National Cancer Institute®
Last Modified: July 1, 2002
UI - 11972272
AU - Brandimarte G; Tursi A
TI - Endoscopic treatment of benign anastomotic esophageal stenosis with electrocautery.
SO - Endoscopy 2002 May;34(5):399-401
AD - Department of Internal Medicine, Digestive Endoscopy Unit, Cristo Re Hospital, Rome, Italy.
BACKGROUND AND STUDY AIMS: Stricture of the esophagus following surgical resection is uncommon. Several methods have been described for treatment of this entity, but the therapeutic success may be impaired either by poor long-term results or by poor acceptance by patients. Even the high cost of the therapeutic management may represent a problem. We describe the use of electrocautery to treat benign anastomotic esophageal stenosis. PATIENTS AND METHODS: Six unselected consecutive patients (four men, two women; mean age 68.3, range 54 - 82) with stenosis following esophagojejunostomy were enrolled in this trial. Postoperative stenoses were shown endoscopically (four patients) or radiographically (two patients). We performed endoscopic dilation of the strictures using electrocautery. RESULTS: In all patients we obtained dilation of the strictures, without any immediate or delayed procedure-related complication. No recurrence of the stenosis was demonstrated during a mean 24-month follow-up (range 8 - 33 months). CONCLUSIONS: This study showed that endoscopic electrocautery is a safe and effective treatment for benign anastomotic esophageal stenosis.
UI - 10997811
AU - Mari E; Floriani I; Tinazzi A; Buda A; Belfiglio M; Valentini M; Cascinu
TI - S; Barni S; Labianca R; Torri V Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trials. A study of the GISCAD (Gruppo Italiano per lo Studio dei Carcinomi dell'Apparato Digerente).
SO - Ann Oncol 2000 Jul;11(7):837-43
AD - Consorzio Mario Negri Sud, Centro di Ricerche Farmacologiche e Biomediche, Dipartimento di Farmacologia ed Epidemiologia Clinica, S. Maria Imbaro, Italy.
BACKGROUND: Several studies have investigated the possible role of the adjuvant chemotherapy after curative resection for gastric cancer failing to show a clear indication; previous meta-analyses suggested small survival benefit of adjuvant chemotherapy, but the statistical methods used were open to criticisms. MATERIALS AND METHODS: Randomised trials were identified by means of Medline and CancerLit and by selecting references from relevant articles. Systematic review of all randomised clinical trials of adjuvant chemotherapy for gastric cancer considered. Pooling of data was performed using the fixed effect model. Death for any cause was the study endpoint. The hazard ratio and its 95% confidence intervals (95% CI), derived according to the method of Parmar, were the statistics chosen for summarising the relative benefit of chemotherapy versus control. RESULTS: Overall 20 articles (21 comparisons) were considered for analysis. Three studies used single agent chemotherapy, seven combination of 5-fluorouracil (5-FU) with anthracyclin, ten combination of 5-FU without anthracyclines. Information on 3658 patients, 2180 deaths, was collected. Chemotherapy reduced the risk of death by 18% (hazard ratio 0.82, 95% CI: 0.75-0.89, P < 0.001). Association of Anthracyclines to 5-FU did not show a statistically significant improvement when compared with the effect of the other regimens. CONCLUSIONS: Chemotherapy produces a small survival benefit in patients with curatively resected gastric cancer. However, taking into account the limitations of literature based meta-analyses, adjuvant chemotherapy is still to be considered as an investigational approach.
UI - 11583204
AU - Gianni L; Panzini I; Tassinari D; Mianulli AM; Desiderio F; Ravaioli A
TI - Meta-analyses of randomized trials of adjuvant chemotherapy in gastric cancer.
SO - Ann Oncol 2001 Aug;12(8):1178-80
UI - 12075173
AU - Nishikawa K; Kawahara H; Yumiba T; Nishida T; Inoue Y; Ito T; Matsuda H
TI - Functional characteristics of the pylorus in patients undergoing pylorus--preserving gastrectomy for early gastric cancer.
SO - Surgery 2002 Jun;131(6):613-24
AD - Department of Surgery, Osaka University Graduate School of Medicine, Japan.
BACKGROUND: This study investigates the functional characteristics of the pylorus in patients undergoing pylorus-preserving gastrectomy (PPG) for early gastric cancer. METHODS: In study 1, postprandial symptoms and gastric emptying were compared between 2 groups of 12 patients with early gastric cancer more than 1 year after either PPG (PPG group) or distal gastrectomy (DG) (DG group). Gastric emptying was evaluated with the dual isotope technique for liquids and solids separately. In study 2, pyloric motility was evaluated with a sleeve/sidehole manometric assembly in 7 patients undergoing PPG, which was compared with that in the preoperative patients. RESULTS: In study 1, the overall modified Visick score of postprandial symptoms and the Sigstad dumping score were significantly lower in the PPG group compared with the DG group (P <.05). Early accelerated gastric emptying was observed in both groups for liquids, but only in the DG group for solids. In study 2, isolated pyloric pressure waves induced by intraduodenal lipid infusion and phase III-like activity induced by intravenous erythromycin infusion were preserved after PPG. CONCLUSIONS: The quantitative analysis of postoperative symptoms revealed that PPG patients were associated with better clinical conditions than DG patients. The clinical benefits of PPG are considered to be based on the function of the preserved pylorus.
