Fertility sparing surgery for early-stage clear cell carcinoma of the ovary; A systematic review and analysis of obstetric outcomes

Clear cell carcinoma of the ovary (CCOC), accounts for 5–25% of epithelial ovarian cancer (EOC) cases. A significant proportion of patients with CCOC are of reproductive age, wishing to preserve their fertility. The application of fertility sparing surgery (FSS) in those patients has been extensively criticized, due to the high reported recurrence rates and chemotherapy resistance. The aim of the present study was to accumulate the current knowledge on obstetric and fertility outcomes of patients with early stage CCOC who underwent fertility sparing surgery.A meticulous search of 3 electronic databases was conducted for articles published up to June 2020 relevant in the field using the terms “ovarian cancer”, “clear cell”, “fertility sparing”, “conservative treatment”. Studies that reported pregnancy and maternal outcomes after fertility sparing surgery for the management of early stage CCOC were considered eligible.A total of 5 studies which comprised of 60 patients with early stage CCOC, who underwent fertility-sparing surgery, were reviewed. Ten patients (16.6%) had disease recurrence. The total clinical pregnancy rate of 32% with a proportion of 24% of live birth rates in 12 of the included patients. The median interval from surgery to pregnancy was 41.5 months, while no evidence of disease was recorded among the patients who achieved pregnancy. No difference in survival and recurrence rates among patients who underwent fertility-sparing surgery and those who had radical surgical procedures.Fertility-sparing treatment for International Federation of Gynaecology and Obstetrics (FIGO) Stage IA/IC CCOC seems to be an acceptable treatment option for selected premenopausal women who strongly wish to preserve their childbearing potential. However, larger studies are needed to validate the safety of the procedure.     

Exploratory thoracotomy on a patient with previous malignancy—“metastasis” or “new primary” or “unrelated lesion”

Surgical resection of a solitary pulmonary metastasis is an established procedure. A medical generation ago when such a shadow appeared on chest roentgenogram of a patient who had known cancer elsewhere in body, it was assumed to be “metastasis” from an extrathoracic site. With increasing advances in knowledge, the occurrence of second primary or new lesion is now no more curiosity in clinical practice. To one's surprise, the lesions that are assumed to be metastatic have often turned out to be “fresh” lesion or even unrelated benign, granulomatous, inflammatory, or parasitic lesion. This paper analyses 66 patients during a period of 20 years who underwent thoracotomy for such solitary pulmonary lesions, and emphasizes the role of diagnostic-cum-therapeutic-thoracotomy in such a clinical situation where in prethoracotomy tissue diagnosis is not forthcoming.     

CT检查在胃癌诊疗中的价值(附126例分析)

目的：研究ＣＴ检查在胃癌诊疗中的价值。方法：对１２６例胃癌患者进行了术前低张水充盈ＣＴ动态扫描，并和手术标本、术后病理检查对照研究。结果：胃癌术前ＣＴ检出率１００％，分期准确率６１．９％，胃癌根治性手术切除术前ＣＴ阳性预测值９１．６％，阴性预测值７１．０％。结论：对胃癌患者术前进行动态ＣＴ检查是必要的，在范围及深度上可弥补胃镜的不足，有助于胃癌的诊断与治疗方案的确定。     

Updated evidence on endoscopic resection of early gastric cancer from Japan

Background

Endoscopic resection for early gastric cancer (EGC) plays a central role in the treatment of EGC in Japan. However, there is still room for improvement, and it is necessary to summarize the recently obtained knowledge from Japan for further improvement.

Methods

We conducted a PubMed search to select relevant articles in the 5 years until September 18, 2016, using the keywords “gastric cancer” and “endoscopic treatment,” “endoscopic submucosal dissection,” “endoscopic mucosal resection,” or “polypectomy” and filtering article types as “clinical study” or “clinical trial.”

