Gastric Cancer Research Articles

Postprandial gastrin-17 level is a useful dynamic marker for atrophic gastritis

Atrophic gastritis and intestinal metaplasia may progress to gastric malignancy. Non-invasive serum biomarkers have been extensively studied and proven to be useful as a screening tool to stratify risk and identify patients for endoscopy to detect early gastric cancer. These non-invasive biomarkers have been endorsed and recommended by many international consensus guidelines. In this letter, we reviewed the literature and evidence supporting the use of serum biomarkers as a dynamic test to monitor the status of atrophic gastritis.

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

Current clinical trials on gastric cancer surgery in China

Current clinical trials on gastric cancer surgery in China

Prognostic value of neutrophil-to-lymphocyte ratio in gastric cancer patients undergoing neoadjuvant chemotherapy: A systematic review and meta-analysis

Prognostic value of neutrophil-to-lymphocyte ratio in gastric cancer patients undergoing neoadjuvant chemotherapy: A systematic review and meta-analysis

ASO Author Reflections: Stage IB Gastric Cancer: More Attention Needed

ASO Author Reflections: Stage IB Gastric Cancer: More Attention Needed

OGC SO46 - Gastric Cancer: A Comprehensive Literature Review

Abstract Background Gastric cancer stands as a significant global health concern with high mortality rates urging urgent attention. This article comprehensively explores the epidemiology, anatomy, risk factors, pathophysiology, clinical presentation, diagnosis, staging, treatment modalities, prevention strategies, and survival rates associated with gastric cancer. Notably, Helicobacter pylori infection, dietary choices, and intricate stomach anatomy play pivotal roles in disease development. Early detection, utilizing staging, grading, and genetic testing for personalized treatment approaches is emphasized. Treatment modalities encompass surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention strategies involve lifestyle changes, and genetic counseling. Survival rates vary by stage, highlighting the need for individualized care. Method This comprehensive review was conducted by systematically analyzing a wide range of published literature on gastric cancer. The search strategy involved utilizing electronic databases such as PubMed, Google Scholar, and Scopus, with specific keywords including "gastric cancer," "stomach cancer," "epidemiology," "anatomy," "risk factors," "pathophysiology," "diagnosis," "treatment modalities," "prevention," and "survival rates." Results Risk Factors: Factors such as Helicobacter pylori infection, dietary choices, tobacco use, and genetic predispositions contribute to gastric cancer risk. Pathophysiology: Genetic alterations, chronic inflammation, and dysregulated signaling pathways drive the development of gastric cancer. Clinical Presentation: Symptoms vary & diagnosis involves a combination of methods, including endoscopy and molecular profiling. Treatment Modalities: Treatment options include surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention Strategies: Prevention efforts focus on minimizing risk factors through lifestyle changes, screening, and genetic counseling. Survival Rates: Survival rates vary significantly by stage, ranging from 90-95% for stage 0 to less than 5% for stage IV Conclusion The intricate anatomy of the stomach plays a crucial role in disease localization, staging, and treatment planning, with genetic mutations and inflammation central to the pathophysiology. Early detection is underscored through clinical presentation and diagnosis processes, utilizing staging, grading, and genetic testing for personalized treatment approaches, including surgery, chemotherapy, radiation therapy, targeted therapy, and immunotherapy. Prevention strategies emphasize lifestyle changes and screening, while survival rates vary by stage, underscoring the need for individualized care. In conclusion, addressing gastric cancer requires a collaborative effort to reduce its impact and enhance outcomes on a global scale.

BS SO17 - Large Bowel Occlusion as a Manifestation of Gastric Adenocarcinoma in a Patient with Previous Gastric Bypass

Abstract Background Gastric bypass surgery has become one of the hallmarks of the treatment of obesity and metabolic syndrome. Over the last decade, an increasing number of gastric cancer cases have been reported following gastric bypass, particularly in the excluded stomach. The anatomical changes and the difficult access to the excluded stomach via endoscopy hinder the diagnosis and treatment of this cancer. Method Literature review and clinical case analysis through clinical records and exam results. Results A 59-year-old male with a history of gastric bypass 15 years prior was admitted to the emergency department with bowel occlusion. A CT scan revealed colonic obstruction due to invasion by a neoplastic/inflammatory process. Consequently, a right hemicolectomy was performed. Histopathological analysis revealed infiltration of the colonic wall by poorly cohesive gastric carcinoma cells. A follow-up CT scan confirmed a lesion in the excluded stomach. A LAMS (lumen-apposing metal stent) was placed to repermeabilize the excluded stomach, and biopsies confirmed gastric mixed adenocarcinoma. A gastroduodenal stent was placed for antropyloric stenosis. A multidisciplinary team opted for palliative chemotherapy. Conclusion The association between bariatric surgery and gastric cancer remains controversial. As described in previous studies, this clinical case demonstrates that gastric adenocarcinoma in patients who underwent gastric bypass often presents as an aggressive and advanced-stage disease. Given the mortality associated with gastric cancer and the increasing number of bariatric surgeries, this case report highlights the important need to develop patient selection protocols for gastric bypass and respective appropriate follow-up.

