scholarly journals Surgical Management of Gastric Cancer: A Systematic Review

2021 ◽  
Vol 10 (12) ◽  
pp. 2557
Author(s):  
Lucian Mocan
Keyword(s):  
Gastric Cancer ◽  
Surgical Treatment ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Surgical Care ◽  
High Volume ◽  
Resection Margins ◽  
Curative Intent ◽  
Surgical Aspects

Gastric cancer is the fifth most common cancer worldwide, and it is responsible for 7.7% of all cancer deaths. Despite advances in the field of oncology, where radiotherapy, neo and adjuvant chemotherapy may improve the outcome, the only treatment with curative intent is represented by surgery as part of a multimodal therapy. Two concepts may be adopted in appropriate cases, neoadjuvant treatment before gastrectomy (G) or primary surgical resection followed by chemotherapy. Such an approach, combined with early detection and better screening, has led to a decrease in the overall incidence of gastric cancer. Unfortunately, malignant tumors of the stomach are often diagnosed in locally advanced or metastatic stages when the median overall survival remains poor. Surgical care in these cases must be provided by a multidisciplinary team in a high-volume center. Important surgical aspects such as optimum resection margins, surgical technique, and number of harvested lymph nodes are important factors for patient outcomes. The standardization of surgical treatment of gastric cancer in accordance with the patient’s profile is of decisive importance for a better outcome. This review aims to summarize the current standards in the surgical treatment of gastric cancer.

scholarly journals Predictors of adjuvant treatment for pancreatic adenocarcinoma at the population level

2016 ◽  
Vol 23 (5) ◽  
pp. 334 ◽  
Author(s):  
D.J. Kagedan ◽  
M.E. Dixon ◽  
R.S. Raju ◽  
Q. Li ◽  
M. Elmi ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Adjuvant Treatment ◽  
Population Level ◽  
Universal Coverage ◽  
High Volume ◽  
Geographic Region ◽  
Administrative Databases ◽  
Resection Margins ◽  
Curative Intent ◽  
Comorbidity Burden

Background In the present study, we aimed to describe, at the population level, patterns of adjuvant treatment use after curative-intent resection for pancreatic adenocarcinoma (pcc) and to identify independent predictors of adjuvant treatment use.Methods In this observational cohort study, patients undergoing pcc resection in the province of Ontario (population 13 million) during 2005–2010 were identified using the provincial cancer registry and were linked to administrative databases that include all treatments received and outcomes experienced in the province. Patients were defined as having received chemotherapy (ctx), chemoradiation (crt), or observation (obs). Clinicopathologic factors associated with the use of ctx, crt, or obs were identified by chi-square test. Logistic regression analyses were used to identify independent predictors of adjuvant treatment versus obs, and ctx versus crt.Results Of the 397 patients included, 75.3% received adjuvant treatment (27.2% crt, 48.1% ctx) and 24.7% received obs. Within a single-payer health care system with universal coverage of costs for ctx and crt, substantial variation by geographic region was observed. Although the likelihood of receiving adjuvant treatment increased from 2005 to 2010 (p = 0.002), multivariate analysis revealed widespread variation between the treating hospitals (p = 0.001), and even between high-volume hepatopancreatobiliary hospitals (p = 0.0006). Younger age, positive lymph nodes, and positive surgical resection margins predicted an increased likelihood of receiving adjuvant treatment. Among patients receiving adjuvant treatment, positive margins and a low comorbidity burden were associated with crt compared with ctx.Conclusions Interinstitutional medical practice variation contributes significantly to differential patterns in the rate of adjuvant treatment for pcc. Whether such variation is warranted or unwarranted requires further investigation.

scholarly journals Perioperative chemotherapy for gastric cancer: the current state

2018 ◽  
Vol 20 (2) ◽  
pp. 56-60
Author(s):  
V K Lyadov ◽  
O A Pardabekova ◽  
M A Lyadova
Keyword(s):  
Gastric Cancer ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
High Rate ◽  
Phase Iii ◽  
Perioperative Chemotherapy ◽  
Phase Iii Trial ◽  
Locally Advanced Gastric Cancer ◽  
Current State ◽  
Resectable Gastric Cancer

Gastric cancer has one of the leading positions in the world in the prevalence and mortality among malignant tumors. The results of surgical treatment of locally advanced gastric cancer remain generally poor due to the high rate of relapse after surgery. Currently, perioperative (pre- and postoperative) chemotherapy in combination with surgery is recommended for patients with stage ≥IB resectable gastric cancer. We analyzed the studies devoted to the problem of choosing the optimal regimen of perioperative chemotherapy in locally advanced and oligometastatic gastric cancer. The highest efficacy was observed in the taxan-containing regimen FLOT which allowed to increase the median overall survival up to 50 months in a randomized controlled phase III trial. The use of perioperative chemotherapy with anti-Her2 therapy, immunotherapy or any other biologic drug remains investigational.

