301
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Takahashi T, Saikawa Y, Kitagawa Y. Gastric cancer: current status of diagnosis and treatment. Cancers (Basel) 2013; 5:48-63. [PMID: 24216698 PMCID: PMC3730304 DOI: 10.3390/cancers5010048] [Citation(s) in RCA: 137] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/08/2013] [Accepted: 01/11/2013] [Indexed: 12/19/2022] Open
Abstract
Gastric cancer is the second leading cause of death from malignant disease worldwide and most frequently discovered in advanced stages. Because curative surgery is regarded as the only option for cure, early detection of resectable gastric cancer is extremely important for good patient outcomes. Therefore, noninvasive diagnostic modalities such as evolutionary endoscopy and positron emission tomography are utilized as screening tools for gastric cancer. To date, early gastric cancer is being treated using minimally invasive methods such as endoscopic treatment and laparoscopic surgery, while in advanced cancer it is necessary to consider multimodality treatment including chemotherapy, radiotherapy, and surgery. Because of the results of large clinical trials, surgery with extended lymphadenectomy could not be recommended as a standard therapy for advanced gastric cancer. Recent clinical trials had shown survival benefits of adjuvant chemotherapy after curative resection compared with surgery alone. In addition, recent advances of molecular targeted agents would play an important role as one of the modalities for advanced gastric cancer. In this review, we summarize the current status of diagnostic technology and treatment for gastric cancer.
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Affiliation(s)
- Tsunehiro Takahashi
- Department of Surgery, School of Medicine, Keio University, Shinjuku-ku, Tokyo 1608582, Japan.
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302
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Lee MH, Choi D, Park MJ, Lee MW. Gastric cancer: imaging and staging with MDCT based on the 7th AJCC guidelines. ACTA ACUST UNITED AC 2013; 37:531-40. [PMID: 21789552 DOI: 10.1007/s00261-011-9780-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Gastric cancer is a common deadly cancer worldwide. The tumor-node-metastasis (TNM) staging system is one of the most commonly used staging systems, and is accepted and maintained by the International Union against Cancer (UICC) and the American Joint Committee on Cancer (AJCC). The TNM system is well known to effectively predict the prognosis of gastric cancer patients. The latest revision of TNM staging was presented in the 7th edition of the AJCC in 2009. Multi-detector row CT (MDCT) is a powerful test for non-invasive evaluation and can assess metastatic and locoregional staging simultaneously. Current MDCT with isotropic imaging and 3D images has increased the accuracy of T and N staging in patients with gastric cancer. Multi-planar reformatted images permit the radiologist to select the optimal imaging plane to accurately evaluate tumor invasion depth of the gastric wall and perigastric infiltration to identify a fat plane between a tumor and adjacent organs, to avoid partial volume averaging effects, and to differentiate lymph nodes from small perigastric vessels. Thus, MDCT provides a useful all-in-one diagnostic method for the pre-operative evaluation of patients with known, or strongly suspected, gastric cancer according to the 7th AJCC TNM staging system.
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Affiliation(s)
- Mi Hee Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Ku, Seoul, Republic of Korea
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303
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Hayakawa Y, Hirata Y, Sakitani K, Nakagawa H, Nakata W, Kinoshita H, Takahashi R, Takeda K, Ichijo H, Maeda S, Koike K. Apoptosis signal-regulating kinase-1 inhibitor as a potent therapeutic drug for the treatment of gastric cancer. Cancer Sci 2012; 103:2181-5. [PMID: 23110662 DOI: 10.1111/cas.12024] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 08/26/2012] [Accepted: 09/02/2012] [Indexed: 01/24/2023] Open
Abstract
Aside from the human epidermal growth factor receptor-2 (HER2)-targeting agent trastuzumab, molecular targeting therapy for gastric cancer (GC) has not been established. We previously reported that apoptosis signal-regulating kinase-1 (ASK1) was upregulated in human GC and that overexpression of ASK1 promoted GC cell proliferation. Here, we investigated the effect of ASK1 inhibitor K811 on GC cells. K811 efficiently prevented cell proliferation in cell lines with high ASK1 expression and in HER2-overexpressing GC cells. Treatment with K811 reduced sizes of xenograft tumors by downregulating proliferation markers. These results indicate that ASK1 inhibition prevents GC cell growth in vitro and in vivo, suggesting that ASK1 inhibitors can be potent therapeutic drugs for GC.
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Affiliation(s)
- Yoku Hayakawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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304
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Dikken JL, Stiekema J, van de Velde CJH, Verheij M, Cats A, Wouters MWJM, van Sandick JW. Quality of care indicators for the surgical treatment of gastric cancer: a systematic review. Ann Surg Oncol 2012; 20:381-98. [PMID: 23054104 DOI: 10.1245/s10434-012-2574-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Indexed: 02/03/2023]
Abstract
BACKGROUND Quality assurance is increasingly acknowledged as a crucial factor for the (surgical) treatment of gastric cancer. The purpose of the current study was to define a minimum set of evidence-based quality of care indicators for the surgical treatment of locally advanced gastric cancer. METHODS A systematic review of the literature published between January 1990 and May 2011 was performed, using search terms on gastric cancer, treatment, and quality of care. Studies were selected based on predefined selection criteria. Potential quality of care indicators were assessed based on their level of evidence and were grouped into structure, process, and outcome indicators. RESULTS A total of 173 articles were included in the current study. For structural measures, evidence was found for the inverse relationship between hospital volume and postoperative mortality as well as overall survival. Regarding process measures, the most common indicators concerned surgical technique, perioperative care, and multimodality treatment. The only outcome indicator with supporting evidence was a microscopically radical resection. CONCLUSIONS Although specific literature on quality of care indicators for the surgical treatment of locally advanced gastric cancer is limited, several quality of care indicators could be identified. These indicators can be used in clinical audits and other quality assurance programs.
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Affiliation(s)
- Johan L Dikken
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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305
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Radical gastrectomy with para-aortic lymphadenectomy for carcinoma? The controversy continues. Commentary on Risk factors for metastasis to para-aortic lymph nodes in gastric cancer: a single institution study in China. Journal of Surgical Research. J Surg Res 2012; 185:e11-3. [PMID: 23036515 DOI: 10.1016/j.jss.2012.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 09/04/2012] [Accepted: 09/05/2012] [Indexed: 01/28/2023]
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306
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Vallbohmer D, Oh DS, Peters JH. The role of lymphadenectomy in the surgical treatment of esophageal and gastric cancer. Curr Probl Surg 2012; 49:471-515. [PMID: 22793506 DOI: 10.1067/j.cpsurg.2012.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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307
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Bickenbach KA, Denton B, Gonen M, Brennan MF, Coit DG, Strong VE. Impact of obesity on perioperative complications and long-term survival of patients with gastric cancer. Ann Surg Oncol 2012; 20:780-7. [PMID: 22976377 DOI: 10.1245/s10434-012-2653-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of obesity is increasing in the United States. Obesity has been associated with worse surgical outcomes, but its impact on long-term outcomes in gastric cancer is unclear. The aim of this study was to evaluate the effects of being overweight on surgical and long-term outcomes for patients with gastric cancer. METHODS Patients who underwent curative intent resection for gastric carcinoma from 1985 to 2007 were identified from a prospectively collected gastric cancer database. Overweight was defined as a body mass index (BMI) of 25 kg/m(2) or higher. Clinical outcomes of overweight and nonoverweight patients were compared. RESULTS From the total population of 1,853 patients, 1,125 (60.7%) were overweight. Overweight patients tended to have more proximal tumors and a lower T stage. Accurate complication data were available on a subset of patients from 2000 to 2007. A BMI of ≥25 was associated with increased postoperative complications (47.9 vs. 35.8%, p < 0.001). This was mainly due to an increase in the rate of wound infections (8.9 vs. 4.7%, p = 0.02) and anastomotic leaks (11.8 vs. 5.4%, p = 0.002). Multivariate logistic regression analysis showed that higher BMI, total gastrectomy, and use of neoadjuvant chemotherapy were associated with increased wound infection and anastomotic leak. Overweight patients were less likely to have adequate lymph node staging (73.3 vs. 79.2%, p = 0.047). There was no difference in overall survival or disease-specific survival between the two groups. CONCLUSIONS Increased BMI is a predictor of increased postoperative complications, including anastomotic leak, but it is not a predictor of survival in gastric cancer.
