LA CONSULTA SEMANAL

ENERO 2001

CONSULTA

Gastrointest Endosc Clin N Am 2000 Jul;10(3):461-80
Photodynamic therapy of gastric cancer.
Gossner L, Ell C
Second Medical Department, Wiesbaden Hospital, Germany.
Photodynamic therapy is a fascinating concept that will continue to occupy many research groups around the world in coming years. Although a widespread clinical application for the method has not yet emerged, there are good prospects that photodynamic therapy will establish itself at major gastroenterologic centers as an endoscopic procedure with few or no side effects in the treatment of Barrett's esophagus (sever dysplasia and early carcinoma) and, in selected cases, for the treatment of early gastric carcinoma.
Publication Types:
  Review
  Review, tutorial


Surg Clin North Am 2000 Apr;80(2):659-82; discussions 683-6
Multidisciplinary approach to esophageal and gastric cancer.
Stein HJ, Sendler A, Fink U, Siewert JR
Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar of the Technische Universitat Munchen, Germany. stein@nt1.chir.med.tu-muenchen.de
Despite marked advances in surgical therapy for patients with esophageal, esophagogastric, and gastric cancers, the overall prognosis of these patients has not markedly improved during the past decades. Multidisciplinary approaches using adjuvant postoperative and neoadjuvant preoperative therapeutic principles have received increasing attention with regard to the management of these patients. A series of randomized, prospective trials has demonstrated that adjuvant postoperative radiation or chemotherapy does not result in a convincing survival advantage after complete tumor resection in esophageal, esophagogastric junction, or gastric cancer. The available data on the role of neoadjuvant preoperative therapy are not yet conclusive. Although neoadjuvant therapy may reduce the tumor mass in many patients, several randomized, controlled trials have shown that, compared with primary resection, a multimodal approach does not result in a survival benefit in patients with locoregional, that is, potentially resectable, tumors. In contrast, in patients with locally advanced tumors, that is, patients in whom complete tumor removal with primary surgery seems unlikely, neoadjuvant therapy increases the likelihood of complete tumor resection on subsequent surgery, but only patients with objective histopathologic response to preoperative therapy seem to benefit from this approach. Consequently, in the future, improvements in the overall survival of patients with esophageal, esophagogastric junction, or gastric cancer most likely will be achieved only by tailored therapeutic strategies that are based on the individual tumor location, tumor stage, and consideration of established prognostic factors. A clear classification of the underlying tumor entity, a profound knowledge of the prognostic factors applicable, a thorough preoperative staging, and identification of parameters that allow for the prediction of response to preoperative therapy will become essential for the selection of the optimal therapeutic modality for individual patients.
Publication Types:
  Review
  Review, tutorial


Ann Surg Oncol 2000 May;7(4):281-8
Preoperative multivariate prediction of morbidity after gastrectomy for  adenocarcinoma.
Onate-Ocana LF, Cortes-Cardenas SA, Aiello-Crocifoglio V, Mondragon-Sanchez R, Ruiz-Molina JM
Gastroenterology Department, Instituto Nacional de Cancerologia, Mexico DF, Mexico. lonate@prodigy.net.mx
BACKGROUND: Gastrectomy remains the only curative treatment for gastric cancer. However, surgical morbidity and mortality remains high. Our aim was to identify the risk factors that determine operative morbidity and mortality and to describe a simple method for preoperative stratification of morbidity outcome. METHODS: Retrospective review of patients who underwent gastrectomy for gastric cancer. Multivariate analysis was used to define risk factors for surgical morbidity and mortality. RESULTS: A total of 208 cases were included. Fifty-one episodes of operative morbidity and 19 surgery-related deaths were found. Operative blood loss (risk ratio [RR], 1.0012), serum albumin (RR, 0.42), extent of gastrectomy (RR, 2.8), lymphocyte count (RR, 0.999), and splenectomy (RR, 1.51) were the most important risk factors for morbidity. However, location of the tumor, serum albumin level, and lymphocyte count were the most important preoperative risk factors that determine the appearance of surgical complications. Receiver operating characteristic analysis of this model allowed definition of three risk groups in terms of surgical morbidity (11.8%, 28.5%, and 52.4%, respectively). CONCLUSIONS: A new method for preoperative calculation of the probability of surgical complications was developed. It must be validated prospectively and in different settings to be used in preoperative interventions designed to reduce that risk.


