Original Article
D2 Lymphadenectomy Alone or with Para-aortic Nodal Dissection for Gastric Cancer
N Engl J Med 2008; 359:453-462July 31, 2008
- Abstract
Background
Gastrectomy with D2 lymphadenectomy is the standard treatment for curable gastric cancer in eastern Asia. Whether the addition of para-aortic nodal dissection (PAND) to D2 lymphadenectomy for stage T2, T3, or T4 tumors improves survival is controversial. We conducted a randomized, controlled trial at 24 hospitals in Japan to compare D2 lymphadenectomy alone with D2 lymphadenectomy plus PAND in patients undergoing gastrectomy for curable gastric cancer.
Methods
Between July 1995 and April 2001, 523 patients with curable stage T2b, T3, or T4 gastric cancer were randomly assigned during surgery to D2 lymphadenectomy alone (263 patients) or to D2 lymphadenectomy plus PAND (260 patients). We did not permit any adjuvant therapy before the recurrence of cancer. The primary end point was overall survival.
Results
The rates of surgery-related complications among patients assigned to D2 lymphadenectomy alone and those assigned to D2 lymphadenectomy plus PAND were 20.9% and 28.1%, respectively (P=0.07). There were no significant differences between the two groups in the frequencies of anastomotic leakage, pancreatic fistula, abdominal abscess, pneumonia, or death from any cause within 30 days after surgery (the rate of death was 0.8% in each group). The median operation time was 63 minutes longer and the median blood loss was 230 ml greater in the group assigned to D2 lymphadenectomy plus PAND. The 5-year overall survival rate was 69.2% for the group assigned to D2 lymphadenectomy alone and 70.3% for the group assigned to D2 lymphadenectomy plus PAND; the hazard ratio for death was 1.03 (95% confidence interval [CI], 0.77 to 1.37; P=0.85). There were no significant differences in recurrence-free survival between the two groups; the hazard ratio for recurrence was 1.08 (95% CI, 0.83 to 1.42; P=0.56).
Conclusions
As compared with D2 lymphadenectomy alone, treatment with D2 lymphadenectomy plus PAND does not improve the survival rate in curable gastric cancer. (ClinicalTrials.gov number, NCT00149279.)
Media in This Article
Figure 1
Disposition of the Patients.Figure 2
Kaplan–Meier Estimates of Overall Survival (Panel A) and Recurrence-free Survival (Panel B).Article Activity
- Article
Gastric cancer is the second leading cause of cancer death worldwide, although its incidence is decreasing.1 About 60% of new cases of gastric cancer occur in eastern Asia; the incidence of new cases in Japan is 100,000 per year. Chemotherapy helps to prolong survival in cases of advanced disease, but surgical resection is the most effective treatment for curable gastric cancer. Reports from the Gastric Cancer Registry and other retrospective studies2-4 have made radical gastrectomy with extended (D2) removal of regional lymph nodes the standard for the treatment of curable gastric cancer in Japan. Two randomized, controlled European trials that compared the less extended D1 dissection with the D2 procedure failed to show a survival benefit for D2 dissection,5,6 but lack of experience with the surgical procedure and with postoperative care were thought to account for the poor outcome of patients who underwent D2 lymphadenectomy.7-9 In 2001, the American Intergroup 0116 study showed that chemoradiotherapy after limited lymphadenectomy (D0 or D1) decreased the local recurrence rate and increased long-term survival,10 a result suggesting that chemoradiotherapy eliminates the residual lymph-node metastases that could be removed by D2 lymphadenectomy. In 2006, a randomized trial in Taiwan showed a significant benefit in overall survival for a D2 or D3 procedure as compared with D1 dissection, with no increase in operative mortality.11 These trials indicate that adequate local control is essential for the treatment of gastric cancer. Hence, the standard of care for curable gastric cancer in eastern Asia and the United States is either gastrectomy with D2 lymphadenectomy and without postoperative chemoradiation or D0 or D1 gastrectomy with postoperative chemoradiation.12-14
Once the gastric tumor invades the subserosa (stage T2b), the serosa (stage T3), or the adjacent structures (stage T4), metastases can spread to the para-aortic lymph nodes, which are termed N3 nodes according to the Japanese Classification of Gastric Carcinoma, second English edition,15 and M1 nodes according to the International Union Against Cancer (UICC) tumor–node–metastasis (TNM) classification.16 In advanced gastric cancer, the incidence of microscopic metastases in the para-aortic region is 10 to 30%.17-19 Because the 5-year overall survival rate of patients with para-aortic nodal metastases can be as high as 20% after systematic dissection,20 extensive surgery has been performed in Japan since the 1980s for stage T2b, T3, and T4 gastric cancers. However, to our knowledge there has never been a large prospective study to investigate whether para-aortic nodal dissection (PAND) for gastric cancer has a survival benefit. Here we report the final results of a multi-institutional, randomized, controlled trial by the Japan Clinical Oncology Group (JCOG9501) that was conducted to determine whether the addition of systematic PAND to standard gastrectomy with D2 lymphadenectomy improves survival rates among patients with curable gastric cancer. An interim analysis found no differences between the two procedures in the rates of short-term major complications or in-hospital death.21
Methods
Eligibility
In this trial, we enrolled patients who were younger than 75 years of age and who had histologically proven gastric adenocarcinoma that was considered potentially curable. Additional eligibility criteria, as determined from intraoperative findings, were the presence of a stage T2b, T3, or T4 tumor, the absence of gross metastases to the para-aortic nodes, and negative cytologic findings in peritoneal-lavage fluid. Diagnosis of metastases by examination of frozen sections of para-aortic nodes was not allowed, because sampling of the nodes would involve dissection. The study protocol was approved by the JCOG protocol review committee and the institutional review boards of each of the 24 participating hospitals. In accordance with JCOG policy in 1995 (the year in which enrollment began), all patients gave written informed consent before undergoing randomization.
Randomization and Data Management
After confirming the eligibility of the patient during surgery, the surgeon contacted the JCOG Data Center by telephone to receive a randomly generated assignment of the patient to standard D2 lymphadenectomy alone or D2 lymphadenectomy plus PAND. Assignments were made by the minimization method according to clinical T stage (T2b vs. T3 or T4), Borrmann macroscopic type (type 0, 1, or 2 vs. type 3 or 5), and institution (patients with Borrmann type 4 tumors were excluded because there was no chance of cure for such patients if they had para-aortic nodal metastases). The surgeon then performed the assigned operation according to the methods described in the protocol.
The JCOG data center performed data management, central monitoring, and statistical analysis. The center also provided twice-yearly monitoring reports, each of which was submitted to and reviewed by an independent JCOG data and safety monitoring committee. None of the surgeons who performed the operations were involved in data analysis. For quality assurance, the JCOG audit committee made site visits to monitor whether the study was being conducted according to protocol.
