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NCI CANCERLIT® Search: Therapy of Gastric Cancer - August 2002
National Cancer Institute®
Ultima Vez Modificado: 1 de agosto del 2002
- Effect of preoperative regional artery chemotherapy on proliferation and apoptosis of gastric carcinoma cells.
- Circulating levels of interleukin-10 and interleukin-6 in gastric and colon cancer patients before and after surgery: relationship with
- Phase I-II study of irinotecan combined with mitomycin-C in patients with advanced gastric cancer.
- [Clinical study of individual TS-1 therapy for inoperable gastric cancer]
- [A novel combined chemotherapy using TS-1 and low-dose cisplatin against liver metastasis of gastric cancer]
- Surgery for gastric cancer: 10-year experience worldwide.
- Adjuvant chemotherapy for gastric cancer: a comprehensive review.
- Phase II study of sequential high-dose methotrexate and fluorouracil combined with doxorubicin as a neoadjuvant chemotherapy for scirrhous
- Combined resection of invaded organs in patients with T4 gastric carcinoma.
- Sequential methotrexate and 5-fluorouracil therapy for gastric cancer patients with peritoneal dissemination: a retrospective study.
- Quality of life in patients with cancers of the upper gastrointestinal tract.
- Retinoic acid receptor beta is required for anti-activator protein-1 activity by retinoic acid in gastric cancer cells.
- Radical resection of gastric carcinoma with pancreas and spleen preservation and functional cleaning of lymph nodes.
- Should gastric cancer patients more than 80 years of age undergo surgery? Comparison with patients not treated surgically concerning
- Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy.
- [Endoscopic gastric polypectomy--personal experience]
- Hospital volume and post-operative mortality after resection for gastric cancer.
- Lymphadenectomy in gastric cancer: prognostic role and therapeutic implications.
- Surgical therapy for loco-regional recurrence and distant metastasis of gastric cancer.
- Helicobacter pylori eradication therapy in primary high-grade gastric MALT lymphoma.
- Concentrated preoperative radiotherapy for resectable gastric cancer: 20-years follow-up of a randomized trial.
- Adjuvant chemotherapy in gastric cancer: 5-year results of a randomised study by the Italian Trials in Medical Oncology (ITMO) Group.
- [Total gastrectomy for gastric cancer in patients over 70 years old]
- Cohort study in South and West England of the influence of specialization on the management and outcome of patients with
- [Stomach carcinoma as a surgical emergency]
- The contribution of laparoscopy to the treatment of gastric cancer.
- Apoptosis and apoptosis-associated gene products related to the response to neoadjuvant chemotherapy for gastric cancer.
- Higher morbidity and mortality after combined total gastrectomy and pancreaticosplenectomy for gastric cancer.
Table of Contents
1
UI - 12046068
AU - Tao HQ; Zou SC
TI -
Effect of preoperative regional artery chemotherapy on proliferation and
apoptosis of gastric carcinoma cells.
SO - World J Gastroenterol 2002 Jun;8(3):451-4
AD - Department of Surgery, Zhejiang Provincial People's Hospital, Hangzhou
310014, Zhejiang Province, China. houquantao@yahoo.com
AIM: To study the effects of preoperative regional artery chemotherapy
(PRACT) in inducing growth inhibition and apoptosis of gastric carcinoma
(GC) cells. METHODS: TUNEL (terminal-deoxynucleotidyl-transferase
TdT-mediated dUTP-fluorescein and labeling) method and
immunohistochemical techniques were used to detect the state of
apoptosis and proliferation of GC cells in histopathologic sections. A
total of 110 cases of GC and 68 cases of metastatic lymph node with or
without PRACT were adopted. Correlations between apoptosis index (AI),
proliferation index (PI) and PRACT and prognosis were analysed. RESULTS:
The apoptosis index (AI) was significantly higher in the PRACT group
(12.5 +/-4.33 ) than in the untreated group (7.1 +/-3.43 , P<0.001),
whereas the proliferation index (PI) in the PRACT group (33.8%+/-8.8%)
was significantly lower than that in untreated group (43.6%+/-12.8%,
P<0.01). Both AI and PI were correlated to the differentiation degree of
GC in PRACT group, the AI in the differentiated group was higher than
that in undifferentiated group (P<0.001), but the PI was lower in the
differentiated group than that of the undifferentiated group (P<0.01).
The AI of GC cells in metastatic lymph node was also significantly
higher in the PRACT group (7.9 +/-3.41 ) than in the untreated group
(3.6 +/-2.93 , P<0.01), though the PI of GC cells in metastatic lymph
nodes in the PRACT group (17.2%+/-6.8%) was significantly lower than
that in the untreated group (26.7%+/-9.3%, P<0.01). The severity of
histopathologic changes was significantly higher in the PRACT group than
in the untreated group (P<0.05). In addition, postoperative surveys
demonstrated that the 5-year survival rate of GC patients in the PRACT
group was significantly higher than that of patients in the untreated
group (P<0.01). CONCLUSION: Preoperative regional artery chemotherapy
(PRACT) showed inhibitory action on the growth of GC cells mainly
through inhibiting proliferation and inducing the apoptosis of tumor
cells. PRACT can improve the progno sis of GC patients also.
2
UI - 12034030
AU - Galizia G; Lieto E; De Vita F; Romano C; Orditura M; Castellano P;
TI -
Imperatore V; Infusino S; Catalano G; Pignatelli C
Circulating levels of interleukin-10 and interleukin-6 in gastric and
colon cancer patients before and after surgery: relationship with
radicality and outcome.
SO - J Interferon Cytokine Res 2002 Apr;22(4):473-82
AD - Division of Surgical Oncology, F. Magrassi and A. Lanzara Department of
Clinical and Experimental Medicine, Second University of Naples School
of Medicine, Naples, Italy. gennaro.galizia@unina2.it
Elevated interleukin-10 (IL-10) and IL-6 serum levels in advanced
gastrointestinal cancer patients have been shown previously. To
investigate the behavior and the prognostic role of IL-10 and IL-6 serum
levels in gastric and colon cancer patients undergoing surgery, we
studied the relationship between these cytokine levels and surgical
radicality and outcome. Seventy-eight patients with gastric or colon
cancer were admitted to the study, and 50 underwent radical surgery.
