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Gastric Cancer Surgery: Gastrectomy, Risk, and Related Prognosis

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 31 March 2026 | Viewed by 5416

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Prof. Dr. Wojciech Piotr Polkowski

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Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13, 20-080 Lublin, Poland
Interests: advanced gastric cancer; neoadjuvant therapy; hyperthermic intraperitoneal chemotherapy; gastrectomy; metastasectomy; peritonectomy; lymphadenectomy; intraoperative radiotherapy
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Dear Colleagues,

Gastric cancer (GC) is one of the most frequent reasons for cancer-related deaths worldwide. Multimodal therapeutic strategies are now pragmatically tailored to each patient, and surgical treatment is combined with perioperative (West) or adjuvant (East) chemotherapy in locally advanced disease. A radical but safe gastrectomy remains the cornerstone of GC treatment. Moreover, quality-of-life (QoL) outcome measures are now routinely utilized in order to select the optimal type of gastrectomy, as well as reconstruction method.

The debate continues on a standard of surgical treatment for patients with proximal GC or at the esophago-gastric junction. While (transhiatal-extended) total gastrectomy (TG) significantly impairs the long-term QoL of patients, proximal gastrectomy (PG) offers similar survival rates and a reduced morbidity with an improved QoL compared to TG, provided an anti-reflux procedure is used.

Traditionally, gastrectomy was performed as an open procedure, although minimally invasive surgical (MIS) approaches have undergone widespread adoption, including laparoscopic and robotic-assisted gastrectomy. The improved recovery outcomes associated with the MIS approaches support their use for patients with resectable GC.

Recently, the prognosis of patients with primary unresectable, incurable, and oligo-metastatic GC has changed through the targeted and immuno-therapy of patients whose tumours express relevant predictive biomarkers. Whether this conversion (immuno-)therapy would influence the extent of gastrectomy and lymph node dissection is unknown.

Prof. Dr. Wojciech Piotr Polkowski
Guest Editor

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Keywords

gastric cancer
surgical treatment
gastrectomy
outcome
minimally invasive surgical

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Published Papers (4 papers)

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Research

12 pages, 2609 KiB

Open AccessArticle

VEGF-C and Lymphatic Vessel Density in Tumor Tissue of Gastric Cancer: Correlations with Pathoclinical Features and Prognosis

by Mariusz Szajewski, Maciej Ciesielski, Rafał Pęksa, Piotr Kurek, Michał Stańczak, Jakub Walczak, Jacek Zieliński and Wiesław Janusz Kruszewski

Cancers 2025, 17(9), 1406; https://doi.org/10.3390/cancers17091406 - 23 Apr 2025

Viewed by 295

Abstract

Objectives: The objective of this study was to assess the relationship of VEGF-C and LVD with pathoclinical factors of potential prognostic value and with the survival time of gastric cancer patients. Materials and methods: A total of 103 radically operated patients for gastric cancer who did not undergo neoadjuvant therapy were included in this study. The minimum follow-up period after surgery was 61 months. VEGF-C and lymphatic vessels were immunohistochemically determined using antibodies, including VEGF-C (c-20) sc 1881-Goat Polyclonal IgG (Santa Cruz Biotechnology) and Podoplanin D2-40 Mouse Monoclonal Antibody (ROCHE). The relationship between VEGF-C expression in gastric adenocarcinoma cells and the density of lymphatic vessels at the periphery of the primary tumor was assessed, along with the relationships of VEGF-C and LVD with selected pathoclinical parameters of gastric cancer and prognosis. Results: VEGF-C overexpression was associated with increased LVD (Mann–Whitney U test, p = 0.03) and the Lauren intestinal type of cancer (Pearson’s chi-square test, p < 0.001). Increased LVD was more often associated with cancers located beyond the cardia (Mann–Whitney U test, p = 0.04). We did not demonstrate an association of VEGF-C or LVD with OS or with prognostic features, such as pT, pN, or pTNM staging. However, in the Lauren intestinal type of cancer, VEGF-C overexpression correlated with shorter OS (log-rank, p = 0.01) and, at the level of p = 0.05 in multivariate analysis, it had an independent negative prognostic value. Conclusions: Peritumoral overexpression of VEGF-C in primary gastric cancer tumors is associated with increased LVD. The Lauren intestinal type of cancer is associated with VEGF-C overexpression. The overexpression of VEGF-C in intestinal-type gastric cancer is associated with worse prognosis. Full article

(This article belongs to the Special Issue Gastric Cancer Surgery: Gastrectomy, Risk, and Related Prognosis)

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20 pages, 2805 KiB

Open AccessArticle

Postoperative Changes in Body Composition Predict Long-Term Prognosis in Patients with Gastric Cancer

by Kiyohiko Shuto, Yoshihiro Nabeya, Mikito Mori, Masato Yamazaki, Chihiro Kosugi, Kazuo Narushima, Akihiro Usui, Hiroyuki Nojima, Hiroaki Shimizu and Keiji Koda

