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Laparoscopy for gastric cancer
1. Laparoscopy for Gastric Cancer Abeezar I. Sarela MBBS FRCS Consultant in Upper Gastrointestinal & Minimally Invasive Surgery The General Infirmary at Leeds, United Kingdom Massachusetts General Hospital, August 17, 2006
12. Laparoscopic M1Gastric Carcinoma, No Resection Memorial Sloan Kettering Cancer Center Experience Sarela AI (Brennan MF) et al. Ann Surg 2006;243:189-95
13. Laparoscopic M1, No resection 165 Patients Sarela AI (Brennan MF) et al. Ann Surg 2006;243:189-95 Primary Tumour Location
14. Laparoscopic M1, No Resection Peritoneal metastasis P1: adjacent to stomach P2: few distant lesions P3: disseminated 165 patients 9%
15. Laparoscopic M1, No Resection Sarela AI (Brennan MF) et al. Ann Surg 2006;243:189-95 Intervention
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17. Laparoscopic M1, No Resection Survival Median survival: 10 months One year survival: 39% 156 patients
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26. Laparoscopic Gastrectomy Complications CT-drain Abscess 3. Lap Subtotal G (C) Re-laparoscopy Chest drain Bleeding O-J leak 2. Lap. Total G Re-laparoscopy Embolisation Duodenal leak Bleeding 1. Lap. Total G Treatment Complications Operation
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Editor's Notes
A prospecitvely maintained database of all patients treated for gastric adenocarcinoma at Memorial Hospital between 1992-2002 was used. In general, the policy was to perform staging laparoscopy if there was no definitive evidence of M1 disease on CT scanning and there was no bleeding or obstruction that required laparotomy irrespective of disease-stage. Accordingly, 718 patients underwent laparoscopy. After excluding selected patients on investigational protocols, there were 147 patients who had M1 disease and no further procedure. Of the laparoscopic M0 group, 18 patients did not have resection because of M1 disease at laparotomy and were included in the study group giving a total of 165 patients. Patients with no resection because of locally advanced primary tumors but no M1 were specifically excluded .
Approximately one-quarter of patients each had primary tumors located at either the GEJ or in the gastric body. For the remaining half, tumors were approx. equally distributed in the proximal stomach, antrum or involved the entire stomach.
M1 disease was limited to the peritoneum adjacent to the stomach in 8%. There were few distant peritoneal metastasis in about one-third of patients and disseminated peritoneal metastasis in another one-third. Metastasis were confined to the liver in 10%. There was a combination of liver and peritoneal metastasis in 16%.
During the follow-up period, 41 of the 97 patients, 40%, had an intervention on the primary tumor. Intervention was required for gastric luminal obstruction or provision of supplemental nutrition in 32 patients. 8 patients had intervention for bleeding and one patients for perforation of the primary tumor.
In summary, intervention on the primary tumor was necessary in 42% of patients. Only 8% had laparotomy and the remaining were treated with endoscopic procedures or radiation therapy only. Median survival of the entire cohort was 10 months. Patients with a low burden of peritoneum only disease or good FPS had significantly longer survival.
Survival data were available for 156 patients. Their estimated median survival was 10 months with a one-year survival of about 40% and two-year survival of 4% . The maximum survival was 37 months.
