Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study

S. Rausei, L. Ruspi, F. Rosa, P. Morgagni, D. Marrelli, A. Cossu, F. C M Cananzi, R. Lomonaco, A. Coniglio, A. Biondi, C. Cipollari, L. Graziosi, U. Fumagalli, F. Casella, P. Bertoli, A. di Leo, S. Alfieri, G. Vittimberga, F. Roviello, E. OrsenigoV. Quagliuolo, S. Montemurro, G. Baiocchi, R. Persiani, M. Bencivenga, A. Donini, R. Rosati, A. Sansonetti, L. Ansaloni, A. Zanoni, F. Galli, G. Dionigi

Research output: Contribution to journalArticle

Abstract

Background: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations.We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Conclusion: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.

Original languageEnglish
JournalEuropean Journal of Surgical Oncology
DOIs
Publication statusAccepted/In press - 2016

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Lymph Node Excision
Multicenter Studies
Stomach Neoplasms
Retrospective Studies
Survival
Gastrectomy
Dissection
Comorbidity
Survival Rate
Morbidity
Safety

Keywords

  • Elderly
  • Gastric cancer
  • High morbidity
  • Lymphadenectomy
  • Tailored treatment

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients : A retrospective multicenter study. / Rausei, S.; Ruspi, L.; Rosa, F.; Morgagni, P.; Marrelli, D.; Cossu, A.; Cananzi, F. C M; Lomonaco, R.; Coniglio, A.; Biondi, A.; Cipollari, C.; Graziosi, L.; Fumagalli, U.; Casella, F.; Bertoli, P.; di Leo, A.; Alfieri, S.; Vittimberga, G.; Roviello, F.; Orsenigo, E.; Quagliuolo, V.; Montemurro, S.; Baiocchi, G.; Persiani, R.; Bencivenga, M.; Donini, A.; Rosati, R.; Sansonetti, A.; Ansaloni, L.; Zanoni, A.; Galli, F.; Dionigi, G.

In: European Journal of Surgical Oncology, 2016.

Research output: Contribution to journalArticle

Rausei, S, Ruspi, L, Rosa, F, Morgagni, P, Marrelli, D, Cossu, A, Cananzi, FCM, Lomonaco, R, Coniglio, A, Biondi, A, Cipollari, C, Graziosi, L, Fumagalli, U, Casella, F, Bertoli, P, di Leo, A, Alfieri, S, Vittimberga, G, Roviello, F, Orsenigo, E, Quagliuolo, V, Montemurro, S, Baiocchi, G, Persiani, R, Bencivenga, M, Donini, A, Rosati, R, Sansonetti, A, Ansaloni, L, Zanoni, A, Galli, F & Dionigi, G 2016, 'Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study', European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2016.05.003
Rausei, S. ; Ruspi, L. ; Rosa, F. ; Morgagni, P. ; Marrelli, D. ; Cossu, A. ; Cananzi, F. C M ; Lomonaco, R. ; Coniglio, A. ; Biondi, A. ; Cipollari, C. ; Graziosi, L. ; Fumagalli, U. ; Casella, F. ; Bertoli, P. ; di Leo, A. ; Alfieri, S. ; Vittimberga, G. ; Roviello, F. ; Orsenigo, E. ; Quagliuolo, V. ; Montemurro, S. ; Baiocchi, G. ; Persiani, R. ; Bencivenga, M. ; Donini, A. ; Rosati, R. ; Sansonetti, A. ; Ansaloni, L. ; Zanoni, A. ; Galli, F. ; Dionigi, G. / Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients : A retrospective multicenter study. In: European Journal of Surgical Oncology. 2016.
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abstract = "Background: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations.We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results: Postoperative morbidity was 30.4{\%}. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9{\%} and 33.2{\%}, respectively), they increased following D2 in highly co-morbid elderly patients (39.6{\%}). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0{\%} vs. 37.6{\%} in D1, p < 0.001 and 72.6{\%} vs. 58.1{\%} in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7{\%} vs. 21.2{\%} in D1, p = 0.008 and 47.5{\%} vs. 30.6{\%} in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Conclusion: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.",
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author = "S. Rausei and L. Ruspi and F. Rosa and P. Morgagni and D. Marrelli and A. Cossu and Cananzi, {F. C M} and R. Lomonaco and A. Coniglio and A. Biondi and C. Cipollari and L. Graziosi and U. Fumagalli and F. Casella and P. Bertoli and {di Leo}, A. and S. Alfieri and G. Vittimberga and F. Roviello and E. Orsenigo and V. Quagliuolo and S. Montemurro and G. Baiocchi and R. Persiani and M. Bencivenga and A. Donini and R. Rosati and A. Sansonetti and L. Ansaloni and A. Zanoni and F. Galli and G. Dionigi",
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language = "English",
journal = "European Journal of Surgical Oncology",
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T1 - Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients

T2 - A retrospective multicenter study

AU - Rausei, S.

AU - Ruspi, L.

AU - Rosa, F.

AU - Morgagni, P.

AU - Marrelli, D.

AU - Cossu, A.

AU - Cananzi, F. C M

AU - Lomonaco, R.

AU - Coniglio, A.

AU - Biondi, A.

AU - Cipollari, C.

AU - Graziosi, L.

AU - Fumagalli, U.

AU - Casella, F.

AU - Bertoli, P.

AU - di Leo, A.

AU - Alfieri, S.

AU - Vittimberga, G.

AU - Roviello, F.

AU - Orsenigo, E.

AU - Quagliuolo, V.

AU - Montemurro, S.

AU - Baiocchi, G.

AU - Persiani, R.

AU - Bencivenga, M.

AU - Donini, A.

AU - Rosati, R.

AU - Sansonetti, A.

AU - Ansaloni, L.

AU - Zanoni, A.

AU - Galli, F.

AU - Dionigi, G.

PY - 2016

Y1 - 2016

N2 - Background: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations.We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Conclusion: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.

AB - Background: Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations.We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. Methods: In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. Results: Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. Conclusion: Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.

KW - Elderly

KW - Gastric cancer

KW - High morbidity

KW - Lymphadenectomy

KW - Tailored treatment

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