title: Is Linitis Plastica a Contraindication for Surgical Resection: A Multi-Institution Study of the U.S. Gastric Cancer Collaborative.
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.
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. aaron.blackham@moffitt.org.
authors.forename: Aaron U
authors.initials: AU
authors.lastname: Blackham
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Doug S
authors.initials: DS
authors.lastname: Swords
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Levine
authors.affiliation: Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Nora F
authors.initials: NF
authors.lastname: Fino
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA, USA.
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Squires
authors.affiliation: Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Poultsides
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Fields
authors.affiliation: Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
authors.affiliation: Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Linda X
authors.initials: LX
authors.lastname: Jin
authors.affiliation: Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Gaya
authors.initials: G
authors.lastname: Spolverato
authors.affiliation: Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Department of Surgery, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Worhunsky
authors.affiliation: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA, USA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. kvotanop@wakehealth.edu.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Votanopoulos
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D008039:Linitis Plastica / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate