectomy has been denied by the reductive gastrectomy for advanced tumor in three Asian countries (REGATTA) trial. Current strategies for treating stage IV patients can be roughly divided into the following five categories: palliative gastrectomy, chemotherapy, radiotherapy, gastric stent, or bypass. In this article, we review recent publications and guidelines along with above categories in the light of individual symptoms and prognosis. Abbreviations: APC: argon plasma coagulation; AVAGAST: anti-angiogenic antibody bevacizumab, the avastin in gastric cancer; BSC: best supportive care; CF: cisplatin and fluorouracil; CRP: C-reactive protein; DCF: docetaxel, cisplatin, and 5-FU; FISH: fluorescent in-situ hybridization; GJ: gastrojejunostomy; GPS: Glasgow Prognostic Score; HER: human epidermal growth factor receptor; HR: hazard ratio; NLR: neutrophil-to-lymphocyte ratio; OS: overall survival; PS: performance status; QOL: quality of life; RAINBOW: ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; RCTs: randomized controlled trials; REAL: randomized ECF for advanced and locally advanced esophagogastric cancer; REGARD: ramucirumab monotherapy for previously-treated advanced gastric or gastro-oesophageal junction adenocarcinoma; REGATTA: reductive gastrectomy for advanced tumor in three Asian countries; SEER: Surveillance Epidemiology and End Results; SEMS: self-expandable metal stents; SPIRITS: S-1 plus cisplatin versus S-1 in RCT in the treatment for stomach cancer; ToGA: trastuzumab for gastric cancer; TTP: time-to-progression; VEGFR: vascular endothelial growth factor receptor.

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Conversion surgery of Stage IV gastric cancer with peritoneal dissemination after nivolumab

International Cancer Conference Journal ◽

10.1007/s13691-021-00503-0 ◽

2021 ◽

Author(s):

Yuji Toyota ◽

Kunio Okamoto ◽

Norimitsu Tanaka ◽

Hugh Shunsuke Colvin ◽

Yuta Takahashi ◽

...

Keyword(s):

Gastric Cancer ◽

Peritoneal Dissemination ◽

Stage Iv ◽

Conversion Surgery ◽

Stage Iv Gastric Cancer

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Gastric Cancer Treatments and Survival Trends in the United States

Current Oncology ◽

10.3390/curroncol28010017 ◽

2020 ◽

Vol 28 (1) ◽

pp. 138-151

Author(s):

Kelly A. Stahl ◽

Elizabeth J. Olecki ◽

Matthew E. Dixon ◽

June S. Peng ◽

Madeline B. Torres ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Stage Iv ◽

The United States ◽

Current Treatment ◽

Stage I ◽

Stage Ii ◽

Chi Square ◽

Specific Guideline ◽

Kaplan Meier

Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004–2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan–Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.

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