National Cancer Institute®
Last Modified: January 1, 2002
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.
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
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. email@example.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.
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.
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.
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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.
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. firstname.lastname@example.org
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.
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.
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.
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. email@example.com
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.
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.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.
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.
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.
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.
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.
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.