National Cancer Institute®
Last Modified: February 1, 2002
UI - 11577792
AU - Sun W; Haller DG
TI - Recent advances in the treatment of gastric cancer.
SO - Drugs 2001;61(11):1545-51
AD - University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania 19104, USA.
Gastric cancer is one of the most common cancers in the world. The prognosis of the disease is poor, with only 40% of patients eligible to undergo potentially curative surgery. Even for those patients who undergo a complete resection, the rate of recurrence is very high. Extensive studies of multidisciplinary adjuvant treatment have been conducted seeking to improve the cure rates in the past two decades. The benefit of D2 dissection is still controversial and is undergoing prospective evaluation. Preliminary results from the United States Gastrointestinal Intergroup study, a well designed trial, have shown overall survival benefit of postoperative chemoradiation therapy. Neoadjuvant chemotherapy or chemoradiation is under active study in order to increase the number of patients to undergo potential curative surgery. Although many chemotherapy regimens have been developed recently, only modest clinical efficacy has been demonstrated for advanced metastatic disease. So far, there is no single regimen considered to be standard.
UI - 11780391
AU - Wu Q; Chen Z; Su W
TI - Growth inhibition of gastric cancer cells by all-trans retinoic acid through arresting cell cycle progression.
SO - Chin Med J (Engl) 2001 Sep;114(9):958-61
AD - Key Laboratory of Ministry of Education for Cell Biology and Tumor Cell Engineering, School of Life Sciences, Xiamen University, Xiamen 361005, China. firstname.lastname@example.org
OBJECTIVE: To investigate the mechanism of all-trans retinoic acid (ATRA) on the regulation of the cell cycle in gastric cancer cells. METHODS: The protein level was detected by Western blot. Immunoprecipitation was used in protein kinase activity determination. Cell growth and cell cycle phase were examined by MTT assay and flow-cytometric analysis, respectively. RESULTS: ATRA could effectively induce G0/G1 arrest and inhibit cell growth in certain human gastric cancer cell lines. ATRA might induce p21WAF1/CIP1 expression in ATRA-sensitive cell lines through p53-dependent and p53-independent pathways. Induction of p21WAF1/CIP1 caused decrease in CDK4 and CDK2 activities independent of CDK4 and CDK2 protein expression levels. In addition, the dephosphorylated form of Rb protein increased because of the down-regulation of CDK4 and CDK2 activities by ATRA. CONCLUSIONS: Growth inhibition on gastric cancer cells by ATRA occurs through the regulation of relevant proteins leading to the arrest of cell cycle progression.
UI - 11778280
AU - Xiong X; Zhu Z; Wen Z
TI - [Preliminary clinical comparison of HLF and ELF regimen in the treatment of advanced gastric carcinoma in middle-aged and elderly patients]
SO - Zhonghua Zhong Liu Za Zhi 2000 Sep;22(5):411-3
AD - Department of Gastrointestinal Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen Medical University, Guangzhou 510120, China.
OBJECTIVE: To observe the therapeutic effects and toxicity of HLF (hydroxycamptothecin HCPT/leucovorin LV/fluorouracil 5-Fu) regimen and ELF (etoposide VP-16/LV/5-Fu) regimen in middle-aged and elderly patients with advanced gastric carcinoma. METHODS: A group of twenty-five cases were treated with HLF regimen, and the other group of 23 cases were treated with ELF regimen. RESULTS: Of the 25 cases treated with HLF regimen, there was no complete remission (CR), but there were 12 partial response (PR), 11 no response (NC), and 2 had progressive disease (PD). The response rate (RR) was 48.0%. Of the 23 patients treated with ELF regimen, there was no CR, there were 9 PR, 11 NC, and 3 PD. The RR was 39.1% (P > 0.05). The main toxicity was myelosuppression and stomatocace. Grade III-IV stomatocace in HLF regimen group (68.0%) was more commonly seen than that in ELF regimen group (39.1%, P < 0.05). There was no cardiac or renal toxicity observed. CONCLUSION: HLF regimen is promising for treatment of advanced gastric carcinoma in middle-aged and elderly patients with the merits of low toxicity affecting heart, kidney and bladder except stomatocace, which is worthy of further clinical trial.
UI - 11808099
AU - Konishi T; Noie T; Furushima K; Harihara Y
TI - [Role of critical pathway in gastric cancer surgery]
SO - Nippon Shokakibyo Gakkai Zasshi 2001 Dec;98(12):1341-8
AD - Department of Surgery, Kanto Medical Center, NTTEC.
UI - 11816479
AU - Fujitani K; Kobayashi K; Tamaki Y; Tsujinaka T; Hirao M
TI - [Adjuvant chemotherapy after curative resection for gastric cancer-5'-DFUR + cisplatin vs 5'-DFUR]
SO - Gan To Kagaku Ryoho 2002 Jan;29(1):61-5
AD - Dept. of Surgery, Osaka National Hospital.
