This paper to assess the long-term outcome of surgical treatment for lower third gastric carcinoma; the patients’ median age was 57.76 ± 11.74 years, the highest 81, and the youngest 31. Gastric cancer occurs most frequently in the age group of 51 - 60 years (39.39%), the male/female ratio was 2.66.
Journal of military pharmaco-medicine no5-2020 SURGICAL TREATMENT RESULTS OF GASTRIC CANCER IN THE LOWER THIRD OF THE STOMACH Heng Lihong1,2, Nguyen Van Xuyen1, Le Thanh Son1 SUMMARY Objectives: To assess the long-term outcome of surgical treatment for lower third gastric carcinoma Methods: Retrospective longitudinal study Results: The patients’ median age was 57.76 ± 11.74 years, the highest 81, and the youngest 31 Gastric cancer occurs most frequently in the age group of 51 - 60 years (39.39%), the male/female ratio was 2.66 The average overall survival time was 73.16 ± 6.35 months There were 29 deaths during the follow-up time, the overall death rate after years was 43.94% The overall survival rate according to Kaplan-Meier after year, years, years, years and years was 87.9%, 66.4%, 54.0%, 54.0% and 54.0%, respectively The 5-year survival rate was 77.8%; 72.9%; 37.6%; 70.0%; 33.3%; 36.4% for stage Ia, Ib, IIa, IIb, IIIa, IIIb, IIIc, respectively Corresponding 5-year survival rate by metastatic lymph nodes harvested in N0, N1, N2, N3a was 64.5%, 55.6%, 47.4%, 50.0% * Keywords: Lower third gastric cancer; Gastric cancer; Surgical treatment; Long-term outcome INTRODUCTION According to the 2018 report by the International Agency for Research on Cancer, in 2018, gastric cancer was the fifth most frequently cancer, accounting for 5.7% of all cancers and the third leading cause of cancer-related mortality making up 8.2% of all cancers with an estimated 1,033,701 new cases and 782,685 deaths worldwide [6] Gastric cancer has a good prognosis if diagnosed early and treated promptly The survival rate after years ranges from - 27% for late stage and 85 - 100% for early stage [1] The early and accurate diagnosis of degree of invasion of gastric cancer is very important for radical surgery, contributing to prolong the survival time and improve the quality of life for patients Currently, radical surgery is still the most effective method of treating gastric cancer In Vietnam, this method has been carried out in large hospitals, however, there have been few reports on the effectiveness of surgical management for the stomach cancer in the lower third Hence, we conducted this research: To assess surgical results of treatment for lower third stomach cancer Department of Gastrointestinal Surgery, Military Hospital 103, Vietnam Military Medical University Phnom Penh Hospital Corresponding author: Henglihong (41hcompany@gmail.com) Date received: 20/5/2020 Date accepted: 01/6/2020 161 Journal of military pharmaco-medicine no5-2020 + Remove metastatic lymph node system: remove gastric lymph node to D2 level SUBJECTS AND METHOD Subjects + Radical ablation of invasive or metastatic organs: Invasive organs such as the colon, pancreatic tail, liver or metastatic organs such as ovary need to be removed with the tumor 66 patients with gastric cancer in the lower third of the stomach, were treated with radical surgery at Military Hospital 103 and National Cancer Hospital (Tan Trieu Facility) from 2009 - 2016 Research methods * Selection criteria: Retrospective longitudinal study Follow post-treatment patients was conducted as follows: - Patients whose histopathological diagnosis was carcinoma