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1.
Medicina UPB ; 41(1): 51-60, mar. 2022. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1362696

ABSTRACT

Helicobacter pylori es un carcinógeno tipo I resistente a múltiples antibióticos y con alta prioridad en salud pública. La infección por este microorganismo está influenciada por una interacción compleja entre la genética del huésped, el entorno y múltiples factores de virulencia de la cepa infectante. Afecta al 50 % de la población mundial, provocando afecciones gastroduodenales graves, la mayoría de forma asintomática. El 20 % de los individuos con H. pylori pueden desarrollar a través del tiempo lesiones gástricas preneoplásicas y el 2 % de ellos un cáncer gástrico. Las manifestaciones clínicas gastrointestinales y extragastrointestinales están asociadas a su virulencia y a la respuesta del sistema inmunológico con la liberación de citosinas proinflamatorias, tales como TNF-alfa, IL-6, IL-10 e IL-8, causantes de inflamación aguda y crónica. Múltiples factores de virulencia han sido estudiados como el gen A asociado a la citotoxina (CagA) y la citotoxina vacuolante (VacA), los cuales juegan un rol importante en la aparición del cáncer gástrico. Dada la resistencia cada vez mayor a los antibióticos utilizados, las líneas de estudio en el futuro inmediato deben estar encaminadas en establecer la utilidad de los nuevos antibióticos y la determinación de profagos colombianos en todo el país. Esta revisión tiene como objetivo hacer una puesta al día sobre las características del H. pylori, los mecanismos patogénicos, genes de virulencia, su asociación con el mayor riesgo de cáncer gástrico, farmacorresistencia microbiana y su erradicación.


Helicobacter pylori is recognized as a class I carcinogen resistant to multiple antibiotics and with high priority in public health. The infection caused by this microorganism is influenced by a complex interaction between host genetics, environment, and multiple virulence factors of the infecting strain. It affects 50% of the world population, causing severe gastroduodenal conditions, most of them asymptomatic. Through time, 20% of individuals with H. pylori may develop preneoplastic gastric lesions and 2% of them develop gastric cancer. The gastrointestinal and extra-gastrointestinal clinical manifestations are associated with its virulence and the response of the immune system with the release of pro-inflammatory cytokines, such as TNF-alpha, IL-6, IL-10 and IL-8, which cause acute and chronic inflammation. Multiple virulence factors have been studied, such as cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA), which play an important role in the development of gastric cancer. Due to the increasing antibiotics resistance, the research in the immediate future should be aimed at establishing the usefulness of the new antibiotics and the determination of Colombian prophages throughout the country. This paper aims to update the characteristics of H. pylori, its pathogenic mechanisms, virulence genes, its association with the increased risk of gastric cancer, microbial drug resistance, and eradication.


Helicobacter pylorié um carcinógeno tipo I resistente a múltiplos antibióticos e com alta prioridade na saúde pública. A infecção por este microrganismo está influenciada por uma interação complexa entre a genética do hospede, o entorno e múltiplos fatores de virulência da cepa infectante. Afeta a 50% da população mundial, provocando afeções gastroduodenais graves, a maioria de forma assintomática. 20% dos indivíduos com H. pylori podem desenvolver através do tempo lesões gástricas pré-neoplásicas e 2% deles um câncer gástrico. As manifestações clínicas gastrointestinais e extragastrointestinais estão associadas à sua virulência e à resposta do sistema imunológico com a liberação de citocinas pró-inflamatórias, tais como TNF-alfa, IL-6, IL-10 e IL-8, causantes de inflamação aguda e crónica. Múltiplos fatores de virulência hão sido estudados como o gene. A associado à citotoxina (CagA) e a citotoxina vacuolante (VacA), os quais jogam um papel importante no aparecimento do câncer gástrico. Dada a resistência cada vez maior aos antibióticos utilizados, as linhas de estudo no futuro imediato devem estar encaminhadas em estabelecer a utilidade dos novos antibióticos e a determinaçãode profagos colombianos em todo o país. Esta revisão tem como objetivo fazer uma atualização sobre as características do H. pylori, os mecanismos patogénicos, genes de virulência, sua associação com o maior risco de câncer gástrico, farmacorresistência microbiana e sua erradicação.


Subject(s)
Humans , Helicobacter pylori , Drug Resistance , Carcinogens , Virulence Factors , Disease Eradication , Immune System , Anti-Bacterial Agents
2.
Rev. Méd. Inst. Mex. Seguro Soc ; 60(1): 96-103, 17-feb-2022. ilus
Article in Spanish | LILACS | ID: biblio-1361701

ABSTRACT

Introducción: la miositis osificante progresiva (MOP) es una enfermedad hereditaria del tejido conectivo de baja prevalencia (1:2,000,000 habitantes). Se caracteriza por osificación heterotópica con un comportamiento incierto que excepcionalmente se ha relacionado con neoplasias. Se buscó conocer la coexistencia de la MOP con neoplasias de origen mesodérmico, para que sean consideradas en el diagnóstico de otros pacientes, así como formular hipótesis para esclarecer su asociación. Caso clínico: mujer de 27 años con dolor de músculo isquitiobial y glúteo derecho que incrementaba con el ejercicio, sin remisión con analgésicos hasta limitar la movilidad de ambas extremidades. Se solicitó una serie ósea donde se evidenciaron zonas de radiolucidez heterogénea en la región de ambos muslos y pelvis de manera irregular, semejante a densidad ósea, que fue compatible con los hallazgos ecográficos y tomográficos; se concluyó que eran imágenes relacionadas con miositis osificante de cadera. La paciente refirió sintomatología gástrica y se solicitó una endoscopía que histopatológicamente reportó carcinoma gástrico difuso con células en anillo de sello; las imágenes de gabinete mostraron tumoración ovárica. Conclusión: la MOP es una patología de baja prevalencia, por lo que su conocimiento y sospecha son fundamentales para el diagnóstico. Hay poca literatura que involucre a las tres entidades; por ende, su fisiopatología y comprensión es limitada. En cuanto a la MOP, aún no hay un tratamiento curativo; sin embargo, el diagnóstico certero permite iniciar rehabilitación de manera oportuna con mejoría de la calidad de vida.


