Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal Carcinomatosis: Is HIPEC the Only Answer?

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52919#.VKydbcnQrzE

ABSTRACT

<span “=””>Gastric cancer with peritoneal carcinomatosis is notorious for its dismal prognosis. While the pathophysiology of peritoneal dissemination is still controversial, the rapid downhill course is universal. Patients usually suffer abdominal distension, intestinal obstruction and various complications before they succumb after a median of 3 – 6 months. Although not adopted in most international treatment guidelines, intraperitoneal chemotherapy has growing evidence compared with conventional systemic chemotherapy for the treatment of peritoneal carcinomatosis. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is well-established for clinical benefit but is technically demanding with substantial treatment-related morbidities and mortality. On the other hand, normothermic intraperitoneal chemotherapy in the form of bidirectional neoadjuvant treatment is promising with various newer chemotherapeutic agents. Regardless of the treatment technique applied, the essential element of success is meticulous patient selection and availability of expertise. Future direction is along the line of personalized treatment with the application of translational science.<span “=””>

Cite this paper

Lam, K. , Law, B. , Law, S. and Kwong, D. (2014) Intraperitoneal Chemotherapy for Gastric Cancer with Peritoneal Carcinomatosis: Is HIPEC the Only Answer?. Modern Chemotherapy, 3, 11-19. doi: 10.4236/mc.2014.32003.

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Complications Following Surgery for Gastric Cancer: Analysis of Prospectively Collected Data

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52613#.VJy_rcCAM4

ABSTRACT

Background and Aims: The complication rate after surgery for gastric cancer varies according to the particular definition of morbidity, so it’s necessary to report them using a standardized method, the Clavien-Dindo system. The purpose of this study was to prospectively analyze all post-gastrectomy complications in patients with gastric adenocarcinoma according to the severity grade using Clavien-Dindo system, in order to identify risk factors for postoperative complications and their prognostic significance on survival. Methods: This study is based on data from 90 consecutive patients who underwent gastrectomy for gastric neoplasia between January 2010 and February 2014 at the same unit. 15 patients were excluded (benign tumors, GISTs, missing data). Complications were categorized according to the Clavien-Dindo classification (uncomplicated patients vs patients classified ≥Grade I). The following risk factors were studied: age, BMI, sex, operation method, extent of resection, duration of surgery, transfusions, TNM staging, and lymph node ratio. Multivariate logistic regression was used to evaluate the association between risk factors and presence of complications. To assess the effect on overall survival, after selection of covariates using backward elimination, the Cox proportional hazard model was applied. Results: Among these patients, 49 (65.3%) developed complications, stratified as follows: Grade I, 6 (8%); Grade II, 24 (32%); Grade III, 6 (8%); Grade IV, 13 (17.3%). The laparoscopic technique (OR=0.050; 95% CI=0.005 – 0.550, p=0.0143) and no transfusions (OR=0.219; 95% CI=0.058 – 0.827, p=0.0251) were found to reduce the incidence of postoperative complications in the multivariate analysis. With regard to the survival analysis, lymph node ratio, malnutrition, extended resection and presence of complications were significant predictors of reduced survival in the multivariate analysis. Conclusions: Some variables can predict the risk of postoperative complications, the occurrence of which is a predictor of reduced probability of survival. In this respect it’s essential to reduce complications.

Cite this paper

Bruno, L. , Barni, L. , Pacciani, S. , Masini, G. , Tofani, L. , Tofani, F. , Melli, F. , Taddei, A. , Miloeva, M. , Boni, L. , Freschi, G. and Bechi, P. (2014) Complications Following Surgery for Gastric Cancer: Analysis of Prospectively Collected Data. Journal of Cancer Therapy, 5, 1454-1466. doi: 10.4236/jct.2014.514147.

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Multiple Detector-Row CT in Gastric Cancer Staging: Prospective Study

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52605#.VJy5NcCAM4

Author(s)

Lorenzo Bruno1*, Lucia Barni1, Gaia Masini1, Sabrina Pacciani1, Edvige Lucarelli2, Antonella Masserelli2, Daniela Tomcykova3, Filippo Melli1, Luca Boni3, Giancarlo Freschi1, Paolo Bechi1

Affiliation(s)

1Surgery and Translational Medicine, University of Florence, Florence, Italy.
2Diagnostic Imaging 4, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
3Clinical Trials Coordinating Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.