A prospective randomized study involving gastric cancer patients was conducted to evaluate combined adjuvant chemotherapy. Forty-two patients under 80 years of age who underwent a curative resection of pathologic stage II or III gastric cancer were randomly assigned to receive adjuvant chemotherapy containing the following two regimens from 1993 to 1996. A) Oral 5'-deoxy-5-fluorouridin (5'-DFUR) plus cisplatin: 5'-DFUR, daily administration, combined with CDDP 15 mg/m2/day, 30-min drip infusion, fortnightly for 8 weeks, repeated every 16 weeks. B) Oral 5'-DFUR alone: 5'-DFUR, daily administration. The dosages of 5'-DFUR were assigned according to the patients' body surface area (BSA): BSA < 1.7 m2, 600 mg and BSA > or = 1.7 m2, 800 mg, daily administration, bid. Twenty patients were assigned to regimen A, and 22 to regimen B. All clinicopathological factors were equally distributed in each regimen. No adverse reactions greater than grade 3 occurred in either regimen. There was no significant difference between the two regimens in overall survival or overall disease-free survival. For patients with positive nodes, the 5-year disease-free survival rates were 56.4% in A and 38.3% in B (p = 0.29). In stage III patients, the 5-year disease-free survival rates were 55.6% in A and 20.7% in B (p = 0.26). No significant survival benefit was observed with the combined chemotherapeutic regimen, 5'-DFUR plus cisplatin, compared with 5'-DFUR alone.
UI - 9790335
AU - Siewert JR; Bottcher K; Stein HJ; Roder JD
TI - Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study.
SO - Ann Surg 1998 Oct;228(4):449-61
AD - Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universitat Munchen, Germany.
OBJECTIVE: In 1986 a prospective multicenter observation trial in patients with resected gastric cancer was initiated in Germany. An analysis of prognostic factors based on the 10-year survival data is now presented. PATIENTS AND METHODS: A total of 1654 patients treated for gastric cancer between 1986 and 1989 at 19 centers in Germany and Austria were included. The resected specimen were evaluated histopathologically according to a standardized protocol. The extent of lymphadenectomy was classified after surgery based on the number of removed lymph nodes on histopathologic assessment (25 or fewer removed nodes, D1 or standard lymphadenectomy; >25 removed nodes, D2 or extended lymphadenectomy). Endpoint of the study was death. Follow-up is complete for 97% of the included patients (median follow-up of the surviving patients is 8.4 years). Prognostic factors were assessed by multivariate analysis. RESULTS: A complete macroscopic and microscopic tumor resection (R0 resection according to the UICC 1997) could be achieved in 1182 of the 1654 patients (71.5%). The calculated 10-year survival rate in the entire patient population was 26.3% +/- 4.7%; it was 36.1% +/- 1.6% after an R0 resection. In the total patient population there was an independent prognostic effect of the ratio between invaded and removed lymph nodes, the residual tumor (R) category, the pT category, the presence of postsurgical complications, and the presence of distant metastases. Multivariate analysis in the subgroup of patients who had a UICC R0 resection confirmed the nodal status, the pT category, and the presence of postsurgical complications as the major independent prognostic factors. The extent of lymph node dissection had a significant and independent effect on the 10-year survival rate in patients with stage II tumors. This effect was present in the subgroups with (pT2N1) and without (pT3N0) lymph node metastases on standard histopathologic assessment. The beneficial effect of extended lymph node dissection for stage II tumors persisted when patients with insufficient lymph node dissection (<15 nodes) were excluded from the analysis. There was no difference in the postsurgical morbidity and mortality rates between patients with standard and extended lymph node dissection. CONCLUSIONS: Lymph node ratio and lymph node status are the most important prognostic factors in patients with resected gastric cancer. In experienced centers, extended lymph node dissection does not increase the mortality or morbidity rate of resection for gastric cancer but markedly improves long-term survival in patients with stage II tumors. This effect appears to be independent of the phenomenon of stage migration.
UI - 11443465
AU - Adachi Y; Shiraishi N; Ikebe K; Aramaki M; Bandoh T; Kitano S
TI - Evaluation of the cost for laparoscopic-assisted Billroth I gastrectomy.
SO - Surg Endosc 2001 Sep;15(9):932-6
AD - Department of Surgery I, Oita Medical University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.
BACKGROUND: Despite the rapid spread of laparoscopic gastric surgery in Japan, no one has yet evaluated the costs for this new technique. The aim of this study was to analyze and compare the hospital charges for laparoscopic-assisted gastrectomy with those for conventional open gastrectomy. METHODS: The study included 48 consecutive patients who underwent laparoscopic-assisted Billroth I gastrectomy and 43 who had a conventional open Billroth I gastrectomy for cure of early gastric costs incurred during the hospital stay; they were divided into charges for consultation, prescription, injection, nursing care, operating theater, laboratory, radiology, ward and meal, and others. RESULTS: The patients who underwent laparoscopic gastrectomy were similar to those who had open gastrectomy in terms of symptoms, concurrent illness, operation time, proximal resection margin, number of harvested lymph nodes, and stage of the disease. Hospital stay after laparoscopic gastrectomy was shorter than that after open gastrectomy (16.1 vs 20.5 days, p < 0.01). Charges for nursing care, charges for ward and meal, and total hospital charges were less in the laparoscopic group than in the open group ( yen5800 vs yen8010, p < 0.01; yen461 x 10(3) vs yen512 x 10(3), p < 0.05; yen1336 x 10(3) vs yen1411 x 10(3), p = 0.072). When we compared laparoscopic gastrectomies performed during 1994-96 with those done during 1997-2000, we found a decrease in charges for ward and meal and total hospital charges ( yen498 x 10(3) vs yen421 x 10(3), p < 0.01; yen1390 x 10(3) vs yen1277 x 103, p < 0.01). Conclusion: Laparoscopic-assisted Billroth I gastrectomy is less expensive than conventional open Billroth I gastrectomy because both the postoperative recovery period and the hospital stay are shorter. In patients who undergo gastrectomy, the additional costs of the disposable instruments can be fully offset by the lower charges for ward and meal and nursing care associated with laparoscopic gastrectomy.
