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Yamaguchi T, Kadoya S, Hayashi K, Gunjigake K, Sakimura Y, Ohbatake Y, Terai S, Kitamura H, Bando H, Inaki N. Noninferiority of additional gastrectomy after endoscopic submucosal dissection compared with surgery alone on long-term prognosis: a propensity score matching analysis. J Gastrointest Surg 2024; 28:1519-1525. [PMID: 38964536 DOI: 10.1016/j.gassur.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/10/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Patients in whom endoscopic submucosal dissection (ESD) has resulted in noncurative resection need further surgical treatment. However, the oncologic outcome of additional gastrectomy after ESD compared with surgery alone remains unclear. METHODS The clinical data of 778 patients who underwent gastrectomy for early gastric cancer (EGC) from January 2008 to December 2019 in Ishikawa Prefectural Central Hospital were retrospectively analyzed. Of these 778 patients, 187 underwent additional gastrectomy after ESD [ESD (+) group] and 591 underwent surgery alone [ESD (-) group]. We compared the overall survival and disease-free survival between the ESD (+) and ESD (-) groups, using propensity score matching (PSM) to adjust for baseline characteristics. We also assessed early postoperative outcomes. RESULTS After PSM based on sex (male or female), age, tumor diameter, tumor gross type, and operative procedure, each group comprised 144 patients with no significant differences in clinical background characteristics. After matching, the 5-year overall survival rate in the ESD (+) and ESD (-) group was 90.9% and 87.8%, respectively, with no significant difference (P = .470). In addition, there was no significant difference in the disease-free survival rate (97.6% vs 95.8%, respectively; P = .504). The postoperative complication rate was similar in both groups. CONCLUSION Additional gastrectomy for patients in whom ESD resulted in noncurative resection did not adversely affect the long-term prognosis. Additional gastrectomy after ESD is oncologically acceptable for EGC.
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Affiliation(s)
- Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
| | - Shinichi Kadoya
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Kengo Hayashi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Katsuya Gunjigake
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Yoshinao Ohbatake
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Shiro Terai
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Kanazawa University, Ishikawa, Japan
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Ramanathan S, Shen N, Johnson T, Cheng C, Tuma F, Serpa E, Ghanem M. Longer Wait Times Do Not Adversely Impact 90-Day Mortality in Patients With Stages I-III Gastric Cancer. Cureus 2023; 15:e46494. [PMID: 37927629 PMCID: PMC10624516 DOI: 10.7759/cureus.46494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Gastric cancer is one of the leading causes of cancer-related death in the United States. Surgery remains integral to the curative management of non-metastatic gastric cancer. However, delays to the date of surgery for gastric cancer patients are commonplace. To investigate the impact of treatment delays on gastric cancer mortality, we conducted a multivariable analysis of over 36,000 patients. Materials & methods After querying the National Cancer Database and excluding patients who did not meet inclusion criteria, our sample included 36,598 patients with stage I-III gastric cancer. We ran multivariable logistic regressions by regressing 90-day mortality on wait time. Other co-variables included sex, race, age, area of residence, comorbidities, insurance, histology, tumor grade, tumor stage, resection margins, treatment facility type, and treatment with chemotherapy. Results Our results demonstrated that each day of increased waiting time is associated with a 0.5% decrease in 90-day mortality. Other statistically significant predictors of higher 90-day mortality risk included male sex, black or white race, living in a small metropolitan or non-metropolitan area, older age, more severe comorbidities, non-private insurance, non-gastric stromal tumor cancer, non-well differentiated tumors, worse clinical stage, residual cancer, treatment at non-academic center, and no adjuvant/neoadjuvant chemotherapy. Conclusion These findings demonstrate that patients with longer wait times until surgery do not experience worse outcomes. These results are reassuring and can be cited to alleviate patient concerns.
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Affiliation(s)
- Siddharth Ramanathan
- Medicine, Oakland University William Beaumont School of Medicine, Rochester Hills, USA
| | - Nathan Shen
- Hematology and Oncology, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Thomas Johnson
- Oncology, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Chin Cheng
- Statistics, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Faiz Tuma
- Surgery, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Eduardo Serpa
- General Surgery, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Maher Ghanem
- General Surgery, Central Michigan University College of Medicine, Mount Pleasant, USA
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Yen C, Yang Y, Ku H, Hu H, Lo S, Chang H, Chao Y, Chen J, Wang H, Wang T, Bai L, Wu M, Yen C, Chen L, Shan Y. The impact of preoperative waiting time in Stage II-III gastric or gastroesophageal junction cancer: A population-based cohort study. Cancer Med 2023; 12:16906-16917. [PMID: 37401402 PMCID: PMC10501262 DOI: 10.1002/cam4.6320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Gastrectomy remains the curative option in gastric cancer. However, the growing concern that preoperative waiting jeopardizes survival has not been fully addressed. The present population-based cohort study aimed to clarify the impact of preoperative waiting time (PreWT). METHODS We included patients with clinical Stage II-III gastric cancer who received curative surgery from 2008 to 2017 of Taiwan Cancer Registry. PreWT was defined as the time from endoscopic diagnosis to surgery. The prognostic impact on overall survival (OS) was evaluated with Cox and restricted cubic spline regressions. RESULTS A total of 3059 patients with a median age of 68 years were evaluated. The median PreWT was 16 days (interquartile range, 11-24 days), and patients with a shorter PreWT were younger, had a more advanced disease and received adjuvant therapies. Despite a shorter OS occurring with prolonged PreWT (median OS by PreWT [days]: 7-13, 2.7 years; 14-20, 3.1 years; 21-27, 3.0 years; 28-34, 4.7 years; 35-31, 3.7 years; 42-48, 3.4 years; 49-118, 2.8 years; p = 0.029), the differences were not significant after adjustment. The Cox and restricted cubic spline regressions showed that prolonged PreWT was not a significant prognostic factor for OS (p = 0.719). CONCLUSIONS The population-based study suggests that a PreWT of 49-118 days does not independently correlate with a poor prognosis in Stage II-III gastric cancer. The study provides rationale for a window period for preoperative therapies and patient optimization.
