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Background: Neoadjuvant chemotherapy (NACT) in carcinoma stomach was introduced in an effort to eliminate micro-metastasis and to improve resectablity before surgery which improves R0 resection rates. The aim of the current study was to evaluate the effect of neoadjuvant chemotherapy on downstaging and resectability rate in locally advanced gastric cancer. Material & Methods: This was a single-center quasi-experimental study conducted in the Department of Surgical Oncology in collaboration with the Departments of Medical Oncology, Radiation oncology, and Pathology at the National Institute of Cancer Research and hospital, Dhaka, which is a tertiary care cancer hospital in Bangladesh, between January 2021 and June 2022.Patients with locally advanced adenocarcinoma stomach staged by contrast-enhanced computed tomography (CECT) were randomly included in this study by purposive sampling. Patients in Group I underwent upfront surgery Patients in Group II were started on neoadjuvant chemotherapy, either XELOX or FLOT regimen. Surgery was done following the response assessment CECT. We assessed R0 resection rate, age, sex, comorbidities, tumour size, TNM stage and complications were compared between the two groups. Response to NACT was assessed in Group II. Results: The mean age of patients in groups 1 & 2 was 56 ± 11.06 and 55.70 ± 10.46 years of age respectively (p > 0.05). Majority of the respondents (55/74) were male and 19 patients (26%) were female. Male to female ratio was (24/37 &31/37) in group 1 and (31/37 & 6/37) groups respectively (p > 0.05). Out of 37 patients who received NACT, in 9 patients (24.32%) complete response was noted. Partial response was found in 20 cases (54.05%), p-value (<.0001) while a stable disease was reported in three (8.1%) cases. 5 patients (13.51%) had progressive disease. In the upfront surgery group, R0 resection was feasible in 16 (43.2%) cases, and in the NACT plus surgery group, R0 resection was done in 29 (78.4%) cases. In group 1, R1 resection was done in considerable numbers (19/37) compared to group 2 (5/37), P=0.001. Three patients (8.1%) in group 2 and one (2.7) in group 1 had irresectable lesions. Conclusion: In this study it can be concluded that neoadjuvant chemotherapy could downstage tumour and increase tumor resectability rate in patients with locally-advanced gastric adenocarcinoma. However, further studies are necessary to confirm the effect of this modality on patients’ overall survival. We await survival analysis to further validate the role of NACT.
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Background: In adenocarcinoma stomach, lymph node involvement is a significant predictor of survival, and a decisive factor in planning management. Size has always been an important criterion while considering the metastatic status of the node, in its radiological evaluation or otherwise. However, to what extent the size of a node can be considered as a reliable criterion for its metastatic potential remains a question.Methods: The present study is based on retrieving lymph nodes per operatively from patients of carcinoma stomach, measuring each node, evaluating its metastatic status and comparing the results to find a correlation between these two parameters.Results: The present study, examined a total of 187 nodes from 30 gastrectomy specimens. Among them, metastasis was found in 59 nodes (31.55%). Among these metastatic nodes, 34 (57.62%) were actually less than 5mm in size. Among the total sizes of all the lymph nodes examined, the mean±SD (standard deviation) of the metastasis positive nodes were found to be 6.42±3.86 mm, while that of the non-metastatic nodes were found to be 5.51±1.99 mm. However, it was also observed that larger nodes (>1 cm), tend to have a high chance of being malignant (62.5%).Conclusions: The above study shows though large nodes tend to be malignant, ignoring small nodes can lead to gross under staging or incomplete clearance while treating patients of adenocarcinoma stomach. Smaller nodes constitute a significant proportion of malignant nodes and must be evaluated. Size is not a reliable criterion of metastasis in lymph nodes of carcinoma stomach.
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Usually gastrointestinal malignancies present with low SAAG ascites. But when there is diffuse liver infiltration following malignancy, high SAAG ascites can occur. So liver infiltration can masquerade as cirrhosis. Malignant acanthosis and tripe palm are the paraneoplastic manifestations seen in GI malignancies. We are reporting a case which was initially managed as a straightforward case of cirrhosis ,but later turned out to be a case with tripe palms, malignant acanthosis and carcinoma stomach as primary with diffuse liver infiltration having high SAAG ascites.
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Background: Dyspepsia is described as recurrent upper abdominal discomfort and epigastric fullness after meals, often described by the patients as indigestion. The assessment of trending diagnostic patterns in upper GI endoscopy is important to validate the priority of endoscopic evaluation over other modalities of investigation for dyspepsia. The significant patterns may form a platform for new epidemiological studies to re-assess the risk factors and distribution of diseases causing dyspepsia in South Indian population. Aim: A retrospective study was done to assess the trends of diagnosis in upper GI endoscopy in adult dyspeptic patients in South Indian population. Materials and methods: Endoscopy database records of 3271 consecutive patients who underwent upper GI endoscopy between January 2014 and March 2016 were retrospectively analyzed from upper GI endoscopy register. The data was subjected to statistical analysis and compared with that of previous similar studies. Suspected malignant lesions were confirmed with histopathology reports. Results: Positive yield was 80.6%. Gastritis (51%), duodenitis (22%) and hiatus hernia (9%) were the leading endoscopy diagnoses. Esophageal growth was 3 times more common in females (p=0.009). Growth in stomach was reported in 2.3% patients. Carcinoma stomach was significantly higher in age above 40 years (p=0.0009). There was a positive correlation between Ca stomach and increasing age. The cumulative frequencies of gastric cancer by age group were as follows: 7 of 1000 OGDs in patients less than 40 years of age and 40 of 1000 OGDs in patients greater than 40 years of age. Conclusion: The results conclude that gastric malignancy is significantly higher in age>40 years. This recommends a routine upper GI endoscopy for patients>40 years. Esophageal growth is significantly higher in females warranting an epidemiological study on association with possibly
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Carcinoma stomach is the second leading cause of cancer death worldwide. This study was undertaken to determine the clinical and pathological profile of carcinoma stomach in Bangladesh and to find out the prevalence of H. pylori infection in carcinoma stomach subjects. Patients with carcinoma stomach confirmed on histopathology were included in the study. Data were recorded regarding demography, clinical features, blood group of the patients, location and macroscopic type of the cancer at endoscopy. Three to five biopsies from non-necrosed region and two paired biopsies from non-cancerous part of stomach were taken. One piece of each paired specimen was placed in the urea-agar media for CLO test and the other piece was used for histological examination. Out of 50 patients, 64% were male and 36% were female. The mean age was 51.05±14.98 years. Common presenting complains were dyspepsia/ abdominal pain, vomiting and dysphagia; abdominal mass, metastatic lymph node and ascites were predominant signs. About one third (34%) patients had blood group A. About 50% cancer was located in antrum followed by antrum and body (24%), then body (18%), fundus and body (4%) and fundus (4%). In 56% cases the lesion was ulcerative followed by polypoid (34%) and ulceroinfiltrative (10%). Histopathologically 52% was intestinal type, 28 % was diffuse type 20% was poorly differentiated adenocarcinoma. The prevalence of H. pylori in overall carcinoma stomach cases was 60% but individually in intestinal type 88%, in diffuse type 57% and in poorly differentiated type 50%.
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A 62 year old female who presented with features of acute duodenal perforation and associated carcinoma stomach (Ca-Stomach) is reported. Upper gastrointestinal endoscopy, biopsy and barium meal showed an adenocarinoma of cat'dia and proximal 1I3rd of stomach. Such an association of pathology is not reported earlier in the literature.