Surgery in the Multimodal Management of Gastric Cancer

Surgery in the Multimodal Management of Gastric Cancer

Giovanni de Manzoni Franco Roviello Walter Siquini Editors Surgery in the Multimodal Management of Gastric Cancer Foreword by Keiichi Maruyama 123

Editors: Giovanni de Manzoni Dept. of Surgery Upper G.I. Surgery Division University of Verona Verona, Italy Franco Roviello Dept. of Human Pathology and Oncology Section of General Surgery and Surgical Oncology Translational Research Laboratory, University of Siena Siena, Italy Walter Siquini Surgical Clinic, Dept. of Medical and Surgical Sciences Ospedali Riuniti University Hospital Polytechnic University of Marche Ancona, Italy ISBN 978-88-470-2317-8 DOI 10.1007/978-88-470-2318-5 ISBN 978-88-470-2318-5 (ebook) Springer Milan Dordrecht Heidelberg London New York Library of Congress Control Number: 2011937633 Springer-Verlag Italia 2012 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the Italian Copyright Law in its current version, and permission for use must always be obtained from Springer. Violations are liable to prosecution under the Italian Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. 9 8 7 6 5 4 3 2 1 2012 2013 2014 Cover design: Simona Colombo, Milan, Italy Typesetting: Graphostudio, Milan, Italy Printing and binding: Grafiche Porpora S.r.L., Segrate (MI) Printed in Italy Springer-Verlag Italia S.r.l. Via Decembrio 28 I-20137 Milan Springer is a part of Springer Science+Business Media (www.springer.com)

Foreword I am very pleased by the publication of this textbook, Surgery in the Multimodal Management of Gastric Cancer. The editors, Professor Giovanni de Manzoni, Professor Franco Roviello, and Doctor Walter Siquini, are internationally well known leaders in this field. Moreover, Giovanni de Manzoni and Franco Roviello, respectively President and Secretary General of the International Gastric Cancer Association, are currently organizing the 10th International Congress, to be held in 2013 in Verona. The book s appearance is therefore particularly timely, as it has strongly benefited from the cooperation and support of world-class specialist authors. Several factors contribute to making this book a valuable reference. Firstly, the editors and authors are actively working specialists, with continuing hands-on experience. Moreover, they are highly engaged not only in communicating their knowledge and preferred surgical techniques but also in seeking out the same from internationally recognized experts, particularly those from Italy, Germany, UK, USA, Brazil, Japan, and Korea. Secondly, this book is not an ordinary textbook, covering all subjects related to this disease, but a unique reference that focuses on the important and practical aspects of gastric cancer. State-of-the-art disease management is presented in detail while emphasizing the need for individualized treatment planning based on the accurate assessment of cancer extension, endoscopic mucosal resection, laparoscopic gastric resection, effective and safe lymph node dissection, neoadjuvant and adjuvant chemotherapy, etc. I would recommend that you keep this textbook ready on your desk, as you will no doubt find yourself reaching for it time and time again. September 2011 Keiichi Maruyama, M.D. Professor of Surgical Oncology University of Health and Welfare Sanno Hospital Tokyo v

Preface The Italian Research Group for Gastric Cancer (GIRCG) was established in the mid 1990s as a collaboration among three Italian centers, in Forlì, Siena, and Verona. It now comprises over 20 specialized centers located throughout Italy. In recognition of the current emphasis on a multidisciplinary approach to oncologic diseases the GIRCG s members include not only surgeons and pathologists but also gastroenterologists, medical oncologists, radiologists, and statisticians. The main aims of the GIRCG are the standardization of surgical treatment, pathological assessment, additional therapies and follow-up, surgical, endoscopic and pathological training, as well as the design and completion of clinical studies and cross-discipline research in gastric cancer (GC). Accordingly, since its establishment the group has met regularly and several research protocols covering the many aspects of GC diagnosis and treatment have been evaluated, with the results published in international journals. Among the ongoing research protocols are those addressing a new TNM classification, the validation of prognostic scores, tailored follow-up, HER-2 expression, genetic polymorphisms and GC risk, the Helicobacter pylori genome and GC, participation in the National Register of EMR/ESD, randomized controlled trials of neoadjuvant chemotherapy, prophylactic cholecystectomy, and nasogastric tube use after subtotal gastrectomy. A centralized database has been established and adopted, with data prospectively stored and updated every six months. The group has an active web site that serves to coordinate its research activities. The aim of this book is to summarize the extensive and multidisciplinary work of the GIRCG in order to provide surgical oncologists with state-of-the-art tools and information required for a thoroughly informed approach to GC treatment. In addition to the published and anecdotal experience of the GIRCG, each chapter also extensively refers to the current literature. Last but not least, this book also serves as a presentation of the GIRCG s research and clinical efforts in advance of its hosting the next International Gastric Cancer Congress, to be held in Verona, Italy, from 19 to 22 June 2013. September 2011 Giovanni de Manzoni Franco Roviello Walter Siquini vii

