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Saito Y, Takahashi T, Nishida T, Murakami K, Endo S, Nishikawa K, Kimura Y, Motoori M, Tanaka K, Miyazaki Y, Makino T, Kurokawa Y, Yamasaki M, Nakajima K, Eguchi H, Doki Y. Long-Term Outcomes of Pylorus-Preserving Gastrectomy for Early Gastric Cancer. Am Surg 2024; 90:386-392. [PMID: 37688476 DOI: 10.1177/00031348231200671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
BACKGROUND In the short term, pylorus-preserving gastrectomy (PPG) has been reported to have advantages over distal gastrectomy (DG) with regard to postprandial symptoms and dumping syndrome. We aimed to evaluate the quality of life after PPG for early gastric cancer in the long term in comparison to that after DG. METHODS Twenty-six patients who underwent gastrectomy (11 PPG, 15 DG) for early gastric cancer at Osaka University Hospital participated and were followed for more than 4 years. Body weight changes, nutritional status, dual-phase scintigraphy findings, endoscopic survey results, and questionnaire responses after gastrectomy were examined. RESULTS There were significantly lower ratios of weight changes in PPG than in DG, 5 years after surgery. There were no differences in the clinicopathological characteristics, nutritional parameters, questionnaire responses, and endoscopic findings between the two groups. Based on gastric scintigraphy, although the gastric emptying of liquids showed similar curves in the two groups, gastric emptying of solids was significantly slower in the PPG group than in the DG group (P = .039). DISCUSSION PPG had advantages with regard to long-term outcomes over DG in terms of weight maintenance and the prevention of rapid gastric emptying. PPG might be efficient in patients with early gastric cancer.
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Affiliation(s)
- Yurina Saito
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tsuyoshi Takahashi
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Toshirou Nishida
- Department of Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Kohei Murakami
- Department of Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan
| | - Shunji Endo
- Department of Gastroenterological Surgery, Kawasaki Medical School Hospital, Kurashiki, Japan
| | | | - Yutaka Kimura
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | - Koji Tanaka
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasuhiro Miyazaki
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoki Makino
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yukinori Kurokawa
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Makoto Yamasaki
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kiyokazu Nakajima
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidetoshi Eguchi
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuichiro Doki
- Department of Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Yao Z, Yang H, Cui M, Xing J, Zhang C, Zhang N, Chen L, Tan F, Xu K, Liu M, Su X. Clinicopathological characteristics and treatment outcome of resectable gastric cancer patients with small para-aortic lymph node. Front Oncol 2023; 13:1131725. [PMID: 36923426 PMCID: PMC10009175 DOI: 10.3389/fonc.2023.1131725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
Background Resectable gastric cancer (GC) patients with small para-aortic lymph node (smaller than 10mm in diameter, sPAN) were seldom reported, and existing guidelines did not provide definite treatment recommendation for them. Methods A total of 667 consecutive resectable GC patients were enrolled. 98 patients were in the sPAN group, and 569 patients without enlarged para-aortic lymph node were in the nPAN group. Standard D2 lymphadenectomy was performed. Neoadjuvant and adjuvant chemotherapy were administrated according to the cTNM and pTNM stage, respectively. Clinicopathological features and prognosis were compared between these two groups. Results The median size of sPAN was 6 (range, 2-9) mm and the distribution was prevalent in No. 16b1. cN stage (p=0.001) was significantly related to the presence of sPAN. sPAN was both independent risk factor for OS (p=0.031) and RFS (p=0.046) of all patients. The prognosis of patients with sPAN was significantly worse than that of patients with nPAN (OS: p=0.008; RFS: p=0.007). Preoperative CEA and CA19-9 were independent risk factors for prognosis of patients with sPAN. Furthermore, patients in the sPAN group with normal CEA and CA19-9 exhibited acceptable prognosis (5-year OS: 67%; RFS: 64%), while those with elevated CEA or CA19-9 suffered significantly poorer prognosis (5-year OS: 17%; RFS: 17%) than patients in the nPAN group (5-year OS: 64%; RFS 62%) (both p < 0.05). Conclusions Standard D2 lymphadenectomy should be considered a valid approach for GC patients with sPAN associate to normal preoperative CEA and CA19-9 levels. Patients with sPAN associated to elevated CEA or CA19-9 levels could benefit from a multimodal approach: neoadjuvant chemotherapy; radical surgery with D2 plus lymph nodal dissection extended to No. 16 station.
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Affiliation(s)
- Zhendan Yao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hong Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ming Cui
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiadi Xing
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chenghai Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Nan Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lei Chen
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fei Tan
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kai Xu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Maoxing Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangqian Su
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department IV of Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
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Shaibu Z, Chen Z, Mzee SAS, Theophilus A, Danbala IA. Effects of reconstruction techniques after proximal gastrectomy: a systematic review and meta-analysis. World J Surg Oncol 2020; 18:171. [PMID: 32677956 PMCID: PMC7367236 DOI: 10.1186/s12957-020-01936-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Additional studies comparing several reconstruction methods after proximal gastrectomy have been published; of note, it is necessary to update systematic reviews and meta-analysis from the current evidence-based literature. AIM To expand the current knowledge on feasibility and safety, and also to analyze postoperative outcomes of several reconstructive techniques after proximal gastrectomy. METHODS PubMed, Google Scholar, and Medline databases were searched for original studies, and relevant literature published between the years 1966 and 2019 concerning various reconstructive techniques on proximal gastrectomy were selected. The postoperative outcomes and complications of the reconstructive techniques were assessed. Meta-analyses were performed using Rev-Man 5.0. A total of 29 studies investigating postoperative outcomes of double tract reconstruction, jejunal pouch interposition, jejunal interposition, esophagogastrostomy, and double flap reconstruction were finally selected in the quantitative analysis. RESULT Pooled incidences of reflux esophagitis for double tract reconstruction, jejunal pouch interposition, jejunal interposition esophagogastrostomy, and double flap reconstruction were 8.6%, 13.8%, 13.8%, 19.3%, and 8.9% respectively. Meta-analysis showed a decreased length of hospital in the JI group as compared to the JPI group (heterogeneity: Chi2 = 1.34, df = 1 (P = 0.25); I2 = 26%, test for overall effect: Z = 2.22 (P = 0.03). There was also a significant difference between JI and EG in length of hospital stay with heterogeneity: Chi2 = 1.40, df = 3 (P = 0.71); I2 = 0%, test for overall effect: Z = 5.04 (P < 0.00001). Operative time was less in the EG group as compared to the JI group (heterogeneity: Chi2 = 31.09, df = 5 (P < 0.00001); I2 = 84%, test for overall effect: Z = 32.35 (P < 0.00001). CONCLUSION Although current reconstructive techniques present excellent anti-reflux efficacy, the optimal reconstructive method remains to be determined. The double flap reconstruction proved to lower the rate of complication, but the DTR, JI, JPI, and EG groups showed higher incidence of complications in anastomotic leakage, anastomotic stricture, and residual food. In the meta-analysis result, the complications between the JI, JPI, and EG were comparable but the EG group showed to have better postoperative outcomes concerning the operative time, blood loss, and length of hospital stay.
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Affiliation(s)
- Zakari Shaibu
- Department of Gastrointestinal Surgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, 212002 Jiangsu People’s Republic of China
- Overseas Education College, Jiangsu university, No 301 xuefu road, Zhenjiang, 212013 Jiangsu People’s Republic of China
| | - Zhihong Chen
- Department of Gastrointestinal Surgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, 212002 Jiangsu People’s Republic of China
| | - Said Abdulrahman Salim Mzee
- Overseas Education College, Jiangsu university, No 301 xuefu road, Zhenjiang, 212013 Jiangsu People’s Republic of China
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu People’s Republic of China
| | - Acquah Theophilus
- Department of Gastrointestinal Surgery, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, 212002 Jiangsu People’s Republic of China
- Overseas Education College, Jiangsu university, No 301 xuefu road, Zhenjiang, 212013 Jiangsu People’s Republic of China
| | - Isah Adamu Danbala
- Overseas Education College, Jiangsu university, No 301 xuefu road, Zhenjiang, 212013 Jiangsu People’s Republic of China
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu People’s Republic of China
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Lee S, Ahn JY, Na S, Na HK, Jung KW, Kim DH, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY, Kim SO. Clinical features of postoperative anastomotic bleeding after gastrectomy and efficacy of endoscopic hemostasis: a case-control study. Surg Endosc 2016; 31:3210-3218. [PMID: 27864714 DOI: 10.1007/s00464-016-5347-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Postoperative anastomotic bleeding (PAB) is relatively rare; however, it can be lethal if not treated immediately. The aim of our study was to investigate the clinical features of PAB and the efficacy of endoscopic hemostasis (EH) for PAB. METHODS Between January 2004 and May 2013, 16,591 patients underwent gastrectomy for gastric cancer at Asan Medical Center. Among them, 36 patients who experienced PAB within 2 months after the gastrectomy were enrolled as a case group. Each subject was matched at a ratio of 1:5 with randomly selected patients without bleeding during the same period (n = 180, control group). The clinical outcomes and risk factors for patients with PAB were compared with those of the control group, and the results of EH were evaluated retrospectively. RESULTS The incidence of PAB was 0.22% (n = 36), and the median duration from gastrectomy to PAB was 34.5 h (interquartile range, 12.3-132.8 h). EH was attempted in 25 patients (69.4%); surgery was performed in 6 patients (16.7%); and conservative management was applied in 5 patients (13.9%). PAB-related death occurred in three patients (8.3%; one in each treatment modality). Among 25 patients with primary EH, 16 were treated successfully (64%) and hemoclip was the most commonly used endoscopic tool (52%). In the multivariate analysis, the type of gastrectomy was found to be a risk factor for PAB (odds ratio 3.448, 95% confidence interval, 1.138-10.448, p = .029). CONCLUSIONS Although PAB is an infrequent and potentially life-threatening complication, endoscopy can be considered as a useful method to avoid additional surgery in properly selected patients.
