BACKGROUND: Surgery for remnant gastric cancer (RGC) frequently fails to obtain the >15 lymph nodes necessary for tumor-node-metastasis (TNM) staging. We aimed to evaluate the utility of the recently developed tumor-ratio-metastasis (TRM) staging system. We also examined the pattern of lymph node metastasis and the role of prophylactic splenectomy in RGC. METHODS: Between May 2003 and December 2012, data from 170 patients who underwent surgery for RGC were retrospectively analyzed. RESULTS: RGC arising after previous benign disease (n = 46) was associated with retrieval of more lymph nodes (27.3 vs 10.0; P < 0.001), and a lower rate of retrieving ≤15 lymph nodes (15.6% vs 77.4%, P < 0.001), than after previous malignant disease (n = 122). The 5 year survival rate according to TNM staging was 75% in stage I, 77.1% in stage II, and 23.5% in stage III, whereas by TRM staging it was 75%, 81.6%, and 23.2%, respectively. Overall survival was not different between the splenectomy and non-splenectomy groups at each stage (P = 0.751, 0.723, 0.151, and 0.706 for stage I, II, III, and IV, respectively). CONCLUSION: The analyses did not identify a survival benefit from prophylactic splenectomy or show an improvement in staging with the TRM system for RGC.
BACKGROUND: Surgery for remnant gastric cancer (RGC) frequently fails to obtain the >15 lymph nodes necessary for tumor-node-metastasis (TNM) staging. We aimed to evaluate the utility of the recently developed tumor-ratio-metastasis (TRM) staging system. We also examined the pattern of lymph node metastasis and the role of prophylactic splenectomy in RGC. METHODS: Between May 2003 and December 2012, data from 170 patients who underwent surgery for RGC were retrospectively analyzed. RESULTS: RGC arising after previous benign disease (n = 46) was associated with retrieval of more lymph nodes (27.3 vs 10.0; P < 0.001), and a lower rate of retrieving ≤15 lymph nodes (15.6% vs 77.4%, P < 0.001), than after previous malignant disease (n = 122). The 5 year survival rate according to TNM staging was 75% in stage I, 77.1% in stage II, and 23.5% in stage III, whereas by TRM staging it was 75%, 81.6%, and 23.2%, respectively. Overall survival was not different between the splenectomy and non-splenectomy groups at each stage (P = 0.751, 0.723, 0.151, and 0.706 for stage I, II, III, and IV, respectively). CONCLUSION: The analyses did not identify a survival benefit from prophylactic splenectomy or show an improvement in staging with the TRM system for RGC.
Authors: Mohamed Barakat; Mohamed Seif; Mohamed M Abdelfatah; Andrew Ofosu; David L Carr-Locke; Mohamed O Othman Journal: Surg Endosc Date: 2019-04-08 Impact factor: 4.584
Authors: Marcus Fernando Kodama Pertille Ramos; Marina Alessandra Pereira; Andre Roncon Dias; Anna Carolina Batista Dantas; Daniel Jose Szor; Ulysses Ribeiro; Bruno Zilberstein; Ivan Cecconello Journal: World J Gastrointest Surg Date: 2021-04-27