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Purpose@#The aim of the present study was to compare the difference between double tract reconstruction and esophagogastrostomy. @*Materials and Methods@#Patients who underwent radical proximal gastrectomy with esophagogastrostomy or double tract reconstruction were included in this study. @*Results@#Sixty-four patients were included in this study and divided into two groups according to reconstruction method. The two groups were well balanced in perioperative safety and 3-year overall survival (OS). The rates of postoperative reflux esophagitis in the double tract reconstruction group and esophagogastrostomy group were 8.0% and 30.8%, respectively (p=0.032). Patients in the double tract reconstruction group had a better global health status (p < 0.001) and emotional functioning (p < 0.001), and complained less about nausea and vomiting (p < 0.001), pain (p=0.039), insomnia (p=0.003), and appetite loss (p < 0.001) based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about dysphagia (p=0.030), pain (p=0.008), reflux (p < 0.001), eating (p < 0.001), anxiety (p < 0.001), dry mouth (p=0.007), and taste (p=0.001). The multiple linear regression analysis showed that reconstruction method, postoperative complications, reflux esophagitis, and operation duration had a linear relationship with the global health status score. @*Conclusion@#Double tract reconstruction could better prevent reflux esophagitis and improve quality of life without scarifying perioperative safety or 3-year OS.
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Purpose@#Gastric cancer (GC) has substantial biological differences between Asian and non-Asian populations, which makes it difficult to have a unified predictive measure for all people. We aimed to identify novel prognostic biomarkers to help predict the prognosis of Asian GC patients. @*Materials and Methods@#We investigated the differential gene expression between GC and normal tissues of GSE66229. Univariate, multivariate and Lasso Cox regression analyses were conducted to establish a four-gene-related prognostic model based on the risk score. The risk score was based on a linear combination of the expression levels of individual genes multiplied by their multivariate Cox regression coefficients. Validation of the prognostic model was conducted using The Cancer Genome Atlas (TCGA) database. A nomogram containing clinical characteristics and the prognostic model was established to predict the prognosis of Asian GC patients. @*Results@#Four genes (RBPMS2, RGN, PLEKHS1, and CT83) were selected to establish the prognostic model, and it was validated in the TCGA Asian cohort. Receiver operating characteristic analysis confirmed the sensitivity and specificity of the prognostic model. Based on the prognostic model, a nomogram containing clinical characteristics and the prognostic model was established, and Harrell’s concordance index of the nomogram for evaluating the overall survival significantly higher than the model only focuses on the pathologic stage (0.74 vs. 0.64, p < 0.001). @*Conclusion@#The four-gene-related prognostic model and the nomogram based on it are reliable tools for predicting the overall survival of Asian GC patients.
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Purpose@#The aim of the present study was to compare the difference between double tract reconstruction and esophagogastrostomy. @*Materials and Methods@#Patients who underwent radical proximal gastrectomy with esophagogastrostomy or double tract reconstruction were included in this study. @*Results@#Sixty-four patients were included in this study and divided into two groups according to reconstruction method. The two groups were well balanced in perioperative safety and 3-year overall survival (OS). The rates of postoperative reflux esophagitis in the double tract reconstruction group and esophagogastrostomy group were 8.0% and 30.8%, respectively (p=0.032). Patients in the double tract reconstruction group had a better global health status (p < 0.001) and emotional functioning (p < 0.001), and complained less about nausea and vomiting (p < 0.001), pain (p=0.039), insomnia (p=0.003), and appetite loss (p < 0.001) based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about dysphagia (p=0.030), pain (p=0.008), reflux (p < 0.001), eating (p < 0.001), anxiety (p < 0.001), dry mouth (p=0.007), and taste (p=0.001). The multiple linear regression analysis showed that reconstruction method, postoperative complications, reflux esophagitis, and operation duration had a linear relationship with the global health status score. @*Conclusion@#Double tract reconstruction could better prevent reflux esophagitis and improve quality of life without scarifying perioperative safety or 3-year OS.
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Synchronous multiple gastric cancer is a rare condition involving multiple malignant tumors at different sites in the stom-ach. Such cases account for 6%-14% of all gastric cancers. Currently, cases of multiple gastric cancer can be classified by the monoclo-nal or polyclonal nature of the original tumor. Some patients with multiple gastric cancer exhibit hereditary susceptibility and muta-tions in mismatch repair genes. Multiple gastric cancer occurs more commonly among elderly male patients and in the proximal stom-ach at an early stage. No significant differences in vascular invasion, differentiation status, and lymph node metastasis have been iden-tified between solitary and multiple gastric cancers. Several treatment approaches for multiple gastric cancer have been applied clini-cally, including endoscopic resection and subtotal and total gastric resection according to the tumor stages and sites. Further discus-sion is needed regarding the extension of gastric resection for multiple gastric cancer in patients with hereditary susceptibility.
