Novosti
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This journal is indexed in Scopus |
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Year 2016 Vol. 24 No 3
ONCOLOGY
A.V. PROCHOROV1, I.N. LABUNETS1, M.N. SHAPETSKA1, V.Y. MAVRICHEV2, A.S. MATYLEVICH1
THE LONG-TERM RESULTS OF SURGICAL TREATMENT OF GASTROESOPHAGEAL CANCER
EE "Belorusian State Medical University"1,
ME "Minsk City Clinical Oncology Dispansery"2,
The Republic of Belarus
Objectives. To study the long-term results of surgical treatment of gastroesophageal cancer in the dependent on the main prognostic factors of the disease, tumor resectability and extent of lymph node dissection.
Methods. The analysis of surgical treatment results was carried out in 329 patients with gastroesophageal cancer who underwent transpleural resection of the stomach and esophagus: gastrectomy with the resection of the lower third of the esophagus by Garlock (n=155); proximal resection of the stomach with the lower third of the esophagus by Garlock (n=96); proximal resection of the stomach with subtotal resection of the esophagus by Lewis (n=78).
Results. Postoperative mortality composed 5,2%: after gastrectomy by Garlock – 3,9%, after proximal gastrectomy by Garlock – 5,2%, after Lewis’s surgery – 7,7%. Overall five-year survival rate was 26.2%. 43.6% of patients without metastatic lymph nodes and 18,4% with nodal metastases had survived this period of observation. Survival of patients didn’t depend of the number of metastatic lymph nodes (N1, N2, N3). Five-year survival after radical resection of the stomach and the esophagus amounted 29,1%, after palliative – 9,4%. After the combined surgeries with the resection of adjacent organs in comparison with those after conventional surgery. After a combiened operations with resection of adjacent organs compared with those afte conventional surgery the survived 5 years (12,5% and 31,3%), respectively. The analysis of treatment results in patients depending on the morphological type of the gastroesophageal tumor didn’t reveal statistically reliable differences in the patients’ survival.
Conclusion. The survival rate of patients after surgical treatment of gastroesophageal cancer remains low. The prognosis depends mainly on the extent of the tumor process. Survival of patients without nodal metastases (all types of operations) is two-fold higher than in those with the regional lymphogenous metastasis. The number of affected groups of lymph nodes doesn’t influence the overall and recurrence-free survival rate. The combined and palliative resections can provide the 5-year relative survival rate only at the level of 10-15%.
- Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013 Apr;49(6):1374-403. doi: 10.1016/j.ejca.2012.12.027.
- Cherniavskii AA, Lavrov NA. Sovremennye podkhody k khirurgicheskomu lecheniiu raka pishchevodno-zheludochnogo perekhoda [Modern approaches to surgical treatment of cancer of esophageal-gastric junction]. Vestn Khirurg Gastroenterologii. 2008;2:13-23.
- Huang CM, Lin BJ, Lu HS, Zhang XF, Li P, Wei X, et al. Prognostic impact of metastatic lymph node ratio in advanced gastric cancer from cardia and fundus. World J Gastroenterol. 2008 Jul 21;14(27):4383-88. doi: 10.3748/wjg.14.4383.
- Okeanov AE, Moiseev PI, Levin LF, Sukonko OG, red. Ctatistika onkologicheskikh zabolevanii v Respublike Belarus' (2005-2014) [Statistics of oncological diseases in the Republic of Belarus (2005-2014)]. Minsk, RB; 2015. 204 p.
- Siewert JR, Feith M, Stein HJ. Biologic and clinical variations of adenocarcinoma at the esophago-gastric junction: relevance of a topographic-anatomic subclassification. J Surg Oncol. 2005 Jun 1;90(3):139-46; discussion 146.
- Shoikhet IaN, Nechunaev VP, Ageev AG, Panas'ian AU, Lomakin AI, Lazarev AF. Dvukhzonal'naia limfodissektsiia kak standart khirurgicheskogo lecheniia kardioezofageal'nogo raka [Bizonal lymphodissection as the standard surgical treatment of cardioesophageal cancer]. Vestn RONTs im NN Blokhina RAMN. 2007;4(18):59-64.
- Davydov MI, Turkin IN, Stilidi IS, Polotskii BE, Ter-Ovanesov MD. Kardioezofageal'nyi rak: klassifikatsiia, khirurgicheskaia taktika, osnovnye faktory prognoza [Cardioesophageal cancer: classification, surgical approach, main prognostic factors]. Vestn RONTs im NN Blokhina RAMN. 2003;1:82-88.
- Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010 May;11(5):439-49. doi: 10.1016/S1470-2045(10)70070-X.
- Ychou M, Boige V, Pignon JP, Conroy T, Bouché O, Lebreton G, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011 May 1;29(13):1715-21. doi: 10.1200/JCO.2010.33.0597.
- Waddell T, Chau I, Cunningham D, Gonzalez D, Okines AF, Okines C, et al. Epirubicin, oxaliplatin, and capecitabine with or without panitumumab for patients with previously untreated advanced oesophagogastric cancer (REAL3): a randomised, open-label phase 3 trial. Lancet Oncol. 2013 May;14(6):481-9. doi: 10.1016/S1470-2045(13)70096-2.
- Smalley SR, Benedetti JK, Haller DG, Hundahl SA, Estes NC, Ajani JA, et al. Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol. 2012 Jul 1;30(19):2327-33. doi: 10.1200/JCO.2011.36.7136.
- Dikken JL, Jansen EP, Cats A, Bakker B, Hartgrink HH, Kranenbarg EM, et al. Impact of the extent of surgery and postoperative chemoradiotherapy on recurrence patterns in gastric cancer. J Clin Oncol. 2010 May 10;28(14):2430-36. doi: 10.1200/JCO.2009.26.9654.
- Kim S, Lim DH, Lee J, Kang WK, MacDonald JS, Park CH, et al. An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach. Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1279-85.
- Lee J, Lim do H, Kim S, Park SH, Park JO, Park YS, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012 Jan 20;30(3):268-73. doi: 10.1200/JCO.2011.39.1953.
- Ohtsu A, Shah MA, Van Cutsem E, Rha SY, Sawaki A, Park SR, et al. Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: a randomized, double-blind, placebo-controlled phase III study. J Clin Oncol. 2011 Oct 20;29(30):3968-76. doi: 10.1200/JCO.2011.36.2236.
- Fuchs CS, Tomasek J, Cho JY, Tomasello G, Goswami C, dos Santos LV, et al. REGARD: a phase 3, randomized, doubleblinded trial of ramucirumab and best supportive care (BSC) versus placebo and BSC in the treatment of metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma following disease progression onfirst-line platinum- and/or fluoropyrimidine-containing combination therapy: age subgroup analysis. J Clin Oncol. 2014;32(suppl; abstr 4057).
220116, Republic of Belarus,
Minsk, pr. Dzerzhinskogo, d. 83,
UO "Belorusskiy gosudarstvennyiy meditsinskiy universitet",
kafedra onkologii,
tel. office: 375172902971,
e-mail: aprokharau@gmail.com,
Prochorov Aleksandr Viktorovich
Prochorov A.V. MD, professor, a head of the oncology chair of EE "Belarusian State Medical University".
Labunets I.N. PhD, an associate professor of the oncology chair of EE "Belarusian State Medical University".
Shapetska M.N. PhD, an associate professor of the oncology chair of EE "Belarusian State Medical University".
Mavrichev V.Y. A head of the oncology-surgical unit №4 of ME "Minsk City Clinical Oncology Dispensary".
Matylevich A.S. A 5-year student of the medical faculty of EE "Belarusian State Medical University".
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