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Impact of D2 Total Gastrectomy Including Splenectomy for Scirrhous Gastric Cancer in the Era of Effective Adjuvant Chemotherapy

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Abstract

Background

Total gastrectomy with D2 dissection including splenectomy (TGS) is usually selected for locally resectable scirrhous gastric cancer (SGC), which was established in the era of surgery alone. However, it remains unclear whether TGS for SGC is justified in the era of effective adjuvant chemotherapy.

Methods

This study included 112 SGC patients, consisting of 60 cases treated between January 2000 and December 2006 (Former group), and 52 cases treated between January 2007 and December 2016 (Latter group). We collected clinicopathological data and then examined the survival and the therapeutic value indexes.

Results

The background characteristics were well-balanced, except for sex and physical status. The Latter group might be characterized by frequent female (P = 0.037) and poorer physical status (P = 0.048). Adjuvant chemotherapy was administered to 86.5% of the Latter group and was 11.7% of the Former group (P < 0.001). The 5-year-overall survival rate of the Latter group was 58.7% (95% confidence interval: 43.5–71.1), seems better than that of the Former group (44.5%; 95% confidence interval 31.7–56.6) (hazard ratio = 0.758, P = 0.291). Improvement of the index from the Former group was observed in the Latter group at almost all stations. The ratio of the index between two groups was 1.42 at the D1 station and 1.67 at the D2 station. Index of splenic hilar node ranked similarly high in both groups.

Conclusion

The therapeutic value index was improved in almost all nodal stations by S-1 adjuvant chemotherapy, especially in D2 nodes. TGS would be more important for locally resectable SGC in the era of effective adjuvant chemotherapy.

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Data Availability

No datasets were generated or analysed during the current study.

Abbreviations

TGS:

Total gastrectomy with D2 dissection including splenectomy

SGC:

scirrhous gastric cancer

ASA-PS:

American Society of Anesthesiologists-Physical Status

CD:

Clavien-Dindo classification

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Authors and Affiliations

  1. Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yukinori Yamagata, Takaki Yoshikawa, Ryota Sakon, Kenichi Ishizu, Takeyuki Wada & Tsutomu Hayashi

Authors
  1. Yukinori Yamagata
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  2. Takaki Yoshikawa
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  3. Ryota Sakon
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  4. Kenichi Ishizu
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  5. Takeyuki Wada
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  6. Tsutomu Hayashi
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Contributions

All authors developed the concept of this manuscript. Y.Y. and T.Y wrote the main manuscript text and prepared all figures. All authors reviewed and revised the manuscript.

Corresponding author

Correspondence to Takaki Yoshikawa.

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Ethics Approval and Consent to Participate

This study has been approved by the ethics committee of National Cancer Center Hospital (No. 2017–077). All the procedures followed were in accordance with the ethical standards of the institutional and national committees governing human experimentation and in compliance with the Helsinki Declaration of 1964 and later versions. Informed consent or an appropriate substitute was obtained from all patients prior to their inclusion in the study.

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The authors declare no competing interests.

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Yamagata, Y., Yoshikawa, T., Sakon, R. et al. Impact of D2 Total Gastrectomy Including Splenectomy for Scirrhous Gastric Cancer in the Era of Effective Adjuvant Chemotherapy. J Gastrointest Canc (2024). https://doi.org/10.1007/s12029-024-01044-4

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