Cargando…

Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series

PURPOSE: No consensus exists on the resection extent needed to ensure oncological safety in gastrectomy for gastric adenocarcinoma (GAC). This study aims to assess the impact of margin adequacy according to Japanese Gastric Cancer Association (JGCA) guidelines on overall survival (OS). PATIENTS AND...

Descripción completa

Detalles Bibliográficos
Autores principales: Maspero, Marianna, Sposito, Carlo, Benedetti, Antonio, Virdis, Matteo, Di Bartolomeo, Maria, Milione, Massimo, Mazzaferro, Vincenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8989928/
https://www.ncbi.nlm.nih.gov/pubmed/34973091
http://dx.doi.org/10.1245/s10434-021-11010-0
_version_ 1784683278197850112
author Maspero, Marianna
Sposito, Carlo
Benedetti, Antonio
Virdis, Matteo
Di Bartolomeo, Maria
Milione, Massimo
Mazzaferro, Vincenzo
author_facet Maspero, Marianna
Sposito, Carlo
Benedetti, Antonio
Virdis, Matteo
Di Bartolomeo, Maria
Milione, Massimo
Mazzaferro, Vincenzo
author_sort Maspero, Marianna
collection PubMed
description PURPOSE: No consensus exists on the resection extent needed to ensure oncological safety in gastrectomy for gastric adenocarcinoma (GAC). This study aims to assess the impact of margin adequacy according to Japanese Gastric Cancer Association (JGCA) guidelines on overall survival (OS). PATIENTS AND METHODS: Patients who underwent surgery for stage I–III GAC at our institution between 2010 and 2017 were included. Margin adequacy according to JGCA, National Comprehensive Cancer Network (NCCN), and European Society for Medical Oncology (ESMO) guidelines was assessed, and their predictive value on OS was evaluated with Harrell’s C-index. Patients were analyzed according to their margins’ adherence to JGCA guidelines, and a propensity score matching (PSM) was run. Indication to either total gastrectomy (TG) or distal gastrectomy (DG) according to each guideline was also assessed. RESULTS: A total of 279 patients were included, of whom 220 (79%) underwent DG. Adequate margins according to JGCA were obtained in 209 patients (75%). On multivariate analysis, JGCA margin adequacy was independently associated with OS, together with American Society of Anesthesiologist class, neoadjuvant chemotherapy, lymphadenectomy extent, R0 resection, and postoperative N stage. After PSM, patients with JGCA adequate margins showed better OS, recurrence-free survival (RFS), and local RFS than patients with JGCA inadequate margins. For 220 DG, JGCA guidelines would have recommended TG in 25 patients (11%), NCCN in 30 (14%), and ESMO in 90 (41%) (p < 0.001). CONCLUSION: Adequacy of surgical resection margins to JGCA guidelines leads to improved survival outcomes and allows for a more organ-preserving approach than Western guidelines.
format Online
Article
Text
id pubmed-8989928
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-89899282022-04-22 Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series Maspero, Marianna Sposito, Carlo Benedetti, Antonio Virdis, Matteo Di Bartolomeo, Maria Milione, Massimo Mazzaferro, Vincenzo Ann Surg Oncol Gastrointestinal Oncology PURPOSE: No consensus exists on the resection extent needed to ensure oncological safety in gastrectomy for gastric adenocarcinoma (GAC). This study aims to assess the impact of margin adequacy according to Japanese Gastric Cancer Association (JGCA) guidelines on overall survival (OS). PATIENTS AND METHODS: Patients who underwent surgery for stage I–III GAC at our institution between 2010 and 2017 were included. Margin adequacy according to JGCA, National Comprehensive Cancer Network (NCCN), and European Society for Medical Oncology (ESMO) guidelines was assessed, and their predictive value on OS was evaluated with Harrell’s C-index. Patients were analyzed according to their margins’ adherence to JGCA guidelines, and a propensity score matching (PSM) was run. Indication to either total gastrectomy (TG) or distal gastrectomy (DG) according to each guideline was also assessed. RESULTS: A total of 279 patients were included, of whom 220 (79%) underwent DG. Adequate margins according to JGCA were obtained in 209 patients (75%). On multivariate analysis, JGCA margin adequacy was independently associated with OS, together with American Society of Anesthesiologist class, neoadjuvant chemotherapy, lymphadenectomy extent, R0 resection, and postoperative N stage. After PSM, patients with JGCA adequate margins showed better OS, recurrence-free survival (RFS), and local RFS than patients with JGCA inadequate margins. For 220 DG, JGCA guidelines would have recommended TG in 25 patients (11%), NCCN in 30 (14%), and ESMO in 90 (41%) (p < 0.001). CONCLUSION: Adequacy of surgical resection margins to JGCA guidelines leads to improved survival outcomes and allows for a more organ-preserving approach than Western guidelines. Springer International Publishing 2022-01-01 2022 /pmc/articles/PMC8989928/ /pubmed/34973091 http://dx.doi.org/10.1245/s10434-021-11010-0 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Gastrointestinal Oncology
Maspero, Marianna
Sposito, Carlo
Benedetti, Antonio
Virdis, Matteo
Di Bartolomeo, Maria
Milione, Massimo
Mazzaferro, Vincenzo
Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series
title Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series
title_full Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series
title_fullStr Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series
title_full_unstemmed Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series
title_short Impact of Surgical Margins on Overall Survival after Gastrectomy for Gastric Cancer: A Validation of Japanese Gastric Cancer Association Guidelines on a Western Series
title_sort impact of surgical margins on overall survival after gastrectomy for gastric cancer: a validation of japanese gastric cancer association guidelines on a western series
topic Gastrointestinal Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8989928/
https://www.ncbi.nlm.nih.gov/pubmed/34973091
http://dx.doi.org/10.1245/s10434-021-11010-0
work_keys_str_mv AT masperomarianna impactofsurgicalmarginsonoverallsurvivalaftergastrectomyforgastriccanceravalidationofjapanesegastriccancerassociationguidelinesonawesternseries
AT spositocarlo impactofsurgicalmarginsonoverallsurvivalaftergastrectomyforgastriccanceravalidationofjapanesegastriccancerassociationguidelinesonawesternseries
AT benedettiantonio impactofsurgicalmarginsonoverallsurvivalaftergastrectomyforgastriccanceravalidationofjapanesegastriccancerassociationguidelinesonawesternseries
AT virdismatteo impactofsurgicalmarginsonoverallsurvivalaftergastrectomyforgastriccanceravalidationofjapanesegastriccancerassociationguidelinesonawesternseries
AT dibartolomeomaria impactofsurgicalmarginsonoverallsurvivalaftergastrectomyforgastriccanceravalidationofjapanesegastriccancerassociationguidelinesonawesternseries
AT milionemassimo impactofsurgicalmarginsonoverallsurvivalaftergastrectomyforgastriccanceravalidationofjapanesegastriccancerassociationguidelinesonawesternseries
AT mazzaferrovincenzo impactofsurgicalmarginsonoverallsurvivalaftergastrectomyforgastriccanceravalidationofjapanesegastriccancerassociationguidelinesonawesternseries