Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer

Background Since the early 1990s, pylorus-preserving gastrectomy (PPG) has been used in the treatment of patients with early gastric cancer in order to reduce postprandial symptoms. To date, there have been few reports of long-term symptom evaluation following this procedure. The aim of this study was to evaluate long-term postoperative outcomes after PPG. Methods Three hundred and ninety-seven patients with early gastric cancer were enrolled in this study: 194 patients who underwent PPG and 203 who underwent distal gastrectomy with Billroth-I reconstruction (DGBI). We compared the symptoms for the two groups in a questionnaire on postoperative functional outcomes, endoscopy findings and the appearance of gallstones after surgery. Results The incidence of symptoms suggesting early dumping syndrome was significantly lower in the PPG group compared with the DGBI group (P < 0.05). The incidences of disturbed bowel habit and frequent flatus were significantly lower in the PPG than in the DGBI group. The average relative body weight (actual BW/ BW immediately before the surgery) was significantly better in the PPG than in the DGBI group (P < 0.001). Conclusion The long-term results show that PPG has clear advantages over DGBI in terms of postoperative symptoms and functional outcomes. These results imply that PPG should be the recommended procedure for early gastric cancers located in the middle third of the stomach.     

Early and late gastric cancer arising in the remnant stomach after distal gastrectomy

AIM: Following distal gastrectomy, carcinogenesis has been suggested to result from gastroduodenal reflux. In this study, surgical cases of gastric cancer arising after distal gastrectomy were analyzed clinico-pathologically and the possible link to reflux examined. PATIENTS: Thirty-two patients (24 males, 8 females; mean age, 68.7 years; age range, 33-84 years) with gastric cancer arising in the remnant stomach after gastrectomy (also known as gastric stump cancer) were included in this study. Patients were divided into two groups on the basis of the initial diagnosis (benign or malignant) prompting surgery, and distal gastrectomy reconstruction method (Billroth I or II). RESULTS: The interval between distal gastrectomy and detection of cancer in the remnant stomach of patients treated initially for a benign gastric condition vs. malignancy was 360+/-33.04 and 63+/-19.16 months (median+/-SE), respectively (p<0.0001). However, the benign and malignant groups did not differ significantly in the clinicopathological analysis of their stump cancers. All 10 patients in whom gastric cancer was diagnosed within five years of initial surgery had initially been surgically treated for malignancy. The interval between surgery and detection of gastric cancer in the Billroth I and Billroth II groups was 84+/-26.67 and 276+/-44.26 months (median+/-SE), respectively (p<0.01). In the remnant stomach, cancer tended to occur near the site of gastrojejunostomy in the Billroth II group (p=0.05). Helicobacter pylori infection was only detected histologically in four patients who had undergone Billroth I reconstructions after distal gastrectomy for malignancy. CONCLUSION: After distal gastrectomy, careful periodic endoscopic examination for microcarcinoma is required in patients, particularly in those who undergo surgery for malignancy, to maximize detection of gastric cancer.     

胃癌高发区功能性消化不良与萎缩性胃炎幽门螺杆菌感染分析

目的:探讨胃癌高发区功能性消化不良(FD)与萎缩性胃炎(CAG)幽门螺杆菌(Hp)感染率及与胃癌高发的关系。方法:经过确诊的78例FD病例和69例CAG病例作为研究对象,通过病理组织学Giemsa染色法确定其Hp感染情况。结果:FD患者的HP感染率为42.3%(33/78),CAG患者的Hp感染率为72.5%(50/69),两组差异有显著性(P<0.01)。结论:该地区的CAG患者Hp感染率高于FD患者的Hp感染率;在该胃癌高发区,CAG的Hp感染率较高,胃癌高发病率可能与Hp感染率高有关。     

用肠内营养预防胃癌患者胃次全切除术后胃瘫综合征

目的:探讨运用肠内营养预防胃癌患者胃次全切除术后胃瘫综合征的作用。方法:200例胃次全切除术后的胃癌患者随机分为实验组105例,术后早期开始实施肠内营养;对照组95例,术后采用传统静脉输液支持。结果:术后实验组有1例(0.9%)出现术后胃瘫综合征。对照组有7例(7.3%)出现术后胃瘫综合征。两组间有明显差异。(P<0.05)。结论:肠内营养预防胃癌患者胃次全切除术后胃瘫综合征效果良好,有助于康复。     