Drugs 1999;58 Suppl 3:85-90
Recent developments in oral chemotherapy options for gastric carcinoma.
Ajani JA, Takiuchi H
Department of Gastrointestinal Medical Oncology and Digestive Diseases,
University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA. Jajani@mdanderson.org
The incidence of carcinoma of the stomach is low in the United States, Canada, and Australia but is a significant health problem in Asia, South America, Eastern Europe, and countries of the previous Soviet Union. For patients with advanced disease, chemotherapy remains palliative. With the increasing emphasis on patients' quality of life, convenience, and cost containment, oral chemotherapy has come into increasing focus. We review oral chemotherapy agents for use in patients with advanced gastric carcinoma. Etoposide, given intravenously, has modest activity in gastric carcinoma. We studied oral etoposide, which was administered to 28 patients at the starting dose of 50 mg/m2/day for 21 days followed by a 7-day rest period. Five patients achieved a partial response and 4 patients achieved a minor response. The drug was well tolerated. Common toxicities included myelosuppression, alopecia, and nausea. Oral etoposide thus shows evidence of modest activity against gastric carcinoma. In Japan, considerable advances have been made in the oral chemotherapy of gastric carcinoma. The second generation fluorouracil prodrug tegafur/uracil (UFT) has been extensively evaluated in Japan, Korea, and Spain. Data predominantly from Japan indicate that tegafur/uracil has a response rate of approximately 20% in treatment naive patients with advanced gastric carcinoma. When combined with other active agents, tegafur/uracil has a response rate of more than 30% in these patients. The available data also suggest that tegafur/uracil is well tolerated and that patient acceptance is high. In conclusion, future clinical research is likely to focus on the development of convenient outpatient regimens with efficacy equal to that of intravenous regimens.
Publication Types:
  Review
  Review, tutorial


Surg Oncol Clin N Am 2000 Jan;9(1):97-117, vii-viii
Influence of surgery on outcomes in gastric cancer.
Hartgrink HH, Bonenkamp HJ, van de Velde CJ
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Surgery is the only possible curative treatment for gastric cancer. Although outcomes over the years have improved, there are still many controversies in the treatment of gastric cancer. One highly controversial topic is the extent of the operation. Results of recently performed large randomized studies may cause some policies to change. This article addresses the influence of surgery on outcomes of D1-D2 dissections, total versus subtotal gastrectomy, and pancreas and spleen resection and staging. Furthermore, several aspects of patient selection, the surgeon as a prognostic factor, noncurative treatment, and chemotherapy are discussed.
Publication Types:
  Review
  Review, tutorial


Hepatogastroenterology 1999 Sep-Oct;46(29):3015-8
Primary squamous cell carcinoma of the stomach: a case report with a review of Japanese and Western literature.
Muto M, Hasebe T, Muro K, Boku N, Ohtsu A, Fujii T, Ono M, Taijiri H, Mukai K, Yoshida S
Department of Intenal Medicine, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
A case of a 75 year-old male with primary squamous cell carcinoma of the stomach is reported. It is extremely rare to see squamous cell carcinoma developing in the stomach, without being accompanied by a component of adenocarcinoma. Up to the present, 18 Japanese and 62 Western cases of this type of carcinoma have been reported in the literature. The origin of this malignancy has not been well elucidated yet and thus, several plausible hypotheses have been proposed. In this presented case, the tumor consisted of only squamous cell carcinoma and the focus of squamous metaplasia was not found histologically in the adjacent mucosa. Therefore, it may be considered that the carcinoma arises from misplaced squamous cell nests of the stomach.
Publication Types:
  Review
  Review, multicase


