Lokal ileri mide kanserlerinde en-blok multiorgan rezeksiyonu yapılan hastaların erken ve geç dönem sonuçları ve bu sonuçlara etki eden faktörler

Giriş ve Amaç: Bu çalışmanın amacı, yüksek volümlü bir merkezde lokal ileri mide kanseri nedeniyle opere edilen komşu organ invazyonu (cT4b) olan hastaların erken ve geç sonuçlarını incelemek ve sağkalımı etkileyen faktörleri araştırmaktır. Gereç ve Yöntem: 2015-2019 yılları arasında lokal ileri mide kanseri nedeniyle gastrektomi ve en-blok komşu organ rezeksiyonu yapılan hastalar çalışmaya dahil edildi. Bulgular: Klinik T4b tümörü nedeniyle mide kanseri nedeniyle ameliyat edilen 435 hastanın 54'üne radikal gastrektomi ve en-blok ek organ rezeksiyonu uygulandı. Tüm hastaların yaş ortalaması 61.87 ± 12.67 idi. Ortanca sağkalım 16.5 (1 - 72) ay olarak bulundu. 37 (%68.5) hastada birinci yıl sağkalım, 11 (%20.3) hastada üç yıllık sağkalım ve sadece 4 (%7.4) hastada beş yıllık sağkalım sağlandı. Uzun dönem sağkalımı etkileyen faktörlere bakıldığında postoperatif komplikasyonların sağkalımı anlamlı olarak etkilediği görüldü (p = 0.04). R1 rezeksiyon (p = 0.001), büyük tümör çapı (p = 0.02), lenfovasküler invazyon (p = 0.024) ve perinöral invazyon (p = 0.024) varlığının uzun dönem sağkalımı olumsuz etkilediğini bulduk. Sonuç: Klinik T4b mide kanserli hastalarda yeterli lenf nodu diseksiyonu ve komşu organla en-blok R0 rezeksiyonu uzun dönem sağkalım için önemlidir. Tümörün T-evresi ne olursa olsun cerrahi yapılmalıdır. Bu açıdan yeterli R0 rezeksiyon ile yapılan cerrahi, sağkalımı etkileyen bağımsız bir prognostik faktör olarak değerlendirilebilir. Uzun süreli sağkalımı etkileyen diğer faktörler, lenf nodu metastazı, tümör boyutu, ameliyat sonrası komplikasyonlar ve vasküler ve perinöral invazyondur.

Anahtar Kelimeler:

Lokal ileri mide kanseri, en-blok multiorgan rezeksiyonu, sonuçlar

Early and late outcomes of patients who underwent en-bloc multiorgan resection in locally advanced gastric cancer and factors affecting the result

Background and Aims: The aim of this study is to examine the early and late results of patients with adjacent organ invasion (cT4b) who were operated for locally advanced gastric cancer in a high-volume center and to investigate the factors affecting survival. Material and Methods: Patients who underwent gastrectomy and en-bloc adjacent organ resection due to locally advanced gastric cancer between 2015 and 2019 were included in the study. Results: Radical gastrectomy and en-bloc additional organ resection were performed in 54 patients out of 435 patients who were operated for gastric cancer due to clinical T4b tumors. The mean age of all patients was 61.87 ± 12.67years. The median survival was found to be 16.5 (1 - 72) months. First-year survival was achieved in 37 (68.5%) patients, three-year survival in 11 (20.3%) and five-year survival in only 4 (7.4%) patients. Considering the factors affecting long-term survival, it was seen that postoperative complications affected survival significantly (p = 0.04). We found that performing R1 resection (p = 0.001), large tumor diameter (p = 0.02), presence of lymphovascular invasion (p = 0.024) and presence of perineural invasion (p = 0.024) adversely affected long-term survival. Conclusion: Adequate lymph node dissection and en bloc R0 resection with adjacent organ are important for long-term survival in patients with clinical T4b gastric cancer. Surgery should be performed regardless of the T-stage of the tumor. In this respect, surgery performed with adequate R0 resection can be considered as an independent prognostic factor affecting survival. Other factors affecting long-term survival are lymph node metastasis, tumor size, post-operative complications, and vascular and perineural invasion.

Keywords:

