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NCI CANCERLIT^® Search: Therapy of Gastric Cancer - October 2002

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National Cancer Institute^®
Ultima Vez Modificado: 1 de octubre del 2002

Nephrotoxicity of heptaplatin: a randomized comparison with cisplatin in advanced gastric cancer.
Docetaxel 75 mg/m(2) is active and well tolerated in patients with metastatic or recurrent gastric cancer: a phase II trial.
Prevalence of Helicobacter pylori in the residual stomach after gastrectomy for gastric cancer.
Role of surgery in the prophylaxis of hereditary cancer syndromes.
Indications of a minimized scope of lymphadenectomy for submucosal gastric cancer.
Brief review of advances in the treatment of gastric carcinoma in North America and Europe, 1995-2001.
[Chemotherapy of gastric cancer--a review of clinical trials in Japan]
[A pilot study of TS-1 combined with cisplatin in patients with advanced gastric cancer]
[Radiotherapy of MALT-lymphoma of the stomach]
Comparison of gastric cancer surgery with versus without nasogastric decompression.
Patients' experiences of their intake of food and fluid following gastrectomy due to tumor.
Treatment of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type with cladribine: a phase II
[Comment apropos of the article: prognostic value of nutritional parameters in gastrectomy for cancer: a study of 203 cases]
Laparoscopic wedge resection of gastric submucosal tumors.
Helicobacter pylori infection.
Stomach cancer.
CT findings in the abdomen and pelvis after gastric carcinoma resection.
Gastric adenocarcinoma--a perspective from Durban, KwaZulu-Natal.
[Prospects in the treatments of stomach neoplasms]
Total gastrectomy is not always necessary for advanced gastric cancer of the cardia.
Clinical potential of biological response modifiers combined with chemotherapy for gastric cancer. Japanese experience.
Aboral pouch with preserved duodenal passage--new reconstruction method after total gastrectomy.
Results of surgical therapy of adenocarcinomas of the esophagogastric junction according to a standardized surgical resection technique.
Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma.
Relationships between gastric development and anatomic bases of radical surgery for cancer.
Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer.
Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer.
Neoadjuvant chemotherapy followed by salvage surgery: effect on survival of patients with primary noncurative gastric cancer.
[The role of D2 lymphadenectomy in the surgical treatment of gastric carcinoma]
Total antioxidant potential of fruit and vegetables and risk of gastric cancer.
[Lymphadenectomy in gastric carcinoma?]
Determination of coagulation inhibitor levels and resistance to activated protein C in patients undergoing gastric surgery for benign

1
UI - 12172973
AU - Ahn JH; Kang YK; Kim TW; Bahng H; Chang HM; Kang WC; Kim WK; Lee JS;
TI - Park JS Nephrotoxicity of heptaplatin: a randomized comparison with cisplatin in advanced gastric cancer.
SO - Cancer Chemother Pharmacol 2002 Aug;50(2):104-10
AD - Section of Hematology/Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Korea.
PURPOSE: Heptaplatin is a newly developed platinum derivative which has been reported to be less toxic than cisplatin. This study was designed to evaluate the nephrotoxicity of heptaplatin in comparison with that of cisplatin. METHODS: Previously untreated advanced gastric cancer patients with normal renal function were randomly assigned into either group I (heptaplatin 400 mg/m(2) i.v. over 1 h on day 1 plus 5-fluorouracil (5-FU) 1000 mg/m(2) per day continuous i.v. from day 1 to day 5), or group II (cisplatin 60 mg/m(2) i.v. over 1 h on day 1 plus 5-FU 1000 mg/m(2) per day continuous i.v. from day 1 to day 5), with the cycles repeated every 4 weeks. Renal function parameters before, during, and after the chemotherapy were compared between the two groups. RESULTS: A total of 99 patients were enrolled in the study, 51 in group I and 48 in group II. The 24-h proteinuria on day 5 was markedly increased in group I (95+/-108 mg/day to 9098+/-4514 mg/day, means+/-SD) in comparison with the increase observed in group II (104+/-148 mg/day to 151+/-102 mg/day), and creatinine clearance showed a greater decrease in group I (83.1+/-23.6 ml/min to 44.9+/-17.3 ml/min) than in group II (89.6+/-22.1 ml/min to 72.8+/-21.0 ml/min). The differences in these parameters between the two groups were statistically significant throughout the subsequent cycles. CONCLUSIONS: Our findings show that nephrotoxicity was more severe in patients treated with heptaplatin 400 mg/m(2) than with cisplatin 60 mg/m(2) when it was combined with 5-FU. Measures to more effectively prevent nephrotoxicity should be developed for the safe use of heptaplatin.

