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Problems faced by evidence-based medicine in evaluating lymphadenectomy for gastric cancer

World Journal of Gastroenterology 2014年第36期20卷 12883-12891页

作者： Giuseppe Verlato Simone Giacopuzzi Maria Bencivenga paolo morgagni Giovanni De Manzoni Unit of Epidemiology and Medical Statistics Department of Public Health and Community Medicine University of Verona 37134 Verona Italy Unit of Upper GI Surgery University of Verona 37126 Verona Italy Gastrointestinal and General Surgery Unit Morgagni-Pierantoni Hospital 47121 Forlì Italy

Gastric cancer surgical management differs between Eastern Asia and Western countries. Extended lymphadenectomy (D2) is the standard of care in Japan and South Korea since decades, while the majority of United States patients receive at most a limited lymphadenectomy (D1). United States and Northern Europe are considered the scientific leaders in medicine and evidence-based procedures are the cornerstone of their clinical practice. However, surgeons in Eastern Asia are more experienced, as there are more new cases of gastric cancer in Japan (107898 in 2012) than in the entire European Union (81592), or in South Korea (31269) than in the entire United States (21155). For quite a long time evidence-based medicine (EBM) did not solve the question whether D2 improves long-term prognosis with respect to D1. Indeed, eastern surgeons were reluctant to perform D1 even in the frame of a clinical trial, as their patients had a very good prognosis after D2. Evidence-based surgical indications provided by Western trials were questioned, as surgical procedures could not be properly standardized. In the present study we analyzed indications about the optimal extension of lymphadenectomy in gastric cancer according to current scientific literature (2008-2012) and surgical guidelines. We searched PubMed for papers using the key words “lymphadenectomy or D1 or D2” AND “gastric cancer” from 2008 to 2012. Moreover, we reviewed national guidelines for gastric cancer management. The support to D2 lymphadenectomy increased progressively from 2008 to 2012: since 2010 papers supporting D2 have achieved a higher overall impact factor than the other papers. Till 2011, D2 was the procedure of choice according to experts’ opinion, while three meta-analyses found no survival advantage after D2 with respect to D1. In 2012-2013, however, two meta-analyses reported that D2 improves prognosis with respect to D1. D2 lymphadenectomy was proposed as the standard

关键词： Gastric cancer Surgical quality Lymphadenectomy Evidence-based medicine National guidelines Eastern Asia United States

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Follow-up after gastrectomy for cancer:results of an international web round table

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World Journal of Gastroenterology 2014年第34期20卷 11966-11971页

作者： Gian Luca Baiocchi Yasuhiro Kodera Daniele Marrelli Fabio Pacelli paolo morgagni Franco Roviello Giovanni De Manzoni Department of Medical and Surgical Sciences Surgical ClinicBrescia UniversityBrescia 25123Italy Department of Gastroenterological Surgery Surgery ⅡNagoya UniversityNagoya 452-0813Japan Department of Human Pathology and Oncology Surgical OncologySiena UniversitySiena 53011Italy Department of Surgical Sciences Digestive SurgeryCatholic UniversityRome 00118Italy Department of General Surgery MorgagniPierantoni HospitalForlì 47121Italy 1~(st) Department of General Surgery Borgo Trento HospitalUniversity of VeronaVerona 37121Italy

Oncological follow-up after radical gastrectomy for cancer still represents a discrepancy in the field, with many retrospective series demonstrating that early diagnosis of recurrence does not result in an improvement in patient survival; yet, many centers with high quality of care still provide routine patient follow-up after surgery by clinical and instrumental controls. This was the topic for a web round table entitled “Rationale and limits of oncological follow-up after gastrectomy for cancer” that was launched one year before the 10th International Gastric Cancer Congress. Authors having specific expertise were invited to comment on their previous publications to provide the subject for an open debate. During a three-month-long discussion, 32 authors from 12 countries participated, and 2299 people visited the dedicated web page. Substantial differences emerged between the participants: authors from Japan, South Korea, Italy, Brazil, Germany and France currently engage in instrumental follow-up, whereas authors from Eastern Europe, Peru and India do not, and British and American surgeons practice it in a rather limited manner or in the context of experimental studies. Although endoscopy is still considered useful by most authors, all the authors recognized that computed tomography scanning is the method of choice to detect recurrence; however, many limit follow-up to clinical and biochemical examinations, and acknowledge the lack of improved survival with early detection.

