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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Gastric Cancer - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
UI - 11928051
AU - Mochiki E; Kamimura H; Haga N; Asao T; Kuwano H
TI -
The technique of laparoscopically assisted total gastrectomy with
jejunal interposition for early gastric cancer.
SO - Surg Endosc 2002 Mar;16(3):540-4
AD - First Department of Surgery, Faculty of Medicine, Gunma University,
3-39-15, Showa-machi, Maebashi 371-8511, Japan.
emochiki@showa.gunma-u.ac.jp
BACKGROUND: In recent years, laparoscopic gastrectomy has been applied
to the treatment of gastric cancer in Japan. However, there are few
reports of laparoscopic or laparoscopically assisted total gastrectomy
in the treatment of gastric cancer because of the difficulty of the
surgical technique. Laparoscopically assisted total gastrectomies with
jejunal interpositions were performed on four patients with early
gastric cancer located in the upper portion of the stomach. METHODS:
Four surgical ports were inserted into the abdomen. The stomach was
lifted to the abdominal wall using newly developed retraction tubes.
Gastric arteries were divided using ultrasonically activated coagulating
shears and ligated with ligation forceps. Following these steps, a total
gastrectomy reconstruction was performed by jejunal interposition
through a small transverse laparotomy. An esophagojejunostomy and a
jejunoduodenostomy were made with circular staplers. RESULTS: The mean
operating time and blood loss were 246 min and 236 ml, respectively. The
operations were performed without serious complications. All patients
were pain free and ambulatory after the laparoscopically assisted total
gastrectomy, and the mean postoperative hospital stay was 16 days.
CONCLUSION: We successfully performed laparoscopically assisted total
gastrectomies in a relatively short period of time. When patients are
carefully selected, the laparoscopic procedure can be curative and
minimally invasive as a treatment for early gastric cancer.
2
UI - 11865342
AU - Tsimoyiannis EC; Jabarin M; Tsimoyiannis JC; Betzios JP; Tsilikatis C;
TI -
Glantzounis G
Ultrasonically activated shears in extended lymphadenectomy for gastric
cancer.
SO - World J Surg 2002 Feb;26(2):158-61
AD - Department of Surgery, G. Hatzikosta General Hospital, Makriyanni
Avenue, GR-45001 Ioannina, Greece. etsimogi@ioa.forthnet.gr
Gastrectomy, followed by extended lymphadenectomy, is the treatment of
choice in some stages of advanced gastric cancer. Lymphorrhea, as a
result of the many divided lymphatic vessels, increases the morbidity.
Ultrasonically activated coagulated shears (UACS) may divide all small
vessels followed by immediate sealing of the coapted vessel walls. We
designed a prospective randomized study to determine the effectiveness
of the UACS versus monopolar electrosurgery in D2 dissection. Forty
patients with gastric cancer stage II or stage IIIA were enrolled and
randomized into 2 groups of 20 patients each. Group A underwent
lymphatic dissection with monopolar cautery. Group B underwent lymphatic
dissection with UACS.Subhepatic and left sudiaphragmatic closed drains
were left until lymphorrhea and/or oozing stopped. Total gastrectomy was
performed in 16 patients of group A and 14 of group B; subtotal
gastrectomy was performed in 4 patients in group A and 6 patients in
group B. The drains were removed after 6-17 days (mean 9.7 +/- 2.9) in
group Aand after 4-8 days (mean 5.6 +/- 1.2) in group B(p < 0.001). The
total amount of drained fluid was 300-2050 ml (mean 985 +/- 602) in
group A and 230-1080 ml (mean 480 +/- 242) in group B (p < 0.002). Eight
patients in group A and 5 in group B had postoperative fever, while 3
and 1 patients, respectively, had wound infections. In conclusion the
use of UACS is a safe method of lymphatic dissection which reduces
operative blood loss, postoperative lymphorrhea, blood transfusions,and
hospital stay.
3
UI - 11910474
AU - Samson PS; Escovidal LA; Yrastorza SG; Veneracion RG; Nerves MY
TI -
Re-study of gastric cancer: analysis of outcome.
SO - World J Surg 2002 Apr;26(4):428-33
AD - Department of Surgery, East Avenue Medical Center, East Avenue, Diliman
1100, Quezon City, Philippines. samson@skyinet.net
Cancer of the stomach (CaS) is a dreaded disease. Fortunately, there is
a decreasing incidence, except in the East. The authors did a re-study
of CaS, a widely investigated but unresolved gastrointestinal
malignancy. The clinicopathologic features were evaluated to identify
and measure the prognostic factors that would help the surgeon decide
optimal therapy. Among 383 admitted for CaS at the East Avenue Medical
149 underwent radical resection with curative intent. (As historical
control, the experience in 136 cases was reviewed during the immediately
preceding 5-year period [1982-1986] when extended lymphadenectomy was
not the standard policy.) For staging, the TNM system
(tumor-node-metastasis) was used; to describe anatomy and surgery of
stomach lymphatics, the "Japanese Rules," as modified, were adapted.
