Recurrence of Gastric Cancer in the Jejunum Close to the Anastomotic Site after Total Gastrectomy

A 61-year-old man underwent total gastrectomy with esophago-jejunostomy for Borrmann type I gastric cancer. Postoperative intra-abdominal abscess made the patient unable to receive adjuvant chemotherapy. Only 23 weeks after operation, the patient developed melena and anemia, leading to the diagnosis of recurrence in the jejunum close to the anastomotic site. The patient received salvage resection of the recurrence. Pathological study showed that the tumor was composed of atypical cells similar to those of the primary gastric cancer. Normal jejunal mucosa was observed between the esophagus and the recurrent tumor. We judged that exfoliation of the gastric cancer cells caused the recurrence due to both the very short disease-free interval and pathological findings. Surgeons should pay attention to this type of recurrence especially for Borrmann type I gastric cancer. In addition to the adjuvant chemotherapy, gastric irrigation using distilled water during the operation seems to be a feasible measure to prevent this type of recurrence.

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Ileocolic Interposition as a Gastric Substitute in Patients with Total Gastrectomy; Case Series and Literature Review

International Journal of Cancer Management ◽

10.5812/ijcm.107505 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Ehsan Soltani ◽

Habibollah Mahmoudzadeh ◽

Ramesh Omranipour

Keyword(s):

Gastric Cancer ◽

Weight Loss ◽

Total Gastrectomy ◽

Case Series ◽

Normal Diet ◽

Anastomotic Site ◽

Nutritional Conditions ◽

Barium Examination ◽

Gastric Cancer Treatment ◽

Nutritional Benefits

Background: The standard method for reconstruction after total gastrectomy is Roux-en-Y reconstruction, which has several negative points such as malabsorption. The most important reasons for weight loss in these patients are reserval insufficiency and reduction of food-digestive juice blending. We suggest that the creation of a food reserve with a natural conduit by ileocolic interposition may help the patient to have more normal diet habits and prevent severe weight loss. Methods: The study enrolled 8 patients with proximal gastric cancer, who underwent total gastrectomy with omentectomy and D2 lymphadenectomy. Then, the ileocolic segment with its vasculature was prepared and the anastomosis was done like right colon interposition between esophagus and duodenum. Intraoperative and postoperative events and also nutritional conditions were recorded. Results: Among 8 patients enrolled in the study, not an intraoperative bad event nor anastomotic site leakage, abscess formation, or other significant post-operative complication were seen. Except for the first two patients, the rest did not suffer from dysphagia. None of the patients suffered from delayed, chronic, or uncontrolled vomiting. All patients experienced weight loss postoperatively but after 2 months, they gained weight. Barium examination and also upper endoscopy revealed that the patients had normal reserval volume, no evidence of erosion or ulceration, no evidence of biliary esophagitis or reflux, and absence of tumor relapse. Conclusions: Because of the nutritional benefits of ileocolic interposition after total gastrectomy in gastric cancer treatment, it can be used as an acceptable alternative method of reconstruction in a subgroup of selected patients.

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145P A nomogram for predicting the benefit of adjuvant chemotherapy after resection in patients with Borrmann type IV gastric cancer

Annals of Oncology ◽

10.1016/j.annonc.2020.10.166 ◽

2020 ◽

Vol 31 ◽

pp. S1297

Author(s):

Q-Z. Qiu ◽

F-H. Wang ◽

Y-H. Tang ◽

C-H. Zheng ◽

P. Li ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Type Iv ◽

Borrmann Type ◽

Borrmann Type Iv

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Effects of perioperative enteral EPA-enriched immunonutrition on meaningful loss of lean body mass after total gastrectomy for gastric cancer: Post hoc analysis of a phase III study.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.85 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 85-85

Author(s):

Takaki Yoshikawa ◽

Naoki Hiki ◽

Kentaro Sakamaki ◽

Seiji Ito ◽

Kazumasa Fujitani ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Enteral Nutrition ◽

