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At least 307 records · Page 17Linked to original sources
PubMed2005

[Relationship between bone metabolism and effects of lifestyles after gastrectomy].

The aim of this study was to examine the effects of bone metabolism impairment after a gastrectomy, as well as the effects of dietary life and physical activity on bone density, in order to obtain basic information on lifestyles that prevent osteoporosis. The study subjects were 27 male patients who had been diagnosed as having gastric cancer at a university hospital and had received a gastrectomy. All subjects gave their informed consent. The level of the bone metabolism impairment was examined by bone cell density measurement, ultrasound densitometer and by the measurements of bone metabolism parameters, i.e., BAP, DPD, NTx, corrected Ca. Physical activity was measured by the number of steps, and dietary life was investigated using a questionnaire. The SOS value, which is an index to the bone metabolism impairment, decreased 3 weeks after the gastrectomy. Although the SOS value recovered once, it decreased after 6 months again. Afterwards, it recovered to the preoperative level in 12 months. The levels of BAP, which are the osteogenesis markers, significantly decreased 3 weeks after the gastrectomy and increased three months later. DPD level, which is a bone resorption marker, increased significantly. The effect of physical activity and dietary life on the bone density was not recognized. Though the bone metabolism impairment appeared 3 weeks after the gastrectomy, the bone formation process after bone resorption was affected by individual differences. Consequently, it was impossible to clarify the factors of lifestyles which affect bone metabolism impairment.

Activities of Daily Living↗
PubMedDate not supplied

Extensive gastrectomy and carbon-adsorbed mitomycin C for gastric cancer with peritoneal metastases. Case reports of survivors and their implications.

BACKGROUND/AIMS: Extensive gastrectomy, defined as gastrectomy with complete omentectomy and extended lymphadenectomy, improves the survival of gastric cancer patients with peritoneal metastases, even though peritoneal metastasis is considered the end-stage of cancer. MMC-CH, a new dosage formulation of mitomycin C, extended the survival of rabbits with peritoneal carcinomatosis as compared to aqueous mitomycin C. METHODOLOGY: We retrospectively reviewed 114 patients who underwent gastrectomy for gastric cancer with peritoneal metastases. RESULTS: Six patients survived for more than 5 years after the therapy out of 63 patients treated with MMC-CH therapy and extensive gastrectomy for gastric cancer with P1, i.e., metastases to the adjacent peritoneum but no metastasis to the distant peritoneum, or P2, i.e., a few metastases to the distant peritoneum. However, there were no 5-year survivors in patients with P3, i.e., numerous metastases to the distant peritoneum, or in patients treated with incomplete omentectomy, limited lymphadenectomy and no MMC-CH therapy. CONCLUSIONS: The results imply that gastric cancer patients with P1 or P2 have a possible chance to survive more than 5 years when treated with MMC-CH therapy and extensive gastrectomy.

Adenocarcinoma↗
PubMedDate not supplied

Total gastrectomy for gastric adenocarcinoma. Analysis of 115 consecutive patients.

BACKGROUND/AIMS: There was a tendency to use more extensive operations for the treatment of gastric cancer during the last decade particularly in Europe. This retrospective study was carried out to review our recent experience with total gastrectomy for gastric adenocarcinoma. METHODOLOGY: One hundred and fifteen patients treated for gastric cancer by total gastrectomy from 1987 to 1996 were analyzed. At the time of surgery 22.3% of patients were older than 70 years of age. RESULTS: Fifty eight cancers (50.4%) were located in the distal third of the stomach, forty-seven (41%) were smaller than 6 cm and seventy-one (61.7%) were of the diffuse type. In 74.9% the tumor had penetrated through the serosa. The mortality and morbidity rates were 6.1% and 35.1% respectively. Age was a major determining factor with respect to hospital mortality and post-operative complications. CONCLUSIONS: Irrespective of personal attitudes, gastrectomy does not have to be total to be curative, and many total gastrectomies performed in Western countries with "curative intent" are noncurative procedures. Nevertheless, to achieve a curative oncologic resection, total gastrectomy is required with growing frequency.

