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1. Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population—on behalf of the Italian Research Group for Gastric Cancer

Author

Lombardi, P, Bernasconi, D, Baiocchi, G, Berselli, M, Biondi, A, Castoro, C, Catarci, M, Degiuli, M, Fumagalli Romario, U, Giacopuzzi, S, Marchesi, F, Marrelli, D, Mazzola, M, Molfino, S, Olmi, S, Rausei, S, Rosa, F, Rosati, R, Roviello, F, Santi, S, Solaini, L, Staderini, F, Vigano, J, Ferrari, G, Agnes, A, Alfieri, S, Alloggio, M, Bencivenga, M, Benedetti, M, Bottari, A, Cianchi, F, Cocozza, E, Dalmonte, G, De Martini, P, De Pascale, S, Desio, M, Emiliani, G, Ercolani, G, Galli, F, Garosio, I, Giani, A, Gualtierotti, M, Marano, L, Morgagni, P, Peri, A, Puccetti, F, Reddavid, R, Uccelli, M, Lombardi P. M., Bernasconi D., Baiocchi G. L., Berselli M., Biondi A., Castoro C., Catarci M., Degiuli M., Fumagalli Romario U., Giacopuzzi S., Marchesi F., Marrelli D., Mazzola M., Molfino S., Olmi S., Rausei S., Rosa F., Rosati R., Roviello F., Santi S., Solaini L., Staderini F., Vigano J., Ferrari G., Agnes A., Alfieri S., Alloggio M., Bencivenga M., Benedetti M., Bottari A., Cianchi F., Cocozza E., Dalmonte G., De Martini P., De Pascale S., Desio M., Emiliani G., Ercolani G., Galli F., Garosio I., Giani A., Gualtierotti M., Marano L., Morgagni P., Peri A., Puccetti F., Reddavid R., Uccelli M., Lombardi, P, Bernasconi, D, Baiocchi, G, Berselli, M, Biondi, A, Castoro, C, Catarci, M, Degiuli, M, Fumagalli Romario, U, Giacopuzzi, S, Marchesi, F, Marrelli, D, Mazzola, M, Molfino, S, Olmi, S, Rausei, S, Rosa, F, Rosati, R, Roviello, F, Santi, S, Solaini, L, Staderini, F, Vigano, J, Ferrari, G, Agnes, A, Alfieri, S, Alloggio, M, Bencivenga, M, Benedetti, M, Bottari, A, Cianchi, F, Cocozza, E, Dalmonte, G, De Martini, P, De Pascale, S, Desio, M, Emiliani, G, Ercolani, G, Galli, F, Garosio, I, Giani, A, Gualtierotti, M, Marano, L, Morgagni, P, Peri, A, Puccetti, F, Reddavid, R, Uccelli, M, Lombardi P. M., Bernasconi D., Baiocchi G. L., Berselli M., Biondi A., Castoro C., Catarci M., Degiuli M., Fumagalli Romario U., Giacopuzzi S., Marchesi F., Marrelli D., Mazzola M., Molfino S., Olmi S., Rausei S., Rosa F., Rosati R., Roviello F., Santi S., Solaini L., Staderini F., Vigano J., Ferrari G., Agnes A., Alfieri S., Alloggio M., Bencivenga M., Benedetti M., Bottari A., Cianchi F., Cocozza E., Dalmonte G., De Martini P., De Pascale S., Desio M., Emiliani G., Ercolani G., Galli F., Garosio I., Giani A., Gualtierotti M., Marano L., Morgagni P., Peri A., Puccetti F., Reddavid R., and Uccelli M.

