scholarly journals The Different Clinicopathological Features of Remnant Gastric Cancer Depending on Initial Disease of Partial Gastrectomy

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2847
Author(s):  
Won Ho Han ◽  
Bang Wool Eom ◽  
Hong Man Yoon ◽  
Young-Woo Kim ◽  
Myeong-Cherl Kook ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Intestinal Metaplasia ◽  
Partial Gastrectomy ◽  
Clinicopathological Features ◽  
High Grade ◽  
Remnant Gastric Cancer ◽  
Curative Surgery ◽  
Anastomosis Site ◽  
Malignant Group ◽  
Background Mucosa

Background: The incidence of gastric cancer increases in the remnant stomach after partial gastrectomy; however, its pathogenesis remains controversial. The clinicopathological features and immunohistochemical subtype were evaluated in patients with remnant gastric cancer considering the initial cause of partial gastrectomy. Methods: We categorized 59 cases of remnant gastric cancer who underwent curative surgery between 2001 and 2016 according to initial pathologies of benign (n = 24) or malignant (n = 35). Histological changes including pyloric metaplasia and intestinal metaplasia in the mucosa around the anastomosis site and the background mucosa of carcinomas were compared between the groups. Results: In the malignant group, the proportion of male patients was substantially lower, with a shorter interval. In background mucosa around the carcinomas, incidence of high-grade pyloric metaplasia was significantly higher in the benign group (13/20, 65.0% vs. 10/28, 35.7%), while high-grade intestinal metaplasia was only observed in the malignant group (0/20, 0% vs. 7/28, 25.0%). Conclusions: The cancers in the initial benign disease are mainly associated with pyloric metaplasia at the anastomosis site, reflecting reflux, but not with intestinal metaplasia. On the other hand, in the initial malignant disease group, intestinal metaplasia has an equally important role as reflux-associated pyloric metaplasia.

Radiotherapy in localized gastric cancer management: To be or not to be?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16511-e16511
Author(s):  
Amany Hussein ◽  
Khaled Al Saleh ◽  
Mustafa El-Sherify ◽  
Nashwa Nazmy ◽  
Jitendra Shete
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Locally Advanced ◽  
Cancer Control ◽  
Clinicopathological Features ◽  
P Value ◽  
High Grade ◽  
Control Center ◽  
Positive Margins ◽  
Cancer Management

e16511 Background: Gastric adenocarcinoma still have dismal outcome in spite of the progress made in systemic treatment in last 2 decades. In localized disease, treatment outcome still suboptimal, with up to 88% suffer from recurrence/metastasis. Hence, improvement in radical initial treatment is mandatory. Recent trials showed survival benefit of adding radiotherapy (preoperative or adjuvant) with favorable toxicity profile when using current advances radiation techniques. Methods: We retrospectively analyzed impact of radiotherapy in management of localized gastric cancer in Kuwait. 87 adult patients with newly diagnosed gastric cancers were treated and followed up at Kuwait Cancer Control Center (KCCC) between 2009-2015, 12 were excluded due to inoperability. 13 patients were excluded as they had early disease and underwent only surgery. Finally, 62 patients were submitted in study 48 patient received radiotherapy (RT group) as part of treatment (44 postoperative, 3 postoperative after induction Chemotherapy, 1 preoperative). 14 patients did not receive radiotherapy (NRT group); five received perioperative chemotherapy, nine received postoperative chemotherapy). Survival analysis was done using Kaplan-Meier, and comparison was done according to clinicopathological features. Results: The median age at diagnosis was 55 (range 25-70). Men represented 65.5%. Asian were 17 patients and Caucasian were 70 patients. 68.9% were nonsmoker while 31% were smoker. Median follow up was 45 months (1-89). 2 year Overall survival in the NRT group was 50% while in RT group was 79.1%. 3 year OAS was 42.8% and 64.5% in NRT group and RT group respectively. Median overall survival for NRT group was 82 months. While for the RT group median survival was not reached at time of analysis with p value (0.025). 2 year DFS in NRT group was 50% while in RT group was 66.6%. 3 year DFS was 42.8% and 54.1% in NRT group and RT group respectively. Median DFS not reached in both groups p value (0.04). On correlation of prognostic clinicopathological features with benefits of adding radiotherapy it was noticed that high grade, positive margins statistically benefit more from local radiotherapy and had better local control. Distal tumours behave badly whether received radiotherapy or not. Interestingly benefit of adding radiotherapy was not significantly affected by nodal status. Conclusions: Radiotherapy should be part of management in postoperative locally advanced gastric cancer especially with high grade tumours and positive margins. However still ongoing trials to clear the role of radiotherapy in preoperative setting.