Curative radical gastrectomy would include removal of the diseased
stomach and regional lymphatics as defined by frozen section, including
subtotal (or total) gastrectomy and "extended" D2 (with no. 12) node
dissection. The clinicopathologic factors were statistically analyzed,
using the accepted methods: Kaplan-Meier for survival, univariate
analysis, and multivariate analysis for independent predictors. Of the
12 risk factors assessed by univariate analysis, the following were
identified by multivariate analysis as independent prognosticators of
survival: (1) wall penetration; (2) node invasion; (3) TNM stage; (4)
resection margin; and (5) tumor size. After curative resection, the
operative mortality was 5.3% and the complications, 19.4%. The 5-year
survival was 60.4%, and recurrence, 15.4%. The results have shown that
the pathology-related factors, (1) wall penetration; (2) node invasion;
and (3) resection margin, are independent prognosticators of survival,
remarkably affecting outcome. In conclusion, the study supports radical
gastrectomy with extended D2 lymphadenectomy for CaS as safe and
effective. Survival and recurrence are a function of pathology and
adequate resection; operative mortality is defined by the patient's
condition.
4
UI - 11910475
AU - Matsumoto K; Murayama T; Nagasaki K; Osumi K; Tanaka K; Nakamaru M;
TI -
Kitajima M
One-stage surgical management of concomitant abdominal aortic aneurysm
and gastric or colorectal cancer.
SO - World J Surg 2002 Apr;26(4):434-7
AD - Department of Surgery, Keio University School of Medicine, 35
Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. surgeo@med.keio.ac.jp
One-stage surgical management of concomitant abdominal aortic aneurysm
(AAA) and gastric or colorectal cancer should provide certain benefits.
We reviewed the records of 21 patients with both AAA and gastric or
colorectal cancer who underwent one-stage surgical management. Four had
distal gastrectomy, 2 had total gastrectomy, and 5 had abdominoperineal
rectal resection transperitoneally; 3 had total gastrectomy
transperitoneally and AAA repair extraperitoneally. Two underwent right
hemicolectomy and thromboexclusion of the AAA. Two had creation of a
temporary ileostomy and implantation of an interposition graft. Two
underwent left hemicolectomy, creation of a temporary transversostomy,
and implantation of an interposition graft. One had a Hartmann's
procedure and implantation of a bifurcated prosthetic interposition
graft for AAA. There were no operative deaths or serious postoperative
complications. One patient had colorectal ischemia that resolved with
conservative treatment. Eighteen of the 21 patients (85.7%) were alive
10 months to 14 years postoperatively. In conclusion, one-stage surgical
treatment of concomitant AAA and gastric or colorectal cancer is well
tolerated and can avoid the time, financial costs, and patient anxiety
involved in a second operation.
5
UI - 11819737
AU - Wang SJ; Wen DG; Zhang J; Man X; Liu H
TI -
Intensify standardized therapy for esophageal and stomach cancer in
tumor hospitals.
SO - World J Gastroenterol 2001 Feb;7(1):80-2
AD - Hebei Tumor Hospital, 5 Jiankanglu, Shijiazhuang 050011, Hebei Province,
China.
6
UI - 11922742
AU - Kasakura Y; Mochizuki F; Wakabayashi K; Kochi M; Fujii M; Takayama T
TI -
An evaluation of the effectiveness of extended lymph node dissection in
patients with gastric cancer: a retrospective study of 1403 cases at a
single institution.
SO - J Surg Res 2002 Apr;103(2):252-9
AD - Third Department of Surgery, Nihon University School of Medicine, 30-1
Oyaguchi-kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
ykasakura@aol.com
BACKGROUND: Many investigators have reported that extended lymph node
dissection (D2 dissection) is probably an effective procedure. However,
the theory that D2 dissection leads to an improvement in survival has
not been confirmed in randomized trials. We attempted to confirm the
effectiveness of D2 dissection with gastrectomy for gastric cancer.
MATERIALS AND METHODS: Gastric cancer patients (1403) underwent curative
resection by D1 (991 patients) or D2 (412 patients) dissection with
gastrectomy. Survival rates calculated for all patients and subdivided
for stage, depth of invasion, and lymph node metastasis were compared
between the two groups. The diagnosis of lymph node metastasis was
compared between macroscopic and histological findings. RESULTS: There
was no significant difference in the survival of patients overall.
However, in the patients with stage II, T1 or T2, or N1 disease, the
survival of the D2 group was significantly better than that of the D1
group. The false positive rates of lymph node metastasis were 53.3% in
the N1 group, 26.2% in the N2 group, and 9.2% in the N3 group. In a
considerable proportion of the N1 and N2 patients, histological findings
proved more or fewer metastases than macroscopic diagnosis. CONCLUSIONS:
Metastatic lymph nodes should be resected as far as possible. D2
dissection with gastrectomy is recommended for T1, N1 or T2, N1 disease,
particularly in younger patients.
7
UI - 11937009
AU - Shah MA
TI -
Recent developments in the treatment of gastric carcinoma.
SO - Curr Oncol Rep 2002 May;4(3):193-201
AD - Gastrointestinal Oncology Service, Department of Medicine, Memorial
Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021,
USA. shah1@mskcc.org
Surgery remains the mainstay for the curative treatment of gastric
carcinoma. However, despite adequate surgery, survival remains poor. The
use of adjuvant chemotherapy and radiotherapy has been examined in
multiple previous clinical trials without convincing evidence of
efficacy. However, recently, a large randomized controlled Intergroup
trial, INT 116, demonstrated a survival advantage with chemoradiotherapy
following curative surgery for gastric cancer. This review discusses the
merits of the Intergroup trial and the ways in which it should affect
the treatment of gastric cancer in the United States. INT 116 provides a
foundation on which we can build to improve the care of patients with
gastric cancer. With the evaluation of potentially better
chemotherapeutic agents and the advent of molecularly directed therapy,
there is increasing hope for improving the care of patients with gastric
carcinoma.
