Table of Contents
1
UI - 11148559
AU - Hsu C; Chen CL; Chen LT; Liu HT; Chen YC; Jan CM; Liu CS; Cheng AL
TI -
Comparison of MALT and non-MALT primary large cell lymphoma of the
stomach: does histologic evidence of MALT affect chemotherapy response?
SO - Cancer 2001 Jan 1;91(1):49-56
AD - Department of Oncology, National Taiwan University Hospital, Taipei,
Taiwan.
BACKGROUND: Although the clinicopathologic features of low grade gastric
MALToma (lymphoma of mucosa-associated lymphoid tissue) recently have
been well delineated, the significance of identifying histologic
evidence of MALT origin in a primary high grade gastric lymphoma is less
clear. The authors sought to address this issue and, in particular, to
clarify if MALT and non-MALT primary large cell gastric lymphoma might
have a different response to systemic chemotherapy. METHODS: The authors
reviewed the pathologic specimens of all patients who had a diagnosis of
primary large cell lymphoma of the stomach and who had been treated
primarily by systemic chemotherapy in our institutions January 1,
1988-December 31, 1998. The patients were divided into two groups by
experienced hematopathologists, based on the presence or absence of
histologic features suggestive of MALToma, including typical
lymphoepithelial lesions and infiltration of characteristic
centrocyte-like cells. Disease staging was done according to the
AJCC/UICC system with Musshoff modification. The median number of
gastric biopsies for each patient was 7 (range, 1-21). RESULTS:
Seventeen patients with and 26 patients without histologic evidence of
MALToma were identified. Clinical features were similar between the two
groups except that a greater proportion of patients without evidence of
MALToma had elevated levels of serum lactate dehydrogenase (50% vs. 12%,
P = 0.01). The median duration of follow-up for the 43 patients was 46.5
months (range, 17-124 mos). All patients received standard systemic
chemotherapy including anthracyclines or anthracenedione. The response
rate was 88.2% for patients with evidence of MALToma and 57.7% for those
without (P = 0.03). The 5-year overall survival rate was 80.5% for
patients with evidence of MALToma and 48.9% for those without (P =
0.02). Multivariate analysis indicated that response to chemotherapy,
disease stage (Stage I and II-1 vs. Stage II-2, III, and IV), and the
presence of MALToma features were independent prognostic factors for
overall survival. CONCLUSION: The results of this relatively small study
series suggested that the presence of histologic features of MALToma in
patients with primary large cell gastric lymphoma might have been
associated with a better response to systemic chemotherapy and a better
prognosis. Further studies to consolidate this conclusion are necessary.
Copyright 2001 American Cancer Society.
2
UI - 11496481
AU - Dzhachvadze DK
TI -
[Morphofunctional state of the gastric transplant after surgery of
cancer of the cardia and esophagus]
SO - Vestn Khir Im I I Grek 2001;160(2):109-12
3
UI - 11482200
AU - Basheev VKh; Ladur AI; Donets VL; Bogdanov VA
TI -
[Combined palliative subtotal pancreatectomy with resection of two
hollow organs in cancer surgery]
SO - Klin Khir 2001 Apr;(4):57-8
4
UI - 11444743
AU - Tanimura S; Higashino M; Fukunaga Y; Osugi H
TI -
Hand-assisted laparoscopic distal gastrectomy with regional lymph node
dissection for gastric cancer.
SO - Surg Laparosc Endosc Percutan Tech 2001 Jun;11(3):155-60
AD - Department of Gastroenterological Surgery, Osaka City General Hospital,
Osaka, Japan. stoghjpn@aol.com
Recently, a minimally invasive operation for gastric malignancies has
been advocated, and the laparoscopic operation is noted as a technique
that raises the quality of life. We performed distal gastrectomy with
regional lymph node dissection by hand-assisted laparoscopic surgery for
60 cases of gastric cancer located in the middle or lower third of the
stomach. Billroth I reconstruction was applied intracorporeally to the
first 30 cases by using the double stapling method with a conventional
circular stapling device, and in the final 30 cases, the quadrilateral
(square) stapling technique with a laparoscopic linear stapling device
was used to prevent postoperative anastomotic bleeding. This technique
not only is less invasive, but also is similarly curative compared with
open gastrectomy that was performed for 60 gastric cancer cases of
similar staging before the beginning of this procedure.
5
UI - 11452825
AU - Civello IM; Nigro C; Maria G; Alfonsi G; Giacchi R; Brisinda G
TI -
Value of extended lymph node dissection in the treatment of gastric
cancer.
SO - Chir Ital 2001 May-Jun;53(3):383-91
AD - Department of Surgery, Catholic School of Medicine, University Hospital
Agostino Gemelli, Rome.