Results

Among the 329 articles selected automatically from the keywords “polypectomy” (1 article), “endoscopic mucosal resection” (29 articles), “endoscopic submucosal dissection” (77 articles), and “endoscopic treatment” (222 articles) in combination with “gastric cancer,” 32 relevant articles from Japanese investigators were chosen. Seven articles were categorized into “equipment,” 4 into “preparation and sedation,” 17 into “complications and their prevention,” and 4 into “therapeutic outcomes.” Among them, CO₂ insufflation, propofol sedation, and how to prevent post-endoscopic submucosal dissection (ESD) ulcer bleeding and achieve post-ESD ulcer healing were intensively investigated. Long-term outcomes of endoscopic mucosal resection and ESD were also reported as favorable outcomes.

Conclusions

Endoscopic resection for EGC is still developing toward an ideal form, pursuing a more reliable, safer, and faster minimally invasive treatment.

     

54例早期胃癌术后临床病理分析

本文报告手术治疗早期胃癌54例,Ⅰ型5例;Ⅱ、Ⅲ各6例,Ⅱ19例、Ⅲ1例、Ⅱ Ⅲ1例、Ⅱ Ⅱ4例;Ⅲ型12例。54例均作R_2术式,7例有淋巴结转移,第1站转移率为12.96％,第站转移率为3.7％.随访率100％。5年生存率为94.5％,其中粘摸内癌5年生存率100％.粘膜下癌为87.5％。本文着重讨论早期胃癌诊断应重视癌前病变的纤维胃镜随访观察。对早癌的手术治疗.术前如能确定为粘膜内癌.可行R1术式。否则以R2术式为宜。     

Frontline treatment of advanced gastric cancer with docetaxel and granulocyte colony-stimulating factor (G-CSF): a phase II trial

We conducted a phase II study to evaluate the efficacy and tolerance of docetaxel monotherapy with granulocyte colony-stimulating factor (G-CSF) support in patients with advanced gastric cancer. Thirty patients with measurable advanced gastric cancer were enrolled. Twenty-four patients were chemotherapy-naive and six patients had previously received adjuvant chemotherapy after complete surgical resection. Docetaxel was administered at 100 mg/m2 IV during 1 hour every 3 weeks. G-CSF 5 microg/kg SC was also given on days 2 through 8 prophylactically to all patients. All patients were evaluable for response and toxicity. We observed one complete and five partial responses for an overall response rate of 20% (95% confidence interval: 6-34%). In addition, seven patients (23%) had stable disease. After a median follow-up time of 7 months, the median duration of response was 4.5 months, the median time of tumor progression was 6 months, and the median survival was 7 months. The estimated probability of 1-year survival was 28%. Toxicity was generally mild. Grade III/IV neutropenia occurred in 11 (36%) patients. Neutropenia with fever developed in three patients (10%). There were no toxic deaths. Docetaxel with G-CSF support is an active drug and well tolerated by patients with advanced gastric cancer. Docetaxel merits further investigation in combination with other active agents as frontline treatment in patients with advanced gastric cancer.     

Endoscopic mucosal resection for early gastric cancer.

Progress in the detection of early gastric cancer has made endoscopic mucosal resection (EMR) possible for the treatment of gastric cancer instead of only conventional surgical resection. The most commonly employed modalities include strip biopsy, double snare polypectomy, and resection with combined use of highly concentrated saline and epinephrine, and resection using a cap. The indications should be strictly limited to the differentiated IIa type (the slightly elevated type) that is smaller than 2 cm, or the differentiated IIc type (slightly depressed type) without ulcer formation and smaller than 1 cm. Both of these entities are thought to have a negligible risk of lymph node metastasis. Prognosis after this treatment is comparable that of surgical resection for early gastric cancer in completely resected cases. EMR also permits local resection in elderly patients with various complications who would be at risk for conventional surgical operations. EMR should be encouraged for treatment of gastric cancer if the indications are strictly chosen.     

