E Norero1, M Bustos2, M E Herrera3, J Cerda4, P González4, M Ceroni4, C Martínez4, E Briceño4, H Rojas3, R Cártes5, V Lopez6, V Hidalgo4, S Báez4, M Caracci4, E Viñuela4, A Díaz4. 1. Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile. Electronic address: enorero@uc.cl. 2. Centro de Cancer Universidad Católica, Radiation Oncology, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 319, RM Santiago, Chile. 3. Hospital Dr. Sotero del Rio, Medical Oncology, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile. 4. Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile. 5. Clínica Radionuclear, Radiation Oncology, Calle Maria Luisa Santander, 514, Providencia, RM Santiago, Chile. 6. IRAM, Radiation Oncology, Américo Vespucio Norte, 1314, Vitacura, RM Santiago, Chile.
Abstract
BACKGROUND: The benefits of adjuvant treatment in the context of a D2 lymph node dissection are controversial. The aim was to investigate the effects of postoperative adjuvant treatment on the survival of patients with a curative resection for gastric cancer and a D2 lymph node dissection. METHODS: We performed a retrospective cohort study. Patients operated from 1996 to 2013 were selected. We compared long term survival of patients treated with surgery alone and those with surgery plus postoperative adjuvant treatment. A multivariate analysis for survival was applied in every stage. RESULTS: The study included 580 patients. Two-hundred and four patients received postoperative adjuvant treatment (AD) and 376 patients were treated only with surgery (SU). Patients in the AD group were younger (60 versus 68, p < 0.001), had a lower rate of multiple organ resection (21% versus 39%, p < 0.001) and had less postoperative complications (14% versus 32%, p < 0.001). In the AD group, patients had more advanced disease (stage III; 77% versus 66%, p < 0.001). No difference was found in lymph nodes resected (31 versus 30, p = ns). The median survival with adjuvant treatment was 33 months (39% 5 year survival) and 22 months (31% 5 year survival) for patients without adjuvant treatment (p = 0.003). On multivariate analysis, patients with stage IIIB and IIIC had significantly better overall and disease specific long-term survival with adjuvant treatment. CONCLUSIONS: These results suggest that there is a long-term survival benefit for patients treated with postoperative adjuvant treatment for stages IIIB and IIIC gastric cancer after D2 lymph node dissection.
BACKGROUND: The benefits of adjuvant treatment in the context of a D2 lymph node dissection are controversial. The aim was to investigate the effects of postoperative adjuvant treatment on the survival of patients with a curative resection for gastric cancer and a D2 lymph node dissection. METHODS: We performed a retrospective cohort study. Patients operated from 1996 to 2013 were selected. We compared long term survival of patients treated with surgery alone and those with surgery plus postoperative adjuvant treatment. A multivariate analysis for survival was applied in every stage. RESULTS: The study included 580 patients. Two-hundred and four patients received postoperative adjuvant treatment (AD) and 376 patients were treated only with surgery (SU). Patients in the AD group were younger (60 versus 68, p < 0.001), had a lower rate of multiple organ resection (21% versus 39%, p < 0.001) and had less postoperative complications (14% versus 32%, p < 0.001). In the AD group, patients had more advanced disease (stage III; 77% versus 66%, p < 0.001). No difference was found in lymph nodes resected (31 versus 30, p = ns). The median survival with adjuvant treatment was 33 months (39% 5 year survival) and 22 months (31% 5 year survival) for patients without adjuvant treatment (p = 0.003). On multivariate analysis, patients with stage IIIB and IIIC had significantly better overall and disease specific long-term survival with adjuvant treatment. CONCLUSIONS: These results suggest that there is a long-term survival benefit for patients treated with postoperative adjuvant treatment for stages IIIB and IIIC gastric cancer after D2 lymph node dissection.
Authors: Yuhree Kim; Malcolm H Squires; George A Poultsides; Ryan C Fields; Sharon M Weber; Konstantinos I Votanopoulos; David A Kooby; David J Worhunsky; Linda X Jin; William G Hawkins; Alexandra W Acher; Clifford S Cho; Neil Saunders; Edward A Levine; Carl R Schmidt; Shishir K Maithel; Timothy M Pawlik Journal: Surgery Date: 2017-05-31 Impact factor: 3.982