Extent Of Gastric Resection Research Articles

Complication After Gastrectomy for Gastric Cancer According to Hospital Volume: Based on Korean Gastric Cancer Association-Led Nationwide Survey Data.

This study aimed to analyze the incidence and risk factors of complications following gastric cancer surgery in Korea and to compare the correlation between hospital complications based on the annual number of gastrectomies performed. A retrospective analysis was conducted using data from 12,244 patients from 64 Korean institutions. Complications were classified using the Clavien-Dindo classification (CDC). Univariate and multivariate analyses were performed to identify the risk factors for severe complications. Postoperative complications occurred in 14% of the patients, severe complications (CDC IIIa or higher) in 4.9%, and postoperative death in 0.2%. The study found that age, stage, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) score, hospital stay, approach methods, and extent of gastric resection showed statistically significant differences depending on hospital volumes (P<0.05). In the univariate analysis, patient age, comorbidity, ASA score, ECOG score, approach methods, extent of gastric resection, tumor-node-metastasis (TNM) stage, and hospital volume were significant risk factors for severe complications. However, only age, sex, ASA score, ECOG score, extent of gastric resection, and TNM stage were statistically significant in the multivariate analysis (P<0.05). Hospital volume was not a significant risk factor in the multivariate analysis (P=0.152). Hospital volume was not a significant risk factor for complications after gastric cancer surgery. The differences in the frequencies of complications based on hospital volumes may be attributed to larger hospitals treating patients with younger age, lower ASA scores, better general conditions, and earlier TNM stages.

Reconstruction and functional results after gastric resection

Depending on the extent of gastric resection, namely total, proximal or distal gastrectomy, different methods of reconstruction are available. These reconstructive procedures have not changed with the implementation of minimally invasive or robotic techniques in general but the spectrum of possible anastomotic techniques has been substantially expanded. Functional, in particular nutritional disorders with subsequent impairment of the health-related quality of life, are often diagnosed after gastric resections. The partial preservation of agastric reservoir has apositive impact on the extent of these disorders. After total gastrectomy, the placement of ajejunal pouch significantly reduces the incidence of postoperative dumping symptoms. Following proximal gastrectomy, double-tract reconstruction offers certain functional advantages as compared to the simple Roux‑Y reconstruction. In Germany, these reconstructive techniques are only used to a low extent and should be include in the repertoire of oncological gastric surgery with appropriate indications.

The benefits of enhanced recovery after surgery for gastric cancer: A large before-and-after propensity score matching study

The benefits of enhanced recovery after surgery (ERAS) in patients undergoing gastrectomy have been reported in several studies; however, there is limited evidence supporting the efficacy of ERAS in clinical settings. We aimed to identify the benefits of ERAS in the clinical setting by investigating short-term surgical outcomes before and after the implementation of ERAS in patients who underwent gastrectomy. We searched our gastric cancer database from 2008 to 2018 to identify patients who underwent gastrectomy before ERAS was implemented (2008-2009) and after the final version of ERAS was implemented (2016-2018). We enrolled 424 patients who were treated before ERAS was implemented and 565 patients who received our completed version of ERAS. After propensity score matching, each group included 219 patients, and short-term surgical outcomes were compared between the two groups. The length of hospital stay was significantly shorter in the ERAS group (8.8 vs. 11.5 days, p=0.001), but the readmission rates were similar in the two groups, at 2.3%. There were no significant differences in morbidity, mortality, and complications of ≥ grade III between the groups. Of the complications, intra-abdominal bleeding (0% vs. 4.1%, p=0.002) and intra-abdominal abscess (0% vs. 2.7%, p=0.038) were significantly lower, whereas postoperative ileus was significantly higher in the ERAS group (8.6% vs. 0.5%, p<0.001). In subgroup analyses by age, operative approach, and the extent of gastric resection, the ERAS group experienced a shorter hospital stay without increased readmission in all subgroups. These results demonstrated that ERAS was associated with a 3-day reduction in hospital stay without increased readmission after gastrectomy. This study validated the benefits of ERAS in the clinical setting of gastrectomy.

