RADICAL SURGERY IN EARLY STAGE GASTRIC CANCER: SINGLE CENTER EXPERIENCE

Abstract

Objective: This study was performed to determine the overall early stage gastric cancer (ESGC) prevalence and to evaluate the short- and long-term postoperative outcomes of patients with ESGC who underwent radical surgery. Method: All 391 gastric cancer patients who underwent radical surgery between 2006 and 2013 were included in the study. Thirty nine patients who were  diagnosed with ESGC were evaluated retrospectively in terms of demographics, pathological findings and clinical outcomes. Results: Thirteen (33%) patients had morbidity and mortality rates of zero. The depth of tumor invasion was submucosal in 26 (67%) patients, intramucosal in 13 (33%). Eleven (28%) patients had lymph node involvement. While lymph node involvement rate in intramucosal tumors was 14%, the rate rose up to 34.6% in submucosal tumors. The average follow-up period was 73.6 months. The long term outcomes in 4 (10%) patients had a recurrence and 3 (7.5%) patients died. 35 (%89.7) patients are being monitored tumor-free at the time of publication. Conclusion: When compared to Asian countries, the prevalence of ESGC was lower in our study. However, lymph node involvement in ESGC was higher. Only 1.8% of patients were found appropriate for endoscopic resection according to the Japanese Endoscopic Treatment Guidelines. In light of these findings, we find that radical surgery is an appropriate treatment choice for ESGC in our country.

Keywords

• Early stage of gastric cancer,metastatic lymph nodes,radical surgery

ERKEN EVRE MİDE KANSERİNDE RADİKAL CERRAHİ: İSTANBUL ÜNİVERSİTESİ TIP FAKÜLTESİ HASTANESİ DENEYİMİ

Abstract

Amaç: Mide kanseri nedeniyle radikal cerrahi uygulanan olgular arasında erken evre mide kanseri sıklığı ve bu olgularda postoperatif erken ve geç dönem sonuçlarının değerlendirilmesi amaçlanmıştır. Yöntem: Bu çalışmada 2006–2013 yılları arasında mide kanseri nedeniyle radikal cerrahi uygulanan 391 olgudan, histopatolojik değerlendirme sonucunda erken evre mide kanseri saptanan 39 olgunun demografik verileri, patolojik bulguları ve klinik sonuçları retrospektif olarak incelenmiştir. Bulgular: Morbidite 13 (%33) hastada izlenirken, mortalite görülmedi. İnvazyon derinliği olguların 26’sında (%67) submukozal, 13’ünde (%33) intramukozal idi. Hastaların 11’inde (%28) lenf nodu metastazı saptanmıştır. İntramukozal yerleşimli tümörlerde lenf nodu metastazı oranı %14’iken submukozal tümörlerde bu oran %34,6’ya çıkmaktaydı. Ortalama takip süreleri 73,6 ay (48-111 ay) idi. Uzun dönem takiplerinde 4 olguda (%10) hastalık nüksü saptanırken 3 olgu (%7,5) ise eks olmuştur. Olguların 35’i (%89,7) hastalıksız olarak takip edilmektedir. Sonuç: Uzak Doğu Ülkelerine kıyasla, çalışmamızda erken evre mide kanseri prevelansı daha düşük olarak bulunmuştur. Bununla birlikte, erken evre mide kanserinde lenf nodu tutulumunun daha yüksek olduğu saptanmıştır. Japon Endoskopik Tedavi Kılavuzuna göre hastaların sadece %1,8’i endoskopik rezeksiyona uygun bulunmuştur. Bu veriler doğrultusunda, ülkemizde radikal cerrahinin erken evre mide kanseri için en uygun tedavi seçeneği olduğunu düşünüyoruz.

Keywords

• Erken evre mide tümörü,metastatik lenf nodu,radikal cerrahi

References

1. 1. Carter KJ, Schaffer HA, Ritchie WP. Early gastric cancer. Ann Surg 1984;199:604-9.
2. 2. Murakami T. Early cancer of the stomach. World J Surg 1979;3:685-92.
3. 3. Marissa Montgomery, Shinichi Fukuhara, Martin Karpeh, Steven Brower, et al. Evidence-based review of the management of early gastric cancer. Gastroenterol Rep (Oxf) 2013;1(2):105-12.
4. 4. Shimizu S, Tada M, Kawai K. Early gastric cancer: its surveillance and natural course. Endoscopy 1995;27:27-31.
5. 5. Maehara Y, Orita H, Okuyama T, et al. Predictors of lymph node metastasis in early gastric cancer. Br J Surg 1992;79:245-47.
6. 6. Leung WK, Wu MS, Kakugawa Y, et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 2008;9:279-87.
7. 7. Everett SM, Axon AT. Early gastric cancer in Europe. Gut 1997;41:143-50.
8. 8. Eckardt VF, Giessler W, Kanzler G, et al. Clinical and morphological characteristics of early gastric cancer. A case-control study. Gastroenterology 1990;98(3):708-14.

9. 9. Everett SM, Axon AT. Early gastric cancer: disease or pseudo-disease? Lancet 1998;351:1350-52.
10. 10. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer 2007;10:1-11.
11. 11. Chiu P, Teoh A, To KF, et al. Endoscopic submucosal dissection (ESD) compared with gastrectomy for treatment of early gastric neoplasia: a retrospective cohort study. Surg Endosc 2012;26:3584-91.
12. 12. Japanese Gastric Cancer Association. 3rd. Gastric Cancer Treatment Guidelines 2010. Gastric Cancer 2011;14:101-12.
13. 13. Gotoda T, Yanagisawa A, Sasako M, et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric cancer 2000;3:219-25.
14. 14. Hirasawa T, Gotoda T, Miyata S, et al. Incidence of lymph node metastasis and the feasibility of endoscopic resection for undifferentiated-type early gastric cancer. Gastric Cancer 2009;12:148-52.
15. 15. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon November 30 to December 1, 2002. Gastrointest Endosc 2003;58(6):S3-43.
16. 16. Choi KS, Jung HY, Choi KD, et al. EMR versus gastrectomy for intramucosal gastric cancer: comparison of long-term outcomes. Gastrointest Endosc 2011;73:942-8.
17. 17. M. Kobayashi, R. Narisawa, Y. Sato, M. Takeuchi, and Y. Aoyagi, “Self-limiting risk of metachronous gastric cancers after endoscopic resection,” Digestive Endoscopy, vol. 2010;22(3):169-73.
18. 18. Lee HJ, Jang YJ, Kim JH, et al. Clinical outcomes of gastrectomy after incomplete EMR/ESD. J Gastric Cancer 2011;11:162-6.
19. 19. Bollschweiler E, Boettcher K, Hoelscher AH, et al. Is the prognosis for Japanese and German patients with gastric cancer really different? Cancer 1993;71:2918-25.
20. 20. Gulluoglu M, Yegen G, Ozluk Y, Keskin M, Doğan S, Gundogdu G, Onder S, Balik E Tumor budding is independently predictive for lymph node imvolvement in early gastric cancer. Int J Surg Pathol 2015;23(5):349-58.