Surgical Outcomes Associated with Operable Gastric Cancer in a Tertiary Care Indian Hospital

Franklyn, Joshua; George, Sam Varghese; Yacob, Myla; Abraham, Vijay; Chandran, Sudhakar; Sebastian, Tunny; Samarasam, Inian

doi:10.5230/jgc.2017.17.e7

Cited by 4 publications

(7 citation statements)

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“…In our study, 153 GC/GOJ patients underwent surgery with an overall resectability rate of 53.6 % (82/153) and curative R0 resection rate of 51.9 (68/74) %. These results are comparable with local study conducted in India and also with western studies [29][30][31] though it is lower than 70-90% curative resection rate reported in Japanese and Australian studies [32,33] In our cohort of patients, resectability of proximal cancers was lower than distal ones.…”

Section: Discussionsupporting

confidence: 91%

Patient Characteristics and Evolution of Surgical Management of Gastric/ Gastro-esophageal Junction (GOJ) Adenocarcinoma From 1998 to 2018: Experience From a Single Gastrointestinal Surgical Unit in a Resource Limited Setting

Subasinghe

Priyantha

2021

Preprint

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Introduction: Gastric/gastro-oesopageal junctional adenocarcinoma/ (GC/GOJ CA) is the fourth commonly diagnosed cancer and the second commonest cancer related cause of death worldwide. Curative therapy for GC involves surgical resection with an accompanying lymphadenectomy. Yet, most of the GC/GOJ tumours are inoperable at presentation and has a poor prognosis in our setup probably due to the absence of screening programme. The objective of this study was to describe the operability and curative resection rate and outcomes of gastric/GOJ adenocarcinoma in Sri Lankan setting from 1998 to 2018.Methodology- In a retrospective analysis of prospectively maintained data from, surgery for GCs in a tertiary care center over a period of 21 years. All patients underwent surgery for GC/GOJ adenocarcinoma by single gastrointestinal surgeon. Results: There were 153 patients with mean age of 57.4(22 to 84) years. The majority (n=109) were Males (Male: Female was 2.3 : 1) . There were 88(56.4%) distal, 60(39.2%) proximal and 5(3.2%) diffuse cancers. Only 82 (53.6 %) patients underwent curative resection. Only 3 patients underwent palliative major resection (total gastrectomy(n=1), distal gastrectomy(n=2) Among curative resections,51(62.2%) had distal gastrectomy and 17(20.7%) had total gastrectomy.R0 resection was performed in 75 (91.5%), and 6 (7.3%) had microscopic positive margins (R1). Resectability of the proximal GCs (48.3%, n=29) was lower (63.4%, n=54) than the distal GCs (p= 0.117). Further, resectability among patients with GCs has not increased significantly over the past 21 years.Conclusions: Majority of the patients especially with proximal GC are inoperable at presentation. Despite the availability of endoscopes the operability has not changed significantly over the years. Given the low incidence, screening for GC is not seemingly feasible in Sri Lanka. Therefore an attempt has to be made to identify those with high risk factors during diagnostic endoscopic procedures.

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Section: Discussionsupporting

confidence: 91%

Patient Characteristics and Evolution of Surgical Management of Gastric/ Gastro-esophageal Junction (GOJ) Adenocarcinoma From 1998 to 2018: Experience From a Single Gastrointestinal Surgical Unit in a Resource Limited Setting

Subasinghe

Priyantha

2021

Preprint

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“…35 In our study the 5-year DFS and OS, across all stages, were 36.70% and 55.93%. The 5-year and 3-year DFS and OS are comparable to that reported for open surgery by Franklyn et al 28 Even stage-wise breakup for 5-year values is similar. Compared with the laparoscopic surgery in the Italian study, 35 5-year OS was similar in stage 1; however, for stages 2 and 3 it is much better.…”

Section: Discussionsupporting

confidence: 86%

“…The mean age was 62.4 ± 12.5 years (range 48-87); the average body mass index (BMI) was 24.5 ± 3 kg/m 2 (range [21][22][23][24][25][26][27][28][29][30][31]. Pain in the abdomen (38.5%) and dyspepsia (30.7%) were the most common symptoms (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The 3-year DFS and OS was 50.0% and 67.9%, respectively. 28 As laparoscopy made its way into gastric surgery, data post-laparoscopic resection started to come up. Multiple recent RCTs including the JCOG 0912, 29 KLASS 01, 30 T A B L E 3 Univariate logistic regression to reveal significant risk factors of complications of Calvien-Dindo grade 3 or 4 In an European retrospective study of laparoscopic gastrectomy (LG) in 74 patients with AGC, the authors observed 5-year OS of 48.6% while 5-year DFS was 42.7% and concluded that LG with extended lymphadenectomy for AGC is feasible with good results in terms of postoperative course, complications, and mortality in experienced hands.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic D2 gastrectomy in advanced gastric cancer: Postoperative outcomes and long‐term survival analysis