Surgery
D2 lymphadenectomy alone and D2 lymphadenectomy plus PAND were performed as described previously.21,22 The dissected lymph nodes were classified according to the Japanese Classification of Gastric Carcinoma, first English edition.23 The method of reconstruction of the gastrointestinal tract was not specified.
During the planning of the study, all participating surgeons reached agreement concerning the technical details of both procedures. All operations either were performed by surgeons who had previously performed more than 100 gastrectomies with D2 dissection or took place at institutions with specialized units where more than 80 gastrectomies were performed annually. In addition to reviewing the twice-yearly monitoring reports, the surgeons observed videos of both types of procedures obtained in a sample of patients (at least three patients from each institution during the course of the study) and discussed the technical details of the operations to ensure uniformity of treatment. To assess adherence to the lymphadenectomy protocol, the dissection status of all regional nodal stations and the number of dissected nodes in the para-aortic area were recorded on case report forms, which were also reviewed by the surgeons.
Postoperative Evaluation
Pathologic findings were categorized according to the first English edition of the Japanese Classification of Gastric Carcinoma 23; thus, some lymph nodes currently classified as N2 or N3 were recorded as N3 or N4 in this study. Stage T2 was subdivided into stages T2a and T2b, as specified by the UICC TNM classification.16 The rates of hospital death, defined as death during the period of hospitalization for the operation or death from any cause within 30 days after surgery, and surgery-related complications were calculated by dividing the number of patients in whom an event occurred by the total number of enrolled patients. Patients were followed every 3 months until April 2006, which was 5 years after the last patient had been enrolled. Adjuvant therapy was not allowed before the recurrence of cancer.
Statistical Analysis
The primary end point of this study was overall survival, defined as the time from randomization to death. The secondary end points were recurrence-free survival, surgery-related complications, and hospital death. Recurrence-free survival was defined as the time from randomization to the first recurrence of cancer or death from any cause.
The expected 5-year survival rate of the group assigned to D2 lymphadenectomy alone was 50%. We initially planned to recruit 412 patients (206 in each group), a number that would allow the detection of a 12% increase in survival in the group assigned to D2 lymphadenectomy plus PAND, with a one-sided alpha level of 0.05 and a power of 80%. We planned this study with a one-sided test because D2 lymphadenectomy plus PAND is more invasive than D2 lymphadenectomy alone and should in principle result in better survival than D2 lymphadenectomy alone. Because differences smaller than 12% would be clinically meaningful, the protocol was amended to increase the sample size to 520 (260 in each group) to detect an 8% increase in survival in the group assigned to D2 lymphadenectomy plus PAND (hazard ratio, 0.73), with a total accrual period of 5.5 years and an additional 5 years of follow-up. The data and safety monitoring committee approved this change in July 2000 without knowledge of any survival data.
Two interim analyses were planned, with adjustments for repeated comparisons taken into account by the O'Brien–Fleming alpha-spending function.24 At the first and second interim analyses in March 2002 and March 2004, the data and safety monitoring committee reviewed the results and approved continuation of the planned follow-up.
Data from all eligible patients were analyzed for overall survival and recurrence-free survival on an intention-to-treat basis. Survival curves were estimated by the Kaplan–Meier method and compared with the use of the log-rank test, with stratification according to the factors used in the randomization, except for the institution where the surgery was performed. Hazard ratios were calculated by Cox regression analysis after adjustment for baseline stratification factors except for institution. Analyses of two prespecified subgroups (Borrmann macroscopic type and clinical T stage) and nine post hoc subgroups were also conducted to evaluate interactions between treatment and subgroup with the use of Cox regression; we report the result of all these analyses. No more than one significant interaction test result (P<0.05) would be expected on the basis of chance alone as a result of multiple testing.
Two-sided P values were calculated for all tests and are reported here. Because the study was planned to use a one-sided test, we also present one-sided P values for the results of the survival analyses. P values less than 0.05 were considered to indicate statistical significance. Analyses were performed with the use of SAS software, version 9.13.
Results
Patients
Between July 1995 and April 2001, 523 patients were randomly assigned to D2 lymphadenectomy alone (263 patients) or D2 lymphadenectomy plus PAND (260 patients). One patient was deemed ineligible after enrollment because of a change in the histologic diagnosis to malignant lymphoma. Protocol violations occurred in 12 patients. In one patient, an intraoperative biopsy of a frozen section of a para-aortic node was performed. Another patient assigned to D2 lymphadenectomy alone underwent D2 lymphadenectomy plus PAND. The remaining 10 patients did not undergo all aspects of the lymph-node dissection required in the protocol. At the time of final analysis in April 2006, two patients had been lost to follow-up for more than 1 year, but they had already been followed for more than 5 years after surgery. Figure 1Figure 1
Disposition of the Patients. shows the disposition of the patients.The characteristics of the two groups were well balanced (Table 1Table 1
Characteristics of the Patients.). Total gastrectomy was performed in 102 patients assigned to D2 lymphadenectomy alone (38.8%) and in 97 patients assigned to D2 lymphadenectomy plus PAND (37.3%); 98 patients assigned to D2 lymphadenectomy alone (37.3%) and 93 assigned to D2 lymphadenectomy plus PAND (35.8%) also underwent splenectomy. Only 9 patients assigned to D2 lymphadenectomy alone (3.4%) and 12 assigned to D2 lymphadenectomy plus PAND (4.6%) underwent distal pancreatectomy. The median operation time for gastrectomy with D2 lymphadenectomy plus PAND was 300 minutes, which was 63 minutes longer than that for gastrectomy with D2 lymphadenectomy alone (P<0.001). The median blood loss was 230 ml greater (660 ml vs. 430 ml, P<0.001) and blood transfusions were more frequent (30.0% vs. 14.1%, P<0.001) in patients undergoing D2 lymphadenectomy plus PAND than in those undergoing D2 lymphadenectomy alone.Operative Complications and Deaths
As reported previously,21 the overall incidence of surgery-related complications was 20.9% (55 of 263 patients) in the group assigned to D2 lymphadenectomy alone and 28.1% (73 of 260 patients) in the group assigned to D2 lymphadenectomy plus PAND (P=0.07). The incidence rates of the four major surgery-related complications in the group assigned to D2 lymphadenectomy alone and the group assigned to D2 lymphadenectomy plus PAND were 2.3% and 1.9%, respectively, for anastomotic leakage, 5.3% and 6.2% for pancreatic fistula, 5.3% and 5.8% for abdominal abscess, and 4.6% and 1.5% for pneumonia. None of these differences were statistically significant. The frequency of minor complications, such as ileus, lymphorrhea, left pleural effusion, and severe diarrhea, was significantly higher in the group assigned to undergo D2 lymphadenectomy plus PAND than in the group assigned to undergo D2 lymphadenectomy alone (20.0% vs. 9.1%, P<0.001). The rate of hospital death was 0.8% (two deaths in each group).
