Gastric cancer

OBJECTIVE: To construct a risk model for total gastrectomy outcomes using a nationwide Internet-based database. BACKGROUND: Total gastrectomy is a very common procedure in Japan. This procedure is among the most invasive gastrointestinal procedures and is known to carry substantial surgical risks. METHODS: The National Clinical Database was used to retrieve records on more than 1,200,000 surgical cases from 3500 hospitals in 2011. After data cleanup, 20,011 records from 1623 hospitals were analyzed for procedures performed between January 1, 2011, and December 31, 2011...

BACKGROUND: The aim of this meta-analysis was to evaluate the necessity of nasogastric or nasojejunal decompression after gastrectomy for gastric cancer. METHODS: Medline, Embase and the Cochrane Library were searched. Only prospective randomized controlled trials (RCTs) that compared subjects with and without nasogastric or nasojejunal decompression after gastrectomy were eligible in this meta-analysis. Time to flatus, time to first oral intake, length of hospital stay, reinsertion rate, anastomotic leakage, pulmonary complications, morbidity and mortality were evaluated...

BACKGROUND: The proximal gastric margin dictates the extent of resection for gastric adenocarcinoma (GAC). The value of achieving negative margins via additional gastric resection after a positive proximal margin frozen section (FS) is unknown. METHODS: The US Gastric Cancer Collaborative includes all patients who underwent resection of GAC at seven institutions from 2000-2012. Intraoperative proximal margin FS data and final permanent section (PS) data were classified as R0 or R1, respectively; positive distal margins were excluded...

Acute upper gastrointestinal bleeding is a common medical emergency worldwide, a major cause of which are bleeding peptic ulcers. Endoscopic treatment and acid suppression with proton-pump inhibitors are cornerstones in the management of the disease, and both treatments have been shown to reduce mortality. The role of emergency surgery continues to diminish. In specialised centres, radiological intervention is increasingly used in patients with severe and recurrent bleeding who do not respond to endoscopic treatment...

The de facto standard treatment for early gastric stump cancer (GSC) has been total gastrectomy combined with radical lymph node dissection. However, some patients could benefit if partial resection of the gastric stump is feasible. We investigated the feasibility of subtotal gastrectomy for early GSC as less invasive surgery. Subtotal gastrectomy was defined as a segmental resection of the gastric remnant including the anastomosis with limited lymph node dissection. A total of 66 patients with early GSC were enrolled and 24 patients (36...

Single incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have been developed to reduce the invasiveness of laparoscopic surgery. SILS has been frequently applied in various clinical settings, such as cholecystectomy, colectomy, and sleeve gastrectomy. So far, there have been four reports on single incision laparoscopic distal gastrectomy and one report on single incision laparoscopic total gastrectomy with D1 lymph node dissection for gastric cancer. In this report, we present our single incision laparoscopic total gastrectomy with D2 lymph node dissection technique using a four-hole single port (OctoPort) in a patient with gastric cancer...

Laparoscopic treatment strategies for synchronous intra-abdominal malignancies have not yet been standardized. We report a successful case of two-step laparoscopic surgery for synchronous double cancer of the colon and stomach accompanied by severe chronic obstructive pulmonary disease (COPD). A 66-year-old man with COPD was diagnosed as having advanced colon cancer and early gastric cancer. On admission, he could not go upstairs (Grade III according to the Hugh-Jones classification) and his forced expiratory volume in 1 second was 600 mL (35...

When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes) adenocarcinoma of the antrum...

Background. With this study we focus on the etiopathogenesis and on the therapy of the simultaneous occurrence of Gastric gastrointestinal stromal tumor (gGIST) and adenocarcinoma of the stomach in a patient with Billroth II gastric resection (BIIGR). We report the first case of this event and a review of the literature. Methods. A 70-year-old man with a BIIGR, affected by adenocarcinoma of the stomach, was successfully treated with total gastrectomy. The histological examination showed a gastric adenocarcinoma with a synchronous GIST sized 2 cm and S-100, CD117, and CD34 positive...

BACKGROUND: The 7th edition of the International Union Against Cancer/American Joint Committee on Cancer (UICC/AJCC) tumor-node-metastasis (TNM) classification system for gastric cancer is more detailed than the 6th edition with respect to tumor depth and lymph node metastasis. The purpose of this study was to evaluate the rationality of the 7th UICC/AJCC TNM classification system, focusing on N3 gastric cancers. METHODS: A total of 338 patients with N3 gastric cancer who underwent curative resection with ≥ 16 retrieved lymph nodes at two institutions between January 1997 and December 2007 were included in this study...

