Gastric Cancer After Laparoscopic Adjustable Gastric Banding

A 63-year-old woman with BMI 46 underwent laparoscopic gastric banding. In the standardized follow-up after 14 and 24 months, the GI series and gastroscopy showed no pathological signs. The patient had hematemesis 32 months after gastric banding, followed by symptoms of obstruction, for which a laparotomy was performed. At operation, peritoneal carcinomatosis due to gastric cancer was found. Symptoms after bariatric procedures can be similar to symptoms of gastric or esophageal cancer. We believe that yearly postoperative gastroscopy is indicated to exclude pathological changes.     

胃癌生物治疗现状与展望

目的 探讨胃癌生物治疗的现状与研究进展。方法 采用文献回顾的方法对胃癌生物治疗现状及其研究进展进行综述。结果 胃癌生物治疗的研究内容及主要方法包括：免疫调节剂治疗。单克隆抗体及其交联物导向治疗，细胞因子治疗，过继免疫治疗，基因治疗等。结论 生物治疗作为手术和放／化疗的有益补充，在胃癌综合治疗中发挥着重要的辅助作用。     

Gastric Cancer and Metastasis to the Brain

Background: Metastasis of gastric carcinoma to the brain is very uncommon. At The University of Texas M. D. Anderson Cancer Center (M. D. Anderson), less than 1% of patients with primary gastric carcinoma are found to have brain metastases. Little has been published regarding the evaluation and treatment of these patients. The purpose of this study was to review our experience with gastric cancer metastatic to the brain and to describe the efficacy of the treatment used.Methods: Between 1957 and 1997, a total of 218,690 patients were seen for evaluation of malignant tumors at M. D. Anderson. Of these patients, 3320 (1.5%) had a diagnosis of gastric cancer; however, only 24 patients (0.7%) were found to have brain metastases on imaging studies or at autopsy. We performed a retrospective review of these 24 patients and divided them into three groups on the basis of the treatment they received.Results: Group 1 included patients who received steroids alone (16 mg of dexamethasone, daily). Group 2 patients received 3000 cGy of whole-brain radiation therapy (WBRT) delivered in 10 fractions in addition to steroids. Group 3 patients were managed with surgical resection, WBRT, and steroids. There were 18 male and 6 female patients, with a median age of 53 years. The most common presenting symptoms were weakness, difficulty with balance, and headache. Of the 19 patients diagnosed antemortem, 11 patients developed neurological symptoms after the primary diagnosis of gastric carcinoma, whereas 8 patients developed neurological symptoms before the diagnosis of gastric cancer. Forty-five percent of patients had a single brain metastasis, whereas 55% had multiple lesions. All patients had systemic disease, with bone, liver, and lung involvement seen in 46%, 42%, and 29%, respectively. Nineteen of 24 patients received treatment after diagnosis of brain metastases. Four patients received steroids only (group 1), 11 patients received WBRT and steroids (group 2), and 4 patients were treated with surgery, WBRT, and steroids (group 3). Median survival was approximately 2 months for patients in groups 1 and 2, whereas group 3 patients had a median survival of slightly greater than 1 year.Conclusions: Our results suggest that the overall prognosis of patients with brain metastases from gastric cancer is extremely poor (median survival, 9 weeks). WBRT, as an adjuvant to steroid treatment, was not effective in improving outcome in our series. In selected patients, most of whom were relatively young and had less advanced systemic disease, surgical resection followed by WBRT was associated with relatively long survival times (median survival, 54 weeks).     

Totally Laparoscopic Gastrectomy for Gastric Cancer

Background and Objectives:

Recent studies have supported minimally invasive techniques as a viable alternative to open surgery in the treatment of gastric cancer. The goal of this study is to review our institution''s experience with totally laparoscopic gastrectomy for the treatment of both early- and advanced-stage gastric cancer.

Methods:

A retrospective study was conducted to examine the short-term outcomes of laparoscopic gastrectomy performed at Monmouth Medical Center between May 2003 and June 2012. We reviewed postoperative complications, surgical margins, number of resected lymph nodes, estimated blood loss, length of stay, narcotic use, and recurrence rate.