Abstract B075: Detection of early gastric carcinoma by micronuclei DNA from erythrocytes

Abstract Background: Advancements in non-invasive diagnostic technologies for gastric carcinoma (GC), including serum microRNA and cell-free DNA assays, have shown promise but still face challenges in achieving consistent early detection. Micronuclei (MN), extranuclear bodies harboring fragmented chromosomal segments, are indicative of genomic instability and have been employed in genotoxicity assessments and cancer diagnostics. We have developed a novel technique (WO2021/228246 A1) for the purification and characterization of micronuclei DNA (MN-DNA) extracted from erythrocytes in peripheral blood. Here, we evaluated the potential of micronuclei DNA (MN-DNA) from 2ml peripheral blood for early gastric carcinoma detection and explored its application for early cancer diagnosis. Methods: We assembled a clinical cohort consisting of 425 healthy donors (HDs) and 282 gastric cancer patients, from whom 1-2 mL peripheral blood samples were collected. Participants were randomly allocated into training, validation, and independent test cohorts in a 7:2:1 ratio, ensuring similar distributions of cancer stages and gender. MN-DNA was isolated from erythrocytes and subjected to comprehensive whole-genome sequencing. Predictive machine learning models were constructed utilizing distinct tumor-associated MN-DNA features identified through genome-wide analysis to distinguish between HDs and GC. Results: Comprehensive genome-wide analysis of MN-DNA demonstrated pronounced disparities in distribution patterns between HDs and GC patients. The predictive model built on MN-DNA features achieved an AUC of 97.69% (95%CI: 95.57- 99.81%), with an 96.47% specificity and 91.07% sensitivity in the independent test cohort. The model identified early GC (stage 0-I) and advanced GC (stage II-IV) with sensitivities of 95.24% or 78.57%, respectively. Conclusions: Our results demonstrate that MN-DNA from 1-2mL peripheral blood enable accurate detection of GC, especially in early GC. As a type of cytoplasmic DNA, MN-DNA can provide a valuable tool for early cancer detection, offering different underlying mechanisms compared to current methods. Research sponsor: Timing Biotech. Citation Format: Yuehua Han, Xingyun Yao, Haobo Sun, Cheng Fang, Peiwei Li, Honghao Liang, Jie Jin, Xiaofei Gao. Detection of early gastric carcinoma by micronuclei DNA from erythrocytes [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr B075.

Dysregulation of deubiquitinases in gastric cancer progression

Gastric cancer (GC), characterized by a high incidence rate, poses significant clinical challenges owing to its poor prognosis despite advancements in diagnostic and therapeutic approaches. Therefore, a comprehensive understanding of the molecular mechanisms driving GC progression is crucial for identifying predictive markers and defining treatment targets. Deubiquitinating enzymes (DUBs), also called deubiquitinases, function as reverse transcriptases within the ubiquitin-proteasome system to counteract protein degradation. Recent findings suggest that DUB dysregulation could be a crucial factor in GC pathogenesis. In this review, we examined recent research findings on DUBs in the context of GC, elucidating their molecular characteristics, categorizations, and roles while also exploring the potential mechanisms underlying their dysregulation in GC. Furthermore, we assessed the therapeutic efficacy of DUB inhibitors in treating malignancies and evaluated the prevalence of aberrant DUB expression in GC.