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Affiliation(s)
- Kai A Bickenbach
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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308
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Wang L, Liang H, Wang X, Li F, Ding X, Deng J. Risk factors for metastasis to para-aortic lymph nodes in gastric cancer: a single institution study in China. J Surg Res 2012; 179:54-9. [PMID: 23040213 DOI: 10.1016/j.jss.2012.08.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND Para-aortic lymph node (PAN) dissection is performed in some gastric cancer patients with extensive lymph node involvement. However, there is no consensus on selection of patients that will benefit from this high risk dissection. This study was to identify risk factors for PAN metastasis in gastric cancer. MATERIALS AND METHODS A total of 174 patients with gastric cancer who underwent D2 lymphadenectomy plus para-aortic nodal dissection in Tianjin Medical University Cancer Institute and Hospital from January 2001 to December 2010 were enrolled in the study. The association between clinicopathologic factors and para-aortic nodal invasion was analyzed. RESULTS Forty-seven patients (27.0%) had PAN metastases. Pathologic N stage was a significant risk factor for PAN metastasis after adjusting for other factors. A significant difference was shown in the proportion of PAN metastases between the N0/N1 group and N2/N3 group (6.2% versus 45.2%, P < 0.001, OR = 12.620). Lymph node station 9 showed a much higher odds ratio with PAN metastases than other routinely retrieved stations. CONCLUSION N stage and perigastric nodal status were important and independent risk factors for PAN metastasis, which may be useful for identifying patients at high risk of PAN metastasis who could benefit from PAN dissection.
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Affiliation(s)
- Li Wang
- Department of Gastric Cancer, Cancer Institute and Hospital of Tianjin Medical University, Tianjin, China
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309
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Mita K, Ito H, Murabayashi R, Sueyoshi K, Asakawa H, Nabetani M, Kamasako A, Koizumi K, Hayashi T. Postoperative bleeding complications after gastric cancer surgery in patients receiving anticoagulation and/or antiplatelet agents. Ann Surg Oncol 2012; 19:3745-52. [PMID: 22805868 DOI: 10.1245/s10434-012-2500-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Perioperative antithrombotic treatment for gastric cancer patients receiving chronic anticoagulation and/or antiplatelet agents requires an understanding of potential bleeding and thromboembolic risks. However, no study has examined the safety aspects of perioperative antithrombotic treatment during radical gastrectomy. This study sought to evaluate postoperative bleeding and thromboembolic complications after radical gastrectomy in patients undergoing perioperative antithrombotic treatment. METHODS The medical records of patient treated by radical gastrectomy from January 2006 to December 2010 were retrospectively reviewed. Those in the thromboprophylaxis group had received one of three regimens of perioperative antithrombotic treatment according to the clinical indications of chronic anticoagulation and/or antiplatelet agents and several published evidence-based recommendations: (1) bridging therapy with unfractionated heparin; (2) continuation of aspirin; or (3) both 1 and 2. multivariate analysis was used to identify risk factors for postoperative bleeding complications after radical gastrectomy. RESULTS During the study period, 340 patients underwent radical gastrectomy. Of these, 62 patients received perioperative antithrombotic treatment; this thromboprophylaxis group had a significantly higher postoperative bleeding rate (8.1 vs. 0.7 %, P = 0.003). However, other complications, including thromboembolic events, were similar in the two study groups. Multivariate analysis revealed that perioperative antithrombotic treatment was the only independent risk factor of postoperative bleeding complications after radical gastrectomy (odds ratio, 8.53; 95 % confidence interval, 1.47-49.39; P = 0.017). CONCLUSIONS Perioperative antithrombotic treatment is an independent risk factor of postoperative bleeding complications in patients with gastric cancer undergoing radical gastrectomy, although such treatment was effective in preventing postoperative thromboembolic events.
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Affiliation(s)
- Kazuhito Mita
- Department of Surgery, New-Tokyo Hospital, Matudo, Chiba, Japan.
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310
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Kanda T, Yajima K, Kosugi SI, Ishikawa T, Ajioka Y, Hatakeyama K. Gastrectomy as a secondary surgery for stage IV gastric cancer patients who underwent S-1-based chemotherapy: a multi-institute retrospective study. Gastric Cancer 2012; 15:235-44. [PMID: 22033890 DOI: 10.1007/s10120-011-0100-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 09/11/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current advances in chemotherapy provide opportunities for stage IV gastric cancer patients with distant metastasis to undergo potentially curable resection. There are, however, few data on gastrectomy as a secondary surgery aimed at rendering such patients cancer-free. METHODS We investigated stage IV gastric cancer patients who underwent surgery with curative intent after S-1-based chemotherapy between 2000 and 2008. Twenty-eight patients from 12 hospitals were enrolled in this study. Factors indicating that the tumors were incurable included clinical stage T4 in 9 patients, para-aortic node metastasis in 15, peritoneal metastasis in 7, and liver metastasis in 4. RESULTS Of the 28 laparotomy patients, 26 underwent complete resection with no residual tumor, obtaining a complete resection rate of 92.9%. There were no in-hospital deaths or reoperations. In four patients, the primary tumor showed pathological complete response. The 1-, 3-, and 5-year overall survival rates after secondary gastrectomy were 82.1, 45.9, and 34.4%, respectively, with a median survival time of 29 months. Univariate analysis revealed histological tumor length, clinical depth of tumor invasion, number of metastatic nodes, pathological depth of tumor invasion, and pathological response to be the factors influencing patient survival after secondary surgery. On multivariate analysis, histological tumor length (5.0 cm or larger) was the only significant prognostic factor (relative risk 3.23, P = 0.028). CONCLUSIONS Secondary gastrectomy following S-1-based chemotherapy was a safe and effective treatment for stage IV gastric cancer. Primary tumor size is an indicator for the appropriate selection of patients for this treatment.
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Affiliation(s)
- Tatsuo Kanda
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi-dori 1-757, Niigata, 951-8510, Japan,
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311
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Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I. Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 2012; 27:286-94. [PMID: 22733201 DOI: 10.1007/s00464-012-2442-x] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/04/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The oncologic safety and feasibility of laparoscopic D2 gastrectomy for advanced gastric cancer are still uncertain. The aim of this study is to compare our results for laparoscopic D2 gastrectomy with those for open D2 gastrectomy. METHODS Between 1998 and 2008, a total of 336 patients with clinical T2, T3, or T4 tumors underwent laparoscopic (n = 186) or open (n = 150) gastrectomy involving D2 lymph node dissection with curative intent. To produce this study population, 123 patients in the open group who matched those of the laparoscopic group with regard to age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor location, and clinical tumor stage were retrospectively selected. The short- and long-term outcomes of these patients were examined. RESULTS Laparoscopic D2 gastrectomy was associated with significantly less operative blood loss and shorter hospital stay, but longer operative time, compared with open D2 gastrectomy. The mortality and morbidity rates of the laparoscopic group were comparable to those of the open group (1.1 % vs. 0, P = 0.519, and 24.2 % vs. 28.5 %, P = 0.402). The 5-year disease-free and overall survival rates were 65.8 and 68.1 % in the laparoscopic group and 62.0 and 63.7 % in the open group (P = 0.737 and P = 0.968). There were no differences in the patterns of recurrence between the two groups. CONCLUSIONS This study suggests that laparoscopic D2 gastrectomy provides reasonable oncologic outcomes with acceptable morbidity and low mortality rates. Although operation time is currently long, this approach is associated with several advantages of laparoscopic surgery, including quick recovery of bowel function and short hospital stay. Laparoscopic D2 gastrectomy may offer a favorable alternative to open D2 gastrectomy for patients with advanced gastric cancer.
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Affiliation(s)
- Toshihiko Shinohara
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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312
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Batista TP, Martins MR. Lymph node dissection for gastric cancer: a critical review. Oncol Rev 2012; 6:e12. [PMID: 25992202 PMCID: PMC4419633 DOI: 10.4081/oncol.2012.e12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 02/29/2012] [Accepted: 06/04/2012] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer is one of the most common neoplasms and an important cause of cancer-related death worldwide. Efforts to reduce its high mortality rates are currently focused on multidisciplinary management. However, surgery remains a cornerstone in the management of patients with resectable disease. There is still some controversy as to the extent of lymph node dissection for potentially curable stomach cancer. Surgeons in eastern countries favor more extensive lymph node dissection, whereas those in the West favor less extensive dissection. Thus, extent of lymph node dissection remains one of the most hotly discussed aspects of gastric surgery, particularly because most stomach cancers are now often comprehensively treated by adding some perioperative chemotherapy or chemo-radiation. We provide a critical review of lymph nodes dissection for gastric cancer with a particular focus on its benefits in a multimodal approach.
