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Background and aim Staging laparoscopy is an important step of the staging of gastric cancer patients, however, its indication are universally accepted by the different guidelines.This study aimed to define those factors which could help in defining the most appropriate use of staging laparoscopy in a western population. Methods A retrospective cohort study was carried out, including 330 (226 cM- and 104 cM+) gastric cancer patients who had undergone staging laparoscopy between 2010–2020 in seven GIRCG centers. A model including easily-accessible clinical, biochemical and pathological markers was constructed to predict the risk of carcinomatosis. ROC curve and decision curve analyses were used to verify its accuracy and net benefit. Results In the cM- population staging laparoscopy could detect 70 cases who had peritoneal carcinomatosis or positive cytology, for a yield of 31.0%. In cM+ patients staging laparoscopy could exclude carcinomatosis in 15 cases. In cM- patients, intestinal type tumors (0.36, 0.14–0.92; P  = 0.035), the presence of signet ring cells (2.58, 1.04–6.33; P  = 0.039) and cancers of the upper third (3.36, 1.43–7.92; P  = 0.005) were associated with the presence of peritoneal carcinomatosis and/or positive cytology. The ROC curve analysis of the model including the three variables showed an AUC of 0.75 (0.66–0.80, P  < 0.001). The decision curve analyses showed that the model had a higher net benefit than the treating all strategy between threshold probabilities of 16 and 50%. Conclusion Staging laparoscopy is a useful tool to address the patient with gastric cancer to the most adequate treatment. In cM- patients the assessment of the location of the tumor, the Lauren's histotype and the presence of signet ring cells may help in providing additional elements in indicating or not the use of staging laparoscopy. [ABSTRACT FROM AUTHOR] more...

Background: The aim of the present multicentre observational study was to evaluate potential changes in clinical and pathological features of patients with gastric cancer (GC) treated in a 15-year interval. Methods: A centralized prospective database including clinical, surgical, pathological and follow-up data from 2822 patients who had resection of a primary GC was analysed. The analysis focused on three periods: 1991-1995 (period 1), 1996-2000 (period 2) and 2001-2005 (period 3). Surgical procedure, pathological classification and follow-up were standardized among centres. Results: The number of resections decreased from 1024 in period 1 to 955 and 843 in periods 2 and 3 respectively. More advanced stages and a smaller number of intestinal-type tumours of the distal third were observed over time. Five-year survival rates after R0 resection (2320 patients) did not change over time (overall: 56·6 and 51·2 per cent in periods 1 and 3; disease-free: 66·8 and 61·1 per cent respectively). Decreases in survival in more recent years were related particularly to more advanced stage, distal tumours and tumours in women. Multivariable analysis showed a lower probability of overall and disease-free survival in the most recent interval: hazard ratio 1·22 (95 per cent confidence interval 1·06 to 1·40) and 1·29 (1·06 to 1·58) respectively compared with period 1. Recurrent tumours were more frequently peritoneal rather than locoregional. Conclusion: Overall and disease-free survival rates after R0 resection of GC were unchanged over time. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR] more...

Resection line infiltration (RLI) after surgical treatment represents an unfavorable prognostic factor in advanced gastric cancer. We performed a retrospective analysis of 89 patients with resection line involvement who did not undergo reoperation. On behalf of the Italian Research Group for Gastric Cancer, we present the characteristics and outcome of 89 patients who were submitted to surgical resection for gastric cancer from 1988 to 2001 and did not undergo reoperation because of disease extension or associated pathologies. RLI was significantly higher in patients with T4 tumors and diffuse histological type. Anastomotic leakages were observed in 4.8% of infiltrated esophageal resection margins, whereas 1.9% of infiltrated duodenal resection lines showed duodenal fistulas. Five-year overall survival of patients with RLI was 29%. Prognosis was not affected by RLI in early forms (100% 5-year survival); however, 5-year survival in T2 and T3 stages was significantly lower with respect to the same stages without residual tumor. The influence of RLI on prognosis was confirmed in N0 as well as in N1 and N2 patients. RLI also was an independent prognostic at multivariate analysis (odds ratio = 1.5; 95% confidence interval, 1.08–2.08; P = 0.0144). RLI significantly affects long-term survival of advanced gastric cancer. The impact on prognosis is independent of lymph node involvement. Patients in good general condition for whom radical surgery is possible should be considered for reoperation. [ABSTRACT FROM AUTHOR] more...