Endoscopy 1999 Oct;31(8):623-6
6. Appropriateness of gastroscopy: risk factors for gastric cancer.
Gonvers JJ, De Bosset V, Vader JP, Dubois RW, Burnand B, Froehlich F
Policlinique Medicale Universitaire, Lausanne, Switzerland. Jean-Jacques.Gonvers@inst.hospvd.ch
Publication Types:
  Review
  Review, tutorial


Cancer 1999 Nov 1;86(9):1657-68
Adjuvant therapy for gastric carcinoma patients in the past 15 years: a review of western and oriental trials.
Shimada K, Ajani JA
Department of Gastrointestinal Oncology and Digestive Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4095, USA.
BACKGROUND: The early detection of gastric carcinoma is neither feasible nor practiced around the world, except on a limited basis in Japan. Thus, because gastric carcinoma is detected later in most patients throughout the world, those who undergo curative resection still remain at high risk for relapse. Adjuvant therapy therefore has a potentially important place in the treatment of these patients. It has been extensively investigated in the Orient, North America, and Europe. The authors reviewed the results of these trials to determine the current status of adjuvant therapy. METHODS: All randomized studies published in the world literature since 1984 were reviewed. These studies were divided into those performed in the West and those performed in Asia and also by the type of therapy investigated (chemotherapy, chemoimmunotherapy, or radiotherapy). These findings were then summarized and tabulated. RESULTS: In the process of evaluating the results of these studies, the authors uncovered some marked differences in the methodologies employed. For example, the use of no treatment control is a norm in the West, whereas a treatment control is commonly used in Asia. In addition, there is a greater emphasis on chemoimmunotherapy in Asia than in the West. Furthermore, results of Western studies suggest that postoperative adjuvant therapy is ineffective, whereas the results of the Asian trials do not give a clear indication. Despite this, most Asian patients receive postoperative or perioperative adjuvant chemoimmunotherapy. CONCLUSIONS: Postoperative chemotherapy as an adjuvant to potentially curative resection of gastric carcinoma remains investigational despite more than 30 years of investigation in the West. Newer therapeutic combinations or strategies (preoperative chemotherapy or chemoradiotherapy) have the potential to benefit the high risk patients. Copyright 1999 American Cancer Society.
Publication Types:
  Review
  Review literature


Rev Gastroenterol Mex 1999 Apr-Jun;64(2):75-7
[Gastric carcinoma in patients under 35 years].
[Article in Spanish]
Quijano Orvananos F, Moreno Paquentin E, Alvarez JJ, Martinez Munive A, Butron Perez L
Departamento de Cirugia, Hospital de Especialidades, Instituto Mexicano del Seguro Social, Mexico, DF, Mexico.
OBJECTIVE: To address the frequency, type of clinical presentation, treatment modalities and survival of gastric carcinoma in young Mexicans. PLACE: Hospital de Especialidades, Centro Medico Nacional Siglo XXI, IMSS, Mexico City. METHODS: A retrospective review of all charts of patients 35 years old or younger, with a diagnosis of gastric carcinoma treated at the department of surgery, from July 1986 to January 1990 was performed. Follow up was conducted at the surgery clinic until death or up to January 1998. RESULTS: Eleven patients under 35 years of age were identified, they represent 13.7% of 80 patients treated during that time period. Women were affected more frequently (1.7:1). Ten patients presented with advanced disease, and only one patient had Stage II. Five gastric resections were performed, one patient had a bypass only, three underwent surgical explorations and two were not operated. Ten had diffuse type lesions and only one intestinal adenocarcinoma. Median survival was 15.3 months and only one patient is alive and well. CONCLUSIONS: In our series, gastric carcinoma is frequent, it is diagnosed in advanced stages, and this is the reason for a very poor prognosis.
Publication Types:
  Clinical trial


