Proximal gastric cancer-time for organ-sparing approach?
Multimodal treatment
Neoadjuvant chemotherapy
Proximal gastrectomy
Proximal gastric cancer
Total gastrectomy
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: Netherlands
ID NLM: 9706084
Informations de publication
Date de publication:
12 Mar 2024
12 Mar 2024
Historique:
received:
26
01
2024
revised:
26
02
2024
accepted:
09
03
2024
medline:
28
3
2024
pubmed:
28
3
2024
entrez:
27
3
2024
Statut:
aheadofprint
Résumé
A steady increase in gastroesophageal junction and proximal gastric cancer (GC) incidence has been observed in the West. Given recent advances in neoadjuvant chemotherapy (NAC), we sought to characterize short- and long-term outcomes of patients with proximal GC who underwent total (TG) vs proximal gastrectomy (PG). Patients with stage II/III proximal GC who underwent curative-intent treatment between 2009 and 2019 were identified using National Cancer Database. Multivariable analysis was used to identify oncologic outcomes after TG vs PG. Among 7616 patients with GC who underwent surgical resection, PG and TG were performed on 5246 (68.8%) and 2370 patients (31.2%), respectively. Patients who underwent PG were more likely to receive NAC (TG 52.3% vs PG 64.5%) (P < .001). On pathologic analysis, patients who underwent TG were more likely to have pT4 tumors (TG 11.7% vs PG 3.1%), metastatic lymph nodes (LNs) (TG 64.6% vs PG 60.4%), and >16 LNs evaluated (TG 64.1% vs PG 53.1%), yet a lower likelihood of negative resection margins (TG 86.6% vs PG 90.0%) (all P < .001). Although gastrectomy procedure type did not affect long-term survival, receipt of NAC was associated with overall survival (OS) among patients who underwent TG (5-year OS, NAC 43.5% vs no NAC 24.6%) and PG (5-year OS, NAC 43.1% vs no NAC 26.7%) (both P < .001). PG may be an alternative surgical approach to TG in well-selected patients with proximal GC after administration of preoperative systemic chemotherapy.
Sections du résumé
BACKGROUND
BACKGROUND
A steady increase in gastroesophageal junction and proximal gastric cancer (GC) incidence has been observed in the West. Given recent advances in neoadjuvant chemotherapy (NAC), we sought to characterize short- and long-term outcomes of patients with proximal GC who underwent total (TG) vs proximal gastrectomy (PG).
METHODS
METHODS
Patients with stage II/III proximal GC who underwent curative-intent treatment between 2009 and 2019 were identified using National Cancer Database. Multivariable analysis was used to identify oncologic outcomes after TG vs PG.
RESULTS
RESULTS
Among 7616 patients with GC who underwent surgical resection, PG and TG were performed on 5246 (68.8%) and 2370 patients (31.2%), respectively. Patients who underwent PG were more likely to receive NAC (TG 52.3% vs PG 64.5%) (P < .001). On pathologic analysis, patients who underwent TG were more likely to have pT4 tumors (TG 11.7% vs PG 3.1%), metastatic lymph nodes (LNs) (TG 64.6% vs PG 60.4%), and >16 LNs evaluated (TG 64.1% vs PG 53.1%), yet a lower likelihood of negative resection margins (TG 86.6% vs PG 90.0%) (all P < .001). Although gastrectomy procedure type did not affect long-term survival, receipt of NAC was associated with overall survival (OS) among patients who underwent TG (5-year OS, NAC 43.5% vs no NAC 24.6%) and PG (5-year OS, NAC 43.1% vs no NAC 26.7%) (both P < .001).
CONCLUSION
CONCLUSIONS
PG may be an alternative surgical approach to TG in well-selected patients with proximal GC after administration of preoperative systemic chemotherapy.
Identifiants
pubmed: 38538476
pii: S1091-255X(24)00365-2
doi: 10.1016/j.gassur.2024.03.017
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Karol Rawicz-Pruszyński is a scholar of the Polish National Agency For Academic Exchange Franciszek Walczak program, which allowed conducting this study as a Research Fellow at the Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, OH. The other authors declare no competing interests.