Surgical results of remnant gastric cancer treatment

ABSTRACT Background: remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with high...

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Published in:Revista do Colégio Brasileiro de Cirurgiões 2020, Vol.47
Main Authors: RAMOS, MARCUS FERNANDO KODAMA PERTILLE, PEREIRA, MARIA CLAUDIA MACHADO, OLIVEIRA, YARA SOUZA, PEREIRA, MARINA ALESSANDRA, BARCHI, LEANDRO CARDOSO, DIAS, ANDRE RONCON, ZILBERSTEIN, BRUNO, RIBEIRO JUNIOR, ULYSSES, CECCONELLO, IVAN
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Language:English
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Gastric Stump
Postoperative Complications
Stomach Neoplasms
Survival Analysis
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creator RAMOS, MARCUS FERNANDO KODAMA PERTILLE
PEREIRA, MARIA CLAUDIA MACHADO
OLIVEIRA, YARA SOUZA
PEREIRA, MARINA ALESSANDRA
BARCHI, LEANDRO CARDOSO
DIAS, ANDRE RONCON
ZILBERSTEIN, BRUNO
RIBEIRO JUNIOR, ULYSSES
CECCONELLO, IVAN
description ABSTRACT Background: remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. Objective: to evaluate surgical results and survival after CTG in patients with RGC. Methods: 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. Results: among the initial characteristics, age (68.0 vs. 60.5; p
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The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. Objective: to evaluate surgical results and survival after CTG in patients with RGC. Methods: 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. Results: among the initial characteristics, age (68.0 vs. 60.5; p&lt;0.001), hemoglobin values (10.9 vs. 12.3; p&lt;0.001) and body mass index (22.5 vs. 24.6; p=0.005) were different between the RGC and PGC groups, respectively. The most frequent postoperative complications were related to pulmonary complications, infection and fistula in both groups. There was a higher incidence of esophagojejunal fistula in the CTG group (14.8% vs 6.5%, p=0.055). Perioperative mortality was higher in RGC patients (9.3% vs. 5.1%), but without significance (p=0.329). Hospital length of stay, postoperative complications graded by the Clavien-Dindo classification, mortality at 30 and 90 days were not different between groups. There was no significant difference in disease-free and overall survival between RGC and PGC groups. Conclusion: despite previous reports, surgical results and survival were similar between groups. Higher risk of esophagojejunal fistula must be considered. RESUMO Antecedentes: o câncer do coto ou remanescente gástrico (CRG) se desenvolve cinco anos ou mais após a ressecção gástrica por lesão benigna ou maligna. O tratamento é realizado através da gastrectomia total complementar (GTC) com linfadenectomia. Alguns relatos consideram que esse procedimento pode estar associado a maiores taxas de morbimortalidade. Objetivo: avaliar os resultados cirúrgicos e a sobrevida após GTC em pacientes com CRG. Métodos: 54 pacientes submetidos a GTC entre 2009 e 2019 foram incluídos no estudo. Como grupo de comparação, foram selecionados 215 pacientes com câncer gástrico primário (CGP) submetidos à gastrectomia total (GT) no mesmo período. Resultados: dentre as características iniciais, a idade média (68,0 vs. 60,5; p &lt;0,001), os valores de hemoglobina (10,9 vs. 12,3; p &lt;0,001) e o índice de massa corporal (22,5 vs. 24,6; p = 0,005) diferiram entre os grupos CRG e CGP, respectivamente. As complicações pós-operatórias mais frequentes foram pulmonares, infecciosas e fístulas nos dois grupos. Houve maior incidência de fístula esofagojejunal no grupo GTC (14,8% vs 6,5%, p = 0,055). A mortalidade perioperatória foi maior nos pacientes com CRG (9,3% vs. 5,1%), mas sem significância (p = 0,329). O tempo de internação hospitalar, complicações pós-operatórias (Clavien-Dindo), mortalidade aos 30 e 90 dias não foram diferentes entre os grupos. Não houve diferença significativa na sobrevida livre de doença e global entre os grupos CRG e CGP. Conclusão: apesar dos relatos anteriores, os resultados cirúrgicos e a sobrevida foram semelhantes entre os grupos. Maior risco de fístula esofagojejunal dever ser considerado.