National Cancer Institute®
Last Modified: April 1, 2002
UI - 11405085
AU - Piso P; Werner U; Benten D; Bektas H; Meuer U; Klempnauer J
TI - Early gastric cancer--excellent prognosis after curative resection in 87 patients irrespective of submucosal infiltration, lymph-node metastases or tumor size.
SO - Langenbecks Arch Surg 2001 Feb;386(1):26-30
AD - Klinik fur Viszeral- und Transplantationschirurgie, Zentrum Chirurgie, Medizinische Hochschule Hannover, Carl Neuberg Strasse 1, 30625 Hannover, Germany. email@example.com
BACKGROUND AND AIMS: Despite a decreasing incidence of primary gastric carcinoma over the last decade, the incidence of early gastric cancer has remained unchanged. Some aspects of the surgical treatment (e.g., extent of resection, lymphadenectomy) are still controversially 1999, 87 patients were operated upon due to primary early gastric adenocarcinoma. All patients data were analyzed retrospectively. RESULTS: Of 626 patients with primary gastric carcinoma, 87 (13.9%) had an early carcinoma (54 men, 33 women; median age 61 years). In all patients, curative (R0-) gastrectomy could be performed, total in 62 patients (71.4%) and subtotal in 25 patients (28.6%). Postoperative morbidity was 23% and mortality 4.5%. Mucosal tumors were found in 34 (39.1%) and submucosal in 53 (60.9%) patients. Multicentricity was present in eight cases (9.1%). Twelve patients (13.8%) had lymph-node metastases. The 5-year survival rate was 88.8%. The submucosal infiltration, the lymph-node infiltration, the histological type, and the tumor size had no statistically significant impact on prognosis. CONCLUSION: Radical resection of early gastric cancer cured most of the patients, irrespective of lymph-node metastases or tumor size. Multicentricity, increasing incidence of proximal cancers, and low mortality suggest that total gastrectomy may be indicated. Patients with early gastric cancer may benefit from D2-lymphadenectomy, but this has to be assessed in further randomized studies, in particular for those with small mucosal tumors.
UI - 11552474
AU - Zucchetti F; Negro F; Matera D; Cagossi M
TI - Gastric cancer in the elderly.
SO - Ann Ital Chir 2001 Mar-Apr;72(2):181-6
AD - Istituto di Clinica Chirurgica Generale, Universita Cattolica del Sacro Cuore, Roma.
Nowadays an increased number of elderly patients undergo surgery for gastric cancer. The old age by itself does not seem to represent a prohibitive risk factor anymore. Two groups of patients operated on of gastric cancer at our surgical unit (Group A = 378 patients younger or as old as 65 years and Group B = 330 patients older than 65 year) were compared. There were not statistically significant differences between the two groups in terms of number of performed radical exereses (57.7% vs. 42.3% respectively), kind of resective operation (total gastrectomy or subtotal gastrectomy) and extent of lymphadenectomy (D2-D3 type: 64.7% vs 63.8% respectively). The location of tumor, the distribution by stage and the long term survival of radically resected cases were not statistically different in the two groups of patients. Five-year survival after radical resection was 56.8% and 54.0% respectively. We conclude that elderly patients in good clinical conditions affected by gastric cancer should undergo radical resection with lymphadenectomy such extensive as D2-D3 type.
UI - 11686031
AU - Aiba K
TI - Upper gastrointestinal tumors.
SO - Cancer Chemother Biol Response Modif 2001;19():535-45
AD - Japanese Foundation for Cancer Research, Cancer Chemotherapy Center, Kami-Ikebukuro 1-37-1, Toshima-ku, Tokyo 170-8455, Japan.
UI - 11816133
AU - Markus B; Pinter G
TI - [Partial versus total gastrectomy in the surgical treatment of stomach cancer]
SO - Magy Seb 2001 Dec;54(6):361-7
AD - Vas Megye es Szombathely Megyei Jogu Varos Markusovszky Korhaza, Egyetemi Oktatokorhaz, Altalanos Sebeszeti Osztaly, 9700 Szombathely, Markusovszky u. 3.
The authors discuss some aspects of radical gastrectomy. They analyse whether there is any progress in their results in the treatment of stomach cancer in the past 5 years. They describe some aspects of total gastrectomy with regards to the need for splenectomy. During 36 years (01.07.1952-30.06.1962 and 1974-1999) 1614 patients were treated for stomach cancer. In the last two 5 year long periods (1990-1994 and 1995-1999) the number of radical operations was 106 and 114. In the second period we used laparoscopic exploration in some patients. We carried out total gastrectomies with modern suturing devices (AutoSuture Premium Plus CEEA, Proximate ILS Straight Intraluminal Stapler Endo Surgery, TA Premium) without compromising the principles of radicality using Rochard-Aesculap retractor in most patients. We tried to avoid splenectomy when possible. In the past 5 years we carried out lymphadenectomy according to the Japanese classification, excising group I and II lymph nodes. The resectability rate rose in the last 6 years compared to the previous ten year period (55.3%, 36.1%, 48.4%, 64.3%). The ratio of total gastrectomies increased from 8.6% (10 out of 106 resections) to 42.9% (49 out of 114 resections) in the two 5 year periods. Mortality for partial and total gastrectomy were 4.6% (65/3) and 6.1% (49/3). They could preserve the spleen in 32.6% of the cases. We found that laparoscopic exploration rarely influenced the operation. Partial resection in intestinal type stomach cancer should be performed, if a margin of 6 cm can be achieved. If the patient is in good general health, total gastrectomy should be performed unless the size, type and lymph node involvement of the cancer indicated otherwise. We think that increased resectability is related to both increased capabilities and better diagnostic tools. It is important to preserve the spleen where oncology principals allow.
