scholarly journals Adjuvant Chemoradiotherapy for Gastric Tumors with D2 Dissection: A Controversial Problem

2021 ◽  
Author(s):  
ibrahim karadag
Keyword(s):  
Adjuvant Chemoradiotherapy ◽  
D2 Dissection ◽  
Gastric Tumors ◽  
Controversial Problem

scholarly journals WHEN SHOULD CLEARANCE OF THE HEPATODUODENAL LIGAMENT (STATION 12) DURING RADICAL RESECTION FOR GASTRIC CANCER BE PERFORMED

2016 ◽  
Vol 3 (1) ◽  
pp. 51-55
Author(s):  
I. Negoi ◽  
S. Păun ◽  
S. Hostiuc ◽  
A. Runcanu ◽  
Ruxandra Irina Negoi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Hepatic Artery ◽  
Radical Resection ◽  
Tumor Location ◽  
Hepatoduodenal Ligament ◽  
Proper Hepatic Artery ◽  
D2 Dissection ◽  
Gastric Tumors ◽  
The Common ◽  
Aggressive Tumor

In Western countries gastric cancer continues to remain a biologically aggressive tumor, with poorlong-term oncological outcomes. In Romania, the estimated gastric cancer was the fifth cause ofoncological death in men and the eighth cause of oncological death in women in 2012.The objectiveof the study is to detail when should the hepatoduodenal ligament (station 12) be cleared surgicallyas a part of D2 dissection during radical gastrectomy.We have performed a review of the Englishlanguage literature using PubMed/Medline library. As keywords we used a combination of thefollowing terms: ‘gastrectomy’, ‘stomach’, ‘cancer’, and ‘lymphadenectomy’. According to theJapanese Gastric Cancer Association, the hepatoduodenal ligament includes the lymph nodesstation 12, which are further divided in 12a – along left side of the proper hepatic artery, 12b –right side of the ligament and posterior to the common bile duct, and 12p – posterior to the portalvein. For middle and lower third gastric tumors, station 12a represents the N2 tier, while for upperthird gastric tumors, it represents the N3 tier. Lymph nodes 12b and 12p represent N3, irrespectiveof the tumor location. For middle and lower third gastric tumors the clearance of the lymph nodessurrounding the proper hepatic artery is a part of the D2 dissection. Dissection of the lymph nodessurrounding the proper hepatic artery is a component of the D2 spleen and pancreas preservinglymphadenectomy, for lesions which extend further than submucosa.

scholarly journals Identification of Patients With Locally Advanced Gastric Cancer Who May Benefit From Adjuvant Chemoradiotherapy After D2 dissection: A Propensity Score Matching Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Shu-Bei Wang ◽  
Wei-Xiang Qi ◽  
Jia-Yi Chen ◽  
Cheng Xu ◽  
Wei-Guo Cao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Advanced Gastric Cancer ◽  
Propensity Score Matching ◽  
Locally Advanced ◽  
Adjuvant Chemoradiotherapy ◽  
D2 Dissection ◽  
Locally Advanced Gastric Cancer ◽  
Increased Risk

BackgroundOne of the most controversial areas in gastrointestinal oncology is the benefit of postoperative chemoradiotherapy (CRT) over chemotherapy (CT) alone after D2 dissection of locally advanced gastric cancer (LAGC). We aimed to identify the LAGC patients who may benefit from adjuvant CRT.MethodsWe analyzed retrospectively 188 patients receiving radical gastrectomy with D2 dissection for LAGC in our hospital. Patients were divided into two balanced groups by using propensity score matching: CRT group (n = 94) received adjuvant CRT, and CT group received adjuvant CT alone.ResultsAt a median follow-up of 27.10 months, 188 patients developed 79 first recurrence events (36 in CRT group and 43 in CT group). Our results showed that adjuvant CRT significantly decreased the risk of developing local regional recurrence (LRR) when compared to CT alone (14.9% vs. 25.5%, p = 0.044), while the estimated 3-year disease-free survival (DFS) was comparable between the CRT and CT groups (59.3% vs. 50.9%, p = 0.239). In the subgroup analysis, a significantly decreased LRR rate was also observed in LAGC patients with N1-3a stage after adjuvant CRT (p = 0.046), but not for N3b. Para-aortic lymph nodes (station No. 16) were the most frequent sites of LRR. After receiving radiotherapy, recurrence of 16 a2 region and 16 b1 region were significantly deceased (p = 0.026 and p = 0.044, respectively). Patients who received irradiation more than 4 months after surgery showed an increased risk of LRR (p = 0.022).ConclusionsThis study showed that adjuvant CRT significantly reduced LRR after D2 dissection of LAGC. Early initiation of adjuvant RT with clinical target volume encompassing a2 and b1 regions of para-aortic lymph nodes is recommended for pN1-3a patients after D2 dissection.

