Detection value of free cancer cells in peritoneal washing in gastric cancer: a systematic review and meta-analysis

Intraperitoneal free cancer cells in gastric adenocarcinoma are associated with a poor outcome. However, the true prognostic value of intraperitoneal free cancer cells is still unclear, leading to a lack of consensus in the management of gastric cancer. The aim of the present study is to perform a systematic review and meta-analysis to analyze intraperitoneal free cancer cells-positive patients with regard to tumor oncologic stage, recurrence, grade of cellular differentiation, and survival rates and to analyze the clinical significance of intraperitoneal free cancer cells with regard to prognosis. Databases were searched up to January 2016 for prognostic factors associated with intraperitoneal free cancer cells, including oncologic stage, depth of neoplasm invasion, lymph nodal spread, differentiation grade of the tumor, and recurrence and survival rates. A total of 100 studies were identified. Meta-analysis revealed a clear association between intraperitoneal free cancer cells and a poor prognosis. intraperitoneal free cancer cells -positive patients had higher rates of nodal spread (risk difference: 0.29;

Surgical treatment of gastric cancer: a 10-year experience in a high-volume university hospital

OBJECTIVES: Surgery remains the cornerstone treatment modality for gastric cancer, the fifth most common type of tumor in Brazil. The aim of this study was to analyze the surgical treatment outcomes of patients with gastric cancer who were referred to a high-volume university hospital. METHODS: We reviewed all consecutive patients who underwent any surgical procedure due to gastric cancer from a prospectively collected database. Clinicopathological characteristics, surgical and survival outcomes were evaluated, with emphasis on patients treated with curative intent. RESULTS: From 2008 to 2017, 934 patients with gastric tumors underwent surgical procedures in our center. Gastric adenocarcinoma accounted for the majority of cases. Of the 875 patients with gastric adenocarcinoma, resection with curative intent was performed in 63.5%, and palliative treatment was performed in 22.4%. The postoperative surgical mortality rate for resected cases was 5.3% and was related to D1 lymphadenectomy and the presence of comorbidities. Analysis of patients treated with curative intent showed that resection extent, pT category, pN category and final pTNM stage were related to disease-free survival (DFS) and overall survival (OS). The DFS rates for D1 and D2 lymphadenectomy were similar, but D2 lymphadenectomy significantly improved the OS rate. Additionally, clinical factors and the presence of comorbidities had influence on the OS. CONCLUSIONS: TNM stage and the type of lymphadenectomy were independent factors related to prognosis. Early diagnosis should be sought to offer the optimal surgical approach in patients with less-advanced disease

INTRAPERITONEAL CHEMOTHERAPY FOR GASTRIC CANCER WITH PERITONEAL CARCINOMATOSIS: STUDY PROTOCOL OF A PHASE II TRIAL

ABSTRACT BACKGROUND: Peritoneal carcinomatosis in gastric cancer is considered a fatal disease, without expectation of definitive cure. As systemic chemotherapy is not sufficient to contain the disease, a multimodal approach associating intraperitoneal chemotherapy with surgery may represent an alternative for these cases. AIMS: The aim of this study was to investigate the role of intraperitoneal chemotherapy in stage IV gastric cancer patients with peritoneal metastasis. METHODS: This study is a single institutional single-arm prospective clinical trial phase II (NCT05541146). Patients with the following inclusion criteria undergo implantation of a peritoneal catheter for intraperitoneal chemotherapy: Stage IV gastric adenocarcinoma; age 18–75 years; Peritoneal carcinomatosis with peritoneal cancer index<12; Eastern Cooperative Oncology Group 0/1; good clinical status; and lab exams within normal limits. The study protocol consists of four cycles of intraperitoneal chemotherapy with paclitaxel associated with systemic chemotherapy. After treatment, patients with peritoneal response assessed by staging laparoscopy undergo conversion gastrectomy. RESULTS: The primary outcome is the rate of complete peritoneal response. Progression-free and overall survivals are other outcomes evaluated. The study started in July 2022, and patients will be screened for inclusion until 30 are enrolled. CONCLUSIONS: Therapies for advanced gastric cancer patients have been evaluated in clinical trials but without success in patients with peritoneal metastasis. The treatment proposed in this trial can be promising, with easy catheter implantation and ambulatory intraperitoneal chemotherapy regime. Verifying the efficacy and safety of paclitaxel with systemic chemotherapy is an important progress that this study intends to investigate

