Title

Is there a role for surgery with adequate nodal evaluation alone in gastric adenocarcinoma

UMMS Affiliation

Department of Surgery

Date

2-2012

Document Type

Article

Medical Subject Headings

Adenocarcinoma; Adolescent; Adult; Aged; Chemoradiotherapy, Adjuvant; Chemotherapy, Adjuvant; Cohort Studies; Female; *Gastrectomy; Humans; Kaplan-Meier Estimate; *Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Multivariate Analysis; Neoplasm Staging; Proportional Hazards Models; Registries; Retrospective Studies; Stomach Neoplasms; Survival Rate; Treatment Outcome; Young Adult

Disciplines

Oncology | Surgery

Abstract

INTRODUCTION: The extent of lymphadenectomy and protocol design in gastric cancer trials limits interpretation of survival benefit of adjuvant therapy after surgery with adequate lymphadenectomy. We examined the impact of surgery with adequate nodal evaluation alone on gastric cancer survival.

METHODS: Using 2001-2008 California Cancer Registry, we identified 2,229 patients who underwent gastrectomy with adequate nodal evaluation (>/=15 lymph nodes) for American Joint Committee on Cancer stage I-IV M0 gastric adenocarcinoma. Cox proportional hazard analyses were used to evaluate the impact of surgery alone on survival.

RESULTS: Nearly 70% of our cohort had T1/2 tumors and 29% had N0 disease. Forty-nine percent of the cohort underwent surgery alone. These patients were more likely to be older, Medicare-insured, with T1 and N0 disease. On unadjusted analyses, persons who underwent surgery alone for stage I or N0 disease experienced 1- and 3-year overall and cancer-specific survival comparable to those who received adjuvant therapy. On multivariate analyses for stage I or N0 disease, surgery alone predicted superior survival outcomes than when combined with adjuvant therapies.

CONCLUSION: Surgery alone with adequate nodal evaluation may have a role in low-risk gastric cancer. To corroborate these findings, surgery with adequate lymphadenectomy alone (as treatment arm) deserves consideration in the design of gastric cancer trials to provide effective yet resource-conserving, rather than maximally tolerated, treatments.

Comments

Citation: J Gastrointest Surg. 2012 Feb;16(2):238-46; discussion 246-7. Epub 2011 Nov 17. Link to article on publisher's site

Related Resources

Link to Article in PubMed