National Cancer Institute®
Last Modified: September 1, 2002
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 - 11890341
AU - Kasakura Y; Fujii M; Mochizuki F; Asaki H; Kobayashi M
TI - Gastrectomy with D2 lymph node dissection in gastric cancer: a retrospective study at a single institution.
SO - Int Surg 2001 Jan-Mar;86(1):50-6
AD - 3rd Department of Surgery, Nihon University School of Medicine, Tokyo, Japan. firstname.lastname@example.org
The purpose of this study was to clarify the clinicopathological characteristics of gastric cancer with lymph node (LN) dissection and the significance of D2 dissection by investigating surgical techniques and prognosis. Three hundred ninety patients with early cancer and 310 with advanced cancer underwent gastrectomy with D1 or D2 dissection, based on the presence or absence of LN metastasis determined pre- and intraoperatively. LN metastasis occurred in 10.5% of early gastric cancer patients, and several cases of advanced cancer were found to have N2 or more advanced metastasis. The pre- and intraoperative macroscopic findings accorded with histological grade of LN metastasis in 69.5% of early cancers and in 56.5% of advanced cancer patients. The false negativity rate was 6.8% in early cancer, 19.4% in advanced cancer, and 8.4% as a whole. Death was operation-related in only two cases and the operative mortality rate was low (0.29%). The 5-year survival rates in early and advanced gastric cancer were 95.8% and 67.6% in the D1 groups, respectively, and 100% and 89.5% in the D2 groups, respectively. Survival was better in the D2 groups than in the D1 groups (P < 0.0001 for early cancer, P = 0.0279 for advanced cancer). D2 dissection should be conducted positively for patients with LN metastasis.
UI - 11890346
AU - Ajisaka H; Fujita H; Kaji M; Maeda K; Yabushita K; Konishi K; Uchiyama
TI - A; Miwa A Treatment of patients with gastric cancer and duodenal invasion.
SO - Int Surg 2001 Jan-Mar;86(1):9-13
AD - Department of Surgery, Toyama Prefectural Central Hospital, Japan.
We retrospectively examined clinicopathologic features of gastric cancer with duodenal invasion to clarify the effect of surgical treatment that include pancreaticoduodenectomy (PD). Among 2504 patients with gastric cancer, 69 (2.8%) who had gastric cancer and duodenal invasion resected by surgical treatment were investigated. The mode of the duodenal invasion was grouped into three categories: mucosal type, submucosal type, and nodal type. Mucosal type is invasion of the duodenal mucosal layer, submucosal type is invasion of the submucosal layer or deeper, and nodal type is invasion from nodal metastatic lesions around the pancreatic head. The 5-year survival rates of curative PD and curative gastrectomy were 37.3% and 33.8%, respectively. Despite the incidence of adjacent tissue infiltration and significantly higher duodenal invasion average length in cases with PD than in cases with gastrectomy, there was no significant difference in the survival curves. However, the prognoses of the cases with nodal-type invasion were significantly poorer, and all these patients died within 2 years, regardless of whether curative PD had been performed. Curative PD improves the prognosis of cases with long duodenal invasion or pancreas infiltration except for nodal-type duodenal invasion.
UI - 12170020
AU - Martin RC 2nd; Jaques DP; Brennan MF; Karpeh M
TI - Extended local resection for advanced gastric cancer: increased survival versus increased morbidity.
SO - Ann Surg 2002 Aug;236(2):159-65
AD - Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
OBJECTIVE: To characterize factors predictive of improved survival following gastrectomy with additional organ resection for the treatment of gastric cancer. SUMMARY BACKGROUND DATA: Recent large series have reported significant survival disadvantages to patients who have undergone gastrectomy with splenectomy or pancreaticosplenectomy, and yet gastrectomy with additional organ resection is needed to accomplish an R0 resection in some cases. Gastrectomy with splenectomy and other organ resections has been associated with advanced T-stage, positive resection margins, and higher postoperative morbidity and mortality rather than an absolute predictor of survival. METHODS: The authors reviewed the Department of Surgery prospective gastric database at During this period, of the 2,112 patients with primary gastric cancer, 1,133 underwent an R0 resection. The R0 resection group included 865 patients who underwent gastrectomy alone and 268 patients who underwent gastrectomy with another organ resection. Clinicopathologic, operative, complication, and survival data were compared between these two groups. Chi-square analysis and the Kaplan-Meier method were used to compare and estimate median survival. RESULTS: The most common organs resected were the spleen and pancreas, with an even distribution of other organs. Pathologic factors revealed that the gastrectomy with organ resection group had significantly larger lesions, greater T-stage, and a higher incidence of advanced nodal disease than the group who did not undergo additional organ resection. The incidence of pathologically confirmed T4 cancers in the additional organ resection group was only 14%. The overall 5-year survival rate for patients with T3/T4 disease was 27% with additional organ resection. The overall 5-year survival rate for the gastrectomy with organ resection group (32%, median 32 months) was significantly less than the group that did not undergo additional resection (50%, median 63 months) on univariate analysis. However, additional organ resection was not a predictor of survival on multivariate analysis. Multivariate analysis identified advanced T-stage (T3 or greater) and nodal stage (N1 or greater) as adverse predictors of survival in this group. CONCLUSIONS: Long-term survival following gastrectomy with additional organ resection is possible. Depth of invasion and the extent of lymph node metastasis are the most important predictors of survival following gastrectomy with additional organ resection, and a R0 resection has been achieved. Judicious use of additional organ resection for the treatment of advanced gastric cancer must be emphasized, given the increased overall morbidity and infrequent finding of actual T4 disease. Additional organ resection can be performed with minimal morbidity and can improve the chance of overall survival in patients with advanced T-stage disease.