in the lower third of the stomach (carcinoma is identified according to WHO regulations and tumor position is located at the lower third according to JGCA 3rd) + To keep in touch with patients, give them medical check up + Those who were still alive would be examined and checked by abdominal computerized tomography to detect abnormalities, recurrence or metastases of gastric cancer after treatment - Patients who received radical surgery for lower third gastric cancer treatment underwent operation according to the following principle: + Gastrectomy line: at the bottom, excision of the duodenum - cm from the pylorus At the top, excision was at least cm away from lesions + Those who were dead would be taken information about the time of survival, the cause of death from their family * Data processing: Using SPSS 22 software to calculate the ratio and average value by percentage (%), average value, Kaplan-Meier analysis + Remove all large and small splices and the upper leaves of transverse colon mesentery RESULTS Age and gender characteristics Table 1: Characteristics of age group and gender distribution Age 162 Gender (n, %) n Ratio % (22.22) 9.09 (10.42) (22.22) 13.64 51 - 60 22 (45.83) (22.22) 26 39.39 61 - 70 11 (22.9) (22.2) 15 22.7 > 70 (16.67) (11.11) 10 15.15 Total 48 (72.73) 18 (27.27) 66 100.0 X ± SD (min - max) 59.04 ± 10.56 (31 - 79) 54.33 ± 14.21 (36 - 81) Male Female ≤ 40 (4.17) 41 - 50 57.76 ± 11.74 (31 - 81) Journal of military pharmaco-medicine no5-2020 The median age of the patients was 57.76 ± 11.74 years, of which the oldest 81, the youngest 31 Male occupied higher rate of gastric cancer than female (72.73% versus 27.27%) The age group of 51 - 60 had the highest incidence of gastric cancer (39.39%), the lowest rate was found in the age group ≤ 40 (9.09%) Follow-up results Among 66 patients, 37 patients were still alive (accounting for 56.06%), the remaining patients were dead (43.94%) Table 2: Overall survival time Survival time Survival The cumulative number of deaths Cumulative survival rate (%) ≥ year ≥ years ≥ years ≥ years ≥ years 22 29 29 29 87.9 66.4 54.0 54.0 54.0 73.16 ± 6.35 ± SE(month) 95%CI 60.71 - 85.61 The average overall survival time was 73.16 ± 6.35 months There were 29 deaths during the follow-up, the total death rate after years was 29/66 (43.94%) The overall survival rate after year, years, years, years, years was 87.9%, 66.4%, 54.0%, 54.0%, 54.0%, respectively Overall survival time (month) Figure 1: Overall survival time 163 Journal of military pharmaco-medicine no5-2020 Table 3: Overall survival time by disease stage The stage of disease n 5-year survival rate (%) Ia 100 Ib 77.8 98.67 ± 12.69 73.80 - 123.53 IIa 72.9 68.96 ± 9.15 51.03 - 86.89 IIb 16 37.6 53.53 ± 10.60 32.75 - 74.31 IIIa 10 70.0 57.50 ± 7.99 41.85 - 73.15 IIIb 33.3 32.83 ± 6.17 20.75 - 44.92 IIIc 11 36.4 26.18 ± 6.88 12.69 - 39.67 IV 0.0 11.50 ± 1.50 8.56 - 14.44 Total 66 70.46 ± 6.55 57.62 - 83.31 ± SE 95%CI p Test Log Rank χ = 21.822 p = 0.001 The 5-year survival rate of patients in stage Ia reached 100% The 5-year survival rate in the stages of: Ia, Ib, IIa, IIb, IIIa, IIIb and IIIc was 77.8%; 72.9%; 37.6%; 70.0%; 33.3% and 36.4%, respectively Two cases of stage IV survived for 11.50 ± 1.50 months One case survived for 10 months, case survived for 13 months Total survival time in stages Ib, IIa, IIb, IIIa, IIIb, IIIC, IV was 70.46 ± 6.55 months, the difference was statistically significant with p < 0.01 (Test Log Rank χ2 = 21.822; p = 0.001) Overall