2
UI - 12324575
AU - Bang YJ; Kang WK; Kang YK; Kim HC; Jacques C; Zuber E; Daglish B;
TI - Boudraa Y; Kim WS; Heo DS; Kim NK Docetaxel 75 mg/m(2) is active and well tolerated in patients with metastatic or recurrent gastric cancer: a phase II trial.
SO - Jpn J Clin Oncol 2002 Jul;32(7):248-54
AD - Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. bangyj@plaza.snu.ac.kr
OBJECTIVE: The aim of the present study was to confirm the efficacy and tolerability of docetaxel 75 mg/m(2) in a population of Korean patients with advanced gastric cancer. METHODS: Patients with metastatic or locally recurrent gastric cancer received docetaxel 75 mg/m(2) by intravenous infusion every 3 weeks. Objective response rate was the primary endpoint. RESULTS: Forty-five patients were enrolled. Most showed adenocarcinomas of the gastric antrum and/or body of the stomach. All showed metastases and two-thirds retained the primary tumour. Forty-four patients received at least one docetaxel infusion ('treated' population), with 40 patients evaluable for response. A total of 159 cycles (median three cycles) were administered, with mean duration of treatment 10.9 weeks. The objective response rate in the treated population was 15.9% (17.5% in the per protocol population), with stable disease in 25.0% of patients and progressive disease in 50.0%. Grade 3-4 neutropenia occurred in 36 (81.8%) patients and 36.1% of cycles. However, febrile neutropenia occurred in only two (4.5%) patients and 1.3% of cycles. Grade 3 anorexia, experienced by two patients (4.5%) and during 1.9% of cycles, was the most frequent non-haematological adverse event possibly or probably related to docetaxel. No grade 4 non-haematological events occurred. CONCLUSION: This study suggests that docetaxel 75 mg/m(2) is active in metastatic or locally recurrent adenocarcinoma with a low incidence of grade 3-4 adverse events. Docetaxel warrants further study in combination regimens for advanced gastric cancer.

4
UI - 12167572
AU - Roukos DH; Kappas AM; Tsianos E
TI - Role of surgery in the prophylaxis of hereditary cancer syndromes.
SO - Ann Surg Oncol 2002 Aug;9(7):607-9

5
UI - 12167575
AU - Shimoyama S; Yasuda H; Mafune K; Kaminishi M
TI - Indications of a minimized scope of lymphadenectomy for submucosal gastric cancer.
SO - Ann Surg Oncol 2002 Aug;9(7):625-31
AD - Department of Gastrointestinal Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. shimoyama-dis@h.u-tokyo.ac.jp
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.

6
UI - 12202975
AU - Hasham-Jiwa N; Kasakura Y; Ajani JA
TI - Brief review of advances in the treatment of gastric carcinoma in North America and Europe, 1995-2001.
SO - Int J Clin Oncol 2002 Aug;7(4):219-24
AD - Department of Gastrointestinal Medical Oncology, Box 426, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
Gastric carcinoma is widespread in many South American and Asian countries but may be especially deadly in the West, due to a lack of programs for early diagnosis. Advanced gastric carcinoma is incurable, and the median survival time of patients with advanced disease is only 6 to 9 months. We sought to examine investigative trends in the utilization of new agents in the treatment of advanced gastric carcinoma in North America and Europe. Representative published reports of phase II and III clinical trials of therapies for gastric carcinoma by PubMed literature database. Fluorouracil, cisplatin, leucovorin, methotrexate, doxorubicin, and mitomycin were considered "conventional" agents; all other drugs were considered "new" agents. Of the 42 reports identified by the literature search, 17 were by investigators in North America and 25 were by investigators in Europe. All reports by investigators in North America were phase II trials, compared with 64% of those studies in Europe; the other studies by European investigators were phase III trials (36%). Chemotherapeutic drugs we considered "new" for the purpose of this study were investigated in 64% of all trials in North America and Europe. Eighty-one percent (22/27) of the 27 trials in which new agents were studied were phase II studies. We conclude that new agents are being widely incorporated in the investigation of advanced gastric cancer in North America and Europe. This trend is likely to be continued as more new chemotherapeutic agents are developed for clinical testing.

7
UI - 12355938
AU - Sato A; Ito T; Tomita T; Nakamura A; Taguchi S
TI - [Chemotherapy of gastric cancer--a review of clinical trials in Japan]
SO - Gan To Kagaku Ryoho 2002 Sep;29(9):1522-31
AD - Department of Internal Medicine, Northern Yokohama Hospital, Showa University, School of Medicine, 35-1 Chigasaki-Chuo, Tsuzuki-ku, Yokohama, Kanagawa 224-8503, Japan.
This review focused on the clinical trials in patients with gastric cancer in Japan. Oral fluoropyrimidines have been extensively used in Japan. Through the decades, these oral fluoropyrimidines have been examined in a variety of combinations. Most of the reports are about randomized phase II trials using overall response rate as a primary endpoint, and are a few phase III trials were conducted. S-1 (TS-1), a novel oral fluoropyrimidine, has demonstrated promising activity in phase II trials. Ongoing phase III trials on S-1 would be defining this as standard chemotherapy for metastatic gastric cancer.

8
UI - 12355943
AU - Iwase H; Shimada M; Nakamura M; Iyo T; Nakarai K; Kaida S; Indo T; Okeya
TI - M; Mizuno T; Ina K; Kusugami K [A pilot study of TS-1 combined with cisplatin in patients with advanced gastric cancer]
SO - Gan To Kagaku Ryoho 2002 Sep;29(9):1575-82
AD - Dept. of Gastroenterology, Nagoya National Hospital.
TS-1 is a novel oral fluoropyrimidine anticancer agent and show synergism with CDDP. The objectives of this study were to determine the clinical toxicities, antitumor effect, survival duration, and a recommended dosage schedule in combination with TS-1 and CDDP. Patients with measurable, locally advanced or metastatic gastric cancer were candidates for the study. Three patients were assigned to one of four levels of treatment, as follows. At first, TS-1 was administered orally twice a day for 14 consecutive days followed by 14 days rest and a 24-h infusion of CDDP (70 mg/m2) was administered on day 8 of 28 every 4 weeks. Next, duration of S1 administration was increased in increments of 25% and in increments of 50%. At last, only the dose of CDDP was increased in increments of 10 mg/m2. The first three patients did not have over grade 3 hematologic and nonhematological toxicity during any course. Grade 4 neutropenia occurred during the second course in two patients consecutively in increments of 50% of TS-1. Neutropenia was considered as a dose limiting toxicity. Nonhematologic side effects generally were mild. The overall response rate including all levels was 90.9%. Three complete responses (27.3%) and 8 partial responses (63.6%) were observed among the 11 patients. At first schedule, CR was two of three patients, and PR by the other (overall response rate, 100%). Survival rate of all cases in eight months were 100%. In conclusion, a combination of TS-1 and CDDP chemotherapy showed favorable antitumor activity and less adverse reaction compared to results reported with other chemotherapy. Administration of TS-1 for 14 days followed by 14 days rest, plus CDDP (70 mg/m2) on day 8 every 4 weeks would be recommended in the view of high responsibility and low adverse reaction.