UI - 11930294
AU - Haag C; Ehninger G
TI - [Indications for chemotherapy in cancers of the esophagus, stomach and pancreas]
SO - Z Gastroenterol 2002 Apr;40 Suppl 1():S68-S70
AD - Medizinische Klinik I, Universitatsklinikum Carl-Gustav-Carus der Technischen Universitat Dresden, Germany. Haag@mkl.med.tu-dresden.de
During the last years the chemotherapy in osophageal, stomach and pancreatic cancer demonstrated some success. Radiochemotherapy for esophageal cancer is indicated as neoadjuvant therapy before surgery in locally advanced cancer or in patients with other diseases, which do not allow surgery. In stomach cancer patient there is a clear indication for chemotherapy in metastatic disease and within clinical trials as neoadjuvant chemotherapy in locally advanced cancer. In pancreatic cancer patient the chemotherapy shows less success comparing to other gastrointestinal cancer; it is part of the palliative concept with other therapeutic strategies.
UI - 12055380
AU - Spector NM; Hicks FD; Pickleman J
TI - Quality of life and symptoms after surgery for gastroesophageal cancer: a pilot study.
SO - Gastroenterol Nurs 2002 May-Jun;25(3):120-5
AD - Loyola University Niehoff School of Nursing, Chicago, Illinois 60626, USA. email@example.com
Oncologic outcomes of gastroesophageal surgery may be similar, but little is known about the impact on patients' postoperative symptom experience and quality of life (QOL). The purpose of this pilot study was to describe overall QOL and symptom experience of individuals who underwent either total gastrectomy with Roux-en-Y esophagojejunostomy or esophagogastrectomy for adenocarcinoma of the gastroesophageal junction. The Gastroenterology Quality of Life Index (GQLI) and the Life After Gastric Surgery (LAGS), developed by the investigators for measuring symptom frequency, were used to measure variables of interest. The sample (n = 27) had a relatively high QOL, but experienced difficulties with eating patterns, physical functioning, socialization, and happiness. There were significant differences between the two procedures related to QOL and symptom frequency in that individuals who had the total gastrectomy fared somewhat better. Further, patients who had esophagogastrectomy had greater symptom frequency and significantly poorer QOL. Although initially compelling, these data warrant further investigation into the QOL and symptom impact in a more diverse population of patients with cancer of the stomach or esophagus. These results, however, suggest several areas where nursing interventions could help these patients.
UI - 11091248
AU - Morii Y; Arita T; Shimoda K; Yasuda K; Matsui Y; Inomata M; Kitano S
TI - Jejunal interposition to prevent postgastrectomy syndromes.
SO - Br J Surg 2000 Nov;87(11):1576-9
AD - Surgery Division, Arita Gastrointestinal Hospital, Oita, Japan.
BACKGROUND: Postgastrectomy syndromes include reflux gastritis and oesophagitis, dumping syndrome, intractable diarrhoea and afferent loop interposition has been used following distal gastrectomy. The aim of this study was to evaluate the benefit of this procedure. METHODS: A consecutive series of 42 patients who underwent distal gastrectomy for gastric cancer was studied. Twenty-two patients had a Billroth I RESULTS: The mean operating time was 260 min for Billroth I and 352 min for jejunal interposition. No serious postoperative complications arose. Reflux gastritis occurred in 19 patients after Billroth I but in none after jejunal interposition. Five patients in the Billroth I group had complaints consistent with dumping syndrome, compared with none after jejunal interposition. The barium gastric emptying time was significantly shorter after Billroth I (mean(s.d.) 269(225)s) than after jejunal interposition (736(479) s) (P < 0.01). CONCLUSION: Jejunal interposition prevented reflux gastritis and inhibited rapid gastric emptying. Postgastrectomy syndromes were effectively prevented by this reconstruction procedure.
UI - 12082864
AU - Eriksen JR
TI - [Palliative care of non-resectable stenosed esophageal and cardiac cancer. A retrospective study of 31 patients treated with endoscopic argon "beam" coagulation]
SO - Ugeskr Laeger 2002 Jun 3;164(23):3067-71
AD - Kirurgisk afdeling, Amtssygehuset i Fakse. firstname.lastname@example.org
INTRODUCTION: The aim of this study was to describe the argon beam coagulation technique in the palliative treatment of patients with non-resectable carcinoma of the cardia and oesophagus and its requirements, complications, and tolerance. MATERIALS AND METHODS: 31 patients, referred for palliation by ABC in a central hospital over a period of nearly four years (1.1.1998-31.8.2001), were evaluated retrospectively. RESULT: Twenty-two men and nine women, median age 72 years (range 49-91), underwent a total of 163 treatments and a median of five treatments per patient (range 1-18). Re-canalisation enabling passage of the scope was achieved in 89% of treatments, and most of the patients had dysphagia grade = 2. The median range between reinterventions was 25 days (range 1-175). Perforation was seen in three patients and in 1.8% of treatments procedure-related mortality was 1.2%. The median hospital stay for each treatment was two days (range 1-27) and the median impatient stay as proportion survival time was 8%. The median survival was 190 days (range 7-612) and the one-year survival 19%. DISCUSSION: ABC is a well tolerated, safe, and effective treatment in patients with non-resectable cancer of the oesophagus or cardia and offers and acceptable complication rate and number of reinterventions compared with laser and stent placement. The technique is easy and inexpensive and requires no further restrictions than conventional monopolar electrocoagulation does.
