Predictors, Outcomes, Miscellaneous

https://www.ncbi.nlm.nih.gov/pubmed/21809111

• Leake, Pierre-Anthony, et al. “A systematic review of the accuracy and utility of peritoneal cytology in patients with gastric cancer.” Gastric Cancer 15.1 (2012): 27-37. Available from: doi: 10.1007/s10120-011-0071-z
• What question are the authors trying to answer?
  1. This paper tries to understand the relationship between intraperitoneal free cancer cells (IFCCs) and the outcomes of gastric cancer treatment.
  2. Cytology generally refers to the practice of examining cells. In this case, peritoneal cytology looks for cancer cells in the peritoneum. The authors were interested in the recurrence of cancer in the peritoneum, and the overall survival of gastric cancer patients who had peritoneal cytology with surgery.
  3. Firstly, there are many ways to detect IFCCs, and it is not known which test is best. It is possible that special lab techniques could be helpful to figure out if IFCCs are present. One example which was used in several of these studies is a genetic test called RT-PCR. Although these lab techniques are more accurate, they are difficult to perform with the samples obtained from surgery, expensive and can take a long time to give results.
  4. Next, the paper discussed if the presence (or absence) of IFCCs actually makes a difference in a patient’s cancer treatment and how likely they are to get better.
• How did they address this question?
  1. This paper is a systematic review of other articles.
  2. The authors looked at n=28 different articles from around the world to gather this information.
• What did they find? Why is this important?
  1. The presence of IFCCs seems to increase the chance that cancer will recur at the peritoneum.
  2. Also, IFCCs decrease overall survival in affected patients compared to others.
  3. Unfortunately, detecting IFCCs costs a lot of money and time. This means that the most efficient way to detect them should be established before making this a standard part of gastric cancer care

https://www.ncbi.nlm.nih.gov/pubmed/22138928

• Raziee, Hamid Reza, et al. “Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival.” Gastric Cancer 15.1 (2012): 116-124. Available from: doi: https://doi.org/10.1007/s10120-011-0112-7
• What were the researchers trying to learn?
  1. This paper looked at the effects of having positive margins after gastric cancer surgery. It discusses:
     1. What factors could lead to positive margins
     2. How these factors affect patient survival
     3. When patients with positive margins should have more surgery.
• How did they address this question?
  1. 7 studies including n=19355 patients from around the world were analyzed.
• What did the find? Why is this important?
  1. Positive margins could come from many different biological features of the tumor. For example, many studies found that surgery of advanced tumors was more likely to leave positive margins. Advanced tumors are those with a higher T and/or N stage.
  2. Larger tumors are more likely to leave positive margins. Bigger tumors are likely to be more spread out, which is why it might be harder for the surgeon to fully cut it out.
  3. Patient survival is worse for those with positive margins in early stage gastric cancer. These patients with less advanced disease should have a second operation if their first one left positive margins.
  4. Advanced gastric cancer patients are more likely to benefit from having more extensive surgery in the first place. This means removing more of the stomach and nearby organs during one surgery.
  5. Even though more extensive surgery can be risky, it may be a good idea to remove all of the cancer in one operation. This is because advanced cancer patients may not survive living with positive margins or having a second surgery.

https://www.ncbi.nlm.nih.gov/pubmed/21983994

• Mahar, Alyson L., et al. “Surgical management of gastric perforation in the setting of gastric cancer.” Gastric Cancer15.1 (2012): 146-152. Available from: https://doi.org/10.1007/s10120-011-0095-4.
• What is a gastric perforation?
  1. In rare emergencies, patients with advanced gastric cancer may have a gastric perforation. This means that there is a hole in the stomach wall and the fluid from the stomach can leak out. Gastric cancer usually only causes perforations when it is very advanced. This can happen if the cancer has not been diagnosed or treated. Sometimes, people may only find out they have advanced gastric cancer because of the pain caused by a perforation.
• What were the authors trying to learn? How did they address this question?
  1. This paper was written to learn about and evaluate the treatments given for gastric perforations.
  2. This review looked at 9 articles including n=127 patients who visited hospitals around the world with a gastric perforation.
  3. The sample size of patients analyzed in this study is so small because of how rare this complication is!
• What did they find? Why is this important?
  1. Most of these patients were diagnosed with gastric cancer during or after surgery. Surgeons treating a gastric perforation have a few options to fix the leak. They can:
     1. Do a total gastrectomy
     2. Cut out the perforated area only, or…
     3. Close the hole.
  2. This paper suggests that patients who underwent a gastrectomy which achieved R0 margins lived the longest following their gastric perforation repair.
  3. However, the surgeon must think about many different factors when choosing how to treat a perforation. This includes: the risk of infection, the extent of the cancer and the possibility of needing a second operation.
  4. Luckily, emergency gastric perforations are quite rare. But, this means that there is not very much information available for doctors to know which treatment option is the best. More research is needed to make sure these results are consistent.