OGC O05 - Utilising patient derived organoids to predict the response to treatment in gastric cancer

Abstract Background Gastric adenocarcinoma remains a significant global health burden. For advanced disease, treatment remains multi-modal with neoadjuvant chemotherapy followed by resectional surgery. Although the FLOT4-AIO trial has established the regimen of 5-fluorauracil, Leucovorin, Oxaliplatin and Docetaxel (FLOT) as the gold standard, some patients demonstrate a poor or no response to treatment, resulting in adverse oncological outcomes. Currently there are no accurate biomarkers to assess or predict the treatment response to neoadjuvant therapy. This study aims to explore the potential of patient-derived organoids as a predictive model to assess the treatment response to neoadjuvant chemotherapy in gastric adenocarcinoma. Method Patient derived organoids are a novel, 3 dimensional in-vitro model which recapitulates the different cells that constitute the tissue of origin. From June 2023 to June 2024, 25 patients with a confirmed diagnosis of gastric adenocarcinoma, were recruited for tissue acquisition for organoid generation. Endoscopic biopsies of cancer tissue taken during OGD and staging laparoscopy were used to generate organoids from each patient. Organoids were subsequently expanded to a sufficient volume to allow cytotoxicity assays in response to different doses of the FLOT regimen. The organoid cytotoxicity response was compared to the patients radiological and pathological response following treatment. Results Organoids were successfully generated from 76% of recruited patients (n=19). Of these, 4 patients and were excluded due to being unfit for neoadjuvant chemotherapy, whilst 2 were excluded due to the confirmation of metastatic disease, precluding neoadjuvant treatment. Finally a single patient was excluded due to mortality during neoadjuvant treatment. Of the remaining organoids, 5 were subjected to FLOT treatment within 2 weeks of tissue acquisition. Organoids demonstrated unique dose response profiles following with statistically significant differences in the IC50 values (p =0.048). The organoid responses corresponded to the clinical responses demonstrated by the patient they were derived from. Conclusion In conclusion, this study underscores the potential of patient-derived cancer organoids as a predictive model for assessing the response to neoadjuvant chemotherapy in gastric adenocarcinoma. The generation of organoids from a significant proportion of patients and the subsequent drug response testing within 2 weeks of tissue acquisition suggests this novel method has the potential to become a valuable tool for predicting patient-specific responses and guiding personalised treatment plans. As such, further research is warranted to further assess the validity of this model, refine the existing techniques and explore its potential integration into clinical practice.

OGC SO34 - Textbook Outcome in Gastric Cancer Elective Surgery: A multicentre analysis

Abstract Background Textbook outcome (TO) is a composite measure of surgical outcomes that, when collectively achieved, depict the optimal result for the patient. Multidimensional parameters, like TO offer a in depth picture of hospital performance, by combining multiple indicators. While an increasing number of studies are evaluating TO in cancer, its application for gastric cancer is still a recent advance. Since surgical reality differs worldwide, a common language is essential when setting outcome goals. This study aims to assess TO accomplishment in several hospital typologies that offer curative-intent resections for gastric cancer. Method A prospective observational multi-institutional audit and 90 day follow-up included data from 138 institutions, in 47 countries. This is a preliminary analysis with focus on TO. Adult patients who underwent elective gastric cancer resection with curative intent, between April 1st and September 30th, 2022, were included. Textbook Outcome (TO) was achieved when all the following seven criteria were met: complete resection (R0), more than 15 lymph nodes sampled, discharge before 21 days, no mortality, no severe morbidity (Clavien–Dindo over 2), no reintervention and no readmission within 90 days post-operative. Results A total of 380 collaborators submitted data on 1538 patients. The mean age was 64.2 years and 58.5% were males. A total of 734 (48%) from the included 1538 patients, achieved TO. “No reintervention in 90 days” was registered in 92% of patients. “No morbidity in 90 days” was observed in 71%. “More than 15 lymph nodes sampled" was achieved in only 79%. The 90-day morbidity and mortality rates were 38.2% (n=587) and 2.9% (n=45), respectively. Conclusion This study demonstrates that achieving Textbook Outcome in gastric cancer resection is seldom attainable. A significant variability across the different outcome parameters within the participating centres was expected. The high rates of mortality-free and reintervention-free outcomes express an effective postoperative care. The lower rates of adequate lymph node sampling and morbidity-free outcomes indicate areas for improvement. Further research should focus on standardizing protocols and improving specific surgical practices to enhance overall TO rates in gastric cancer patients, among the hospital typologies and geographic locations, included in this study.

Interplay of circular RNAs in gastric cancer - a systematic review

Circular RNAs (circRNAs) have gained prominence as important players in various biological processes such as gastric cancer (GC). Identification of several dysregulated circRNAs may serve as biomarkers for early diagnosis or as novel therapeutic targets. Predictive models can suggest potential new interactions and regulatory roles of circRNAs in GCs. Experimental validations of key interactions are being performed using in vitro models, confirming the significance of identified circRNA networks. The aim of this review is to highlight the important circRNAs associated with GC. On top of that an overview of the mechanistic details of the biogenesis and functionalities of the circRNAs are also presented. Furthermore, the potentialities of the circRNAs in the field of new drug discovery are deciphered.