9
UI - 12152534
AU - Szekely J; Petranyi A; Glavak C; Schneider T; Rosta A; Esik O
TI - [Radiotherapy of MALT-lymphoma of the stomach]
SO - Orv Hetil 2002 Jul 14;143(28):1683-9
AD - Orszagos Onkologiai intezet, Sugarterapias Osztaly, Budapest. szekely@oncol.hu
INTRODUCTION: The stomach is the most common extranodal site of the low-grade MALT lymphoma. This lymphoma usually appears in elderly patients, with typically indolent signs. At the time of the diagnosis, the lymphoma is usually localized in the stomach and/or the adjacent lymph nodes. The choice in these cases is local treatment, which in the past involved only a surgical approach (total/partial gastrectomy), whereas more recently radiotherapy is preferred. PURPOSE: The radiation fields cover the whole stomach and the paragastric lymph nodes. The radiation doses range from 30 to 40 Gy, given in 1.5 Gy fractions 5 days a week. An adequate dose distribution to the target volume can be achieved by 3D treatment planning and conformal irradiation. METHODS: At our institute, 5 patients were treated with this method, the intention was curative in 3 cases, and palliative in 2 cases. The median dose in the 4 cases completed as initially planned was 33.6 Gy, delivered at 1.5 Gy per fraction. The adjacent critical organs do not exceed the tolerance doses by this method. RESULTS: In these 4 cases, complete regression was achieved, as determined by endoscopy and biopsy. In the fifth, locally advanced case, irradiation had to be terminated because of gastric bleeding. During irradiation, no other severe acute side-effects were detected. CONCLUSION: The literature and our preliminary results confirm that radiation therapy for early, localized MALT lymphoma of the stomach, or in disseminated cases, can be not only effective and safe, but offers the significant advantages of low treatment-related morbidity and preservation of the gastric function.

10
UI - 12205733
AU - Lee JH; Hyung WJ; Noh SH
TI - Comparison of gastric cancer surgery with versus without nasogastric decompression.
SO - Yonsei Med J 2002 Aug;43(4):451-6
AD - Department of Surgery, Cancer Metastasis Research Center and Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, C.P.O. Box 8044, Seoul 120-752, Korea.
There is a widespread belief that nasogastric decompression in gastric cancer surgery allows better surgical field and leads to the reduction of postoperative complications. The aim of this study was to evaluate whether gastric cancer surgery can be safely performed without gastric adenocarcinoma were randomized into either a tubeless group (n=56) or an intubated group (n=63). Exclusion criteria included a history of upper gastrointestinal bleeding and pyloric obstruction. No remarkable difference was found in the incidence of complications in the tubeless and intubated groups (mean 10.9%, p=0.945). The incidence of nasogastric tube insertion in the tubeless group was similar to the incidence of nasogastric tube reinsertion in the intubated group (p=0.747). Time to pass flatus was not different in the two groups (p=0.054), nor was the length of hospital stay (p=0.148). These results suggest that gastric cancer surgery can be performed safely without nasogastric decompression.

11
UI - 12195148
AU - Olsson U; Bergbom I; Bosaeus I
TI - Patients' experiences of their intake of food and fluid following gastrectomy due to tumor.
SO - Gastroenterol Nurs 2002 Jul-Aug;25(4):146-53
AD - Institute for Nursing Science, Boras University, Sweden. ulla-olle.olsson@swipnet.se
Several studies have documented patients' intake of parenteral and enteral nutrition following gastrointestinal surgery. There is a lack of knowledge, however, regarding patients' experiences of intake of food and fluid following gastrointestinal surgery. The aim of this study was to describe patients' experiences of their appetite, hunger, changes in weight, and intake of food and fluid three months after gastrointestinal surgery due to tumor. Fifteen patients were invited to be interviewed regarding their experiences following gastrointestinal surgery due to tumor. The method used for data analysis was a qualitative content analyses approach. The categorization of data identified three themes: 1) the struggle to eat and drink; 2) bodily estrangement; and 3) nutritional treatment regimens. These three themes consisted of subthemes such as: lack of appetite and hunger; difficulties in eating and drinking; feelings of nausea; and fighting and adaptation. The findings contribute to a deeper understanding of these patients' nutritional regimen and suggest the individual's personal situation and living circumstances should be considered when developing a nutritional plan following gastrointestinal surgery for tumor.