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Affiliation(s)
- Chih‐Chieh Yen
- Department of OncologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
- Institute of Clinical Medicine, School of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Yi‐Hsin Yang
- National Institute of Cancer Research, National Health Research InstitutesTainanTaiwan
| | - Hsiu‐Ying Ku
- National Institute of Cancer Research, National Health Research InstitutesTainanTaiwan
- Department of Healthcare AdministrationAsia UniversityTaichungTaiwan
| | - Huang‐Ming Hu
- Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
- Department of Internal MedicineKaohsiung Municipal Ta‐Tung HospitalKaohsiungTaiwan
| | - Su‐Shun Lo
- Department of SurgeryNational Yang Ming Chiao Tung University HospitalYilanTaiwan
| | - Hung‐Chi Chang
- Department of SurgeryChang‐Hua Christian HospitalChanghuaTaiwan
| | - Yee Chao
- Department of Oncology, School of Medicine, Taipei Veterans General HospitalNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Jen‐Shi Chen
- Department of Hematology‐OncologyLinkou Chang Gung Memorial Hospital and Chang Gung UniversityLinkouTaiwan
| | - Hsiu‐Po Wang
- Department of Internal MedicineNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
| | - Tsang‐En Wang
- Department of Internal MedicineMackay Memorial HospitalTaipeiTaiwan
| | - Li‐Yuan Bai
- Division of Hematology and Oncology, Department of Internal MedicineChina Medical University Hospital, and China Medical UniversityTaichungTaiwan
| | - Ming‐Shiang Wu
- Department of Internal MedicineNational Taiwan University College of Medicine and HospitalTaipeiTaiwan
| | - Chia‐Jui Yen
- Department of OncologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Li‐Tzong Chen
- National Institute of Cancer Research, National Health Research InstitutesTainanTaiwan
- Department of Internal MedicineKaohsiung Medical University Hospital, Kaohsiung Medical UniversityKaohsiungTaiwan
| | - Yan‐Shen Shan
- Institute of Clinical Medicine, School of MedicineNational Cheng Kung UniversityTainanTaiwan
- Department of Surgery, National Cheng Kung University HospitalCollege of Medicine, National Cheng Kung UniversityTainanTaiwan
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Cao J, Yan J, Hu J, Zhang B, Topatana W, Li S, Chen T, Jeungpanich S, Lu Z, Peng S, Cai X, Chen M. Estimating the influencing factors for T1b/T2 gallbladder cancer on survival and surgical approaches selection. Cancer Med 2023; 12:16744-16755. [PMID: 37366278 PMCID: PMC10501227 DOI: 10.1002/cam4.6297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/17/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The influencing factors, especially time to treatment (TTT), for T1b/T2 gallbladder cancer (GBC) patients remain unknown. We aimed to identify the influencing factors on survival and surgical approaches selection for T1b/T2 GBC. METHODS We retrospectively screened GBC patients between January 2011 and August 2018 from our hospital. Clinical variables, including patient characteristics, TTT, overall survival (OS), disease-free survival (DFS), surgery-related outcomes, and surgical approaches were collected. RESULTS A total of 114 T1b/T2 GBC patients who underwent radical resection were included. Based on the median TTT of 7.5 days, the study cohort was divided into short TTT group (TTT ≤7 days, n = 57) and long TTT group (TTT >7 days, n = 57). Referrals were identified as the primary factor prolonging TTT (p < 0.001). There was no significance in OS (p = 0.790), DFS (p = 0.580), and surgery-related outcomes (all p > 0.05) between both groups. Decreased referrals (p = 0.005), fewer positive lymph nodes (LNs; p = 0.004), and well tumor differentiation (p = 0.004) were all associated with better OS, while fewer positive LNs (p = 0.049) were associated with better DFS. Subgroup analyses revealed no significant difference in survival between patients undergoing laparoscopic or open approach in different TTT groups (all p > 0.05). And secondary subgroup analyses found no significance in survival and surgery-related outcomes between different TTT groups of incidental GBC patients (all p > 0.05). CONCLUSIONS Positive LNs and tumor differentiation were prognostic factors for T1b/T2 GBC survival. Referrals associating with poor OS would delay TTT, while the prolonged TTT would not impact survival, surgery-related outcomes, and surgical approaches decisions in T1b/T2 GBC patients.