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Affiliation(s)
- Thales Paulo Batista
- Department of Surgery/Oncology, FPS/IMIP - Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira
| | - Mário Rino Martins
- Department of Surgical Oncology, HCP - Hospital de Câncer de Pernambuco, Brazil
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313
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Mita K, Ito H, Fukumoto M, Murabayashi R, Koizumi K, Hayashi T. An adequate perioperative management and strategy for gastric cancer after coronary artery bypass using the right gastroepiploic artery. Surg Today 2012; 43:284-8. [PMID: 22706786 DOI: 10.1007/s00595-012-0224-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 01/12/2012] [Indexed: 12/29/2022]
Abstract
PURPOSE Interruption of the right gastroepiploic artery (RGEA) used for prior coronary artery bypass grafting (CABG) may cause life-threatening myocardial ischemia during gastrectomy. This study investigated the cases treated in this department and pooled data in the literature to identify an adequate perioperative RGEA management strategy. METHODS Eight patients underwent gastrectomy after CABG with the RGEA. This study examined conditions, management of the RGEA, No. 6 lymph node metastasis, and complications of these cases and those in the pooled data. RESULTS Percutaneous coronary intervention or a redo CABG was performed in advance in 7 and 1 patients, respectively. The RGEA was resected for dissection of No. 6 lymph nodes in 6 patients. Five patients had lymph node metastasis. Thirty-seven patients from 40 combined cases (92.5 %) underwent total or distal gastrectomy, but 17 patients (42.5 %) had RGEA resection. Resections of the RGEA and No. 6 lymph node metastasis were significantly higher in patients with perioperative coronary management than in those without such management. CONCLUSION Coronary and celiac angiography and coronary revascularization are prerequisites to prevent cardiac events during gastrectomy and dissection of No. 6 lymph nodes should be performed with resection of RGEA. Standard lymph node dissection should therefore be performed with a curative intent for all patients even those undergoing gastrectomy after CABG using RGEA.
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Affiliation(s)
- Kazuhito Mita
- Department of Surgery, New-Tokyo Hospital, Chiba, Japan.
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314
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Russell MC, Mansfield PF. Surgical approaches to gastric cancer. J Surg Oncol 2012; 107:250-8. [PMID: 22674546 DOI: 10.1002/jso.23180] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 05/14/2012] [Indexed: 12/11/2022]
Abstract
While the incidence of gastric cancer has declined substantially, it remains a major cause of morbidity and mortality. Surgical resection offers the best chance for curative treatment. Despite numerous studies, surgical controversies persist including endoscopic resection, extent of gastric resection, degree of lymphadenectomy, and laparoscopic resection. Balancing the benefits with the risks of surgical morbidity and mortality is essential. This review examines these controversies and provides insight into the surgical management of gastric cancer.
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Affiliation(s)
- Maria C Russell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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315
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Risk factors for surgical site infections after elective gastrectomy. J Gastrointest Surg 2012; 16:1107-15. [PMID: 22350727 DOI: 10.1007/s11605-012-1838-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/02/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to identify the risk factors for surgical site infections (SSIs) after elective gastrectomy. METHODS This study reviewed the medical records of 842 patients who underwent elective gastrectomy. Multivariate analyses were performed to determine the risk factors for SSIs. RESULTS Superficial incisional, deep incisional, and organ/space SSIs were detected in 50 (5.9%) patients, 2 (0.2%) patients, and 90 (10.7%) patients, respectively. A multivariate analysis demonstrated that female gender (p = 0.0332) and allogenic blood transfusion (p = 0.0266) were independent predictors for superficial incisional SSIs, while a male gender (p = 0.0355), corticosteroid therapy (p = 0.037), total gastrectomy (p < 0.0001), and a duration of operation ≥300 min (p = 0.0062) were independent predictors for organ/space SSIs. The median length of postoperative hospital stay was significantly longer in patients with organ/space SSIs in comparison to those without SSIs (p < 0.0001) and with superficial incisional SSIs (p < 0.0001). The patients with organ/space SSIs had a significantly higher re-operation rate in comparison to those without SSIs (p < 0.0001). CONCLUSIONS The risk factors both for incisional SSIs and for organ/space SSIs are strongly associated with surgical results. Meticulous surgical techniques are therefore required to prevent SSIs.
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316
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Severity of Complications After Gastrectomy in Elderly Patients With Gastric Cancer. World J Surg 2012; 36:2139-45. [DOI: 10.1007/s00268-012-1653-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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317
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Dikken JL, Cats A, Verheij M, van de Velde CJ. Randomized trials and quality assurance in gastric cancer surgery. J Surg Oncol 2012; 107:298-305. [DOI: 10.1002/jso.23080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 02/09/2012] [Indexed: 01/07/2023]
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318
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Sugisawa N, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat. Gastric Cancer 2012; 15:206-12. [PMID: 21993853 DOI: 10.1007/s10120-011-0099-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 09/11/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive visceral fat may be a better predictor of the development of postoperative morbidity after gastrectomy than body mass index (BMI). The aim of the present study was to clarify the most appropriate fat parameter to predict pancreas-related infection and anastomotic leakage following gastrectomy. METHODS The study was performed in 206 patients who underwent curative gastrectomy at the Shizuoka Cancer Center between April 2008 and March 2009. Relationships between fat parameters, including visceral fat area (VFA), and early surgical outcomes were investigated. The risk factors for pancreas-related infection and anastomotic leakage were identified using univariate and multivariate analyses. RESULTS There was no strong association between any of the fat parameters and operating time, intraoperative blood loss, the number of lymph nodes retrieved, or the duration of the postoperative hospital stay. Pancreas-related infection occurred in 18 patients (8.7%), whereas anastomotic leakage was observed in 10 patients (4.9%). Of all the fat parameters, only VFA was found to be an independent risk factor for both pancreas-related infection and anastomotic leakage, with odds ratios (95% confidence intervals) of 1.015 (1.005-1.025) and 1.010 (1.000-1.021), respectively. CONCLUSIONS Excessive visceral fat, represented by the VFA, was found to be an independent risk factor for both pancreas-related infection and anastomotic leakage following gastrectomy.
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Affiliation(s)
- Norihiko Sugisawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
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319
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An JY, Kim KM, Kim YM, Cheong JH, Hyung WJ, Noh SH. Surgical complications in gastric cancer patients preoperatively treated with chemotherapy: their risk factors and clinical relevance. Ann Surg Oncol 2012; 19:2452-8. [PMID: 22395984 DOI: 10.1245/s10434-012-2267-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study was designed to identify risk factors and oncological value for the development of postoperative complications after gastrectomy in gastric cancer patients with preoperative chemotherapy. METHODS A total of 123 gastric cancer patients who underwent gastrectomy after chemotherapy were enrolled in this study. The incidence, type, risk factors, and prognostic value of surgical complications were evaluated. RESULTS The postoperative complication rate was 29.3% and mortality rate was 1.6%. The development of postoperative complications was associated with operation time (>200 min) and transfusion during surgery. The resection extent, preoperative chemotherapy cycles and regimens, tumor stage, and patients' nutritional status were not predictive factors for the development of surgical complications. In the multivariate analysis, operation time was an independent risk factor for the development of postoperative complications (odds ratio, 3.813; P = 0.011). The median follow-up after surgery was 19 months. The 3-year, disease-free survival was 57.1% in patients without complications and 25.7% in patients with complications (P = 0.004). Multivariable analysis demonstrated postoperative complications were a significant prognostic factor for disease-free survival (hazard ratio, 2.676; P = 0.024). CONCLUSIONS The incidence of surgical complications was high in gastric cancer patients who received preoperative chemotherapy. Long operation time was a risk factor for surgical complications, and the development of postoperative complication was predictive of patients' prognoses.
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Affiliation(s)
- Ji Yeong An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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320
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Abstract
The overall prognosis of gastric cancer has gradually improved over the past decades with growing awareness of potential carcinogens, surveillance programs and early diagnosis, as well as advances in surgical techniques and multimodality treatments. Nevertheless, the outcome of advanced stage disease still remains poor with currently available treatments, and a worldwide consensus on the standard management thereof has not been established. To improve prognosis and quality of life in gastric cancer patients, both standardization and individualization of managements are imperative. Diagnostic tests and surgical procedures need to be further sophisticated and standardized based on more recent evidences from ongoing and future randomized controlled trials, while comprehensive management should be individualized to each patient. Future challenges lie with how to optimize personalized therapies by deciphering biological complexity of gastric cancer and incorporating molecular biomarkers in clinical practice to forecast prognosis and to guide targeted therapeutics in adjunct to current standards of care.
