To assess the efficacy of primary chemotherapy for treatment of early stage patients with gastric lymphoma, multiple agent chemotherapy was given to patients prior to surgery. Five patients with stages IE and IIE of primary gastric lymphoma (54-65 years of age; three men, two women) were treated with multiple agent chemotherapy prior to gastric resection. In all patients the diagnosis was established by endoscopic biopsy. Two patients had stage IE disease, and three had stage IIE. Histopathologically, there was one diffuse large cell lesion and four diffuse medium cell lesions. All patients received two cycles of VEPA every 4 weeks. On the 16th to 44th day after completion of chemotherapy, total gastrectomy, systematic dissection of regional lymph nodes with resection of the caudal pancreas, and splenectomy were performed. Swelling of the regional lymph nodes was noted in four cases. In all five cases, histologic findings revealed no residual cells of malignant lymphoma in the resected specimen. None of the patients had no evidence of recurrence at 12 to 40 months after surgery. Primary chemotherapy alone thus resulted in the disappearance of malignant cells in stage IE/IIE gastric lymphoma. Our results suggest that surgery may not be an essential procedure for treatment of early stage gastric lymphoma.

Aged↗

PubMedDate not supplied

A new technique for the resection of gastric cancer: modified Appleby procedure with reconstruction of hepatic artery.

The Appleby operation allows resection of gastric cancer with lymph nodes around the stomach and celiac axis en bloc. Hepatic arterial blood flow after resection of the celiac axis is supplied by the superior mesenteric artery. In some patients, however, hepatic arterial flow becomes decreased after resection of the celiac axis. This abrupt reduction of hepatic arterial blood flow sometimes causes postoperative complications such as severe liver dysfunction or gallbladder necrosis. To prevent the reduction of hepatic arterial blood flow and to perform the Appleby operation more safely, we modified the Appleby operation to include reconstruction of the hepatic artery. We found that after dissection of lymph nodes around the hepatoduodenal ligament, the proper hepatic artery and gastroduodenal artery can be well mobilized and it becomes possible to anastomose the celiac axis to the common hepatic artery directly without using anticoagulants. From May, 1989 to November, 1990, 15 patients with advanced gastric cancer underwent the modified Appleby procedure at Kinan General Hospital. Postoperatively, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were determined for evaluation of liver function. These levels were almost the same as those found after traditional total gastrectomy without resection of the celiac axis. Indocyanine green (ICG) clearance tests were performed before and 1 month after operation. There was no significant difference between the preoperative and postoperative values. Common hepatic arterial flow after celiacohepatic anastomosis was 390 ml/min on average. The modified Appleby procedure can be done quite safely.

Adult↗