8
UI - 11937012
AU - Yao JC; Ajani JA
TI -
Adjuvant and preoperative chemotherapy for gastric cancer.
SO - Curr Oncol Rep 2002 May;4(3):222-8
AD - Department of Gastrointestinal Oncology, The University of Texas M.D.
Anderson Cancer Center, Box 426, 1515 Holcombe Boulevard, Houston, TX
77005-4341, USA.
Gastric cancer is the second most frequently diagnosed malignancy
worldwide, and the risk of relapse remains high in the majority of
patients undergoing resection. Attempts to reduce this risk and prolong
survival have led to numerous adjuvant chemotherapy trials that either
had no benefit for patients or occasionally had controversial results.
The recently reported Intergroup 0116 trial shows conclusive evidence of
survival benefit for patients treated with postoperative
chemoradiotherapy. In this Intergroup trial, which involves over 600
patients, a regimen of postoperative chemotherapy plus chemoradiotherapy
was shown to prolong overall and disease-free survival in gastric cancer
patients with stage IB through IV disease following a curative (R0)
resection. This approach should be considered the standard of care in
patients with gastric cancer who have undergone curative resection.
Preoperative chemotherapy shows promise in downstaging tumors and
increasing the rate of curative resection, but randomized trials are
needed to assess survival benefits. Efforts to combine existing
treatment modalities and new agents with novel mechanisms of action hold
promise for the future.
9
UI - 11938366
AU - Schumacher IK; Hunsicker A; Youssef PS; Lorenz D
TI -
Current concepts in gastric cancer surgery.
SO - Saudi Med J 2002 Jan;23(1):62-8
AD - Department of General and Gastroenterologic Surgery, Trauma Center,
Warener Str. 7, D-12683, Berlin, Germany.
OBJECTIVE: Current problems in gastric cancer surgery concern the extent
of gastric resection, the need for abdominal evisceration, the degree of
lymphadenectomy, and an optimal preoperative tumor staging procedure.
METHODS: A retrospective clinical trial of 284 patients who underwent
surgery at Ernst-Moritz-Arndt-University, Greifswald, Germany for
gastric cancer between 1987 and 1996. Main outcome measures consist of
epidemiological parameters, data on type of surgery, histopathology,
postoperative complications, mortality and cancer survival. Statistical
analysis between groups was performed using Chi square test
(perioperative risk factors, tumor localization, and surgical treatment)
and Mann Whitney U tests (Lauren classification). Survival was
calculated according to the Kaplan Meier method. RESULTS: The results
are in favor of subtotal gastrectomy performed for all T stages located
in the distal or middle 3rd provided that a tumor-free margin of 5 cm in
intestinal type and 10 cm in diffuse Lauren's type tumor can be
achieved, since this operation carries the lowest postoperative risks
and provides the best postoperative quality of life. Resection of
adjacent organs are indicated only if they are invaded by the primary
tumor (T4). They should not be resected as part of an extended
lymphadenectomy procedure. The primary tumor site should guide the
degree of lymph node removal. Multimodal therapeutic approaches and high
postoperative morbidity and mortality after exploratory laparotomy
justify the use of diagnostic laparoscopy in T3 and T4 stage tumors and
if diagnostic scans suggest tumor spread. CONCLUSION: Even though
surgery for gastric cancer is well standardized, a tailored surgical
approach to different extents of gastric cancer appears justified.
10
UI - 11954403
AU - Melville A
TI -
Better quality of care for UGI cancer patients.
SO - Nurs Times 2001 Mar 22-28;97(12):36-7
11
UI - 11961634
AU - Tagaya N; Mikami H; Kogure H; Kubota K; Hosoya Y; Nagai H
TI -
Laparoscopic intragastric stapled resection of gastric submucosal tumors
located near the esophagogastric junction.
SO - Surg Endosc 2002 Jan;16(1):177-9
AD - Second Department of Surgery, Dokkyo University School of Medicine, 880
Kitakobayashi, Mibu, Tochigi 321-0293, Japan. tagaya@dokkyomed.ac.jp
BACKGROUND: Laparoscopic resection cannot be applied easily to tumors
located near the esophagogastric junction or the pyloric ring. We
evaluated our laparoscopic intragastric surgical technique for gastric
submucosal tumors located near the esophagogastric junction and the
results of a clinical study. MATERIALS AND METHODS: We performed our
technique in six patients: one man and five woman with a mean age of 61
years. Using the laparoscopic procedure, after inflation of the stomach,
we inserted two or three balloon-type ports into the stomach through the
abdominal wall. RESULTS: A stapled resection of gastric submucosal
tumors using a laparoscopic linear stapler was performed successfully in
all the patients. Without exception, stapled resections were
successfully performed. The mean operation time was 168 min, and the
blood loss was minimal There were no intra- or postoperative
complications. The mean postoperative hospital stay was 9.8 days. The
mean maximal diameter size of the resected specimens was 2.4 cm.
Histopathologic diagnoses were gastrointestinal stromal tumors in five
cases and enterogenous cyst in one. There were no recurrences during a
mean follow-up period of 27 +/- 11.6 months. CONCLUSION: Although we
need to evaluate the long-term outcomes, our procedure is considered
technically feasible, safe, and useful for the resection of gastric
submucosal tumors located near the esophagogastric junction.