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Affiliation(s)
- Joong Ho Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Ho Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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321
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Kim KH, Kim MC, Jung GJ, Jang JS, Choi SR. Endoscopic treatment and risk factors of postoperative anastomotic bleeding after gastrectomy for gastric cancer. Int J Surg 2012; 10:593-7. [DOI: 10.1016/j.ijsu.2012.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/06/2012] [Accepted: 09/11/2012] [Indexed: 11/29/2022]
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322
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Usefulness of enhanced recovery after surgery protocol as compared with conventional perioperative care in gastric surgery. Gastric Cancer 2012; 15:34-41. [PMID: 21573918 DOI: 10.1007/s10120-011-0057-x] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/18/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radical gastrectomy for gastric cancer is among the most invasive procedures in gastrointestinal surgery. Several studies have found that an enhanced recovery after surgery (ERAS) protocol is useful in patients who undergo colorectal surgery, but its value in gastric surgery remains uncertain. The aim of this study was to assess the usefulness of an ERAS protocol for gastric surgery. METHODS We studied the clinical characteristics, oncological factors, surgical factors, and outcomes in patients who underwent elective radical gastrectomy for gastric cancer before and after the introduction of an ERAS protocol. RESULTS The first days of oral intake, oral intake recovery, flatus, and defecation were significantly earlier in the ERAS group (n = 91) than in the conventional care (CONV) group (n = 100). Maximum pain evaluated on a visual analog scale and the number of additional analgesics on demand were significantly less in the ERAS group than in the CONV group. The ratio of the postoperative body weight at 1 week to the preoperative body weight was significantly higher in the ERAS group than in the CONV group (0.95 vs. 0.94, respectively, P = 0.01). CONCLUSION Our results suggest that the ERAS protocol is useful in patients who undergo elective radical gastrectomy.
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323
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Dikken JL, van de Velde CJ, Coit DG, Shah MA, Verheij M, Cats A. Treatment of resectable gastric cancer. Therap Adv Gastroenterol 2012; 5:49-69. [PMID: 22282708 PMCID: PMC3263979 DOI: 10.1177/1756283x11410771] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Stomach cancer is one of the most common cancers worldwide, despite its declining overall incidence. Although there are differences in incidence, etiology and pathological factors, most studies do not separately analyze cardia and noncardia gastric cancer. Surgery is the only potentially curative treatment for advanced, resectable gastric cancer, but locoregional relapse rate is high with a consequently poor prognosis. To improve survival, several preoperative and postoperative treatment strategies have been investigated. Whereas perioperative chemotherapy and postoperative chemoradiation (CRT) are considered standard therapy in the Western world, in Asia postoperative monochemotherapy with S-1 is often used. Several other therapeutic options, although generally not accepted as standard treatment, are postoperative combination chemotherapy, hyperthermic intraperitoneal chemotherapy and preoperative radiotherapy and CRT. Postoperative combination chemotherapy does show a statistically significant but clinically equivocal survival advantage in several meta-analyses. Hyperthermic intraperitoneal chemotherapy is mainly performed in Asia and is associated with a higher postoperative complication rate. Based on the currently available data, the use of postoperative radiotherapy alone and the use of intraoperative radiotherapy should not be advised in the treatment of resectable gastric cancer. Western randomized trials on gastric cancer are often hampered by slow or incomplete accrual. Reduction of toxicity for preoperative and especially postoperative treatment is essential for the ongoing improvement of gastric cancer care.
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Affiliation(s)
- Johan L. Dikken
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands and Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | | | - Daniel G. Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Manish A. Shah
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Marcel Verheij
- Department of Radiotherapy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annemieke Cats
- Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, P.O. Box 90203, 1006 BE Amsterdam, The Netherlands
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324
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Inoue K, Nakane Y, Kogire M, Fujitani K, Kimura Y, Imamura H, Tamura S, Okano S, Kwon AH, Kurokawa Y, Shimokawa T, Takiuchi H, Tsujinaka T, Furukawa H. Phase II trial of preoperative S-1 plus cisplatin followed by surgery for initially unresectable locally advanced gastric cancer. Eur J Surg Oncol 2011; 38:143-9. [PMID: 22154885 DOI: 10.1016/j.ejso.2011.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 11/17/2011] [Accepted: 11/21/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and feasibility of preoperative chemotherapy with S-1 plus cisplatin in patients with initially unresectable locally advanced gastric cancer. METHODS We enrolled patients with initially unresectable locally advanced gastric cancer because of severe lymph node metastases or invasion of adjacent structures. Preoperative chemotherapy consisted of S-1 at 80 mg/m(2) divided in two daily doses for 21 days and cisplatin at 60 mg/m(2) intravenously on day 8, repeated every 35 days. If a tumor decreased in size, patients received 1 or 2 more courses. Surgery involved radical resection with D2 lymphadenectomy. RESULTS Between December 2000 and December 2007, 27 patients were enrolled on the study. No CR was obtained, but PR was seen in 17 cases, and the response rate was 63.0%. Thirteen patients (48.1%) had R0 resections. There were no treatment related deaths. The median overall survival time (MST) and the 3-year overall survival (OS) of all patients were 31.4 months and 31.0%, respectively. Among the 13 patients who underwent curative resection, the median disease-free survival (DFS) and the 3-year DFS were 17.4 months and 23.1%, respectively. The MST and the 3-year OS were 50.1 months and 53.8%, respectively. The most common site of initial recurrence after the R0 resection was the para-aortic lymph nodes. CONCLUSIONS Preoperative S-1 plus cisplatin can be safely delivered to patients undergoing radical gastrectomy. This regimen is promising as neoadjuvant chemotherapy for resectable gastric cancer. For initially unresectable locally advanced gastric cancer, new trials using more effective regimens along with extended lymph node dissection are necessary.
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Affiliation(s)
- K Inoue
- Department of Surgery, Kansai Medical University, Shinmachi 2-3-1, Hirakata city, Osaka 573-1191, Japan.
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325
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Togo A, Diakité I, Togo B, Coulibaly Y, Kanté L, Dembélé BT, Traoré A, Traoré C, Kanouté M, Diallo G. Cancer gastrique au CHU Gabriel-Touré : aspects épidémiologique et diagnostique. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s12558-011-0167-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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326
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Chua TC, Merrett ND. Clinicopathologic factors associated with HER2-positive gastric cancer and its impact on survival outcomes--a systematic review. Int J Cancer 2011; 130:2845-56. [PMID: 21780108 DOI: 10.1002/ijc.26292] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 06/08/2011] [Indexed: 12/12/2022]
Abstract
With the availability of a therapeutic target and an effective agent in trastuzumab, a systematic examination of the literature to investigate the role of human epidermal growth factor 2 (HER2) as a prognostic factor for survival and its association with clinicopathologic markers may improve treatment. An electronic search of the MEDLINE and PubMed databases (January 1990 to January 2011) was undertaken to identify translational studies that correlated HER2 with clinicopathologic markers and/or survival outcome. This review included 49 studies totaling 11,337 patients. Forty-four percent of patients had Stage I/II, and 56% had Stage III/IV disease. Immunohistochemistry was most commonly used to assess HER2 expression, identifying a median rate of 18% (range, 4-53%) of gastric cancer demonstrating HER2 overexpression. In patients with and without HER2 overexpression, the median 3-year disease-free survival rate was 58% (range, 50-88%) and 86% (range, 62-97%), respectively. Of the 35 studies reporting the impact of HER2 overexpression on survival, 20 studies (57%) reported no difference in overall survival, two studies (6%) reported significantly longer overall survival in patients with HER2 overexpression and 13 studies (37%) reported significantly poorer overall survival in patients with HER2 overexpression. The median overall survival and 5-year survival rate was 21 (range, 10-57) months and 42%, and 33 (range, 13-80) months and 52% in patients with and without HER2 overexpression, respectively. HER2 overexpression appears to be associated with poorer survival and with intestinal-type gastric cancer in this group of patients for whom majority undergone curative gastrectomy.
