Risk Stratification for Serosal Invasion Using Preoperative Predictors in Patients with Advanced Gastric Cancer

Abstract

PurposeAlthough serosal invasion is a critical predisposing factor for peritoneal dissemination in advanced gastric cancer, the accuracy of preoperative assessment using routine imaging studies is unsatisfactory. This study was conducted to identify high-risk group for serosal invasion using preoperative factors in patients with advanced gastric cancer.Materials and MethodsWe retrospectively analyzed clinicopathological features of 3,529 advanced gastric cancer patients with Borrmann type I/II/III who underwent gastrectomy at Korea Cancer Center Hospital between 1991 and 2005. We stratified patients into low- (≤40%), intermediate- (40~70%), and high-risk (>70%) groups, according to the probability of serosal invasion.ResultsBorrmann type, size, longitudinal and circumferential location, and histology of tumors were independent risk factors for serosal invasion. Most tumors of whole stomach location or encircling type had serosal invasion, so they belonged to high-risk group. Patients were subdivided into 12 subgroups in combination of Borrmann type, size, and histology. A subgroup with Borrmann type II, large size (≥7 cm), and undifferentiated histology and 2 subgroups with Borrmann type III, large size, and regardless of histology belonged to high-risk group and corresponded to 25% of eligible patients.ConclusionsThis study have documented high-risk group for serosal invasion using preoperative predictors. And risk stratification for serosal invasion through the combination with imaging studies may collaboratively improve the accuracy of preoperative assessment, reduce the number of eligible patients for further staging laparoscopy, and optimize therapeutic strategy for each individual patient prior to surgery.

At Which Stage of Gastric Cancer Progression Do Levels of Carcinoembryonic Antigen and Carbohydrate Antigen 19-9 Increase? Application in Advanced Gastric Cancer Treatment

“…There are two distinct modes of progression in gastric cancer: local invasion and peritoneal seeding. 18 , 19 In some cases, local invasion is advanced, but there is no peritoneal dissemination. In contrast, some cases show peritoneal dissemination with no local invasion.…”

Accuracy of staging laparoscopy in detecting peritoneal dissemination in patients with gastroesophageal adenocarcinoma

“…In addition, we showed that distal esophagus adenocarcinoma had a lower risk of peritoneal seeding. In that sense, knowing predictive factors of peritoneal seeding could help in the selection of high‐risk patients qualifying for SL in order to avoid an unnecessary laparotomy with inherent costs and risks in the others . Even though the role of SL should probably be attenuated in the management of patients with gastroesophageal adenocarcinoma, one should nevertheless bear in mind that laparoscopy may be useful in various circumstances such as (i) preoperative doubt of liver cirrhosis; (ii) unclear tumoral location, particularly for junctional tumors when location above or below the Z line is not well determined by endoscopic examination and finally; and (iii) when a jejunostomy tube for preoperative feeding is indicated.…”