Regional lymph node metastasis is a critical prognostic factor in
gastric cancer, and extended lymph node dissection and routine
microscopic examination of all resected nodes could potentially provide
accurate information regarding lymph node status. On the other hand, the
therapeutic value of extended lymph node dissection is controversial.
While retrospective and prospective non-randomised comparative studies
have shown that extended lymph node dissection significantly improves
the survival rate, prospective randomised trials have failed to
demonstrate the efficacy of extended dissection, although the number of
patients in these studies was limited. The present review of the
literature therefore considers the prognostic significance of regional
lymph node metastases and the therapeutic efficacy of lymph node
dissection performed for gastric cancer.
6
UI - 11456047
AU - Ota DM
TI -
A pilot study of preoperative chemoradiation for gastric cancer.
SO - Ann Surg Oncol 2001 Jul;8(6):482-3
7
UI - 11456051
AU - Lowy AM; Feig BW; Janjan N; Rich TA; Pisters PW; Ajani JA; Mansfield PF
TI -
A pilot study of preoperative chemoradiotherapy for resectable gastric
cancer.
SO - Ann Surg Oncol 2001 Jul;8(6):519-24
AD - Department of Surgical Oncology, University of Cincinnati, Ohio, USA.
BACKGROUND: The goals of this study were to assess the feasibility and
toxicity of a regimen of preoperative chemoradiotherapy, surgery, and
intraoperative radiotherapy in the treatment of patients with
potentially resectable gastric cancer. A secondary objective was to
assess pathologic response to chemoradiotherapy in the treated tumors.
METHODS: Twenty-four patients were entered in the protocol. Treatment
regimen consisted of 45 Gy of external beam radiotherapy with concurrent
5-FU given as a continuous infusion at a dose of 300 mg/m2. Patients
were restaged 4-6 weeks after chemoradiotherapy and then underwent
surgical resection and intraoperative radiotherapy to a dose of 10 Gy.
RESULTS: Twenty-three patients (96%) completed chemoradiotherapy in
accordance with the study protocol. Nineteen (83%) of 23 patients who
completed chemoradiotherapy underwent surgical resection with D2
lymphadenectomy. Four patients (17%) had progressive disease and were
not resected. The morbidity and mortality rates were 32% and 5%,
respectively. Of the resected patients, two (11%) had complete
pathologic responses while 12 (63%) had pathologic evidence of
significant treatment effect. CONCLUSIONS: Preoperative
chemoradiotherapy for gastric cancer can be delivered safely and is well
tolerated. The rate of surgical complications is consistent with that of
other recently reported prospective trials of gastrectomy alone.
Preoperative chemoradiotherapy resulted in significant pathologic
responses in the majority of treated tumors, and complete pathologic
responses were achieved in some patients.
8
UI - 11464489
AU - de Manzoni G; Roviello F; Marrelli D; Morgagni P; Di Leo A; Saragoni L;
TI -
De Stefano A; Bazzocchi F; Pinto E
[Influence of histologic type on prognosis of patients undergoing
curative intervention for gastric adenocarcinoma. Italian multicenter
study]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):13-8
AD - Istituto di Semeiotica Chirurgica, I, Divisione Clinicizzata di
Chirurgia Generale, Universita di Verona.
BACKGROUND: The prognostic significance of the histological type in
gastric cancer is still debated. The correlation between
intestinal-diffuse type and tumor recurrence was investigated in a
prospective multicentric study which collects the cases from three
surgical Departments of Italy. PATIENTS AND METHODS: Four-hundred and
twelve patients who underwent a potentially curative resection between
1988 and 1995 were considered; 273 cases were classified as intestinal
type (group A), and 139 cases as diffuse type (group B). Mixed cases
were excluded from the study. All patients were included in a complete
follow-up program for the early diagnosis of recurrence. Clinical,
histopathological and surgical factors were examined for their influence
on tumor recurrence by univariate and multivariate analysis. RESULTS:
Recurrence rate was 41.4% in intestinal type, and 65.5% in diffuse type
cases (p < 0.0001). In group A, multivariate analysis identified nodal
status (p < 0.0001), depth of invasion (p < 0.005), lymph node
dissection (D1 vs. D2-D4, p < 0.01), advanced age (p < 0.01) and male
sex (p < 0.05) as significant prognostic factors. In group B, depth of
invasion (p < 0.0005), lymph node dissection (p < 0.005), tumor size (p
< 0.01) and nodal status (p < 0.05) resulted as significant variables;
no preventive effect on tumor recurrence was found for D2 vs. D1
lymphadenectomy. Multivariate analysis performed on the totality of the
cases demonstrated diffuse type as an independent predictor of poor
prognosis (relative risk: 1.67, p < 0.001). CONCLUSIONS: Diffuse type of
gastric cancer is an independent risk factor for tumor recurrence as
compared with intestinal type; clinical and pathological variables play
a different role as prognostic factors in the two histotypes.