survival time (month) Figure 2: Overall survival time by disease stage 164 Journal of military pharmaco-medicine no5-2020 Table 4: Overall survival time by metastatic lymph nodes Lymph node stages n 5-year survival rate (%) N0 20 64.5 86.88 ± 10.86 65.60 - 108.17 N1 12 55.6 66.72 ± 12.57 42.09 - 91.35 N2 25 47.4 46.95 ± 6.26 34.68 - 59.21 N3a 50.0 32.63 ± 8.30 16.36 - 48.89 N3b 0.0 9.00 9.00 Total 66 73.16 ± 6.35 60.71 - 85.61 ± SE 95%CI p Test Log Rank χ = 14.498 p = 0.006 case of lymph node metastasis in stage N3b survived for months The 5-year survival rates by metastatic lymph nodes were N0 (64.5%), N1 (55.6%), N2 (47.4%), N3a (50.0%) Total survival time in stages N0, N1, N2, N3a, N3b was 73.16 ± 6.35, the different was statistically significant with p < 0.01 (Test Log Rank χ2 = 14.498; p = 0.006) Overall survival time (month) Figure 3: Overall survival time by metastatic lymph nodes Table 5: Overall survival time by degree of invasion Degree of invasion n 5-year survival rate (%) T1a 100.0 T1b 85.7 77.71 ± 11.37 55.42 - 100.01 T2 13 61.5 83.69 ± 12.42 59.35 - 108.03 T3 22 55.8 67.73 ± 9.16 49.79 - 85.67 T4a 15 37.3 26.63 ± 3.28 20.20 - 33.05 T4b 28.6 24.00 ± 8.08 8.17 - 39.83 Total 66 71.62 ± 6.48 58.92 - 84.32 ± SE 95%CI p Test Log Rank χ = 8.979 p = 0.062 165 Journal of military pharmaco-medicine no5-2020 The 5-year survival rate of two patients with invasive gastric cancer T1a reached 100% The 5-year survival rates by degree of invasions of T1b, T2, T3, T4a and T4b were 85.7%; 61.5%; 55.8%; 37.3% and 28.6%, respectively The overall survival time by degree of invasions of T1b, T2, T3, T4a and T4b was 71.62 ± 6.48 months, the difference was not statistically significant with p > 0.05 (Test Log Rank χ2 = 8,979; p = 0,062) Overall survival time (month) Figure 4: Overall survival time by degree of invasion DISCUSSION Age and gender characteristics The average age of the study group was 57.76 ± 11.74 years, of which the oldest was 81, the youngest was 31 Males had higher rate of gastric cancer than females (72.73% vs 27.27%) The age group of 51 - 60 had the highest incidence of gastric cancer (39.39%), whereas the lowest incidence was found in the age group ≤ 40 (9.09%) Our results were consistent with Ho Chi Thanh’s findings (2015), with an average age of 57.03 ± 11.92, male: 58.44 ± 11.27 years old, female: 54.97 ± 12.64 years old, the male/female ratio was 1.45, the age group with the highest 166 incidence being 51 - 60 (34.68%) [3] According to Dang Van Thoi’s study (2017), the average age of gastric cancer patients was 58.43 ± 13.20, the male/female ratio was 4, the highest incidence found in the group of 51 - 60 was 36% [4] Isobe’s study results (2013) revealed the rate of gastric cancer in patients under 40 years old was only 6% [7] Thus, studies have shown that gastric cancer was the most frequently detected in the age group of 51 - 60, rarely seen in the age of under 40, males are more vulnerable to gastric carcinoma than females Post-surgery results Among our 66 study subjects, there were 37 survivors (accounting for 56.06%) and 29 deaths (43.94%) Journal of military pharmaco-medicine no5-2020 - Overall survival time: The average overall survival time was 73.16 ± 6.35 months There were 29 deaths during the follow-up, the total death rate after years reached 43.94% The overall survival rate after year, years, years, years, years was 87.9%, 66.4%, 54.0%, 54.0%, 54.0%, respectively According to the long-term outcome in Wei-Juan Zeng’s study (2014) on 533 