Background
The prognosis for stage 3 gastric cancer is not satisfactory, even with S-1 adjuvant chemotherapy. A randomized phase II trial was conducted to compare two and four courses of neoadjuvant ...S-1/cisplatin (SC) and paclitaxel/cisplatin (PC) using a two-by-two factorial design for locally advanced gastric cancer. The primary endpoint was overall survival. We clarified the impact of these regimens on the secondary endpoints, including the clinical and pathological responses, chemotherapy-related toxicities, and surgical results.
Methods
Patients received S-1 (80 mg/m
2
for 21 days with 1 week’s rest)/cisplatin (60 mg/m
2
at day 8) or paclitaxel/cisplatin (80 and 25 mg/m
2
, respectively, on days 1, 8, and 15 with 1 week’s rest) as neoadjuvant chemotherapy.
Results
Eighty-three patients were assigned to arm A (two courses of SC,
n
= 21), arm B (four courses of SC,
n
= 20), arm C (two courses of PC,
n
= 21), and arm D (four courses of PC,
n
= 21). Pathological response rate was 43 % in arm A, 40 % in arm B, 29 % in arm C, and 38 % in arm D. Pathological complete response was only observed in arms B (10 %) and D (10 %). Most bone marrow toxicities, nausea, vomiting, alopecia, and fatigue were slightly higher but acceptable in arms B and D. Grade 3/4 surgical morbidities were not commonly observed in all four arms.
Conclusions
Pathological complete response could be induced by four courses of neoadjuvant chemotherapy without a marked increase of toxicities, regardless of a SC or PC regimen.
Background
It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We ...identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the optimal extent of abdominal lymphadenectomy.
Methods
Eighty-six patients undergoing R0 total gastrectomy for advanced type II adenocarcinoma were identified from the gastric cancer database of 4,884 patients. Prognostic factors were investigated by multivariate analysis. The therapeutic value of lymph node dissection for each station was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes in each station.
Results
The overall 5-year survival rate was 37.1 %. Age less than 65 years hazard ratio, 0.455 (95 % confidence interval (CI), 0.261–0.793) and nodal involvement with pN3 as referent hazard ratio for pN0, 0.129 (95 % CI, 0.048–0.344); for pN1, 0.209 (95 % CI, 0.097–0.448); and for pN2, 0.376 (95 % CI, 0.189–0.746) were identified as significant prognosticators for longer survival. Perigastric nodes of the lower half of the stomach in positions 4d–6 were considered not beneficial to dissect, whereas there were substantial therapeutic benefits to dissecting the perigastric nodes of the upper half of the stomach in positions 1–3 and the second-tier nodes in positions 7 and 11.
Conclusions
Limited lymphadenectomy attained by proximal gastrectomy might suffice as an alternative to extended lymphadenectomy with total gastrectomy for obtaining potential therapeutic benefit in abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma.
Purpose
This study aimed to assess the efficacy of daikenchuto (DKT), a commonly prescribed, traditional Japanese herbal medicine, on postoperative intestinal dysfunction after gastric cancer ...surgery.
Methods
Patients with gastric cancer scheduled for a total gastrectomy were randomly assigned before surgery to receive either no treatment (
n
= 40; control group) or DKT (7.5 g/day, t.i.d.) for 3 months (
n
= 41) postoperatively. We examined gastrointestinal motility, stool attributes, the quantity of bowel gas, the quality of life, and the incidence of postoperative ileus.
Results
During the hospital stay, significant differences were observed between the DKT group and controls in the number of stools per day (1.1 ± 0.6 vs 0.8 ± 0.4, respectively;
P
= 0.037) and stool consistencies (Bristol scale ratings were 3.7 ± 0.8 vs 3.1 ± 0.8, respectively;
P
= 0.041). The DKT group showed significant reductions in gas volume scores, calculated from abdominal radiographs, at 7 days, 1 month, and 3 months after surgery. The groups did not show significant differences in quality of life scores (based on the Gastrointestinal Symptom Rating Scale) or in the incidence of postoperative ileus.
Conclusion
DKT improved bowel movements, stool properties, and bowel gas. These results suggested that DKT promoted early postoperative bowel functions after total gastrectomy.
Purpose
Pinch-off syndrome (POS) is a serious complication encountered during the long-term management of totally implantable access ports (TIAPs). The aim of this study was to examine the effect of ...ultrasound-guided infraclavicular axillary vein puncture to avoid POS in patients with long-term use of a TIAP.
Methods
This was a retrospective review of 207 consecutive TIAPs: one hundred devices implanted using an anatomical landmark technique were used as historical controls (Landmark group), while 107 devices were implanted using an ultrasound (US)-guided puncture method (US group). The pinch-off grade (POG) was determined using chest X-ray findings following the definition of Hinke, and the progression of POG during the follow-up period of the Landmark and US groups was compared.
Results
Sixteen cases in the Landmark group were POG-1 and 3 were POG-2, while all cases in the US group were POG-0 at the time of venipuncture (
p
< 0.001). Eleven patients in the Landmark group showed some degree of progression of the POG during the follow-up period. In contrast, there were no cases showing progression of the POG in the US group (
p
= 0.002).