9
UI - 11464490
AU - Bozzetti F; Bignami P; Baratti D; Mancino G
TI -
[Principles of oncologic radicality in the surgical treatment of gastric
carcinoma]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):19-26
AD - Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano.
dottfb@tin.it
To date the basic guidelines in surgical oncology of the stomach may be
summarized in the correct definition of "R0" exeresis (curative
operation), but there is still much debate on which should practically
be the extension of the gastric resection and which the kind of
lymphatic dissection in order to fulfill all the criteria for a correct
definition of "curative surgery". As regards the T factor, almost all
Authors agree on the fact the a correct R0 gastric resection must
include a tumor-free distal margin at least 6 cm from the superior edge
of the neoplasm; a safe distal margin should be at least at 1 cm. below
the pylorus. Provided that these principles are thoroughly observed,
there is no oncologic advantage in performing a total gastrectomy
instead of a sub-total gastric resection. Differently, as regards the N
factor, there is no agreement on which kind of lymph nodal dissection
shoul be routinely adopted: published reports on this subject are
somewhat controversial and also whereas a systematic extended
lymphadenectomy showed a possible statistical benefit in long
term-survival, unacceptable morbidity rates discourage a diffuse
application of extended lymphatic dissection out of dedicated;
institutions. Anyhow, at the moment it is almost universally accepted
that a minimum of 25 removed nodes are necessary for a correct and
comparable staging of gastric cancer. At last, literature data do not
support the routine use of splenectomy, with the only exception of those
cases with documented lymph nodal enlargement at the splenic hilum.
10
UI - 11464491
AU - Kondo H; Gotoda T; Ono H; Oda I; Yamaguchi H; Saito D; Yoshida S
TI -
Early gastric cancer: endoscopic mucosal resection.
SO - Ann Ital Chir 2001 Jan-Feb;72(1):27-31
AD - Department of Endoscopy and Gastrointestinal, Oncology National Cancer
Center Hospital. htkondoh@ncc.go.jp
In Japan, endoscopic mucosal resection (EMR) is now accepted as a
treatment option for cases of early gastric cancer (EGC) with minimum
probability of associated lymph node metastasis. In National Cancer
Center Hospital (NCCH), EMR is currently applied to patients with early
cancers up to 30 mm diameter that were of intestinal type, and were
superficially elevated and/or depressed (Type I, IIa and IIc) but
without ulceration or definite signs of submucosal invasion. Four
hundred seventy nine lesions of EGC in 449 patients were treated by EMR
from 1987 through 1998. Submucosal invasion was found on subsequent
pathologic examination in 74 lesions, and surgery was recommended. Sixty
nine percent of intramucosal cancer was resected with a clear margin,
which was therefore judged to be a "complete resection". Local
recurrence in the stomach occurred in 2% (5 lesions) with complete
resection and in 17% (18 lesions) without complete resection treated
conservatively or endoscopically, and all were subsequently treated with
curative intent. There were no gastric cancer-related deaths for a
median follow-up period of 38 months (3-120 months). Bleeding and
perforation were two major complications in EMR, but there were no
treatment-related deaths. We believe that EMR allows us to perform
less-invasive treatment without sacrificing the possibility of cure. We
hope to promote its use around the world.
11
UI - 11464492
AU - Picciocchi A
TI -
["Update on gastric carcinoma"]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):3-4
12
UI - 11464494
AU - Doglietto GB; Pacelli F; Caprino P; Papa V
TI -
[Role of lymphadenectomy in gastric carcinoma]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):39-46
AD - Istituto di Clinica Chirurgica, Divisione di Chirurgia Digestiva
Universita Cattolica del Sacro Cuore, Roma.
Controversy still surrounds the value of extensive regional lymphnode
dissection in the treatment of gastric cancer. The aim of the present
paper is to give this topic a contribution through the review of the
literature and the analysis of personal results.
13
UI - 11464495
AU - D'Ugo D; Persiani R; Pende V; Picciocchi A
TI -
[Neoadjuvant chemotherapy in gastric carcinoma]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):47-53
AD - Istituto di Patologia Speciale Chirurgica Policlinico Agostino Gemelli,
Universita Cattolica del Sacro Cuore Roma. ddugo@tin.it
A complete surgical resection currently represents the only curative
treatment option for gastric carcinoma, but as regards locally advanced
cancer the possibility of local or distant recurrence remains extremely
high even following a R0 resection. As far as T3-4/N+ tumors are
concerned, unsatisfying results of surgery alone have stressed the need
for multimodal treatments: in the recent past adjuvant chemotherapy has
represented a common complementary treatment for locally advanced
gastric cancer, but conclusive results of most randomized trials did not
show a significant impact on long term survival. Literature review shows
a growing trend throughout the 90's towards the adoption of a
preoperative chemotherapy, initially evaluated as a form of "salvage"
palliative treatment for unresectable patients. To date a number of
phase II study suggests the efficacy of neo-adjuvant treatment
administered to resectable patients with the purpose of inducing tumor
downstaging, increasing the rate of R0 resections and controlling
study on neo-adjuvant therapy for locally advanced gastric cancer.