ABSTRACT

The aim of this study was to evaluate the accuracy of multiple detector computed tomography (MDCT) in the preoperative staging of gastric cancer, prospectively comparing CT findings with pathological findings at surgery, in a single-center study. A total of 19 consecutive patients with primary cancer recruited between March and July 2014 were submitted to preoperative MDCT staging according to a standard protocol. All diagnostic procedures were performed by dedicated radiologists who were unaware of the final pathological results. Subsequently, 16 patients underwent surgical treatment and 15 were finally included in the study. The primary tumor was detected at CT in all 15 cases. CT results for T staging were in agreement with pathological findings in 12 of 15 cases, with overall accuracy of 80%. Stage-specific sensibility was high for advanced stages (sensibility for T1, T3, and T4 resulted 60%, 85.7%, and 100%, respectively), while earlier stages showed higher specificity (specificity for T1, T3, and T4 resulted 100%, 75%, and 91.7%, respectively). Overall N staging accuracy was 86.7%, with 13 of 15 patients correctly staged. Stage-specific sensibility was 75% for N0 and 100% for N3, while specificity was 100% for N0 and lower for advanced stages. Accuracy for peritoneal involvement was 100%. Our findings show a good performance of the diagnostic protocol performed with MDCT tested in this study.

KEYWORDS

Gastric Cancer, MDCT, Staging, Oncologic Imaging

Cite this paper

Bruno, L. , Barni, L. , Masini, G. , Pacciani, S. , Lucarelli, E. , Masserelli, A. , Tomcykova, D. , Melli, F. , Boni, L. , Freschi, G. and Bechi, P. (2014) Multiple Detector-Row CT in Gastric Cancer Staging: Prospective Study. Journal of Cancer Therapy, 5, 1438-1449. doi: 10.4236/jct.2014.514145.

References

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http://dx.doi.org/10.1007/s00261-013-0013-9                                                                                   eww141226lx

Clinicpathological Features of Gastric Cancer in Young Patients

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52043#.VH-yDmfHRK0

ABSTRACT

The incidence of gastric cancer (GC) in young patients has showed a stable or even slightly increasing trend in recent years all over the world. Little is known about the clinicpathological features of young patients with GC in Ningxia region, located in the northwest part of China. To define the clinicpathological features of GC in young patients in this region, 117 patients with GC, who were admitted to the Department of Medical Oncology, General Hospital of Ningxia Medical University, Ningxia, China, were enrolled in a retrospective database between 2000 and 2005. The data from 55 patients aged less than 35 years old were compared with those from 62 controls aged between 36 and 70. It was found that in young group, the percentages of females, the tumors in the lower third of the stomach, tumor size larger than 4 cm, macroscopic type Borrmann III tumors, poorly differentiated histology, the 7th T stage T3 + T4, the distribution of tumor-nodes-metastasis(TNM)stage IV, surgical exploratory laparoscopy, and anemia symptoms were significantly higher than those in the control group (P < 0.05). The 5-year survival in the young group was lower than that in the control group (21.8% vs. 48.4%, P < 0.05). It was obvious that the clinicpathological features of GC in young patients were different from those in the control group. Focusing on early diagnostic rate and choosing a suitable operative treatment should be critical to improve prognosis of young patients with GC in Ningxia region of China.

Cite this paper

Wang, Y. , Lian, B. , Dong, Y. , Wang, N. and Yang, W. (2014) Clinicpathological Features of Gastric Cancer in Young Patients. Journal of Cancer Therapy, 5, 1366-1371. doi: 10.4236/jct.2014.514137.

References

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Down-Regulation of Claudin-1 Expression in Gastric Cancer Mucosa Is Correlated with Poor Prognosis