12
UI - 12228207
AU - Jager G; Neumeister P; Brezinschek R; Hinterleitner T; Fiebiger W; Penz
TI - M; Neumann HJ; Mlineritsch B; DeSantis M; Quehenberger F; Chott A; Beham-Schmid C; Hofler G; Linkesch W; Raderer M Treatment of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type with cladribine: a phase II study.
SO - J Clin Oncol 2002 Sep 15;20(18):3872-7
AD - Division of Hematology, Division of Gastroenterology, Institute of Medical Informatics, Statistics and Documentation, Karl-Franzens University of Graz, Graz, Austria. gerald.jaeger@kfunigraz.ac.at
PURPOSE: As chemotherapy has not been extensively studied in patients with lymphoma of the mucosa-associated lymphoid tissue (MALT), we initiated a prospective study to evaluate the activity of the nucleoside analog cladribine (2-chlorodeoxyadenosine [2-CdA]) in this disease. PATIENTS AND METHODS: Patients with histologically verified MALT-type lymphoma were enrolled. 2-CdA was administered at a dose of 0.12 mg/kg body weight on 5 consecutive days, as a 2-hour infusion. Cycles were repeated every 4 weeks for a maximum of six cycles. RESULTS: Nineteen patients with gastric and seven patients with extragastric MALT lymphoma were enrolled. All patients were chemotherapy-naive, and two had been locally irradiated before systemic relapse of the lymphoma. A total of 102 cycles was administered to our patients (median number of cycles per patient, four). All 25 assessable patients responded to treatment: 21 patients (84%) achieved complete remission (CR) and four patients achieved partial remission. All patients (100%) with gastric presentation, but only three patients (43%) with extragastric presentation, achieved CR. Toxicities were moderate and mainly hematologic and required dose reduction and/or premature discontinuation of therapy in only three cases. Two patients died from vascular events, one shortly after the first cycle because of myocardial infarction and the other from stroke 3 months after the second course. Three patients relapsed after 13, 18, and 22 months and one patient showed progressive disease after 15 months. At present, 24 patients are alive at a median follow-up time of 32 months. CONCLUSION: Our data demonstrate that 2-CdA is highly effective in inducing CR in 84% of patients with MALT-type lymphoma.

13
UI - 7537991
AU - Watine J; Charet JC
TI - [Comment apropos of the article: prognostic value of nutritional parameters in gastrectomy for cancer: a study of 203 cases]
SO - Bull Cancer 1995 Jan;82(1):77-9

14
UI - 12119518
AU - Shimizu S; Noshiro H; Nagai E; Uchiyama A; Mizumoto K; Tanaka M
TI - Laparoscopic wedge resection of gastric submucosal tumors.
SO - Dig Surg 2002;19(3):169-73
AD - Department of Endoscopic Diagnostics and Therapeutics, Kyushu University Faculty of Medicine, Fukuoka, Japan. shimizu@surg1.med.kyushu-u.ac.jp
BACKGROUND/AIMS: The purpose of this study was to evaluate the clinical utility of laparoscopic surgery for gastric submucosal tumor. METHODS: The records of 11 patients who underwent laparoscopic wedge resection (LR group) for gastric submucosal tumors were reviewed and compared with those of 8 patients who underwent open surgery (OS group). RESULTS: Mean operation time was 145 +/- 43 min in the LR group and 127 +/- 33 min in the OS group (p = 0.301). Mean blood loss was 97 +/- 107 and 107 +/- 47 g, respectively (p = 0.387). Patients in the LR group began walking 1.4 +/- 0.7 days after surgery, which was significantly earlier than those in the OS group (2.7 +/- 1.3 days, p = 0.021). The first flatus (1.5 +/- 0.5 vs. 3.1 +/- 0.6 days, respectively, p = 0.0004) and resumption of oral food intake (3.0 +/- 1.7 vs. 4.3 +/- 0.9 days, respectively, p = 0.020) were also earlier in the LR group. White blood cell count on the first postoperative day was lower (7,000 +/- 2,100 vs. 11,900 +/- 3,580/mm(3), respectively, p = 0.004) in the LR group than in the OS group, and the duration of fever (>38.0 degrees C; 0.1 +/- 0.3 vs. 0.9 +/- 0.8 days, respectively, p = 0.014) and the period of postoperative hospitalization (13.2 +/- 3.7 vs. 20.8 +/- 6.1 days, respectively, p = 0.014) were significantly shorter in the LR group than in the OS group. No complications occurred in either group. CONCLUSION: Laparoscopic surgery was superior to open surgery in terms of postoperative recovery time with comparable operation time and blood loss. Laparoscopic wedge resection is a promising surgical alternative for the treatment of gastric submucosal tumors. Copyright 2002 S. Karger AG, Basel

15
UI - 12230667
AU - Delaney B; Moayyedi P; Forman D
TI - Helicobacter pylori infection.
SO - Clin Evid 2002 Jun;(7):414-28
AD - Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK.

16
UI - 12230668
AU - McCulloch P
TI - Stomach cancer.
SO - Clin Evid 2002 Jun;(7):429-39
AD - University Hospital Aintree, University of Liverpool, Liverpool, UK.

17
UI - 12239061
AU - Kim KA; Park CM; Park SW; Cha SH; Seol HY; Cha IH; Lee KY
TI - CT findings in the abdomen and pelvis after gastric carcinoma resection.
SO - AJR Am J Roentgenol 2002 Oct;179(4):1037-41
AD - Department of Radiology, Medical Science Research Center, Korea University Guro Hospital, 80, Guro-Dong, Guro-Ku, Seoul 152-050, Korea.

