scholarly journals nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shinichi Kinami ◽  
Naohiko Nakamura ◽  
Tomoharu Miyashita ◽  
Hidekazu Kitakata ◽  
Sachio Fushida ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Flow Distribution ◽  
Muscle Layer ◽  
Tumor Location ◽  
Lymphatic Flow ◽  
Greater Curvature ◽  
Gastric Cancer Patients ◽  
The Right ◽  
Lesser Curvature

Abstract Background The correlation between tumor location and lymphatic flow distribution in gastric cancer has been previously reported, and PTD (Proximal – Transitional – Distal) classification was proposed. Our group updated and developed the nPTD classification. Method We retrospectively studied gastric cancer patients who underwent the dye method sentinel node biopsy from 1993 to 2020. The inclusion criteria were a single lesion type 0 cancer of ≤5 cm in the long axis, clinically node-negative, and invasion within the proper muscle layer pathologically. In this study, the distribution of dyed lymphatic flow was evaluated for each occupied area of the tumor. Results We included 416 patients in this study. The tumors located in the watershed of the right and left gastroepiploic arteries near greater curvature had extensive lymphatic flow; therefore, a newly circular region with a diameter of 5 cm is set on the watershed of the greater curvature between P and T zone as the ‘n’ zone. In addition, for cancers located in the lesser P curvature, lymphatic flow to the greater curvature was not observed. Therefore, the P zone was divided into two: the lesser curvature side (PL) and the greater curvature side (PG). Conclusions The advantage of the nPTD classification is that it provides not only proper nodal dissection but also adequate function-preserving gastrectomy. If the tumor is localized within the PL, the proximal gastrectomy resection area can be further reduced. In contrast, for cancers located in the ‘n’ zone, near-total gastrectomy is required because of the extensive lymphatic flow.

scholarly journals nPTD Classification: An Updated Classification of Gastric Cancer Location for Function Preserving Gastrectomy Based on Physiological Lymphatic Flow

2021 ◽  
Author(s):  
Shinichi Kinami ◽  
Naohiko Nakamura ◽  
Tomoharu Miyashita ◽  
Hidekazu Kitakata ◽  
Sachio Fushida ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Flow Distribution ◽  
Muscle Layer ◽  
Tumor Location ◽  
Lymphatic Flow ◽  
Greater Curvature ◽  
Gastric Cancer Patients ◽  
The Right ◽  
Lesser Curvature

Abstract Background: The correlation between tumor location and lymphatic flow distribution in gastric cancer has been previously reported, and PTD (Proximal – Transitional – Distal) classification, proposed. We updated and developed the nPTD classification.Method: We retrospectively studied gastric cancer patients who underwent the dye method sentinel node biopsy from 1993 to 2020. The inclusion criteria were a single lesion type 0 cancer of ≤5 cm in the long axis, clinically node-negative, and invasion within the proper muscle layer pathologically. In this study, the distribution of dyed lymphatic flow was evaluated for each occupied area of the tumor.Results: We selected 416. The tumors located watershed of the right and left gastroepiploic artery near greater curvature had extensive lymphatic flow; therefore, a newly circular region with a diameter of 5 cm is set on the watershed on greater curvature between P and T zone as the ‘n’ zone. In addition, for cancers located in the lesser P curvature, lymphatic flow to the greater curvature was not observed. Therefore, the P zone is divided into two: the lesser curvature side (PL) and the greater curvature side (PG).Conclusions: The advantage of the nPTD classification is that it provides not only proper nodal dissection, but also adequate function-preserving gastrectomy. If the tumor is localized within the PL, the proximal gastrectomy resection area can be further reduced. In contrast, for cancers located in the ‘n’ zone, near-total gastrectomy is required because of the extensive lymphatic flow.

scholarly journals Laparoscopic proximal gastrectomy with double-tract reconstruction for upper third gastric cancer