Total Gastrectomy ◽

Phase Iii ◽

Standard Diet ◽

Group A ◽

Phase Iii Study ◽

Group B ◽

Post Hoc

85 Background: Total gastrectomy for gastric cancer significantly reduces body weight, especially lean body mass (LBM), through surgical stress and decrease of the calorie intake. Eicosapentaenoic acid (EPA)-enriched enteral nutrition (EPA-EN) could modulate immune function and limits catabolism. In our phase III study to compare perioperative standard diet with or without EPA-EN, additional EPA-EN did not contribute to prevent weight loss or LBM. Recently, 5% or more LBM loss after surgery was reported to impair compliance of post-operative S-1 adjuvant chemotherapy. This post hoc study explored whether additional EPA-EN prevented meaningful loss of LBM for compliance of adjuvant chemotherapy after surgery. Methods: Key entry criteria of this phase III study was (1) histologically proven adenocarcinoma of the stomach, (2) clinical T1-T4a and M0, (3) R0 resection is possible by total gastrectomy, (4) sufficient oral intake, and (5) sufficient organ function. The patients were randomized to Group A: no supplementation with oral nutrients (standard diet) or Group B: standard diet with oral supplementation of ProSure including 600 kcal with 2.2 g EPA for 7 days before surgery and for 21 days after surgery. For both groups, patients underwent total gastrectomy with Roux-en Y reconstruction. Results: A total of 127 patients (Group A: 63, Group B: 64) were enrolled in the study. All background factors were well balanced between the both groups. Median relative performance of supplement in group B was 100% before surgery and 54% after surgery. 5% or more LBM loss at 1 month after surgery was observed in 44 patients (80.0%) in group A and in 37 patients (67.3%) in group B (p = 0.194), while that at 3 months after surgery was found in 51 patients (91.1%) in group A and in 43 patients (76.8%) in group B (p = 0.070). Conclusions: Perioperative standard diet with EPA-enriched enteral nutrition tended to prevent meaningful loss of LBM after total gastrectomy. Further analysis is required whether perioperative EPA enriched EN improve compliance of S-1 adjuvant chemotherapy after total gastrectomy. Clinical trial information: UMIN000006380.

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Promotion of gastric tumor initiating cells in a 3D collagen gel culture model via YBX1/SPP1/NF-κB signaling

Cancer Cell International ◽

10.1186/s12935-021-02307-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuangya Deng ◽

Lun Li ◽

Shu Xu ◽

Xiaobo Wang ◽

Tong Han

Keyword(s):

Gastric Cancer ◽

Tumor Recurrence ◽

Type I Collagen ◽

Chemotherapeutic Agents ◽

Collagen I ◽

Type I ◽

Collagen Gels ◽

Tumor Initiating Cells ◽

Gastric Cancer Cells ◽

3D Collagen

Abstract Background The high potential for tumor recurrence and chemoresistance is a major challenge of clinical gastric cancer treatment. Increasing evidence suggests that the presence of tumor initiating cells (TICs) is the principal cause of tumor recurrence and chemoresistance. However, the underlying mechanism of TIC development remains controversial. Methods To identify novel molecular pathways in gastric cancer, we screened the genomic expression profile of 155 gastric cancer patients from the TCGA database. We then described an improved 3D collagen I gels and tested the effects of collagen on the TIC phenotype of gastric cells using colony formation assay, transwell assay, and nude mouse models. Additionally, cell apoptosis assay was performed to examine the cytotoxicity of 5-fluorine and paclitaxel on gastric cancer cells cultured in 3D collagen I gels. Results Elevated expression of type I collagen was observed in tumor tissues from high stage patients (stage T3–T4) when compared to the low stage group (n=10, stage T1–T2). Furthermore, tumor cells seeded in a low concentration of collagen gels acquired TIC-like phenotypes and revealed enhanced resistance to chemotherapeutic agents, which was dependent on an integrin β1 (ITGB1)/Y-box Binding Protein 1 (YBX1)/Secreted Phosphoprotein 1 (SPP1)/NF-κB signaling pathway. Importantly, inhibition of ITGB1/NF-κB signaling efficiently reversed the chemoresistance induced by collagen and promoted anticancer effects in vivo. Conclusions Our findings demonstrated that type I collagen promoted TIC-like phenotypes and chemoresistance through ITGB1/YBX1/SPP1/NF-κB pathway, which may provide novel insights into gastric cancer therapy.