18
UI - 12365119
AU - Chetty R; Sitti CW
TI - Gastric adenocarcinoma--a perspective from Durban, KwaZulu-Natal.
SO - S Afr J Surg 2000 May;38(1):7-8
AD - Department of Pathology, University of Natal, Durban.
KwaZulu-Natal is not a recognised 'hot-spot' for gastric cancer. The purpose of this paper was to ascertain the clinicopathological features of a cohort of cases encountered in the province. Data for 124 cases were collected and analysed for age, gender, race, tumour size, histological type, lymph node status and Helicobacter pylori status. The majority of cancers occurred in the 6th and 7th decades, irrespective of sex and race. More cases were encountered in males than females. The average tumour size was 4.5 cm, two-thirds of cases presented with lymph node metastases, and the vast majority of cases were of the intestinal histological subtype. Only 50 of the 124 cases contained microscopically demonstrable H. pylori organisms. While not as common as in the Western Cape and Japan, gastric cancer in KwaZulu-Natal has similar clinicopathological features to those found in these two high-risk areas.

19
UI - 11944373
AU - Shchepotin IB; Galakhin KA; Kurik EG
TI - [Prospects in the treatments of stomach neoplasms]
SO - Lik Sprava 2002;(1):3-8
Highlighted in the paper are basic treatment modalities for carcinoma of the stomach at the present stage of development of abdominal oncology, including original developments of the Ukrainean Research Institute of Oncology and Radiobiology of the Ministry of Health of Ukraine as the head institution of the country. The main index of references reflect potentialities of and prospects for treatment of gastric carcinoma over the last ten years.

20
UI - 11961350
AU - Kobayashi T; Sugimura H; Kimura T
TI - Total gastrectomy is not always necessary for advanced gastric cancer of the cardia.
SO - Dig Surg 2002;19(1):15-21
AD - First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. slkoba@hama-med.ac.jp
BACKGROUND: It is unclear whether total gastrectomy (TG) is always necessary for gastric cancer of the cardia. We therefore investigated whether cardiac cancers treated by TG would have been cured by proximal gastrectomy (PG). METHODS: Photocopies of the resected stomachs of 55 patients who had received TG for cardiac cancer were reviewed. A simulated resection line for PG was drawn connecting a point 5 cm from the pyloric ring on the lesser curvature with a point 15 cm from the pyloric ring on the greater curvature. The distal surgical margin between the tumor edge and the simulated resection line was measured, and lymph nodes (LN) dissected surgically were examined for tumor involvement. RESULTS: Tumor location fell into three categories, upper-middle (UM, n = 28), upper (U, n = 18), and upper-esophagus (UE, n = 9). The means of the simulated surgical margins were 1.0 cm for UM, 4.7 cm for U, and 5.7 cm for UE tumors. UE tumors had no metastasis to No. 4d, 5, or 6 LN, and only one U tumor showed metastasis to No. 4d and 5 LN. In contrast, UM tumors had a higher incidence of these nodes involved. CONCLUSION: Advanced gastric cancer located in the U or UE regions is mostly curable by PG. Copyright 2002 S. Karger AG, Basel

21
UI - 12207066
AU - Shibata M; Nezu T; Fujisaki S; Andou K; Tomita R; Fukuzawa M
TI - Clinical potential of biological response modifiers combined with chemotherapy for gastric cancer. Japanese experience.
SO - Dig Surg 2002;19(4):255-60
AD - First Department of Surgery, Nihon University School of Medicine, Tokyo, Japan. mshibata@med.nihon-u.ac.jp
The most effective treatment for gastric cancer is complete surgical resection with lymphadenectomy. However, a number of patients experience recurrence of the cancer even after curative surgery. This review focuses on comparative trials studying the use of adjuvant therapy with chemotherapy plus immunotherapy in the treatment of patients with curatively resected gastric cancer. Preoperative and intraperitoneal therapy, and therapy for advanced or recurrent gastric cancer are also discussed. At present, some subset analyses of adjuvant trials have shown favorable results suggesting that the biological response modifiers (BRMs), PSK or OK-432, add a benefit to chemotherapy. For advanced gastric cancer, although gastric cancer cells are generally not very sensitive to most of the currently available chemotherapeutic agents, it has been reported that biochemical modulation with treatments including low-dose cisplatin + 5-FU (fluorouracil) have high response rates and exert an immunomodulatory effect especially when used in combination with BRMs. The impact of splenectomy and some of the promising newly developed drugs are discussed. Copyright 2002 S. Karger AG, Basel

22
UI - 12207067
AU - Horvath OP; Kalmar K; Cseke L
TI - Aboral pouch with preserved duodenal passage--new reconstruction method after total gastrectomy.
SO - Dig Surg 2002;19(4):261-4; discussion 264-6
AD - Department of Surgery, University of Pecs, Hungary. ophorvath@iseb.pote.hu
A new reconstruction method--the aboral pouch with preserved duodenal passage--has been introduced after total gastrectomy. After removal of the stomach, preparation of the Roux loop and construction of the esophago-jejunostomy, a jejuno-duodenostomy is performed approximately 50 cm away from the esophageal anastomosis between the Roux limb and the duodenal stump. Right below this second anastomosis, the Roux limb is closed with a stapling device to provide a unidirectional food passage through the duodenum. The aboral pouch is constructed as a side-to-side anastomosis between the Roux limb under the stapled segment and the aboral end of the Y limb. The advantages of the reservoir-constructing methods and the interposition methods are combined in this new reconstruction type. Our experiences of 17 cases having undergone this reconstruction method are presented. Copyright 2002 S. Karger AG, Basel