Gastric expression of peroxisome proliterator-activated receptorx (PPARx) in gastritis and gastric tumors

2001 ◽  
Vol 120 (5) ◽  
pp. A506-A506 ◽  
Author(s):  
S NOMURA ◽  
A NAKAJIMA ◽  
E OSAWA ◽  
H SEKIHARA ◽  
N MATSUHASHI ◽  
...  
Keyword(s):  
Gastric Tumors

POLIGAMI DALAM PERSPEKTIF AL-QUR’AN

2016 ◽  
Vol 1 (2) ◽  
pp. 35-50
Author(s):  
Makrum Makrum
Keyword(s):  
Qualitative Research ◽  
Islamic Law ◽  
Qualitative Approach ◽  
Comprehensive Understanding ◽  
Research Results ◽  
Library Research ◽  
Difference Of Opinion ◽  
Controversial Problem ◽  
The Difference ◽  
Interpretation Method

This paper is discusion the polygamy is still a controversial problem, although much discussed and examined. The difference of opinion among scholars make this problem continues to potentially raises the agree and disagree. Even though it has been regulated in Act Number 1 of 1974 concerning marriage and the compilation of Islamic law (KHI), this does not necessarily make the problem of polygamy is complete. Not a few perpetrators of polygamy choose married under the hand or by sirri. This research uses qualitative approach by implementing thematic interpretation method (maudhu'i) to obtain a comprehensive understanding about polygamy in the Qur'an. The Data obtained through the study of a library research by sharing the data that comes from the various verse of the Qur'an, hadith, book fiqh, research results, books and the news in various media outlets in order to complete the interpretation of the verses of polygamy. Based on the results of this research it is known that the verses of the Qur'an gives a very tight restrictions for those who want to in polygamy. Justice that the conditions of polygamy is not only were quantitative but also qualitative research. In the context of historical-socio, the command of polygamy is intended as a form of the solution to avoid injustice to orphans women. Even if polygamy still want to do, should the husband marrying the widows who have lighten the orphan.

scholarly journals A preliminary assessment of guideline adherence and clinical variation in oral cancer treatment: a MarketScan database study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Antoine Eskander ◽  
Axel Sahovaler ◽  
Jennifer Shin ◽  
Konrado Deutsch ◽  
Matthew Crowson ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Radiation Treatment ◽  
Tube Placement ◽  
Adjuvant Chemoradiotherapy ◽  
Research Database ◽  
Chest Imaging ◽  
Geographical Differences ◽  
Processes Of Care ◽  
North East ◽  
Multidisciplinary Consultation

Abstract Background To assess variations in adherence to guideline-recommended processes of care for oral cavity cancer patients. Methods Retrospective study using a U.S. healthcare research database (MarketScan). Index diagnoses were considered from 2010 to 2012 with follow-up from 2013 to 2014. Diagnostic and procedure codes were utilized to identify oral cavity patients with a defined treatment modality. Compliance with guideline-recommended processes of care, which included pre-treatment imaging, thyroid-function testing (TFTs), multidisciplinary consultation and gastrostomy-tube insertion rates, were assessed. Results A total of 2752 patients were identified. Surgery alone was the most common treatment (60.8%), followed by surgery with adjuvant chemoradiotherapy (20.4%) and surgery with adjuvant radiotherapy (18.8%). Head/neck and chest imaging were obtained in 60% and 62.5% of patients respectively. Significant geographical differences in head and neck imaging were observed between North-central (64%), South (58.4%) and West (56.1%) regions (p = 0.026). Differences in chest imaging were also present between North-east (65%) and West (56.8%; p = 0.007). TFTs were obtained in 54.4% of the patients after radiation treatment, and 18.6% of patients had multidisciplinary consultation during the 6 months before and 3 months after initiation of treatment. During the year after treatment initiation, 21.2% of patients underwent G-tube placement, with significantly higher rates in patients receiving triple modality treatment (58%) when compared to surgery plus radiation (27%) and surgery alone (15%; p < 0.01). Conclusion Adherence to evidence-based practices was low based on the database coding. These data suggest a potential to improve adherence and increase the routine use of practices delineated in national clinical practice guidelines. Clinical relevance This study reflects a suboptimal adherence to guidelines based on the database employed. This study should be considered by healthcare providers and efforts should be maximized to follow the processes of care which have proven to impact on patient's outcomes.

Sign in / Sign up

Export Citation Format

Share Document