Abstract

Background: Oncologic outcomes after laparoscopic gastrectomy for advanced gastric cancer in the West have been poorly investigated. The aim of the present study was to compare survival outcomes in patients undergoing curative-intent laparoscopic and open gastrectomy for advanced gastric cancer in several centres belonging to the Italian Research Group for Gastric Cancer. Methods: Data of patients operated between 2015 and 2018 were retrospectively analysed. Propensity Score Matching was performed to balance baseline characteristics of patients undergoing laparoscopic and open gastrectomy. The primary endpoint was 3-year overall survival. Secondary endpoints were 3-year disease-free survival and short-term outcomes. Multivariable regression analyses for survival were conducted. Results: Data were retrieved from 20 centres. Of the 717 patients included, 438 patients were correctly matched, 219 per group. The 3-year overall survival was 73.6% and 68.7% in the laparoscopic and open group, respectively (p = 0.40). When compared with open gastrectomy, laparoscopic gastrectomy showed comparable 3-year disease-free survival (62.8%, vs 58.9%, p = 0.40), higher rate of return to intended oncologic treatment (56.9% vs 40.2%, p = 0.001), similar 30-day morbidity/mortality. Prognostic factors for survival were ASA Score ≥ 3, age-adjusted Charlson Comorbidity Index ≥ 5, lymph node ratio ≥ 0.15, p/ypTNM Stage III and return to intended oncologic treatment. Conclusions: Laparoscopic gastrectomy for advanced gastric cancer offers similar rates of survival when compared to open gastrectomy, with higher rates of return to intended oncologic treatment. ASA score, age-adjusted Charlson Comorbidity Index, lymph node ratio, return to intended oncologic treatment and p/ypTNM Stage, but not surgical approach, are prognostic factors for survival.

