Gastric cancer: a curable disease in Britain.

Sue‐Ling, H. M.; Johnston, D.; Martin, I. G.; Dixon, M. F.; Lansdown, Mark; McMahon, M. J.; Axon, Anthony

doi:10.1136/bmj.307.6904.591

Cited by 226 publications

(125 citation statements)

References 37 publications

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“…Furthermore, the existence of a relationship between caseload and operative mortality remains controversial. The specialist surgical unit in Leeds has described a long learning curve during the adoption of D2 gastrectomy, with 10 years elapsing before operative mortality fell to 5% (Sue-Ling et al, 1993). Our results parallel this finding, with surgical subspecialisation reducing operative mortality after D2 gastrectomy from 12.5 to 2.4% over a period of 5 years.…”

Section: Discussionsupporting

confidence: 77%

“…The first reports of outcomes after modified D2 gastrectomy for gastric cancer were originally published in Britain by Sue-Ling et al, 1993(Sue-Ling et al, 1993 and subsequently Griffith et al (1995) from the University Department of Surgery at Leeds. We have subsequently demonstrated that similar results can be achieved in a large British district general hospital Barry et al, 2003).…”

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confidence: 99%

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Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma

et al. 2004

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To compare the outcomes after D1 gastrectomy with those after modified D2 gastrectomy (preserving pancreas and spleen) performed by specialist surgeons for gastric cancer in a large UK NHS Trust. In all, 118 consecutive patients with gastric adenocarcinoma were referred by postcode, to undergo either a D1 gastrectomy (North Gwent (RJ), n ¼ 36, median age 76 years, 21 m) or a modified D2 gastrectomy (South Gwent (WL), n ¼ 82, 70 years, 57 m). Operative mortality in the two groups of patients was similar (D1 8.3% vs D2 7.3%, w 2 0.286, DF 1, P ¼ 0.593). Overall cumulative survival at 5 years was 32% after D1 gastrectomy compared to 59% after D2 gastrectomy (w 2 4.25, DF 1, P ¼ 0.0392). In patients with stage III cancers, survival was 8% after D1, compared with 33% after D2 gastrectomy (w 2 6.43, DF 1, P ¼ 0.0112). In a multivariate analysis, T stage (hazard ratio 2.339, 95% CI 1.683 -2.995, P ¼ 0.01), N stage (hazard ratio 4.026, 95% CI 3.536 -4.516, P ¼ 0.0001) and the extent of lymphadenectomy (hazard ratio 0.258, 95% CI -0.426 -0.942, P ¼ 0.0001) were independently associated with durations of survival. In conclusion, modified D2 gastrectomy can improve survival four-fold for patients with stage III gastric cancer, without significantly increasing morbidity and mortality when compared with a D1 gastrectomy. Opinion over the optimum resection for patients with gastric cancer remains divided, and the literature polarised. The impressive outcomes after D2 gastrectomy published in large retrospective series from Japan (Soga et al, 1979;Maruyama et al, 1987) have not been reproduced in randomised comparative studies from Europe (Bonenkamp et al, 1995(Bonenkamp et al, , 1999Cuschieri et al, 1996Cuschieri et al, , 1999. The two largest randomised studies both report significantly greater operative morbidity and mortality associated with an extended D2 lymphadenectomy when compared with the less aggressive D1 lymphadenectomy, and have failed to demonstrate any survival advantage for a D2 resection. Many of the serious complications associated with D2 resections were associated with resections of the pancreas and spleen (Bonenkamp et al, 1995;Cuschieri et al, 1996), and the best long-term survival was observed in patients undergoing D2 gastrectomy without pancreatico-splenectomy (Cuschieri et al, 1999). Although this latter report concluded than a classical D2 resection offered no survival advantage over a D1 resection, the possibility that a modified D2 resection, preserving pancreas and spleen, might be better than a D1 resection was not dismissed (Cuschieri et al, 1999).The first reports of outcomes after modified D2 gastrectomy for gastric cancer were originally published in Britain by Sue-Ling

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Section: Discussionsupporting

confidence: 77%

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confidence: 99%

Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma

et al. 2004

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“…Patients with EGC have an excellent prognosis after surgical treatment, with 5-year survival rates being in excess of 90% [1][2][3][4][5][6][7]. In addition, the incidence of nodal involve-sparing the infrapyloric vessels, we have been able to preserve even longer pyloric cuffs in procedures performed at the National Cancer Center Hospital.…”