Cytokine serum levels were measured by ELISA the day before surgery and
16 days after surgery. Circulating levels of IL-10 and IL-6 were found
to be higher in cancer patients than in controls. Both IL-10 and IL-6
serum levels were demonstrated to be able to predict likelihood to
perform radical surgery. IL-10 serum levels returned to normal in all
but 8 radically resected patients. These 8 patients had tumor
recurrence. In contrast, IL-6 serum levels were shown to significantly
decrease in all patients but not to normalize regardless of the
radicality of the operation. On multivariate analysis, basal IL-10 serum
levels were found to be among the variables significantly affecting the
disease-free survival rate. Stepwise regression selected tumor stage,
number of metastatic resected nodes, and basal IL-10 serum level as the
best combination of variables for prediction of likelihood of tumor
recurrence. Preoperative IL-10 serum levels may be a useful marker to
predict likelihood of performing radical surgery. Abnormally high
postoperative IL-10 values negatively affected disease-free survival and
tumor recurrence. IL-6 serum levels were found to have a more limited
prognostic role.
3
UI - 11843251
AU - Yamao T; Shirao K; Matsumura Y; Muro K; Yamada Y; Goto M; Chin K;
TI -
Shimada Y
Phase I-II study of irinotecan combined with mitomycin-C in patients
with advanced gastric cancer.
SO - Ann Oncol 2001 Dec;12(12):1729-35
AD - Department of Internal Medicine, Cancer Institute Hospital, Tokyo,
National Cancer Center Hospital, Tokyo, Japan. tyamao-gi@umin.ac.jp
BACKGROUND: Irinotecan (CPT-11) shows synergism with mitomycin-C (MMC)
in a preclinical setting. The goals of this study were to determine the
maximum tolerated dose (MTD), the dose limiting toxicity, the
recommended dose (RD), and preliminary anti-tumor activity in a combined
CPT-11 and MMC treatment of advanced gastric cancer. PATIENTS AND
METHODS: The study was designed to evaluate escalated doses of CPT-11
and MMC administered every two weeks. Five escalating dose levels were
studied (CPT-11/ MMC: 100/5; 125/5; 150/5; 150/7; 150/10 mg/m2).
RESULTS: Thirty-one patients were enrolled. Thirty patients were
assessable for toxicity and tumor response for 89 treatment cycles. The
median age was 60 years (32-73 years), and most patients (90%) had a
performance status of 0 to 1. Fourteen patients were previously treated
and 17 were chemotherapynaive. The MTD was CPT-11 150 mg/m2 plus MMC 10
mg/m2, in which all three patients experienced grade 4 neutropenia.
including one episode of prolonged and one of febrile neutropenia, and
one patient experienced grade 3 diarrhea during the first cycle. Fifteen
partial responses were observed. CONCLUSIONS: The RD based on this phase
I-II study was CPT-11 150 mg/m2 plus MMC 5 mg/m2 administered every two
weeks. This combination demonstrates promising activity against advanced
gastric cancer and warrants further investigation in another phase II
study.
4
UI - 12145996
AU - Kubo S; Misawa T; Yoshida K; Nasu T; Ihara Y; Chinen T; Harada N; Nawada
TI -
H
[Clinical study of individual TS-1 therapy for inoperable gastric
cancer]
SO - Gan To Kagaku Ryoho 2002 Jul;29(7):1161-5
AD - Dept. of Gastroenterology, Kitakyushu Municipal Medical Center.
TS-1 is a novel oral anticancer drug that is a formation of 5-FU. It
consists of tegafur, CDHP (which inhibits 5-FU degradation enzyme), and
Oxo (which reduces gastrointestinal toxicities) for an increased
anticancer effect. We applied individual TS-1 therapy in 22 cases (cs)
of inoperable gastric cancer and studied the clinical and adverse
effects. Patients were treated with daily oral administration of 80-100
mg TS-1 for 4 weeks, followed by a rest for 1 or 2 weeks. The response
rate was found to be 27.3% (6/22) (PR: 6 cs, NC: 4 cs, PD: 10 cs, NE: 2
cs). Overall, the median survival time was 8.2 months and the one-year
survival rate was 23.6%. By location, the response rate of the primary
lesion was 27.3% (6/22), abdominal lymph node metastasis 18.8% (3/16),
and liver metastasis 33.3% (4/12). There was no significant difference
in the response rate by tissue type. A comparison by whether or not
patients had undergone previous chemotherapy revealed a response rate of
37.5% (6/16) in patients who had undergone previous chemotherapy, and 0%
(0/6) in those who had not. The prevalence of adverse effects was 68.2%
(15/22), with the main adverse effects being myelosuppression,
pigmentation and appetite loss. However, adverse effects with a grade of
more than 3 occurred in only one case of neutropenia. We could observe
the course of all patients on an outpatient basis.
5
UI - 12146007
AU - Saikawa Y; Kanai T; Kawano Y; Otani Y; Kubota T; Kitajima M
TI -
[A novel combined chemotherapy using TS-1 and low-dose cisplatin against
liver metastasis of gastric cancer]
SO - Gan To Kagaku Ryoho 2002 Jul;29(7):1241-5
AD - Dept. of Surgery, Hiratsuka City Hospital.
We used a novel combination chemotherapy of TS-1 and low-dose cisplatin
(CDDP) with 4 gastric cancer patients with liver metastases (one far
advanced and 3 recurrent patients). TS-1 was administered at 80 mg-120
mg/body/day, twice daily for 3 weeks followed by a 2-week interval as
one cycle, and CDDP was administered at 6 mg/m2/day div, for 5 days
followed by a 2-day interval (1 cycle for an inpatient) or at 6
mg/m2/day div, at 5 times for 2-3 weeks (1 cycle for an outpatient).
Efficacy and toxicity were evaluated after 3-6 cycles of the regimen, as
long as the patients tolerated the regimen without severe side effects.
This regimen resulted in 1 complete response, 2 partial responses and 1
progressive disease, showing a 75% efficacy rate. One patient
experienced grade 2 nausea from this regimen, which was ameliorated by
means of prolonging the interval of CDDP-administration. Thus, the
regimen is useful to maintain patients' quality of life without severe
adverse effects, and has a high efficacy in gastric cancer patients with
liver metastases.
6
UI - 11846059
AU - Adachi Y; Kitano S; Sugimachi K
TI -
Surgery for gastric cancer: 10-year experience worldwide.