patients with gastric cancer with an average of 38.6 months, the results show that the average survival time was 25.3 months The overall survival rates after year, years, years and years were 78.4%; 61.4%; 53.3% and 48.4%, respectively [8] - Overall survival time by disease stages: Stage of cancer is one of the prognostic factors for survival time of patients with gastric cancer, the higher the stage is, the shorter the post-operative survival time is Our study shows that the survival rate in the stage Ia was 100% The 5-year survival rates in the stages of Ia, Ib, IIa, IIb, IIIa, IIIb, IIIc were 77.8%; 72.9%; 37.6%; 70.0%; 33.3%; 36.4%, respectively Stage IV survived for 11.50 ± 1.50 months One case survived for 10 months, case survived for 13 months The total survival time in stages Ib, IIa, IIb, IIIa, IIIb, IIIC, IV was 70.46 ± 6.55 months, the average survival time by stages of Ib, IIa, IIb, IIIa, IIIb, IIIc and IV was 98.67 ± 12.69 months, 68.96 ± 9.15 months, 53.53 ± 10.60 months, 57.50 ± 7.99 months, 32.83 ± 6.17 months, 26.18 ± 6.88 months, 11.50 ± 1.50 months, the difference was statistically significant with p < 0.01 (Test Log Rank χ2 = 21.822; p = 0.001) Compared to previous studies, Ho Chi Thanh’s study (2015) showed that, the stage II had an average survival time of 50.688 ± 4.009 months; stage IIIa (45.592 ± 6.600 months); stage IIIb (33.025 ± 4.184 months); stage IV (20.049 ± 3.007 months) [3] Do Van Trang’s study, the average survival time in stage IIIa was 34.5 ± 3.5 months; IIIb (23.4 ± 5.38 months) and stage IV (10.67 ± 5.41 months) [5] - Overall survival time by metastatic lymph nodes: Following the survival time of the study subjects by metastatic lymph nodes, we realized: There was one case of N3b lymph node metastasis who survived for months The 5-year survival rate by metastatic lymph nodes was N0, N1, N2, N3a was 64.5%, 55.6%, 47.4%, 50.0%, respectively The overall survival time of N0, N1, N2, N3a, N3b was 73.16 ± 6.35, the average survival time by metastatic lymph nodes of N0, N1, N2, N3a was 86.88 ± 10.86 months, 66.72 ± 12.57 months, 46.95 ± 6.26 months, 32.63 ± 8.30 months, respectively, the difference was statistically significant with p < 0.01 (Test Log Rank χ2 = 14.498; p = 0.006) According to Ho Chi Thanh’s study, the average survival time was 38.079 ± 3.094 months; N1 lymph node metastasis was 46.021 ± 5.572 months; N3 metastasis was 20.049 ± 3.007 months [2] According to Nguyen Xuan Kien’s results (2005), non-metastatic lymph nodes had an average survival time of 69.35 months, the average survival time of - lymph nodes 167 Journal of military pharmaco-medicine no5-2020 metastasis was 35.55 months, ≥ lymph nodes metastasis: 17.55 months and over 15 lymph nodes: 13.17 months [1] years, years, years and years was 87.9%, 66.4%, 54.0%, 54.0% and 54.0%, respectively - Overall survival time by degree of invasion: The 5-year survival rates by stages of Ia, Ib, IIa, IIb, IIIa, IIIb, IIIc were 77.8%; 72.9%; 37.6%; 70.0%; 33.3%; 36.4%, respectively The overall survival time by stages of Ib, IIa, IIb, IIIa, IIIb, IIIC, IV was 70.46 ± 6.55 months, the difference was statistically significant with p < 0.01 Stage Ib was 98.67 ± 12.69 months; stage IIa was 68.96 ± 9.15 months; stage IIb was 53.53 ± 10.60 months; stage IIIa was 57.50 ± 7.99 months; stage IIIb was 32.83 ± 6.17 months; stage IIIc was 26.18 ± 6.88 months In our study, the survival rate according to the degree of invasion T1a was 100% The 5-year survival rate by degrees of invasion