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=50920#.VFBMHFfHRK0

ABSTRACT

Background: Cell adhesion molecule abnormalities are given as one reason for the occurrence of invasion and metastasis in various cancers. In this study, we conducted an immunohistochemical examination of cell adhesion molecule claudin-1 in mucosa and invasive front of gastric cancer, and investigated the correlation of claudin-1 expression and clinicopathological factors. Methods: Immunohistochemical examination was performed for 35 patients who underwent surgery be-tween January 2010 and October 2011, to assess the correlation of claudin-1 with primary gastric cancer. Results: The expression rate of claudin-1 was 48.6% (17/35) in 35 gastric carcinoma patients. The positive rates of claudin-1 were 42.9% (15/35) in mucosa and 28.6% (10/35) in invasive front of gastric cancer. The expression rate of claudin-1 in invasive front was lower than in mucosa. From comparing claudin-1 expression in mucosa, it was found that well-to moderately-differentiated adenocarcinoma had significantly more claudin-1 expression than poorly-differrentiated adenocarcinoma. Claudin-1 expression of well-to moderately-differentiated adenocar-cinoma decreased in the invasive front of gastric cancer. Expression of claudin-1 in mucosa was negative in many cases with advanced tumor invasion (T2, T3, T4) and positive in many cases with early tumor invasion (T1), with a significant difference between the two (p < 0.05). In mucosa, many cases at an advanced stage (Stage II, III, IV) were negative for claudin-1 expression and many cases at an early stage (Stage I) were positive for claudin-1 expression. A significant difference was seen between the two (p < 0.05). However, claudin-1 expression in the invasive front was not correlated with histological type, depth of tumor invasion and stage. Conclusion: From the above results, it is considered that decreased claudin-1expression in mucosa is related to histological type, gastric cancer invasion and stage, and this information may be useful when making a pathological diagnosis of advanced gastric cancer and estimating outcomes.

Cite this paper

Hirakawa, E. , Tokuhara, Y. , Morinishi, T. , Ohsaki, H. , Uemura, E. , Miki, Y. , Matsunaga, T. , Kushida, Y. and Haba, R. (2014) Down-Regulation of Claudin-1 Expression in Gastric Cancer Mucosa Is Correlated with Poor Prognosis. Open Journal of Pathology, 4, 206-212. doi: 10.4236/ojpathology.2014.44026.

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A Rare Case of Gastric Linitis Plastica Revealed by Isolated Vertebral Metastases in a Young Woman in a Less Developed Country

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=50685#.VEhuslfHRK0

ABSTRACT

Aim: We report a rare case of gastric linitis plastica revealed by vertebral metastases without another digestive dissemination. Case presentation: The Benin native woman was hospitalized in rheumatology for inflammatory back pain without another signs. Rx ray showed vertebra metastasis. In the etiologic research, gastroscopy showed an infiltrating lesion of the antral area, indicating gastric linitis which was confirmed by biopsy. Short and medium-term evolution was favourable, characterized by a complete disappearance of the pains and a good physical condition. Conclusion: Vertebral metastases can reveal digestive cancer, although human gut is not among the most bone metastatic cancers.

Cite this paper

Zomalheto, Z. , Kpossou, R. , Agbodande, A. and Larbre, J. (2014) A Rare Case of Gastric Linitis Plastica Revealed by Isolated Vertebral Metastases in a Young Woman in a Less Developed Country. Open Journal of Rheumatology and Autoimmune Diseases, 4, 207-211. doi: 10.4236/ojra.2014.44028.

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Update of Aetiological Patterns of Adult Gastric Outlet Obstruction in Accra, Ghana

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=49528#.VBJb66N2W3M

Update of Aetiological Patterns of Adult Gastric Outlet Obstruction in Accra, Ghana.

ABSTRACT

Background: The aetiology of gastric outlet obstruction globally has evolved from benign to malignant causes, but there seem to be no recent data on the trends in Ghana. The aim was, therefore, to identify the current patterns in the aetiology of gastric outlet obstruction in the adult population in Ghana. Methodology: This was a retrospective review of all confirmed cases of gastric outlet obstruction in the last decade, spanning from June 2004 to May 2014, that were managed at the Korle Bu Teaching Hospital. Results: A total of 107 patients were managed for gastric outlet obstruction with a male to female ratio of 2.15:1 and most of the patients making 71.3% of cases belonged to the age range of 40 to 60 years. The predominant aetiology for gastric outlet obstruction was found to be gastric cancer (55.140%), followed by peptic ulcer disease (27.103%). Conclusion: The aetiology of gastric outlet obstruction in Ghana has evolved from benign to malignant causes, following current global trends. Gastric cancer is now the most important cause of gastric outlet obstruction in Ghana, followed by peptic ulcer disease which predominates as the commonest benign cause.

Cite this paper

Essoun, S. and Dakubo, J. (2014) Update of Aetiological Patterns of Adult Gastric Outlet Obstruction in Accra, Ghana. International Journal of Clinical Medicine, 5, 1059-1064. doi: 10.4236/ijcm.2014.517136.
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