Impact of Carnoy\'s solution in lymph node retrieval following D2 gastrectomy for gastric cancer: prospective randomized trial

Introdução: O adenocarcinoma gástrico é uma doença de elevada incidência e alta mortalidade. A gastrectomia com linfadenectomia é tratamento potencialmente curativo, promovendo controle loco-regional da doença e fornecendo material para análise histopatológica. Para o adequado estadiamento dos pacientes é recomendado que pelo menos 16 linfonodos sejam examinados pela patologia, entretanto, espera-se maior sobrevida quando >= 30 linfonodos são avaliados, mesmo em pacientes com tumores precoces. A justificativa para este achado é o sub-estadiamento de pacientes com poucos linfonodos examinados. Linfonodos pequenos são particularmente difíceis de serem encontrados, mas podem conter metástases e impactar negativamente na sobrevida. Visando facilitar sua identificação, soluções clareadoras de gordura foram propostas, entretanto não há evidência clara de seu benefício clínico. Objetivos: Comparar as soluções de Carnoy e de formalina neutra tamponada em relação ao número absoluto de linfonodos encontrados na peça cirúrgica de pacientes submetidos a gastrectomia. Averiguar se linfonodos retirados cirurgicamente são perdidos com a fixação em formalina e, caso isso ocorra, se este fato é relevante para o estadiamento. Observar se o protocolo de pesquisa influenciou o número de linfonodos encontrados. Métodos: Cinquenta produtos de gastrectomia subtotal com linfadenectomia D2 por adenocarcinoma gástrico foram randomizados para fixação em Carnoy ou formalina com posterior dissecção da peça em busca de linfonodos. Após a dissecção do grupo Formalina, a gordura residual a ser desprezada foi imersa em Carnoy e reavaliada posteriormente. Os dados de 25 gastrectomias D2 operadas previamente ao estudo também foram avaliados. Resultados: A média de linfonodos encontrados nos grupos Carnoy e Formalina foi de 50,4 e 34,8; respectivamente (p =30 lymph nodes are examined, even for early gastric cancer. The understaging of patients with less examined lymph nodes justifies this findings. Small lymph nodes are particularly difficult to identify and fat clearing solutions have been proposed to improve this, but there is no evidence of their clinical benefit. Objectives: Compare Carnoy\'s solution (CS) and formalin in terms of the total number of examined lymph nodes following gastrectomy. Verify if surgically retrieved lymph nodes are lost with the formalin fixation and if this fact is clinically significant. Observe if a research protocol influences the number of examined lymph nodes. Methods: Fifty specimens of gastrectomy with D2 lymphadenectomy were randomized for fixation in CS or formalin with posterior dissection in search for lymph nodes. In the Formalin group, the residual fat to be discarded was immersed in CS and dissected again. Data from 25 D2 gastrectomies performed previously the present study were retrospectively analyzed. Results: The medium number of examined lymph nodes was 50.4 and 34.8 for CS and formalin, respectively (p < 0.001). Lost lymph nodes were found in all cases in the Residual Fat group (medium 16.9), this increased the Formalin group average to 51.7 (which is similar to the CS group, p=0.809). With one exception (7mm), all other examined lymph nodes in the Residual Fat group measured <= 3mm. Thirteen lymph nodes from this group were metastatic, this determined the upstaging of 2 (8%) patients. Lymph nodes from the CS group were smaller than those found in the formalin group (p=0.01). The medium number of retrieved lymph nodes in the retrospective group was similar to the formalin group (p=0.802). Conclusions: When compared to formalin, Carnoy\'s solution increases lymph node detection following gastrectomy with lymphadenectomy. CS identifies small lymph nodes lost with formalin fixation and that are clinically significant, since they may contain metastasis, modifying the TNM classification. No influence of the research protocol over the number of examined lymph nodes was observed in the present study