UI - 11547741
AU - Macdonald JS; Smalley SR; Benedetti J; Hundahl SA; Estes NC; Stemmermann
TI - GN; Haller DG; Ajani JA; Gunderson LL; Jessup JM; Martenson JA Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction.
SO - N Engl J Med 2001 Sep 6;345(10):725-30
AD - St Vincent's Comprehensive Cancer Center, New York, USA.
BACKGROUND: Surgical resection of adenocarcinoma of the stomach is curative in less than 40 percent of cases. We investigated the effect of surgery plus postoperative (adjuvant) chemoradiotherapy on the survival of patients with resectable adenocarcinoma of the stomach or gastroesophageal junction. METHODS: A total of 556 patients with resected adenocarcinoma of the stomach or gastroesophageal junction were randomly assigned to surgery plus postoperative chemoradiotherapy or surgery alone. The adjuvant treatment consisted of 425 mg of fluorouracil per square meter of body-surface area per day, plus 20 mg of leucovorin per square meter per day, for five days, followed by 4500 cGy of radiation at 180 cGy per day, given five days per week for five weeks, with modified doses of fluorouracil and leucovorin on the first four and the last three days of radiotherapy. One month after the completion of radiotherapy, two five-day cycles of fluorouracil (425 mg per square meter per day) plus leucovorin (20 mg per square meter per day) were given one month apart. RESULTS: The median overall survival in the surgery-only group was 27 months, as compared with 36 months in the chemoradiotherapy group; the hazard ratio for death was 1.35 (95 percent confidence interval, 1.09 to 1.66; P=0.005). The hazard ratio for relapse was 1.52 (95 percent confidence interval, 1.23 to 1.86; P<0.001). Three patients (1 percent) died from toxic effects of the chemoradiotherapy; grade 3 toxic effects occurred in 41 percent of the patients in the chemoradiotherapy group, and grade 4 toxic effects occurred in 32 percent. CONCLUSIONS: Postoperative chemoradiotherapy should be considered for all patients at high risk for recurrence of adenocarcinoma of the stomach or gastroesophageal junction who have undergone curative resection.
UI - 11855062
AU - Mitrokhin AA; Meshcheriakov GN; Moroz VV
TI - [Comparative evaluation of methods of analgesia after operations on the stomach]
SO - Anesteziol Reanimatol 2001 May-Jun;(6):43-6
A general somatic syndromal approach to evaluation of clinical status by SAPS II and APACH II scores was used in 41 patients operated on for gastric cancer. Epidural analgesia in these patients promoted rapid regression of the severity of condition, did not require high opioid doses, had a positive effect on the peristaltic activity of the intestine, and accelerated treatment in intensive care wards.
UI - 12109442
AU - Sasaki T; Maeda Y; Mukoyama O
TI - [Guideline for proper use of antineoplastic agents. Cancer of the digestive system--malignant cancers (stomach, colonic, and pancreatic cancers)]
SO - Gan To Kagaku Ryoho 2002 Jun;29(6):1008-14
UI - 11571980
AU - Yu W; Whang I; Chung HY; Averbach A; Sugarbaker PH
TI - Indications for early postoperative intraperitoneal chemotherapy of advanced gastric cancer: results of a prospective randomized trial.
SO - World J Surg 2001 Aug;25(8):985-90
AD - Department of Surgery, Cancer Research Institute, Kyungpook National University, 50 Samduk-dong, Taegu 700-721, Korea. firstname.lastname@example.org
Previous analysis of this prospective randomized trial and meta-analysis of published randomized trials of adjuvant intraperitoneal chemotherapy demonstrated improved survival in patients with advanced gastric cancer. Simple criteria applicable at the time of surgery for patient selection were sought in this analysis. From 1990 to 1995 a series of 248 patients with biopsy-proven gastric cancer were randomized intraoperatively to receive early postoperative intraperitoneal mitomycin C and 5-fluorouracil (125 patients) versus surgery only (123 patients). Gastric resection plus early postoperative intraperitoneal chemotherapy showed improved overall survival compared to surgery only (54% and 38%, respectively; p = 0.0278). There were statistically significant differences in patients with stage III (57% and 23%, respectively; p = 0.0024) and in those with stage IV (28% and 5%, respectively; p = 0.0098) gastric cancer. The improvement in survival rate was statistically significant for the subgroup of patients with gross serosal invasion (52% and 25%, respectively; p = 0.0004) and patients with lymph node metastasis (46% and 22%, respectively; p = 0.0027). The surgeons' impression about lymph node status was unreliable, but assessment of serosal invasion was accurate in 80% of cases. Gross serosal invasion with or without frozen section evaluation of lymph nodes can be used as the major selection criteria for early postoperative intraperitoneal chemotherapy of advanced gastric cancer.
UI - 11731922
AU - Ma J; Fu NY; Pang DB; Wu WY; Xu AL
TI - Apoptosis induced by isoliquiritigenin in human gastric cancer MGC-803 cells.
SO - Planta Med 2001 Nov;67(8):754-7
AD - Department of Biochemistry, Center for Biopharmaceutical Research and State Key Laboratory For Biocontrol, College of Life Science, Zhongshan University, Guangzhou, P. R. China.