Published
2022

2. A national survey on the current status of minimally invasive gastric practice on behalf of GIRCG

Author

Milone, M, D'Amore, A, Alfieri, S, Ambrosio, M, Andreuccetti, J, Ansaloni, L, Antonucci, A, Arganini, M, Baiocchi, G, Barone, M, Bencini, L, Bencivenga, M, Boccia, L, Boni, L, Braga, M, Cianchi, F, Cipollari, C, Contine, A, Cotsoglou, C, D'Imporzano, S, De Manzoni, G, De Pascale, S, De Ruvo, N, Degiuli, M, Donini, A, Elmore, U, Ercolani, G, Ferrari, G, Fumagalli, R, Garulli, G, Gelmini, R, Graziosi, L, Gualtierotti, M, Guglielmi, A, Inama, M, Maffeis, F, Maione, F, Manigrasso, M, Marchesi, F, Marrelli, D, Massobrio, A, Moretto, G, Moukachar, A, Navarra, G, Nigri, G, Olmi, S, Palaia, R, Papis, D, Parise, P, Pedrazzani, C, Petri, R, Pignata, G, Pisano, M, Rausei, S, Reddavid, R, Rocco, G, Rosa, F, Rosati, R, Rossit, L, Rottoli, M, Roviello, F, Santi, S, Scabini, S, Scaringi, S, Solaini, L, Staderini, F, Taglietti, L, Torre, B, Ubiali, P, Uccelli, M, Uggeri, F, Vertaldi, S, Viganò, J, De Palma, G, Giacopuzzi, S, Milone, Marco, D'Amore, Anna, Alfieri, Sergio, Ambrosio, Maria Raffaella, Andreuccetti, Jacopo, Ansaloni, Luca, Antonucci, Adelmo, Arganini, Marco, Baiocchi, Gianluca, Barone, Mirko, Bencini, Lapo, Bencivenga, Maria, Boccia, Luigi, Boni, Luigi, Braga, Marco, Cianchi, Fabio, Cipollari, Chiara, Contine, Alessandro, Cotsoglou, Christian, D'Imporzano, Simone, De Manzoni, Giovanni, De Pascale, Stefano, De Ruvo, Nicola, Degiuli, Maurizio, Donini, Annibale, Elmore, Ugo, Ercolani, Giorgio, Ferrari, Giovanni, Fumagalli, Romario Uberto, Garulli, Gianluca, Gelmini, Roberta, Graziosi, Luigina, Gualtierotti, Monica, Guglielmi, Alfredo, Inama, Marco, Maffeis, Federica, Maione, Francesco, Manigrasso, Michele, Marchesi, Federico, Marrelli, Daniele, Massobrio, Andrea, Moretto, Gianluigi, Moukachar, Aballah, Navarra, Giuseppe, Nigri, Giuseppe, Olmi, Stefano, Palaia, Raffaele, Papis, Davide, Parise, Paolo, Pedrazzani, Corrado, Petri, Roberto, Pignata, Giusto, Pisano, Michele, Rausei, Stefano, Reddavid, Rossella, Rocco, Giuseppe, Rosa, Fausto, Rosati, Riccardo, Rossit, Luca, Rottoli, Matteo, Roviello, Franco, Santi, Stefano, Scabini, Stefano, Scaringi, Stefano, Solaini, Leonardo, Staderini, Fabio, Taglietti, Lucio, Torre, Beatrice, Ubiali, Paolo, Uccelli, Matteo, Uggeri, Fabio, Vertaldi, Sara, Viganò, Jacopo, De Palma, Giovanni Domenico, Giacopuzzi, Simone, Milone, M, D'Amore, A, Alfieri, S, Ambrosio, M, Andreuccetti, J, Ansaloni, L, Antonucci, A, Arganini, M, Baiocchi, G, Barone, M, Bencini, L, Bencivenga, M, Boccia, L, Boni, L, Braga, M, Cianchi, F, Cipollari, C, Contine, A, Cotsoglou, C, D'Imporzano, S, De Manzoni, G, De Pascale, S, De Ruvo, N, Degiuli, M, Donini, A, Elmore, U, Ercolani, G, Ferrari, G, Fumagalli, R, Garulli, G, Gelmini, R, Graziosi, L, Gualtierotti, M, Guglielmi, A, Inama, M, Maffeis, F, Maione, F, Manigrasso, M, Marchesi, F, Marrelli, D, Massobrio, A, Moretto, G, Moukachar, A, Navarra, G, Nigri, G, Olmi, S, Palaia, R, Papis, D, Parise, P, Pedrazzani, C, Petri, R, Pignata, G, Pisano, M, Rausei, S, Reddavid, R, Rocco, G, Rosa, F, Rosati, R, Rossit, L, Rottoli, M, Roviello, F, Santi, S, Scabini, S, Scaringi, S, Solaini, L, Staderini, F, Taglietti, L, Torre, B, Ubiali, P, Uccelli, M, Uggeri, F, Vertaldi, S, Viganò, J, De Palma, G, Giacopuzzi, S, Milone, Marco, D'Amore, Anna, Alfieri, Sergio, Ambrosio, Maria Raffaella, Andreuccetti, Jacopo, Ansaloni, Luca, Antonucci, Adelmo, Arganini, Marco, Baiocchi, Gianluca, Barone, Mirko, Bencini, Lapo, Bencivenga, Maria, Boccia, Luigi, Boni, Luigi, Braga, Marco, Cianchi, Fabio, Cipollari, Chiara, Contine, Alessandro, Cotsoglou, Christian, D'Imporzano, Simone, De Manzoni, Giovanni, De Pascale, Stefano, De Ruvo, Nicola, Degiuli, Maurizio, Donini, Annibale, Elmore, Ugo, Ercolani, Giorgio, Ferrari, Giovanni, Fumagalli, Romario Uberto, Garulli, Gianluca, Gelmini, Roberta, Graziosi, Luigina, Gualtierotti, Monica, Guglielmi, Alfredo, Inama, Marco, Maffeis, Federica, Maione, Francesco, Manigrasso, Michele, Marchesi, Federico, Marrelli, Daniele, Massobrio, Andrea, Moretto, Gianluigi, Moukachar, Aballah, Navarra, Giuseppe, Nigri, Giuseppe, Olmi, Stefano, Palaia, Raffaele, Papis, Davide, Parise, Paolo, Pedrazzani, Corrado, Petri, Roberto, Pignata, Giusto, Pisano, Michele, Rausei, Stefano, Reddavid, Rossella, Rocco, Giuseppe, Rosa, Fausto, Rosati, Riccardo, Rossit, Luca, Rottoli, Matteo, Roviello, Franco, Santi, Stefano, Scabini, Stefano, Scaringi, Stefano, Solaini, Leonardo, Staderini, Fabio, Taglietti, Lucio, Torre, Beatrice, Ubiali, Paolo, Uccelli, Matteo, Uggeri, Fabio, Vertaldi, Sara, Viganò, Jacopo, De Palma, Giovanni Domenico, and Giacopuzzi, Simone