Am Surg 1999 Oct;65(10):905-7
Gastroduodenostomy after gastric resection for cancer.
Kim BJ, O'Connell T
Kaiser Permanente Medical Center, Los Angeles, California, USA.
Gastrojejunostomy after resection for gastric cancer has been associated with a variety of complications, including bile reflux gastritis, marginal ulcers, and afferent loop syndrome. Gastroduodenostomy, although more physiologic, has not been recommended because of the fear of obstruction due to tumor recurrence. A review of 62 patients with gastric adenocarcinoma who underwent gastric resection from 1986 to 1996 was performed. Of the 62 patients, 52 (83%) underwent subtotal gastric resection and 10 (17%) underwent total gastrectomy with Roux-en-Y reconstruction due to tumor location. Forty-seven (90%) of the 52 patients underwent gastroduodenostomy, and 5 (10%) of these patients underwent gastrojejunostomy due to operative findings of excessive tumor burden or the inability to create a safe tension-free anastomosis. Patients who underwent gastroduodenostomies were followed for a period of 6 months to 5 years and had a median survival of 2.5 years. Two (4.2%) of the 47 patients obstructed due to tumor recurrence at 2 and 4 years postoperatively. One patient (2%) had symptomatic bile reflux gastritis, which was treated conservatively without  reoperation. There were no incidences of marginal ulcers. In conclusion, gastroduodenostomy should be considered for patients undergoing resection for gastric cancer due to its physiological benefits and acceptable rate of obstruction.


Hepatogastroenterology 1999 May-Jun;46(27):2044-7
Total gastrectomy for gastric adenocarcinoma. Analysis of 115 consecutive patients.
Oliveira FJ, Ferrao H, Furtado E, Batista H, Santos MS
IInd Department of Surgery, University Hospital of Coimbra, Portugal.
BACKGROUND/AIMS: There was a tendency to use more extensive operations for the treatment of gastric cancer during the last decade particularly in Europe. This retrospective study was carried out to review our recent experience with total gastrectomy for gastric adenocarcinoma. METHODOLOGY: One hundred and fifteen patients treated for gastric cancer by total gastrectomy from 1987 to 1996 were analyzed. At the time of surgery 22.3% of patients were older than 70 years of age. RESULTS: Fifty eight cancers (50.4%) were located in the distal third of the stomach, forty-seven (41%) were smaller than 6 cm and seventy-one (61.7%) were of the diffuse type. In 74.9% the tumor had penetrated through the serosa. The mortality and morbidity rates were 6.1% and 35.1% respectively. Age was a major determining factor with respect to hospital mortality and post-operative complications. CONCLUSIONS: Irrespective of personal attitudes, gastrectomy does not have to be total to be curative, and many total gastrectomies performed in Western countries with "curative intent" are noncurative procedures. Nevertheless, to achieve a curative oncologic resection, total gastrectomy is required with growing frequency.


Hepatogastroenterology 1999 May-Jun;46(27):1998-2004
Health-related quality of life evaluations of gastric and pancreatic cancer.
Schmier J, Elixhauser A, Halpern MT
MEDTAP International, Bethesda, Maryland 20814, USA.
This review addresses the state of the literature on health-related quality of life (HRQL) assessment among patients with cancers of the pancreas and stomach. We first briefly review the epidemiology of these cancers. We examine the concept of HRQL and the degree to which it has been measured among these patient groups. The impact of gastric and pancreatic cancers on HRQL is described, including the domains which these conditions are most likely to impact. The effect of different treatments on HRQL is considered, including surgical procedures, pharmacological and non-pharmacological therapies, and procedures for symptom palliation. Based on our findings on the limited quantity and quality of the body of literature, we make suggestions for further research in the area. Results suggest three areas in which HRQL can play an important role in the study of gastric and pancreatic cancer. First, future investigations
should consider both survival and HRQL in comparing surgical procedures. Second, studies of chemotherapy should include HRQL evaluation, with careful attention to conducting assessments at times appropriate to capture the effects of chemotherapy. Third, studies of the impact of palliative care should include assessments of HRQL.
Publication Types:
  Review
  Review, tutorial


