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

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.

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

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

Results
Location of the tumor
15%
Proximal
60%

26%

Mid third
Distal third

Complications associated with the tumor

21%

2%2%

No complications
Stenosis
Bleeding
75%

Both

Results
Types of gastrectomies

Type of lymphadenectomy
15%

45%
55%

Total

D1

Subtotal

D2
85%

Postoperative complications
No complications
4% 2% 2%
2%

Postoperative
bleeding
Duodenal stump
fistula

89%

Anastomotic oedema
Pleural effusion

Results
pT stages
13%

pN stages
pT1

11%
26%

pN0
17%

pT2
pT3
pT4

51%

Degree of differentiation

30%

pN1

28%

pN2
pN3

26%

2% 15%
47%

36%

Well
differentiated
Moderately
differentiated
Poorly
differentiated
Undifferentiat
ed

Comparison between the cN and pN stages

Comparison between the cT and pT stages
Same T stage
Underestimated T
stage
Overestimated T
stage

17%
23%

Same N stage
26%

60%

43%
32%

Underestimated N
stage
Overestimated N
stage

Results

p < 0,001

P =0,004

Results
Survival of the pacient groups at given points in time

D1

D2

D2_new

p < 0,001, F = 12,85

Results
Survival of the pacient groups at given points in time

R1

R2

Laparo

R0_new

p < 0,001, F = 10,09

Discussion

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.

Discussion

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.

Discussion

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.

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