Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Gastrectomy”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2003

[Prevalence of erosive esophagitis in patients with subtotal gastrectomy: case-control study].

BACKGROUND/AIMS: Enterogastric bile reflux has been implicated as a definite causative factor for the development of postoperative bile reflux gastritis. However, little is known about the role of bile reflux into the stomach in gastro-esophageal reflux disease in patients with subtotal gastrectomy. In this study, we tried to prove that the bile reflux gastritis does increase the development of erosive esophagitis in patients who underwent subtotal gastrectomy. METHODS: From January 1997 to December 2001, 222 patients with previous subtotal gastrectomy were enrolled. We also reviewed the endoscopic findings in 1,633 age and sex-matched healthy controls who had visited our hospital for routine check-up without significant gastrointestinal symptoms. RESULTS: The prevalence of erosive esophagitis is 5% (LA A 2.7%, LA B 2.3%) in gastrectomized patients and 4.9% (LA A 3.2%, LA B 1.7%, LA C 0.0%) in healthy controls. There was no significant difference in the prevalence and the degree of esophagitis between the two groups. CONCLUSIONS: These results suggest that subtotal gastrectomy may not be a risk factor for developing the erosive reflux esophagitis.

Aged↗
PubMedDate not supplied

[Cholelithiasis after total gastrectomy for gastric cancer].

After gastric resection for peptic ulcer and total gastrectomy for Zollinger-Ellison syndrome, there is an increased prevalence of cholelithiasis. In order to assess whether this increased prevalence also exists after total gastrectomy for cancer, we evaluated the rate of cholelithiasis (echographic diagnosis) both before and after this operation. Between 1980 and 1990, 89 patients underwent total gastrectomy for cancer in the Surgical Department of our Institute. The pre-operative prevalence of gallstones was 5% in the males and 13.8% in the females. Seventy-four of the eighty-nine patients (83%) were examined post-operatively (7 patients with pre-operative cholelithiasis, 3 who died during the post-operative stay and 5 lost to follow-up were excluded from the study). The median post-operative follow-up was 24 months (range 3-115 months). The post-operative prevalence of cholelithiasis in the 74 patients was 39.6% in the males and 19% in the females. We also calculated the expected frequency of gallstones in both the pre- and post-operative groups from prevalence data in the population of the city where our Institute is based (taken from an echographic survey). We then compared the observed frequency of cholelithiasis with the expected frequency and we found that the difference in pre-operative frequencies, both in the males and females, was not statistically significant (p > 0.05). The same was true of the post-operative frequencies in the females (p = 0.48), but in the males there was a statistically significant difference between the observed frequency of cholelithiasis and that expected after total gastrectomy (p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Change in arterial ketone body ratio during gastrectomy and mastectomy].

We evaluated the influence of operative procedure on arterial ketone body ratio (AKBR), which indicates the function of the liver cells, in patients undergoing gastrectomy or mastectomy. AKBR during the stomach resection was significantly lower than that during the breast resection. A significant reduction in AKBR due to induced hypotension was observed in mastectomy group. SGOT and SGPT increased significantly in gastrectomy group, but unchanged in mastectomy group on the first and the seventh postoperative days. On the first post-operative day, SGOT and SGPT in gastrectomy group were significantly higher than those in mastectomy group. These findings suggest that influence of operative procedure on the liver during gastrectomy is more serious than that during mastectomy.

Adult↗
PubMedDate not supplied

Postoperative morbidity/mortality and survival rates after total gastrectomy, with splenectomy/pancreaticosplenectomy for patients with advanced gastric cancer.

BACKGROUND/AIMS: Indications for splenectomy in patients with proximal and middle gastric cancer remain controversial. We investigated characteristic findings in patients with lymph node metastasis to the splenic hilus and the indication of splenectomy with total gastectomy for T2 and T3 advanced gastric cancer. METHODOLOGY: Two hundred and forty-one Japanese patients underwent curative operations for T2 and T3 advanced gastric cancer. RESULTS: The mortality rates were similar, but the morbidity rate for patients who underwent pancreaticosplenectomy was higher than for patients who underwent either total gastrectomy alone or with splenectomy (p<0.007). The rates in cases of lymph node metastasis at the depth of tumor invasion within the subserosa and serosa (T3) were 1.7% and 17.5%, respectively (p<0.003). Lymph node metastasis to the splenic hilus was also evident in patients with T3 or T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes). The 10-year survival rates for patients who underwent total gastrectomy alone, with splenectomy, and with pancreaticosplenectomy in T3 advanced gastric cancers were 25%, 42% and 32%, respectively (p=0.184). CONCLUSIONS: Based on these data, the addition of distal pancreaticosplenectomy to total gastrectomy in patients with T2 and T3 advanced gastric cancer increased the risk of complications. Nevertheless, we recommend that total gastrectomy with splenectomy should be done for patients with T3 advanced gastric cancers [and T2 advanced gastric cancer with multiple lymph nodes metastasis (more than 7 nodes)], recognizing the lymph node metastasis to the splenic hilus.