SO - Gastric Cancer 2001;4(4):166-74
AD - First Department of Surgery, Oita Medical University, Japan.
To demonstrate recent experience of gastric cancer surgery worldwide and
to evaluate modern strategies for the treatment of gastric cancer, we
investigated the English-language literature of the past 10 years, based
on papers published in well-known medical journals. In many countries,
the increased detection of early gastric cancer, advanced operative
procedures, and careful postoperative management have improved the
surgical results of gastric cancer over the years. Although randomized
controlled trials in Europe showed no survival benefit of D2 resection
over D1 resection, the results must be interpreted with caution and
cannot be extrapolated to Japanese patients, because the morbidity and
mortality after D2 gastrectomy in Japan are much less than those after
D1 gastrectomy in Europe. Recently, less invasive treatments, including
endoscopic mucosal resection and laparoscopic gastrectomy, have become
feasible for patients with early gastric cancer, but their risks and
benefits compared with traditional gastrectomy are unclear.
7
UI - 11846060
AU - Maehara Y; Baba H; Sugimachi K
TI -
Adjuvant chemotherapy for gastric cancer: a comprehensive review.
SO - Gastric Cancer 2001;4(4):175-84
AD - Department of Surgery and Science, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan.
The role of adjuvant chemotherapy in gastric cancer has been studied
extensively over the past three decades in an attempt to further improve
the prognosis of patients with gastric cancer who have undergone
curative surgery. To date, no definitive conclusions have been drawn
from randomized clinical trials of adjuvant chemotherapy for gastric
cancer, because few studies have shown a significant positive impact on
survival as compared with surgery alone. The negative results of most
previous clinical studies do not necessarily mean that the adjuvant
chemotherapy approach to treatment of gastric cancer does not work.
Recent published reports of meta-analyses concerning adjuvant
chemotherapy of gastric cancer revealed small but clear survival
advantages for adjuvant therapy over surgery alone. The positive data
from meta-analyses suggests that there are potential survival advantages
of adjuvant chemotherapy, but this must be proven in the future by
well-designed clinical trials that compare adjuvant chemotherapy with
surgery alone, in which sufficient numbers of patients are enrolled and
effective chemotherapeutic regimens with appropriate dose intensity are
employed. Newly developed anticancer agents and/or newer therapeutic
combinations or strategies (neoadjuvant chemotherapy, chemoradiotherapy,
intraperitoneal chemotherapy) have the potential to benefit high-risk
patients.
8
UI - 11846062
AU - Takahashi S; Kinoshita T; Konishi M; Nakagouri T; Inoue K; Ono M;
TI -
Sugitou M; Ohtsu A; Boku N; Yoshida S
Phase II study of sequential high-dose methotrexate and fluorouracil
combined with doxorubicin as a neoadjuvant chemotherapy for scirrhous
gastric cancer.
SO - Gastric Cancer 2001;4(4):192-7
AD - Department of Surgery, National Cancer Center Hospital East, Kashiwa,
Chiba, Japan.
BACKGROUND: The prognosis of scirrhous gastric cancer remains poor when
it is treated with surgical resection alone or chemotherapy alone. A
phase II study of sequential high-dose methotrexate and fluorouracil,
combined with doxorubicin, as a neoadjuvant chemotherapy was conducted
in an attempt to evaluate the efficacy of this regimen in improving the
survival of patients with scirrhous gastric cancer. METHODS: Patients
were eligible if they had potentially resectable scirrhous gastric
cancer with adequate organ functions and no prior treatment. The
treatment schedule consisted of methotrexate (1 g/m2, day 1)
fluorouracil (1.5 g/m2, day 1), leucovorin (15 mg/m2, days 2-4), and
doxorubicin (30 mg/m2, day 15), repeated at a 28-day interval, and
followed by radical surgery. RESULTS: A total of 20 eligible patients
were registered. Objective responses in the neoadjuvant chemotherapy
segment were observed in 3 of the 20 (15%) patients. No complete
remission was observed. The neoadjuvant chemotherapy was associated with
grade 3 or 4 neutropenia in 14 of the 20 (70%) patients. The median time
from the initial therapy to the operative day was 82 days. Thirteen of
the 20 (65%) patients underwent curative resection. No treatment-related
deaths occurred. However, the 2-year survival rate in this treatment
program (25%) did not show any superiority over that in historical
controls. CONCLUSIONS: Sequential high-dose methotrexate and
fluorouracil, combined, with doxorubicin, as a neoadjuvant chemotherapy
for scirrhous gastric cancer did not improve the survival rate in spite
of improving the curative resection rate.
9
UI - 11846064
AU - Saito H; Tsujitani S; Maeda Y; Fukuda K; Yamaguchi K; Ikeguchi M; Maeta
TI -
M; Kaibara N
Combined resection of invaded organs in patients with T4 gastric
carcinoma.
SO - Gastric Cancer 2001;4(4):206-11
AD - First Department of Surgery, Faculty of Medicine, Tottori University,
Yonago, Japan.
BACKGROUND: To understand the efficacy of gastrectomy combined with the
resection of other organs and to refine the indications for this type of
surgery, the records of 156 patients with carcinoma of the stomach
directly invading adjacent organs or structures (T4 gastric carcinoma)
were analyzed retrospectively. METHODS: The patients were divided into
three groups, as follows: in group A, curative resection was performed
by the combined resection of invaded organs or structures; in group B,
although combined resection was performed, curative resection could not
be performed because of the extent of lymph node metastasis, liver
metastasis, and/or peritoneal metastasis; in group C, combined resection
was not performed. RESULTS: In patients with peritoneal or liver
metastasis, there was no significant difference in prognosis among the
three groups. In patients without peritoneal and liver metastasis, the
prognosis of group A was significantly better than that of group B or
group C, irrespective of the extent of lymph node metastasis or the
number of invaded organs. In these group A patients, the 5-year survival
rates of those with localized tumors and no lymph node metastasis, those
with localized tumors and lymph node metastasis, those with infiltrating
tumors and no lymph node metastasis, and those with infiltrating tumors
and lymph node metastasis were 100%, 56.2%, 57.1%, and 13.6%,
respectively. CONCLUSIONS: Combined resection of involved organs should
be carried out with curative intent in patients with localized gastric
cancer or infiltrating gastric cancer without lymph node metastasis.
