Related factors and prognosis of hepatic metastasis and peritoneal dissemination in gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the related factors and prognosis of peritoneal dissemination and hepatic metastasis in gastric cancer, and the impact of palliative surgery on the prognosis.</p><p><b>METHODS</b>The clinicopathologic and follow-up data of the patients with gastric carcinoma treated in our hospital from Aug. 1994 to Jul. 2005 were analyzed retrospectively.</p><p><b>RESULTS</b>The clinicopathologic factors correlated with peritoneal dissemination included serosal penetration, whole stomach cancer, undifferentiated type, female and hepatic metastasis, while those correlated with hepatic metastasis included Borrmann IV, lymph node metastasis and peritoneal dissemination (P< 0.05). The postoperative one-year survival rate of the patients with hepatic metastasis (H group) were lower than that of the patients with peritoneal dissemination (P group)(P< 0.05). The one- year survival rate of the patients with peritoneal dissemination undergoing palliative resection was significantly higher than that of the patients undergoing by-pass operation or feeding neostomy, and exploratory laparotomy (P< 0.05), while there was no significant difference among the three groups of the patients with hepatic metastasis.</p><p><b>CONCLUSIONS</b>The short-term prognosis of the patients with hepatic metastasis is poorer than that of the patients with peritoneal dissemination. Palliative resection could improve the short-term survival rate of the patients with peritoneal dissemination, while it had no significant impact on the survival rate of the patients with hepatic metastasis.</p>

Disciplinarian of lymph node metastasis and effect of paraaortic lymph nodes dissection on clinical outcomes in advanced gastric carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the disciplinarian of lymph node metastasis and evaluate the effect of paraaortic lymph nodes dissection on the clinical outcomes in advanced gastric carcinoma.</p><p><b>METHODS</b>One hundred and twenty-six patients who underwent D(3) (including D(3)(+)) radical resection (group D(3)) and 146 patients who underwent D(2) radical resection by the same surgical team (group D(2)) for advanced gastric cancer were enrolled in the present study. The dissected lymph nodes were grouped according to the definition of Japanese Research Society for the Study of Gastric Cancer (JRSGC) (Edition 13th). The lymph node metastasis was analyzed in group D(3). The clinicopathological characteristics and clinical outcomes were compared between the two groups.</p><p><b>RESULTS</b>There were no differences in age, sex, tumor location, Borrman type, histological type and TNM stage between group D(2) and group D(3) (P > 0.05). The No16 lymph node metastatic rate was 3.8%, 22.3%, 46.8% and 32.1% in T(1), T(2), T(3), T(4) stage tumors respectively, 16.3% and 69.5% in the patients with negative and positive serosal invasion respectively; there were no differences in operative mortality (2/126 vs 2/146) and surgical complications (4/126 vs 6/146) between group D(2) and group D(3) (P > 0.05). The 5-year survival rate was 66.5% in group D(3) and 40.2% in group D(2) (P< 0.01). The 5-year survival rates of the patients with I, II, IIIa, IIIb and IV stage tumors who were No16 lymph nodes negative were 94.8%, 95.6%, 72.1%, 58.6%, 59% respectively in group D(3), and 42%, 36%, 27%, 35.6%, 16.3% respectively in group D(2). The 5-year survival rate of the patients with No16 (+) lymph nodes less than 3 was higher than that of the patients with No16(+) lymph nodes more than 3.</p><p><b>CONCLUSIONS</b>No16a2 and No16b1 are the common locations of lymph node metastasis in advanced gastric cancer. The paraaortic lymph node metastasis closely is related with the depth of tumor invasion and serosal invasion. Paraaortic lymph nodes dissection (D(3) or D(3)(+) radical resection) improves the 5-year survival rate of the patients with No16 (-) and No16 (+) lymph nodes less than 3.</p>

The expression of VEGF-C, VEGFR-3 and its predictive value on lymph node metastasis and prognosis of gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>s To investigate the relationship between the expression of VEGF-C, VEGFR-3 and lymph node metastasis (LNM) in the gastric cancer, and explore the role of VEGF-C, VEGFR-3 in the prognosis of gastric cancer.</p><p><b>METHODS</b>Gastric cancer specimens were selected from gastric cancer database from April, 1994 to December, 2003, which were registered and followed up. The specimens were divided into two groups according to LNM existing or not. Immunohistochemistry staining was performed with anti-VEGF-C, anti-VEGFR-3 monoclonal antibody by DAB method. Their effects on prognosis of gastric cancer patients were analyzed by Kaplan-meier, Logistic and Cox Regression methods.</p><p><b>RESULTS</b>In 188 cases of gastric cancer patients, 97 patients presented with LNM and the rest did not. The positive expression rate of VEGF-C, VEGFR-3 in the group without LNM was lower than those in group with LNM, and there was significant difference between the two groups. There was significant difference in the average lymphatic vessel density between the group with LNM and the group without, and the same results were found between the group with positive VEGF-C expression and the group without.</p><p><b>CONCLUSIONS</b>VEGF-C, VEGFR-3 are over-expressed in gastric cancer patients with LNM, and the expression of VEGF-C, VEGFR-3 are important predictors for the prognosis of gastric cancer.</p>