Liver resection for metastatic gastric cancer: experience with 42 patients including eight long-term survivors

BACKGROUND: The indication for liver resection for gastric metastases remains controversial and few previous studies have reported the outcome of surgery in the treatment of liver metastases of gastric cancer. The aim of this study is to clarify the effectiveness of surgical resection for liver metastases arising from gastric cancer. METHODS: A retrospective analysis was performed on the outcome of 42 consecutive patients with synchronous (n = 20) or metachronous (n = 22) gastric liver metastases that were curatively resected. RESULTS: The overall 1, 3 and 5 year survival rates after hepatic resection were 76, 48 and 42%, respectively, and the median survival was 34 months. Univariate analysis revealed that survival significantly differed between cases of solitary and multiple metastases (P = 0.03). Multivariate analysis revealed that solitary liver metastasis and the absence of serosal invasion by primary gastric cancer were favorable independent prognostic factors (P = 0.005 and P = 0.02, respectively). All eight patients who survived for more than 5 years after initial hepatectomy had a solitary metastasis, and six of these had no serosal invasion by the primary gastric cancer. No patient with multiple metastatic diseases survived beyond 3 years. CONCLUSIONS: Patients with a solitary liver metastasis are good candidates for surgical resection, whereas those with multiple gastric liver metastases should be treated by multimodal approaches.     

Ⅳ期胃癌化疗后行手术治疗的临床疗效及预后影响因素分析

目的探讨Ⅳ期胃癌化疗后行手术治疗的临床疗效及其手术指征、手术时机的选择。方法回顾性分析2010年1月至2018年3月福建省肿瘤医院收治的化疗后行手术治疗(D2手术和／或扩大切除术)的40例Ⅳ期胃癌患者的临床资料,采用单因素分析及COX多因素分析法研究其预后的相关影响因素。结果40例患者中男19例,女21例;中位年龄575岁。单发转移24例,转移2个脏器14例,3个脏器2例。转移脏器包括远处淋巴结23例(575％)、腹膜17例(425％)、肝脏8例(200％)、卵巢4例(100％)、肺部1例(25％)、横结肠1例(25％)。术前中位化疗时间109(27～1 475)d,化疗后疗效评价:疾病缓解24例(600％)、疾病稳定15例(375％)、疾病进展1例(25％)。手术与首次化疗间距1315(31～1 581)d。30例行全胃切除术,10例行远端胃大部切除术。8例行16组淋巴结清扫术,12例行联合脏器切除,包括胰体尾及脾脏3例、肝转移瘤2例、附件5例、横结肠2例。其中R0切除24例,R2切除15例,R1切除1例。全组患者中位总生存时间为27个月,术前化疗时长>12周是Ⅳ期胃癌化疗后手术治疗患者预后的保护因素［OR(95％CI)=2601(1072～6313),P=0035］。结论部分经选择的Ⅳ期胃癌患者在化疗后行D2手术和(或)扩大切除术可改善预后,对化疗反应良好且能够达到R0切除是手术治疗的最重要筛选指标,手术时机建议在全身化疗12周后。     

Epirubicin, cisplatin and continuous infusion 5-fluorouracil (ECF) as neoadjuvant chemotherapy in gastro-oesophageal cancer.