UI - 11735276
AU - Takeuchi K; Tsuzuki Y; Ando T; Sekihara M; Hara T; Yoshikawa M; Ohno Y;
TI - Kuwano H Total gastrectomy with distal pancreatectomy and splenectomy for advanced gastric cancer.
SO - J Surg Res 2001 Dec;101(2):196-201
AD - Department of Surgery, Tone Chuo Hospital, Numata-City, Gunma, Japan.
BACKGROUND: Pancreaticosplenectomy (PS) is often performed simultaneously with total gastrectomy (TG) to facilitate dissection of the lymph nodes around the splenic artery and splenic hilus. To evaluate the effects of PS on survival, a retrospective study was performed. METHODS: Various clinicopathological factors influencing lymph node metastasis around the splenic hilus (No. 10) and the splenic artery (No. 11) were studied retrospectively in the upper or middle third of advanced gastric cancer patients who underwent TG with PS. The postoperative morbidity, mortality, and survival rate of patients who underwent TG with PS (the TG with PS group) were compared with those of patients who underwent TG alone (the TG-alone group). RESULTS: Tumor size larger than 41 mm and lymph node No. 2 metastasis were independently correlated with lymph node No. 10 and No. 11 metastasis. The mortality rate was similar, but the morbidity rate was significantly higher in the TG with PS group. In the patients with stage I and III, there was no significant difference between the two groups, but in the patients with stage II, the TG-alone group was significantly better than the TG with PS group (P = 0.0400). CONCLUSIONS: Combined PS with TG should never be performed as the standard surgical procedure for every stage of gastric cancer, especially stage II.
UI - 11776630
AU - Shan J; Chen J; Wang S
TI - [Relationship between extent of tumor resection and prognosis: an evaluation in 533 cases of gastric cancer]
SO - Zhonghua Zhong Liu Za Zhi 1999 Nov;21(6):467-9
AD - Department of Oncology, First Affiliated Hospital, China Medical University, Shenyang, 110001.
OBJECTIVE: To evaluate prognosis of patients with stomach cancer based on the extent of tumor resection. METHODS: Five hundred and thirty-three cases of gastric cancer resected from 1980 through 1990 were divided into 3 categories A, B, and C, in the order of decreasing completeness of tumor resection as set forth in the 12th edition of "Rules for Gastric Cancer in Japan". RESULTS: There were 157 cases in category A, 209 cases in category B and 167 cases in category C. Their survival rate was 80.9%, 34.9%, and 9%, respectively. In category A and B, the depth of tumor invasion and lymph node metastasis were the major factors affecting survival rate. In the presence of lymph node metastasis, prognosis was dependent on which station (D1-D3) of lymph nodes dissected. In category B, if dissection covered D3 but metastasis was limited to I or II, the 5-year survival rate was 48%; if lymph node dissection performed was limited to the same station of lymph nodes where metastasis occurred, the 5-year survival rate dropped to 22.4% (P < 0.05). In case cancer left over at the cutting edge, the completeness of resection might drop from category A or B to C, and the 5-year survival rate correspondingly decreased to 6% and 12.2%, respectively. CONCLUSION: In order to ensure completeness of tumor resection, lymph node station dissected should be farther than that with metastasis, and the distance between the tumor and the cutting edge should be long enough to prevent residual tumor left behind.
UI - 11677934
AU - Bonenkamp JJ; Sasako M; Hermans J; van de Velde CJ
TI - Tumor load and surgical palliation in gastric cancer.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1219-21
AD - University Medical Center, St Radboud Nijmegen, The Netherlands.
BACKGROUND/AIMS: Most patients with gastric cancer will have resection, even if their disease stage is beyond curability. Proper criteria to assess tumor load in patients deemed noncurative are lacking, and therefore, it is not clear which of these patients will benefit from resection. METHODOLOGY: Of 996 gastric cancer patients who had laparotomy in a national randomized trial of lymphadenectomy for gastric cancer, 285 (29%) were found to be noncurable because of remnant tumor, peritoneal metastases, distant lymph node metastases or liver metastases. They underwent a palliative procedure considered appropriate by the surgeon. Tumor load in this group was analyzed retrospectively by calculating the number of noncurability signs. RESULTS: The number of signs of noncurability was related to the type of surgical palliation chosen by the surgeon: of those patients with only one sign of noncurability, 68% had a palliative stomach resection but, of patients with two or more positive signs of noncurability only 36% had a stomach resection. Median survival after palliative resection was 253 days compared to 169 days after a nonresective procedure (P = 0.002). This survival advantage for resected patients disappeared when two or more signs of noncurability were found. CONCLUSIONS: For patients deemed noncurative, survival depends on tumor load. Accurate preoperative assessment of tumor spread may prevent unnecessary high-risk surgical interventions for patients with noncurative gastric cancer.