Isoliquiritigenin, which is possibly a principal anti-tumor constituent of licorice, a traditional Chinese herb, was examined for apoptosis-inducing activity in human gastric cancer MGC-803 cells. Typical morphological and biochemical features of apoptosis including cell shrinkage, chromatin condensation, DNA ladder formation, and appearance of apoptotic peaks (subG(1)) were observed in MGC-803 cells with isoliquiritigenin treatment. Using Fluo-3 and Rh123 as fluorescent probes, respectively, it was found that the intracellular free calcium concentration increased and the mitochondrial transmembrane potential (Deltapsi(m)) decreased in a dose-dependent manner in apoptotic cells. These results suggest that isoliquiritigenin induced apoptosis of MGC-803 cells through calcium- and Deltapsi(m)-dependent pathways, indicating that it is potentially useful as a natural anti-cancer agent.
UI - 11822757
AU - Blanke CD; Haller DG; Benson AB; Rothenberg ML; Berlin J; Mori M; Hsieh
TI - YC; Miller LL A phase II study of irinotecan with 5-fluorouracil and leucovorin in patients with previously untreated gastric adenocarcinoma.
SO - Ann Oncol 2001 Nov;12(11):1575-80
AD - Department of Medicine, Oregon Health & Science Uniiversity, Portland 97201, USA. email@example.com
BACKGROUND: A phase II study testing the safety and efficacy of irinotecan (CPT-11). 5-fluorouracil (5-FU), and leucovorin (LCV) was conducted in patients with advanced gastric adenocarcinomas. PATIENTS AND METHODS: Patients with metastatic or recurrent adenocarcinoma of the gastroesophageal junction (GEJ) or stomach were entered onto this study. Previous chemotherapy for metastatic disease was not allowed. Treatment consisted of repeated 6-week cycles comprising CPT-11 125 mg/m2 intravenously (i.v.) followed immediately by LCV 20 mg/m2 i.v. and 5-FU 500 mg/m2 i.v., all given weekly for four weeks followed by a two-week rest. RESULTS: Thirty-eight patients were enrolled and 36 eligible patients received protocol therapy. Grade 3-5 toxicities consisted primarily of neutropenia (36%) and diarrhea (28%). Neutropenic infection was observed in 14% of patients, with 3 (8%) dying of neutropenic sepsis. The overall response rate was 22% (95% confidence interval [CI] 8.5% to 35.5%). Median survival was 7.6 months, and median time to progression was 4.4 months. CONCLUSION: This weekly regimen of CPT-11 with bolus 5-FU/LCV is active in patients with advanced adenocarcinomas of the stomach or gastroesophageal junction. While rates of grade 3-4 neutropenia and diarrhea were similar to those observed historically in patients receiving this regimen for colorectal cancer, neutropenic fever/sepsis appeared to be more frequent, and dose modifications were substantial. Future trials of this combination in patients with gastric cancer should decrease the absolute starting drug doses and/ or employ altered scheduling that better accommodates the pattern of toxicity.
UI - 12051736
AU - Lee DY; Yi HK; Hwang PH; Oh Y
TI - Enhanced expression of insulin-like growth factor binding protein-3 sensitizes the growth inhibitory effect of anticancer drugs in gastric cancer cells.
SO - Biochem Biophys Res Commun 2002 Jun 7;294(2):480-6
AD - Department of Pediatrics and Research Institute of Clinical Medicine, Chonbuk National University Medical School, 634-18, Keumam-dong, Jeonju, Jeonbuk 561-712, South Korea. firstname.lastname@example.org
Insulin-like growth factor (IGF)-I and -II are potent mitogens and their mitogenic effects are modulated by IGF binding proteins (IGFBPs). In this study, we evaluated whether the enhanced expression of IGFBP-3 may increase the sensitivity of human gastric cancer cells to the anticancer drugs. We further investigated the potential mechanism for the growth inhibitory effect of anticancer drug induced-IGFBP-3 expression. These IGFBP-3-expressing gastric cancer cells showed a lower proliferation rate than IGFBP-3-non-expressing cells. Treatment with anticancer drugs resulted in up-regulation of IGFBP-3 expression in IGFBP-3-expressing cells. Interestingly the anticancer drug-induced-growth inhibition was more evident in IGFBP-3-expressing cells causing the IGFBP-3 expressing cells but not the IGFBP-3 non-expressing cells to accumulate in the G1/G0 phase and induce apoptosis. The exogenous addition of IGFBP-3 inhibited the growth of IGFBP-3-non-expressing cells, causing them to undergo apoptosis. Our data suggest that IGFBP-3 may have an important role in the biology of gastric cancer cell growth and provides a potential marker for predicting the responsiveness to anticancer drugs. (c) 2002 Elsevier Science (USA).
UI - 12099002
AU - Sasagawa Y; Sasagawa T; Takasaki K
TI - [Mass screening for gastric cancer performed in Costa Rica]
SO - Nippon Shokakibyo Gakkai Zasshi 2002 Jun;99(6):577-83
AD - Tokyo Women's Medical University, Institute of Gastroenterology, Department of Surgery.
We performed mass screening for gastric cancer by means of X-ray in Costa Rica from 1996 through 1999. Screening was performed on 10,064 subjects and 69 gastric cancers were detected (screening group). During the same period 172 gastric cancer patients were referred to us (non-screening group). Results of screening in Japan (Japanese group) were quoted from the annual report of the Japanese Society of Gastroenterological Mass Survey. This study is a comparison of these 3 groups. The detection rate was 0.68% in the screening group, 0.11% in the Japanese group. The operability was 92.7%, 76.1%, 97.0%, the resectability 96.8%, 83.2%, 98.6%, the rate of early gastric cancer 64.5%, 30.3%, 65.9%, and the rate of curability A 79.0%, 38.5%. 82.6% in the screening group, non-screening group and Japanese group respectively. The results in the screening group were exactly equal to those in the Japanese group. These results show that the same results can be obtained in Costa Rica as in Japan, if screening is performed with the same diagnostic level and skill as in Japan.
