1. A.DELENS, MEDICAL STUDENT J.M. WEERTS, FRCS Eng, JM.DEWANDRE, D. FRANCART, C. JEHAES, B. MONAMI. C. WHALEN, S. MARKIEWICZ ABDOMINAL SURGERY, CHC LIEGE HOSPITAL CENTER Cardia and gastric adenocarcinoma surgery: experience of a teaching hospital 2000 -- 2012.

2. Plan Introduction objective Patients and method Results Discussion Conclusion

3. Introduction Gastric and oesophageal adenocarcinoma incidence in Belgium during 2010: 2300 patients Sexe ratio: 1,5 H: 1 F Mean age: 72 years Overall 5-y survival: Men: 22,3% Women: 25,3%

4. Introduction Invasive cancer mucosal REM/RES +/-resection +/- surgery Follow-up T1- T2 N0 NAC Gastrectomy + D2 lymphadenectomy AC Follow-up M1/inoperablepalliation Stadification MOC Guidelines of management: T2 – T3/N+

5. Surgical resection = standard treatment for resectable gastric cancer. D2 lymphadenectomy should be standard during gastrectomy Splenectomy and pancreatectomy not considered standard practice if no disease infiltration Perioperative mortality in Belgium : 5,6% (KCE report 2013)

6. Objective: To evaluate: the outcome of surgical resection of gastric and cardia adenocarcinoma retrospectively. the impact of neoadjuvant chemotherapy on survival of patients operated for cardia and gastric adenocarcinoma

7. Patients and methods: Retrospective study 103 consecutive patients operated in a single institution between 2000 and 2012 Including 42 women and 61 men Median age at diagnosis of 66,8 years old TNM stage, histological stage, post-operative morbidity and mortality, follow-up were evaluated 71 patients have a follow-up of more than 5 years Median follow-up??

8. Results Surgery: Oesogastric resection: N=5 Total gastrectomy: N=60 Partial gastrectomy: N=32 Laparotomy (scopy) +bx: N=3 R1 rate: 8,7% N=9 Mortality: 5,8% ( N=6) ( Belgium : 5,6%) Morbidity: 22,3% - Digestive: 19 - Pulmonary: 5 - Cardiac: 2

9. N 1y Survival 1y ( %) N with follow up of 5yrs minimum Survival 5yrs (%) global10376,67139,5 Free of recurrence 7139,5 men6172,34637 women4280,92542 Results Belgium: 22,3% for men and 25,3% for women KCE REPORT 2013 ???

10. StagingN 1ySurvival 1y (%) N 5ySurvival 5y (%) Stage IA23871464,2 Stage IB20901464,2 Stage II16811353,8 Stage IIIA1377825 Stage IIIB107050 Stage IV1844,4156 locationN 1ySurvival 1y (%) N 5ySurvival 5y (%) cardia1442,8119 gastric8980,85942,4

11. Invasion depthN 1ySurvival 1y (%) N 5ySurvival 5y (%) pT0366,6// pT125841560 pT23086,62259,1 pT33375,72425 pT4107070 Nodal status Negative5780,73855,3 positive4367,43221,8 N1208046,6 N21764,70 N3333,30

12. Histological type N% survival 1 yr N with follow up of 5yr % survival 5 yrs Lauren: diffuse2965,52425 intestinal7182,64447,7 WHO: papillary11001 Tubular5882,73450 Poorly differenciated 1172,7118 Signet single cell 2864,32222,7 mucinous2100250

13. Results 2005: Start of neoadjuvant chemotherapy Patients with advanced cancer (T2-T3, N) 3 courses of 5FU-folinic acid – ciplatine (MAGIC) NAC Mortality: 0% NAC Morbidity: 17% response rate: 37,1%

14. Results All patients with T2-T3/ N- any have been selected ( N=75) Similar surgery morbidity and mortality No neoadjuvant radiotherapy D2 Gastrectomy R1 rate: Group A: N=3 Group B: N=4 103 patients T2-T3/N0N+ N=75 Group A 2005-2012 NAC+ surgery N=35 Group B 2000-2005 surgery alone N=40

15. Results 103 patients T2-T3/N0N+ N=75 Group A 2005-2012 NAC+ surgery N=35 Group B 2000-2005 surgery alone N=40

16. results globalintestinaldiffusecardiagastric Response for all 37,1%52%( 12/23)10% ( 1/10)30% ( 3/10)40% ( 10/25) Partial response 31,4%44%10%30%32% Complete response 5,7 %8%0%08% Response to the neoadjuvant therapy:

17. Results

21. Cardia and gastric adenocarcinoma 503 patients: surg alone: N=253 NAC+ surg: N=250 NAC: ECF ( epirubicin, infused fluorouracil, cisplatin): 3 courses NAC response rate? Median follow-up?

22. MAGIC 5y survival: NAC+ surg: 36% Surg alone:23% Results: -> no impact of NAC on perioperatives complications -> significant impact of NAC on survival at 5 years

24. Hartgrink Gastric adenocarcinoma 59 randomised patients NAC + surg: N=29 Surg alone: N=30 Median follow-up: 83 months NAC: 5FU, doxorubicin, methotrexate NAC response rate: 32%

25. Hartgrink

27. Schuhmacher Cardia and gastric cancer 144 randomnised patients : NAC+ surg: N=72 Surg alone: N=72 NAC: cisplatin, folinic acid, 5FU Response rate: 36,2% ( 5,8% complete response) Median follow-up: 4,4 years

28. Median survival: CTx + surg: 64,6 m Surg alone: 52,53 m 2y survival: CTx+ Surg: 72,7% Surg alone: 69,9%

29. Conclusion Our study does not demonstrate a significant impact of neoajuvant chemotherapy on survival at 5 years.

30. Conclusion