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Affiliation(s)
- Sunpyo Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Shin Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olimpic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Nomura E, Okajima K. Function-preserving gastrectomy for gastric cancer in Japan. World J Gastroenterol 2016; 22:5888-5895. [PMID: 27468183 PMCID: PMC4948261 DOI: 10.3748/wjg.v22.i26.5888] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/30/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
Surgery used to be the only therapy for gastric cancer, and since its ability to cure gastric cancer was the focus of attention, less attention was paid to function-preserving surgery in gastric cancer, though it was studied for gastroduodenal ulcer. Maki et al developed pylorus-preserving gastrectomy for gastric ulcer in 1967. At the same time, the definition of early gastric cancer (EGC) was being considered, histopathological investigations of EGC were carried out, and the validity of modified surgery was sustained. After the development of H2-blockers, the number of operations for gastroduodenal ulcers decreased, and the number of EGC patients increased simultaneously. As a result, the indications for pylorus-preserving gastrectomy for EGC in the middle third of the stomach extended, and various alterations were added. Since then, many kinds of function-preserving gastrectomies have been performed and studied in other fields of gastric cancer, and proximal gastrectomy, jejunal pouch interposition, segmental gastrectomy, and local resection have been performed. On the other hand, from the overall perspective, it can be said that endoscopic resection, which was launched at almost the same time, is the ultimate function-preserving surgery under the current circumstances. The current function-preserving gastrectomies that are often performed and studied are pylorus-preserving gastrectomy and proximal gastrectomy. The reasons for this are that these procedures that can be performed with systemic lymph node dissection, and they include three important elements: (1) reduction of the extent of gastrectomy; (2) preservation of the pylorus; and (3) preservation of the vagal nerve. In addition, these operations are more likely to be performed with a laparoscopic approach as minimally invasive surgery. Of the above-mentioned three elements, reduction of the extent of gastrectomy is the most important in our view. Therefore, we should try to reduce the extent of gastrectomy if curability of the gastric cancer can still be achieved. However, if we preserve a wider residual stomach in function-preserving gastrectomy, we should pay attention to the development of metachronous gastric cancer.
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Kodera Y, Kobayashi D, Tanaka C, Fujiwara M. Gastric adenocarcinoma with para-aortic lymph node metastasis: a borderline resectable cancer? Surg Today 2014; 45:1082-90. [PMID: 25366353 DOI: 10.1007/s00595-014-1067-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 10/16/2014] [Indexed: 12/20/2022]
Abstract
Dissection of the para-aortic lymph nodes (PAN) had once been enthusiastically explored at dedicated centers throughout Japan. Reflecting the results of a randomized trial, however, the current standard surgery for advanced resectable gastric cancer does not include systematic dissection of the PAN. Gastric cancer with PAN metastases, currently considered distant metastases, is classified as Stage IV, and according to the algorithm of the Japanese guidelines, is not indicated for surgery with curative intent. Historical data indicates, however, that a certain proportion of long-term survivors can be introduced among patients with PAN metastasis through D2 + PAN dissection. The Japan Clinical Oncology Group launched a series of phase II trials exploring a strategy employing neoadjuvant chemotherapy followed by D2 + PAN dissection for patients radiologically diagnosed to harbor metastases to the PAN. The campaign was successful, with 57% of these patients surviving for 5 years after two cycles of neoadjuvant S-1/CDDP followed by surgery. This strategy is now the tentative standard, mentioned in the 4th version of the Japanese Gastric Cancer Treatment Guidelines as one of the current clinical questions, and could be replaced by a more powerful combination chemotherapy or treatment employing more or longer cycles of chemotherapy in the future. The relevance of the strategy consisting of neoadjuvant chemotherapy followed by D2 + PAN dissection and its fundamental difference from the concept of conversion therapy are discussed herein with reference to the literature.
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Affiliation(s)
- Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan,
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Zhang J, Cao L, Wang Z, Zhang C, Hu X. Pylorus- and vagus-nerve-preserving partial gastrectomy (D2 dissection). Chin J Cancer Res 2013; 25:457-9. [PMID: 23997535 DOI: 10.3978/j.issn.1000-9604.2013.08.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 07/10/2013] [Indexed: 11/14/2022] Open
Abstract
Pylorus- and vagus nerve-preserving partial gastrectomy is important in improving the prognosis of early gastric cancer surgery, reducing surgical complications and improving the quality of life for such patients. In the present case, pylorus- and vagus nerve-preserving partial gastrectomy was performed using the bipolar electrocautery dissection technique combined with D2 dissection along the lesser sac.
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Affiliation(s)
- Jian Zhang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
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Takiguchi S, Hiura Y, Takahashi T, Kurokawa Y, Yamasaki M, Nakajima K, Miyata H, Mori M, Hosoda H, Kangawa K, Doki Y. Effect of rikkunshito, a Japanese herbal medicine, on gastrointestinal symptoms and ghrelin levels in gastric cancer patients after gastrectomy. Gastric Cancer 2013; 16:167-74. [PMID: 22895614 DOI: 10.1007/s10120-012-0164-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 05/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric cancer patients who undergo gastrectomy suffer from a post-gastrectomy syndrome that includes weight loss, dumping syndrome, reflux esophagitis, alkaline gastritis, and finally malnutrition. It is important to ameliorate the post-gastrectomy symptoms to restore postoperative quality of life (QoL). The aim of this study was to investigate the effect of rikkunshito, a Japanese herbal medicine, on postoperative symptoms and ghrelin levels in gastric cancer patients after gastrectomy. METHODS Twenty-five patients who had undergone gastrectomy received 2.5 g of rikkunshito before every meal for 4 weeks, and a drug withdrawal period was established for the next 4 weeks. Changes in gastrointestinal hormones, including ghrelin, and appetite visual analog scale scores were measured, and QoL was estimated by using the European Organization for Research and Treatment of Cancer core questionnaire QLQ-C30. The Dysfunction After Upper Gastrointestinal Surgery for Cancer (DAUGS) scoring system was used to evaluate gastrointestinal symptoms after gastrectomy. RESULTS Sixteen men and nine women (mean age 61.9 years) were enrolled in the study. All patients had either stage I (n = 24) or II (n = 1) disease and had undergone either distal gastrectomy (n = 17) or total gastrectomy (n = 8) by a laparoscopy-assisted approach. The mean ratio of the acyl-/total ghrelin concentration increased significantly after rikkunshito administration (Pre: 7.8 ± 2.1, 4 weeks: 10.5 ± 1.7 %, p = 0.0026). The total DAUGS score, as well as the scores reflecting limited activity due to decreased food consumption, reflux symptoms, dumping symptoms, and nausea and vomiting significantly improved after rikkunshito administration. CONCLUSIONS The present study demonstrated a significant attenuation of gastrointestinal symptoms after gastrectomy by treatment with rikkunshito. Rikkunshito is potentially useful to minimize gastrointestinal symptoms after gastrectomy.
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Affiliation(s)
- Shuji Takiguchi
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2, E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Chun HT, Kim KH, Kim MC, Jung GJ. Comparative study of laparoscopy-assisted versus open subtotal gastrectomy for pT2 gastric cancer. Yonsei Med J 2012; 53:952-9. [PMID: 22869478 PMCID: PMC3423848 DOI: 10.3349/ymj.2012.53.5.952] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Laparoscopy-assisted distal gastrectomy (LADG) is a widely accepted surgery for early gastric cancer. However, its use in advanced gastric cancer has rarely been studied. The aim of this study is to investigate the feasibility and survival outcomes of LADG for pT2 gastric cancer. MATERIALS AND METHODS Between January 2004 and December 2009, we evaluated 67 and 52 patients who underwent open distal gastrectomy (ODG) and LADG, respectively, with diagnosis of pT2 gastric cancer. The clinicopathological characteristics, postoperative outcomes, and survival were retrospectively compared between the two groups. RESULTS There were statistically significant differences in the proximal margin of the clinicopathological parameters. The operation time was significantly longer in LADG than in ODG (207.7 vs. 159.9 minutes). There were 6 (9.0%) and 5 (9.6%) complications in ODG and LADG, respectively. During follow-up periods, tumor recurrence occurred in 7 (10.4%) patients of the ODG and in 4 (7.7%) patients of the LADG group. The 5-year survival rate of ODG and LADG was 88.6% and 91.3% (p=0.613), respectively. In view of lymph node involvement, 5-year survival rates were 96.0% in ODG versus 97.0% in LADG for patients with negative nodal metastasis (p=0.968) and 80.9% in ODG versus 78.7% in LADG for those with positive nodal metastasis (p=0.868). CONCLUSION Although prospective study is necessary to compare LADG with open gastrectomy for the treatment of advanced gastric cancer, laparoscopy-assisted distal gastrectomy might be considered as an alternative treatment for some pT2 gastric cancer.
