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Cancers
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Surgical Management of Gastric Cancer: New Insights and Future Prospectives
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Surgical Management of Gastric Cancer: New Insights and Future Prospectives

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

Deadline for manuscript submissions: closed (31 January 2025) | Viewed by 7564

Special Issue Editors

Dr. Claudio Fiorillo

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Guest Editor
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
Interests: minimally invasive surgery; foregut surgery; colorectal surgery
Dr. Giuseppe Quero

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Guest Editor
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
Interests: upper GI surgery; pancreatic cancer; pancreatic cancer surgery

Special Issue Information

Dear Colleagues,

Surgery still represents the cornerstone of treatment for gastric cancer. During the last decades, the improvement of multimodal treatments and the promising results achieved with minimally invasive approaches have ameliorated oncological outcomes and surgery sustainability for patients. This topic aims to offer a comprehensive overview of recent technological applications, advances, challenges, and future perspectives concerning the surgical treatment of gastric cancer. We invite manuscripts that contain both reviews and original articles. Potential topics include, but are not limited to, laparoscopic gastrectomy, robotic gastrectomy, the endoscopic treatment of early gastric cancer, the use of new technological tools (i.e., fluorescence-guided surgery), minimally invasive approaches, and endoscopic approaches for the treatment of gastric surgery complications.

Dr. Claudio Fiorillo
Dr. Giuseppe Quero
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastric cancer
  • minimally invasive gastrectomy
  • endoscopy
  • robotic surgery
  • surgical management

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Published Papers (5 papers)

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Research

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15 pages, 544 KiB  
Article
Lymph Node Yield and Lymph Node Ratio for Prognosis of Long-Term Survival in Gastric Carcinoma
by Olof Jannasch, Martin Schwanz, Ronny Otto, Michal Mik, Hans Lippert and Pawel Mroczkowski
Cancers 2025, 17(3), 414; https://doi.org/10.3390/cancers17030414 - 27 Jan 2025
Viewed by 857
Abstract
Background: Lymphadenectomy is a fundamental part of surgical strategy in patients with gastric cancer. Lymph node (LN) status is a key point in assessment of prognosis in gastric cancer. The LN ratio (LNR)—number of positive LNs/number of sampled LNs—offers a new approach for [...] Read more.
Background: Lymphadenectomy is a fundamental part of surgical strategy in patients with gastric cancer. Lymph node (LN) status is a key point in assessment of prognosis in gastric cancer. The LN ratio (LNR)—number of positive LNs/number of sampled LNs—offers a new approach for predicting survival. The aim of the study was to find factors affecting LN yield and the impact of LNR on 5-year survival. Methods: Prospective multicenter quality assurance study. Only LN-positive patients were included in the LNR calculations. Results: 4946 patients from 149 hospitals were enrolled. The inclusion criteria were met by 1884 patients. Patients were divided into two groups: Group 1 (<16 LN), 456 patients and Group 2 (≥16 LN), 1428 patients. The multivariate analysis found G2 (OR 1.98; 95%CI 1.11–3.54), G3 (OR 2.15; 95%CI 1.212–3.829), UICC-stage II (OR 1.44; 95%CI 1.01–2.06) and III (OR 1.71; 95%CI 1.14–2.57), age < 70 (OR 1.818 95%CI 1.19–2.78) and female gender (OR 1.37; 95%CI 1.00–1.86) as independent factors of ≥16 LN yield. Patients with a LNR ≥ 0.4 have a lower probability of survival (p = 0.039 and <0.001) than patients with a LNR = 0.1. Patients with UICC-II have a lower probability of survival than UICC-I (p = 0.023). Age 70–80 (p = 0.045) and > 80 years (p = 0.003) were negative prognostic factors for long-term survival. Conclusion: Long-term survival is directly related to adequate lymphadenectomy. LNR could be superior to pN-stage for estimating survival and adds remarkable nuances in prognosis compared to UICC-stage. LNR also appears valid, even in the case of insufficient LN yield. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer: New Insights and Future Prospectives)
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20 pages, 3568 KiB  
Article
Prealbumin Prognostic Score: A Novel Prognostic Indicator After Radical Gastrectomy in Patients with Gastric Cancer
by Ryota Matsui, Souya Nunobe, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Masaru Hayami, Manabu Ohashi and Takeshi Sano
Cancers 2024, 16(22), 3889; https://doi.org/10.3390/cancers16223889 - 20 Nov 2024
Viewed by 990
Abstract
Background: This study aimed to determine whether the prealbumin prognostic score (PPS), a novel indicator using prealbumin instead of albumin in the modified Glasgow Prognostic Score (mGPS), is a better predictive marker postoperatively in patients with gastric cancer. Methods: This retrospective [...] Read more.
Background: This study aimed to determine whether the prealbumin prognostic score (PPS), a novel indicator using prealbumin instead of albumin in the modified Glasgow Prognostic Score (mGPS), is a better predictive marker postoperatively in patients with gastric cancer. Methods: This retrospective study included consecutive patients who underwent radical gastrectomy for primary pStages I–III gastric cancer between 2006 and 2017. The cutoff values for preoperative prealbumin and C-reactive protein (CRP) were 22 mg/dL and 0.5 mg/dL, respectively. According to the prealbumin and CRP levels, a PPS of zero was defined as both being above the cutoff value, of one as either being below the cutoff value, and of two as both being below the cutoff value. Results: Of the 4663 patients, 3421 (73.4%) had a score of zero, 984 (21.1%) had a score of one, and 258 (5.5%) had a score of two. The higher the PPS, the poorer the overall survival [OS] (p < 0.001). When comparing OS by the PPS in patients with an mGPS of zero, a PPS of one indicated poorer OS than a PPS of zero (p < 0.001). In the multivariate analysis, PPSs of one (hazard ratio [HR]: 1.603; 95% confidence interval [CI]: 1.378–1.866; p < 0.001) and two (HR: 1.322; 95% CI: 1.055–1.656; p = 0.015) were independent poor prognostic factors for OS. Conclusions: The PPS, which is based on a combination of prealbumin and CRP levels, can identify a wider range of patients with poor OS than mGPS in patients with gastric cancer after gastrectomy. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer: New Insights and Future Prospectives)
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Other