胃癌高发区胃炎患者幽门螺杆菌感染和社会心理因素的相关性研究

目的：探讨胃癌高发区慢性胃炎患者幽门螺杆菌（HP）感染和社会心理因素的相关性。方法：经胃镜及病理组织检查确诊慢性胃炎，其中浅表性胃炎（CSG）93例，萎缩性胃炎（CAG）69例。通过病理组织学Giemsa染色法确定HP感染情况。采用统一的调查表格通过询问或查体进行调查。社会心理因素调查包括6项：工作（劳动）紧张、生活不规律、负性生活事件、人际关系敏感、焦虑、抑郁。结果：HP阴性和阳性的CSG患者各项社会心理因素发生率虽有高低不同，但均无显著性差异（P值均〉0．05）。HP阴性和阳性的CAG患者亦如此。结论：该胃癌高发区慢性胃炎患者HP感染和被调查的6项社会心理因素无相关性。     

Correlation between the prevalence of gastritis and gastric cancer in Japan

To verify the hypothesis that chronic atrophic gastritis (CAG) is a precancerous lesion for gastric cancer, we investigated the correlation between the prevalence rates for CAG determined by levels of serum pepsinogens (I and II) of randomly selected, healthy, blood donors and the mortality rates for gastric cancer among four prefectures (Akita, Iwate, Miyagi, and Okinawa) in Japan. The prevalence rates for CAG according to a criterion that the level of pepsinogen I is below 70 ng/ml and the pepsinogen I to pepsinogen II ratio is below 3.0, were the highest in Akita for both sexes (38.8 percent in males, 37.8 percent in females) and the lowest in Okinawa (13.9 percent in males, 12.3 percent in females), where mortality rates for gastric cancer are the highest and the lowest in Japan, respectively. The correlation between the prevalence rates for CAG and the standardized mortality ratios for gastric cancer among these four prefectures was statistically significant in males (r=0.97, P=0.03), but less significant in females (r=0.92, P=0.08). These data strongly support the hypothesis that CAG is a precancerous lesion. The limitations of our cross-sectional study and the advantages of measuring the levels of serum pepsinogens in epidemiologic studies and in mass-screening programs for gastric cancer are discussed.Drs Fukao and Hisamichi are with the Toboku University School of Medicine, Sendai, Japan. Dr Obsato is with the Akita Blood Center. Dr Fujino is with the Iwate Blood Center. Dr Endo is with the Miyagi Blood Center. Dr Iha is with the Okinawa Blood Center, Japan. Address correspondence to Dr Fukao, Department of Public Health, Toboku University School of Medicine, 2-1, Seiryomachi, Aobaku, Sendai, 980 Japan. This work was supported in part by a Grant-in-Aid for Cancer Research from The Ministry of Education, Science and Culture of Japan.     

胃大部分切除术与全胃切除术对胃癌患者预后影响的对比分析

目的:比较胃大部分切除术（subtotal gastrectomy,SG）与全胃切除术（total gastrectomy,TG）对胃癌患者生存的影响。方法:回顾性收集2009年12月至2017年09月间宁夏医科大学总医院入院诊治的1 903例II/III期胃癌患者的一般人口学资料、临床病理资料及预后信息,其中SG组1 020例（53.6%）,TG组883例（46.4%）,运用单、多因素分析两组患者生存差异及预后因素。结果:与TG组相比,SG组的总生存率较高（67.3% vs 49.0%,P＜0.001);单、多因素分析结果均支持:年龄、临床分期、肿瘤位置、化疗等是胃癌患者的独立预后因素（P＜0.05）。进一步对肿瘤位置和分期进行分层,肿瘤位于上段Ⅱ/Ⅲ期患者的总生存差于中、下段患者（58.3% vs 66.6%、62.6%,P＜0.05）;肿瘤位于上、中段接受SG和TG的长期生存无差异,而肿瘤位于下段的III期胃癌患者行TG的5、7年长期生存高于SG（30.6% vs 17.1%,29.4% vs 3.7%,P＜0.05）。结论:与全胃切除术相比,无论肿瘤位于上、中、下段,行远端胃大部分切除术可提高Ⅱ/Ⅲ期胃癌患者短期生存率,而分化程度较差、分期较晚的下段胃癌患者,情况允许时全胃切除术可常规实行。     

