R1-Resektion beim Magenkarzinom

Ridwelski, K.; Fahlke, J.; Huss, M; Otto, Ronny; Wolff, S.

doi:10.1007/s00104-017-0460-x

Cited by 9 publications

(5 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A radical gastrectomy is one of the most important predictors of survival in patients with gastric cancer 1. An nonradical resection, i.e., gastrectomy with a tumor-positive resection margin (incomplete tumor removal), is seen in approximately 1.8–8.4% of patients 2. In the Netherlands, the percentage of incomplete tumor removal is used as one of the quality indicators of gastrectomies.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Population-Based Study on Risk Factors for Tumor-Positive Resection Margins in Patients with Gastric Cancer

et al. 2019

View full text Add to dashboard Cite

Background Radical gastrectomy is the cornerstone of the treatment of locally advanced gastric cancer. This study was designed to evaluate factors associated with a tumor-positive resection margin after gastrectomy and to evaluate the influence of hospital volume. Methods In this Dutch cohort study, patients with junctional or gastric cancer who underwent curative gastrectomy between 2011 and 2017 were included. The primary outcome was incomplete tumor removal after the operation defined as the microscopic presence of tumor cells at the resection margin. The association of patient and disease characteristics with incomplete tumor removal was tested with multivariable regression analysis. The association of annual hospital volume with incomplete tumor removal was tested and adjusted for the patient- and disease characteristics. Results In total, 2799 patients were included. Incomplete tumor removal was seen in 265 (9.5%) patients. Factors associated with incomplete tumor removal were: tumor located in the entire stomach (odds ratio (OR) [95% confidence interval (CI): 3.38 [1.91–5.96] reference: gastroesophageal junction), cT3, cT4, cTx (1.75 [1.20–2.56], 2.63 [1.47–4.70], 1.60 [1.03–2.48], reference: cT0-2), pN+ (2.73 [1.96–3.80], reference: pN−), and diffuse and unknown histological subtype (3.15 [2.14–4.46] and 2.05 [1.34–3.13], reference: intestinal). Unknown differentiation grade was associated with complete tumor removal (0.50 [0.30–0.83], reference: poor/undifferentiated). Compared with a hospital volume of < 20 resections/year, 20–39, and > 39 resections were associated with lower probability for incomplete tumor removal (OR 0.56 [0.42–0.76] and 0.34 [0.18–0.64]). Conclusions Tumor location, cT, pN, histological subtype, and tumor differentiation are associated with incomplete tumor removal. The association of incomplete tumor removal with an annual hospital volume of < 20 resections may underline the need for further centralization of gastric cancer care in the Netherlands. Electronic supplementary material The online version of this article (10.1245/s10434-019-07381-0) contains supplementary material, which is available to authorized users.

show abstract

mentioning

confidence: 99%

“…However, data on factors associated with incomplete tumor removal, including preoperative risk assessment models, are scarce. So far, retrospective studies have reported on cohorts from single centers, and only few patients were included 2,7. Also, surgical expertise and quality assurance may play an important role.…”

mentioning

confidence: 99%

Population-Based Study on Risk Factors for Tumor-Positive Resection Margins in Patients with Gastric Cancer

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Additionally, over 60% of the cases were poorly differentiated (Table 1). In the literature, the absence of radical resections is reported to range from 1.8% to 9% for gastric adenocarcinoma and more than 10% for the tumors of gastroesophageal junction [22]. A slightly higher R1 rate can be explained in our sample by the late presentation, with advanced disease at the patient's arrival to surgery.…”

Section: Discussionmentioning

confidence: 56%

“…A slightly higher R1 rate can be explained in our sample by the late presentation, with advanced disease at the patient's arrival to surgery. Ridwelski et al also noted that the rate of R1 resections increases with tumor size (>5 cm), tumor stage (T34), N stage, and poor differentiation [22]. Accordingly, Shiraishi et al observed a poor prognosis for patients with extragastric lymph node involvement with less than a 6% survival rate at five years, regardless of the surgical management [14].…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Ratios as Survival Prognostic Factors in Resectable Gastric Adenocarcinoma