Accurate staging and patients selection were based upon immediately
preoperative laparoscopy. In this ongoing study, patients are
administered two preoperative cycles of EEP chemotherapy (Etoposide,
Epirubicin, cis-Platin). Preliminary data have been evaluated on the
first 15 cases. Grade I myelosuppression has been observed in 12/15
cases and grade II/III in 3/15 cases; 1 patient died by septic
complications. Restaging has not shown progression of the disease in
13/14 cases; a macroscopic response was evidenced in 7/14 patients;
14/14 patients could undergo a successful D2 surgical resection
following neo-adjuvant therapy. Pathological staging confirmed tumor
downstaging in 7 out of 14 cases; 12/14 patients in this group (85.7%)
could benefit a R0 resection. These preliminary data encourage us to
proceed in our prospective investigation.
14
UI - 11464497
AU - Degiuli M; Ortega C; Mineccia M
TI -
[Adjuvant chemotherapy in gastric carcinoma]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):55-8
AD - Dipartimento di Oncologia, Divisione di Chirurgia Ospedale S.G.A.S., Via
Cavour 31, Torino. uFbde@tin.it
The adjuvant chemotherapy (A.C.) is considered as a complementary
treatment in patients who underwent radical surgery for gastric cancer,
with complete removal of the tumor and absence of macroscopically
detectable metastasis. This treatment is generally started within 4-6
weeks after the operation. The indication to A.C. is related practically
only to the stage of the disease, due to the fact that no other
prognostic factors of an increased risk of relapse have been detected.
Two metanalysis have been recently published by Earle (1998) and
Floriani (1998); both the two have recognized a possible effective role
of the CA for Gastric Cancer. Naturally these "impressions" of efficacy
documented by these two metanalysis should be confirmed through new
trials with larger recruitment. In these new trials the new generation
schedules (weekly PELF, ECF plus 5-FU), which showed an increased
response for advanced disease, should be administered.
15
UI - 11464498
AU - Napolitano L; Francomano F; Gargano E; Francione T; Angelucci D;
TI -
Napolitano AM
[Our experience regarding biologically inactive gastroenteropancreatic
neuroendocrine tumors]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):61-4; discussion 65
AD - Dipartimento di Scienze Chirurgiche Universita di Chieti.
The Authors present 9 cases of gastro-enteropancreatic neuro-endocrine
biologically inactive tumors. In 5 cases the tumor site was
appendicular. In 4 patients an appendectomy was performed, in one
patient a right hemicolectomy and the patients after a period of 3-9
years are well and disease free. In a patient with a gastric carcinoid
and a single hepatic metastasis a total gastrectomy with an hepatic
metastasectomy were performed but the patient died 16 months thereafter.
In a case localized to the right colon with a single hepatic metastasis
a right hemicolectomy was performed with a metastasectomy but the
patient died after 12 months. In a case localized to an ileal loop a
segmental resection was performed followed by a medical therapy with
octreotide and the patient is well and disease free after 3 years. In a
case localized to the pancreas with widespread lymphatic metastasis it
was performed a simple biliary diversion (coledocho-duodenostomy)
followed by medical therapy with octreotide. Surprisingly after 4 years
the patient is alive and a TC control shows a decrease of the pancreatic
tumor and of the lympho glandular tumefactions.
16
UI - 11490828
AU - Isozaki H; Tanaka N; Fujii K; Tanigawa N; Okajima K
TI -
Improvement of the prognosis of gastric cancer with extensive serosal
invasion using left upper abdominal evisceration.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1179-82
AD - First Department of Surgery, Okayama University Medical School, 2-5-1,
Shikata-cho, Okayama, 700-8558, Japan. isozakih@md.okayama-u.ac.jp
BACKGROUND/AIMS: The prognosis of gastric cancer patients with serosal
invasion is very poor. In this study, the effectiveness of the LUAE
(left upper abdominal evisceration) procedure for these patients was
evaluated retrospectively. METHODOLOGY: Thirty-seven gastric cancer
patients who had serosal invasion but no massive peritoneal metastasis
or hepatic metastasis, and underwent LUAE, were enrolled in this study
(LUAE group). As a control, 66 gastric cancer patients who had the same
disease conditions as the LUAE group, and underwent conventional total
gastrectomy with the combined resection of the pancreatic body and tail
and spleen (TPS group), were also investigated. RESULTS: The survival
rate (5-year, 42.2%) of the LUAE group was significantly better than
that (5-year, 21.2%) of the TPS group (P = 0.009). Although D4
super-extended lymphadenectomy and intraperitoneal chemotherapy during
surgery was performed more frequently in the LUAE group than those in
the TPS group, multivariate analysis demonstrated that the LUAE
procedure was a better independent prognostic factor. CONCLUSIONS: The
LUAE procedure in combination with D4 super-extended lymphadenectomy and
intraperitoneal chemotherapy improved the prognosis of gastric cancer
patients with extensive serosal invasion.