UI - 11484287
AU - Belchev B; Belchev N
TI - [Surgical treatment outlook for gastric carcinoma (a 10-year retrospective study)]
SO - Khirurgiia (Sofiia) 2000;56(2):38-9
After analyzing clinical material of 159 patients with gastric cancer into Surgical department of the Regional hospital in Dobrich, the authors signified the tendency of later coming for surgery of predominant patients. The part of 66.8% patients coming in 3rd and 4th stage of disease is disturbing. The subtotal resection and gastrectomy like a method of choice are 40.4% with a something more true survival chances.
UI - 11484290
AU - Gaydarsky R; Tasev V; Draganov K; Yonkov A; Bulanov D
TI - [Carcinoma of the stomach - our experience with surgical treatment]
SO - Khirurgiia (Sofiia) 2000;56(2):5-9
Carcinoma of the stomach is among the commonest malignancies of the gastrointestinal tract regardless of the permanent tendency of its diffusion to decrease, observed in the last 25-30 years. The readily accessible methods of diagnosing the disease contribute greatly to its early detection. However, owing to diverse causes, in over 70 per cent of cases the diagnosis is usually made as late as in the advanced III-IV stages. The latter circumstance preordains largely the unfavourable long-term results of the treatment undertaken where surgery plays a major role. It is the purpose of this study to analyze the surgical strategy and tactics currently used in the management of gastric carcinoma. Over a 5-year period (Jan 1995 through Dec 1999), in the Chair of General and Operative Surgery of the Medical University--Sofia a total of 184 gastric carcinoma patients, including 116 men (63.1%) and 68 women (36.9%) with age ranging from 23 to 80 years, undergo operation. Diagnosing is based on past history, physical, laboratory and x-ray data, but first and foremost on evidence from FGS and histological assessment of biopsy material (carried out in all patients). With a view to precise preoperative staging of the lesion, roentgenoscopy + roentgenography of lungs, USD and CAT of the abdominal organs are also done. The following intervention are performed: gastrectomy 18 (9.8%), upper pole resection 43 (23.4%), subtotal resection of stomach 4 (2.2%), prosthetic replacement of cardia 8 (4.3%), derivations 22 (11.9%), and explorative laparotomies. Combined subtotal gastric resections of gastrectomies are necessitated in 73 patients (39.7%) because of carcinomatous infiltration of contiguous organs and/or presence of liver metastases. Morbidity involves 29 patients (15.7%) with lethality amounting to 16 (8.7%). The long-term postoperative results are discussed under a separate heading. Operative treatment of gastric carcinoma patients is the only chance of survival. The scope of indication for more aggressive surgical interventions, including combined resections and gastrectomies, are broadened leading in turn to a considerable reduction of the proportion of explorative laparotomies.
UI - 11852408
AU - Huntsman D; Carneiro F; Lewis F; MacLeod P; Hayashi A; Monaghan K; Maung
TI - R; Seruca R; Jackson C; Caldas C [Prophylactic gastrectomy in patients with deleterious E-cadherin gene mutation]
SO - Gastroenterol Clin Biol 2001 Oct;25(10):931-2
AD - Hopital Europeen Georges-Pompidou, Paris, France.
UI - 11902529
AU - Du MQ; Isaccson PG
TI - Gastric MALT lymphoma: from aetiology to treatment.
SO - Lancet Oncol 2002 Feb;3(2):97-104
AD - Department of Histopathology, Royal Free and University College Medical School, University College London, UK. firstname.lastname@example.org
The development of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is dependent on Helicobacter pylori infection. Bacterial colonisation of the gastric mucosa triggers lymphoid infiltration and the formation of acquired MALT. The bacterial infection induces and sustains an actively proliferating B-cell population through direct (autoantigen) and indirect (intratumoral T cells specific for H. pylori) immunological stimulation. Moreover, the bacterial infection provokes a neutrophilic response, which causes the release of oxygen free radicals. These reactive species may promote the acquisition of genetic abnormalities and malignant transformation of reactive B cells. A transformed clone carrying the translocation t(1;18)(q21;q21) forms a MALT lymphoma, the growth of which is independent of H. pylori and will not respond to bacterial eradication. Malignant clones without t(11;18)(q21;q21), but with other genetic abnormalities, such as trisomy 3 or microsatellite instability, depend critically on immune stimulation mediated by H. pylori for their clonal expansion. In the early stages, the tumour can be successfully treated by eradication of the bacterium, whereas at later stages the tumour may escape its growth dependency through acquisition of additional genetic abnormalities such as t(1;14)(p22;q32) and t(1;2)(p22,p12) involving the BCL-10 gene. Finally, further genetic abnormalities, such as inactivation of the tumour suppressor genes, p53 and p16, can lead to high-grade transformation. Detection of these abnormalities may help with the clinical management of patients with gastric MALT lymphoma.
