The term R0 describes  a microscopically margin  negative resection, in which  NO MICROSCOPIC TUMOR  REMAINS IN THE TUMOR ...
Survival  after R0-Resection Siewert JR, et al. Ann Surg, 1998 36.1%
Recurrence  after R0-Resection Marrelli D, et al. Ann Surg, 2005 52.0%
R0-Resection: what if it’s true?  D’Angelica M, et al. Ann Surg, 2004 7% 92%
Recurrence  after R0-Resection D’Ugo D, Catholic University, 2007 Risk factors pT3-4 pN+ diffuse type G3 larger size proxi...
? or Recurrence  (of disease) Failure (of treatment)
Survival  after R0-Resection Siewert JR, et al. Ann Surg, 1998 36.1% Siewert 1998 64.8% Kim 1998 Kim JP, et al. Gastric Ca...
Nishi M, et al. Gastric Cancer, 1993 1962 General Rules for Gastric Cancer Study in Surgery and Pathology Survival  after ...
 
 
 
 
Randomized Controlled Trials No survival benefit  (but in selected patients) Dutch MRC
D2 D1
 
What selection? Maruyama Index of unresected disease %   Likelihood of  nodal involvement for each lymph node station left...
Maruyama Index: a old parameter, a new R0-Resection?
 
 
Macdonald JS et al. N Engl J Med, 2001 CH-RT Surgery
Maruyama Index: a old parameter, a new R0-Resection?
Induction of R0-Resection 7-year survival results of perioperative chemotherapy with epidoxorubicin, etoposide, cisplatin ...
 
Magic Trial INT-0116 ACTS-GC S-1 CH-RT ECF
 
Maruyama Index: a old parameter, a new R0-Resection? <ul><li>Surg Oncol Clin N Am. 2007 Jan;16(1):133-55 </li></ul><ul><li...
R0-Resection: is there a need a new definition? <ul><li>Current criteria do not warrant for the  </li></ul><ul><li>accompl...
Randomized Controlled Trials High morbidity and mortality
What selection? Sentinel node biopsy Kitagawa Y, et al. Gastric Cancer, 2005
What selection? Targeted surgery Junctional nodes  for intraoperative evaluation Fielding J, et al. Gastric Cancer, 2004
What selection? cDNA.Microarray Analysis N0 N+
 
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R0 D'Ugo Eune 2008

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  • R0 D'Ugo Eune 2008

    1. 1. The term R0 describes a microscopically margin negative resection, in which NO MICROSCOPIC TUMOR REMAINS IN THE TUMOR BED R0-Resection Domenico D’UGO Full Professor of Surgery Catholic University - Rome (Hermaneck, 1994)
    2. 2. Survival after R0-Resection Siewert JR, et al. Ann Surg, 1998 36.1%
    3. 3. Recurrence after R0-Resection Marrelli D, et al. Ann Surg, 2005 52.0%
    4. 4. R0-Resection: what if it’s true? D’Angelica M, et al. Ann Surg, 2004 7% 92%
    5. 5. Recurrence after R0-Resection D’Ugo D, Catholic University, 2007 Risk factors pT3-4 pN+ diffuse type G3 larger size proximal site Time to recurrence months 19.0% 16.7% 39.3% 25.0% Peritoneal Lymph nodal Haematogenous Locoregional 60.7% Locoregional 19.1 Lymph nodal 24.2 Peritoneal 19.9 Haematogenous 25.9
    6. 6. ? or Recurrence (of disease) Failure (of treatment)
    7. 7. Survival after R0-Resection Siewert JR, et al. Ann Surg, 1998 36.1% Siewert 1998 64.8% Kim 1998 Kim JP, et al. Gastric Cancer, 1998 ≈ ≈ 30.7 12.3 15.8 13.9 13.4 13.8 Siewert 1998 (%) 13.2 IV 23.3 IIIB 20.0 IIIA 15.0 II 11.6 IB 17.3 IA Kim 1998 (%) UICC-TNM
    8. 8. Nishi M, et al. Gastric Cancer, 1993 1962 General Rules for Gastric Cancer Study in Surgery and Pathology Survival after Japanese R0-Resection
    9. 13. Randomized Controlled Trials No survival benefit (but in selected patients) Dutch MRC
    10. 14. D2 D1
    11. 16. What selection? Maruyama Index of unresected disease % Likelihood of nodal involvement for each lymph node station left in situ Sex Age Borrmann type Tumor size (luminal surface) Tumor location Tumor depth (cT) Histology Maruyama K, et al. Br J Surg, 1989
    12. 17. Maruyama Index: a old parameter, a new R0-Resection?
    13. 20. Macdonald JS et al. N Engl J Med, 2001 CH-RT Surgery
    14. 21. Maruyama Index: a old parameter, a new R0-Resection?
    15. 22. Induction of R0-Resection 7-year survival results of perioperative chemotherapy with epidoxorubicin, etoposide, cisplatin (EEP) in locally advanced resectable gastric cancer: up-to-date analysis of a phase II study. Persiani R, Rausei S, Pozzo C, Biondi A, Barone C, Cananzi FCM, Schinzari G, D’Ugo D
    16. 24. Magic Trial INT-0116 ACTS-GC S-1 CH-RT ECF
    17. 26. Maruyama Index: a old parameter, a new R0-Resection? <ul><li>Surg Oncol Clin N Am. 2007 Jan;16(1):133-55 </li></ul><ul><li>Gastric cancer: D2 dissection </li></ul><ul><li>or low Maruyama Index-based surgery--a debate. </li></ul><ul><ul><li>Douglass HO Jr , Hundahl SA , Macdonald JS , Khatri VP . </li></ul></ul>
    18. 27. R0-Resection: is there a need a new definition? <ul><li>Current criteria do not warrant for the </li></ul><ul><li>accomplishment of a “true” R0-Resection </li></ul>In case of LAGC <ul><li>Pathologically confirmed downstaging of tumor after neoadjuvant therapy is statistically associated with the same survival benefit of “true” R0-Resections </li></ul>
    19. 28. Randomized Controlled Trials High morbidity and mortality
    20. 29. What selection? Sentinel node biopsy Kitagawa Y, et al. Gastric Cancer, 2005
    21. 30. What selection? Targeted surgery Junctional nodes for intraoperative evaluation Fielding J, et al. Gastric Cancer, 2004
    22. 31. What selection? cDNA.Microarray Analysis N0 N+

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