A novel platelets-related gene signature for predicting prognosis, immune features and drug sensitivity in gastric cancer

BackgroundPlatelets can dynamically regulate tumor development and progression. Nevertheless, research on the predictive value and specific roles of platelets in gastric cancer (GC) is limited. This research aims to establish a predictive platelets-related gene signature in GC with prognostic and therapeutic implications.MethodsWe downloaded the transcriptome data and clinical materials of GC patients (n=378) from The Cancer Genome Atlas (TCGA) database. Prognostic platelets-related genes screened by univariate Cox regression were included in Least Absolute Shrinkage and Selection Operator (LASSO) analysis to construct a risk model. Kaplan-Meier curves and receiver operating characteristic curves (ROCs) were performed in the TCGA cohort and three independent validation cohorts. A nomogram integrating the risk score and clinicopathological features was constructed. Functional enrichment and tumor microenvironment (TME) analyses were performed. Drug sensitivity prediction was conducted through The Cancer Therapeutics Response Portal (CTRP) database. Finally, the expression of ten signature genes was validated by quantitative real-time PCR (qRT-PCR).ResultsA ten-gene (SERPINE1, ANXA5, DGKQ, PTPN6, F5, DGKB, PCDH7, GNG11, APOA1, and TF) predictive risk model was finally constructed. Patients were categorized as high- or low-risk using median risk score as the threshold. The area under the ROC curve (AUC) values for the 1-, 2-, and 3-year overall survival (OS) in the training cohort were 0.670, 0.695, and 0.707, respectively. Survival analysis showed a better OS in low-risk patients in the training and validation cohorts. The AUCs of the nomogram for predicting 1-, 2-, and 3-year OS were 0.708, 0.763, and 0.742, respectively. TME analyses revealed a higher M2 macrophage infiltration and an immunosuppressive TME in the high-risk group. Furthermore, High-risk patients tended to be more sensitive to thalidomide, MK-0752, and BRD-K17060750.ConclusionThe novel platelets-related genes signature we identified could be used for prognosis and treatment prediction in GC.

OGC SO20 - Audit of the guidelines for staging laparoscopy in gastro-oesophageal cancers

Abstract Background Staging laparoscopy and peritoneal washings form part of surgical work up of oesopheageal and gastric cancers. Peritoneal washings help to identify microscopic disease, the presence of which drastically alters prognosis. This audit looks at the adherence to staging laparoscopy guidelines introduced, and the intraoperative finding. Method Staging laparoscopy and peritoneal washings form part of surgical work up of oesophageal and gastric cancers. Peritoneal washings help to identify microscopic disease, the presence of which drastically alters prognosis. This audit looks at the adherence to staging laparoscopy guidelines introduced, and the intraoperative finding. Results Two hundred and twenty-seven patients were identified. Two patients did not have washings performed due to the extent of their disease, which was appropriate. The remaining patients had washings performed. Twelve patients had washings performed but not in line with policy. In all cases a clinical reason was found. Overall twelve patients had positive cytology from the washings. Of those that had washings, forty-one patient’s had T1/T2 disease and one hundred and eight-four patients had T3/T4 disease. All cytology positive patients had T3/T4 stage disease. Conclusion Two hundred and twenty-seven patients were identified. Two patients did not have washings performed due to the extent of their disease, which was appropriate. The remaining patients had washings performed. Twelve patients had washings performed but not in line with policy. In all cases a clinical reason was found. Overall twelve patients had positive cytology from the washings. Of those that had washings, forty-one patient’s had T1/T2 disease and one hundred and eight-four patients had T3/T4 disease. All cytology positive patients had T3/T4 stage disease

OGC SO21 - Role of Staging Laparoscopy on oesophageal and junctional cancer management