Background: Myositis ossificans progressiva (MOP) is a low prevalence hereditary connective tissue disease (1:2,000,000 habitants). It is characterized by heterotopic ossification with an uncertain behavior that has been exceptionally related to neoplasms. The objective was to know the coexistence of MOP with neoplasms of mesodermal origin, so that they can be considered in the diagnosis of other patients, as well as formulate hypotheses to clarify their association. Clinical case: 27-year-old female with right gluteal and ischitiobial muscle pain that increased with exercise, without remission with analgesics until limiting the mobility of both extremities. A bone series was requested where areas of heterogeneous radiolucency were evidenced in the region of, both, thighs and pelvis in an irregular manner, similar to bone density, which was compatible with the ultrasound and tomographic findings; we concluded that they were images of myositis ossificans of the hip. The patient reported gastric symptoms and an endoscopy was requested, which histopathologically reported diffuse gastric carcinoma with signet ring cells; cabinet images showed an ovarian tumor. Conclusion: MOP is a low prevalence disease, which is why its knowledge and suspicion are essential for the diagnosis. We found little literature that involves the three entities; therefore, their pathophysiology and understanding is limited. Regarding MOP, at this moment there is no curative treatment; however, an accurate diagnosis allows to start rehabilitation in a timely manner with an improvement in the quality of life.


Subject(s)
Humans , Female , Adult , Bone Neoplasms , Ossification, Heterotopic , Myositis Ossificans , Diagnostic Imaging , Bone Density , Risk Factors
3.
Rev. colomb. cir ; 37(1): 60-71, 20211217. tab, fig
Article in Spanish | LILACS | ID: biblio-1355299

ABSTRACT

Introducción. El cáncer gástrico es el quinto cáncer diagnosticado con mayor frecuencia y la tercera causa de muerte por cáncer en el mundo. En el tratamiento quirúrgico, la evidencia actual apoya las medidas preoperatorias e índices pronósticos para mejorar la supervivencia. El índice nutricional pronóstico, que une los valores de los linfocitos circulantes en sangre periférica con los de la albúmina sérica, ha presentado características de ser un marcador nutricional e inmunológico con valor predictivo sobre complicaciones y mortalidad. El objetivo de este estudio fue determinar la relación entre el índice nutricional pronóstico con las complicaciones y mortalidad en pacientes con cáncer gástrico sometidos a gastrectomía. Métodos. Se llevó a cabo un estudio observacional descriptivo, de corte transversal, con componente analítico, mediante la revisión retrospectiva de las historias clínicas. Resultados. Se analizaron 113 pacientes sometidos a gastrectomía total o subtotal. Se encontró asociación entre el índice nutricional pronóstico y la mortalidad; todos los pacientes que murieron tenían un índice menor o igual a 46. También se encontró asociación inversa entre el valor del índice y la presentación de complicaciones posoperatorias, como sepsis, peritonitis, fuga de la anastomosis y sangrado. Discusión. Similar a nuestro análisis, varios estudios plantean que un índice nutricional pronóstico bajo podría tener un valor predictivo sobre la frecuencia de complicaciones y supervivencia global en pacientes con cáncer gástrico llevados a cirugía. Conclusión. El índice nutricional pronóstico se asocia con la mortalidad y complicaciones posoperatorias en pacientes sometidos a gastrectomía por cáncer gástrico.


Introduction. Gastric cancer is the fifth most frequently diagnosed cancer and the third cause of cancer death in the world. In surgical treatment, current evidence supports preoperative measures and prognostic index to improve survival. The prognostic nutritional index, which unites the values of circulating lymphocytes in peripheral blood with those of serum albumin, has presented characteristics of being a nutritional and immunological marker with predictive value on complications and mortality. The objective of this study was to determine the relationship between the prognostic nutritional index with complications and mortality in patients with gastric cancer undergoing gastrectomy.Methods. A descriptive, cross-sectional, observational study with an analytical component was carried out by a retrospective review of medical records. Results. A total of 113 patients who underwent total or subtotal gastrectomy were analyzed. An association was found between mortality and the prognostic nutritional index and mortality; all patients who died had an index ≤ 46. An inverse association was also found between the value of the index and the presentation of postoperative complications, such as sepsis, peritonitis, anastomotic leak, and bleeding.Discussion. Similar to our analysis, several studies suggest that a low prognostic nutritional index could have a predictive value on the frequency of complications and overall survival in patients with gastric cancer undergoing surgery.Conclusion. The prognostic nutritional index is associated with mortality and postoperative complications in patients undergoing gastrectomy for gastric cancer.


Subject(s)
Humans , Stomach Neoplasms , Nutrition Assessment , Postoperative Complications , Prognosis , Mortality , Gastrectomy
4.
Rev. enferm. Inst. Mex. Seguro Soc ; 29(3): 136-134, 04-oct-2021. tab
Article in Spanish | LILACS, BDENF | ID: biblio-1357685

ABSTRACT

Introducción: en la actualidad, el cáncer gástrico sigue ocupando un lugar importante entre las causas de muerte a nivel mundial. Objetivo: determinar las características sociodemográficas, ambientales y clínicas de los pacientes con cáncer gástrico en el municipio de San Gil, Colombia. Metodología: estudio descriptivo transversal. La muestra estuvo conformada por 13 casos de personas con diagnóstico clínico e histopatológico de cáncer gástrico del municipio de San Gil, Santander, residentes del área rural y urbana. El análisis estadístico fue realizado con el programa Statistical Product and Service Solutions, versión 24.0 Resultados: el género con mayor afectación fue el masculino con un 62%. La mediana de edad de los participantes fue de 51 años con una edad mínima de 36 años y una edad máxima de 87 años. En el 61.5% el nivel de escolaridad fue la educación primaria. En cuanto a los factores ambientales, se encontró que el 69.2% consumieron alimentos salados y condimentados. Conclusiones: se encontró que una gran proporción de los participantes fueron del género masculino y residentes del casco urbano. Entre las ocupaciones, las más frecuentes fueron amas de casa y conductores de transporte pesado. Los síntomas que presentaron los participantes en el momento del diagnóstico fueron: pérdida de peso, hematemesis, dolor epigástrico y sensación de plenitud abdominal


Introduction: At present, gastric cancer continues to occupy an important place among the causes of death worldwide. Objective: To determine the sociodemographic, environmental, and clinical characteristics of patients with gastric cancer in the municipality of San Gil, Colombia. Methods: Descriptive cross-sectional study. The sample consisted of 13 cases of people with clinical and histopathological diagnosis of gastric cancer from the municipality of San Gil, Santander, who were residents of rural and urban areas. Statistical analysis was carried out with the program Statistical Product and Service Solutions (SPSS), version 24.0. Results: Men were the most affected, with 61.5%. The median age of the participants was 51 years with a minimum age of 36 years and a maximum of 87 years. In 61.5% the level of education was primary education. Regarding environmental factors, it was found that 69.2% consumed salty and spicy foods. Conclusions: It was found that a large proportion of the participants were male, urban residents. Concerning occupations, the most frequent were housewives and heavy truck drivers. Symptoms that participants presented at the time of diagnosis were weight loss, hematemesis, epigastric pain and fullness in upper abdomen.


