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What are the important prognostic factors in gastric cancer with positive duodenal margins? A multi-institutional analysis

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Abstract

Purpose

Positive margins are reported in from 4.8 to 9.5% of all gastric cancer surgeries and they have a negative impact on the overall survival. Few cases with positive duodenal margins have been included in previous studies regarding the prognosis.

Methods

This multi-institutional retrospective study included 115 gastric cancer patients with positive duodenal margins following gastrectomy between January 2002 and December 2017. The association between clinicopathological factors and the overall survival was evaluated by univariate and multivariate analyses.

Results

The three-year overall survival was 22% and the median survival was 13 months. A multivariate analysis found that distant metastasis, no postoperative chemotherapy, and non-Type 4 disease were significantly associated with a poor survival. Patients without distant metastasis who received postoperative chemotherapy had a 3-year overall survival of 56% and a median survival of 44 months.

Conclusion

The patients who underwent post-operative chemotherapy showed a significantly better OS compared with those who did not undergo post-operative chemotherapy, regardless of the existence of distant metastasis. Postoperative chemotherapy may, therefore, improve the prognosis of surgically treated gastric cancer patients with positive duodenal margins.

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Acknowledgement

This study was supported by investigators at eight hospitals (Toho University Ohashi Medical Center, Toho University Omori Medical Center, Japanese Red Cross Medical Center, University of Tokyo Hospital, The Jikei University Hospital, Showa University Hospital, National Hospital Organization Tokyo Medical Center, and NTT Medical Center Tokyo). We thank all the investigators of these institutions. We are deeply grateful to Yuko Okamura and Seiko Otsuka for their assistance in collecting the patient data.

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Authors and Affiliations

  1. Department of Surgery, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan

    Shohei Fujita & Yoshihisa Saida

  2. Division of General and Gastroenterological Surgery, Department of Surgery (Omori), Toho University, 6-11-1, Omori-nishi, Ota-Ku, Tokyo, 143-8541, Japan

    Yoko Oshima, Satoshi Yajima & Hideaki Shimada

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Toho University, 6-11-1, Omori-nishi, Ota-Ku, Tokyo, 143-8541, Japan

    Yoshinori Kikuchi

  4. Department of Gastroesophageal Surgery, Japanese Red Cross Medical Center, 4-1-22, Hiroo, Shibuya-Ku, Tokyo, 150-8935, Japan

    Sakae Nagaoka

  5. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Hiroharu Yamashita & Yasuyuki Seto

  6. Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan

    Muneharu Fujisaki & Norio Mitsumori

  7. Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan

    Koji Otsuka & Masahiko Murakami

  8. National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan

    Hidejiro Urakami & Yoh Isobe

  9. NTT Medical Center Tokyo, 5-9-22, Higashi-gotanda, Shinagawa-ku, Tokyo, 141-0022, Japan

    Yutaro Yoshimoto & Hitoshi Satodate

  10. Department of Gastroenterological Surgery and Clinical Oncology, Toho University Graduate School of Medicine, 6-11-1, Omori-nishi, Ota-Ku, Tokyo, 143-8541, Japan

    Hideaki Shimada

Authors
  1. Shohei Fujita
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  2. Yoko Oshima
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  3. Satoshi Yajima
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  4. Yoshinori Kikuchi
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  5. Sakae Nagaoka
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  6. Hiroharu Yamashita
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  7. Yasuyuki Seto
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  8. Muneharu Fujisaki
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  9. Norio Mitsumori
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  10. Koji Otsuka
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  11. Masahiko Murakami
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  12. Hidejiro Urakami
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  13. Yoh Isobe
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  14. Yutaro Yoshimoto
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  15. Hitoshi Satodate
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  16. Yoshihisa Saida
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  17. Hideaki Shimada
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Corresponding author

Correspondence to Hideaki Shimada.

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Conflict of Interest

Yoshinori Kikuchi, Yasuyuki Seto, Yoh Isobe and Hideaki Shimada received research grant and lecture fees from Taiho Pharmaceutical co. ltd. Yasuyuki Seto received research grant and lecture fees from Chugai Pharmaceutical co. ltd. The other authors have no conflicts of interest to declare in association with this study.

Ethical approval

The study protocol was approved by the Ethics Committee of the Faculty of Medicine, Toho University (#A19017, #A16084).

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Cite this article

Fujita, S., Oshima, Y., Yajima, S. et al. What are the important prognostic factors in gastric cancer with positive duodenal margins? A multi-institutional analysis. Surg Today 51, 561–567 (2021). https://doi.org/10.1007/s00595-020-02110-7

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  • DOI: https://doi.org/10.1007/s00595-020-02110-7

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