Abstract Background Staging laparoscopy and peritoneal cytology is currently recommended as a staging tool required for oesophageal and gastro-oesophageal junction (OGJ) adenocarcinomas. However, evidence is variable regarding the utility of this investigation, leading to heterogenous practice in the UK. With improved staging sensitivity of CT and PET imaging and inclusion of routine MDT discussion for upper GI cancer patients, staging laparoscopy may not be necessary for all patients with oesophago-gastric cancer, and in fact may delay their treatment. We thus aimed to assess the impact of staging laparoscopy on the treatment algorithm of patients with oesophago-gastric cancer. Method All staging laparoscopies undertaken between January 2022 and March 2024 were identified from our surgical database. Patients were included if they had oesophago-gastric adenocarcinoma, with a plan for curative treatment. Data collected included age, gender, location of primary tumour, CT/PET staging, laparoscopy findings, impact on treatment intention, neoadjuvant treatment, and final histology. Primary outcome was incidence of positive microscopic or macroscopic peritoneal disease for oesophageal and OGJ malignancy. Results 127 patients were identified - 69 (55%) oesophageal, 25 (20%) GOJ, and 32 (24.4%) gastric cancer. 1/70 (1.4%) patient diagnosed endoscopically with oesophageal cancer had positive peritoneal disease, which was suspected due to pre-operative imaging findings of ascites and suspicions of linitis plastica. Of patients diagnosed with GOJ cancer, 4/25 patients (16%) had peritoneal disease present. None of the 39 patients with oesophageal/junctional tumours with clinical T1-2 disease were found to have peritoneal disease on staging laparoscopy. 6/32 (19%) patients with gastric cancer were found to have unexpected peritoneal disease present. Conclusion This study found minimal impact staging laparoscopy has on the management of primary oesophageal cancers. Consideration can be made of limiting staging in oesophageal cancer to patients with suspicious findings on CT/PET imaging. For GOJ tumours, there may be a role for limiting staging laparoscopy for Siewert 1 tumours to T3/4 tumours based on CT/PET findings. Importantly, accurate identification on primary endoscopy of the location of the tumour in relation to the gastro-oesophageal junction is necessary to help guide ongoing management.

OGC O01 - Stomach Cancer Elective Surgery Morbidity and Mortality at 90-Days (HOLD Study): A Prospective, International Collaborative Cohort Study

Abstract Background Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors. Method We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome. Results 380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45). Pre-operative higher CCI or ASA score, pre-operative weight loss >10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value<0.05) were identified as predictors of postoperative severe complications and mortality. Conclusion Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes.

OGC SO31 - Treatment of cachexia in gastric cancer: A literature review exploring the use of natural anti-inflammatory products and their derivatives

Abstract Background Gastric cancer is a major cause of global cancer-related mortality, with 5-year survival rates of 7% in advanced disease. Cancer cachexia, characterised by irreversible skeletal muscle loss driven by systemic inflammation, contributes to approximately 20% of cancer-related deaths. Cachexia differs from malnutrition in that it cannot be fully reversed with nutritional support alone. Current treatments that focus on nutritional support, psychological counselling and anti-inflammatory medication are lacking in efficacy. Natural dietary supplements and their derivatives such as fatty acids, probiotics, amino acids, curcumin, ginger and resveratrol, may offer additional therapeutic benefits in managing gastric cancer cachexia. Method A comprehensive literature review was conducted to evaluate the efficacy of natural anti-inflammatory products in managing gastric cancer cachexia. The review focused on widely studied compounds including omega-3 fatty acids, probiotics, amino acids, curcumin, fucoidan, epigallocatechin-3-gallate (EGCG), resveratrol and ginger, assessing their impact on inflammation, muscle mass preservation, and overall patient outcomes. Results Natural anti-inflammatory compounds demonstrate efficacy in mitigating cancer cachexia by reducing systemic inflammation and muscle wasting. Essential fatty acids from nuts, seeds, and fish oil decrease pro-inflammatory cytokines and improve chemotherapy tolerance. Probiotics reduce gut dysbiosis and may enhance chemotherapy tolerance. Essential amino acids may promote muscle anabolism and reduce catabolism. Curcumin, fucoidan, EGCG and ginger exhibit anti-inflammatory properties, with some improving appetite and reducing nausea. While promising, these compounds need further clinical trials to validate their efficacy and safety in cancer cachexia management. Conclusion Natural anti-inflammatory products hold promise as adjunctive therapies in management of gastric cancer cachexia. While preclinical evidence is encouraging, robust clinical trials are essential to confirm their efficacy and safety. Integrating these compounds with conventional treatments may offer a comprehensive approach to addressing the complex metabolic and inflammatory challenges of cancer cachexia, potentially improving patient outcomes. Future research should focus on understanding mechanisms, optimising dosages, and overcoming bioavailability challenges.