Subject(s)
Humans , Male , Female , Stomach Neoplasms , Epidemiologic Factors , Cross-Sectional Studies , Public Health , Cause of Death , Colombia
5.
Rev. argent. cir ; 113(2): 253-257, jun. 2021. graf
Article in Spanish | LILACS-Express | LILACS, BINACIS | ID: biblio-1365482

ABSTRACT

RESUMEN La prevalencia de los pólipos gástricos es del 6% en videoendoscopias digestivas altas; el 17% de estos está constituido por pólipos hiperplásicos gástricos. Generalmente se revelan de manera accidental durante la videoendoscopia digestiva alta. No obstante, cuando aumentan su tamaño pueden ser sin tomáticos. El cáncer gástrico presenta una prevalencia del 2,1% en los pólipos hiperplásicos gástricos. El objetivo de este artículo es describir una forma de presentación atípica de esta patología y realizar una revisión de la literatura. Presentamos el caso de un paciente de 73 años, con anemia y posterior diagnóstico endoscópico de cáncer gástrico temprano sobre un pólipo hiperplásico gástrico, al que se le realizó polipectomía mediante resección endoscópica con asa. Es fundamental tener en cuenta el tratamiento mínimamente invasivo, mediante resección endoscópica ya que se considera suficiente en este tipo de pacientes.


ABSTRACT The prevalence of gastric polyps during upper gastrointestinal endoscopies is 6%, and 17% correspond to gastric hyperplastic polyps. They are usually incidentally found during upper gastrointestinal endoscopy; yet, large polyps may become symptomatic. The prevalence of gastric cancer in gastric hyperplastic polyps is 2.1%. The aim of this paper is to describe an atypical presentation of this disease with review of the literature. A 73-year-old male patient with anemia and subsequent diagnosis of early gastric cancer in a gastric hyperplastic polyp was treated with endoscopic polypectomy with endoloop.Minimally invasive treatment by endoscopic resection is sufficient in this type of patients.

6.
Rev. Finlay ; 11(2): 189-199, 2021. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1340760

ABSTRACT

RESUMEN El cáncer gástrico es una de las principales causas de muerte por neoplasias en el mundo. Las guías de prácticas clínicas actuales ofrecen modelos de tratamiento que involucran a la cirugía, radioterapia, quimioterapia, inmunoterapia y terapia dirigida a receptores de crecimiento específicos, sin embargo, los aspectos genéticos y de la biología molecular no siempre son tenidos en cuenta en la práctica médica. El objetivo de la presente revisión es articular los aspectos actuales más relevantes de la genética y la biología molecular en relación con el cáncer gástrico, para integrarlos en las guías clínicas de pacientes y familiares con el diagnóstico o con riesgo de padecer este tipo de neoplasia. Para ello se revisaron los avances genéticos y los síndromes relacionados con el cáncer gástrico, clasificaciones moleculares e implicaciones en su manejo. Se utilizaron las bases de datos Google Scholar, Elsevier y PubMed en los últimos 10 años, seleccionándose los de mayor importancia a texto completo desde el punto de vista cualitativo. La integración de antecedentes personales y familiares con elementos genéticos precisan ser tenidos en cuenta en el manejo, diagnóstico y prevención de esta enfermedad. Se sugiere la inclusión de elementos genéticos y moleculares en toda guía de práctica clínica.


ABSTRACT Gastric cancer is one of the leading causes of death from neoplasms in the world. Current clinical practice guidelines offer treatment models that involve surgery, radiotherapy, chemotherapy, immunotherapy and therapy directed at specific growth receptors, however, genetic and molecular biology aspects are not always taken into account in medical practice. The objective of this review is to articulate the most relevant current aspects of genetics and molecular biology in relation to gastric cancer, to integrate them into the clinical guidelines of patients and relatives with the diagnosis or at risk of suffering from this type of neoplasia. For them, genetic advances and syndromes related to gastric cancer, molecular classifications and implications in their management were reviewed. The databases Google Scholar, Elsevier, and PubMed were used in the last 10 years, selecting the most important full-text from a qualitative point of view. The integration of personal and family history with genetic elements needs to be taken into account in the diagnostic management and prevention of this disease. The inclusion of genetic and molecular elements in all clinical practice guidelines is suggested.

7.
An. Fac. Med. (Perú) ; 82(2): 146-149, abr.-jun 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1339087

ABSTRACT

RESUMEN Se reporta el primer caso en Perú de una fístula gastroesplénica (FGE) secundaria a adenocarcinoma gástrico penetrante al hilio esplénico que ocasionó infarto esplénico maligno y peritonitis difusa. Se discute la racionalidad del tratamiento quirúrgico. Varón de 84 años con peritonitis difusa secundario a un adenocarcinoma gástrico Borrmann III (BIII) fístulizado al bazo y en comunicación con la cavidad peritoneal. Se hallaron en la literatura cuatro casos de FGE asociadas a cáncer gástrico. La gastrectomía con intención curativa en un solo tiempo estaría indicada para casos con buena condición general y criterios de curabilidad. La gastrectomía en un segundo tiempo se reserva para casos con mala condición general y criterios de curabilidad. Las resecciones locales o paliativas estarían indicadas para los casos con mala condición general e incurabilidad.


ABSTRACT The first case in Peru of a gastro-splenic fistula (GSF) secondary to gastric adenocarcinoma penetrating the splenic hilum, causing malignant splenic infarction and diffuse peritonitis, is reported. The rationale for surgical treatment is discussed. An 84-year-old man with diffuse peritonitis secondary to a Borrmann III (BIII) gastric adenocarcinoma fistulized to the spleen and in communication with the peritoneal cavity. Four cases of GSF associated with gastric cancer were found in the literature. The gastrectomy with curative intention in a single stage, would be indicated for cases with good general condition and criteria of curability. A second stage gastrectomy is reserved for cases with poor general condition and curability criteria. Local or palliative resections would be indicated for cases with poor general condition and incurability.

