Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial

Cuschieri, Alfred; Joypaul, V; Fayers, Peter; Cook, Pat; Fielding, J. W. L.; Craven, John; Bancewicz, J.

doi:10.1016/s0140-6736(96)90144-0

Cited by 926 publications

(701 citation statements)

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“…As already indicated, subset analysis of the Dutch and MRC trials documented that the higher morbidity in the D2 arm is mostly due to pancreas and spleen removal (Cuschieri et al, 1996). Hence, pancreas preservation was adopted as standard procedure in D2 dissection in the present trial.…”

Section: Survival Of Igcsg D2 Gastrectomy Phase II Study M Degiuli Et Almentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

“…Moreover, the Dutch and British trials have shown increased morbidity and mortality figures after D2 gastrectomy (Bonenkamp et al, 1995;Cuschieri et al, 1996). Potential reasons for this unfavourable outcome include the lack of surgical skilfulness/training and poor quality control, and the routine removal of the spleen and tail of the pancreas in total gastrectomy (Cuschieri et al, 1996). In our previous paper, we showed that it is possible to achieve low morbidity and mortality after extended lymph node dissection, if the operation is performed in specialised centres with a strict quality control system, and without removing the pancreas during total gastrectomy unless it is suspected to be involved by the tumour (Degiuli et al, 1998).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the lack of experience in this technique of dissection and in postoperative care by each surgeon participating in these trials has been claimed as one of the reasons for the results (Bonenkamp et al, 1995;Cuschieri et al, 1996). Both studies were carried out without pretrial training and without preliminary studies to confirm the safety of the procedure locally, and were concluded before many surgeons would have reached the plateau of the learning curve.…”

mentioning

confidence: 99%

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Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Degiuli¹,

et al. 2004

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Curative resection is the treatment of choice for potentially curable gastric cancer. Two major Western studies in the 1990s failed to show a benefit from D2 dissection. They showed extremely high postoperative mortality after D2 dissection, and were criticised for the potential inadequacy of the pretrial training in the new technique of D2 dissection, prior to the phase III studies being initiated. The inclusion of pancreatectomy and splenectomy in D2 dissection was associated with increased morbidity and mortality. Following these results, we started a phase II trial to evaluate the safety and efficacy of pancreas-preserving D2 dissection. The results of this trial regarding the safety of pancreas preserving D2 dissection were published in 1998. In this paper, we present the survival results of this phase II trial to confirm the rationale of carrying out a phase III study comparing D1 vs D2 dissection for curable gastric cancer. Italian patients with histologically proven gastric adenocarcinoma were registered in the Italian Gastric Cancer Study Group Multicenter trial. The study was carried out based on the General Rules of the Japanese Research Society for Gastric Cancer. A strict quality control system was achieved by a supervising surgeon of the reference centre who had stayed at the National Cancer Center Hospital, Tokyo, to learn the standard D2 gastrectomy and the postoperative management. The standard procedure entailed removal of the first and second tier lymph nodes. During total gastrectomy, the pancreas was preserved according to the Maruyama technique. Complete follow-up was available to death or 5 years in 100% of patients and the median follow-up time was 4.38 years. Out of 297 consecutive patients registered, 191 patients were enrolled in the study between May 1994 and December 1996. The overall morbidity rate was 20.9%. The postoperative in-hospital mortality was 3.1%. The overall 5-year survival rate among all eligible patients was 55%. Survival was strictly related to stage, depth of wall invasion, lymph node involvement and type of gastrectomy (distal vs total). Our results suggest a survival benefit for pancreas-preserving D2 dissection in Italian patients with gastric cancer if performed in experienced centres. A phase III trial among exclusively experienced centres is urgently needed.

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Section: Survival Of Igcsg D2 Gastrectomy Phase II Study M Degiuli Et Almentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Degiuli¹,

et al. 2004

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“…The preliminary results of ST01 (Cuschieri et al, 1996) and a similar Dutch trial (Bonenkamp et al, 1995) had documented higher post-operative mortality and morbidity for patients randomised to D 2 resection. This was thought to be a consequence of distal pancreatectomy and splenectomy, which were an integral part of most D 2 procedures when these trials were designed.…”

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confidence: 96%

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

2002

Self Cite

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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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Multivisceral Resection for Locally Advanced Gastric Cancer

Pacelli¹

2013

JAMA Surg

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The role of multivisceral resection, in the setting of locally advanced gastric cancer, is still debated. Previous studies have reported a higher risk for perioperative morbidity and mortality, with limited objective benefit in terms of survival. Conversely, recent studies have shown the feasibility of enlarged resections and the potential advantage of extended resection for clinical stage T4b gastric adenocarcinoma with good longterm results.Objective: To analyze the role of multivisceral resection for locally advanced gastric cancer with particular attention to the brief and long-term results and to the prognostic value of clinical and pathologic factors.

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Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial

Cited by 926 publications

References 10 publications

Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer

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

Multivisceral Resection for Locally Advanced Gastric Cancer

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