12
UI - 11917491
AU - Yoshida S
TI -
[Therapeutic guideline reviews. Stomach cancer--the Japanese Society of
Stomach Cancer]
SO - Nippon Naika Gakkai Zasshi 2002 Feb 10;91(2):674-84
13
UI - 11944951
AU - Yokota T; Kunii Y; Saito T; Teshima S; Yamada Y; Iwamoto K; Takahashi H;
TI -
Takahashi M; Kikuchi S; Yamauchi H
Prognostic factors of gastric cancer tumours of less than 2 cm in
diameter: rationale for limited surgery.
SO - Eur J Surg Oncol 2002 Apr;28(3):209-13
AD - Department of Surgery, Sendai National Hospital, Sendai 983-8520, Japan.
yo40@sh.comminet.or.jp
BACKGROUND: A recent trend in the surgical treatment of patients with
early gastric cancer in Japan has been to limit surgery to an extent
that ensures complete cure and improvement in the patient's quality of
life. If a gastric cancer tumour can be completely eradicated by
laparoscopic surgery, the patient can be cured of cancer without major
operative stress. A small gastric cancer tumour of less than 2 cm in
diameter is an indication for laparoscopic surgery, but little is known
about what protocol of surgical treatment is appropriate for this type
of tumour. PATIENTS AND METHODS: The clinicopathological features of 150
patients with gastric cancer tumour of less than 2 cm in diameter were
reviewed retrospectively from hospital records between 1985 and 1995.
The results of retrospective analysis of clinicopathological data of 24
patients with advanced cancer were compared with those of 126 patients
with early cancer. Univariate and multivariate analyses of patients with
small gastric cancer tumours were performed to evaluate the prognostic
significance of clinicopathological features. RESULTS: A significant
difference was seen between the gross tumour appearances in the two
groups; Borrmann type-4 tumours were more common in the advanced group.
Lymph-node metastasis, lymphatic vessel invasion and vascular invasion
were found more frequently in the advanced cancer group than in the
early cancer group. Scirrhous type was more common in the advanced
cancer group. In univariate analysis, unfavourable prognostic factors
included deep cancer invasion, presence of lymph-node metastasis,
lymphatic invasion and vascular invasion. Using Cox's proportional
hazard regression model, only nodal involvement emerged as an
independent statistically significant prognostic parameter associated
with long-term survival. CONCLUSION: Laparoscopic surgery should not be
performed on tumours that are Borrmann type in macroscopic appearance
and scirrhous-type histologically. Lymph-node metastasis is an
independent prognostic factor. We recommend laparoscopic surgery
involving local resection of the stomach without lymphadenectomy for
small, early gastric cancer tumours that satisfy the criteria mentioned
above. However, the validity of this recommendation should be tested by
a prospective randomized control trial in the future. Copyright Harcourt
Publishers Limited.
14
UI - 11995696
AU - Cascinu S
TI -
[Role of docetaxel in the treatment of gastric cancer]
SO - Tumori 2001 Nov-Dec;87(6):A10-2
15
UI - 11995706
AU - Barone C
TI -
[Irinotecan in the treatment of stomach cancer]
SO - Tumori 2001 Nov-Dec;87(6):A33-5
16
UI - 11757291
AU - Petrova MV; Voskresenskii SV; Krasnova TE
TI -
[Changes in mechanical properties of the lungs in thoracic surgery in
cancer patients]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):16-9
Mechanical characteristics of the lungs and time course of their changes
at various stages of thoracal surgery were studied in 119 cancer
patients. Lung compliance significantly decreased during transfer of the
patients into lateral position. The ranges of normal values of lung
compliance and aerodynamic resistance at the stage of one-lung
ventilation were determined. The studies confirmed the necessity of
intraoperative spirometry in the complex of thoracal operation
monitoring.
17
UI - 11757296
AU - Pleskov AP
TI -
[Central hemodynamics and prognostic significance of circulatory
hyperdynamics after interventions for esophageal cancer]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):33-6
Central hemodynamic parameters were studied by direct catheterization of
the pulmonary artery in 70 patients with cancer of the esophagus and
cardial portion of the stomach during the early postoperative period
after extensive or extensive-combined interventions through the
thoracoabdominal access. Analysis of the mean initial and intraoperative
parameters at different stages of the operation showed no essential
deviations from the norm. Studies of heart production at different
stages showed that during transfer of patients from the operation room
into intensive care ward, one-third of patients developed low ejection
syndrome and another one-third hyperdynamic syndrome, while the mean
values looked satisfactory. On days 3-5, circulatory hyperdynamia was
detected in 60% patients, which was observed over the entire period of
observation in 75% patients. It is noteworthy that polyorgan failure was
4-fold more often observed in patients with normal cardiac output than
in those with the hyperdynamic syndrome. Probable causes of this
phenomenon are discussed.
18
UI - 11757308
AU - Nekhaev IV; Sviridova SP; Kiselevskii MV
TI -
[Possibilities of immune prevention of pyo-septic complications in
cancer patients by granulocytic colony stimulating factors]
SO - Anesteziol Reanimatol 2001 Sep-Oct;(5):64-7
The study was carried out during the postoperative period in 75 patients
with cancer of the esophagus and cardial portion of the stomach and 40
patients with lung cancer; 64 of these patients received
immunoprophylactic treatment with neipogen, granulocytic
colony-stimulating factor. Immune prevention resulted in a 2-fold
decrease in the incidence and severity of pyoseptic and visceral
complications and 1.5 times decrease in the duration of hospital
treatment and mortality during the early postoperative period. Neipogen
therapy was conductive to a 2-fold increase in the leukocyte count
during the postoperative period in comparison with the control. The
range of "safe" values of the major mediators of inflammations
(TNF-alpha, IL-1, IL-8), characteristic of uneventful course of the
postoperative period, was determined. About 75% pyoseptic complications
were associated with mediator levels below this range. The levels of
inflammation mediators in the patients treated with neipogen were within
the safe range.