23
UI - 12207069
AU - Meyer W; Popp M; Klinger L; Awad-Allah A; Gebhardt C
TI - Results of surgical therapy of adenocarcinomas of the esophagogastric junction according to a standardized surgical resection technique.
SO - Dig Surg 2002;19(4):269-74; discussion 275
AD - Department of Abdominal, Thoracic and Endocrine Surgery, Klinikum Nurnberg-Nord, Nuremberg, Germany.
AIM: The aim of this retrospective analysis was to exclusively present the surgical results of patients with type-I-III adenocarcinomas of the esophagogastric junction thereby providing a basis for comparison with other approaches. METHODS: 56 patients with Barrett's carcinomas and 74 patients with cardial and subcardial tumors were operated on and evaluated. The surgical procedure for type-II/III carcinomas was identical: total gastrectomy, omentectomy and splenectomy with lymph node dissection after a combined left thoraco-abdominal incision. Both tumor entities were summarized into 1 group and compared with the results of surgery for Barrett's carcinomas: subtotal esophagectomy and proximal stomach resection with lymph node dissection after right thoracotomy and an additional abdominal incision. RESULTS: In 93% of all patients an R0 resection was possible. In patients with Barrett's carcinomas pulmonal complications (41%) were the predominant postoperative problems. The 30-day lethality (5.3%) was higher in the group of patients with type-I carcinomas compared to those with type-II/III carcinomas (1.4%). Tumor infiltration and nodal involvement determined the prognosis after R0 resection. The presence of Barrett's mucosa in type-I adenocarcinomas and the histological assessment according to Lauren's classification into type-II/III carcinomas also influenced the long-term prognosis. CONCLUSION: After R0 resection it is not the tumor location but tumor infiltration, lymph node status and a differentiated histological assessment that determine the prognosis of patients with adenocarcinomas of the esophagogastric junction. Copyright 2002 S. Karger AG, Basel

24
UI - 12207071
AU - Piso P; Bellin T; Aselmann H; Bektas H; Schlitt HJ; Klempnauer J
TI - Results of combined gastrectomy and pancreatic resection in patients with advanced primary gastric carcinoma.
SO - Dig Surg 2002;19(4):281-5
AD - Klinik fur Viszeral- und Transplantationschirurgie, Zentrum Chirurgie, Medizinische Hochschule Hannover, Deutschland. piso.pompiliu@mh-hannover.de
BACKGROUND/AIMS: Although the incidence of primary gastric carcinoma is decreasing, the majority of patients in Western countries are still diagnosed with advanced tumor stages. In many cases surgical therapy can be performed only by multivisceral resections including the pancreas. primary gastric carcinoma underwent gastric resection and segmental/total pancreatectomy at our institution (21 males, 12 females; median age 57 years). The operative and pathologic findings and clinical course in these patients were analyzed retrospectively. RESULTS: In all patients total gastrectomy with D2 lymphadenectomy was performed. In 26 patients (79%) the pancreatic tail was also resected. Other resections included the pancreatic head in 5 patients (15%) and the whole pancreas in 2 cases (6%). Radical (R0) resections were possible in 73% of all cases (n = 24). 22 patients (67%) had stage-IV disease due to liver/peritoneal metastases (n = 11) or to extensive lymph node metastases (N3, n = 11). Histology showed a predominance of the diffuse type according to Lauren (n = 16, 49%). Intraoperatively suspected tumor infiltration of the pancreas was confirmed by histology only in 39% (n = 13) of the examined resection specimens. Postoperative morbidity was 36% (n = 12) and mortality was 9% (n = 3). Five patients developed pancreatitis or peripancreatic abscess, 2 with a lethal outcome. Overall the median survival was 13 months. Following R0 resection median survival was 17 months. If the pancreas was microscopically not infiltrated, median survival was 23 months. CONCLUSION: Pancreatic invasion in patients with gastric carcinoma is often associated with positive lymph nodes and liver metastases or peritoneal carcinomatosis. Intraoperatively, true pancreas invasion is difficult to differentiate from inflammatory reactions. Postoperative morbidity and mortality are increased by pancreatic resection, mainly due to pancreatitis or peripancreatic abscess. Curative (R0) resection improves prognosis and even long-term survival can be achieved in selected individual cases. Palliative resections can be performed for local complications like bleeding or obstruction refractory to other therapies. Copyright 2002 S. Karger AG, Basel

25
UI - 12181607
AU - Borghi F; Gattolin A; Bogliatto F; Garavoglia M; Levi AC
TI - Relationships between gastric development and anatomic bases of radical surgery for cancer.
SO - World J Surg 2002 Sep;26(9):1139-44
AD - Department of General Surgery, Valdese Evangelic Hospital, Via Silvio Pellico 19, 10125 Turin, Italy. felice.borghi@tin.it
The aim of this study was to determine with all possible accuracy the processes of embryologic development of the stomach and its lymphatics in order to confirm their supposed link with the modern anatomic bases of gastric cancer surgery. The knowledge of the anatomic behavior of the peritoneal folds and of the lymphatic drainage of the stomach is, in fact, considered the essential basis for the comprehension of the oncologic dissection of the stomach. The study was based on reconstruction of serial histologic sections of 9 human embryos and 8 human fetuses regarding the mesogastric area, as well as anatomic microdissection of 2 9-month fetuses. The proximal part of the stomach is not involved in the rotation mechanism of the other portions; the lesser sac development follows cranial migration of the spleen; the cardiac (pars cardiaca gastris) area is in continuity with the zone of paraaortic lymph node development; lateral and posterior lymph nodes of the hepatoduodenal ligament do not take origin in the dorsal mesogastrium: they develop together with the common bile duct and the ventral pancreas inside the mesoduodenum; the fusion of the dorsal mesogastrium and the gastric fundus with the posterior abdominal wall appears late in development. The embryologic study of the mesogastric area clarifies the real mechanism of development of the stomach and its lymphatic pathways with some differences from classic reports; these results agree with the more recent modification of the lymph nodes classification used in the radical treatment of gastric cancer.