Results:

Forty patients were included in the study. There were 21 cases of adenocarcinoma, 15 cases of gastrointestinal stromal tumor, 2 cases of carcinoid, 1 case of small cell neuroendocrine tumor, and 1 case of squamous cell carcinoma. The mean operative time was 220 minutes (range, 67–450 minutes). The median length of stay was 6 days (range, 1–37 days). The mean number of harvested lymph nodes was 11. Early postoperative complications occurred in 7 patients and included anastomotic stricture, wound infection, intra-abdominal abscess, bowel obstruction, and esophageal pneumatosis. There were two deaths. The Kaplan-Meier 5-year overall and recurrence-free survival rate for all cases of adenocarcinoma was 63.2%.

Conclusions:

Totally laparoscopic gastrectomy is a reasonable option for the treatment of gastric malignancy, with early data showing acceptable survival rates and perioperative outcomes. Large-scale randomized trials are still needed to confirm oncologic equivalency to open gastrectomy in patients with advanced disease.     

Simultaneous Laparoscopy-Assisted Resection for Rectal and Gastric Cancer

Laparoscopy-assisted surgery for either rectal or gastric cancer has been increasingly performed. However, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is rarely reported in the literature. In our study, 3 cases of patients who received simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer were recorded. The results showed that all 3 patients recovered well, with only 253 minutes of mean operation time, 57 mL of intraoperative blood loss, 5 cm of assisted operation incision, 4 days to resume oral intake, 12 days'' postoperative hospital stay, and no complication or mortality. No recurrence or metastasis was found within the follow-up period of 22 months. When performed by surgeons with plentiful experience in laparoscopic technology, simultaneous laparoscopy-assisted resection for synchronous rectal and gastric cancer is safe and feasible, with the benefits of minimal trauma, fast recovery, and better cosmetic results, compared with open surgery.     

1034例胃癌的临床及病理学分析

目的　探讨胃癌的生物学特性及与临床之间的关系。方法　对 10 3 4例各期、各个部位的胃癌的临床及病理资料进行回顾性分析。结果　早期胃癌 14 8例 ,占总数的 14 .3 % ;胃体和胃底部的胃癌淋巴结转移率明显高于其它部位的胃癌 (P<0 .0 0 0 1) ;肿瘤直径大的胃癌分化差 (P=0 .0 0 4)、浸润深 (P<0 .0 0 0 1) ,淋巴结转移率也较高 (P<0 .0 1)。浸润深度较深的胃癌患者平均年龄大于浸润深度较浅的患者 (P=0 .0 0 3 ) ,分化差的患者平均年龄低于分化好的患者 (P<0 .0 0 0 1)。女性患者的肿瘤相当一部分位于胃的近端 ,男性则以位于胃的远端为多见 (P<0 .0 0 1) ;女性患者肿瘤分化差的比例高于男性 (P<0 .0 0 1) ,淋巴结转移率 >3 0 %以上者也比男性高 (P=0 .0 1)。多因素线性多元回归分析发现 ,肿瘤部位 (P=0 .0 0 3 )、直径 (P<0 .0 0 0 1)、浸润深度 (P<0 .0 0 0 1)及分化程度 (P<0 .0 0 1)与淋巴结转移密切相关 ,女性患者较男性更易发生淋巴结转移 (P<0 .0 0 1) ,其中决定淋巴结转移最重要的因素是肿瘤浸润胃壁的深度。全胃切除术清扫的淋巴结数最多 ,其次为远端胃大部切除术 ;术后并发症发生率最高的手术是经腹近端胃大部切除术 (17% )。结论　为降低术后复发 ,对各期胃癌手术时均应进行淋巴结的清扫     

Controversies and Challenging Therapeutic Modalities in Gastric Cancer

Gastric cancer is still the fourth common neoplasm worldwide. Gastric ulcers, adenomatous polyps, and intestinal metaplasia have been associated with an increased relative risk. Tissue diagnosis and anatomic localization of the primary tumor are best obtained by upper gastrointestinal endoscopy. Despite new screening techniques peritoneal tumor spread and occult liver and lymph node metastases are only detected intra-operatively. Therapy is becoming more and more complex comprising surgical resection, investigational neoadjuvant, adjuvant or palliative chemotherapy, or supportive care. Complete surgical eradication of a tumor with resection of adjacent lymph nodes represents the best chance for long-term survival. The choice of operation depends upon the location of the tumor, the clinical stage, and the histologic type. Chemotherapy can provide symptom palliation, improve quality of life, and prolong survival in patients with advanced gastric cancer. Preoperative radiation therapy may allow for tumor downstaging and reduced probability of residual microscopic disease at surgery.     