High response rates have been reported in the treatment of advanced gastric cancer with epirubicin, cisplatin and continuous infusion 5-fluorouracil (ECF), including instances of unresectable disease being rendered operable by chemotherapy. We report our experience with ECF as neoadjuvant treatment in gastric and lower oesophageal carcinoma. Twenty-seven patients were treated, of whom ten (37%) had carcinoma of the stomach and 17 (63%) tumours of the lower oesophagus. Histology in the majority of cases, 21 (78%), was adenocarcinoma. Before chemotherapy ten patients (37%) had evidence of initially unresectable locally advanced disease, 16 (59%) had localised disease only and one patient (4%) had a localised primary with a single liver metastasis. Epirubicin (50 mg m(-2) i.v.) and cisplatin (60 mg m(-2) i.v.) were administered every 3 weeks for four cycles together with a continuous 12 week infusion of 5-fluorouracil (200 mg m(-2) day(-1)). Fifteen of 24 assessable patients (62%) had symptomatic improvement on chemotherapy. On combined surgical and/or radiological assessment, 15 of the 27 patients (56%) had objective evidence of tumour response. In all patients assessment for radical surgery was made following chemotherapy. Eighteen patients (67%) proceeded to operation: of these, 11 had complete resection of their disease, one had a histologically incomplete resection and six were found to have unresectable disease. No pathological complete responses were observed. Only one of the ten patients with locally advanced disease achieved complete surgical resection after chemotherapy. At a median follow-up of 36 months from date of diagnosis (range 30-47 months), 19 of the 27 patients (70%) have died. Of 11 patients who had a complete surgical resection, one died post-operatively, three have subsequently relapsed (of whom two have died) and seven remain disease free. Toxicity from treatment was mild and included emesis, myelosuppression, stomatitis and exfoliation. Myelosuppression caused modification of treatment in 14 of 108 chemotherapy cycles (13%). There was one surgical death but no chemotherapy-related deaths. These early results show encouraging symptomatic and objective responses of gastro-oesophageal carcinoma to ECF, but provide no instances of ECF achieving complete pathological response. Only randomised trials can establish the role of neoadjuvant ECF chemotherapy in both initially resectable and unresectable carcinoma of the stomach and lower oesophagus.     

The prognostic determinants of gastric cancer treatment outcome in Omani Arab patients

BACKGROUND: Gastric cancer is the most common cancer in Oman and a leading cause of cancer death. The variation in survival rates between countries and ethnic groups has been attributed to early detection policies, differences in clinicopathological features, treatment approaches, and biological characteristics. There were no previous reports on gastric cancer from Oman and very few studies on Asian Arabs. AIM: To evaluate the impact of clinicopathological and treatment variables on the survival prospects of Omani Arab patients diagnosed with gastric cancer. METHODS: The medical records of 339 Omani Arab patients diagnosed with invasive gastric adenocarcinoma during the period 1993-2004 were retrospectively reviewed. The relative importance of clinicopathological features and surgical and medical treatments were assessed using univariate and multivariate analyses. RESULTS: Most patients had distal ulcerating-type gastric cancer and presented at advanced stages. The median survival time for the entire cohort was 12 months (95% CI 9.7-14.4) with a 5-year overall survival rate of 16.7%. On univariate analysis of 237 patients who underwent surgical resection, the following positive prognostic factors emerged as significant: early overall TNM stage, early T stage, negative lymph nodes, tumor size <5 cm, ulcerating macroscopic appearance, and curative surgical attempt. The independent prognostic factors on multivariate analysis were T stage and lymph node involvement. CONCLUSION: The overall T and N stages are the most important determining factor for survival in Omani Arab patients. More efforts need to be made for the early detection of gastric cancer in developing countries such as Oman, while continuing to employ the standard surgical and medical treatments.     

Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups?

BACKGROUND: Patients who present with stage IV gastric cancer are not commonly managed with surgical resection as effective palliation can usually be accomplished with systemic chemotherapy, endoscopic stenting, or surgical bypass procedures. Given the inherent morbidity and mortality associated with gastrectomy, palliative resection for stage IV gastric cancer should be reserved for ideal surgical candidates who are most likely to benefit from the procedure. The purpose of this study is to review outcomes following resection for stage IV gastric cancer, and to identify criteria predictive of improved outcomes following gastrectomy in this setting. METHODS: A retrospective review of a prospective GI oncology database was conducted. Sixty-three patients with stage IV gastric cancer managed with surgical resection between 1989 and 2001 were identified. Variables including demographic data, patterns of distant spread (ex: peritoneal, lymphatic, hematogenous), location of tumor, and type of gastrectomy were utilized to conduct survival analyses. RESULTS: Actuarial survival for all patients at one and 3-year intervals was 52% and 12%, respectively. Improved survival was observed for patients of East Asian race (median survival 20 vs. 12 months, P < 0.05, students t-test) and age less than 60 years (median survival 15 vs. 12 months, P < 0.05). This trend was also illustrated by Kaplan-Meier survival analysis. Other variables including pattern of distant spread, location of tumor, and type of gastrectomy were not associated with a significant difference in survival. Both East Asian race and age less than 60 years were statistically significant predictors of improved survival when assessed by univariate regression analysis. When variables were analyzed in a multivariate regression analysis, Asian race and age <60 both lost their statistical significance as independent predictors of improved survival. CONCLUSIONS: Long-term survival for patients with stage IV gastric cancer who are managed with surgical resection is achievable. Patient specific variables including East Asian race and age less than 60 years appear to be associated with prolonged survival when assessed by comparison of means, Kaplan-Meier analysis, and univariate regression analysis. However, multivariate regression analysis failed to demonstrate these factors as independent predictors of improved outcome. In conclusion, highly selected acceptable risk surgical candidates with stage IV gastric cancer should be considered for management with surgical resection in clinically appropriate scenarios.     