Overall and Recurrence-free Survival
After median follow-up periods of 5.6 years in the group assigned to D2 lymphadenectomy alone and 5.7 years in the group assigned to D2 lymphadenectomy plus PAND, 96 patients assigned to D2 lymphadenectomy alone and 95 assigned to D2 lymphadenectomy plus PAND had died, and 100 patients assigned to D2 lymphadenectomy alone and 98 assigned to D2 lymphadenectomy plus PAND had had recurrences of cancer. Table 2Table 2
Site of First Tumor Recurrence. lists the site of first tumor recurrence for the two groups. The most frequent site was the peritoneum (38.1% of all recurrences), and the pattern of recurrence was similar in the two groups. The 5-year overall survival rate for 22 of 260 patients (8.5%) who had histologically detected metastases in the para-aortic lymph nodes after undergoing D2 lymphadenectomy plus PAND was 18.2% (95% confidence interval [CI], 5.7 to 36.3).Figure 2A and 2BFigure 2
Kaplan–Meier Estimates of Overall Survival (Panel A) and Recurrence-free Survival (Panel B). show the overall and recurrence-free survival rates for all eligible patients. The 5-year overall survival rate was 69.2% (95% CI, 63.2 to 74.4) for the group assigned to D2 lymphadenectomy alone and 70.3% (95% CI, 64.3 to 75.4) for the group assigned to D2 lymphadenectomy plus PAND. The hazard ratio for death was 1.03 (95% CI, 0.77 to 1.37) in the group assigned to D2 lymphadenectomy plus PAND, and the stratified log-rank test showed no significant difference between the groups (one-sided P=0.57, two-sided P=0.85). After adjustment of eight baseline variables (age, sex, body-mass index, tumor location, tumor size, Borrmann macroscopic type, clinical T stage, and clinical N stage) with the use of Cox regression analysis, the hazard ratio was essentially unchanged (hazard ratio, 1.03; 95% CI, 0.78 to 1.38; P=0.83).The 5-year recurrence-free survival rate was 62.6% (95% CI, 56.4 to 68.2) in the group assigned to D2 lymphadenectomy alone and 61.7% (95% CI, 55.4 to 67.3) in the group assigned to D2 lymphadenectomy plus PAND. The hazard ratio for recurrence in the group assigned to D2 lymphadenectomy plus PAND was 1.08 (95% CI, 0.83 to 1.42; one-sided P=0.72; two-sided P=0.56).
Although there were no significant interactions between treatment effect and any baseline clinical findings, there were significant interactions between treatment effect and pathologic T stage and nodal status (Figure 3Figure 3
Tests for Heterogeneity of Treatment Effect According to the Clinicopathological Characteristics of the Patients.). Among the 174 node-negative patients, the 5-year overall survival rate was 78.4% (95% CI, 67.6 to 86.0) in the group assigned to D2 lymphadenectomy alone and 96.8% (95% CI, 90.5 to 99.0) in the group assigned to D2 lymphadenectomy plus PAND. Conversely, among the 348 node-positive patients, the 5-year overall survival rate was 65.2% (95% CI, 57.9 to 71.6) in the group assigned to D2 lymphadenectomy alone and 54.9% (95% CI, 46.9 to 62.1) in the group assigned to D2 lymphadenectomy plus PAND. The hazard ratios for death in the group assigned to D2 lymphadenectomy plus PAND were 0.39 (95% CI, 0.18 to 0.84; P=0.009) for node-negative patients and 1.39 (95% CI, 1.02 to 1.89; P=0.04) for node-positive patients.Discussion
The clinical value of systematic PAND in addition to D2 gastrectomy in curable gastric cancer has been controversial. In this randomized trial, we found no improvement in overall or recurrence-free survival with D2 lymphadenectomy plus PAND gastrectomy as compared with D2 lymphadenectomy alone. The pattern of recurrence was similar in the two groups, and D2 lymphadenectomy plus PAND did not reduce the rate of recurrence of cancer in the lymph nodes. There were no significant differences between the two groups in the rates of surgery-related complications. D2 lymphadenectomy plus PAND, however, was associated with a longer operation time, greater blood loss, and a significant increase in minor complications. For all these reasons, we cannot recommend D2 lymphadenectomy plus PAND for patients with curable gastric cancer.
Multiple studies have reported a close relation between the number of cases treated in a hospital and outcomes in the surgical treatment of cancer.25-29 In two European randomized trials comparing D1 with D2 gastrectomy, the mortality rates in patients treated with D2 gastrectomy reached 10% or higher.30,31 The excessive number of early deaths in these studies may have obscured any potential difference in long-term survival between patients undergoing D1 and D2 gastrectomy. The Dutch trial was conducted in 80 hospitals, including small community hospitals, by 11 surgeons who had little experience with D2 gastrectomy before the study. The limited experience of the surgeons made it difficult for them to learn how to perform the procedure safely and effectively, and the small volume of cases limited the ability of the hospitals to manage major surgical complications. By contrast, in a Taiwanese single-institution trial comparing D1 gastrectomy with D2 or more extensive gastrectomy, all the surgeons had performed at least 80 D2 procedures before participating in the study, and there were no deaths in either group. The procedures in our study either were performed by experienced surgeons or took place in 24 specialized hospitals with a high volume of cases, and our patients had no major coexisting conditions. These two features accounted for very low mortality rates (0.8%) and good long-term survival in both groups.
There were no significant interactions between treatment effect and any baseline clinical findings. We also conducted a post hoc subgroup analysis based on pathologic T stage and node status, variables that were determined after randomization. Surprisingly, among patients with pathologically negative nodes, survival rates were better in those assigned to D2 lymphadenectomy plus PAND than in those assigned to D2 lymphadenectomy alone, whereas in patients with any metastatic nodes, survival rates in the group assigned to D2 lymphadenectomy plus PAND were worse than those in the group assigned to D2 lymphadenectomy alone. This paradoxical interaction with nodal pathologic findings needs cautious interpretation, because it was detected in a post hoc subgroup analysis and was thus subject to biases and errors resulting from multiple testing; moreover, this finding should not influence clinical decisions, since we have no accurate method of assessing lymph-node metastases before surgery, and intraoperative frozen-section diagnosis of all dissected lymph nodes (of which the median number is >50) is not feasible. In fact, the proportion of patients with pathologically negative nodes (33.5%) was twice as high as that determined from clinical findings (16.3%). Within the range of the first- and second-tier nodal stations, a high probability of residual nodal metastasis, as calculated by a computer program based on the large database at the National Cancer Center Tokyo, was associated with a poor prognosis. This finding was confirmed in two randomized trials of surgery for gastric cancer conducted in Europe and the United States.32,33 Our results are contradictory, since treatment with D2 lymphadenectomy plus PAND should reduce the probability of residual metastases in node-positive patients but not in node-negative patients, in whom there is no possibility of nodal metastases in the para-aortic area. Since this result from a post hoc subgroup might be a false positive owing to multiple testing, the possible survival benefit of D2 lymphadenectomy plus PAND in node-negative patients will need to be clarified in further studies.