UI - 11865370
AU - Nogueira C; Silva AS; Santos JN; Silva AG; Ferreira J; Matos E; Vilaca H
TI - Early gastric cancer: ten years of experience.
SO - World J Surg 2002 Mar;26(3):330-4
AD - Surgery Department, Surgery 1, Hospital Geral de Santo Antonio, Largo Prof. Abel Salazar, 4000 Oporto, Portugal. email@example.com
Gastric cancer is a disease in which the main treatment is surgical extirpation. The modifications introduced in the surgical treatment over the last decades were accompanied by a clear increase of survival, which reaches global values of 61% at 5 years in Japan. One of the reasons that contribute to this improvement is early diagnosis of the lesions. In the period between January 1, 1990 and December 31, 1999 662 patients with gastric adenocarcinoma were treated in the Service of Surgery 1 of our hospital; 110 were refused surgical treatment. Of the resected patients, 91 (21.4%) were classified as early gastric cancer according to the definition of the Japanese Society of Digestive Endoscopy. There were 30 women and 61 men, with a median age of 60.2 +/- 15 years; 3 patients had a preoperative diagnosis of gastric ulcer; 2 others were operated without recent histology; and 1 patient was urgently resected for a bleeding ulcer. In all the remaining patients biopsy confirmed the presence of cancer (89%) or serious dysplasia (4.6%). The lesions had been distributed essentially in the medium 1/3 (48.3%) and distal 1/3 of the stomach. Subtotal gastrectomy was accomplished in 48 patients, total gastrectomy in 40, total desgastrogastrectomy in 3, and in 9 patients the surgery involved the spleen (8 patients) and the spleen and tail of the pancreas in 1 patient. Lymphadenectomy was not performed in 5 patients, lymph nodes by the first lymph node barrier were removed in 25 patients and by the second barrier in 61 patients (67%). Median tumor size was 26 +/- 1.8 mm. The lesion reached the mucosa in 46 patients and the mucosa and submucosa in 45. In 6 patients the removed lymph nodes were microscopically invaded (6.7%). Five patients died (5.7%). The median follow-up of the patients is 41 +/- 26 months; 7 patients died (8.1%) during this period; 4 died unequivocally of disease progression. The median survival of patients was 85% at 5 years and 80% at 10 years. In our series, survival was affected by the presence of invaded lymph nodes, not by the penetration in depth of the lesion or the size of the tumor.
UI - 11865371
AU - Hoksch B; Ablassmaier B; Zieren J; Muller JM
TI - Quality of life after gastrectomy: Longmire's reconstruction alone compared with additional pouch reconstruction.
SO - World J Surg 2002 Mar;26(3):335-41
AD - University Department of Surgery, Charite/Humboldt-University, Schumannstrasse 20/21, D-10117 Berlin, Germany.
The optimal reconstruction protocol after total gastrectomy is still a matter of debate. Pouch reconstructions are developed to create a larger reservoir for food, to provide a barrier against intestinoesophageal reflux, and to lengthen the food transit time. Preservation of the duodenal passage should result in better physiologic regulation of the ingested food. Controlled randomized clinical studies must be conducted to assess the quality of life after gastrectomy and various types of reconstruction. In the present trial, which compared Longmire's reconstruction without a pouch and Longmire's reconstruction with a pouch of varying sizes, we evaluated the quality of life for 41 patients during the first postoperative year. The quality of life was examined by an EORTC questionnaire and an organ-specific module. There were no statistically proven benefits for pouch reconstruction in comparison with Longmire's reconstruction alone. Some benefits are shown for the large pouch but it was only a trend. This is especially so with regard to diarrhea and food consumption. A definitive answer to the question about the value of a pouch reconstruction after gastrectomy has not yet been attained. It is possible that there will be significant differences between reconstruction groups during the long-term follow-up.
UI - 11869332
AU - Kun L; Yun-Jie W; Qing-Shu C; Dao-Xi W; Zhen-Yuan Z
TI - Emergency re-operation for postoperative hemorrhage following partial esophagectomy for carcinoma of the esophagus and cardia of the stomach.
SO - Dis Esophagus 2001;14(3-4):251-3
AD - Department of Thoracic Surgery, The 4th Military Medical University, Tang Du Hospital, Xian, PR, China. firstname.lastname@example.org
The clinical records of 12 cases of emergency re-operation for management of postoperative hemorrhage (POH) following partial esophagectomy and esophago-gastrostomy or colonic interposition for a group of 3690 cases of carcinoma of the esophagus (CE) and cardia of the studied. There were 10 survivors and two deaths, giving a mortality rate of 16.6% (2/12). It was concluded that an emergency re-operation was a cardinal surgical procedure to save the patient's life if a serious POH had developed. The POH could be prevented by a careful, conscientious and strict hemostasis during the primary operation. The criteria for the diagnosis are presented.
