Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy: results from a European randomized clinical trial.
Lymph node distribution
Minimally invasive gastrectomy
Survival
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
09 2023
09 2023
Historique:
received:
31
03
2023
accepted:
02
07
2023
medline:
31
8
2023
pubmed:
20
7
2023
entrez:
19
7
2023
Statut:
ppublish
Résumé
Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy. This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined. A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients). No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186). The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7-12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024). No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low.
Sections du résumé
BACKGROUND
Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy.
METHODS
This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined.
RESULTS
A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients). No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186). The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7-12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024).
CONCLUSION
No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low.
Identifiants
pubmed: 37468751
doi: 10.1007/s00464-023-10278-5
pii: 10.1007/s00464-023-10278-5
pmc: PMC10462494
doi:
Banques de données
ClinicalTrials.gov
['NCT02130726']
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
7317-7324Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. The Author(s).
Références
Front Oncol. 2020 Feb 12;10:123
pubmed: 32117770
Br J Surg. 2010 May;97(5):643-9
pubmed: 20186890
Gastric Cancer. 2023 Jan;26(1):1-25
pubmed: 36342574
Gastric Cancer. 2019 Jul;22(4):853-863
pubmed: 30483985
J Am Coll Surg. 2017 Apr;224(4):546-555
pubmed: 28017807
J Clin Oncol. 2005 Oct 1;23(28):7114-24
pubmed: 16192595
Ann Surg Oncol. 2021 Jan;28(1):133-141
pubmed: 33067746
Trials. 2015 Mar 27;16:123
pubmed: 25873249
Ann Surg. 2021 Feb 1;273(2):315-324
pubmed: 33064386
Gastric Cancer. 2021 Jan;24(1):258-271
pubmed: 32737637
Br J Surg. 2015 Oct;102(11):1388-93
pubmed: 26313463
Surg Today. 2022 Nov;52(11):1515-1523
pubmed: 34686929
Br J Surg. 1998 Sep;85(9):1281-4
pubmed: 9752878
Lancet. 1995 Mar 25;345(8952):745-8
pubmed: 7891484
Lancet Oncol. 2010 May;11(5):439-49
pubmed: 20409751
JMIR Res Protoc. 2022 Apr 28;11(4):e35243
pubmed: 35482374
Ann Oncol. 2022 Oct;33(10):1005-1020
pubmed: 35914639
Ann Surg Oncol. 2022 Feb;29(2):1242-1253
pubmed: 34601642
Scand J Gastroenterol. 2018 Feb;53(2):185-192
pubmed: 29228846