10
UI - 11846065
AU - Tahara M; Ohtsu A; Boku N; Nagashima F; Muto M; Sano Y; Yoshida M; Mera
TI -
K; Hironaka S; Tajiri H; Yoshida S
Sequential methotrexate and 5-fluorouracil therapy for gastric cancer
patients with peritoneal dissemination: a retrospective study.
SO - Gastric Cancer 2001;4(4):212-8
AD - Division of Digestive Endoscopy and Gastrointestinal Oncology, National
Cancer Center Hospital East, Kashiwa, Chiba, Japan.
BACKGROUND: Most gastric cancer patients with peritoneal dissemination
have been excluded from clinical studies because they usually have no
measurable lesions. They also have a high risk of toxicity because of
complications such as intestinal obstruction and ascites. We conducted a
retrospective analysis to evaluate the efficacy and feasibility of
sequential methotrexate (MTX) and 5-flurorouracil (5FU) therapy for this
population. METHODS: This analysis was based on 56 consecutive
chemotherapy-naive patients with confirmed peritoneal dissemination of
gastric cancer who were being treated with sequential MTX/5FU. The
therapy comprised a weekly schedule of MTX 100 mg/m2, given as a bolus
infusion 3 h prior to a bolus infusion of 5FU 600 mg/m2. Leucovorin
10mg/m2 was administered six times, every 6h, starting 24h after MTX
administration. RESULTS: Evidence of peritoneal dissemination was
confirmed by laparotomy in 16 patients, by cytologic examination of
ascites in 11 patients, and by clinical imaging in 29 patients (15 with
ascites, 13 with intestinal obstruction; in 10 of the 29 patients,
detection was by barium enema or computed tomography [CT] scan).
Neutropenia of grade 3 or worse and anemia were observed in 8 (14%) and
10 (18%) of the 56 patients, respectively. There was one
treatment-related death due to neutropenic sepsis. Of the 26 patients
with measurable lesions, 9 showed a response (36%). The median survival
time and median time to treatment failure were 259 days and 167 days,
respectively. Objective improvement of ascites was seen in 13 of 26
patients (50%), including 5 with showed complete disappearance of
ascites. Seven of the 15 patients (47%) with intestinal obstruction
showed resolution, and 8 of the 21 patients (38%) who needed nutritional
support before the treatment were free of that support for a median
duration of 220 days after the completion of the treatment. Forty-seven
of the 56 patients (84%) could be treated at outpatient clinics.
CONCLUSIONS: This regimen may be of clinical benefit for patients with
peritoneal dissemination of gastric cancer.
11
UI - 12113032
AU - Blazeby JM; Vickery CW
TI -
Quality of life in patients with cancers of the upper gastrointestinal
tract.
SO - Expert Rev Anticancer Ther 2001 Aug;1(2):269-76
AD - University Division of Surgery, Bristol Royal Infirmary, Bristol, BS2
8HW, UK. jmblazeby@hotmail.com
Accurate assessment of health-related quality of life in patients with
upper gastrointestinal cancers is essential to help determine treatment
strategies. Questionnaires may be used to screen for physical and
psychosocial morbidity, to evaluate new therapies and there is
accumulating evidence to suggest that quality of life scores have
prognostic value. There are well validated generic measures of quality
of life suitable to use in patients with cancers of the upper
gastrointestinal tract, but only two systems (EORTC QLQ-C30 and the
FACT-G) have site-specific modules that have been constructed for this
patient group. The future use of computer-assisted techniques to
collect, analyze and interpret quality of life data will enable the
implementation of quality of life results in clinical practice.
12
UI - 12123542
AU - Wu Q; Zhang M; Liu S; Chen Y; Su W
TI -
Retinoic acid receptor beta is required for anti-activator protein-1
activity by retinoic acid in gastric cancer cells.
SO - Chin Med J (Engl) 2002 Jun;115(6):810-4
AD - Key Laboratory of the Ministry of Education for Cell Biology and Tumor
Cell Engineering, the School of Life Sciences, Xiamen University, China.
xgwu@xmu.edu.cn
OBJECTIVE: To investigate the role of retinoic acid receptor beta
(RARbeta) in mediating inhibitory effect of all-trans retinoic acid
(ATRA) on activator protein-1 (AP-1) activity in gastric cancer cells.
METHODS: Transient transfection and chloramphenicol acetyltransferase
(CAT) assay, Nort hern blot, gene transfection,
3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT)
assay, and anchorage independent growth assay were used. RESULTS:
Transient transfection of RARbeta expression vector into MKN-45 cells
resulted in the RARbeta concentration dependent repression of AP-1
activity induced by 12-o-tetradecanoylphorbol-13-acetate (TPA),
regardless of the presence of ATRA. When the c-jun and c-fos expression
vectors were cotransfected with the RARbeta expression vector into
MKN-45 cells, AP-1 activity was also obviously repressed. The inhibitory
effect, again, was RARbeta-concentration-dependent. The stable
transfection of the RARbeta gene into MKN-45 cells led to cell growth
inhibition and colony formation inhibition by ATRA. Furthermore,
Cotransfection of both RARbeta/DNA binding domain (DBD) and reporter
gene could not alter AP-1 activity, even in the presence of
ATRA.However, when the cotransfection was substituted with the
RARbeta/ligand binding domain (LBD), the inhibition was significantly
enhanced by ATRA. CONCLUSION: RARbeta might be required for anti-AP-1
activity, and contribute to growth inhibition of gastric cancer cells by
ATRA.
13
UI - 12133545
AU - Qin H; Lin C
TI -
Radical resection of gastric carcinoma with pancreas and spleen
preservation and functional cleaning of lymph nodes.
SO - Chin Med J (Engl) 2002 May;115(5):736-9
AD - Department of Surgery, Shanghai Sixth People's Hospital, Shanghai
200233, China.