Updated evidence on endoscopic resection of early gastric cancer from Japan

Background

Endoscopic resection for early gastric cancer (EGC) plays a central role in the treatment of EGC in Japan. However, there is still room for improvement, and it is necessary to summarize the recently obtained knowledge from Japan for further improvement.

Methods

We conducted a PubMed search to select relevant articles in the 5 years until September 18, 2016, using the keywords “gastric cancer” and “endoscopic treatment,” “endoscopic submucosal dissection,” “endoscopic mucosal resection,” or “polypectomy” and filtering article types as “clinical study” or “clinical trial.”

Results

Among the 329 articles selected automatically from the keywords “polypectomy” (1 article), “endoscopic mucosal resection” (29 articles), “endoscopic submucosal dissection” (77 articles), and “endoscopic treatment” (222 articles) in combination with “gastric cancer,” 32 relevant articles from Japanese investigators were chosen. Seven articles were categorized into “equipment,” 4 into “preparation and sedation,” 17 into “complications and their prevention,” and 4 into “therapeutic outcomes.” Among them, CO₂ insufflation, propofol sedation, and how to prevent post-endoscopic submucosal dissection (ESD) ulcer bleeding and achieve post-ESD ulcer healing were intensively investigated. Long-term outcomes of endoscopic mucosal resection and ESD were also reported as favorable outcomes.

Conclusions

Endoscopic resection for EGC is still developing toward an ideal form, pursuing a more reliable, safer, and faster minimally invasive treatment.

     

A qualitative exploration of the meaning of the term “survivor” to young women living with a history of breast cancer

There has been a recent increase in research considering the perceptions of the term “cancer survivor” held by individuals who have or have had cancer. This article explores the meaning of the term to young women living with a history of breast cancer. Twenty women participated in semi‐structured interviews about their experience of breast cancer. The methodology was informed by social constructionist grounded theory. Three of the women interviewed said they would use the term survivor to describe themselves, but most of the women felt it did not fit with their experiences. The accounts of those who accepted and rejected the survivor identity are explored, and subthemes in the latter are “survivor as somebody else” and “cancer's ongoing presence.” This article calls into question the basing of intervention strategies on the notion of the “cancer survivor,” and the assumption that younger women favour the survivor identity. Participants struggled with the demand to live up to the ideal of the survivor, which implied a high degree of agency where in reality, cancer was a disempowering experience. Being labelled a survivor obscured ongoing impacts of cancer on the young women's lives.     

Surgical treatment of gastric metastases from cutaneous melanoma: experience of the National Cancer Institute of Milan.