UI - 11986192
AU - Schwarz RE; Zagala-Nevarez K
TI - Recurrence patterns after radical gastrectomy for gastric cancer: prognostic factors and implications for postoperative adjuvant therapy.
SO - Ann Surg Oncol 2002 May;9(4):394-400
AD - Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California, USA. email@example.com
BACKGROUND: A recent Intergroup trial demonstrated a significant survival advantage of postgastrectomy chemoradiation in gastric cancer patients, primarily because of a reduction of a relative locoregional recurrence (LRR) rate exceeding 70% in control patients. Radical gastrectomy with extended lymphadenectomy may reduce LRR, possibly affecting adjuvant treatment strategies. METHODS: Information on patients undergoing gastrectomy for potentially curable gastric cancer between 1990 and 2000 was reviewed. Patterns of first disease recurrence, survival, and disease-free survival were calculated, and predictors were identified. RESULTS: Gastrectomies were performed in 73 patients, with R0 resections in 82%. The median lymph node count was 24; positive nodes were found in 64% of patients. The median actuarial survival was 27 months, with a 5-year survival of 37%. Disease recurred in 35 patients (48%) after a median interval of 7 months (range,.5-67). Recurrent disease patterns included distant only (37%), peritoneal only (23%), peritoneal/locoregional (17%), all sites combined (14%), locoregional only (6%), and distant/locoregional (3%). Recurrence predictors were N3 category for distant recurrence (hazard ratio [HR], 10.2; P =.005), T3/4 category for peritoneal recurrence (HR, 4.8; P =.008), peritoneal relapse (HR, 40; P =.002), and a prior abdominal operation for LRR (HR, 3.2; P =.01). N2 disease had a distant failure risk similar to N1 status and an intraperitoneal failure risk similar to an N3 category. CONCLUSIONS: Isolated LRR of gastric cancer after gastrectomy and extended lymphadenectomy is rare in this series. Most recurrences appeared diffusely at distant or peritoneal sites, and most LRRs occurred in conjunction with relapse at extraregional sites. Pathologic predictors of intraperitoneal (T3/4) or systemic failure (>N1) could be used to guide individualized, risk-oriented, adjuvant treatment.
UI - 11986193
AU - Yoshikawa T; Tsuburaya A; Kobayashi O; Sairenji M; Motohashi H; Noguchi
TI - Y Is D2 lymph node dissection necessary for early gastric cancer?
SO - Ann Surg Oncol 2002 May;9(4):401-5
AD - Department of Gastrointestinal Surgery, Kanagawa Cancer Center Hospital, Yokohama, Japan. firstname.lastname@example.org
BACKGROUND: The objective of this study was to clarify a survival benefit of D2 lymphadenectomy in patients with early gastric carcinoma (GC). METHODS: A retrospective study was conducted to examine the incidence of metastasis to level 2 lymph nodes, the causes of postoperative death, and the mode of recurrence in 1041 patients who had early GC and underwent D2 lymphadenectomy with curative intent. RESULTS: Postoperative mortality occurred in 129 (12.4%) of 1041 patients, 6 patients (.6%) died of surgical complications, 108 (10.2%) died of diseases other than cancer, and 16 (1.5%) died of recurrence. Hematogenous metastasis was the major mode of recurrence (56.3% of recurrences). The incidence of metastasis to level 2 nodes was 2.5% (26 of 1041 patients, 18 of whom were alive). Thus, the estimated survival benefit of radical lymphadenectomy for patients with early GC was calculated to be 1.7% (18 of 1041 patients). CONCLUSIONS: D2 lymphadenectomy in patients with early GC had little survival benefit because (1) metastasis to level 2 nodes was rare, (2) most causes of death were not related to the tumor, and (3) more than half the recurrences were hematogenous. Use of radical lymphadenectomy for early GC should be limited.
UI - 12080272
AU - Kitano S; Shiraishi N; Kakisako K; Yasuda K; Inomata M; Adachi Y
TI - Laparoscopy-assisted Billroth-I gastrectomy (LADG) for cancer: our 10 years' experience.
SO - Surg Laparosc Endosc Percutan Tech 2002 Jun;12(3):204-7
AD - Department of Surgery I, Oita Medical University, Japan. email@example.com
To evaluate laparoscopy-assisted Billroth-I gastrectomy (LADG), we examined the outcome of its use over the last 10 years. From December LADG in the surgical department of Oita Medical University and Koga hospital by the same surgical staffs. An operation record and clinical sheets were reviewed to obtain the operative findings, clinical course, and pathologic findings of resected specimens to evaluate the usefulness of LADG in the management of early gastric cancer. In all LADG procedures, regional lymph nodes dissection (D1+alpha) was successfully performed using laparoscopy. The mean operative duration and blood loss were 234 minutes and 139 mL, respectively. There were only four major complications, including pneumonia, leakage of anastomosis, pancreatic injury, and anastomotic stenosis, but all these cases were successfully treated conservatively. The mean length of postoperative stay was 16.3 +/- 2.5 days. All patients except one, who died not of cancer but of cerebral bleeding, were alive without recurrence or port-site metastasis during mean follow-up period of 45 months. We successfully performed 116 LADG procedures over 10 years. This procedure is recommended for the treatment of patients with early gastric cancer because of the associated good prognosis and several benefits, including less invasiveness and early recovery.