Aged↗
PubMedDate not supplied

A comparative study of pancreatectomy and pancreas-preserving gastrectomy in advanced gastric carcinomas.

BACKGROUND/AIMS: In patients with advanced gastric carcinoma (tumor infiltrating beyond submucosal layer), distal pancreatectomy has been frequently performed simultaneously with gastrectomy for complete removal of the lymph nodes along the splenic artery. However, the possibility of a negative impact has also been reported. To evaluate the effects of distal pancreatectomy with gastrectomy for patients with advanced gastric cancer, we retrospectively analyzed 84 patients who had proximal- or middle-third advanced gastric cancer resected in an institution in Taiwan. METHODOLOGY: From 1988 to 1998, 46 patients who underwent gastrectomy with distal pancreatectomy (DP group) and 38 patients who had pancreas-preserving gastrectomy (PS group) for advanced gastric cancer were reviewed. The clinicopathological details and survival rates were compared between the two groups. RESULTS: In terms of clinicopathological factors and operative mortality, there were no significantly statistical differences between the patients who did and did not undergo distal pancreatectomy. The cumulative 5-year survival rate for the DP group was 35.6%, whereas the 5-year survival rate for the PS group was 42.4% (P=0.6224). In contrast, the operative morbidity was significantly higher in patients who had distal pancreatectomy (P=0.008). CONCLUSIONS: Since distal pancreatectomy does not benefit patients with advanced gastric cancer, this procedure should not be regarded as routine in a radical resection.

Carcinoma↗
PubMedDate not supplied

Role of pyloroplasty after proximal gastrectomy for cancer.

BACKGROUND/AIMS: The necessity of pyloroplasty as a drainage procedure after proximal gastrectomy remains controversial in terms of the postoperative quality of life. The aim of this retrospective study was to evaluate whether pyloroplasty is necessary after proximal gastrectomy. METHODOLOGY: Thirty-five patients who underwent proximal gastrectomy with jejunal interposition between 1993 and 2000 were studied. They were divided into two groups: Group A, jejunal interposition without pyloroplasty (n=17); Group B, jejunal interposition with pyloroplasty (n=18). The subjects were interviewed and examined to assess their symptoms, food intake and body weight at 6, 12, and 24 months after the operation. Endoscopy and a radioisotope gastric emptying test were performed one year postoperatively. RESULTS: A low incidence of epigastric fullness, nausea, and vomiting and a high frequency of patients with greater than 80% of pre-illness food intake were found in Group B. A high recovery of bodyweight was also achieved in Group B. On the other hand, a high incidence of reflux gastritis or bile regurgitation was found in Group B. Gastric emptying was significantly delayed in Group A. CONCLUSIONS: Pyloroplasty as a drainage procedure after proximal gastrectomy is necessary in terms of the clinical symptoms, dietary intake, recovery of body weight, or gastric emptying.

Anastomosis, Surgical↗
PubMedDate not supplied

Nasogastric decompression after total gastrectomy.

BACKGROUND/AIMS: Although it is clearly known that there is no need of routine nasogastric decompression after some abdominal operations, we still do not know whether it is necessary for esophageal anastomosis. Traditionally, nasogastric decompression is mandatory after total gastrectomy complemented with esophagojejunostomy. METHODOLOGY: Consecutive 66 patients with gastric cancer who underwent total gastrectomy and esophagojejunostomy were prospectively evaluated. Patients were divided into two groups, those with nasogastric decompression and those without decompression. RESULTS: Postoperative complications were similar among the groups. Vomiting, distention, belching, hiccupping, dysphagia complaints were similar among the groups, but sore throat (100% vs. 22%, p<0.001), nausea (32% vs. 13%, p=0.054), fever (35% vs. 16%, p=0.068) and pulmonary complications (26% vs. 9%. p=0.072) were much more in the nasogastric decompression than the no-tube group. Starting oral feeding and postoperative hospital stay were similar in both groups. CONCLUSIONS: Omission of nasogastric decompression after elective total gastrectomy complemented with esophagojejunostomy did not increase postoperative complications, on the contrary it decreased postoperative fever and pulmonary problems, and improved patient comfort by decreasing sore throat and nausea. Therefore, we do not recommend the routine use of nasogastric tubes after total gastrectomy complemented with esophagojejunostomy.