AIM: To evaluate the role of a surgical approach in patients affected with gastric metastases from cutaneous melanoma. METHODS: A retrospective review of our local melanoma database of 2100 patients identified 31 cases with gastric metastatic deposits. Nine of them were considered candidates for surgical resection. RESULTS: Median overall survival of the 9 patients who underwent surgery was 14.2 months. Six (67%) underwent a local radical resection of disease, and 3 (33%) had a simple exploratory laparotomy. The median survival was 21.6 months (range, 4-32 months) for the subset receiving radical surgery and 3.6 months (range, 2-6 months) for the patients who had no resection. Median follow-up was 14.2 months. No specific correlation of serologic LDH levels and final outcome, as documented elsewhere, was observed. A marked decreased or substantial remission of symptoms with an improvement in quality of life was observed in all radically resected patients. CONCLUSIONS: Patients with gastric metastases from melanoma may benefit from surgery if all macroscopic disease can be removed. In addition, gastric resection in patients with symptomatic melanoma spread to the stomach provides important symptomatic palliation.     

Laparoscopic Roux-en-Y reconstruction using conventional linear stapler in robotic total gastrectomy for gastric cancer

BackgroundRobotic stapling devices have been designed to create staple formation equivalent to conventional laparoscopic stapling. In gastric cancer surgery, however, any advantages the robotic stapler has in maneuverability compared to standard laparoscopic stapling devices remain unclear [1]. We applied robotic-assisted laparoscopic stapling techniques during reconstruction after robotic total gastrectomy (RTG) for gastric cancers (GCs) as “fusion surgery”. Here, we outline our stapling technique and retrospectively evaluate surgical outcomes of laparoscopic staplers in patients undergoing RTG for GCs.MethodsThis is a single-center retrospective analysis of prospectively collected data. We performed robotic gastrectomy (RG) for GCs on 70 patients at the Wakayama Medical University Hospital (WMUH) between May 1, 2017 and July 31, 2019. RG was adopted for all patients with GCs in whom curative gastrectomy was applicable. All operations were performed by a single surgeon (T.O.). Of our 70 consecutive patients who underwent robotic gastrectomy for GCs, 22 underwent RTG with Roux-en-Y reconstruction using laparoscopic staplers. All RTG procedures were performed using the da Vinci Surgical System. The duodenum and abdominal esophagus were transected using a 45 mm long laparoscopic linear stapler. After total gastrectomy, we performed antecolic Roux-en-Y reconstruction. Jejunojejunostomy was completed under direct vision following retrieval of the stomach. In robotic view, an intracorporeal side-to-side esophagojejunostomy was constructed using a laparoscopic linear stapler [2]. The 22 patients were followed-up for at least 3 months. Follow-up data were obtained from the hospital database, including the patient background, tumor characteristics, and surgical data. Postoperative complications higher than Clavien–Dindo grade 2 were regarded as clinically significant postoperative complications [3].ResultsThe duration of operation and reconstruction were 385 min and 81 min, respectively. The median intraoperative bleeding was 45 ml. There were no conversions to conventional laparoscopy or open surgery in all patients. Of these 22 patients, one patient had postoperative pneumonia (Grade 2) and another developed postoperative intraabdominal bleeding (Grade 3a) [3]. No anastomosis-related complications developed in all patients.ConclusionsRegarding short-term surgical outcomes, robotic-assisted laparoscopic stapling techniques for reconstruction after RTG, “fusion surgery” are both feasible and safe for GCs. This study had several limitations. It was a retrospective study. Moreover, it was conducted at a single institution and the sample size was small (n = 22).     

63例胰腺癌临床诊治分析

目的探讨胰腺癌早期诊断方法,减少误诊误治率。方法回顾分析63例胰腺癌临床诊治资料。结果63例胰腺癌中49例有误诊史,误诊率高达78%,多数误诊为胃炎、胃溃疡、胆囊炎及肝炎,仅14例初诊明确诊断。63例中外科根治性手术14例,剖腹探查、姑息性手术24例,经门诊筛查不能手术的25例内科化疗或介入治疗。3种疗法治疗后平均生存时间为:18个月、9个月、10个月。结论胰腺癌早期诊断率低,手术切除率低,B型超声显像及CT检查是诊断胰腺癌理想的无创伤检查方法,可在术前精确判断肿瘤能否被切除,减少误诊误治率。     