UI - 12153632
AU - Popiela T; Kulig J; Kolodziejczyk P; Sierzega M; Polish Gastric Cancer
TI - Study Group Long-term results of surgery for early gastric cancer.
SO - Br J Surg 2002 Aug;89(8):1035-42
AD - First Department of General and Gastrointestinal Surgery, Jagiellonian University, 40 Kopernika Street, 31-501 Krakow, Poland. email@example.com
BACKGROUND: Gastrectomy for early gastric cancer is widely accepted as an adequate therapeutic method. Recent developments of less invasive procedures require the identification of patients who will benefit from such an approach. METHODS: A retrospective study was undertaken of 238 patients with early gastric cancer who underwent gastrectomy from 1977 to 1999. Clinicopathological data relating to survival were evaluated. RESULTS: Analysis of 33 node-positive patients (14 per cent) revealed a tumour diameter greater than 20 mm (P = 0.011), depressed macroscopic type (P < 0.05), diffuse histological type (P < 0.001), poor tumour differentiation (P < 0.001) and infiltration of the submucosal layer (P < 0.002) as factors associated with lymph node metastasis. Multivariate analysis found diffuse histological type to be an independent risk factor. The overall 5-year survival rate was 87 per cent, and was significantly better in patients who underwent radical lymphadenectomy than in those who had regional lymph node dissection (92 versus 78 per cent; P < 0.01). Similarly, patients younger than 65 years had a more favourable 5-year survival rate (90 per cent) than older ones (77 per cent). Multivariate analysis with the Cox proportional hazards model confirmed patient age and type of lymphadenectomy as independent prognostic factors. CONCLUSION: The findings suggest that extended lymph node dissection may be beneficial for some patients with early gastric cancer, although randomized clinical trials are needed to evaluate this observation further.
UI - 8239771
AU - Longmire WP Jr
TI - A current view of gastric cancer in the US.
SO - Ann Surg 1993 Nov;218(5):579-82
In the US, the remarkable decline in the incidence of gastric cancer during the mid-portion of this century has leveled off during the last two decades as an equally remarkable and poorly understood increase in the percentage of the generally more unfavorable cardia cancers has become apparent. The importance of H. pylori infection is being actively investigated and treatment to reduce the infection may offer a means of decreasing the disease, particularly in areas of high incidence. The potential danger of inciting gastric cancer by the prolonged use of drugs that severely reduce or eliminate gastric acid has been mentioned, but the degree of risk must await the passage of years before it can be properly evaluated. "Early gastric cancer" or, probably more appropriately, "superficial gastric adenocarcinoma" continues to comprise a relatively small segment of gastric cancers in the US and most Western countries. Seventeen per cent of cases in the ACS series were classified as stage I, a much higher incidence than reported for early gastric cancer in most individual North American series. The ACS report suggests "special education of the surgeon in the requisites for adequate gastrectomy with node dissection, coupled with effective adjuvant therapy" as a means of improving results in the US. This is a significant consideration because, unfortunately, gastric surgery for ulcer or cancer no longer plays the important role it did in past decades in many US surgical training programs. As has been demonstrated in Japan and in certain larger US series, excellent surgical technique, particularly for cardia tumors, plays an important role in obtaining improved results. The value of radical lymph node dissection continues to be controversial in US cases, and a successful chemotherapeutic regimen has yet to be found. Subtotal gastric resection, as noted in the ACS report, continues to be the procedure of choice in the US for most gastric cancers, even for cardia cancers. Although there is no improvement in survival, quality of life is thought by some to be better after total gastrectomy for cardia cancers rather than proximal subtotal esophagogastrectomy. However, equally important for improved survival is the ACS recommendation of earlier referral for gastric surgery patients with precursor lesions, but the lack of improvement in the pathological stage of disease in the two ACS time periods suggests that little progress is being made in this country in this regard.
UI - 8239772
AU - Wanebo HJ; Kennedy BJ; Chmiel J; Steele G Jr; Winchester D; Osteen R
TI - Cancer of the stomach. A patient care study by the American College of Surgeons.
SO - Ann Surg 1993 Nov;218(5):583-92
AD - Department of Surgery, Roger Williams Hospital, Brown University, Providence, Rhode Island.