Adenocarcinoma↗
PubMed1975

Graded gastrectomy for duodenal ulcer -- a five-year prospective study.

One hundred and twelve consecutive patients selected for surgical treatment for duodenal ulcer disease were treated by a graded gastrectomy according to the Moynihan modification of the Billroth II partial gastrectomy. A large partial gastrectomy (R) (2/3-3/4 gastrectomy) was done in patients who after maximal stimulation with histamine showed a high acid output (MAO greater than 30 mEa/hr), and a small resection (r) (1/3-1/2 gastrectomy) in low secretors (MAO less than 30 mEq/hr). The material was prospectively controlled by admission to hospital at 3 months, 1 year and 5 years postoperatively. The preoperative values of MAO found in R and r were 42.8 and 21.5 mEq/hr (p less than 0.001), respectively. The postoperative MAO values at the 3-month control were 4.5 and 3.0 mEq/hr by R and r, respectively, which shows that the grading of resection had been successful. Atrophic gastritis increased in frequency from 4% at the time of operation to 72% at the 1-year control...

Adolescent↗
PubMed2000

Functional results of reconstruction after subtotal or total gastrectomy.

The aim of surgical treatment of gastric cancer must be complete removal of the tumor including systematic lymphadenectomy. The performance of R0-resection has to take into consideration tumor site as well as the histomorphological type described by Lauren. Therefore, subtotal distal- or total gastrectomy are complementary operative procedures nowadays. From the oncological point of view proximal gastrectomy might be indicated in some situation but increased postoperative morbidity including severe reflux-esophagitis can be obtained. According to the functional outcome subtotal distal gastrectomy should be preferred whenever justified oncologically in comparison to total gastrectomy. Among the different reconstructive methods after total gastrectomy the Roux-en-Y technique is one of the most common procedure performed. Furthermore, some patients can benefit from a reconstruction of a gastric substitute and maintenance of duodenal passage but the superiority of this technique must be evaluated in further prospective studies. The question of the optimal mode of reconstruction of the upper gastrointestinal tract is still open.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

Palliative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: Although palliative gastrectomy for advanced gastric cancer may be favorable in selected patients presenting with bleeding and obstruction, little has been reported about the clinical significance of palliative gastrectomy, including prognosis. METHODOLOGY: A retrospective comparison between 84 patients with palliative gastrectomy (PG group) and 100 patients with unresectable operation (UO group) for advanced gastric cancer was carried out. RESULTS: The incidence of serosal invasion, peritoneal dissemination, hepatic and lymph node metastases, and undifferentiated tissue type in the UO group were significantly higher than in the PG group. Median survival after operation in the PG group (20.6 months) was significantly longer than in the UO group (5.7 months). Also, in stage IVb patients, median survival time in the PG group (10.2 months) was significantly longer than in the UO group (5.0 months). However, median survival in the patients with synchronous liver metastasis between PG (8.4 months) and UO (4.6 months) groups was not significantly different. Survival rates after operation of 6 months, 1 year and 2 years in all patients between the palliative gastrectomy group versus UO group were 83.6% versus 38.3% (P < 0.01), 63.0% versus 9.3% (P < 0.01) and 35.2% versus 0% (P < 0.01), respectively. CONCLUSIONS: Palliative gastrectomy compared to unresectable operation may be effective for improvement of prognosis even if stage IVb patients with peritoneal dissemination and/or distant lymph node metastasis. However, it may be unfavorable on survival of patients with synchronous liver metastasis.

Adenocarcinoma↗
PubMed2001

Early experience with laparoscopic radical gastrectomy for advanced gastric cancer.