胃癌与慢性萎缩性胃炎基因表达谱的差异和关联

背景与目的:胃黏膜自慢性炎症演变为胃癌的过程中,隐伏着一系列的基因变化.本研究采用高通量基因芯片,检测慢性萎缩性胃炎和胃癌组织的基因表达,结合病理资料,分析和比较两者基因表达的异常及其生物学意义.方法:收集23例胃癌以及15例慢性萎缩性胃炎的病变及配对非病变部位胃粘膜组织,以载有13824个基因/EST序列的基因芯片检测基因表达谱,结合病理等临床资料,应用系统聚类法、t检验、Fisher确切概率法等统计学方法进行分析.结果:胃癌组和慢性萎缩性胃炎组分别筛选出符合条件的基因53个和21个.胃癌组的特征性表达基因中,STS、HAP1等基因与Borrmann分型等病理改变相关联;慢性萎缩性胃炎组的特征性表达基因中,BRD3、BF508879等基因与肠化等病理改变相关联;慢性萎缩性胃炎和胃癌组中共同存在的SLC26A3等基因与癌前病变相关联.结论:慢性萎缩性胃炎和胃癌组织基因的表达既有相似性,又有异质性.肿瘤基因表达与癌前状态和癌前病变相关.基因表达的相似性提示慢性萎缩性胃炎与胃癌这两者病理发展的相关性和延续性.     

The prevalence of premalignant gastric lesions in asymptomatic patients: predicting the future incidence of gastric cancer

Background

Helicobacter pylori is the main risk-factor for gastric cancer through a cascade from gastritis through atrophic gastritis (AG), intestinal metaplasia (IM), dysplasia (DYS) to malignancy. The presence of these lesions in the general population predicts the gastric cancer incidence in the coming decades. Prevalence data are mostly obtained from serological studies and endoscopy data in symptomatic patients.

Aim

To investigate the prevalence of H. pylori infection and its related gastric changes in asymptomatic subjects.

Methods

383 Patients undergoing routine colonoscopy were included. All subjects underwent upper GI endoscopy and completed the Gastrointestinal Symptom Rating Scale (GSRS). Biopsies were taken from antrum and corpus.

Results

H. pylori infection was present in 22%. Non-Caucasian subjects had a significantly higher H. pylori prevalence (p < 0.001). AG, IM and DYS were together found in 9.3% of subjects. Subjects with AG, IM or DYS were significantly older (p < 0.001). No differences were found with respect to gender, presence of GI symptoms as scored by GSRS, lifestyle and medication use.

Conclusions

The prevalence of premalignant gastric lesions is considerable in general Western population with increasing age as the main risk factor. One time screening for premalignant lesions at the age of 60 years is a reasonable strategy since the numbers found imply that gastric cancer will remain a prevalent disease.     

Comparisons of remnant primary,residual, and recurrent gastric cancer and applicability of the 8th AJCC TNM classification for remnant gastric cancer staging