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Affiliation(s)
- Hyun-Tae Chun
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Ki-Han Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Ghap-Joong Jung
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
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Shibata C, Saijo F, Kakyo M, Kinouchi M, Tanaka N, Sasaki I, Aikou T. Current Status of Pylorus-Preserving Gastrectomy for the Treatment of Gastric Cancer: A Questionnaire Survey and Review of Literatures. World J Surg 2012; 36:858-63. [DOI: 10.1007/s00268-012-1491-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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11
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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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12
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Saka M, Morita S, Fukagawa T, Katai H. Present and future status of gastric cancer surgery. Jpn J Clin Oncol 2011; 41:307-13. [PMID: 21242182 DOI: 10.1093/jjco/hyq240] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The type of surgery and the role of adjuvant therapies in the treatment of gastric cancer have changed in recent times. The treatment of gastric cancer with curative intent is moving away from standard D2 or more extensive surgery to a tailored approach depending on the stage of the disease. Data collected from extensive lymphadenectomy for all stages of gastric cancer have confirmed that some subsets of early gastric cancer are very low risk for nodal metastasis. This group of patients may benefit from resection by endoscopic or laparoscopic techniques and may also be suitable for function-preserving procedures. The extent of resection for gastric cancer has always excited debate. D2 gastrectomy was criticized for its higher mortality in the early European Phase III trials, but recent studies from Taiwan and Italy have shown that the procedure is safe when performed by experienced surgeons and has a survival benefit over D1 gastrectomy. The role of para-aortic lymph node dissection for nodes without apparent metastasis in advanced gastric cancer was assessed by a Phase III Japanese trial and showed no additional benefit over D2 resection. Radical gastric resections, involving resection of adjacent organs for direct tumor invasion result in higher rates of complications, and the role of multi-visceral resections has also been reevaluated. Effective adjuvant therapies for gastric cancer have been reported since the early part of 2000. Development of more effective adjuvant therapy combined with D2 resection should continue to improve survival in the future.
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Affiliation(s)
- Makoto Saka
- Gastric Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo 104-0045, Japan.
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13
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Tanaka N, Katai H, Taniguchi H, Saka M, Morita S, Fukagawa T, Gotoda T. Trends in characteristics of surgically treated early gastric cancer patients after the introduction of gastric cancer treatment guidelines in Japan. Gastric Cancer 2010; 13:74-7. [PMID: 20602192 DOI: 10.1007/s10120-009-0536-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 12/02/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND The gastric cancer treatment guidelines (Guidelines) of the Japanese Gastric Cancer Association allow endoscopic treatment and a modified gastrectomy for the treatment of early gastric cancer (EGC). Endoscopic treatment is indicated for EGC with a minimal chance of nodal metastasis. Consequently, surgeons will likely treat an increasing number of EGC patients with greater chance of nodal metastasis using a reduced extent of lymphadenectomy. The aim of this study was to investigate the trends in characteristics and long-term oncological outcomes of surgically treated EGC patients after the introduction of the Guidelines. METHODS Between 2001 and 2003, 696 patients underwent a gastrectomy according to the Guidelines. These 696 patients (the Guidelines group) were retrospectively compared with 635 patients (the control group) who had undergone a gastrectomy between 1991 and 1995 (before the introduction of the Guidelines). RESULTS The incidence of nodal metastasis in mucosal cancers was higher in the Guidelines group than in the control group (6.5% vs 2.6%). The proportion of D2 or greater extended lymphadenectomy in the Guidelines group was lower than that in the control group (29.7% vs 62.5%). Nevertheless, the 5-year survival rate in the Guidelines group was similar to that in the control group (94.2% vs 92.3%). CONCLUSION Surgeons treated more cases of mucosal cancer with nodal metastasis after the introduction of the Guidelines. The long-term oncological outcomes for patients with EGC remained excellent. So far, the Guidelines for the treatment of EGC appear acceptable.
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Affiliation(s)
- Norimitsu Tanaka
- Gastric Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan
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14
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Hur H, Park CH. [Surgical treatment of gastric carcinoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 54:83-98. [PMID: 19696536 DOI: 10.4166/kjg.2009.54.2.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The gastric cancer is the most common cancer in Korea. The only treatment modality showing improved survival for gastric cancer is curative surgical resection, which comprises the resection of stomach, proper lymphadenectomy, and reconstruction. However, specific surgical procedures should be decided according to the location of the cancer, advancement of the tumor, and patients condition. Surgical treatment for gastric cancer has been developed toward two directions that are minimal invasive surgery for early gastric cancer and multi-disciplinary approach for advanced gastric cancer. Laparoscopic surgery for early gastric cancer has been accepted for minimally invasive surgery. Moreover, the advancement of diagnostic tools to assess biological aggressiveness of the tumor enables physicians to perform endoscopic resection or minimized resection for early gastric cancer. Recently, surgeons try to extend the application of laparoscopic gastric resection and D2 lymphadenectomy to advanced gastric cancer. However, technical and oncological evidences based on clinical trials should be filed up before adopting it as a standard therapy. In case of advanced gastric cancer, in addition to radical surgery, various treatment modalities including chemotherapy, radiation, and molecular target therapy also have been applied in many clinical trials. However, it should be stressed that a prerequisite for precise evaluation of the efficacy of these combined treatment modalities would be the standardization of surgical procedure.
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Affiliation(s)
- Hoon Hur
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Effect of rikkunshito, a chinese herbal medicine, on stasis in patients after pylorus-preserving gastrectomy. World J Surg 2009; 33:296-302. [PMID: 19082653 DOI: 10.1007/s00268-008-9854-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Distal gastrectomy (DG) and pylorus-preserving gastrectomy (PPG) have been employed for gastric cancer, with PPG having been reported to be superior to DG in regard to postoperative quality of life. Some patients with these operations still suffer from gastric stasis, however. In this study, we aimed to examine the clinical effects of rikkunshito on patients who were to undergo PPG. METHODS A total of 11 patients who were scheduled to undergo PPG for early gastric cancer at the Osaka University Hospital were enrolled. The patients were randomly assigned to the crossover study with and without rikkunshito 7.5 g/day. Questionnaires and emptying tests using (111)In-labeled liquid scintigraphy and (99m)Tc-labeled solid scintigraphy were performed at the end of each treatment period. RESULTS Stasis-related symptoms were significantly reduced during rikkunshito treatment (p = 0.043). The emptying test showed that rikkunshito improved emptying of solid meals (p = 0.0003) from the remnant stomach but did not accelerate gastric empting of liquid meals. CONCLUSIONS Rikkunshito improved gastric emptying and ameliorated postoperative symptoms of patients who had undergone a PPG.
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16
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Cho JN, Kim YH. Clinicopathologic Evaluation of Patients with Recurrence of Gastric Cancer within 6 Months after Curative Resection. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.6.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jeong Nam Cho
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Yong Ho Kim
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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17
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Zhao SL, Fang JY. The role of postoperative adjuvant chemotherapy following curative resection for gastric cancer: a meta-analysis. Cancer Invest 2008; 26:317-25. [PMID: 18317973 DOI: 10.1080/07357900701834686] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To evaluate the effect of adjuvant chemotherapy on survival rates after curative resection of gastric cancer, MEDLINE (1969-2006), EMBASE (1974-2006), bibliographies, and review articles were searched for relevant articles. The meta-analysis was finally based on 15 trials that included 3212 patients. RR for death in the treated group was 0.90 (95% CI, 0.84-0.96) (P = 0.0010). Little or no significant benefits were suggested in subgroup analyses between different population and regimens either. Postoperative adjuvant chemotherapy for gastric cancer confers slightly significant benefits compared to the surgery only group. The prognoses after surgery may differ among various population groups or because of different regimens.
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Affiliation(s)
- Shu-Liang Zhao
- Shanghai Jiao-Tong University School of Medicine Renji Hospital, Shanghai Institute of Digestive Disease, Shanghai, China
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18
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Abstract
Early gastric cancer (EGC) with 5-year survival rates exceeding 90% now accounts for nearly 50% of all gastric cancers treated at major institutions in Japan. D2 lymphadenectomy with resection of at least two-thirds of the stomach has been the mainstay of treatment for every stage of gastric cancer, including EGC. Post-gastrectomy syndrome is inevitable after surgery. Most of the symptoms resolve with time, though some patients suffer immensely for prolonged periods. Mucosal cancers rarely metastasize (3% or less). Surgeons have altered the traditional strategy for treatment which focused only on highly radical operations. The new strategy preserves patients' quality of life, while at the same time maintaining a high level of radicality, by employing a function-preserving operation which prevents post-gastrectomy syndrome. The Japanese gastric cancer treatment guidelines have standardized indications for the function-preserving surgery that is widely performed in Japan. There are various kinds of function-preserving operations, such as those reducing the extent of gastrectomy, and those providing nerve preservation, sphincter preservation, and formation of a new-stomach. Evaluation of preserved function is not satisfactory, because there is no gold standard for measuring gastrointestinal motor function and patients' quality of life.