UI - 11783171
AU - Yu Q; Chen Z; Tang X
TI - [Study on early application of Chinese medicinal herbs after total gastrectomy]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 Oct;19(10):592-4
AD - First Affiliated Hospital of Anhui College of TCM, Hefei (230031).
OBJECTIVE: To evaluate the effect of Chinese medicinal herbs on digestive function, nutritional status, immune function and complication rate in patients after total gastrectomy. METHODS: Thirty-nine patients of gastrectomy were divided into two groups and were intubated into small intestine for administering postoperatively. Twenty-one of them belonged to the treated group and were dripped with Chinese medicinal herbs intraluminally during the early postoperative stage, while 18 cases of the control group were dripped with 0.9% sodium chloride. RESULTS: The digestive function of the treated group recovered rapidly, and the nutritional status and immune function improved markedly as compared with those of the control group (P < 0.001-0.05). CONCLUSION: Early application of Chinese medicinal herbs after total gastrectomy could promote the digestive function to recover to normal, the nutritional status and immune function to improve. The occurrence of complication was reduced.
UI - 11783197
AU - Wang S; Qi Q
TI - [Influence of pre-operational medicated dachengqi granule on inflammatory mediator in tumor patients]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 Jun;19(6):337-9
AD - Surgical Department of Dagang Hospital, Tianjin (300270).
OBJECTIVE: To find a simple, effective, with few side effect method of pre-cleaning intestine for surgical operation of abdominal malignancy. METHODS: Thirty-five patients of abdominal malignant tumor were divided into two groups randomly and treated with Dachengqi Granule (DCQG) and routine western management (including oral taking antibiotics and enema with soap solution) respectively. Serum level of nitric oxide (NO), tumor necrosis factor (TNF), intercellular adhesive molecule-1 (ICAM-1), and enteric function recovering of patients were observed before operation, and 1, 3 and 7 days after operation. RESULTS: Time of borborygmus recovering and gas discharging after operation in the DCQG group was earlier than that of the control group, P < 0.05. Serum NO level was raised in both groups after operation, and reaching peak level at 3rd day post-operationally, as compared with pre-operation, P < 0.05, the difference between the two groups was insignificant. Serum TNF level lowered in both groups, but more apparent in the DCQG group, the inter-group difference was significant at the first day of operation, P < 0.05. Serum ICAM-1 level in the DCQG group decreased at the day 3 after operation with significant difference in comparison with pre-operational level, P < 0.05, but in the control group, change of ICAM-1 before and after operation was insignificant. The mean ICAM-1 level of the DCQG group at the day 3 post-operationally was significantly lower than that of the control group, P < 0.05. CONCLUSIONS: Compared with the routine management of western medicine, using DCQG for intestine pre-cleaning before operation could obviously lower the operation induced inflammatory reaction of tumor patients, reduce the secretion of inflammatory mediator, improve the recovery of enteric function and reduce the post-operational complication. Therefore, applying DCQG for pre-operational enteric preparing could provide a satisfactory effect in surgical operation of abdominal malignancy.
UI - 11783204
AU - Hu L; Lao S; Chen W
TI - [Therapeutic study of gastric precancerous condition]
SO - Zhongguo Zhong Xi Yi Jie He Za Zhi 1999 Jun;19(6):372-3
UI - 11998610
AU - Giarelli E
TI - Prophylactic gastrectomy for CDH1 mutation carriers.
SO - Clin J Oncol Nurs 2002 May-Jun;6(3):161-2
AD - IMLNG@aol.com
Gastric cancer is difficult to diagnose at an early stage. Signs and symptoms of the disease often only occur when advanced or metastatic disease is present. A very small number of gastric cancers are hereditary. The mutation to the E-cadherin gene has high penetrance and confers a lifetime risk of gastric cancer of 80% for carriers. Because of the high penetrance of the mutation and the difficulty of diagnosing gastric cancer at an early stage, carriers of the mutation may be candidates for prophylactic gastrectomy. Although limited data are available about the complications and outcomes associated with prophylactic gastrectomy, nurses should be knowledgeable about prophylactic surgery for hereditary cancers and prepared to answer patients' questions about their prevention.
UI - 12066046
AU - Hicks S
TI - Gastric cancer: diagnosis, risk factors, treatment and life issues.
SO - Br J Nurs 2001 Apr 26-May 9;10(8):529-36
AD - Surgical High Dependency Unit, North Staffordshire NHS Trust, UK.
Gastric cancer is the sixth most common malignancy in the UK. It is responsible for over 9000 deaths annually in the UK. Distal gastric cancer has a decreasing incidence, but proximal gastric cancer continues to increase. Gastroscopy remains the gold standards for accurate diagnosis. Early diagnosis is essential, but symptoms and signs are often mistaken for other less serious diseases. Major surgery is the only proven treatment, but 5-year survival rates postoperatively are only 34%, and many people will continue to suffer side-effects of the surgery. Open access gastroscopy and health promotion may be the best chance of detecting this disease early enough so that it is treated successfully.
UI - 11982716
AU - Inoue H; Fukami N; Yoshida T; Kudo SE
TI - Endoscopic mucosal resection for esophageal and gastric cancers.