BackgroundBecause there is no well-established postoperative staging system for patients with remnant gastric cancer (RGC), we compared the overall survival of patients categorized with the 8th AJCC TNM staging system.MethodA total of 391 patients underwent surgery for RGC at our institution between 1996 and 2019. Among them, 201 patients received their first surgery at our institution and 190 received primary surgery elsewhere. We retrospectively reviewed their medical records and classified each according to Kaminishi’s classification and the 8th AJCC TNM staging system for comparison and analysis.ResultsAll 201 patients who underwent their first operation at our institution for malignancy were classified as primary (n = 41, 20.4%), residual (n = 103, 51.2%), and recurrent (n = 57, 28.4%) RGC. The 5-year overall survival (OS) rates for the primary, residual, and recurrent RGC groups were 78.1%, 73.8% and 56.0%, respectively (p = 0.004). In a multivariate analysis, RGC classification was an independent prognostic factor along with the TNM staging system (p = 0.001). However, there was no significant difference in OS between the three groups of the same TNM stage. In addition, the OS of each stage related to primary cancer was not significantly different from the OS of RGC patients classified in TNM staging.ConclusionThe RGC classification system we used may reflect the comprehensive aspects of previous disease states and predict the prognosis of patients with gastric cancer. In addition, the 8th AJCC TNM classification is a practical and applicable staging system for RGC.     

Development of gastric cancer in nonatrophic stomach with highly active inflammation identified by serum levels of pepsinogen and Helicobacter pylori antibody together with endoscopic rugal hyperplastic gastritis

This study aimed to elucidate groups at high risk of developing cancer among patients with serologically identified Helicobacter pylori infection and nonatrophic stomach. Annual endoscopy was performed for a mean of 5.4 years in 496 asymptomatic middle-aged men who were H. pylori antibody-positive and pepsinogen (PG) test-negative. Subjects were stratified according to the activity of H. pylori-associated gastritis measured by serum levels of PG and H. pylori antibody, and/or by endoscopic findings of rugal hyperplastic gastritis (RHG), and cancer development was investigated. During the study period, seven cases of cancer developed in the cohort (incidence rate, 261/100,000 person-years), with 85.7% developing in the group showing a PGI/II ratio ≤3.0, reflecting active inflammation-based high PGII levels. Cancer incidence was significantly higher in this group (750/100,000 person-years) than in groups with less active gastritis. Furthermore, cancer incidence for this group was significantly higher in the subgroup with high H. pylori antibody titers than in the low-titer subgroup. Meanwhile, endoscopic findings revealed that 11.7% of subjects showed RHG reflecting localized highly active inflammation, and cancer risk was significantly higher in patients with RHG than in patients without. Combining the two serum tests and endoscopic examination for RHG allowed identification of subjects with more active gastritis and higher cancer risk. No cancer development was observed in these high-risk subjects after H. pylori eradication. Subjects with highly active gastritis identified by the two serological tests and endoscopic RHG constitute a group at high risk of cancer development with H. pylori-infected nonatrophic stomach.     

饮绿茶对胃癌、慢性胃炎发病影响的流行病学调查

目的尽管我国胃癌死亡率有下降趋势,但仍旧是第二位恶性肿瘤,扬中是我国胃癌高发区之一.我们在扬中进行胃癌和慢性胃炎与饮绿茶的调查,以研究饮绿茶与它们发病的关系.以及他们之间的交互作用.方法在扬中开展以人群基础的病例对照调查其中有病理学证明的胃癌143例,慢性胃炎166例和对照433例.用统一的流行病学调查表,同时采血作幽门螺杆菌感染测定.分析用logistic回归计算比数比(OR)和95%可信限(CI).分析时用各种混杂因素进行调整.结果饮绿茶可降低胃癌和慢性胃炎危险度各54%,其比数比分别为0.46(95%CI0.22-0.96)和0.46(95%CI0.27-0.77).每周饮绿茶杯数愈多,胃癌和慢性胃炎OR下降愈低(趋势检验P＜0.05).饮绿茶与胃癌家族史,幽门螺杆菌感染和饮酒可能有相乘交互作用.结论饮绿茶可降低胃癌和慢性胃炎危险度各54%.     