19
UI - 11928796
AU - Weber SM; Karpeh MS
TI -
Randomized clinical trials in gastric cancer.
SO - Surg Oncol Clin N Am 2002 Jan;11(1):111-31, ix
AD - Section of Surgical Oncology, University of Wisconsin Hospital, Madison,
USA. webers@mskcc.org
A total of 52 prospective, randomized controlled trials (RCT), published
from 1975 to 2000, were reviewed for gastric cancer. The primary focus
of these efforts has been the use of chemotherapy in patients with
metastatic or locally advanced disease, accounting for 23 of the 52
trials. In comparison, there were only six surgical trials evaluating
the extent of either primary resection or lymphadenectomy.
20
UI - 11996237
AU - de Manzoni G; Pedrazzani C; Pasini F; Di Leo A; Durante E; Castaldini G;
TI -
Cordiano C
Results of surgical treatment of adenocarcinoma of the gastric cardia.
SO - Ann Thorac Surg 2002 Apr;73(4):1035-40
AD - First Division of General Surgery, University of Verona, Italy.
chirurgia.urgenza@univr.it
BACKGROUND: Comparison among different studies regarding adenocarcinoma
of the cardia has been difficult since the Siewert classification was
introduced. This study analyzed the experience of a single institution
in the treatment of gastric cardia cancer with the aim of assessing
principal prognostic factors and long-term outcome. METHODS: The results
of 96 patients who underwent resection with curative intent for gastric
cardia cancer at the First Division of General Surgery, University of
with special reference to Siewert type. RESULTS: Despite a high number
of curative resections (85.4%), the 5-year survival rate was poor (24%)
for all Siewert types (p = 0.8), and for early tumors (51%) also. Chance
of cure was limited to pN0 and pN1 patients. Multivariate analysis
showed that microscopic or macroscopic residual tumor and pN-positive
categories had a significantly higher risk of death (risk ratio, 2.18
and 2.68, respectively) and the pN2 and pN3 category had the most
negative prognostic factor (risk ratio, 7.6). CONCLUSIONS: The long-term
prognosis for gastric cardia cancer remains poor and is independent of
Siewert type, with cure limited to pN0 and pN1 patients.
21
UI - 11941998
AU - de Manzoni G; Di Leo A; Tomezzoli A; Pedrazzani C; Piubello Q; Bonfiglio
TI -
M; Valloncini E; Veraldi GF
[Prognostic value of peritoneal lavage cytology in gastric cancer]
SO - Chir Ital 2002 Jan-Feb;54(1):1-6
AD - Divisione Clinicizzata di Chirurgia Generale, Universita di Verona,
Ospedale Civile Maggiore, 37126 Verona.
The microscopic detection of free peritoneal tumour cells in peritoneal
lavage fluid in gastric cancer patients is a useful predictor of
peritoneal recurrence and poor prognosis. The aim of this study was to
verify the prognostic significance of intraoperative peritoneal lavage
cytology and its value as a predictor of peritoneal recurrence. We
evaluated the presence of free peritoneal tumour cells with extemporary
cytological examination in a series of 170 peritoneal washing samples
from patients undergoing gastrectomy for gastric cancer over the period
extemporary lavage cytology and there were no false-negatives as
compared with the final examination. All patients with positive cytology
presented serosal infiltration (T3/T4). Positive peritoneal lavage
cytology was a predictor of poor prognosis and peritoneal recurrence:
the 24 month survival rate was 17% for positive and 60% for negative
cases (P = 0.003); in positive cases 71% of recurrences were located in
the peritoneum. Intraoperative cytological examination of peritoneal
washings can detect the presence of free malignant cells in the
peritoneal cavity and can be used to select patients who may benefit
from intraperitoneal chemotherapy.
22
UI - 11942007
AU - Sivelli R; Del Rio P; Bonati L; Sianesi M
TI -
[Gastric polyps: a clinical contribution]
SO - Chir Ital 2002 Jan-Feb;54(1):37-40
AD - Istituto di Clinica Chirurgica Generale e dei Trapianti d'Organo
Universita degli Studi di Parma.
The incidence of diagnosis of gastric polyps is now higher than in past
years owing to the introduction of endoscopy in the diagnosis and
treatment of upper digestive tract disease. One hundred and sixty-four
median age of the patients was 61.4 years (range: 16-84 yrs). Polypoid
lesions were more frequent in males (M:F = 1.5:1). Seventy-nine patients
were asymptomatic (48.2%). Sixty-four percent of the polyps were located
in the antrum. We diagnosed 73 hyperplastic polyps, 27 adenomatous
lesions, 8 inflammatory polyps and 56 pseudopolyps. Malignant lesions
were detected in 9 adenomatous polyps (4 type I and 5 type II early
gastric cancers). Endoscopy is the examination of choice in the
diagnosis and treatment of gastric polyps. We confirm that there is a
relationship between histological type, neoplastic change and the size
of the polyps.
23
UI - 11952588
AU - Jeung HC; Rha SY; Jang WI; Noh SH; Chung HC
TI -
Treatment of advanced gastric cancer by palliative gastrectomy,
cytoreductive therapy and postoperative intraperitoneal chemotherapy.