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ADAR1 Suppresses Interferon Signaling in Gastric Cancer Cells by MicroRNA-302a-Mediated IRF9/STAT1 Regulation

International Journal of Molecular Sciences ◽

10.3390/ijms21176195 ◽

2020 ◽

Vol 21 (17) ◽

pp. 6195

Author(s):

Lushang Jiang ◽

Min Ji Park ◽

Charles J. Cho ◽

Kihak Lee ◽

Min Kyo Jung ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Cells ◽

Rna Editing ◽

Protein Level ◽

Type I ◽

Interferon Signaling ◽

Gastric Cancer Cells ◽

Ags Cells ◽

Ifn Treatment ◽

Mitochondrial Antiviral Signaling

ADAR (adenosine deaminase acting on RNA) catalyzes the deamination of adenosine to generate inosine, through its binding to double-stranded RNA (dsRNA), a phenomenon known as RNA editing. One of the functions of ADAR1 is suppressing the type I interferon (IFN) response, but its mechanism in gastric cancer is not clearly understood. We analyzed changes in RNA editing and IFN signaling in ADAR1-depleted gastric cancer cells, to clarify how ADAR1 regulates IFN signaling. Interestingly, we observed a dramatic increase in the protein level of signal transducer and activator of transcription 1 (STAT1) and interferon regulatory factor 9 (IRF9) upon ADAR1 knockdown, in the absence of type I or type II IFN treatment. However, there were no changes in protein expression or localization of the mitochondrial antiviral signaling protein (MAVS) and interferon alpha and beta-receptor subunit 2 (IFNAR2), the two known mediators of IFN production. Instead, we found that miR-302a-3p binds to the untranslated region (UTR) of IRF9 and regulate its expression. The treatment of ADAR1-depleted AGS cells with an miR-302a mimic successfully restored IRF9 as well as STAT1 protein level. Hence, our results suggest that ADAR1 regulates IFN signaling in gastric cancer through the suppression of STAT1 and IRF9 via miR-302a, which is independent from the RNA editing of known IFN production pathway.

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The effects of ERCC1 expression levels on the chemosensitivity of gastric cancer cells to platinum agents and survival in gastric cancer patients treated with oxaliplatin-based adjuvant chemotherapy

Oncology Letters ◽

10.3892/ol.2012.1096 ◽

2012 ◽

Vol 5 (3) ◽

pp. 935-942 ◽

Cited By ~ 20

Author(s):

YONG-PING LIU ◽

YANG LING ◽

QIU-FENG QI ◽

YA-PING ZHANG ◽

CHANG-SONG ZHANG ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Cancer Cells ◽

Cancer Patients ◽

Gastric Cancer Cells ◽

Expression Levels ◽

Ercc1 Expression ◽

Gastric Cancer Patients ◽

Platinum Agents

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Lauren Histology and Lymphatic Permeation are Critical Prognostic Factors in Borrmann Type I Gastric Cancer

International Surgery ◽

10.9738/intsurg-d-15-00205.1 ◽

2019 ◽

Vol 103 (1-2) ◽

pp. 95-104 ◽

Cited By ~ 1

Author(s):