Contents 1 Epidemiology of Gastric Cancer and Screening Programs.......... 1 Giuseppe Verlato, Alberto Di Leo, Gian Maria Rossi, and Giovanni de Manzoni 2 Etiopathogenesis of Gastric Cancer............................. 9 Giovanni Corso, Daniele Marrelli, and Franco Roviello 3 Lymphatic Spread, Lymph Node Stations, and Levels of Lymphatic Dissection in Gastric Cancer.................................. 15 Giovanni de Manzoni, Franco Roviello, Alberto Di Leo, and Giuseppe Verlato 4 Pathologic Classifications and Staging Systems................... 25 Giovanni de Manzoni, Marco Catarci, Alberto Di Leo, Anna Tomezzoli, and Carla Vindigni 5 Prognostic Factors and Score Systems in Gastric Cancer........... 35 Daniele Marrelli, Stefano Caruso, and Franco Roviello 6 Preoperative Work-up: Endoscopy and Endoscopic Ultrasonography............................................ 43 Emanuele Bendia, Marco Marzioni, Antonio Di Sario, Walter Siquini, and Antonio Benedetti 7 Preoperative Work-Up and Assessment of Resectability............ 51 Luigina Graziosi, Walter Bugiantella, Emanuel Cavazzoni, and Annibale Donini 8 Resection Margins in Gastric Cancer........................... 59 Paolo Morgagni, Giuliano La Barba, and Luca Saragoni 9 Gastric Cancer: Standard or Extended Lymphadenectomy?........ 63 Giovanni de Manzoni, Alberto Di Leo, and Giuseppe Verlato 10 Reconstruction After Gastrectomy............................. 69 Francesco Tonelli, Stefano Scaringi, Francesco Giudici, and Francesco Bellucci ix

x Contents 11 Endoscopic and Surgical Treatment of Early Gastric Cancer....... 81 Paolo Morgagni, Luca Saragoni, Filippo Catalano, Alessandro Casadei, and Mario Marini 12 Treatment of Resectable Advanced Gastric Cancer................ 89 Alberto Marchet, Gian Maria Rossi, Simone Mocellin, and Donato Nitti 13 Multivisceral Resection for Locally Advanced Gastric Cancer...... 95 Fabio Pacelli, Giacomo Cusumano, Fausto Rosa, and Giovan Battista Doglietto 14 Surgical Treatment of Liver Metastases from Gastric Cancer....... 101 Guido A.M. Tiberio, Arianna Coniglio, Gian Luca Baiocchi, and Stefano M. Giulini 15 Hyperthermic Intraperitoneal Chemotherapy in Gastric Cancer: Indications and Technical Notes................................ 107 Gianni Mura, Orietta Federici, and Alfredo Garofalo 16 Postoperative Course: Morbidity, Mortality, and Treatment of Complications............................................ 113 Giovanni de Manzoni, Luca Cozzaglio, Simone Giacopuzzi, and Antonella Ardito 17 Long-term Results after R0 Resection in the Surgical Treatment of Gastric Cancer............................................ 125 Franco Roviello, Giovanni Corso, and Daniele Marrelli 18 Surgical Treatment of Gastric Cancer Infiltrating the Esophago-gastric Junction................................. 131 Giovanni de Manzoni, Andrea Zanoni, and Corrado Pedrazzani 19 Surgical Treatment of Gastric Cancer in Elderly Patients.......... 139 Pasquina M.C. Tomaiuolo, Andrea Mazzari, Ugo Grossi, and Antonio Crucitti 20 Cholecystectomy: Pros and Cons?.............................. 149 Marco Farsi, Marco Bernini, and Lapo Bencini 21 Neoadjuvant Treatment for Resectable Locally Advanced Gastric Cancer.............................................. 155 Domenico D Ugo, Alberto Biondi, and Ferdinando Cananzi 22 Neoadjuvant Treatment for Resectable Locally Advanced Gastric Cancer: European Ongoing Trials....................... 167 William H. Allum 23 The Role of Chemotherapy in Metastatic Disease................. 175 Felice Pasini, Anna Paola Fraccon, Giorgio Crepaldi, and Giovanni de Manzoni