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuo-meng Xiao ◽  
Ping Zhao ◽  
Zhi Ding ◽  
Rui Xu ◽  
Chao Yang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Operation Time ◽  
Nutrition Status ◽  
Proximal Gastric Cancer ◽  
Double Tract Reconstruction ◽  
Significant Difference ◽  
Laparoscopic Proximal Gastrectomy ◽  
Gastric Cancer Patients ◽  
Upper Third

Abstract Background Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. Methods Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case–control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. Results The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. Conclusion LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

scholarly journals Effectiveness of a Novel Covered Stent without External Thread Fixation for Anastomotic Leakage after Total or Proximal Gastrectomy for Gastric Cancer

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3720
Author(s):  
Young-Il Kim ◽  
Chan Gyoo Kim ◽  
Jong Yeul Lee ◽  
Il Ju Choi ◽  
Bang Wool Eom ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leakage ◽  
Stent Placement ◽  
Proximal Gastrectomy ◽  
Stent Migration ◽  
Covered Stent ◽  
Double Layers ◽  
Stent Group ◽  
Hospitalization Period ◽  
Gastric Cancer Patients

A thread-fix stent entails long hospitalization and patient discomfort. We aimed to evaluate the efficacy of a novel stent with silicone-covered outer double layers without external fixation (Beta stent) for anastomotic leakage after total or proximal gastrectomy. The outcomes were compared between gastric cancer patients who underwent stent placement using a thread-fix stent between 2014 and 2015 (Thread-Fix Group) and those who received a Beta stent in the succeeding period until October 2018 (Beta Stent Group). The Beta Stent Group (n = 14) had a significantly higher leakage healing rate by the first stent placement (92.9% vs. 53.8%; p = 0.021) and had a shorter hospitalization period (median: 16 days vs. 28 days; p = 0.037) than the Thread-Fix Group (n = 13). Further, 50% of the Beta stent patients received outpatient management until stent removal. Stent maintenance duration was significantly longer in the Beta Stent Group (median, 28 days vs. 18 days; p = 0.006). There was no significant between-group difference in stent-related complications except for stent migration (7.1% (Beta Stent Group) vs. 0% (Thread-Fix Group), p = 0.326). In conclusion, the Niti-S Beta stent is an effective treatment for anastomotic leakage from total or proximal gastrectomy for gastric cancer. Stent maintenance is possible without hospitalization.

scholarly journals Endoscopic submucosal dissection of early gastric cancer via inverted overtube in a patient with situs inversus totalis: a case report

2018 ◽  
Vol 06 (05) ◽  
pp. E625-E629
Author(s):  
Youichi Miyaoka ◽  
Shinsuke Suemitsu ◽  
Aya Fujiwara ◽  
Satoshi Kotani ◽  
Kosuke Tsukano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Situs Inversus ◽  
Gastric Fluid ◽  
Situs Inversus Totalis ◽  
Endoscopic View ◽  
Submucosal Dissection ◽  
The Right ◽  
Lesser Curvature

Abstract Background and study aims A 72-year-old man with complete situs inversus presented with early gastric cancer on the lesser curvature wall of the antrum of the stomach. Endoscopic submucosal dissection (ESD) was selected as a treatment. When the patient was positioned in the left decubitus position, the lesion was hidden by blood and gastric fluid because it was located on the gravitational side. Therefore, we decided to perform ESD with the patient in the right lateral decubitus position and use an inverted overtube, which provided a good endoscopic view without the need to rearrange the endoscopist, assistants, or endoscopic system. ESD was safe and feasible using the inverted overtube.

scholarly journals Cyclin D1 and Clinicopathological Characteristics of Gastric Cancer

2021 ◽  
Author(s):  
Rahmat Cahyanur ◽  
Amanda Pitarini Utari ◽  
Nur Rahadiani
Keyword(s):  
Gastric Cancer ◽  
Cyclin D1 ◽  
Demographic Data ◽  
Tumor Location ◽  
Lymph Node Involvement ◽  
Cross Sectional Study ◽  
Clinicopathological Characteristics ◽  
Cancer Cell Growth ◽  
Cross Sectional ◽  
Gastric Cancer Patients

