Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: A 15‐year experience at a single institute

Cho, Byoung Chul; Jeung, Hei Cheul; Choi, Hye Jin; Rha, Sun Young; Hyung, Woo Jin; Cheong, Jae‐Ho; Noh, Sung Hoon; Chung, Hyun Cheol

doi:10.1002/jso.20731

Cited by 97 publications

(115 citation statements)

References 25 publications

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“…In analysis of 2,740 resected cases from Korea, 49 had a positive margin on final histology; survival time was similar (P ¼ 0.259) for positive (33 months median survival) and negative (37 months median survival) margin patients with node positive disease. In node negative patients, however, median survival was 174 months for negative margin resections and 37 months for patients with positive margins (P ¼ 0.0001), prompting the authors to conclude that more aggressive treatment, including reoperation, should be offered only to node negative patients with positive microscopic margins [96]. Kim et al [97] published similar findings: of D2/D3 dissection patients who had fewer than 6 LN involved with tumor, survival was significantly worsened by a microscopically positive margin.…”

Section: Intra-operative Decision-makingmentioning

confidence: 99%

Lymph nodes and gastric cancer

Coburn

2009

Journal of Surgical Oncology

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Worldwide, gastric cancer is one of the top three leading causes of cancer mortality, but incidence and presentation vary geographically. Currently, surgery is the only possible cure. Nodal status is an important prognostic indicator for gastric cancer, and despite results of randomized controlled trials, debate continues over the importance of aggressive lymphadenectomy.J. Surg. Oncol. 2009;99:199-206. ß 2009 Wiley-Liss, Inc. KEY WORDS: gastric neoplasm; lymph nodes; surgery Despite a decrease in incidence in recent decades, gastric cancer is still one of the most common causes of cancer death worldwide [1]. In areas without screening for gastric cancer, it presents late, and has a high frequency of nodal involvement [1]. Surgery is the only effective intervention for cure or long-term survival. Nodal status is an important prognostic indicator for gastric cancer, and debate continues over the importance of aggressive lymphadenectomy for gastric cancer.Historically, gastric lymph node (LN) metastases were detected as distant disease due to advanced presentation, with resultant poor prognosis. Sister Mary Joseph, surgical assistant to Dr. William Mayo, first described the relationship between advanced intra-abdominal malignancy and an umbilical nodule, now known as the Sister Mary Joseph's nodule [2], while Virchow's node (supra-clavicular) [3] and an Irish node (axillary) are used to describe other distant metastatic LN disease for gastric cancer. The idea of an extended lymphadenectomy for gastric cancer was first advanced by Mikulicz in 1889, who stated that the distal pancreas should be removed if necessary [4,5]. ASSESSING LYMPH NODE INVOLVEMENT IN GASTRIC CANCERStudies estimate that LNs will be involved with tumors for 3-5% of cases of gastric adenocarcinoma limited to the mucosa; 11-25% of cases for those limited to the sub-mucosa; 50% for T2; and 83% for T3 tumors [6,7]. Nodal status is one of the most important independent predictors of patient survival [8,9]. For example, for 288 T4 gastric cancers, the 1 and 3-year survivals were 76% and 21.9% for node negative cases, versus 40% and 10% for node positive cases, respectively [10].Pre-operative examinations to study the extent of the cancer may include esophagogastro-duodenoscopy (EGD), radiological imaging, and laparoscopy. A computed tomography (CT) scan of the abdomen and pelvis is the most widely recommended method for pre-operative staging of gastric cancer [11,12]. The sensitivity and specificity of CT scan for determining nodal involvement ranges from 50 to 95% and 40 to 99%, respectively; typically, specificity is higher than sensitivity for nodal involvement, but this is not consistent between studies [13][14][15]. Importantly, the ability of the CT scan to detect nodal involvement is determined primarily by the size of the nodes. In a recent study of 23 patients with equivocal findings of para-aortic LN involvement on CT scan (0.7-1 cm or nodes >1 cm with a fatty marrow) treated with an aggressive LN dissection, including paraaortic LN diss...