UI - 11054376
AU - Fischbach W; Dragosics B; Kolve-Goebeler ME; Ohmann C; Greiner A; Yang
TI - Q; Bohm S; Verreet P; Horstmann O; Busch M; Duhmke E; Muller-Hermelink HK; Wilms K; Allinger S; Bauer P; Bauer S; Bender A; Brandstatter G; Chott A; Dittrich C; Erhart K; Eysselt D; Ellersdorfer H; Ferlitsch A; Fridrik MA; Gartner A; Hausmaninger M; Hinterberger W; Hugel K; Ilsinger P; Jonaus K; Judmaier G; Karner J; Kerstan E; Knoflach P; Lenz K; Kandutsch A; Lobmeyer M; Michlmeier H; Mach H; Marosi C; Ohlinger W; Oprean H; Pointer H; Pont J; Salabon H; Samec HJ; Ulsperger A; Wimmer A; Wewalka F Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group.
SO - Gastroenterology 2000 Nov;119(5):1191-202
AD - Medizinische Klinik II, Klinikum Aschaffenburg, Aschaffenburg, Germany.
BACKGROUND & AIMS: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. METHODS: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori-positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. RESULTS: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P < 0.001). CONCLUSIONS: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori-positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed.
UI - 11762812
AU - Mackay HJ; McInnes A; Paul J; Raby N; Lofts FJ; McDonald AC; Soukop M;
TI - Fullarton GM; Harris AL; Garcia-Vargas J; Evans TR A phase II study of epirubicin, cisplatin and raltitrexed combination chemotherapy (ECT) in patients with advanced oesophageal and gastric adenocarcinoma.
SO - Ann Oncol 2001 Oct;12(10):1407-10
AD - CRC Department of Medical Oncology Beatson Oncology Centre, Western Infirmary, Glasgow, UK. email@example.com
BACKGROUND: The aim of this study was to evaluate the efficacy of the combination of epirubicin, cisplatin and ralitrexed (Tomudex). ECT, in patients with advanced oesophageal or gastric adenocarcinoma. Efficacy was assessed primarily as response rate and secondarily in terms of toxicity, time to progression and survival. PATIENTS AND METHODS: Twenty-one patients with histologically and/or cytologically proven unresectable (7) or metastatic (14) gastro-oesophageal adenocarcinoma, who had bi-dimensionally measurable disease, with ECOG performance status < or = 2. with adequate haematological, hepatic and renal function received first-line chemotherapy with epirubicin (50 mg/m2). cisplatin (60 mg/m2) and Tomudex (2.5 mg/m2), ECT, at three-weekly intervals. Treatment consisted of three cycles of chemotherapy, with a further three cycles if there was disease response or stabilisation. RESULTS: ECT is an active regimen in the treatment of advanced gastro-oesophageal adenocarcinoma with an overall intention-to-treat response rate of 29% (95% confidence intervals (CI): 11%-52%). In addition, 4 (19%) patients had stable disease. Median time to progression was 19 weeks (95% CI: 7-31 weeks). Median overall survival was 18 weeks (95% CI: 11-24 weeks). Seventeen patients failed to complete the six cycles of treatment due to disease progression (5). toxicity (3), non-toxic death (1 pulmonary embolism, 1 cardiac), severe allergy to epirubicin (1), patient decision (1) and five patients after the study was discontinued early due to toxicity. There were three toxic deaths: two due to sepsis complicating neutropaenia and one due to cardiorespiratory failure following drug induced enteritis. Nine patients experienced grade 3 or 4 neutropaenia, two patients experienced grade 3 or 4 nausea and vomiting and one patient had grade 4 diarrhoea. CONCLUSIONS: The combination of epirubicin, cisplatin and tomudex is active against advanced gastro-oesophageal adenocarcinoma but the toxicity suggests that further evaluation in a randomised comparison to ECF is not appropriate.
UI - 11872061
AU - Gillison EW; Powell J; McConkey CC; Spychal RT
TI - Surgical workload and outcome after resection for carcinoma of the oesophagus and cardia.
SO - Br J Surg 2002 Mar;89(3):344-8
AD - Department of Surgery, City Hospital, Cancer Research Campaign Clinical Trials Unit, University of Birmingham, Birmingham, UK.
BACKGROUND: Performing cancer surgery in high-volume centres may lead to improved outcomes. This study explored the relationship between annual workload and outcome following resection for carcinoma of the oesophagus and cardia. METHODS: The study was a retrospective case-note review of 1125 patients who had surgery for cardio-oesophageal cancer in the West Midlands region of England. Outcome measures were 30-day mortality and long-term survival. RESULTS: The overall 30-day mortality rate was 10.0 per cent with a median survival of 14 months and a 5-year survival rate of 17.2 per cent. Increasing age, advanced stage of disease and emergency resection independently affected outcome adversely. Forty-one infrequent operators (fewer than four resections per year) performed 146 resections (13.0 per cent), 18 intermediate operators (between four and 11 resections per year) performed 488 resections (43.4 per cent) and five frequent operators (12 or more resections per year) performed 491 resections (43.6 per cent). The 30-day mortality rate was greatest in the infrequent group (15.1 per cent) compared with both the intermediate group (6.6 per cent; adjusted odds 0.40, P = 0.004) and the frequent group (11.8 per cent; odds 0.73, P = 0.28). There were no differences in survival rates between the groups, and no difference in outcome between high- and low-volume hospitals. CONCLUSION: In this unselected population-based series there was little evidence of a trend of improving 30-day mortality rate with increasing workload, or between workload and long-term survival.