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13 pages, 1363 KiB  
Systematic Review
Minimally Invasive Versus Open Distal Gastrectomy for Locally Advanced Gastric Cancer: Trial Sequential Analysis of Randomized Trials
by Alberto Aiolfi, Matteo Calì, Francesco Cammarata, Federica Grasso, Gianluca Bonitta, Antonio Biondi, Luigi Bonavina and Davide Bona
Cancers 2024, 16(23), 4098; https://doi.org/10.3390/cancers16234098 - 6 Dec 2024
Cited by 1 | Viewed by 1110
Abstract
Background. Minimally invasive distal gastrectomy (MIDG) has been shown to be associated with improved short-term outcomes compared to open distal gastrectomy (ODG) in patients with locally advanced gastric cancer (LAGC). The impact of MIDG on long-term patient survival remains debated. Aim was to [...] Read more.
Background. Minimally invasive distal gastrectomy (MIDG) has been shown to be associated with improved short-term outcomes compared to open distal gastrectomy (ODG) in patients with locally advanced gastric cancer (LAGC). The impact of MIDG on long-term patient survival remains debated. Aim was to compare the MIDG vs. ODG effect on long-term survival. Methods. Systematic review and trial sequential analysis (TSA) of randomized controlled trials (RCTs). Web of Science, Scopus, MEDLINE, the Cochrane Central Library, and ClinicalTrials.gov were queried. Hazard ratio (HR) and 95% confidence intervals (CI) were used as pooled effect size measures. Five-year overall (OS) and disease-free survival (DFS) were primary outcomes. Results. Five RCTs were included (2835 patients). Overall, 1421 (50.1%) patients underwent MIDG and 1414 (49.9%) ODG. The ages ranged from 48 to 70 years and 63.4% were males. The pooled 5-year OS (HR = 0.86; 95% CI 0.70–1.04; I2 = 0.0%) and 5-year DFS (HR = 1.03; 95% CI 0.87–1.23; I2 = 0.0%) were similar for MIDG vs. ODG. The TSA shows a cumulative z-curve without crossing the monitoring boundaries line (Z = 1.96), thus suggesting not conclusive 5-year OS and DFS results because the total information size was not sufficient. Conclusions. MIDG and ODG seem to have equivalent 5-year OS and DFS in patients with LAGC. However, the cumulative evidence derived from the TSA showed that the actual information size is not sufficient to provide conclusive data. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer: New Insights and Future Prospectives)
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16 pages, 1374 KiB  
Systematic Review
Short-Term Outcomes Analysis Comparing Open, Laparoscopic, Laparoscopic-Assisted, and Robotic Distal Gastrectomy for Locally Advanced Gastric Cancer: A Randomized Trials Network Analysis
by Michele Manara, Alberto Aiolfi, Andrea Sozzi, Matteo Calì, Federica Grasso, Emanuele Rausa, Gianluca Bonitta, Luigi Bonavina and Davide Bona
Cancers 2024, 16(9), 1620; https://doi.org/10.3390/cancers16091620 - 23 Apr 2024
Cited by 7 | Viewed by 2060
Abstract
Background. Minimally invasive surgery for the treatment of locally advanced gastric cancer (AGC) is debated. The aim of this study was to execute a comprehensive assessment of principal surgical treatments for resectable distal gastric cancer. Methods. Systematic review and randomized controlled trials (RCTs) [...] Read more.
