WHAT DID WE LEARN IN SURGICAL TREATMENT OF GASTRIC ADENOCARCINOMA: COMPARISON OF TWO PERIODS

  • Stojan Potrč Oddelek za abdominalno in splošno kirurgijo Učna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Rajko Kavalar Oddelek za patološko morfologijo Učna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Tine Hajdinjak Oddelek za urologijo Učna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Matjaž Horvat Oddelek za abdominalno in splošno kirurgijo Učna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Damjan Vidovič Oddelek za abdominalno in splošno kirurgijo Učna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Maja Šturm Oddelek za abdominalno in splošno kirurgijo Učna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Arpad Ivanecz Oddelek za abdominalno in splošno kirurgijo Učna bolnišnica Maribor Ljubljanska 5 2000 Maribor
  • Eldar Gadžijev Oddelek za abdominalno in splošno kirurgijo Učna bolnišnica Maribor Ljubljanska 5 2000 Maribor
DOI: https://doi.org/10.6016/ZdravVestn.2294
Keywords: gastric cancer, gastrectomy, learning curve

Abstract

Background. In January 1992 a standardized and more radical surgical approach in gastric cancer treatment as well as standardized pathohistological workup of specimens was started in our institution. The aim of our retrospectively designed study was to evaluate results of this work for the 10 year period.

Methods. We compared the results of two chronologically subsequent groups of altogether 402 patients who underwent a total or subtotal gastrectomy for gastric cancer (period A: 166 patients operated in a period between 1992 and 1996; period B: 236 patients operated in a period between 1997 and 2001).

Results. The two groups of patients were comparable with regard to age, gender, general condition of the patient and proportion of potentially curable (R0) resections. There was significant difference between the groups with regard to type of operation (more total gastrectomies in period B), extend of lymphadenectomy (more D2 and D3 in period B), average number of examined nodes (higher in period B) and to the UICC stage (less stage II in period B). Incidence of surgical complications (15.6% vs. 18.7%) and average hospital stay were not significantly different between the two groups (14.72 days vs. 14.70 days). The 5-year survival calculated according to Kaplan-Meier for all patients with R0 and R2 resections together was 30.3% and was 39.1% for the group of R0 resected patients. In patients with UICC stage I–IIIa and R0 resection the 5-year survival was significantly higher in period B (59.9%) than in period A (40.6%) (p = 0.0197).

Conclusions. Comparison of two chronologically subsequent groups of patients shows that after a definite period of systematical surgical work improvements of results set in, and are reflecting in the present study in higher number of extracted lymph nodes, in higher number of total gastrectomies and in higher 5-year survival for stages Ia, Ib, II and IIIa in the period B.

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References

Karpeh MS Jr, Brennan MF. Gastric carcinoma. Ann Surg Oncol 1998; 5: 650–6.

Gall FP, Hermanek P. New aspects in the surgical treatment of gastric carcinoma – a comparative study of 1636 patients operated on between 1969 and 1982. Eur J Surg Oncol 1985; 11: 219–25.

Jähne J, Piso P, Meyer HJ. 1114 total gastrectomies in the surgical treatment of primary gastric adenocarcinoma – a 30-year single institution experience. Hepato-Gastroenterol 2001; 48: 1222–6.

Patino JF. The current management of gastric cancer. Adv Surg 1994; 27: 1– 19.

Weed TE, Nuessle W, Ochsner A. Carcinoma of the stomach. Why are we failing to improve survival. Ann Surg 1981; 193: 407–13.

Bunt TM, Bonenkamp HJ, Hermans J et al. Factors influencing noncompliance and contamination in a randomised trial of »Western« (r1) versus »Japanese« (r2) type surgery in gastric cancer. Cancer 1994; 73: 1544–51.

Bonenkamp JJ, Songun I, Hermans J et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995; 345: 745–8.

Cuschieri A, Fayers P, Fielding J V et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 1996; 347: 995–9.

Wanebo HJ, Kennedy BJ, Winchester DP, Fremgen A, Stewart AK. Gastric carcinoma: does lymph node dissection alter survival? J Am Coll Surg 1996; 183: 616–24.

Siewert JR, Bottcher K, Roder JD, Busch R, Hermanek P, Meyer HJ. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg 1993; 80: 1015–8.

Fass J, Schumpelick V. Principles of radical surgery in gastric carcinoma. Hepatogastroenterology 1989; 36: 13–7.