17
UI - 11490834
AU - Bozer M; Eroglu A; Unal E; Eryavuz Y; Kocaoglu H; Demirci S
TI -
Survival after curative resection for stage IE and IIE primary gastric
lymphoma.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1202-5
AD - Ankara University, Medical School, Surgical Oncology Department, Ankara,
Turkey.
BACKGROUND/AIMS: There is considerable controversy regarding the optimal
treatment of patients with primary gastric lymphomas. However, surgery
still plays an important role in the management of stage IE and IIE
gastric lymphomas. We aimed at assessing survival of primary gastric
lymphoma cases with stage IE or IIE that were surgically treated at the
Surgical Oncology Department. METHODOLOGY: Thirty-seven patients with
stage IE and IIE primary gastric lymphoma who were surgically treated
reviewed retrospectively. Patients' age, gender, tumor location, tumor
grade, histologic type, depth of tumor invasion, regional lymph node
status, tumor stage, type of gastrectomy (total/subtotal), combined
resection, extensive lymphadenectomy, adjuvant chemotherapy were used as
the clinicopathologic variables. RESULTS: Five-year survival rates for
stage IE and stage IIE disease were 75% and 37%, respectively. The
overall 5-year survival rate of the patients was 57%. Univariate
analysis demonstrated that age, tumor stage, and type of gastrectomy
were associated with prognosis, but only type of gastrectomy (subtotal
gastrectomy) and tumor stage were found to be independent prognostic
factors (P < 0.05). CONCLUSIONS: To obtain prolonged survival we
recommend radical resection with extensive lymphadenectomy for malignant
lymphoma stages IE and IIE. Patients with small distal lymphomas of the
stomach can be treated with subtotal gastric resection.
18
UI - 11060322
AU - Kelsen DP
TI -
Postoperative adjuvant chemoradiation therapy for patients with resected
gastric cancer: intergroup 116.
SO - J Clin Oncol 2000 Nov 1;18(21 Suppl):32S-4S
AD - Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
kelsend@mskcc.org
19
UI - 11512601
AU - Boussioutas A; Taupin D
TI -
Towards a molecular approach to gastric cancer management.
SO - Intern Med J 2001 Jul;31(5):296-303
AD - Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
Gastric cancer is a leading cause of cancer death worldwide. Most
patients with gastric cancer present with locally advanced and incurable
disease, and overall survival is poor. Considerable research efforts
towards the epidemiology and pathogenesis of gastric cancer have not
been translated into treatment success. We discuss current concepts of
the pathogenesis of gastric cancer and how recent research advances, in
particular global gene expression strategies, may improve this
understanding, and suggest a framework wherein these approaches may be
used.
20
UI - 11520089
AU - Horvath OP; Kalmar K; Cseke L; Poto L; Zambo K
TI -
Nutritional and life-quality consequences of aboral pouch construction
after total gastrectomy: a randomized, controlled study.
SO - Eur J Surg Oncol 2001 Sep;27(6):558-63
AD - Department of Surgery, University of Pecs, Pecs, Hungary.
ophorvath@iseb.pote.hu
AIMS: The aboral pouch, a new type of gastric substitute, has been
introduced after total gastrectomy and compared to simple Roux-en-Y
reconstruction in a prospective, randomized study. Anthropometric data,
serum nutritional parameters, small intestinal passage, lipid and
carbohydrate absorption and quality of life were measured 6 and 12
months after total gastrectomy. PATIENTS AND METHODS: Between September
pouch group and 22 to the control, simple Roux-en-Y group. RESULTS:
Interim analysis of the data revealed significantly higher serum
cholesterol levels, better lipid absorption and quality of life in
patients who underwent aboral pouch construction. CONCLUSION: Aboral
pouch construction is a feasible reconstruction method after total
gastrectomy providing better lipid absorption and quality of life for
patients after total gastrectomy. Copyright 2001 Harcourt Publishers
Limited.
21
UI - 11553218
AU - Mattioli S; Di Simone MP; Ferruzzi L; D'Ovidio F; Pilotti V; Carella R;
TI -
D'Errico A; Grigioni WF
Surgical therapy for adenocarcinoma of the cardia: modalities of
recurrence and extension of resection.