Use of the laparoscopic approach for the management of gastric cancer is still in the developmental phase. The authors present their experience with laparoscopic radical gastrectomy for advanced gastric cancer. Between September 1997 and August 1999, four laparoscopic gastrectomies for gastric carcinoma were performed on two male and two female patients (mean age, 61.5 years). One D2 total radical gastrectomy and three D2 subtotal distal gastrectomies were performed, using a totally laparoscopic approach. Mean operative time was 210 minutes. There were no intraoperative complications. All four patients recovered uneventfully from surgery and began oral feeding on the third postoperative day. Median postoperative stay was 7 days (range, 6-9). All patients were alive 8 months to 3 years after the operation, with no cancer recurrences. This series shows that laparoscopic radical gastrectomy for moderately advanced cancers can produce good results in terms of safety and oncologic adequacy.

Adenocarcinoma↗
PubMed2001

[Gastrectomy in treating gastric hemorrhage].

Use of gastrectomy for gastric bleeding in emergency cases is analyzed. Gastrectomy was performed in 15 patients over 7 years. When tumor of the stomach penetrated into other organs combined operations were performed: gastrectomy with splenectomy and left-sided hemipancreatectomy, gastrectomy with cholecystectomy, choledocholythotomy and choledochoduodenostomy. Results of treatment were good. There were no lethal outcomes. New variant of gastrectomy was developed and performed in 5 patients. Technical simplicity and reliability of esophagoduodenal anastomosis, optimal functional result and good life quality were demonstrated in gastrectomized patients.

Gastrectomy↗
PubMed2001

[Curative effect of radical gastrectomy combined with peritoneal lavage with thermal hypoosmotic solution in treatment of gastric cancer].

OBJECTIVE: To evaluate the curative effect and indications of radical gastrectomy combined with peritoneal lavage with thermal hypoosmotic solution, double distilled water (DDW) or DDW plus chlorhexidine acetate, in treatment of gastric cancer. METHODS: Five hundred cases of gastric cancer who underwent radical gastrectomy from January 1986 to December 1995 were divided into three groups: group A with 198 cases who underwent radical gastrectomy and peritoneal lavage for 10 minutes with 400 ml of DDW at 43 degrees C, group B, with 89 cases who underwent radical gastrectomy and peritoneal lavage for ten minutes with 4 000 ml of DDW plus 0.6 g chlorhexidine acetate, and group C, with 213 cases who underwent radical gastrectorny and peritoneal lavage for four minutes with 4 000 ml of normal saline at normal temperature as controls. RESULTS: The group A and group B (called lavage group as a whole) had almost the same curative effects. The one-year survival rates and three-year survival rates were similar among the cases in different stages in no matter what group. The five-year survival rate was 63.8% in the lavage group and 51.2% in the control group, most of the cases with a good effect being at the mid-stage (II and III A stages). CONCLUSION: Peritoneal lavage, helpful in killing the exfoliated cancer cells in peritoneal cavity of patients with gastric cancer at II and III A stages, should be conducted in the treatment of gastric cancer by radical gastrectomy before closing the abdomen.

Adult↗
PubMed2003

Increased sensitivity in detection of a porcine high-turnover osteopenia after total gastrectomy by dynamic 18F-fluoride ion PET and quantitative CT.

UNLABELLED: High-resolution (18)F-fluoride ion PET in combination with quantitative CT (QCT) allows the assessment of bone metabolism in relation to bone mass. This combined imaging approach was used to elucidate porcine bone metabolic changes after gastrectomy, which are frequently associated with osteopenia or osteomalacia. METHODS: Six months after total gastrectomy (n = 7) or sham operation (n = 6), bone blood flow and bone metabolic activity (K(i), K(flux)) were calculated from dynamic PET measurements from vertebral bodies and compared with corresponding QCT bone mineral density (BMD) measurements. RESULTS: Total gastrectomy resulted in a significant reduction of the BMD (-21%; P < 0.005), whereas 1,25-(OH)(2)-vitamin D, serum phosphate, and parathyroid hormone were significantly increased compared with that of sham-operated animals. Because of the significant increase of the rate constant k(3) (+325%; P < 0.05), describing chemisorption and incorporation of (18)F-fluoride onto or into the bone matrix, K(i) (+36%) and K(flux) (+37%) were significantly elevated after total gastrectomy compared with that of control animals (P < 0.01), whereas bone blood flow was not significantly different between groups. The normalization of K(i) and K(flux) values by the specific bone mass (K(i/BMD); K(flux/BMD)) largely increased the differences between groups (K(i/BMD), +74%; K(flux), +76%; P < 0.001). CONCLUSION: Dynamic (18)F-fluoride ion PET revealed that porcine bone loss after total gastrectomy is related to a high-turnover bone disease without significant changes in bone blood flow. In mini pigs, the increased bone metabolism is probably related to an elevated parathyroid hormone secretion, thus maintaining serum calcium homeostasis at the expense of the bone mineral content. Normalizing bone metabolic activity by the specific bone mass increases the sensitivity in the detection of osteopenic high-turnover bone diseases. Therefore, the combination of QCT and (18)F-fluoride ion PET seems to be the method of choice for the classification of metabolic bone diseases and for monitoring treatment effects quantitatively.