https://www.ncbi.nlm.nih.gov/pubmed/22160243

• Seevaratnam, Rajini, et al. “A systematic review of the indications for genetic testing and prophylactic gastrectomy among patients with hereditary diffuse gastric cancer.” Gastric cancer 15.1 (2012): 153-163. Available from: doi: https://doi.org/10.1007/s10120-011-0116-3
• What are the risks of gastric cancer in a patient’s family?
  1. Hereditary Diffuse Gastric Cancer is a rare form of gastric cancer.
  2. It is caused by mutations to the CDH1 gene.
  3. Essentially, this means that gastric cancer runs in the families of people with this mutation in their DNA.
• What question is this paper trying to answer?
  1. The authors wanted to learn about the usefulness of testing for the CDH1 mutation, specifically in people who have family members with gastric cancer.
  2. The paper also talks about methods of preventing gastric cancer in people who are more likely to get the disease based on the results of the genetic testing.
• How did they answer this question?
  1. This review looked at 70 different articles to learn about testing for the CDH1 mutation.
• What did they find? Why is this important?
  1. People with multiple family members who have gastric cancer should be tested for the CDH1 mutation.
  2. If someone tests positive, this means that they have a higher chance of developing cancer.
  3. One option to reduce the risk of  cancer in these individuals is to have a prophylactic gastrectomy. This is a preventative surgery which removes the stomach before the cancer can show up.
  4. In fact, one experiment found that 87% of high-risk individuals who had a prophylactic gastrectomy already had cancer cells in the removed tissue!
  5. People in this high-risk group might choose to have their stomach removed while they are still healthy. If they develop gastric cancer, there is a good chance that they will have a gastrectomy anyways.
  6. Prophylactic gastrectomy is not recommended for people who test negative for the CDH1 mutation.

https://link.springer.com/article/10.1007/s10120-012-0142-9

• Cardoso, Roberta, et al. “A systematic review of patient surveillance after curative gastrectomy for gastric cancer: a brief review.” Gastric Cancer 15.1 (2012): 164-167. Available from: doi: https://doi.org/10.1007/s10120-012-0142-9
• What happens after surgery?
  1. Even after undergoing gastrectomy and lymphadenectomy procedures, many gastric cancer patients have recurrent disease. When the cancer comes back, it can be very difficult to treat.
  2. It is important that doctors follow up with their patients after surgery to check on their health over time. This is called surveillance.
• What was this paper trying to learn about?
  1. Unfortunately, there is no standard surveillance method. This makes it hard to know when patients should see their doctor long after surgery.
  2. It is also challenging to decide how patients should be most effectively be assessed at each visit to the doctor. There is not a lot of information available on this topic.
  3. The authors wrote this paper to try and learn about surveillance after gastric cancer surgery. They assessed different methods of testing.
• How did they address their research question?
  1. This paper reviewed 5 articles from the USA, Germany, Singapore and Japan.
• What did they find? Why is this important?
  1. Both CT scans and endoscopic ultrasound are good ways of detecting recurrent cancer after surgery.
  2. Finding recurrent cancer before patients start to notice symptoms means that chemotherapy can be started earlier. At this early point, patients usually feel healthy enough to tolerate chemotherapy better, so it is even more helpful in treating the disease.
  3. This shows how important it is for patients to take care of their health and have regular tests after their operation.
  4. More information is needed to learn about assessing quality of life after surgery. This can also be helpful in deciding how often patients need to see their doctor after surgery