Contents xi 24 Adjuvant Treatment After Surgical Resection.................... 187 Mario Scartozzi, Walter Siquini, Elena Maccaroni, Maristella Bianconi, Riccardo Giampieri, Rossana Berardi, and Stefano Cascinu 25 Follow-up and Treatment of Recurrence......................... 195 Daniele Marrelli, Stefano Caruso, and Franco Roviello 26 Endoscopic and Surgical Palliation of Unresectable Gastric Cancer.. 203 Giovanni de Manzoni, Alberto Di Leo, Luca Rodella, Francesco Lombardo, and Filippo Catalano 27 Palliative Treatment......................................... 209 Mario Scartozzi, Walter Siquini, Alessandro Bittoni, Luca Faloppi, and Stefano Cascinu 28 Gastric Cancer: a Model to Study Skeletal Muscle Wasting of Cachexia................................................. 215 Maurizio Bossola, Fabio Pacelli, Fausto Rosa, Giacomo Cusumano, Antonio Tortorelli, and Giovan Battista Doglietto 29 Quality of Life After Gastrectomy.............................. 223 Natale Di Martino and Francesco Torelli 30 Total and Subtotal Gastrectomy with D2 Lymphadenectomy: Technical Notes............................................. 231 Walter Siquini, Pierpaolo Stortoni, Emilio Feliciotti, Raffaella Ridolfo, Sonia Maurizi, Alessandro Cardinali, Cristina Marmorale, Aroldo Fianchini, and Edoardo Landi 31 Proximal Gastrectomy: Technical Notes......................... 247 Claudio Cordiano, Gerardo Mangiante, Simone Giacopuzzi, and Giovanni de Manzoni 32 Total and Subtotal Minimally Invasive Gastrectomy: Technical Notes............................................. 251 Raffaele Pugliese, Dario Maggioni, Giovanni C. Ferrari, Andrea Costanzi, and Monica Gualtierotti 33 Standard and Extended Lymphadenectomy: Technical Notes....... 259 Franco Roviello, Giovanni Corso, and Daniele Marrelli Subject Index.................................................. 265

Contributors William H. Allum, Royal Marsden NHS Foundation Trust, London, UK Antonella Ardito, Surgical Oncology Unit, IRCCS Istituto Clinico Humanitas, Rozzano (MI), Italy Gian Luca Baiocchi, Surgical Clinic, Dept. of Medical and Surgical Sciences, University of Brescia, Brescia, Italy Francesco Bellucci, Dept. of Clinical Pathophysiology, Surgical Unit, University of Florence, Florence, Italy Lapo Bencini, Oncological Surgery, Careggi University Hospital, Florence, Italy Emanuele Bendia, Dept. of Gastroenterology, Ospedali Riuniti University Antonio Benedetti, Dept. of Gastroenterology, Ospedali Riuniti University Rossana Berardi, Dept. of Medical Oncology, Ospedali Riuniti University Marco Bernini, Oncological Surgery, Careggi University Hospital, Florence, Italy Maristella Bianconi, Dept. of Medical Oncology, Ospedali Riuniti University Alberto Biondi, Dept. of Surgery, General Surgery Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Alessandro Bittoni, Dept. of Medical Oncology, Ospedali Riuniti University Maurizio Bossola, Digestive Surgery Unit, Dept. of Surgical Sciences, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Walter Bugiantella, Dept. of General and Emergency Surgery, University of Perugia, Perugia, Italy xiii