</description><identifier>ISSN: 0100-6991</identifier><identifier>EISSN: 1809-4546</identifier><identifier>DOI: 10.1590/0100-6991e-20202703</identifier><language>eng</language><publisher>Colégio Brasileiro de Cirurgiões</publisher><subject>Gastric Stump ; Postoperative Complications ; Stomach Neoplasms ; Survival Analysis</subject><ispartof>Revista do Colégio Brasileiro de Cirurgiões, 2020, Vol.47</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3473-d1d14efb3962d02843f664389624423bffc6048e3ee07a4876c619edc0ee28123</citedby><cites>FETCH-LOGICAL-c3473-d1d14efb3962d02843f664389624423bffc6048e3ee07a4876c619edc0ee28123</cites><orcidid>0000-0003-0200-7858</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,4043,27956,27957,27958</link.rule.ids></links><search><creatorcontrib>RAMOS, MARCUS FERNANDO KODAMA PERTILLE</creatorcontrib><creatorcontrib>PEREIRA, MARIA CLAUDIA MACHADO</creatorcontrib><creatorcontrib>OLIVEIRA, YARA SOUZA</creatorcontrib><creatorcontrib>PEREIRA, MARINA ALESSANDRA</creatorcontrib><creatorcontrib>BARCHI, LEANDRO CARDOSO</creatorcontrib><creatorcontrib>DIAS, ANDRE RONCON</creatorcontrib><creatorcontrib>ZILBERSTEIN, BRUNO</creatorcontrib><creatorcontrib>RIBEIRO JUNIOR, ULYSSES</creatorcontrib><creatorcontrib>CECCONELLO, IVAN</creatorcontrib><title>Surgical results of remnant gastric cancer treatment</title><title>Revista do Colégio Brasileiro de Cirurgiões</title><description>ABSTRACT Background: remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. Objective: to evaluate surgical results and survival after CTG in patients with RGC. Methods: 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. Results: among the initial characteristics, age (68.0 vs. 60.5; p&lt;0.001), hemoglobin values (10.9 vs. 12.3; p&lt;0.001) and body mass index (22.5 vs. 24.6; p=0.005) were different between the RGC and PGC groups, respectively. The most frequent postoperative complications were related to pulmonary complications, infection and fistula in both groups. There was a higher incidence of esophagojejunal fistula in the CTG group (14.8% vs 6.5%, p=0.055). Perioperative mortality was higher in RGC patients (9.3% vs. 5.1%), but without significance (p=0.329). Hospital length of stay, postoperative complications graded by the Clavien-Dindo classification, mortality at 30 and 90 days were not different between groups. There was no significant difference in disease-free and overall survival between RGC and PGC groups. Conclusion: despite previous reports, surgical results and survival were similar between groups. Higher risk of esophagojejunal fistula must be considered. RESUMO Antecedentes: o câncer do coto ou remanescente gástrico (CRG) se desenvolve cinco anos ou mais após a ressecção gástrica por lesão benigna ou maligna. O tratamento é realizado através da gastrectomia total complementar (GTC) com linfadenectomia. Alguns relatos consideram que esse procedimento pode estar associado a maiores taxas de morbimortalidade. Objetivo: avaliar os resultados cirúrgicos e a sobrevida após GTC em pacientes com CRG. Métodos: 54 pacientes submetidos a GTC entre 2009 e 2019 foram incluídos no estudo. Como grupo de comparação, foram selecionados 215 pacientes com câncer gástrico primário (CGP) submetidos à gastrectomia