Conclusions
US-guided infraclavicular axillary vein puncture was found to effectively make it possible to avoid POS for the long-term management of TIAPs, as well as at the time of implantation.
Background
We examined the effectiveness of volume replacement using a lateral tissue flap (LTF) in breast-conserving surgery for a good cosmetic outcome.
Methods
We analyzed the results of 130 ...patients with breast cancer who underwent breast-conserving surgery with replacement using an LTF from 2006 to 2010 with cosmetic evaluations performed according to the criteria of the Japanese Breast Cancer Society. We examined scores with regard to the following possible contributing factors: partial resection (Bp) or quadrantectomy (Bq), diameter of the specimen, body mass index (BMI), axillary lymphadenectomy, postoperative irradiation, and position of the tumor.
Results
The scores for cases with Bp and non-postoperative irradiation were higher than those for Bq and postoperative irradiation cases, though they were not significant factors in multivariate analysis. A negative correlation was seen between score and diameter of the specimen, whereas there was no significant correlation with BMI. There was no significant difference between scores of cases with or without an axillary lymphadenectomy. However, the score for the extended upper-outer area including the upper and outer borders was significantly higher than scores for other portions. In multiple regression analysis, cases with a tumor diameter less than 4 cm in the extended upper-outer area or less than 2 cm in other areas showed good adaptation.
Conclusion
Tumor location and diameter are important factors for cosmetic evaluation of volume replacement using an LTF.
Introduction
Fecal diversion may be performed using various techniques. Each technique has advantages that affect patient selection. In this report, we report our experience with 31 patients who ...underwent single‐incision laparoscopic stoma creation using only a pre‐selected stoma site as the point of port access.
Methods
A 2.5‐cm skin incision was made at a previously marked stoma site, and two 5‐mm trocars were placed into the abdomen through the stoma site. An optional third trocar was inserted at the stoma site only if the bowel needed to be mobilized or if adhesions needed to be divided. After full intra‐abdominal exploration, a selected intestinal loop was brought up to the stoma site, and the ostomy was then matured using standard techniques.
Results
Between April 2009 and March 2012, 31 patients (19 men) with a mean age of 68 years (range, 46–87 years) underwent single‐incision laparoscopic stoma creation. Fecal diversion included ileostomy (n = 18) and colostomy (n = 13). There were no intraoperative complications. Two patients (6.5%) required additional port placement in the midline suprapubic area. Conversion to open laparotomy was required in two patients (6.5%) because of the presence of extensive adhesions. Postoperative complications were observed in two patients and included peristomal ileus and dehydration due to high ileostomy output.
Conclusions
Single‐incision laparoscopic stoma creation is an effective technique that allows full intra‐abdominal visualization and bowel mobilization, while reducing the need for additional skin incisions beyond that of the stoma site.
The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted ...splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy.
An extremely elderly female aged 101 years was examined at our hospital for vomiting and was subsequently hospitalized with a diagnosis of intestinal obstruction. After insertion of an ileus tube, ...her symptoms improved. However, the tube tip could not be further inserted, and ileus tube contrast radiography indicated a stricture at the tube tip. Because conservative treatment is limited in such cases, surgery was indicated. Assessment of surgical risk indicated a high risk of complications and death; however, surgery was performed after providing the family with a full explanation of the risks and obtaining their consent. A closed loop had been formed by a cord-like material from the greater omentum originating from a site approximately 10 cm from the terminal ileum and extending as far as approximately 50 cm, which was causing the constriction. Although the color of the intestinal tract was relatively good, after severing the cord-like material, cicatricial stenosis remained, and partial resection of the small intestine was performed. There were no postoperative complications, and she was discharged on the 21st postoperative day because her progress was satisfactory. Here we report the case of an extremely elderly patient aged 101 years in whom surgery of intestinal obstruction was performed with satisfactory results.
Herein we report our experience treating an extremely rare case of synchronous cancers of the small intestine and appendix. The patient was an 84-year-old man who presented to his local physician ...with chief complaints of diarrhea, vomiting, constipation, and abdominal bloating. The patient was subsequently referred to our hospital and was admitted with a diagnosis of intestinal obstruction. Symptoms were ameliorated following the insertion of an ileus tube. However, as the intestinal obstruction was not the result of previous operative therapy and CT findings revealed that the ileum was the source of the obstruction, we considered the possibility that the obstruction was due to a neoplastic lesion and recommended the patient for surgical treatment. A tumor was observed approximately 60 cm from the terminal ileum. It had infiltrated the surrounding intestinal mesentery and formed a tumor mass. Furthermore, the caudal end of the appendix had become attached to the nearby mesentery. Based on intraoperative findings, we determined that the ileal tumor had infiltrated the intestinal mesentery and appendix; therefore, we performed partial ileectomy and appendectomy. However, histopathological diagnosis revealed that the ileal tumor was a moderately differentiated adenocarcinoma, whereas the appendiceal tumor was a mucinous, well-differentiated adenocarcinoma. As a result, we comprehensively determined that both tumors were primary cancers.
PDF
