National Cancer Institute®
Last Modified: May 1, 2002
UI - 11928051
AU - Mochiki E; Kamimura H; Haga N; Asao T; Kuwano H
TI - The technique of laparoscopically assisted total gastrectomy with jejunal interposition for early gastric cancer.
SO - Surg Endosc 2002 Mar;16(3):540-4
AD - First Department of Surgery, Faculty of Medicine, Gunma University, 3-39-15, Showa-machi, Maebashi 371-8511, Japan. firstname.lastname@example.org
BACKGROUND: In recent years, laparoscopic gastrectomy has been applied to the treatment of gastric cancer in Japan. However, there are few reports of laparoscopic or laparoscopically assisted total gastrectomy in the treatment of gastric cancer because of the difficulty of the surgical technique. Laparoscopically assisted total gastrectomies with jejunal interpositions were performed on four patients with early gastric cancer located in the upper portion of the stomach. METHODS: Four surgical ports were inserted into the abdomen. The stomach was lifted to the abdominal wall using newly developed retraction tubes. Gastric arteries were divided using ultrasonically activated coagulating shears and ligated with ligation forceps. Following these steps, a total gastrectomy reconstruction was performed by jejunal interposition through a small transverse laparotomy. An esophagojejunostomy and a jejunoduodenostomy were made with circular staplers. RESULTS: The mean operating time and blood loss were 246 min and 236 ml, respectively. The operations were performed without serious complications. All patients were pain free and ambulatory after the laparoscopically assisted total gastrectomy, and the mean postoperative hospital stay was 16 days. CONCLUSION: We successfully performed laparoscopically assisted total gastrectomies in a relatively short period of time. When patients are carefully selected, the laparoscopic procedure can be curative and minimally invasive as a treatment for early gastric cancer.
UI - 11865342
AU - Tsimoyiannis EC; Jabarin M; Tsimoyiannis JC; Betzios JP; Tsilikatis C;
TI - Glantzounis G Ultrasonically activated shears in extended lymphadenectomy for gastric cancer.
SO - World J Surg 2002 Feb;26(2):158-61
AD - Department of Surgery, G. Hatzikosta General Hospital, Makriyanni Avenue, GR-45001 Ioannina, Greece. email@example.com
Gastrectomy, followed by extended lymphadenectomy, is the treatment of choice in some stages of advanced gastric cancer. Lymphorrhea, as a result of the many divided lymphatic vessels, increases the morbidity. Ultrasonically activated coagulated shears (UACS) may divide all small vessels followed by immediate sealing of the coapted vessel walls. We designed a prospective randomized study to determine the effectiveness of the UACS versus monopolar electrosurgery in D2 dissection. Forty patients with gastric cancer stage II or stage IIIA were enrolled and randomized into 2 groups of 20 patients each. Group A underwent lymphatic dissection with monopolar cautery. Group B underwent lymphatic dissection with UACS.Subhepatic and left sudiaphragmatic closed drains were left until lymphorrhea and/or oozing stopped. Total gastrectomy was performed in 16 patients of group A and 14 of group B; subtotal gastrectomy was performed in 4 patients in group A and 6 patients in group B. The drains were removed after 6-17 days (mean 9.7 +/- 2.9) in group Aand after 4-8 days (mean 5.6 +/- 1.2) in group B(p < 0.001). The total amount of drained fluid was 300-2050 ml (mean 985 +/- 602) in group A and 230-1080 ml (mean 480 +/- 242) in group B (p < 0.002). Eight patients in group A and 5 in group B had postoperative fever, while 3 and 1 patients, respectively, had wound infections. In conclusion the use of UACS is a safe method of lymphatic dissection which reduces operative blood loss, postoperative lymphorrhea, blood transfusions,and hospital stay.
UI - 11910474
AU - Samson PS; Escovidal LA; Yrastorza SG; Veneracion RG; Nerves MY
TI - Re-study of gastric cancer: analysis of outcome.
SO - World J Surg 2002 Apr;26(4):428-33
AD - Department of Surgery, East Avenue Medical Center, East Avenue, Diliman 1100, Quezon City, Philippines. firstname.lastname@example.org
Cancer of the stomach (CaS) is a dreaded disease. Fortunately, there is a decreasing incidence, except in the East. The authors did a re-study of CaS, a widely investigated but unresolved gastrointestinal malignancy. The clinicopathologic features were evaluated to identify and measure the prognostic factors that would help the surgeon decide optimal therapy. Among 383 admitted for CaS at the East Avenue Medical 149 underwent radical resection with curative intent. (As historical control, the experience in 136 cases was reviewed during the immediately preceding 5-year period [1982-1986] when extended lymphadenectomy was not the standard policy.) For staging, the TNM system (tumor-node-metastasis) was used; to describe anatomy and surgery of stomach lymphatics, the "Japanese Rules," as modified, were adapted. Curative radical gastrectomy would include removal of the diseased stomach and regional lymphatics as defined by frozen section, including subtotal (or total) gastrectomy and "extended" D2 (with no. 12) node dissection. The clinicopathologic factors were statistically analyzed, using the accepted methods: Kaplan-Meier for survival, univariate analysis, and multivariate analysis for independent predictors. Of the 12 risk factors assessed by univariate analysis, the following were identified by multivariate analysis as independent prognosticators of survival: (1) wall penetration; (2) node invasion; (3) TNM stage; (4) resection margin; and (5) tumor size. After curative resection, the operative mortality was 5.3% and the complications, 19.4%. The 5-year survival was 60.4%, and recurrence, 15.4%. The results have shown that the pathology-related factors, (1) wall penetration; (2) node invasion; and (3) resection margin, are independent prognosticators of survival, remarkably affecting outcome. In conclusion, the study supports radical gastrectomy with extended D2 lymphadenectomy for CaS as safe and effective. Survival and recurrence are a function of pathology and adequate resection; operative mortality is defined by the patient's condition.