One limitation of this study is that the incidence of metastases in the para-aortic nodes (8.5%) was lower than expected. A previous report showed that the most reliable predictor of metastases in the para-aortic nodes was the pathologic status of nodes at station 7.34 In our 76 patients with metastases at this station, however, 5-year overall survival rates after D2 lymphadenectomy plus PAND (36.4%; 95% CI, 20.6 to 52.3) were not significantly better than those after D2 lymphadenectomy alone (44.2%; 95% CI, 29.2 to 58.2; hazard ratio, 1.09; 95% CI, 0.62 to 1.93; P=0.76). D2 lymphadenectomy plus PAND in node-positive patients results in worse survival rates; it is unlikely that D2 lymphadenectomy plus PAND would have resulted in better survival rates if we had had more patients with para-aortic node metastases.
A large phase 3 trial recently demonstrated that adjuvant therapy with S-1, an orally active fluoropyrimidine, significantly improved survival in Japanese patients with stage II or III gastric cancer.35 As was suggested in the case of chemoradiation,10 there may be some interaction between surgery and adjuvant treatment. In our study, which was performed before the S-1 trial, no patients received any adjuvant treatment.
In conclusion, extended D2 lymphadenectomy plus PAND should not be used to treat curable stage T2b, T3, or T4 gastric cancer. D2 gastrectomy is associated with low mortality and reasonable survival times when performed in selected institutions that have had sufficient experience with the operation and with postoperative management.
Supported in part by grants-in-aid for cancer research (5S-1, 8S-1, 11S-3, 11S-4, 14S-3, 14S-4, 17S-3, 17S-5) and for the Second Term Comprehensive 10-Year Strategy for Cancer Control (H10-Gan-027, H12-Gan-012) from the Ministry of Health, Labor, and Welfare of Japan.
No potential conflict of interest relevant to this article was reported.
We thank Dr. Kenichi Yoshimura and Dr. Naoki Ishizuka for data analysis; Ms. Kyoko Hongo, Ms. Chizuko Takeuchi, and Ms. Harumi Kaba for data management; and Dr. Haruhiko Fukuda for directing the JCOG Data Center and overseeing the management of this study.
Source Information
From the Gastric Surgery Division, National Cancer Center Hospital, Tokyo (M.S., T.S.); the Japan Clinical Oncology Group Data Center, National Cancer Center, Tokyo (S.Y., Y.K.); the Department of Surgery, Niigata Cancer Center Hospital, Niigata (A.N.); the Department of Surgery, National Shikoku Cancer Center, Matsuyama (A.K.); the Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka (M.H.); the Department of Surgery, Osaka National Hospital, Osaka (T.T.); the Department of Surgery, National Cancer Center Hospital East, Kashiwa (T.K.); the Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo (K.A.); the Department of Surgery, Aichi Cancer Center, Nagoya (Y.Y.); and Osaka Medical College, Osaka (K.O.) — all in Japan.
Address reprint requests to Dr. Sasako at the Department of Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan, or at msasako@hyo-med.ac.jp.
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Citing Articles
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K. Inoue, Y. Nakane, M. Kogire, K. Fujitani, Y. Kimura, H. Imamura, S. Tamura, S. Okano, A.H. Kwon, Y. Kurokawa, T. Shimokawa, H. Takiuchi, T. Tsujinaka, H. Furukawa. (2012) Phase II trial of preoperative S-1 plus cisplatin followed by surgery for initially unresectable locally advanced gastric cancer. European Journal of Surgical Oncology (EJSO) 38:2, 143-149
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Sébastien Gaujoux, Murray F. Brennan. (2012) Recommendation for standardized surgical management of primary adrenocortical carcinoma. Surgery
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Scott A. Hundahl. (2012) Surgery for Gastric Cancer: What the Trials Indicate. Surgical Oncology Clinics of North America 21:1, 79-97
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Mitsuru Sasako. (2012) Gastric Cancer Eastern Experience. Surgical Oncology Clinics of North America 21:1, 71-77
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Susanne Blank, Hendrik Bläker, Anja Schaible, Florian Lordick, Lars Grenacher, Markus Buechler, Katja Ott. (2012) Impact of pretherapeutic routine clinical staging for the individualization of treatment in gastric cancer patients. Langenbeck's Archives of Surgery 397:1, 45-55
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Carsten Kamphues, Daniel Wittschieber, Frederick Klauschen, Atsuko Kasajima, Manfred Dietel, Sven-Christian Schmidt, Matthias Glanemann, Marcus Bahra, Peter Neuhaus, Wilko Weichert, Albrecht Stenzinger. (2012) Prolyl Hydroxylase Domain 2 Protein Is a Strong Prognostic Marker in Human Gastric Cancer. Pathobiology 79:1, 11-17
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Masayuki Watanabe, Hideo Baba, Chikashi Ishioka, Yasumasa Nishimura, Manabu Muto. (2012) Recent Advances in Diagnosis and Treatment for Malignancies of the Gastrointestinal Tract. Digestion 85:2, 95-98
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Hiroshi Imamura, Yukinori Kurokawa, Toshimasa Tsujinaka, Kentaro Inoue, Yutaka Kimura, Shohei Iijima, Toshio Shimokawa, Hiroshi Furukawa. (2012) Intraoperative versus extended antimicrobial prophylaxis after gastric cancer surgery: a phase 3, open-label, randomised controlled, non-inferiority trial. The Lancet Infectious Diseases
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Joong Ho Lee, Kyung Min Kim, Jae-Ho Cheong, Sung Hoon Noh. (2012) Current Management and Future Strategies of Gastric Cancer. Yonsei Medical Journal 53:2, 248
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Akira Sawaki, Yasuo Ohashi, Yasushi Omuro, Taroh Satoh, Yasuo Hamamoto, Narikazu Boku, Yoshinori Miyata, Hiroya Takiuchi, Kensei Yamaguchi, Yasutsuna Sasaki, Tomohiro Nishina, Atsushi Satoh, Eishi Baba, Takao Tamura, Takashi Abe, Kiyohiko Hatake, Atsushi Ohtsu. (2011) Efficacy of trastuzumab in Japanese patients with HER2-positive advanced gastric or gastroesophageal junction cancer: a subgroup analysis of the Trastuzumab for Gastric Cancer (ToGA) study. Gastric Cancer
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Toshiyasu Ojima, Makoto Iwahashi, Mikihito Nakamori, Masaki Nakamura, Katsunari Takifuji, Masahiro Katsuda, Takeshi Iida, Toshiaki Tsuji, Keiji Hayata, Hiroki Yamaue. (2011) The impact of abdominal shape index of patients on laparoscopy-assisted distal gastrectomy for early gastric cancer. Langenbeck's Archives of Surgery