关键词： Gastric cancer Recurrence Follow-up Diagnosis Prognosis Surgery Chemotherapy

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Recurrence in node-negative advanced gastric cancer:Novel findings from an in-depth pathological analysis of prognostic factors from a multicentric series

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World Journal of Gastroenterology 2017年第45期23卷 8000-8007页

作者： Gian Luca Baiocchi Sarah Molfino Carla Baronchelli Simone Giacopuzzi Daniele Marrelli paolo morgagni Maria Bencivenga Luca Saragoni Carla Vindigni Nazario Portolani Maristella Botticini Giovanni De Manzoni Department of Clinical and Experimental Sciences University of Brescia Department of Pathology Spedali Civili di Brescia 1st Department of General Surgery Borgo Trento HospitalUniversity of Verona Department of Human Pathology and Oncology Surgical OncologyUniversity of Siena Department of General Surgery Morgagni-Pierantoni Hospital Department of Pathology Morgagni-Pierantoni Hospital Department of Pathology Azienda Ospedaliera Universitaria Senese IGIER Università Bocconi

AIM To analyze the clinicopathological characteristics of patients with both node-negative gastric carcinoma and diagnosis of recurrence during follow-up. METHODS We enrolled 41 patients treated with curative gastrectomy for p T2-4 a N0 gastric carcinoma between 1992 and 2010,who developed recurrence(Group 1). We retrospectively selected this group from the prospectively collected database of 4 centers belonging to the Italian Research Group for Gastric Cancer,and compared them with 437 p T2-4 a N0 patients without recurrence(Group 2). We analyzed lymphatic embolization,microvascular infiltration,perineural infiltration,and immunohistochemical determination of p53,Ki67,and HER2 in Group 1 and in a subgroup of Group 2(Group 2 bis) of 41 cases matched with Group 1 according to demographic and pathological characteristics. RESULTS T4 a stage and diffuse histotype were associated with recurrence in the group of p N0 patients. In-depth pathological analysis of two homogenous groups of p N0 patients,with and without recurrence during longterm follow-up(groups 1 and 2 bis),revealed two striking patterns: lymphatic embolization and perineural infiltration(two parameters that pathologists can easily report),and p53 and Ki67,represent significant factors for *** The reported pathological features should be considered predictive factors for recurrence and could be useful to stratify node-negative gastric cancer patients for adjuvant treatment and tailored follow-up.

关键词： N0 gastric cancer Recurrence Prognostic factors Pathological analysis Lymphatic embolization Perineural infiltration p53 Ki67

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Multimodal treatment of gastric cancer in the west: Where are we going?

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World Journal of Gastroenterology 2015年第26期21卷 7954-7969页

作者： Daniele Marrelli Karol Polom Giovanni de Manzoni paolo morgagni Gian Luca Baiocchi Franco Roviello Department of Medicine Surgery and NeurosciencesUniversity of Siena Department of Surgery University of Verona Depertment of Surgery "Morgani-Pierantoni" Hospital Surgical Clinic University of Brescia

The incidence of gastric cancer(GC) is decreasing worldwide,especially for intestinal histotype of the distal third of the *** the contrary,proximal location and diffuse Lauren histotype have been reported to be generally stable over *** the west,no clear improvement in long-term results was observed in clinical and population-based *** of treatment in these neoplasms are strictly dependent on tumor *** surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however,results are still unsatisfactory for advanced stages(Ⅲ and Ⅳ),for which additional treatments could provide a survival *** implies a tailored approach to *** aim of this review was to summarize the main multimodal treatment options in advanced resectable *** or postoperative treatments,including chemotherapy,chemoradiotherapy,targeted therapies,and hyperthermic intraperitoneal chemotherapy have been reviewed,and the main ongoing and completed trials have been *** original tailored multimodal approach to non-cardia GC has been also proposed.

关键词： Epidemiology Hyperthermic intraperitonealchemotherapy Chemotherapy Radiotherapy Gastriccancer Targeted therapy

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Experimental evaluation of mechanical compression of lattice trusses made with Ti6Al4V for aerospace use

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Chinese Journal of Aeronautics 2024年第5期37卷 520-532页

作者： Carlo Giovanni FERRO Sara VARETTI paolo MAGGIORE Department of Mechanical and Aerospace Engineering Politecnico di TorinoCorso Duca degli AbruzziTorino 10124Italy

Lattice structures are three-dimensional structures composed of repeated geometrical shapes with multiple interconnected nodes,providing high strength-to-weight ratios,customizable properties,and efficient use of materials.A smart use of materials leads to reduced fuel consumption and lower operating costs,making them highly desirable for aircraft ***,the customizable properties of lattice structures allow for tailoring to specific design requirements,leading to improved performance and safety for *** advantages make lattice structures an important focus for research and development in the aviation *** paper presents an experimental evaluation of the mechanical compression properties of lattice trusses made with Ti6Al4V,designed for use in an anti-ice *** truss structures were manufactured using additive manufacturing techniques and tested under compressive loads to determine mechanical *** showed that lattice trusses exhibited high levels of compressive strength,making them suitable for use in applications where mechanical resistance and durability are critical,such as in anti-ice *** also highlight the potential of additive manufacturing techniques for the fabrication of lattice trusses with tailored mechanical *** study provides valuable insights into the mechanical behavior of Ti6Al4V lattice trusses and their potential applications in anti-ice systems,as well as other areas where high strength-to-weight ratios are *** results of this research contribute to the development of lightweight,efficient,and durable anti-ice systems for use in aviation and other industries.

关键词： Additive Manufacturing(AM) Selective Laser Sintering(SLM) Anti ice systems Lattice structures Aircraft on board systems Design of Experiments(DOE)

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