The incidence and outcomes of GRC remain variable. Minority published researches have paid attention to the characteristics of GRC. This study aimed to make a systematic review and meta-analysis of the prevalence of GRC, with a focus on characteristics and survival rates of GRC. PubMed, EMBASE, and CENTRAL were searched for related clinical studies. Data were pooled using Stata 11.0, and subgroup and sensitivity analyses were performed if necessary and feasible. Moreover, SPSS (version 19.0) was used for comparing the clinical characteristics of GRC. Twenty studies were selected in this meta-analysis. The results indicated that the pooled prevalence of GRC was 2.6% (95% confidence interval (CI), 2.2–3.0%, p = 0.000). European population and American populations have a higher rate of prevalence of GRC than Chinese populations and Japan. There is no significant difference in histology and the TNM stage between the benign group and the malignant group. The five-year survival rate for GRC cases with benign primary gastric diseases is poorer than the primary gastric diseases malignant. Gastric remnant cancer is not a very rare clinical problem, especially for European and American patients. Active treatment and regular follow-up are conductive to increase 5-years survival rate. 相似文献
Recurrent symptomatic cholelithiasis can arise from residual gallbladder after a previous incomplete cholecystectomy. Diagnosis relies on a high index of suspicion and appropriate investigations such as ultrasound, computed tomography scan, endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography (MRCP). A case of symptomatic gallbladder remnant with gallstone 3 years after a previous laparoscopic cholecystectomy, which was managed successfully with laparoscopic resection, is described. The predisposing factors and preventive measures for such a rare complication are discussed. Chinese Abstract Figure Chinese Abstract Open in figure viewer PowerPoint
Partial gastrectomy for benign ulcer disease has been associated with an increased incidence of mucosal dysplasia and invasive adenocarcinoma, particularly in patients who are 15–20 years postresection. Using a planned protocol of routine endoscopic surveillance with biopsy, 163 patients who were at least 10 years postgastrectomy for benign ulcer disease have undergone screening flexible esophagogas-troduodenoscopy (EGD) between July 1980 and August 1994. The completed study group consists of 153 patients who have been examined at least yearly over the 14-year period of surveillance. Routine biopsies from various areas of the gastric remnant have been interpreted for dysplasia or early gastric adenocarcinoma. Patients who evidenced significant dysplasia or adenocarcinoma were offered complete gastrectomy during the study. Results of this ongoing 14-year screening program revealed severe dysplasia of the gastric remnant in 13 patients (8.4%) with eventual findings of adenocarcinoma in seven of this group (54%). These seven patients underwent total gastrectomy with findings of limited disease. Six patients continue to be followed with evidence of dysplasia. During this 14-year screening program, seven patients undergoing completion gastrectomy for early gastric remnant adenocarcinoma continue to be well and free of disease. This aggressive screening program supports the concept that neoplastic change in the gastric remnant is a function of time from the initial gastric resection. Patients identified with early gastric remnant carcinoma benefit by completion gastrectomy. In addition, patients harboring dysplasia in the gastric remnant should continue to be followed in an aggressive screening protocol utilizing random biopsy. 相似文献
IntroductionGastric remnant reconstruction is commonly used for esophagectomy reconstruction. However, standard reconstruction cannot be performed in some patients with a specific medical history. We report a case of esophagectomy and gastric remnant reconstruction with left gastroepiploic artery (LGEA) supercharge to treat esophageal cancer in a patient in whom the right gastroepiploic artery (RGEA) had previously been occluded.Presentation of caseA 65-year-old man underwent endoscopic submucosal dissection for thoracic esophageal squamous cell carcinoma. He was diagnosed with pathological T1b cancer with lymphatic invasion and a positive horizontal margin, and needed curative resection. He had previously undergone RGEA embolization to treat a pseudoaneurysm caused by chronic pancreatitis. We successfully performed esophagectomy and gastric remnant reconstruction with preoperative left gastric artery embolization and intraoperative LGEA supercharge.DiscussionAn absent RGEA blood supply is not always a contraindication for gastric remnant reconstruction when the collateral blood flows are well developed and supercharge can maintain the blood supply to the gastric remnant.ConclusionsGastric remnant reconstruction with preoperative selective arterial embolization and intraoperative supercharge represents one of the options for high-risk patients with an altered gastric blood supply. 相似文献