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Affiliation(s)
- Terence C Chua
- Department of Surgery, South Western Sydney Upper GI Surgical Unit, Bankstown Hospital, University of Western Sydney, Bankstown, NSW 2200, Sydney, Australia
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327
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Abstract
Gastric adenocarcinoma is one of the most common causes of death worldwide. Surgical resection remains the mainstay of therapy, offering the only chance for complete cure. Resection is based on the principles of obtaining adequate margins, with the extent of lymphadenectomy remaining controversial. Neoadjuvant and adjuvant therapies are used to reduce local recurrence and improve long-term survival. This article reviews the literature and provides a summary of surgical management options and neoadjuvant/adjuvant therapies for gastric adenocarcinoma.
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Affiliation(s)
- Sameer H Patel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road, Northeast 2nd Floor, Atlanta, GA 30322, USA
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328
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Miki Y, Tokunaga M, Bando E, Tanizawa Y, Kawamura T, Terashima M. Evaluation of postoperative pancreatic fistula after total gastrectomy with D2 lymphadenectomy by ISGPF classification. J Gastrointest Surg 2011; 15:1969-76. [PMID: 21833745 DOI: 10.1007/s11605-011-1628-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 07/12/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) is a serious complication of total gastrectomy (TG) with D2 lymphadenectomy (D2). However, the actual incidence and risk factors are not yet completely understood, due in part to the absence of the widely accepted criteria for POPF following gastrectomy. PATIENTS AND METHODS One hundred and four patients who underwent TG with D2 between March 2007 and December 2009 were included in this study. The incidence and severity of POPF were evaluated according to the International Study Group on Pancreatic Fistula (ISGPF) classification. In addition, risk factors for POPF of ISGPF grade B or higher were investigated. RESULTS POPFs of ISGPF grade B or higher were observed in 23 patients (22.1%). Univariate analysis found that sex, body mass index, and amylase concentration of drainage fluid (D: -AMY) on the first postoperative day (1POD) were significant predictors of POPF grade B or higher. The appropriate cutoff level of D: -AMY on 1POD was calculated as 3398 IU/l. Multivariate analysis showed that D: -AMY ≥3,398 IU/l on 1POD was the only independent risk factor. CONCLUSIONS High D: -AMY on 1POD (≥3,398 IU/l) can predict a grade B or higher POPF, and this value may be useful in the early detection of POPF following TG with D2.
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Affiliation(s)
- Yuichiro Miki
- Department of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
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329
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The clinical value of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in postoperative patients with gastrointestinal mucinous adenocarcinoma. Nucl Med Commun 2011; 32:1018-25. [DOI: 10.1097/mnm.0b013e32834bbd22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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330
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Chen XZ, Yang K, Liu J, Chen XL, Hu JK. Neoadjuvant plus adjuvant chemotherapy benefits overall survival of locally advanced gastric cancer. World J Gastroenterol 2011; 17:4542-4. [PMID: 22110287 PMCID: PMC3218147 DOI: 10.3748/wjg.v17.i40.4542] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 04/03/2011] [Accepted: 04/10/2011] [Indexed: 02/06/2023] Open
Abstract
Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally advanced gastric cancer (AGC) in the current multidisciplinary treatment model. EORTC trial 40954 has recently reported that NAC plus surgery without postoperative adjuvant chemotherapy could not benefit the locally AGC patients in their overall survival. We performed a meta-analysis of 10 studies including 1518 gastric cancer patients. Stratified subgroups were NAC plus surgery and NAC plus both surgery and adjuvant chemotherapy (AC), while control was surgery alone. The results showed that NAC plus surgery did not benefit the patients with locally AGC in their overall survival [odds ratio (OR) = 1.20, 95% CI 0.80-1.80, P = 0.37] and the number needed to treat (NNT) was 74. However, the NAC plus both surgery and AC had a slight overall survival benefit (OR = 1.33, 95% CI 1.03-1.71, P = 0.03) and NNT was 14, which is superior to the NAC plus surgery. Therefore, we recommend that combined NAC and AC should be used to improve the overall survival of the locally AGC patients.
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331
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Fujitani K, Yamada M, Hirao M, Kurokawa Y, Tsujinaka T. Optimal indications of surgical palliation for incurable advanced gastric cancer presenting with malignant gastrointestinal obstruction. Gastric Cancer 2011; 14:353-9. [PMID: 21559861 DOI: 10.1007/s10120-011-0053-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 03/28/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Decision-making for surgical palliation remains one of the most challenging clinical scenarios. We investigated the optimal indications for surgical palliation in advanced gastric cancer (AGC) patients presenting with gastrointestinal (GI) obstruction. METHODS A retrospective analysis was performed on 53 consecutive patients who underwent surgical palliation for GI obstruction caused by AGC between 2000 and 2007 at Osaka National Hospital. The clinical course of each patient was followed until death. Postoperative improvement of oral intake, achievement of hospital discharge, and implementation of chemotherapy in each patient were documented and used as a triad to assess the quality of life (QOL). Prognostic factors for overall survival were investigated by univariate and multivariate analyses. In addition, postoperative morbidity and mortality rates were recorded. RESULTS Of the entire patient cohort, 64% demonstrated a QOL improvement by having achieved the triad. Performance status (PS) of 1 or less was the only significant predictive factor for QOL improvement. The median survival time (MST) of the whole patient cohort following surgical palliation was 161 days, while the MSTs of patients fulfilling the triad and of those failing to achieve the triad were 253 and 60 days, respectively, with a significant difference between them (P < 0.0001). PS of 1 or less (hazard ratio 0.265, P = 0.0008) and recurrent disease (hazard ratio 0.394, P = 0.043) were identified as significant independent prognostic factors for longer survival on multivariate analysis. Overall morbidity and 30-day postoperative mortality rates were 24.5% (13 patients) and 7.5% (4 patients) respectively. CONCLUSIONS In AGC patients presenting with GI obstruction, surgical palliation was beneficial in patients with PS of 0-1 and those with recurrent disease, in terms of improved QOL and prolonged survival, with acceptable operative morbidity and mortality rates.
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Affiliation(s)
- Kazumasa Fujitani
- Department of Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, Japan.
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332
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Zheng B, Ma B, Yang K, Mi D. Meta-analysis of randomized controlled trials comparing D2 and D4 lymphadenectomy for gastric cancer. Eur Surg 2011. [DOI: 10.1007/s10353-011-0614-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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333
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Abstract
The incidence of gastric cancer in India is low compared to developed countries, though there are certain geographical areas (Southern part and northeastern states of country) where the incidence is comparable to high-incidence areas of world. Despite the large number of patients being treated for gastric cancer, there are not sufficient publications discussing associated risk factors and outcomes in these patients. This article discusses relevant Indian epidemiological and clinical studies about gastric cancers. This article also highlights the gap in publication from India and developed countries regarding gastric cancer and stresses on collaborative efforts of the Indian scientific community to conduct epidemiological, pathological, and clinical studies to have a new standard of care for Indian patients.
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Affiliation(s)
- Atul Sharma
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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334
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Kim DW, Park SA, Kim CG. Detecting the recurrence of gastric cancer after curative resection: comparison of FDG PET/CT and contrast-enhanced abdominal CT. J Korean Med Sci 2011; 26:875-80. [PMID: 21738339 PMCID: PMC3124716 DOI: 10.3346/jkms.2011.26.7.875] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/19/2011] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate the value of fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) for detecting the recurrence of gastric cancer. We performed a retrospective review of 139 consecutive patients who underwent PET/CT and contrast-enhanced abdominal CT (CECT) for surveillance of gastric cancer after curative resection. Recurrence of gastric cancer was validated by histopathologic examination for local recurrence or serial imaging study follow-up with at least 1 yr interval for recurrence of distant metastasis form. Twenty-eight patients (20.1%) were confirmed as recurrence. On the patient based analysis, there was no statistically significant difference in the sensitivity, specificity and accuracy of PET/CT (53.6%, 84.7%, and 78.4%, respectively) and those of CECT (64.3%, 86.5%, and 82.0%, respectively) for detecting tumor recurrence except in detection of peritoneal carcinomatosis. Among 36 recurrent lesions, 8 lesions (22.2%) were detected only on PET/CT, and 10 lesions (27.8%) only on CECT. PET/CT had detected secondary malignancy in 8 patients. PET/CT is as accurate as CECT in detection of gastric cancer recurrence after curative resection, excepting detection of peritoneal carcinomatosis. Moreover, additional PET/CT on CECT could improve detection rate of tumor recurrence and provide other critical information such as unexpected secondary malignancy.