et al. 2023

View full text Add to dashboard Cite

Background: The purpose of the study was to assess the relationship between inflammatory biomarkers (NLR—neutrophil-to-lymphocyte ratio, PLR—platelet-to-lymphocyte ratio, LMR—lymphocyte-to-monocyte ratio, SII—systemic immune-inflammation index) and overall survival in gastric cancer patients. Methods: Over a six-year period (2016–2021), we conducted a longitudinal retrospective cohort research on 549 patients with resectable stomach adenocarcinoma. The overall survival was determined using the univariate and multivariate COX proportional hazards models. Results: The age of the cohort varied between 30 and 89 years old, with an average age of 64.85 ± 10.51 years. Four hundred seventy-six patients (86.7%) had R0 resection margins. Eighty-nine (16.21%) subjects received neoadjuvant chemotherapy. Two hundred sixty-two (47.72%) patients died during the follow-up period. The median survival time in the cohort was 390 days. A significantly lower (p = 0.029—Logrank test) median survival was observed for R1 resections (355 days) in comparison with R0 resections (395 days). Significant differences in survival were observed regarding tumor differentiation, tumoral (T), and node (N) stage. No differences in survival were observed between the low or high value of inflammatory biomarkers (dichotomized by median value in the sample). In the COX univariate and multivariate regression models, elevated NLR proved an independent prognostic factor for lower overall survival [HR = 1.068, (95% CI 1.011–1.12)]. In this study, the other inflammatory ratios (PLR, LMR, and SII) did not prove as prognostic factors for gastric adenocarcinoma. Conclusions: In resectable gastric adenocarcinoma, elevated NLR before surgery was associated with lower overall survival. PLR, LMR, and SII had no prognostic value for the patient’s survival.

show abstract

“…The reported rate of R1 resection is also highly variable. 25 The British National Oesophago-Gastric Cancer Audit (NOGCA) reported that up to 29% of the gastrectomies performed in individual hospitals had tumor-positive margins, 26 whereas the Swedish Register for Esophageal and Gastric Cancer (NREV), the percentage of incomplete tumor removal/unknown resection status was 17%. 27 Although it is well known that R1 resection has negative prognostic impact, its significance in specific T stage is yet to be uniformly defined.…”

Section: Discussionmentioning

confidence: 99%

Risk factor analysis for duodenal margin positivity following gastrectomy for resectable gastric cancer

Kalayarasan

Gnanasekaran

et al. 2022

Asia-Pac J Clncl Oncology

View full text Add to dashboard Cite

BackgroundDuodenal margin positivity is a poor prognostic factor following gastrectomy for resectable gastric cancer. Intraoperative frozen section (IFS) analysis allows radical resection to be achieved in a single operation but is time‐ and resource‐consuming. Hence resection is usually performed based on surgeon's judgment and palpation.Aim of studyTo determine risk factors for duodenal resection margin (RM) positivity following gastrectomy for resectable gastric cancer.Materials and methodsWe retrospectively analyzed prospectively maintained data of 376 patients admitted with diagnosis of gastric cancer from August 2011 to January 2020 in JIPMER, a tertiary center in Puducherry, India. Of these, 146 patients underwent gastric resection with curative intent and were the subject of this study. RM status was assessed by definitive histopathology examination. The potential risk factors were compared between patients with positive margin on definitive histopathology examination and a control cohort of similar patients with negative margins.ResultsOf the 146 patients, 16 patients (10.9%), 11 men and 5 women, had positive duodenal margin. The mean age of study group was 59 years. None of the patient characteristics like age, sex, comorbidities, or addictions were statistically significant with regard to duodenal margin positivity. Among tumor characteristics, locally advanced tumors and pyloroantral tumors were found more frequently in the margin‐positive group. High‐risk features for duodenal margin positivity were extensive nodal disease, oligometastatic disease, lymphovascular invasion, and perineural invasion. Neoadjuvant chemotherapy and types of surgical access did not have significant impact on RM. Interestingly, both proximal and circumferential resection margin positivity had a linear association with distal margin positivity suggesting that tumor biology may have a significant role in margin positivity. However, none of these factors were statistically significant on multivariate analysis using logistic regression model. Among oligometastatic patients, survival was dependent on R0 resection and was not different from patients without metastases though our study was not powered for survival analysis (mean survival of 11.040 months) and expectedly, duodenal margin positive patients had lower overall survival compared to margin negative patients (mean survival of 5.188 vs. 11.763 months, p = 0.12).ConclusionsLocally advanced tumors and pyloroantral tumors are associated with an increased risk of duodenal margin positivity after gastrectomy for carcinoma stomach and may benefit from intraoperative frozen section analysis as survival is negatively affected by positive RM. Patients with high‐risk features like extensive nodal and oligometastatic disease have a greater propensity for positive duodenal margin. A prospective study with a large sample size is needed to further validate these results.

show abstract

R1-Resektion beim Magenkarzinom

Cited by 9 publications

References 28 publications

Population-Based Study on Risk Factors for Tumor-Positive Resection Margins in Patients with Gastric Cancer

Population-Based Study on Risk Factors for Tumor-Positive Resection Margins in Patients with Gastric Cancer

Inflammatory Ratios as Survival Prognostic Factors in Resectable Gastric Adenocarcinoma

Risk factor analysis for duodenal margin positivity following gastrectomy for resectable gastric cancer

Contact Info

Product

Resources

About