scholarly journals Gastric Cancer in Nepal A Locally Advanced Disease

2019 ◽  
Vol 21 (3) ◽  
pp. 199-203
Author(s):  
Rabin Koirala ◽  
N. Acharya ◽  
S. Khanal ◽  
A. Rajbhandary
Keyword(s):  
Gastric Cancer ◽  
Locally Advanced ◽  
College Teaching ◽  
Albumin Level ◽  
Curative Intent ◽  
Duration Of Symptoms ◽  
Medical College ◽  
Duration Of Illness ◽  
Long Duration ◽  
Operative Findings

The goal of this study is to describe the distribution of gastric cancer by age, gender, duration of symptoms, nutritional status and staging of the disease based on operative findings and correlation between the data. This was an observational study. The study was conducted at Department of Surgery, Nepal Medical College Teaching Hospital from December 2012 to December 2017. All patients who were admitted to the department with a diagnosis of stomach cancer and underwent palliative or curative intent procedure were reviewed and analyzed. Out of the 80 patients, 51(63.7%) were male and 29 (36.3%) patients were female. The disease was commonest in the 6th and 7th decades of life. Majority of the patients were of Tibetoburmese (Mongolian) origin with 44 (55%). Majority of patients, 60 (75%) patients had long duration of illness of more than 6 months. Most of the patients had albumin level less than 3gm/dl. Gastric carcinoma is a male predominant malignancy usually of old age and commonly observed in the Tibeto-Burman group of people. Overwhelming majority diagnosed at an advanced stage and had poor prognosis.

scholarly journals Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre

ESMO Open ◽  
2020 ◽  
Vol 5 (6) ◽  
pp. e000929
Author(s):  
Susana Roselló ◽  
Claudio Pizzo ◽  
Marisol Huerta ◽  
Elena Muñoz ◽  
Roberto Aliaga ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Progression Free Survival ◽  
Rank Test ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Curative Intent ◽  
Kaplan Meier ◽  
Dismal Prognosis

IntroductionPancreatic cancer (PC), even in the absence of metastatic disease, has a dismal prognosis. One-third of them are borderline resectable (BRPC) or locally advanced unresectable PC (LAUPC) at diagnosis. There are limited prospective data supporting the best approach on these tumours. Neoadjuvant chemotherapy (ChT) is being increasingly used in this setting.MethodsThis is a retrospective series of consecutive patients staged as BRPC or LAUPC after discussion in the multidisciplinary board (MDB) at an academic centre. All received neoadjuvant ChT, followed by chemoradiation (ChRT) in some cases, and those achieving enough downstaging had a curative-intent surgery. Descriptive data about patient’s characteristics, neoadjuvant treatments, toxicities, curative resections, postoperative complications, pathology reports and adjuvant treatment were collected. Overall survival (OS) and progression-free survival was calculated with Kaplan-Meier method and log-rank test.ResultsBetween August 2011 and July 2019, 49 patients fulfilled the inclusion criteria, and all of them received neoadjuvant ChT. Fluorouracil+folinic acid, irinotecan and oxaliplatin was the most frequently used scheme (77%). The most prevalent grade 3 or 4 toxicities were neutropenia (26.5%), neurotoxicity (12.2%), diarrhoea (8.2%) and nausea (8.2%). 18 patients (36.7%) received ChRT thereafter. In total, 22 patients (44,9%) became potentially resectable and 19 of them had an R0 or R1 pancreatic resection. One was found to be unresectable at surgery and two refused surgery. A vascular resection was required in 7 (35%). No postoperative deaths were observed. Postoperative ChT was given to 12 (66.7%) of resected patients. Median OS of the whole cohort was 24,9 months (95% CI 14.1 to 35.7), with 30.6 months for resected and 13.1 months for non-resected patients, respectively (p<0.001).ConclusionA neoadjuvant approach in BRPC and LAUPC was well tolerated and allowed a curative resection in 38.8% of them with a potential improvement on OS.