26
UI - 12209244
AU - Mochiki E; Nakabayashi T; Kamimura H; Haga N; Asao T; Kuwano H
TI - Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer.
SO - World J Surg 2002 Sep;26(9):1145-9
AD - First Department of Surgery, Faculty of Medicine, Gunma University, 3-39-15, Showa-machi, Maebashi, 371-8511, Japan. emochiki@showa.gunma-u.ac.jp
Laparoscopy-assisted gastrectomy has been increasingly reported as the treatment of choice for early gastric cancer. However, there is little information regarding the benefits of laparoscopy-assisted distal gastrectomy (LADG). LADG and conventional open distal gastrectomy (DG) for early gastric cancer were compared in terms of operative outcome, recovery of bowel function, complications, and changes in body weight. Thirty-four patients underwent LADG for early gastric cancer. These patients were compared with 31 patients who underwent DG during the same period. For estimating gastrointestinal motility recovery, 20 radiopaque markers were inserted into the duodenum during surgery, and abdominal X-rays were taken daily until all markers were seen in the ascending colon. Age, gender, and histologic differentiation of the lesions were matched. The LADG group required a significantly longer operative time and the dissection of fewer lymph nodes. Postoperative hospital stay and the occurrence of postoperative complications (ileus) were significantly shorter and less frequent in the LADG group. The LADG group showed a more rapid recovery of gastrointestinal motor function compared with the DG group during the early postoperative period. Body weight 24 months after LADG was about 100% of pre-illness weight, but no further weight change was encountered in the DG group. For selected patients with early gastric cancer, LADG with lymphadenectomy can provide a rapid recovery and good quality of life without compromising the cure rate.

27
UI - 12209245
AU - Shiraishi N; Adachi Y; Kitano S; Kakisako K; Inomata M; Yasuda K
TI - Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer.
SO - World J Surg 2002 Sep;26(9):1150-4
AD - First Department of Surgery, Oita Medical University, 1-1 Idaigaoka, Hasama-machi, Oita 879-5593, Japan.
Tumors in the upper one-third of the stomach has been increasing. Although the standard operation for proximal gastric cancer has been total gastrectomy, some have used proximal gastrectomy reconstructed by jejunum or gastric tube. The aim of this study was to evaluate the surgical results, hospital costs, and quality of life after gastrectomy for cancer. A consecutive series of 51 patients with stage I or II proximal gastric cancer was studied: 14 underwent proximal gastrectomy reconstructed by gastric tube (direct anastomosis between esophagus and remnant of tube-like stomach), 17 proximal gastrectomy reconstructed by jejunum, and 20 total gastrectomy in Roux-en-Y fashion. Quality of life was estimated by a 24-item questionnaire with a scoring system of 1 to 3, and hospital costs covered all charges during the hospital stay. Operating time, blood loss, and hospital stay for the gastric tube group were less than those for the jejunum group or the total gastrectomy group. Hospital charges for the gastric tube group were lower than those for the jejunum group or the total gastrectomy group (141 x 10 4 yen, 179 x 10 4 yen, 211 x 10 4 yen, respectively). Although the total score for quality of life was not significantly different among the three groups (35.9, 39.5, 37.6), the number of meals per day was less and the performance status was better in the gastric tube group. Jejunal interposition was less favorably accepted by the patients as a good operation they would recommend to others. The results indicate that, in patients with proximal gastric cancer, proximal gastrectomy reconstructed by gastric tube provides a shorter operating time, earlier recovery, lower hospital charge, and better performance status when compared with proximal gastrectomy reconstructed with jejunum or total gastrectomy.

28
UI - 12209246
AU - Yano M; Shiozaki H; Inoue M; Tamura S; Doki Y; Yasuda T; Fujiwara Y;
TI - Tsujinaka T; Monden M Neoadjuvant chemotherapy followed by salvage surgery: effect on survival of patients with primary noncurative gastric cancer.
SO - World J Surg 2002 Sep;26(9):1155-9
AD - Department of Surgery and Clinical Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. myano@surg2.med.osaka-u.ac.jp
The prognosis for gastric cancer patients who undergo noncurative resection is extremely poor. This study evaluated the effects of neoadjuvant chemotherapy for primary noncurative gastric cancer. Thirty-four patients with biopsy-proven noncurative gastric cancer were treated with either of two neoadjuvant chemotherapies: FEMTXP (5-fluorouracil, epirubicin, methotrexate, cisplatin) or THP-FLPM (pirarubicin, 5-fluorouracil, leucovorin, cisplatin, mitomycin C). Noncurability was determined by conventional staging procedures, staging laparoscopy, and exploratory laparotomy. After chemotherapy the resectability of the tumors was reassessed. Patients who were judged to be candidates for curative resection underwent salvage surgery. Of the final 33 patients, 8 (24.2%) showed a major response [0 complete response (CR), 8 partial response (PR)]. In three patients the second laparoscopy revealed disappearance of the peritoneal metastasis. Of the 33 patients, 14 (42.4%) underwent salvage surgery, including 8 curative resections (2 curability A, 6 curability B). Pathologic examinations revealed a grade 2 response in eight patients but no grade 3 response. Univariate analysis showed the following to be significant prognostic factors: histology type (differentiated type vs. undifferentiated type; p = 0.035), T4 as a noncurative factor (T4 vs. T3 or less; p = 0.025), clinical response (PR + no change vs. progressive disease; p = 0.002), and salvage surgery (resected vs. unresected; p = 0.001). Among these factors, salvage surgery was found to be the only independent prognostic factor by multivariate analysis, with a relative risk of 0.253 and a 95% confidence interval of 0.066 to 0.974. The treatment was well tolerated. Major toxicities of WHO grade 3 or more were leukopenia in 20 (60.6%), gastrointestinal toxicities in 5 (15.2%), renal toxicities in 2 (6.1%), and alopecia in 1 (3.0%). In conclusion, neoadjuvant chemotherapy is effective for primary noncurative gastric cancer when salvage surgery can be performed. A chemotherapy regimen with a higher complete response rate would improve the prognosis of this dismal disease even more.

