Is Laparoscopic Approach Also Safe for the Treatment of Remnant Gastric Cancer?

The most important advantages of laparoscopic gastrectomy are the minimal invasiveness, including less postoperative pain, shorter recovery, and minimal complications. A laparoscopic distal gastrectomy is accepted widely as a standard treatment for gastric cancer. On the other hand, a laparoscopic total gastrectomy has not been popularized as a distal gastrectomy because of the complexity of a lymph node dissection and the diversity of reconstruction. In terms of laparoscopic surgery for a remnant gastrectomy, there are three key points, which are critical for safe operation: adequate lymph node dissection, meticulous adhesiolysis, and reconstruction. After radical surgery for gastric cancer, the intra-abdominal condition is greatly changed. In addition, the lymphatic anatomy around the stomach is broken and surgeons should be aware of a newly developed lymphatic system to perform adequate node dissection. An esophago-jejunal reconstruction is at risk of leakage. Until evidence that is more concrete can be obtained, experienced surgeons should consider the laparoscopic approach.

Study on the monitoring of gastric residual status during enteral nutrition in patients with craniocerebral injury / 中国实用护理杂志

Objective To explore the effect of monitoring gastric residual status during enteral nutrition in patients with craniocerebral injury. Methods Totally 114 cases were selected from January 2014 to January 2017 in our hospital for enteral nutrition in patients with craniocerebral injury, the patients were divided intocontrol group and observation group according to the random number table, every group had 57 cases,the control received routine nursing care in addition to residual gastric volume status of the patients during enteral nutrition, the observation group adopted nursing measures by monitoring residual gastric volume related to the timing of monitoring gastric residual patients,adjusting nutrient supply rate.The two groups of patients with nursing before and 14 d weight,hemoglobin,plasma albumin,blood glucose were counted and compared; statistics and compared two groups of patients with reflux or aspiration,diarrhea,abdominal distension and the incidence of nutritional compliance rate of two groups of patients in hospital; the incidence of aspiration pneumonia were statistically analyzed and compared. Results Nursing care of two groups before the index contrast, there was no significant difference (P>0.05), the patients in the observation group after nursing 14 d weight, plasma albumin, hemoglobin,blood glucose and other indicators were(57.8±6.7)kg,(38.3±5.9)g/L,(107.2±2.4)g/L,(8.2±2.5)mmol/L,were higher than the control group(55.5±1.3)kg,(37.1±1.3)g/L,(98.7±1.9)g/L,(7.4±3.9)mmol/L, the difference was significant (t=2.015-2.325, P<0.05); the observation group of patients with nutritional compliance rate of 91.23% (52/57) was higher than the control group 63.16% (36/57), the difference was statistically significant(χ2=4.872,P=0.032);the incidence of aspiration pneumonia in the observation group was 7.02% (4/57) which was significantly lower than 12.28% (7/57) in the control group, the difference was statistically significant (χ2=2.124, P=0.045); patients of observation group with reflux and aspiration the incidence of abdominal distension,diarrhea,were 17.54%(10/57),19.30%(11/57),15.79%(9/57),lower than 26.32% (15/57), 29.82% (17/57), 28.07% (16/57) of the control group, the differences were statistically significant (χ2=3.916-5.379, P<0.05). Conclusion It is helpful to improve the nutritional compliance rate and reduce the incidence of complications such as aspiration pneumonia in patients with craniocerebral injury.

