Gallbladder perforation: a rare complication of postoperative chemotherapy of gastric cancer

PurposePatients with locally advanced gastric cancer benefit from combined pre- and postoperative chemotherapy, although fewer than 50% could receive postoperative chemotherapy. We examined the value of purely preoperative chemotherapy in a phase III trial with strict preoperative staging and surgical resection guidelines.Patients and MethodsPatients with locally advanced adenocarcinoma of the stomach or esophagogastric junction (AEG II and III) were randomly assigned to preoperative chemotherapy followed by surgery or to surgery alone. To detect with 80% power an improvement in median survival from 17 months with surgery alone to 24 months with neoadjuvant, 282 events were required.ResultsThis trial was stopped for poor accrual after 144 patients were randomly assigned (72:72); 52.8% patients had tumors located in the proximal third of the stomach, including AEG type II and III. The International Union Against Cancer R0 resection rate was 81.9% after neoadjuvant chemotherapy as compared with 66.7% with surgery alone (P = .036). The surgery-only group had more lymph node metastases than the neoadjuvant group (76.5% v 61.4%; P = .018). Postoperative complications were more frequent in the neoadjuvant arm (27.1% v 16.2%; P = .09). After a median follow-up of 4.4 years and 67 deaths, a survival benefit could not be shown (hazard ratio, 0.84; 95% CI, 0.52 to 1.35; P = .466).ConclusionThis trial showed a significantly increased R0 resection rate but failed to demonstrate a survival benefit. Possible explanations are low statistical power, a high rate of proximal gastric cancer including AEG and/or a better outcome than expected after radical surgery alone due to the high quality of surgery with resections of regional lymph nodes outside the perigastic area (celiac trunc, hepatic ligament, lymph node at a. lienalis; D2).

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Helicobacter pylori bacteremia: an unusual finding

Infectious Disease Reports ◽

10.4081/idr.2016.6612 ◽

2016 ◽

Vol 8 (3) ◽

Author(s):

Concetta De Luca ◽

Annalisa Mancin ◽

Maria Calabrò ◽

Cristina Daleno ◽

Antonella Ferrario ◽

...

Keyword(s):

Gastric Cancer ◽

Helicobacter Pylori ◽

Potential Role ◽

Rare Complication ◽

Subtotal Gastrectomy ◽

Blood Cultures ◽

H Pylori ◽

Stomach Surgery ◽

Unusual Finding

We report a case of Helicobacter pylori transient bacteremia in a woman with ulcerated antral gastric cancer. The patient was hospitalized for laparoscopy and subtotal gastrectomy. After surgery she developed fever (39°C) and was empirically treated with levofloxacin. Blood cultures, collected and sent immediately to Laboratory, were positive for a spiral Gramnegative bacterium. This isolate was identified as H. pylori and the specific susceptibility test was performed. One day after the fever was decreased but antibiotic treatment with levofloxacin was continued and it was maintained until discharge. In summary, H. pylori transient bacteremia may occur as a rare complication after stomach surgery. Further studies are necessary to elucidate the potential role of H. pylori presence in blood.

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Efficacy of Postoperative FOLFOX Versus XELOX Chemotherapy for Gastric Cancer and Prognostic Value of Platelet–Lymphocyte Ratio in Patients Receiving XELOX

Frontiers in Oncology ◽

10.3389/fonc.2020.584772 ◽

2020 ◽

Vol 10 ◽

Author(s):

Xin Yin ◽

Tianyi Fang ◽

Yimin Wang ◽

Chunfeng Li ◽

Yufei Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Tumor Size ◽

Prognostic Value ◽

Cox Regression ◽

Postoperative Chemotherapy ◽

Chinese Patients ◽

Cox Regression Analysis ◽

Lymphocyte Ratio ◽

Platelet Lymphocyte Ratio ◽

Ptnm Stage

BackgroundSurgery combined with postoperative chemotherapy is an effective method for treating patients with gastric cancer (GC) in Asia. The important roles of systemic inflammatory response in chemotherapy have been gradually verified. The purpose of this study was to assess the difference in clinical effectiveness of FOLFOX (oxaliplatin + leucovorin + 5-fluorouracil) and XELOX (oxaliplatin + capecitabine), and the prognostic value of postoperative platelet–lymphocyte ratio (PLR) in the XELOX group.MethodsPatients who received radical gastrectomy combined with postoperative chemotherapy between 2004 and 2014 were consecutively selected into the FOLFOX and XELOX groups. Group bias was reduced through propensity score matching, which resulted in 278 patients in each group. Cut-off values of systemic immune inflammation (SII) score and PLR were obtained by receiver operating characteristic curve. Kaplan–Meier and Log-rank tests were used to analyze overall survival. The chi-square test was used to analyze the association between clinical characteristics and inflammatory indexes. Univariate and multivariate analyses based on Cox regression analysis showed independent risk factors for prognosis. The nomogram was made by R studio.ResultsPatients receiving XELOX postoperative chemotherapy had better survival than those receiving FOLFOX (P < 0.001), especially for stage III GC (P = 0.002). Preoperative SII was an independent risk factor for prognosis in the FOLFOX group, and PLR of the second postoperative chemotherapy regimen in the XELOX group, combined with tumor size and pTNM stage, could construct a nomogram for evaluating recurrence and prognosis.ConclusionXELOX is better than FOLFOX for treatment of GC in Chinese patients, and a nomogram constructed by PLR, tumor size and pTNM stage can predict recurrence and prognosis.