胄窦癌对空腹血清胆囊收缩素的影响

为探讨胃窦癌对胆囊收缩功能的影响,用放射免疫法测定了49例病人(对照组12例、胃窦癌组37例)空腹血清中的胆囊收缩素水平。结果:胃窦癌组(110.26±132.50pmol/L)明显低于对照组(345.37±77.40pmol/L),P<0.01。提示胃寞癌对胆囊排空功能有明显影响。     

青年女性胃癌的临床病理分析

目的:分析青年女性胃癌的临床及病理特点。方法:1984～1995年我科收治胃癌病人1586例,内有≤40岁的女性胃癌病人75例,本文分析其临床症状、病理类型、分期、手术和5年生存率。结果:青年女性胃癌好发于胃窦部(51/75,68.0%);以低分化腺癌、印戒细胞癌为多见,分别占31.7%(19/60)和61.6%(37/60);病期晚,Ⅳ期占40.0%;5年生存率为30.7%,显著低于大组病例的43.5%。与肿瘤大小、病理类型、淋巴结转移、TNM分期等因素相关。结论:早期诊断、早期治疗是提高青年女性胃癌预后的关键,综合治疗是其主要治疗手段。     

Perforated Gastric Cancer Complicating Early Postpartum Period of Pregnancy

Background: An unique association of gastric cancer with pregnancy and puerperium is rare. Case: A 29-year-old woman had complained of epigastric pain, postprandial vomiting and weight loss during the last 3 months of pregnancy. She first applied to our centre for premature rupture of membranes at the 38^th week of gestation and underwent an emergency caesarean section because of umblical cord prolapsus. The patient developed generalised abdominal pain, distention and fever on the 2^nd postpartum day. She was operated on due to acute abdomen. During surgery, generalised peritonitis with a gastric ulcer perforation at the corpus was found. The perforation area was repaired primarily. Pathological examination revealed gastric adenocarcinoma. Definitive surgery was carried out 2 weeks later. The patient received 6 cycles of adjuvant chemotherapy. After completing chemotherapy the patient was re-explored because of developing intestinal obstruction. In surgical exploration, a disseminated peritonitis carcinomatosa and extensive adhesions were observed and the patient was therefore evaluated as incurable. Postoperatively, the patient developed a high output intestinal fistula which could not be treated with palliative care. The patient died 6 months after initial diagnosis of gastric cancer.

Conclusion: When peritonitis symptoms exist in a postpartum woman in addition to other peritonitis causes, malignant gastro-intestinal perforations such as gastric cancer perforation should be kept in mind.     

抑癌基因Lumican在胃癌中的表达及其临床意义

目的探讨抑癌基因Lumican mRNA在胃癌组织中的表达及其在胃癌发生、发展中的意义。方法采用逆转录聚合酶链反应(RT-PCR)方法检测66例胃癌组织及其相应的近癌旁组织及正常组织中LumicanmRNA的表达,并分析胃癌组织中Lumican mRNA表达与其临床病理特征的关系。结果Lumican mRNA在胃癌组织、近癌旁组织及正常组织中的表达缺失率分别为42.4%(28/66)、15.2%(10/66)及0(0/66)。有淋巴结转移者胃癌组织中Lumican mRNA表达缺失率(61.1%)明显高于无淋巴结转移者(20.0%),差异有统计学意义(χ2=11.323,P=0.001);晚期(Ⅲ、Ⅳ期)胃癌组织中Lumican mRNA表达缺失率(61.5%)明显高于早期(Ⅰ、Ⅱ期,30.0%),差异有统计学意义(χ2=6.417,P=0.011;胃癌组织中Lumican mRNA表达缺失与肿瘤分化程度无关(χ2=1.576,P=0.455)。结论Lumican mRNA表达缺失可能在胃癌的发生和发展过程中起重要作用,并影响其预后。     