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Affiliation(s)
- Jiasheng Cao
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Jiafei Yan
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Jiahao Hu
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Bin Zhang
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Win Topatana
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Shijie Li
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Tianen Chen
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Sarun Jeungpanich
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Ziyi Lu
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Shuyou Peng
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
- Department of General Surgerythe Second Affiliated Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Xiujun Cai
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
| | - Mingyu Chen
- Department of General SurgerySir Run‐Run Shaw Hospital, Zhejiang UniversityHangzhouZhejiang ProvinceChina
- Zhejiang University School of MedicineZhejiang UniversityHangzhouZhejiang ProvinceChina
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Kaslow SR, He Y, Sacks GD, Berman RS, Lee AY, Correa-Gallego C. Time to Curative-Intent Surgery in Gastric Cancer Shows a Bimodal Relationship with Overall Survival. J Gastrointest Surg 2023; 27:855-865. [PMID: 36650415 DOI: 10.1007/s11605-023-05585-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Time to treatment (TTT) varies widely for patients with gastric cancer. We aimed to evaluate relationships between time to treatment, overall survival (OS), and other surgical outcomes in patients with stage I-III gastric cancer. METHODS We identified patients with clinical stage I-III gastric cancer who underwent curative-intent gastrectomy within the National Cancer Database (2006-2015) and grouped them by treatment sequence: neoadjuvant chemotherapy or surgery upfront. We defined TTT as weeks from diagnosis to treatment initiation (neoadjuvant chemotherapy or definitive surgical procedure, respectively). Survival differences were assessed by Kaplan-Meier estimate, Cox proportional hazard regression, and log rank test. RESULTS Among the 22,846 patients with stage I-III gastric cancer, most (56%) received surgery upfront. Median TTT was 5 weeks (IQR 4-7) and 6 weeks (IQR 3-9) for patients in the neoadjuvant and surgery upfront groups, respectively. In the neoadjuvant group, increasing TTT was significantly associated with increasing median OS up to TTT of 5 weeks, with no change in median OS when TTT was > 5 weeks. In the surgery group, increasing TTT was significantly associated with increasing median OS up to 6 weeks; however, increasing TTT between 14 and 21 weeks was associated with decreasing median OS. CONCLUSIONS The relationship between time to treatment and survival outcomes is non-linear. Among patients who underwent surgery upfront, the relationship between time to treatment and OS was bimodal, suggesting that deferring definitive surgery, up to 14 weeks, is not associated with worse OS or oncologic outcomes. The relationship between time to treatment and overall survival among patients was bimodal, suggesting that deferring definitive surgery up to 14 weeks is not associated with worse OS.
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Affiliation(s)
- Sarah R Kaslow
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
| | - Yanjie He
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Greg D Sacks
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Russell S Berman
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Ann Y Lee
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Camilo Correa-Gallego
- Department of Surgery, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, USA
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Wada Y, Nishi M, Yoshikawa K, Takasu C, Tokunaga T, Nakao T, Kashihara H, Yoshimoto T, Shimada M. Preoperative nutrition and exercise intervention in frailty patients with gastric cancer undergoing gastrectomy. Int J Clin Oncol 2022; 27:1421-1427. [PMID: 35771395 DOI: 10.1007/s10147-022-02202-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The frailty was associated with the worse surgical outcomes and poor prognosis in several cancers. Therefore, we aimed to identify the usefulness of nutrition and exercise intervention (NEI) in frailty patients with GC. METHODS We analyzed 58 frailty patients with GC who underwent radical surgery. Among these, 15 patients were performed NEI by nutritional and rehabilitation support team. We compared the surgical outcomes between NEI and non-NEI groups with frailty patients and evaluated the nutrition and rehabilitation markers in pre- and post-NEI groups. RESULTS The postoperative complication of NEI groups was 6.7% and less than that of non-NEI groups (p = 0.08). The mean postoperative hospital stay of NEI groups was 13.0 ± 1.0 days for NEI groups and significantly shorter than that of non-NEI groups (p = 0.03). The NLR was 4.3 ± 0.6 for pre-NEI and significantly improved by NEI between pre- and post-NEI (p = 0.03). CONCLUSION We identified the clinical importance of NEI for improving the surgical outcomes in frailty patients with GC. Our findings highlight the potential clinical impact of optimizing treatment strategies to select and manage the frailty patients.
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Affiliation(s)
- Yuma Wada
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Masaaki Nishi
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Kozo Yoshikawa
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Chie Takasu
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Toshihiro Nakao
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hideya Kashihara
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Toshiaki Yoshimoto
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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Ma J, Zhu C, Li W, Qiu Z, Yang J, Ge L, Da M. The Effect of Delayed Oncology Surgery on Survival Outcomes for Patients With Gastric Cancer During the COVID-19 Pandemic: Evidence-Based Strategies. Front Oncol 2022; 12:780949. [PMID: 35664784 PMCID: PMC9162578 DOI: 10.3389/fonc.2022.780949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/12/2022] [Indexed: 01/10/2023] Open
Abstract
Objective To evaluate the impact of delay in gastrectomy on gastric cancer patients’ survival outcomes during the COVID-19 pandemic. Methods Databases including PubMed, MEDLINE (using the Ovid platform), Embase, the Cochrane Library, COVID-19 Open Research Dataset Challenge, COVID-19 Research Database (WHO), ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform were searched for studies of any design and in any setting that included patients with gastric cancer from their inception to July 31, 2021. Hazard ratio (HR) and 95% confidence intervals (CI) of research endpoints in each study were calculated. Statistical analyses were performed with Stata 12.0. Results A total of 8 studies involving 4,052 gastric cancer patients were eligible and included in the present meta-analysis. The result of the meta-analysis was shown that delaying surgery for less than 8 weeks may not decrease OS (HR = 0.91, 95% CI: 0.80~1.04, p = 0.167) and DFS (HR = 0.96, 95% CI: 0.62~1.50, p = 0.872) in gastric cancer. Our meta-analysis also illustrated that delay in surgery for more than 4 weeks (HR = 0.85, 95% CI: 0.56~1.27, p = 0.421), 6 weeks (HR = 0.88, 95% CI: 0.61~1.27, p = 0.490), and 8 weeks (HR = 0.93, 95% CI: 0.80~1.07, p = 0.314) was also not associated with a decreased OS. Conclusion A delay in surgery of less than 8 weeks is not associated with worse overall survival for patients with gastric cancer.
