[An 84-year-old man with highly advanced gastric cancer showing good response after chemotherapy with docetaxel, cisplatin and S-1 combination therapy].

An 84-year-old man had the wall thickness of his stomach accidentally detected by CT scan, and was diagnosed as type 2 advanced gastric cancer with liver and lung metastasis. Chemotherapy with docetaxel, cisplatin and S-1 combination therapy was adopted. Grade 4 neutropenia was revealed, but the treatment could be continued by G-CSF or by down dosing the anticancer agents. By maintaining CR of the primary lesion and PR of the liver and lung metastases, he has been kept at a PS 0 state and has been receiving regular outpatient treatment for 28 months now since the beginning of treatment.

An adequate perioperative management and strategy for gastric cancer after coronary artery bypass using the right gastroepiploic artery.

PURPOSE: Interruption of the right gastroepiploic artery (RGEA) used for prior coronary artery bypass grafting (CABG) may cause life-threatening myocardial ischemia during gastrectomy. This study investigated the cases treated in this department and pooled data in the literature to identify an adequate perioperative RGEA management strategy. METHODS: Eight patients underwent gastrectomy after CABG with the RGEA. This study examined conditions, management of the RGEA, No. 6 lymph node metastasis, and complications of these cases and those in the pooled data. RESULTS: Percutaneous coronary intervention or a redo CABG was performed in advance in 7 and 1 patients, respectively. The RGEA was resected for dissection of No. 6 lymph nodes in 6 patients. Five patients had lymph node metastasis. Thirty-seven patients from 40 combined cases (92.5 %) underwent total or distal gastrectomy, but 17 patients (42.5 %) had RGEA resection. Resections of the RGEA and No. 6 lymph node metastasis were significantly higher in patients with perioperative coronary management than in those without such management. CONCLUSION: Coronary and celiac angiography and coronary revascularization are prerequisites to prevent cardiac events during gastrectomy and dissection of No. 6 lymph nodes should be performed with resection of RGEA. Standard lymph node dissection should therefore be performed with a curative intent for all patients even those undergoing gastrectomy after CABG using RGEA.

Surgical outcomes and survival after extended multiorgan resection for T4 gastric cancer.

BACKGROUND: Extended multiorgan resection (EMR) for locally advanced (T4) gastric cancer remains controversial. The aim of this study was to evaluate the effectiveness of this approach with regard to morbidity, mortality, and survival. METHODS: Between 2005 and 2009, 41 patients underwent aggressive surgery for clinical T4 gastric cancer. Univariate and multivariate analyses were used to identify prognostic factors for surgical outcomes and survival in these patients. RESULTS: Curative resection was performed in 29 patients (70.7%); postoperative morbidity and mortality rates were 17.1% and 4.9%, respectively. The survival rate in R0 resection patients was significantly longer than that in patients undergoing R1 or R2 resection. Multivariate analysis identified resectability and tumor size (≥10 cm) as independent prognostic factor for patients with T4 gastric cancer undergoing combined resection. CONCLUSIONS: EMR should be performed for patients with T4 gastric cancer in whom curative resection can be used.

A fibrin adhesive sealing method for the prevention of pancreatic fistula following distal pancreatectomy.

BACKGROUND/AIMS: Pancreatic fistula is the most common complication following distal pancreatectomy. We have developed a fibrin adhesive sealing method which covers the cut surface and parenchyma of the pancreas, to prevent pancreatic fistula. METHODOLOGY: We performed 25 distal pancreatectomies. Fibrin adhesive (TachoComb) was applied to the staple line of the pancreas before stapling. Pancreatic fistula was defined and graded according to the International Study Group of Postoperative Pancreatic Fistula (ISGPF) definition. RESULTS: The overall incidence of pancreatic fistula was five cases (20%). Four cases (16%) were classified as Grade A. Only one case (4%) was classified as Grade B. In patients with or without pancreatic fistula, the mean length of postoperative hospital stay was not significant. CONCLUSIONS: The fibrin adhesive sealing method is a simple and effective method of preventing postoperative pancreatic fistula formation after distal pancreatectomy.