Effect of Margin Status on Survival After Resection of Hilar Cholangiocarcinoma in the Modern Era of Adjuvant Therapies

2020 ◽  
pp. 000313482097340
Author(s):  
Michael D. Watson ◽  
Maria R. Baimas-George ◽  
Michael J. Passeri ◽  
Jesse K. Sulzer ◽  
Erin H. Baker ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hilar Cholangiocarcinoma ◽  
Demographic Data ◽  
Locally Advanced ◽  
Resection Margins ◽  
R0 Resection ◽  
Complication Rates ◽  
Curative Intent ◽  
Adjuvant Therapies

Introduction Studies have shown that for patients with hilar cholangiocarcinoma (HC), survival is associated with negative resection margins (R0). This requires increasingly proximal resection, putting patients at higher risk for complications, which may delay chemotherapy. For patients with microscopically positive resection margins (R1), the use of modern adjuvant therapies may offset the effect of R1 resection. Methods Patients at our institution with HC undergoing curative-intent resection between January 2008 and July 2019 were identified by retrospective record review. Demographic data, operative details, tumor characteristics, postoperative outcomes, recurrence, survival, and follow-up were recorded. Patients with R0 margin were compared to those with R1 margin. Patients with R2 resection were excluded. Results Seventy-five patients underwent attempted resection with 34 (45.3%) cases aborted due to metastatic disease or locally advanced disease. Forty-one (54.7%) patients underwent curative-intent resection with R1 rate of 43.9%. Both groups had similar rates of adjuvant therapy (56.5% vs. 61.1%, P = .7672). Complication rates and 30 mortality were similar between groups (all P > .05). Both groups had similar median recurrence-free survival (R0 29.2 months vs. R1 27.8 months, P = .540) and median overall survival (R0 31.2 months vs. R1 38.8 months, P = .736) with similar median follow-up time (R0 29.9 months vs. R1 28.5 months, P = .8864). Conclusions At our institution, patients undergoing hepatic resection for HC with R1 margins have similar recurrence-free and overall survival to those with R0 margins. Complications and short-term mortality were similar. This may indicate that with use of modern adjuvant therapies obtaining an R0 resection is not an absolute mandate.

ECX as neoadjvuant chemotherapy for gastric cancer in South America.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15190-e15190
Author(s):  
Leandro Machado Colli ◽  
Antonio Carlos Godoy ◽  
Bruno Filardi ◽  
Jose Marcio Barros Figueiredo ◽  
José Sebastião Santos ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Disease Progression ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Progression Free Survival ◽  
Complete Response ◽  
Brazilian Population ◽  
South American ◽  
South American Population

e15190 Background: Gastric cancer is a common malignant disease with a high mortality rate. Neoadjuvant treatment is efficient, but not the first option for treatment in all countries. Studies of neadjuvant chemotherapy in gastric cancer in South American countries are lacking. The aim of this retrospective analysis was to investigate the use of the ECX (epirubicin, cisplatin, and capecitabine) regimen in the neoadjuvant therapy in a Brazilian population. Methods: 25 patients (median age, 61; range 36-78 years; 14 pts >60 years) with locally advanced gastric adenocarcinoma received three courses of preoperative chemotherapy with epirubicin 50 mg/m², day 1, cisplatin 60 mg/m², day 1, and capecitabine 625 mg/m² bid, days 2-21, of a 21-day cycle. Toxicity was assessed by the Common Toxicity Criteria (CTC) after every cycle. Progression-free survival (PFS) was defined as time from diagnosis to disease progression assessed by CT. Results: 21 pts completed all three planned cycles of neoadjuvant chemotherapy. Four patients receiced surgery earlier than planned due to bleeding (1), toxicity (1), abdominal infection (1), and non-adherence to treatment (1). Three patients could not be operated due to disease progression. 70% of operated patients had curative resection with two pathologic complete response. Only six out 25 patients had disease progression and only two died after a median follow-up of 11.5 months (range 3.4-20.2). Median PFS and overall survival were not reached. Toxicities grade 3-4 were neutropenia (28%), febrile neutropenia (8%), bleeding (8%), and heart failure (6,2%). Conclusions: ECX is a efficacious neoadjuvant treatment in the Brazilian population and also well tolerated and safe. However, more studies with a larger South American population are needed.

Clinical outcomes of patients with gastric cancer according to pre and post-neoadjuvant chemotherapy PD-L1 immunohistochemistry (IHC) expression.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16569-e16569
Author(s):  
Heber Salvador de Castro Ribeiro ◽  
Wilson Luiz da Costa ◽  
Maria Dirlei de Souza Begnami ◽  
Celso Abdon Lopes Mello ◽  
Tatiane Neotti ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Gastric Cancer ◽  
Cox Regression ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Surgical Specimen ◽  
Locally Advanced Gastric Cancer