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With the approaches of artificial intelligence and big data, the development of cancer genomics and updating of imaging technology, gastric cancer surgery is facing great challenges and opportunities. The main focus is on laparoscopic surgery technology, enhanced recovery after surgery, multidisciplinary comprehensive treatment, and precision medicine. Considering the common de-mand for reduced complication rate among doctors and patients, laparoscopic surgery has become widely popular owing to its advan-tages of small incision and rapid recovery. Furthermore, the development of artificial intelligence and big data has raised a new chal-lenge in routine diagnosis and treatment. As a result, we encourage multicenter cooperation, and data standardization and sharing. At present, completion of the transition from empirical medicine to evidence-based medicine and promotion of the individualization and standardization of gastric cancer treatment are needed.
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Objective To investigate the clinical effects of gastrointestinal decompression with enteral feeding tube in elderly patients with gastric cancer.Methods 78 cases of gastric cancer patients undergoing postoperative gastric decompression with enteral feeding tube were selected as the treatment group,and 66 patients with gastric cancer undergoing postoperative intravenous nutrition and gastric decompression with routine nasogastric tube as the control group in our hospital from January 2015 to December 2015.The incidence rate of gastric tube patency,faster postoperative recovery,nutritional immune improvement,adverse reaction and complication were compared between the two groups.Results The incidence rate of adverse reactions and complications in treatment group were significant lower than in control group (3.0 ％ vs.12.8 ％,x2 =4.4857,P =0.0342;1.5 ％ vs.10.2％,x2 =4.6620,P =0.0308,respectively).Following parameters were significant better in treatment group versus in control group:the time of evacuating [(3.1 ± 0.3) d vs.(4.0 ± 0.1) d,t =24.9227,P =0.0000],defecation[(4.3 ± 0.6) d vs.(5.5 ± 1.1) d,t =7.9189,P =0.0000],extubation [(5.3±1.3)d vs.(10.1±2.2)d,t=15.5690,P=0.0000],hospitalization[(12.3±2.5)d vs.(18.6± 3.2)d,t=12.9864,P=0.0000],postoperative body weight[(57.2±4.9)kg vs(49.0±7.2)kg,t=-7.8408,P=0.0000],plasma protein[(133.2± 11.2)g/L vs(104.5± 10.3)g/L,t=-16.0055,P=0.0000],hemoglobin[(4.7 ± 1.0) g/L vs (3.2 ± 0.6) g/L,t =-11.0991,P =0.0000] and peripheral blood lymphocyte count[(3.5 ± 0.7) × 109/L vs (2.1 ± 0.4) × 109/L,t =-15.0088,P =0.0000].Conclusions Effects of postoperative gastrointestinal decompression in elderly patients with gastric cancer are similar between with routine gastric tube and with enteral feeding tube.However,the enteral feeding tube-induced enteral nutrition shows fewer side effects and complications,better nutritional and immune effects,and faster postoperative recovery,which is worthy of a generalization and application.
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<p><b>OBJECTIVE</b>To explore the risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer in order to guide clinical measures to reduce the incidence of pulmonary infection.</p><p><b>METHODS</b>Clinical data of 371 patients undergoing D2 radical gastrectomy at Division 2 of Gastrointestinal Cancer Center from October 2014 to October 2016 were collected for retrospective cohort study. Associated risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer were analyzed. Diagnosis criteria of pulmonary infection: occurrence of new pulmonary rales; new infiltrative change or consolidation in chest by imaging examination; with at least one of the following: temperature ≥38.5centi-degree, emergence of new purulent sputum or sputum character change, isolated pathogens from bronchial brush biopsy or tracheal secretion culture.</p><p><b>RESULTS</b>Of 371 patients, 265 were males and 106 were females. The average age was 59.1(22-80) years old. There were 38(10.2%) cases of pulmonary infection after radical resection of gastric cancer. Univariate analysis showed that smoking history, intra-operative blood loss ≥200 ml, total gastrectomy, and gastric intubation ≥6 d were associated with pulmonary infection after D2 radical gastrectomy (all P<0.05). Six cases quitted smoking 2 weeks before operation with pulmonary infection incidence of 8.1%(6/74), and 16 patients did not quit smoking 2 weeks before operation with pulmonary infection incidence of 21.1%(16/76), and the difference was statistically significant (χ=4.0387, P=0.0445). Multivariate Logistic regression analysis showed that postoperative gastric intubation ≥6 d (OR=4.335, 95%CI: 1.088 to 4.586, P=0.05), smoking history (OR=3.469, 95%CI: 1.056 to 5.252, P=0.043) and intra-operative blood loss ≥200 ml (OR=3.931, 95%CI: 1.350 to 10.574, P=0.013) were independent risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer.</p><p><b>CONCLUSION</b>For gastric cancer patients undergoing D2 radical gastrtectomy with smoking history, greater blood loss during operation and postoperative gastric intubation ≥6 d, surgeons must pay attention to the prevention of postoperative pulmonary infection.</p>
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Objective To evaluate the clinical value of mini-probe endoscopic ultrasonography (EUS) in determin-ing the therapeutic strategy for early gastric cancer (EGC) before surgery. Methods 151 EGC lesions were enrolled in the study. The accuracy of EUS-determined depths were compared with histopathologic results, and the effects of EUS-based therapeutic decision-making plan was evaluated. Results The overall accuracy of EUS-determined T staging was 74.8%. Multivariate analysis revealed that tumor size larger than 2 cm, endoscopic ulceration and tumor located at upper two thirds of the stomach were associated with EUS misdiagnosis ( < 0.05). 75.3 %(107/142) of the EGC patients received proper treatment according to EUS-based therapeutic selection. Conclusions Mini-probe EUS is a useful utility in T-staging and therapeutic strategy selection for EGC. Special attention should be paid when tumor diameter exceeds 2 cm, co-existence of ulcer or tumor located in the upper two-thirds portion of the stomach.