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Affiliation(s)
- Jichun Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Chenglou Zhu
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Weidong Li
- Clinical Medicine College, Ningxia Medical University, Yinchuan, China
| | - Zhisheng Qiu
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China.,Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Jian Yang
- The First Clinical Medical College of Lanzhou University, Lanzhou University, Lanzhou, China.,Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mingxu Da
- Department of Oncology Surgery, Gansu Provincial Hospital, Lanzhou, China
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Gastric Cancer Surgery During the Pandemic: What It Costs? J Gastrointest Cancer 2021; 53:848-853. [PMID: 34811648 PMCID: PMC8608237 DOI: 10.1007/s12029-021-00751-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND From the early days of 2020, the COVID-19 pandemic continues to change whole life all around the world. Oncological patients are the most affected populations since these days. Because of decreasing numbers in surgery and endoscopy, gastric cancer patients had difficulties in treatment and diagnoses. Therefore, the early and long-term results may be affected during the pandemic. In this study, we aimed to evaluate pandemia effects on gastric cancer surgery in a single center. PATIENTS-METHODS Patients were categorized as the COVID group and the Pre-COVID group. Patients who received neoadjuvant chemotherapy were excluded from the study. In the COVID period, 50 patients underwent gastric cancer surgery, while 64 were operated on in the pre-COVID period. Patients' demographics and clinical and pathological outcomes were evaluated. RESULTS There was no statistically significant difference in both periods among patient characteristics such as age, gender, and body mass index. Pre-operative laboratory results were similar between two groups. Although there was no difference in operation types, an increase was detected in Clavien-Dindo grade 3 and higher complications during the COVID period. During the pandemic, there was a significant difference in the pathological outcomes. Peritoneal cytology-positive patients were hıgher in the COVID group. More lymphovascular invasions were also detected in the COVID period. Finally, it resulted stage differences between two groups. CONCLUSION Because of COVID-19's heavy burden on healthcare system, delays in the diagnosis and treatment of oncological patients may occur. Therefore, this may be affected pathological and survival outcomes of cancer patients. Finally, further investigations are needed.
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Zhao F, Liu X, Zhang C, Zhu H, Qi N. Mortality Increases When Radical Nephrectomy is Delayed More Than 60 Days for T3 Renal Cell Carcinoma. Technol Cancer Res Treat 2021; 20:15330338211043963. [PMID: 34595976 PMCID: PMC8489746 DOI: 10.1177/15330338211043963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Radical nephrectomy is widely accepted as the default management option for patients with T3 renal cell carcinoma (RCC). However, it may require a certain time before surgery for various reasons. There are concerns that the delay in surgery may affect postoperative outcomes. The present study aimed to evaluate the impact of surgical wait time on survival in patients with T3 RCC. Methods: We retrospectively selected 138 patients with T3 RCC who underwent radical surgery between July 2009 and December 2019. Surgical wait time was defined as the period from initial imaging diagnosis to surgery. Patients were divided into the following 2 groups according to wait time: short-wait group(≤60 days), and long-wait group (>60 days). The clinical and pathological characteristics were evaluated. The overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) of each group were calculated and compared. Age, gender, interval, tumor size, pathological grade, Eastern Cooperative Oncology Group performance status (ECOG PS), surgical approach, year of surgery, and pathological type were included in the multivariable model. Results: This study included 91 male (65.9%) and 47 female (34.1%) patients. The median age of all patients was 60 years (interquartile range [IQR] 52-68 years). The median body mass index is 22.2 kg/m2 (IQR 18.9-24.7 kg/m2). There were 128 patients (92.8%) with pT3a disease and 10 patients (7.3%) with pT3b disease. The median surgical wait time for all patients was 16 days (IQR 10-77 days). The median surgical wait time of the short- and long-wait groups was 12 days (IQR 8-16 days) and 92 days (IQR 79-115 days), respectively. Until the last follow-up, 54 patients died. Among them, 49 patients (90.7%) died of tumor-related causes, and 5 patients (9.3%) died of other causes. There are 1 and 4 cases in the short-wait and long-wait groups, respectively. There were no significant differences in gender, ECOG PS, American society of anesthesiologists score, Charlson comorbidity index, clinical T stage, clinical N stage, and body mass index. And there were no significant differences in tumor size, surgical approach, year of surgery, pathological type, tumor grade, pathological T stage, pathological N stage, and venous involvement between the 2 groups. OS, CSS, and RFS were compared. The 5-year OS of the short- and long-wait time groups were 65.0% and 40.9%, respectively (P = .030). The 5-year CSS rates of the short- and long-wait time groups were 68.7% and 51.5%, respectively (P = .012). The 5-year RFS rates of the short- and long-wait time groups were 61.5% and 46.8%, respectively (P = .119). Multivariable analysis revealed that surgical wait time interval and tumor size were independent risk factors for OS and that wait time was also an independent risk factor for CCS. Conclusion: Delay in radical surgery beyond 60 days can negatively affect OS in patients with T3 RCC.
