Laparoscopy alone is superior to peritoneal cytology in staging gastric and esophageal carcinoma

Background Laparoscopy identifies metastatic disease in patients with upper gastrointestinal malignancies; however, it has been suggested that cytological examination of peritoneal washings may increase the diagnostic yield. We hypothesize that the addition of cytologic washings to a standardized staging laparoscopy is unnecessary for the identification of intraabdominal metastasis in patients with gastric/esophageal cancer.Methods Forty patients with gastric/esophageal cancer were prospectively evaluated. Patients successfully underwent a diagnostic laparoscopy protocol (with biopsies) during which peritoneal washings were obtained and processed for cytologic analysis. Laparoscopic versus cytologic identification of intraabdominal metastasis were compared.Results Forty patients successfully completed laparoscopy with collection of peritoneal washings. Laparoscopic examination of the peritoneal cavity upstaged 21 (52.5%) patients. Laparoscopic examination consistently identified a statistically significant higher number of positive patients than cytologic examination of peritoneal washings (p = 0.001) and examination of cytologic washings alone failed to identify 45% of patients with positive findings and laparoscopy. The addition of cytologic examination added no additional stage IV patients to the laparoscopy-negative group.Conclusion A standardized laparoscopic examination alone is sufficient for the identification of intraabdominal metastatic disease in patients with gastric and esophageal cancer.Paper presented at the ninth World Congress of Endoscopic Surgery/Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Los Angeles, CA, USA, March 2003     

腹膜乳斑在胃癌腹膜播散过程中的作用

目的　研究胃癌腹膜播散过程中腹膜乳斑的作用。方法　在 3组实验动物中 ,分别向大鼠腹腔内接种经 5 溴脱氧尿苷 ( 5 bromodeoxyurdine ,5 BrdU)标记的Sy86B裸鼠可移植性人胃癌细胞 ,每毫升数量分别为 1× 1 0 5 个、1× 1 0 6 个和 1× 1 0 7个。应用免疫组织化学染色 ,观察癌细胞的分布。计数网膜乳斑或非乳斑区标记细胞的数量 ,确定癌细胞的分布。结果　在乳斑或非乳斑区平均标记细胞数 3组的比率分别是 1 63∶1 ( 1× 1 0 5 个 /ml组 )、2 80∶1 ( 1× 1 0 6 个 /ml组 )和 697∶1 ( 1× 1 0 7个/ml组 )。在乳斑或非乳斑区标记细胞数比较差异有非常显著性 (P <0 .0 1 )。结论　标记细胞选择性地侵入网膜乳斑。在胃癌腹膜播散的早期 ,癌细胞具有特异地侵入腹膜乳斑的特性     

Long-term survival after sequential chemotherapy and surgery for advanced gastric cancer

INTRODUCTIONWe experienced a case with long relapse-free survival after successful treatment of chemotherapy and surgery to advanced gastric cancer.PRESENTATION OF CASEA 56-year-old man was examined because of rapid weight loss and was diagnosed as having far-advanced gastric cancer with portal vein tumor thrombus (PVTT) and liver, lymph node and peritoneal metastases. Immediately after beginning chemotherapy, gastric obstruction due to gastric cancer was discovered. Therefore gastrojejunostomy, a bypass operation, was performed, and this was followed by the first course chemotherapy with S-1 and cisplatin. After 4 courses of this regimen were completed, PVTT and the peritoneal metastasis could no longer be confirmed, and new lesion had not appeared; therefore, the patient underwent a radical operation with distal gastrectomy, lymph node dissection and partial hepatectomy. After the operation, he received second-line chemotherapy with S-1 and paclitaxel for 1 year. He has been in good health without any signs of recurrence for 3 years and 8 months after the radical operation.DISCUSSION AND CONCLUSIONAlthough complete recovery from far-advanced gastric cancer is rarely expected, this case demonstrates that long-term survival is achievable with carefully considered treatment plans.     