SO - Dis Esophagus 2001;14(2):104-9
AD - Department of Surgery, Intensive Care and Transplants, Center for the
Study and Therapy of Diseases of the Esophagus of the University of
Bologna, Bologna, Italy. mattioli@med.unibo.it
In order to define the optimal extent of resection for cancer of the
cardia, we considered 116 patients operated upon with five different
surgical techniques. The procedures were: transabdominal total
gastrectomy associated with distal esophagectomy in 38 patients;
transabdominal total gastrectomy and left thoracotomic esophageal
resection at the inferior pulmonary vein level in 26 patients;
transabdominal total gastrectomy and right thoracotomic esophageal
resection at the azygos vein level in 27 patients; transabdominal total
gastrectomy and transhiatal lower third esophagectomy in 18 patients;
transhiatal total esophagectomy and upper third gastrectomy with
cervical esophago-gastroplasty in seven patients. Grading, staging,
neoplastic lymphangitis, satellite intramural metastases, infiltration
of the resection margin, site of recurrence, and survival were analyzed.
N+ was the single independent prognostic factor for survival. A poorly
differentiated grading was related to T (P = 0.0009), N (P = 0.001),
satellite growth (P = 0.05), and infiltration of the resection margin (P
= 0.0001). Recurrence was local in 26% and distant in 74% of patients.
The modalities of recurrence were not related to the aggressiveness
parameters and the surgical technique. Infiltration of the esophageal
resection margin was related to the type of operation (P = 0.005) and
survival (P = 0.02), but it was not related to the site of recurrence.
Transabdominal total gastrectomy and the right thoracotomic esophageal
resection procedure achieved free margins and control of the lymph nodal
metastatic spread. Transabdominal total gastrectomy and right
thoracotomic esophageal resection at the azygos vein level provides a
radical oncologic resection, particularly in poorly differentiated
tumors. However, surgery alone cannot cure the majority of
adenocarcinomas of the cardia.
22
UI - 11553220
AU - Ulrich B; Zahedi A
TI -
Technical aspects and results of the transhiatal resection in
adenocarcinomas of the gastroesophageal junction.
SO - Dis Esophagus 2001;14(2):115-9
AD - Department of Surgery, Townhospital Dusseldorf Gerresheim, Dusseldorf,
Germany. Prof.Ulrich@Kliniken-Duesseldorf.de
The distribution of lymph node metastases of adenocarcinomas of the
gastroesophageal junction is classified into three types. The R0
resection with complete lymphadenectomy therefore requires different
resection methods for type 1 and type 2/3 tumors. Comparing the subtotal
esophagectomy and the extended gastrectomy, no advantage in survival can
be seen for one method or one tumor type (type 1 or type 2/3). The same
is true for the lethality. Indeed, the transhiatal resection is
accompanied by a higher complication rate. However, the different
operation methods for cardiacarcinomas, with subtotal esophagectomy in
type 1 and extended gastrectomy in type 2/3 tumors, should be maintained
because of increased rates of local recurrence that may be expected if
all cardiacarcinoma types were treated using subtotal esophagectomy with
gastric tube interposition. Therefore, we suggest a subtotal
esophagectomy only in type 1 tumors. In type 2/3 tumors, an extended
gastrectomy with resection of the distal esophagus, lymphadenectomy of
the lower mediastinum, and D2 lymphadenectomy should be performed.
23
UI - 11577462
AU - Takeuchi S; Murakami M
TI -
[Levofolinate and fluorouracil combination therapy]
SO - Nippon Yakurigaku Zasshi 2001 Sep;118(3):211-8
AD - Nagoya Branch Oncology Group, Wyeth Lederle (Japan), 2-2-13 Nishiki,
Naka-ku, Nagoya 460-0003, Japan. takeucs2@wai.wyeth.com
Levofolinate and fluorouracil regimen (l-leucovorin and 5 fluorouracil
regimen) is a biochemical modulation of 5 fluorouracil (5FU) by
leucovorin (LV). In the USA and Europe d,l-LV and 5FU regimen is
frequently administered for colorectal cancer treatment and recognized
as the standard regimen. In Japan, multi-institutional clinical trials
of l-leucovorin (l-LV), a bioactive diastereomer of leucovorin, and 5FU
combination were conducted for the treatment of advanced
gastrointestinal cancer with comparable results to the US/Europe data.
indications of advanced gastric cancer and colorectal cancer. The dosage
and administration is referred to the weekly method developed at RPMI.