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Affiliation(s)
- Fangzheng Zhao
- Department of Urology, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiaoxiao Liu
- 38044Department of Radiation Oncology, Cancer Center, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Chu Zhang
- 38044Department of Radiation Oncology, Cancer Center, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Haitao Zhu
- Department of Urology, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Nienie Qi
- Department of Urology, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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10
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Impact of Preoperative Time Interval on Survival in Patients With Gastric Cancer. World J Surg 2021; 45:2860-2867. [PMID: 34121136 DOI: 10.1007/s00268-021-06187-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A time interval between diagnosis and surgery for gastric cancer is necessary, although its impact on survival remains controversial. We evaluated the impact of preoperative time interval on survival in gastric cancer patients. METHODS We enrolled 332 patients who underwent curative gastrectomy for clinical stage (cStage) I-III gastric cancer between 2012 and 2015. We separately analyzed early- (cStage I) and advanced-stage (cStages II and III) patients. Early-stage patients were divided according to preoperative time interval: short (≤ 42 days) and long (> 42 days) groups. Advanced-stage patients were also divided into short (≤ 21 days) and long (> 21 days) groups. We compared the survival between the short and long groups in early- and advanced-stage patients. RESULTS The median preoperative time interval was 29 days, and no significant differences were found in patient characteristics between the short and long groups in early- and advanced-stage patients. In early-stage patients, the 5-year survival rates of the short and long groups were 86.5% and 88.4%, respectively (P = 0.917). In advanced-stage patients, the 5-year survival rates were 72.1% and 70.0%, respectively (P = 0.552). In multivariate analysis, a longer time interval was not selected as an independent prognostic factor in early- and advanced-stage patients. CONCLUSIONS In this study, survival difference was not found based upon preoperative time interval. The results do not affirm the delay of treatment without reason, however, imperative extension of preoperative time interval may be justified from the standpoint of long-term survival.
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11
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Optimal care and survival for signet-ring cell and non-signet-ring cell gastric cancer are more achievable at academic cancer centers. Am J Surg 2021; 222:969-975. [PMID: 34045068 DOI: 10.1016/j.amjsurg.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Western literature lacks large-scale population studies comparing the influence of academic and high-volume (HV) versus low-volume (LV) cancer centers on gastric cancer oncologic outcomes. METHODS The National Cancer Database from 2004 to 2016 was used. RESULTS 22871 patients were studied. Patients with stage III signet-ring cell gastric carcinoma (SRGC) received neoadjuvant treatment (NAT) more frequently at academic and HV comprehensive cancer centers (OR: 4.27 and 2.42; p < 0.0001 and 0.009) compared to community centers. Patients with stage III non-SRGC (NSRGC) had a 2.4 times higher odds of receiving NAT at academic centers. The R1 resection rate for NSRGC was lower at academic centers (OR: 0.67; p = 0.0018). Lymph node harvest ≥15 nodes was 1.6 and 1.9 times higher at academic centers for NSRGC and SRGC, respectively. Patients treated at academic centers had a significantly improved overall survival (OS). CONCLUSIONS Treatment at academic centers is associated with significant improvements in oncologic metrics and OS.
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12
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Shiomi S, Toriumi T, Yagi K, Asaoka R, Okumura Y, Wakamatsu K, Aikou S, Yamashita H, Nomura S, Seto Y. Trunk fat volume can be a predictor of postoperative complications after gastrectomy: a retrospective cohort study. BMC Surg 2021; 21:207. [PMID: 33892713 PMCID: PMC8067392 DOI: 10.1186/s12893-021-01221-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background Obesity can affect postoperative outcomes of gastrectomy. Visceral fat area is superior to body mass index in predicting postoperative complications. However, visceral fat area measurement is time-consuming and is not optimum for clinical use. Meanwhile, trunk fat volume (TFV) can be easily measured via bioelectrical impedance analysis. Hence, the current study aimed to determine the ability of TFV to predict the occurrence of complications after gastrectomy. Methods We retrospectively reviewed patients who underwent curative gastrectomy for gastric cancer between November 2016 and November 2019. The trunk fat volume-to-the ideal amount (%TFV) ratio was obtained using InBody 770 before surgery. The patients were classified into the obese and nonobese groups according to %TFV (TFV-H group, ≥ 150%; TFV-L group, < 150%) and body mass index (BMI-H group, ≥ 25 kg/m2; BMI-L group, < 25 kg/m2). We compared the short-term postoperative outcomes (e.g., operative time, blood loss volume, number of resected lymph nodes, and duration of hospital stay) between the obese and nonobese patients. Risk factors for complications were assessed using logistic regression analysis. Results In total, 232 patients were included in this study. The TFV-H and BMI-H groups had a significantly longer operative time than the TFV-L (p = 0.022) and BMI-L groups (p = 0.006). Moreover, the TFV-H group had a significantly higher complication rate (p = 0.004) and a lower number of resected lymph nodes (p < 0.001) than the TFV-L group. In the univariate analysis, %TFV ≥ 150, total or proximal gastrectomy, and open gastrectomy were found to be potentially associated with higher complication rates (p < 0.1 for all). Moreover, the multivariate analysis revealed that %TFV ≥ 150 (OR: 2.73; 95% CI: 1.37–5.46; p = 0.005) and total or proximal gastrectomy (OR: 3.57; 95% CI: 1.79–7.12; p < 0.001) were independently correlated with postoperative morbidity. Conclusions %TFV independently affected postoperative complications. Hence, it may be a useful parameter for the evaluation of obesity and a predictor of complications after gastrectomy.