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Affiliation(s)
- Hitoshi Katai
- Department of Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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19
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Michiura T, Nakane Y, Kanbara T, Nakai K, Inoue K, Yamamichi K, Kamiyama Y. Assessment of the preserved function of the remnant stomach in pylorus-preserving gastrectomy by gastric emptying scintigraphy. World J Surg 2006; 30:1277-83. [PMID: 16794905 DOI: 10.1007/s00268-005-7983-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study evaluated the preserved function of the remnant stomach by gastric emptying scintigraphy in patients who underwent pylorus-preserving gastrectomy (PPG), and it investigated whether this examination method is a useful tool for evaluation. MATERIALS AND METHODS The residual stomach function was evaluated by gastric emptying scintigraphy in 45 patients with early gastric cancer who had undergone PPG. Function was classified as rapid, intermediate, and delayed emptying types according to gastric emptying curves. Then, the relationships were examined between the gastric emptying types and postprandial symptoms, food intake status, body weight changes, and endoscopic findings. RESULTS Seventy-three percent of the PPG patients were classified as belonging to the intermediate emptying type, and the remainder to the delayed emptying type. The frequencies of complaints such as epigastric fullness, nausea, and vomiting were high in the delayed emptying-type patients. The intermediate emptying-type patients consumed larger amounts of food and gained more weight than the delayed emptying-type patients. It was difficult to estimate gastric emptying function from endoscopic findings. CONCLUSIONS Gastric function was evaluated by gastric emptying scintigraphy in PPG patients. This method might be useful not only for evaluating the motor function of the remnant stomach, but also for predicting postoperative status.
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Affiliation(s)
- Taku Michiura
- Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka, 570-8507, Japan.
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20
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Zhang RP, Tian SL, Zhang HG. Clinical application of submucosal injection of particulate carbon around the rectal cancer lesions in total mesorectal excision. Shijie Huaren Xiaohua Zazhi 2006; 14:2652-2654. [DOI: 10.11569/wcjd.v14.i26.2652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the application value of particulate carbon in total mesorectal excision..
METHODS: Particulate carbon was submucosally injected around the rectal cancer lesions under rectoscope in 45 patients 3 d before total mesorectal excision. The expression of matrix metalloproteinase-7 (MMP-7) mRNA was detected by reverse transcription-polymerase chain reaction (RT-PCR) to ascertain the lymph node metastasis.
RESULTS: The labelled lymph nodes were easily identified during the operation. The average numbers of eliminated lymph nodes and metastatic lymph nodes in the labelled group were larger than those in the controls (23.5 vs 16.1, t = 7.3733, P < 0.05; 9.0 vs 6.2, t = 5.4235, P < 0.05). In the labelled group, there were 680 labelled lymph nodes, of which 322 were metastatic ones. The numbers of labelled and metastatic lymph nodes were linearly correlated with each other (r = 0.3468, P < 0.05).
CONCLUSION: Submucosal injection of particulate carbon can help to clean metastatic lymph nodes in total mesorectal excision. The number of labelled lymph nodes is correlated with that of metastatic lymph nodes.
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Katai H, Sano T. Early gastric cancer: concepts, diagnosis, and management. Int J Clin Oncol 2006; 10:375-83. [PMID: 16369740 DOI: 10.1007/s10147-005-0534-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Indexed: 12/16/2022]
Affiliation(s)
- Hitoshi Katai
- Department of Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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22
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Shibata C, Shiiba KI, Funayama Y, Ishii S, Fukushima K, Mizoi T, Koyama K, Miura K, Matsuno S, Naito H, Kato E, Honda T, Momono S, Ouchi A, Ashino Y, Takahashi Y, Fujiya T, Iwatsuki A, Sasaki I. Outcomes after pylorus-preserving gastrectomy for early gastric cancer: a prospective multicenter trial. World J Surg 2005; 28:857-61. [PMID: 15593456 DOI: 10.1007/s00268-004-7369-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of the present study was to compare in a prospective, multicenter trial the results early and late after pylorus-preserving gastrectomy (PPG) versus conventional distal gastrectomy (CDG) with Billroth I anastomosis for early gastric cancer. Eighty-one patients with early gastric cancer were randomized and then underwent either PPG or CDG. Duration of operation, intraoperative blood loss, days until removal of the nasogastric tube, days until start of oral intake, and decrease in body weight were studied as parameters for outcomes early after the surgery. Late results were studied in patients followed for longer than 3 years. Change in body weight, status of oral intake, symptoms suggesting early dumping syndrome, and overall satisfaction were addressed in the questionnaire. The presence of gallstones was examined with ultrasonography. There were no differences in early results between PPG and CDG. The incidence of early dumping syndrome was lower in PPG (8%) than in CDG (33%). Other late results including the incidence of gallstones were not different between the 2 groups. These results indicate that PPG is as safe as CDG and has an advantage in terms of early dumping syndrome.
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Affiliation(s)
- Chikashi Shibata
- Department of Surgery, Tohoku University School of Medicine, Seiryo-machi, 980-8574 Aoba-ku, Sendai, Japan.
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23
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Ishikawa M, Kitayama J, Kazama S, Nagawa H. Expression of vascular endothelial growth factor (VEGF)-C in preoperative biopsy specimens and metastatic foci of regional lymph nodes in submucosal gastric carcinoma. World J Surg Oncol 2005; 3:2. [PMID: 15636643 PMCID: PMC545047 DOI: 10.1186/1477-7819-3-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Accepted: 01/07/2005] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND: Vascular endothelial growth factor (VEGF)-C is implicated in lymphangiogenesis, however the exact role of VEGF-C in promoting lymphatic spread of cancer cells remains largely unknown. METHODS: The expression of VEGF-C was immunohistochemically determined in 97 endoscopic biopsy specimens from 46 patients with submucosal gastric carcinoma (SGC). Nodal metastases including micrometastasis and isolated tumor cells (ITC) were evaluated by immunohistochemical staining for cytokeratin in 1650 lymph nodes, and tumor cells in these metastatic nodes were also examined for VEGF-C expression. RESULTS: In biopsy samples, VEGF-C was positively detected in 21 (47%) patients. Metastases were identified in 46 (2.8%) nodes from 15 (33%) patients. Metastases were detected in 39 nodes by hematoxylin-eosin (H&E) staining and in additional 7 nodes as ITC by immunohistochemical staining. The rate of lymph node metastases was significantly correlated with VEGF-C expression in biopsy samples (p < 0.05). The positive and negative predictive values of VEGF-C in biopsy specimens for nodal metastasis were 44 %(10/21) and 80% (20/25), respectively. Among the 46 metastatic nodes, tumor cells in 29 (63%) nodes positive patients expressed VEGF-C, whereas those in 17 (37%) nodes did not. VEGF-C expression was high in macronodular foci in medullary areas, whereas more than half of ITC or micrometastasis located in peripheral sinus lacked the expression of VEGF-C. CONCLUSIONS: Despite the significant correlation, immunodetcetion of VEGF-C in endoscopic biopsy specimens could not accurately predict the nodal status, and thus cannot be applied for the decision of the treatment for SGC. VEGF-C may not be essential for lymphatic transport, but rather important to develop the macronodular lesion in metastatic nodes.
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Affiliation(s)
- Makoto Ishikawa
- Department of Surgery, Division of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Joji Kitayama
- Department of Surgery, Division of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Shinsuke Kazama
- Department of Surgery, Division of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hirokazu Nagawa
- Department of Surgery, Division of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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24
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Otsuji E, Kuriu Y, Ichikawa D, Okamoto K, Ochiai T, Hagiwara A, Yamagishi H. Time to Death and Pattern of Death in Recurrence following Curative Resection of Gastric Carcinoma: Analysis Based on Depth of Invasion. World J Surg 2004; 28:866-9. [PMID: 15593458 DOI: 10.1007/s00268-004-7359-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
It is difficult to predict recurrence in patients who undergo curative gastrectomy for gastric carcinoma. If the timing and site of recurrence can be predicted, it becomes easier to detect recurrent disease. Records of 290 patients who died of tumor recurrence after curative gastrectomy for gastric carcinoma were retrospectively analyzed to determine whether the depth of carcinoma invasion is independently correlated with the time to death due to tumor recurrence. Additionally, the relation between the pattern of recurrence and the depth of invasion of the gastric wall was examined. Postoperative survival in patients with tumors with deep invasion was shorter than that of patients with tumors with shallow invasion. Depth of invasion was a predictor of survival on multivariate analysis. When carcinoma invaded into deeper layers, the incidence of peritoneal metastasis and local recurrence rose and that of hematogenous metastasis fell. In conclusion, the timing of death and the site of recurrence after gastrectomy for gastric carcinoma might be predicted by the depth of invasion of the gastric wall.