Siewert JR, Böttcher K, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study. Ann Surg 1998; 228: 449–61.

Gouzi JL, Huguier M, Fagniez PL et al. Total versus subtotal gastrectomy for adenocarcinoma of the gastric antum. A French prospective controlled study. Ann Surg 1989; 209: 162–6.

Sasako M. Risk factors for surgical treatment in the Dutch gastric cancer trial. Br J Surg 1997; 84: 1567–71.

Žakelj B. Standardna R0 resekcija. In: Kirurgija želodca: zbornik simpozija, Ljubljana 1995. Ljubljana: Klinični center, Kirurške klinike, Kirurška šola, 1995: 113–5.

Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal type carcinoma. Acta Pathol Microbiol Scand 1965; 64: 31–49.

Lehnert T, Kienle P, Maksan S, Herfarth C. Standardresektion und Lymphadenektomie beim Magenkarzinom. Chirur Gastroenterologie 1999; 15: 227– 36.

Sobin LH, Wittekind C. TNM classification of malignant tumours. Wiley-Liss, 1997.

Roder JD, Bottcher K, Busch R, Wittekind C, Hermanek P, Siewert JR. Classification of regional lymph node metastasis from gastric carcinoma (German Gastric Cancer Study Group). Cancer 1998; 82: 621–31.

Jelenc F, Repše S, Omejc M, Juvan R. Sistematična limfadenektomija. In: Kirurgija želodca: zbornik simpozija, Ljubljana 1995. Ljubljana: Klinični center, Kirurške klinike, Kirurška šola, 1995: 116–20.

Wittekind C. Pathologie des Magenkarzinoms: Typing, Grading und Staging. Chirur Gastroenterologie 1999; 15: 216–22.

Barash P, Cullen B, Stoelting R. Preoperative evaluation. In: Fleisher L. Clinical anesthesia. 3th ed. Philadelphia – New York: Lippincott-Raven, 1996: 444–4.

Kaplan EL, Meier P. Non parametric estimation from incomplete observation. J Am Stat Assoc 1958; 53: 457–81.

Cox DR. Regression models and life-tables. JR Stat Soc B 1972; 34: 187–220.

Shiu MH, Moore E, Sanders M et al. Influence of the extent of resection on survival after curative treatment of gastric carcinoma: a rectrospective multivariate analysis. Arch Surg 1987; 122: 1347–51.

Smith JW, Brennan MF. Surgical treatment of gastric cancer. Surg Clin North Am 1992; 72: 381–99.

Püspök A, Ferenci P. Magenkarzinom: Epidemiologie, Risikofaktoren und Rolle der Ehrnährung. Chirur Gastroenterologie 1999; 15: 211–4.

Jatzko G, Bittner R. Chirurgische Therapie des Magenkarzinoms. Chirur Gastroenterologie 1999; 15: 210–0.

Jatzko G, Pertl A, Jagoditsch M. Chirurgische Therapie und Ergebnisse beim Magenfrühkarzinom. Chirur Gastroenterologie 1999; 15: 223–6.

Bunt AM, Hermans J, Smit VT, van de Velde CJ, Fleuren GJ, Bruijn JA. Surgical/pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol 1995; 13: 19–25.

Jähne J, Meyer HJ, Maschek H, Geerlings H, Burns E, Pichlmayr R. Lymphadenectomy in gastric carcinoma. A prospective and prognostic study. Arch Surg 1992; 127: 290–4.

Bozzetti F, Marubini E, Bonfanti G et al. Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. The Italian Gastrointestinal Tumor Study Group. Ann Surg 1997; 226: 613–20.

Allgayer H, Heiss MM, Schildberg FW. Prognostic factors in gastric cancer. Br J Surg 1997; 84: 1651–64.

How to Cite
1.
Potrč S, Kavalar R, Hajdinjak T, Horvat M, Vidovič D, Šturm M, Ivanecz A, Gadžijev E. WHAT DID WE LEARN IN SURGICAL TREATMENT OF GASTRIC ADENOCARCINOMA: COMPARISON OF TWO PERIODS. TEST ZdravVestn [Internet]. 1 [cited 5Aug.2024];73(4). Available from: http://vestnik-dev.szd.si/index.php/ZdravVest/article/view/2294
Issue
Vol 73 No 4 (2004): April
Section
Professional Article


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