SO - Br J Surg 2002 Apr;89(4):460-6
AD - Cancer Metastasis Research Centre, Yonsei University College of
Medicine, Seoul, Korea.
BACKGROUND: The treatment options for the 10-20 per cent of patients
with gastric cancer who present with peritoneal dissemination are
extremely limited and no standard approach exists. METHODS: The
feasibility of using intraperitoneal chemotherapy to treat gastric
cancer with intra-abdominal gross residual lesions after palliative
gastrectomy with maximal cytoreduction was investigated. Early
postoperative intraperitoneal chemotherapy started on the day of
operation with 5-fluorouracil 500 mg/m2 and cisplatin 40 mg/m2 (days
1-3) over a 4-week interval. RESULTS: Of the 53 patients enrolled
progression-free survival (PFS) was 7 months and the overall survival
was 12 months. In multivariate analysis, performance status was the only
significant defining factor for PFS (P = 0.009). The predominant
toxicity was neutropenia and nausea/vomiting. The relative dose
intensity of 5-fluorouracil and cisplatin was 89 and 63 per cent
respectively. CONCLUSION: Performance status emerged as a major
determining factor for prognosis and patient selection for early
postoperative intraperitoneal chemotherapy in patients with advanced
gastric cancer after maximally cytoreductive surgery.
24
UI - 11952589
AU - Yu W; Seo BY; Chung HY
TI -
Postoperative body-weight loss and survival after curative resection for
gastric cancer.
SO - Br J Surg 2002 Apr;89(4):467-70
AD - Department of Surgery, School of Medicine, Kyungpook National
University, 50 Samduk-dong, Taegu, 700-721, Korea. wyu@knu.ac.kr
BACKGROUND: Body-weight loss has been reported as a poor prognostic
factor for some malignancies. The purpose of this study was to evaluate
the prognostic value of postoperative body-weight loss in patients with
gastric cancer. METHODS: In 564 patients who underwent curative
resection for gastric cancer, usual body-weight, body-weight at the time
of resection and that 6 and 12 months after resection were recorded
prospectively. RESULTS: The 5-year survival rate of patients who lost
more than 5 per cent of their 6-month postoperative weight by 12 months
after resection was 63 per cent while that of patients who maintained 95
per cent or more of their 6-month postoperative weight was 84 per cent
(P < 0.001). Multivariate analysis revealed that serosal invasion, nodal
metastasis, body-weight loss during the second 6-month interval after
resection and extent of gastric resection were independent prognostic
indicators. CONCLUSION: When a patient loses body-weight during the
second 6-month interval after curative resection for gastric cancer,
recurrent disease should be suspected.
25
UI - 11997826
AU - Matthews BD; Walsh RM; Kercher KW; Sing RF; Pratt BL; Answini GA;
TI -
Heniford BT
Laparoscopic vs open resection of gastric stromal tumors.
SO - Surg Endosc 2002 May;16(5):803-7
AD - Department of Surgery, Carolinas Medical Center, 1000 Blythe Boulevard,
Charlotte, NC 28203, USA. bmatthews@carolinas.org
BACKGROUND: Gastric stromal tumors are rare neoplasms that may be benign
or malignant. Given that malignant gastric stromal tumors rarely involve
lymph nodes and require excision with negative margins, they appear
amendable to laparoscopic excision. There are few reports of
laparoscopic resection, and no comparisons have been done between
laparoscopic and open surgery. This study compares the relative efficacy
patients underwent 35 operations for gastric stromal tumors.
Laparoscopic resections were performed in 21 patients; open resections
were done in 12 patients. The medical records of the patients were
reviewed retrospectively with regard to operating time, blood loss,
length of stay, and clinical course. RESULTS: Patient demographics,
tumor characteristics (mean tumor size, benign vs malignant), and
presenting symptoms were similar for both groups. In the laparoscopic
group, 15 wedge resections; three partial gastrectomies, and three
transgastric needlescopic enucleations were performed. In the open
group, six wedge resections, four antrectomies, and two partial proximal
gastrectomies were performed. There were no significant differences in
mean operative time (169 vs 160 min), mean estimated blood loss (106 vs
129 cc), or perioperative complication rate (9.5% vs 8.3%) between the
laparoscopic and open groups, respectively. The mean length of stay was
significantly less (p<0.05) in the laparoscopic group (3.8 vs 6.2 days).
Average follow-up was 1.5 years. One patient in each group has died due
to metastatic disease. There have been no trocar site recurrences.
CONCLUSIONS: Laparoscopic resection of gastric stromal tumors is safe
and appropriate. Tumor size, operating time, and estimated blood loss
were equivalent to the open approach, and there was a statistically
shorter hospital stay in the laparoscopic group.
26
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
27
UI - 12019399
AU - Grossmann EM; Longo WE; Virgo KS; Johnson FE; Oprian CA; Henderson W;
TI -
Daley J; Khuri SF
Morbidity and mortality of gastrectomy for cancer in Department of
Veterans Affairs Medical Centers.
SO - Surgery 2002 May;131(5):484-90
AD - Department of Surgery, Saint Louis University School of Medicine and the
St Louis VA Medical Center, MO 63110-0250, USA.
BACKGROUND: The purpose of this study was to define risk factors that
predict 30-day morbidity and mortality after gastrectomy for cancer in
Veterans Affairs (VA) Medical Centers. METHODS: The VA National Surgical
Quality Improvement Program prospectively collected data on 708 patients
undergoing gastrectomy for cancer in 123 participating VA medical
centers from 1991 to 1998. Independent variables included 68
preoperative patient characteristics and 12 intraoperative variables;
the dependent variables were 21 defined adverse outcomes and death.