Am J Gastroenterol 1999 May;94(5):1402-4
Primary advanced gastric small cell carcinoma: a case report and review of the literature.
Takaku H, Oka K, Naoi Y, Santoh N, Setsu Y, Mori N
Department of Surgery, Mito Saiseikai General Hospital, Ibaraki, Japan.
We report a 73-yr-old man with primary advanced gastric small cell carcinoma, pure type. A large, Borrman type I tumor was located from the cardia to the entire gastric fundus and upper body. Atypical cells showed a round nucleus, small nucleolus, dense to granular chromatin, and scant cytoplasm. The histological findings indicates an advanced stage and exposure to the gastric serosa. Mitotic figures were observed. There was a proliferation of a sheet-like, solid pattern, but no rosette-like, sqamoid, or glandular patterns. The neoplastic cells were positive for Leu-7 (CD57) and 123C3 (CD56, neural cell adhesion molecule, NCAM) on the surface membrane. We diagnosed this case as primary advanced gastric small cell carcinoma, pure type, and report that Leu-7 and 123C3 monoclonal antibodies are useful markers for gastric small cell carcinoma. The 32 previously reported cases of gastric small cell carcinoma arealso reviewed.
Publication Types:
  Review
  Review of reported cases


Am J Med 1999 Feb;106(2):222-6
Helicobacter pylori and gastric cancer.
Scheiman JM, Cutler AF
Division of Gastroenterology, The University of Michigan Medical Center, Ann Arbor 48109-0362, USA.
Infection with Helicobacter pylori is now recognized as the primary cause of peptic ulcers and their recurrence. Compelling evidence has also been found linking H. pylori infection to gastric cancer, the second most common cancer in the world. Given the high rate of patient morbidity and mortality associated with gastric cancer, any method by which one can reduce the occurrence of the disease or increase its early detection is desirable. The strong correlation with H. pylori infection and the current availability of easily administered tests for the detection of the pathogen argue for screening at least those individuals with a family history of gastric cancer or other risk factors. This article reviews the association between H. pylori and gastric cancer and the pathologic changes that the infection produces in the gastric mucosa, as well as the cost-effectiveness of universal testing and eradication of the infection in H. pylori-positive individuals to reduce gastric cancer. 

Publication Types:
  Review
  Review, tutorial
Comments:
  Comment in: Am J Med 1999 Dec;107(6):646-7


Endoscopy 1999 Jan;31(1):47-55
Treatment of esophageal and gastric tumors.
Inoue H, Tani M, Nagai K, Kawano T, Takeshita K, Endo M, Iwai T
First Dept. of Surgery, Tokyo Medical and Dental University, Japan. hiro.inoue.srg1@med.tmd.ac.jp
Endoscopic mucosal resection (EMR) has gained increasing popularity in the treatment of esophageal and gastric mucosal cancers in Japan, for complete local resection of the cancer-bearing mucosa. In Western countries, the concept of mucosal cancer and the necessity of treating it are gradually but steadily coming to be accepted. As a treatment for inoperable cases of advanced cancer, on the other hand, intubation with self-expanding metal stents has been widely accepted as a less invasive form of palliation for malignant obstruction of the upper gastrointestinal tract. Tumor ingrowth into the stent can be mechanically avoided by adding a membrane coating to it. In the last two years, applications for therapeutic endoscopy in the treatment of esophageal and gastric tumors have continued to widen.
Publication Types:
  Review
  Review, tutorial