Animals↗
PubMed2002

Influence of surgeon's volume on early outcome after total gastrectomy.

OBJECTIVE: To examine correlation between number of total gastrectomies done by each of 21 surgeons and the early outcome of these operations. DESIGN: Retrospective case series. SETTING: University hospital, Japan. PATIENTS: 136 patients treated by total gastrectomy for gastric cancer during a 4-year period. INTERVENTION: Univariate and multivariate analyses of the effect of each surgeon's volume on the early outcome of total gastrectomy. MAIN OUTCOME MEASURES: Differences in the morbidity and mortality after total gastrectomy between high-volume and low-volume surgeons. RESULTS: There was a significant difference in the incidence of major complications of total gastrectomy between high-volume (7/66, 11%) and low-volume (17/70, 24%) surgeons (p = 0.04). CONCLUSION: Possible reasons for differences in outcome between high-volume and low-volume surgeons should be investigated in an attempt to define and describe the methods that are associated with the best outcome.

Adult↗
PubMed1992

[The role of total gastrectomy in the management of gastrinoma syndrome].

Total gastrectomy used to be considered as a standard operation in the surgical treatment for gastrinoma syndrome. Although this end organ resection is a good palliation, to cure this ulcerogenic disease, gastrinoma resection is preferred. It remains a question if a total gastrectomy is necessary when a gastrinoma is found and resected. In a period of 12 years, nine out of 17 patients with gastrinoma syndrome were surgically treated. Fifteen gastrinomas were removed without histologic evidence of malignancy. Total gastrectomy was added in three, Whipple's operation was done in one and tumor resection alone in five. Serial examination of the resected stomach didn't find any gastrinoma. Eight gastrinomas of seven patients were found located in the pancreas, duodenum and lymph nodes within the gastrinoma triangle. These patients except one were followed up for six months to five years (mean 32 months). One died of post-operative hepatic failure, and one died of hypophysectomy for a co-existent huge prolactinoma (MEN I) four years later. Cure of the disease in terms of normal fasting serum gastrin levels, symptom free without medication, endoscopic evidence of healed ulcer, and a negative conversion of secretin provocative test was found in 2/3 of the patients with additional total gastrectomy, and 4/6 of the others. All cured patients had their gastrinomas located in the gastrinoma triangle, and six of the seven (85.7%) patients with gastrinomas in the triangle were cured. It is our conclusion that total gastrectomy was retrospectively unnecessary in most of the patients with gastrinomas in the gastrinoma triangle. Staged operations should be planned.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Blood concentrations of futraful, uracil and 5-fluorouracil (5-FU) after UFT administration in the various reconstructions after gastrectomy. Saitama UFT Research Group].