UI - 11677935
AU - Jahne J; Piso P; Meyer HJ
TI - 1114 total gastrectomies in the surgical treatment of primary gastric adenocarcinoma--a 30-year single institution experience.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1222-6
AD - Klinik fur Allgemein-, Visceral- und Gefasschirurgie, Zentrum Chirurgie, Henriettenstiftung Hannover, Marienstrasse 72-90, D-30171 Hannover, Germany. email@example.com
BACKGROUND/AIMS: Surgical therapy still represents the standard treatment for gastric carcinoma. Due to epidemiology and tumor stage, total gastrectomy is the most often required extent of gastric resection to obtain a potentially curative status. After a 30-year period we overviewed 1114 total gastrectomies, to our knowledge one of the biggest single-institution series in the Western Hemisphere. METHODOLOGY: Among 1998, 1114 patients underwent total gastrectomy. This prospectively documented series was retrospectively analyzed with special focus on various time periods. RESULTS: A constant increase of proximal gastric carcinomas was noted. R0-resections were feasible in 84.6% of total gastrectomies. Morbidity and mortality decreased to 22.2% and 5.5%, respectively, in the last decade. Overall 5-years survival rate was 32.4%. Survival was strongly influenced by tumor stage and R-classification. Overall and prognosis after R0-resection showed a significant time-dependent improvement. CONCLUSIONS: Total gastrectomy requires intensive surgical skills and can be performed with acceptable morbidity and low mortality. Survival after total gastrectomy can be improved with increasing experience, and the aim of total gastrectomy for gastric carcinoma should always focus on a R0-resection.
UI - 11677936
AU - Kim JP; Yu HJ; Lee JH
TI - Results of immunochemo-surgery for gastric carcinoma.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1227-30
AD - Department of Surgery, Inje University Paik Hospital, 85 2-Ka, Jur-Dong, Chung-Ku, Seoul, 100-032, Korea. firstname.lastname@example.org
BACKGROUND/AIMS: Although the therapeutic results of gastric cancer have markedly improved, it still remains the most common cancer death in Korea. METHODOLOGY: The clinicopathologic characteristics were analyzed for 11,491 consecutive patients who underwent operation for gastric cancer at the Department of Surgery, Seoul National University Hospital from 1971 to 1997. We also evaluated the survival and prognostic factors for 9,262 consecutive patients from 1981 to 1996. The prognostic significance of treatment modality [surgery alone, surgery + chemotherapy, surgery + immunotherapy + chemotherapy (immunochemo-surgery)] were evaluated in stage III gastric cancer. RESULTS: The 5-year survival rate of overall patients was 55.8%, and that of patients who received curative resection was 64.8%. The 5-year survival rates according to TNM stage were 92.9% for Ia, 84.2% for Ib, 69.3% for II, 45.8% for IIIa, 29.6% for IIIb and 9.2% for IV. Depending on the extent of resection, the 5-year survival rates were 68.7% for STG, 45.4% for TG, 19.6% for combined resection and there was no 5-year survivor in the nonresection group. Regarding adjuvant treatment modality, significant survival difference was observed in stage III patients. The 5-year survival rates were 44.8% for the immunochemo-surgery group, 36.8% for the surgery + chemotherapy group and 27.2% for the surgery alone group. CONCLUSIONS: Curative resection, depth of invasion and lymph node metastasis were the most significant prognostic factors in gastric cancer. Consequently, early detection and curative resection with radical lymph node dissection, followed by immunochemotherapy especially in patients with stage III gastric cancer should be recommended as a standard treatment principle for patients with gastric cancer.
UI - 11677937
AU - Monig SP; Schroder W; Beckurts KT; Holscher AH
TI - Classification, diagnosis and surgical treatment of carcinomas of the gastroesophageal junction.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1231-7
AD - Department of Visceral and Vascular Surgery, University of Cologne, Joseph-Stelzmann Str. 9, 50924 Cologne, Germany.
The incidence of adenocarcinoma of the gastroesophageal junction has risen faster than that of any other malignancy in various western countries. Adenocarcinoma of the gastroesophageal junction can be topographically classified into three types: carcinomas of the distal esophagus (type I), true carcinomas of the cardia (type II) and carcinomas of the subcardial region (type III). This surgical classification has proven to be of value for planning the extent of resection and for comparing epidemiologic data and therapeutic results of different series. The preoperative assignment is achieved by contrast X-ray and endoscopy and enables the surgeon to plan preoperatively the adequate extent of the resection. The type I-adenocarcinoma represents a distal esophageal cancer and consequently is treated by esophageal resection as transhiatal subtotal radical esophagectomy or in case of more proximal carcinoma by transthoracic en bloc esophagectomy. The type II- and type III-adenocarcinomas are treated by a gastrectomy and distal esophageal resection with D2-lymphadenectomy via an abdominal and transhiatal approach. In case of an advanced carcinoma with high risk of incomplete resection, neoadjuvant radiochemotherapy should be taken into consideration.
UI - 11677938
AU - Sugarbaker PH; Yonemura Y
TI - Palliation with a glimmer of hope: management of resectable gastric cancer with peritoneal carcinomatosis.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1238-47
AD - Washington Cancer Institute, Washington, DC 20010, USA.