Pancreaticojejunostomy using a fibrin adhesive sealant (TachoComb) for the prevention of pancreatic fistula after pancreaticoduodenectomy.

BACKGROUND/AIMS: Pancreatic fistula is a common complication following pancreaticoduodenectomy. A number of technical modifications aimed to improve the pancreato-enteric anastomosis technique have been reported. The aim of this study was to evaluate the safety of TachoComb fibrin adhesive as a sealing method in duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. METHODOLOGY: Between 2005 to 2009, 40 patients (28 men and 12 women) underwent duct-to-mucosa pancreaticojejunostomy using a fibrin adhesive (TachoComb) sealing method after pancreaticoduodenectomy (either pylorus-preserving or modified Child's methods). The mean age was 67.9 years (range of 49 to 80 years). RESULTS: The overall postoperative rates of mortality and morbidity were 0.0% and 35.0%, respectively. Following the classification system described by the International Study Group on Pancreatic Fistula, 5 patients (12.5%) had Grade A pancreatic fistulas and 3 patients (7.5%) had Grade B pancreatic fistulas. There were no patients with Grade C pancreatic fistulas, and no cases of postoperative hemorrhage. No significant difference in the length of postoperative hospital stay was observed in patients with or without pancreatic fistulas. CONCLUSIONS: The use of TachoComb fibrin adhesive as a sealing method in duct-to-mucosa pancreaticojejunostomy is safe, reliable for the prevention of pancreatic fistula, and shows promise for all types of reconstruction following pancreaticoduodenectomy.

Alternating treatment with S-1 plus low-dose cisplatin and S-1 alone for advanced gastric cancer.

BACKGROUND: The aim of this study was to investigate the efficacy and safety of an alternating regimen of S-1 plus low-dose cisplatin and S-1 alone as adjuvant therapy in patients with advanced gastric cancer. PATIENTS AND METHODS: The study group comprised 100 patients with stage IIIA, stage IIIB, or stage IV. Patients postoperatively received three 5-week cycles of chemotherapy. In the first cycle, S-1 (80 mg/m(2)) was given daily for 3 weeks, followed by 2 weeks of rest, and low-dose cisplatin (10 mg) was given on days 1 to 5 and 8 to 12. In the second and third 5-week cycles, S-1 alone was given. The primary endpoints were median survival time, and survival at 1 and 3 years. Secondary endpoints were safety and overall response rates. RESULTS: Median survival time was 18 months in stage IV and 32 months in stage IIIB. The rates of survival at 1 and 3 years were 68.7% and 30.6% in stage IV, 100% and 68.4% in stage IIIA, and 100% and 46.6% in stage IIIB, respectively. Adverse events of grade 3 or 4 occurred in 14% of the patients. The overall response rate of target lesions was 54%. CONCLUSION: Our regimen is effective and safe for adjuvant therapy in patients with curatively resected stage III gastric cancer.

Gemcitabine and s-1 combination chemotherapy in patients with advanced biliary tract cancer: a retrospective study.

BACKGROUND: The aim of this study was to investigate the efficacy and safety of gemcitabine and S-1 combination chemotherapy in patients with advanced biliary tract cancer. PATIENTS AND METHODS: A retrospective study was performed on 15 consecutive patients. Gemcitabine was administered intravenously at 1,000 mg/m(2) on days 8 and 15. Oral S-1 (60 mg/m(2) in 2 divided doses) was given daily for the first 2 weeks, followed by 1 week of rest. This 3-week course of treatment was repeated. The primary endpoint was response rate, and the secondary endpoints were overall survival, progression-free survival, and safety. RESULTS: The overall response rate was 26.7%, and the disease control rate was 73.4%. The overall survival was 12.0 months (95% CI, 9.5-14.5 months), and the progression-free survival was 8.0 months (95% CI, 4.3-11.7 months). Adverse events of grade 3 or 4 occurred in 33.3%, and the major grade 3/4 toxicities were anemia (20.0%), leukopenia (13.3%), and anorexia (13.3%). CONCLUSION: Gemcitabine and S-1 combination chemotherapy is effective and safe in patients with advanced biliary tract cancer.