UI - 11910475
AU - Matsumoto K; Murayama T; Nagasaki K; Osumi K; Tanaka K; Nakamaru M;
TI - Kitajima M One-stage surgical management of concomitant abdominal aortic aneurysm and gastric or colorectal cancer.
SO - World J Surg 2002 Apr;26(4):434-7
AD - Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. email@example.com
One-stage surgical management of concomitant abdominal aortic aneurysm (AAA) and gastric or colorectal cancer should provide certain benefits. We reviewed the records of 21 patients with both AAA and gastric or colorectal cancer who underwent one-stage surgical management. Four had distal gastrectomy, 2 had total gastrectomy, and 5 had abdominoperineal rectal resection transperitoneally; 3 had total gastrectomy transperitoneally and AAA repair extraperitoneally. Two underwent right hemicolectomy and thromboexclusion of the AAA. Two had creation of a temporary ileostomy and implantation of an interposition graft. Two underwent left hemicolectomy, creation of a temporary transversostomy, and implantation of an interposition graft. One had a Hartmann's procedure and implantation of a bifurcated prosthetic interposition graft for AAA. There were no operative deaths or serious postoperative complications. One patient had colorectal ischemia that resolved with conservative treatment. Eighteen of the 21 patients (85.7%) were alive 10 months to 14 years postoperatively. In conclusion, one-stage surgical treatment of concomitant AAA and gastric or colorectal cancer is well tolerated and can avoid the time, financial costs, and patient anxiety involved in a second operation.
UI - 11819737
AU - Wang SJ; Wen DG; Zhang J; Man X; Liu H
TI - Intensify standardized therapy for esophageal and stomach cancer in tumor hospitals.
SO - World J Gastroenterol 2001 Feb;7(1):80-2
AD - Hebei Tumor Hospital, 5 Jiankanglu, Shijiazhuang 050011, Hebei Province, China.
UI - 11922742
AU - Kasakura Y; Mochizuki F; Wakabayashi K; Kochi M; Fujii M; Takayama T
TI - An evaluation of the effectiveness of extended lymph node dissection in patients with gastric cancer: a retrospective study of 1403 cases at a single institution.
SO - J Surg Res 2002 Apr;103(2):252-9
AD - Third Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan. firstname.lastname@example.org
BACKGROUND: Many investigators have reported that extended lymph node dissection (D2 dissection) is probably an effective procedure. However, the theory that D2 dissection leads to an improvement in survival has not been confirmed in randomized trials. We attempted to confirm the effectiveness of D2 dissection with gastrectomy for gastric cancer. MATERIALS AND METHODS: Gastric cancer patients (1403) underwent curative resection by D1 (991 patients) or D2 (412 patients) dissection with gastrectomy. Survival rates calculated for all patients and subdivided for stage, depth of invasion, and lymph node metastasis were compared between the two groups. The diagnosis of lymph node metastasis was compared between macroscopic and histological findings. RESULTS: There was no significant difference in the survival of patients overall. However, in the patients with stage II, T1 or T2, or N1 disease, the survival of the D2 group was significantly better than that of the D1 group. The false positive rates of lymph node metastasis were 53.3% in the N1 group, 26.2% in the N2 group, and 9.2% in the N3 group. In a considerable proportion of the N1 and N2 patients, histological findings proved more or fewer metastases than macroscopic diagnosis. CONCLUSIONS: Metastatic lymph nodes should be resected as far as possible. D2 dissection with gastrectomy is recommended for T1, N1 or T2, N1 disease, particularly in younger patients.
UI - 11937009
AU - Shah MA
TI - Recent developments in the treatment of gastric carcinoma.
SO - Curr Oncol Rep 2002 May;4(3):193-201
AD - Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. email@example.com
Surgery remains the mainstay for the curative treatment of gastric carcinoma. However, despite adequate surgery, survival remains poor. The use of adjuvant chemotherapy and radiotherapy has been examined in multiple previous clinical trials without convincing evidence of efficacy. However, recently, a large randomized controlled Intergroup trial, INT 116, demonstrated a survival advantage with chemoradiotherapy following curative surgery for gastric cancer. This review discusses the merits of the Intergroup trial and the ways in which it should affect the treatment of gastric cancer in the United States. INT 116 provides a foundation on which we can build to improve the care of patients with gastric cancer. With the evaluation of potentially better chemotherapeutic agents and the advent of molecularly directed therapy, there is increasing hope for improving the care of patients with gastric carcinoma.