OBJECTIVE: To study the clinical value of radical resection of gastric
carcinoma with pancreas and spleen preservation (PSP) and functional
cleaning of lymph nodes (LNs) of the spleen hillus and along the splenic
artery. METHODS: Pancreas and spleen involvement was retrospectively
reviewed among 439 cases of resectable carcinoma of the gastric cardia,
gastric corpus and total stomach. During gastric surgery, 2 ml of
methylene blue was injected into the subserosal space of the gastric
cardia or corpus to observe the spread of lymphatic flow in 54 cases of
gastric carcinoma. The metastatic rate of LNs in splenic hillus and
along the trunk of the splenic artery (No10, No11), postoperative
complications and survival rates were investigated in 63 gastric
carcinoma patients that had received gastrectomy with pancreas and
spleen preservation (PSP). These were compared with the pancreas
preservation (PP) group and pancreas and spleen combined resection (PSR)
group. RESULTS: Among these 439 cases, only 25 cases were observed with
direct invasion to the pancreas (5.7%), and 10 cases with direct
invasion to the spleen (2.3%). After pathological examination of the
pancreatic body and tail, we found 22 cases with pancreas and spleen
combined resection, 4 cases (18.2%, 4/22) with direct invasion of the
capsule and 2 with invasion to the superficial parenchyma (9.1%, 2/22),
without metastasis to the lymph nodes within the pancreas and spleen.
The metastatic rate of No10, No11 lymph nodes were 17.5% (11/63) and
19.1% (12/63) in the PSP group, 20.8% (45/216) and 25% (54/216) in the
PP group, and 20% (6/30) and 23.3% (7/30) in the PSR group. There were
no statistically significant differences (P > 0.05). Injection of
methylene blue into the subserosal space of the stomach did not diffuse
into the spleen or pancreatic parenchyma. Postoperative complications,
diabetes and mortality in PSP (0%, 0%, 0%) were lower than in PP (4.2%,
0.9%, 0.9%) or PSR (40%, 10%, 3.3%). The 5-year survival rate (5-YSR)
and 10-YSR in PSP (57.5%, 52.0%) were higher than in PSR (37.5%, 30.0%).
Those patients with stage II and III(a) treated by PSP, improved
markedly. CONCLUSIONS: The surgical procedure of pancreas and spleen
preservation for gastric cancer is a safe and organ function protected
method. Postoperative complications were lower and survival rates were
higher, the radicality was not reduced. These results indicate that PSP
is preferred in patients with gastric carcinoma of stage II or III(a).
14
UI - 12080223
AU - Matsushita I; Hanai H; Kajimura M; Tamakoshi K; Nakajima T; Matsubayashi
TI -
Y; Kanek E
Should gastric cancer patients more than 80 years of age undergo
surgery? Comparison with patients not treated surgically concerning
prognosis and quality of life.
SO - J Clin Gastroenterol 2002 Jul;35(1):29-34
AD - First Department of Medicine, Hamamatsu University School of Medicine,
Shizuoka, Japan. matsushi@mail.wbs.ne.jp
This study investigated the performance status, mental status, and
prognosis of 24 patients older than 80 years whose gastric cancer had
been managed surgically during the past 6 years, and 21 patients who
were observed conservatively. The advantages and disadvantages of
surgery for elderly patients with gastric cancer is discussed. The
3-year survival rate for patients with advanced gastric cancer was 31%
for those surgically treated and 0% for those observed conservatively.
The difference is statistically significant. The survival rate for
patients with early gastric cancer was 62.5% in the surgical treatment
group and 33.3% in the conservative observation group, a difference that
is not significant. Decline in performance status and deterioration of
mental status after open surgery were slight, and the survival rate for
patients treated surgically was significantly higher than for
conservatively observed patients, regardless of performance status and
whether mental status had deteriorated. On univariate and multivariate
analyses, the presence or absence of open surgery and macroscopic
classification were the only significant prognostic factors, whereas
performance status and the presence or absence of mental deterioration
were not significant prognostic factors. These results suggest that
surgical treatment should not be discouraged even for patients older
than 80 years.
15
UI - 12135722
AU - Matsui H; Uyama I; Sugioka A; Fujita J; Komori Y; Ochiai M; Hasumi A
TI -
Linear stapling forms improved anastomoses during esophagojejunostomy
after a total gastrectomy.
SO - Am J Surg 2002 Jul;184(1):58-60
AD - Department of Surgery, Fujita Health University School of Medicine, 1-98
Dengakugakubo, Kutsukakecho, Toyoake, Aichi 470-1192, Japan.
maheday@aol.com
BACKGROUND: Circular stapling devices are commonly used to form
esophagojejunal anastomoses after total gastrectomy. However, the
technique has potential problems with placement of the purse-string
suture and insertion of the anvil of the instrument. METHODS: We
describe an improved technique for esophagojejunostomy by functional
end-to-end anastomosis with linear stapling devices. RESULTS: Three
patients with gastric cancer underwent this procedure after total
gastrectomy. No anastomotic leakage or clinical evidence of stenosis was
encountered. The maximum diameters of the anastomoses, evaluated by
radiography with barium at 6 months after surgery, were 3.5 cm and 4.0
cm in 2 patients. Endoscopic examination revealed clear lines of
anastomosis with a straight continuity between the distal esophagus and
the jejunum. CONCLUSIONS: Our improved technique for esophagojejunostomy
by functional end-to-end anastomosis with two linear staplers is a
convenient, safe and reliable procedure that is independent of the width
of the esophagus and the depth of the esophageal hiatus.
16
UI - 12149880
AU - Hnizdil L; Piskac P; Dvorak M
TI -
[Endoscopic gastric polypectomy--personal experience]
SO - Rozhl Chir 2002 Jun;81(6):324-6
AD - II. chirurgicka klinika FN u sv. Anny, Brno.
gastrofibroscopic examinations were performed in our department. Gastric
polyps were found in 28 patients--in 15 men and 13 women. Polypoid
foveolar hyperplasia was present in 67.8% patients, hyperplasiogenic
polyps in 21.5%, and adenomatous polyps in 10.7% of patients. Multiple
gastric polyposis was found in 3 patients: in two of them all polyps
were removed and one patient has regular gastrofibroscopic checkups. We
did not encounter complications after endoscopic polypectomy of the
stomach in our study group. Polypectomy via gastrotomy was not performed
in any of our patients.
17
UI - 12099650
AU - Damhuis RA; Meurs CJ; Dijkhuis CM; Stassen LP; Wiggers T
TI -
Hospital volume and post-operative mortality after resection for gastric
cancer.