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Affiliation(s)
- Eigo Otsuji
- Department of Surgery, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji Kamigyo-ku, 602-8566 Kyoto, Japan
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25
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Ishikawa M, Kitayama J, Nariko H, Kohno K, Nagawa H. The expression pattern of UDP-N-acetyl-alpha-d-galactosamine: polypeptide N-acetylgalactosaminyl transferase-3 in early gastric carcinoma. J Surg Oncol 2004; 86:28-33. [PMID: 15048677 DOI: 10.1002/jso.20042] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Tumor development usually is accompanied by alterations of O-glycosylation. Initial glycosylation of mucin-type O-linked proteins is regulated by UDP-N-acetyl-alpha-d-galactosamine: polypeptide N-acetylgalactosaminyl transferase-3 (GalNAc-T3). Although the expression of GalNAc-T3 has been examined in various cancers, the expression has not been characterized in early stages of cancer. METHODS Using the specific antibody, we evaluated the expression of GalNAc-T3 in 125 early gastric cancers that were treated as classical gastrectomy with lymphadenectomy, and analyzed the relationship between the expression of GalNAc-T3 and clinicopathological features. RESULTS GalNac-T3 was positively expressed in 40 cases (76%) in differentiated carcinomas, whereas in only six cases (8%) in undifferentiated carcinomas (P < 0.001). Positive staining was observed in 17 (26%) intramucosal and in 29 (48%) submucosal carcinomas, indicating that GalNac-T3 tended to be highly expressed as the depth of invasion increased (P < 0.05). Lymph node metastasis tended to be observed more frequently in GalNac-T3 positive than negative cases, and the difference was significant in undifferentiated type cancer (P < 0.05). CONCLUSIONS GalNAc-T3 expression was a useful indicator of tumor differentiation in early gastric cancer, and the expression had positive correlation with depth of tumor invasion and lymph node metastasis. This suggests that the overexpression of GalNAc-T3 may have a role in invasion and metastasis in early stages of gastric cancer.
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Katai H, Sano T, Sasako M, Fukagawa T, Saka M. Update on surgery of gastric cancer: new procedures versus standard technique. Dig Dis 2004; 22:338-44. [PMID: 15812157 DOI: 10.1159/000083596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
D2 lymphadenectomy has been the mainstay of treatment for every stage of gastric cancer including early gastric cancer in Japan. However, the use of conventional D2 nodal dissection is being challenged. There was a recent improvement in techniques for preoperative diagnosis and perioperative diagnosis. Less extensive surgeries to maintain patients' quality of life have been introduced as standard treatment for some forms of early gastric cancer in the Gastric Cancer Treatment Guidelines 2001 (The Japanese Gastric Cancer Association). Superextended dissection (more than D2) for non-early gastric cancer is set at investigational treatment. Japanese surgeons are now aiming at wide variations of surgical treatment according to the stage of disease based on new procedures. Further evaluations are proceeding to prove superior to standard techniques.
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Affiliation(s)
- Hitoshi Katai
- Department of Surgical Oncology, National Cancer Center Hospital, Tokyo, Japan.
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27
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Ikeda Y, Sasaki Y, Niimi M, Kan S, Takami H, Kodaira S. Hand-assisted laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy. J Am Coll Surg 2002; 195:578-81. [PMID: 12375768 DOI: 10.1016/s1072-7515(02)01291-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Yoshifiimi Ikeda
- Department of Surgery, Teikyo University School of Medicine. Tokyo, Japan
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28
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Shimoyama S, Yasuda H, Mafune K, Kaminishi M. Indications of a minimized scope of lymphadenectomy for submucosal gastric cancer. Ann Surg Oncol 2002; 9:625-31. [PMID: 12167575 DOI: 10.1007/bf02574477] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A recent trend for less invasive surgery has increased consideration for a minimized scope of lymphadenectomy for submucosal cancer; however, feasibility criteria have not been precisely established. METHODS Patterns and sites of nodal involvement were retrospectively investigated in 294 patients with solitary submucosal gastric cancer in association with other clinicopathologic characteristics, including pre- and intraoperative evaluations of cancer depth (cT) and nodal involvement (cN). RESULTS Among the early (cT1) and node-negative (cN0) cancer, intestinal (< or =1.5 cm) and diffuse types (< or =1.0 cm) of submucosal cancer showed low incidences of nodal involvement (3%) confined to the first tier. When the cancer exceeded these cutoff diameters, positive nodes of the second tier were confined to three priority stations (left gastric, common hepatic, and celiac arteries) at an incidence of 2.3%. Perigastric and preferential dissection of these three node stations (modified D2 dissection) showed survival benefits identical to those of a conventional D2 dissection. CONCLUSIONS When submucosal cancer is evaluated as cT1cN0, a virtually sufficient minimized scope of lymphadenectomy is a D1 dissection for that within the cutoff diameter and a modified D2 dissection for that exceeding the cutoff diameter. These two types of dissection can even cover the infrequently observed node-positive stations and can realize no residual disease at surgery.
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Affiliation(s)
- Shouji Shimoyama
- Department of Gastrointestinal Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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29
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Nishikawa K, Kawahara H, Yumiba T, Nishida T, Inoue Y, Ito T, Matsuda H. Functional characteristics of the pylorus in patients undergoing pylorus--preserving gastrectomy for early gastric cancer. Surgery 2002; 131:613-24. [PMID: 12075173 DOI: 10.1067/msy.2002.124630] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study investigates the functional characteristics of the pylorus in patients undergoing pylorus-preserving gastrectomy (PPG) for early gastric cancer. METHODS In study 1, postprandial symptoms and gastric emptying were compared between 2 groups of 12 patients with early gastric cancer more than 1 year after either PPG (PPG group) or distal gastrectomy (DG) (DG group). Gastric emptying was evaluated with the dual isotope technique for liquids and solids separately. In study 2, pyloric motility was evaluated with a sleeve/sidehole manometric assembly in 7 patients undergoing PPG, which was compared with that in the preoperative patients. RESULTS In study 1, the overall modified Visick score of postprandial symptoms and the Sigstad dumping score were significantly lower in the PPG group compared with the DG group (P <.05). Early accelerated gastric emptying was observed in both groups for liquids, but only in the DG group for solids. In study 2, isolated pyloric pressure waves induced by intraduodenal lipid infusion and phase III-like activity induced by intravenous erythromycin infusion were preserved after PPG. CONCLUSIONS The quantitative analysis of postoperative symptoms revealed that PPG patients were associated with better clinical conditions than DG patients. The clinical benefits of PPG are considered to be based on the function of the preserved pylorus.
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Affiliation(s)
- Kazuhiro Nishikawa
- Department of Surgery, Osaka University Graduate School of Medicine, Japan
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Huang Y, Hagiwara A, Wang W, Su G, Qi X, Ma D, Fan Y. Local injection of M-CH combined with i.p. hyperthermic hypo-osmolar infusion is an effective therapy in advanced gastric cancer. Anticancer Drugs 2002; 13:431-5. [PMID: 11984090 DOI: 10.1097/00001813-200204000-00013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Treatment failure of surgically treated gastric cancer is attributed to the spread of gastric cancer cells into the abdominal cavity and lymphatic or hematogenic canals. In the present study, local injection of mitomycin C bound to activated carbon (M-CH) combined with i.p. hyperthermic hypo-osmolar infusion (IPHHOI) was intraoperatively administered to prevent lymph node recurrence and peritoneal recurrence of gastric cancer. Between April 1998 and August 1999, 79 patients with advanced gastric cancer were allocated randomly to two groups. Forty patients underwent M-CH plus IPHHOI combined with surgery (M-CH1+IPHHOI group) and the remaining 39 underwent surgery alone (control group). Lymph node and peritoneal recurrence were significantly decreased in the M-CH1+IPHHOI group compared to that in the control group (p<0.05). The 1- and 2-year survival rates for the M-CH1+IPHHOI group were 91.2 and 72.1%, and those for the control group were 78.9 and 45.5%. The M-CH1IPHHOI group reaped a significant survival benefit (p=0.0352) compared to the control group. Although this study was conducted randomly for a small number of patients and short time, compared with the control group, the M-CH1+IPHHOI group had a beneficial effect in preventing lymph node recurrence and peritoneal recurrence after curative gastrectomy for advanced gastric cancer.