Impact of the anatomical location and the number of metastatic lymph nodes on gastric cancer patient´s survival.

The most serious problem in surgical treatment of gastric cancer includes the area of resection and the extent of lymphadenectomy. The extent of gastric resection is determined by the extent of tumor affection. The aim of radical surgical intervention is to achieve microscopically clear resection line, since R0 resection is the main criterion for the patient´s prognosis. Curative surgical resection for gastric cancer includes the lymph nodes dissection. In the treatment of gastric cancer, there are two views on the importance of lymphadenectomy. The Far East considers that operation improves the survival and the Europe considers that surgery is not curative, but it determines the staging and prognosis. There is also a difference in staging systems. The one from East is importance based on the anatomical location of affected lymph nodes, the second from Europe is based on the number of positive lymph nodes. This work is a retrospective observational study. In the study cohort, comparing the survival of patients according to different classification systems, depending on the N-stage of disease, 119 patients with gastric adenocarcinoma in clinical stage I to III, i.e. without metastasis, who underwent a radical surgical resection with D2 lymphadenectomy, were enrolled. For the evaluation of the survival versus the time after operation, we used Kaplan‒Meier method. To evaluate the correlation between the survival rate and the explanatory variables, Cox regression and Kendall correlation coefficient were used. The median survival, according to different classification systems, depending on the N-stage of the disease, was significantly correlated with the survival for the 6th and 7th editions of TNM classification system for the Japanese classification system, for N-ratio classification system).The new finding was differentiation of patients in groups N1 vs N2 under the 6th TNM classification (HR=0.910249), also a little differentiation in groups N1 vs N2 according to the classification of N-ratio (HR=0.8750926) and equally a poor differentiation in the survival in groups N2 vs N3 according to the 7th TNM classification (HR=0.881797).The strongest correlation reached the Japanese classification system, but not significantly different from the 6th TNM classification system. In the 7th edition of TNM classification system, we then found the weakest correlation with the survival time, but not significantly different from the previous two. Our retrospective study confirmed the strongest correlation between the patient´s prognosis and the anatomic localization of the affected lymph nodes. This correlation was not statistically significant compared to the correlation between patient´s prognosis and the number of positive lymph nodes. It leads us to the conclusion that both classification systems are comparable and the difference is statistically insignificant (Tab. 4, Fig. 8, Ref. 16).

Short-Term Clinical Outcomes After Laparoscopic and Robotic Gastrectomy for Gastric Cancer: a Propensity Score Matching Analysis

BackgroundThe different advantages of laparoscopic gastrectomy (LG) and robotic gastrectomy (RG), two new minimally invasive surgical techniques for gastric cancer, remain controversial. PurposeTo compare the short-term clinical outcomes of LG and RG. MethodsA retrospective, single-center comparative study of 1044 patients (LG = 750, RG = 294) was conducted. Patients undergoing LG and RG were matched (2:1 ratio) according to sex, age, BMI, extent of gastric resection, and pathologic stage. The primary outcomes were morbidity and mortality and perioperative recovery parameters; major types of complications were also analyzed. ResultsAfter matching, 798 patients (LG = 532, RG = 266) were included. Both the LG and RG groups showed similar overall complication rates (LG = 12.8% vs RG = 12.4%) and operative mortality (LG = 0.4% vs RG = 0.4%). Compared to those who underwent LG, patients undergoing RG had significantly longer operative times (236.92±57.28 vs 217.77±65.00 min, p < 0.001), higher total costs (US$16,241.42 vs US$12,497, p < 0.001), less operative blood loss (77.07±64.37 vs 103.68±86.92 ml, p < 0.001), higher numbers of retrieved lymph nodes (32.0 vs 29.9, p < 0.001), and higher rates of retrieving more than 16 lymph nodes (94.0 vs 85.5%; p < 0.001). No significant differences between groups were noted in terms of the rate of reoperation, time until a soft diet was consumed, or length of hospital stay. The major complication and readmission rates were similar in both groups. ConclusionRG and LG produced similar short-term clinical outcomes, indicating that RG is a safe and beneficial surgical procedure.