total (GT) no mesmo período. Resultados: dentre as características iniciais, a idade média (68,0 vs. 60,5; p &lt;0,001), os valores de hemoglobina (10,9 vs. 12,3; p &lt;0,001) e o índice de massa corporal (22,5 vs. 24,6; p = 0,005) diferiram entre os grupos CRG e CGP, respectivamente. As complicações pós-operatórias mais frequentes foram pulmonares, infecciosas e fístulas nos dois grupos. Houve maior incidência de fístula esofagojejunal no grupo GTC (14,8% vs 6,5%, p = 0,055). A mortalidade perioperatória foi maior nos pacientes com CRG (9,3% vs. 5,1%), mas sem significância (p = 0,329). O tempo de internação hospitalar, complicações pós-operatórias (Clavien-Dindo), mortalidade aos 30 e 90 dias não foram diferentes entre os grupos. Não houve diferença significativa na sobrevida livre de doença e global entre os grupos CRG e CGP. Conclusão: apesar dos relatos anteriores, os resultados cirúrgicos e a sobrevida foram semelhantes entre os grupos. Maior risco de fístula esofagojejunal dever ser considerado.</description><subject>Gastric Stump</subject><subject>Postoperative Complications</subject><subject>Stomach Neoplasms</subject><subject>Survival Analysis</subject><issn>0100-6991</issn><issn>1809-4546</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNo9kM9OwzAMhyMEEmPwBFz6AgUn9tLmiCb-TJrEAThHaeJOnboWJdmBt6fbYLIs_2xZ3-ET4l7Cg1wYeAQJUGpjJJcKpqoAL8RM1mBKWpC-FLPzx7W4SWkLQCgNzgR97OOm864vIqd9n1MxtlPcDW7IxcalHDtfeDd4jkWO7PKOh3wrrlrXJ777m3Px9fL8uXwr1--vq-XTuvRIFZZBBkncNmi0CqBqwlZrwnpaiRQ2bes1UM3IDJWjutJeS8PBA7OqpcK5WJ24YXRb-x27nYs_dnSdPR7GuLEu5s73bLV3TCCJFlOboI3CIKsGnEOodGMmFp5YPo4pRW7PPAn2INEeFNmjRPsvEX8Bh5Ziww</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>RAMOS, MARCUS FERNANDO KODAMA PERTILLE</creator><creator>PEREIRA, MARIA CLAUDIA MACHADO</creator><creator>OLIVEIRA, YARA SOUZA</creator><creator>PEREIRA, MARINA ALESSANDRA</creator><creator>BARCHI, LEANDRO CARDOSO</creator><creator>DIAS, ANDRE RONCON</creator><creator>ZILBERSTEIN, BRUNO</creator><creator>RIBEIRO JUNIOR, ULYSSES</creator><creator>CECCONELLO, IVAN</creator><general>Colégio Brasileiro de Cirurgiões</general><scope>AAYXX</scope><scope>CITATION</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-0200-7858</orcidid></search><sort><creationdate>2020</creationdate><title>Surgical results of remnant gastric cancer treatment</title><author>RAMOS, MARCUS FERNANDO KODAMA PERTILLE ; PEREIRA, MARIA CLAUDIA MACHADO ; OLIVEIRA, YARA SOUZA ; PEREIRA, MARINA ALESSANDRA ; BARCHI, LEANDRO CARDOSO ; DIAS, ANDRE RONCON ; ZILBERSTEIN, BRUNO ; RIBEIRO JUNIOR, ULYSSES ; CECCONELLO, IVAN</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3473-d1d14efb3962d02843f664389624423bffc6048e3ee07a4876c619edc0ee28123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Gastric Stump</topic><topic>Postoperative Complications</topic><topic>Stomach Neoplasms</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RAMOS, MARCUS FERNANDO KODAMA PERTILLE</creatorcontrib><creatorcontrib>PEREIRA, MARIA CLAUDIA MACHADO</creatorcontrib><creatorcontrib>OLIVEIRA, YARA SOUZA</creatorcontrib><creatorcontrib>PEREIRA, MARINA ALESSANDRA</creatorcontrib><creatorcontrib>BARCHI, LEANDRO CARDOSO</creatorcontrib><creatorcontrib>DIAS, ANDRE RONCON</creatorcontrib><creatorcontrib>ZILBERSTEIN, BRUNO</creatorcontrib><creatorcontrib>RIBEIRO JUNIOR, ULYSSES</creatorcontrib><creatorcontrib>CECCONELLO, IVAN</creatorcontrib><collection>CrossRef</collection><collection>Directory of Open Access Journals</collection><jtitle>Revista do Colégio Brasileiro de Cirurgiões</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>RAMOS, MARCUS FERNANDO KODAMA PERTILLE</au><au>PEREIRA, MARIA CLAUDIA MACHADO</au><au>OLIVEIRA, YARA SOUZA</au><au>PEREIRA, MARINA