ABSTRACT
Gastric cancer with positive peritoneal cytology is a hotspot in the study of gastric cancer, and its prognosis is poor. Intraperitoneal free cancer cells may be associated with cancer cells migration, invasion and metastasis. Tumor T stage, peritoneal metastasis, lymph node metastasis, low histological differentiation, linitis plastica, adenocarcinoma of esophagogastric junction, and operation are the clinicopathological risk factors of gastric cancer with positive peritoneal cytology. Currently, the acquisition of free cancer cells is mainly through diagnostic laparoscopy combined with peritoneal lavage, and cytopathological examination is gold standard for diagnosis. Its treatment strategies are not in consensus, including preoperative chemotherapy combined with radical resection, postoperative chemotherapy and peritoneal local treatment, which can prolong the survival of patients. At present, postoperative chemotherapy is often used in China, and the best treatment strategies remain to be further studied.
Subject(s)
Humans , China , Gastrectomy , Neoplasm Staging , Peritoneal Lavage , Peritoneal Neoplasms/diagnosis , Prognosis , Retrospective Studies , Stomach Neoplasms/surgeryABSTRACT
OBJECTIVE: To analyze the detection rate of the inferior pyloric artery (IPA) in patients with gastric cancer by computed tomography arteriography (CTA). MATERIALS AND METHODS: Fifty-four patients (48 males and 6 females; mean age, 59.0 ± 1.5 years) who had undergone radical gastrectomy for gastric cancer from September 2016 to July 2017 at our institution were recruited prospectively. Patients underwent abdominal contrast-enhanced CT scans and CTA imaging reconstruction before the operation. The origin of the IPA in all cases was determined by a radiologist based on CTA images and verified by the surgeon. The accuracy of CTA in diagnosing the origin of the IPA was calculated. Dominant vessels of the origin were analyzed. RESULTS: IPAs were detected by CTA in 51 patients (94.4%). Among these, IPAs originated from the right gastroepiploic artery (RGEA) (24 cases), the gastroduodenal artery (GDA) (4 cases), and the anterior superior pancreaticoduodenal artery (ASPDA) (20 cases). In the remaining 3 cases, the IPAs contained two branches originating from the RGEA and ASPDA, respectively. During surgery, in 2 (3.7%) of the 54 cases of gastric cancer, IPAs could not be detected; the IPAs originated from the RGEA (22 cases), GDA (5 cases), and ASPDA (24 cases). One case had an IPA originating from both the RGEA and the GDA. Finally, the accuracy of CTA in diagnosing the origin artery of the IPA was 85.2% (46/54). CONCLUSION: CTA can detect the origin of the IPA accurately, which can aid surgeons while performing pylorus-preserving operations.
Subject(s)
Female , Humans , Male , Angiography , Arteries , Gastrectomy , Gastroepiploic Artery , Prospective Studies , Stomach Neoplasms , Surgeons , Tomography, X-Ray ComputedABSTRACT
Gastric cancer is one of the most common cancersin China. The proportion of early gastric cancer(EGC) is stillrelatively low in China. The data of China Gastrointestinal Can-cer Surgery Union from 2014 to 2017 can reflect the currentstatus and trends of diagnose and treatment of EGC in China.The union collected data of 134,111 cases of gastric cancer in95 centers in China. The trend analysis was performed with da-ta from centers with at least 3 years data collected. Within allthe patients, the proportion of EGC was 19.7%. The propor-tions of EGC were higher in Zhejiang, Beijing, Jiangsu, Tian-jin, and Shanghai, and were lower in Qinghai, Hainan, InnerMongolia, Yunnan, and Guangxi. The proportion of EGC in-creased from 19.7% in 2014 to 20.9% in 2017. In terms oftreatment, the proportions of endoscopic treatment, laparoscop-ic surgery, and open surgery were 24.3%, 37.7%, and 38.0%.From 2014 to 2017, the proportions of endoscopic treatmentand laparoscopic surgery increased while the proportion ofopen surgery decreased. Among patients received surgery,5.9% of pT1 a patients and 19.6% of pT1 b patients were withlymph node metastasis. In conclusion, the proportion of EGCincreased slightly in China but was still lower than that of Ja-pan and South Korea. Minimally invasive treatment graduallybecome the main treatment method of EGC.