Clinicopathological Features and Surgical Outcomes of Patients with Remnant Gastric Cancer after a Distal Gastrectomy

2008 ◽  
Vol 15 (6) ◽  
pp. 1632-1639 ◽  
Author(s):  
Hye Seong Ahn ◽  
Jong Won Kim ◽  
Moon-Won Yoo ◽  
Do Joong Park ◽  
Hyuk-Joon Lee ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Surgical Outcomes ◽  
Distal Gastrectomy ◽  
Clinicopathological Features ◽  
Remnant Gastric Cancer

Surveillance of premalignant gastric lesions: a multicentre prospective cohort study from low incidence regions

Gut ◽  
2018 ◽  
Vol 68 (4) ◽  
pp. 585-593 ◽  
Author(s):  
Wouter J den Hollander ◽  
I Lisanne Holster ◽  
Caroline M den Hoed ◽  
Lisette G Capelle ◽  
Tjon J Tang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Intestinal Metaplasia ◽  
Diagnostic Yield ◽  
Endoscopic Surveillance ◽  
High Grade ◽  
Neoplastic Progression ◽  
Gastric Lesions ◽  
Gastric Intestinal Metaplasia ◽  
Improve Risk Stratification

ObjectiveInternational guidelines recommend endoscopic surveillance of premalignant gastric lesions. However, the diagnostic yield and preventive effect require further study. We therefore aimed to assess the incidence of neoplastic progression and to assess the ability of various tests to identify patients most at risk for progression.DesignPatients from the Netherlands and Norway with a previous diagnosis of atrophic gastritis (AG), intestinal metaplasia (IM) or dysplasia were offered endoscopic surveillance. All histological specimens were assessed according to the updated Sydney classification and the operative link on gastric intestinal metaplasia (OLGIM) system. In addition, we measured serum pepsinogens (PG) and gastrin-17.Results279 (mean age 57.9 years, SD 11.4, male/female 137/142) patients were included and underwent at least one surveillance endoscopy during follow-up. The mean follow-up time was 57 months (SD 36). Four subjects (1.4%) were diagnosed with high-grade adenoma/dysplasia or invasive neoplasia (ie, gastric cancer) during follow-up. Two of these patients were successfully treated with endoscopic submucosal dissection, while the other two underwent a total gastrectomy. Compared with patients with extended AG/IM (PGI/II≤3 and/or OGLIM stage III–IV), patients with limited AG/IM (PG I/II>3 and OLGIM stage 0–II) did not develop high-grade adenoma/dysplasia or invasive neoplasia during follow-up (p=0.02).ConclusionIn a low gastric cancer incidence area, a surveillance programme can detect gastric cancer at an early curable stage with an overall risk of neoplastic progression of 0.3% per year. Use of serological markers in endoscopic surveillance programmes may improve risk stratification.

Clinicopathologic Analysis of Remnant Gastric Cancer after Distal Partial Gastrectomy: Experience of Single Center during 15 Years

2010 ◽  
Vol 10 (2) ◽  
pp. 63 ◽  
Author(s):  
Seung Hui Choi ◽  
Tae Gyun Kim ◽  
June Young Kim ◽  
Hoon Hur ◽  
Sang-Uk Han ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Partial Gastrectomy ◽  
Remnant Gastric Cancer ◽  
Single Center ◽  
Distal Partial Gastrectomy

scholarly journals Successful treatment of remnant gastric cancer with afferent loop syndrome managed by percutaneous transhepatic cholangial drainage followed by elective gastrectomy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Shu Aoyama ◽  
Masaaki Motoori ◽  
Yasuhiro Miyazaki ◽  
Tomoki Sugimoto ◽  
Yujiro Nishizawa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Emergency Surgery ◽  
Radical Surgery ◽  
Elective Surgery ◽  
Remnant Gastric Cancer ◽  
Afferent Loop ◽  
Afferent Loop Syndrome ◽  
Afferent Loop Obstruction ◽  
Anastomosis Site ◽  
Billroth Ii Reconstruction