SO - J Gastroenterol Hepatol 2002 Apr;17(4):382-8
AD - Digestive Disease Center, Northern Yokohama Hospital, Showa University, Chuo 35-1, Chigasaki, Tzusuki-ku, Yokohama 224-8503, Japan. firstname.lastname@example.org
Better outcomes for digestive tract cancers are likely to be possible if the tumors are detected in their earliest stages, particularly when they exist as mucosal lesions without lymph node metastases. Early esophageal squamous cell cancers can be detected with high sensitivity and specificity by iodine staining. Only mucosal cancers are suitable for the curative approach of submucosal resection; the rate of metastasis is 4%, compared to a rate of metastasis of 35% in tumors with submucosal spread. In this review, the history of endscopic mucosal resection is reviewed, including the factors that have refined the technique and technical aspects crucial for effective results. The importance of adequate submucosal injection of dilute epinephrine in saline solution is particularly emphasized. The overall efficacy, low rate of complications and such practical aspects as post-therapeutic care are discussed. In general, mucosal cancers of the gastrointestinal tract have no risk of lymph node metastases and can be curatively managed by refined endoscopic mucosal resection procedures. Copyright 2002 Blackwell Publishing Asia Pty Ltd
UI - 12085176
AU - Kornek GV; Raderer M; Schull B; Fiebiger W; Gedlicka C; Lenauer A;
TI - Depisch D; Schneeweiss B; Lang F; Scheithauer W Effective combination chemotherapy with paclitaxel and cisplatin with or without human granulocyte colony-stimulating factor and/or erythropoietin in patients with advanced gastric cancer.
SO - Br J Cancer 2002 Jun 17;86(12):1858-63
AD - Department of Internal Medicine I, University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
A phase II trial was performed to determine the antitumour efficacy and tolerance of combined paclitaxel and cisplatin with or without hematopoetic growth factor support in patients with advanced gastric cancer. Forty-five patients with histologically confirmed metastatic gastric cancer were entered in this trial. Treatment consisted of 2-weekly courses of paclitaxel 160 mg per m2 and cisplatin 60 mg per m2 both given on day 1. Depending on absolute neutrophil counts on the days of scheduled chemotherapeutic drug administration (1000-2000 per microl), a 5-day course of human granulocyte colony-stimulating factor 5 microg x kg(-1) per day was given subcutaneously; in addition, if haemoglobin was <12.0 mg dl(-1), erythropoietin 10 000 IU was administered subcutaneously three times per week. The confirmed overall response rate (intent-to-treat) was 44%, including five complete (11%) and 15 partial remissions (33%). Twelve patients had stable disease (27%), 11 (24%) progressed while on chemotherapy, and two patients were not evaluable. The median time to response was 3 months, the median time to progression 7.0 months, and the median survival time was 11.2 months with 12 patients currently alive. Haematologic toxicity was common, though WHO grade 4 neutropenia occurred in only five patients (11%). Apart from total alopecia in 16 patients (36%), severe non-haematologic adverse reactions included grade 3 peripheral neuropathy in six (13%) and anaphylaxis in two patients. In addition, there was one patient each who experienced grade 3 emesis, diarrhea, and infection, respectively. Our data suggest that the combination of paclitaxel and cisplatin with or without G-CSF and/or erythropoietin has promising therapeutic activity in patients with advanced gastric cancer. Copyright 2002 Cancer Research UK
UI - 12085177
AU - Bramhall SR; Hallissey MT; Whiting J; Scholefield J; Tierney G; Stuart
TI - RC; Hawkins RE; McCulloch P; Maughan T; Brown PD; Baillet M; Fielding JW Marimastat as maintenance therapy for patients with advanced gastric cancer: a randomised trial.
SO - Br J Cancer 2002 Jun 17;86(12):1864-70
AD - Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK. S.R.Bramhall@bham.ac.uk
This randomised, double-blind, placebo-controlled study was designed to evaluate the ability of the orally administered matrix metalloproteinase inhibitor, marimastat, to prolong survival in patients with non-resectable gastric and gastro-oesophageal adenocarcinoma. Three hundred and sixty-nine patients with histological proof of adenocarcinoma, who had received no more than a single regimen of 5-fluorouracil-based chemotherapy, were randomised to receive either marimastat (10 mg b.d.) or placebo. Patients were treated for as long as was tolerable. The primary endpoint was overall survival with secondary endpoints of time to disease progression and quality of life. At the point of protocol-defined study completion (85% mortality in the placebo arm) there was a modest difference in survival in the intention-to-treat population in favour of marimastat (P=0.07 log-rank test, hazard ratio=1.23 (95% confidence interval 0.98-1.55)). This survival benefit was maintained over a further 2 years of follow-up (P=0.024, hazard ratio=1.27 (1.03-1.57)). The median survival was 138 days for placebo and 160 days for marimastat, with 2-year survival of 3% and 9% respectively. A significant survival benefit was identified at study completion in the pre-defined sub-group of 123 patients who had received prior chemotherapy (P=0.045, hazard ratio=1.53 (1.00-2.34)). This benefit increased with 2 years additional follow-up (P=0.006, hazard ratio=1.68 (1.16-2.44)), with 2-year survival of 5% and 18% respectively. Progression-free survival was also significantly longer for patients receiving marimastat compared to placebo (P=0.009, hazard ratio=1.32 (1.07-1.63)). Marimastat treatment was associated with the development of musculoskeletal pain and inflammation. Events of anaemia, abdominal pain, jaundice and weight loss were more common in the placebo arm. This is one of the first demonstrations of a therapeutic benefit for a matrix metalloproteinase inhibitor in cancer patients. The greatest benefit was observed in patients who had previously received chemotherapy. A further randomised study of marimastat in these patients is warranted. Copyright 2002 Cancer Research UK
UI - 12132737
AU - Lekakos LN; Triantafillopoulos JK; Milingos ND; Sfikakis PG
TI - Adenocarcinoma of the gastric cardia: treatment via a left thoracoabdominal approach.