UI - 11937012
AU - Yao JC; Ajani JA
TI - Adjuvant and preoperative chemotherapy for gastric cancer.
SO - Curr Oncol Rep 2002 May;4(3):222-8
AD - Department of Gastrointestinal Oncology, The University of Texas M.D. Anderson Cancer Center, Box 426, 1515 Holcombe Boulevard, Houston, TX 77005-4341, USA.
Gastric cancer is the second most frequently diagnosed malignancy worldwide, and the risk of relapse remains high in the majority of patients undergoing resection. Attempts to reduce this risk and prolong survival have led to numerous adjuvant chemotherapy trials that either had no benefit for patients or occasionally had controversial results. The recently reported Intergroup 0116 trial shows conclusive evidence of survival benefit for patients treated with postoperative chemoradiotherapy. In this Intergroup trial, which involves over 600 patients, a regimen of postoperative chemotherapy plus chemoradiotherapy was shown to prolong overall and disease-free survival in gastric cancer patients with stage IB through IV disease following a curative (R0) resection. This approach should be considered the standard of care in patients with gastric cancer who have undergone curative resection. Preoperative chemotherapy shows promise in downstaging tumors and increasing the rate of curative resection, but randomized trials are needed to assess survival benefits. Efforts to combine existing treatment modalities and new agents with novel mechanisms of action hold promise for the future.
UI - 11938366
AU - Schumacher IK; Hunsicker A; Youssef PS; Lorenz D
TI - Current concepts in gastric cancer surgery.
SO - Saudi Med J 2002 Jan;23(1):62-8
AD - Department of General and Gastroenterologic Surgery, Trauma Center, Warener Str. 7, D-12683, Berlin, Germany.
OBJECTIVE: Current problems in gastric cancer surgery concern the extent of gastric resection, the need for abdominal evisceration, the degree of lymphadenectomy, and an optimal preoperative tumor staging procedure. METHODS: A retrospective clinical trial of 284 patients who underwent surgery at Ernst-Moritz-Arndt-University, Greifswald, Germany for gastric cancer between 1987 and 1996. Main outcome measures consist of epidemiological parameters, data on type of surgery, histopathology, postoperative complications, mortality and cancer survival. Statistical analysis between groups was performed using Chi square test (perioperative risk factors, tumor localization, and surgical treatment) and Mann Whitney U tests (Lauren classification). Survival was calculated according to the Kaplan Meier method. RESULTS: The results are in favor of subtotal gastrectomy performed for all T stages located in the distal or middle 3rd provided that a tumor-free margin of 5 cm in intestinal type and 10 cm in diffuse Lauren's type tumor can be achieved, since this operation carries the lowest postoperative risks and provides the best postoperative quality of life. Resection of adjacent organs are indicated only if they are invaded by the primary tumor (T4). They should not be resected as part of an extended lymphadenectomy procedure. The primary tumor site should guide the degree of lymph node removal. Multimodal therapeutic approaches and high postoperative morbidity and mortality after exploratory laparotomy justify the use of diagnostic laparoscopy in T3 and T4 stage tumors and if diagnostic scans suggest tumor spread. CONCLUSION: Even though surgery for gastric cancer is well standardized, a tailored surgical approach to different extents of gastric cancer appears justified.
UI - 11961634
AU - Tagaya N; Mikami H; Kogure H; Kubota K; Hosoya Y; Nagai H
TI - Laparoscopic intragastric stapled resection of gastric submucosal tumors located near the esophagogastric junction.
SO - Surg Endosc 2002 Jan;16(1):177-9
AD - Second Department of Surgery, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan. firstname.lastname@example.org
BACKGROUND: Laparoscopic resection cannot be applied easily to tumors located near the esophagogastric junction or the pyloric ring. We evaluated our laparoscopic intragastric surgical technique for gastric submucosal tumors located near the esophagogastric junction and the results of a clinical study. MATERIALS AND METHODS: We performed our technique in six patients: one man and five woman with a mean age of 61 years. Using the laparoscopic procedure, after inflation of the stomach, we inserted two or three balloon-type ports into the stomach through the abdominal wall. RESULTS: A stapled resection of gastric submucosal tumors using a laparoscopic linear stapler was performed successfully in all the patients. Without exception, stapled resections were successfully performed. The mean operation time was 168 min, and the blood loss was minimal There were no intra- or postoperative complications. The mean postoperative hospital stay was 9.8 days. The mean maximal diameter size of the resected specimens was 2.4 cm. Histopathologic diagnoses were gastrointestinal stromal tumors in five cases and enterogenous cyst in one. There were no recurrences during a mean follow-up period of 27 +/- 11.6 months. CONCLUSION: Although we need to evaluate the long-term outcomes, our procedure is considered technically feasible, safe, and useful for the resection of gastric submucosal tumors located near the esophagogastric junction.