The study was undertaken in the total of 58 gastric cancer patients among which 17 of Billroth (BI), 14 of Billroth II (B II) anastomosis after subtotal gastrectomy, and 7 of jejunal interposition, 9 of double tract and 11 of Roux en Y anastomosis after total gastrectomy were included. Blood samples were taken before 200 mg of per oral UFT administration and after 1, 2, 3, 5 and 7hrs. consecutively. The blood Futraful (FT) level in the total gastrectomy groups reached peak concentration within 1hr and kept in relatively high level during the observation period of 7hrs. The time to maximum FT concentration delayed in almost of B I and a few of B II patients. The concentration curves of uracil (URA) and 5-FU were similar in shape, revealing steep increase and decrease except B I anastomosis which showed gentle course. The plotted maximum concentrations of URA and 5-FU in the every type of reconstruction showed a significant correlation in the regression line. In the analysis of AUC, URA/FT was under 10%, suggesting the longer retention of the unmetabolite type of FT and early disappearance of URA. The ratio of 5-FU/FT was indifferent in each reconstruction. 5-FU/URA was higher in subtotal rather than total gastrectomy groups. From the data obtained, blood concentration of 5-FU after UFT administration was considered to depend on the emptying status in the gastrectomies. And moreover, it depended on blood URA level, since FT from which 5-FU was derived, was kept still sufficiently remained during observation period.

Anastomosis, Roux-en-Y↗
PubMed2003

[Helicobacter pylori infection in the remnant stomach after radical subtotal gastrectomy].

BACKGROUND/AIMS: It was reported that the prevalence of Helicobacter pylori (H. pylori) infection decreased after gastrectomy, but persistent H. pylori infection may cause residual gastritis or stump cancer. We studied the prevalence of H. pylori infection in patients who had undergone subtotal gastrectomy for the treatment of gastric cancer and the factors that influence H. pylori positivity in the remnant stomach. METHODS: Ninety-eight patients who had undergone radical subtotal gastrectomy (RSG group) for the treatment of gastric cancer and eighty-four patients diagnosed as having gastric cancer (GC group) were enrolled. H. pylori status was diagnosed by rapid urease test, histological examination, and 13C-urea breath test. We evaluated whether there were differences in various clinical characteristics according to the H. pylori status in the remnant stomach. RESULTS: The prevalences of H. pylori infection in RSG group and GC group were 55% and 69%, respectively. In RSG group, the prevalence of H. pylori was 76.9% in patients aged 49 or less, and it decreased with age. The prevalence of H. pylori within 3 years of gastrectomy was 59.5% and it decreased to 28.6% after 3 years of gastrectomy. CONCLUSIONS: The positive rate of H. pylori in RSG group is lower than that in GC group and decreases with age and time interval after operation.

Aged↗
PubMed2003

[Long-term therapeutic effects of total gastrectomy in cancer of the cardia and stomach fundus].

OBJECTIVE: To evaluate total gastrectomy for the treatment of cancer of the cardia and stomach fundus. METHODS: Five hundred and thirteen patients with cancer of the cardia and stomach fundus underwent radical resection. Of them, 326 were treated using total gastrectomy (group TG); and 187, using proximal gastrectomy (group PG). The 5-year and 10-year survival rates and the postoperative complication rate and mortality rate were followed up and compared in the two groups. RESULTS: The 5-year and 10-year survival rates of group TG were 43.6% and 24.5%, of group PG were 33.9% and 14.1%, respectively, and the difference was statistically significant (chi(2) = 4.421, P < 0.05, chi(2) = 5.726, P < 0.05). The postoperative complication rate and mortality rate of group TG were 14.7% and 3.1%, of group PG were 10.2% and 2.1%, respectively, and the difference was not statistically significant (chi(2) = 1.796, P > 0.05, chi(2) = 0.082, P > 0.05). CONCLUSIONS: To improve long-term therapeutic effects, total gastrectomy should be recommended for stage III patients with cancer of the cardia and stomach fundus when tumor size is bigger than 3.0 cm or lymph node metastasis occur. The postoperative complication rate and mortality rate should not be increased and the esophagitis of gastroesophageal reflux should be avoided in the patients treated using total gastrectomy.

Adult↗
PubMedDate not supplied

Extended intestinal metaplasia. A survey of 1392 gastrectomies from dwellers of the Pacific basin.