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Affiliation(s)
- Shinichiro Shiomi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tetsuro Toriumi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Raito Asaoka
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kotaro Wakamatsu
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sachiyo Nomura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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13
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DE Rosa M, Pasculli A, Rondelli F, Mariani L, Avenia S, Ceccarelli G, Testini M, Avenia N, Bugiantella W. Could diagnostic and therapeutic delay affect the prognosis of gastrointestinal primary malignancies in the COVID-19 pandemic era? A literature review. Minerva Surg 2021; 76:467-476. [PMID: 33890444 DOI: 10.23736/s2724-5691.21.08736-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Emergency situations, as the Covid-19 pandemic that is striking the world nowadays, stress the national health systems which are forced to rapidly reorganizing their sources. Therefore, many elective diagnostic and surgical procedures are being suspended or significantly delayed. Moreover, patients might find it difficult to refer to physicians and delay the diagnostic and even the therapeutic procedures because of emotional or logistic problems. The effect of diagnostic and therapeutic delay on survival in patients affected by gastrointestinal malignancies is still unclear. METHODS We carried out a review of the available literature, in order to determine whether the delay in performing diagnosis and curative-intent surgical procedures affects the oncological outcomes in patients with oesophageal, gastric, colorectal cancers, and colorectal liver metastasis. RESULTS The findings indicate that for oesophageal, gastric and colon cancers delaying surgery up to 2 months after the end of the staging process does not worsen the oncological outcomes. Oesophageal cancer should undergo surgery within 7-8 weeks after the end of neoadjuvant chemoradiation. Rectal cancers should undergo surgery within 31 days after the diagnostic process and within 12 weeks after neoadjuvant therapy. Adjuvant therapy should start within 4 weeks after surgery, especially in gastric cancer; a delay up to 42 days may be allowed for oesophageal cancer undergoing adjuvant radiotherapy. CONCLUSIONS Gastrointestinal malignancies can be safely managed taking into account that reasonable delays of planned treatments appear a generally safe approach, not having a significant impact on long-term oncological outcome.
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Affiliation(s)
- Michele DE Rosa
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Alessandro Pasculli
- Department of Biomedical Sciences and Human Oncology - Unit Of Endocrine, Digestive And Emergency Surgery, University A. Moro of Bari, Polyclinic of Bari, Bari, Italy
| | - Fabio Rondelli
- General and Specialized Surgery, Santa Maria Hospital, Terni, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Lorenzo Mariani
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Stefano Avenia
- Postgraduate School of General Surgery, University of Perugia, Perugia, Italy
| | - Graziano Ceccarelli
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology - Unit Of Endocrine, Digestive And Emergency Surgery, University A. Moro of Bari, Polyclinic of Bari, Bari, Italy
| | - Nicola Avenia
- General and Specialized Surgery, Santa Maria Hospital, Terni, Italy.,Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Walter Bugiantella
- General Surgery, San Giovanni Battista Hospital, USL Umbria 2, Foligno, Perugia, Italy -
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14
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Rucker AJ, Raman V, Jawitz OK, Rhodin KE, Tong BC, Harpole DH, D'Amico TA. Impact of Time to Endoscopic Resection on Outcomes for Stage I Esophageal Adenocarcinoma. Ann Thorac Surg 2021; 113:942-948. [PMID: 33857493 DOI: 10.1016/j.athoracsur.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endoscopic resection (ER) is the preferred treatment for superficial esophageal cancer; however, a safe timeframe for performing ER has not been established. The aim of this study was to evaluate the period in which ER can be performed for patients with stage I esophageal adenocarcinoma without compromising outcomes. METHODS The 2004-2015 National Cancer Database was used to identify patients with cT1N0M0 esophageal adenocarcinoma who underwent upfront ER. The primary outcome was overall survival, which was evaluated using Kaplan-Meier and multivariable Cox Proportional Hazards methods. The secondary outcome was rate of margin-positive resection, which was evaluated using a multivariable logistic regression. RESULTS A total of 983 patients met study criteria. The median time from diagnosis to ER was 34 days (IQR 5-70). Patients in the highest quartile of time to ER were more likely to be treated at a high-volume center and at a center different from that of diagnosis compared to those in the lowest quartile. Increasing time to ER was not independently associated with survival (adjusted HR per 10 days 1.02; 95% CI 0.98-1.05; p=0.32) nor margin-positive resection (OR per 10 days 1.01; 95% CI 0.96-1.06; p=0.60) CONCLUSIONS: In this NCDB analysis, increasing time to endoscopic resection, up to 180 days from diagnosis, was not associated with worsened survival or increased odds of margin-positive resection in patients with cT1N0M0 esophageal adenocarcinoma. Given these findings, patients may be afforded time to be seen in specialty centers without risk of tumor progression.
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Affiliation(s)
- A Justin Rucker
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Oliver K Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kristen E Rhodin
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - David H Harpole
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas A D'Amico
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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15
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Qi N, Zhao F, Liu X, Wei W, Wang J. Safety of Prolonged Wait Time for Nephrectomy for Clinically Localized Renal Cell Carcinoma. Front Oncol 2021; 11:617383. [PMID: 33859936 PMCID: PMC8042291 DOI: 10.3389/fonc.2021.617383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/16/2021] [Indexed: 12/28/2022] Open
Abstract
Background There is usually a surgical wait time before nephrectomy for patients with clinically localized renal cell carcinoma, and many factors can influence this preoperative wait time. A relatively prolonged wait time may cause tumor progression. Therefore, we assessed the effect of preoperative wait time on the prognosis of patients with clinically localized renal cell carcinoma. Methods The outcomes of 561 patients with clinically localized renal cell carcinoma who underwent nephrectomy between July 2011 and March 2017 were retrospectively evaluated. According to the wait time before surgery, we divided the patients into three groups: short-wait group (≤ 30 days), intermediate-wait group (> 30 and ≤ 90 days), and long-wait group (>90 days). The clinicopathological characteristics were evaluated, and the survival rates of the three groups were compared. Results This study included 370 male (66%) and 191(34%) female patients, with a median age of 64 years. There were 520 patients with stage T1 and 41 patients with stage T2 tumors. The median interval between diagnosis and surgery was 21 days. There were no significant differences in age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, body mass index, tumor size, surgical approach, surgical procedure, pathological subtype, tumor stage, tumor grade, and residual tumor among the three groups. Overall survival(OS) and cancer-specific survival (CSS) were comparable; the 5-year OS of the short-, intermediate-, and long-wait time groups were 84.2%, 82.0%, and 89.8%, respectively (P=0.732). The 5-year CSS rates of the short-, intermediate-, and long-wait time groups were 87.1%, 88.9%, and 90.4%, respectively (P=0.896). Multivariate analysis revealed that wait time was not an independent prognostic factor for OS or CSS. Conclusion Prolonged surgical wait time (> 90 days) does not influence survival in patients with clinically localized renal cell carcinoma.