Recently, the irinotecan (CPT-11) or oxariplatin plus LV and 5FU
combination showed higher antitumor activities than the LV and 5FU
combination with increased progression-free survival. These regimens,
however, are not yet properly established because clinical trial results
with Japanese patients are not completed for agreement of the dosage and
administration schedule. For the l-LV and 5FU regimen diarrhea and
leukocytopenia, including grade 3 and higher, were reported as the major
adverse events. Administration for eligible patients with periodical
monitoring of diagnostic data is necessary.
24
UI - 11577750
AU - Mezger J
TI -
[Neoadjuvant and adjuvant chemotherapy of locally advanced stomach
cancer]
SO - Onkologie 2001 Aug;24(4):374-5
25
UI - 11574091
AU - Parker J; Sell H Jr; Stahlfeld K
TI -
A new technique for esophagojejunostomy after total gastrectomy for
gastric cancer.
SO - Am J Surg 2001 Aug;182(2):174-6
AD - Department of Surgery, Mercy Hospital of Pittsburgh, 1400 Locust St.,
Pittsburgh, PA 15219, USA.
BACKGROUND: The critical part of any operation involving a proximal
gastric resection is the esophageal anastomosis. Leakage from this
anastomosis is one of the main reasons for postoperative morbidity and
death after gastrectomy. Application of the double-stapling technique
affords many of the same advantages that it does for low rectal tumors,
especially in obese patients with narrow costal margins. METHODS: A new
technique for esophagojejunostomy after total gastrectomy for gastric
cancer is described. RESULTS: This technique has been used in 3
patients. At a follow-up of 22 months, there have been no anastomotic
leaks or evidence of clinical stenoses. CONCLUSIONS: This technique
minimizes manipulation and dissection around the distal esophagus. Not
only does this make the operation easier, but it also allows for a
longer proximal resection margin. Possibly this will result in lower
rates of esophageal breakdown.
26
UI - 11588769
AU - Walsh RM; Heniford BT
TI -
Laparoendoscopic treatment of gastric stromal tumors.
SO - Semin Laparosc Surg 2001 Sep;8(3):189-94
AD - Department of General Surgery, Cleveland Clinic Foundation, Cleveland,
OH, USA.
Gastric stromal tumors are the most common submucosal mass found in the
stomach. These tumors are most often diagnosed at endoscopy and can be
accurately characterized by endoscopic ultrasound. They typically
require surgical resection, and an increasing number of patients undergo
laparoscopic resection. A combined laparoscopic/endoscopic, intragastric
enucleation technique is described, and results are reported in 10
patients. Eleven nonmalignant lesions were excised, with a mean size of
4.12 (2.0 to 7.0) cm. There were no complications, and the median length
of stay was 3.5 days. This surgical approach appears appropriate for
predominantly intraluminal, benign-appearing lesions of the proximal
stomach. Copyright 2001 by W.B. Saunders Company.
27
UI - 11603094
AU - Bigard MA
TI -
[Helicobacter pylori eradication. Therapeutic evolution, value of
complementary studies]
SO - Presse Med 2001 Sep 22;30(26):1305-12
AD - Service d'Hepatogastroenterologie, CHU de Nancy-Brabois, F54500
Vandoeuvre-les-Nancy. bigard.LettreHGE@wanadoo.fr
INDICATIONS: Eradication of Helicobacter pylori is needed for patients
with a gastroduodenal ulcer associated with H. pylori gastritis.
Eradication modifies the natural history of the disease and greatly
reduces the risk of recurrence. Eradication is also indicated for
patients with MALT lymphoma with a low degree of malignancy. Systematic
eradication of H. pylori would not be necessary for patients with
dyspepsia associated with H. pylori gastritis since a beneficial effect
is achieved in only 5% of the treated patients. Systematic eradication
in order to reduce the incidence of gastric adenocarcinoma is not
recommended. DIAGNOSIS: Direct tests (urease, pathology) provide the
diagnosis of H. pylori gastritis. Indirect tests (13C-labeled urea
respiratory test) can be most useful to determine the efficacy of
eradication treatments. THERAPY: A tri-therapy regimen given for 7 days
combining a double-dosed proton pump inhibitor, amoxicillin (2 g/d), and
clarithromycin (0.5 g b.i.d) is used to eradicate H. pylori. With this
regimen, the mean rate of eradication achieved in France is 67%. The
principal causes of failure are poor compliance and bacterial resistance
to clarithromycin. Metronidazole (1 g/d) can be used for patients
allergic to penicillin. A second cycle can be prescribed in case of
failure, substituting metronidazole for clarithromycin. FOLLOW-UP:
Eradication treatment is prescribed for patients with an ulcer after
confirmation of infection by one or two direct tests. Treatment efficacy
can be assessed by the respiratory test for patients with a duodenal
ulcer but is not systematically needed. Biopsy of a gastric ulcer can
also provide an assessment of treatment efficacy. For patients with a
non-complicated duodenal ulcer, antisecretion treatment is not required
in addition to eradication treatment.