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Affiliation(s)
- Dae-Weung Kim
- Department of Nuclear Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Soon-Ah Park
- Department of Nuclear Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Chang Guhn Kim
- Department of Nuclear Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
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335
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Seo SH, Hur H, An CW, Yi X, Kim JY, Han SU, Cho YK. Operative risk factors in gastric cancer surgery for elderly patients. J Gastric Cancer 2011; 11:116-21. [PMID: 22076212 PMCID: PMC3204490 DOI: 10.5230/jgc.2011.11.2.116] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 05/30/2011] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Gastric cancer surgery is a common operation in East Asia, such as Korea and Japan, and there has been a significant increase in the need for this procedure due to the aging population. As a result, surgery for the treatment of gastric cancer for elderly patients is expected to increase. This study examined the effect of old age on gastric cancer surgery, and analyzed the operative risk factors for elderly patients. MATERIALS AND METHODS From November 2008 to August 2010, 590 patients, who underwent a curative resection for gastric cancers, were enrolled. Patients who underwent palliative or emergency surgery were excluded. A retrospective analysis of the correlation between surgical outcomes and age was performed. The elderly were defined as patients who were over the age of 65 years. RESULTS The mean age of all patients was 58.3 years, and complications occurred in 87 cases (14.7%). The most common complication was wound infection and severe complications requiring surgical, endoscopic, or radiologic intervention developed in 52 cases (8.8%). The rate of complications increased with increasing age of the patients. Univariate analysis revealed age, comorbidity, extent of resection, operation time, and combined resection to be associated with surgical complications. In particular, age over 75 years old, operation time, and comorbidity were predictive factors in multivariate analysis. In the elderly, only comorbidity was associated with surgical complications. CONCLUSIONS The patients' age is the most important factor for predicting surgical complications. Surgeons should pay an attention to the performance of gastric cancer surgery on elderly patients. In particular, it must be performed carefully for elderly patients with a comorbidity.
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Affiliation(s)
- Su Han Seo
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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336
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Lymph node dissection in curative gastrectomy for advanced gastric cancer. Int J Surg Oncol 2011; 2011:748745. [PMID: 22312521 PMCID: PMC3263688 DOI: 10.1155/2011/748745] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Accepted: 03/29/2011] [Indexed: 12/13/2022] Open
Abstract
Gastric cancer is one of the most common causes of cancer-related death worldwide. Surgical resection with lymph node dissection is the only potentially curative therapy for gastric cancer. However, the appropriate extent of lymph node dissection accompanied by gastrectomy for cancer remains controversial. In East Asian countries, especially in Japan and Korea, D2 lymph node dissection has been regularly performed as a standard procedure. In Western countries, surgeons perform gastrectomy with D1 dissection only because D2 is associated with high mortality and morbidity compared to those associated with D1 alone but does not improve the 5-year survival rate. However, more recent studies have demonstrated that western surgeons can be trained to perform D2 lymphadenectomies on western patients with a lower morbidity and mortality. When extensive D2 lymph node dissection is preformed safely, there may be some benefit to D2 dissection even in western countries. In this paper, we present an update on the current literature regarding the extent of lymphadenectomy for advanced gastric cancer.
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337
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Kosuga T, Ichikawa D, Okamoto K, Komatsu S, Shiozaki A, Fujiwara H, Otsuji E. Survival benefits from splenic hilar lymph node dissection by splenectomy in gastric cancer patients: relative comparison of the benefits in subgroups of patients. Gastric Cancer 2011; 14:172-7. [PMID: 21331530 DOI: 10.1007/s10120-011-0028-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 12/27/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The present study estimated survival benefits from lymph node dissection at the splenic hilus in advanced proximal gastric cancer patients who underwent total gastrectomy with simultaneous splenectomy, and then determined patient subgroups that received relatively high survival benefits from splenectomy. METHODS A total of 280 patients with advanced proximal gastric cancer who underwent curative total gastrectomy with simultaneous splenectomy were retrospectively analyzed. Patients with primary tumors directly invading the spleen or pancreas and those with gross metastases to the para-aortic nodes, as determined by intraoperative diagnosis, were excluded from analyses. The index of estimated benefit from lymph node dissection at the splenic hilus by splenectomy was calculated for each clinicopathological factor by multiplying the incidence of splenic hilar metastasis by the 5-year survival rate of patients with metastasis to that nodal station. RESULTS Thirty patients (10.7%) showed lymph node metastasis at the splenic hilus, and the 5-year survival rate of these patients was 51.3% (overall index 5.49). The index was relatively high in patient subgroups with tumors localized on the greater curvature (19.4) and Borrmann type 4 cancers (12.9), while relatively low in subgroups with encircling tumors (1.62) and tumors invading adjacent organs other than the spleen and pancreas (0). CONCLUSION Patients with tumors localized on the greater curvature and Borrmann type 4 cancers might obtain relatively high survival benefits from lymph node dissection at the splenic hilus by splenectomy.
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Affiliation(s)
- Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
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338
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Maduekwe UN, Yoon SS. An evidence-based review of the surgical treatment of gastric adenocarcinoma. J Gastrointest Surg 2011; 15:730-41. [PMID: 21399886 DOI: 10.1007/s11605-011-1477-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 02/23/2011] [Indexed: 01/31/2023]
Abstract
The management of gastric adenocarcinoma continues to evolve. Chemotherapy is being increasingly used in both the neoadjuvant and adjuvant setting. Surgical resection of the stomach and regional lymph nodes remains the mainstay of potentially curative therapy, but significant regional differences persist in the surgical management. This review provides an update on the current literature regarding the preoperative evaluation and staging, extent of gastric resection, extent of lymph node resection, and adjuvant therapy for patients with gastric adenocarcinoma.
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Affiliation(s)
- Ugwuji N Maduekwe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Yawkey 7B, 55 Fruit St., Boston, MA 02114, USA
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339
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Akagi T, Shiraishi N, Kitano S. Lymph node metastasis of gastric cancer. Cancers (Basel) 2011; 3:2141-59. [PMID: 24212800 PMCID: PMC3757408 DOI: 10.3390/cancers3022141] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/01/2011] [Accepted: 04/04/2011] [Indexed: 12/13/2022] Open
Abstract
Despite a decrease in incidence in recent decades, gastric cancer is still one of the most common causes of cancer death worldwide [1]. In areas without screening for gastric cancer, it is diagnosed late and has a high frequency of nodal involvement [1]. Even in early gastric cancer (EGC), the incidence of lymph node (LN) metastasis exceeds 10%; it was reported to be 14.1% overall and was 4.8 to 23.6% depending on cancer depth [2]. It is important to evaluate LN status preoperatively for proper treatment strategy; however, sufficient results are not being obtained using various modalities. Surgery is the only effective intervention for cure or long-term survival. It is possible to cure local disease without distant metastasis by gastrectomy and LN dissection. However, there is no survival benefit from surgery for systemic disease with distant metastasis such as para-aortic lymph node metastasis [3]. Therefore, whether the disease is local or systemic is an important prognostic indicator for gastric cancer, and the debate continues over the importance of extended lymphadenectomy for gastric cancer. The concept of micro-metastasis has been described as a prognostic factor [4-9], and the biological mechanisms of LN metastasis are currently under study [10-12]. In this article, we review the status of LN metastasis including its molecular mechanisms and evaluate LN dissection for the treatment of gastric cancer.
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Affiliation(s)
- Tomonori Akagi
- Oita University Faculty of Medicine, Department of Gastroenterological Surgery, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan; E-Mail:
- Author to whom correspondance should be addressed; E-Mail: ; Tel.: +81-97-586-5843, Fax: +81-97-549-6039
| | - Norio Shiraishi
- Surgical division, Center for community medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan; E-Mail:
| | - Seigo Kitano
- Oita University Faculty of Medicine, Department of Gastroenterological Surgery, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan; E-Mail:
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340
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Tomimaru Y, Miyashiro I, Kishi K, Motoori M, Yano M, Shingai T, Noura S, Ohue M, Ohigashi H, Ishikawa O. Is routine measurement of amylase concentration in drainage fluid necessary after total gastrectomy for gastric cancer? J Surg Oncol 2011; 104:274-7. [PMID: 21495031 DOI: 10.1002/jso.21938] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 03/16/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Measurement of amylase level in drainage fluid (D-AMY) is often performed for detection of pancreatic fistula (PF) formation after total gastrectomy. However, PF incidence has decreased and PF formation can be judged by changes in drainage fluid properties. The aim of study is to compare the significance of drainage fluid inspection for PF formation with D-AMY measurement. METHODS PF incidence, drainage fluid properties, and D-AMY level in drainage fluid were investigated retrospectively in 173 patients undergoing total gastrectomy for gastric cancer. The sensitivity and specificity of changes in fluid properties for PF detection were compared to D-AMY measurement. RESULTS PF incidence in patients with dark-red colored drainage fluid (16/51) was higher than in those without dark-red fluid (0/122, P < 0.0001). The sensitivity and specificity of diagnosis by fluid properties were 100% and 77.7%, respectively. PF formation also correlated with D-AMY level, with sensitivity and specificity of diagnosis by D-AMY level of 5,000 U of 100% and 82.2%, respectively. There were no differences in the above parameters between the two diagnostic methods. CONCLUSIONS Drainage fluid inspection can provide accurate diagnosis of PF formation, similar to D-AMY measurement, suggesting that routine D-AMY measurement is probably not necessary in every patient.
