Long‐term Survival of Transmural Advanced Gastric Carcinoma following Curative Resection: Multivariate Analysis of Prognostic Factors

Dhar, Dipok Kumar; Kubota, Hirofumi; Tachibana, Mitsuo; Kotoh, Tsukasa; Tabara, Hideki; Watanabe, Reiko; Kohno, Hitoshi; Nagasue, Naofumi

doi:10.1007/s002689910099

Cited by 42 publications

(59 citation statements)

References 23 publications

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“…Curative resection is an important prognostic factor for patients with advanced gastric cancer [19,20,21]. Although the prognosis of patients with tumors of Borr-mann type III and IV was poor in our current study because of a larger proportion of late stage and noncurative resection, those who underwent curative resections had better prognoses than those who underwent noncurative resection.…”

Section: Discussionmentioning

confidence: 47%

Macroscopic Borrmann Type as a Simple Prognostic Indicator in Patients with Advanced Gastric Cancer

Oh²,

Kim³

et al. 2009

Oncology

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Background: The purpose of this study was to clarify the clinical significance of macroscopic Borrmann type in advanced gastric cancer. Methods: From 1987 to 2001, we retrospectively studied the clinicopathological features and prognoses of 3,966 patients with advanced gastric cancer according to the macroscopic classification of Borrmann type. Results: Multivariate analysis showed that gender, Borrmann type and depth of invasion were all associated with the status of nodal involvement. There were statistically significant differences in overall survival among patients with Borrmann type I and II tumors, Borrmann type III tumors, and Borrmann type IV tumors according to depth of invasion (pT) and nodal involvement (pN), except in pN3 tumors. Borrmann type was an independent prognostic factor in patients with advanced gastric cancer. Furthermore, the 5-year survival rates of patients with Borrmann type III and type IV tumors after curative resection were 62.0 and 51.2%, respectively; this was significantly higher than after noncurative resection (17.8 and 18.0%, respectively). Conclusion: Macroscopic Borrmann type is a simple and valuable predictor for lymph node metastasis and survival in advanced gastric cancer patients.

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Section: Discussionmentioning

confidence: 47%

Macroscopic Borrmann Type as a Simple Prognostic Indicator in Patients with Advanced Gastric Cancer

Oh²,

Kim³

et al. 2009

Oncology

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“…In particular, for what concern gastric surgery, no studies were found in literature describing direct correlation between intra-operative blood losses and post-operative complications. Nevertheless, high blood losses [36,37] and subsequent transfusions [38] are anyhow associated with a higher rate of recurrence, especially peritoneal, and therefore poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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Background Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy. Methods All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications. Results Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p \ 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p \ 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p \ 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p \ 0.001), liver cirrhosis (OR 13.2; p \ 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses [300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p \ 0.001) were found to be independent risk factors for DSF development. Conclusions Duodenal stump fistula still remains a lifethreatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.

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“…The prognostic significance and optimal cutoff for predicting patients' outcomes as a function of EBL in GC remain controversial [15][16][17] . Inconsistency in the criteria for patient inclusion and analyses, combined with blood transfusion, are inextricably intertwined with EBL and are cited as a possible cause of the conflicting data.…”

Section: Discussionmentioning

confidence: 99%

Adverse Effects of Intraoperative Blood Loss on Long-Term Outcomes after Curative Gastrectomy of Patients with Stage II/III Gastric Cancer

et al. 2016

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Background/Aims: Gastrectomy with systemic lymphadenectomy sometimes causes excessive bleeding even by experienced surgeons. The aim of this study was to evaluate how intraoperative estimated blood loss (EBL) affected the long-term outcomes after curative surgery of patients with stage II/III gastric cancer (GC). Methods: This study included 203 patients with stage II/III GC who did not receive perioperative blood transfusion between 1999 and 2015. The optimal cutoff and the prognostic significance of EBL were determined retrospectively. Results: The median EBL was 285 ml. Receiver operating characteristic curve analysis identified 400 ml as an optimal cutoff. Patients with EBL ≥400 ml were more likely to have hepatic relapse and worse prognosis compared to those with EBL <400 ml. EBL ≥400 ml was identified as an independent prognostic factor for mortality by multivariable analysis. When patients were subdivided according to administration of adjuvant chemotherapy, there was a significant difference between the EBL ≥400 and <400 ml groups in patients who underwent surgery alone, whereas the prognosis was similar for patients of both groups who received adjuvant chemotherapy. Conclusion: EBL serves as a useful predictor for risk stratification after curative gastrectomy in patients with stage II/III GC.

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Long‐term Survival of Transmural Advanced Gastric Carcinoma following Curative Resection: Multivariate Analysis of Prognostic Factors

Cited by 42 publications

References 23 publications

Macroscopic Borrmann Type as a Simple Prognostic Indicator in Patients with Advanced Gastric Cancer

Macroscopic Borrmann Type as a Simple Prognostic Indicator in Patients with Advanced Gastric Cancer

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

Adverse Effects of Intraoperative Blood Loss on Long-Term Outcomes after Curative Gastrectomy of Patients with Stage II/III Gastric Cancer

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