Surgical treatment of early gastric cancer

In Japan, R2-gastric resection which consists of gastrectomy, omentectomy and complete removal of Group 1 and 2 regional lymph nodes has been generally accepted as the procedure of choice in the treatment of early gastric cancer during the past 20 years. As a result, surgical treatment for early gastric cancer patients has achieved a very good survival rate, 97.7% and 96.2% 5 and 10 years, respectively, after surgery. To determine a new rationale for surgical treatment for early gastric cancer, the relationship between various prognostic factors and postoperative prognosis in 1,200 patients with early gastric cancer was studied. The survival rate for patients with a single focus of cancer in the stomach was significantly higher than that for patients with multiple foci. The incidence of recurrence was very low (2.8%) as a whole and most recurrence was found in patients who have had invasion into the submucosa with regional lymph node metastasis. The characteristic mode of recurrence was hematogenous metastasis to the liver and lung. The majority of causes of death were non-malignant disease and multiple primary malignant neoplasms. As to the survival rate in relation to the extent of lymph node dissection, no significant difference in survival rate was observed among the three procedures R0-, R1- and R2-resection in single cancer regardless of cancer invasion through the gastric wall. The survival rate for intramucosal carcinoma without lymph node metastases and with Group 1 lymph node metastases in both single and multiple cancer was 100%. In addition, 125 patients with intramucosal polypoid cancer (types I and IIa according to the macroscopic classification of early gastric cancer) showed no lymph node metastasis and had 100% survival. Therefore, from the present study a new rationale for surgical treatment for early gastric cancer is recommended as follows: 1) In general, R1-resection is indicated for intramucosal carcinoma and R2-resection for submucosal carcinoma. 2) Local resection of the tumor or R0-resection with preservation of the regional lymph nodes is thought to be sufficient for an intramucosal polypoid carcinoma less than 2.0 cm in diameter.     

Evaluation of surgical submucosal resection for an early stage gastric cancer

In the present study, we demonstrated a surgical submucosal resection (SSR) with an early stage gastric cancer for 212 patients. We assessed the results of SSR in 212 patients based on the outcome of surgery, recurrent cases and prognoses. RESULT: The mean operation time was 93 +/- 36 minutes, bleeding volume was 34.6 +/- 12.0 mL, and postoperative hospitalization in days was 11 +/- 4 days. Pathological examination revealed a tumor invasion of the mucosal layer in 155 cases, submucosal layer in 55 cases, and proper muscle in 2 cases. There were 14 cases (6.6%) of incomplete resection. We performed a curative resection for 6 cases and a frequent follow-up for 7 cases of incomplete resection. There was one gastric cancer death case in incomplete resection. There were no recurrent cases in complete resection. However, we found 3 missing diagnosis cases of synchronous multiple gastric cancer and 10 metachronous multiple gastric cancer cases. CONCLUSION: SSR is a useful option of minimally invasive surgery for an early stage gastric cancer.     

A carcinoma of the reconstructed gastric tube after a radical esophageal cancer operation

Reported are five patients who developed a carcinoma of the reconstructed gastric tube. In 3 of the 5 patients, the esophageal cancer was preceded by a gastric cancer, and the intervals before the gastric cancer was detected were 34, 24, and 60 months. The gastric tube the had been reconstructed by the retrosternal rout was resected with a median sternotomy in cases 1 and 2. In case 3, since a liver and lung metastasis had been detected by routine examination, surgery was not performed. Cases 4 and 5 had an esophageal cancer associated with a simultaneous early gastric cancer located in the lesser curvature of the upper body. Thus, a esophagectomy and a partial gastrectomy were performed. Twenty-eight and 21 months later, respectively, an early gastric cancer was found at the stump of the gastric tube that had been reconstructed by the retrosternal route. Endoscopic laser therapy was subsequently employed for both patients. Because of these findings, the author have concluded that postoperative serial examination of the gastric tube are very important, since cases of a gastric tube cancer are increasing.