8.
Arq. gastroenterol ; 58(1): 93-99, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1248989

ABSTRACT

ABSTRACT BACKGROUND: As age advances, a higher burden of comorbidities and less functional reserve are expected, however, the impact of aging in the surgical outcomes of gastric cancer (GC) patients is unknown. OBJECTIVE: The aim of this study is to evaluate surgical outcomes of GC patients according to their age group. METHODS: Patients submitted to gastrectomy with curative intent due to gastric adenocarcinoma were divided in quartiles. Each group had 150 patients and age limits were: ≤54.8, 54.9-63.7, 63.8-72, >72. The outcomes assessed were: postoperative complications (POC), 90-day postoperative mortality, disease-free survival (DFS) and overall survival (OS). RESULTS: Major surgical complications were 2.7% in the younger quartile vs 12% for the others (P=0.007). Major clinical complications raised according to the age quartile: 0.7% vs 4.7% vs 5.3% vs 7.3% (P<0.042). ASA score and age were independent risk factors for major POC. The 90-day mortality progressively increased according to the age quartile: 1.3% vs 6.0% vs 7.3% vs 14% (P<0.001). DFS was equivalent among quartile groups, while OS was significantly worse for those >72-year-old. D2 lymphadenectomy only improved OS in the three younger quartiles. Age >72 was an independent risk factor for worse OS (hazard ratio of 1.72). CONCLUSION: Patients <55-year-old have less surgical complications. As age progresses, clinical complications and 90-day mortality gradually rise. OS is worse for those above age 72, and D2 lymphadenectomy should be individualized after this age.


RESUMO CONTEXTO: Conforme a idade avança, se esperam mais morbidades e menor reserva funcional. Entretanto não está claro qual o impacto do envelhecimento nos resultados cirúrgicos do câncer gástrico (CaG). OBJETIVO: O intuito deste estudo é avaliar os resultados cirúrgicos de pacientes com CaG de acordo com o grupo etário. MÉTODOS: Pacientes submetidos a gastrectomia por adenocarcinoma gástrico com intuito curativo foram divididos em quartis. Cada grupo incluiu 150 indivíduos e os limites etários foram: ≤54,8; 54,9-63,7; 63,8-72; >72. Os resultados avaliados foram: complicações pós-operatórias (CPO), mortalidade em 90 dias, sobrevida livre de doença (SLD) e sobrevida global (SG). RESULTADOS: Complicações cirúrgicas maiores ocorreram em 2,7% dos pacientes no quartil mais jovem vs 12% para os demais (P=0,007). A incidência de complicações clínicas maiores aumentou conforme o quartil: 0,7% vs 4,7% vs 5,3% vs 7,3% (P<0,042). A pontuação ASA e a idade foram fatores de risco independentes para CPO maiores. A mortalidade em 90 dias aumentou progressivamente conforme o quartil etário: 1,3% vs 6,0% vs 7,3% vs 14% (P<0,001). A SLD foi equivalente entre os quartis, enquanto a SG foi significativamente pior para os >72 anos de idade. Linfadenectomia D2 aumentou a SG apenas para os 3 quartis mais jovens. Idade > 72 foi fator independente de risco para pior SG (razão de chances de 1,72) CONCLUSÃO: Pacientes < 55 anos tem menos complicações cirúrgicas. Conforme a idade avança, as complicações clínicas e a mortalidade em 90 dias aumenta gradualmente. A SG é pior se >72 anos e a indicação de linfadenectomia D2 deve ser individualizada a partir dessa idade.


Subject(s)
Humans , Aged , Stomach Neoplasms/surgery , Adenocarcinoma/surgery , Postoperative Complications , Survival Rate , Retrospective Studies , Gastrectomy/adverse effects , Lymph Node Excision , Middle Aged
9.
Arq. gastroenterol ; 58(1): 26-31, Jan.-Mar. 2021. tab
Article in English | LILACS | ID: biblio-1248982

ABSTRACT

ABSTRACT BACKGROUND: Worldwide, colorectal cancer (CRC) and gastric cancer (GC) are the third and the fifth most prevalent, respectively. Diarrhea is a common symptom in patients on chemotherapy or radiotherapy treatment and can reduce treatment tolerance. Surgical resections and chemotherapy change the intestinal microbiota that can lead to lactose intolerance, small intestinal bacterial overgrowth (SIBO). OBJECTIVE: The aim of the study was to evaluate the frequency of diarrhea in patients with CRC and GC on chemotherapy with SIBO or intolerance of lactose. METHODS: This is a descriptive and observational study with patients of both sexes, over 18 years old, in treatment in the Gastro-Oncology outpatient clinic of the Federal University of São Paulo. Patients with a confirmed diagnosis of CRC or GC during chemotherapy treatment were included. To detect bacterial overgrowth and lactose intolerance, breath hydrogen test with lactulose and lactose was done. Number and aspects of the evacuations and toxicity degree were collected. For the nutritional assessment, weight and height were performed to calculate the BMI. and the Patient Generated Subjective Global Assessment (PG-SGA). RESULTS: A total of 33 patients were included, 29 with CRC and 3 with GC. Most of them were male (57.57%), mean age of 60.03±10.01 years and in chemotherapy with fluoropyrimidine and oxaliplatin (54.5%). Diarrhea was present in 57.6% and 30.3% had toxicity grade 2. According to the BMI, 78.9% were eutrophics, obese or overweight, but according to PG-SGA, 84.9% had moderate or severe nutritional risk grade. Between patients, 45% had lactose intolerance and 9% SIBO. Diarrhea grade 2-3 was observed in 66.6% of patients with SIBO and 66.7% of that with lactose intolerance. No statistical difference was observed between patients with SIBO or lactose intolerance and grade of diarrhea. CONCLUSION: Diarrhea was a frequent symptom in chemotherapy patients with gastric or colorectal cancer independent of the presence of SIBO or lactose intolerance. Surgery and chemotherapy treatment impacted in the intestinal habit of patients. Diagnosis of other causes of diarrhea may contribute to a better tolerance to treatment and quality of life.


