Surgical outcomes of gastrectomy with D1 lymph node dissection performed for patients with unfavorable clinical conditions

Ramos, Marcus Fernando Kodama Pertille; Pereira, Marina Alessandra; Dias, André Roncon; Yagi, Osmar Kenji; Zaidan, Evelise Pelegrinelli; Ribeiro-Júnior, Ulysses; Zilberstein, Bruno; Cecconello, Ivan

doi:10.1016/j.ejso.2018.11.013

Cited by 28 publications

(19 citation statements)

References 32 publications

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“…The study by Bozzetti et al ( 42 ) indicated a comparable 5-year OS for both the two procedures, while Chen et al ( 43 ) reported a significantly superior 5-year OS of patients with DG compared with that of patients who underwent TG in the same period. Further multivariate analyses considered the resection extent as an independent factor for post-operative survival ( 44 – 46 ); however, this was not supported by the evidence provided in certain other studies ( 47 , 48 ). In the present study, it was explored whether the 5-year OS of patients with MTGC differed between those receiving TG and DG.…”

Section: Discussionmentioning

confidence: 85%

Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle‑third gastric cancer: A systematic review and meta‑analysis

Jiang

Yang

et al. 2022

Oncol Lett

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Distal gastrectomy (DG) and total gastrectomy (TG) are the most common types of radical surgery for patients with middle-third gastric cancer (MTGC). However, the indications and benefits of the two procedures still remain controversial. The present meta-analysis aimed to compare the surgical and oncological outcomes of DG and TG in the treatment of MTGC. A rigorous literature review was performed in the databases of PubMed, Embase, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature to retrieve studies published up to February 2022. The Newcastle-Ottawa Scale was used to assess the quality of included studies and a meta-analysis was performed using RevMan 5.3 software. A total of 12 retrospective studies performing comparisons of DG and TG were included in the present meta-analysis. For patients who underwent DG, a lower rate of overall post-operative complications, anastomosis leakage and intro-abdominal infection was determined. No significant difference was observed between DG and TG in the 5-year overall survival when the proximal resection margin ranged from 3 to 5 cm. Although DG was associated with a higher 5-year overall survival rate when compared to TG, there was no significant difference in the stratified analyses by TNM stage. In conclusion, the prognosis of MTGC did not depend on the extent of gastrectomy. With lower complications and acceptable oncological outcomes, DG was a safe and feasible surgical procedure for MTGC when a negative proximal margin was confirmed.

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Section: Discussionmentioning

confidence: 85%

Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle‑third gastric cancer: A systematic review and meta‑analysis

Jiang

Yang

et al. 2022

Oncol Lett

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“…Other researchers have conjectured patients with stage III scirrhous gastric carcinoma, which is a type of gastric cancer equivalent to GLP in some studies, should undergo gastrectomy with extended lymphadenectomy due to a high rate of positive lymph nodes (28). However, this type of lymphadenectomy might increase surgery related morbidity and mortality (29). JCOG0501, a randomized phase III trial, demonstrated the safety of neoadjuvant chemotherapy followed by D2 gastrectomy for patients with Bormann type 4 or large (a tumor size of equal to or more than 8 cm) type 3 (19), while the efficacy of this strategy remains to be explored.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of treating patients with non-metastatic gastric linitis plastica using surgery with chemotherapy and/or radiotherapy

Song

Shi

et al. 2020

Ann Transl Med

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Background: To explore the efficacy of treatment strategies for non-metastatic gastric linitis plastica (GLP). Methods: Patients with non-metastatic GLP from 2004 to 2014 were identified from the National Cancer Database (NCDB). We compared overall survival (OS) of those patients who received different treatments, including surgery alone, a combination of surgery with chemotherapy and/or radiotherapy (S + C/R), chemotherapy and/or radiotherapy (C/R), and no treatment. Results: The cohort included 474 patients with non-metastatic GLP. Overall, the median survival was significantly different among four groups (13.90 months in S + C/R, 8.38 months in surgery alone, 8.94 months in C/R and 2.50 months in no treatment). Then, we compared the efficacy of surgery alone and surgery with postoperative chemotherapy and/or radiotherapy (S + post C/R). When the tumor size was greater than 8 cm in stage III patients, S + post C/R was associated with a better survival benefit than surgery alone. S + post C/R also conferred an obvious survival advantage compared to surgery alone for R0 patients with positive lymph nodes and patients with positive margins. Conclusions: Surgery plays the fundamental role in improving the OS of patients with non-metastatic GLP. S + post C/R would benefit patients in stage III with large-sized tumors (>8 cm), patients with negative margins and positive lymph nodes, and/or patients with positive margins.

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“…A D1 dissection involves the affected distal section of the stomach or the stomach in its entirety (subtotal or total resection) being removed, including the greater and lesser omenta ( 7 - 9 ). D2 dissection, meanwhile, sees the removal of the omental bursa as well as the front leaf of the transverse mesocolon, and the mentioned arteries are totally cleared.…”

Section: Methodsmentioning

confidence: 99%

A retrospective study comparing D1 limited lymph node dissection and D2 extended lymph node dissection for N3 gastric cancer

Luo¹,

Zhou²,

Wei³

et al. 2020

Transl Cancer Res TCR

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Background In countries in East Asia, the typical treatment for curable gastric cancer is gastrectomy with D2 lymphadenectomy. However, whether D2 lymphadenectomy is beneficial for high-risk N3 node disease remains controversial. We conducted a multi-institution retrospective study on patients with high-risk, locally advanced gastric cancer. To compare the rates of disease-free survival (DFS) and overall survival (OS) between radical D2-type gastric resection and lymphadenectomy and the more limited D1 type resection and lymphadenectomy. Methods From July 2010 to June 2015, 74 patients out of 949 who underwent curative-intent R0 surgery were selected in pairs to compare the survival outcomes between those who underwent radical D2 type (n=37) vs. the more limited D1 type (n=37) gastric resection and lymphadenectomy. Results The median DFS was 9.72 and 7.81 months for the D2 and D1 types, respectively (P=0.746), and the OS was 16.39 and 15.85 months for the D2 and D1 types, respectively (P=0.937). Conclusions No statistically significant differences in DFS and OS were noted between D1 and D2 procedures for those with N3 disease. Our results support the hypothesis that a novel multidisciplinary approach rather than a surgical approach alone is needed to improve the survival outcomes of high-risk patients with N3 gastric cancer.

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Surgical outcomes of gastrectomy with D1 lymph node dissection performed for patients with unfavorable clinical conditions

Cited by 28 publications

References 32 publications

Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle‑third gastric cancer: A systematic review and meta‑analysis

Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle‑third gastric cancer: A systematic review and meta‑analysis

The efficacy of treating patients with non-metastatic gastric linitis plastica using surgery with chemotherapy and/or radiotherapy

A retrospective study comparing D1 limited lymph node dissection and D2 extended lymph node dissection for N3 gastric cancer

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