scholarly journals Geographic variation in surgical practice patterns and outcomes for resected nonmetastatic gastric cancer in Ontario

2018 ◽  
Vol 25 (5) ◽  
Author(s):  
A. L. Mahar ◽  
A. El-Sedfy ◽  
M. Dixon ◽  
M. Siddiqui ◽  
M. Elmi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Practice Patterns ◽  
Early Stage ◽  
Primary Tumour ◽  
Disease Stage ◽  
Resection Margins ◽  
Local Health ◽  
Surgical Practice ◽  
Tumour Location

BackgroundGastrectomy with negative resection margins and adequate lymph node dissection is the cornerstone of curative treatment for gastric cancer (gc). However, gastrectomy is a complex and invasive operation with significant morbidity and mortality. Little is known about surgical practice patterns or short- and long-term outcomes in early-stage gc in Canada.MethodsWe undertook a population-based retrospective cohort study of patients with gc diagnosed between 1 April 2005 and 31 March 2008. Chart review provided clinical and operative details such as disease stage, primary tumour location, surgical approach, operation, lymph nodes, and resection margins. Administrative data provided patient demographics, geography, and vital status. Variations in treatment and outcomes were compared for 14 local health integration networks. Descriptive statistics and log-rank tests were used to examine geographic variation.ResultsWe identified 722 patients with nonmetastatic resected gc. We documented significant provincial variation in case mix, including primary tumour location, stage at diagnosis, and tumour grade. Short-term surgical outcomes varied across the province. The percentage of patients with 15 or fewer lymph nodes removed and examined varied from 41.8% to 73.8% (p = 0.02), and the rate of positive surgical margins ranged from 15.2% to 50.0% (p = 0.002). The 30-day surgical mortality rates did not vary statistically significantly across the province (p = 0.13); however, rates ranged from 0% to 16.7%. Overall 5-year survival was 44% and ranged from 31% to 55% across the province.ConclusionsThis cohort of patients with resected stages i–iii gc is the largest analyzed in Canada, providing important historical information about treatment outcomes. Understanding the causes of regional variation will support interventions aiming to improve gc operative outcomes in the cancer system.

Detection and quantitation of human papillomavirus DNA in primary tumour and lymph nodes of patients with early stage cervical carcinoma

2005 ◽  
Vol 33 (3) ◽  
pp. 201-205 ◽  
Author(s):  
Paul K.S. Chan ◽  
May M.Y. Yu ◽  
Tak-Hong Cheung ◽  
Ka-Fai To ◽  
Keith W.K. Lo ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Lymph Nodes ◽  
Cervical Carcinoma ◽  
Early Stage ◽  
Primary Tumour ◽  
Papillomavirus Dna

Radiotherapy for intrahepatic cholangiocarcinoma: An analysis of the National Cancer Database.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 379-379
Author(s):  
Abdulrahman Y Hammad ◽  
George Younan ◽  
Rahul Rajeev ◽  
Nicholas Gerard Berger ◽  
Kiran Turaga ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Intrahepatic Cholangiocarcinoma ◽  
Resection Margin ◽  
Early Stage ◽  
Disease Stage ◽  
Resection Margins ◽  
National Cancer Database ◽  
Kaplan Meier ◽  
Positive Resection Margins ◽  
The Impact

379 Background: The role of radiotherapy (RT) for surgically resected intrahepatic cholangiocarcinoma (ICC) remains poorly defined. Radiotherapy is often considered when a positive resection margin exists. The present study sought to examine the impact of radiotherapy following liver resection. Methods: Patients with early stage ICC, who underwent surgical resection, were identified from the National Cancer Database (1998-2011). Patients were stratified by resection margin status and receipt of RT. Survival was analyzed by Kaplan-Meier method and a multivariate regression model was used to identify predictors of survival. Results: A total of 2,182 patients were identified. R0 status was obtained in 1,624 patients (74.4%). RT was delivered to 405 patients (R0=209, R1/R2=196). In the R1/R2 group, 196 patients received RT vs. 362 R1/R2 patients that did not receive RT. Survival for R0 vs. R1/R2 was 32m vs. 16.5m (p<0.001). RT appeared to trend toward improving survival for R1/R2 patients, though this was not significant (20.4m vs. 14.5m, p=0.191). In a multivariate model accounting for age, sex, comorbidities, disease stage and resection margins, RT was not a predictor of survival. Negative predictors of survival included age>65years (Hazards Ratio [HR]: 1.20 (95%CI: 1.04-1.39), p=0.013), and positive resection margins (HR: 1.95 (95%CI: 1.65-2.30), p<0.001). Female sex was the only positive predictor of survival identified (HR: 0.76 (95%CI: 0.65 -0.88), p<0.001). Conclusions: Surgical resection with negative margins provides the best outcome for patients with ICC. Radiotherapy does not appear to significantly impact survival in patients with positive resection margins.

scholarly journals RETROSPECTIVE STUDY OF CLINICOPATHOLOGICAL PARAMETERS IN GASTRIC CARCINOMA.