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Affiliation(s)
- Yunning Huang
- Department of Digestive Surgery, Ningxia Hospital, Yinchuan, Ningxia, PRC
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31
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Noda H, Maehara Y, Irie K, Kakeji Y, Yonemura T, Sugimachi K. Increased proliferative activity caused by loss of p21(WAF1/CIP1) expression and its clinical significance in patients with early-stage gastric carcinoma. Cancer 2002; 94:2107-12. [PMID: 11932915 DOI: 10.1002/cncr.10417] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Recurrences of gastric carcinoma are likely to take on a variety forms, even after patients undergo curative resection for early-stage gastric carcinoma. It is important to identify the biologic markers that predict tumor progression and survival in these patients. Proliferating cell nuclear antigen (PCNA) acts as a processivity factor for DNA polymerase delta, which is involved directly in DNA synthesis, and the PCNA level is correlated with the proliferative state of cells. p21(WAF1/CIP1) interacts with PCNA to inhibit DNA synthesis and plays a central role in regulating the cell cycle. The authors investigated patients with early-stage gastric carcinoma to determine the clinical significance of proliferative activity and p21 expression. METHODS Tissue specimens from 133 Japanese patients with early-stage gastric carcinoma that invaded the submucosal layer were immunostained with a monoclonal antibody against PCNA and p21(WAF1/CIP1), and the correlations between the PCNA labeling index and p21(WAF1/CIP1) expression as well as clinicopathologic factors were investigated. RESULTS The PCNA labeling index varied from 9.9% to 81.4%, (mean, 31.2%). The incidence of p21 positive expression was 87 of 133 patients (65.4%). The patients with a high labeling index had a significantly higher rate of lymph node metastasis (P < 0.01) and loss of p21(WAF1/CIP1) expression (P < 0.05) compared with the patients with a low labeling index. The 5-year survival rate for patients in the high labeling index group (87.0%) was significantly lower compared with the 5-year survival rate for the patients in the low labeling index group (98.6%; P < 0.05). CONCLUSIONS Loss of p21(WAF1/CIP1) expression contributes to the amplification of proliferative activity in patients with early-stage gastric carcinoma. Estimation of the proliferative activity of early-stage gastric carcinoma provides information on lymph node metastasis and prognosis. Even after patients undergo curative resection, those with early-stage gastric carcinoma should be followed closely.
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Affiliation(s)
- Hiroshi Noda
- Department of Surgery, Saga Prefectural Hospital Koseikan, Saga, Japan
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Yokota T, Kunii Y, Saito T, Teshima S, Yamada Y, Iwamoto K, Takahashi H, Takahashi M, Kikuchi S, Yamauchi H. Prognostic factors of gastric cancer tumours of less than 2 cm in diameter: rationale for limited surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2002; 28:209-13. [PMID: 11944951 DOI: 10.1053/ejso.2001.1178] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A recent trend in the surgical treatment of patients with early gastric cancer in Japan has been to limit surgery to an extent that ensures complete cure and improvement in the patient's quality of life. If a gastric cancer tumour can be completely eradicated by laparoscopic surgery, the patient can be cured of cancer without major operative stress. A small gastric cancer tumour of less than 2 cm in diameter is an indication for laparoscopic surgery, but little is known about what protocol of surgical treatment is appropriate for this type of tumour. PATIENTS AND METHODS The clinicopathological features of 150 patients with gastric cancer tumour of less than 2 cm in diameter were reviewed retrospectively from hospital records between 1985 and 1995. The results of retrospective analysis of clinicopathological data of 24 patients with advanced cancer were compared with those of 126 patients with early cancer. Univariate and multivariate analyses of patients with small gastric cancer tumours were performed to evaluate the prognostic significance of clinicopathological features. RESULTS A significant difference was seen between the gross tumour appearances in the two groups; Borrmann type-4 tumours were more common in the advanced group. Lymph-node metastasis, lymphatic vessel invasion and vascular invasion were found more frequently in the advanced cancer group than in the early cancer group. Scirrhous type was more common in the advanced cancer group. In univariate analysis, unfavourable prognostic factors included deep cancer invasion, presence of lymph-node metastasis, lymphatic invasion and vascular invasion. Using Cox's proportional hazard regression model, only nodal involvement emerged as an independent statistically significant prognostic parameter associated with long-term survival. CONCLUSION Laparoscopic surgery should not be performed on tumours that are Borrmann type in macroscopic appearance and scirrhous-type histologically. Lymph-node metastasis is an independent prognostic factor. We recommend laparoscopic surgery involving local resection of the stomach without lymphadenectomy for small, early gastric cancer tumours that satisfy the criteria mentioned above. However, the validity of this recommendation should be tested by a prospective randomized control trial in the future.
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Affiliation(s)
- T Yokota
- Department of Surgery, Sendai National Hospital, Sendai 983-8520, Japan.
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Tanaka M, Kitajima Y, Edakuni G, Sato S, Miyazaki K. Abnormal expression of E-cadherin and beta-catenin may be a molecular marker of submucosal invasion and lymph node metastasis in early gastric cancer. Br J Surg 2002. [PMID: 11856141 DOI: 10.1046/j.1365-2168.2002.01985.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Impaired expression of E-cadherin and alpha- and beta-catenin is frequently observed in several human cancers. The aim of this study was to examine immunohistochemical expression of these adhesion molecules, focusing on early gastric carcinomas, and to investigate differences between differentiated and undifferentiated gastric cancer at the early phase of carcinogenesis. METHODS Immunohistochemical staining of E-cadherin and alpha- and beta-catenin was performed using specimens from 143 patients with early gastric cancer. RESULTS Abnormal E-cadherin and beta-catenin staining correlated with depth of tumour invasion in differentiated-type tumours. In contrast, abnormal staining was frequently found even in intramucosal carcinoma of undifferentiated-type tumours, suggesting an apparent difference in the onset of E-cadherin-catenin complex abnormality between the two cancer types. Absent staining of beta-catenin was associated with lymph node metastasis. Multivariate analysis revealed abnormal E-cadherin expression as an independent factor that correlated with submucosal invasion in early gastric cancer. CONCLUSION Abnormal E-cadherin expression is a possible marker of submucosal invasion in differentiated-type early gastric cancer and absent beta-catenin staining could be used as a predictor of lymph node metastasis in both types.
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Affiliation(s)
- M Tanaka
- Department of Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
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Seto Y, Yamaguchi H, Shimoyama S, Shimizu N, Aoki F, Kaminishi M. Results of local resection with regional lymphadenectomy for early gastric cancer. Am J Surg 2001; 182:498-501. [PMID: 11754858 DOI: 10.1016/s0002-9610(01)00747-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In 1999, the authors reported preliminary results of local resection with regional lymphadenectomy(LR) for early gastric cancer. METHODS Twenty-four patients underwent LR until May 2000. Laparoscopic techniques were recently applied. The dissected area for lymphadenectomy depended on the lymphatic flow from the tumor. Local gastric resection was performed with a 2 cm cancer-free margin. Among the 24 patients, 14 who had been followed up for more than 1 year were eligible for the nutritional study, and the nutritional parameters were compared with those for patients undergoing pylorus-preserving gastrectomy (PPG). RESULTS Twenty-two patients not receiving additional gastrectomy needed no restriction of food intake and had neither postgastrectomy symptoms nor recurrence. All nutritional parameters remained stable between the preoperative and the subsequent period. Nutritional superiority of LR over PPG was observed. CONCLUSIONS For selected patients with early gastric cancer, LR can be a treatment of choice to provide a good quality of life.
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Affiliation(s)
- Y Seto
- Department of Gastrointestinal Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
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35
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Davis PA, Sano T. The difference in gastric cancer between Japan, USA and Europe: what are the facts? what are the suggestions? Crit Rev Oncol Hematol 2001; 40:77-94. [PMID: 11578917 DOI: 10.1016/s1040-8428(00)00131-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In Japan the survival rate for gastric cancer has steadily improved over the last 30 years whilst that in the West has remained static and inferior. In this review three hypotheses are examined to explain the difference. There is little evidence to suggest genetic differences, which might result in a less aggressive cancer in Japan. Recently there has been a rise in the proportion of cancers of the gastro-oesophageal junction in the West and this has not been seen in Japan. The comparison of survival data from these two regions is problematic with different staging systems and a stage migration effect. The established surgical treatment of gastric cancer in Japan is radical gastrectomy and regional lymphadenectomy and this has been proposed as a superior treatment to the standard gastrectomy common in the West. The results for survival benefit however, have not been reproduced in randomized clinical trials. The heterogeneity of adjuvant and neoadjuvant treatment regimens in Japan and the West has led to difficulties in the interpretation of their effects. There is considerable scope for future collaboration between clinicians in the West and Japan.
