BACKGROUND: A retrospective study was performed to evaluate our recent results of curative gastric resections for adenocarcinoma. METHODS: Between 1979 and 1988, 187 patients fulfilled study entry criteria. This group of patients composes 64% of all patients with tumors arising distal to the gastroesophageal junction. Tumors arising in the region of the gastroesophageal junction were excluded. Patients were classified according to the American Society of Anesthesiologists physical status classification ( > or = 3, 56%) and Eastern Cooperative Oncology Group performance status ( > or = 2, 44%). Histologic characteristics were re-reviewed. INTERVENTIONS: Subtotal and total gastrectomies were performed in 78% and 22% of the patients, respectively. Extended lymph node dissections were performed selectively (5%). Adjuvant chemotherapy and radiotherapy were employed in 3% and 2% of patients, respectively. RESULTS: Postoperative morbidity and mortality were 27% and 4%, respectively. Synchronous splenectomy (P = .06) and type of gastric resection (P = .06) showed a borderline association with postoperative complications, but did not affect postoperative mortality. With a median follow-up time of 47 months in all patients, and a median of 9 years in patients still alive, the 5- and 10-year overall survival rates (Kaplan-Meier method) were 48% and 32%, respectively. In univariate survival analysis, age, American Society of Anesthesiologists classification, stage, tumor diameter, serosal extension of tumor lymph node metastases, and type of resection showed prognostic significance. In the Cox multivariate analysis, however, only serosal extension of tumor (P < .001) and lymph node metastases (P = .02) were independent prognostic factors. CONCLUSIONS: Despite the older age and comorbid conditions of patients with gastric cancer, 5-year survival was achieved in half the patients by standard radical operations. Until appropriate controlled prospective studies are performed, total gastrectomy, splenectomy, and extended lymph node dissection should not be routinely adopted, given their unproven efficacy and potentially increased morbidity and mortality.
BACKGROUND: A retrospective study was performed to evaluate our recent results of curative gastric resections for adenocarcinoma. METHODS: Between 1979 and 1988, 187 patients fulfilled study entry criteria. This group of patients composes 64% of all patients with tumors arising distal to the gastroesophageal junction. Tumors arising in the region of the gastroesophageal junction were excluded. Patients were classified according to the American Society of Anesthesiologists physical status classification ( > or = 3, 56%) and Eastern Cooperative Oncology Group performance status ( > or = 2, 44%). Histologic characteristics were re-reviewed. INTERVENTIONS: Subtotal and total gastrectomies were performed in 78% and 22% of the patients, respectively. Extended lymph node dissections were performed selectively (5%). Adjuvant chemotherapy and radiotherapy were employed in 3% and 2% of patients, respectively. RESULTS: Postoperative morbidity and mortality were 27% and 4%, respectively. Synchronous splenectomy (P = .06) and type of gastric resection (P = .06) showed a borderline association with postoperative complications, but did not affect postoperative mortality. With a median follow-up time of 47 months in all patients, and a median of 9 years in patients still alive, the 5- and 10-year overall survival rates (Kaplan-Meier method) were 48% and 32%, respectively. In univariate survival analysis, age, American Society of Anesthesiologists classification, stage, tumor diameter, serosal extension of tumor lymph node metastases, and type of resection showed prognostic significance. In the Cox multivariate analysis, however, only serosal extension of tumor (P < .001) and lymph node metastases (P = .02) were independent prognostic factors. CONCLUSIONS: Despite the older age and comorbid conditions of patients with gastric cancer, 5-year survival was achieved in half the patients by standard radical operations. Until appropriate controlled prospective studies are performed, total gastrectomy, splenectomy, and extended lymph node dissection should not be routinely adopted, given their unproven efficacy and potentially increased morbidity and mortality.
Authors: Steven C Cunningham; Farin Kamangar; Min P Kim; Sommer Hammoud; Raqeeb Haque; Anirban Maitra; Elizabeth Montgomery; Richard E Heitmiller; Michael A Choti; Keith D Lillemoe; John L Cameron; Charles J Yeo; Richard D Schulick Journal: J Gastrointest Surg Date: 2005 May-Jun Impact factor: 3.452
Authors: M Mahir Ozmen; Baris Zulfikaroglu; N Ozlem Kucuk; Necdet Ozalp; Gulseren Aras; Tankut Koseoglu; Mahmut Koç Journal: Ann R Coll Surg Engl Date: 2006-11 Impact factor: 1.891
Authors: Paolo Del Rio; Paolo Dell'Abate; Paolo Soliani; Maria Francesca Arcuri; Sara Tacci; Stefanie Ziegler; Mario Sianesi Journal: J Gastrointest Surg Date: 2003-11 Impact factor: 3.452
Authors: Stuart G Marcus; Daniel Cohen; Ke Lin; Kwok Wong; Scott Thompson; Adina Rothberger; Milan Potmesil; Spiros Hiotis; Elliot Newman Journal: J Gastrointest Surg Date: 2003-12 Impact factor: 3.267