2020 ◽  
pp. 1-4
Author(s):  
Muruganantham Arunagirinathan ◽  
Rekha Mariappan ◽  
P. Magesh
Keyword(s):  
Gastric Cancer ◽  
Tissue Sample ◽  
Early Stage ◽  
Clinicopathological Parameters ◽  
Clinical Parameters ◽  
Need To Evaluate ◽  
Back Ground ◽  
Tumour Location ◽  
Poorly Differentiated ◽  
Well Differentiated

BACK GROUND: The incidence of gastric cancer is increasing worldwide, that presents with varied symptoms and signs. To diagnose gastric cancer in early stage we need to evaluate various clinical parameters and to grade the tumour we need to correlate with expression of P21 in tissue sample. METHODS: Clinical parameters like age, sex, symptoms & signs and tumour location of 50 patients were noted from the biopsy register and paraffin blocks with tumour of corresponding patients were evaluated for P21 expression by immunohistochemistry. CONCLUSION: In the present study, men were twice more commonly affected by gastric cancer than women. Most of the patients were aged above 50 years of age. P21 expression was found to be positive in most of the well differentiated grade and loss of P21 expression was noted in most of the poorly differentiated gastric adenocarcinoma.

scholarly journals Staging and surgical approaches in gastric cancer: a clinical practice guideline

2017 ◽  
Vol 24 (5) ◽  
pp. 324 ◽  
Author(s):  
N. Coburn ◽  
R. Cosby ◽  
L. Klein ◽  
G. Knight ◽  
R. Malthaner ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Practice Guideline ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Resection Margins ◽  
R0 Resection ◽  
Guidance Document ◽  
Cancer Management ◽  
Metastatic Setting

Background 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, including staging, extent of lymphadenectomy (lnd), minimum number of lymph nodes that have to be assessed, gross resection margins, use of minimally invasive surgery, and relationship of surgical volumes with patient outcomes and resection in stage iv gastric cancer.Methods Literature searches were conducted in databases including medline (up to 10 June 2016), embase (up to week 24 of 2016), the Cochrane Library and various other practice guideline sites and guideline developer Web sites. A practice guideline was developed.Results One guideline, seven systematic reviews, and forty-eight primary studies were included in the evidence base for this guidance document. Seven recommendations are presented.Conclusions All patients should be discussed at a multidisciplinary team meeting, and computed tomography (ct) imaging of chest and abdomen should always be performed when staging patients. Diagnostic laparoscopy is useful in the determination of M1 disease not visible on ct images. A D2 lnd is preferred for curative-intent resection of gastric cancer. At least 16 lymph nodes should be assessed for adequate staging of curative-resected gastric cancer. Gastric cancer surgery should aim to achieve an R0 resection margin. In the metastatic setting, surgery should be considered only for palliation of symptoms. Patients should be referred to higher-volume centres and those that have adequate support to manage potential complications. Laparoscopic resections should be performed to the same standards as those for open resections, by surgeons who are experienced in both advanced laparoscopic surgery and gastric cancer management.

scholarly journals Possibilities of performance of nonstandard operative interventions in patients, suffering early gastric cancer

2019 ◽  
Vol 86 (11-12) ◽  
pp. 51-55
Author(s):  
V. V. Grubnik ◽  
Yu. V. Grubnik ◽  
R. P. Nikitenko
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Lymph Node ◽  
Early Gastric Cancer ◽  
Lymph Nodes ◽  
Lymph Node Dissection ◽  
Sentinel Lymph Nodes ◽  
Disease Stage ◽  
Node Dissection

Objective. To study a possibility of performance of nonstandard organ-preserving operations in patients, suffering early gastric cancer, using application of the sentinel lymph nodes visualization procedures and the lymph node dissection procedure. Materials and methods. There were performed operative interventions in 35 patients, suffering early gastric cancer (Stages T1 and T2). For identification of sentinel lymph nodes a procedure of luminescence, using green indocyan, was applied. Results.  In all the patients early gastric cancer was diagnosed (T1,T2). Possibility for performance of organ-preserving operations in early gastric cancer was shown. Miniinvasive interventions in a patient with severe concurrent diseases have appeared sufficiently effective and radical. The patients’ quality of life after laparoscopic pylorus-preserving and organ-preserving operations was significantly better, than quality of life in patients, to whom gastric resection with extended D2 lymph node dissection was done. Conclusion. There was established, that intraoperative lymphography constitutes he informative method, which helps to estimate the disease Stage in gastric cancer and to apply the adequate scheme of combined and complex treatment. More sensitive is a procedure of luminescence, using green indocyan. Determination of the affection degree of «sentinel lymph nodes» in gastric cancer may serve as an argument for change of the selection tactics while changing the tactics for the operative intervention volume choice.