SO - Eur J Surg Oncol 2002 Jun;28(4):401-5
AD - Department of Cancer Registry and Research, Comprehensive Cancer Centre,
Rotterdam, The Netherlands. canreg@ikr.nl
AIMS: In low-volume hospitals, expertise in gastric surgery is difficult
to maintain because of the decreasing incidence of gastric cancer and
the fall of surgery for ulcer disease. We evaluated the prognostic
impact of hospital volume on post-operative mortality (POM) in a
consecutive series of 1978 patients. METHODS: Information on patients
undergoing resection for gastric cancer in the period 1987-97 was
retrieved from the Rotterdam Cancer Registry. The relationship between
hospital volume and POM was analysed by logistic regression, adjusting
for other prognostic factors. RESULTS: POM was 7.9% on average but
varied between the 22 hospitals from 3.1% to 15.1% (P=0.15). Hospital
volume had no prognostic influence (P=0.74). Prognostic factors were age
(70-79 years odds ratio (OR)=3.8, 80+ years OR=6.0), sex (male OR=1.7),
stage (IV OR=1.8) and (partial) gastrectomy for cardia cancers (OR=2.0).
CONCLUSION: Variation in POM between hospitals was large but not related
to hospital volume. For cardia cancer, POM rates were lower after
oesophagogastrectomy.
18
UI - 12099651
AU - Marubini E; Bozzetti F; Miceli R; Bonfanti G; Gennari L;
TI -
Gastrointestinal Tumor Study Group
Lymphadenectomy in gastric cancer: prognostic role and therapeutic
implications.
SO - Eur J Surg Oncol 2002 Jun;28(4):406-12
AD - Institute of Medical Statistics and Biometry, University of Milan, Via
G. Venezian 1, 20133 Milan, Italy.
AIMS: Surgeons involved in the treatment of gastric cancer are
interested in the extent of lymphadenectomy as the latter may not only
influence the reliability of the tumour, node and metastasis
classification but also be relevant for the long-term oncological
outcome. The purpose of the study was to evaluate the prognostic role of
the number of resected lymph nodes (as an indicator of the scope of
lymphadenectomy) and of the number of metastatic lymph nodes on the
long-term mortality for all causes and to provide clinicians with
estimates of predictive survival probabilities. METHODS: The study
involved 615 cancer patients subjected to a curative (R0) subtotal or
total gastrectomy in a randomized Italian trial. According to the trial
protocol, a D2 lymphadenectomy had been advised. The number of resected
and metastatic lymph nodes was analysed as a continuous variable in
multiple Cox models. RESULTS: There was no difference in operative
mortality (about 1.8%) according to the number of lymph nodes in the
specimen (< or =15, 16-25, >25). The risk of long-term death for all
causes tended to decrease with increasing number of resected lymph nodes
up to about 25, and then could be considered stable for wider
lymphadenectomies. An increasing risk of death for all causes was
associated with an increasing number of metastatic lymph nodes; the risk
could be considered stable for more than 20 metastatic lymph nodes.
CONCLUSIONS: A lymphadenectomy including more than 25 lymph nodes is
suggested, provided that there is a low risk of operative mortality.
19
UI - 12099659
AU - Lehnert T; Rudek B; Buhl K; Golling M
TI -
Surgical therapy for loco-regional recurrence and distant metastasis of
gastric cancer.
SO - Eur J Surg Oncol 2002 Jun;28(4):455-61
AD - Division of Surgical Oncology, Department of Surgery, University of
Heidelberg, Im Neuenheimer Feld 110, Heidelberg, D-69120, Germany.
thomas_lehnert@med.uni-heidelberg.de
The appearence of distant metastases or local recurrence is assumed to
render gastric cancer incurable. However, experience with colorectal
cancer has shown that patients with recurrent disease may have a chance
for cure, if recurrent or metastatic disease can be completely resected.
Since improved imaging allows detection of ever smaller tumour deposits,
we have reviewed the pertinent literature to determine the current
surgical options for recurrent or metastatic gastric cancer. Metastatic
disease or local recurrence is rarely resectable. Tumour recurrence in
the remnant stomach after partial gastrectomy can be treated by
secondary total gastrectomy and may occasionally result in long-term
survival. Other types of local recurrence are generally not amenable to
complete resection. The same is true for distant metastases. If,
however, distant metasases are technically resectable, 5 year survival
of approximately 20% has been documented. Solitary and late appearing
metachronous tumours are associated with an improved prognosis. As a
consequence resection of distant metastases should be considered,
because the risk of metastasectomy is generally low and there is no
alternative treatment with a chance for cure. Copyright 2002 Elsevier
Science Ltd. All rights reserved.
20
UI - 12105882
AU - Fischbach W
TI -
Helicobacter pylori eradication therapy in primary high-grade gastric
MALT lymphoma.
SO - Gastroenterology 2002 Jul;123(1):393
21
UI - 12173383
AU - Skoropad V; Berdov B; Zagrebin V
TI -
Concentrated preoperative radiotherapy for resectable gastric cancer:
20-years follow-up of a randomized trial.
SO - J Surg Oncol 2002 Jun;80(2):72-8
AD - Department of Surgical and Combined Treatment of Abdominal Tumors,
Medical Radiological Research Center of Russian Academy of Medical
Sciences (MRRC RAMS), Obninsk, Russia.
BACKGROUND AND OBJECTIVES: The role of radiation therapy in resectable
gastric cancer is questionable. To study the value of concentrated
preoperative radiotherapy, a randomized clinical trial had been carried
out. METHODS: From 1974 to 1978, 152 patients were randomized and
underwent exploratory laparotomy; in 50 patients curative surgery was
not possible, while 102 patients satisfied protocol requirements and
entered in the trial. Patients in the experimental group were treated
with preoperative radiotherapy (20 Gy/5 days) and subtotal or total
gastrectomy. Patients in the control group underwent surgery alone.
RESULTS: Study showed acceptable tolerance of radiotherapy regime with
no increase of postoperative mortality and morbidity. There was no
significant difference in survival between the two treatment groups (chi
2 = 0.349, df = 1, P = 0.555). Subset analysis also failed to
demonstrate significant survival advantages of the combined treatment;
however, some positive trends were seen in patients with locally
advanced gastric cancer. CONCLUSIONS: Concentrated preoperative
radiotherapy in the dose of 20 Gy is safe and feasible, but seems to be
insufficient to improve survival in gastric cancer patients. However,
the results are promising in selected subgroups of patients, which
encourages future trials with adjuvant radiation therapy.