Twist of stomach remnant post sleeve gastrectomy is a rare entity and difficult to diagnose pre-operatively. We are reporting a case of gastric volvulus post laparoscopic sleeve gastrectomy, which was managed conservatively. A 38-year-old lady with a body mass index of 54 underwent laparoscopic sleeve gastrectomy. Sleeve gastrectomy was performed over a 32 French bougie using Endo-GIA tri-stapler. On post-operative day 1, patient had nausea and non-bilious vomiting. An upper gastrointestinal gastrografin study on postoperative days 1 and 2 revealed collection of contrast in the fundic area of stomach with poor flow distally, and she vomited gastrograffin immediately post procedure. With the suspicion of a stricture in the mid stomach as the cause, the patient was taken back for a exploratory laparoscopy and intra-operative endoscopy. We found a twist in the gastric tube which was too tight for the endoscope to pass through. This was managed conservatively with a long stent to keep the gastric tube straight and patent. The stent was discontinued in 7 d and the patient did well. In laparoscopic sleeve gastrectomy the stomach is converted into a tube and is devoid of its supports. If the staples fired are not aligned appropriately, it can predispose this stomach tube to undergo torsion along its long axis. Such a twist can be avoided by properly aligning the staples and by placing tacking sutures to the omentum and new stomach tube. This twist is a functional obstruction rather than a stricture; thus, it can be managed by endoscopy and stent placement. 相似文献
Background and aims D2 gastrectomy has improved survival in gastric cancer. Adjuvant intravenous chemotherapy, radiotherapy, or multimodal therapy
has failed to demonstrate improved survival. The results of intraarterial chemotherapy (IARC) as an adjuvant have been encouraging
in a few studies. A prospective randomized trial was designed to evaluate the toxicity and survival in locally advanced gastric
cancer using IARC as an adjuvant after potentially curative gastrectomy.
Patients and methods Forty patients with locally advanced gastric cancer were randomly selected to undergo either potentially curative gastrectomy
and receive IARC (study group) or gastrectomy only (control group). Clinical and histopathologic data were analyzed and the
toxicity related to IARC was recorded.
Results The groups were comparable (p>0.05). Three patients in the study group had minor toxicity. Five-year survival rate for the study and the control group
was 52 and 54%, respectively (p>0.05). Mean survival for the study and the control group was 50±8 and 62±10 months, respectively (p>0.05). The number of recurrences and the failure sites were comparable (p>0.05).
Conclusion Intraarterial chemotherapy can be safely applied to gastric cancer patients. As proposed by the protocol, the method cannot
be recommended as an adjuvant treatment for locally advanced tumors because it appears that there is no survival benefit compared
to potentially curative gastrectomy alone. 相似文献
Background Conflicting results from previous studies on gastric adenocarcinoma (GC) in young patients have led to controversy surrounding
the prognosis for young GC patients.
Methods The authors studied 6954 patients with GC who received curative resections. They were classified into three groups: those
aged 40 years or less (“young,” 12.7%); those aged 41–65 years (“middle-aged,” 66.7%); and those aged more than 65 years (“elderly,”
20.6%). Clinicopathologic characteristics and overall survival rates were analyzed.
Results Young patients were predominately female and had tumors that were histologically undifferentiated. However, in regard to T4
invasion, N3 lymph node metastasis, and TNM stage IV, the characteristics of the tumors of young patients were similar to
those of middle-aged and elderly patients. Overall survival rate was significantly better in young patients than middle-aged
patients (P = .018) and elderly patients (P < .001). Stratified by TNM stage, young patients showed better overall survival at stage I than middle-aged patients, and
at stages I, II, and IIIa than elderly patients. Multivariate analysis indicated that age was an independent prognostic factor
(as well as gender, operation type, depth of invasion, and lymph node status).
Conclusions The predominance of female cases and tumors that were histologically undifferentiated were distinctive characteristics in
young patients. Young patients could gain a survival benefit after curative resection with stage I disease.
Ji Fu Lai and Sungsoo Kim contribute equally to this work. 相似文献
Zusammenfassung Berichtet wird über die operative Behandlung von 589 Patienten mit einem Magenkarzinom aus den Jahren 1985–1990. Entsprechend einer Resektionsquote von 71 % wurden 416 Patienten reseziert bzw. gastrektomiert (kurativ: n = 330, palliativ: n = 86). Bei 15% der resezierten Patienten (n = 61) war wegen Fernmetastasen oder T4-Tumoren eine multiviszerale Resektion erforderlich (43mal kurativ, 18ma1 palliativ). Komplikationsraten (27 zu 26%) und die 30-Tage-Letalität (5,2 zu 3,3%) waren in beiden Gruppen der kurativ und erweitert Resezierten gleich. Die Berechnung der 5-Jahres-Überlebensraten ergab für die kurativ resezierten Patienten ohne Erweiterung einen Wert von 48 % gegenüber 22% mit Erweiterung. Werden jedoch aus der ersten Gruppe nur die T3-Tumoren berücksichtigt, so ergibt sich eine identische Überlebenszeit von 21 %. Die Ergebnisse lassen den Schlu zu, da bei der gleichen Komplikations-und Letalitätsrate die kurative Resektion von T4-Tumoren gleiche Spätergebnisse wie die entsprechende Behandlung von T3-Tumoren erwarten lät.
