Is Linitis Plastica a Contraindication for Surgical Resection: A Multi-Institution Study of the US Gastric Cancer Collaborative

• Authors: Aaron U. Blackham, Wake Forest School of Medicine; Doug S. Swords, Wake Forest School of Medicine; Edward A. Levine, Wake Forest School of Medicine; Nora F. Fino, Wake Forest School of Medicine; Malcolm H. Squires, Emory University; George Poultsides, Stanford University; Ryan C. Fields, Washington University; Mark Bloomston, Ohio State University; Sharon M. Weber, University of Wisconsin; Timothy M. Pawlik, Johns Hopkins University; Linda X. Jin, Washington University; Gaya Spolverato, Johns Hopkins University; Carl Schmidt, Ohio State University; David Worhunsky, Stanford University; Clifford S. Cho, University of Wisconsin; Shishir Maithel, Emory University; Konstantinos I. Votanopoulos, Wake Forest School of Medicine
• Journal Title: Annals of Surgical Oncology
• Volume: Volume 23, Number 4
• Publisher: Springer Verlag (Germany) | 2016-04-01, Pages 1203-1211
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1245/s10434-015-4947-8
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Biology, Biostatistics
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; BORRMANN TYPE-IV; MULTIINSTITUTIONAL ANALYSIS; PROGNOSTIC-FACTORS; PHASE-II; CARCINOMA; SURVIVAL; CHEMOTHERAPY; SURGERY; THERAPY; STOMACH

Abstract

Background: Current staging and treatment guidelines for gastric adenocarcinoma do not differentiate between linitis plastic (LP) and non-LP cancers. Significant controversy exists regarding the surgical management of LP patients. Methods: Using the multi-institutional U.S. Gastric Cancer Collaborative database, 869 gastric cancer patients who underwent resection between 2000 and 2012 were identified. Clinicopathologic and outcomes data of 58 LP patients were compared to 811 non-LP patients. Results: Stage III/IV disease was more common at presentation in LP patients compared with non-LP patients (90 vs. 44 %, p < 0.01). Despite the fact that most LP patients underwent total gastrectomy (88 vs. 39 %, p < 0.01), final positive margins were more common in LP patients (33 vs. 7 %, p < 0.01). The use of frozen section allowed 15 intraoperative positive margins in 38 patients to be converted to negative final margins. Median overall survival (OS) was significantly worse in patients with LP (11.6 vs. 37.8 months, p < 0.01). There was no difference in median OS of LP patients based on stage (I/II, 17.3 mo; III, 10.6 mo; IV, 12.0 mo; p = 0.46). LP and non-LP patients who underwent optimal resection (negative margin and D2/3 lymphadenectomy) had better survival compared with those with nonoptimal resections. The median OS for optimally resected stage III LP (n = 22) and stage III non-LP (n = 185) patients was nearly identical (26.7 vs. 25.3 mo; p = 0.69). Conclusions: Future staging systems and treatment guidelines should differentiate between LP and non-LP gastric cancers. Long-term survival in select LP patients who undergo optimal resections is comparable to optimally resected non-LP patients.