AIMS: This study was designed to investigate the clinical features of delayed massive hemorrhage (DMH) after gastrectomy in patients with gastric cancer (GC). METHODS: This study retrospectively reviewed 1536 GC patients with major gastrectomy between 1998 and 2011. Based on the time onset of postoperative bleeding, patients were divided into early postoperative hemorrhage (EPH), delayed massive hemorrhage (DMH), and no-bleeding groups. Postoperative mortality, bleeding treatment, and risk factors of hemorrhage were explored...

Background. D2 lymphadenectomy is a demanding technique which is associated with high morbidity in the West. We report our experience with D2 lymphadenectomy after a training period in Japan. Methods. Prospective, descriptive study in 133 consecutive patients undergoing radical gastrectomy for gastric adenocarcinoma from 2005 to 2011. We analysed the number of lymph nodes removed, observed morbidity/mortality compared with the predictions of POSSUM and O-POSSUM, survival, and disease-free interval for patients with D1 and D2 lymphadenectomy...

BACKGROUND: Gastric cancer (GC) is the third leading cause of cancer death in China and the outcome of GC patients is poor. The aim of the research is to study the prognostic factors of gastric cancer patients who had curative intent or palliative resection, completed clinical database and follow-up. METHODS: This retrospective study analyzed 533 GC patients from three tertiary referral teaching hospitals from January 2004 to December 2010 who had curative intent or palliative resection, complete clinical database and follow-up information...

BACKGROUND: The aim of this study was to evaluate the impact of obesity on surgical outcome and prognosis in patients with gastric cancer. METHODS: A total of 304 patients who underwent curative gastrectomy for gastric adenocarcinoma between January 2005 and March 2008were enrolled. Body mass index (BMI) was calculated before the operation and visceral fat area (VFA) was measured by abdominal computed tomography (CT). The patients were divided according to BMI class and VFA quartile...

BACKGROUND: The addition of splenectomy to a D2 gastrectomy in patients with gastric adenocarcinoma (GA) has remained controversial. This study aimed to assess the impact of splenectomy on the overall survival of patients undergoing total gastrectomy for GA. METHODS: This was a retrospective review of 463 GA patients (excluding positive resection margins and pathologic spleen invasion) undergoing curative total gastrectomy with (TS) and without splenectomy (T) between 1994 and 2008...

BACKGROUND: The number of lymph nodes harvested during gastrectomy depends on the extension of lymphadenectomy and the method of lymph node retrieval. AIM: The objective of this study was to evaluate two methods of lymph node retrieval in specimens of gastric cancer. METHODS: The number of lymph nodes was compared using two different techniques. The technique used in the first group was manual dissection following formalin fixation, and the techniques used in the second group was fat-clearing by acetone...

BACKGROUND: To evaluate the effect of early oral feeding on postoperative short-term outcome of gastric cancer patients receiving laparoscopic distal gastrectomy. METHODS: From Oct 1, 2011 to Mar 1, 2013, 84 consecutive patients with gastric cancer were involved in this retrospective study. Patients received either early oral feeding (early feeding group) or not (control group) after laparoscopic distal gastrectomy. Details concerning the postoperative outcomes and the quality of life questionnaires were collected and compared...

INTRODUCTION: This study investigated how total gastrectomy (TG), along with memories of cancer, affect the subjective wellness of survivors long after surgery. Rational approaches for effectively improving the quality of life (QoL) of these survivors were suggested. METHODS: Between 2008 and 2013, QoL data of gastric cancer patients who underwent a curative TG, were obtained at 5-year postoperative follow-up visits (5-year survivors) and at visits beyond 5 years (long-term survivors)...

BACKGROUND: It is still unclear whether D2 lymphadenectomy improves the survival of patients with gastric cancer and should therefore be performed routinely or selectively. The aim of this multicentre randomized trial was to compare D2 and D1 lymphadenectomy in the treatment of gastric cancer. METHODS: Between June 1998 and December 2006, patients with gastric adenocarcinoma were assigned randomly to either D1 or D2 gastrectomy. Intraoperative randomization was implemented centrally by telephone...

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