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Affiliation(s)
- P A Davis
- Imperial College School of Medicine, St. Mary's Hospital, London, UK
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Shimoyama S, Seto Y, Yasuda H, Kaminishi M. Wider indications for the local resection of gastric cancer by adjacent lymphadenectomy. J Surg Oncol 2000; 75:157-64. [PMID: 11088046 DOI: 10.1002/1096-9098(200011)75:3<157::aid-jso2>3.0.co;2-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES A variety of minimal invasive treatment strategies for early gastric cancer without reducing the curability have been introduced, however, the indications for the local resection of early gastric cancer have not been precisely established. METHODS Two approaches are adopted in this study to elucidate indications for local resection. One is a retrospective review of surgically resected, postoperatively histologically proven early gastric cancers between 1976 and 1996 (611 patients), and the other is the patient selection from those who underwent modified D(1) lymphadenectomy in a prospective manner between 1987 and 1996, based on the preoperative and intraoperative diagnoses of mucosal, node negative, nonpalpable gastric cancer (125 patients). In these approaches, patterns of nodal involvement in association with clinicopathological characteristics of gastric cancer were investigated. RESULTS The depressed with ulceration type and histologically high grade type were predominant characteristics of mucosal, node positive gastric cancer patients. Of these patients, after the exclusion of those who were diagnosed to have submucosal or advanced cancer preoperatively or who had palpable cancer intraoperatively, the gastric cancer < or =4 cm in maximum diameter had positive nodes confined to only one station adjacent to the cancer without simultaneous nodal involvement in the other stations. CONCLUSIONS Local resection can be performed for gastric cancers < or = 4 cm in maximum diameter that meet our criteria for modified D(1) lymphadenectomy, in association with the frozen section confirmation of cancer negative in the simultaneously dissected lymph nodes in the stations adjacent to the cancer. The adjacent lymphadenectomy and frozen section examination make the application of local resection possible for a wider segment of patients.
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Affiliation(s)
- S Shimoyama
- Department of Gastrointestinal Surgery, University of Tokyo, Tokyo, Japan.
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Millham FH, Becker JM. Trends in the surgical management of gastric cancer(1). CURRENT SURGERY 2000; 57:292-296. [PMID: 11024235 DOI: 10.1016/s0149-7944(00)00217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- FH Millham
- Boston University School of Medicine, Boston, Massachusetts, USA
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Cirera L, Balil A, Batiste-Alentorn E, Tusquets I, Cardona T, Arcusa A, Jolis L, Saigí E, Guasch I, Badia A, Boleda M. Randomized clinical trial of adjuvant mitomycin plus tegafur in patients with resected stage III gastric cancer. J Clin Oncol 1999; 17:3810-5. [PMID: 10577853 DOI: 10.1200/jco.1999.17.12.3810] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The efficacy of adjuvant chemotherapy in gastric cancer is controversial. We conducted a phase III, randomized, multicentric clinical trial with the goal of assessing the efficacy of the combination of mitomycin plus tegafur in prolonging the disease-free survival and overall survival of patients with resected stage III gastric cancer. PATIENTS AND METHODS Patients with resected stage III gastric adenocarcinoma were randomly assigned, using sealed envelopes, to receive either chemotherapy or no further treatment. Chemotherapy was started within 28 days after surgery according to the following schedule: mitomycin 20 mg/m(2) intravenously (bolus) at day 1 of chemotherapy; 30 days later, oral tegafur at 400 mg bid daily for 3 months. Disease-free survival and overall survival were estimated using the Kaplan-Meier analysis and the Cox proportional hazards model. RESULTS Between January 1988 and September 1994, 148 patients from 10 hospitals in Catalonia, Spain, were included in the study. The median follow-up period was 37 months. The tolerability of the treatment was excellent. The overall survival and disease-free survival were higher in the group of patients treated with chemotherapy (P =.04 for survival and P =.01 for disease-free survival in the log-rank test). The overall 5-year survival rate and the 5-year disease-free survival rate were, respectively, 56% and 51% in the treatment group and 36% and 31% in the control group. CONCLUSION Our positive results are consistent with the results of recent studies; which conclude that there is a potential benefit from adjuvant chemotherapy in resected gastric cancer.
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Affiliation(s)
- L Cirera
- Medical Oncology, Unit, Hospital Mútua de Terrassa-Universitat de Barcelona, Spain
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Ohya T, Ohwada S, Iesato H, Takeyoshi I, Kawashima Y, Ogawa T, Yokomori T, Morishita Y. Jejunal pouch interposition after pylorus-preserving gastrectomy. J Surg Res 1999; 86:177-82. [PMID: 10534421 DOI: 10.1006/jsre.1999.5710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND To improve the quality of life of patients undergoing gastrectomy, a nerve-conserving jejunal pouch was interposed after pylorus-preserving gastrectomy (PPG) with vagal nerve preservation. We report the details of the operative technique and the outcome. METHODS PPG with lymph node dissection was performed, preserving the hepatic, pyloric, and celiac branches of vagal nerve. The jejunum was cut approximately 20 cm distal to the ligament of Treitz. Marginal vessels were not divided in order to preserve the nerves in the jejunum that were used to construct the pouch. A linear stapler was used to perform a side-to-side jejunojejunostomy. A 12-cm-long pouch was formed by firing the stapler twice. The pouch was interposed between the residual parts of the stomach. Postoperatively, the patients were interviewed periodically. A dual-phase, dual-isotope radionucleid pouch-emptying study was performed 6 months after surgery. RESULTS A total of 13 patients underwent the operation. No complication developed. During the first 6 months after surgery, the body weight of the patients was maintained at 91% of the preoperative level. The radioisotope retention rate for the combined pouch and residual stomach was 46% for liquid food and 76% for solid food 120 min after ingestion. The pattern of its emptying was similar to that in healthy individuals. CONCLUSIONS The pouch-emptying test demonstrated a satisfactory retention capacity and acceptable emptying for the gastric substitute. A reasonably good quality of life has been obtained for patients undergoing PPG with interposition of a nerve-preserving jejunal pouch.
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Affiliation(s)
- T Ohya
- Second Department of Surgery, Gunma University School of Medicine, Maebashi, Gunma, 371-8511, Japan
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Maeda K, Kang SM, Onoda N, Ogawa M, Kato Y, Sawada T, Chung KH. Vascular endothelial growth factor expression in preoperative biopsy specimens correlates with disease recurrence in patients with early gastric carcinoma. Cancer 1999. [PMID: 10440683 DOI: 10.1002/(sici)1097-0142(19990815)86:4%3c566::aid-cncr4%3e3.0.co;2-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Recently many studies have demonstrated that the degree of tumor angiogenesis is related to the aggressiveness of the tumor and clinical outcome. Vascular endothelial growth factor (VEGF) is a well characterized inducer of angiogenesis. In this study, the authors investigated the prognostic significance of VEGF expression in patients with early gastric carcinoma together with p53 gene abnormality and tumor cell proliferation. METHODS One hundred ninety-five endoscopically biopsied specimens obtained preoperatively from patients with early gastric carcinoma were studied immunohistochemically. RESULTS According to conventional clinicopathologic factors, submucosal invasion, lymph node metastases, and tumor size were associated significantly with the incidence of disease recurrence. According to conventional biologic factors, VEGF expression was observed more frequently in patients with disease recurrence compared with those without disease recurrence whereas neither p53 abnormality nor tumor cell proliferation were correlated with prognosis. Moreover, multivariate analysis indicated that VEGF expression (as well as submucosal invasion and lymph node metastases) is an independent predictor of disease recurrence. CONCLUSIONS The results of the current study show that VEGF expression may be a useful prognostic factor for patients with early gastric carcinoma.
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Affiliation(s)
- K Maeda
- First Department of Surgery, Osaka City University Medical School, Osaka, Japan
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Maeda K, Kang SM, Onoda N, Ogawa M, Kato Y, Sawada T, Chung KH. Vascular endothelial growth factor expression in preoperative biopsy specimens correlates with disease recurrence in patients with early gastric carcinoma. Cancer 1999; 86:566-71. [PMID: 10440683 DOI: 10.1002/(sici)1097-0142(19990815)86:4<566::aid-cncr4>3.0.co;2-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Recently many studies have demonstrated that the degree of tumor angiogenesis is related to the aggressiveness of the tumor and clinical outcome. Vascular endothelial growth factor (VEGF) is a well characterized inducer of angiogenesis. In this study, the authors investigated the prognostic significance of VEGF expression in patients with early gastric carcinoma together with p53 gene abnormality and tumor cell proliferation. METHODS One hundred ninety-five endoscopically biopsied specimens obtained preoperatively from patients with early gastric carcinoma were studied immunohistochemically. RESULTS According to conventional clinicopathologic factors, submucosal invasion, lymph node metastases, and tumor size were associated significantly with the incidence of disease recurrence. According to conventional biologic factors, VEGF expression was observed more frequently in patients with disease recurrence compared with those without disease recurrence whereas neither p53 abnormality nor tumor cell proliferation were correlated with prognosis. Moreover, multivariate analysis indicated that VEGF expression (as well as submucosal invasion and lymph node metastases) is an independent predictor of disease recurrence. CONCLUSIONS The results of the current study show that VEGF expression may be a useful prognostic factor for patients with early gastric carcinoma.