SO - Am Surg 2002 Jul;68(7):584-90
AD - Second Surgical Unit, Tzanion General Hospital, Pizaeus, Greece.
We examined the outcome of adenocarcinomas of the gastric cardia treated by total or proximal gastrectomy, lower esophagectomy, and D2 lymphadenectomy via a left thoracoabdominal approach. We compare these results with those of other methods as well as review the literature. During a 10-year period (1991-2000) 180 patients with primary gastric cancer were admitted to our department. Thirty-six of the patients had adenocarcinoma of the cardia. Twenty-four patients underwent total gastrectomy, D2 lymphadenectomy, and esophagectomy, and four others underwent proximal gastrectomy and esophagectomy with esophagogastric anastomosis via a left thoracoabdominal approach. These latter 28 patients compose our study group. We had no operative mortality, the morbidity varied, and the quality of life and the loss of body weight ranged within satisfactory levels, but the survival rate was rather poor. The median survival time was 19 +/- 1.2 months. Survival was significantly longer in patients with less than 40 per cent positive resected lymph nodes (P = 0.035). From the resulting data and our experience we believe that the left thoracoabdominal approach gives excellent exposure for radical resection of cancer of the gastric cardia and should be the procedure of choice for curative resection of such tumors. This approach combined with total gastrectomy and D2 lymphadenectomy can be performed with an acceptably low mortality rate; it provides good palliation but not encouraging survival rates. Although it is less radical proximal gastrectomy gives the same results and a better quality of life but may be performed only in the early stages of the disease.
UI - 11930849
AU - Bol P
TI - [Stomach cancer]
SO - Ned Tijdschr Tandheelkd 1999 Dec;106(12):461-2
UI - 12028004
AU - Thompson AM; Park KG
TI - Diagnosis and management of a mediastinal leak following radical oesophagectomy (Br J Surg 2001; 88: 1346-51).
SO - Br J Surg 2002 Jun;89(6):810-1; discussion 811
UI - 11829431
AU - Hyung WJ; Noh SH; Shin DW; Huh J; Huh BJ; Choi SH; Min JS
TI - Adverse effects of perioperative transfusion on patients with stage III and IV gastric cancer.
SO - Ann Surg Oncol 2002 Jan-Feb;9(1):5-12
AD - Department of Surgery and the Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea.
BACKGROUND: The degree of immunomodulation by perioperative blood transfusion and its resultant effects on cancer surgery are a subject of controversy. We evaluated the prognostic effects of perioperative blood transfusion on gastric cancer surgery. METHODS: A total of 1710 patients who underwent curative gastrectomy for gastric cancer from 1991 to 1995 were retrospectively reviewed. Uni- and multivariate analyses of the incidence, amount, and timing of perioperative blood transfusions and a comparison of the clinicopathological features were performed. RESULTS: A higher incidence of blood transfusions was associated with female sex, large tumors, upper-body location, Borrmann type III or IV lesions, longer operations, total gastrectomies, splenectomies, and D3 or more extended lymphadenectomy. The tumors in the transfused group were more advanced in depth of invasion and nodal classification. More frequent tumor recurrences were found in the transfused group. A dose-response relationship between the amount of transfused blood and prognosis was evident. Subgroup analyses of prognosis according to stage showed significant differences in stages III and IV between the transfused and nontransfused groups. On multivariate analysis, transfusion was shown to be an independent risk factor for recurrence and poor prognosis. CONCLUSIONS: These results suggest that perioperative transfusion is an unfavorable prognostic factor. It is thus better to refrain from unnecessary blood transfusion and to give the least amount of blood to patients with gastric cancer when transfusion is inevitable, especially for those with stage III and IV gastric cancers.
UI - 11882966
AU - Davydov MI; Ter-Ovanesov MD; Stilidi IS; Germanov AB; Efimov ON;
TI - Abdikhakimov AN; Marchuk VA [Cancer of the proximal section of the stomach: the standards of surgical treatment based on 30 years of experience]
SO - Vestn Ross Akad Med Nauk 2002;(1):25-9
Cancer of the GE-junction is a highly malignant tumor with early lymphatic metastasis to the lymph nodes both in the abdomen and mediastenum. At surgery, lymph nodal metastasis is revealed in nearly 80% of cases. At present, surgical treatment with extended lymph node dissection is the "golden standard". Over 30-year experience in surgically treating GE-junction tumors in 1209 patients at the Thoracoabdominal Department, Russian Cancer Research Center, Russian Academy of Medical Sciences, support the view that extended procedures are superior to standard procedures. Radical procedures were made in 956 of the 1209 patients. These included subtotal proximal gastrectomies in 54.2% of cases, transpleural gastrectomies with esophageal resection in 42.4%, and Ivor-Lewis type procedures in 3.4%. In cases with extended lymph nodal dissection, five-year survival was superior to the results of standard procedures: 32.8 +/- 6.0 and 22.6 +/- 2.8%, respectively (t = 1.8). These figures obviously testify that extended and combined procedures with extended lymph nodal dissection make it possible to stage of a primary tumor and to improve long-term survival.