UI - 11917491
AU - Yoshida S
TI - [Therapeutic guideline reviews. Stomach cancer--the Japanese Society of Stomach Cancer]
SO - Nippon Naika Gakkai Zasshi 2002 Feb 10;91(2):674-84
UI - 11944951
AU - Yokota T; Kunii Y; Saito T; Teshima S; Yamada Y; Iwamoto K; Takahashi H;
TI - Takahashi M; Kikuchi S; Yamauchi H Prognostic factors of gastric cancer tumours of less than 2 cm in diameter: rationale for limited surgery.
SO - Eur J Surg Oncol 2002 Apr;28(3):209-13
AD - Department of Surgery, Sendai National Hospital, Sendai 983-8520, Japan. email@example.com
BACKGROUND: A recent trend in the surgical treatment of patients with early gastric cancer in Japan has been to limit surgery to an extent that ensures complete cure and improvement in the patient's quality of life. If a gastric cancer tumour can be completely eradicated by laparoscopic surgery, the patient can be cured of cancer without major operative stress. A small gastric cancer tumour of less than 2 cm in diameter is an indication for laparoscopic surgery, but little is known about what protocol of surgical treatment is appropriate for this type of tumour. PATIENTS AND METHODS: The clinicopathological features of 150 patients with gastric cancer tumour of less than 2 cm in diameter were reviewed retrospectively from hospital records between 1985 and 1995. The results of retrospective analysis of clinicopathological data of 24 patients with advanced cancer were compared with those of 126 patients with early cancer. Univariate and multivariate analyses of patients with small gastric cancer tumours were performed to evaluate the prognostic significance of clinicopathological features. RESULTS: A significant difference was seen between the gross tumour appearances in the two groups; Borrmann type-4 tumours were more common in the advanced group. Lymph-node metastasis, lymphatic vessel invasion and vascular invasion were found more frequently in the advanced cancer group than in the early cancer group. Scirrhous type was more common in the advanced cancer group. In univariate analysis, unfavourable prognostic factors included deep cancer invasion, presence of lymph-node metastasis, lymphatic invasion and vascular invasion. Using Cox's proportional hazard regression model, only nodal involvement emerged as an independent statistically significant prognostic parameter associated with long-term survival. CONCLUSION: Laparoscopic surgery should not be performed on tumours that are Borrmann type in macroscopic appearance and scirrhous-type histologically. Lymph-node metastasis is an independent prognostic factor. We recommend laparoscopic surgery involving local resection of the stomach without lymphadenectomy for small, early gastric cancer tumours that satisfy the criteria mentioned above. However, the validity of this recommendation should be tested by a prospective randomized control trial in the future. Copyright Harcourt Publishers Limited.
UI - 11757291
AU - Petrova MV; Voskresenskii SV; Krasnova TE
TI - [Changes in mechanical properties of the lungs in thoracic surgery in cancer patients]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):16-9
Mechanical characteristics of the lungs and time course of their changes at various stages of thoracal surgery were studied in 119 cancer patients. Lung compliance significantly decreased during transfer of the patients into lateral position. The ranges of normal values of lung compliance and aerodynamic resistance at the stage of one-lung ventilation were determined. The studies confirmed the necessity of intraoperative spirometry in the complex of thoracal operation monitoring.
UI - 11757296
AU - Pleskov AP
TI - [Central hemodynamics and prognostic significance of circulatory hyperdynamics after interventions for esophageal cancer]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):33-6
Central hemodynamic parameters were studied by direct catheterization of the pulmonary artery in 70 patients with cancer of the esophagus and cardial portion of the stomach during the early postoperative period after extensive or extensive-combined interventions through the thoracoabdominal access. Analysis of the mean initial and intraoperative parameters at different stages of the operation showed no essential deviations from the norm. Studies of heart production at different stages showed that during transfer of patients from the operation room into intensive care ward, one-third of patients developed low ejection syndrome and another one-third hyperdynamic syndrome, while the mean values looked satisfactory. On days 3-5, circulatory hyperdynamia was detected in 60% patients, which was observed over the entire period of observation in 75% patients. It is noteworthy that polyorgan failure was 4-fold more often observed in patients with normal cardiac output than in those with the hyperdynamic syndrome. Probable causes of this phenomenon are discussed.
UI - 11757308
AU - Nekhaev IV; Sviridova SP; Kiselevskii MV
TI - [Possibilities of immune prevention of pyo-septic complications in cancer patients by granulocytic colony stimulating factors]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):64-7
The study was carried out during the postoperative period in 75 patients with cancer of the esophagus and cardial portion of the stomach and 40 patients with lung cancer; 64 of these patients received immunoprophylactic treatment with neipogen, granulocytic colony-stimulating factor. Immune prevention resulted in a 2-fold decrease in the incidence and severity of pyoseptic and visceral complications and 1.5 times decrease in the duration of hospital treatment and mortality during the early postoperative period. Neipogen therapy was conductive to a 2-fold increase in the leukocyte count during the postoperative period in comparison with the control. The range of "safe" values of the major mediators of inflammations (TNF-alpha, IL-1, IL-8), characteristic of uneventful course of the postoperative period, was determined. About 75% pyoseptic complications were associated with mediator levels below this range. The levels of inflammation mediators in the patients treated with neipogen were within the safe range.
UI - 11928796
AU - Weber SM; Karpeh MS
TI - Randomized clinical trials in gastric cancer.