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H.-J. Meyer, A.H. Hölscher, F. Lordick, H. Messmann, S. Mönig, C. Schumacher, M. Stahl, H. Wilke, M. Möhler. (2011) Aktuelle S3-Leitlinie zur Chirurgie des Magenkarzinoms. Der Chirurg
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Yuichiro Miki, Masanori Tokunaga, Etsuro Bando, Yutaka Tanizawa, Taiichi Kawamura, Masanori Terashima. (2011) Evaluation of Postoperative Pancreatic Fistula After Total Gastrectomy with D2 Lymphadenectomy by ISGPF Classification. Journal of Gastrointestinal Surgery 15:11, 1969-1976
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B. Zheng, B. Ma, K. Yang, D. Mi. (2011) Meta-analysis of randomized controlled trials comparing D2 and D4 lymphadenectomy for gastric cancer. European Surgery 43:5, 255-261
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D. Marrelli, C. Pedrazzani, P. Morgagni, G. de Manzoni, F. Pacelli, A. Coniglio, A. Marchet, L. Saragoni, S. Giacopuzzi, F. Roviello, . (2011) Changing clinical and pathological features of gastric cancer over time. British Journal of Surgery 98:9, 1273-1283
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Katja Ott, Florian Lordick, Susanne Blank, Markus Büchler. (2011) Gastric cancer: surgery in 2011. Langenbeck's Archives of Surgery 396:6, 743-758
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Giovanni Manzoni, Alberto Di Leo, Franco Roviello, Daniele Marrelli, Simone Giacopuzzi, Anna Maria Minicozzi, Giuseppe Verlato. (2011) Tumor Site and Perigastric Nodal Status are the Most Important Predictors of Para-Aortic Nodal Involvement in Advanced Gastric Cancer. Annals of Surgical Oncology 18:8, 2273-2280
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Bruno Märkl, Alexandra I. Moldovan, Hendrik Jähnig, Claudio Cacchi, Hanno Spatz, Matthias Anthuber, Daniel V. Oruzio, Hallie Kretsinger, Hans M. Arnholdt. (2011) Combination of Ex Vivo Sentinel Lymph Node Mapping and Methylene Blue-Assisted Lymph Node Dissection in Gastric Cancer: A Prospective and Randomized Study. Annals of Surgical Oncology 18:7, 1860-1868
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Toru Aoyama, Takaki Yoshikawa, Takafumi Watanabe, Tsutomu Hayashi, Takashi Ogata, Haruhiko Cho, Akira Tsuburaya. (2011) Safety and feasibility of S-1 adjuvant chemotherapy for gastric cancer in elderly patients. Gastric Cancer
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Jingyu Deng, Han Liang, Dan Sun, Yi Pan, Yong Liu, Dianchang Wang. (2011) Extended lymphadenectomy improvement of overall survival of gastric cancer patients with perigastric node metastasis. Langenbeck's Archives of Surgery 396:5, 615-623
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Toshiyuki Kosuga, Daisuke Ichikawa, Kazuma Okamoto, Shuhei Komatsu, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji. (2011) Survival benefits from splenic hilar lymph node dissection by splenectomy in gastric cancer patients: relative comparison of the benefits in subgroups of patients. Gastric Cancer 14:2, 172-177
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E. Van Cutsem, M. Dicato, R. Geva, N. Arber, Y. Bang, A. Benson, A. Cervantes, E. Diaz-Rubio, M. Ducreux, R. Glynne-Jones, A. Grothey, D. Haller, K. Haustermans, D. Kerr, B. Nordlinger, J. Marshall, B. D. Minsky, Y. K. Kang, R. Labianca, F. Lordick, A. Ohtsu, N. Pavlidis, A. Roth, P. Rougier, H. J. Schmoll, A. Sobrero, J. Tabernero, C. Van de Velde, J. Zalcberg. (2011) The diagnosis and management of gastric cancer: expert discussion and recommendations from the 12th ESMO/World Congress on Gastrointestinal Cancer, Barcelona, 2010. Annals of Oncology 22:Supplement 5, v1-v9
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(2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:2, 113-123
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Takeshi Sano, Takashi Aiko. (2011) New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer 14:2, 97-100
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Takanobu Yamada, Tsutomu Hayashi, Haruhiko Cho, Takaki Yoshikawa, Hideki Taniguchi, Ryoji Fukushima, Akira Tsuburaya. (2011) Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer
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Joaquín M. Rodríguez Santiago, Mitsuru Sasako, Javier Osorio. (2011) TNM 7.a edición 2009 (UICC/AJCC) y Clasificación Japonesa 2010 en Cáncer Gástrico. Hacia la simplicidad y estandarización en el manejo del cáncer gástrico. Cirugía Española 89:5, 275-281
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J. Y. An, K. H. Pak, K. Inaba, J.-H. Cheong, W. J. Hyung, S. H. Noh. (2011) Relevance of lymph node metastasis along the superior mesenteric vein in gastric cancer. British Journal of Surgery 98:5, 667-672
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Joshua D. Lawson, Jason K. Sicklick, Paul T. Fanta. (2011) Gastric Cancer. Current Problems in Cancer 35:3, 97-127
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David P. Wood. (2011) Re: Extensive Inguinal Lymphadenectomy Improves Overall 5-Year Survival in Penile Cancer Patients: Results From the Surveillance, Epidemiology, and End Results Program. The Journal of Urology 185:4, 1282
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David P. Wood. (2011) Re: Carcinoma of the Urethra: Radiation Oncology. The Journal of Urology 185:4, 1281-1282
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Toshiyoshi Fujiwara, Yasuhiro Shirakawa, Shunsuke Kagawa. (2011) Telomerase-specific oncolytic virotherapy for human gastrointestinal cancer. Expert Review of Anticancer Therapy 11:4, 525-532
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Christophe Mariette, Guillaume Piessen, Nicolas Briez, Caroline Gronnier, Jean Pierre Triboulet. (2011) Oesophagogastric junction adenocarcinoma: which therapeutic approach?. The Lancet Oncology 12:3, 296-305
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M. Saka, S. Morita, T. Fukagawa, H. Katai. (2011) Present and Future Status of Gastric Cancer Surgery. Japanese Journal of Clinical Oncology 41:3, 307-313
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Hiroshi Imamura, Yukinori Kurokawa, Junji Kawada, Toshimasa Tsujinaka, Shuji Takiguchi, Yoshiyuki Fujiwara, Masaki Mori, Yuichiro Doki. (2011) Influence of Bursectomy on Operative Morbidity and Mortality After Radical Gastrectomy for Gastric Cancer: Results of a Randomized Controlled Trial. World Journal of Surgery 35:3, 625-630