In advanced gastric cancer:Prognosis and treatment of patients with positive peritoneal cytology

Positive peritoneal cytology in gastric cancer is classified as M1 disease by the 7thEdition of American Joint Committee on Cancer staging system.With the introduction of laparoscopy and peritoneal washing cytology in the staging of gastric cancer a new category of patients has been identified.These are patients with no macroscopic peritoneal metastases but with peritoneal cytology positive(P0C1).Prognosis and treatment of such patientsrepresent a controversial issue.We evaluate the state of the art of staging system in gastric cancer and discusss tandardisation in staging and treatment procedures.There is still a lack of uniformity in the use of laparoscopy with peritoneal cytology in clinical decision making and in the surgical treatment for gastric cancer.Survival of this patient subset remains poor.Multimodal therapies and new therapeutic strategies are required to improve the survival of these patients.     

胃癌腹膜种植瘤动物模型的构建

目的建立稳定实用的人胃癌鼠腹膜种植瘤模型。方法通过对裸鼠和SCID鼠腹腔注射胃癌细胞株AGS、NCI—N87和SNUl6构建腹膜种植瘤模型,比较不同细胞株模型成功率和生存期的差异。结果裸鼠腹腔种植5×106个AGS、NCI—N87和SNUl6细胞腹膜瘤形成率分别是（3／8、6／8和2／8;SCID鼠腹腔种植5×106个AGS、NCI—N87和SNUl6细胞,腹膜瘤形成率分别是0／6、6／6和6／6。SCID鼠腹膜瘤模型中位生存期：NCI—N87细胞组（10x10。）为74d;SNUl6细胞3个不同剂量组（10×106、20×106和40×106）分别为95、78和44d。结论SCID鼠腹腔种植（20—40）×106个SNUl6细胞可以构建稳定实用的胃癌腹膜种植瘤模型。     

The significance of MMP-1 and MMP-2 in peritoneal disseminated metastasis of gastric cancer

The purpose of this study was to clarify the role of the matrix metalloproteinases (MMPs), collagenase (MMP-1), and gelatinase A (MMP-2), both of which are known to be involved in the development of gastric cancer, in peritoneal dissemination. The concentrations of MMP-1 and MMP-2 in the supernatant of mixed culture simulated peritoneal dissemination were measured in vitro with mesothelial cells and cancer cells using an enzyme-linked immunosorbent assay. The concentration of MMP-1 increased significantly after the contact culture was mixed with these two cells, in comparison with the non-contact mixed culture or the mesothelial cell culture alone. These results demonstrate that the production of MMP-1 derived from mesothelial cells was increased by contact with cancer cells. To clarify the effect of MMP-1 and MMP-2 on gastric cancer invasion, an invasion assay using matrigel was performed. After treatment with anti-MMP-1 monoclonal antibody (mAb) or anti-MMP-2 mAb, the number of matrigel-penetrating cancer cells was significantly reduced, indicating that MMP-1 and MMP-2 derived from mesothelial cells had a strong reaction to gastric cancer invasion. In conclusion, as MMP-1 showed a paracrine-like action responding to stimulus from cancer cells, it seemed to play an important role in the progression of peritoneal dissemination. Received: January 14, 1999 / Accepted: January 7, 2000     

Clinical and diagnostic significance of preoperative computed tomography findings of ascites in patients with advanced gastric cancer

BACKGROUND: The relationship between ascites, as detected by preoperative computed tomography (CT), and peritoneal metastasis of gastric cancer requires clarification because of its likely significance for clinical outcome. METHODS: A retrospective analysis of 293 patients with advanced gastric cancer investigated the association between preoperative CT findings of ascites and surgical findings of peritoneal washing cytology and peritoneal metastasis. RESULTS: Forty-five of 293 patients (15%) presented with ascites on preoperative CT. Positive ascites on CT predicted the presence of free tumor cells with 40% sensitivity and 97% specificity, and peritoneal metastasis with 51% sensitivity and 97% specificity. Ascites on CT was an independent prognostic factor by univariate (P < .001) and multivariate (relative risk, 2.03; 95% confidence interval, 1.39-2.96; P < .001) analyses. The median survival time was 6.0 months in patients with positive ascites on CT. CONCLUSIONS: The presence of ascites on CT suggests the presence of peritoneal metastasis and indicates a poor prognosis. The presence of peritoneal metastasis should be confirmed by diagnostic laparoscopy in gastric cancer patients with ascites.     