SO - Surg Oncol Clin N Am 2002 Jan;11(1):111-31, ix
AD - Section of Surgical Oncology, University of Wisconsin Hospital, Madison, USA. firstname.lastname@example.org
A total of 52 prospective, randomized controlled trials (RCT), published from 1975 to 2000, were reviewed for gastric cancer. The primary focus of these efforts has been the use of chemotherapy in patients with metastatic or locally advanced disease, accounting for 23 of the 52 trials. In comparison, there were only six surgical trials evaluating the extent of either primary resection or lymphadenectomy.
UI - 11996237
AU - de Manzoni G; Pedrazzani C; Pasini F; Di Leo A; Durante E; Castaldini G;
TI - Cordiano C Results of surgical treatment of adenocarcinoma of the gastric cardia.
SO - Ann Thorac Surg 2002 Apr;73(4):1035-40
AD - First Division of General Surgery, University of Verona, Italy. email@example.com
BACKGROUND: Comparison among different studies regarding adenocarcinoma of the cardia has been difficult since the Siewert classification was introduced. This study analyzed the experience of a single institution in the treatment of gastric cardia cancer with the aim of assessing principal prognostic factors and long-term outcome. METHODS: The results of 96 patients who underwent resection with curative intent for gastric cardia cancer at the First Division of General Surgery, University of with special reference to Siewert type. RESULTS: Despite a high number of curative resections (85.4%), the 5-year survival rate was poor (24%) for all Siewert types (p = 0.8), and for early tumors (51%) also. Chance of cure was limited to pN0 and pN1 patients. Multivariate analysis showed that microscopic or macroscopic residual tumor and pN-positive categories had a significantly higher risk of death (risk ratio, 2.18 and 2.68, respectively) and the pN2 and pN3 category had the most negative prognostic factor (risk ratio, 7.6). CONCLUSIONS: The long-term prognosis for gastric cardia cancer remains poor and is independent of Siewert type, with cure limited to pN0 and pN1 patients.
UI - 11941998
AU - de Manzoni G; Di Leo A; Tomezzoli A; Pedrazzani C; Piubello Q; Bonfiglio
TI - M; Valloncini E; Veraldi GF [Prognostic value of peritoneal lavage cytology in gastric cancer]
SO - Chir Ital 2002 Jan-Feb;54(1):1-6
AD - Divisione Clinicizzata di Chirurgia Generale, Universita di Verona, Ospedale Civile Maggiore, 37126 Verona.
The microscopic detection of free peritoneal tumour cells in peritoneal lavage fluid in gastric cancer patients is a useful predictor of peritoneal recurrence and poor prognosis. The aim of this study was to verify the prognostic significance of intraoperative peritoneal lavage cytology and its value as a predictor of peritoneal recurrence. We evaluated the presence of free peritoneal tumour cells with extemporary cytological examination in a series of 170 peritoneal washing samples from patients undergoing gastrectomy for gastric cancer over the period extemporary lavage cytology and there were no false-negatives as compared with the final examination. All patients with positive cytology presented serosal infiltration (T3/T4). Positive peritoneal lavage cytology was a predictor of poor prognosis and peritoneal recurrence: the 24 month survival rate was 17% for positive and 60% for negative cases (P = 0.003); in positive cases 71% of recurrences were located in the peritoneum. Intraoperative cytological examination of peritoneal washings can detect the presence of free malignant cells in the peritoneal cavity and can be used to select patients who may benefit from intraperitoneal chemotherapy.
UI - 11942007
AU - Sivelli R; Del Rio P; Bonati L; Sianesi M
TI - [Gastric polyps: a clinical contribution]
SO - Chir Ital 2002 Jan-Feb;54(1):37-40
AD - Istituto di Clinica Chirurgica Generale e dei Trapianti d'Organo Universita degli Studi di Parma.
The incidence of diagnosis of gastric polyps is now higher than in past years owing to the introduction of endoscopy in the diagnosis and treatment of upper digestive tract disease. One hundred and sixty-four median age of the patients was 61.4 years (range: 16-84 yrs). Polypoid lesions were more frequent in males (M:F = 1.5:1). Seventy-nine patients were asymptomatic (48.2%). Sixty-four percent of the polyps were located in the antrum. We diagnosed 73 hyperplastic polyps, 27 adenomatous lesions, 8 inflammatory polyps and 56 pseudopolyps. Malignant lesions were detected in 9 adenomatous polyps (4 type I and 5 type II early gastric cancers). Endoscopy is the examination of choice in the diagnosis and treatment of gastric polyps. We confirm that there is a relationship between histological type, neoplastic change and the size of the polyps.
UI - 11952588
AU - Jeung HC; Rha SY; Jang WI; Noh SH; Chung HC
TI - Treatment of advanced gastric cancer by palliative gastrectomy, cytoreductive therapy and postoperative intraperitoneal chemotherapy.
SO - Br J Surg 2002 Apr;89(4):460-6
AD - Cancer Metastasis Research Centre, Yonsei University College of Medicine, Seoul, Korea.