RESUMO CONTEXTO: Mundialmente, o câncer colorretal (CCR) e gástrico (CG) são a terceira e a quinta causa de câncer mais prevalente, respectivamente. A diarreia é um sintoma comum entre os pacientes em quimioterapia ou radioterapia e pode reduzir a tolerância ao tratamento. Quimioterapia e ressecções cirúrgicas causam alterações da microbiota intestinal que podem levar a intolerância à lactose e ao supercrescimento bacteriano do intestino delgado (SBID). OBJETIVO: Avaliar a presença de diarreia nos pacientes com câncer colorretal e gástrico em quimioterapia e a presença de SBID ou intolerância à lactose. MÉTODOS: Foi realizado um estudo descritivo, observacional com pacientes ambulatoriais de ambos os sexos, maiores de 18 anos, em tratamento no ambulatório de gastro-oncologia da Universidade Federal de São Paulo. Foram incluídos pacientes com diagnóstico confirmado de CCR ou CG durante tratamento quimioterápico. Para detectar supercrescimento bacteriano e intolerância à lactose, foram realizados testes respiratórios com lactulose e lactose respectivamente. Número, aspecto das evacuações e grau de toxicidade foram coletados. Para a avaliação nutricional foram aferidos peso e altura para cálculo do IMC e para avaliação do risco nutricional foi realizada a avaliação subjetiva global produzida pelo próprio paciente (ASG-PPP). RESULTADOS: Foram incluídos 33 pacientes, 29 com CCR e 3 com CG. A maioria era do sexo masculino (57,5%) com média de idade 60,03±10,01 anos e em tratamento quimioterápico com fluoropirimidina e oxaliplatina (54,5%). Diarreia foi relatada por 57,6% dos pacientes sendo em 30% grau 2. Pelo IMC, 78,9% apresentavam eutrofia, sobrepeso ou obesidade grau 1, mas pela ASG-PPP 84,9 apresentavam risco nutricional moderado ou severo. Entre os pacientes 9% apresentavam SBID e 45% intolerância à lactose. Diarreia grau 2-3 foi observada em 66,6% daqueles pacientes com SBID e 66,7% dos com intolerância à lactose. Não encontramos diferenças estatísticas entre os pacientes com SBID ou intolerância à lactose e intensidade de diarreia. CONCLUSÃO: Diarreia foi um sintoma frequente entre os pacientes com câncer gástrico ou colorretal em quimioterapia independente da presença de SBID ou intolerância à lactose. Cirurgia e quimioterapia impactaram no hábito intestinal dos pacientes. O diagnóstico de outras causas de diarreia pode contribuir para a melhor tolerância do tratamento e qualidade de vida.


Subject(s)
Humans , Male , Female , Adolescent , Aged , Stomach Neoplasms , Colorectal Neoplasms/drug therapy , Lactose Intolerance/diagnosis , Quality of Life , Breath Tests , Hydrogen , Intestine, Small , Lactose , Middle Aged
10.
Journal of Chinese Physician ; (12): 974-977, 2021.
Article in Chinese | WPRIM | ID: wpr-909650

ABSTRACT

Objective:To study the short-term effect of early application of intestinal microecological therapy after gastric cancer surgery.Methods:A retrospective analysis was made on 96 patients with early and middle stage gastric cancer who underwent surgical treatment in the department of gastrointestinal surgery of Shulan (Hangzhou) Hospital from June 1, 2020 to May 31, 2021. Among them, 48 patients in the observation group were given enteral nutrition support treatment in the early stage after operation and intestinal microecological preparation, while the control group of 48 patients in the early postoperative were given enteral nutrition support. The serum total protein, albumin, prealbumin and other nutrition related indexes and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before and 7 days after operation. The clinical indexes such as the time of first anal exhaust and the incidence of infectious complications were recorded. Results:There was no significant difference between the two groups in preoperative serum total protein, albumin, prealbumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + ( P>0.05). 7 days after operation, the above indexes in the observation group were significantly higher than those in the control group (all P<0.05). The anal exhaust recovery time of observation group was faster ( P<0.05); There was no significant difference in the incidence of postoperative infectious complications between the two groups ( P>0.05). Conclusions:Early application of intestinal microecological agents in patients with gastric cancer after operation can significantly improve the nutritional status and immune function, promote the recovery of intestinal function, and will not increase the incidence of complications.

11.
Article in Chinese | WPRIM | ID: wpr-909291

ABSTRACT

Objective:To investigate the short-term efficacy of Shenmai injection combined with FOLFOX chemotherapy in the treatment of advanced gastric cancer and its effects on immune function and tumor markers. Methods:Eighty-two patients with advanced gastric cancer who received treatment in Shengzhou Hospital of Traditional Chinese Medicine, China between June 2018 and June 2020 were included in this study. They were randomly assigned to receive either FOLFOX chemotherapy (control group, n = 41) or Shenmai injection combined with FOLFOX chemotherapy (observation group, n = 41). All patients received three 21-day courses of treatment. Short-term efficacy of chemotherapy and improvement in quality of life were compared between the two groups. Immune function, expression of tumor markers (carcinoembryonic antigen and carbohydrate antigen 724) and adverse reactions were determined before and after three courses of treatment. Results:Total effective rate in the observation group was significantly higher than that in the control group [70.73% (29/41) vs. 46.34% (19/41), χ2 = 5.025, P < 0.05]. The proportion of patients had improved quality of life in the observation group was significantly higher than that in the control group [78.05% (32/41) vs. 56.10% (23/41), χ2 = 4.473, P < 0.05]. After three courses of treatment, the proportion of CD 3+ and CD 4+ cells and the ratio of CD 4+/CD 8+ cells in the observation group were (58.39 ± 3.14)%, (38.79 ± 2.35)% and (1.54 ± 0.17), respectively, which were significantly higher than those in the control group [(48.10 ± 3.01)%, (30.10 ± 1.78)%, (0.92 ± 0.15), t = 15.148, 18.875, 17.511, all P < 0.05]. After three courses of treatment, serum carcinoembryonic antigen and carbohydrate antigen 724 levels in the observation group were (6.98 ± 1.45) μg/L and (7.85 ± 1.76) μg/L, respectively, which were significantly lower than those in the control group [(15.47 ± 3.21) μg/L, (18.97 ± 3.25) μg/L), t = 15.434, 19.265, both P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Shenmai injection combined with FOLFOX chemotherapy in the treatment of advanced gastric cancer exhibits good short-term efficacy, can improve the immune function, and reduce the levels of carcinoembryonic antigen and carbohydrate antigen 724.

12.
Article in Chinese | WPRIM | ID: wpr-909231

ABSTRACT

Objective:To investigate the application value of multi-slice spiral CT (MSCT) in Borrmann classification of advanced gastric cancer.Methods:The clinical data of 80 patients with advanced gastric cancer who received treatment in Cixi Integrated Traditional Chinese and Western Medicine and Health Group from January 2016 to January 2020 were analyzed. Clinical results were compared with MSCT imaging findings.Results:Postoperative specimens of 80 patients with gastric cancer showed that a single cancer occurred in cardiac fundus of 13 (16.25%) patients, in gastric body of 21 (26.25%) patients, in gastric antrum of 46 (57.50%) patients. Advanced gastric cancer involved gastric fundus and gastric body in 21(26.25%) patients, gastric antrum and gastric body in 34 (42.50%) patients, and gastric fundus, gastric body and gastric antrum in 13 (16.25%) patients. Pathological results of gastric cancer showed Borrmann type I in 12 (15.00%) patients, Borrmann type II in 28 (35.00%) patients, Borrmann type III in 27 (33.75%) patients and Borrmann type IV in 13 (16.25%) patients. The accuracy rate of preoperative MSCT in the identification of Borrmann type I, II, III and IV gastric cancer was 83.33%, 78.57%, 77.78%, and 84.62%, respectively, with the total preoperative MSCT accuracy rate of 80.00%. Preoperative MSCT has good intra-observer consistency and inter-observer consistency in the Borrmann classification of advanced gastric cancer, with the kappa values of 0.883 and 0.853, respectively ( P < 0.001). Conclusion:MSCT has a high accuracy rate and good repeatability in Borrmann typing of advanced gastric cancer.