OBJECTIVE. The major purpose of this study was to document the modes of presentation, diagnostic methods, clinical management, and outcome of gastric cancer as reported by tumor registries of US hospitals and cancer programs approved by the American College of Surgeons. SUMMARY BACKGROUND DATA. Gastric cancer continues to diminish in the US, but the stage of disease and survival outcome after surgical resection is unchanged despite increased availability and sophistication of diagnostic techniques. This is in contrast to the marked improvement in survival outcome in Japanese and other Eastern series over the last decades. Possible reasons for the improved Japanese results have been earlier detection secondary to active diagnostic surveillance of the population and widespread adoption of aggressive surgical resection emphasizing wide-field node (R2) dissection. Although selected US centers using the Japanese approach report better survival data, the approach has not been widely adapted by US treatment centers. METHODS. Tumor registries at American College of Surgeons (ACS) approved hospitals were mailed a study protocol in 1987. They were instructed to review 25 consecutive patients with gastric cancer treated in 1982 (long-term study) and 25 patients treated in 1987 (short-term study). A detailed protocol included significant history, diagnostic results, staging, pathology findings, and treatment results. The data forms on 18,365 patients were returned and analyzed (11,264 patients in the long-term study and 7101 patients in the short-term study). RESULTS. Of 18,365 patients, 63% were males. The median ages were 68.4 years in males and 71.9 years in females. There was a history of gastric ulcer in 25.5% of the patients. Lesion location was upper third in 31%, middle third in 14%, distal third in 26%, and entire stomach in 10% of patients (and the site was unknown in 19%). Gastric resection was performed for 80% of upper third cancers and 85% of distal third cancers; 50% of patients with total gastric involvement had gastric resection. The extent of gastric resection varied according to location. For lower third lesions, subtotal gastrectomy was done in 55% of the cases, extended resection in 21%, and total gastrectomy in 6%. For proximal lesions, 29% had subtotal, 4.6% had total, and 41% had extended gastrectomies (including esophagus), and 13.6% had dissection of celiac nodes. The operative mortality rate was 7.2%. Staging (American Joint Committee on Cancer [AJCC]) was as follows: I, 17%; II, 17%; III, 36%; and IV, 31%. The overall survival rate reflecting deaths from all causes was 14% among 10,891 patients diagnosed in 1982, and it was 19% in patients having resection. The disease specific survival rate was 26%. The survival rate after resection was 19% and 21% for lower and mid third cancers, 10% for upper third cancers, and 4% if the entire stomach was involved. The stage-related survival rates were 50% (stage I), 29% (stage II), 13% (stage III), and 3% (stage IV). Among patients with pathologically clear margins, the survival rate was 35% versus 13% in those with microscopically involved margins, and it was 3% in those with grossly involved margins. CONCLUSION. This report of gastric cancer treatment by American College of Surgeons approved institutions in the US provides an overview of the disease as commonly treated throughout the US. Although the results are less favorable than those reported by centers with large institutional experiences with this disease and are inferior to those of the Japanese and other Eastern centers, they suggest potential for increasing survival by upstaging through earlier diagnosis and using resectional techniques demonstrated to more adequately control local regional disease.
UI - 12109179
AU - Cherniavskii AA; Ershov VV; Strazhnov AV
TI - [Pancreatoduodenal resection and total duodenopancreatectomy in surgery for stomach cancer]
SO - Khirurgiia (Mosk) 2002;(6):17-21
Experience with combined operations for stomach cancer in combination with pancreatoduodenal resection or total duodenopancreatectomy is presented. Immediate and long-term results of 10 pancreatoduodenal resections and 5 total duodenopancreatectomies are analyzed. There were 2 lethal outcomes. Complicated postoperative period was seen in 7 patients. During the first year of follow-up 6 of 13 operated patients died due to dissemination. After total pancreatectomy severe homeostatic disorders were seen. Prognosis after pancreatoduodenal resection is better when the tumor involves the duodenum than when it invades the pancreas. Subtotal resection of the stomach and gastrectomy in combination with duodenopancreatosplenectomy lead to unfavorable functional results and have bad long-term prognosis.
UI - 12214468
AU - Kimura Y; Kikkawa N; Iijima S; Kato T; Naoi Y; Hayashi T; Tanigawa T;
TI - Yamamoto H; Kurokawa E [A new regimen for TS-1 therapy designed to minimize adverse reactions by introducing a one-week interval after each two-week dosing session]
SO - Gan To Kagaku Ryoho 2002 Aug;29(8):1403-9
AD - Gastrointestinal Research Center, Dept. of Surgery, Minoh City Hospital.
It has been reported that the response rate to TS-1 of advanced recurrent gastric cancer was the highest rate (46.5%) of effectiveness among anti-cancer agents, but the incidence of adverse reactions to this drug has been found to be as high as 83.2%, with grade 3 or severer reactions occurring in 20.3% of patients. Taking into consideration the post-marketing survey finding that adverse reactions to the drug first appear 2-3 weeks after the start of oral TS-1 therapy, we attempted a new dosing regimen for this drug, wherein each session of therapy lasted for 2 weeks, with a one-week interval between two consecutive sessions (herein-after called "the 2-week regimen"). This regimen was employed based on the expectation that the adverse reactions to the drug would be minimized and that the consecutive dosing period could be prolonged, while keeping the anti-cancer potency at a level similar to that expected with the 4-week dosing regimen with a 2-week interval between sessions (the 4-week regimen). The subjects were 38 patients with advanced or recurrent stomach cancer who were treated with TS-1 at our historical control, and compared with 14 patients treated using the adverse reactions was 71% in the 2-week regimen group against 92% in the 4-week regimen group. The incidence of grade 3 or severe adverse reactions was 8% in the 2-week group and 21% in the 4-week group. Thus, the incidence of adverse reactions was lower in the 2-week group. The percentage of patients who complied with the dosing instructions completely during a 6-month period, as evaluated by the Kaplan-Meier method, was 86% in the 2-week group and 58% in the 4-week group. The response rate, as calculated in patients whose lesions could be evaluated, was 25% in the 2-week group and 19% in the 4-week group. These results suggest that the 2-week regimen may allow safer outpatient drug therapy using TS-1 and merits a trial when considering the QOL of patients. We propose conducting a phase-II multi-center clinical study of this regimen in the near future.