Chittawadagi

Nayak

Parthasarathi

et al. 2021

Asian J Endoscop Surgery

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Introduction: Data on laparoscopic treatment of operable gastric cancer from India is sparse. This study aims to document outcomes of laparoscopic D2 gastrectomy in an Indian population.Materials and methods: Data of patients who underwent laparoscopic D2 gastrectomy for operable advanced gastric cancer between February 2012 and January 2017 were collected from electronic hospital records supplemented by telephonic interviews and analyzed. Survival was evaluated using Kaplan-Meier survival analysis curves.Results: In total 121 patients were included. Conversion to open gastrectomy was 5.7%. One hundred and fourteen patients (73 laparoscopic subtotal gastrectomy and 41 laparoscopic total gastrectomy) were included for analysis. D2 lymphadenectomy was done in all cases; mean number of dissected lymph nodes was 23.12 ± 9.14 (12-45). Major complications (Clavien-Dindo Grade III and IV) was seen in 6.1% of cases with reoperation rate of 3.5% (4/114). Stage 3 disease was seen in 60.6% cases and stage 2 disease in 32.5%. Follow-up data were available for 76.3% of patients with mean follow-up of 29.5 months. Overall survival across all stages was 38.7 months. Five-year disease-free survival and overall survival were 36.7% and 55.9% respectively, across all stages. Conclusion:Laparoscopic D2 gastrectomy is safe, feasible with similar postoperative complications and comparable survival outcomes across all stages when compared to available literature on open gastrectomy cases.

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“…27 Similarly in the retrospective study conducted by Franklyn et al, 26% of included patients had a BMI less than 18.5 whereas it was close to 50% in our study. 28 These significant variations in patient characteristics when compared with other tertiary centres reflects the unfavorable socioeconomic status of the majority of patients who are treated in this hospital. 29,30 Numerous studies done on malnourished patients undergoing gastrointestinal surgery and gastric cancer surgery in particular concluded that malnourishment portends a poor postoperative course in terms of minor and major morbidity.…”

Section: Discussionmentioning

confidence: 97%

Post-operative morbidity and mortality following D2 gastrectomy in a state funded tertiary care centre in South India

Jayaraman

Chidambaram

et al. 2019

Int Surg J

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Background: Radical gastrectomy with D2 lymphadenectomy is a surgery with significant post-operative morbidity. Pre-operative malnutrition portends a poor post-operative outcome following any gastrointestinal surgery in general. This study aims at finding out whether it is feasible to perform D2 lymphadenectomy in patients presenting with significant malnutrition.Methods: In this single centre study, we retrospectively analysed the post-operative morbidity and mortality data of 46 patients who underwent D2 gastrectomy for operable gastric cancer between October 2016 to April 2019. Almost all the patients who were analysed fulfilled at least one criterion for malnutrition.Results: The morbidity rate was 39.1% and the mortality rate was 6.5% which were a little high when compared to results from other Indian centres but not prohibitive, considering the nutritional status of these patients. Almost 50% of these patients were able to complete adjuvant chemotherapy.Conclusions: D2 gastrectomy can be performed in patients with poor pre-operative nutritional status. If perioperative nutritional requirements are taken care of promptly, the post-operative outcomes can be better.

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Surgical Outcomes Associated with Operable Gastric Cancer in a Tertiary Care Indian Hospital

Cited by 4 publications

References 24 publications

Patient Characteristics and Evolution of Surgical Management of Gastric/ Gastro-esophageal Junction (GOJ) Adenocarcinoma From 1998 to 2018: Experience From a Single Gastrointestinal Surgical Unit in a Resource Limited Setting

Patient Characteristics and Evolution of Surgical Management of Gastric/ Gastro-esophageal Junction (GOJ) Adenocarcinoma From 1998 to 2018: Experience From a Single Gastrointestinal Surgical Unit in a Resource Limited Setting

Laparoscopic D2 gastrectomy in advanced gastric cancer: Postoperative outcomes and long‐term survival analysis

Post-operative morbidity and mortality following D2 gastrectomy in a state funded tertiary care centre in South India

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