Abstract Gastric cancer is found at a rate of 2.4 to 3.5 percent in Indonesia, with the majority of cases discovered at an advanced stage. Cyclin D1 is a protein that promotes cancer cell growth. It has been shown to be expressed in a variety of cancers, including stomach cancer. A recent study of cyclin D1 in gastric cancer has been associated with lymph node involvement, metastasis, poor prognosis, and lack of response to platinum chemotherapy. This study aims to determine the relationship between cyclin D1 expression and clinicopathological features in gastric cancer. This cross-sectional study used medical records and paraffin blocks of gastric cancer patients at Cipto Mangunkusumo General Hospital, Jakarta, in 2015–2020. Demographic data, clinical characteristics, radiological findings, histopathological features, and cyclin D1 expression were collected and examined. Data was collected from 39 subjects. Most of the subjects experienced eating disorders (69.23%), weight loss (76.92%), melena (53.85%), and anemia (51.28%). Tumor locations were mostly found in the cardia and corpus of the gaster. Overexpression of cyclin D1 was found in 30.77% of cases. Cyclin D1 expression was greater in subjects with liver metastases (50% vs. 14.8%, p 0.04). Cyclin D1 expression was not associated with tumor location, TNM stage, and histopathological findings.

scholarly journals Retrospective Evaluation of Factors Affecting Lymph Node Retrieval Following Gastrectomies with Oncologic Intent

2021 ◽  
Vol 12 (2) ◽  
pp. e0012
Author(s):  
Steven Fuchs ◽  
◽  
Itamar Ashkenazi ◽  
◽  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Medical Center ◽  
Proximal Gastrectomy ◽  
Univariate Analysis ◽  
Related Factors ◽  
Factors Affecting ◽  
Lymph Node Retrieval ◽  
Gastric Cancer Patients

Background: Adequate lymphadenectomy is an important factor affecting survival in gastric cancer patients. Retrieval and examination of at least 15 lymph nodes is recommended in order to properly stage gastric malignancies. The objectives of this study were to evaluate the proportion of patients undergoing inadequate lymphadenectomies and possible risk factors for inadequate surgery. Methods: This was a retrospective study that included patients, 18 years and older, who underwent gastrectomies with oncologic intent in the Hillel Yaffe Medical Center. We analyzed the association of demographic, clinical, and pathological variables with adequate number of lymph nodes. Results: The retrieval of less than 15 lymph nodes was reported in 51% (53/104) patients undergoing gastrectomies with oncologic intent. The extent of surgery was the only variable associated with inadequate lymphadenectomy on univariate analysis: subtotal/proximal versus total gastrectomy (P=0.047). Differ¬ences observed for previous surgery (P=0.193), T stage (P=0.053), N stage (P=0.051), and lymphovascular invasion (P=0.14) did not reach significance. Subtotal/proximal gastrectomy resulted in inadequate resec¬tion of lymph nodes in 56% of the patients, while this occurred in only 30% of the patients undergoing total gastrectomy (relative risk 1.865; 95% CI 0.93, 3.741). Logistic regression confirmed that only subtotal/prox¬imal versus total gastrectomy was associated with inadequate number of lymph nodes resected (P=0.043). Discussion and Conclusion: In this study we analyzed the association of patient, tumor, and surgery-related factors on adequate lymphadenectomy in patients undergoing gastrectomies for possible gastric cancer. Larger extent of the surgery (total, rather than subtotal/proximal gastrectomy) was revealed to be the only indicator positively associated with adequate lymphadenectomy.