Percutaneous endoscopic gastrostomy (PEG) is a well-established technique for providing long-term nutritional support. The advantages and most frequent complications have been widely documented, but less is known about the danger of removing or replacing a PEG by cutting the device at skin level without endoscopic assistance to ensure the removal of the inner part. Laparotomy is often required in elderly and high-risk patients to relieve an intestinal obstruction or perforation. We describe a fatal case of small bowel perforation, resulting from the inability to remove an inner bumper. [ABSTRACT FROM AUTHOR] more...

Background: The test and treat strategy for Helicobacter pylori infection has raised some concern since young gastric cancer patients may have no alarm symptoms. In this study the frequency of alarm symptoms was assessed in a series of young gastric cancer patients, as well as the impact of absence of alarm symptoms on delay in diagnosis and stage of gastric cancer at diagnosis and survival. Methods: A retrospective study was carried out on 92 gastric cancer patients ≤ 45 years of age identified from databases in four hospitals between January 1985 and December 2001. Characteristics analysed included duration and features of dyspeptic symptoms, presence of alarm symptoms, time interval from the onset of symptoms to diagnosis, pTNM stage and survival. Results: Of the 92 patients, 54 (58.7%) presented uncomplicated dyspepsia and 38 (41.3%) alarm symptoms. In those with uncomplicated dyspepsia, epigastric pain was the most common complaint (64.1%) followed by vomiting (30.4%), heartburn and nausea. Weight loss was the most common alarm symptom (30.4%), followed by anorexia (10.9%), dysphagia or anaemia (7.6%). The mean delay from first symptoms to final diagnosis was 16.8 ± 13.9 weeks in patients with alarm symptoms and 29.3 ± 39.9 weeks in patients without alarm symptoms ( P :ns). Patients without alarm symptoms showed significantly less aggressive gastric cancer compared to patients with alarm symptoms in relation to TNM stage and survival (cumulative 5-year survival rate: 76% versus 49% P : 0.01). The survival rate, at 5 years, of patients without alarm symptoms, and with a history of dyspepsia of more than 24 weeks, was higher than that in patients with early diagnosis (93.4% versus 66.5%; P : 0.05). Conclusions : A large proportion of young gastric cancer patients present without alarm symptoms. Despite the delay in diagnosis, these patients have a better outcome than those with alarm symptoms. Thus the delay in diagnosis of patients without alarm symptoms does not affect survival. [ABSTRACT FROM AUTHOR] more...

Background: Peritoneal carcinomatosis is a common cause of failure after surgery for gastric cancer. The present longitudinal study was designed to evaluate the incidence and potential predictors of peritoneal recurrence after curative resection for gastric cancer. Methods: Four hundred and forty-one patients who underwent potentially curative resections for gastric cancer in three surgical centres between 1988 and 1996 were evaluated. All patients were followed using a standard protocol following discharge from hospital. The correlation between tumour recurrence and clinicopathological variables was studied by univariate and multivariate analyses. Results: Gastric cancer recurred in 215 (49 per cent) of 441 patients. Peritoneal recurrence was observed in 77 patients (17 per cent), locoregional recurrence in 96 patients and haematogenous recurrence in 75. Multivariate logistic regression analysis of factors associated with peritoneal recurrence identified diffuse-mixed histological type (relative risk (RR) 4·31, P < 0·001), infiltration of the serosa (RR 3·36, P = 0·001), lymph node involvement (RR 2·67, P = 0·023) and tumour size (RR 1·11, P = 0·050) as significant independent variables. In the diffuse-mixed histological subtype, the 5-year cumulative risk of peritoneal recurrence was 12 per cent in the absence of serosal invasion, and 69 per cent in patients with infiltration of the serosa; in the intestinal subtype, the cumulative risk in patients with serosa-negative and -positive turnouts was 4 and 21 per cent respectively. Conclusion: Radical surgery offers a low probability of cure in patients with diffuse-mixed type of gastric cancer and involvement of the serosa, due to a high risk of peritoneal recurrence. These patients might benefit from adjuvant therapies to prevent peritoneal carcinomatosis. [ABSTRACT FROM AUTHOR] more...