28
UI - 11665692
AU - Fishman V; Friedel D
TI -
Inverse association between intake of cereal fiber and risk of gastric
cardia cancer.
SO - Gastroenterology 2001 Oct;121(4):1024-5
29
UI - 11603551
AU - Grise K; McFadden D
TI -
Anastomotic technique influences outcomes after partial gastrectomy for
adenocarcinoma.
SO - Am Surg 2001 Oct;67(10):948-50
AD - Department of Surgery, UCLA Medical Center, Los Angeles, California,
USA.
The proper reconstructive technique after partial gastrectomy for
adenocarcinoma of the stomach is often debated, but few data exist to
clarify the issue. We evaluated outcomes after different anastomoses
used during partial gastrectomy for gastric adenocarcinoma. We reviewed
the hospital records of all 277 patients who underwent operation for
gastric cancer at our institution from 1970 to 1996. Of 118 partial
gastrectomies performed with curative intent 57 anastomoses were
Billroth II gastrojejunostomies, 22 were Billroth I gastroduodenal
reconstructions, and 39 were Roux-en-Y gastrojejunostomies. There was no
difference in the incidence of early gastric emptying problems or early
or late postoperative obstruction among the groups. Average hospital
stay was 14 days for the Billroth I group, 15 days for those with
Billroth II reconstructions, and 22 days for the Roux-en-Y cohort.
Documented late gastric outlet obstruction occurred in 29 per cent of
patients having Billroth I and in 33 per cent of those with Billroth II
anastomoses. Antecolic anastomoses represented 30 (53 per cent) and
retrocolic 27 (47 per cent) of the 57 Billroth II reconstructions
performed. Late gastric outlet obstructions occurred in seven (23 per
cent) patients who had antecolic reconstructions and in just one (4 per
cent) with a retrocolic anastomosis (P < 0.05). Five-year cumulative
survival was lower for patients having Billroth I reconstructions than
for those with Billroth II (P < 0.05). Among patients with Billroth II
reconstructions, 5-year cumulative survival was lower for those with
antecolic reconstructions compared with those with retrocolic
anastomoses (P < 0.05). Although conventional teaching dictates
otherwise our data indicate that retrocolic Billroth II anastomoses are
preferable to antecolic Billroth II reconstructions after partial
gastrectomy for adenocarcinoma of the stomach, as there is a diminished
risk of late gastric outlet obstruction and a greater 5-year survival
among patients having the former procedure. Survival is unacceptably low
after Billroth I anastomoses.
30
UI - 11602891
AU - Lewis FR; Mellinger JD; Hayashi A; Lorelli D; Monaghan KG; Carneiro F;
TI -
Huntsman DG; Jackson CE; Caldas C
Prophylactic total gastrectomy for familial gastric cancer.
SO - Surgery 2001 Oct;130(4):612-7; discussion 617-9
AD - Henry Ford Hospital, Detroit, Mich, USA.
BACKGROUND: An autosomal dominant syndrome of diffuse gastric cancer has
been reported with germline mutations in the E-cadherin (CDH1) gene and
has been identified in approximately 14 families and 50 individuals
worldwide. Penetrance of the gene is 70% to 80%, and the average age of
onset of gastric cancer is 37 years. These characteristics have led to
the consideration of prophylactic total gastrectomy in family members
with CDH1 mutations. METHODS: We report here the first use of
prophylactic gastrectomy in 6 asymptomatic members of 2 families (2
males, 4 females; ages 22, 27, 28, 35, 39, and 40) based on family
pedigree and genetic analysis. Total gastrectomy was performed via an
upper midline incision, and reconstruction of the gastrointestinal tract
was done via a Roux-en-Y esophagojejunostomy. Complete removal of all
gastric mucosa was documented intraoperatively, and confirmation was
made that only esophageal mucosa remained at the proximal specimen
margin. RESULTS: The gastric specimens appeared normal, and the results
of routine pathologic examination were negative for cancer. All
specimens from patients who tested positive for E-cadherin mutations
were subjected to a research protocol of microscopic sectioning in which
150 to 250 tissue blocks were examined. All of these patients had
microscopic foci of cancer, often at multiple sites, with overlying
normal gastric mucosa. CONCLUSIONS: E-cadherin gene mutations in
association with familial gastric cancer is a new disease for which
prophylactic surgery must be considered. The morbidity of this operation
is much higher than that for other genetic diseases, but the alternative
is a mortality risk of more than 80% at a young age.
31
UI - 11605052
AU - Hoshikawa T; Denno R; Ura H; Yamaguchi K; Hirata K
TI -
Proximal gastrectomy and jejunal pouch interposition: evaluation of
postoperative symptoms and gastroi
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