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Satoru Iwasa, Yasuhide Yamada, Takeo Fukagawa, Takako Eguchi Nakajima, Ken Kato, Tetsuya Hamaguchi, Shinji Morita, Makoto Saka, Hitoshi Katai, Yasuhiro Shimada. (2011) Management of adjuvant S-1 therapy after curative resection of gastric cancer: dose reduction and treatment schedule modification. Gastric Cancer 14:1, 28-34
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Jingyu Deng, Han Liang, Dianchang Wang, Dan Sun, Yi Pan, Yong Liu. (2011) Investigation of the recurrence patterns of gastric cancer following a curative resection. Surgery Today 41:2, 210-215
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Wu Wenguang, Wang Xuefeng, Zhang Zhiping, Wu Xiangsong, Wang Jianwei, Li Songgang, Liu Yingbin. (2011) Three-Step Method for Lymphadenectomy in Gastric Cancer Surgery: A Single Institution Experience of 120 Patients. Journal of the American College of Surgeons 212:2, 200-208
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J.-S. Kim, M.-A. Kim, D.-Y. Oh, S.-H. Lee, D.-W. Kim, S.-A. Im, W. H. Kim, H.-K. Yang, D. S. Heo, Y.-J. Bang, K.-U. Lee, T.-Y. Kim. (2011) Increasing Nodal Ratio is a Poor Prognostic Factor for Survival in Stage III-IV (M0) Gastric Cancer Patients Who Received Curative Surgery Followed by Adjuvant Chemotherapy: A Retrospective Study. Japanese Journal of Clinical Oncology 41:2, 245-252
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Y. Kurokawa, M. Sasako, T. Sano, T. Shibata, S. Ito, A. Nashimoto, A. Kurita, T. Kinoshita, . (2011) Functional outcomes after extended surgery for gastric cancer. British Journal of Surgery 98:2, 239-245
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Seiji Ito. (2011) Adjuvant S-1 Chemotherapy for Gastric Cancer and Peritoneal Wash. World Journal of Surgery 35:2, 470-471
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Ji Yeong An, Jae-Ho Cheong, Woo Jin Hyung, Sung Hoon Noh. (2011) Recent Evolution of Surgical Treatment for Gastric Cancer in Korea. Journal of Gastric Cancer 11:1, 1
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Guo-lian Zhu, Zhe Sun, Zhen-ning Wang, Ying-ying Xu, Bao-jun Huang, Yan Xu, Zhi Zhu, Hui-mian Xu. (2011) Splenic hilar lymph node metastasis independently predicts poor survival for patients with gastric cancers in the upper and/or the middle third of the stomach. Journal of Surgical Oncologyn/a-n/a
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Keishi Yamashita, Shinichi Sakuramoto, Masahiko Watanabe. (2011) Genomic and epigenetic profiles of gastric cancer: Potential diagnostic and therapeutic applications. Surgery Today 41:1, 24-38
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Hyun Il Kim, Tae Kyung Ha, Sung Joon Kwon. (2011) Prognostic Factors for Gastric Cancer Patients with Synchronous Metastasis. Journal of the Korean Surgical Society 80:1, 16
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Kazuhiro Yoshida, Kazuya Yamaguchi, Naoki Okumura, Shinji Osada, Takao Takahashi, Yoshihiro Tanaka, Kazuaki Tanabe, Takahisa Suzuki. (2011) The Roles of Surgical Oncologists in the New Era – Minimally Invasive Surgery for Early Gastric Cancer and Adjuvant Surgery for Metastatic Gastric Cancer. Pathobiology 78:6, 343-352
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Zi-Yu Li, Cherry E. Koh, Zhao-De Bu, Ai-Wen Wu, Lian-Hai Zhang, Xiao-Jiang Wu, Qi Wu, Xiang-Long Zong, Hui Ren, Lei Tang, Xiao-Peng Zhang, Ji-You Li, Ying Hu, Lin Shen, Jia-Fu Ji. (2011) Neoadjuvant chemotherapy with FOLFOX: Improved outcomes in Chinese patients with locally advanced gastric cancer. Journal of Surgical Oncologyn/a-n/a
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Dong Hoon Jo, Oh Jeong, Jang Won Sun, Mi Ran Jeong, Seong Yeop Ryu, Young Kyu Park. (2011) Feasibility Study of Early Oral Intake after Gastrectomy for Gastric Carcinoma. Journal of Gastric Cancer 11:2, 101
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Joaquín M. Rodríguez Santiago, Mitsuru Sasako, Javier Osorio. (2011) TNM-7th edition 2009 (UICC/AJCC) and Japanese Classification 2010 in Gastric Cancer. Towards simplicity and standardisation in the management of gastric cancer. Cirugía Española (English Edition) 89:5, 275-281
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Hossein Khedmat, Mohammad Panahian, Mehrdad Mashahdian, Mojtaba Vand Rajabpour, Kazem Zendehdel. (2011) Prognostic Factors and Survival in Stomach Cancer – Analysis of 15 Years of Data from a Referral Hospital in Iran and Evaluation of International Variation. Onkologie 34:4, 178-182
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Kyung Won Seo, Ki Young Yoon. (2011) Individualized Surgery for Gastric Cancer. The Korean Journal of Gastroenterology 57:6, 335
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Shigeyuki Tamura, Atsushi Takeno, Hirofumi Miki. (2011) Lymph Node Dissection in Curative Gastrectomy for Advanced Gastric Cancer. International Journal of Surgical Oncology 2011, 1-8
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In Hae Park, Sun Young Kim, Young-Woo Kim, Keun Won Ryu, Jun Ho Lee, Jong Seok Lee, Young-Iee Park, Noe Kyeong Kim, Sook Ryun Park. (2011) Clinical characteristics and treatment outcomes of gastric cancer patients with isolated para-aortic lymph node involvement. Cancer Chemotherapy and Pharmacology 67:1, 127-136
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Kazutaka Obama, Hiroshi Okabe, Hisahiro Hosogi, Eiji Tanaka, Atsushi Itami, Yoshiharu Sakai. (2011) Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: From a viewpoint of pancreas-related complications. Surgery 149:1, 15-21
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Katsunobu Oyama, Sachio Fushida, Jun Kinoshita, Isamu Makino, Keishi Nakamura, Hironori Hayashi, Hisatoshi Nakagawara, Hidehiro Tajima, Hideto Fujita, Hiroyuki Takamura, Itasu Ninomiya, Hirohisa Kitagawa, Takashi Tani, Takashi Fujimura, Tetsuo Ohta. (2011) Efficacy of pre-operative chemotherapy with docetaxel, cisplatin, and S-1 (DCS therapy) and curative resection for gastric cancer with pathologically positive para-aortic lymph nodes. Journal of Surgical Oncologyn/a-n/a
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Hironori Ohdaira, Yutaka Suzuki, Mai Tsutsui, Taizo Iwasaki, Munefumi Arita, Takuji Noro, Naruo Kawasaki, Tadashi Ohara, Keiichi Yoshino, Hajime Kuroda, Masaki Kitajima. (2010) Laparoscopy-assisted Total Gastrectomy for Advanced Gastric Cancer With Carcinomatous Ascites After S1 Plus Cisplatin Chemotherapy. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 20:6, e206-e210
