A randomized phase II trial to test the efficacy of intra-peritoneal paclitaxel for gastric cancer with high risk for the peritoneal metastasis (INPACT trial)

Owing to its peculiar pharmacological characteristics, paclitaxel attains substantial intra-peritoneal concentration for a prolonged period when delivered intra-peritoneally, and is active against peritoneal metastasis of ovarian cancer. It is also considered promising against disseminated gastric cancer. However, the fact that the intra-peritoneal paclitaxel has not been approved in Japan has rendered its evaluation by a formal clinical trial impossible. The authors designed a randomized phase II trial using the Kodo Iryo Hyoka system, a new system to legally test an yet unapproved mode of treatment. It is hoped that this trial will result in a breakthrough in the treatment of peritoneal carcinomatosis from gastric cancer.     

Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma

Background

Esophagogastric junction (EGJ) carcinoma has attracted considerable attention because of the marked increase in its incidence globally. However, the optimal extent of esophagogastric resection for this tumor entity remains highly controversial.

Methods

This was a questionnaire-based national retrospective study undertaken in an attempt to define the optimal extent of lymph node dissection for EGJ cancer. Data from patients with EGJ carcinoma, less than 40 mm in diameter, who underwent R0 resection between January 2001 and December 2010 were reviewed.

Results

Clinical records of 2807 patients without preoperative therapy were included in the analysis. There are distinct disparities in terms of the nodal dissection rate according to histology and the predominant tumor location. Nodal metastases frequently involved the abdominal nodes, especially those at the right and left cardia, lesser curvature and along the left gastric artery. Nodes along the distal portion of the stomach were much less often metastatic, and their dissection seemed unlikely to be beneficial. Lower mediastinal node dissection might contribute to improving survival for patients with esophagus-predominant EGJ cancer. However, due to low dissection rates for nodes of the middle and upper mediastinum, no conclusive result was obtained regarding the optimal extent of nodal dissection in this region.

Conclusions

Complete nodal clearance along the distal portion of the stomach offers marginal survival benefits for patients with EGJ cancers less than 4 cm in diameter. The optimal extent of esophageal resection and the benefits of mediastinal node dissection remain issues to be addressed in managing patients with esophagus-predominant EGJ cancers.

     

Hepatic IRS1 and ß-catenin expression is associated with histological progression and overt diabetes emergence in NAFLD patients

Journal of Gastroenterology - Nonalcoholic fatty liver disease (NAFLD) is a risk factor for type 2 diabetes. Our aim was to investigate the relationship between NAFLD and impaired glucose...     

Adjuvant chemotherapy with 5-FU or regimens including oral fluoropyrimidine for curable gastric cancer

Since 2000, several studies have reported positive results in reasonable-size randomized controlled trials of adjuvant treatment for potentially curable gastric cancer. At present, postoperative adjuvant chemoradiotherapy and perioperative chemotherapy are the standard of care in the United States and Europe (including Great Britain), respectively, while postoperative S-1 monotherapy is the standard of care in Japan. The effect of adjuvant treatment varies according to the type of surgery, and the best results so far have been observed in the adjuvant chemotherapy of TS-1 for gastric cancer (ACTS-GC) trial, in which D2 surgery followed by S-1 monotherapy was tested. The role of radiotherapy after D2 dissection remains unclear.     

Mitral valve surgery for patients after undergoing percutaneous transvenous mitral commissurotomy (PTMC)--investigation on indication of PTMC based on the intraoperative findings]

Ten patients underwent open heart surgery for mitral valve after PTMC because of post PTMC MS (n = 4) and MR (n = 6) out of 150 patients undergoing PTMC in our hospital between June 1987 and October 1991. Intraoperative findings of 4 patients with residual mitral stenosis included severe thickening, stiffening and calcification on anterior and posterior leaflets, commissures and subvalvular apparatus. Mitral valve repair was possible in 2 and mitral valve replacement (MVR) was necessary in the other 2. In all 6 cases who massive mitral regurgitation after PTMC, in repairable tears in the mitral leaflets necessitated MVR. Since in these cases changes in the leaflets were less severe than those of the commissures or subvalvular apparatus, surgical repair could have been possible if open mitral commissurotomy (OMC) was done primarily. Patients selection for PTMC versus OMC based on precise morphological evaluation of mitral valve would reduce occurrence of massive MR resulting in surgical replacement.     

Lymph node metastases of gastric cancer. General pattern in 1931 patients.

The incidence of metastases from gastric adenocarcinoma to various regional lymph node stations was studied after meticulous node dissection and correlated to survival in 1931 resected patients. The incidence of metastases increased with deeper tumor invasion into the stomach wall. Deposits were most common in some perigastric node stations, and their distribution was clearly related to the location of the tumor. Some nonperigastric node stations also were frequently involved, e.g., those around the left gastric artery or in the splenic hilum, and may be considered primary draining nodes. Skip metastases to distant nodes were found in a few per cent of perigastric node-negative patients. Deposits in nodes around the middle colic artery, but not in any other upper abdominal node stations, were incompatible with 5-year survival rates. The analysis favors a so-called R2 or more extensive resection for cancers invading beyond the submucosa.     

Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer

BACKGROUND: Extended lymphadenectomy for gastric carcinoma has been associated with high mortality and morbidity rates in several multicentre randomized trials. METHODS: Using data from 523 patients registered for a prospective randomized trial comparing extended (D2) and superextended (D3) lymphadenectomies, risk factors for overall complications and major surgical complications (anastomotic leakage, intra-abdominal abscess and pancreatic fistula) were identified by multivariate logistic regression analysis. RESULTS: Mortality and morbidity rates were 0.8 per cent (four of 523) and 24.5 per cent (128 of 523) respectively. Pancreatectomy (relative risk 5.62 (95 per cent confidence interval (c.i.) 1.94 to 16.27)) and prolonged operating time (relative risk 2.65 (95 per cent confidence interval 1.34 to 5.23)) were the most important risk factors for overall complications. A body mass index of 25 kg/m2 or above, pancreatectomy and age greater than 65 years were significant predictors of major surgical complications. CONCLUSION: Pancreatectomy should be reserved for patients with stage T4 disease. Age and obesity should be considered when planning surgery.