胃癌腹膜转移手术治疗的探讨

目的 研究胃癌远处腹膜转移肿瘤姑息性切除的可行性问题。方法 1994年9月至2004年9月共实施胃癌腹膜转移手术治疗44例，将其分为两组，胃癌姑息切除组29例，其中远处腹膜少处转移（P2）20例，远处腹膜多处转移（P3）9例；胃癌未切除组15例，其中P24例，P311例，探讨胃癌伴腹膜转移病人的存活率和影响存活率的因素。结果 胃癌姑息切除组和未切除组的存活率差异有显著性（P=0．004），胃癌站息切除组的中位生存时间为13．6个月，而未切除组的中位生存时间为4．5个月；胃癌切除组和非切除组内P2、P3组之间的存活率差异无显著性。结论 腹膜转移的程度不是判断是否手术的标准，手术切除肿瘤病灶能提高P2和P3病人的存活率。     

Acute acalculous cholecystitis caused by gallbladder metastasis due to the peritoneal dissemination of gastric cancer: A case report

Introduction and importanceAcute acalculous cholecystitis (AAC) is associated with a high mortality rate. AAC caused by metastasis to the gallbladder is rare. We report a case of AAC caused by gallbladder metastasis due to the peritoneal dissemination of gastric cancer.Case presentationAn 84-year-old male visited our hospital because of epigastric pain. Ultrasonography and computed tomography revealed swelling and thickening of the gallbladder wall, but stones were not observed in the gallbladder. We performed emergency surgery with a diagnosis of acute cholecystitis. Laparoscopy revealed the presence of many nodules around the abdominal cavity including the hepatoduodenal ligament. Inflammation of Calot’s triangle was severe, so we performed subtotal cholecystectomy. We also resected one of the peritoneal nodules. Macroscopically, there were no stones in the gallbladder and histopathological examination revealed acute cholecystitis and existence of adenocarcinoma involving the subserosa of the gallbladder wall and the resected peritoneal nodule. After surgery, esophagogastroduodenoscopy revealed Borrmann type II lesions at the antrum and gastric biopsy showed adenocarcinoma. He was diagnosed with advanced gastric cancer with peritoneal dissemination. His postoperative course was good.Clinical discussionThe cases of AAC caused by gallbladder metastasis have been little reported in the literature. This case is advanced gastric cancer with peritoneal dissemination and AAC was thought to be caused by peritoneal dissemination from operative and histopathological findings. We successfully treated this rare case of AAC with laparoscopic surgery.ConclusionAlthough metastasis to the gallbladder is rare, it is necessary to be aware of this possibility when treating AAC.     

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目的 研究^131I-3H11对裸鼠的胃癌腹膜亚临床种植灶形成的抑制作用。方法 裸鼠腹腔内接种胃癌细胞后分组，按不同时间分别腹腔内给予^131I-3H11,5-FU、顺铂、阿霉素、^131I-NMIgG和生理盐水。结果 RIT（导向治疗）组动物生存期延长，腹膜种植瘤的发生率低于非RIT组。结论 ^131I-3H11可有效地杀伤胃癌亚临床腹腔内病灶，起到了防治裸鼠胃癌腹膜种植瘤发生的作用，在临床应用时，术后24h开始腹腔局部应用较合理。     

Is palliative resection necessary for gastric carcinoma patients?

Background and aims The benefit of palliative resection for gastric carcinoma patients remains controversial. We thus evaluated the survival benefit of palliative resection in advanced gastric carcinoma patients. Materials and methods We reviewed the hospital records of 466 gastric carcinoma patients who had palliative resection and compared the clinicopathologic findings to those of patients who underwent a bypass or exploration from 1986 to 2000. Results Cox’s proportional hazard regression model revealed only one independent statistically significant prognostic parameter, the presence of peritoneal dissemination (risk ratio, 0.739; 95% confidence interval, 0.564–0.967; P < 0.05). The 5-year survival rate of patients who had palliative resection was higher than that of patients who did not (7.03 vs 0%, P < 0.001). When the 5-year survival rates of patients with peritoneal dissemination were examined, the rate was higher for those who underwent resection (4.43 vs 0%, P < 0.001). Conclusion The results highlight the improved survivorship of gastric carcinoma patients with palliative resection compared to those who did not undergo the procedure. Although curative resection is not possible in this group of patients, we recommend performing resection aimed at palliation.     