Permanent Breast Seed Implant for Early-stage Breast Cancer: Impact of Primary Tumour Location on the Overall Cosmetic Outcome

2015 ◽  
Vol 46 (1) ◽  
pp. 85-89 ◽  
Author(s):  
Jee Hae Rebekah Shin ◽  
Merrylee McGuffin ◽  
Jean-Philippe Pignol ◽  
Brian Keller ◽  
Laura D'Alimonte
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Primary Tumour ◽  
Cosmetic Outcome ◽  
Early Stage Breast Cancer ◽  
Tumour Location

Submandibular gland invasion and feasibility of gland-sparing neck dissection in oral cavity carcinoma

2018 ◽  
Vol 132 (5) ◽  
pp. 446-451 ◽  
Author(s):  
A Cakir Cetin ◽  
E Dogan ◽  
H Ozay ◽  
O Kumus ◽  
T K Erdag ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Neck Dissection ◽  
Submandibular Gland ◽  
Early Stage ◽  
Primary Tumour ◽  
Floor Of Mouth ◽  
Direct Invasion ◽  
Oral Cavity Carcinoma ◽  
Tumour Location ◽  
Level I

AbstractObjective:This study investigated the incidence and routes of submandibular gland involvement in oral cavity carcinoma to determine the feasibility of submandibular gland sparing neck dissection.Methods:The records of 155 patients diagnosed with oral cavity squamous cell carcinoma, with a total of 183 neck specimens, including those involving level I, were reviewed retrospectively.Results:Submandibular gland involvement, via direct invasion from the anatomical proximity of T4a tumours, was evident in two patients. The floor of mouth location, either primarily or as an extension of the primary tumour, was the only risk factor for submandibular gland involvement in oral cavity carcinoma (p = 0.042). Tumour location, clinical and pathological tumour (T) and nodal (N) stages, and radiological suspicion of mandible invasion, were not found to be statistically relevant (p > 0.05).Conclusion:The results suggest the feasibility of preserving the submandibular gland in early stage oral cavity carcinoma unless the tumour is located in, or extends to, the floor of mouth.

scholarly journals Radical Gastrectomy: Still the Cornerstone of Curative Treatment for Gastric Cancer in the Perioperative Chemotherapy Era—A Single Institute Experience over a Decade

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Harsh Kanhere ◽  
Raghav Goel ◽  
Ben Finlay ◽  
Markus Trochsler ◽  
Guy Maddern
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Gastric Carcinoma ◽  
Lymph Nodes ◽  
Survival Data ◽  
Early Stage ◽  
Radical Gastrectomy ◽  
Perioperative Chemotherapy ◽  
Lymph Node Yield ◽  
The Impact

Background and Objectives. Most gastric cancer patients now undergo perioperative chemotherapy (POCT) based on the MAGIC trial results. POCT consists of neoadjuvant chemotherapy (NACT) as well as postoperative adjuvant chemotherapy. This study assessed the applicability of perioperative chemotherapy and the impact of radical gastrectomy encompassing a detailed lymph-node resection on outcomes of gastric cancer. Methods. Medical and pathology records of all gastric carcinoma resections were reviewed from 2006 onwards. Pathological details, number of lymph-nodes resected, and proportion of involved nodes, reasons for nonadministration of NACT, complications, recurrence, and survival data were analysed. Results. Only twenty-eight (37.8%) out of 74 patients underwent NACT and only nine completed POCT. NACT was declined due to comorbidities/patient refusal n=24, early stage n=14, and emergency presentation n=8. Patients receiving NACT were much younger. Anastomotic leaks, hospital-mortality, lymph-node yield, and proportion of involved lymph-nodes were similar in both groups. Thirty-two patients died due to recurrence with lymph-node involvement heralding higher recurrence risk and much poorer survival (HR 2.66; p=0.013). Conclusion. More than 60% patients with resectable gastric carcinoma did not undergo NACT. Radical gastrectomy with lymphadenectomy remained the cornerstone of treatment in this period.

Sign in / Sign up

Export Citation Format

Share Document