Function-preserving gastrectomy for early gastric cancer based on Japanese researches

In the past, people only focused on surgical resection of gastric cancer to obtain satisfactory therapeutic effect, while the concept of function-preserving in gastric cancer surgery has not been emphasized. Gastric function-preserving surgery was originally performed by Japanese doctor Maki for surgical treatment of gastroduodenal ulcer. With the definition of early gastric cancer being accepted, the pylorus-preserving gastrectomy can be used continuously in the treatment of gastric cancer. Because of high incidence of early gastric cancer in Japan, a variety of application and research about function-preserving gastrectomy in other areas for treatment of early gastric cancer, such as proximal gastrectomy and jejunal interposition, segmental gastrectomy, gastric local resection and laparoscopic and endoscopic cooperative surgery (LECS) at the same time, and regional or sentinel lymph node dissection were performed for the purpose of radical cure. Function-preserving gastrectomy for the treatment of early gastric cancer should include four important factors: (1) decrease of the scope of gastrectomy; (2)retaining pylorus; (3)retaining vagus nerve; (4)regional or sentinel lymph node dissection. The technique of sentinel lymph node can reduce the extent of gastric resection, avoid distal gastrectomy or total gastrectomy, and make gastric resection more suitable for laparoscopic partial gastrectomy, segmental resection, pylorus-preserving gastrectomy and proximal gastrectomy. Function-preserving gastrectomy has the advantage of improving the quality of life and has great potential in the treatment of early gastric cancer. However, the various treatment methods including LECS need strict technical standardization for confirmation of oncology safety. We need careful design, prospective multicenter randomized controlled trials to provide theoretical and technical support.

Laparoscopy and endoscopy cooperative surgery for gastric tumor.

168 Background: Laparoscopic wedge resection is widely performed for managing gastric submucosal tumors (SMTs) that measure ≤5 cm in diameter. Laparoscopy and endoscopy cooperative surgery (LECS) is performed to ensure a sufficient margin while avoiding deformation or stenosis. Methods: We conducted a retrospective review of the data of 76 patients who underwent LECS for SMTs or early gastric cancers at our institution between April 2012 and July 2017. While Non-exposed Endoscopic Wall-inversion Surgery (NEWS) was performed for tumors with a major axis diameter of ≤5 cm and minor axis diameter of ≤3 cm, for other tumors, we adopted classical LECS or used the combination of laparoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET). Results: The tumor was located in the upper-/middle-/lower-third of the stomach in 49/20/7 cases. The mean operation time was 201.7 ± 66.2 min, and the mean blood loss was 4.7 ± 12.8 ml. The mean tumor size was 28.6 ± 11.6 mm. The histological tumor types included GIST (n = 38), leiomyoma (n = 14), schwannoma (n = 6), early gastric cancer (n = 8) and others (n = 10). The surgical procedure consisted of classical LECS/CLEAN-NET/NEWS in 17/15/44 cases; all early gastric cancers were treated by NEWS. The mean length of postoperative hospital stay was 8.7 ± 3.9 days. The mean serum levels of C-reactive protein on POD1 and POD3 were 3.2 ± 1.9 and 4.4 ± 3.4 mg/dl, respectively. The postoperative complications were anastomotic stenosis (n = 1), delayed gastric emptying (n = 3), pneumonia (&gt;Grade II by the Clavien-Dindo classification) (n = 1) and exacerbation of GERD (&gt;Grade II by the Clavien-Dindo classification) (n = 3). In the patient group that developed complications, the postoperative resumption of water intake was later, and the postoperative hospital stay was longer as compared to the group without complications (p = 0.04, 0.028). No relationship was observed between the likelihood of development of complications and the tumor location. Conclusions: Use of minimally invasive surgical procedures such as LECS could minimize the extent of gastric resection without deformation, stenosis. We consider that for surgical complications the LECS approach can be employed, regardless of the tumor location.

Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

Gastric adenocarcinoma is one of the most common and lethal cancers worldwide and is associated with a high frequency of nodal metastasis. The value of multimodality therapy is well established, but gastric resection and locoregional lymph node dissection are important mainstays in potentially curative therapy. However, there has been considerable regional variation in surgical approach and debate regarding the ideal extent of gastric resection, gastric reconstruction, and extent of lymphadenectomy. This review outlines the current evidence in the surgical management of gastric adenocarcinoma. The advent of minimally invasive approaches to gastric operations is also discussed. This review contains 4 figures, 7 tables, and 50 references. Key words: gastrectomy, gastric cancer, lymphadenectomy, lymph node, lymph node staging, stomach

Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

Gastric adenocarcinoma is one of the most common and lethal cancers worldwide and is associated with a high frequency of nodal metastasis. The value of multimodality therapy is well established, but gastric resection and locoregional lymph node dissection are important mainstays in potentially curative therapy. However, there has been considerable regional variation in surgical approach and debate regarding the ideal extent of gastric resection, gastric reconstruction, and extent of lymphadenectomy. This review outlines the current evidence in the surgical management of gastric adenocarcinoma. The advent of minimally invasive approaches to gastric operations is also discussed. This review contains 4 figures, 7 tables, and 50 references. Key words: gastrectomy, gastric cancer, lymphadenectomy, lymph node, lymph node staging, stomach

Surgical treatment of gastric cancer: then and now

Gastric cancer is one of the most commonly diagnosed cancers found in the world (980,000 new cases in 2008), but its treatment outcomes are poor, particularly in the European Union (EU); only a 25% survival after 5 years. Despite advances made in combination therapy, the only effective treatment that remains is surgery. The extent of gastric resection and lymphadenectomy, along with reconstruction methods, have systematically evolved over the last 100 years. This paper discusses both present day recommendations and the pathways that were taken enabling modern gastric surgery to develop.

The impact of the extent of gastric resection on advanced gastric cancer treated with systemic chemotherapy.

194 Background: In previous clinical trials of adjuvant chemotherapy for gastric cancer, severe toxicity and discontinuation of chemotherapy was more common in patients receiving total gastrectomy (TG) than in those with distal gastrectomy (DG). However, data on the significance of the extent of gastric resection for stage IV gastric cancer treated with systemic chemotherapy are not available. Methods: This is a retrospective review of patients who were received chemotherapy with S-1 and cisplatin for stage IV gastric cancer at our institution between June 2009 and August 2015. The patients were classified into three groups according to the extent of gastrectomy (TG, DG and no gastric resection (NG)) before chemotherapy. Patient characteristics, survival and toxicities of chemotherapy were compared between three groups. Results: Among the 83 patients, 24 underwent TG, 19 DG, and 40 NG. Patient characteristics were well balanced between three groups. There was no significant difference in the requirement for dose reduction between TG, DG and NG patients (29% vs 11% vs 20%, respectively, p= 0.32). However, the rate of discontinuation because of toxicity was significantly higher in TG than in DG or NG patients (46% vs 16% vs 25%, respectively, p= 0.04). The main reasons of discontinuation were anorexia (43%), myelosuppression (23%), nausea (18%) and diarrhea (16%). The median progression-free survival was 8.9, 6.1 and 5.3 months ( p= 0.25), and the median overall survival was 16.0, 16.0 and 9.8 months ( p= 0.40) in the patients with TG, DG and NG, respectively. Conclusions: There was a high frequency of discontinuation of systemic chemotherapy in the advanced gastric cancer patients who underwent TG, but it was not associated with prognosis.

Complications and failure to rescue following laparoscopic or open gastrectomy for gastric cancer: a propensity-matched analysis.