29
UI - 12236082
AU - Buris L; Halasz L; Sasi SL; Czako D
TI - [The role of D2 lymphadenectomy in the surgical treatment of gastric carcinoma]
SO - Magy Seb 2002 Aug;55(4):257-60
AD - Debreceni Egyetem Orvos- es Egeszsegtudomanyi Centrum II. sz. Sebeszeti Klinika 4004 Debrecen.
The authors examine 145 patients with gastric carcinoma who underwent curative resection with additional D2 lymphadenectomy at the 2nd Surgical Department of DUMHSC between January 1, 1996 and December 31, 2000. Subtotal resection was performed in 103 patients, and total, gastrectomy was performed in 42 patients. Postoperative mortality was 5.5% and disease-related complications occurred in 17.9%. The three-year survival was 49.7%, while in patients with "early" (maximum infiltration to the level of the submucosa) gastric carcinoma 3-year survival rate of was 86.3%. The results correlate with the data in the literature, so the use of D2 lymphadenectomy in the surgical treatment of gastric carcinoma is strongly advised.

30
UI - 12360458
AU - Serafini M; Bellocco R; Wolk A; Ekstrom AM
TI - Total antioxidant potential of fruit and vegetables and risk of gastric cancer.
SO - Gastroenterology 2002 Oct;123(4):985-91
AD - Antioxidant Research Laboratory, Unit of Human Nutrition, Istituto Nazionale di Ricerca per gli Alimenti e la Nutrizione (INRAN), Rome, Italy. serafini@inran.it
BACKGROUND & AIMS: Dietary antioxidants, with additive and synergistic effects, can mediate the observed inverse association between plant food intake and risk of gastric cancer. We investigated whether the total dietary antioxidant potential of fruit and vegetables is an appropriate means of estimating the antioxidant impact on gastric cancer risk in a large population-based study. METHODS: With a population-based case-control design, data were collected through face-to-face interviews with 505 newly diagnosed gastric adenocarcinoma patients and 1116 control subjects to assess dietary habits 20 years before interview. The total radical-trapping antioxidant potential (TRAP) of different plant foods was used to convert food frequency intake into antioxidant potential. Gastric cancer risk in groups exposed to higher levels of oxidative stress (smoking and Helicobacter pylori infection) was also examined. RESULTS: Intake of antioxidant equivalents was inversely associated with the risk of both cardia and distal gastric cancer (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.48-0.89 for the highest quartile of TRAP). Controlling for smoking, the inverse relationship between TRAP values displayed a clearer dose-response pattern. Never-smokers with the highest antioxidant intake had the lowest risk of cancer, 0.44 (95% CI, 0.27-0.71). Among H. pylori-infected subjects, the ORs varied between 0.66 and 0.41 for increasing levels of antioxidant potential. CONCLUSIONS: Our results suggest that dietary intake of antioxidants measured as total antioxidant potential is inversely associated with risk of both cardia and distal cancer. The innovative approach used in this study provides a new tool for investigating the relationship between dietary antioxidants and oxidative stress-related carcinogenesis.

31
UI - 12094284
AU - Jahne J
TI - [Lymphadenectomy in gastric carcinoma?]
SO - Zentralbl Chir 2002 Jun;127(6):550-3; discussion 553
AD - Klinik fur Allgemein-, Viszeral- und Gefasschirurgie, Zentrum Chirurgie, Henriettenstiftung Hannover, Germany. avg.chirurgie@henriettenstiftung.de
Lymphadenectomy in gastric carcinoma is still discussed. Based on non-randomised and randomised studies D2-lymphadenectomy is indicated only in R0-resections. D2-lymph-node dissection requires great experience with this technique as well as for the management of possible postoperative complications. Survival advantages can be expected in patients with a limited nodal involvement, a favorable lymph node ratio between resected and involved nodes and in stage II disease. Therefore, survival improvement can be expected in 15-20 % of all R0-resections. Despite these limited prognostic advantages D2-lymphadenectomy should be performed in all R0-procedures since only the pathologic data of the resected specimen supply reliable prognostic parameter. If in the future sentinel lymphadenectomy allows selection criteria for a balanced indication for D2-lymphadenectomy in gastric carcinoma, needs to be awaited.

32
UI - 9483169
AU - Andersen BS; Rahr HB; Sorensen JV
TI - Determination of coagulation inhibitor levels and resistance to activated protein C in patients undergoing gastric surgery for benign and malignant disorders.
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