BACKGROUND: The treatment options for the 10-20 per cent of patients with gastric cancer who present with peritoneal dissemination are extremely limited and no standard approach exists. METHODS: The feasibility of using intraperitoneal chemotherapy to treat gastric cancer with intra-abdominal gross residual lesions after palliative gastrectomy with maximal cytoreduction was investigated. Early postoperative intraperitoneal chemotherapy started on the day of operation with 5-fluorouracil 500 mg/m2 and cisplatin 40 mg/m2 (days 1-3) over a 4-week interval. RESULTS: Of the 53 patients enrolled progression-free survival (PFS) was 7 months and the overall survival was 12 months. In multivariate analysis, performance status was the only significant defining factor for PFS (P = 0.009). The predominant toxicity was neutropenia and nausea/vomiting. The relative dose intensity of 5-fluorouracil and cisplatin was 89 and 63 per cent respectively. CONCLUSION: Performance status emerged as a major determining factor for prognosis and patient selection for early postoperative intraperitoneal chemotherapy in patients with advanced gastric cancer after maximally cytoreductive surgery.
UI - 11952589
AU - Yu W; Seo BY; Chung HY
TI - Postoperative body-weight loss and survival after curative resection for gastric cancer.
SO - Br J Surg 2002 Apr;89(4):467-70
AD - Department of Surgery, School of Medicine, Kyungpook National University, 50 Samduk-dong, Taegu, 700-721, Korea. firstname.lastname@example.org
BACKGROUND: Body-weight loss has been reported as a poor prognostic factor for some malignancies. The purpose of this study was to evaluate the prognostic value of postoperative body-weight loss in patients with gastric cancer. METHODS: In 564 patients who underwent curative resection for gastric cancer, usual body-weight, body-weight at the time of resection and that 6 and 12 months after resection were recorded prospectively. RESULTS: The 5-year survival rate of patients who lost more than 5 per cent of their 6-month postoperative weight by 12 months after resection was 63 per cent while that of patients who maintained 95 per cent or more of their 6-month postoperative weight was 84 per cent (P < 0.001). Multivariate analysis revealed that serosal invasion, nodal metastasis, body-weight loss during the second 6-month interval after resection and extent of gastric resection were independent prognostic indicators. CONCLUSION: When a patient loses body-weight during the second 6-month interval after curative resection for gastric cancer, recurrent disease should be suspected.
UI - 11997826
AU - Matthews BD; Walsh RM; Kercher KW; Sing RF; Pratt BL; Answini GA;
TI - Heniford BT Laparoscopic vs open resection of gastric stromal tumors.
SO - Surg Endosc 2002 May;16(5):803-7
AD - Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA. email@example.com
BACKGROUND: Gastric stromal tumors are rare neoplasms that may be benign or malignant. Given that malignant gastric stromal tumors rarely involve lymph nodes and require excision with negative margins, they appear amendable to laparoscopic excision. There are few reports of laparoscopic resection, and no comparisons have been done between laparoscopic and open surgery. This study compares the relative efficacy patients underwent 35 operations for gastric stromal tumors. Laparoscopic resections were performed in 21 patients; open resections were done in 12 patients. The medical records of the patients were reviewed retrospectively with regard to operating time, blood loss, length of stay, and clinical course. RESULTS: Patient demographics, tumor characteristics (mean tumor size, benign vs malignant), and presenting symptoms were similar for both groups. In the laparoscopic group, 15 wedge resections; three partial gastrectomies, and three transgastric needlescopic enucleations were performed. In the open group, six wedge resections, four antrectomies, and two partial proximal gastrectomies were performed. There were no significant differences in mean operative time (169 vs 160 min), mean estimated blood loss (106 vs 129 cc), or perioperative complication rate (9.5% vs 8.3%) between the laparoscopic and open groups, respectively. The mean length of stay was significantly less (p<0.05) in the laparoscopic group (3.8 vs 6.2 days). Average follow-up was 1.5 years. One patient in each group has died due to metastatic disease. There have been no trocar site recurrences. CONCLUSIONS: Laparoscopic resection of gastric stromal tumors is safe and appropriate. Tumor size, operating time, and estimated blood loss were equivalent to the open approach, and there was a statistically shorter hospital stay in the laparoscopic group.
UI - 11974538
AU - Barrientos C; Ponce R
TI - [Management of early gastric neoplasm]
SO - Rev Med Chil 2002 Feb;130(2):230-1; discussion 231-2
UI - 12019399
AU - Grossmann EM; Longo WE; Virgo KS; Johnson FE; Oprian CA; Henderson W;
TI - Daley J; Khuri SF Morbidity and mortality of gastrectomy for cancer in Department of Veterans Affairs Medical Centers.
SO - Surgery 2002 May;131(5):484-90
AD - Department of Surgery, Saint Louis University School of Medicine and the St Louis VA Medical Center, MO 63110-0250, USA.