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Section: Intra-operative Decision-makingmentioning

confidence: 99%

Lymph nodes and gastric cancer

Coburn

2009

Journal of Surgical Oncology

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“…retropancreatic nodes or superior mesenteric nodes). Cho et al [19] reported their 15-year experience of extended gastrectomy for advanced gastric cancer. The median survival time of the positive margin group was 34 mo.…”

Section: Discussionmentioning

confidence: 99%

“…And when pancreaticoduodenal region is involved by advanced gastric cancer, combined PD and gastrectomy will bring the chance of tumor-free resection margin. And curative (R0) resection improves prognosis [19,20] . PD with gastrectomy will benefit the lymphadenectomy of No.…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement

Wang

Yang²,

Zhang³

et al. 2008

WJG

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“…Em um estudo a incidência foi de 8,2% em 572 operações.9 Outro estudo detectou acometimento da margem proximal em 1% das 2740 gastrectomias subtotais avaliadas 4 . De Gara et al 5 demonstraram margem comprometida em 6% dos 121 pacientes estádio 1 e 2 da classificação TNM; 22% dos 132 pacientes com estádio 3 e 25% dos 60 pacientes com 4.…”

Section: Discussionunclassified

“…No entanto, também existe possibilidade de acometimento da margem cirúrgica proximal. Esse acometimento, mesmo que microscópico, cursa com redução na sobrevida 9,13,4 . Cho et al 4 demonstraram sobrevida média de 34 meses em 49 pacientes com margem comprometida e sobrevida de 69 meses em 2691 pacientes com margens livres.…”

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Análise da margem cirúrgica proximal do estômago em pacientes submetidos à gastrectomia subtotal por adenocarcinoma

Freitas¹,

Dias²,

Okawa³

et al. 2008

ABCD, arq. bras. cir. dig.

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RACIONAL: A gastrectomia subtotal atualmente é considerada padrão ouro no tratamento da neoplasia gástrica do terço médio e distal. No entanto, foi demonstrado que a ocorrência de neoplasia residual na margem cirúrgica proximal está associada à redução da sobrevida. OBJETIVOS: analisar a margem cirúrgica proximal no exame anátomo-patológico de pacientes submetidos à gastrectomia subtotal por adenocarcinoma gástrico e identificar os fatores relacionados com o acometimento neoplásico dessa margem. MÉTODOS: No período entre janeiro de 1998 e dezembro de 2007 foram revisados os prontuários dos pacientes submetidos à gastrectomia subtotal devido a adenocarcinoma gástrico do terço médio e distal. Os pacientes foram analisados quanto à idade, sexo, classificação de Lauren, classificação de Borrmann, maior diâmetro da lesão, localização da lesão no estômago, clínico e presença de invasão angiolinfática. Foi realizada análise univariada desses dados em relação ao acometimento da margem proximal do estômago no exame anátomo-patológico. RESULTADOS: Foram analisados 104 casos: 34 do sexo feminino e 70 do sexo masculino com idade média de 57±13 anos. Doze pacientes (12,3%) apresentaram acometimento da margem proximal. A análise univariada entre os fatores analisados e o acometimento neoplásico da margem proximal demonstrou associação somente em relação à classificação de Borrmann. CONCLUSÃO: A classificação macroscópica de Borrmann, especialmente nos estágios III e IV, está relacionada à presença de acometimento da margem proximal nos casos de adenocarcinoma gástrico dos terços médio e distal submetidos a tratamento com gastrectomia subtotal.

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Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: A 15‐year experience at a single institute

Abstract: Our results suggest that a positive microscopic margin is associated with a worse outcome in patients with node-negative disease. Therefore, a more aggressive treatment, such as re-operation, is needed in node-negative patients with a positive microscopic disease.

Cited by 97 publications

References 25 publications

Lymph nodes and gastric cancer

Lymph nodes and gastric cancer

Pancreaticoduodenectomy for advanced gastric cancer with pancreaticoduodenal region involvement

Análise da margem cirúrgica proximal do estômago em pacientes submetidos à gastrectomia subtotal por adenocarcinoma

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