Abstract

Italian Research Group for Gastric Cancer (GIRCG), during the 2013 annual Consensus Conference to gastric cancer, stated that laparoscopic or robotic approach should be limited only to early gastric cancer (EGC) and no further guidelines were currently available. However, accumulated evidences, mainly from eastern experiences, have supported the application of minimally invasive surgery also for locally advanced gastric cancer (AGC). The aim of our study is to give a snapshot of current surgical propensity of expert Italian upper gastrointestinal surgeons in performing minimally invasive techniques for the treatment of gastric cancer in order to answer to the question if clinical practice overcome the recommendation. Experts in the field among the Italian Research Group for Gastric Cancer (GIRCG) were invited to join a web 30-item survey through a formal e-mail from January 1st, 2020, to June 31st, 2020. Responses were collected from 46 participants out of 100 upper gastrointestinal surgeons. Percentage of surgeons choosing a minimally invasive approach to treat early and advanced gastric cancer was similar. Additionally analyzing data from the centers involved, we obtained that the percentage of minimally invasive total and partial gastrectomies in advanced cases augmented with the increase of surgical procedures performed per year (p=0.02 and p=0.04 respectively). It is reasonable to assume that there is a widening of indications given by the current national guideline into clinical practice. Propensity of expert Italian upper gastrointestinal surgeons was to perform minimally invasive surgery not only for early but also for advanced gastric cancer. Of interest volume activity correlated with the propensity of surgeons to select a minimally invasive approach.

Published
2023

3. Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population-on behalf of the Italian Research Group for Gastric Cancer

Author

Lombardi, P. M., Bernasconi, D., Baiocchi, G. L., Berselli, M., Biondi, Alberto, Castoro, C., Catarci, Marco, Degiuli, M., Fumagalli Romario, U., Giacopuzzi, S., Marchesi, F., Marrelli, D., Mazzola, M., Molfino, S., Olmi, S., Rausei, S., Rosa, Fausto, Rosati, R., Roviello, F., Santi, Samuele, Solaini, L., Staderini, F., Vigano, J., Ferrari, G., Agnes, Annamaria, Alfieri, Sergio, Alloggio, M., Bencivenga, M., Benedetti, M., Bottari, A., Cianchi, F., Cocozza, E., Dalmonte, G., De Martini, P., De Pascale, S., Desio, M., Emiliani, G., Ercolani, G., Galli, F., Garosio, I., Giani, A., Gualtierotti, M., Marano, L., Morgagni, P., Peri, A., Puccetti, F., Reddavid, R., Uccelli, M., Biondi A. (ORCID:0000-0002-2470-7858), Catarci M., Rosa F. (ORCID:0000-0002-7280-8354), Santi S., Agnes A., Alfieri S. (ORCID:0000-0002-0404-724X), Lombardi, P. M., Bernasconi, D., Baiocchi, G. L., Berselli, M., Biondi, Alberto, Castoro, C., Catarci, Marco, Degiuli, M., Fumagalli Romario, U., Giacopuzzi, S., Marchesi, F., Marrelli, D., Mazzola, M., Molfino, S., Olmi, S., Rausei, S., Rosa, Fausto, Rosati, R., Roviello, F., Santi, Samuele, Solaini, L., Staderini, F., Vigano, J., Ferrari, G., Agnes, Annamaria, Alfieri, Sergio, Alloggio, M., Bencivenga, M., Benedetti, M., Bottari, A., Cianchi, F., Cocozza, E., Dalmonte, G., De Martini, P., De Pascale, S., Desio, M., Emiliani, G., Ercolani, G., Galli, F., Garosio, I., Giani, A., Gualtierotti, M., Marano, L., Morgagni, P., Peri, A., Puccetti, F., Reddavid, R., Uccelli, M., Biondi A. (ORCID:0000-0002-2470-7858), Catarci M., Rosa F. (ORCID:0000-0002-7280-8354), Santi S., Agnes A., and Alfieri S. (ORCID:0000-0002-0404-724X)