The multivisceral resection of advanced gastric cancer
From 1985 to 1990, 589 patients with gastric cancer were operated upon. Gastric resection was performed on 416 patients (71%); it was curative in 330 cases and palliative in 86 cases. Multivisceral resection was necessary in 61 patients (i.e. 15% of the resected patients) because of distant metastases or T4 tumors (curative: 43 cases — palliative: 18 cases). Compared to the group of curative resections without multivisceral extension, the complication rate (27% vs 26%) and 30-day lethality (5.2% vs 3.3 %) were similar, whereas the 5-year survival rate was lower (22% vs 48%). However, the survival rate (21 %) was nearly identical for T3 tumors in the group without multivisceral extension. These results show that curative gastric resections of T4 tumors lead to the same long-term results as resections of T3 tumors and the complication rate and lethality are equal.
Background and aim: The present multicenter, retrospective study aimed at determining the factors affecting survival in patients who were operated on due to gastric cancer (GC).Patients and methods: The data of 234 patients, who underwent elective surgery due to GC were retrospectively analyzed. The demographic characteristics, tumor localization and diameter, type of resection and lymph node dissection, experience of the operating surgeon (senior or junior), tumor grade, pT stage, number of lymph nodes harvested, number of lymph nodes with and without metastasis, tumor stage and survival data were recorded.Results: Survival was better a tumor diameter <4?cm, lower localization, experience of the operating surgeon (senior), without metastatic lymph nodes, tumor grade and decreased invasion depth (p?<?.05). There was no statistically significant difference between D1 LND and D2 LND with respect to survival (p?=?.793). Mortality was higher and survival was lower in patients with metastatic lymph nodes (p?=?.001). A number of harvested lymph nodes of 16 or more increased mortality (p?=?.003). Also, as disease stage increased, there was a decrease in survival and increase in mortality rates (p?=?.001).Conclusions: Survival outcomes in resectable GCs are affected by the experience of the surgeon and patient-related factors at the time of surgery, including tumor size, T stage, and presence of metastatic lymph nodes. 相似文献
Background: Although routine follow-up to detect asymptomatic recurrence after surgery for gastric cancer is recommended, the effect of such reassessment on survival has not been evaluated.Methods: Clinical records of patients developing recurrent disease after potentially curative resection between 1985 and 1996 were retrieved. Among these patients, 197 were in our follow-up program. We analyzed survival in these patients according to the presence or absence of cancer-related symptoms when recurrent disease was diagnosed.Results: Of all patients with recurrent disease, 50% were diagnosed within 1 year and 75% within 2 years of surgery. Asymptomatic recurrence, detected in 88 patients (45%), frequently represented distant metastasis. Although early detection significantly improved survival after detection of recurrent disease, disease-free survival for this subset was shorter. Thus, no significant difference in overall survival was observed.Conclusions: Early detection of asymptomatic gastric cancer recurrence did not improve overall survival of patients with recurrence after curative resection. Until development of more effective treatment for this disease, close follow-up may offer no survival benefit. 相似文献
AIM: To elucidate the influence of liver cirrhosis (LC) on the prognosis of patients with gastric cancer (GC).METHODS: Of the 1347 GC patients who underwent curative gastrectomy for GC between January 1984 and June 2007, 25 patients (21 men and 4 women with a median age of 67 years; range 54-77 years) with LC were enrolled in this study. Using the Child-Pugh classification, 15 patients were evaluated as grade A and 10 patients as grade B. No grade C patient underwent gastrectomy in this series. Clinical outcomes, including postoperative morbidity and survival, were retrospectively analyzed based on medical records and surgical files.RESULTS: There was no significant difference in operative blood loss and perioperative blood transfusion between the two groups. The most common postoperative complication was intractable ascites, which was the single postoperative morbidity noted more frequently in grade B patients (40.0%) than in grade A patients (6.7%) with statistical significance (P = 0.041). Operative mortality due to hepatic failure was seen in one grade A patient. Three patients had hepatocellular carcinoma (HCC) at presentation and two patients developed HCC after surgery. Overall 5-year survival rate was 58.9% in patients with early GC and 33.3% in patients with advanced GC (P = 0.230). GC-specific 5-year survival rate of early GC patients was 90.0% while that of advanced GC patients was 58.3% (P = 0.010). Four patients with early GC died of uncontrolled HCC, of which two were synchronous and two metachronous.CONCLUSION: The risk of postoperative intractable ascites is high, particularly in grade B patients. Early detection and complete control of HCC is vital to improve a patient’s prognosis. 相似文献
