R0 D'Ugo Eune 2008

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Domenico M. D'Ugo

Santé & Médecine

The term R0 describes a microscopically margin negative resection, in which NO MICROSCOPIC TUMOR REMAINS IN THE TUMOR BED R0-Resection Domenico D’UGO Full Professor of Surgery Catholic University - Rome (Hermaneck, 1994)

Survival after R0-Resection Siewert JR, et al. Ann Surg, 1998 36.1%

Recurrence after R0-Resection Marrelli D, et al. Ann Surg, 2005 52.0%

R0-Resection: what if it’s true? D’Angelica M, et al. Ann Surg, 2004 7% 92%

Recurrence after R0-Resection D’Ugo D, Catholic University, 2007 Risk factors pT3-4 pN+ diffuse type G3 larger size proximal site Time to recurrence months 19.0% 16.7% 39.3% 25.0% Peritoneal Lymph nodal Haematogenous Locoregional 60.7% Locoregional 19.1 Lymph nodal 24.2 Peritoneal 19.9 Haematogenous 25.9

? or Recurrence (of disease) Failure (of treatment)

Survival after R0-Resection Siewert JR, et al. Ann Surg, 1998 36.1% Siewert 1998 64.8% Kim 1998 Kim JP, et al. Gastric Cancer, 1998 ≈ ≈ 30.7 12.3 15.8 13.9 13.4 13.8 Siewert 1998 (%) 13.2 IV 23.3 IIIB 20.0 IIIA 15.0 II 11.6 IB 17.3 IA Kim 1998 (%) UICC-TNM

Nishi M, et al. Gastric Cancer, 1993 1962 General Rules for Gastric Cancer Study in Surgery and Pathology Survival after Japanese R0-Resection

Randomized Controlled Trials No survival benefit (but in selected patients) Dutch MRC

What selection? Maruyama Index of unresected disease % Likelihood of nodal involvement for each lymph node station left in situ Sex Age Borrmann type Tumor size (luminal surface) Tumor location Tumor depth (cT) Histology Maruyama K, et al. Br J Surg, 1989

Maruyama Index: a old parameter, a new R0-Resection?

Macdonald JS et al. N Engl J Med, 2001 CH-RT Surgery

Induction of R0-Resection 7-year survival results of perioperative chemotherapy with epidoxorubicin, etoposide, cisplatin (EEP) in locally advanced resectable gastric cancer: up-to-date analysis of a phase II study. Persiani R, Rausei S, Pozzo C, Biondi A, Barone C, Cananzi FCM, Schinzari G, D’Ugo D

Magic Trial INT-0116 ACTS-GC S-1 CH-RT ECF

Maruyama Index: a old parameter, a new R0-Resection? ,[object Object],[object Object],[object Object],[object Object]

R0-Resection: is there a need a new definition? ,[object Object],[object Object],In case of LAGC ,[object Object]

Randomized Controlled Trials High morbidity and mortality

What selection? Sentinel node biopsy Kitagawa Y, et al. Gastric Cancer, 2005

What selection? Targeted surgery Junctional nodes for intraoperative evaluation Fielding J, et al. Gastric Cancer, 2004

What selection? cDNA.Microarray Analysis N0 N+

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