Length of negative resection margin does not affect local recurrence and survival in the patients with gastric cancer

AIM: To investigate the influence of the resection margin on local recurrence and survival in gastric cancer patients.

Sex-based differences in histology,staging,and prognosis among 2983 gastric cancer surgery patients

BACKGROUND Few studies have been conducted on sex differences in the incidence, pathophysiology, and prognosis of gastric cancer(GC).AIM To analyze the differences in GC characteristics according to sex in patients who underwent surgical treatment for GC.METHODS A total of 2983 patients diagnosed with gastric adenocarcinoma who received surgical treatment at the Seoul National University Bundang Hospital between 2003 and 2017 were included.Baseline clinicopathological characteristics, histologic type of GC, overall and GC-specific survival rates, and associated risk factors were analyzed.RESULTS Among the 2983 patients, 2005(67.2%) and 978(32.8%) were males and females, respectively.The average age of the female group(59.36 years) was significantly younger than that of the male group(61.66 years;P < 0.001).Cancer of the gastric body(P < 0.001) and diffuse-type histology(P < 0.001) were more common in females than in males.This trend was more prominent in females younger than 60 years of age, with a significantly higher proportion of diffuse-type cancer than in the male group.Regardless of sex, diffuse-type GC was more common in younger patients, and the proportion of intestinal-type GC increased with age.The overall survival rate was significantly higher in females(P < 0.001).However, this difference disappeared for GC-specific survival(P = 0.168), except for the poor GC-specific survival rate in advanced-stage cancer(stage Ⅲ or above) in females(P = 0.045).The risk factors for GC-related mortality were older age, upper location of GC, and diffuse-or mixed-type histology.In terms of comorbidities, more males died from diseases other than GC, including other malignancies such as lung cancer, hepatocellular carcinoma, and pancreatic cancer, and respiratory diseases such as interstitial lung disease and chronic obstructive pulmonary disease, while there were relatively more cardiovascular or cerebrovascular deaths in females.CONCLUSION Sex-based differences in GC were observed in clinicopathological features, including age at diagnosis, tumor location, histologic type, survival rate, and comorbidities.

National validation of laparoscopic approach for locally advanced gastric cancer:Comparison of a randomized controlled trial and real-world practice results

Objective:The laparoscopic approach for locally advanced gastric cancer has recently been adopted based on the results of several randomized controlled trials(RCTs).However,findings from RCTs have not been examined at the national level.This study aimed to investigate the external validity of the Korean Laparoscopic Gastrointestinal Surgery Study-02(KLASS-02)trial involving 13 tertiary hospitals,using data from the Korean Gastric Cancer Association(KGCA)-led nationwide survey involving 68 tertiary or general hospitals.Methods:Data on patients who underwent laparoscopic or open distal gastrectomy for pathological stageⅠB-ⅢC gastric cancer under the same conditions were collected from the KLASS-02 trial and the KGCA nationwide survey datasets.Surgical outcomes were assessed for each dataset and multivariable analyses were performed to examine the effect of the laparoscopic approach on surgical outcomes.Results:The laparoscopic group had a lower overall complication rate than the open group in both KLASS-02and KGCA datasets(16.1%vs.23.5%for the KLASS-02 and 12.6%vs.19.6%for the KGCA).Moreover,the laparoscopic group had fewer wound problems,and fewer gradeⅡ,Ⅲa,andⅣcomplications than the open group in the KGCA data(0.8%vs.3.4%,5.8%vs.10.4%,2.3%vs.3.7%,and 0.5%vs.1.4%,respectively),which were not observed in the KLASS-02 data.Multivariable analyses revealed that the laparoscopic approach was not associated with overall complications,but reduced wound problems and more harvested lymph nodes in the KGCA survey data(adjusted odds ratios,0.19 for wound problems,adjustedβcoefficient 4.39 for number of harvested lymph nodes),which were not shown in the KLASS-02 data.Conclusions:The safety and feasibility of the laparoscopic approach for locally advanced gastric cancer were validated at a national level.The laparoscopic approach for locally advanced gastric cancer can be implemented in the Republic of Korea.