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