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The Prognostic Significance of an R1 Resection in Gastric Cancer Patients Treated with Adjuvant Chemoradiotherapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A microscopically irradical (R1) resection is a well-known adverse prognostic factor after gastric cancer surgery. However, the prognostic significance of an R1 resection in gastric cancer patients who are treated with chemoradiotherapy (CRT) after the operation has been poorly studied. Therefore, the aim of this study was to evaluate the effect of an R1 resection on (recurrence-free) survival in gastric cancer patients who were treated with CRT after surgery.

Methods

Gastric cancer patients who had undergone a resection with curative intent followed by adjuvant CRT at our institute between 2001 and 2011 were included. CRT consisted of radiotherapy (45 Gy/25 fractions) combined with concurrent capecitabine (with or without cisplatin) or 5-fluorouracil/leucovorin.

Results

A consecutive series of 110 patients was studied, including 80 (73 %) patients who had undergone an R0 resection and 30 (27 %) patients with an R1 resection. Pathologic T-classification (p = 0.26), N-classification (p = 0.77), and histologic subtype according to Laurén (p = 0.071) were not significantly different between these groups. Three-year recurrence-free survival (45 vs. 35 %, p = 0.34) and overall survival (47 vs. 48 %, p = 0.58) did not significantly differ between patients who had undergone an R0 or R1 resection. In a multivariate analysis, pathologic T-classification and N-classification were independent prognostic factors for survival.

Conclusions

A R1 resection was not an adverse prognostic factor in gastric cancer patients who had undergone CRT after the operation.

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Acknowledgment

The authors thank Michael Hauptmann as the statistician who assisted with the statistical analyses.

Funding

Stichting Cornelis Vrolijk Development Fund.

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Authors and Affiliations

  1. Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Jurriën Stiekema MD & Johanna W. van Sandick MD, PhD

  2. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Anouk K. Trip MD, Edwin P. M. Jansen MD, PhD & Marcel Verheij MD, PhD

  3. Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Henk Boot MD, PhD & Annemieke Cats MD, PhD

  4. Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Olga Balague Ponz MD, PhD

Authors
  1. Jurriën Stiekema MD
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  2. Anouk K. Trip MD
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  3. Edwin P. M. Jansen MD, PhD
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  4. Henk Boot MD, PhD
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  5. Annemieke Cats MD, PhD
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  6. Olga Balague Ponz MD, PhD
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  7. Marcel Verheij MD, PhD
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  8. Johanna W. van Sandick MD, PhD
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Corresponding author

Correspondence to Johanna W. van Sandick MD, PhD.

Additional information

Jurriën Stiekema and Anouk K. Trip have contributed equally to this work.

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Stiekema, J., Trip, A.K., Jansen, E.P.M. et al. The Prognostic Significance of an R1 Resection in Gastric Cancer Patients Treated with Adjuvant Chemoradiotherapy. Ann Surg Oncol 21, 1107–1114 (2014). https://doi.org/10.1245/s10434-013-3397-4

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  • DOI: https://doi.org/10.1245/s10434-013-3397-4

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