Outcomes of locoregional therapy for metastatic gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 143-143
Author(s):  
Ravi Shridhar ◽  
Jamie Huston ◽  
Kenneth L Meredith
Keyword(s):  
Gastric Cancer ◽  
Stage Iv ◽  
Metastatic Gastric Cancer ◽  
Tumor Location ◽  
Peritoneal Metastases ◽  
Locoregional Therapy ◽  
Stage Iv Gastric Cancer ◽  
Rank Analysis ◽  
Signet Ring ◽  
Gastric Cancer Patients

143 Background: Patients with metastatic gastric cancer have poor survival. The purpose of this study was to compare outcomes of metastatic gastric cancer patients with or without surgery and radiation therapy (RT). Methods: The National Cancer Database (NCDB) was accessed to identify patients with stage IV gastric cancer between 2004 and 2013 and stratified by surgery. Propensity score matching was performed against age, metastatic site, radiation, and signet ring histology. Overall survival (OS) analysis was determined by Kaplan-Meier and log-rank analysis. Multivariate analysis (MVA) was analyzed by the Cox proportional hazard ratio model. Results: A total of 1808 patients were identified. Surgery was associated with an OS benefit. Median and 5-year OS for surgery and no surgery was 16 months and 16% and 10 months and 2%, respectively (p < 0.001). Median and 5 year OS for patients treated with surgery and RT was 22.4 months and 26%. Median and 5 year OS for surgery patients treated with or without preoperative RT was 27.2 months and 28% and 15.2 months and 12%, respectively (p < 0.001). There was no OS benefit with postoperative RT. MVA for all patients revealed that surgery and tumor location were associated with decreased mortality while peritoneal metastases were associated with increased mortality. In surgical patients, MVA showed that RT, partial esophagectomy, and tumor location were associated with decreased mortality, while positive margins, signet ring histology, and peritoneal metastases were associated with increased mortality. In nonsurgical patients, only carcinomatosis was prognostic on MVA. Conclusions: Surgery and radiation are associated with increased survival in a subset of patients with metastatic gastric cancer. Prospective trials will be needed to address the role and sequence of surgery and radiation in metastatic gastric cancer.

Ảnh hưởng của một số đặc điểm lâm sàng, cận lâm sàng lên sống còn toàn bộ bệnh nhân ung thư dạ dày giai đoạn tiến xa

2021 ◽  
Author(s):  
Hong Chuyen Nguyen-Thi
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Serum Albumin ◽  
Cancer Patients ◽  
Tumor Location ◽  
Albumin Level ◽  
Nodal Metastasis ◽  
Rank Test ◽  
Advanced Stage ◽  
Gastric Cancer Patients