Section: Introductionmentioning

confidence: 79%

Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy

et al. 2010

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ment from EGC is low, and involved lymph nodes are fundamentally confi ned to the perigastric area [7][8][9]. Therefore, Japanese surgeons have re-evaluated the treatment strategy of exclusive radical D2 gastrectomy for EGC and focused on function-preserving gastrectomy to attenuate postoperative symptoms such as weight loss, dumping syndrome, and residual gastritis caused by bile refl ux, these being well known as frequent problems after subtotal gastrectomy.Pylorus-preserving gastrectomy (PPG) is a modifi ed distal gastrectomy for the treatment of gastric ulcers, designed by Maki et al. [10] in 1967 as a functionpreserving procedure. PPG is aimed at maintaining stomach capacity and reducing the amount of regurgitated duodenal juice by preserving the pyloric antrum. A limited lymph node dissection, as performed in the PPG operation, was shown to be a suffi ciently safe and effective treatment for EGC by Kodama and Koyama in 1991 [11]. Since 1995, we have actively utilized PPG for the treatment of EGC in the middle body to minimize postoperative dysfunction in patients. Our recent study also showed the safety and radicality of PPG as a standard operation for EGC located in the middle body [12]. We have also reported that, as shown by the longterm follow-up results, PPG has clear advantages over distal gastrectomy with Billroth-I reconstruction, in terms of postoperative symptoms and functional outcomes [13].Initially, the length of the preserved pyloric cuff was 1.5 cm, as Maki et al. noted in the original article describing PPG [10]. Subsequently, Nakane et al. [14] reported that PPG with the transection of 2.5 cm proximal to the pyloric ring was superior to that with the transection of 1.5 cm in terms of some postoperative symptoms and weight recovery. Recently, Nunobe et al. [15] showed the low frequency of gastric stasis in patients with a 3-cm length of pyloric cuff. Thus, in clinical practice, the length of the preserved pyloric cuff has tended to be increased, compared to that in the initial setting. By Abstract Background. Recent years have seen the preserved pyloric cuff being lengthened in pylorus-preserving gastrectomy for early gastric cancer. We performed clinical assessment of the symptoms after pylorus-preserving gastrectomy in patients treated at the National Cancer Center Hospital in Japan during the past 9 years. Methods. Four hundred and fi fty-six patients who had undergone pylorus-preserving gastrectomy and been followed up for at least 3 years were studied. We classifi ed the patients into two groups according to the length of the pyloric cuff (group A, within 3.0 cm; group B, more than 3.0 cm). Medical records were reviewed for further histological and follow-up data. A questionnaire regarding dumping syndrome and gastric stasis was also completed by the patients. Results. Our results showed no statistically signifi cant differences in symptoms, such as dumping syndrome or emptying disturbances, between the two groups. Conclusion. Our study revealed that the differences in several functio...

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“…In the 1980s, results from Japan suggested that gastrectomy with radical lymphadenectomy (D 2 resection) improved survival over the standard D 1 resection (Maruyama et al, 1987). Some Western centres practised and reported favourably on D 2 resections (Sue-Ling et al, 1993) but the superiority of these operations was not tested prospectively until the launch of the Medical Research Council Gastric Cancer Surgical Trial (ST01) in 1986. In this prospective randomized study, D 1 resection (removal of regional perigastric nodes) was compared with D 2 resection (extended lymphadenectomy to include level 1 and 2 regional nodes).…”

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confidence: 99%

Influence of pathological tumour variables on long-term survival in resectable gastric cancer

2002

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Although tumour stage and nodal status are established prognostic factors for resectable gastric cancer, the relative importance of other pathological characteristics remains unclear. This study reports univariate and multivariate analyses of the prognostic value of various pathological and staging factors based on 324 patients entered into the MRC randomised surgical trial for gastric cancer. In the univariate analysis tumour stage, nodal status, UICC clinical stage, number of involved nodes, WHO predominant type, mixed Lauren type, Ming type, tumour differentiation, lymphocytic and tumour stromal eosinophilic infiltration were all found to have a significant impact on survival (logrank test, 5% level). In the multivariate analysis, UICC clinical stage and eosinophilic infiltration were found to have a significant influence. Risk of death increased for UICC stage II and III patients (Hazard Ratio for stage II compared to stage I=2.0, 95% Confidence Interval (CI) 1.4 -2.9; Hazard Ratio for stage III compared to stage I=3.5, 95% CI 2.5 -4.8). Patients with numerous eosinophils had a lower risk of death than those with none (Hazard Ratio=0.5, 95% CI 0.3 -0.8). This association between survival and eosinophilic infiltration merits further study.

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Gastric cancer: a curable disease in Britain.

Cited by 226 publications

References 37 publications

Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma

Prospective comparison of D1 vs modified D2 gastrectomy for carcinoma

Correlation between the length of the pyloric cuff and postoperative evaluation after pylorus-preserving gastrectomy

Influence of pathological tumour variables on long-term survival in resectable gastric cancer

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