UI - 12142981
AU - Dorffner R; Neumann C; Gergely I; Stimakovits J; Renner R
TI - [First experience with a non-covered CHOO enteral stent in the stomach,duodenum, and jejunum]
SO - Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2002 Aug;174(8):1018-21
AD - Rontgenabteilung, Osterreich, Germany.
AIM: To evaluate the technical performance of the non-covered CHOO enteral stent in the stomach, duodenum and jejunum. METHODS: In 8 patients (two men, 6 women) with malignant tumors of the stomach (n = 4), duodenum (n = 3) and jejunum (n = 1) stent implantation was performed under fluoroscopic control. In two patients endoscopy was needed additionally. The patients were followed for 1 to 168 days. RESULTS: Stent implantation was technically successful in 7 of 8 patients. In 6 patients symptoms improved. In two patients a second stent implantation was necessary 35 and 161 days after primary implantation, respectively. There was no stent migration or tumor ingrowth. CONCLUSION: The implantation of the non-covered CHOO enteral stent into the upper gastrointestinal tract is safe and effective.
UI - 11857350
AU - Stein U; Lage H; Jordan A; Walther W; Bates SE; Litman T; Hohenberger P;
TI - Dietel M Impact of BCRP/MXR, MRP1 and MDR1/P-Glycoprotein on thermoresistant variants of atypical and classical multidrug resistant cancer cells.
SO - Int J Cancer 2002 Feb 20;97(6):751-60
AD - Max-Delbruck-Center for Molecular Medicine, Berlin, Germany. firstname.lastname@example.org
The impact of the ABC transporters breast cancer resistance protein/mitoxantrone resistance associated transporter (BCRP/MXR), multidrug resistance-associated protein 1 (MRP1) and multidrug resistance gene-1/P-glycoprotein (MDR1/PGP) on the multidrug resistance (MDR) phenotype in chemoresistance and thermoresistance was investigated in the parental human gastric carcinoma cell line EPG85-257P, the atypical MDR subline EPG85-257RNOV, the classical MDR subline EPG85-257RDB and their thermoresistant counterparts EPG85-257P-TR, EPG85-257RNOV-TR and EPG85-257RDB-TR. Within the atypical MDR subline EPG85-257RNOV expression of BCRP/MXR and of MRP1 were clearly enhanced (vs. parental and classical MDR lines). MDR1/PGP expression was distinctly elevated in the classical MDR subline EPG85-257RDB (vs. parental and atypical MDR sublines). In all thermoresistant counterparts basal expression of BCRP/MXR, MRP1 and MDR1/PGP was increased relative to thermosensitive sublines. Although it could be shown that the overexpressed ABC transporters were functionally active, however, no decreased drug accumulations of doxorubicin, mitoxantrone and rhodamine 123 were observed. Thus, expression of BCRP/MXR, MRP1 and MDR1/PGP was found to be dependent on the appropriate type of chemoresistance; correlating with a classical or atypical MDR phenotype. Within the thermoresistant variants, however, the increase in ABC transporter expression did obviously not influence the MDR phenotype. Copyright 2001 Wiley-Liss, Inc.
UI - 11054376
AU - Fischbach W; Dragosics B; Kolve-Goebeler ME; Ohmann C; Greiner A; Yang
TI - Q; Bohm S; Verreet P; Horstmann O; Busch M; Duhmke E; Muller-Hermelink HK; Wilms K; Allinger S; Bauer P; Bauer S; Bender A; Brandstatter G; Chott A; Dittrich C; Erhart K; Eysselt D; Ellersdorfer H; Ferlitsch A; Fridrik MA; Gartner A; Hausmaninger M; Hinterberger W; Hugel K; Ilsinger P; Jonaus K; Judmaier G; Karner J; Kerstan E; Knoflach P; Lenz K; Kandutsch A; Lobmeyer M; Michlmeier H; Mach H; Marosi C; Ohlinger W; Oprean H; Pointer H; Pont J; Salabon H; Samec HJ; Ulsperger A; Wimmer A; Wewalka F Primary gastric B-cell lymphoma: results of a prospective multicenter study. The German-Austrian Gastrointestinal Lymphoma Study Group.
SO - Gastroenterology 2000 Nov;119(5):1191-202
AD - Medizinische Klinik II, Klinikum Aschaffenburg, Aschaffenburg, Germany.