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Affiliation(s)
- Yoshito Tomimaru
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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341
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Iwata N, Kodera Y, Eguchi T, Ohashi N, Nakayama G, Koike M, Fujiwara M, Nakao A. Amylase concentration of the drainage fluid as a risk factor for intra-abdominal abscess following gastrectomy for gastric cancer. World J Surg 2011; 34:1534-9. [PMID: 20198371 DOI: 10.1007/s00268-010-0516-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insertion of drainage tubes at gastric cancer surgery could be useful for the prediction and management of postoperative complications. However, drains should be removed as soon as they are deemed unnecessary for various reasons. Amylase concentration of the drainage fluid following total gastrectomy for gastric cancer has been reported to be a useful risk factor for surgical complications. METHODS Between January 2002 and December 2008, the authors measured amylase concentration of the drainage fluid on the first postoperative day for 372 patients who underwent gastrectomy with lymphadenectomy for gastric cancer at the Department of Surgery II, Nagoya University. Univariate and multivariate analyses were performed to evaluate the significance of various covariates as risk factors for the pancreas-related complications. RESULTS Postoperative complications developed in 111 patients, of which 27 were pancreas-related. Amylase concentration was significantly higher in patients who underwent splenectomy, pancreaticosplenectomy, total/proximal gastrectomies, and extended lymphadenectomy and in those who eventually developed intra-abdominal abscess. Amylase concentration > or =1,000 IU/l on the first postoperative day, along with the body mass index, was an independent risk factor for pancreas-related intra-abdominal abscess. CONCLUSIONS With a negative predictive value of 97.7%, pancreas-related complications are highly unlikely to be observed when amylase concentration is less than 1,000 IU/l, and early removal of the drainage tube could be recommended for these patients.
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Affiliation(s)
- Naoki Iwata
- Department of Surgery II, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
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342
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An JY, Cheong JH, Hyung WJ, Noh SH. Recent evolution of surgical treatment for gastric cancer in Korea. J Gastric Cancer 2011; 11:1-6. [PMID: 22076195 PMCID: PMC3204480 DOI: 10.5230/jgc.2011.11.1.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 03/10/2011] [Indexed: 12/11/2022] Open
Abstract
Gastric cancer is the most common malignancy and the incidence is steadily increasing in Korea. The principal treatment modality for gastric cancer is surgical extirpation of tumor along with draining lymph nodes. Gastrectomy with D2 lymph node dissection has been well established as a standard of surgery and improved the survival of gastric cancer patients. Recently, technological advances are drastically reshaping the landscape of surgical treatment of gastric cancer. One of the most notable trends is that minimal access surgery becomes dominating the treatment of early stage diseases. For advanced diseases, the standard access surgery is considered a reference treatment. Although there is a pilot study underway to evaluate the feasibility of the application of minimal access surgery to advanced gastric cancer (AGC), the evidence for oncological safety is not yet provided sufficiently. Based on the recent randomized controlled trials, the extent of surgery for AGC has re-defined as para-aortic lymph node dissection dose not add any survival benefit while increasing surgery-related morbidities. In addition, it is now accepted as a standard operation omitting unnecessary procedures such as splenectomy and/or distal pancreatectomy for prophylactic lymph node dissection. Conceptual and technical innovation has contributed to decreasing morbidity and mortality without impairing oncological safety. All these recent advances in the field of gastric cancer surgery would be concluded in maximizing therapeutic index for gastric cancer while improving quality of life.
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Affiliation(s)
- Ji Yeong An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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343
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Deng J, Liang H, Sun D, Pan Y, Liu Y, Wang D. Extended lymphadenectomy improvement of overall survival of gastric cancer patients with perigastric node metastasis. Langenbecks Arch Surg 2011; 396:615-23. [PMID: 21380618 DOI: 10.1007/s00423-011-0753-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 02/11/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND The superiority of extended lymphadenectomy for the prognosis of gastric cancer (GC) is still controversial. The authors hypothesized that extended lymphadenectomy could improve the overall survival (OS) of GC patients with a specific extent of lymph node metastasis. METHODS Data from 456 GC patients who underwent curative gastrectomy with lymphadenectomy were used to illuminate the difference of OS between patients who underwent limited lymphadenectomy and patients who underwent extended lymphadenectomy. RESULTS As a whole, there was no significant difference of OS between patients who underwent extended lymphadenectomy and patients who underwent limited lymphadenectomy in all 456 GC patients. However, we demonstrated that extended lymphadenectomy significantly improved the OS of GC patients with perigastric lymph node metastasis (n1 stage based on the Japanese Gastric Cancer Association classification) compared to limited lymphadenectomy (P = 0.023). Furthermore, the more the negative lymph nodes were, the longer the OS of GC patients with perigastric node metastasis following extended lymphadenectomy was (P < 0.001). CONCLUSIONS Extensive lymph node dissection and good harvest of negative lymph nodes should be deemed as the most important factors to improve the OS of GC patients with perigastric node metastasis.
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Affiliation(s)
- Jingyu Deng
- Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Hospital and City Key Laboratory of Tianjin Cancer Center, Tianjin, China
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344
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Jeong O, Park YK, Ryu SY, Kim DY, Kim HK, Jeong MR. Predisposing factors and management of postoperative bleeding after radical gastrectomy for gastric carcinoma. Surg Today 2011; 41:363-8. [PMID: 21365417 DOI: 10.1007/s00595-010-4284-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 01/05/2010] [Indexed: 02/06/2023]
Abstract
PURPOSE To promote proper management of postoperative bleeding, we investigated the clinical manifestations, predisposing factors, diagnostic approaches, and treatments of bleeding complications after gastric cancer surgery. METHODS Using a prospectively constructed database, we reviewed retrospectively 39 patients who suffered bleeding complications from among a total 1027 patients who underwent surgery for gastric cancer between 2004 and 2008. RESULTS Operating time (hazard ratio [HR] 1.842, 95% confidence interval [CI] 1.524-2.367) and body mass index (HR 1.454, 95% CI 1.128-1.792) were significant predisposing factors for postoperative bleeding after gastric cancer surgery. Luminal bleeding occurred in 16 patients: as simple anastomosis site bleeding, treated successfully with conservative or endoscopic treatment, in 13; and as pseudoaneurysmal bleeding in 3, treated successfully with surgery in 2, but resulting in the death of 1. Abdominal bleeding occurred in 23 patients, requiring surgery in 9 and arterial embolization in 1. The most common finding at reoperation was bleeding from the mesocolon surface. The mean hospital stay of patients with postoperative bleeding was 21 (± 20) days. CONCLUSIONS Postoperative bleeding can be managed successfully with a tailored approach, considering its origins and clinical manifestations. Arterial pseudoaneurysms are a rare cause of luminal bleeding, but they can be fatal and should be suspected when extensive luminal bleeding presents after gastric cancer surgery.
