Modificare supravietuirii in cancerul gastric
-
Upload
popa-tiberiu -
Category
Documents
-
view
226 -
download
3
description
Transcript of Modificare supravietuirii in cancerul gastric
![Page 1: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/1.jpg)
LONG-TERM SURVIVAL DIFFERENCES IN GASTRIC CANCER
S.T. Makkai-Popa, T. Frunza, V. Porumb, N. Velenciuc, C. Roata, G.M. Dimofte
Second Surgical Clinic, Regional Institute for Oncology, Iasi
![Page 2: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/2.jpg)
Introduction
Songun I1, 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;11(5):439-49. 9.
![Page 3: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/3.jpg)
Materials and method
Patients operated on for gastric cancer with a curative intent by a single surgeon
Exclusion criteria: Patients lost to follow-up Patients with incomplete medical records – e.g. missing
pathology reports
Compare the survival between this group of patients and a previous group of 143 patients operated on between January 1996 and December 2001, from a point of view of type of lymphadenectomy and type of resection
SPSS version 17 for Windows – ANOVA – 5% significance level
![Page 4: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/4.jpg)
Results
47 cases operated on between January 1999 and September 2013
Age: 64 ± 17,5 years Sex: 27 (57,44%) male and 20 (42,55%) females Mean survival: 39,19 ± 32,29 months Average number of harvested lymph nodes: 26,31 ± 12,15
nodes (9 – 64 nodes) Average number of positive nodes: 6,89 ± 8,8 nodes (0 – 31
nodes) Splenectomy was performed in 9 cases
![Page 5: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/5.jpg)
Results
15%
26%60%
Location of the tumor
ProximalMid thirdDistal third
75%
21%2% 2%
Complications associated with the tumor
No complicationsStenosisBleedingBoth
![Page 6: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/6.jpg)
Results
15%
85%
Type of lymphadenectomy
D1D2
45%
55%
Types of gastrectomies
TotalSubtotal
89%
2%
4% 2%2%
Postoperative compli-cations
No complicationsPostoperative bleed-ingDuodenal stump fis-tulaAnastomotic oedemaPleural effusion
![Page 7: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/7.jpg)
Results
11%
26%
51%
13%
pT stagespT1pT2pT3pT4
28%
26%30%
17%
pN stagespN0pN1pN2pN3
15%
36%47%
2%
Degree of dif -ferentiationWell differen-
tiatedModerately dif -ferentiatedPoorly differen-tiatedUndifferen-tiated
43%
32%
26%
Comparison between the cN and pN stages
Same N stageUnderestimated N stageOverestimated N stage
60%23%
17%
Comparison between the cT and pT stages
Same T stageUnderestimated T stageOverestimated T stage
![Page 8: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/8.jpg)
Results
p < 0,001 P =0,004
![Page 9: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/9.jpg)
Results
0 10 20 30 40 50 600
10
20
30
40
50
60
70
80
90
100
Survival of the pacient groups at given points in time
D1 D2 D2_new
p < 0,001, F = 12,85
![Page 10: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/10.jpg)
Results
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 560
10
20
30
40
50
60
70
80
90
100
Survival of the pacient groups at given points in time
R1 R2 Laparo R0_new
p < 0,001, F = 10,09
![Page 11: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/11.jpg)
Discussion
![Page 12: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/12.jpg)
Discussion
Songun I1, 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;11(5):439-49. 9.
![Page 13: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/13.jpg)
Discussion
![Page 14: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/14.jpg)
Discussion
Schwarz RE1, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2007;14(2):317-28.
![Page 15: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/15.jpg)
Discussion
![Page 16: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/16.jpg)
Discussion
“Biology is King. Selection is Queen. Technical maneuvers are the Prince and Princess. Occasionally the Prince and Princess try to overthrow the powerful forces of the King and Queen, sometimes with temporary apparent victories, usually to no long term avail.”
![Page 17: Modificare supravietuirii in cancerul gastric](https://reader034.fdocuments.in/reader034/viewer/2022042523/5695cf0c1a28ab9b028c5ac2/html5/thumbnails/17.jpg)
Conclusion
Our study – statistically significant difference between our study group and a previous study group depending on the type of lymphadenectomy
No clear consensus on D2 vs D1 lymphadenectomy – WHY?
RCTs which uniformly define interventions and outcomes
Spleen and pancreas preserving surgery – decreased morbidity