Predictive models for 30-day morbidity and mortality were constructed by
using stepwise logistic regression analysis. RESULTS: The 30-day
morbidity rate was 33.3% (236 of 708). The overall 30-day mortality rate
was 7.6% (54 of 708). Significant positive predictors of morbidity (P
<.05) included current pneumonia, American Society of Anesthesiologists
class IV (threat to life), partially dependent functional status,
dyspnea on minimal exertion, preoperative transfusion, extended
operative time, and increasing age. Significant positive predictors of
mortality (P <.05) included do not resuscitate status, prior stroke,
intraoperative transfusion, preoperative weight loss, preoperative
transfusion, and elevated preoperative alkaline phosphatase level.
CONCLUSIONS: Risk factors predicting morbidity and mortality rates at VA
hospitals after gastrectomy for gastric cancer are reported by using a
prospectively collected, multi-institutional database. Assigning
relative weights to factors associated with adverse outcomes may help
improve patient care.
28
UI - 12019405
AU - Kunisaki C; Shimada H; Nomura M; Akiyama H; Takahashi M; Matsuda G
TI -
Lack of efficacy of prophylactic continuous hyperthermic peritoneal
perfusion on subsequent peritoneal recurrence and survival in patients
with advanced gastric cancer.
SO - Surgery 2002 May;131(5):521-8
AD - Second Department of Surgery, Yokohama City University, School of
Medicine, Yokohama, Japan.
BACKGROUND: Peritoneal recurrence is a major cause of death in advanced
gastric cancer. Although many kinds of chemotherapy intended to prevent
peritoneal recurrence of gastric cancer have been evaluated, few have
been successful. Few studies have assessed the clinical significance of
continuous hyperthermic peritoneal perfusion in peritoneal recurrence.
METHODS: From 1992 to 1999, a total of 124 patients with advanced
gastric cancer with tumors invading deeper than the serosa but with no
peritoneal metastasis underwent potentially curative gastrectomy and
were enrolled in this study. Prophylactic continuous hyperthermic
peritoneal perfusion (P-CHPP) was performed in 45 patients younger than
65 years old and without comorbidity who gave informed consent.
Seventy-nine patients who did not meet the inclusion criteria
represented the control group. After reconstruction of the alimentary
tract, P-CHPP was carried out for 40 minutes with 150 mg cisplatin, 15
mg mitomycin C, and 150 mg etoposide in 5 to 6 L physiologic saline
maintained at 42 degrees C to 43 degrees C. The surgical results,
recurrent pattern, and postoperative morbidity were assessed by
univariate and multivariate analysis. RESULTS: When compared with
patients not undergoing P-CHPP, patients treated by P-CHPP had higher
incidences of respiratory failure (73% vs 19%; P <.0001) and renal
failure (7% vs 0%; P <.03). Neither 5-year survival (49% vs 56%) nor the
patterns of recurrence (peritoneal, hematogenous, and lymphatic) were
affected by P-CHPP. CONCLUSIONS: P-CHPP by our methods had no efficacy
as prophylactic treatment for peritoneal recurrence induced by gastric
cancer. New therapeutic strategies, such as chemosensitivity assessment,
are necessary to obtain good therapeutic results with CHPP.
29
UI - 11374723
AU - Declich P; Tavani E; Porcellati M; Bellone S; Grassini R
TI -
Long-term omeprazole treatment and fundic gland polyps: a very
authoritative proof against a link?
SO - Am J Gastroenterol 2001 May;96(5):1650
30
UI - 11853213
AU - Hsu PI; Lai KH; Lo GH; Lin CK; Lo CC; Wang EM; Wang YY; Tsai WL; Lin CP;
TI -
Tseng HH; Chen HC; Chen JL
Sequential changes of gastric hyperplastic polyps following endoscopic
ligation.
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Nov;64(11):609-14
AD - Department of Internal Medicine, Kaohsiung Veterans General Hospital,
Taiwan, ROC.
BACKGROUND: Endoscopic ligation has been extensively applied in the
management of esophageal and gastric varices with or without bleeding.
The varices are automatically eradicated through the use of ligation.
However, whether avascular necrosis will occur in a gastrointestinal
polyp when the base is ligated remains unclear. The aims of this pilot
study were to investigate the sequential changes of gastric hyperplastic
polyps following endoscopic detachable snare ligation and to determine
the possibility of induction of avascular necrosis in these lesions
following ligation. METHODS: Eleven patients with eighteen gastric
hyperplastic polyps were treated with endoscopic detachable-snare
ligation. The polyps were observed for 5 minutes and biopsies were then
conducted. At 14 days after endoscopic ligation, follow-up endoscopies
were performed to assess the outcome of the strangulated polyps.
RESULTS: After being strangulated by the detachable snares, a majority
of the polyps immediately congested (94%), and then developed cyanotic
change (89%) approximately 4 minutes later. Pathological examination
revealed severe venous congestion in the lamina propria of the
strangulated polyps. On follow-up endoscopy 2 weeks later, all the
snares had dropped off, and avascular necrosis occurred in sixteen
polyps (89%). All of the polyps with avascular necrosis were detected to
have developed cyanotic changes in initial endoscopy. No complications
occurred during or following the ligation procedure. CONCLUSIONS: Most
gastric hyperplastic polyps develop avascular necrosis following
ligation by detachable snare. Cyanotic change is an important predictor
of the outcomes of the lesions following endoscopic ligation. The
application of this ligation technique in treatment of bleeding or
non-bleeding gastrointestinal polyps deserves further investigation.