In the United States peritoneal seeding from primary gastric cancer occurs in 20-30% of patients. The diagnosis of this advanced disease is usually not provided by clinical studies prior to abdominal exploration. The surgeon is forced to make an intraoperative judgement concerning the risks and benefits of an aggressive management plan versus supportive care. A treatment strategy for this difficult group of patients has been devised and tested in phase II studies. It utilizes extended gastrectomy plus peritonectomy to maximally cytoreduce tumor combined with perioperative intraperitoneal chemotherapy. The perioperative intraperitoneal mitomycin-C chemotherapy is heated to 42 degrees C and manually distributed to provide uniform treatment to all peritoneal surfaces and the resection site. Early postoperative intraperitoneal 5-fluorouracil is gravity distributed. The pharmacologic parameters have been established. Relevant clinical information was collected in this review. Five-year survival of these patients in whom a complete cytoreduction was possible has been observed and a prolonged median survival occurs. Gastrectomy with peritonectomy to eliminate all visible implants combined with perioperative intraperitoneal chemotherapy should be considered in all patients with primary gastric cancer and peritoneal carcinomatosis.
UI - 11677969
AU - Hsieh YH; Lin HJ; Tseng GY; Perng CL; Li AF; Chang FY; Lee SD
TI - Is submucosal epinephrine injection necessary before polypectomy? A prospective, comparative study.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1379-82
AD - Buddhish Tzu Chi Dalin General Hospital, Taiwan, ROC.
BACKGROUND/AIMS: Polyps of the gastrointestinal tract are usually removed due to their link to bleeding, obstruction and malignancy. However, complications may occur following polypectomy. The aim of this study was to assess whether submucosal epinephrine injection before polypectomy could reduce the incidence of bleeding and perforation. polyps of the gastrointestinal tract found in our endoscopic unit were randomized to receive submucosal epinephrine injection (epinephrine group) or no injection (control group) before polypectomy. In the epinephrine group, epinephrine (1:10,000) was injected surrounding the stalk of the polyp until the mucosa was blanched and bulged. The patients were observed for complications in the following month. RESULTS: A total of 120 patients with 151 sessile polyps were enrolled in this study. In the epinephrine group, 75 polyps (n = 68) were randomized to receive epinephrine injection before polypectomy. In the control group, 76 polyps (n = 61) underwent polypectomy without epinephrine injection. In both groups, there was no significant difference in clinical features including the sizes of the polyps and their stalks, the location of polyps and the pathological diagnosis. There were a total of nine episodes of post-polypectomy hemorrhage, two in the epinephrine group and seven in the control group (2/75 vs. 7/76) (P = 0.07). One case in the epinephrine group experienced delayed bleeding (4 days later). Immediate hemorrhage occurred less in the epinephrine group than that in the control group (1/75 vs. 7/76, P = 0.03). There was one case of perforation in each group. CONCLUSIONS: Epinephrine injection prior to polypectomy is effective in preventing immediate bleeding.
UI - 11677971
AU - Korenaga D; Yasuda M; Takesue F; Honda M; Inutsuka S; Nagahama S;
TI - Maekawa S Factors influencing the development of small intestinal obstruction following total gastrectomy for gastric cancer: the impact of reconstructive route in the Roux-en-Y procedure.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1389-92
AD - Department of General Surgery, Fukuoka Dental College Hospital, Tamura 2-15-1, Sawara-ku, Fukuoka 814-0193, Japan.
BACKGROUND/AIMS: The factors influencing the development of small intestinal obstruction following gastric surgery are controversial. METHODOLOGY: Univariate and multivariate analyses were carried out on data from 48 patients with gastric cancer who underwent total gastrectomy and Roux-en-Y reconstruction for a potential cure. RESULTS: Of these 48 patients, 11 (22.9%) presented with mechanical obstruction in the small intestine postoperatively. There were no statistically significant differences with regard to age, sex, and the presenting pathology. The development of obstruction was not related to a longer operation time, a greater estimated blood loss during surgery, an extensive lymph node dissection and a combined resection of adjacent organs. The probability that the antecolic anastomosis would cause obstruction was significant when compared with findings in case of the retrocolic anastomosis (P < 0.05). In the multivariate logistic regression analysis, the significant risk factors related to the development of small intestinal obstruction proved to be reconstructive route of jejunal loop. CONCLUSIONS: In potentially curative patients undergoing total gastrectomy, retrocolic anastomosis should be attempted to prevent the development of postoperative intestinal obstruction.
