P-0080 - Treatment outcome after D2 dissection in operable gastric cancer – a retrospective analysis
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Gastric Cancer
Surgery and/or Radiotherapy of Cancer
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
S. Gupta, S. Maitra, C. Goswami, M. Goenka, D. Ray, S. Saha
cancers is still a debatable issue. While D1 dissection is considered adequate in many centers, D2 dissection has been the standard of care in specialized centers in India. The other important controversy in gastric cancer management is sequencing of chemotherapy (with or without radiotherapy) with surgery. Objective of this retrospective review is to find the long term outcome after D2 dissection (followed by postoperative adjuvant chemotherapy) done in a tertiary cancer hospital in India, to analyze surgical results and patterns of failure.
A total of 112 gastric adenocarcinoma patients were taken up for surgery between 2003 and 2010 (including Siewert type III GEJ lesions). Pre-surgery work up included endoscopic biopsy and CT scan of abdomen & thorax. Endoscopic ultrasound was done in only 14. 82 operable patients underwent gastrectomy with D2 nodal dissection. Distal gastrectomy was carried out for antral and pyloric lesions, total gastrectomy for body lesions and esophagogastrectomy for Siewert III GEJ lesions. Node positive patients received post surgery chemotherapy with ECF and patients with R1 resection (positive C/M) received radiotherapy (IMRT) in addition to chemotherapy. Information related to surgical details, complications, duration of hospital stay, histopathology, adjuvant treatment and treatment outcomes were retrospectively analyzed.
Out of 112 patients (79 male and 33 female with median age of 58.5) 71 had disease in distal stomach, 17 in body, 4 in fundus and 20 at GE junction. 30/112 (26%) patients were found non resectable on laparoscopy prior to exploration, predominantly due to peritoneal disease. The analysis of pathological data of 82/112 resected patients revealed 7 patients had pT1 disease (8.5%), pT2 = 17 (20%), pT3 = 47 (57%) and pT4 = 11 (13.5%). 35% patients had pN3 disease. Stage wise breakup of the resected patients revealed Stage I= 22% Stage II = 33%, Stage III = 40%, Stage IV= 5%. Average nodal harvest was 29 (maximum= 80). 4/82 had a positive C/M and all of them received IMRT in addition to chemotherapy. All 4 suffered from local recurrence. PNI was recorded in 26/82 (31%). Surgical mortality was zero and major morbidity 8%. Median duration of hospitalization was 18 days. Regarding treatment outcome with a minimum duration of follow up of 3 years and a maximum of 10 years, 53/82 (64.6%) are alive disease free. Correlation of failure pattern with TNM established, on univariate analysis, that increasing nodal burden increased the risk of local recurrence whereas increasing T stage predisposed to systemic spread. Both univariate and multivariate analysis of 26 PNI positive patients failed to establish any correlation of PNI as an independent risk factor for recurrence.
D2 dissection with postoperative adjuvant chemotherapy is safe and effective for long term control, when done in specialized centres. Correlation of higher T stage with distant failure and higher N stage with local relapse, as indicated in this study, needs further assessment with more number of patients to gain statistical significance.