xiv Contributors Ferdinando Cananzi, Dept. of Surgery, General Surgery Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Alessandro Cardinali, Surgical Clinic, Dept. of Medical and Surgical Sciences, Ospedali Riuniti University Hospital, Polytechnic University of Marche, Ancona, Italy Stefano Caruso, Dept. of Human Pathology and Oncology, Surgical Oncology Unit, University of Siena, Siena, Italy Alessandro Casadei, Gastroenterology and Endoscopy Unit, GB Morgagni L. Pierantoni Hospital, Forli, Italy Stefano Cascinu, Dept. of Medical Oncology, Ospedali Riuniti University Filippo Catalano, Surgical Endoscopy Unit, Borgo Trento Hospital, Verona, Italy Marco Catarci, Dept. of Surgery, San Filippo Neri Hospital, Rome, Italy Emanuel Cavazzoni, Dept. of General and Emergency Surgery, University of Perugia, Perugia, Italy Arianna Coniglio, Surgical Clinic, Dept. of Medical and Surgical Sciences, University of Brescia, Brescia, Italy Claudio Cordiano, Dept. of Surgery, University of Verona, Verona, Italy Giovanni Corso, Dept. of Human Pathology and Oncology, Section of General Surgery and Surgical Oncology, Translational Research Laboratory, University of Siena, Siena, Italy Andrea Costanzi, General Surgery, Desio Hospital; AIMS Academy, Milan, Italy Luca Cozzaglio, Surgical Oncology Unit, IRCCS Istituto Clinico Humanitas, Rozzano (MI), Italy Giorgio Crepaldi, Dept. of Medical Oncology, Santa Maria della Misericordia Hospital, Rovigo, Italy Antonio Crucitti, Dept. of Surgery, General Surgery Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Giacomo Cusumano, Digestive Surgery Unit, Dept. of Surgical Sciences, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Domenico D Ugo, Dept. of Surgery, General Surgery Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy

Contributors xv Giovanni de Manzoni, Dept. of Surgery, Upper G.I. Surgery Division, University of Verona, Verona, Italy Alberto Di Leo, General Surgery Unit, Arco Hospital, APSS of Trento, Trento, Italy Natale Di Martino, VIII Unit of General Surgery and Gastrointestinal Physiophatology - Second University of Naples, Naples, Italy Antonio Di Sario, Dept. of Gastroenterology, Ospedali Riuniti University Giovan Battista Doglietto, Digestive Surgery Unit, Dept. of Surgical Sciences, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Annibale Donini, Dept. of General and Emergency Surgery, University of Perugia, Perugia, Italy Luca Faloppi, Dept. of Medical Oncology, Ospedali Riuniti University Hospital, Polytechnic University of Marche, Ancona, Italy Marco Farsi, Oncological Surgery, Careggi University Hospital, Florence, Italy Orietta Federici, National Cancer Institute Regina Elena, Rome, Italy Emilio Feliciotti, Surgical Clinic, Dept. of Medical and Surgical Sciences, Ospedali Riuniti University Hospital, Polytechnic University of Marche, Ancona, Italy Giovanni C. Ferrari, Minimally Invasive and Oncology Surgery, Niguarda Hospital Ca -Granda; AIMS Academy, Milan, Italy Aroldo Fianchini, Surgical Clinic, Dept. of Medical and Surgical Sciences, Ospedali Riuniti University Hospital, Polytechnic University of Marche, Ancona, Italy Anna Paola Fraccon, Service of Medical Oncology, Dott. Pederzoli Polyspecialist Private Clinic, Peschiera del Garda (VR), Italy Alfredo Garofalo, National Cancer Institute Regina Elena, Rome, Italy Simone Giacopuzzi, Dept. of Surgery, Upper G.I. Surgery Division, University of Verona, Verona, Italy Riccardo Giampieri, Dept. of Medical Oncology, Ospedali Riuniti University Francesco Giudici, Dept. of Clinical Pathophysiology, Surgical Unit, University of Florence, Florence, Italy Stefano M. Giulini, Surgical Clinic, Dept. of Medical and Surgical Sciences, University of Brescia, Brescia, Italy