BACKGROUND & AIMS: Appropriate management of primary gastric lymphoma is controversial. This prospective, multicenter study aimed to evaluate the accuracy of endoscopic biopsy diagnosis and clinical staging procedures and assess a treatment strategy based on Helicobacter pylori status and tumor stage and grade. METHODS: Of 266 patients with primary gastric B-cell lymphoma, 236 with stages EI (n = 151) or EII (n = 85) were included in an intention-to-treat analysis. Patients with H. pylori-positive stage EI low-grade lymphoma underwent eradication therapy. Nonresponders and patients with stage EII low-grade lymphoma underwent gastric surgery. Depending on the residual tumor status and predefined risk factors, patients received either radiotherapy or no further treatment. Patients with high-grade lymphoma underwent surgery and chemotherapy at stages EI/EII, complemented by radiation in case of incomplete resection. RESULTS: Endoscopic-bioptic typing and grading and clinical staging were accurate to 73% and 70%, respectively, based on the histopathology of resected specimens. The overall 2-year survival rates for low-grade lymphoma did not differ in the risk-adjusted treatment groups, ranging from 89% to 96%. In high-grade lymphoma, patients with complete resection or microscopic tumor residuals had significantly better survival rates (88% for EI and 83% for EII) than those with macroscopic tumor residues (53%; P < 0.001). CONCLUSIONS: There is a considerable need for improvement in clinical diagnostic and staging procedures, especially with a view toward nonsurgical treatment. With the exception of eradication therapy in H. pylori-positive low-grade lymphoma of stage EI and the subgroup of locally advanced high-grade lymphoma, resection remains the treatment of choice. However, because there is an increasing trend toward stomach-conserving therapy, a randomized trial comparing cure of disease and quality of life with surgical and conservative treatment is needed.
UI - 12063914
AU - Ajani JA
TI - [Is neoadjuvant therapy for locally advanced stomach carcinoma standard?]
SO - Chirurg 2002 Apr;73(4):312-5
AD - Department of GI Oncology, Box 426, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA. Jajani@mdanderson.org
Despite surgical efforts and encouraging data of a few postoperative therapy trials, locally advanced gastric cancer is in need of the development of effective multimodal therapeutic concepts. Regarding preoperative therapy the goal is to raise the number of complete tumor resections (R0-resections) leading to an improved prognosis of the disease. Neoadjuvant therapy has the theoretical advantage of early destruction of distant micrometastasis with a consecutive reduction of tumor relapse outside the resection margins. The likelihood of R0-resections should be increased with the response of the primary tumor to neoadjuvant therapy. Neoadjuvant chemotherapy using platinum based regimens in gastric cancer has shown its activity in a number of phase II studies. Especially after response to chemotherapy the survival was significantly better after complete surgical tumor resection. The neoadjuvant use of a sequence of chemotherapy followed by radiotherapy before gastrectomy did result in a complete histopathological response in 20-25% of gastric cancer patients. This regimen seems to be promising, but there are still no long term results available. Parallel to the expected data from the first phase III studies the main impact of research in this field has to be focused on to the development of new and effective therapeutic agents and with accompanying identification of factors which are able to predict the response to neoadjuvant treatment.
UI - 12063915
AU - Sendler A; Etter M; Bottcher K; Siewert JR
TI - [Extent of resection in surgery of stomach carcinoma]
SO - Chirurg 2002 Apr;73(4):316-24
AD - Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU Munchen, Ismaninger Strasse 22, 81675 Munchen. Sendler@nt1.chir.med.tu-muenchen.de
The extraluminal extent of resection in cases of advanced gastric cancer is controversial. If, however, following meticulous staging--including the detection of free abdominal tumor cells--complete resection seems possible, then multivisceral resection is justified. If complete resection is achieved, the prognosis of these patients can be improved. Left pancreatic resection should be performed only if the tumor invades the pancreas directly. Splenectomy is indicated if the tumor invades the organ directly or if there are locally advanced tumors of the proximal third of the stomach and tumors of the esophageal-gastric junction. However, it has to be kept in mind that splenectomy is an independent negative prognostic factor. The extent of lymphadenectomy (LA) in gastric cancer is still under discussion. According to the 10-year results of the Dutch Gastric Cancer Study, there might be subgroups which have a survival benefit after extended (D2) LA. These include, as the German Gastric Cancer Study corroborated, patients with very early stage II and stage IIIa lymph node metastases. As neither of these stages can at present be diagnosed before or during surgery, D2 lymphadenectomy should be the standard procedure for all patients with gastric cancer. Recent studies have shown that it might be possible with the help of the Sentinel Node Technique to individualize lymphadenectomy in locally gastric cancer as well. The beneficial effects of adjuvant chemoradiation in gastric cancer do not mean, however, that the extent of resection may be reduced. Adjuvant chemoradiation following complete resection and D2 lymphadenectomy should still not be regarded as standard therapy.
UI - 12063916
AU - Shah MA; Kelsen DP
TI - [Postoperative adjuvant chemoradiotherapy in high risk stomach carcinoma]
SO - Chirurg 2002 Apr;73(4):325-30
AD - Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill School of Medicine, Cornell University, New York, NY, USA.