Prognostic Role of Neutrophil/Lymphocyte Ratio in Resected Gastric Cancer: A Systematic Review and Meta-analysis

High levels of inflammatory markers and the neutrophil-lymphocyte ratio appear to be associated with worse overall survival in solid tumors. However, few studies have analyzed the role of the neutrophil-lymphocyte ratio in gastric cancer patients scheduled to undergo curative resection. In the present study, a systematic review and meta-analysis was performed to analyze the relationship between the neutrophil-lymphocyte ratio and overall survival in patients with gastric cancer submitted to curative resection and to identify the clinicopathological features (age, gender, tumor depth, nodal involvement and tumor differentiation) that are correlated with high neutrophil-lymphocyte ratios. A literature search of PubMed, Scopus, Cochrane and EMBASE through November 2017 was conducted. Articles that included gastric cancer patients submitted to curative resection and preoperatory neutrophil-lymphocyte ratio values were included. A total of 7 studies comprising 3264 patients from 5 different countries were included. The meta-analysis revealed an association of high neutrophil-lymphocyte ratios with older age, male gender, lower 5-year overall survival, increased depth of tumor invasion, positive nodal involvement but not with histological differentiation. Evaluation of the neutrophil-lymphocyte ratio is a cost-effective method that is widely available in preoperatory settings. Furthermore, it can effectively predict prognosis, as high values of this biomarker are related to more aggressive tumor characteristics. This ratio can also be used to stratify risk in patients within the same disease stage and may be used to assist in individualized follow-up and treatment

Detection value of free cancer cells in peritoneal washing in gastric cancer: a systematic review and meta-analysis

Intraperitoneal free cancer cells in gastric adenocarcinoma are associated with a poor outcome. However, the true prognostic value of intraperitoneal free cancer cells is still unclear, leading to a lack of consensus in the management of gastric cancer. The aim of the present study is to perform a systematic review and meta-analysis to analyze intraperitoneal free cancer cells-positive patients with regard to tumor oncologic stage, recurrence, grade of cellular differentiation, and survival rates and to analyze the clinical significance of intraperitoneal free cancer cells with regard to prognosis. Databases were searched up to January 2016 for prognostic factors associated with intraperitoneal free cancer cells, including oncologic stage, depth of neoplasm invasion, lymph nodal spread, differentiation grade of the tumor, and recurrence and survival rates. A total of 100 studies were identified. Meta-analysis revealed a clear association between intraperitoneal free cancer cells and a poor prognosis. intraperitoneal free cancer cells -positive patients had higher rates of nodal spread (risk difference: 0.29; p<0.01), serosal invasion (risk difference: 0.43; p<0.01), recurrence (after 60 months of follow-up, risk difference: 0.44; p<0.01), and mortality (after 60 months of follow-up, risk difference: 0.34; p<0.01). Intraperitoneal free cancer cells are associated with a poor outcome in gastric cancer. This surrogate biomarker should be used to guide therapy both prior to and after surgery

Gastric Mixed Neuroendocrine Non-Neuroendocrine Neoplasms: A Western Center Case Series

Background: Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) represent a rare tumor composed of adenocarcinoma and neuroendocrine carcinoma components. This study reports a case series of gastric MiNEN and discusses issues related to its diagnosis, management, and outcomes. Methods: We retrospectively analyzed data from patients with gastric MiNEN who underwent surgical resection at our service from 2009 to 2020. Patients with gastric adenocarcinoma served as a comparison group. Clinical, pathologic, and surgical characteristics were compared. Results: During the selected period, 5 gastric MiNEN patients and 597 patients with gastric adenocarcinoma were included. Among the clinical variables, age, sex, BMI, and laboratory exams were similar between the two groups. Only ASA classification was different (p = 0.015). Pathological variables such as tumor size, lymphovascular invasion, number of retrieved lymph nodes, and pTNM staging were also similar between both groups. Lastly, early surgical outcomes and long-term survival did not differ between gastric MiNEN and adenocarcinoma patients. Conclusion: A MiNEN is a rare tumor that represents less than 1% of GC patients undergoing curative treatment, and demonstrated clinicopathological characteristics and outcomes similar to gastric adenocarcinoma