13.
Article in Chinese | WPRIM | ID: wpr-909198

ABSTRACT

Objective:To systematically evaluate manual suture versus mechanical anastomosis in esophagojejunostomy, two methods of digestive tract reconstruction after laparoscopic total gastrectomy. Methods:A computer-based online search of PubMed, CBM, Wanfang database and CNKI database was performed to retrieve clinical studies related to manual suture (manual suture group) and mechanical anastomosis (mechanical anastomosis group) in esophagojejunostomy after laparoscopic total gastrectomy published between January 2015 and October 2020. The quality of eligible literature was evaluated and data were extracted for meta-analysis using Review Manager 5.4 software.Results:Four clinical studies involving 746 patients were included in the final analysis. Meta-analysis results revealed that there was no significant difference in operative time between manual suture and mechanical anastomosis methods [ MD = 8.32, 95% CI (-5.94, 22.57), P > 0.05]. The intraoperative blood loss in manual suture group was significantly less than that in mechanical anastomosis group [ MD = -9.54, 95% CI (-15.54, -3.55), P < 0.05]. The time to exhaust in the manual suture group was shorter than that in the mechanical anastomosis group [ MD = -0.38, 95% CI (-0.59, -0.18), P < 0.05]. The length of hospital stay in the manual suture group was less than that in the mechanical anastomosis group [ MD = -0.88, 95% CI (-1.23, -0.54), P < 0.05]. The incidence of anastomotic leakage in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.23, 95% CI (0.06, 0.93), P < 0.05]. The incidence of anastomotic stenosis in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.14, 95% CI (0.04, 0.54), P < 0.05]. Conclusion:After total gastrectomy, continuous suture of oesophago-jejuno ends with barbed threads under laparoscopy is safer and less expensive and needs less time to postoperative recovery and shorter length of hospital stay compared with mechanical anastomosis.

14.
Article in Chinese | WPRIM | ID: wpr-908735

ABSTRACT

Objective:To explore the expression and detection significance of peripheral blood interferon-gamma (IFN-γ) and hepcidin-25 (Hepc-25) in primary gastric cancer combined with thalassemia minor.Methods:One hundred and fifty primary gastric cancer combined with thalassemia minor patients admitted to of Jiangsu Province Official Hospital from January 2017 to December 2019 were selected as the research group, and 150 cases of primary gastric cancer without thalassemia minor admitted in the same period were selected as the control group. The levels of peripheral blood IFN-γ and Hepc-25 in the two groups were determined by enzyme-linked immunosorbent assay, and the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic sensitivity and specificity of peripheral blood IFN-γ and Hepc-25 on primary gastric cancer combined with thalassemia minor. The level of hemoglobin (Hb) was measured by the cyanmethemoglobin method, and the Pearson correlation analysis was used to analyzed the relationship among the peripheral blood IFN-γ, Hepc-25 and Hb levels in the research group.Results:The levels of peripheral blood IFN-γ and Hb in the research group were lower than those in the control group: (115.18 ± 27.05) ng/L vs. (137.17 ± 35.66) ng/L, (88.44 ± 10.71) g/L vs. (120.60 ± 29.46) g/L; the level of Hepc-25 in the research group was higher than that in the control group: (49.32 ± 15.05) μg/L vs. (32.66 ± 12.22) μg/L, and the differences were statistically significant ( P<0.05). There were no significant differences in the levels of peripheral blood IFN-γ, Hepc-25 and Hb between the patients with α-thalassemia and β-thalassemia ( P>0.05). The area under the curve (AUC) of thalassemia predicted by of peripheral blood IFN-γ level was 0.709.When the cut-off value was≤138.89 ng/L, its diagnostic sensitivity and specificity were 81.33% and 70.67% respectively, and when the serum AUC of Hepc-25 was 0.811 and cut-off value was ≥ 40.13 μg/L, its diagnostic sensitivity and specificity were 75.33% and 74.00% respectively. Pearson correlation analysis showed that in the research group IFN-γ and Hb had positive correlation ( r = 0.245, P<0.05), Hepc-25 and IFN-γ had negative correlation ( r = - 0.378, P<0.05); Hepc-25 and Hb had negative correlation ( r = - 0.647, P<0.05). Conclusions:The low level of IFN-γ and the high level of Hepc-25 in peripheral blood of patients with primary gastric cancer combined with thalassemia minor are related to Hb and have certain diagnostic value for thalassemia.

15.
Article in Chinese | WPRIM | ID: wpr-908663

ABSTRACT

Objective:To investigate the relationship between Helicobacter pylori(HP) cytotoxin-associated gene A (HP-CagA), HP isolate vacuole-forming toxin gene A (HP-VacA) and gastric cancer occurrence and clinical pathological factors.Methods:Eighty-eight patients with gastric cancer from January 2018 to January 2020 in Suzhou Hospital Affiliated of Anhui Medical University was selected as the observation group, 80 patients with benign gastric lesions during the same period was selected as the benign control group, and 80 healthy patients was selected as the healthy control group. The clinical data, HP-CagA, HP-VacA positive expression rates of the three groups were compared, the risk factors of gastric cancer were analyzed, and the relationship between HP-CagA, HP-VacA and gastric cancer clinicopathological factors were evaluated.Results:Family history of gastric cancer, high-salt diet, preference for hot food, decreased pepsinogen (PG)Ⅰ/PGⅡ, combined with fatty liver, increased triglyceride, total cholesterol and low density lipoprotein cholesterin, smoking and depression were risk factors of gastric cancer ( P<0.05). The positive rate of HP-CagA, HP-VacA in the observation group were higher than those in the benign control group and the healthy control group: 82.93%(73/88) vs. 62.50%(50/80) and 26.25%(21/80), 30.68%(27/88) vs. 7.50%(6/80) and 0, the differences were statistically significant ( P<0.05). The positive of HP-CagA and HP-VacA had correlation with age, pathological type, and degree of differentiation of gastric cancer ( P<0.05). The 1-year survival rate of HP-CagA and HP-VacA positive patients was lower than that of negative patients by Kaplan-Meier analysis ( P<0.05). Conclusions:The positive of HP-CagA and HP-VacA in HP infections are closely related togastric cancer. Strengthening the treatment of HP infection patients with positive HP-CagA and HP-VacA has important clinical value and social significance for cutting off the early stage of gastric cancer and improving prognosis.

