Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach

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doi:10.5230/jgc.2019.19.e8

Cited by 343 publications

(222 citation statements)

References 273 publications

(398 reference statements)

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“…The prognosis for those undergoing systemic therapies only for gastric cancers who were either initially diagnosed as metastatic or having developed recurrence after initial curative resection was dismal, in spite of recent advancements made in targeted and immune-based therapies [3]. Accordingly, there have been attempts to proceed to conversion surgery in metastatic gastric cancer in an effort to add survival benefit to chemotherapy even when systemic treatment only could at least temporarily control the microscopic disease [4][5][6][7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

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Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Choe

Kim

Han

et al. 2019

Cancers

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The role of conversion surgery in metastatic gastric cancer remains unclear. Cancer dormancy markers might have a role in predicting the survival in patients with conversion surgery. We identified 26 patients who went through conversion surgery, i.e., a curative-intent gastrectomy with metastasectomy after chemotherapy in initially metastatic gastric cancer. As controls, 114 potential candidates for conversion surgery who only received chemotherapy were included for the propensity score matching. Conversion surgery showed a significantly longer overall survival (OS) compared with only palliative chemotherapy (median-43.6 vs. 14.0 months, respectively, p < 0.001). This better survival in the conversion surgery group persisted even after propensity matching (p < 0.001), and also when compared to patients with tumor response over 5.1 months in the chemotherapy only group (p = 0.005). In the conversion surgery group, OS was longer in patients with R0 resection (22/26, 84.6%) than without R0 resection (4/26, 15.4%) (median-not reached vs 22.1 months, respectively, p = 0.005). Although it should be interpreted with caution due to the primitive analysis in a small population, the positive expression of NR2F1 showed a longer duration of disease-free survival (DFS) after conversion surgery (p = 0.016). In conclusion, conversion surgery showed a durable OS even in patients with initially metastatic gastric cancer when R0 resection was achieved after chemotherapy.

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Section: Discussionmentioning

confidence: 99%

“…As for metastatic gastric cancer, systemic chemotherapy is the standard treatment modality. However, the prognosis remains poor with a median survival of about 12 months, despite recent advancements made in chemotherapeutics, including molecular targeting agents and cancer immunotherapy [3].…”

Section: Introductionmentioning

confidence: 99%

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Choe

Kim

Han

et al. 2019

Cancers

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“…One of the main goals in the treatment of gastric cancer is to perform adequate and appropriate lymph node dissection. [17,18] In our clinic, we routinely perform D2 lymph node dissection in patients with indication for laparo-scopic surgical treatment of gastric cancer. We prefer to perform D1+ lymph node dissection only in T1N0 cases.…”

Section: Discussionmentioning

confidence: 99%

Early outcomes of laparoscopic total gastrectomy with hemi-double stapling technique in gastric cancer

Karagül¹

2019

Laparosc Endosc Surg Sci

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Introduction: The most difficult step of laparoscopic total gastrectomy for gastric cancer is esophagojejunostomy anastomosis. Although various techniques are recommended for this anastomosis, there is no standard method. This study aims to present the outcomes of our patients who underwent esophagojejunostomy using the hemi-double stapling technique (HDST). Materials and Methods: Patients who had laparoscopic surgery due to gastric cancer in our hospital between October 2016 and May 2019 were retrospectively analyzed. Patients who underwent laparoscopic total gastrectomy with HDST were included in this study. The patients' clinical characteristics and histopathological data were evaluated. Age, sex, body mass index (BMI), comorbidities, and American Society of Anesthesiologists (ASA) scores were documented. Operative time, intraoperative blood loss, specimen extraction site, day of oral intake, length of stay, postoperative complications, and mortality were evaluated. Results: A total of 13 patients (eight male, five female) were included in this study. The mean age was 63.3±15.8 years, and mean BMI was 26.4±6.8 kg/m 2. ASA score was ASA III in seven patients (54%), ASA II in three patients (23%), and ASA I in the remaining three patients (23%). Mean operative time was 222.7±39.6 minutes, and mean intraoperative blood loss was 97.3±52.4 mL. There were no complications related to esophagojejunostomy. A mean of 23.8±11.1 lymph nodes was removed, of which a mean of 10.8±11.9 were tumor-positive. Mean length of stay was 10.9±9.8 days, and mean follow-up was 10.1±7 months. Conclusion: HDST appears to be a safe method that can be used in the esophagojejunostomy step of laparoscopic total gastrectomy for gastric cancer.

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“…The mainstay curative modality for gastric cancer is surgical resection. Except for early-stage cases that are amenable to endoscopic resection (e.g., well-differentiated tumors <2 cm in size), gastrectomy with D2 lymphatic dissection (D2 gastrectomy) is commonly applied, specifically in Asian countries [2][3][4][5][6]. Adjuvant chemotherapy (CT) was previously found to benefit western patients, in whom D2 gastrectomy is less commonly performed [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…This "Adjuvant Chemoradiation Therapy in Stomach Cancer" (ARTIST) trial failed to meet its primary endpoint of disease-free survival (DFS, p = 0.0862) [12]. Therefore, adjuvant CRT is generally not recommended after D2 gastrectomy in major clinical guidelines except for high-risk subgroups with R1 resection or remnant disease [2][3][4][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review

Rim

Shin

Lee

et al. 2020

Cancers

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Our study aimed to evaluate the benefits of chemoradiotherapy (CRT) after D2 gastrectomy, as compared to adjuvant chemotherapy, alone. PubMed, MEDLINE, Embase, and the Cochrane Library were systematically searched. We applied stepwise analyses that enabled the evaluation of data from randomized controlled trials (RCTs), balanced studies, and all studies separately and in a hierarchical manner. Thirteen controlled studies, including six RCTs involving 2603 patients, were included. Overall pooled analysis revealed a disease-free survival benefit of CRT (odds ratio (OR): 1.264, p = 0.053), which was more evident in the subgroup analysis of RCTs (OR: 1.440, p = 0.006) and balanced studies (OR: 1.417, p < 0.001). Overall survival was insignificantly different in the overall pooled analysis (OR: 1.124, p = 0.347). However, the difference was marginally significant in the subgroup analysis of balanced studies (OR: 1.279, p = 0.055) and significant in the subgroup analysis of studies involving stage ≥III patients only (OR: 1.663, p = 0.005). Locoregional recurrence (LRR) reduction was noted in the overall pooled analysis (OR: 0.559, p = 0.012; pooled rate: 11.3% vs. 18.1%) and was more robust in the subgroup analyses. Grade ≥3 leukopenia was higher in the CRT arm (OR: 1.387, p = 0.004; pooled rate: 26.4% vs. 15.7%). CRT after D2 gastrectomy should be applied for patients with high risk of LRR (e.g., stage ≥ III), along with efforts to reduce leukopenia.

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Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach

Cited by 343 publications

References 273 publications

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Early outcomes of laparoscopic total gastrectomy with hemi-double stapling technique in gastric cancer

Oncologic Benefit of Adjuvant Chemoradiation after D2 Gastrectomy: A Stepwise Hierarchical Pooled Analysis and Systematic Review

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