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Objective:To investigate the efficacy, safety, and overall survival of advanced upper gastric cancer patients who received preoperative chemoradiation therapy. Methods:A total of 62 patients who received preoperative chemotherapy or chemoradiation therapy in the Department of Gastrointestinal Surgery of Beijing Cancer Hospital&Institute were retrospectively observed to determine the efficacy and safety and to perform survival analysis of preoperative chemoradiation therapy. Results:Results of the postoperative pathology showed that the number of patients with T4 and N3 stages was significantly lower in the preoperative chemoradiation therapy group than in the preoperative chemotherapy group (P<0.05). In addition, the differences between the two groups in terms of safety and toxicity were not significant (P≥0.05). Analysis also showed that the differences between the two groups in terms of survival were not significant (P≥0.05). Conclusion:Patients with advanced upper gastric cancer can gain a potential survival advantage from preoperative chemoradiation therapy. Compared with preoperative chemotherapy, preoperative chemoradiation therapy was performed without increased risk of toxicity and insecurity. Preoperative chemoradiation therapy can also improve the local control ratio, especial y the control ratio of lymphatic metastasis. However, the final results of survival analysis depend on long-term follow-up of patients.
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Since the biological characteristics of esophageal gastric junction (EGJ) cancer are different from those of gastric cancer and esophageal cancer, the choice of initial treatment is particularly important. This article introduces a case of locally advanced EGJ can-cer with single metastasis factor treated with preoperative radiochemotherapy in the Beijing Cancer Hospital. Through the multidisci-plinary team, we aim to achieve a better prognosis for this patient and propose new treatment practices for EGJ cancer.
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Objective To investigate the safety and efficacy of endoscopic submucosal dissection (ESD) in elderly patients (age ≥ 65 years) with early gastric cancer.Methods The retrospective cohort study was adopted.The clinical data of 145 patients with early gastric cancer who underwent ESD at the Peking University Cancer Hospital between January 2011 and June 2014 were collected.Of 145 patients,57 (age≥65 years) were allocated into the elderly group and 88 (age ＜ 65 years) were allocated into the non-elderly group.ESD was performed to all the patients after the multidisciplinary discussion and evaluation.Observation indicators included operation time,volume of intraoperative blood loss,duration of hospital stay,complications,integrity of resected specimens,negative resection margin,tumor cure and follow-up (survival,tumor recurrence and metastasis).The follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence and metastasis till June 2015.Measurement data with normal distribution were presented as x ± s and comparison between groups was analyzed using t test.Measurement data with skewed distribution were presented as M (range) and comparison between groups was analyzed using nonparametric U test.Count data were analyzed using the chi-square test.Results Operation time,volume of intraoperative blood loss,duration of hospital stay,numbers of patients with postoperative perforation,bleeding,en bloc resection of tumor,piecemeal resection of tumor,negative resection margins,positive resection margins,curative resection,extended curative resection and non-curative resection were 100 minutes (range,20-470 minutes),25 mL (range,5-200 mL),5 days (range,2-10 days),1,2,52,5,50,7,30,17,10 in the elderly group and 110 minutes (range,25-480 minutes),25 mL (range,5-600 mL),4 days (range,2-29 days),3,3,85,3,83,5,47,24,17 in the non-elderly group,respectively,with no significant differences between the 2 groups (U =2 451.000,2 183.500,2 116.500,x2=1.544,1.018,1.210,0.142,P ＞ 0.05).Patients with complications were improved after symptomatic treatment.Of 145 patients,135 were followed up for a median time of 26 months (range,12-53 months).Tumor recurrence rates in the elderly and non-elderly groups were 1.8％ (1/57) and 2.3％ (2/88),showing no significant difference between the 2 groups (x2=0.000,P ＞ 0.05).No tumor recurrence and metastasis and death were occurred in other patients.Conclusion ESD is safe and feasible in the treatment of elderly patients with early gastric cancer,and it is equivalent to short-and long-term efficacies of ESD in non-elderly patients.
