a.delens, medical student j.m. weerts, frcs eng, jm.dewandre, d. francart, c. jehaes, b. monami. c....
TRANSCRIPT
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A.DELENS, MEDICAL STUDENT
J.M. WEERTS,FRCS Eng, JM.DEWANDRE, D. FRANCART, C. JEHAES, B. MONAMI.
C. WHALEN, S. MARKIEWICZ
ABDOMINAL SURGERY, CHC LIEGE HOSPITAL CENTER
Cardia and gastric adenocarcinoma surgery: experience of a teaching
hospital2000 -- 2012.
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Plan
IntroductionobjectivePatients and methodResultsDiscussion Conclusion
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Introduction
Gastric and oesophageal adenocarcinoma incidence in Belgium during 2010: 2300 patients
Sexe ratio: 1,5 H: 1 FMean age: 72 years Overall 5-y survival:
Men: 22,3% Women: 25,3%
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Introduction
Stadification
MOC
Guidelines of management:
T2 – T3/N+
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Surgical resection = standard treatment for resectable gastric cancer .
D2 lymphadenectomy should be standard during gastrectomy
Splenectomy and pancreatectomy not considered standard practice if no disease infiltration
Perioperative mortality in Belgium : 5,6% (KCE report 2013)
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Objective:
To evaluate:the outcome of surgical resection of gastric and cardia adenocarcinoma retrospectively.
the impact of neoadjuvant chemotherapy on survival of patients operated for cardia and gastric adenocarcinoma
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Patients and methods:
Retrospective study103 consecutive patients operated in a single
institution between 2000 and 2012Including 42 women and 61 men Median age at diagnosis of 66,8 years oldTNM stage, histological stage, post-operative
morbidity and mortality, follow-up were evaluated71 patients have a follow-up of more than 5 yearsMedian follow-up??
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Results
Surgery:
Oesogastric resection: N=5Total gastrectomy: N=60Partial gastrectomy: N=32Laparotomy (scopy) +bx: N=3
R1 rate: 8,7% N=9
Mortality: 5,8% ( N=6) ( Belgium : 5,6%)
Morbidity: 22,3%- Digestive: 19 - Pulmonary: 5- Cardiac: 2
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N 1y
Survival 1y ( %)
N with follow up of 5yrs
minimum
Survival 5yrs (%)
global 103 76,6 71 39,5
Free of recurrence
71 39,5
men 61 72,3 46 37
women 42 80,9 25 42
Results
Belgium: 22,3% for men and 25,3% for women KCE REPORT 2013 ???
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Staging N 1y
Survival 1y (%)
N 5y Survival 5y (%)
Stage IA 23 87 14 64,2
Stage IB 20 90 14 64,2
Stage II 16 81 13 53,8
Stage IIIA 13 77 8 25
Stage IIIB 10 70 5 0
Stage IV 18 44,4 15 6
location N 1y
Survival 1y (%)
N 5y Survival 5y (%)
cardia 14 42,8 11 9
gastric 89 80,8 59 42,4
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Invasion depth
N 1y Survival 1y (%)
N 5y
Survival 5y (%)
pT0 3 66,6 / /
pT1 25 84 15 60
pT2 30 86,6 22 59,1
pT3 33 75,7 24 25
pT4 10 70 7 0
Nodal status
Negative 57 80,7 38 55,3
positive 43 67,4 32 21,8
N1 20 80 46,6
N2 17 64,7 0
N3 3 33,3 0
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Histological type
N % survival 1 yr
N with follow up
of 5yr
% survival 5 yrs
Lauren:
diffuse 29 65,5 24 25
intestinal 71 82,6 44 47,7
WHO:
papillary 1 100 1 100
Tubular 58 82,7 34 50
Poorly differenciat
ed
11 72,7 11 8
Signet single cell
28 64,3 22 22,7
mucinous 2 100 2 50
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Results
2005: Start of neoadjuvant chemotherapyPatients with advanced cancer (T2-T3, N)3 courses of 5FU-folinic acid – ciplatine
(MAGIC)
NAC Mortality: 0%NAC Morbidity: 17%response rate: 37,1%
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Results
All patients with T2-T3/ N-any have been selected ( N=75)
Similar surgery morbidity and mortality
No neoadjuvant radiotherapy
D2 GastrectomyR1 rate:
Group A: N=3 Group B: N=4
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Results
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results
global intestinal diffuse cardia gastric
Response for all
37,1% 52%( 12/23)
10% ( 1/10)
30% ( 3/10) 40% ( 10/25)
Partial response
31,4% 44% 10% 30% 32%
Complete response
5,7 % 8% 0% 0 8%
Response to the neoadjuvant therapy:
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Results
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Results
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Results
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Cardia and gastric adenocarcinoma 503 patients:
surg alone: N=253 NAC+ surg: N=250
NAC: ECF ( epirubicin, infused fluorouracil, cisplatin): 3 courses
NAC response rate? Median follow-up?
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MAGIC
5y survival:•NAC+ surg: 36%•Surg alone:23%
Results:-> no impact of NAC on perioperatives complications
-> significant impact of NAC on survival at 5 years
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Hartgrink
Gastric adenocarcinoma 59 randomised patients
NAC + surg: N=29 Surg alone: N=30
Median follow-up: 83 months NAC: 5FU, doxorubicin, methotrexate NAC response rate: 32%
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Hartgrink
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Schuhmacher
Cardia and gastric cancer 144 randomnised patients :
NAC+ surg: N=72 Surg alone: N=72
NAC: cisplatin, folinic acid, 5FU Response rate: 36,2% ( 5,8% complete response) Median follow-up: 4,4 years
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Median survival:•CTx + surg: 64,6 m•Surg alone: 52,53 m
2y survival:•CTx+ Surg: 72,7%•Surg alone: 69,9%
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Conclusion
Our study does not demonstrate a significant impact of neoajuvant chemotherapy on survival at 5 years.
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Conclusion