Abstract

Background Oncologic outcomes after laparoscopic gastrectomy for advanced gastric cancer in the West have been poorly investigated. The aim of the present study was to compare survival outcomes in patients undergoing curative-intent laparoscopic and open gastrectomy for advanced gastric cancer in several centres belonging to the Italian Research Group for Gastric Cancer. Methods Data of patients operated between 2015 and 2018 were retrospectively analysed. Propensity Score Matching was performed to balance baseline characteristics of patients undergoing laparoscopic and open gastrectomy. The primary endpoint was 3-year overall survival. Secondary endpoints were 3-year disease-free survival and short-term outcomes. Multivariable regression analyses for survival were conducted. Results Data were retrieved from 20 centres. Of the 717 patients included, 438 patients were correctly matched, 219 per group. The 3-year overall survival was 73.6% and 68.7% in the laparoscopic and open group, respectively (p = 0.40). When compared with open gastrectomy, laparoscopic gastrectomy showed comparable 3-year disease-free survival (62.8%, vs 58.9%, p = 0.40), higher rate of return to intended oncologic treatment (56.9% vs 40.2%, p = 0.001), similar 30-day morbidity/mortality. Prognostic factors for survival were ASA Score >= 3, age-adjusted Charlson Comorbidity Index >= 5, lymph node ratio >= 0.15, p/ypTNM Stage III and return to intended oncologic treatment. Conclusions Laparoscopic gastrectomy for advanced gastric cancer offers similar rates of survival when compared to open gastrectomy, with higher rates of return to intended oncologic treatment. ASA score, age-adjusted Charlson Comorbidity Index, lymph node ratio, return to intended oncologic treatment and p/ypTNM Stage, but not surgical approach, are prognostic factors for survival.

Published
2022

4. Bidirectional Approach with PIPAC and Systemic Chemotherapy for Patients with Synchronous Gastric Cancer Peritoneal Metastases (GCPM).

Author

Casella F, Bencivenga M, Brancato G, Torroni L, Ridolfi C, Puccio C, Alloggio M, Meloni F, Fusario D, Marrelli D, Giacopuzzi S, Roviello F, and de Manzoni G

Subjects
Humans, Female, Middle Aged, Male, Cisplatin therapeutic use, Doxorubicin, Retrospective Studies, Prospective Studies, Aerosols, Stomach Neoplasms drug therapy, Stomach Neoplasms surgery, Stomach Neoplasms pathology, Peritoneal Neoplasms secondary
Abstract

Background: This study evaluated the efficacy of pressurized intraperitoneal aerosol chemotherapy (PIPAC) with systemic chemotherapy as a bidirectional approach for gastric cancer (GC) patients with synchronous peritoneal metastases (SPM)., Methods: A retrospective analysis of a prospective PIPAC database was queried for patients who underwent a bidirectional approach between October 2019 and April 2022 at two high-volume GC surgery units in Italy (Verona and Siena). Surgical and oncological outcomes were analyzed., Results: Between October 2019 and April 2022, 74 PIPAC procedures in 42 consecutive patients with Eastern Cooperative Oncology Group performance status ≤2 were performed-32 patients treated in Verona and 10 in Siena. Twenty-seven patients (64%) were female and median age at first PIPAC was 60.5 years (I-III quartiles: 49-68 years). Median Peritoneal Cancer Index (PCI) was 16 (I-III quartiles: 8-26) and 25 patients (59%) had at least two PIPAC procedures. Major complications according to the Common Terminology Criteria for Adverse Events (CTCAE; 3 and 4) occurred in three (4%) procedures, and, according to the Clavien-Dindo classification (>3a), one (1%) severe complication occurred. There were no reoperations or deaths within 30 days. Median overall survival (mOS) from diagnosis was 19.6 months (range 14-24), and mOS from first PIPAC was 10.5 months (range 7-13). Excluding cases with very heavy metastatic peritoneal burden, with PCI from 2 to 26, treated with more than one PIPAC, mOS from diagnosis was 22 months (range 14-39). Eleven patients (26%) underwent curative-intent surgery after a bidirectional approach. R0 was achieved in nine (82%) patients and complete pathological response was obtained in three (27%) cases., Conclusions: Patient selection is associated with bidirectional approach efficacy and feasibility for SPM GC treatment, which may allow potentially curative surgical radicalization in highly selected cases., (© 2023. The Author(s).)

Published
2023
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5. Pretreatment Primary Tumor Stage is a Risk Factor for Recurrence in Patients with Esophageal Squamous Cell Carcinoma Who Achieve Pathological Complete Response After Neoadjuvant Chemoradiotherapy.