BACKGROUND: The purpose of this study was to define risk factors that predict 30-day morbidity and mortality after gastrectomy for cancer in Veterans Affairs (VA) Medical Centers. METHODS: The VA National Surgical Quality Improvement Program prospectively collected data on 708 patients undergoing gastrectomy for cancer in 123 participating VA medical centers from 1991 to 1998. Independent variables included 68 preoperative patient characteristics and 12 intraoperative variables; the dependent variables were 21 defined adverse outcomes and death. Predictive models for 30-day morbidity and mortality were constructed by using stepwise logistic regression analysis. RESULTS: The 30-day morbidity rate was 33.3% (236 of 708). The overall 30-day mortality rate was 7.6% (54 of 708). Significant positive predictors of morbidity (P <.05) included current pneumonia, American Society of Anesthesiologists class IV (threat to life), partially dependent functional status, dyspnea on minimal exertion, preoperative transfusion, extended operative time, and increasing age. Significant positive predictors of mortality (P <.05) included do not resuscitate status, prior stroke, intraoperative transfusion, preoperative weight loss, preoperative transfusion, and elevated preoperative alkaline phosphatase level. CONCLUSIONS: Risk factors predicting morbidity and mortality rates at VA hospitals after gastrectomy for gastric cancer are reported by using a prospectively collected, multi-institutional database. Assigning relative weights to factors associated with adverse outcomes may help improve patient care.
UI - 12019405
AU - Kunisaki C; Shimada H; Nomura M; Akiyama H; Takahashi M; Matsuda G
TI - Lack of efficacy of prophylactic continuous hyperthermic peritoneal perfusion on subsequent peritoneal recurrence and survival in patients with advanced gastric cancer.
SO - Surgery 2002 May;131(5):521-8
AD - Second Department of Surgery, Yokohama City University, School of Medicine, Yokohama, Japan.
BACKGROUND: Peritoneal recurrence is a major cause of death in advanced gastric cancer. Although many kinds of chemotherapy intended to prevent peritoneal recurrence of gastric cancer have been evaluated, few have been successful. Few studies have assessed the clinical significance of continuous hyperthermic peritoneal perfusion in peritoneal recurrence. METHODS: From 1992 to 1999, a total of 124 patients with advanced gastric cancer with tumors invading deeper than the serosa but with no peritoneal metastasis underwent potentially curative gastrectomy and were enrolled in this study. Prophylactic continuous hyperthermic peritoneal perfusion (P-CHPP) was performed in 45 patients younger than 65 years old and without comorbidity who gave informed consent. Seventy-nine patients who did not meet the inclusion criteria represented the control group. After reconstruction of the alimentary tract, P-CHPP was carried out for 40 minutes with 150 mg cisplatin, 15 mg mitomycin C, and 150 mg etoposide in 5 to 6 L physiologic saline maintained at 42 degrees C to 43 degrees C. The surgical results, recurrent pattern, and postoperative morbidity were assessed by univariate and multivariate analysis. RESULTS: When compared with patients not undergoing P-CHPP, patients treated by P-CHPP had higher incidences of respiratory failure (73% vs 19%; P <.0001) and renal failure (7% vs 0%; P <.03). Neither 5-year survival (49% vs 56%) nor the patterns of recurrence (peritoneal, hematogenous, and lymphatic) were affected by P-CHPP. CONCLUSIONS: P-CHPP by our methods had no efficacy as prophylactic treatment for peritoneal recurrence induced by gastric cancer. New therapeutic strategies, such as chemosensitivity assessment, are necessary to obtain good therapeutic results with CHPP.
UI - 11374723
AU - Declich P; Tavani E; Porcellati M; Bellone S; Grassini R
TI - Long-term omeprazole treatment and fundic gland polyps: a very authoritative proof against a link?
SO - Am J Gastroenterol 2001 May;96(5):1650
UI - 11853213
AU - Hsu PI; Lai KH; Lo GH; Lin CK; Lo CC; Wang EM; Wang YY; Tsai WL; Lin CP;
TI - Tseng HH; Chen HC; Chen JL Sequential changes of gastric hyperplastic polyps following endoscopic ligation.
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Nov;64(11):609-14
AD - Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC.
BACKGROUND: Endoscopic ligation has been extensively applied in the management of esophageal and gastric varices with or without bleeding. The varices are automatically eradicated through the use of ligation. However, whether avascular necrosis will occur in a gastrointestinal polyp when the base is ligated remains unclear. The aims of this pilot study were to investigate the sequential changes of gastric hyperplastic polyps following endoscopic detachable snare ligation and to determine the possibility of induction of avascular necrosis in these lesions following ligation. METHODS: Eleven patients with eighteen gastric hyperplastic polyps were treated with endoscopic detachable-snare ligation. The polyps were observed for 5 minutes and biopsies were then conducted. At 14 days after endoscopic ligation, follow-up endoscopies were performed to assess the outcome of the strangulated polyps. RESULTS: After being strangulated by the detachable snares, a majority of the polyps immediately congested (94%), and then developed cyanotic change (89%) approximately 4 minutes later. Pathological examination revealed severe venous congestion in the lamina propria of the strangulated polyps. On follow-up endoscopy 2 weeks later, all the snares had dropped off, and avascular necrosis occurred in sixteen polyps (89%). All of the polyps with avascular necrosis were detected to have developed cyanotic changes in initial endoscopy. No complications occurred during or following the ligation procedure. CONCLUSIONS: Most gastric hyperplastic polyps develop avascular necrosis following ligation by detachable snare. Cyanotic change is an important predictor of the outcomes of the lesions following endoscopic ligation. The application of this ligation technique in treatment of bleeding or non-bleeding gastrointestinal polyps deserves further investigation.