J R Coll Surg Edinb 1999 Feb;44(1):61-2 [Texto completo]
Synchronous and metachronous gastric adenocarcinoma: case report and literature review.
Gnanalingham KK, Hall CN, Bishop P
Department of Surgery, Wythenshawe Hospital, South Manchester University Hospitals Trust, Manchester, UK.
Whilst synchronous adenocarcinoma of the stomach is well documented, metachronous primary disease is exceedingly rare. We report a man with a family history of colonic and gastric cancer, who underwent a resection of a Duke's C adenocarcinoma of the rectum, aged 56 years, and a proximal partial gastrectomy for synchronous stage 1 gastric adenocarcinomas of the lesser curve, aged 61 years. Nine years later, a metachronous gastric primary was discovered in the gastric remnant, necessitating total gastrectomy. Total gastrectomy is the operation of choice for synchronous gastric primaries as it ensures clearance and prevents metachronous growth. However, it may not be appropriate for all gastric cancer as operative morbidity and mortality are increased, and because synchronicity and metachronicity of gastric cancer are uncommon. Moreover, there are no consistent data to demonstrate a survival advantage for total compared with partial gastrectomy for operable gastric cancer. If, after partial gastrectomy, synchronous disease is detected in the resected specimen (as in this reported case), endoscopic surveillance for metachronous disease is advised, since this may be amenable to surgical cure.
Publication Types:
  Review
  Review of reported cases


Hepatogastroenterology 1998 Sep-Oct;45(23):1930-4
Gastric cancer.
Triantafillidis JK
Department of Gastroenterology, Saint Panteleimon General State Hospital, Nicea,
Greece.
Publication Types:
  Review
  Review literature


Ann Surg Oncol 1998 Oct-Nov;5(7):650-6
Gastric carcinoma.
Karpeh MS Jr, Brennan MF
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. karpehm@mskcc.org
Gastric cancer continues to be a major global health problem. In the American College of Surgeons Patient Care study on gastric cancer, 5-year disease-specific survival was 26%, with an overall survival of 14%. Improvements in survival will require both earlier diagnosis and new therapeutic strategies. The ability of surgical oncologists to understand the natural history of the disease, accurately define its extent, and provide the most effective treatment places them in a key position to see that improvements in outcome are brought about expeditiously.
Publication Types:
  Review
  Review, tutorial


Am J Surg 1998 May;175(5):418-21
Surgical management of adenocarcinoma of the cardia.
Graham AJ, Finley RJ, Clifton JC, Evans KG, Fradet G
Division of Thoracic Surgery, University of British Columbia, Vancouver Hospital & Health Sciences Centre, Canada.
BACKGROUND: The incidence of adenocarcinoma of the cardia is increasing. The surgical management remains controversial. The present study reviews our experience with surgically resected adenocarcinoma of the cardia. METHODS: A retrospective review of 153 cases of surgically resected adenocarcinoma of the cardia was performed. Preoperative radiotherapy was used in 31 patients. The surgical approach, morbidity, mortality, impact of preoperative radiotherapy, and survival were determined. RESULTS: The type of resection performed was a transhiatal esophagogastrectomy in 78%, a transthoracic esophagogastrectomy in 21%, and a transabdominal esophagogastrectomy in 1%. The in-hospital mortality rate was 4%. The frequency of complications was not associated with the use of preoperative radiotherapy or surgical approach. The 1-year (61%), 2-year (38%), 3-year (23%), and 5-year (16%) survival were not affected by the use of preoperative radiotherapy or surgical approach. Survival was significantly associated with stage and the presence of lymph node metastasis. CONCLUSIONS: Adenocarcinoma of the cardia is associated with a poor long-term prognosis. The long-term survival does not appear to be affected by the use of preoperative radiotherapy or by surgical approach.