Author

La Mendola R, Bencivenga M, Torroni L, Alberti L, Sacco M, Casella F, Ridolfi C, Simoni N, Micera R, Pavarana M, Verlato G, and Giacopuzzi S

Subjects
Chemoradiotherapy, Esophagectomy, Humans, Male, Neoadjuvant Therapy, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local therapy, Neoplasm Staging, Retrospective Studies, Risk Factors, Carcinoma, Squamous Cell pathology, Carcinoma, Squamous Cell therapy, Esophageal Neoplasms pathology, Esophageal Neoplasms therapy, Esophageal Squamous Cell Carcinoma therapy, Head and Neck Neoplasms
Abstract

Background: Although pathological complete response (pCR) after multimodal treatment for esophageal cancer is associated to the best prognosis, recurrence may occur in 20-40% of cases. The present study investigated the recurrence pattern and predictive factors of recurrence after pCR in patients with esophageal cancer., Methods: In this study, 427 patients received preoperative treatment for either esophageal squamous cell carcinoma (SCC) or adenocarcinoma at Verona University Hospital between 2000 and 2018. Of these, 145 patients (34%) achieved a pCR. Long-term prognosis, recurrence pattern, and risk factors for relapse in pCR patients were analysed., Results: During a median follow-up of 52 months, 37 relapses (25.5%) occurred, mostly at distant level (n = 28). Nearly all locoregional relapses (8/9) were detected in SCC cases. The 5-year overall survival and cancer-related survival were 71.7% (95% confidence interval [CI] 62.6-78.9%) and 77.5% (95% CI 68.5-84.2%) respectively. Male sex, higher body mass index, and cT4 were significant risk factors for recurrence at univariate analysis. The multivariate analysis confirmed the role of cT4 as predictor of recurrence only in SCCs., Conclusions: Esophageal cancer recurs in about one-fourth of pCR cases. A fair number of local recurrences occurs in SCCs, but the main problem is the systemic disease control. According to our analysis, SCCs patients with cT4 stage have an increased risk to recur, so they should be managed differently by a personalized approach in terms of adjuvant treatment and follow-up.

Published
2021
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7. Multicenter Study of Presentation, Management, and Postoperative and Long-Term Outcomes of Septegenerians and Octogenerians Undergoing Gastrectomy for Gastric Cancer.

Author

Mengardo V, Cormack OM, Weindelmayer J, Chaudry A, Bencivenga M, Giacopuzzi S, Allum WH, and de Manzoni G

Subjects
Adenocarcinoma pathology, Adenocarcinoma surgery, Adult, Aged, Aged, 80 and over, Comorbidity, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Stomach Neoplasms pathology, Stomach Neoplasms surgery, Survival Rate, Time Factors, Adenocarcinoma mortality, Gastrectomy mortality, Postoperative Complications mortality, Stomach Neoplasms mortality
Abstract

Background: The optimal treatment strategy for elderly patients with gastric cancer is still controversial. This study aimed to assess the impact of age on short- and long-term outcomes after treatment for primary gastric cancer., Methods: From January 2004 to December 2014, a total of 507 patients underwent gastrectomy for gastric adenocarcinoma at two high-volume upper gastrointestinal (GI) centers. The patients were classified into three groups as follows: group A (patients ≤ 69 years old, n = 266), group B (patients 70-79 years old, n = 166), and group C (patients ≥ 80 years old, n = 75). Clinicopathologic characteristics as well as, short- and long-term outcomes were compared between the groups., Results: The patients in groups B and C had more comorbidities, whereas the younger subjects (group A) had more advanced tumor stages. Less extensive surgery was performed in the groups B and C. Older patients (age ≥ 70 years) had more postoperative medical complications. Moreover, group C had a higher postoperative mortality rate (8.1%) than group A (1.8%) or group B (1.9%). In the multivariable analysis, age older than 80 years (group C) was a negative independent factor for overall survival (OS) (hazard ratio [HR], 2.36) compared with group A, whereas group B seemed to have a comparable risk (HR, 1.37). Notably, the three groups did not show significant differences in disease-related survival (DRS)., Conclusion: The data suggest that patients 70-79 years of age show a risk of postoperative death comparable with that of younger subjects. However, patients older than 80 years should be carefully selected for surgical treatment due to the increased risk of postoperative mortality.

Published
2018
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8. Extranodal Extension of Nodal Metastases Is a Poor Prognostic Indicator in Gastric Cancer: a Systematic Review and Meta-analysis.

