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- Kung, Chih Han, et al.
(författare)
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Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden
- 2017
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Ingår i: Chinese Journal of Cancer Research. - : Chinese Journal of Cancer Research. - 1000-9604. ; 29:4, s. 313-322
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990’s reported increased morbidity and mortality for D2 compared to D1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods: A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into D0, D1, or D1+/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results: In total, 349 (31.7%) patients had a D0, 494 (44.9%) D1, and 258 (23.4%) D1+/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2% (D0, D1 and D1+/D2, respectively), and 90-d mortality rates were 8.3%, 4.3% and 5.8%. After adjustment for confounders, in multivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. D0. Conclusions: The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy (D0 and D1). More extensive lymphadenectomy (D1+/D2) seemed to have no impact on postoperative morbidity or mortality.
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| 3. |
- Kung, Chih-Han
(författare)
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Outcome of gastric cancer surgery in Sweden
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Gastric cancer worldwide is the fifth most common cancer and has the third highest cancer related mortality. Curative treatment includes surgical resection but comes with risk of complications and the optimal surgery including extent of lymphadenectomy has evolved over time. This thesis aims to assess the impact of surgical treatment and lymphadenectomy in gastric cancer and its postoperative short-term outcomes and long-term survival effects. It also examines the decision-making process and impact of the variation of different proportion of the population that is offered curative treatment for gastric cancer. Paper I is a single center retrospective study examining the incidence of postoperative pancreatic fistula following gastrectomy with D2 lymphadenectomy and bursectomy. The results show that there is an acceptable general complication rate and the risk of postoperative pancreatic fistula is low when no concomitant pancreatic resection is carried out. Paper II and III are national register-based studies using the National Register of Oesophageal and Gastric Cancer (NREV) quality register. The studies examine the impact of different extent of lymphadenectomy on postoperative morbidity, mortality and long-term survival. The results show that extensive lymphadenectomy, D1+/D2, can be performed with acceptable and low postoperative complication rate and mortality and offers a survival advantage compared to limited, D0/D1, lymphadenectomy. Paper IV is a NREV study examining the different rates of curative gastric cancer resection across geographical regions in Sweden and its impact on survival. The results show that the rate of resection varies greatly across different regions and years in Sweden indicative of room for improvement in the decision-making process. A higher rate of curative resection is accompanied with improved survival for the entire population of gastric cancer.
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| 4. |
- Lindmark, Gudrun, et al.
(författare)
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qRT-PCR analysis of CEACAM5, KLK6, SLC35D3, MUC2 and POSTN in colon cancer lymph nodes : An improved method for assessment of tumor stage and prognosis
- 2024
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Ingår i: International Journal of Cancer. - : John Wiley & Sons. - 0020-7136 .- 1097-0215. ; 154:3, s. 573-584
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Tidskriftsartikel (refereegranskat)abstract
- One fourth of colorectal cancer patients having curative surgery will relapse of which the majority will die. Lymph node (LN) metastasis is the single most important prognostic factor and a key factor when deciding on postoperative treatment. Presently, LN metastases are identified by histopathological examination, a subjective method analyzing only a small LN volume and giving no information on tumor aggressiveness. To better identify patients at risk of relapse we constructed a qRT-PCR test, ColoNode, that determines levels of CEACAM5, KLK6, SLC35D3, MUC2 and POSTN mRNAs. Combined these biomarkers estimate the tumor cell load and aggressiveness allocating patients to risk categories with low (0, −1), medium (1), high (2) and very high (3) risk of recurrence. Here we present result of a prospective, national multicenter study including 196 colon cancer patients from 8 hospitals. On average, 21 LNs/patient, totally 4698 LNs, were examined by both histopathology and ColoNode. At 3-year follow-up, 36 patients had died from colon cancer or lived with recurrence. ColoNode identified all patients that were identified by histopathology and in addition 9 patients who were undetected by histopathology. Thus, 25% of the patients who recurred were identified by ColoNode only. Multivariate Cox regression analysis proved ColoNode (1, 2, 3 vs 0, −1) as a highly significant risk factor with HR 4.24 [95% confidence interval, 1.42-12.69, P =.01], while pTN-stage (III vs I/II) lost its univariate significance. In conclusion, ColoNode surpassed histopathology by identifying a significantly larger number of patients with future relapse and will be a valuable tool for decisions on postoperative treatment.
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| 5. |
- Lu, Chih Hsuan, et al.
(författare)
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Multi-plate generation and compression of an intense supercontinuum pulse
- 2016
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Ingår i: High Intensity Lasers and High Field Phenomena, HILAS 2016. - 9781943580095
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Konferensbidrag (refereegranskat)abstract
- An intense octave-spanning supercontinuum with pulse energy of 160 μJ has been generated in an all-solid-state multiple-plate arrangement and successfully compressed to near-transform limited single-cycle duration of 2.8 fs.
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