Long-term survival after perforation of advanced gastric cancer: Case report and review of the literature

Although the standard operation for early cancer of gastric cardia is proximal gastrectomy followed by jejunal interposition, we recently reported a simple and useful technique for proximal gastrectomy with gastric tube reconstruction. The operative procedures included resection of the proximal two-thirds of the stomach, followed by anastomosis between the esophagus and gastric tube, using a circular stapler (Proximate ILS 25; Ethicon, Cincinnati, OH, USA). The gastric tube was about 20 cm long and 4 cm wide. The patient a 76-year-old man had no reflux symptoms such as heartburn, retrosternal pain, and regurgitation. Endoscopy showed no evidence of reflux esophagitis, including mucosal redness, erosion, and ulceration. Ambulatory 24-h pH monitoring indicated that the pH of the lower esophagus was between 6 and 8 when the patient was upright and between 5 and 7 when he was in the supine position. There were nine reflux episodes during the day, and no reflux episode while he was asleep. The duration of each reflux episode was less than 1 min, and the total reflux time was 1 min in the 12-h day (0.1%). These data indicate that reconstruction by gastric tube may prevent esophageal reflux in patients who have undergone proximal gastrectomy for early cancer of the gastric cardia. Received for publication on Jan. 14, 1998; accepted on Apr. 1, 1998     

胃癌的淋巴结转移与清扫范围关系的探讨

目的:探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义.方法:收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系.结果:103例患者胃癌淋巴结转移率为68.9%(71/103).随着肿瘤直径的增加,淋巴结转移率(度)也增高(P<0.05);临床分期中,胃癌的淋巴结转移率(度)随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率(度)均低于其它期 (P<0.01);Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%(40/49),高于其它型(P<0.05),而Ⅳ型患者淋巴结转移度32.4%(161/497)最高.结论:淋巴结转移率和转移度随着胃癌的临床进展而增高.合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性.     

胃癌的淋巴结转移与清扫范围关系的探讨

目的：探讨胃癌淋巴结转移的特点及其对手术清扫范围的指导意义。方法：收集我院经手术治疗的103例胃癌患者的临床及病理资料,统计资料中淋巴结转移情况并计算淋巴结转移率,分析淋巴结转移率与肿瘤大小、临床分期、Borrmann分型的关系。结果：103例患者胃癌淋巴结转移率为68.9%（71/103）。随着肿瘤直径的增加,淋巴结转移率（度）也增高（P〈0.05）;临床分期中,胃癌的淋巴结转移率（度）随着临床分期的进展而增高,Ⅰ期患者淋巴结转移率（度）均低于其它期（P〈0.01）;Borrmann分型中,Ⅲ型患者的淋巴结转移率为81.6%（40/49）,高于其它型（P〈0.05）,而Ⅳ型患者淋巴结转移度32.4%（161/497）最高。结论：淋巴结转移率和转移度随着胃癌的临床进展而增高。合理行扩大淋巴结清扫术能够及时清除肿瘤可能的转移灶,进而有助于降低患者肿瘤转移的可能性。     

Patterns,timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy: Reliable results following long-term follow-up

Background

To clarify the patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy.

Methods

From January 1999 to March 2012, 577 patients underwent laparoscopic or laparoscopy-assisted gastrectomy for curative resection of gastric cancer. Recurrence patterns were classified as locoregional, hematogenous, peritoneal, distant lymph node and mixed. Recurrence patterns and time to recurrence were retrospectively examined and risk factors for recurrence were analyzed.

Results

Recurrence occurred in 28 (4.9%) cases with patterns as follows: locoregional in 2 patients (7.1%), hematogenous in seven (25.0%), peritoneal in nine (32.1%), distant lymph node in four (14.3%), and mixed in 6 (21.4%). There was no recurrence pattern peculiar to laparoscopic surgery. Recurrence occurred at one site in 21 patients (78.6%), two in 4 patients (14.3%), and three in 2 patients (7.1%). The median time to recurrence was 384 days (range 83–1497 days). Recurrence was detected within a year in 13 cases (46.4%), within two years in 21 (75%), and within three years in 25 (89.3%). Univariate analysis revealed tumor location, tumor size, type of operation, tumor depth, and lymph node classification as risk factors for recurrence. Multivariate analysis indicated tumor depth and lymph node classification as risk factors of recurrence.

Conclusions

Patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy are similar to those after open gastrectomy, with no peculiarities specific to laparoscopic gastrectomy. Thus, as long as laparoscopic gastrectomy is performed according to the present inclusion criteria, follow-up can be similarly performed as for open gastrectomy.