RhoA和Snail的表达与胃癌生物学行为的关系

目的检测RhoA和Snail在胃癌组织中的表达,以探讨它们与胃癌生物学行为的关系。方法采用免疫组织化学方法检测189例胃癌患者术后石蜡标本中RhoA和Snail蛋白的表达,分析它们的相关性以及与胃癌临床病理学特征和生存的关系。结果①RhoA和Snail在胃癌组织中的表达阳性率均分别明显高于其在癌旁组织（RhoA：P=0.008;Snail：P=0.000）和正常胃黏膜组织（RhoA：P=0.010;Snail：P=0.000）中的表达阳性率;RhoA在癌旁组织中的表达与其在正常胃黏膜组织中的表达差异无统计学意义（P=0.782）,而Snail在癌旁组织中的表达明显高于其在正常胃黏膜组织中的表达,差异有统计学意义（P=0.001）。②RhoA在胃癌组织中的阳性表达与胃癌的TNM分期和Lauren分型有关（P〈0.05）,而与胃癌的肿瘤直径、有无淋巴结转移及分化程度无关（P〉0.05）。Snail在胃癌组织中的阳性表达与胃癌肿瘤直径、有无淋巴结转移、分化程度、TNM分期及Lauren分型均有关（P〈0.05）。RhoA和Snail在胃癌组织中的阳性表达均与患者的性别和年龄无关（P〉0.05）。③胃癌组织中RhoA蛋白和Snail蛋白的表达呈显著正相关（rs=0.203,P=0.005）。④肿瘤TNM分期、RhoA及Snail表达和淋巴结转移均为胃癌术后患者的独立预后因素（P〈0.05）。结论 RhoA和Snail在胃癌组织中表达上调,它们可能共同参与了胃癌的发生、发展过程,且RhoA/Snail信号途径可能在胃癌的浸润和转移过程中发挥着重要作用。     

肿瘤抑制基因甲基化与胃癌

目的 探讨肿瘤抑制基因甲基化与胃癌的关系。方法 对近年来关于肿瘤抑制基因甲基化与胃癌关系的文献进行综述分析。结果 胃癌中，细胞周期调控基因、有丝分裂检测点基因、凋亡相关基因、错配修复基因、转移相关基因等多种肿瘤抑制基因发生甲基化而失活。结论 肿瘤抑制基因甲基化在胃癌的发生、发展过程中起重要作用，肿瘤抑制基因的甲基化有可能成为胃癌诊断、判断转移和评价预后的分子标记物，去甲基化干预有望成为胃癌治疗的新方法。     

Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

Objective  The purpose of this study was to evaluate the safety and value of laparoscopy-assisted distal gastrectomy (LADG) for early stage gastric cancer (stages IA, IB, and II). Materials and Methods  We retrospectively assessed 101 cases treated by LADG and compared to 49 contemporaneous cases treated by open distal gastrectomy (DG) between 2001 and 2006. Clinical variables, such as tumor diameter, operation time, blood loss, number of lymph nodes dissected, and length of stay were investigated. Results  Tumor size (mm) was significantly smaller in the LADG group (p < 0.0001). Although operation time (min) in the two groups was similar (278 ± 57 vs. 268 ± 55), mean blood loss was significantly higher in the DG group (139 ± 181 vs. 460 ± 301, p < 0.0001). Fewer lymph nodes were harvested in the LADG group (27 ± 14 vs. 34 ± 19, p = 0.012). Hospital stay was longer in the DG group (13.3 ± 8.5 vs. 16.7 ± 10.5, p = 0.034). There was no mortality in either group. Postoperative surgical complications occurred in six (6%) of the LADG and four (8%) of the DG. Conclusions  The authors conclude that laparoscopy-assisted distal gastrectomy is a safe and useful operation for early-stage gastric cancers. If patients are selected properly, laparoscopy-assisted distal gastrectomy can be a curative and minimally invasive treatment for gastric cancer. Presented at The Forty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington DC, May 19–24, 2007.     

