Evaluation of the recurrence pattern of gastric cancer after laparoscopic gastrectomy with D2 lymphadenectomy
Tóm tắt
The aim of this study was to analyze the oncological aspects of gastric cancer following laparoscopic gastrectomy with D2 lymphadenectomy (LG-D2). We retrospectively evaluated the long-term outcomes of 354 patients who underwent LG-D2 for primary gastric cancer. Recurrence patterns and predictors of peritoneal metastasis were analyzed. Median follow-up time was 43.8 months. Five-year overall survival rates for yp/pStages I, II, and III gastric cancer were 93.7, 78.5, and 42.2 %, respectively. Recurrence was observed in 86 patients. Peritoneal metastasis was the most frequent recurrence pattern (n = 51), followed by hepatic metastasis (n = 17). Lymphatic recurrence at distant sites was observed in 10 patients. No locoregional lymph node metastasis or local recurrence was seen. Nine of 51 cases of peritoneal recurrence were detected by probe laparoscopy. Peritoneal recurrence rates were significantly higher in yp/pT4 and yp/pN3 diseases compared with yp/pT ≤ 3 and yp/pN ≤ 2 diseases. Multivariate analyses demonstrated that yp/pT4, yp/pN3, tumor size ≥70 mm, vascular invasion, and undifferentiated tumors were predictors of peritoneal recurrence following LG-D2. Long-term outcomes of gastric cancer following LG-D2, including recurrence patterns and predictors of peritoneal metastasis, were comparable to those following open D2 gastrectomy. LG-D2 showed good local control. Probe laparoscopy after LG may be effective in detecting peritoneal recurrence, which is not determined with less invasive examinations, including a CT scan. Future large-scale prospective studies are desirable to evaluate not only surgical but also oncological benefits and safety of LG-D2 for advanced gastric cancer.
Tài liệu tham khảo
Aoyama T, Yoshikawa T, Hayashi T, Kuwabara H, Mikayama Y, Ogata T et al (2012) Risk factors for peritoneal recurrence in stage II/III gastric cancer patients who received S-1 adjuvant chemotherapy after D2 gastrectomy. Ann Surg Oncol 19:1568–1574
Cai J, Wei D, Gao CF, Zhang CS, Zhang H, Zhao T (2011) A prospective randomized study comparing open versus laparoscopy-assisted D2 radical gastrectomy in advanced gastric cancer. Dig Surg 28:331–337
D’Angelica M, Gonen M, Brennan MF, Turnbull AD, Bains M, Karpeh MS (2004) Patterns of initial recurrence in completely resected gastric adenocarcinoma. Ann Surg 240:808–816
Degiuli M, Sasako M, Ponti A (2010) Morbidity and mortality in the Italian Gastric Cancer Study Group randomized clinical trial of D1 versus D2 resection for gastric cancer. Br J Surg 97:643–649
Huang YL, Lin HG, Yang JW, Jiang FQ, Zhang T, Yang HM et al (2014) Laparoscopy-assisted versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer: a meta-analysis. Int J Clin Exp Med 7:1490–1499
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A et al (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237
Im WJ, Kim MG, Ha TK, Kwon SJ (2012) Tumor size as a prognostic factor in gastric cancer patient. J Gastric Cancer 12:164–172
Isobe Y, Nashimoto A, Akazawa K, Oda I, Hayashi K, Miyashiro I et al (2011) Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry. Gastric Cancer 14:301–316
Japanese Gastric Cancer Association (2011a) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112
Japanese Gastric Cancer Association (2011b) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123
Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M et al (2010) JCOG Gastric Cancer Surgical Study Group. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244
Kim SJ, Kim HH, Kim YH, Hwang SH, Lee HS, Park do J et al (2009) Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer. Radiology 253:407–415
Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W et al (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420
Kim KH, Kim MC, Jung GJ, Kim HH (2012) Long-term outcomes and feasibility with laparoscopy-assisted gastrectomy for gastric cancer. J Gastric Cancer 12:18–25
Kitano S, Iso Y, Moriyama M, Suqimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148
Lee CM, Jee YS, Lee JH, Son SY, Ahn SH, Park do J et al (2014a) Length of negative resection margin does not affect local recurrence and survival in the patients with gastric cancer. World J Gastroenterol 20:10518–10524
Lee JH, Son SY, Lee CM, Ahn SH, Park do J, Kim HH (2014b) Factors predicting peritoneal recurrence in advanced gastric cancer: implication for adjuvant intraperitoneal chemotherapy. Gastric Cancer 17:529–536
Maruyama K, Kaminishi M, Hayashi K, Isobe Y, Honda I, Katai H et al (2006) Japanese Gastric Cancer Association Registration Committee. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer 9:51–66
Nakauchi M, Suda K, Kadoya S, Inaba K, Ishida Y, Uyama I (2015) Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study. Surg Endosc. 2015 Dec 24. [Epub ahead of print]. PMID: 26703126
Otsuji E, Kuriu Y, Ichikawa D, Okamoto K, Ochiai T, Hagiwara A et al (2004) Time to death and pattern of death in recurrence following curative resection of gastric carcinoma: analysis based on depth of invasion. World J Surg 28:866–869
Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A et al (2007) ACTS-GC Group. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 357:1810–1820
Sasako M, Sano T, Yamamoto S, Kurokawa Y, Nashimoto A, Kurita A et al (2008) Japan Clinical Oncology Group. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med 359:453–462
Shim JH, Yoo HM, Lee HH, Kim JG, Jeon HM, Song KY et al (2011) Use of laparoscopy as an alternative to computed tomography (CT) and positron emission tomography (PET) scans for the detection of recurrence in patients with gastric cancer: a pilot study. Surg Endosc 25:3338–3344
Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J et al (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294
Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomized nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449
Suda K, Man-I M, Ishida Y, Kawamura Y, Satoh S, Uyama I (2015) Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc 29:673–685
Tajima Y, Yamazaki K, Nishino N, Morohara K, Yamazaki T, Kaetsu T et al (2004) Gastric and intestinal phenotypic marker expression in gastric carcinomas and recurrence pattern after surgery-immunohistochemical analysis of 213 lesions. Br J Cancer 91:1342–1348
Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Soga R et al (1999a) Completely laparoscopic extraperigastric lymph node dissection for gastric malignancies located in the middle or lower third of the stomach. Gastric Cancer 2:186–190
Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A (1999b) Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer 2:230–234
Yoshimura F, Inaba K, Kawamura Y, Ishida Y, Taniguchi K, Isogaki J et al (2011) Clinical outcome and clinicopathological characteristics of recurrence after laparoscopic gastrectomy for advanced gastric cancer. Digestion 83:184–190
Zeng YK, Yang ZL, Peng JS, Lin HS, Cai L (2012) Laparoscopy-assisted versus open distal gastrectomy for early gastric cancer: evidence from randomized and nonrandomized clinical trials. Ann Surg 256:39–52
Zou ZH, Zhao LY, Mou TY, Hu YF, Yu J, Liu H et al (2014) Laparoscopic vs open D2 gastrectomy for locally advanced gastric cancer: a meta-analysis. World J Gastroenterol 20:16750–16764