TÓM TẮT Mục tiêu: Khảo sát ảnh hưởng của một số đặc điểm lâm sàng và cận lâm sàng lên sống còn toàn bộ của bệnh nhân ung thư dạ dày giai đoạn tiến xa. Phương pháp: Nghiên cứu mô tả loạt ca, hồi cứu trên 167 bệnh nhân ung thư dạ dày giai đoạn tiến xa được chẩn đoán và điều trị triệu chứng tại khoa Ung Bướu bệnh viện Trường Đại học Y Dược Huế và Trung tâm Ung Bướu Bệnh viện Trung Ương Huế từ tháng 01/2015 đến tháng 12/2020. Phân tích thời gian sống còn bằng mô hình Kaplan Meier và so sánh sự khác biệt về thời gian sống giữa các nhóm bệnh nhân theo đặc điểm lâm sàng, cận lâm sàng bằng Log rank test. Kết quả: Tuổi trung bình là 58,2; tỷ lệ nam/nữ là 2.5/1. Tại thời điểm chẩn đoán, đa số bệnh nhân có BMI là dưới 18,5 kg/m2 (64,1%) và KPS = 90% (50,3%). Triệu chứng lâm sàng phổ biến nhất là đau thượng vị (73,7%). Albumin máu < 35g/L chiếm 86,2%. Hầu hết bệnh nhân có tình trạng di căn xa (89,8%); 2,4% bệnh nhân có tình trạng huyết khối tĩnh mạch. Trung vị sống còn toàn bộ là 11 tháng. Phân tích đơn biến cho thấy các yếu tố ảnh hưởng đến sống còn toàn bộ là tuổi, chỉ số trạng thái hoạt động cơ thể Karnofsky (KPS), vị trí tổn thương, di căn hạch vùng, huyết khối tĩnh mạch, Albumin huyết thanh. Kết luận: Nghiên cứu cho thấy bệnh nhân ung thư dạ dày giai đoạn tiến xa có tiên lượng xấu với sống còn toàn bộ là 11 tháng. Các yếu tố lâm sàng gồm tuổi, chỉ số KPS, vị trí tổn thương, di căn hạch vùng, huyết khối tĩnh mạch ảnh hưởng đến sống còn toàn bộ bệnh nhân. ABSTRACT THE EFFECT OF SOME CLINICAL AND LABORATORY CHARACTERISTICS ON OVERALL SURVIVAL OF ADVANCED - STAGE GASTRIC CANCER PATIENTS Purposes: To investigate the influence of some clinical and laboratory characteristics on the overall survival of advanced - stage gastric cancer patients. Methods: A retrospective case series study with 167 early - stageadvanced - stage gastric cancer patients recruited from at oncology department, the Hospital of Hue University of Medicine and Pharmacy and Oncology Center of Hue Central HospitalfromJanuary 2015 to December 2020. The Kaplan - Meier method was used to estimate survival, the log - rank test analyzed the relevant factors. Results: Median age was 58.2; male/female was 2.5/1; the most common clinical symptom was epigastric pain (78.7%); at the time of diagnosis, almost all patients had KPS 90% (50.3%); BMI index below 18.5 (64.1%). Serum albumin < 35g/l accounting for 86.2% of patients. 89.8% of patients had distant metastasis disease. The median survival was 11 months. Univariate analysis indicated that age, KPS, primary tumor location, regional nodal metastasis, venous thrombosis, serum albumin level affecting on overall survival. Conclusions: Advanced - stage gastric cancer patients had poor survival with a median of 11 months. Age, KPS, tumor location, regional nodal metastasis, venous thrombosis, serum albumin level influence overall survival. Keywords: Outcomes, advanced - stage, gastric cancer.

scholarly journals Tumor Size Is a Critical Factor in Adjuvant Chemotherapy for T3-4aN0M0 Gastric Cancer Patients after D2 Gastrectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Shi Chen ◽  
Li-Ying Ou-Yang ◽  
Run-Cong Nie ◽  
Yuan-Fang Li ◽  
Jun Xiang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Tumor Size ◽  
Critical Factor ◽  
Tumor Location ◽  
D2 Gastrectomy ◽  
T Stage ◽  
Gastric Cancer Patients

Aim.To investigate whether tumor size is a reasonable indication for adjuvant chemotherapy for T3-4aN0M0 gastric cancer patients after D2 gastrectomy.Method. We performed a retrospective study of 269 patients with a histological diagnosis of T3-4aN0M0 stage gastric cancer who underwent D2 radical surgery at the Sun Yat-sen University Cancer Center or the Sixth Affiliated Hospital of Sun Yat-sen University between January 2006 and December 2010. The follow-up lasted until June of 2015. Chi-square tests and Kaplan-Meier methods were employed to compare the clinicopathological variables and prognoses.Result. For this group of patients, univariate analyses revealed that tumor size (p<0.001), pathological T stage (p<0.001), and tumor location (p=0.025) were significant prognostic factors. Adjuvant chemotherapy did not exhibit prognostic benefits. For patients with tumors larger than 5 cm, univariate analysis revealed that tumor location (p=0.007), Borrmann type (p=0.039), postoperative chemotherapy (p=0.003), and pathological T stage (p<0.001) were significant prognostic factors. Multivariate analysis revealed that postoperative chemotherapy and pathological T stage were independent prognostic factors.Conclusion. Our results imply that tumor size should be a critical factor in the decision to utilize adjuvant chemotherapy for T3-4aN0M0 gastric cancer patients after D2 gastrectomy. Additional randomized controlled trials are required before this conclusion can be considered definitive.

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