UI - 11677996
AU - Tsujitani S; Oka S; Suzuki K; Saito H; Kondo A; Ikeguchi M; Maeta M;
TI - Kaibara N Prognostic factors in patients with advanced gastric cancer treated by noncurative resection: a multivariate analysis.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1504-8
AD - Department of Surgery I, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan. email@example.com
BACKGROUND/AIMS: The relationship between prognostic factors and survival time after noncurative gastric resection in patients with advanced gastric cancer was examined by a retrospective review of data on 364 patients. METHODOLOGY: There were 168 patients without metastasis to the liver or peritoneum (group A), 127 with peritoneal metastasis and no liver metastasis (group B), 50 with liver metastasis and no peritoneal metastasis (group C) and 19 with synchronous liver and peritoneal metastases (group D). Patients were primarily treated with the following 3 drugs: the fluorinated pyrimidines, cisplatin, and mitomycin C. RESULTS: Patients in group D had a very poor prognosis as compared with the other groups. Multivariate analysis using the Cox's proportional hazard model adjusted for sex, age, and other covariants indicated that lymph node metastasis, lymph node dissection, and fluorinated pyrimidines for group A, cisplatin for group B, and lymph node dissection for group C were independent prognostic factors. An analysis of patients excluding cases who died within 30 days after surgery revealed that lymph node dissection for group A, lymph node dissection and cisplatin for group B, and lymph node dissection for group C were independent prognostic factors. CONCLUSIONS: Treatment protocol specific for the residual disease may improve the survival of patients with advanced gastric cancer treated by noncurative resection.
UI - 11677997
AU - Yoshikawa T; Tsuburaya A; Kobayashi O; Sairenji M; Motohashi H; Noguchi
TI - Y Should scirrhous gastric carcinoma be treated surgically? Clinical experiences with 233 cases and a retrospective analysis of prognosticators.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1509-12
AD - Third Department of Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama 241, Japan. firstname.lastname@example.org
BACKGROUND/AIMS: The prognosis of patients with scirrhous gastric carcinoma has been poorest. METHODOLOGY: To clarify the role of surgical treatment, 233 patients with a primary scirrhous gastric carcinoma were retrospectively analyzed. RESULTS: Of the 233 patients, 182 underwent surgical resection, while the other 51 did not. The median survival time of those with unresectable tumors was 88.0 +/- 15.3 days and that of those who underwent resection was 380.0 +/- 41.8 days. In the 182 patients who underwent resection, multivariate analysis revealed four significant factors; lymphatic invasion, serosal invasion, curability, and lymph node dissection. Of these, curability was the most significant. The median survival time of patients whose tumor were curatively resected was 727.0 +/- 116.3 days, significantly longer than 272 +/- 34.9 days for those whose resection ended noncuratively. In 65 patients whose tumor was curatively resected, subset analyses of factors by multivariate analyses revealed an absence of serosal invasion as the single significant prognosticator. The 5-year survival rate was 55.6% in patients with scirrhous cancer without serosal invasion. CONCLUSIONS: For patients with scirrhous gastric carcinoma, palliative resection should not be attempted for poor outcome. However, if curative resection seems feasible, radical surgery would be justified, especially for tumors without serosal exposure.
UI - 11677998
AU - Hinoshita E; Takahashi I; Onohara T; Nishizaki T; Matsusaka T; Wakasugi
TI - K; Ishikawa T; Kume K; Maehara Y; Sugimachi K The nutritional advantages of proximal gastrectomy for early gastric cancer.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1513-6
AD - Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan. email@example.com
BACKGROUND/AIMS: Total gastrectomy has generally been performed for the treatment of early gastric cancers involving the upper third of the stomach. However, proximal gastrectomy has also been used for the treatment of cardial early gastric cancer. METHODOLOGY: To compare the nutritional parameters after proximal gastrectomy with the parameters after total gastrectomy, and to also determine the advantages of the postoperative nutritional states, a retrospective analysis was made to evaluate the nutritional status of patients with early gastric cancer who underwent proximal gastrectomy with those undergoing total gastrectomy. Forty-nine patients were studied for one year after surgery; 9 underwent proximal gastrectomy while 40 had a total gastrectomy. RESULTS: Proximal gastrectomy allowed the patient to better maintain both their nutritional parameters and body weight. CONCLUSIONS: Proximal gastrectomy was thus found to be a beneficial modality for early gastric cancer patients regarding terms of the postoperative nutritional status, in comparison to total gastrectomy.
UI - 11677999
AU - Ikeguchi M; Oka S; Gomyo Y; Tsujitani S; Maeta M; Kaibara N
TI - Postoperative morbidity and mortality after gastrectomy for gastric carcinoma.
SO - Hepatogastroenterology 2001 Sep-Oct;48(41):1517-20
AD - First Department of Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago 683-8504, Japan.
BACKGROUND/AIMS: Surgical technique and postoperative care for gastric cancer have significantly improved in recent years. However, whether postoperative morbidity or mortality rates after gastrectomy for gastric cancer were reduced or not in recent years was unclear. In this study, we analyzed the chronological changes of postoperative morbidity and mortality rates, and we analyzed risk factors for postoperative morbidity and mortality in patients undergoing gastrectomy for carcinomas of the stomach. METHODOLOGY: A total of 887 patients with basis of chronology. The first group included patients treated over the period 1985 to 1988 (n = 324); the second group, 1989 to 1992 (n = 300); and the third group, 1993 to 1996 (n = 263). Postoperative morbidity rates and mortality rates were compared among the three groups. Also, significant risk factors affecting postoperative morbidity and in-hospital mortality were analyzed by the multiple logistic regression analysis. RESULTS: Postoperative complications were detected in 95 patients (10.7%) and in-hospital mortality rate was 2.4% (21/887). Postoperative morbidity rates were 10.5%, 11%, and 10.6% in the first, second, and third groups, respectively and postoperative mortality rates were 2.5%, 2%, and 2.7%, respectively. These postoperative morbidity and mortality rates were not different between the groups (P = 0.979 and P = 0.866). The most common postoperative complication was anastomotic leakage (56/95, 58.9%). Significant risk factors affecting in-hospital mortality were Stage IV (P = 0.006) and noncurative gastric resection (P = 0.004). However, the extent of lymph node dissection, combined resection, or the existence of preoperative complications were not significant risk factors of in-hospital mortality by multiple logistic regression analysis. CONCLUSIONS: These results indicate that patients with far-advanced gastric cancer might have a high risk of postoperative mortality. In noncurative operations for patients with advanced gastric cancer, unnecessary lymph node dissection or combined resection should be avoided.