Surgical treatment and prognosis analysis for patients with gastric cancer infiltrating esophagus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the reasonable operative approaches,rang e of lymph node dissection and prognostic factors for patients with gastric cancer infiltrating esophagus.</p><p><b>METHODS</b>Six hundred and ninety-three patients were treated surgically for gastric cancer from August 1994 to February 2004. Clinica l data of 63 cases with esophagus invasion were reviewed retrospectively. The range of lymph node metastasis rounding stomach and lymph node metastasis rates were analyzed. The survival rate was compared between the patients with operation performed through upper abdomen median incision and the patients through combined left thoracotomy and abdomen incision. Different factors influencing survival rates were analyzed.</p><p><b>RESULTS</b>Radical resection rate was 85.7%, combined viscera excision was performed in 25 cases (39.7%). The overall rate of lymph node metastasis was 73.0%, and lymph node metastasis rate involving abdominal cavity and thoracic cavity was 73.0% and 12.7% respectively. Upper abdomen median incision was applied in 35 cases with 18% of 5-year survival rate, while combined left thoracotomy and abdomen incision was performed in 28 cases with 38% of 5-year survival rate. There was a significant difference in 5-year survival rate between the two groups (P< 0.05). The survival rate was 16% in combined viscera excision group. Logistic analysis revealed that age, histologic type, tumor diameter, Borrmann type, lymph node metastasis, lymph node metastasis involving thoracic cavity and operative approach were important factors influencing postoperative survival rate.</p><p><b>CONCLUSION</b>Radical resection of gastric cancer infiltrating esophagus ought to include dissection of upper abdominal cavity, lower thoracic cavity and para-midkiff lymph nodes. Combined left thoracotomy and abdomen incision may improve the efficacy of radical resection and postoperative 5-year survival rate for patients with gastric cancer infiltrating oesophagus.</p>

Analysis of long-term results of radical gastrectomy combining splenectomy for gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the influence of radical excision combining splenectomy on prognosis of the patients with gastric cancer.</p><p><b>METHODS</b>Between June 1994 and March 2004, 692 patients were operated on for gastric cancer and registered into gastric cancer database. Radical excision (D2, D3 or D4) combining splenectomy for gastric cancer was performed in 45 cases. 343 cases were selected simultaneously for comparison according to the resembling rules in sex, age, tumor size, location, serosa invasion, Borrmann type and range of lymph node dissection. Clinicopathological factors affecting lymph node metastasis, patterns of lymph node metastasis, 5-year survival rate after radical excision combined with splenectomy for gastric cancer were compared.</p><p><b>RESULTS</b>Lymph node metastasis rate of splenic hilus was 15.6 percent. Among them, upper, middle and lower domain is 11.5 percent, 33.3 percent and zero respectively. It was significantly different between gastric adenocarcinoma in proximal and body of stomach and that in distal stomach, poor differentiation and adenocarcinoma anaplastic and well and moderately differentiation adenocarcinoma, Borrmann III and IV types and Borrmann I and II types, infiltrated depth in T(3) and T(4) and infiltrated depth in T(1) and T(2), clinical stages III and IV and clinical stages I and II. The average and median survival time between radical gastrectomy only and radical gastrectomy combining splenectomy for gastric cancer at stage I and II patients were significantly different, but at stage III and IV patients not significantly different.</p><p><b>CONCLUSIONS</b>Spleen should be reserved for patients with gastric cancer at stage I and II, and radical excision combining splenectomy could only be performed at stage III and IV patients with cancer infiltrating body and tail of the pancreas, or lymph nodes metastasis in the splenic hilus. Indication of radical excision combining splenectomy for gastric cancer must be further study to clarify its efficacy.</p>

Effectiveness of para-aortic lymph node dissection for advanced gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To assess whether any correlation exists between survival and the extent of lymph-node dissection.</p><p><b>METHODS</b>D(2), D(2)(+) or D(3) radical resection was performed on 158 patients with advanced gastric cancer. Among them, 73 were subjected to para-aortic lymph node dissection, (PALD group), and the other 85 were not subjected to the operation (non-PALD group). There was no significant difference in age, gender, site of tumors, type of Borrmann and histology between the two groups. The PALD group showed more advanced diseases in term of tumor invasion, lymph node metastasis and clinicopathological stage.</p><p><b>RESULTS</b>Average operation time was longer in the PALD group than in the non-PALD group [(280 +/- 93) min VS. (245 +/- 91) min, (P < 0.01)]. Blood transfusion volume was (693 +/- 324) ml in the PALD group, and (460 +/- 375) ml in the non-PALD group (P < 0.01). No anastomotic leaks, pancreatic fistula, abdominal abscess and ileus were observed in both groups. No significant complications were found except for a higher incidence of diarrhea in the PALD group. Significant difference was found in survival curve, mean and median survival time between the two groups. The difference in survival was also found between patients with positive and negative lymph node metastasis in the PALD and non-PALD groups. Again, there was significant difference in survival between positive and negative No. 16 lymph node in the PALD group.</p><p><b>CONCLUSION</b>Para-aortic lymph node dissection offers a significant survival benefit to curable patients with advanced gastric cancer. It is similar to limited lymphadenectomy in morbidity and mortality.</p>