BACKGROUND: To assess the extent of gastric intestinal metaplasia (IM) in gastrectomy specimens in populations of the Pacific basin having different incidence of gastric carcinoma. MATERIALS AND METHODS: One thousand three hundred and nine-two gastrectomies were investigated: 1088 had a gastric carcinoma and 304 miscellaneous gastric diseases. Twenty-one thousand three hundred and fourteen histological sections were reviewed under low-power (4X). IM was either spotty (SIM) or extended (EIM= encompassing one or more entire low-power fields/section). Widespread IM (WIM) was regarded as EIM if present in > or =5 histological sections. RESULTS AND CONCLUSION: The percent of gastrectomies harboring a carcinoma increased significantly with increasing age more notably in those with diffuse carcinomas (DC) than in those with intestinal carcinomas (IC). The percent of gastrectomies with EIM was significantly higher in specimens with IC than with DC, particularly among elderly patients, and in specimens from countries with a high cancer incidence. The percent of gastrectomies with WIM was higher in specimens having IC than in those having DC. Migration per se did not influence the frequency of specimens with EIM in elderly Japanese patients: Japanese migrants to Hawaii had a similarly high frequency of EIM as those dwelling in Japan. Japanese patients with a gastric carcinoma showed atypical mitoses in areas with EIM far from the tumor, suggesting that cellular mutation(s) play a role in the evolution of EIM towards gastric dysplasia and carcinoma in that ethnic group. The drawback of gastric biopsies in assessing the extent of gastric intestinal metaplasia and, thereby, estimating possible cancer risk in long-term studies has been stressed.

Age Factors↗
PubMed2005

[The appreciation and limitation of regional gastrectomy for early gastric cancer].

We performed limited surgical treatments, including modified radical gastrectomy (D1+ alpha) for 7 patients, segmental gastrectomy for 9 patients and regional gastrectomy for 13 patients from September 1999 to December 2004. Eligibility criteria were as follows: 1) mucosal gastric cancer without an ulcer and/or scar; 2) contraindication to EMR; 3) located at M or L area; 4) negative for lymph node metastasis in clinical and surgical findings. Regional gastrectomy, especially in the patients whose gastric cancer located at the side of greater curvature, improved postoperative remnant gastric function according to the average of half-emptying times determined by RI scintigraphy, endoscopic examination and so on. However, the accuracy of mucosal cancer without lymph node metastasis in clinical and surgical findings was 69% and there was a patient with recurrence of lymph node after regional gastrectomy. These limited surgical treatments were thought to be limited due to more careful diagnosis as to sentinel lymph node navigation surgery in the future.

Adult↗
PubMed2006

[The effects of enteral nutrition vs parenteral nutrition on gastric motility and gastroenteric hormones after subtotal gastrectomy: a perspective randomized compared clinical trial].

OBJECTIVE: To compare the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroenteric hormones after subtotal gastrectomy. Try to find the possible prognosticating marks for the postoperative gastroparesis. METHODS: Forty-one patients after gastrectomy were randomly divided into EN group (n = 20) and PN group (n = 21). From the first day after operation (POD + 1) to the seventh day (POD + 7), patients received either EN (EN group) or PN (PN group) with isocaloric and isonitrogenous intake. Serum gastrin (GAS), plasma motilin (MTL) and plasma cholecystokinin (CCK) were measured on preoperative day, POD + 1 and POD + 7. Electrogastrography (EGG) was measured on preoperative day, and POD + 7. RESULTS: On the seventh day after gastrectomy, plasma MTL and CCK levels in EN group are higher than those in PN group. There is no difference in GAS between two groups. EGG in EN group is better than that in PN group postoperatively. CONCLUSIONS: The level of gastroenteric hormones and the gastric motility are decreased significantly after subtotal gastrectomy. In contrast with PN, EN could accelerate the recovery of some gastroenteric hormones and the gastric motility after subtotal gastrectomy. GAS, MTL, CCK and EGG are not accurate enough as the marks for prognosticating the postoperative gastroparesis.

Adolescent↗