scholarly journals Risk Assessment and Preventive Treatment for Peritoneal Recurrence Following Radical Resection for Gastric Cancer

2022 ◽  
Vol 11 ◽  
Author(s):  
Lin Xiang ◽  
Shuai Jin ◽  
Peng Zheng ◽  
Ewetse Paul Maswikiti ◽  
Yang Yu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Risk Assessment ◽  
Treatment Strategies ◽  
Preventive Treatment ◽  
Peritoneal Recurrence ◽  
Postoperative Treatment ◽  
Photodynamic Diagnosis ◽  
Radical Gastrectomy ◽  
Peritoneal Lavage Cytology ◽  
Preventive Methods

As the most common recurrence pattern after radical gastric cancer resection, peritoneal recurrence is a major cause of mortality, which affects the prognosis of patients to a very large extent. Peritoneal status and risk of peritoneal recurrence can be evaluated by peritoneal lavage cytology, photodynamic diagnosis, imaging examination, and pathologic analysis. Presently, there is no standard approach for preventing peritoneal recurrence after radical surgery; furthermore, controversies exist regarding the effects of some preventive methods. Among the preventive methods, there are high expectations about the potential of preoperative therapy, surgical skill improvement, hyperthermic intraperitoneal chemotherapy, and postoperative treatment to reduce the incidence of peritoneal recurrence after radical gastrectomy. This study aimed to analyze the results of previous studies on the risk assessment and preventive methods of peritoneal recurrence after radical gastrectomy in recent years. We hope to provide references for better approach to clinical diagnosis and treatment strategies for peritoneal recurrence after radical gastrectomy.

scholarly journals Intraperitoneal Chemotherapy Using Fluorouracil Implants Combined With Radical Resection and Postoperative Adjuvant Chemotherapy for Stage III Gastric Cancer: A Multi-Center, Randomized, Open-Label, Controlled Clinical Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Yan Xu ◽  
Rupeng Zhang ◽  
Chunfeng Li ◽  
Zhe Sun ◽  
Jingyu Deng ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Sustained Release ◽  
Intraperitoneal Chemotherapy ◽  
Radical Resection ◽  
Peritoneal Recurrence ◽  
Stage Iii ◽  
Control Group ◽  
Radical Gastrectomy ◽  
Chemotherapy Group

BackgroundReducing peritoneal recurrence after radical surgery is an important choice to improve the prognosis of patients with advanced gastric cancer. Intraoperative intraperitoneal chemotherapy has the potential to be a promising treatment strategy. In the present study, we conducted a multi-center, randomized, controlled clinical study to evaluate the efficacy and safety of intraoperative intraperitoneal chemotherapy using sustained-release fluorouracil implants plus radical gastrectomy and adjuvant chemotherapy for cTNM stage III gastric cancer.MethodsThe patients were randomized into intraperitoneal chemotherapy group (sustained-release fluorouracil implants administration after standard D2 radical gastrectomy, and followed by XELOX adjuvant chemotherapy) and control group (standard D2 radical gastrectomy, and followed by XELOX adjuvant chemotherapy). A total of 122 patients from three centers were enrolled from September 2015 to February 2017.ResultsOne hundred and two eligible patients completed the treatment course. The median follow-up time was 41.7 months (36.1–52.9 months). The 3-year progression-free survival rate and overall survival of patients in the intraperitoneal chemotherapy group were 43.9% and 49.1%, respectively, which were significantly better than those of the control group, 31.0% and 38.4%. In the intraperitoneal chemotherapy group, the number of cases with peritoneal recurrence was significantly less than that of the control group, 9 cases (17.3%) vs. 19 cases (44.2%). There were neither significant differences between the groups in the incidence of hematogenous metastasis, lymph node metastasis, nor local metastasis.ConclusionFor cTNM stage III gastric cancer, intraoperative sustained-release fluorouracil implants after radical resection combined with postoperative adjuvant chemotherapy, could significantly reduce the risk of peritoneal recurrence and prolong PFS.Clinical Trial Registrationhttps://clinicaltrials.gov/, identifier (NCT02269904).

Avoid suboptimal perioperative analgesia during major surgery by enhancing thoracic epidural catheter placement and hemodynamic performance

2021 ◽  
pp. rapm-2020-102352
Author(s):  
Sarah A Bachman ◽  
Johan Lundberg ◽  
Michael Herrick
Keyword(s):  
Epidural Catheter ◽  
Treatment Strategies ◽  
Preventive Treatment ◽  
Catheter Placement ◽  
Major Surgery ◽  
Perioperative Analgesia ◽  
Neuraxial Blockade ◽  
Epidural Catheter Placement ◽  
Thoracic Epidural ◽  
Catheter Failure

Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. However, if an FPB is performed, postoperative monitoring and adjuvant treatments are still necessary. Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive treatment strategies for epidural catheter failure and hypotension exist for TEA? It is time to promote and underscore the benefits of TEA provided to patients undergoing major open surgical procedures. In our mind, FPBs and landmark-guided techniques should be limited to less extensive surgery and when either neuraxial blockade is contraindicated or resources for optimal epidural catheter placement and maintenance are not available.

scholarly journals Gastric Cancer Risk Prediction Using an Epidemiological Risk Assessment Model and Polygenic Risk Score

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 876
Author(s):  
Boyoung Park ◽  
Sarah Yang ◽  
Jeonghee Lee ◽  
Il Ju Choi ◽  
Young-Il Kim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Risk Assessment ◽  
Risk Score ◽  
Assessment Model ◽  
Polygenic Risk Score ◽  
Genome Wide Association Studies ◽  
Risk Assessment Model ◽  
Infection Status ◽  
Polygenic Risk ◽  
H Pylori

We investigated the performance of a gastric cancer (GC) risk assessment model in combination with single-nucleotide polymorphisms (SNPs) as a polygenic risk score (PRS) in consideration of Helicobacter pylori (H. pylori) infection status. Six SNPs identified from genome-wide association studies and a marginal association with GC in the study population were included in the PRS. Discrimination of the GC risk assessment model, PRS, and the combination of the two (PRS-GCS) were examined regarding incremental risk and the area under the receiver operating characteristic curve (AUC), with grouping according to H. pylori infection status. The GC risk assessment model score showed an association with GC, irrespective of H. pylori infection. Conversely, the PRS exhibited an association only for those with H. pylori infection. The PRS did not discriminate GC in those without H. pylori infection, whereas the GC risk assessment model showed a modest discrimination. Among individuals with H. pylori infection, discrimination by the GC risk assessment model and the PRS were comparable, with the PRS-GCS combination resulting in an increase in the AUC of 3%. In addition, the PRS-GCS classified more patients and fewer controls at the highest score quintile in those with H. pylori infection. Overall, the PRS-GCS improved the identification of a GC-susceptible population of people with H. pylori infection. In those without H. pylori infection, the GC risk assessment model was better at identifying the high-risk group.

Myosteatosis predicts prognosis after radical gastrectomy for gastric cancer: A propensity score–matched analysis from a large-scale cohort

Surgery ◽  
2019 ◽  
Vol 166 (3) ◽  
pp. 297-304 ◽  
Author(s):  
Cheng-Le Zhuang ◽  
Xian Shen ◽  
Yang-Yang Huang ◽  
Feng-Min Zhang ◽  
Xi-Yi Chen ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Large Scale ◽  
Radical Gastrectomy
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