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Affiliation(s)
- Nienie Qi
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University. Xuzhou Medical University, Xuzhou, China
| | - Fangzheng Zhao
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University. Xuzhou Medical University, Xuzhou, China
| | - Xiaoxiao Liu
- Department of Radiation Oncology, Cancer Center, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Center for the Collaboration and Innovation of Cancer Biotherapy, Cancer Institute, Xuzhou Medical University, Xuzhou, China
| | - Wei Wei
- Department of Health Management Center, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Junqi Wang
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University. Xuzhou Medical University, Xuzhou, China
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16
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Peng D, Zou YY, Cheng YX, Tao W, Zhang W. Effect of Time (Season, Surgical Starting Time, Waiting Time) on Patients with Gastric Cancer. Risk Manag Healthc Policy 2021; 14:1327-1333. [PMID: 33824610 PMCID: PMC8018433 DOI: 10.2147/rmhp.s294141] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the present study was to evaluate the effect of time (season, surgical starting time in the daytime, preoperative waiting time) on patients with gastric cancer. Methods A retrospective collection of medical records of patients who underwent gastrectomy at a single clinical center from January 2013 to December 2018 was performed. Medical records were collected, and short-term outcomes and long-term survival were analyzed by different time groups. Results A total of 586 patients were included in this study. In terms of surgical starting time, the midday group had a shorter operation time (p=0.017) but more complications (p=0.048) than the non-midday group. No significant difference was found based on the season of gastrectomy. The long preoperative waiting group had a shorter postoperative hospital stay than the short waiting group (p=0.026). No significant difference was found between the short-waiting group and long-waiting group in overall survival for all clinical stages. Age (p=0.040, HR=1.017, 95% CI=1.001-1.033), BMI (p<0.001, HR=0.879, 95% CI=0.844-0.953) and clinical stage (p<0.001, HR=2.053, 95% CI=1.619-2.603) were independent prognostic factors predicting overall survival; however, season of gastrectomy, surgical starting time and preoperative waiting time were not identified as independent prognostic factors. Conclusion Surgical starting time at the midday could cause more complications, and surgeons should be careful when the surgical starting time is midday.
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Affiliation(s)
- Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ying-Ying Zou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yu-Xi Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Wei Tao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
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17
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Kang WZ, Zhong YX, Ma FH, Liu H, Ma S, Li Y, Hu HT, Li WK, Tian YT. Treatment strategies for gastric cancer during the COVID-19 pandemic. World J Clin Cases 2020; 8:5099-5103. [PMID: 33269246 PMCID: PMC7674715 DOI: 10.12998/wjcc.v8.i21.5099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/29/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 pandemic has become a major global public health problem. Governments are taking the necessary steps to reduce the movement of people to contain the spread of the virus. However, these measures have caused considerable distress to patients with gastric cancer who are newly diagnosed or are undergoing treatment. In addition to the cancer, they must deal with longer waiting times for surgery and poor communication with doctors. Furthermore, gastric cancer patients generally have low immunity and a poor nutritional status, so they are a high-risk group for infection with the novel coronavirus. Therefore, it is necessary to formulate reasonable outpatient management strategies to reduce the adverse effects of the pandemic on their treatment. We summarize the management strategies for patients with gastric cancer during the pandemic.
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Affiliation(s)
- Wen-Zhe Kang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu-Xin Zhong
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fu-Hai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hao Liu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yang Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hai-Tao Hu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wei-Kun Li
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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18
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Garcia D, Siegel JB, Mahvi DA, Zhang B, Mahvi DM, Camp ER, Graybill W, Savage SJ, Giordano A, Giordano S, Carneiro-Pla D, Javid M, Lesher AP, Abbott A, DeMore NK. What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer. ACTA ACUST UNITED AC 2020; 3:1-11. [PMID: 34142081 PMCID: PMC8208646 DOI: 10.31487/j.cor.2020.06.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The impact of the COVID-19 pandemic has spread beyond those infected with SARS-CoV-2. Its widespread consequences have affected cancer patients whose surgeries may be delayed in order to minimize exposure and conserve resources. Methods Experts in each surgical oncology subspecialty were selected to perform a review of the relevant literature. Articles were obtained through PubMed searches in each cancer subtype using the following terms: delay to surgery, time to surgery, outcomes, and survival. Results Delays in surgery > 4 weeks in breast cancer, ductal carcinoma in situ, T1 pancreatic cancer, ovarian cancer, and pediatric osteosarcoma, negatively impacted survival. Studies on hepatocellular cancer, colon cancer, and melanoma (Stage I) demonstrated reduced survival with delays > 3 months. Conclusion Studies have shown that short-term surgical delays can result in negative impacts on patient outcomes in multiple cancer types as well as in situ carcinoma. Conversely, other cancers such as gastric cancer, advanced melanoma and pancreatic cancer, well-differentiated thyroid cancer, and several genitourinary cancers demonstrated no significant outcome differences with surgical delays.