31
UI - 11853214
AU - Chang FY
TI -
Endoscopic ligation for removal of stomach hyperptastic polyp: less risk
or saving money?
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Nov;64(11):615-6
32
UI - 12004845
AU - Panzini I; Gianni L; Fattori PP; Tassinari D; Imola M; Fabbri P;
TI -
Arcangeli V; Drudi G; Canuti D; Fochessati F; Ravaioli A
Adjuvant chemotherapy in gastric cancer: a meta-analysis of randomized
trials and a comparison with previous meta-analyses.
SO - Tumori 2002 Jan-Feb;88(1):21-7
AD - Division of Medical Oncology, Ospedale Infermi, Rimini, Italy.
ilariapanzini@virgilio.it
AIMS AND BACKGROUND: Up to now adjuvant chemotherapy after curative
resection for gastric cancer (GC) has been considered an experimental
approach. The results of existing phase III randomized trials comparing
chemotherapy with control after surgery are controversial. Three
meta-analyses have been published in recent years. It is likely that
each of them presents a theoretical bias, mainly as regards the
inclusion criteria of the trials. In this article we re-examine this
potential bias, highlighting the differences between the present and
past meta-analyses on adjuvant chemotherapy for GC. METHODS: Only
randomized controlled clinical trials comparing systemic adjuvant
chemotherapy with control after radical resection of GC were eligible.
Total mortality was assessed as outcome measure of the treatment effect
and a pooled odds ratio was calculated using the Peto-Mantel-Haenszel
method. RESULTS: After the selection process 17 papers (18 comparisons)
proved eligible for inclusion in the meta-analysis with a total of 3118
patients, of whom 1546 randomized to the treatment arms and 1572 to the
control arms; 762 and 871 deaths occurred in the treatment and control
arms, respectively. Statistical analysis suggests an absence of
significant heterogeneity between the trials and a significant advantage
in survival for adjuvant chemotherapy (pooled odds ratio, 0.72, 95% Cl,
0.62-0.84). CONCLUSIONS: Our meta-analysis would seem to indicate that
adjuvant chemotherapy results in a significant survival advantage in
patients with GC. However, this observation undoubtedly requires
confirmation in large randomized controlled trials including cisplatin
before adjuvant chemotherapy after curative resection for GC can be
proposed for use in clinical practice.
33
UI - 11836567
AU - Kim R; Tanabe K; Inoue H; Toge T
TI -
Mechanism(s) of antitumor action in protracted infusion of low dose
5-fluorouracil and cisplatin in gastric carcinoma.
SO - Int J Oncol 2002 Mar;20(3):549-55
AD - Department of Surgical Oncology, Research Institute for Radiation
Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan.
rkim@ipc.hiroshima-u.ac.jp
The therapeutic efficacy of low dose administration of 5-fluorouracil
(5-FU) and cisplatin (CDDP) (low dose FP) has been reported in patients
with advanced and recurrent gastric carcinoma. Mechanism(s) by which low
dose FP exerts antitumor effect is not entirely clear. We investigated
mechanism(s) of the therapeutic efficacy in combination with 5-FU and
CDDP in terms of signal transduction pathways leading to apoptosis.
Using two human gastric carcinoma cell lines, MKN28 and MKN45, antitumor
effect in combination treatment with 5-FU and CDDP was assessed by MTT
5-day assay. The significant antitumor effect was determined with more
than 50% growth inhibition compared to control cells. Enhancement of
antitumor effect in the combination treatment was analyzed using
isobologram. Apoptotic cell death was assessed by DNA ladder formation
assay, and expression of apoptosis-related genes was detected by Western
blotting. Concentration of free platinum and 5-FU was measured by
high-pressure liquid chromatography (HPLC), and dihydropyrimidine
dehydrogenase (DPD) activity and total folate levels were assessed by
enzyme immunoassays. Antitumor effect in single treatment with 5-FU was
not observed significantly with the concentration from 1 to 5 microM in
vitro. In contrast, antitumor effect in combination treatment with 5-FU
and CDDP showed a synergism with the concentration of CDDP from 1.5 to 3
microM. Single treatment with CDDP also did not show significant
antitumor effect with the concentration from 1.5 to 3 microM. The
enhancement in the synergistic effect by CDDP was dose-dependent. Any
free platinum treated with low dose CDDP was not detected into gastric
carcinoma cells, however, treatment with CDDP induced a receptor
signaling pathway, that is mediated by Fas but not DR4. It may directly
activate caspase 3 leading to apoptosis. Although the receptor signaling
pathway in apoptosis was not observed by 5-FU, Bax-induced cytochrome c
and caspase 3 was also observed in a receptor-independent pathway by
5-FU and CDDP. Total folate levels by cotreatment with CDDP was
increased to 1.5-fold compared to 5-FU alone, whereas DPD activity and
5-FU concentration were not changed by cotreatment of CDDP in vivo. The
enhancement of antitumor effect by low dose FP can be explained as
follows: i) low dose treatment with CDDP induces apoptotic cell death
through a receptor signaling pathway even in absence of free platinum
into cells; ii) increased folate level by CDDP and a non-receptor
signaling pathways by 5-FU contribute to apoptotic cell death in gastric
carcinoma.
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