UI - 11788554
AU - Zhang ZW; Abdullahi M; Farthing MJ
TI - Effect of physiological concentrations of vitamin C on gastric cancer cells and Helicobacter pylori.
SO - Gut 2002 Feb;50(2):165-9
AD - Digestive Diseases Research Centre, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK. firstname.lastname@example.org
BACKGROUND: Gastric juice vitamin C may be protective against gastric carcinogenesis but concentrations are significantly reduced by Helicobacter pylori infection. We investigated the in vitro effects of vitamin C at concentrations comparable with those found in gastric juice on gastric cancer cells and H pylori. METHODS: Gastric cancer cell lines and various H pylori strains were treated with L-ascorbic acid for up to 72 hours. Cell viability, and protein and DNA synthesis were determined. Flow cytometry was used for assessment of H pylori adherence, cell cycle distribution, and apoptosis. H pylori growth and its haemagglutination activity were determined using viability count and microtitration assay. RESULTS: Vitamin C induced a significant dose dependent growth inhibition of gastric AGS and MKN45 cells but this effect was significantly reduced at levels similar to those in gastric juice of H pylori infected patients (<50 microM). Although vitamin C had no obvious effect on H pylori growth, haemagglutination activity, or adherence ability to gastric AGS cells compared with untreated controls, it significantly enhanced H pylori associated apoptosis and induced cell cycle arrest in these cells. CONCLUSION: Vitamin C may inhibit gastric cancer cell growth and alter H pylori induced cell cycle events at concentrations comparable with those in gastric juice, but has no effect on H pylori growth or pathogenicity. However, the inhibitory effect on gastric cancer cells was lost at vitamin C concentrations found in patients with H pylori infection.
UI - 11788564
AU - Spencer GM; Thorpe SM; Blackman GM; Solano J; Tobias JS; Lovat LB; Bown
TI - SG Laser augmented by brachytherapy versus laser alone in the palliation of adenocarcinoma of the oesophagus and cardia: a randomised study.
SO - Gut 2002 Feb;50(2):224-7
AD - National Medical Laser Centre, Institute of Surgical Studies, Royal Free and University College Medical School, London, UK.
BACKGROUND: Many patients with advanced malignant dysphagia are not suitable for definitive treatment. The best option for palliation of dysphagia varies between patients. This paper looks at a simple technique for enhancing laser recanalisation. AIM: To assess the value of adjunctive brachytherapy in prolonging palliation of malignant dysphagia by endoscopic laser therapy. PATIENTS: Twenty two patients with advanced malignant dysphagia due to adenocarcinoma of the oesophagus or gastric cardia, unsuitable for surgery or radical chemoradiotherapy. METHODS: Patients able to eat a soft diet after laser recanalisation were randomised to no further therapy or a single treatment with brachytherapy (10 Gy). Results were judged on the quality and duration of dysphagia palliation, need for subsequent intervention, complications, and survival. RESULTS: The median dysphagia score for all patients two weeks after initial treatment was 1 (some solids). The median dysphagia palliated interval from the end of initial treatment to recurrent dysphagia or death increased from five weeks (control group) to 19 weeks (brachytherapy group). Three patients had some odynophagia for up to six weeks after brachytherapy. There was no other treatment related morbidity or mortality. Further intervention was required in 10 of 11 control patients (median five further procedures) compared with 7/11 brachytherapy patients (median two further procedures). There was no difference in survival (median 20 weeks (control), 26 weeks (brachytherapy)). CONCLUSIONS: Laser therapy followed by brachytherapy is a safe, straightforward, and effective option for palliating advanced malignant dysphagia, which is complementary to stent insertion.
UI - 11778748
AU - Inoue H
TI - Endoscopic mucosal resection for the entire gastrointestinal mucosal lesions.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):459-78
AD - Department of Gastroenterology, Showa Northern Yokohama Hospital School of Medicine, Showa University, Japan. email@example.com
In general, mucosal cancer of the gastrointestinal tract has the lowest risk of lymph node metastasis, and is curatively managed by the EMR procedure.
UI - 11778751
AU - Tada M
TI - Endoscopic mucosal resection of the stomach: initial description.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):499-510
AD - Division of Gastroenterology, Saitama Cancer Center, Japan. firstname.lastname@example.org
A quantitative change of the enlargement of the biopsy specimen resulted in a qualitative change for endoscopy from only diagnosis to include therapy. This change of quality was also caused by another quantitative change of the size of detectable lesion, which was made smaller.
UI - 11778752
AU - Suzuki H
TI - Endoscopic mucosal resection using ligating device for early gastric cancer.
SO - Gastrointest Endosc Clin N Am 2001 Jul;11(3):511-8
AD - Department of Endoscopy, Jikei University School of Medicine, Tokyo, Japan.
