LONG-TERM SURVIVAL DIFFERENCES IN GASTRIC CANCER

S.T. Makkai-Popa, T. Frunza, V. Porumb, N. Velenciuc, C. Roata, G.M. Dimofte

Second Surgical Clinic, Regional Institute for Oncology, Iasi

Introduction

Songun I1, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439-49. 9.

Materials and method

Patients operated on for gastric cancer with a curative intent by a single surgeon

Exclusion criteria: Patients lost to follow-up Patients with incomplete medical records – e.g. missing

pathology reports

Compare the survival between this group of patients and a previous group of 143 patients operated on between January 1996 and December 2001, from a point of view of type of lymphadenectomy and type of resection

SPSS version 17 for Windows – ANOVA – 5% significance level

Results

47 cases operated on between January 1999 and September 2013

Age: 64 ± 17,5 years Sex: 27 (57,44%) male and 20 (42,55%) females Mean survival: 39,19 ± 32,29 months Average number of harvested lymph nodes: 26,31 ± 12,15

nodes (9 – 64 nodes) Average number of positive nodes: 6,89 ± 8,8 nodes (0 – 31

nodes) Splenectomy was performed in 9 cases

Results

15%

26%60%

Location of the tumor

ProximalMid thirdDistal third

75%

21%2% 2%

Complications associated with the tumor

No complicationsStenosisBleedingBoth

Results

15%

85%

Type of lymphadenectomy

D1D2

45%

55%

Types of gastrectomies

TotalSubtotal

89%

2%

4% 2%2%

Postoperative compli-cations

No complicationsPostoperative bleed-ingDuodenal stump fis-tulaAnastomotic oedemaPleural effusion

Results

11%

26%

51%

13%

pT stagespT1pT2pT3pT4

28%

26%30%

17%

pN stagespN0pN1pN2pN3

15%

36%47%

2%

Degree of dif -ferentiationWell differen-

tiatedModerately dif -ferentiatedPoorly differen-tiatedUndifferen-tiated

43%

32%

26%

Comparison between the cN and pN stages

Same N stageUnderestimated N stageOverestimated N stage

60%23%

17%

Comparison between the cT and pT stages

Same T stageUnderestimated T stageOverestimated T stage

Results

p < 0,001 P =0,004

Results

0 10 20 30 40 50 600

10

20

30

40

50

60

70

80

90

100

Survival of the pacient groups at given points in time

D1 D2 D2_new

p < 0,001, F = 12,85

Results

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 560

10

20

30

40

50

60

70

80

90

100

Survival of the pacient groups at given points in time

R1 R2 Laparo R0_new

p < 0,001, F = 10,09

Discussion

Discussion

Songun I1, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439-49. 9.

Discussion

Discussion

Schwarz RE1, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2007;14(2):317-28.

Discussion

Discussion

“Biology is King. Selection is Queen. Technical maneuvers are the Prince and Princess. Occasionally the Prince and Princess try to overthrow the powerful forces of the King and Queen, sometimes with temporary apparent victories, usually to no long term avail.”

Conclusion

Our study – statistically significant difference between our study group and a previous study group depending on the type of lymphadenectomy

No clear consensus on D2 vs D1 lymphadenectomy – WHY?

RCTs which uniformly define interventions and outcomes

Spleen and pancreas preserving surgery – decreased morbidity