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Affiliation(s)
- Oh Jeong
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea
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345
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Effect of negative lymph node count on survival for gastric cancer after curative distal gastrectomy. Eur J Surg Oncol 2011; 37:481-7. [PMID: 21371852 DOI: 10.1016/j.ejso.2011.01.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 10/29/2010] [Accepted: 01/10/2011] [Indexed: 12/11/2022] Open
Abstract
AIMS The aim of this study is to evaluate the long-term effect of negative lymph node (LN) counts on the prognosis after curative distal gastrectomy among gastric cancer patients. METHODS The study enrolled 634 patients with gastric cancer, who had undergone curative resection (R0) with distal gastrectomy from 1995 to 2004. Long-term surgical outcomes and relationships between the negative LN count and the 5-year survival rate were investigated. RESULTS The 5-year survival rate of the entire cohort was 57.6%. The number of metastasis negative LN was positively associated with the retrieved node according to the Pearson's correlation test (P < 0.001). Cox regression analysis showed the negative LN count was an independent predictor of survival (P < 0.05). Based on the statistical assumption the best fitting linear, linear regression showed a significant survival improvement based on increasing negative LN count for patients with stages I (P = 0.014), II (P = 0.011) and III (P = 0.003). The greatest survival differences were observed at cutoff value 10 negative LN counts for stage I, and 15 for stages II, III and IV. CONCLUSION Negative LN counts can reflect the extent of lymphadenectomy for gastric cancer after curative distal gastrectomy. The higher the negative LN count, the better the survival would be; the best long-term survival outcome was observed on the negative LN count more than 10 (stage I) or 15 (stages II, III, and IV).
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346
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Revisional surgery after gastrectomy for gastric cancer: review of the literature. Surg Laparosc Endosc Percutan Tech 2011; 20:332-7. [PMID: 20975505 DOI: 10.1097/sle.0b013e3181f39ff1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent reports have shown that morbidity and mortality after gastrectomy for gastric cancer vary between authors, countries, and procedures. Common complications related to gastrectomy are postoperative bleeding, anastomotic leakage, pancreatic juice leakage, intra-abdominal abscess, intestinal obstruction, wound dehiscence, and so on. Recently, laparoscopic gastrectomy for gastric cancer has developed, especially in Japan and East Asian countries because it is less invasive. Several retrospective studies have shown that the operative complication rate is similar to that of conventional open surgery. Although most postoperative complications can be successfully treated by conservative therapies, surgical management is occasionally needed to prevent a fatal outcome. This review article provides insight into how surgeons can make efforts to reduce postoperative complications through proper preoperative evaluation and improved surgical skills during the initial gastrectomy. In addition, it reviews guidance for timely revisional surgery to allow salvage of patients with serious acute operative complications based on clinical findings made by a group of experienced surgeons.
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347
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An JY, Pak KH, Inaba K, Cheong JH, Hyung WJ, Noh SH. Relevance of lymph node metastasis along the superior mesenteric vein in gastric cancer. Br J Surg 2011; 98:667-72. [PMID: 21294111 DOI: 10.1002/bjs.7414] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic value of lymph node metastasis along the superior mesenteric vein (station 14v) to determine the need for 14v dissection in gastric cancer surgery. METHODS A total of 1104 patients with gastric cancer who underwent gastrectomy including 14v dissection were enrolled. Patients were categorized into two groups: those with and those without 14v lymph node involvement by metastasis. RESULTS Of the total study population, 73 patients (6·6 per cent) had 14v-positive gastric cancer. These patients were more likely to have advanced tumour (T), node (N) and distant metastatic (M) status, and histologically undifferentiated gastric cancers. The 3- and 5-year survival rates of patients with 14v-positive disease were 24 and 9 per cent respectively. Survival in this group was similar to that of patients who had gastric cancer with distant metastasis (M1). Multivariable analysis demonstrated that 14v status was a significant prognostic factor for gastric cancer (hazard ratio 2·13; P < 0·001). After histologically complete (R0) resection, the overall survival of 14v-positive patients with any stage of cancer was significantly worse than that for 14v-negative patients with stage IV cancer (P = 0·006). CONCLUSION 14v status is an independent prognostic factor for gastric cancer, with 14v-positive gastric cancer having a poor prognosis, similar to that of M1 disease. The exclusion of 14v in regional lymph node dissection should be considered.
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Affiliation(s)
- J Y An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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348
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Kurokawa Y, Sasako M, Sano T, Shibata T, Ito S, Nashimoto A, Kurita A, Kinoshita T. Functional outcomes after extended surgery for gastric cancer. Br J Surg 2011; 98:239-45. [PMID: 21104822 DOI: 10.1002/bjs.7297] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Extended gastrectomy with para-aortic nodal dissection (PAND) or thorough dissection of mediastinal nodes using a left thoracoabdominal (LTA) approach is an alternative to D2 lymphadenectomy, with variable postoperative results. METHODS Two randomized controlled trials have been conducted to compare D2 lymphadenectomy alone (263 patients) versus D2 lymphadenectomy plus PAND (260), and the abdominal-transhiatal (TH) approach (82) versus the LTA approach (85), in patients with gastric cancer. Prospectively registered secondary endpoints bodyweight, symptom scores and respiratory function were evaluated in the present study. RESULTS Bodyweight was comparable after D2 and D2 plus PAND, but higher after TH than after LTA procedures at 1 and 3 years. At 1- and 3-year follow-up symptom scores were comparable between D2 and D2 plus PAND. A LTA approach resulted in significantly worse scores than a TH approach in terms of meal volume, return to work, incisional pain and dyspnoea up to 1 year. The decrease in vital capacity was significantly greater after LTA than TH procedures up to 6 months. CONCLUSION Bodyweight and postoperative symptoms were not affected by adding PAND to a D2 procedure. A LTA approach aggravated weight loss, symptoms and respiratory functions compared with a TH approach.
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Affiliation(s)
- Y Kurokawa
- Department of Surgery, Osaka National Hospital, Osaka, Japan.
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349
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Marrelli D, Mazzei MA, Pedrazzani C, Di Martino M, Vindigni C, Corso G, Morelli E, Volterrani L, Roviello F. High accuracy of multislices computed tomography (MSCT) for para-aortic lymph node metastases from gastric cancer: a prospective single-center study. Ann Surg Oncol 2011; 18:2265-72. [PMID: 21267792 DOI: 10.1245/s10434-010-1541-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND The purpose of this study is to analyze the diagnostic accuracy of MSCT in the identification of para-aortic lymph node metastases from gastric cancer. METHODS A total of 92 consecutive patients with primary gastric cancer were prospectively submitted to preoperative MSCT staging according to a standard protocol in the period 2003-2010. All diagnostic procedures were performed by dedicated radiologists who were unaware of the final pathological nodal status. Subsequently all patients underwent potentially curative (R0) resection with extended lymphadenectomy plus para-aortic nodal dissection. Lymph node mapping in different stations and retrieval of single lymph nodes were performed by the surgeon on the fresh specimen and then submitted for pathological examination. Clinical, radiological, and pathological data were prospectively stored on database. RESULTS A median number of 47 (range: 18-114) total lymph nodes and 7 (range: 3-29) para-aortic lymph nodes were removed. In 13 of 92 included patients (14%), histological examination demonstrated para-aortic nodal metastases; MSCT was correctly positive in 11 of these cases (sensitivity: 85%). In 79 patients para-aortic nodes were not involved, and MSCT resulted correctly negative in 75 of these patients (specificity: 95%). Positive (PPV) and negative (NPV) predictive values were 73 and 97%, with a global accuracy of 93%. CONCLUSIONS MSCT performed according to a standard protocol by dedicated radiologists demonstrated high accuracy in preoperative identification of para-aortic nodal metastases from gastric cancer. These results may be useful in planning surgical approach or during clinical staging before neoadjuvant chemotherapy.
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Affiliation(s)
- Daniele Marrelli
- Department of Human Pathology and Oncology, Section of Advanced Surgical Oncology, University of Siena, Siena, Italy.
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350
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Santiago JMR, Sasako M, Osorio J. [TNM-7th edition 2009 (UICC/AJCC) and Japanese Classification 2010 in Gastric Cancer. Towards simplicity and standardisation in the management of gastric cancer]. Cir Esp 2011; 89:275-81. [PMID: 21256476 DOI: 10.1016/j.ciresp.2010.10.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 10/18/2010] [Accepted: 10/20/2010] [Indexed: 12/14/2022]
Abstract
The 7th edition of the UICC/AJCC TNM, and a new revision of the Japanese Classification for Gastric Cancer and Treatment Guidelines (Japanese Gastric Cancer Association) have been available since the beginning of 2010. One of the most important changes consists on the redefining and simplification of type D1/D2 lymphadenectomy depending on the type of gastrectomy performed (previously it depended on the location of the primary tumour), and the adoption of numeric criteria of TNM-7th Edition to evaluate the level of lymph node involvement (before, according to the anatomical location of the groups as regards the primary tumour). These changes attempt to make therapeutic management easier and a more uniform comparison of results between countries. The importance of these modifications in both systems justifies this exhaustive analysis and update of the new concepts for a correct management of gastric cancer.
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