To investigate the incidence of and factors associated with postoperative complications and failure to rescue following laparoscopic and open gastrectomy for gastric cancer. We analyzed the records of 4124 patients who underwent a laparoscopic or open gastrectomy for gastric cancer. One-to-one propensity score matching was performed to compare the difference between the two groups. A total of 4124 patients were included in the study, 627 of whom (15.2%) developed postoperative complications. Postoperative deaths occurred in 23 (0.6%) patients with serious complications. In the propensity score matching analysis with 1361 pairs, no significant differences in the rates of overall complications (14.2 vs. 16.5%, p=0.093) were observed between laparoscopic and open gastrectomy group. In-hospital mortality decreased in patients who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy (0.3 vs. 1.2%, p=0.004). Failure to rescue rates were lower in patients who underwent laparoscopic gastrectomy (2.1 vs. 7.6%, p=0.008). Multivariate analysis showed that older age, tumor location, TNM stage classification, extent of gastric resection, operative time and intra-operative blood loss were adverse risk factors for postoperative complications. Laparoscopic gastrectomy was found to be a protective factor for failure to rescue. Complications associated with failure to rescue included abdominal bleeding, anastomotic leakage and cardiac events. In-hospital mortality increased as the number of complications per patient increased. Assuming equal competence with open and laparoscopic approaches of a surgeon, the proportion of patients with postoperative complications were similar among those who underwent laparoscopic gastrectomy compared to patients who underwent open gastrectomy. However, when complications occurred, patients with open gastrectomy were more likely to die.

Patterns and Predictors of Weight Loss After Gastrectomy for Cancer.

Weight loss following gastrectomy for patients with gastric cancer has not been well characterized. We assessed the impact of patient and procedure-specific variables on postoperative weight loss following gastrectomy for cancer. A prospectively maintained gastric cancer database identified patients undergoing gastrectomy for cancer. Clinical and pathologic characteristics, baseline body mass index (BMI), and postoperative weights were extracted. Change in weight was analyzed by percent change in weight and absolute change in BMI. Random coefficients models were used to test whether the rate of change in weight over time differed by factors of interest. Of 376 consecutive patients who underwent resection for gastric adenocarcinoma, 55% were male, median age 66years, and mean preoperative BMI 27.1 (range 16.2-45.6). Total gastrectomy was associated with more weight loss than subtotal gastrectomy at 1year (15 vs. 6%, early stage; 17 vs. 7%, late stage). Maximum weight change was observed at 6-12months after operation and remained stable or improved at 2years. For early- and late-stage patients, median percent weight loss at 1year was greater for BMI≥30 versus BMI<30 (14 vs. 8%, early stage; 15 vs. 9%, late stage). The extent of weight loss after gastrectomy for gastric cancer is dependent on preoperative BMI and extent of gastric resection. Maximum weight change is expected by 12months after operation and will stabilize or improve over time.

Early Postoperative Intraperitoneal Chemotherapy for Macroscopically Serosa-Invading Gastric Cancer Patients

PurposePeritoneal recurrence is one of the most common patterns of recurrence after gastric cancer surgery and it has a poor prognosis despite all efforts. The aim of this study is to evaluate the prognostic impact of early postoperative intraperitoneal chemotherapy (EPIC) after surgery with curative intent for macroscopically serosa-invading gastric cancer patients.Materials and MethodsThe records of 245 patients under the age of 70 were reviewed. These patients were suffering from macroscopically seroa-invading gastric cancer and they underwent curative surgery from 1995 to 2004 at the Kyungpook National University Hospital, Daegu, Korea. The overall survival, gastric cancer-specific survival, complications, and patterns of recurrence were compared between the patients who were treated with EPIC and those who were not.ResultsEPIC was administered to 65 patients, and the remaining 180 patients did not receive this treatment. The 5-year overall and gastric cancer-specific survival rates for the EPIC group were 47.4% and 53.1%, respectively, and those for the non-EPIC group were 26.7% and 29.7%, respectively (p=0.012 for overall survival and p=0.011 for gastric cancer-specific survival). The rates of peritoneal recurrence for the EPIC group and the non-EPIC group were 18.5% and 32.2%, respectively (p=0.038). There were no significant differences in the morbidity or mortality between the two groups. Based on a multivariate analysis of the factors with prognostic significance in univariate analyses, EPIC, pathological lymph node metastasis, differentiation, and the extent of gastric resection were independent prognostic factors.ConclusionThe use of EPIC to treat gastric cancer patients with macroscopic serosal invasions resulted in better survival rate by reducing the risk of peritoneal recurrence.