Clinicopathological characteristics and prognosis of gastric remnant cancer / 肿瘤

Objective: To explore the clinicopathological characteristics of gastric remnant cancer (GRC) and identify its prognostic factors. Methods: From January 2003 to December 2012, 85 patients with gastric remnant cancer were treated in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. The medical records of 58 patients who underwent surgical resection were retrospectively analyzed. Results: The patients with GRC accounted for 1.5% of the patients with gastric cancer during the same period. GRC was likely to develop in males, and the ratio of males to females was 4.3:1. The median age was 70 years old. As compared to patients with previous gastric cancer, Billroth II reconstruction was more common in patients with previous peptic ulcer (73.8% vs 37.5%; P = 0.010). The interval time from first surgical resection to diagnosis of GRC was longer in cases of previous peptic ulcer than in cases of previous gastric cancer (29.2±10.6 vs 12.7±12.9 years; P = 0.000). Tumors located in anastomotic sites were more common in Billroth II reconstruction than in Billroth I reconstruction (73.0% vs 28.6%; P = 0.001). Borrmann type IV cancers had a high incidence of larger tumor size, undifferentiated pathology and diffuse tumor in whole gastric remnant. The resection and radical resection rates of GRC were 68.2% (58/85) and 55.3% (47/85), respectively. The overall 1-, 3-, and 5-year survival rates of patients who underwent radical resection were 70.2%, 38.4% and 32.4%, respectively. Univariate analysis showed that the significant factors affecting survival included tumor location, differentiation, tumor diameter, anemia, serum carcino-embryonic antigen (CEA) level, depth of invasion, nodal metastasis, distant metastasis, TNM stage, curability, resection combined with organs, and Borrmann type (all P < 0.05); whereas differentiation, anemia, serum CEA level and distant metastasis were independent prognostic factors in multivariable analysis (all P < 0.05). Conclusion: The factors influencing the prognosis of GRC include differentiation, anemia, serum CEA level and distant metastasis. Regular follow-up is essential for monitoring the occurrence and evaluating the prognosis of GRC after gastrectomy, regardless of peptic ulcer or gastric cancer.

Clinicopathological Characteristics and Prognosis of Remnant Gastric Cancer

PURPOSE: The long-term survival rate of gastric cancer patients after surgery has recently increased as a result of making an early diagnosis of gastric cancer. Therefore, the incidence of remnant gastric cancer is increasing. This study was performed to evaluate the clinicopathological characteristics and prognosis of patients with remnant gastric cancer. MATERIALS AND METHODS: From January 2005 to December 2009, twenty-nine patients with remnant gastric cancer and who underwent surgery at Pusan National University Hospital were enrolled in this study. We retrospectively reviewed and analyzed their medical records. We also divided them into two groups: the remnant gastric cancer (RGC)-B group (first operation for benign disease) and the RGC-M group (first operation for malignant disease). RESULTS: The RGC-B group included ten patients and the RGC-M group included nineteen patients. The mean interval between the first and second operations was 17 years. The curative resection rate was 93.1% (27/29). The postoperative complication rate was 20.7% (6/29) and there was no perioperative mortality. Ten (37%) of twenty-seven patients experienced recurrence after curative resection and eight patients (27.6%) expired due to aggravation of remnant stomach cancer. An advanced TNM stage and non-curative resection were the negative prognostic factors for survival for patients with remnant stomach cancer (P=0.0453 and P<0.001). The RGC-M group showed a shorter interval (P<0.001) and the RGC-B group had more advanced TNM stage (P=0.003). CONCLUSIONS: Long-term follow-up should be considered not only for patients who undergo an operation for malignant disease, but also for the patients who underwent an operation for benign disease. When remnant gastric cancer is diagnosed, curative resection is essential to improve the survival.