Ann R Coll Surg Engl 1998 Jan;80(1):16-24
Extended lymphadenectomy in gastric cancer: when, for whom and why.
Roukos DH
Department of Surgery, Medical School, University of Ioannina, Greece.
Although lymph node metastasis is a major prognostic factor in gastric cancer, the optimal extent of lymph node dissection still remains a subject of debate. The influence of extended D2 lymphadenectomy on morbidity and long-term survival is controversial. Reports from many Japanese and some Western institutions show similar morbidity and mortality rates for both limited D1 and extended D2 resections. However, the four available randomised trials show a significant increase in operative morbidity and mortality after a D2 resection. The authors of these trials believe that distal pancreaticosplenectomy is responsible for this increased morbidity and mortality and not the lymphadenectomy itself. Retrospective and prospective non-randomised studies show superior stage (II/IIIA) specific survival rates after D2 resections. However, these studies did not eliminate stage migration and randomised trials failed to show any survival advantage in favour of the D2 resection. Current data suggest that D2 resection is beneficial to the subgroup of patients with N1 or N2 disease undergoing potentially curative resection. However, Western studies that support D2 resection, fail to show any survival advantage for D2 resection in N2 patients, reporting a benefit only to N0 or N1 patients. In contrast, Japanese series report a large number of N2 long-term survivors. The question as to the possible beneficial effect of extended lymphadenectomy in gastric cancer is difficult and complex. D2 resection increases the potentially curative resection rate, at least in N2 patients, achieves a better locoregional tumour control and provides the only chance for cure among N2 patients since adjuvant treatment in gastric carcinoma has not yet been proved effective. However, all randomised comparisons warn of an increased risk after D2 resection. By avoiding pancreaticosplenectomy, however, the morbidity can be within acceptable limits. D2 gastrectomy seems to be the most attractive procedure in the surgical management of gastric cancer.
Publication Types:
  Review
  Review, academic


Surgery 1998 Feb;123(2):127-30
Total gastrectomy is not necessary for proximal gastric cancer.
Harrison LE, Karpeh MS, Brennan MF
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
BACKGROUND: Although there is an increasing incidence of proximal gastric cancers in the United States, the appropriate extent of resection for proximal gastric cancer is not known. This study addresses whether the type of operation (total gastrectomy [TG] vs proximal gastrectomy [PG]) affects outcome for proximal gastric adenocarcinoma. METHODS: Review of the prospective gastric database at Memorial Sloan-Kettering Cancer Center from July 1985 to August 1995 identified 391 patients with proximal gastric cancer. Of those patients, 98 underwent curative TG or PG through an exclusively abdominal approach. Patients undergoing esophagogastrectomy (n = 293) were excluded from analysis. Data are expressed as medians and ranges. RESULTS: The length of hospital stay was the same for patients undergoing resection for PG (16.5 days [range 8 to 55]) and for TG (18 days [range 8 to 48]). In addition, hospital mortality rates for PG (6.0%) were similar to those for TG (3.0%). There was no significant difference in tumor differentiation and overall stage between the groups that underwent TG and those that underwent PG. There was no significant difference in time to recurrence between the two operative groups (PG, 15.7 months, versus TG, 18 months). In addition, there was no association between first site of recurrence and type of procedure. The overall 5-year survival rate for proximal gastric cancer was 43% (median survival 46 months), whereas the 5-year survival rate for TG was 41% (median survival 51 months; difference not significant). CONCLUSIONS: The extent of resection for proximal gastric cancer does not affect long-term outcome. TG and PG have similar overall survival rates and time and rate of recurrence, and both procedures can be accomplished safely.


Rev Gastroenterol Mex 1997 Jul-Sep;62(3):160-6
[Gastric cancer].
[Article in Spanish]
Onate-Ocana LF, Mondragon-Sanchez R, Ruiz-Molina JM, Ochoa-Carrillo FJ, Aiello-Crocifoglio V
Departamento de Gastroenterologia, Instituto Nacional de Cancerologia, Mexico, Mexico, D.F.
Gastric cancer (GC) is a frequent neoplasm with high mortality. Most patients in occidental countries show advanced stages of the disease, and low resectability rates. In this paper, some epidemiological items are detailed. The morphologic classifications, TNM stages and risk factors for GC are defined. Clinical manifestations are described, focused in the necessity of early diagnosis as it is the only way to reduce mortality. The usefulness of diagnostic methods in preoperative staging are discussed in relation to the role of these methods in the prediction of resectability and the evaluation of new therapeutic regimens.
The role of radical surgery and extended lymphadenectomy as definitive treatment is analyzed as well the role of adjuvant and palliative interventions. The experience in Instituto Nacional de Cancerologia is briefly described.
Publication Types:
  Review
  Review, tutorial