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Prediction of Efficacy of Postoperative Chemotherapy by DNA Methylation of CDO1 in Gastric Cancer

Journal of Surgical Research ◽

10.1016/j.jss.2020.07.001 ◽

2020 ◽

Vol 256 ◽

pp. 404-412

Author(s):

Hiroki Harada ◽

Takafumi Soeno ◽

Keigo Yokoi ◽

Nobuyuki Nishizawa ◽

Hideki Ushiku ◽

...

Keyword(s):

Gastric Cancer ◽

Dna Methylation ◽

Postoperative Chemotherapy

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The prognostic value of a Surgical Outcome Risk Tool in patients after radical gastrectomy for gastric cancer and its guiding significance for postoperative chemotherapy

Surgical Oncology ◽

10.1016/j.suronc.2018.11.008 ◽

2019 ◽

Vol 28 ◽

pp. 128-134 ◽

Cited By ~ 1

Author(s):

Ru-Hong Tu ◽

Jian-Xian Lin ◽

Ping Li ◽

Jian-Wei Xie ◽

Jia-Bin Wang ◽

...

Keyword(s):

Gastric Cancer ◽

Surgical Outcome ◽

Prognostic Value ◽

Postoperative Chemotherapy ◽

Radical Gastrectomy

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Postoperative chemotherapy in gastric cancer, consisting of etoposide, doxorubicin and cisplatin, followed by radiotherapy with concomitant cisplatin: A feasibility study

Oncology Letters ◽

10.3892/ol.2012.617 ◽

2012 ◽

Vol 3 (5) ◽

pp. 1154-1158 ◽

Cited By ~ 4

Author(s):

KATERINA SHULMAN ◽

NISSIM HAIM ◽

MIRA WOLLNER ◽

ZVI BERNSTEIN ◽

ROXYLANA ABDAH-BORTNYAK ◽

...

Keyword(s):

Gastric Cancer ◽

Feasibility Study ◽

Postoperative Chemotherapy

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A phase II study of neoadjuvant chemotherapy with a modified FOLFOX6 regimen for locally advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.81 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 81-81

Author(s):

Xiang Wang ◽

Lin Zhao ◽

Hongfeng Liu ◽

Chunmei Bai ◽

Xiaoyi Li

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Phase Ii ◽

Phase Ii Study ◽

Locally Advanced ◽

Postoperative Chemotherapy ◽

Regression Rate ◽

Locally Advanced Gastric Cancer ◽

Laurén Classification

81 Background: The aim of this study was to evaluate the efficacy and safety of neoadjuvant chemotherapy with the mFOLFOX6 regimen in gastric cancer patients. Methods: This study was a single-arm phase II study. 73 patients with histologically confirmed locally advanced gastric cancer (T2-T4 or N+) were enrolled. The patients were administered the mFOLFOX6 regimen for 3 cycles. Surgery was scheduled 3-4 weeks after the completion of the chemotherapy. Postoperative chemotherapy began 4 weeks after surgery, and the program choice was based on the results of patients’ clinical/pathological evaluations. Perioperative efficacy, toxicity, effects of surgery, postoperative observation, and prognosis were studied. Survival analysis was performed to identify the relationship between the response and outcome and to identify factors predictive of OS. Results: 73 patients received the neoadjuvant chemotherapy, and 67 (91.8%) completed all of the preoperative cycles, with grade 3-4 toxicity arising in 33.0%. Surgery was performed in 71 (97.3%) patients, and radical resection was achieved in 67 (91.8%) patients. Postoperative chemotherapy started in 63 (88.7%) patients. The radiology response rate of chemotherapy was 45.8%. Among the patients who underwent radical surgery, pT downstaging was observed in 22 (32.8%) patients and pN downstaging was observed in 17 (25.4%) patients. All of the patients showed different levels of histological regression of the primary tumour, with a ≥ 50% regression rate of 49.2% and a pCR rate of 3.0%. Univariate analysis identified factors that were associated with OS, including local tumour infiltration, Lauren classification, pre-chemotherapy N stage, ypTNM stage, and pathologic regression rate (GHR)( ≥ 2/3/ < 2/3, ≥ 50%/ < 50%). Multivariate analysis identified both ypTNM stage and Lauren classification as independent predictors of survival. Conclusions: The mFOLFOX6 regimen was very effective and well-tolerated as a neoadjuvant chemotherapy for locally advanced gastric cancer. The ypTNM stage could serve as an independent predictor of survival. GHR ≥ 50% / < 50% could be used as a surrogate marker to guide the selection of a postoperative chemotherapy regimen. Clinical trial information: NCT02226380.

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