Cancer Research and Treatment

Gastrointestinal Cancer

Effect of Preoperative Tumor Under-Staging on the Long-term Survival of Patients Undergoing Radical Gastrectomy for Gastric Cancer: Mi Lin, Qi-Yue Chen, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Chang-Ming Huang; Cancer Res Treat. 2021;53(4):1123-1133. Published online March 5, 2021; DOI: https://doi.org/10.4143/crt.2020.651

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Purpose
This study aimed to evaluate the effect of preoperative tumor staging deviation (PTSD) on the long-term survival of patients undergoing radical gastrectomy for gastric cancer (RGGC).
Materials and Methods
Clinicopathological data of 2,346 patients who underwent RGGC were retrospectively analyzed. The preoperative tumor-lymph node-metastasis (TNM) under-staging group (uTNM) comprised patients who had earlier preoperative TNM than postoperative TNM, and the no preoperative under-staging group (nTNM) comprised the remaining patients.
Results
There were 1,031 uTNM (44.0%) and 1,315 nTNM cases (56.0%). Cox prognostic analysis revealed that PTSD independently affected the overall survival (OS) after surgery. The 5-year OS was lower in the uTNM group (41.8%) than in the nTNM group (71.6%). The patients less than 65 years old, with lower American Society of Anaesthesiologists score, 2-5 cm tumor located at the lower stomach, and cT1 or cN0 preoperative staging would more likely undergo D1+ lymph node dissection (LND) in uTNM (p < 0.05). Logistic analyses revealed that tumor size > 2 cm and body mass index ≤ 22.72 kg/m2 were independent risk factors of preoperative TNM tumor under-staging in patients with cT1N0M0 staging (p < 0.05).
Conclusion
Underestimated tumor staging is not rare, which possibly results in inadequate LND and affects the long-term survival for patients undergoing RGGC. D2 LND should be carefully performed in patients who are predisposed to this underestimation.

Citations

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Long-term Survival after Surgical Resection for Liver Metastasis from Gastric Cancer: Two Case Reports: Jong Keun Lim, Joong Bae Ahn, Sung Ha Cheon, Hyun Chang, Jong Yul Jung, Sun Young Rha, Jae Kyung Roh, Sung Hoon Noh, Ho Geun Kim, Hyun Cheol Chung, Hei-Cheul Jeung; Cancer Res Treat. 2006;38(3):184-188. Published online June 30, 2006; DOI: https://doi.org/10.4143/crt.2006.38.3.184

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Surgical resection of colorectal cancer metastasis to the liver results in a 5-year survival rate of around 40%. Liver metastasis from other cancers such as neuroendocrine carcinoma and genitourinary tumors are also treated effectively with combined liver resection. However, hepatic metastasectomy for liver tumor from gastric cancer hasn't been considered as a standard treatment, and the benefit for this treatment has not been established. We report here on two cases of gastrectomy and combined liver resection for synchronous liver metastasis without any evidence of other metastatic lesions, and these two patients have survived for more than 7 years without evidence of disease recurrence. In conclusion, for patients with hepatic metastasis from gastric cancer, combined surgical resection of the liver metastasis should be considered as a treatment option when metastasis to other sites can be excluded.

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Radical gastrectomy with hepatoarterial catheter implantation for late-stage gastric cancer
Guo-Liang Yao
World Journal of Gastroenterology.2015; 21(9): 2754. CrossRef

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What is the Proper Management for Stage 4 Gastric Cancer ?: Chang Hak Yoo, Sung Hoon Noh, Yong Il Kim, Jin Sik Min, Kyung Shik Lee; J Korean Cancer Assoc. 1996;28(5):860-868.

Abstract PDF: Among 2118 patients with gastric cancer who had undergone gastric resection in the Department of Sursery, Yonsei University College of Medicine over the 7 years period from January 1987 to December 1993, there were 214(10.l%) with stage IV gastric cancer, designated as a lesion with factors such as direct invasion of adjacent organs(T factor), tertiary or quaternary nodal involvement(N factor), peritoneal metastasis(P factor) or hepatic metastasis(H factor). The overall 5-year survival rate in patients with stage IV gastric cancer after gastric resection was 11.3%. The 5-year survival rate in patients without distant metastasis(n=122) was 17.5%, being significantly higher than the 4.4% in cases with distant metastasis(n=92). Patients with tertiary nodal involvement or directly invaded organs alone survived at a rate of 23.8% and 10.2% in the 5-year follow-up, respectively. Signifi cant difference in 5-year survival rates were also noted in curability(curative resection:22.3 %, palliative resection: 5.1%) and type of operation(subtotal: 15.6%, total: 6.0%). But the mean survival time was less than 10months in patients with more than 2 factors in combination. In conclusion, there appear to be 2 subgroups in whom the rates of survival differ in stage IV gastric cancer according to distant metastasis. Therefore radical procedures such as extended lymphadenectomy and combined resection of invaded organ should be performed in M0 cases. On the other hand, in Ml cases, consideration and adaptation of new therapeutic approach except gastric resection will improve the survival and quality of life.

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