Surgery for Gastric Remnant Cancer Results in Similar Overall Survival Rates Compared with Primary Gastric Cancer: A Pro
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ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
Surgery for Gastric Remnant Cancer Results in Similar Overall Survival Rates Compared with Primary Gastric Cancer: A Propensity Score-Matched Analysis Christian Galata, MD1, Ulrich Ronellenfitsch, MD2, Christel Weiß, PhD3, Susanne Blank, MD1, Christoph Reißfelder, MD1, and Julia Hardt, MD1 1
Department of Surgery, Universita¨tsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 2Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Martin-LutherUniversity Halle-Wittenberg, Halle (Saale), Germany; 3Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
ABSTRACT Background. The purpose of this study was to investigate clinical features, prognostic factors, and overall survival (OS) in surgical patients with gastric remnant cancer (GRC). Methods. A retrospective analysis of patients with gastrectomy for pT1–4 gastric cancer between October 1972 and February 2014 at our institution was performed. Clinical characteristics were compared between patients with GRC and those with primary gastric cancer (PGC). Multivariable Cox regression analysis was performed to determine the prognostic factors for OS in patients with GRC. A propensity score-matched cohort was used to investigate OS between the GRC and PGC groups. Results. Of a baseline cohort of 1440 patients, 95 patients with GRC were identified. Patients with GRC underwent more multivisceral resections (p \ 0.001) than patients with PGC despite lower tumor stages (p = 0.018); however, R0 resection rates were not significantly different (p = 0.211). The postoperative overall (p = 0.032) and major surgical (p = 0.021) complication rates and the 30-day (p = 0.003) and in-hospital (p = 0.008) mortality rates were higher in patients with GRC. In multivariable analysis, the only prognostic factors for worse OS in GRC were higher tumor stage (p \ 0.001) and the occurrence of
Ó Society of Surgical Oncology 2020 First Received: 27 November 2019 J. Hardt, MD e-mail: [email protected]
postoperative complications (p \ 0.001). OS between propensity score-matched GRC and PGC groups was not significantly different (p = 0.772). Conclusions. GRC required more invasive surgery than PGC; however, the feasibility of R0 resection was similar. The prognostic factors of GRC were similar to those of PGC, and OS was not significantly different between both groups. Patients with GRC benefit from extensive surgery when performed with low morbidity and mortality.
Gastric remnant cancer (GRC) is defined as an adenocarcinoma arising in the residual stomach after partial gastrectomy and is considered a distinct clinical entity.1 Earlier definitions referred only to cancers diagnosed after partial gastric resection for benign indications.2 Recently, the definition has changed, and several studies have investigated GRC following oncologic resection for primary gastric cancer (PGC).3,4 While the overall incidence of PG
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