HG-1/IL-2基因修饰瘤苗治疗晚期胃癌的初步临床研究(附8例报告)

目的 :评估同种异型 (HLA A2 +)IL 2基因工程化人胃癌细胞瘤苗 (HG 1/IL 2 )治疗晚期胃癌的毒副作用及临床安全性。方法 :应用基因工程技术 ,以逆转录病毒载体介导将人IL 2cDNA转导入人胃癌细胞株MKN 45 ,经10 0Gy60Co照射灭活后 ,制备成基因工程化胃癌细胞瘤苗 (HG 1/IL 2 )。 2 0 0 1年 4月～ 2 0 0 1年 7月 ,对 8例晚期胃癌病人施行HG 1/IL 2瘤苗治疗。以 5次接种为一疗程 ,接种时间分别在第 1、8、15、2 9和第 5 8天 ,每次于一侧腹股沟和对侧腋部皮下多点注射 1× 10 7个细胞。每次接种后严格观察毒副反应 ,并在治疗开始前一周和治疗结束后进行临床评估 ,同时进行凝血功能、血液生化学、肿瘤标记物及相关免疫指标检测。结果 :除 1例在第 3次接种后 ,因高热和全身性荨麻疹而终止试验外 ,余均顺利完成治疗。接种后低热和注射局部红肿、酸胀感是最常见的反应。治疗前后未观察到病人血液学、凝血功能、肝肾功能、血清标志物等指标的明显异常。部分病人治疗后血清转铁蛋白、IgG、IgA、IgM、IL 2等体液免疫指标和CD3 、CD4 、CD8等细胞免疫指标有一定程度升高。结论 :在密切观察的前提下 ,HG 1/IL 2基因工程化胃癌细胞瘤苗应用于晚期胃癌的辅助治疗是安全可行的     

胃癌术中盆腹膜取材检测微转移及其临床意义评估

目的采用胃癌术中直肠子宫（膀胱）陷窝腹膜活检并应用CEA、CK-20免疫组织化学染色的方法确定胃癌腹膜远处的微转移。方法2004年6月至2006年3月期间，选择南京市鼓楼医院40例术前物理学检查和影像学检查未能发现，术中无肉眼及用手可触及的腹膜远处转移的胃癌病例，行术中直肠子宫（膀胱）陷窝腹膜活检并行HE常规染色和CEA、CK-20免疫组织化学染色检查有无腹膜远处微转移。结果本组40例胃癌患者中有10例发生直肠子宫（膀胱）陷窝腹膜的微转移，均发生在肿瘤侵及胃壁全层或浆膜外者[27．8％（10／36）]，其微转移发生率明显高于肿瘤未侵及胃壁全层或浆膜外者[0（0／4）]，P〈0．05。10例中8例淋巴结转移数目均超过6枚，另外2例淋巴结转移数目均为1枚；转移淋巴结数≥7枚时的腹膜微转移发生率[44．4％（8／18）]明显高于转移淋巴结数〈7枚者[16．7％（2／12）]，P〈0．05。10例中，有8例为低分化腺癌，2例为中分化腺癌。结论侵及浆膜或浆膜外的胃癌病例，即使在术前检查或术中探查时未发现远处腹膜转移，术中仍可行直肠子宫（膀胱）陷窝腹膜活检，以发现有无远处腹膜的微转移，为胃癌分期、腹腔内辅助化疗及预测预后提供证据。     

进展期胃癌MRI影像分析

目的总结分析进展期胃癌MRI影像特点,以进一步提高其影像诊断水平。方法回顾性分析8例志愿者和30例经手术切除病理检查证实的进展期胃癌患者的MRI平扫及动态增强扫描图像。结果进展期胃癌胃壁呈不均匀增厚,T1WI呈等或稍低信号,T2WI多呈等或稍高信号,累及浆膜者浆膜面模糊、毛糙,部分于T1WI反相位可见病灶处胃壁与胃周脂肪间低信号带中断,侵及邻近器官者胃周脂肪间隙模糊、消失;动态增强扫描病灶呈明显强化,表现为不规则强化和分层强化两种类型。结论当胃壁不均匀增厚并信号异常,胃周脂肪间隙模糊、消失,增强扫描出现不规则强化或分层强化时对进展期胃癌临床诊断具有较大的参考价值。