Cancers 2025, 17(5), 738; https://doi.org/10.3390/cancers17050738 - 21 Feb 2025

Viewed by 520

Abstract

Background: Postoperative changes in body composition (BC) have not been clearly defined. The aim of this study was to clarify the impact of postoperative comprehensive changes in BC on long-term prognosis in gastric cancer (GC) patients. Methods: A total of 366 GC patients who underwent radical gastrectomy were included. Postoperative changes in skeletal muscle volume, body fat volume, and skeletal muscle density were investigated at six months postoperatively using computed tomography and evaluated their association with long-term survival. Results: Patients with decreased muscle volume, decreased fat volume, and increased muscle density had a poor prognosis, respectively. When the risk scores based on these three BC parameters were applied, patients were classified from score 0 to 4, with survival rate declining as the scores improved: score 0, interim 5-year overall survival 94%; score 1, 82%; score 2, 73%; score 3, 56%; and score 4, 20%. BC change (score > 2) was an independent poor prognosticator (HR, 3.086; p < 0.001). Preoperative myosteatosis, high Charlson comorbidity, and total gastrectomy were identified as significant independent risk factors for BC change. Conclusions: Each of postoperative skeletal muscle loss, body fat loss, and muscle hyperdensity negatively affected prognosis of GC patients after surgery, and the BC risk scoring assessment well predicted the prognosis of postoperative patients with GC. Full article

(This article belongs to the Special Issue Gastric Cancer Surgery: Gastrectomy, Risk, and Related Prognosis)

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34 pages, 2622 KiB

Open AccessArticle

Relative Survival, Conditional Survival, and Causes of Death in Patients with Early Gastric Cancer, with a Focus on Differences Between Cardia and Non-Cardia Cancer

by Anas Elgenidy, Omar Alomari, Mohamed Marey Hesn, Anas Khaled, Sarah A. Nada, Mostafa Elsayed, Ali Mahmoud, Mohammed Al-mahdi Al-kurdi, Ahmed M. Afifi and George Cholankeril

Cancers 2024, 16(24), 4262; https://doi.org/10.3390/cancers16244262 - 21 Dec 2024

Viewed by 1570

Abstract

Background: Many researchers believe that cardia (CGC) and non-cardia (NCGC) are two different types of tumors, having different features like incidence rate, risk factors, geographical location, and socioeconomic status. This study aims to investigate the causes of death (COD) survival rates among early gastric cancer patients with a focus on differences between CGC and NCGC. Methods: This retrospective study employed SEER*stat software (version 8.3.92) to analyze the SEER 17 plus dataset (2000–2019). Standardized mortality ratios (SMR) were computed. Relative survival and conditional survival post-diagnosis were calculated using R software (version 4.1.0) among the different subgroups. Results: Within the follow-up period, 55.4% (5381) died, predominantly within the initial year post-diagnosis. Esophageal cancer was the leading non-gastric cancer cause in CGC, while miscellaneous tumors dominated in NCGC. The 1-year and 5-year relative survival for CGC patients were 76.4% and 48.9% respectively, while for NCGC were 80.4% and 63.9%. The 3-year conditional survival after 1 year and 5e years of survival for CGC were 68.7% and 88.8%, respectively, while for NCGC were 82.2% and 93.5%, respectively. This means that the longer a person has survived after diagnosis with cancer, the greater the likelihood that person will survive for another 3 years. Conclusions: This study sheds light on the substantial impact of non-cancer COD in GC patients, underscoring the necessity of considering comorbidities in their comprehensive management and follow-up. Impact: This study contributes valuable insights for clinical decision-making and informs future research directions regarding CGC and NCGC. Full article

(This article belongs to the Special Issue Gastric Cancer Surgery: Gastrectomy, Risk, and Related Prognosis)

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14 pages, 2284 KiB

Open AccessArticle

Prognostic Value of Inflammatory Burden Index in Advanced Gastric Cancer Patients Undergoing Multimodal Treatment

by Zuzanna Pelc, Katarzyna Sędłak, Radosław Mlak, Magdalena Leśniewska, Katarzyna Mielniczek, Piotr Rola, Jacek Januszewski, Olena Zhaldak, Anna Rekowska, Katarzyna Gęca, Magdalena Skórzewska, Wojciech P. Polkowski, Timothy M. Pawlik and Karol Rawicz-Pruszyński

Cancers 2024, 16(4), 828; https://doi.org/10.3390/cancers16040828 - 18 Feb 2024

Cited by 8 | Viewed by 2162

Abstract

Since increasing evidence underlines the prominent role of systemic inflammation in carcinogenesis, the inflammation burden index (IBI) has emerged as a promising biomarker to estimate survival outcomes among cancer patients. The IBI has only been validated in Eastern gastric cancer (GC) patients; therefore, the aim of this study was to evaluate the IBI as a prognostic biomarker in Central European GC patients undergoing multimodal treatment. Ninety-three patients with histologically confirmed GC who underwent multimodal treatment between 2013 and 2021 were included. Patient recruitment started with the standardization of neoadjuvant chemotherapy (NAC). Blood samples were obtained one day prior to surgical treatment. The textbook outcome (TO) served as the measure of surgical quality, and tumor responses to NAC were evaluated according to Becker’s system tumor regression grade (TRG). A high IBI was associated with an increased risk of postoperative complications (OR 2.95, 95% CI 1.13–7.72). In multivariate analysis, a high IBI (HR = 2.56, 95% CI 1.28–5.13) and a high neutrophil-to-lymphocyte ratio (NLR, HR = 2.55, 95% CI 1.32–4.94) were associated with an increased risk of death, while NAC administration (HR = 0.40, 95% CI 0.18–0.90) and TO achievement (HR = 0.42, 95% CI 0.22–0.81) were associated with a lower risk of death. The IBI was associated with postoperative complications and mortality among GC patients undergoing multimodal treatment. Full article

(This article belongs to the Special Issue Gastric Cancer Surgery: Gastrectomy, Risk, and Related Prognosis)

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