Abstract Background There are only few reported cases of remnant gastric cancer with concomitant afferent loop syndrome. Emergency surgery is the standard treatment strategy for this disease. However, some afferent loop syndrome cases, especially those with complete obstruction, can lead to a septic state, which makes performing emergency surgery risky. We describe a case of remnant gastric cancer with complete afferent loop obstruction, which was successfully managed by radical surgery following percutaneous transhepatic cholangial drainage of the afferent loop. Case presentation A 71-year-old man presented with nausea and abdominal discomfort. When he was 27 years old, he had undergone distal gastrectomy for a benign gastric ulcer, with gastrojejunostomy (Billroth II reconstruction). Abdominal computed tomography revealed thickening of the anastomosis site and significant dilation of the afferent loop. Gastrointestinal fiberscopy revealed advanced remnant gastric cancer at the anastomosis site, and the stoma of the afferent loop was completely obstructed. We diagnosed the patient with remnant gastric cancer with afferent loop syndrome. Percutaneous transhepatic cholangial drainage was performed twice before surgery to decompress the afferent loop. This provided more time for the patient to recover. Radical surgery of total remnant gastrectomy and Roux-en-Y reconstruction were performed electively. There were no severe postoperative complications. The patient died 8 months following the operation owing to peritoneal dissemination recurrence. Conclusion We encountered a case of remnant gastric cancer with afferent loop obstruction, which was successfully managed by radical surgery following decompression of the afferent loop by percutaneous transhepatic cholangial drainage. Percutaneous transhepatic cholangial drainage effectively managed the afferent loop syndrome, resulting in the safe performance of elective surgery.

scholarly journals Clinicopathologic features of remnant gastric cancer after curative distal gastrectomy according to previous reconstruction method: a retrospective cohort study

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Yong-Eun Park ◽  
Sang-Woon Kim
Keyword(s):  
Gastric Cancer ◽  
Distal Gastrectomy ◽  
Reconstruction Method ◽  
Remnant Gastric Cancer ◽  
Billroth Ii ◽  
Billroth I ◽  
Billroth I Reconstruction ◽  
Anastomosis Site ◽  
Billroth Ii Reconstruction ◽  
The Mean

Abstract Background Survival rate of patients treated for gastric cancer has increased due to early detection and improvements of surgical technique and chemotherapy. Increase in survival rate has led to an increase in the risk for remnant gastric cancer (RGC). The purpose of this study was to investigate clinicopathologic features of RGC according to previous reconstruction method and factors affecting the interval from previous curative distal gastrectomy for gastric cancer to RGC occurrence. Methods Medical records of patients diagnosed with RGC at Yeungnam University Medical Center from January 2000 to December 2017 who had a history of distal gastrectomy with D2 LN dissection due to gastric cancer were reviewed retrospectively. Results Forty-eight patients were enrolled in this study. The mean interval of 48 RGC patients was 105.6 months (8.8 years). RGC after Billroth II reconstruction recurred more often at anastomosis site than RGC after Billroth I reconstruction (p = 0.001). The mean interval of RGC after Billroth I reconstruction was 67 months, shorter than 119 months of RGC after Billroth II reconstruction (p = 0.003). On the contrary, interval showed no difference according to stage of previous gastric cancer, remnant gastric cancer, or sex (p = 0.810, 0.145, and 0.372, respectively). Conclusions RGC after Billroth I reconstruction tends to arise earlier at non-anastomosis site than RGC after Billroth II. Therefore, we should examine non-anastomosis site carefully from the beginning of surveillance after gastric cancer surgery with Billroth I reconstruction for better outcome.