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Affiliation(s)
- Denise Garcia
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julie B Siegel
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David A Mahvi
- Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA
| | - Biqi Zhang
- Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA
| | - David M Mahvi
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - E Ramsay Camp
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Whitney Graybill
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephen J Savage
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Antonio Giordano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara Giordano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Denise Carneiro-Pla
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mahsa Javid
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aaron P Lesher
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrea Abbott
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nancy Klauber DeMore
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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19
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Shinde RS, Naik MD, Shinde SR, Bhandare MS, Chaudhari VA, Shrikhande SV, Dcruz AK. To Do or Not to Do?-A Review of Cancer Surgery Triage Guidelines in COVID-19 Pandemic. Indian J Surg Oncol 2020; 11:175-181. [PMID: 32395064 PMCID: PMC7212248 DOI: 10.1007/s13193-020-01086-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022] Open
Abstract
COVID-19 pandemic has emerged as a global health emergency involving more than 200 countries so far. The number of affected population is on rising, so is the mortality. This crisis has overwhelmed the healthcare infrastructures in many affected countries. Due to overall rising cancer incidence and specific concerns, a cohort of cancer patients forms a distinct subset of the population in whom a correct and timely treatment has a huge impact on the outcome. During this period, oncology care is definitely affected owing to many factors like lockdowns, reduced beds and deferral of elective cases to halt the spread of the pandemic. Surgery remains the best line of defence in many solid organ tumours especially in early stage and is potentially curative. China, the source of this pandemic, has taken more than 3 months to enter the post transitional phase of this pandemic. Deferring cancer surgeries for this long period may have a direct impact on the long-term outcomes of cancer patients. Many surgical oncology associations across the globe have come up with triage guidelines for surgical care of cancer patients; however, these are based on expert opinion rather than actual data. Herein, we intend to review these guidelines with respect to the risk of disease progression in cancer patients. In the absence of actual data on cancer surgery care during this pandemic, clinical decisions should be based on careful consideration of disease-related and patient-related factors. While some of the cancer surgeries can be safely delayed for some time, how long we can delay surgeries safely cannot be answered/ explained by any means. Thorough evaluation and discussion by an expert and experienced multidisciplinary team appears to be the most effective way forward.
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Affiliation(s)
- Rajesh S. Shinde
- Department of Surgical Oncology, Gastrointestinal Cancer Surgery, Apollo Hospitals, Navi Mumbai, India
- Department of Surgical Oncology, Gastrointestinal Cancer Surgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Mekhala D. Naik
- Department of Urology, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | | | - Manish S. Bhandare
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vikram A. Chaudhari
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shailesh V. Shrikhande
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil K. Dcruz
- Department of Surgical Oncology, Gastrointestinal Cancer Surgery, Apollo Hospitals, Navi Mumbai, India
- Department of Surgical Oncology, Gastrointestinal Cancer Surgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India
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Wu C, Wang N, Zhou H, Wang T, Mao Q, Zhang X, Zhao D. Effects of Neoadjuvant Chemotherapy Toxicity and Postoperative Complications on Short-term and Long-term Outcomes After Curative Resection of Gastric Cancer. J Gastrointest Surg 2020; 24:1278-1289. [PMID: 31140064 DOI: 10.1007/s11605-019-04257-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Whether neoadjuvant chemotherapy (NAC) increased the risk of postoperative morbidities for patients with locally advanced gastric cancer (GC) is unknown. Whether neoadjuvant chemotherapy toxicity (NCT) and postoperative complications (POCs) correlate with short-term and long-term outcomes also remains unclear. We aimed to evaluate the role of NAC on the development of POCs, as well as the impact of NCT and POCs on postoperative and oncologic outcomes in curatively resected GC treated with NAC. METHODS This study retrospectively reviewed 230 patients who underwent curative gastrectomy for locally advanced GC (clinically T3/4 or N+) after NAC between 2006 and 2016. Five hundred patients undergoing upfront and curative surgery were selected as a control group. After matching, the incidence of POCs was compared between two groups. In the NAC group, clinicopathological characteristics of patients who experienced POCs were compared to those who did not. Logistic and Cox multivariate regression analyses were used to examine factors associated with POCs, disease-free survival (DFS), and overall survival (OS). RESULTS Following matching, 230 and 230 patients treated with surgery plus NAC and upfront surgery remained, respectively. The incidence of POCs was 28.7% and 24.3%, respectively (p = 0.290). In the NAC group, NCT (OR [odds ratio] 22.968, 95% CI [confidence interval] 2.948-> 99, p = 0.003) and operation time (OR 1.006, 95% CI 1.001-1.011, p = 0.021) were independent predictive factors of POCs. NCT did not affect oncologic outcomes. The Cox regression model demonstrated that POCs were independently associated with worse DFS (HR [hazard ratio] 2.128, 95% CI 1.240-3.653, p = 0.006) but not OS for patients treated with NAC. CONCLUSIONS The administration of NAC is not associated with an elevated risk of POCs. For patients treated with NAC, NCT is an independent predictor of POCs, but does not affect oncologic outcomes. POCs is independently associated with worse DFS but not OS. NAC should be considered a safe approach in patients who have locally advanced GC. Strategies to minimize chemotherapy toxicity and postoperative morbidities associated with NAC are warranted.
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Affiliation(s)
- Chaorui Wu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Nianchang Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Hong Zhou
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tongbo Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Qikun Mao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaojie Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dongbing Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Preoperative Exercise Habits are Associated with Post-gastrectomy Complications. World J Surg 2020; 44:2736-2742. [DOI: 10.1007/s00268-020-05493-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. J Gastrointest Surg 2020; 24:2357-2373. [PMID: 32607860 PMCID: PMC7325836 DOI: 10.1007/s11605-020-04712-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines. METHODS A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer. RESULTS For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery. CONCLUSION Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes.
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