Aaron U Blackham1, Doug S Swords2, Edward A Levine2, Nora F Fino3, Malcolm H Squires4, George Poultsides5, Ryan C Fields6, Mark Bloomston7, Sharon M Weber8, Timothy M Pawlik9, Linda X Jin6, Gaya Spolverato9, Carl Schmidt7, David Worhunsky5, Clifford S Cho8, Shishir K Maithel4, Konstantinos I Votanopoulos10. 1. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. aaron.blackham@moffitt.org. 2. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. 3. Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA. 4. Department of Surgery, Emory University, Atlanta, GA, USA. 5. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. 6. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. 7. Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA. 8. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 9. Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 10. Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. kvotanop@wakehealth.edu.
Abstract
BACKGROUND: Current staging and treatment guidelines for gastric adenocarcinoma do not differentiate between linitis plastic (LP) and non-LP cancers. Significant controversy exists regarding the surgical management of LP patients. METHODS: Using the multi-institutional U.S. Gastric Cancer Collaborative database, 869 gastric cancer patients who underwent resection between 2000 and 2012 were identified. Clinicopathologic and outcomes data of 58 LP patients were compared to 811 non-LP patients. RESULTS: Stage III/IV disease was more common at presentation in LP patients compared with non-LP patients (90 vs. 44 %, p < 0.01). Despite the fact that most LP patients underwent total gastrectomy (88 vs. 39 %, p < 0.01), final positive margins were more common in LP patients (33 vs. 7 %, p < 0.01). The use of frozen section allowed 15 intraoperative positive margins in 38 patients to be converted to negative final margins. Median overall survival (OS) was significantly worse in patients with LP (11.6 vs. 37.8 months, p < 0.01). There was no difference in median OS of LP patients based on stage (I/II, 17.3 mo; III, 10.6 mo; IV, 12.0 mo; p = 0.46). LP and non-LP patients who underwent optimal resection (negative margin and D2/3 lymphadenectomy) had better survival compared with those with nonoptimal resections. The median OS for optimally resected stage III LP (n = 22) and stage III non-LP (n = 185) patients was nearly identical (26.7 vs. 25.3 mo; p = 0.69). CONCLUSIONS: Future staging systems and treatment guidelines should differentiate between LP and non-LP gastric cancers. Long-term survival in select LP patients who undergo optimal resections is comparable to optimally resected non-LP patients.
BACKGROUND: Current staging and treatment guidelines for gastric adenocarcinoma do not differentiate between linitis plastic (LP) and non-LPcancers. Significant controversy exists regarding the surgical management of LPpatients. METHODS: Using the multi-institutional U.S. Gastric Cancer Collaborative database, 869 gastric cancerpatients who underwent resection between 2000 and 2012 were identified. Clinicopathologic and outcomes data of 58 LPpatients were compared to 811 non-LPpatients. RESULTS: Stage III/IV disease was more common at presentation in LPpatients compared with non-LPpatients (90 vs. 44 %, p < 0.01). Despite the fact that most LPpatients underwent total gastrectomy (88 vs. 39 %, p < 0.01), final positive margins were more common in LPpatients (33 vs. 7 %, p < 0.01). The use of frozen section allowed 15 intraoperative positive margins in 38 patients to be converted to negative final margins. Median overall survival (OS) was significantly worse in patients with LP (11.6 vs. 37.8 months, p < 0.01). There was no difference in median OS of LPpatients based on stage (I/II, 17.3 mo; III, 10.6 mo; IV, 12.0 mo; p = 0.46). LP and non-LPpatients who underwent optimal resection (negative margin and D2/3 lymphadenectomy) had better survival compared with those with nonoptimal resections. The median OS for optimally resected stage III LP (n = 22) and stage III non-LP (n = 185) patients was nearly identical (26.7 vs. 25.3 mo; p = 0.69). CONCLUSIONS: Future staging systems and treatment guidelines should differentiate between LP and non-LPgastric cancers. Long-term survival in select LPpatients who undergo optimal resections is comparable to optimally resected non-LPpatients.
Authors: Gaya Spolverato; Aslam Ejaz; Yuhree Kim; Malcolm H Squires; George A Poultsides; Ryan C Fields; Carl Schmidt; Sharon M Weber; Konstantinos Votanopoulos; Shishir K Maithel; Timothy M Pawlik Journal: J Am Coll Surg Date: 2014-06-26 Impact factor: 6.113
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