UI - 11798956
AU - Chen J; Wang S; Xu H
TI - [Curative effect of radical gastrectomy combined with peritoneal lavage with thermal hypoosmotic solution in treatment of gastric cancer]
SO - Zhonghua Yi Xue Za Zhi 2001 Jun 25;81(12):730-2
AD - China Medical University Cancer Institute, Shenyang 110001, China.
OBJECTIVE: To evaluate the curative effect and indications of radical gastrectomy combined with peritoneal lavage with thermal hypoosmotic solution, double distilled water (DDW) or DDW plus chlorhexidine acetate, in treatment of gastric cancer. METHODS: Five hundred cases of underwent radical gastrectomy and peritoneal lavage for 10 minutes with 400 ml of DDW at 43 degrees C, group B, with 89 cases who underwent radical gastrectomy and peritoneal lavage for ten minutes with 4 000 ml of DDW plus 0.6 g chlorhexidine acetate, and group C, with 213 cases who underwent radical gastrectorny and peritoneal lavage for four minutes with 4 000 ml of normal saline at normal temperature as controls. RESULTS: The group A and group B (called lavage group as a whole) had almost the same curative effects. The one-year survival rates and three-year survival rates were similar among the cases in different stages in no matter what group. The five-year survival rate was 63.8% in the lavage group and 51.2% in the control group, most of the cases with a good effect being at the mid-stage (II and III A stages). CONCLUSION: Peritoneal lavage, helpful in killing the exfoliated cancer cells in peritoneal cavity of patients with gastric cancer at II and III A stages, should be conducted in the treatment of gastric cancer by radical gastrectomy before closing the abdomen.
UI - 11819768
AU - Miehlke S; Kirsch C; Dragosics B; Gschwantler M; Oberhuber G; Antos D;
TI - Dite P; Lauter J; Labenz J; Leodolter A; Malfertheiner P; Neubauer A; Ehninger G; Stolte M; Bayerdorffer E Helicobacter pylori and gastric cancer:current status of the Austrain Czech German gastric cancer prevention trial (PRISMA Study).
SO - World J Gastroenterol 2001 Apr;7(2):243-7
AD - Medical Department I, Technical University Hospital Carl Gustav Carus, Fetscherstrabetae 74, D 01307 Dresden, Germany.
AIM: To test the hypothesis that Helicobacter pylori eradication alone can reduce the incidence of gastric cancer in a subgroup of individuals with an increased risk for this fatal disease. METHODS: It is a prospective, randomized, double blind, placebo controlled multinational multicenter trial. Men between 55 and 65 years of age with a gastric cancer phenotype of Helicobacter pylori gastritis are randomized to receive a 7 day course of omeprazole 2 X 20mg, clarithromycin 2 X 500mg, and amoxicillin 2 X 1g for 7 days, or omeprazole 2 X 20mg plus placebo. Follow-up endoscopy is scheduled 3 months after therapy, and thereafter in one-year intervals. Predefined study endpoints are gastric cancer, precancerous lesions (dysplasia, adenoma), other cancers, and death. patients (18.3%) had a corpus dominant type of H. pylori gastritis, and 167 of those were randomized (58.8%). In the active treatment group (r = 86), H. pylori infection infection was cured in 88.9% of patients. Currently, the cumulative follow-up time is 3046 months (253.38 patient years, median follow up 16 months). So far, none of the patients developed gastric cancer or any precancerous lesion. Three (1.8%) patients reached study endpoints other than gastric cancer. CONCLUSION: Among men between 55 and 65 years of age, the gastric cancer phenotype of H. pylori gastritis appears to be more common than expected. Further follow up and continuing recruitment are necessary to fulfil the main aim of the study.
UI - 11922582
AU - Hamajima N; Matuo K; Watanabe Y; Suzuki T; Nakamura T; Matsuura A; Yamao
TI - K; Ohashi K; Tominaga S A pilot study to evaluate stomach cancer risk reduction by Helicobacter pylori eradication.
SO - Am J Gastroenterol 2002 Mar;97(3):764-5
UI - 11956303
AU - Ikeda N; Shimada Y; Ohtsu A; Boku N; Tsuji Y; Saito H; Koizumi W; Iwase
TI - H; Yoshida S; Fukuda H A phase II study of doxifluridine in elderly patients with advanced gastric cancer: the Japan Clinical Oncology Group Study (JCOG 9410).
SO - Jpn J Clin Oncol 2002 Mar;32(3):90-4
AD - Department of Internal Medicine, Mitoyo General Hospital, Mitoyo-gun, Kagawa, Japan.
BACKGROUND: A previous phase II study of doxifluridine in non-elderly patients with advanced gastric cancer demonstrated a favorable survival with mild toxicity, despite a low response rate. The objectives of this study were to evaluate efficacy and feasibility of this agent for elderly patients. METHODS: This study protocol required elderly patients, aged 76-80 years, with advanced gastric cancer and having no prior chemotherapy. Doxifluridine, at a dose of 1400 mg/m(2)/day, was administered for four consecutive days followed by a 10-day rest. registered. The study was then closed because of poor accrual. Toxicity was moderate; three patients suffered from grade 3 anemia and one patient each had grade 3 thrombocytopenia, nausea/vomiting and grade 4 diarrhea. There was one partial response, seven with no change and 10 with progressive disease, yielding a response rate of 5.6%. The median progression-free survival and median survival time for the 18 patients were 55 and 164 days, respectively, with a 1-year survival rate of 5.6%. CONCLUSIONS: Although the number of patients was too small to draw any definitive conclusions, this study failed to demonstrate the survival advantage of doxifluridine.
