ABSTRACT
BACKGROUND/AIMS: The necessity of pyloroplasty as a drainage procedure after proximal gastrectomy remains controversial in terms of the postoperative quality of life. The aim of this retrospective study was to evaluate whether pyloroplasty is necessary after proximal gastrectomy. METHODOLOGY: Thirty-five patients who underwent proximal gastrectomy with jejunal interposition between 1993 and 2000 were studied. They were divided into two groups: Group A, jejunal interposition without pyloroplasty (n=17); Group B, jejunal interposition with pyloroplasty (n=18). The subjects were interviewed and examined to assess their symptoms, food intake and body weight at 6, 12, and 24 months after the operation. Endoscopy and a radioisotope gastric emptying test were performed one year postoperatively. RESULTS: A low incidence of epigastric fullness, nausea, and vomiting and a high frequency of patients with greater than 80% of pre-illness food intake were found in Group B. A high recovery of bodyweight was also achieved in Group B. On the other hand, a high incidence of reflux gastritis or bile regurgitation was found in Group B. Gastric emptying was significantly delayed in Group A. CONCLUSIONS: Pyloroplasty as a drainage procedure after proximal gastrectomy is necessary in terms of the clinical symptoms, dietary intake, recovery of body weight, or gastric emptying.
Subject(s)
Gastrectomy/methods , Jejunum/surgery , Postgastrectomy Syndromes/prevention & control , Pyloric Antrum/surgery , Quality of Life , Stomach Neoplasms/surgery , Anastomosis, Surgical , Female , Follow-Up Studies , Gastrectomy/adverse effects , Gastric Emptying/physiology , Gastric Stump , Gastroscopy , Humans , Male , Neoplasm Staging , Patient Satisfaction , Postgastrectomy Syndromes/etiology , Probability , Retrospective Studies , Risk Assessment , Sampling Studies , Stomach Neoplasms/pathology , Treatment OutcomeABSTRACT
BACKGROUND/AIMS: A high response rate with acceptable toxicities is required in the setting of neoadjuvant chemotherapy. Five cases (3 stage IV, 2 stage IIIb) of advanced gastric cancer were successfully treated by neoadjuvant chemotherapy consisting of a combination of S-1 and cisplatin. METHODOLOGY: All 5 patients were men younger than age 60, with no severe complications. S-1 was administered orally (80 mg/m2/day) twice daily for 21 consecutive days, and cisplatin (60 mg/m2) was infused over 2 hours on day 8 with hydration. This schedule was repeated every 5 weeks. After each cycle, the clinical response evaluation was performed with endoscopy, barium meal, and spiral CT scan. Surgery was carried out about 3 weeks after chemotherapy. RESULTS: All patients were responders (100%) after one or two cycles. However, there was no patient with either complete response, or down-staging. Toxicities, according to the WHO criteria, were very mild and none required treatment. Postoperatively one patient died of aspiration pneumonia unrelated to the chemotherapy. The others were discharged within 3 weeks after operation without complications. CONCLUSIONS: S-1 plus cisplatin seems safe and effective as neoadjuvant chemotherapy in advanced gastric cancer patients.
Subject(s)
Antimetabolites, Antineoplastic/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cisplatin/administration & dosage , Neoadjuvant Therapy , Oxonic Acid/administration & dosage , Pyridines/administration & dosage , Stomach Neoplasms/drug therapy , Stomach Neoplasms/surgery , Tegafur/administration & dosage , Drug Combinations , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND/AIMS: Jejunal interposition after distal gastrectomy is reported to prevent both duodenogastric reflux and rapid gastric emptying. However, comparing primary reconstruction with this procedure and Billroth-I in terms of clinical evaluation by the same surgeon is rare. In this study, the benefit of this procedure was retrospectively evaluated as compared to the Billroth-I method. METHODOLOGY: Of 30 patients with early gastric cancer located at the middle third of the stomach, 15 underwent distal gastrectomy with jejunal interposition and the other 15 underwent Billroth-I gastrectomy by the same surgeon. Isoperistaltic jejunal interposition measuring 10-12 cm was used. All the anastomoses without jejunojejunostomy were performed using auto-suture staplers. Assessment of postoperative symptoms and functions was performed one year after surgery. RESULTS: The mean operation time was significantly longer after jejunal interposition (p < 0.01). No serious complications occurred in either group, and the hospital stay after operation was also similar. There were no significant differences in terms of postoperative symptoms, food intake, and recovery of body weight. The incidence of bile regurgitation and reflux gastritis was very low or zero in the jejunal interposition group, which indicated differences (p < 0.05, p < 0.01, respectively). Reflux esophagitis was not found in jejunal interposition, but two patients after Billroth I showed grade B esophagitis. As regards gastric emptying, the retention capacity was very poor and there was no significant difference between the two groups. CONCLUSIONS: Jejunal interposition after distal gastrectomy was superior to the Billroth-I procedure in terms of reflux gastritis prevention. However, dumping syndrome and rapid gastric emptying were not prevented.