术中腹腔内温热化疗对进展期胃癌的临床疗效研究

目的 探讨术中腹腔内温热化疗（IPHC）治疗进展期胃癌的临床疗效。方法 1998年至2001年手术切除的T3、T4胃癌118例。将无腹膜转移的96例作为预防性研究组，其中42例行IPHC，54例单纯手术作对照，随访观察术后生存情况和IPHC对腹膜复发的预防作用；将有腹膜转移的22例作为治疗性研究组，其中10例行IPHC，12例作对照，观察术后生存期。同时对全组IPHC（52例）和单纯手术者（66例）进行总的生存分析比较。结果 预防性研究组中，IPHC者术后1、2、4年生存率为85．7％、81．0％和63．9％，优于单纯手术者（77．3％、61．0％和50．8％）。C0x模型提示，IPHC是T3、T4胃癌的独立预后因素；术后腹膜复发率10．3％，低于单纯手术者的34．7％。治疗性研究组中，IPHC者术后生存时间（中位生存期10个月）较单纯手术者（中位生存期5个月）长。全组IPHC病例总的术后1、2、4年生存率（76．9％、69．2％和55．2％）高于单纯手术的病例（66．2％、49．7％和41．4％）。结论 IPHC可提高B、L胃癌患者的生存率，延长生存期。     

胃癌腹膜转移病人腹腔化疗港并发症发生及危险因素分析

目的:分析腹腔化疗港并发症发生及相关危险因素.方法:回顾性分析我院323例放置腹腔化疗港病人的临床资料,纳人261例胃癌腹膜转移病人.分析腹腔化疗港在胃癌腹膜转移病人腹腔化疗时发生的并发症及其危险因素.结果:261例中59例(22.6％)发生化疗港相关并发症.其中,皮下积液(25例,42.4％)和化疗港感染(16例,2...     

腹腔镜检查结合RT-PCR在胃癌诊疗中的临床意义

目的：探讨进展期胃癌术前腹腔镜检查与RT—PCR检测腹腔灌洗液中游离癌细胞CEAmRNA的表达水平,在胃癌患者术后微转移及预后的临床意义。方法：对22例进展期胃癌患者术前行腹腔镜探查,灭菌生理盐水冲洗腹腔4～5次,收集脱落细胞．进行细胞学检查和RT—PCR检测CEAmRNA表达水平。结果：22例胃癌患者中,细胞形态学捡测31．8％（7／22）阳性,RT—PCR捡测54．5％（12／22）CEAmRNA阳性表达,二者阳性率有显著性差异（P〈0．05）。结论：诊断性腹腔镜检查、RT—PCR与PLC有效结合,可提高腹腔转移复发诊断的灵敏性和特异性,有助于对胃癌分期、淋巴转移和预后的综合判断,对胃癌的辅助治疗提供依据。     

EB病毒阳性的胃癌与伴有淋巴样间质的胃癌——诊断及分子检测进展

EB病毒阳性的胃癌与伴有淋巴样间质的胃癌均属于胃癌特殊病理亚型。其组织学形态、免疫学与遗传学特征存在部分重叠,却不完全相同。因此,这一组肿瘤不仅引起病理医师诊断上的困惑,同时也不利于临床治疗及后续研究。本文对这两种肿瘤以及与之相近诊断术语作详细介绍及对比,探讨其临床病理特征、遗传学改变、分子检测及治疗进展,并归纳总结现存争议及未来研究方向。     

Double contrast-enhanced ultrasonography for the preoperative evaluation of gastric cancer: a comparison to endoscopic ultrasonography with respect to histopathology

Background

This study was designed to compare the accuracy of endoscopic ultrasound (EUS) with double contrast–enhanced ultrasound (DCUS) in the staging of gastric malignancies. DCUS is a transabdominal ultrasound technique using both intravenous and intraluminal contrast to enhance sonographic visualization.

Methods

This retrospective study included 162 patients with biopsy-proven gastric cancer who underwent DCUS and EUS preoperatively with the ultrasound results compared with the pathologic findings of the resected specimens.

Results

The overall accuracy of DCUS and EUS for tumor (T) staging was 77.2% and 74.7%, respectively_. Comparison of ultrasound techniques for T staging revealed that DCUS was superior to EUS only for a tumor depth of T3 (chi-square, P = .025). Lymph nodes were staged correctly with DCUS and EUS in 78.4% and 57.4% of cases, respectively (chi-square, P = .001).