Keishi Yamashita ◽

Natsuya Katada ◽

Kei Hosoda ◽

Hiroaki Mieno ◽

Hiromitsu Moriya ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Factors ◽

Cancer Patients ◽

Lymphatic Invasion ◽

Stage Ii ◽

Type I ◽

Diffuse Type ◽

Borrmann Type ◽

Gastric Cancer Patients ◽

Lymphatic Permeation

Macroscopic Borrmann type I is relatively rare in advanced gastric cancer, and its detailed prognostic traits are unknown. Among 5172 gastric cancer patients between 1971 and 2013, 114 cases with macroscopic Borrmann type I were identified (2.2%), among which 112 displayed clinicopathologic factors. Univariate prognostic factors with statistical significance were initially selected, which were further applied to the multivariate proportional hazards model. Recently, postoperative adjuvant chemotherapy was recommended for stage II/III gastric cancer patients. Results were as follows: (1) Five-year overall survival (OS) was 66% in Borrmann type I gastric cancer. Five-year relapse-free survival (RFS) was 100%, 87.1%, and 65.5% in stage IA, stage IB, and stage II/III, respectively. (2) Multivariate proportional hazard model for OS identified lymphatic permeation [hazard ratio (HR) = 4.8–7.5, P = 0.0021] and age (HR = 2.4, P = 0.026), while the multivariate analysis for RFS identified histology (HR = 3.5, P = 0.018) and lymphatic permeation (HR = 3.5–4.7, P = 0.049) as independent prognostic factors. (3) Recurrence was recognized more in liver of the intestinal type histology. Diffuse type histology with robust lymphatic invasion was all attributed to stage II/III, which occurred largely within 1 year and exhibited 49% RFS. Recurrence pattern of Borrmann Type I gastric cancer with intestinal type histology is unique, and patients with high risk for recurrences were enriched in diffuse type histology with robust lymphatic invasion.

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A phase III trial to confirm the superiority of S-1 adjuvant chemotherapy for vulnerable elderly patients with pathological stage II/III gastric cancer after curative resection: JCOG1507 (BIRDIE).

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.tps196 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. TPS196-TPS196

Author(s):

Kazuya Yamaguchi ◽

Kazuhiro Yoshida ◽

Junki Mizusawa ◽

Tomonori Mizutani ◽

Seiji Ito ◽

...

Keyword(s):

Gastric Cancer ◽

Clinical Trial ◽

Weight Loss ◽

Adjuvant Chemotherapy ◽

Total Gastrectomy ◽

Curative Resection ◽

Stage Ii ◽

Phase Iii ◽

Vulnerable Elderly ◽

Clinical Trial Information

TPS196 Background: Base on the ACTS-GC trial, adjuvant chemotherapy with S-1 at a dose of 80 mg/m2/day (4 weeks on and 2 weeks off, repeated for one year) is the standard care for stage II/III gastric cancer (GC) patients (pts) after D2 gastrectomy. As Japan has the most aged population in the world, the actual number of elderly GC pts is still increasing. While elderly pts population is heterogeneous and is conceptually composed of “fit”, “vulnerable” and “frail” pts, full-dose adjuvant chemotherapy tends to be given to fit elderly pts in clinical practice. However, it has not been determined yet whether S-1 should be administered to vulnerable pts over 80. Actually, according to the questionnaire survey conducted on 58 institutions of Stomach Cancer Study Group of Japan Clinical Oncology Group, S-1 was administered on only 15% to stage II/III pts > = 80 years old suggesting that surgery alone is generally considered as community standard for vulnerable pts. It is an urgent need to establish the standard adjuvant treatment of the vulnerable elderly GC pts. Methods: The study is designed to confirm the superiority of S-1 treatment group over surgery alone group focusing on vulnerable > = 80 years old pts in stage II / III GC after curative resection. The “vulnerable” is defined in this study based on the three factors [creatinine clearance (Ccr), weight loss, type of surgery] considered to have the most influence on compliance of S-1, that is Ccr > = 30ml/min, weight loss < 15% and total gastrectomy, or 80 > Ccr > = 30ml/min, weight loss < 15% and other than total gastrectomy. Initial dose was reduced by 1 rank from the standard dose. The primary endpoint is overall survival (OS) and the secondary endpoints are relapse free survival, time to treatment failure, treatment continuity, relative dose intensity and adverse events. We assume expected 3-year OS in surgery alone arm will be 55% and S-1 treatment will improve the survival by more than 10%. 370 pts are required to provide 75% of power and 5% one-sided alpha error, with 4 years accrual and 3 years of follow up period. The trial has started from January 2017. Clinical trial information: UMIN000025742. Clinical trial information: 000025742.

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