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Y. Takahashi, Y. Takesue, K. Nakajima, K. Ichiki, Y. Wada, T. Tsuchida, M. Ishihara, H. Ikeuchi, M. Uchino. (2010) Implementation of a hospital-wide project for appropriate antimicrobial prophylaxis. Journal of Infection and Chemotherapy 16:6, 418-423
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Christos Katsios, Dimitrios H. Roukos, Georgios Baltogiannis. (2010) Hope from Japan for esophagogastric cancers: esophagectomy and endoscopic submucosal dissection for gastric tube cancer. Surgical Endoscopy 24:11, 2924-2925
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F. De Vita, F. Giuliani, N. Silvestris, G. Catalano, F. Ciardiello, M. Orditura. (2010) Human epidermal growth factor receptor 2 (HER2) in gastric cancer: a new therapeutic target. Cancer Treatment Reviews 36, S11-S15
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Eelco de Bree, Vasilis Charalampakis, John Melissas, Dimitris D. Tsiftsis. (2010) The extent of lymph node dissection for gastric cancer: A critical appraisal. Journal of Surgical Oncology 102:6, 552-562
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Raffaele Pugliese, Dario Maggioni, Fabio Sansonna, Andrea Costanzi, Giovanni Carlo Ferrari, Stefano Di Lernia, Carmelo Magistro, Paolo Martini, Francesco Pugliese. (2010) Subtotal gastrectomy with D2 dissection by minimally invasive surgery for distal adenocarcinoma of the stomach: results and 5-year survival. Surgical Endoscopy 24:10, 2594-2602
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M. Sasako, M. Inoue, J.-T. Lin, C. Khor, H.-K. Yang, A. Ohtsu. (2010) Gastric Cancer Working Group Report. Japanese Journal of Clinical Oncology 40:Supplement 1, i28-i37
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Alon Z. Weizer, Jeffrey S. Montgomery. (2010) The Role of Lymphadenectomy in Minimally Invasive Urologic Oncology. Journal of Endourology 24:8, 1229-1240
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Yutaka Tanizawa, Masanori Terashima. (2010) Lymph node dissection in the resection of gastric cancer: Review of existing evidence. Gastric Cancer 13:3, 137-148
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Masanori Tokunaga, Shigekazu Ohyama, Naoki Hiki, Tetsu Fukunaga, Susumu Aikou, Toshiharu Yamaguchi. (2010) Can Superextended Lymph Node Dissection be Justified for Gastric Cancer with Pathologically Positive Para-aortic Lymph Nodes?. Annals of Surgical Oncology 17:8, 2031-2036
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Hyuk–Joon Lee, Ki Taek Nam, Heae Surng Park, Min A. Kim, Bonnie J. LaFleur, Hiroyuki Aburatani, Han–Kwang Yang, Woo Ho Kim, James R. Goldenring. (2010) Gene Expression Profiling of Metaplastic Lineages Identifies CDH17 as a Prognostic Marker in Early Stage Gastric Cancer. Gastroenterology 139:1, 213-225.e3
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, Nobuhiko Tanigawa, Eiji Nomura, Sang-Woong Lee, Michio Kaminishi, Mitsugu Sugiyama, Takashi Aikou, Masaki Kitajima. (2010) Current State of Gastric Stump Carcinoma in Japan: Based on the Results of a Nationwide Survey. World Journal of Surgery 34:7, 1540-1547
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Hiroshi Okabe, Kazutaka Obama, Takatsugu Kan, Eiji Tanaka, Atsushi Itami, Yoshiharu Sakai. (2010) Medial Approach for Laparoscopic Total Gastrectomy with Splenic Lymph Node Dissection. Journal of the American College of Surgeons 211:1, e1-e6
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Yingqiang Shi, Ye Zhou. (2010) The role of surgery in the treatment of gastric cancer. Journal of Surgical Oncology 101:8, 687-692
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Alon Z Weizer, Gaetano V Palella, Jeffrey S Montgomery. (2010) Managing muscle-invasive bladder cancer in the elderly. Expert Review of Anticancer Therapy 10:6, 903-915
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Toru Kojima, Yuichi Watanabe, Yuuri Hashimoto, Shinji Kuroda, Yasumoto Yamasaki, Shuya Yano, Masaaki Ouchi, Hiroshi Tazawa, Futoshi Uno, Shunsuke Kagawa, Satoru Kyo, Hiroyuki Mizuguchi, Yasuo Urata, Noriaki Tanaka, Toshiyoshi Fujiwara. (2010) In Vivo Biological Purging for Lymph Node Metastasis of Human Colorectal Cancer by Telomerase-Specific Oncolytic Virotherapy. Annals of Surgery 251:6, 1079-1086
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Oh Jeong, Young Kyu Park, Seong Yeob Ryu, Young Jin Kim. (2010) Effect of Age on Surgical Outcomes of Extended Gastrectomy With D2 Lymph Node Dissection in Gastric Carcinoma: Prospective Cohort Study. Annals of Surgical Oncology 17:6, 1589-1596
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T. Yoshikawa, K. Omura, O. Kobayashi, A. Nashimoto, A. Takabayashi, T. Yamada, H. Yamaue, M. Fujii, T. Yamaguchi, T. Nakajima. (2010) A phase II study of preoperative chemotherapy with S-1 plus cisplatin followed by D2/D3 gastrectomy for clinically serosa-positive gastric cancer (JACCRO GC-01 study). European Journal of Surgical Oncology (EJSO) 36:6, 546-551
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Shinichi Hasegawa, Takaki Yoshikawa. (2010) Adenocarcinoma of the esophagogastric junction: incidence, characteristics, and treatment strategies. Gastric Cancer 13:2, 63-73
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Y. Kodera. (2010) Para-aortic lymph node dissection revisited: Have we been neglecting a promising treatment option for gastric carcinoma?. European Journal of Surgical Oncology (EJSO) 36:5, 447-448
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A. Okines, M. Verheij, W. Allum, D. Cunningham, A. Cervantes, . (2010) Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 21:Supplement 5, v50-v54
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Shinsuke Sasada, Motoki Ninomiya, Masahiko Nishizaki, Masao Harano, Yasutomo Ojima, Hiroyoshi Matsukawa, Shigehiro Shiozaki, Satoshi Ohno, Norihisa Takakura. (2010) Survival of patients treated by an autonomic nerve-preserving gastrectomy for early gastric cancer. Surgery Today 40:5, 444-450
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F. Roviello, C. Pedrazzani, D. Marrelli, A. Di Leo, S. Caruso, S. Giacopuzzi, G. Corso, G. de Manzoni. (2010) Super-extended (D3) lymphadenectomy in advanced gastric cancer. European Journal of Surgical Oncology (EJSO) 36:5, 439-446