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Objective:To evaluate the clinical outcomes of endoscopic submucosal dissection ( ESD ) for early gastric cancer ( EGC) in a single center in China. Methods:We performed a retrospective ana-lysis of the patients with single EGC lesion who received ESD in Peking University Cancer Hospital from January 2011 to December 2013. Their clinicopathologic data, resectability, curability, complications and follow-up data were assessed. Results:A total of 116 patients were enrolled in the study. The patients in-cluded 88 men and 28 women, with a median age of 63 years ( range:25-80 years) . The post-operative histology of the lesions included 28 (24. 1%) high grade intraepithelial neoplasia, 35 (30. 2%) well differentiated adenocarcinoma, 35 (30. 2%) moderated differentiated adenocarcinoma and 18 (15. 5%) poorly differentiated adenocarcinoma. Of all the lesions, 75. 0% (87/116) were confined into mucosa, 15. 5% (18/116) invaded SM1 ( <500 μm from the muscularis mucosae) and 9. 5% (11/116) inva-ded SM2 (≥500 μm from the muscularis mucosae). The mean tumor size was (1. 49 ± 0. 96) cm, and the rate of ulceration was 14. 7% (17/116). The en bloc resection rates were 96. 7% (111/116), com-plete resection rates were 93. 1% (108/116) and curative resection rates were 77. 6% (90/116). Ac-cording to the curability, 62 (53. 4%) cases were classified into the standard curative resection ( sCR) group, 28 (24. 2%) into the expanded curative resection ( eCR) group and 26 (22. 4%) into thenon-curative resection ( nCR) group. The mean tumor size of the sCR group was smaller than that of the eCR and nCR group (t= -4. 121, P<0. 001 and t= -3. 420, P=0. 001). In the nCR group, the portion of type 0-Ⅲlesion and ulceration were significantly higher (χ2 =10 . 287 , P=0 . 006 andχ2 =17 . 737 , P<0. 001). In multivariate analysis, EGC with ulceration and submucosal invasion were the risk factors for non-curative resection ( OR=6 . 634 , P=0 . 006 and OR=12 . 735 , P<0 . 001 ) . The ESD-related complications included 4 ( 3. 4%) post-operative bleeding, 3 ( 2. 6%) intra-operative perforation, 2 (1. 7%) cardiac stenosis and 1 (0. 9%) heart failure. In the study, 106 of the 116 patients received periodic follow-up, during a median follow-up of 22 months(12 -47 months), Local tumor recurrence developed in 1 patient of the eCR group 8 months post the ESD. Conclusion:ESD is a safe and feasible option for EGC in China, ulceration and submucosal invasion are associated with non-curative resection, and post-operative bleeding and intra-operative perforation should be concerned as the main complica-tions.
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Objective To investigate the relationship between the fluorouracil pathway gene and effect of chemotherapy in advanced gastric cancer after surgery. Methods 52 postoperative patients with advanced gastric cancer using FOLFOX4 6-cycles combined chemotherapy were collected to set up the database. The expression of thymidine synthase (TS), dihydropyrimidine dehydrogenase (DPD) and orotate phosphoribosyltransferase(OPRT) in tumor tissue and adjacent non-tumor tissue of 52 patients with advanced gastric cancer were measured by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR). The influence of fluorouracil pathway gene on chemotherapy was investigated. Results The TS-mRNA level in tumor tissue was significantly higher than non-tumor tissue (0.92±0.28 vs 0.71±0.30) (t = 3.730, P =0.001).OPRT-mRNA level in tumor tissue was positively correlated with the non-tumor tissue (r =0.45, P =0.001). No correlations were observed among other gene expressions. Patients whose high OPRT-mRNA gene expression in their tumors and non-tumor tissue showed an obviously better survival (t = 3.036, P =0.003;t = 2.713, P =0.009). Patients with low DPD-mRNA gene expression survived longer than those with high DPD-mRNA gene expression in tumor tissue with statistical significance(t = 2.708, P =0.009), whereas prolonged survival was observed in patients with high DPD-mRNA gene expression in non-tumor tissue (t = 2.616, P =0.012).Conclusion There is close relationships between chemotherapy in advanced gastric cancer and the expression of DPD-mRNA, OPRT-mRNA;while the expression of TS-mRNA have no relation with the survival time.