Conclusions

DCUS offers a noninvasive approach for the staging of gastric cancer. DCUS was comparable to EUS in tumor depth evaluation but offered an advantage in lymph node detection.     

Postoperative long term chemotherapy for advanced gastric cancer

A postoperative long term chemotherapy was carried out against stage IV gastric cancer with Mitomycin-C, Futraful and a plant polysaccharide, PS-K. The 2-year survival rate was 15 per cent in patients who received an intraoperative Mitomycin-C alone, while it increased to 34 per cent in those receiving the anticancer agents for a prolonged period. The postoperative long term chemotherapy is assumed to be an effective means of improving the therapeutical results of gastric cancer.     

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目的 探讨胃癌腹膜转移的临床病理特点以提供术前诊断的依据，并评估手术治疗的结果。方法 回顾性分析57例胃癌腹膜转移病人的临床病理特点和生存情况。结果 57例胃癌腹膜转移病人中，女性年龄小于男性(50％vs22．58％，P＜0．05)，而且其手术切除率明显低于男性(39．13％vs67．85％，P＜0．05)。51例手术病人中，35．29％(18／51)出现腹水，17.65％(9／51)直肠指检发现肿块。生存分析表明姑息切除病人的生存时间明显长于未切除者(P＜0．001)，Cox回归分析显示手术切除是影响预后的唯一因素(相对危险度0．261)，但腹膜转移为P3时手术切除季明显下降(P＜0．001)。结论 腹水和直肠指检发现肿块是胃癌腹膜转移的常见临床表现，其中女性病人年龄偏小且手术切除可能性也较小。如果可能应行姑息切除手术，但腹膜转移为P3时应慎重。     

新辅助化疗在腹腔镜手术治疗进展期胃癌中的应用

目的探讨进展期胃癌在新辅助化疗后施行腹腔镜手术治疗的有效性。方法选择2005年6月至2007年3月间经病理确诊的45例进展期胃腺癌（Ⅱ、Ⅲ、Ⅳ期M0）患者,其中15例根据本人意愿和经济承受能力先用FOLFOX7方案进行新辅助化疗后予以手术（试验组）;另外30例直接行手术治疗作为对照。比较试验组患者新辅化疗后胃癌分期的变化、两组施行腹腔镜手术情况及术后病理结果的差异。结果试验组患者均顺利完成了4个周期的化疗,2例完全缓解,10例部分缓解,3例无变化;无Ⅲ级以上的不良反应发生。试验组66．7％的患者施行了腹腔镜手术,与对照组（33．3％）比较,差异有统计学意义（X^2=4．5,P=0．030）。试验组R0切除率（80．0％）和pN0比例（60．0％）明显高于对照组（46．7％和20．0％）（P〈0．05和P〈0．01）;试验组清扫淋巴结阳性率11．0％,明显低于对照组的23．8％（P〈0．01）。两组患者手术时间和术后并发症发生率比较,差异无统计学意义（P〉0．05）。结论进展期胃癌行新辅助化疗后能明显降低肿瘤的临床分期,增加R0切除的比例,缩小肿瘤的浸润范围,减少淋巴结的转移,提高使用腹腔镜进行微创手术的机会。     

进展期胃癌术前靶向磁化疗的临床研究

目的观察进展期胃癌术前应用抗癌药物阿霉素磁液联合外磁场靶向磁化疗的临床及病理组织学疗效 .方法进展期胃癌 145例分为靶向磁化疗组 (75例 ),非靶向化疗组 (40例 )及单纯手术组 (30例 ),观察治疗后各组患者临床症状、肿瘤手术切除率、生存率以及肿瘤标本的病理组织学改变 .结果靶向磁化疗组可明显改善患者症状 ,增加肿瘤及区域淋巴结中抗癌药物浓度及持续时间 ,肿瘤手术切除率为 77 3% ,再次手术切除率达 15 0% ,肿瘤及转移淋巴结病理组织学疗效分别达 78 3%和 57 5% ,术后短期生存率有所提高 .结论进展期胃癌术前应用阿霉素磁液联合磁场的靶向磁化疗具有一定的临床意义 .