Prognostic Factors for Gastrectomy in Elderly Patients

The decision to undergo surgery for gastric cancer patients aged ≥85 years should be made carefully. We retrospectively reviewed the prognostic factors of gastrectomy for 64 patients aged ≥85 years who had undergone curative gastrectomy for gastric cancer. The effects of various clinical characteristics and surgical interventions on survival were retrospectively analyzed. Univariate analysis revealed that sex (male/female; P = 0.001), the extent of gastric resection (total/distal; P = 0.028), the extent of lymph node dissection (D2/<D2; P = 0.019), and blood loss (P = 0.005) were significant prognostic factors for overall survival. Multivariate analysis demonstrated that sex was the only independent prognostic factor. For pneumonia-specific survival, sex was also the only prognostic factor by multivariate analysis.Prognoses of males aged ≥85 years after gastrectomy were significantly worse than those of females, as they were more likely to die of pneumonia.

Subtotal gastrectomy for gastric cancer

Although a steady decline in the incidence and mortality rates of gastric carcinoma has been observed in the last century worldwide, the absolute number of new cases/year is increasing because of the aging of the population. So far, surgical resection with curative intent has been the only treatment providing hope for cure; therefore, gastric cancer surgery has become a specialized field in digestive surgery. Gastrectomy with lymph node (LN) dissection for cancer patients remains a challenging procedure which requires skilled, well-trained surgeons who are very familiar with the fast-evolving oncological principles of gastric cancer surgery. As a matter of fact, the extent of gastric resection and LN dissection depends on the size of the disease and gastric cancer surgery has become a patient and "disease-tailored" surgery, ranging from endoscopic resection to laparoscopic assisted gastrectomy and conventional extended multivisceral resections. LN metastases are the most important prognostic factor in patients that undergo curative resection. LN dissection remains the most challenging part of the operation due to the location of LN stations around major retroperitoneal vessels and adjacent organs, which are not routinely included in the resected specimen and need to be preserved in order to avoid dangerous intra- and postoperative complications. Hence, the surgeon is the most important non-TMN prognostic factor in gastric cancer. Subtotal gastrectomy is the treatment of choice for middle and distal-third gastric cancer as it provides similar survival rates and better functional outcome compared to total gastrectomy, especially in early-stage disease with favorable prognosis. Nonetheless, the resection range for middle-third gastric cancer cases and the extent of LN dissection at early stages remains controversial. Due to the necessity of a more extended procedure at advanced stages and the trend for more conservative treatments in early gastric cancer, the indication for conventional subtotal gastrectomy depends on multiple variables. This review aims to clarify and define the actual landmarks of this procedure and the role it plays compared to the whole range of new and old treatment methods.

A Comparison of Quality of Life and Nutritional Status after Gastrectomy in Korean Gastric Cancer Patient

The purpose of this study was to evaluate QoL (quality of life) and nutritional status after surgery in 222 patients with gastric cancer during followup duration. Malnutrition status was 67.7% at 6 months postoperatively and nutritional satus improved as time went on (p&lt;0.001). In the survey of the nutrient intake, malnutrition group showed significantly lower intake of energy, protein, phosphorous, sodium, potassium, zinc, niacin, folic acid. The QoL mean score of malnutrition group was 22.3 ±14.6 and normal group was 17.2±11.8(p&lt;0.001). Malnutrition group experienced worse QoL in eating restrictions (p&lt;0.001), anxiety (p&lt;0.001), taste problem (p&lt;0.01), and hair loss (p&lt;0.001). After postoperatively, also showed a trend to experience worse QoL in taste problem (p&lt;0.001), body image (p&lt;0.01). Factors that independently influenced QoL were follow up duration (p&lt;0.05), extent of gastric resection (p&lt;0.01), chemotherapy (p&lt;0.001), and nutritional status (p&lt;0.01). These results suggest that nutritional status improvement may be associated with QoL and early recovery.