22
UI - 11886009
AU - Bajetta E; Buzzoni R; Mariani L; Beretta E; Bozzetti F; Bordogna G;
TI -
Aitini E; Fava S; Schieppati G; Pinotti G; Visini M; Ianniello G; Di BM
Adjuvant chemotherapy in gastric cancer: 5-year results of a randomised
study by the Italian Trials in Medical Oncology (ITMO) Group.
SO - Ann Oncol 2002 Feb;13(2):299-307
AD - Medical Oncology Unit B, Istituto Nazionale per lo Studio e la Cura dei
Tumori of Milano, Milan, Italy. bajetta@istitutotumori.mi.it
BACKGROUND: The aim of this study was to determine the efficacy of the
EAP regimen (etoposide, adriamycin and cisplatin) followed by the
Machover schedule (fluorouracil and folinic acid) given as adjuvant
treatment to patients with poor prognostic factors (N+ or T3/4).
PATIENTS AND METHODS: Before randomisation, the subjects were stratified
on the basis of node involvement (N+ or N-) and the time from surgery to
randomisation (< or = 21 days or > 22 days). The surgical procedures for
sub-total or total gastrectomy with D2 dissection were standardised
137 in the control arm. The majority of the patients (90%) were N+.
After a median follow up of 66 months (range 2-83), the 5-year overall
survival (OS) was 52% in the treatment arm and 48% in the control arm
[hazard ratio (HR) 0.93; 95% confidence interval (CI) 0.65-1.34]; the
5-year disease-free survival (DFS) was 49% and 44%, respectively (HR:
0.83; 95% CI 0.59-1.17). Among the patients with N-/N+ (1-6), the 5-year
OS was 61% in the treatment group and 60% in the control group; in those
with N+ (1-6), it was 42% and 22%. The treatment was completed by 87% of
patients. Drug-related grade 3/4 WHO toxicities included leukopenia
(21%), nausea and vomiting (14%), mucositis (9%), neutropenia (3%) and
thrombocytopenia (2%). There were two deaths due to sepsis. CONCLUSIONS:
Although our results are not statistically significant, there was a
limited relative risk reduction in the patients receiving adjuvant
therapy (17% in DFS and 7% in OS). The data suggest that D2 surgery may
have a favourable impact on OS.
23
UI - 11818980
AU - Ruiz E; Quispe D; Celis J; Berrospi F; Payet E
TI -
[Total gastrectomy for gastric cancer in patients over 70 years old]
SO - Rev Gastroenterol Peru 2001 Jul-Sep;21(3):205-11
AD - Departamento de Abdomen, Instituto Enfermedades Neoplasicas, Peru.
OBJECTIVE: To determine if the morbidity and postoperative mortality
after a full gastrectomy for gastric cancer performed on patients of
more than 70 years of age were different from those of younger patients.
MATERIAL AND METHODS: Between 1980 and 1999, a total of 411
gastrectomies for gastric adenocarcinoma were performed at the Institute
of Cancer Diseases (INEN). Of these, 87 were inpatients older than 70
years of age (elderly group) and 92 were inpatients between 50 and 59
years of age (young group). The clinical record of both groups were
studied and the clinical-pathological features, morbidity and
postoperative mortality, staying time in hospital and survival rate were
compared. RESULTS: There was no significant difference between the two
groups regarding clinical-pathological features except in the TNM stage.
In the elderly group 23.0% had stage IV and 43.5% in the young group
(p=0.007). The average operating time in the elderly group was shorter
than in the young group (5.5 hours versus 6.0 hours, p=0.015). The
morbidity for the elderly group was 29.9% and that of the young group
was 34.8%, whereas the postoperative mortality for the elderly and young
groups was 4.6% and 2.2%, respectively. Pneumonia was the most frequent
postoperative complication (14.8%) and the primary cause of
postoperative death in the elderly group. Time in hospital and survival
were similar between both groups. CONCLUSIONS: The morbidity and
postoperative mortality after a full gastrectomy for cancer of the
stomach in the elderly is no different from those found in younger
patients.
24
UI - 12081743
AU - Bachmann MO; Alderson D; Edwards D; Wotton S; Bedford C; Peters TJ;
TI -
Harvey IM
Cohort study in South and West England of the influence of
specialization on the management and outcome of patients with
oesophageal and gastric cancers.
SO - Br J Surg 2002 Jul;89(7):914-22
AD - Medical Research Council Health Services Research Collaboration,
Department of Social Medicine, University of Bristol, Bristol, UK.
gngmomb@med.uovs.ac.za
BACKGROUND: To evaluate specialization in National Health Service (NHS)
cancer care, volume-outcome relationships were examined. METHODS: This
was a cohort study of 1512 patients with oesophageal or gastric cancer
in 23 acute NHS hospitals. Outcomes were survival time and operative (30
day) mortality. Multiple regression analysis was performed, adjusted for
diagnoses, prognoses and treatments. RESULTS: For oesophageal cancer,
the operative mortality rate decreased by 40 per cent (odds ratio 0.60
(95 per cent confidence interval (c.i.) 0.36 to 0.99 per cent); P =
0.047) for each increase of ten patients in doctors' annual surgical
caseloads, and the risk of death decreased by 8 per cent (hazard ratio
0.92 (95 per cent c.i. 0.85 to 0.99); P = 0.021) for each increase of
ten patients in doctors' annual caseloads. For gastric cancer, the
operative mortality rate decreased by 41 per cent (odds ratio 0.59 (95
per cent c.i. 0.32 to 1.07)) for each increase of ten patients in
doctors' annual surgical caseloads, and the risk of death decreased by 7
per cent (hazard ratio 0.93 (95 per cent c.i. 0.89 to 0.98); P = 0.009)
for each increase of ten patients in hospitals' annual caseloads.
Patients of higher-volume doctors were more likely to receive most
investigations and treatments, independently of presenting features.
CONCLUSION: The study supports concentration of services for oesophageal
and gastric cancers. Specialization of doctors and their teams is at
least as important as specialization of hospitals.
25
UI - 12013691
AU - Maurer CA; Lindemann W; Schilling MK
TI -
[Stomach carcinoma as a surgical emergency]
SO - Swiss Surg 2002;8(2):56-60
AD - Abteilung fur Allgemein-, Viszeral- und Gefasschirurgie,
Universitatskliniken des Saarlandes, Homburg/Saar, Deutschland.