Am J Surg 1996 Jul;172(1):75-8
A review of carcinoma of the stomach at a tertiary care referral hospital.
Walker MJ
Department of Surgery, Ohio State University, Columbus, USA.
BACKGROUND: Carcinoma of the stomach continues to cause a significant mortality in the United States. We reviewed the characteristics, treatment modalities, and survival of a group of patients with this cancer at a tertiary care referral hospital. MATERIALS AND METHODS: A retrospective computer based review of all patients with a diagnosis of carcinoma of the stomach in the Ohio State University (OSU) tumor registry was made. One hundred ninety-two analytical cases were found and the data was entered into a computerized database and analyzed. RESULTS: The overall median survival in this series of patients is 10 months with a median survival of 16 months (n.s.) in patients who underwent curative surgery (50% of the patients). There was an increased number of cardia lesion (37%) predominately in male patients (P < 0.05). A significantly greater number of female patients presented with linitis plastica and male patients with adenocarcinoma, although there was no difference in the operability, types of operations, and survival between the genders. Patients with signet ring cell cancer were significantly younger than the other two histological types reviewed but this did not alter outcome. CONCLUSION: Carcinoma of the stomach, despite newer image modalities, continues to present at advanced stages at time of diagnosis with an overall dismal prognosis. The increased incidence of cardia lesions noted require innovative therapies if any progress is to be made.


N Engl J Med 1995 Jul 6;333(1):32-41
Gastric carcinoma.
Fuchs CS, Mayer RJ
Division of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02115,
USA.
Publication Types:
  Review
  Review, tutorial
Comments:
  Comment in: N Engl J Med 1995 Nov 23;333(21):1426-7; discussion 1428
  Comment in: N Engl J Med 1995 Nov 23;333(21):1427; discussion 1428
  Comment in: N Engl J Med 1995 Nov 23;333(21):1427-8


BMJ 1994 Mar 26;308(6932):834-8 [Texto completo]
Management of carcinomas of the upper gastrointestinal tract.
Ellis P, Cunningham D
Cancer Research Campaign Section of Medicine, Sutton, Surrey.
Patients with oesophageal, gastric, and pancreatic carcinomas present a common and difficult problem for the clinician. Surgery is the best option for curative treatment but overall survival figures remain low. Recent improvements in our understanding of the biology of these tumours and improvements in their clinical staging, along with the development of combined modality approaches to local-regional disease, have led to renewed optimism that survival figures may be improved. This is particularly so for oesophageal and gastric carcinomas. In addition, there have been advances in the palliative management of all three tumours. This article examines some of these developments and looks at future prospects.
Publication Types:
  Review
  Review, academic
Comments:
  Comment in: BMJ 1994 Apr 23;308(6936):1103
  Comment in: BMJ 1994 Jun 4;308(6942):1508-9
  Comment in: BMJ 1994 Jun 25;308(6945):1715


Am Surg 1993 Dec;59(12):855-9
Factors influencing survival in advanced gastric cancer.
Tabuenca AD, Aitken DR, Ihde JK, Smith J, Garberoglio C
Dept. of Surgery, Loma Linda University Medical Center, CA 92354.
Even though the incidence of gastric carcinoma is decreasing, the prognosis remains poor. A review of 88 patients with advanced gastric cancer was evaluated by univariate and multivariate analysis to determine prognostic factors. Univariate analysis showed that both "curative" resection (P = 0.006) and adjuvant chemotherapy (P = 0.02) were important therapy variables. These factors were not independent when evaluated by multivariate analysis. However, when they were combined and re-evaluated by multivariate analysis, the combination of "curative" surgery and adjuvant chemotherapy significantly improved survival in advanced gastric cancer (P = 0.04).


Lancet 1993 Sep 18;342(8873):713-8
Adenocarcinoma of the stomach: are we making progress?
Thompson GB, van Heerden JA, Sarr MG
Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Publication Types:
  Review
  Review, tutorial
Comments:
  Comment in: Lancet 1993 Nov 20;342(8882):1299
  Comment in: Lancet 1993 Nov 20;342(8882):1299-300
  Comment in: Lancet 1994 Jan 8;343(8889):117