Author

Veronese N, Fassan M, Wood LD, Stubbs B, Solmi M, Capelli P, Pea A, Nottegar A, Sergi G, Manzato E, Carraro S, Maruzzo M, Cataldo I, Bagante F, Barbareschi M, Cheng L, Bencivenga M, de Manzoni G, and Luchini C

Subjects
Humans, Neoplasm Recurrence, Local pathology, Odds Ratio, Prognosis, Proportional Hazards Models, Recurrence, Lymph Nodes pathology, Lymphatic Metastasis, Stomach Neoplasms pathology
Abstract

Introduction: The extranodal extension (ENE) of nodal metastases (the extension of neoplastic cells through the nodal capsule into the perinodal soft tissue) is a histological feature that has been considered a prognostic factor in several cancers, but the role in gastric cancer was not yet investigated. We aimed to investigate the prognostic role of ENE in patients affected by gastric cancer through a systematic review and meta-analysis., Material and Methods: Two independent authors searched major databases until 09/30/2015 to identify studies providing data on gastric cancer patients' prognostic parameters and comparing patients with ENE (ENE+) vs intra-nodal extension (ENE-). The data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) with 95 % confidence intervals (CI), adjusted for potential confounders., Results: Nine studies followed up 3250 patients with gastric cancer (1064 ENE+ and 2186 ENE-). ENE+ was associated with a significantly higher risk of all-cause mortality (RR = 1.70; 95 % CI: 1.43-2.03, I (2) = 66 %; HR = 2.14; 95 % CI: 1.66-2.75, I (2) = 0 %), cancer-specific mortality (RR = 1.59; 95 % CI: 1.42-1.79; HR = 1.52; 95 % CI: 1.19-1.96), and disease recurrence (RR = 3.43, 95 % CI: 1.80-6.54, I (2) = 0 %)., Discussion: Judging from our results, ENE in gastric cancer patients should be considered for prognostic purposes from the gross sample to the pathology report.

Published
2016
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9. Gastric stump cancer after distal gastrectomy for benign disease: clinicopathological features and surgical outcomes.

Author

Di Leo A, Pedrazzani C, Bencivenga M, Coniglio A, Rosa F, Morgani P, Marrelli D, Marchet A, Cozzaglio L, Giacopuzzi S, Tiberio GA, Doglietto GB, Vittimberga G, Roviello F, and Ricci F

Subjects
Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Follow-Up Studies, Gastric Stump surgery, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging, Neoplasm, Residual etiology, Neoplasm, Residual mortality, Postoperative Complications etiology, Postoperative Complications mortality, Precancerous Conditions mortality, Precancerous Conditions pathology, Prognosis, Stomach Neoplasms mortality, Stomach Neoplasms pathology, Survival Rate, Gastrectomy adverse effects, Gastric Stump pathology, Lymph Node Excision adverse effects, Neoplasm, Residual pathology, Postoperative Complications pathology, Precancerous Conditions surgery, Stomach Neoplasms surgery
Abstract

Purpose: The purpose of the present study was to analyze clinicopathologic features and long-term prognosis of gastric stump cancer (GSC) arising in the remnant stomach 5 years or later after partial gastrectomy for benign disease., Methods: We reviewed the results of 176 patients resected with curative intent for GSC at 8 Italian centers belonging to the Italian Research Group for Gastric Cancer (GIRCG). The median (range) follow-up time for surviving patients was 71.2 (6-207) months., Results: One hundred forty-six patients were men, the mean age at the time of diagnosis was 69.2 years, and the great majority (167 cases) underwent Billroth II reconstruction. R0 resection was achieved in 158 (90 %) patients, and in 94 (53 %) lymph node dissection was ≥D2. Postoperative mortality and complication rates were 6.2 and 43.2 %, respectively. T1 tumor was diagnosed in 45 (25 %) cases. Lymph node metastases were evident in 86 patients (49 %). Thirteen patients had involvement of the jejunal mesentery nodes (pJN+); five cases were T2-T3 and eight cases were T4. Overall 5-year survival rate was 53.1 %. Five-year survival rates were 68.1, 37.8, and 33.1 % for pT1, pT2-3, and pT4 tumors, respectively (P = 0.001). Five-year survival rate was 56.5 % for node-negative tumors (pN0), 32.3 % for tumors with nodal metastases without involvement of jejunal mesentery nodes (pN+), and 17.1 % for tumors with involvement of jejunal mesentery nodes (pJN+) (P = 0.002)., Conclusions: Our study suggests that an aggressive surgical approach can achieve a satisfactory outcome in GSC.

Published
2014
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