e16569 Background: The incidence, prognostic and predictive impacts of PD-L1 expression in locally advanced gastric cancer is unknown. We aimed to determine the expression of PD-L1 by CPS in the pre-treatment biopsy and surgical specimens of patients (pts) with gastric cancer who received neoadjuvant therapy and its association with pathological response and survival outcomes. Methods: Retrospective cohort of pts treated at a cancer center from 2007 to 2017. Pts with confirmed gastric or GEJ adenocarcinoma who received neoadjuvant treatment and curative-intent D2 surgery were included. Gastric stump tumors and those who had a total esophagectomy were excluded. Clinical data were obtained from medical charts. Biopsy samples and a tissue microarray with the most representative areas of the surgical specimen were used to detect PD-L1 IHC expression with 22C3 phamDx antibody. Results were analyzed using the CPS score. Overall and DFS survival included the Kaplan-Meier product-limit estimator in an ITT analysis and a Cox regression was used to obtain crude and adjusted HR for prognostic factors. Results: 270 pts were included: median age was 58.9 years, most (51.5%) had cT3-T4N+ stages, 45% had diffuse histology and 87.8% completed the preoperative regimen. 13% had a pCR, while 53% had minimal tumor regression. With a median follow-up of 60.3 months (CI 95% 54.7 – 65.8), the median OS and DFS were not reached. 11.4% of biopsies and 18.6% of surgical specimens had positive CPS, with a median score of 3 (IQR 2,0 – 7,5) and 9 (IQR 5.0 – 20.0) respectively. In 18.9% of paired samples the PD-L1 expression was found to be negative in the biopsy sample and positive in the surgical specimen. PD-L1 expression was neither associated with pathologic response after neoadjuvant chemotherapy, nor with survival outcomes. Conclusions: PD-L1 expression on the setting of locally advanced gastric cancer was low and it was different when biopsy and surgical specimens were compared. No impact on survival results could be detected. [Table: see text]

TRG as indicator of efficacy of FLOT versus FOLFOX in perioperative chemotherapy for resectable gastric cancer patients (single institution experience).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16061-e16061
Author(s):  
Natalia P. Beliak ◽  
Rashida Orlova ◽  
Svetlana Kutukova ◽  
Natalia V. Zhukova ◽  
Pavel Balashov ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Chemotherapy Regimen ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Similar Efficacy ◽  
Nccn Guidelines ◽  
Locally Advanced Gastric Cancer ◽  
Drug Regimens ◽  
Folfox Chemotherapy ◽  
Gastric Cancer Patients

e16061 Background: Based on results German FLOT-4 study, the FLOT regimen could be considered the new standard chemotherapy regimen for perioperative strategy of resectable GC. Since more and more patients have received neoadjuvant treatment,the efficacy and side effect must be weighted before performing NACT. Two-drug regimens were preferred according to the NCCN guidelines in principle because of their lower toxicity. And three-drug regimens may be applied in medically fit patients with access to frequent evaluation during treatment, to ensure that they can still tolerate surgery after NACT. Methods: We analyzed the data of 79 patients with resectable locally advanced gastric cancer who received the FLOT or FOLFOX regimen as NACT. The group of patients with NAСT FLOT included 44 patients, including 32 men, 12 women. Age in the first group varied from 28 to 80 years, the median age was 59.0 (95% CI 54.1-62.0) The group of patients with the FOLFOX chemotherapy regimen included 35: 17 (48.6%) men and 18 women (51.4%). Age in the second group varied from 60 to 75 years, the median age in the second group was 67.5 (95% CI 62.2-71.0). The second group included significantly older patients U = 137.0; p = 0.0001. Results: The severity of drug pathomorphosis was assessed in a standard way according to the Mandard system, in the first group there were 5 patients - TRG1 (11.4%), 7 patients - TRG2 (15.9%), 9 patients - TRG3 (20.5%), 15 patients TRG4 (34.0%), 5 patients - TRG5 (11.4%), 3 patients it was not evaluated (6.8%). In the second group, 6 patients - TRG1 (17.1%), 2 patients - TRG2 (5.7%), 2 patients - TRG3 (5.7%), 16 patients - TRG4 (45.8 %), 7 patients - TRG5 (20.0%), for 2 patients it was not evaluated (5.7%). Complete pathomorphosis was not statistically different in both groups (p = 0.47). TRG 2 was not statistically different (p = 0.16). The number of registered cases of TRG3 in the first group exceeded (p = 0.06). The frequency of TRG4 and TRG 5 did not differ (p = 0.29). Major pathological regression (TRG1 + TRG2) was 27.3% in the first group and 22.8% (p = 0.65). A decrease in the stage in the first group occurred in 22 patients (50.0%), and in the second group - in 19 patients (54.3%), p = 0.70. yp≤ T2 was diagnosed in 21 out of 79 patients (26.6%), in the first group in 11 patients (25%), in the second group in 10 (28.6%), p = 0.72. Conclusions: the FOLFOX regimen showed similar efficacy in the tumor response grade rate compared to the FLOT regimen, therefore, these two regimes are interchangeable, especially among patients of the older age group or in patients with high risks of a four-component regimen.

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