Locally advanced gastric cancer, en-bloc multiorgan resection, results,

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1. Chun YS, Pawlik TM, Vauthey JN. 8th Edition of the AJCC Cancer Staging Manual: Pancreas and Hepatobiliary Cancers. Ann Surg Oncol 2018;25:845-7.
2. Pacelli F, Cusumano G, Rosa F, et al; Italian Research Group for Gastric Cancer. Multivisceral resection for locally advanced gastric cancer: an Italian multicenter observational study. JAMA Surg 2013;148:353-60.
3. Machairas N, Charalampoudis P, Molmenti EP, et al. The value of staging laparoscopy in gastric cancer. Ann Gastroenterol 2017;30:287-94.
4. Stewart C, Chao J, Chen YJ, et al. Multimodality management of locally advanced gastric cancer-the timing and extent of surgery. Transl Gastroenterol Hepatol 2019;4:42.
5. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24:1-21.
6. Zhang CD, Yamashita H, Seto Y. Gastric cancer surgery: historical background and perspective in Western countries versus Japan. Ann Transl Med 2019;7:493.
7. Ozer I, Bostanci EB, Orug T, et al. Surgical outcomes and survival after multiorgan resection for locally advanced gastric cancer. Am J Surg 2009;198:25-30.
8. Dias AR, Pereira MA, Oliveira RJ, et al. Multivisceral resection vs standard gastrectomy for gastric adenocarcinoma. J Surg Oncol 2020;121:840-7.
9. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017;20:1-19.
10. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-55.
11. GRADE: Baratti D, Kusamura S, Mingrone E, et al. Identification of a subgroup of patients at highest risk for complications after surgical cytoreduction and hyperthermic intraperitoneal chemotherapy; Ann Surg 2012;256:334-41.
12. Carboni F, Lepiane P, Santoro R, et al. Extended multiorgan resection for T4 gastric carcinoma: 25-year experience. J Surg Oncol 2005;90:95-100.
13. Brar SS, Seevaratnam R, Cardoso R, et al. Multivisceral resection for gastric cancer: a systematic review. Gastric Cancer 2012;15(Suppl 1):100-7.
14. Zhu Z, Gong Y, Xu H. Clinical and pathological staging of gastric cancer: Current perspectives and implications. Eur J Surg Oncol 2020;46:e14-9.
15. Bartoş A, Bartoş D, Dunca F, et al. Multi-organ resections for colorectal cancer: analysis of potential factors with role in the occurrence of postoperative complications and deaths. Chirurgia 2012;107:476-2.
16. Lehnert T, Methner M, Pollok A, et al. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 2002;235:217-25.
17. Martin RC 2nd, Jaques DP, Brennan MF, Karpeh M. Extended local resection for advanced gastric cancer: increased survival versus increased morbidity. Ann Surg 2002;236:159-65.
18. Yang Y, Hu J, Ma Y, Chen G, Liu Y. Multivisceral resection for locally advanced gastric cancer: A retrospective study. Am J Surg 2021;221:1011-7.
19. Mita K, Ito H, Katsube T, et al. Prognostic factors affecting survival after multivisceral resection in patients with clinical T4b gastric cancer. J Gastrointest Surg 2017;21:1993-9.
20. Molina JC, Al-Hinai A, Gosseling-Tardif A et al. Multivisceral resection for locally advanced gastric and gastroesophageal junction cancers-11-year experience at a high-volume North American Center. J Gastrointest Surg 2019;23:43-50.
21. Beeharry MK, Zhu ZL, Liu WT, et al. Prophylactic HIPEC with radical D2 gastrectomy improves survival and peritoneal recurrence rates for locally advanced gastric cancer: personal experience from a randomized case control study. BMC Cancer 2019;19:932. Erratum in: BMC Cancer 2019;19:1256.
22. Tran TB, Worhunsky DJ, Norton JA, et al. Multivisceral resection for gastric cancer: Results from the US Gastric Cancer Collaborative. Ann Surg Oncol 2015;22(Suppl 3):840-7.
23. van der Werf LR, Eshuis WJ, Draaisma WA, et al; Dutch Upper Gastrointestinal Cancer Audit (DUCA) group. Nationwide outcome of gastrectomy with en-bloc partial pancreatectomy for gastric cancer. J Gastrointest Surg 2019;23:2327-37.
24. Kasakura Y, Fujii M, Mochizuki F, Kochi M, Kaiga T. Is there a benefit of pancreaticosplenectomy with gastrectomy for advanced gastric cancer? Am J Surg 2000;179:237-42.
25. Fukuda N, Sugiyama Y, Wada J. Prognostic factors of T4 gastric cancer patients undergoing potentially curative resection. World J Gastroenterol 2011;17:1180-4.
26. Cheng CT, Tsai CY, Hsu JT, et al. Aggressive surgical approach for patients with T4 gastric carcinoma: promise or myth? Ann Surg Oncol 2011;18:1606-14.
27. Li MZ, Deng L, Wang JJ, et al. Surgical outcomes and prognostic factors of T4 gastric cancer patients without distant metastasis. PLoS One 2014;9:e107061.
28. Zhang X, Huang H, Wei Z, et al. Comparison of docetaxel + oxaliplatin + S-1 vs oxalipatin + S-1 as neoadjuvant chemotherapy for locally advanced gastric cancer: A propensity score matched analysis. Cancer Manag Res. 2020;12:6641-53.
29. Cunningham D, Allum WH, Stenning SP, et al, MAGIC Trial Participants. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006;355:11-20.
30. Yoshikawa T, Omura K, Kobayashi O, et al. A phase II study of preoperative chemotherapy with S-1 plus cisplatin followed by D2/D3 gastrectomy for clinically serosa-positive gastric cancer (JACCRO GC-01 study). Eur J Surg Oncol 2010;36:546-51.
31. Seevaratnam R, Bocicariu A, Cardoso R, et al. How many lymph nodes should be assessed in patients with gastric cancer? A systematic review. Gastric Cancer 2012;15(Suppl 1):S70-88.
32. Gholami S, Janson L, Worhunsky DJ, et al. Number of lymph nodes removed and survival after gastric cancer resection: An analysis from the US Gastric Cancer Collaborative. J Am Coll Surg 2015;221:291-9.
33. Kunisaki C, Akiyama H, Nomura M, et al. Surgical outcomes in patients with T4 gastric carcinoma. J Am Coll Surg 2006;202:223-30.
34. Xiao L, Li M, Xu F, et al. Extended multi-organ resection for cT4 gastric carcinoma: A retrospective analysis. Pak J Med Sci 2013;29:581-5.