Assessment of Nutrition Status and Quality of Life after Curative Resection in Patients with Upper Gastric Cancer: Comparison of Total Gastrectomy and Proximal Gastrectomy

PURPOSE: A total gastrectomy is generally performed for the treatment of upper third gastric cancer. However, the optimal extent of resection for early-stage upper third gastric cancer is still controversial. In this research, we compared the nutritional status and the quality of life in patients who underwent a total gastrectomy with uncut Roux en Y esophagojejunostomy with those in patients who underwent a proximal gastrectomy with esophagogastrostomy for treatment of upper third gastric cancer. MATERIALS AND METHODS: We reviewed 50 patients with no evidence of recurrent disease following curative surgery for upper third gastric cancer. Among this group, 25 patients underwent a total gastrectomy (TG) and 25 patients a proximal gastrectomy (PG). 8 TG and 4 PG patients were excluded from this study because of death, refusal to interview, etc. The nutritional status was assessed by measuring body weight, serum albumin, serum hemoglobin, and serum total protein. The gastrointestinal function and the quality of life were assessed by Cuschieri grading and modified Visick grading. RESULTS: In analysis of covariance of age and preoperative serum albumin, PG patients demonstrated lower weight loss (P=0.038), elevated serum albumin (P=0.049), and better outcome based on modified Visick grading (P=0.016) than TG, but there were no significant differences in the serum hemoglobin change (P=0.165), serum total protein change (P=0.435), and Cuschieri grading (P=0.064) between the preoperative and the postoperative data. CONCLUSION: In this study, a proximal gastrectomy led to a better nutritional status and quality of life than a total gastrectomy, as judged from the low weight loss, elevated serum albumin and better modified Visick grade.

Assessment of Peritoneal Irrigation and Drainage by Perioperative Leukocyte Count following Gastric Cancer Surgery

PURPOSE: There has been debate on the use of peritoneal irrigation and drainage following gastric cancer surgery. This study was conducted to evaluate the usefulness of routine peritoneal irrigation and drainage following gastric cancer surgery, especially with regard to the perioperative leukocyte count. METHODS: Of 298 patients, 153 were enrolled in the test group (without peritoneal irrigation & drainage), between October 2001 and August 2002, and 145 in the control group (with peritoneal irrigation and drainage), between January 2001 and September 2001. The demographics, range of dissection, pathological staging, operation times, anesthesia times, fever, perioperative leukocyte counts and operative complications were retrospectively analyzed in these consecutive patients. RESULTS: It was found that there was no difference in the demographics, range of dissection, pathological staging and operative complications between the two groups. However, the operation times, anesthesia times, and mean length of hospitalization in the test group were significantly shorter than those in the control group. No significance differences were found between the two groups with regard to the perioperative leukocyte counts. CONCLUSION: The routine usage of peritoneal irrigation and drainage was found to be neither safe nor effective in gastric cancer surgery patients.

Assessment of Microvessel Density and Expression of p53, Ki67 in Gastric Adenocarcinoma: Relationship to the Clinicopathological Parameters

PURPOSE: This study was a retrospective evaluation of the correlation between the MVD (microvessel density) stained by anti-CD34 monoclonal antibodies, the expressions of p53 and Ki67 in gastric adenocarcinomas. The relationship between these markers and several clinicopathological parameters, if any, were also sort. METHODS: The study was performed on 82 patients diagnosed with gastric cancer, and operated on between July, 2000 and June, 2001. No neoadjuvant chemotherapy or radiation therapy was administered. Immunohistochemical staining was performed with monoclonal antibodies to CD34, p53, and Ki67 (DAKO, Copenhagen, Denmark). Independent t- and ANOVA tests were used to find any clinical correlation between the clinical parameters and MVD, from the immunohistochemical staining of the p53 and Ki67. A probability value (P value) less than 0.05 was considered as statistically significant. RESULTS: The mean values of MVD, p53 and Ki67 expressions (mean value+/-SD) were 38.5+/-15.2, 2.1+/-1.3, and 3.3+/-0.6, respectively. The maximal/minimal values were 153/4, 5/0 and 5/2. There was no apparent correlation found between the expressions of MVD, p53 and Ki67. Also, there was no correlation between the immunohistochemical staining and the clinicopathological parameters, such as age, sexual distribution, histological differentiation, N category and TNM stage. However, according to the depth of tumor invasion (T category), the MVD was found to be moreincreased in the early gastric adenocarcinomas (T1) than in advanced gastric adenocarcinomas (T2-4)(P=0.014). CONCLUSION: There was no apparent correlation between the expression of p53 and Ki67, or the clinicopathological parameters, such as age, sex, histological differentiation, T category, and N category and TNM stage. MVD was higher in the early gastric adenocarcinomas than in advanced gastric adenocarcinomas but further studies will be required to evaluate whether the MVD is a reliable prognostic factor in gastric adenocarcinomas.