Clinicopathological Characteristics and Prognosis of Remnant Gastric Cancer

PURPOSE: The long-term survival rate of gastric cancer patients after surgery has recently increased as a result of making an early diagnosis of gastric cancer. Therefore, the incidence of remnant gastric cancer is increasing. This study was performed to evaluate the clinicopathological characteristics and prognosis of patients with remnant gastric cancer. MATERIALS AND METHODS: From January 2005 to December 2009, twenty-nine patients with remnant gastric cancer and who underwent surgery at Pusan National University Hospital were enrolled in this study. We retrospectively reviewed and analyzed their medical records. We also divided them into two groups: the remnant gastric cancer (RGC)-B group (first operation for benign disease) and the RGC-M group (first operation for malignant disease). RESULTS: The RGC-B group included ten patients and the RGC-M group included nineteen patients. The mean interval between the first and second operations was 17 years. The curative resection rate was 93.1% (27/29). The postoperative complication rate was 20.7% (6/29) and there was no perioperative mortality. Ten (37%) of twenty-seven patients experienced recurrence after curative resection and eight patients (27.6%) expired due to aggravation of remnant stomach cancer. An advanced TNM stage and non-curative resection were the negative prognostic factors for survival for patients with remnant stomach cancer (P=0.0453 and P<0.001). The RGC-M group showed a shorter interval (P<0.001) and the RGC-B group had more advanced TNM stage (P=0.003). CONCLUSIONS: Long-term follow-up should be considered not only for patients who undergo an operation for malignant disease, but also for the patients who underwent an operation for benign disease. When remnant gastric cancer is diagnosed, curative resection is essential to improve the survival.

The Laparoscopic Approach for Gastric Remnant Cancer

PURPOSE: We wanted to examine the feasibility of employing a laparoscopic approach for treating gastric remnant cancer based on our experience with preliminary laparoscopic surgery. METHODS: Between September 2005 and January 2007, nine consecutive gastric remnant cancer patients underwent an initial laparoscopic approach. Their medical records, including the preoperative condition, the operation data, the histopathologic results and the follow-up data, were retrospectively reviewed. RESULTS: Four patients underwent laparoscopic radical resection with at least D2 lymph node dissection. The other five patients initially underwent diagnostic laparoscopy. Overall, four patients had open conversion and they underwent radical resection (2 patients) or palliative surgery (2 patients). Another patient underwent diagnostic laparoscopy only. The intra-operative complications related to the previous gastrectomy and adhesions are not occurred. Eight of the nine patients underwent postoperative adjuvant or palliative chemotherapy. CONCLUSION: An initial laparoscopic approach that's performed by a well-trained laparoscopic surgeon is feasible for treating gastric remnant cancer, although the results of long-term follow-up and a well-designed clinical trial are needed.

The Laparoscopic Approach for Gastric Remnant Cancer

PURPOSE: We wanted to examine the feasibility of employing a laparoscopic approach for treating gastric remnant cancer based on our experience with preliminary laparoscopic surgery. METHODS: Between September 2005 and January 2007, nine consecutive gastric remnant cancer patients underwent an initial laparoscopic approach. Their medical records, including the preoperative condition, the operation data, the histopathologic results and the follow-up data, were retrospectively reviewed. RESULTS: Four patients underwent laparoscopic radical resection with at least D2 lymph node dissection. The other five patients initially underwent diagnostic laparoscopy. Overall, four patients had open conversion and they underwent radical resection (2 patients) or palliative surgery (2 patients). Another patient underwent diagnostic laparoscopy only. The intra-operative complications related to the previous gastrectomy and adhesions are not occurred. Eight of the nine patients underwent postoperative adjuvant or palliative chemotherapy. CONCLUSION: An initial laparoscopic approach that's performed by a well-trained laparoscopic surgeon is feasible for treating gastric remnant cancer, although the results of long-term follow-up and a well-designed clinical trial are needed.

A Case of Early Gastric Remnant Cancer Treated by Endoscopic Mucosal Resection / 대한소화기내시경학회지

Patients who have undergone partial gastric resection are at an increased risk for the development of cancer and polyps in the gastric remnant, and this risk increases with time following gastrectomy. The prevalence of polypoid change at 15~20 years after surgery is approximately 10%, about four or five times higher as compared to nonoperated one. Hyperplastic polyps are encountered more frequently than adenomatous polyps. Surgical treatment for gastric remnant cancer has been regarded as standard method, but it was reported that endoscopic mucosal resection of early gastric remnant cancer could be performed under strict indication, as the incidence of lymph node metastasis was very low. Recently one adenomatous polyp with focally carcinoma in situ in the gastric remnant was removed by endoscopic mucosal resection in male patient who had undergone Billroth II gastrojejunostomy for gastric ulcer disease 12 years earlier.

