A.DELENS, MEDICAL STUDENT J.M. WEERTS, FRCS Eng, JM.DEWANDRE, D. FRANCART, C. JEHAES, B. MONAMI. C....

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.

Plan

IntroductionobjectivePatients and methodResultsDiscussion Conclusion

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%

Introduction

Stadification

MOC

Guidelines of management:

T2 – T3/N+

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)

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

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??

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

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 ???

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

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

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

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%

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

Results

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:

Results

Results

Results

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?

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

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%

Hartgrink

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

Median survival:•CTx + surg: 64,6 m•Surg alone: 52,53 m

2y survival:•CTx+ Surg: 72,7%•Surg alone: 69,9%

Conclusion

Our study does not demonstrate a significant impact of neoajuvant chemotherapy on survival at 5 years.

Conclusion