Gastric cancer is a common cancer worldwide with a high mortality rate. Despite curative intent resection, locoregional failure as a frequent site of recurrence is responsible in part for this high mortality. Many attempts have been made to decrease the risk of recurrence after resection. Studies involving postoperative chemotherapy as a single modality have not clearly demonstrated benefit. Similarly, most studies of postoperative radiation therapy have not clearly shown an improvement in overall survival. Recently, however, a USA Intergroup study indicated a survival advantage for chemoradiation therapy compared to surgery alone for patients with locally advanced gastric cancer. "Intergroup-116" is a large-scale randomized trial designed to evaluate the role of adjuvant chemotherapy plus radiotherapy following curative intent gastric resection. The data from this study demonstrate a survival benefit with adjuvant chemoradiation that may in large part be due to better locoregional control. While many patients had a less then adequate lymph node dissection, survival was not associated with the type of lymph node dissection performed. Toxicity was acceptable. "Intergroup-116" indicates that postoperative chemoradiation should be considered as a standard care option for patients with locally advanced gastric cancer. Future studies should evaluate potentially more effective systemic therapy, molecularly-directed treatment, and possibly, whether or not more formal lymph node dissections would obviate the need for radiation.
UI - 12063917
AU - Bektas H; Langer F; Piso P; Werner U; Musholt TJ; Lehner F; Becker T;
TI - Klempnauer J [Neuroendocrine tumors of the stomach. Surgery therapy and prognosis]
SO - Chirurg 2002 Apr;73(4):331-5
AD - Klinik fur Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl Neuberg-Strasse 1, 30625 Hannover. Bektas.Hueseyin@mh-hannover.de
Gastric carcinoid tumors are rare lesions characterized by hypergastrinemia that arise from enterochromaffin-like (ECL) cells of the stomach. A classification system distinguishing three types of gastric carcinoid tumors has been proposed: 1) tumors related to chronic atrophic gastritis, 2) tumors associated with Zollinger-Ellison syndrome, and 3) sporadic lesions. It is apparent that hypergastrinemia-associated gastric carcinoids show a rather benign biological behavior. Normo-gastrinemic sporadic lesions, on the other hand, require an aggressive surgical management. We report seven patients with gastric neuroendocrine tumors ("carcinoids"), who underwent surgical treatment in our department between 1988 and 2000. Surgical therapy included total gastrectomy with D2 lymphadenectomy in two cases with type I tumors and for one patient with type III tumor. One patient with a type II tumor was treated by distal subtotal gastrectomy and another by antrectomy. A local excision was performed on one patient with type I tumor. After a mean follow-up of 8 years, 5 of 7 patients are alive without recurrence.
UI - 12063918
AU - Bittorf BR; Gunther F; Merkel S; Horbach T; Hohenberger W; Gunther K
TI - [D3 versus D2 dissection in stomach carcinoma. A case-control study of postoperative morbidity, survival and early oncologic outcome]
SO - Chirurg 2002 Apr;73(4):336-47
AD - Chirurgische Klinik mit Poliklinik der Universitat Erlangen-Nurnberg, Krankenhausstrasse 12, 91054 Erlangen.
INTRODUCTION: In western countries, the benefit of the Japanese extended D3 lymph node dissection in gastric cancer patients who have been operated on in curative intent has not been proven and higher rates of side effects are expected. The present matched-pair study retrospectively compared the new D3 method (1995-1999) with the historic D2 dissection (1982-1995). METHODS: Two 1:1 matched-pair populations were created: (1) regarding intra- and postoperative course, morbidity and mortality, 2 x 67 patients stratified to "age", "gender", "surgical procedure", "splenectomy" and "extended resections"; and (2) regarding early oncologic outcome, 2 x 32 patients additionally stratified to "UICC-stage" and "Lauren-classification". The D3 dissection was performed according to the Japanese method without routine pancreaticosplenectomy. RESULTS: D3 dissection harvested significantly (P = 0.004) more lymph nodes per patient: 56.4 vs. 46.8. Postoperative mortality was 3% (n = 2) in both groups, the overall complication rate of 30% (D3) vs. 25% (D2) was equivalent (P = 0.678) and the rate of surgical complications was identical (21%). Non-surgical complications of 21% after D3 dissection were not significantly elevated (vs. 10%; P = 0.143). Operative time [289 min (D3) vs. 218 min (D2); P = 0.0001] and postoperative stay [17.4 days (D3) vs. 14.5 days (D2); P = 0.003] were significantly longer after the extended procedure. The were no statistically significant differences between 2-year overall survival, locoregional-, distant- and overall recurrence-free survival. CONCLUSIONS: Compared to the D2 method, D3 dissection is feasible without disadvantages in the patients. However, D3 dissection cannot routinely be recommended because--possibly due to the short follow-up period and the small number of patients so far observed--an oncologic benefit could not be shown.
UI - 12168913
AU - Enjoji A; The Nagasaki Digestive Organ Cancer Chemotherapy Study Group
TI - Japan Combination chemotherapy of 5-fluorouracil and low-dose cisplatin in advanced and recurrent gastric cancer: a multicenter retrospective study in Nagasaki, Japan.