Clinicopathological Features of Remnant Gastric Cancer (RGC): Detection of RGC after Five Years of Follow-Up Was Associated with a Poor Prognosis

2019 ◽  
Vol 85 (4) ◽  
pp. 384-389
Author(s):  
Chizu Kameda ◽  
Ryohei Kawabata ◽  
Chikato Koga ◽  
Tae Matsumura ◽  
Masahiro Murakami ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Treatment Guidelines ◽  
Distal Gastrectomy ◽  
Significant Risk ◽  
Clinicopathological Features ◽  
Remnant Gastric Cancer ◽  
Cancer Specific Survival ◽  
Kaplan Meier ◽  
Gastric Cancer Treatment

The purpose of this study was to evaluate the clinicopathological features and prognosis of patients who underwent surgery for remnant gastric cancer (RGC) during/after the regular five-year follow-up period after initial distal gastrectomy for gastric cancer that is recommended by the Japanese gastric cancer treatment guidelines. Between January 2007 and December 2017, 40 patients underwent surgery for RGC after distal gastrectomy. Twenty-eight of the 40 patients underwent initial gastrectomy for cancer. We divided the 28 patients into two groups: patients who were diagnosed with RGC during/after the five-year follow-up period after initial gastrectomy, and analyzed their retrospectively collected data. Among the 28 patients, 15 patients were diagnosed with RGC within five years and 13 patients were diagnosed with RGC after five years. There were significant differences in the reconstruction of the initial operation, curative resection, pathological depth of the tumor, and pathological stage of the two groups. Multivariate analyses revealed that the interval between initial gastrectomy and RGC and the pathological TNM stage were significant risk factors for shorter cancer-specific survival. Kaplan-Meier analyses demonstrated that patients with RGC after the five-year follow-up period had a significantly worse prognosis in terms of cancer-specific survival than those who developed RGC within five years. This study suggested surveillance by using the annual endoscopy might be necessary beyond the initial five-year period for patients who underwent gastrectomy for gastric cancer.

Ultrastructural Localization Study of Carcinoembryonic Antigen (CEA) in Gastric Cancer: Immunoelectron Microscopic Observation

1990 ◽  
Vol 48 (3) ◽  
pp. 252-253
Author(s):  
Dong Yuming ◽  
Yang Guanglin ◽  
Wu Jifeng ◽  
Chen Xiaolin
Keyword(s):  
Gastric Cancer ◽  
Intestinal Metaplasia ◽  
Cancer Cells ◽  
Microscopic Observation ◽  
Biological Significance ◽  
Ultrastructural Localization ◽  
Mucinous Carcinoma ◽  
Surface Glycoprotein ◽  
Tubular Adenocarcinoma ◽  
Pap Method

On the basis of light microscopic observation, the ultrastructural localization of CEA in gastric cancer was studied by immunoelectron microscopic technique. The distribution of CEA in gastric cancer and its biological significance and the mechanism of abnormal distribution of CEA were further discussed.Among 104 surgically resected specimens of gastric cancer with PAP method at light microscopic level, the incidence of CEA(+) was 85.58%. All of mucinous carcinoma exhibited CEA(+). In tubular adenocarcinoma the incidence of CEA(+) showed a tendency to rising with the increase of degree of differentiation. In normal epithelia and intestinal metaplasia CEA was faintly present and was found only in the luminal surface. The CEA staining patterns in cancer cells were of three types--- cytoplasmic, membranous and weak reactive type. The ultrastructural localization of CEA in 14 cases of gastric cancer was studied by immunoelectron microscopic technique.There was a little or no CEA in the microvilli of normal epithelia. In intestinal metaplasia CEA was found on the microvilli of absorptive cells and among the mucus particles of goblet cells. In gastric cancer CEA was also distributed on the lateral and basal surface or even over the entire surface of cancer cells and lost their polarity completely. Many studies had proved that the alterations in surface glycoprotein were characteristic changes of tumor cells. The antigenic determinant of CEA was glycoprotein, so the alterations of tumor-associated surface glycoprotein opened up a new way for the diagnosis of tumors.

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