Gastric Remnant Cancer Following a Partial Gastrectomy for Benign Gastroduodenal Disease

BACKGROUND: Gastric cancer that occurs 5 or more years after a partial gastric resection for benign disease is defined as gastric remnant cancer. The purpose of this study was to examine the clinicopathologic features and the treatment results of sixteen cases of gastric remnant cancer following partial gastrectomies for benign gastroduodenal diseases. METHODS: Sixteen patients who underwent operations for gastric cancer in the remnant stomach from January 1980 to December 1996 were evaluated retrospectively. RESULTS: The mean age was 51.5 years, and 15 patients were male. All of them had undergone surgical treatment for benign disorders, including gastric ulcers (14 cases) and duodenal ulcers (2 cases), and the mean time interval between the primary operation and the diagnosis of gastric cancer was 24.5 years. Most patients presented vague, nonspecific symptoms, except two cases of early diagnosis without symptom. Surgical resection of the remnant stomach was performed in 13 patients of which 11 patients underwent a curative resection with curative intent. Of these 13 patients, a combined resection of adjacent organs was performed in 10 cases. Fifteen patients had advanced gastric cancer, most of which involved depth of invasions to seromuscular layers, and lymph-node metastases were found in 8 patients. Most of patients who underwent bypass surgery or palliative resection died within 1 year of the operation. Among the 11 patients who underwent a curative resection, 3 patients died within 1 month of the operation due to postoperative complications, 2 patients died of recurrent cancer, and another 6 patients are alive without evidence of recurrence. CONCLUSIONS: Eearly detection of gastric cancer in the remnant stomach by periodic follow up is important, especially in high-risk groups, and the application of aggressive surgical treatment will provide for better patient survival.

Clinicopathologic Features and Prognosis of Gastric Remnant Cancer after Partial Gastrectomy for Benign and Malignant Gastric Lesions / 대한암학회지

PURPOSE: Despite the decreasing incidence of primary gastric cancer, the incidence of gastric cancer in the remnant stomach has been increasing. This study evaluated the clinicopathologic features and prognosis of gastric cancer in the remnant stomach. METHODS AND MATERIALS: The clinicopathologic features and prognosis of 31 cases of gastric cancers in the remnant stomach were evaluated retrospectively. 19 patients among them underwent partial gastrectomy for benign gastroduodenal disease (Group I), while 12 patients for malignant disease (Group II) which were detected at least 5 years after initial surgery and the clinicopathologic features and survival curves of two groups were compared. The clinicopathologic features evaluated included age, sex, interval between operations, type of operation, location of tumor, tumor size, Borrmann type, depth of invasion, lymph node metastasis, distant metastasis, TNM stage, histologic differentiation and Lauren classification. RESULTS: The median age was 59 years, 28 patients (90.3%) were male and median time interval between operations was 15 years. Group I gastric remnant cancers were detected late after initial gastrectomy and have a significant tendency toward lymph node metastasis. Resection was carried out in 25 patients (81.0%) in which 22 patient (71.0%) underwent resections with curative intent. The overall 5 year survival rate was 45.5% and no significant difference was observed between the survival curves for patients with group I and group II. Depth of invasion, lymph node metastasis, distant metastasis, tumor size and curability of operation have prognostic significance in univariate analysis and multivariate analysis performed with above 5 factors has revealed that depth of invasion is the only independent prognostic factor. CONCLUSIONS: Both groups are similar in survival rate and clinicopathologic characteristics except time interval between operations and lymph node metastasis. Early detection by periodic endoscopic follow-up and radical resection is a reasonable policy as a treatment of gastric remnant cancer.