Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery.

BACKGROUND: Laparoscopy-assisted approaches have become popular for dissecting early-stage gastric cancer in Japan, but the outcomes after 5 years of followup have not been reported. STUDY DESIGN: Between January 1998 and March 2002, 94 patients with histologically proved early-stage gastric carcinoma participated in clinical studies and underwent gastrectomy with regional lymphadenectomy to evaluate feasibility and safety of the laparoscopy-assisted approach. Outcomes and pattern of disease failure during followup up to 5 years were evaluated in all patients. Multivariable analysis was performed to identify relevant prognostic factors. RESULTS: Conversion to open procedures occurred in three patients. Median blood loss was 90 mL (interquartile range, 160 mL), and duration of operation was 230 minutes (interquartile range, 60 minutes). Operative morbidity and mortality were 22.3% and 0%, respectively. Nine patients died during the course of followup, for an overall 5-year survival rate of 90%. Two patients died of recurrent disease, and 2 other patients have been diagnosed with recurrences, for a 5-year recurrence-free survival of 95.6%. Three patients with recurrent cancer, including 1 with port-site recurrence, had stage IA disease (pT1pN0) at operation. Diabetes mellitus as a comorbidity was prominent as a prognostic factor. CONCLUSIONS: Outcomes of patients with a preoperative diagnosis of early-stage cancer were excellent when treated with a laparoscopy-assisted approach, although rare patterns of disease failure were observed.

Gene expression profile of 5-fluorouracil metabolic enzymes in primary colorectal cancer: potential as predictive parameters for response to fluorouracil-based chemotherapy.

BACKGROUND: Thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD), thymidine phosphorylase (TP) and orotate phosphoribosyltransferase (OPRT) have been reported to be predictive parameters for the efficacy of fluoropyrimidine-based chemotherapy. Therapy guided by chemotherapy sensitivity and resistance assays may lead to rational treatment decisions. MATERIALS AND METHODS: mRNA expression of TS, DPD, TP, and OPRT were quantified by reverse-transcriptase polymerase chain reaction (RT-PCR) after harvesting from paraffin embedded specimens through microdissection. In vitro chemosensitivity testing by histoculture drug response assay (HDRA) was performed with fresh specimens of the primary tumor from 49 patients with colorectal cancer. Correlations between the results of a chemosensitivity test (the T/C ratio; the percentage of optical density of a tumor treated with anticancer drugs in relation to the optical density of the tumor cultured in RPMI 1640 medium only) and the gene expression were assessed. RESULTS: The gene expression of TS, TP, and OPRT had no correlation with clinicopathological factors, survival, and T/C ratio. The DPD mRNA levels (0.295 vs. 0.381, p = 0.2460) and OPRT/DPD ratio (5.535 vs. 4.394. p = 0.226) had a weak correlation with the T/C ratio. Of the eleven patients who were actually treated with chemotherapy, the responders had higher OPRT/DPD ratios (8.065 vs. 4.081, p = 0.090). CONCLUSION: The DPD mRNA level and OPRT/DPD ratio evaluated from paraffin embedded specimens are candidates for further evaluation as predictors of response against 5-fluorouracil-based chemotherapy in colorectal cancer.

[A case of endocrine cell carcinoma (small cell carcinoma) of duodenum].

Extra-ampullary duodenal endocrine cell carcinoma is extremely rare. A 65-year-old woman visited our hospital, complaining of epigastralgia, anorexia and vomiting. She was admitted for suspected duodenal or pancreas head tumor by abdominal CT. Fiberscopic examination revealed a circumferential tumor in the extra-ampullary duodenal second portion. Histopathological findings of biopsy specimen showed a small cell carcinoma, and positive immunohistochemical staining for synaptophysin revealed this tumor to be endocrine cell carcinoma. Pylorus-preserving pancreaticoduodenectomy with partial transversocolectomy was performed, and intraoperative washing cytology detected tumor cells in the peritoneal cavity. Although she discharged from hospital uneventfully, she died 11 months later of multiple liver metastases and peritoneal dissemination. This case showed the high malignant potential of this tumor.

[A phase I study of TS-1 and weekly cisplatin in patients with advanced gastric cancer].

This is a phase I study to determine the maximum tolerated dose (MTD) and toxicity of a combination of TS-1 and weekly cisplatin (CDDP) in advanced gastric cancer patients. TS-1 was administered orally twice daily after meals, at a standard dose of 80 mg/m2. One course consisted of 21 days' consecutive administration followed by 14 days' rest. Cisplatin (CDDP) was injected intravenously on days 8, 15 and 22 using the following dose levels: dose level 1 20 mg/m2, dose level 2 25 mg/m2, and dose level 3 30 mg/m2. Twelve patients were entered in this trial. One of the 6 patients at dose level 3 had neutropenia NCI-CTC grade 3, while another patient at dose level 3 suffered from DLT (liver function grade 3. The maximal tolerable dose (MTD) was not reached using dose level 3. Partial responses were seen in 5 (62.5%) of 8 patients with evaluable lesions. At level 2 (25 mg/m2), the response rate was 100%. We recommended dose level 2 for phase II trials from the standpoint of toxicity and response rate.

[A case of recurrent advanced gastric cancer with lung metastasis effectively treated by combined chemotherapy of TS-1 and weekly CDDP].

We report a case of a patient with recurrent gastric cancer and lung metastasis, who responded remarkably to combination chemotherapy using TS-1 and weekly CDDP. The patient was administered 2 courses of TS-1 (80 mg/m2/day, on day 1-21) and CDDP (25 mg/m2/day, on day 8, 15, 22) every 5 weeks. The regimen was done on an outpatient basis. The treatment resulted in the metastatic tumors in the lung disappearing after 1 course. No severe side effects were observed. This combination therapy proved useful for treating lung metastasis from gastric cancer in this patient.