of T1b, T2, T3, T4a and T4b were 85.7%; 61.5%; 55.8%; 37.3% and 28.6%, respectively The overall survival time by degrees of invasion of T1b, T2, T3, T4a and T4b was 71.62 ± 6.48 months, the average survival time by each degree of invasion of T1b, T2, T3, T4a and T4b was 77.71 ± 11.37 months, 83.69 ± 12.42 months, 67.73 ± 9.16 months, 26.63 ± 3.28 months, 24.00 ± 8.08 months, respectively, the difference was not statistically significant with p > 0.05 (Test Log Rank χ2 = 8.979; p = 0.062) According to Ho Chi Thanh’s findings (2015), the overall degree of invasion of T2 and T3 was 43.679 ± 2.587 months, of which, the group with the degree of invasion T2 had an average survival time of 53.134 ± 2.799 months, the average survival time of the group with the degree of invasion T3 was 31.900 ± 3.217 months [2] According to Nguyen Xuan Kien’s study (2005), the average survival time by degrees of invasion of T1, T2, T3 and T4 was 74.41; 58.22; 36.2; 21.91 months, respectively [1] CONCLUSION The average overall survival time was 73.16 ± 6.35 months The overall survival rate according to Kaplan-Meier after year, 168 The degree of invasion is proven to be significant in the prognosis of additional survival time after radical surgery in treatment for gastric cancer in the lower third of the stomach The 5-year survival rate by metastatic lymph nodes harvested in N0, N1, N2, N3a was 64.5%, 55.6%, 47.4%, 50.0% The overall survival time by metastatic lymph nodes N0, N1, N2, N3a, N3b was 73.16 ± 6.35, the difference was statistically significant with p < 0.01 The survival time by each metastatic lymph nodes was 66.72 ± 12.57 months (N1); 46.95 ± 6.26 months (N2); 32.63 ± 8.30 months (N3a), non-metastatic lymph nodes N0 was 86.88 ± 10.86 months REFERENCES Nguyễn Cường Thịnh CS Nhận xét qua 228 trường hợp cắt toàn dày điều trị ung thư dày Tạp chí Y học Thực hành 2013; 6(874):65-68 Journal of military pharmaco-medicine no5-2020 Hồ Chí Thanh Nghiên cứu ứng dụng phẫu thuật nội soi điều trị triệt ung thư biểu mô 1/3 dày Bệnh viện Quân y 103 Luận án Tiến sĩ Y học Học viện Quân y 2015 Đặng Văn Thởi Nghiên cứu đặc điểm lâm sàng, thương tổn đánh giá kết lâu dài phẫu thuật triệt ung thư phần dày Luận án Tiến sĩ Y học Trường Đại học Y Dược Huế 2017 Đỗ Văn Tráng Nghiên cứu kỹ thuật nạo vét hạch phẫu thuật nội soi điều trị ung thư dày vùng hang môn vị Luận án Tiến sĩ Y học Trường Đại học Y Hà Nội 2012 Nguyễn Xuân Kiên Nghiên cứu số yếu tố giải phẫu bệnh liên quan đến thời gian sống thêm sau phẫu thuật ung thư dày Luận án Tiến sĩ Y học Học viện Quân y 2005 International Agency for Research on Cancer Globocan 2018 Isobe T, Hashimoto K, Kizaki J, et al Characteristics and prognosis of gastric cancer in young patients (Gastric Cancer In Young Patients) 2013:43-49 Wei-Juan Zeng, Wen-Qin Hu, Lin-Wei Wang, et al Long term follow up and retrospective study on 533 gastric cancer cases BMC Surgery 2014; 14(29):1-8 169 ... was carcinoma in the lower third of the stomach (carcinoma is identified according to WHO regulations and tumor position is located at the lower third according to JGCA 3rd) + To keep in touch... years, of which the oldest 81, the youngest 31 Male occupied higher rate of gastric cancer than female (72.73% versus 27.27%) The age group of 51 - 60 had the highest incidence of gastric cancer. .. cancer after treatment - Patients who received radical surgery for lower third gastric cancer treatment underwent operation according to the following principle: + Gastrectomy line: at the bottom,