Laparoscopic Surgery for Submucosal Tumor Near the Esophagogastric Junction

Laparoscopic surgery is widely accepted as a treatment for gastric submucosal tumors (SMTs). However, laparoscopy is not easily applied to tumors near the esophagogastric junction (EGJ). This study was conducted to evaluate laparoscopic techniques for treating SMTs near the EGJ. Between March 2008 and August 2012 at the Asan Medical Center, Seoul, Korea, we performed laparoscopic surgery on 71 patients who had SMTs located within 3 cm of the EGJ. The laparoscopic approach chosen depended on the position of the tumor, which was located accurately by preoperative diagnosis. None of the patients required conversion to open surgery. Of the 71 patients in the study, 66 had laparoscopic wedge resection (LAPWR), 4 had laparoscopic enucleation, and 1 had laparoscopic proximal gastrectomy. Two patients had intraoperative events during LAPWR. One had EGJ stricture, which required laparoscopic esophagogastrostomy. The other had a muscle defect of the posterior wall of the distal esophagus, and the defect was covered using fundus-like fundoplication. All patients had tumor-free resection margins, and there were no deaths. Laparoscopic resection of SMTs near the EGJ may be performed safely. The laparoscopic approach used depends on the location and size of the tumor and on the extent of gastric resection.

Prognostic Value of Postoperative CA19-9 Normalization in Patients with Advanced Gastric Cancer

CA19-9 is known to have positive correlation with depth of invasion, nodal involvement, and peritoneal metastasis in gastric adenocarcinoma. In patients with high preoperative CA19-9 serum levels who underwent curative gastrectomy, we evaluated the prognostic impact of postoperative normalization of CA 19-9. Among 1,439 patients who underwent curative gastrectomy for advanced gastric adenocarcinoma, data of 102 patients with advanced gastric adenocarcinoma whose preoperative serum CA19-9 level was higher than cutoff value (37 U/mL) were reviewed. If serum CA19-9 level had fallen below 37 U/mL at 6 months after surgery, the CA19-9 level was considered normalized. CA19-9 levels were normalized in 79 patients but not in 23 patients. There were statistically significant differences in prognosis according to depth of invasion, presence of lymph node metastasis, extent of gastric resection, and postoperative CA19-9 normalization on univariate analyses. Multivariate analysis revealed that pathological lymph node metastasis (p<0.001) and postoperative CA19-9 normalization were independent prognostic factors (p=0.001). In patients with advanced gastric adenocarcinoma who underwent curative gastric resection, postoperative normalization of CA19-9 can be a surrogate for potentially curative surgical treatment and can be used as a good prognostic factor.

684P - Results of Treatment of Locally advanced Gastric Cancer in the Elderly Patients

ABSTRACT Background Although the incidence of gastric cancer has declined in the general population, it is the second most frequent cancer in Uzbekistan with its incidence in the elderly increasing as a result of increased life expectancy. This present study tried to determine the role of age on outcomes of surgical treatment for gastric cancer in Uzbek population. Methods The study reviewed 288 patients who underwent gasterectomy for locally advanced gastric cancer. The clinicopathological features of elderly patients (≥75 years, n = 167) and younger patients ( Results Distinct characteristics of elderly patients included more frequent underlying disease, deeper invasion, and more frequent lymph node metastasis. The postoperative morbidity and mortality rate did not differ between the two groups. Age, preoperative performance status, preoperative transfusion, and presence of comorbidity were not independent predictors of postoperative complications. However, the extent of gastric resection and combined resection were closely related to postoperative complications in patients with non-curative gastrectomy. Conclusion Analysis the direct results of surgical treatment of elderly gastric cancer patients shows that, age is not a limiting factor for performing curative surgery. However, the risk of postoperative morbidity should be considered carefully in total gastrectomy and combined resection. Disclosure All authors have declared no conflicts of interest.