UI - 11853214
AU - Chang FY
TI - Endoscopic ligation for removal of stomach hyperptastic polyp: less risk or saving money?
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Nov;64(11):615-6
UI - 12004845
AU - Panzini I; Gianni L; Fattori PP; Tassinari D; Imola M; Fabbri P;
TI - Arcangeli V; Drudi G; Canuti D; Fochessati F; Ravaioli A Adjuvant chemotherapy in gastric cancer: a meta-analysis of randomized trials and a comparison with previous meta-analyses.
SO - Tumori 2002 Jan-Feb;88(1):21-7
AD - Division of Medical Oncology, Ospedale Infermi, Rimini, Italy. firstname.lastname@example.org
AIMS AND BACKGROUND: Up to now adjuvant chemotherapy after curative resection for gastric cancer (GC) has been considered an experimental approach. The results of existing phase III randomized trials comparing chemotherapy with control after surgery are controversial. Three meta-analyses have been published in recent years. It is likely that each of them presents a theoretical bias, mainly as regards the inclusion criteria of the trials. In this article we re-examine this potential bias, highlighting the differences between the present and past meta-analyses on adjuvant chemotherapy for GC. METHODS: Only randomized controlled clinical trials comparing systemic adjuvant chemotherapy with control after radical resection of GC were eligible. Total mortality was assessed as outcome measure of the treatment effect and a pooled odds ratio was calculated using the Peto-Mantel-Haenszel method. RESULTS: After the selection process 17 papers (18 comparisons) proved eligible for inclusion in the meta-analysis with a total of 3118 patients, of whom 1546 randomized to the treatment arms and 1572 to the control arms; 762 and 871 deaths occurred in the treatment and control arms, respectively. Statistical analysis suggests an absence of significant heterogeneity between the trials and a significant advantage in survival for adjuvant chemotherapy (pooled odds ratio, 0.72, 95% Cl, 0.62-0.84). CONCLUSIONS: Our meta-analysis would seem to indicate that adjuvant chemotherapy results in a significant survival advantage in patients with GC. However, this observation undoubtedly requires confirmation in large randomized controlled trials including cisplatin before adjuvant chemotherapy after curative resection for GC can be proposed for use in clinical practice.
UI - 11836567
AU - Kim R; Tanabe K; Inoue H; Toge T
TI - Mechanism(s) of antitumor action in protracted infusion of low dose 5-fluorouracil and cisplatin in gastric carcinoma.
SO - Int J Oncol 2002 Mar;20(3):549-55
AD - Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan. email@example.com
The therapeutic efficacy of low dose administration of 5-fluorouracil (5-FU) and cisplatin (CDDP) (low dose FP) has been reported in patients with advanced and recurrent gastric carcinoma. Mechanism(s) by which low dose FP exerts antitumor effect is not entirely clear. We investigated mechanism(s) of the therapeutic efficacy in combination with 5-FU and CDDP in terms of signal transduction pathways leading to apoptosis. Using two human gastric carcinoma cell lines, MKN28 and MKN45, antitumor effect in combination treatment with 5-FU and CDDP was assessed by MTT 5-day assay. The significant antitumor effect was determined with more than 50% growth inhibition compared to control cells. Enhancement of antitumor effect in the combination treatment was analyzed using isobologram. Apoptotic cell death was assessed by DNA ladder formation assay, and expression of apoptosis-related genes was detected by Western blotting. Concentration of free platinum and 5-FU was measured by high-pressure liquid chromatography (HPLC), and dihydropyrimidine dehydrogenase (DPD) activity and total folate levels were assessed by enzyme immunoassays. Antitumor effect in single treatment with 5-FU was not observed significantly with the concentration from 1 to 5 microM in vitro. In contrast, antitumor effect in combination treatment with 5-FU and CDDP showed a synergism with the concentration of CDDP from 1.5 to 3 microM. Single treatment with CDDP also did not show significant antitumor effect with the concentration from 1.5 to 3 microM. The enhancement in the synergistic effect by CDDP was dose-dependent. Any free platinum treated with low dose CDDP was not detected into gastric carcinoma cells, however, treatment with CDDP induced a receptor signaling pathway, that is mediated by Fas but not DR4. It may directly activate caspase 3 leading to apoptosis. Although the receptor signaling pathway in apoptosis was not observed by 5-FU, Bax-induced cytochrome c and caspase 3 was also observed in a receptor-independent pathway by 5-FU and CDDP. Total folate levels by cotreatment with CDDP was increased to 1.5-fold compared to 5-FU alone, whereas DPD activity and 5-FU concentration were not changed by cotreatment of CDDP in vivo. The enhancement of antitumor effect by low dose FP can be explained as follows: i) low dose treatment with CDDP induces apoptotic cell death through a receptor signaling pathway even in absence of free platinum into cells; ii) increased folate level by CDDP and a non-receptor signaling pathways by 5-FU contribute to apoptotic cell death in gastric carcinoma.
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