16.
Article in Chinese | WPRIM | ID: wpr-908469

ABSTRACT

Laparoscopic gastrectomy (LG) has been proven to be safe and feasible and widely used in surgical treatment of early and advanced gastric cancer (AGC), which has advantages over open gastrectomy in intraoperative bleeding and postoperative recovery. Neoadjuvant chemo-therapy (NACT) could achieve the effect of tumor downstaging and provide more surgical treatment chances for patients with AGC, thus improving their prognosis. Feasibility of LG for patients with AGC after NACT is a crucial problem for surgeons. The authors review the relevant studies and conducte a Meta-analysis to evaluate the short-term efficacy of laparoscopic versus open gastrec-tomy in the treatment of AGC after NACT.

17.
Article in Chinese | WPRIM | ID: wpr-908466

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Objective:To investigate the application value of esophagogastric anastomosis with double muscle flap plasty in total laparoscopic radical resection of proximal gastric cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 5 patients undergoing radical resection of proximal gastric cancer in Cancer Hospital of China Medical University from January to December 2020 were collected. All 5 cases were male, aged from 57 to 72 years, with a median age of 65 years. All 5 patients underwent total laparoscopic radical resection of proximal gastric cancer combined with esophagogastric anastomosis with double muscle flap plasty. Observation indicators: (1) operative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative anastomosis, esophageal reflux, nutritional status, quality of life, tumor recurrence and metastasis of patients up to February 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Operative situations: all 5 patients underwent surgery successfully. The operation time, time of esophagogastric anastomosis with double muscle flap plasty, number of lymph node dissected, volume of intraoperative blood loss, length of surgical incision of 5 patients were (316±41)minutes,(109±11)minutes, 26±4, (48±12)mL, (3.4±0.4)cm, respectively. Results of intraoperative rapid frozen section pathological examination showed negative of esophageal margin. (2) Postoperative situations: the time to postoperative initial flatus, time to postoperative initial food intake, during of postoperative hospital stay, cost of treat-ment of 5 patients were (4.8±1.5)days, (5.8±1.5)days, (11.6±2.1)days and (5.5±0.4)×10 4 yuan, respectively. Results of postoperative pathological examination of 5 patients showed gastric adeno-carcinoma in all 5 patients including 4 cases with moderately and poorly differentiated adeno-carcinoma and 1 case with highly differentiated adenocarcinoma, with the TNM staging of pT1a-3N0-1 M0 stage. Of the 5 patients, 1 case underwent postoperative mild pneumonia and was cured by conservative treatment such as anti-infection and promotion of sputum evacuation. (3) Follow-up: all 5 patients were followed up for 2 to 12 months, with a median follow-up time of 6 months. Of the 5 patients, 4 cases underwent anastomotic patency and 1 case underwent mild anastomotic stenosis who was improved after endoscopic treatment. None of the 5 patients underwent reflux esophagitis. The body mass index, the score of nutritional risk screening 2002, the score of patient-generated subjective global assessment and the score of tumor patient quality of life of 5 patients were 21 kg/m 2(range, 19-27 kg/m 2), 2(range, 1-2), 2(range, 1-3) and 47(range, 42-52), respectively. None of the 5 patients underwent tumor recurrence or metastasis. Conclusion:Esophagogastric anas-tomosis with double muscle flap plasty can be used in total laparoscopic radical resection of proximal gastric cancer which will lead to satisfactory short-term efficacy.

18.
Article in Chinese | WPRIM | ID: wpr-908464

ABSTRACT

Objective:To investigate the predictive value of postoperative C-reactive protein for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 298 patients with advanced gastric cancer who underwent Da Vinci robotic surgical system radical gastrectomy in the 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2017 to June 2019 were collected. There were 253 males and 45 females, aged from 24 to 86 years, with a median age of 60 years. Of the 298 patients, 275 cases underwent no serious postoperative complications and 23 cases underwent serious postoperative complications. Observation indicators: (1) serious postoperative complications; (2) analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer; (3) performance evaluation of the predictive indicators. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Univariate analysis was conducted using the chi-square test. Multivariate analysis was conducted using Logistic regression model. The receiver operating characteristic curve was drawn and the area under curve (AUC) was used to compare and estimate the efficiency of diagnostic criteria. The value of Youden index was used to determine the optimal cut-off point. Results:(1) Serious postoperative complications: of the 298 patients, 23 cases underwent complications classified ≥grade Ⅲa of Clavien-Dindo classifica-tion, including 10 cases with grade Ⅲa complications, 7 cases with grade Ⅲb complications, 4 cases with grade Ⅳa complications, 1 case with grade Ⅳb complications and 1 case with grade Ⅴ complications. (2) Analysis of risk factors for serious postoperative complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer. Results of univariate analysis showed that operation time, indicators of C-reactive protein concentration and neutrophil count at post-operative day 1, and indicators of C-reactive protein concentration, white blood cells count, neutrophil count and platelet count at postoperative day 3 and pathological stage were related factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( χ2=7.671, 4.504, 5.045, 48.293, 9.575, 15.436, 13.731, 9.537, P<0.05). Results of multivariate analysis showed that the operation time ≥250 minutes, the concentration of C-reactive protein at postoperative day 3 ≥16.65 mg/dL, the neutrophil count at postoperative day 3 ≥8.167×10 9/L, the platelet count at postoperative day 3 ≥218×10 9/L and the pathological stage of tumor as stage Ⅱ and stage Ⅲ were independent risk factors affecting serious complications for advanced gastric cancer after Da Vinci robotic surgical system radical gastrectomy ( odds ratio=3.721, 16.084, 6.056, 6.893, 12.455, 95% confidence interval: 1.032-13.421, 4.657-55.547, 1.073-34.163, 1.798-26.423, 1.338-115.930, P<0.05). (3) Performance evaluation of the predictive indicators: the C-reactive protein concentration at postoperative day 3 was a high-performance predictor with the AUC as 0.851 (95% c onfidence interval: 0.780-0.921, P<0.05) and neutrophil count and platelet count at postoperative day 3 were low-performance predictors with the AUC as 0.659 and 0.666 (95% confidence interval: 0.570-0.748 and 0.581-0.750, P<0.05). Conclusion:The C-reactive protein concentration ≥16.65 mg/dL at postoperative day 3 is a high performance predictive indicator for serious complications after Da Vinci robotic surgical system radical gastrectomy of gastric cancer.

