TY - JOUR
T1 - Three-year survival and distribution of lymph node metastases in gastric cancer following neoadjuvant chemotherapy
T2 - results from a European randomized clinical trial
AU - van der Wielen, Nicole
AU - Daams, Freek
AU - Rosati, Riccardo
AU - Parise, Paolo
AU - Weitz, J. rgen
AU - Reissfelder, Christoph
AU - del Val, Ismael Diez
AU - Loureiro, Carlos
AU - Parada-González, Purificación
AU - Pintos-Martínez, Elena
AU - Vallejo, Francisco Mateo
AU - Achirica, Carlos Medina
AU - Sánchez-Pernaute, Andrés
AU - Campos, Adriana Ruano
AU - Bonavina, Luigi
AU - Asti, Emanuele L. G.
AU - Poza, Alfredo Alonso
AU - Gilsanz, Carlos
AU - Nilsson, Magnus
AU - Lindblad, Mats
AU - Gisbertz, Suzanne S.
AU - van Berge Henegouwen, Mark I.
AU - Romario, Uberto Fumagalli
AU - de Pascale, Stefano
AU - Akhtar, Khurshid
AU - Cuesta, Miguel A.
AU - van der Peet, Donald L.
AU - Straatman, Jennifer
N1 - Funding Information: The STOMACH trial received funding from Fonds NutsOhra (FNO). This was given to the department of gastro-intestinal surgery at Amsterdam University Medical Center, location VU University. Prof. Mark van Berge Henegouwen is consultant for Mylan, Johnson & Johnson, Alesi Surgical, BBraun, and Medtronic and received unrestricted research grants from Stryker. All fees are paid to the institution. Publisher Copyright: © 2023, The Author(s).
PY - 2023/9
Y1 - 2023/9
N2 - Background: Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy. Methods: This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined. Results: A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients). No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186). The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7–12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024). Conclusion: No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low.
AB - Background: Adequate lymphadenectomy is an important step in gastrectomy for cancer, with a modified D2 lymphadenectomy being recommended for advanced gastric cancers. When assessing a novel technique for the treatment of gastric cancer, lymphadenectomy should be non-inferior. The aim of this study was to assess completeness of lymphadenectomy and distribution patterns between open total gastrectomy (OTG) and minimally invasive total gastrectomy (MITG) in the era of peri-operative chemotherapy. Methods: This is a retrospective analysis of the STOMACH trial, a randomized clinical trial in thirteen hospitals in Europe. Patients were randomized between OTG and MITG for advanced gastric cancer after neoadjuvant chemotherapy. Three-year survival, number of resected lymph nodes, completeness of lymphadenectomy, and distribution patterns were examined. Results: A total of 96 patients were included in this trial and randomized between OTG (49 patients) and MITG (47 patients). No difference in 3-year survival was observed, this was 57.1% in OTG group versus 46.8% in MITG group (P = 0.186). The mean number of examined lymph nodes per patient was 44.3 ± 16.7 in the OTG group and 40.7 ± 16.3 in the MITG group (P = 0.209). D2 lymphadenectomy of 71.4% in the OTG group and 74.5% in the MITG group was performed according to the surgeons; according to the pathologist compliance to D2 lymphadenectomy was 30% in the OTG group and 36% in the MITG group. Tier 2 lymph node metastases (stations 7–12) were observed in 19.6% in the OTG group versus 43.5% in the MITG group (P = 0.024). Conclusion: No difference in 3-year survival was observed between open and minimally invasive gastrectomy. No differences were observed for lymph node yield and type of lymphadenectomy. Adherence to D2 lymphadenectomy reported by the pathologist was markedly low.
KW - Lymph node distribution
KW - Minimally invasive gastrectomy
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85165153211&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-023-10278-5
DO - https://doi.org/10.1007/s00464-023-10278-5
M3 - Article
C2 - 37468751
SN - 0930-2794
VL - 37
SP - 7317
EP - 7324
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 9
ER -