Background. Minimally invasive surgery for the treatment of locally advanced gastric cancer (AGC) is debated. The aim of this study was to execute a comprehensive assessment of principal surgical treatments for resectable distal gastric cancer. Methods. Systematic review and randomized controlled trials (RCTs) network meta-analysis. Open (Op-DG), laparoscopic-assisted (LapAs-DG), totally laparoscopic (Lap-DG), and robotic distal gastrectomy (Rob-DG) were compared. Pooled effect-size measures were the risk ratio (RR), the weighted mean difference (WMD), and the 95% credible intervals (CrIs). Results. Ten RCTs (3823 patients) were included. Overall, 1012 (26.5%) underwent Lap-DG, 902 (23.6%) LapAs-DG, 1768 (46.2%) Op-DG, and 141 (3.7%) Rob-DG. Anastomotic leak, severe complications (Clavien–Dindo > 3), and in-hospital mortality were comparable. No differences were observed for reoperation rate, pulmonary complications, postoperative bleeding requiring transfusion, surgical-site infection, cardiovascular complications, number of harvested lymph nodes, and tumor-free resection margins. Compared to Op-DG, Lap-DG and LapAs-DG showed a significantly reduced intraoperative blood loss with a trend toward shorter time to first flatus and reduced length of stay. Conclusions. LapAs-DG, Lap-DG, and Rob-DG performed in referral centers by dedicated surgeons have comparable short-term outcomes to Op-DG for locally AGC. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer: New Insights and Future Prospectives)
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13 pages, 1273 KiB  
Systematic Review
Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation
by Alberto Aiolfi, Davide Bona, Gianluca Bonitta, Francesca Lombardo, Michele Manara, Andrea Sozzi, Diana Schlanger, Calin Popa, Marta Cavalli, Giampiero Campanelli, Antonio Biondi and Luigi Bonavina
Cancers 2024, 16(2), 424; https://doi.org/10.3390/cancers16020424 - 19 Jan 2024
Cited by 8 | Viewed by 1827
Abstract
Background: Debate exists concerning the impact of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched and randomized controlled trials (RCTs) analyzing the effect of D2 vs. D1 on survival [...] Read more.
Background: Debate exists concerning the impact of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched and randomized controlled trials (RCTs) analyzing the effect of D2 vs. D1 on survival were included. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were assessed. Restricted mean survival time difference (RMSTD) and 95% confidence intervals (CI) were used as effect size measures. Results: Five RCTs (1653 patients) were included. Overall, 805 (48.7%) underwent D2 lymphadenectomy. The RMSTD OS analysis shows that at 60-month follow-up, D2 patients lived 1.8 months (95% CI −4.2, 0.7; p = 0.14) longer on average compared to D1 patients. Similarly, 60-month CSS (1.2 months, 95% CI −3.9, 5.7; p = 0.72) and DFS (0.8 months, 95% CI −1.7, 3.4; p = 0.53) tended to be improved for D2 vs. D1 lymphadenectomy. Conclusions: Compared to D1, D2 lymphadenectomy is associated with a clinical trend toward improved OS, CSS, and DFS at 60-month follow-up. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer: New Insights and Future Prospectives)
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