xvi Contributors Luigina Graziosi, Dept. of General and Emergency Surgery, University of Perugia, Perugia, Italy Ugo Grossi, Dept. of Surgery, General Surgery Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Monica Gualtierotti, Minimally Invasive and Oncology Surgery, Niguarda Hospital Ca -Granda; AIMS Academy, Milan, Italy Giuliano La Barba, Dept. of General Surgery, G.B. Morgagni L. Pierantoni Hospital, Forlì, Italy Edoardo Landi, Surgical Clinic, Dept. of Medical and Surgical Sciences, Ospedali Riuniti University Hospital, Polytechnic University of Marche, Ancona, Italy Francesco Lombardo, Surgical Endoscopy Unit, Borgo Trento Hospital, Verona, Italy Elena Maccaroni, Dept. of Medical Oncology, Ospedali Riuniti University Dario Maggioni, General Surgery, Desio Hospital; AIMS Academy, Milan, Italy Gerardo Mangiante, Dept. of Surgery, Upper G.I. Surgery Division, University of Verona, Verona, Italy Alberto Marchet, Dept. of Oncological and Surgical Sciences, Surgery Section, University of Padova, Padova, Italy Mario Marini, Gastro-Intestinal Unit Santa Maria alle Scotte University Hospital, Siena Italy Cristina Marmorale, Surgical Clinic, Dept. of Medical and Surgical Sciences, Ospedali Riuniti University Hospital, Polytechnic University of Marche, Ancona, Italy Daniele Marrelli, Dept. of Human Pathology and Oncology, Section of General Surgery and Surgical Oncology, Translational Research Laboratory, University of Siena, Siena, Italy Marco Marzioni, Dept. of Gastroenterology, Ospedali Riuniti University Sonia Maurizi, Surgical Clinic, Dept. of Medical and Surgical Sciences, Ospedali Riuniti University Andrea Mazzari, Dept. of Surgery, General Surgery Unit, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy

Contributors xvii Simone Mocellin, Dept. of Oncological and Surgical Sciences, Surgery Section, University of Padova, Padova, Italy Paolo Morgagni, Dept. of General Surgery, G.B. Morgagni L. Pierantoni Hospital, Forlì, Italy Gianni Mura, Dept. of Surgery, Valdarno Hospital, Arezzo, Italy Donato Nitti, Dept. of Oncological and Surgical Sciences, Surgery Section, University of Padova, Padova, Italy Fabio Pacelli, Digestive Surgery Unit, Dept. of Surgical Sciences, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Felice Pasini, Dept. of Medical Oncology, Santa Maria della Misericordia Hospital, Rovigo, Italy Corrado Pedrazzani, Surgery Division, Rovereto Hospital, Rovereto (TN), Italy Raffaele Pugliese, Minimally Invasive and Oncology Surgery, Niguarda Hospital Ca -Granda; AIMS Academy, Milan, Italy Raffaella Ridolfo, General Surgery Unit, Pergola Hospital, Pesaro, Italy Luca Rodella, Surgical Endoscopy Unit, Borgo Trento Hospital, Verona, Italy Fausto Rosa, Digestive Surgery Unit, Dept. of Surgical Sciences, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Gian Maria Rossi, Dept. of Oncological and Surgical Sciences, Surgery Section, University of Padova, Padova, Italy Franco Roviello, Dept. of Human Pathology and Oncology, Section of General Surgery and Surgical Oncology, Translational Research Laboratory, University of Siena, Siena, Italy Luca Saragoni, Dept. of Pathology, G.B. Morgagni L. Pierantoni Hospital, Forlì, Italy Stefano Scaringi, Dept. of Clinical Pathophysiology, Surgical Unit, University of Florence, Florence, Italy Mario Scartozzi, Dept. of Medical Oncology, Ospedali Riuniti University Walter Siquini, Surgical Clinic, Dept. of Medical and Surgical Sciences, Ospedali Riuniti University

xviii Contributors Pierpaolo Stortoni, Surgical Clinic, Dept. of Medical and Surgical Sciences, Ospedali Riuniti University Hospital, Polytechnic University of Marche, Ancona, Italy Guido A.M. Tiberio, Surgical Clinic, Dept. of Medical and Surgical Sciences, University of Brescia, Brescia, Italy Pasquina M.C. Tomaiuolo, Dept. of Surgery, General Surgery Unit, Catholic University of Rome, A. Gemelli Hospital, Roma, Italy Anna Tomezzoli, Pathology Unit, Borgo Trento Hospital, Verona, Italy Francesco Tonelli, Dept. of Clinical Pathophysiology, Surgical Unit, University of Florence, Florence, Italy Francesco Torelli, VIII Unit of General Surgery and Gastrointestinal Physiophatology - Second University of Naples, Naples, Italy Antonio Tortorelli, Digestive Surgery Unit, Dept. of Surgical Sciences, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy Giuseppe Verlato, Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy Carla Vindigni, Division of Pathological Anatomy and Histopathology, University of Siena, Siena, Italy Andrea Zanoni, Dept. of Surgery, Upper G.I. Surgery Division, University of Verona,Verona, Italy