UI - 2016625
AU - Wils JA; Klein HO; Wagener DJ; Bleiberg H; Reis H; Korsten F; Conroy T;
TI - Fickers M; Leyvraz S; Buyse M; et al Sequential high-dose methotrexate and fluorouracil combined with doxorubicin--a step ahead in the treatment of advanced gastric cancer: a trial of the European Organization for Research and Treatment of Cancer Gastrointestinal Tract Cooperative Group.
SO - J Clin Oncol 1991 May;9(5):827-31
AD - Laurentius Hospital, Roermond, The Netherlands.
In a prospective phase III multicenter trial, 213 patients with advanced measurable or nonmeasurable gastric cancer were randomized to receive methotrexate (MTX), fluorouracil (5-FU), and Adriamycin (doxorubicin; Farmitalia Carlo Erba, Milan, Italy) (FAMTX) or 5-FU, Adriamycin, and mitomycin (FAM). The results show a significantly superior response rate (41% v 9% [P less than .0001]), and survival (median, 42 weeks v 29 weeks [P = .004]) for FAMTX. There was a cumulative thrombocytopenia in FAM and not in FAMTX. The FAMTX protocol should be the reference treatment in future clinical trials that seek to improve the therapeutic outcome in advanced gastric cancer.
UI - 8996151
AU - Webb A; Cunningham D; Scarffe JH; Harper P; Norman A; Joffe JK; Hughes
TI - M; Mansi J; Findlay M; Hill A; Oates J; Nicolson M; Hickish T; O'Brien M; Iveson T; Watson M; Underhill C; Wardley A; Meehan M Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer.
SO - J Clin Oncol 1997 Jan;15(1):261-7
AD - Cancer Research Campaign (CRC) Section of Medicine, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.
PURPOSE: We report the results of a prospectively randomized study that compared the combination of epirubicin, cisplatin, and protracted venous infusion fluorouracil (5-FU) (ECF regimen) with the standard combination of 5-FU, doxorubicin, and methotrexate (FAMTX) in previously untreated patients with advanced esophagogastric cancer. PATIENTS AND METHODS: Two hundred seventy-four patients with adenocarcinoma or undifferentiated carcinoma were randomized and analyzed for survival, tumor response, toxicity, and quality of life (QL). RESULTS: The overall response rate was 45% (95% confidence interval [CI], 36% to 54%) with ECF and 21% (95% CI, 13% to 29%) with FAMTX (P = .0002). Toxicity was tolerable and there were only three toxic deaths. The FAMTX regimen caused more hematologic toxicity and serious infections, but ECF caused more emesis and alopecia. The median survival duration was 8.9 months with ECF and 5.7 months with FAMTX (P = .0009); at 1 year, 36% (95% CI, 27% to 45%) of ECF and 21% (95% CI, 14% to 29%) of FAMTX patients were alive. The median failure-free survival duration was 7.4 months with ECF and 3.4 months with FAMTX (P = .00006). The global QL scores were better for ECF at 24 weeks, but the remaining QL data showed no differences between either arm of the study. Hospital-based cost analysis on a subset of patients was similar for each arm and translated into an increment cost of $975 per life-year gained. CONCLUSION: The ECF regimen results in a survival and response advantage, tolerable toxicity, better QL and cost-effectiveness compared with FAMTX chemotherapy. This regimen should now be considered the standard treatment for advanced esophagogastric cancer.
UI - 11775185
AU - Tomita R; Fujisaki S; Tanjoh K; Fukuzawa M
TI - Operative technique on nearly total gastrectomy reconstructed by interposition of a jejunal J pouch with preservation of vagal nerve, lower esophageal sphincter, and pyloric sphincter for early gastric cancer.
SO - World J Surg 2001 Dec;25(12):1524-31
AD - Department of Surgery, Nippon Dental University, Tokyo, Japan.
Nearly total gastrectomy preserving the vagal nerve, the lower esophageal sphincter (LES), and the pyloric sphincter was developed as a function-preserving surgical technique to improve postgastrectomy disorders. In this paper, application criteria and technique are outlined, and postoperative quality of life was clinically investigated. Ten subjects who underwent this surgical operation (group A: 7 male and 3 female subjects at age 48 to 68 years with a mean age of 58.3 years) were interviewed to inquire about reflux esophagitis, dumping syndrome, and microgastria. Group A was compared with 20 cases of conventional total gastrectomy with D2 lymphadenectomy, excision of the lower esophageal sphincter (LES), total vagotomy, and single jejunal interposition (group B: 16 male and 4 female subjects at age 48 to 72 years with a mean age of 63.9 years). Included were cases with early cancer (M or SM1 of N0) localizing at the middle third and lower stomach, which was not applicable to endoscopic excision of gastric mucosa or partial gastric excision in M cancer, 2 cm or farther from the margin of the cancer to the esophagogastric mucosa cephalad junction and 3.5 cm or farther from the margin of the cancer to the pyloric caudad sphincter; in SM1 cancer, 4 cm or farther from the oral-side margin of the cancer to esophagogastric mucosa junction and 5.5 cm or farther from the anal-side margin of the cancer to the pyloric sphincter. In excision with lymph nodes, hepatic and celiac branches bifurcating from anterior and posterior trunks of the vagal nerve were preserved. To preserve LES, the esophagus was severed at the His angle at right angle to the longitudinal axis of the esophagus. The antrum was severed at 1.5 cm from the pyloric sphincter, preserving the arteria supraduodenalis. An alternative gaster was created as a 15-cm jejunal pouch with a 5-cm jejunal conduit for orthodromic peristaltic movement, using an automatic suture instrument to complete side-to-side anastomosis of folded jejunum with 1- to 1.5-cm long upper end of the pouch not anastomosed. The abdominal esophagus was mechanically anastomosed with a jejunal J pouch, and anastomosis of the pyloric antrum with a jejunal conduit was manually completed by stratum anastomosis. In group A, food ingestion per time could be taken the same as that of a healthy person, with no reflux esophagitis and dumping syndrome being noticed. Reflux esophagitis developed more significantly in group B than in group A (p < 0.05). In food ingestion per time, group B was significantly delayed compared with group A (p < 0.05). The present results suggested that the surgical technique proposed is a function-preserving gastric surgery appropriate to prevent postgastrectomy disorder of subjects.