The present study aimed at investigating whether in gastric cancer patients stage migration occurs with extension of lymphadenectomy, when node metastases are staged according to the new pN classification (UICC 1997). The investigation involved 921 patients, who underwent R0 gastric resection for gastric cancer between 1988 and 1998 in three different Italian centres: Verona (n=236), Forlì (n=409), Siena (n=276). The relation among lymphadenectomy and pN category was assessed by Kendall's partial rank-order correlation coefficient, controlling for depth of tumour invasion. A direct evaluation of the Will Rogers phenomenon was accomplished in the Verona series, by comparing the number of positive nodes actually observed with the number of positive nodes which would have been retrieved by a less extended lymphadenectomy (D1). The number of positive nodes increased remarkably with the enlargement of lymphadenectomy, especially in pT2 patients (from 2.2+/-3.9 in D1 to 3.9+/-5.0 in D3) and in pT3/pT4 patients (from 5.1+/-5.9 in D1 to 11.3+/-12.6 in D3). Non-parametric statistics highlighted a weak (Kendall's partial T=0.128) but significant (P<0.001) correlation between pN category and extension of lymphadenectomy. In the direct analysis of the Verona series, 22 patients out of 230 (9.6%) migrated to a lower pN tier when ignoring positive nodes retrieved from the second and third level. This percentage increased to 39.1% (90 out of 230) when adopting the TNM 87 classification. In conclusion stage migration is of minor importance in gastric cancer patients, staged according to the new pN classification. [ABSTRACT FROM AUTHOR] more...

Objective: Test and treat strategy for H. pylori infection has been recommended as cost-effective management of dyspeptic patients but has raised concern because young GC patients may have no AS. We determined the frequency of AS in a series of young GC patients and assessed the impact of absence of AS on delay of diagnosis, stage of GC at diagnosis and survival. Methods: We retrospectively studied 92 patients with GC less than 45 years of age, identified from prospective databases in four hospitals from January 1985 to December 2001. Characteristics analysed included gender, age at diagnosis, duration and features of dyspeptic symptoms, presence of AS, time interval from the onset of symptoms to histological diagnosis, final TNM stage of GC and survival. Results: We identified 56 men and 36 women (median age: 40 years, range: 19-45). 54 patients (58.7%) complained of uncomplicated dyspepsia and 38 (41.3%) of AS. Epigastric pain was the most common complaint (64.1%) followed by vomiting (30.4%), heartburn and nausea. Weight loss was the most common AS (30.4%), followed by anorexia (10.9%), dysphagia or anaemia (7.6%) and GI bleeding (3.2%). The mean delay from first symptoms to final diagnosis was 16.5±13.8 weeks for patients with AS and 30.3±41.4 weeks for patients without AS (p:0.051). Patients without AS showed significant less aggressive GC compared to patients with AS as regard TNM stage an survival (cumulative 5-year survival rate: 51.8% vs 31.6%; p:0.052). The survival rate of patients without AS with more than a 24-week delay in diagnosis was higher to that of patients with early diagnosis (75% vs 40.5%; p:0.035). Conclusions: A high proportion of young GC patients presented without AS. Despite the delay in diagnosis, these patients have a better outcome than those with AS. The delay in diagnosis of patients without AS does not affect survival. [ABSTRACT FROM AUTHOR] more...