title: Postoperative adjuvant treatment for gastric cancer improves long-term survival after curative resection and D2 lymphadenectomy. Results from a Latin American Center.
abstract: BACKGROUND
  The benefits of adjuvant treatment in the context of a D2 lymph node dissection are controversial. The aim was to investigate the effects of postoperative adjuvant treatment on the survival of patients with a curative resection for gastric cancer and a D2 lymph node dissection.
  
  
  METHODS
  We performed a retrospective cohort study. Patients operated from 1996 to 2013 were selected. We compared long term survival of patients treated with surgery alone and those with surgery plus postoperative adjuvant treatment. A multivariate analysis for survival was applied in every stage.
  
  
  RESULTS
  The study included 580 patients. Two-hundred and four patients received postoperative adjuvant treatment (AD) and 376 patients were treated only with surgery (SU). Patients in the AD group were younger (60 versus 68, p < 0.001), had a lower rate of multiple organ resection (21% versus 39%, p < 0.001) and had less postoperative complications (14% versus 32%, p < 0.001). In the AD group, patients had more advanced disease (stage III; 77% versus 66%, p < 0.001). No difference was found in lymph nodes resected (31 versus 30, p = ns). The median survival with adjuvant treatment was 33 months (39% 5 year survival) and 22 months (31% 5 year survival) for patients without adjuvant treatment (p = 0.003). On multivariate analysis, patients with stage IIIB and IIIC had significantly better overall and disease specific long-term survival with adjuvant treatment.
  
  
  CONCLUSIONS
  These results suggest that there is a long-term survival benefit for patients treated with postoperative adjuvant treatment for stages IIIB and IIIC gastric cancer after D2 lymph node dissection.
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile. Electronic address: enorero@uc.cl.
authors.forename: E
authors.initials: E
authors.lastname: Norero
authors.affiliation: Centro de Cancer Universidad Católica, Radiation Oncology, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 319, RM Santiago, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Bustos
authors.affiliation: Hospital Dr. Sotero del Rio, Medical Oncology, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: M E
authors.initials: ME
authors.lastname: Herrera
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: J
authors.initials: J
authors.lastname: Cerda
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: P
authors.initials: P
authors.lastname: González
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Ceroni
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: C
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: E
authors.initials: E
authors.lastname: Briceño
authors.affiliation: Hospital Dr. Sotero del Rio, Medical Oncology, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: H
authors.initials: H
authors.lastname: Rojas
authors.affiliation: Clínica Radionuclear, Radiation Oncology, Calle Maria Luisa Santander, 514, Providencia, RM Santiago, Chile.
authors.forename: R
authors.initials: R
authors.lastname: Cártes
authors.affiliation: IRAM, Radiation Oncology, Américo Vespucio Norte, 1314, Vitacura, RM Santiago, Chile.
authors.forename: V
authors.initials: V
authors.lastname: Lopez
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: V
authors.initials: V
authors.lastname: Hidalgo
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: S
authors.initials: S
authors.lastname: Báez
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: M
authors.initials: M
authors.lastname: Caracci
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: E
authors.initials: E
authors.lastname: Viñuela
authors.affiliation: Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Católica de Chile, Avenida Concha y Toro, 3459, Puente Alto, RM Santiago, Chile.
authors.forename: A
authors.initials: A
authors.lastname: Díaz
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D017024:Chemotherapy, Adjuvant; D002677:Chile; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007843:Latin America; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adjuvant chemotherapy; Adjuvant radiotherapy; Gastrectomy; Stomach neoplasms