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Ilfet Songun, Hein Putter, Elma Meershoek-Klein Kranenbarg, Mitsuru Sasako, Cornelis JH van de Velde. (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. The Lancet Oncology 11:5, 439-449
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Christos G Katsios, George Baltogiannis, Dimitrios H Roukos. (2010) Laparoscopic surgery for gastric cancer: comparative-effectiveness research and future trends. Expert Review of Anticancer Therapy 10:4, 473-476
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Yoshihiro Kakeji, Masaru Morita, Yoshihiko Maehara. (2010) Strategies for treating liver metastasis from gastric cancer. Surgery Today 40:4, 287-294
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Masatsugu Hiraki, Yoshihiko Kitajima, Seiji Sato, Mayumi Mitsuno, Yasuo Koga, Jun Nakamura, Kazuyoshi Hashiguchi, Hirokazu Noshiro, Kohji Miyazaki. (2010) Aberrant Gene Methylation in the Lymph Nodes Provides a Possible Marker for Diagnosing Micrometastasis in Gastric Cancer. Annals of Surgical Oncology 17:4, 1177-1186
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Takeo Fukagawa, Hitoshi Katai, Makoto Saka, Shinji Morita, Yuko Sasajima, Hirokazu Taniguchi, Takeshi Sano, Mitsuru Sasako. (2010) Significance of Lavage Cytology in Advanced Gastric Cancer Patients. World Journal of Surgery 34:3, 563-568
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Masayoshi Hioki, Naoto Gotohda, Masaru Konishi, Toshio Nakagohri, Shinichiro Takahashi, Taira Kinoshita. (2010) Predictive Factors Improving Survival After Gastrectomy in Gastric Cancer Patients with Peritoneal Carcinomatosis. World Journal of Surgery 34:3, 555-562
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A. Sendler. (2010) Tumoren des oberen Gastrointestinaltrakts. Der Chirurg 81:2, 103-110
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Chen Li, Min Yan, Jun Chen, Min Xiang, Zheng Gang Zhu, Hao Ran Yin, Yan Zheng Lin. (2010) Survival Benefit of Non-curative Gastrectomy for Gastric Cancer Patients with Synchronous Distant Metastasis. Journal of Gastrointestinal Surgery 14:2, 282-288
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G. Lurje, H. Husain, D. G. Power, D. Yang, S. Groshen, A. Pohl, W. Zhang, Y. Ning, P. C. Manegold, A. El-Khoueiry, S. Iqbal, L. H. Tang, M. A. Shah, H.-J. Lenz. (2010) Genetic variations in angiogenesis pathway genes associated with clinical outcome in localized gastric adenocarcinoma. Annals of Oncology 21:1, 78-86
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J. Kim, C.-L. Sun, B. Mailey, C. Prendergast, A. Artinyan, S. Bhatia, A. Pigazzi, J. D. I. Ellenhorn. (2010) Race and ethnicity correlate with survival in patients with gastric adenocarcinoma. Annals of Oncology 21:1, 152-160
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Xin-Zu Chen, Jian-Kun Hu, Zong-Guang Zhou, Yuan-Yi Rui, Kun Yang, Li Wang, Bo Zhang, Zhi-Xin Chen, Jia-Ping Chen. (2010) Meta-Analysis of Effectiveness and Safety of D2 Plus Para-Aortic Lymphadenectomy for Resectable Gastric Cancer. Journal of the American College of Surgeons 210:1, 100-105
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Masanori Tokunaga, Naoki Hiki. (2010) Reply to “Lymphadenectomy in Gastric Cancer: The Controversy Refuses to Die”. Annals of Surgical Oncology 17:1, 336-337
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Brigette BY Ma, Edwin P Hui, Tony SK Mok. (2010) Population-based differences in treatment outcome following anticancer drug therapies. The Lancet Oncology 11:1, 75-84
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James J. Mezhir, Venu G. Pillarisetty, Manish A. Shah, Daniel G. Coit. (2010) Randomized Clinical Trials in Gastric Cancer. Surgical Oncology Clinics of North America 19:1, 81-100
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Masanori Tokunaga, Naoki Hiki, Tetsu Fukunaga, Shigekazu Ohyama, Toshiharu Yamaguchi, Toshifusa Nakajima. (2009) Better 5-Year Survival Rate Following Curative Gastrectomy in Overweight Patients. Annals of Surgical Oncology 16:12, 3245-3251
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Christof Hottenrott. (2009) Body mass index and risks of laparoscopic gastrectomy. Surgical Endoscopy 23:12, 2864-2866
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Ilfet Songun, Cornelis JH van de Velde. (2009) Optimal surgery for advanced gastric cancer. Expert Review of Anticancer Therapy 9:12, 1849-1858
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K. Ott, F. Lordick. (2009) Neoadjuvante Therapie im oberen Gastrointestinaltrakt. Der Chirurg 80:11, 1028-1034
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Arnulf H. Hölscher, Uta Drebber, Stefan P. Mönig, Christian Schulte, Daniel Vallböhmer, Elfriede Bollschweiler. (2009) Early Gastric Cancer. Annals of Surgery 250:5, 791-797
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HH Hartgrink, EPM Jansen, NCT van Grieken, CJH van de Velde. (2009) Gastric cancer – Authors' reply. The Lancet 374:9701, 1594-1595
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Toshiyasu Ojima, Makoto Iwahashi, Mikihito Nakamori, Masaki Nakamura, Teiji Naka, Masahiro Katsuda, Takeshi Iida, Keiji Hayata, Hiroki Yamaue. (2009) Association of Allogeneic Blood Transfusions and Long-Term Survival of Patients with Gastric Cancer after Curative Gastrectomy. Journal of Gastrointestinal Surgery 13:10, 1821-1830
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Dimitrios H. Roukos. (2009) Laparoscopic Gastrectomy and Personal Genomics: High-Volume Surgeons and Predictive Biomedicine May Govern the Future for Resectable Gastric Cancer. Annals of Surgery 250:4, 650-651
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Sachio Fushida, Takashi Fujimura, Katsunobu Oyama, Yasumichi Yagi, Jun Kinoshita, Tetsuo Ohta. (2009) Feasibility and efficacy of preoperative chemotherapy with docetaxel, cisplatin and S-1 in gastric cancer patients with para-aortic lymph node metastases. Anti-Cancer Drugs 20:8, 752-756
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Mark L. Gonzalgo, Dipen J. Parekh. (2009) Re: Trends in Pelvic Lymphadenectomy at the Time of Radical Cystectomy: 1988 to 2004. European Urology 56:3, 571-572
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Jan Bornschein, Theodore Rokkas, Michael Selgrad, Peter Malfertheiner. (2009) Helicobacter pylori and Clinical Aspects of Gastric Cancer. Helicobacter 14, 41-45
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