OGC SO22 - Accuracy of CT and FDG/PET clinical staging within a dedicated multidisciplinary service for patients with oesophago-gastric cancer

Abstract Background Accurate staging for oesophago-gastric cancer is important in ensuring correct treatment pathways, avoiding unnecessary surgery and providing prognostication for patients. Previously, cross sectional imaging in accurately providing tumour (T) and nodal (N) staging has been variable for upper GI malignancies, with usage of invasive investigations such as EUS to provide more specific local staging. With the increased utilisation of specialist multidisciplinary involvement and improved technology, we aimed to assess whether CT and PET imaging may be able to provide sufficiently accurate staging required for treatment decision making. Method All patients who underwent oesoophagogastric resections between January 2022 and March 2024 were identified from our surgical database. Patients were included if they had oesophago-gastric cancer, and underwent curative resection without neo-adjuvant treatment. Data collected included age, gender, location of primary tumour, CT/PET staging, and final histology. Outcomes assessed included rate of understaging in clinical and pathological T and N staging, and sensitivity and specificity of imaging in identifying presence of nodal disease. Results 38 patients were included in this analysis. For oesophageal and GOJ cancers, T stage under-reporting occurred in 6/27 (22%) patients, and N under-reporting in 7/27 (27%) patients. Radiological staging correlated with final pathological staging in 55% of T staging and 59% of N staging. Sensitivity (55.56%, 95% CI 21-86%) and specificity (72.2%, 95% CI 46.5-90.3%) for nodal disease on CT/PET was low, however no tumour or nodal under-staging would have impacted management. Gastric cancer staging accuracy assessment was limited by small numbers (n=12), however T under-staging occurred in 5/12 (42%) patients and N under-staging occurred in 5/11 patients (45%). Conclusion Involvement of dedicated radiology services in multidisciplinary care for oesophago-gastric cancer provides adequate radiological staging to guide treatment. Gastric cancer clinical staging requires laparoscopic and endoscopic assessment for accurate tumour assessment and management guidance. Radiological under-staging is less common in oesophageal and GOJ tumours than gastric cancer and has minimal impact on patient management.

MS O07 - OGC ‘Textbook Outcome’ for Gastrectomy: Redefining a Valid Composite Measure Assessment Tool for Surgical Performance in a Specialist Unit within the United Kingdom

Abstract Background A ten-item composite measure defining ‘textbook outcome’ (TBO) following oesophagogastric cancer surgery was proposed to benchmark surgical quality. While subsequent studies have demonstrated an association between TBO and improved survival, the reported proportion of patients who meet all the required criteria remained consistently low. Postoperative complications of Clavien-Dindo grade ≥2 (CD≥2) commonly preclude TBO, despite evidence that minor complications are unlikely to influence long-term outcomes. This study aimed to assess whether modification of TBO parameters to Clavien-Dindo grade ≥3 (CD≥3) is associated with improved overall survival in patients undergoing gastric cancer surgery within an UK specialist unit. Method Consecutive patients who underwent a surgical resection for gastric cancer, at a single tertiary centre between January 2016 and December 2019, were identified from a prospectively maintained regional database. Patients were included irrespective of (neo)adjuvant treatments. Data collected included clinicopathological characteristics, treatment modalities and postoperative outcomes. Comparisons were drawn between patients who met all the parameters defining TBO and those who did not, using both CD≥2 and CD≥3 classifications for ‘major’ complications. The primary outcome of interest was overall survival. Results Sixty-seven patients (median 70 years, 61.2% male) underwent resection for gastric cancer during this study. Of these, 27 patients (40.3%) achieved TBO based on a CD≥2 complication grading and 38 patients (56.7%) when CD≥3 was used. Clinicopathological characteristics were all comparable between TBO groups based on both cut-offs. Improved overall survival was evident with a CD≥3 TBO (p=0.026), however not with CD≥2 TBO (p=0.430). Following adjustment for confounding variables, CD≥3 TBO remained associated with improved overall survival (HR: 0.30 (95% CI: 0.10-0.93), p=0.037) while CD≥2 TBO was not (HR: 0.64 (95% CI: 0.21-1.93), p=0.428). Conclusion Textbook outcome is a multi-parameter metric for benchmarking quality in gastric cancer surgery. Modification of the complications parameter required for TBO to CD≥3 in our patient population resulted in a stronger association with overall survival amongst patients undergoing surgical resection for gastric cancer.

Early gastric adenocarcinoma with enteroblastic differentiation diagnosed synchronously with a conventional gastric adenocarcinoma

Early gastric adenocarcinoma with enteroblastic differentiation diagnosed synchronously with a conventional gastric adenocarcinoma