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Affiliation(s)
- K Maeda
- First Department of Surgery, Osaka City University Medical School, Osaka, Japan
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Seto Y, Nagawa H, Muto Y, Kaizaki S, Kitayama J, Muto T. Preliminary report on local resection with lymphadenectomy for early gastric cancer. Br J Surg 1999; 86:526-8. [PMID: 10215830 DOI: 10.1046/j.1365-2168.1999.01069.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The frequency of lymph node metastasis in mucosal gastric cancers 2-4 cm in diameter was low (three (1.3 per cent) of 234) in patients treated in this unit between 1966 and 1995. This study was a prospective report on local resection with lymphadenectomy for early gastric cancer. METHODS Eight patients with a single early gastric cancer underwent local resection with lymphadenectomy. The tumour was excised with a non-cancerous rim of approximately 2 cm. The extent of lymphadenectomy depended on tumour location. Intraoperative endoscopic examination and frozen-section analysis of the dissected nodes were used to determine the resection line and evaluate nodal status. RESULTS Mean operating time, blood loss and number of dissected nodes were 171 min, 87 ml and 8 respectively. There were no operative complications. Cancer invasion was confined to the mucosa in six tumours but two patients had minute submucosal invasion. The maximum diameter of the resected specimens was 10 cm and no nodal involvement was detected. No patient developed postgastrectomy syndrome. CONCLUSION For selected patients with early gastric cancer, local resection with lymphadenectomy can provide a good quality of life without compromising cure rate.
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Affiliation(s)
- Y Seto
- Department of Surgery, Faculty of Medicine, University of Tokyo, 3-28-6 Mejirodai Bunkyo-ku, Tokyo 112-8688, Japan
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Tsujitani S, Oka S, Saito H, Kondo A, Ikeguchi M, Maeta M, Kaibara N. Less invasive surgery for early gastric cancer based on the low probability of lymph node metastasis. Surgery 1999. [PMID: 10026747 DOI: 10.1016/s0039-6060(99)70258-8] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Less invasive treatment is the current trend in many surgical fields. Most patients with early gastric cancer do not have lymph node metastasis. Thus extensive resection of the stomach and extended lymph node dissection do not appear to be necessary. METHODS In a retrospective study, 890 consecutive patients with early gastric cancer who had undergone standard gastrectomy were assessed for depth of invasion, gross appearance, and maximum diameter of the tumor to examine the possibility of limiting the extent of lymph node dissection. A variety of limited gastrectomies have been developed and now include endoscopic mucosal resection, wedge resection, segmental gastrectomy, limited proximal gastrectomy, and distal hemigastrectomy. RESULTS A retrospective study revealed that extensive lymph node dissection did not improve the survival of patients with early gastric cancer. Endoscopic mucosal resection was suitable for cancers of the depressed type of less than 1 cm in diameter and the elevated type of less than 2 cm in diameter. Wedge, segmental, or limited proximal gastrectomy was suitable for the elevated type of 2 to 3 cm in diameter. The elevated type of more than 3 cm in diameter and the depressed type of 1 to 3 cm in diameter sometimes involved metastasis to group 1 nodes. The depressed type of more than 3 cm in diameter sometimes involved metastasis to group 2 nodes. Thus such cases should be treated by gastrectomy with dissection of potentially metastatic lymph nodes. CONCLUSIONS Limitation of the extent of gastrectomy and lymph node dissection may be possible, depending on the gross appearance and size of the tumor.
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Affiliation(s)
- S Tsujitani
- Department of Surgery I, Faculty of Medicine, Tottori University, Yonago, Japan
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Okamoto K, Sawai K, Minato H, Yada H, Shirasu M, Sakakura C, Otsuji E, Kitamura K, Taniguchi H, Hagiwara A, Yamaguchi T, Takahashi T. Number and anatomical extent of lymph node metastases in gastric cancer: analysis using intra-lymph node injection of activated carbon particles (CH40). Jpn J Clin Oncol 1999; 29:74-7. [PMID: 10089947 DOI: 10.1093/jjco/29.2.74] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The long-term survival of 200 patients with gastric cancer who underwent radical gastrectomy was analyzed with respect to the number and anatomical extent of lymph node metastasis. All of the patients received intra-lymph node injection of fine activated carbon particle solution (CH40) during surgery. METHODS The average number of resected lymph nodes increased in line with the anatomical level of lymph node dissection; 32.5 per patient in D1, 42.3 in D2, 3 and 66.3 in D4. The percentage of blackened lymph nodes without metastasis (42.4%) was slightly higher than that of lymph nodes containing metastasis (37.2%), but the difference was not statistically significant. Of the 200 patients, 61 (30.5%) had microscopic evidence of metastatic lymph node involvement. Twenty-two patients had between one and three metastatic lymph nodes, 19 had between four and nine and 20 patients had more than nine. The 5-year survival rate was 93.1% in patients without lymph node metastasis, 71.9% in patients with 1-8 metastatic nodes, 36.1% in patients with 4-9 nodes and 19.2% in patients with > 9 nodes. RESULTS The 5-year survival rate according to the anatomical extent of metastatic lymph nodes was 93.1% in n0, 63.1% in n1, 37.9% in n2, 27.8% in n3 and 0% in n4. The number of metastatic lymph nodes and also their anatomical extent were identified as independent prognostic factors for survival by multivariate analysis. CONCLUSION The number and anatomical extent of metastatic lymph nodes have similar impacts on prognosis in gastric cancer.
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Affiliation(s)
- K Okamoto
- First Department of Surgery, Kyoto Prefectural University of Medicine, Japan.
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45
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Otsuji E, Yamaguchi T, Sawai K, Hagiwara A, Taniguchi H, Takahashi T. Recent advances in surgical treatment have improved the survival of patients with gastric carcinoma. Cancer 1998. [DOI: 10.1002/(sici)1097-0142(19980401)82:7<1233::aid-cncr4>3.0.co;2-g] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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46
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Cady B. Contemporary approaches to gastric carcinoma. Cancer Treat Res 1997; 90:239-52. [PMID: 9367087 DOI: 10.1007/978-1-4615-6165-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- B Cady
- New England Deaconess Hospital, Boston, MA 02215, USA
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47
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Shibata C, Sasaki I, Naito H, Ohtani N, Sato S, Ise H, Matsuno S. Duodenal but not gastric transection disturbs motility of the sphincter of Oddi in the dog. World J Surg 1997; 21:191-4. [PMID: 8995077 DOI: 10.1007/s002689900214] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to elucidate the effect of gastric and duodenal transection on biliary manometry in anesthetized dogs. The basal biliary pressure and increase in pressure during saline perfusion at rates of 1.0 and 1.5 ml/min were studied in intact controls, during infusion of cholecystokinin (CCK) alone, and after gastric and duodenal transection. CCK dose-dependently lowered the basal pressure and the increase in pressure during perfusion. Gastric transection 1.5 cm proximal to the pylorus did not affect these parameters. In contrast, duodenal transection 1.0 cm distal to the pylorus significantly increased these parameters compared to all other groups. These observations suggest that the proximal duodenal transection, as performed during conventional distal gastrectomy, may contribute to the pathogenesis of postgastrectomy gallstone formation by altering motor function of the sphincter of Oddi.
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Affiliation(s)
- C Shibata
- First Department of Surgery, Tohoku University School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai 980-77, Japan
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48
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Isozaki H, Okajima K, Momura E, Ichinona T, Fujii K, Izumi N, Takeda Y. Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 1996. [PMID: 8689185 DOI: 10.1002/bjs.1800830239] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Physical results after pylorus-preserving gastrectomy (PPG) with preservation of the vagus nerve were evaluated. The status of 15 patients with early gastric cancer after PPG was compared with that of 14 patients after distal gastrectomy (DG). The postoperative/preoperative body-weight ratio of the PPG group (0.99) was significantly greater than that of the DG group (0.92). Patients who had PPG had fewer postoperative abdominal symptoms than those who underwent DG. The gastric emptying pattern of patients who had a pylorus-preserving procedure was slower than that of those who had conventional gastrectomy, and more similar to the preoperative pattern. Contraction of the gallbladder after PPG was better than after DG. Gastroscopy revealed that the mucosa of the stomach remnant after PPG was less abnormal than after DG. In conclusion, PPG is a more physiological operation than conventional DG and should be applied in carefully selected cases of early gastric cancer.
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Affiliation(s)
- H Isozaki
- Department of Surgery, Osaka Medical College, Japan
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Isozaki H, Okajima K, Momura E, Ichinona T, Fujii K, Izumi N, Takeda Y. Postoperative evaluation of pylorus-preserving gastrectomy for early gastric cancer. Br J Surg 1996. [PMID: 8689185 DOI: 10.1046/j.1365-2168.1996.02093.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Physical results after pylorus-preserving gastrectomy (PPG) with preservation of the vagus nerve were evaluated. The status of 15 patients with early gastric cancer after PPG was compared with that of 14 patients after distal gastrectomy (DG). The postoperative/preoperative body-weight ratio of the PPG group (0.99) was significantly greater than that of the DG group (0.92). Patients who had PPG had fewer postoperative abdominal symptoms than those who underwent DG. The gastric emptying pattern of patients who had a pylorus-preserving procedure was slower than that of those who had conventional gastrectomy, and more similar to the preoperative pattern. Contraction of the gallbladder after PPG was better than after DG. Gastroscopy revealed that the mucosa of the stomach remnant after PPG was less abnormal than after DG. In conclusion, PPG is a more physiological operation than conventional DG and should be applied in carefully selected cases of early gastric cancer.
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Affiliation(s)
- H Isozaki
- Department of Surgery, Osaka Medical College, Japan
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