19.
Article in Chinese | WPRIM | ID: wpr-908463

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Objective:To investigate the risk factors for early complications after laparoscopy-assisted gastrectomy in patients with gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 196 patients who underwent laparos-copy-assisted radical gastrectomy at Peking Union Medical College Hospital from March 2016 to March 2019 were collected. There were 144 males and 52 females, aged (61±10)years. Observation indicators: (1) early complications after laparoscopy-assisted radical gastrectomy and treatment; (2) analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy.Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( P25,P75). Count data were represented as absolute numbers. Univariate analysis was conducted using the t test, Mann-Whitney U test or chi-square test. Multivariate analysis was conducted using the Logistic regressional model. Results:(1) Early complications after laparoscopy-assisted radical gastrectomy and treatment: 51 of 196 patients had early postoperative complications, including 7 cases of grade Ⅰ according to Clavien-Dindo classi-fication system, 32 cases of grade Ⅱ, 9 cases of grade Ⅲa, 3 cases of grade Ⅲb. There was no grade Ⅳ or Ⅴ complication. There were 25 cases with abdominal complications, 7 cases with thoracic complications, 3 cases with internal/catheter related complications and 16 cases with other unclassified complications. All patients with complications were improved after symptomatic and supportive treatments. (2) Analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy: results of univariate analysis showed that the lymphocyte count, neutrophil-to-lymphocyte ratio, radiotherapy, operation time, volume of intraoperative blood loss, T stage, lymph node metastasis were related factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( Z=?2.048, χ2=6.385, 4.168, 8.068, 6.336, 12.497, 7.522, P<0.05). Results of multivariate analysis showed that the neutrophil/lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis were independent risk factors for early complica-tions after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( odds ratio=2.279, 2.245, 2.226, 95% confidence interval as 1.149-4.519, 1.116-4.517, 1.125-4.402, P<0.05). Conclusions:The abdominal complications are the most common early complications after laparoscopy-assisted radical gastrectomy. The neutrophil-to-lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis are independent risk factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer.

20.
Article in Chinese | WPRIM | ID: wpr-908462

ABSTRACT

Objective:To investigate the clinical efficacy of gastrojejunal bypass surgery combined with radical gastrectomy following conversion therapy for gastric cancer with outlet obstruction.Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 10 initially unresectable gastric cancer patients with outlet obstruction who were admitted to Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from October 2019 to July 2020 were collected. There were 8 males and 2 females, aged from 41 to 59 years, with a median age of 53 years. Patients underwent 'sandwich therapy' of gastrojejunal bypass surgery combined with gastrectomy following conversion therapy. Observation indicators: (1) gastrojejunal bypass surgery and postoperative situations; (2) conversion therapy and complications; (3) radical gastrectomy and postoperative situations; (4) follow-up. Follow-up using outpatient examinations or telephone interview was conducted to detect postoperative complications, progress-free survival, tumor recurrence and metastasis up to March 2019. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Gastrojejunal bypass surgery and postoperative situations: 10 patients received modified gastrojejunal bypass surgery combined with No.4sb lymph node dissection, without intraoperative serious complications, conversion to laparotomy or death. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to liquid diet intake were 73 minutes(range, 60-87 minutes), 33 mL(range,20-110 mL), 3 days(range, 2-6 days), 4 days(range, 4-9 days). One patient had post-operative Clavien-Dindo grade Ⅱ complication of anastomotic bleeding, and was improved after transfusion of blood products. (2) Conversion therapy and complications: of 10 patients, 9 cases received 4 cycles of FLOT regimen. One of the 9 cases was suspended chemotherapy due to Clavien-Dindo grade Ⅱ anastomotic edema after 2 cycles of FLOT regimen. Of 10 patients, there were 6 cases with partial response and 4 cases with stable disease. Of 6 patients with partial response, 4 cases with preoperative cT4b stage were down stage to T4a stage, showing the relationship of tumor with transverse mesentery and pancreatic capsule clearer than the first exploration, 2 cases with preoperative lymph nodes fusion had shrank obviously. Of 4 patients with stable disease, 3 cases were negative for lymph nodes shranking, and the rest 1 case with tumor peritoneal metastasis diagnosed by initial laparoscopy can not be evaluated by imaging examination after chemotherapy. Two of 10 patients had Clavien-Dindo grade I complication of elevated blood glucose during the chemotherapy, which were improved after insulin therapy. (3) Radical gastrectomy and post-operative situations: 10 patients underwent radical resection after conversion therapy. Of 4 cases with stable disease, 3 cases with preoperative lymph nodes fusion showed obvious space between lymph nodes and surrounding tissues at resurgical exploration and received radical resection, 1 case with peritoneal metastasis showed abdominal wall nodelus and omental tuberosity as fibrous scars at resurgical exploration and received radical resection. The operation time, volume of intra-operative blood loss, time to postoperative first flatus, time to initial liquid diet intake, duration of total hospital stay, duration of postoperative hospital stay of 10 patients were 148 minutes(range, 95-195 minutes), 108 mL(range, 100-180 mL), 3 days(range, 2-7 days), 4 days(range, 3-9 days), 11 days(range, 10-21 days), 8 days(range, 7-16 days). Two of 10 patients had perioperative complications. Results of pathological examination of 10 patients showed the number of dissected lymph nodes as 25±6. There were 1 case of stage T1, 5 cases of stage T3, 4 cases of stage T4a. There were 1 case of stage N0, 2 cases of stage N1, 3 cases of stage N2, 4 cases of stage N3. There were 3 cases of tumor regression grade 1a, 1 case of grade 1b, 4 cases of grade 2, 2 cases of grade 3. (4) Follow-up: 10 patients were followed up for 3.9-13.0 months, with a median follow-up time of 6.0 months. The median progression-free survival time of 10 patients was 6.0 months. During the follow-up, 1 case underwent postoperative Clavien-Dindo grade Ⅱ complication of delayed gastric emptying and was improved after symptomatic treatment.Conclusion:The gastrojejunal bypass surgery combined with gastrectomy following conversion therapy for gastric cancer with outlet obstruction is safe and effective.

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