The advent of EMR made a major change in the strategy for early gastric cancer. Recently, many modified EMR techniques have been developed, such as using an endoscopic cap, a special tube, and so forth. We regard EMR-L as the first-line procedure because of its simplicity and ease, and it is hoped that all endoscopists will learn this procedure to improve the quality of life of patients who suffer from gastric cancer.
UI - 9424910
AU - Gorka Z; Wojtyczka A; Lampe P; Nowak J; Kusnierz K
TI - [Total gastrectomy using Longmire's and Roux method. Evaluation of the invagination technique for esophageal-jejunal anastomosis]
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():394-400
AD - Kliniki Chirurgii Przewodu Pokarmowego Slaskiej Akademii Medycznej w Katowicach.
582 patients were gastrectomized between 1976 and 1996 in the Department for Gastrointestinal Surgery in Katowice/Poland for gastric cancer. Before 1985 esophago-jejunal anastomosis have been accomplished using a simple end-to-end or special end-to-side (Schreiber-Eichfuss) method with jejunoplication. Thereafter we used an end-to-end invagination method with 4-5 cm deep intussusception of the first raw of sutures into jejunum. Comparison of the occurrence of short and long term complications at the site of esophago-jejunal anastomosis showed that invagination technique is safer that the previous one. It is associated with the lower rate of short and long term complications (dehiscence, stenosis, oesophagitis). Details of the surgical procedure facilitating the accomplishment of the tight and safe anastomosis are presented.
UI - 9424911
AU - Tenderenda M; Berner J; Pasz S; Berner A; Nowicki T
TI - [Reconstruction methods for the continuous digestive tract using surgical stapling after gastrectomy with lymphadenectomy in patients undergoing surgery for stomach cancer. Personal evaluation]
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():401-6
AD - Kliniki Chirurgii Onkologicznej Akademii Medycznej w Lodzi.
From 1984 to 1994, 152 patients were operated for gastric cancer in Clinical Department of Surgical Oncology, Medical University of Lodz. Patients age ranged from 31 to 82 years (mean age-61.2). The purpose of this study was to evaluate the methods of reconstruction of gastrointestinal tract (GIT) continuity. Our material comprised patients who underwent total gastrectomy for gastric cancer. In 52 patients radical procedure--total gastrectomy--was performed, with reconstruction of gastrointestinal tract continuity. The latter part of surgery was accomplished using different methods: Roux-Y anastomosis-10 patients (19.2%); esophago-jejunal "end to side" anastomosis-8 patients (15.4%); Hunt-Lawrence-Rodino anastomosis-34(65%). During procedures staplers and VALTRAC rings were used, as well as ultrasound selector and argon coagulator for hepatic and pancreatic resections. Quality of life after gastrectomy was determined on the basis of interviews taken from patients, in whom GIT continuity was reconstructed with or without intestinal pouch creation. We also evaluated incidence and type of complications after such procedures. Perioperative mortality in our material was 7.7%. We concluded that the best results was achieved when continuity of gastrointestinal tract after total gastrectomy was reconstructed with intestinal (first loop of jejunum) pouch creation (Hunt-Lawrence procedure). This method warranted high quality of life and low incidence of complications. Staplers enables us to shorten time of procedure and to decrease the number of anastomosis leaks, so that our results of surgical treatment of patients with gastric cancer were better.
UI - 9424912
AU - Murawa P; Nowakowski W; Gracz A
TI - [The effect of regional lymphatic metastasis on the methods and results of treating stomach neoplasms]
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():407-10
AD - I Oddzialu Chirurgii Onkologicznej Wielkopolskiego Centrum Onkologii w Poznaniu.
From I 1986 to I 1997 we have operated in our Department 333 patients with gastric cancer. Resection has been done in 204 cases (with total resection rate 97%). Mostly there were patients with advanced disease (totally 160 cases with III and IV stage according to UICC classification). Metastases to regional lymph nodes were confirmed at 186 patients (91%). In every resection for cure and in palliative operations, where it was possible, we have done lymphangiectomy contained D1 and D2 level of regional lymph nodes. We achieved 28.9% 5-year survival rate (according to Kaplan-Meier) with postoperative mortality 2% and low number of surgical complications. Total resection of the stomach with regional node dissection (levels D1 and D2) is good and safe procedure and should be performed in majority cases of gastric cancer particularly in early and middle stages of disease.
UI - 9424914
AU - Herman K; Stelmach A; Kalita A; Gruchala A
TI - [Prognostic factors in gastric lymphoma]
SO - Wiad Lek 1997;50 Suppl 1 Pt 2():411-6
AD - Kliniki Chirurgii Onkologicznej, Centrum Onkologii Instytutu im. M. Sklodowskiej-Curie, Oddzial w Krakowie.
Stomach is the most common site of extranodal lymphoma, but lymphoma's biology differs from other types of gastric cancer. From 1982 to 1994, 80 cases of primary gastric lymphoma were treated in Cancer Center in Krakow. In order to assess the best mode of treatment the retrospective analysis of disease related parameters was performed. Sixty four patients were primary treated with surgery, and 11 with radiotherapy. After surgery 21 patients received adjuvant chemo or radiotherapy. Radi