SO - Anticancer Res 2002 Mar-Apr;22(2B):1135-9
AD - Department of Surgery II, Nagasaki University School of Medicine, Japan. email@example.com
BACKGROUND: Combination therapy consisting of 5-fluorouracil (5-FU) and cisplatin (CDDP) has been shown to be effective in the treatment of gastric cancer. Patients and METHODS: The efficacy and safety of the combination therapy consisting of 5-FU and low-dose CDDP were assessed in 37 patients with advanced or recurrent gastric cancer. One course consisted of continuous drip infusion of 5-FU (330 mg/m2/day) on days 1-5 (7) + 5-day drip infusion of CDDP (5 mg/m2/day) for 4 weeks. The patients were treated with at least one course. RESULTS: The complete response (CR) + partial response (PR) rate was 35.1% and median survival-time (MST) was 7.1 months. There were no grade 3 or more adverse effects. CONCLUSION: Our results suggest that this mode of combination therapy leads to a fairly favorable outcome with few adverse effects in patients with advanced and recurrent gastric cancer.
UI - 12215042
AU - Dehn TC; Paterson I; Hunter D; Rae D
TI - Should we continue oesophageal surgery in a district general hospital? A review of 200 consecutive cases.
SO - Ann R Coll Surg Engl 2002 Jul;84(4):292-3
UI - 12215043
AU - Harvey M
TI - Should we continue oesophageal surgery in a district general hospital? A review of 200 consecutive cases.
SO - Ann R Coll Surg Engl 2002 Jul;84(4):293; discussion 293-4
UI - 12215045
AU - Shackcloth MJ; Page RD
TI - Should we continue oesophageal surgery in a district general hospital? A review of 200 consecutive cases.
SO - Ann R Coll Surg Engl 2002 Jul;84(4):295; discussion 295-6
UI - 11896222
AU - Kim KW; Choi BI; Han JK; Kim TK; Kim AY; Lee HJ; Kim YH; Choi JI; Do KH;
TI - Kim HC; Lee MW Postoperative anatomic and pathologic findings at CT following gastrectomy.
SO - Radiographics 2002 Mar-Apr;22(2):323-36
AD - Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Korea.
Helical computed tomography (CT) is useful in identifying postoperative anatomic changes, complications, and tumor recurrence in gastric cancer patients who have undergone gastrectomy. Postoperative anatomic changes can usually be identified on consecutive CT scans. Complications include anastomotic leakage, duodenal stump leakage, intraabdominal bleeding, wound complications, and other less common complications (postoperative pancreatitis, retention of surgical foreign bodies, diffuse peritonitis). The degree and extent of bowel wall thickening is important in diagnosing tumor recurrence; however, CT lacks specificity. Large or conglomerated lymph node metastases can be easily diagnosed at CT; however, small solitary or focal metastases may not be detected or differentiated from nonmetastatic nodes. Ascites, a common finding with peritoneal seeding in gastrointestinal tumors, is well depicted at CT. Hematogenous metastases from gastric carcinoma are most frequently seen in the liver and are best demonstrated with helical CT performed during the portal venous phase of enhancement (sensitivity >90% for the detection of lesions >1 cm). The sophisticated surgical procedures used in gastrectomy can alter normal anatomy and make image interpretation difficult; thus, familiarity with the appearance of postoperative anatomic changes, complications, and tumor recurrence is essential for accurate CT evaluation of affected patients. Copyright RSNA, 2002
UI - 12085274
AU - Piso P; Bektas H; Werner U; Becker T; Aselmann H; Schlitt HJ; Klempnauer
TI - J [Comparison between treatment results for gastric cancer in younger and elderly patients]
SO - Zentralbl Chir 2002 Apr;127(4):270-4
AD - Klinik fur Viszeral- und Transplantationschirurgie, Zentrum Chirurgie, Medizinischen Hochschule Hannover, Germany. Piso.Pompiliu@mh-hannover.de
INTRODUCTION: While gastric cancer shows an increased incidence in elderly patients, the rate of younger patients affected by this disease represents up to 15 %. Younger patients are frequently diagnosed with advanced tumor stages with a poor prognosis although literature data on this issue are controversial. PATIENTS AND METHODS: 643 patients with primary gastric carcinoma were operated in our institution between March these patients. We analysed the data of these patients retrospectively. A comparison of the results between patients younger than 40 years (n = 38, median age 37 years) and older than 70 years (n = 182, median age 75 years) was performed. RESULTS: The radical (R0-) resectability rate was rather high for both, younger (78.9 %) and elderly (76.9 %) patients. Postoperative morbidity was higher in elderly than in younger patients (32.9 % vs. 23.2 %; p < 0.05), as well as the postoperative mortality (7.7 % vs. 2.6 %; p < 0.05). Both younger and elderly patients showed advanced (II to IV) tumor stages (76.3 % vs. 73.3 %, n. s.). There was a significant difference between the rate of diffuse carcinomas in young and elderly patients (63.2 % vs. 22.5 %). The 5-years survival rate following R0-resection was significantly higher for younger patients (54.2 % vs. 32.9 %; p = 0.01), differences occurred only after the second postoperative year. CONCLUSIONS: The resectability of gastric carcinoma is not related to the patients age. Due to comorbidity, postoperative morbidity may be increased in elderly patients. Although both younger and elderly patients show advanced tumor stages, diffuse carcinomas are more frequent in younger patients. The short-term prognosis is similar for both age groups, long-term results are better for younger patients. The different life expectancy should be considered when interpreting these results.