Gastric Cancer - HBazan

Gastric Cancer - HBazan -...

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Controversies in the Management of Gastric  Cancer Update on D1 vs. D2 dissection Is There a Role for Adjuvant Treatment? Hernan Bazan, MD 1 June 2004 Team IV Conference
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The problem Gastric cancer remains a major worldwide  problem Despite a decrease in incidence over the last 70  years Still remains one of the most common causes of  cancer-related deaths worldwide Second  leading cause of cancer death worldwide In 2002 800,000 people diagnosed 500,000 deaths USA 21,600 new cases 12,400 deaths 2% cancer deaths (10 th ) Diagnosed at an advanced stage in Western  countries Present with locally advanced disease
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GE Junction Tumor/ Distal Esophageal  Cancer 1930 – 1976: Esophageal cancer 75%  incidence But, >1976   incidence of GE junction  tumors Major shift in the histologic type has  occurred in USA and Europe over the  past 15 years Incidence of adenocarcinoma  distal esophagus Devesa SS et al  Cancer  1998
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Staging T1 Invades Submucosa T2 Muscularis propia T3 Serosa T4  Adjacent organs
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National Cancer Database on 50,169 US  patients who underwent gastrectomies  1985-1996 10-year survival: Stage IA :  65% Stages II/III 3-42% *Need at least 15 LNs for proper staging N Regional LNs: Perigastric (lesser and greater curvature, left gastric, common hepatic, splenic, celiac) Distant Mets : Involvement of hepato- duodenal, retropancreatic, para-aortic N1  1-6 regional LNs;  N2  7-15 LNs  N3  >15 LNs
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Controversies in Management of Gastric Cancer Lymphadenectomy
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Controversies in Management of Gastric Cancer Japanese advocate radical LN dissection Retrospective Japanese studies: Stage II/III 5 yr survival 60% (vs.  20% in USA) D1 Dissection: Removal of perigastric LNs D2 Dissection: Hepatic, gastric, cardiac, splenic LNs
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Controversies in Management of Gastric Cancer In operable gastric cancer, the extent of surgery (node dissection)  remains controversial Japanese : Advocate D2 extended lymphadenectomy [resection of spleen  and distal pancreas necessary for removal splenic LNs (Station 10, 11)] Dutch and British studies 1999 : No survival differences in D1 vs. D2  resections; higher morbidity and mortality associated with D2 resection  involving distal pancreatic and splenic resections US : D1 resection (unfortunately, oftentimes D0 resection) Value of adjuvant therapy also remains controversial Chemotherapy Chemoradiation therapy Neoadjuvant?
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LN group 1 R cardiac 2 L cardiac 3 Lesser curvature 4 Greater curvature 5 Suprapyloric 6 Infrapyloric 7 L gastric artery 8 Common hepatic artery 9 Celiac artery 10 Splenic hilar 11 Splenic artery 12 Hepatic pedicle 13 Retropancreatic 14 Mesenteric root 15 Middle colic artery 16 Paraaortic N1 N2
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Gastric Cancer - HBazan -...

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