ALESSANDRA</au><au>BARCHI, LEANDRO CARDOSO</au><au>DIAS, ANDRE RONCON</au><au>ZILBERSTEIN, BRUNO</au><au>RIBEIRO JUNIOR, ULYSSES</au><au>CECCONELLO, IVAN</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical results of remnant gastric cancer treatment</atitle><jtitle>Revista do Colégio Brasileiro de Cirurgiões</jtitle><date>2020</date><risdate>2020</risdate><volume>47</volume><issn>0100-6991</issn><eissn>1809-4546</eissn><abstract>ABSTRACT Background: remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. Objective: to evaluate surgical results and survival after CTG in patients with RGC. Methods: 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. Results: among the initial characteristics, age (68.0 vs. 60.5; p&lt;0.001), hemoglobin values (10.9 vs. 12.3; p&lt;0.001) and body mass index (22.5 vs. 24.6; p=0.005) were different between the RGC and PGC groups, respectively. The most frequent postoperative complications were related to pulmonary complications, infection and fistula in both groups. There was a higher incidence of esophagojejunal fistula in the CTG group (14.8% vs 6.5%, p=0.055). Perioperative mortality was higher in RGC patients (9.3% vs. 5.1%), but without significance (p=0.329). Hospital length of stay, postoperative complications graded by the Clavien-Dindo classification, mortality at 30 and 90 days were not different between groups. There was no significant difference in disease-free and overall survival between RGC and PGC groups. Conclusion: despite previous reports, surgical results and survival were similar between groups. Higher risk of esophagojejunal fistula must be considered. RESUMO Antecedentes: o câncer do coto ou remanescente gástrico (CRG) se desenvolve cinco anos ou mais após a ressecção gástrica por lesão benigna ou maligna. O tratamento é realizado através da gastrectomia total complementar (GTC) com linfadenectomia. Alguns relatos consideram que esse procedimento pode estar associado a maiores taxas de morbimortalidade. Objetivo: avaliar os resultados cirúrgicos e a sobrevida após GTC em pacientes com CRG. Métodos: 54 pacientes submetidos a GTC entre 2009 e 2019 foram incluídos no estudo. Como grupo de comparação, foram selecionados 215 pacientes com câncer gástrico primário (CGP) submetidos à gastrectomia total (GT) no mesmo período. Resultados: dentre as características iniciais, a idade média (68,0 vs. 60,5; p &lt;0,001), os valores de hemoglobina (10,9 vs. 12,3; p &lt;0,001) e o índice de massa corporal (22,5 vs. 24,6; p = 0,005) diferiram entre os grupos CRG e CGP, respectivamente. As complicações pós-operatórias mais frequentes foram pulmonares, infecciosas e fístulas nos dois grupos. Houve maior incidência de fístula esofagojejunal no grupo GTC (14,8% vs 6,5%, p = 0,055). A mortalidade perioperatória foi maior nos pacientes com CRG (9,3% vs. 5,1%), mas sem significância (p = 0,329). O tempo de internação hospitalar, complicações pós-operatórias (Clavien-Dindo), mortalidade aos 30 e 90 dias não foram diferentes entre os grupos. Não houve diferença significativa na sobrevida livre de doença e global entre os grupos CRG e CGP. Conclusão: apesar dos relatos anteriores, os resultados cirúrgicos e a sobrevida foram semelhantes entre os grupos. Maior risco de fístula esofagojejunal dever ser considerado.</abstract><pub>Colégio Brasileiro de Cirurgiões</pub><doi>10.1590/0100-6991e-20202703</doi><orcidid>https://orcid.org/0000-0003-0200-7858</orcidid><oa>free_for_read</oa></addata></record>
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subjects Gastric Stump
Postoperative Complications
Stomach Neoplasms
Survival Analysis
title Surgical results of remnant gastric cancer treatment
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