UI - 11789278
AU - Yin G; Zhang W; Li G
TI - [Therapeutic effect of weikangfu on gastric precancerous disorder with spleen deficiency syndrome and its effect of gastric mucosal zinc, copper, cyclic adenosine monophosphate, superoxide dismutase, lipid peroxide and 3H-TdR lymphocyte conversion test]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 2000 Mar;20(3):176-9
AD - Wuxi Third People's Hospital, Jiangsu (214041).
OBJECTIVE: To observe the clinical therapeutic effect of Weikangfu granule (WKF) on intestinal metaplasia (IM), atypical proliferation (ATP) and its therapeutic mechanism. METHODS: Sixty-one patients (treated group) were diagnosed by integrated TCM and western medicine (WM), and treated according to Syndrome Differentiation, the amount of WKF was adjusted according to various Syndromes. The control group consisted of 54 patients, took Weisu granule without considering their Syndromes. Besides, 15 healthy subjects comprised of the control group. Gastroscopy was conducted both before and after the treatment, mucosal sample was taken from antral region of stomach for pathological changes, for IM classification through histochemical staining and for determination of gastric mucosal Zn, Cu, cAMP, SOD, serum LPO and 3H-TdR lymphocyte conversion test (LCT). RESULTS: (1) The symptomatic and pathologic therapeutic effect of the treated group were markedly better than those of the control group (P < 0.05, P < 0.01). (2) The levels of gastric mucosal Zn, Cu, cAMP, SOD and 3H-TdR LCT of the treated group before treatment were all lower than that of the healthy control group, but they were markedly increased after treatment, while serum LPO, however, increased before treatment, significant difference existed between the above groups (P < 0.05, P < 0.01). CONCLUSION: WKF can reverse IM and ATP of Spleen Deficiency Syndrome through the mechanism of improving the level of gastric mucosal Zn, Cu, cAMP and SOD, promoting cytodifferentiation, improving cytoimmunity, reducing superoxide and LPO.
UI - 11783226
AU - Hua B; Wang A
TI - [Clinical study on treatment of mid-late stage gastric carcinoma by composite xiansu capsule combined with chemotherapy]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 Aug;19(8):470-2
AD - Hou Wei Heilongjiang University of TCM, Harbin (150040).
OBJECTIVE: To assess the effect and mechanism of composite Xiansu Capsule (CXSC) combined with chemotherapy in treating gastric carcinoma of mid-late stage. METHODS: The 61 patients of the test group were treated by CXSC combined with chemotherapy and 30 patients of the control group treated with chemotherapy alone. The effect of treatment and cell mediated immunity of patients were observed. RESULTS: The effective rate of the test group and the control group was 32.8% and 13.3% respectively (P < 0.05), the chemotherapy caused toxic reaction occurrence was less in the former than that in the latter group (P < 0.01). The CD3 level of patients in the test group was decreased, and CD4/CD8 level was raised obviously, which suggested that CXSC had immuno-regulating effect on T-cells. CONCLUSION: CXSC could enhance the efficacy and reduce the toxic side-effect of chemotherapy. To regulate the cell mediated immunity of patients is possibly its mechanism.