UI - 12085252
AU - Nagata C; Takatsuka N; Kawakami N; Shimizu H
TI - A prospective cohort study of soy product intake and stomach cancer death.
SO - Br J Cancer 2002 Jul 1;87(1):31-6
AD - Department of Public Health, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500-8705, Japan. email@example.com
The relationship between intake of soy products and death from stomach cancer was examined in a community-based prospective study of Japanese men and women in Takayama, Japan. Over 7 years of follow-up, 121 deaths from stomach cancer (81 men and 40 women) occurred among 30,304 (13,880 men and 16,424 women) participants who were at least 35 years of age. Diet including the intake of soy products and isoflavones was assessed by a validated semiquantitative food-frequency questionnaire at the beginning of the study. In men, the highest compared to the lowest tertile of total soy product intake was significantly inversely associated with death from stomach cancer after controlling for covariates (hazard ratios=0.50; 95% confidence intervals (CIs) 0.26-0.93, P for trend=0.03). Decreased hazard ratios for the highest compared to the lowest tertiles of total soy product intake (hazard ratios=0.49; 95% CI 0.22-1.13) was observed in women, although this association was of marginal significance. These data suggest that soy intake may reduce the risk of death from stomach cancer. Copyright 2002 Cancer Research UK
UI - 11568724
AU - Bellini M; Di Palma R; Lombardi S; Ferraiuolo G; Salvatore G
TI - [Long-term evaluation of the endoscopic treatment of gastric polyps]
SO - Minerva Chir 2001 Oct;56(5):487-93
AD - Istituto di Chirurgia Generale e d'Urgenza, Universita degli Studi Federico II, Naples, Italy.
BACKGROUND: The authors intend to evaluate the long-term efficacy of endoscopic treatment of gastric polyps. METHODS: They report their experience in 5000 upper gastro intestinal endoscopies performed between 1985 and 1998. The method used aimed to evaluate the distribution of polyps by sex and age, the frequency of various histological types and the incidence of complications in relation to histological type and the size of the polyps. The authors also analysed the indications and criteria of choice between endoscopic treatment and surgery and they calculated the incidence of malignant neoplasm and complications in relation to the endoscopic method used, as well as the incidence of relapse at the medium and long-term follow-up. They searched for the presence of neoplasms in the follow-up and compared their personal experience with data from international literature. RESULTS: The results obtained show that non-surgical treatment of gastric polyps is resolutive in most cases. The endoscopic resection of polyps was performed using a polypectomy loop. In patients converted to surgery, the necessity for the operation was caused by an unexpected hemorrhage that could not be controlled using endoscopic treatment. In this case, the operation consisted of resecting the entire wall of the lesion, including an extemporary histological analysis. CONCLUSIONS: The authors' experience allows them to state that endoscopic treatment of this gastric pathology is efficacious and free from risks and complications if stringent patient selection criteria are used (dimensions, morphological characteristics of the lesion) and control procedures over time suited to the potential malignancy of each histological type are carried out.
UI - 11818987
AU - Celis J; Ruiz E; Berrospi F; Payet E
TI - [Mechanical versus manual suture in the jejunal esophageal anastomosis after total gastrectomy in gastric cancer]
SO - Rev Gastroenterol Peru 2001 Oct-Dec;21(4):271-5
AD - Departamento de Abdomen, Instituto de Enfermedades Neoplasicas, Lima, Peru.
AIM: To compare the leakage rate of esophagojejunal anastomosis performed with stapler or hand sutures. MATERIAL AND METHODS: We studied a series of 367 patients who underwent total gastrectomy for gastric cancer at the Instituto de Enfermedades Neoplasicas (Lima-Peru) from 1986 to 1999. RESULTS: In 197 patients esophagojejunal anastomosis was performed with stapler and in 170 with manual sutures. There were no differences between both groups with regard to age, TNM stage, operating time and hospital stay. There were 8 anastomotic leakage (4.1%) in the stapler group and 4 (2.4%) in the hand sutures group (p> 0.05). Of these 12 cases, 2 patients (16%) died of causes directly related to the leak of the esophagojejunal anastomosis. CONCLUSION: There were no statistical differences in the rate of leakage of the esophagojejunal anastomosis performed with stapler or hand sutures, thus both techniques should be accepted as standard procedures.
UI - 12113541
AU - Suzuki S; Nishimaki T; Suzuki T; Kanda T; Nakagawa S; Hatakeyama K
TI - Outcomes of simultaneous resection of synchronous esophageal and extraesophageal carcinomas.
SO - J Am Coll Surg 2002 Jul;195(1):23-9
AD - First Department of Surgery, Niigata University School of Medicine, Japan.
BACKGROUND: Adequate extent of surgical resection of simultaneous primary esophageal and extraesophageal carcinomas is controversial. STUDY DESIGN: Clinicopathologic records and treatment outcomes of 57 patients undergoing simultaneous resection of both synchronous esophageal and extraesophageal carcinomas (SC group) were reviewed and compared with those of 316 patients receiving esophagectomy for solitary esophageal carcinoma (EC group). RESULTS: Mortality and morbidity rates