Perforated or bleeding gastric cancer is a life threatening situation
that occurs in less than 10% of all patients with gastric cancer in the
Western world. Three quarters of these complicated gastric carcinomas
show advanced stages (UICC stages III and IV). Diagnosis is made
intraoperatively only in the majority of patients. Emergency gastrectomy
is superior to any type of local excision and/or local repair regarding
surgical mortality and long-term survival and should be the intervention
of choice. Stage-related long term survival of patients with emergency
gastrectomy is comparable to that of electively resected patients.
Minimalism and nihilism are therefore not appropriate in the treatment
of complicated gastric cancer and are often deleterious. Subtotal
gastrectomy without D2 lymphadenectomy is regarded as the adeqauate
procedure in most cases.
26
UI - 11972200
AU - Ballesta Lopez C; Ruggiero R; Poves I; Bettonica C; Procaccini E
TI -
The contribution of laparoscopy to the treatment of gastric cancer.
SO - Surg Endosc 2002 Apr;16(4):616-9
AD - Centro Laparoscopico de Barcelona, C. Vilana-Vilana 12, 08022 Barcelona,
Spain.
BACKGROUND: Laparoscopy plays a role in the preoperative diagnosis of
gastric cancer, particularly in determining the location and extent of
the neoplasia. In addition to its use in staging, laparoscopy is
indicated for the gastric resection of T1-T2, and its middle- and
long-term results are comparable to those obtainable with open surgery.
Herein we describe our experience with the laparoscopic resection of
gastric carcinomas, including the dissection of lymph nodes and the
Billroth II reconstruction of digestive continuity with
gastrojejunostomia. METHODS: We carried out laparoscopic gastric
resections in 25 patients with adenocarcinomas. Our method involved
installing five trocars, tying the left and right gastric vessels and
the right gastro-epiploic vessels, sectioning the duodenum 3 cm from the
pylorus, sectioning the remaining portion of the stomach obliquely 3 cm
from the cardias, and performing Billroth II reconstruction. RESULTS:
The average duration of the operation was 4 h 45 min. The average number
of removed lymph nodes was 30.5 (range, 22-41). Five patients were
converted to laparotomy. Significant complications were observed in four
cases (16%). Hospitalization ranged from 5 to 16 days. The average
follow-up was 38 months (range, 7-63), without evidence of relapse.
CONCLUSION: In terms of morbidity, our results were similar to those
obtained with open surgery. Lymphectomy according to the extent and
number of lymph nodes is acceptable in the treatment of tumors of the
lower third of the stomach. More case studies are needed to provide
further indications of the applicability of the technique (which is
currently used only in a few centers) and long-term results.
27
UI - 12011994
AU - Satomi D; Takiguchi N; Koda K; Oda K; Suzuki H; Yasutomi J; Ishikura H;
TI -
Miyazaki M
Apoptosis and apoptosis-associated gene products related to the response
to neoadjuvant chemotherapy for gastric cancer.
SO - Int J Oncol 2002 Jun;20(6):1167-71
AD - First Department of Surgery, Chiba University School of Medicine, 1-8-1
Inohana, Chuo-ku, Chiba-shi 260-8670, Japan. dsk-satomi@umin.ac.jp
To evaluate the effect of neoadjuvant chemotherapy on gastric cancer, we
examined the correlation between induction of apoptosis and expression
of p53, Bcl-2, and Bax. Eighty-five patients with advanced gastric
cancer were retrospectively divided into the following two groups: 54
patients received 5-fluorouracil (5-FU) at 300 mg/body/day for 14 days
and cisplatin (CDDP) at 15 mg/body/day for 2 days as group A; 31
patients without any preoperative chemotherapy as group B. According to
histological changes in tumors due to neoadjuvant chemotherapy, the
therapeutic effects on tumors were evaluated. The apoptotic index (AI)
of group A was significantly higher than that of group B (1.12+/-0.40
vs. 0.67+/-0.24; p<0.01). In group A, the AI of p53-positive cases was
significantly lower than that of negative cases (0.92+/-0.32 vs.
1.39+/-0.32; p<0.01). The AI of histological responders was
significantly higher than that of non-responders (1.34+/-0.35 vs.
1.02+/-0.38; p<0.01). There was no significant correlation between AI
and expression of Bcl-2 or Bax. In group A, histological responders,
Bcl-2 positive, and high AI patients had better prognosis, respectively.
In conclusion, neoadjuvant chemotherapy for gastric cancer enhanced
induction of apoptosis, and AI might be useful to evaluate the effect of
neoadjuvant chemotherapy.
28
UI - 12053218
AU - Lo SS; Wu CW; Shen KH; Hsieh MC; Lui WY
TI -
Higher morbidity and mortality after combined total gastrectomy and
pancreaticosplenectomy for gastric cancer.
SO - World J Surg 2002 Jun;26(6):678-82
AD - Division of General Surgery, Taipei-Veterans General Hospital and
National Yang Ming University, No. 201, Section 2, Shih-pai Road,
Taipei, Taiwan. sslo@vghtpe.gov.tw
Total gastrectomy with pancreaticosplenectomy for gastric cancer has
been proposed for facilitating lymph node dissection or for resection of
direct tumor invasion to the pancreas, especially for T4 lesions. Its
effectiveness in improving patient survival is still controversial, and
higher morbidity and mortality with this procedure have been reported in
several series. Such risks to patient survival were not observed in the
Japanese series. Based on a prospective gastric cancer database
maintained from 1987 to 1999 in our institution, the morbidity and
mortality were analyzed in our series of pancreaticosplenectomies. A
total of 1,278 patients with gastric cancer received gastrectomy in our
surgical unit. Of these, 127 patients underwent curative total
gastrectomy with pancreaticosplenectomy in order to facilitate lymph
node dissection or removal of direct tumor invasion. Operative time,
postoperative hospital stay, postoperative complications, and surgical
mortality were analyzed. Compared to another 201 total gastrectomies,
longer mean operative time (7.91 +/- 2.16 hours vs. 6.67 +/- 2.01, p
<0.001) and postoperative hospital stay (median, 24.5 days vs. 17, p
<0.001)
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