UI - 11857099
AU - Madisch A; Wiedbrauck F; Marquard F; Stolte M; Hotz J
TI - [5-Fluorouracil-induced colitis--a review based upon consideration of 6 cases]
SO - Z Gastroenterol 2002 Feb;40(2):59-66
AD - Klinik fur Gastroenterologie, Allgemeines Krankenhaus Celle, Germany. firstname.lastname@example.org
BACKGROUND: At increasing use of high-dose 5-fluorouracil-based chemotherapy for metastatic colorectal and gastric cancer complicated which we looked for involvement of small intestine. We report summing up on the 6 cases including both endoscopic and histological findings in both sites of the gut.CASE REPORTS: In 2 men and 4 women (age 49-78 years) with advanced colon (n = 2), gastric (n = 3 ) and gallbladder (n = 1) cancer a palliative weekly high-dose infusional 5-fluorouracil (2,6 g/m(2)/24 h) and folinic acid (500 mg/m(2)/2 h) chemotherapy was performed. Few days after 1-5 chemotherapy courses the patients were admitted to our hospital with abdominal pain and partly severe watery diarrhea (up to 20 times evacuations/per day). The stool cultures were negative and there were no proof both of clostridium difficile and his toxin A and B. In 4 patients colonoscopy showed different grades of colitis up to diffuse erythema and microlesions, 2 patients had no visible lesions. In 4 patients endoscopy of the upper GI-tract showed a severe inflammation (n = 1) and a fibrinopurulent exsudate, severe edema and isolated ulcerations (n = 3) of jejunum after gastrectomy or duodenum with intact stomach. In the histological assessment different grades of 5-FU-induced colitis without (n = 2) or with (n = 4) involvement of the upper small intestine destruction of the superficial mucosa and crypts (epitheliumapoptosis) were found. 5 patients were treated by antibiotics (vancomycin n = 2, metronidazole n = 3), glucocorticoids (n = 5) and Saccaromyces cerevisiae (n = 3). After 8-10 days the patients were complete free of symptoms. One patient died due to the enterocolitis.CONCLUSIONS: The present cases demonstrate that high-dose 5-fluorouracil-based chemotherapy not only induces a colitis but also may involve the upper small intestine tract. Consequently, it represents an increasing and serious adverse event of high-dose chemotherapy. The etiology of the enterocolitis (drug- or bacterial-induced) needs further investigations in order to find a causal therapy and/or prophylaxis.
UI - 11952248
AU - Liu KJ; Atten MJ; Donahue PE; Attar BM
TI - Extended lymphadenectomy for gastric cancer: results in a teaching hospital.
SO - Am Surg 2002 Apr;68(4):365-71; discussion 371-2
AD - Department of Surgery, Cook County Hospital, Chicago, Illinois 60612, USA.
Lymphadenectomy including second-echelon lymph nodes (D2 resection) for gastric cancer has not been widely adopted partly as a result of a reported increase in operative morbidity and mortality. In the present study we examined the operative risk of D2 resection in a public teaching hospital. From 1995 to 1998, 57 patients underwent exploratory laparotomy for gastric neoplasm: nine with curative D2 resection (Group I), 17 with curative but less than D2 resection (Group II), 16 with palliative resection (Group III), and 15 with no resection (Group IV). Among the four groups, patients with curative D2 resection (Group I) were older and had increased operative time and estimated blood loss, but their need for blood transfusion, the operative morbidity and mortality, and the mean hospital stay were not increased. In contrast, those patients with palliative resection (Group III) had the highest morbidity among all groups, the only fatality, and prolonged hospital stay. Therefore, curative D2 resection can be performed safely even with significant resident involvement. The advanced patient age or the extensive dissection does not increase its surgical risk. Hence, D2 dissection should be considered whenever curative resection is feasible because it allows accurate staging with the added benefit of possible improvement in patient survival.
UI - 11962195
AU - Hehr T; Adamek HE
TI - [Value of postoperative radiochemotherapy with 5-fluorouracil plus leucovorin in stage IB-IV M0 stomach carcinoma]
SO - Strahlenther Onkol 2002 Mar;178(3):164-6
UI - 11783251
AU - Zhou K; Wang J; Liu B
TI - [Clinical study on effect of shenqi fuzheng injection combined with chemotherapy in treating gastric cancer]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 Jan;19(1):11-3
AD - Affiliated Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing (100700).
OBJECTIVE: To assess the clinical effect of Shenqi Fuzheng Injection (SQFZI) combined with chemotherapy in treating gastric cancer. METHODS: One hundred and twenty patients were randomly divided into 3 groups, the combined therapy group (Group A), the chemotherapy group (Group B) and the SQFZI group (Group C) and the effect on remission and stabilization of patients were observed. RESULTS: The remission rate and stabilizing rate of Group A were 16.1% and 87.1%, those of Group B were 13.5% and 64.9%, the difference between the two groups was significant, P < 0.05. The symptom and living quality improving rate of Group A were 75.8% and 43.5% respectively, those of Group C were 61.9% and 57.1% and of Group B were 35.1% and 29.7% respectively. SQFZI showed good protective effect on hemopoietic system, 4.8% patients in Group A with WBC count lower than 4 x 10(9)/L, while the percentage reached 21.6% in Group B, the difference between the two groups was significant, P < 0.05. Moreover, SQFZI could raise activity of NK cell, macrophage and T-lymphocyte subgroups, without any injury on heart, liver and kidney function or other adverse reaction. CONCLUSION: SQFZI combined with chemotherapy has certain effect of remission and stabilization on gastric cancer, the clinical effect is significant to patients with Qi-Deficiency, and is reliable and safe.
UI - 11923778
AU - Miyamoto S; Muto M; Hamamoto Y; Boku N; Ohtsu A; Baba S; Yoshida M;
TI - Ohkuwa M; Hosokawa K; Tajiri H; Yoshida S A new technique for endoscopic mucosal resection with an insulated-tip electrosurgical knife improves the completeness of resection of intramucosal gastric neoplasms.
SO - Gastrointest Endosc 2002 Apr;55(4):576-81
AD - Division of Digestive Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital, East Chiba, Japan.
BACKGROUND: En bloc resection is optimal for the cure of gastric neoplasms by endoscopic mu