Adult↗
PubMed1992

Remnant-stump gastric cancer following partial gastrectomy.

Between 1970 and 1990, a total of 2,189 patients with gastric cancer underwent resection in the First Department of Surgery, Kurume University Hospital. Of these, 54 patients had previously undergone a partial gastrectomy. The time interval between the initial partial gastrectomy and the resection of the remnant-stump gastric cancer was more than 10 years in 25 patients and less than 10 years in 29 patients. Those with a time interval of more than 10 years we have termed remnant-stump cancer. The original pathology was a gastric ulcer in 13, a duodenal ulcer in 5, a gastric polyp in 1, and a gastric cancer in 6 patients. Of the 19 patients that had undergone an initial operation for benign disease (Group 1), 15 (79%) patients had received initial reconstruction by B-II and 4 (21%) by B-I. On the other hand, of the 6 patients with an initial operation for gastric cancer (Group 2), 3 (50%) had undergone reconstruction by B-I and the other 3 (50%) had received a B-II procedure. Twenty-three of 25 (92%) remnant-stump gastric cancers underwent total gastrectomy, while the other 2 (8%) were early remnant-stump cancers in the stoma and underwent partial gastrectomy. In group 1, only 5 out of 19 (26.3%) patients are alive, while in group 2 all 6 patients are alive, including the 2 (33.3%) early-stage cancers that were found through periodical endoscopic follow-up examinations.

Adult↗
PubMed1992

Nutrient intake and biochemical markers of nutritional status during long-term follow-up after total and partial gastrectomy.

Dietary intake and biochemical nutritional status was studied in patients who had undergone total gastrectomy (TG, n = 10) or partial gastrectomy (PG, n = 10) several years ago. The dietary intake of energy, macronutrients and micronutrients was very similar in the two groups and was also similar to the intake reported for healthy subjects in Sweden. The concentration of alpha-tocopherol in serum was subnormal in the TG group and that of carotene in both groups of patients, and the values were also significantly lower in the TG group than in the PG group. This was probably due to fat malabsorption, since dietary intake was found to be adequate. The proportions of n-6 and n-3 polyunsaturated fatty acids in serum phosphatidylcholine were not significantly different between the TG and PG groups. Iron deficiency was found in three patients in the TG group. Three patients (two TG, one PG) had elevated serum alkaline phosphatase and one patient (PG) had subnormal cobalamin concentration. For ascorbic acid, folate, calcium, phosphorus, magnesium, zinc, copper and selenium, the serum concentrations were normal or close to normal. Although the stores of some micronutrients seemed smaller after total gastrectomy, no major differences in nutritional status were found between the TG and PG groups. For the demonstration of decreased micronutrient stores during long-term follow-up after gastrectomy, an extended profile of biochemical markers of nutritional status is recommended.

Biomarkers↗
PubMed2005

[Surgery for upper or middle thoracic esophageal carcinoma after gastrectomy].

OBJECTIVE: To evaluate the surgical treatment and technical key-points of upper or middle thoracic esophageal carcinoma in patients with history of gastrectomy. METHODS: Eighty-six patients with upper or middle thoracic esophageal carcinoma after previous gastrectomy received surgical treatment between 1980 and 2004. Among them, tumor location was in middle thoracic esophagus in 50 patients, in upper thoracic esophagus in 31 and cervical esophagus in 5. Postoperative pathological staging was stage I in 16 patients, stage IIa in 62, stage IIb in 5 and stage III in 8. The interval between gastrectomy and the diagnosis of esophageal carcinoma ranged from 2 to 22 years. Surgical procedures included esophagectomy and reconstruction with nonreversed gastric tube in 2 patients and reversed gastric tube in 3. The esophagus was reconstructed with short segment of colon in 5 patients and long segment of colon in 74. Two cases underwent jejunostomy only. RESULTS: Seventy-six patients (88%) were treated with curative intent. Seven patients (8%) received palliative surgery. Postoperative complication rate was 12% (10/86). One patient died of multiple organ dysfunction syndrome (MODS). Sixty-seven patients were followed up, the 1-, 3-, 5-year survival rates were 84% (56/67), 57% (38/67) and 22% (15/67), respectively. CONCLUSIONS: Surgical treatment is the first choice for esophageal cancer patients after gastrectomy although the procedures are complicated. The surgery should be considered as a reliable therapeutic modality because of favorable patient prognosis. The replacement with colon is recommended for those patients.

Adult↗
PubMed1991

Reservoir function after subtotal or total gastrectomy with or without gastric substitute.

Volume and pressure characteristics as a measure of reservoir function were studied in three patient groups greater than 1 year after gastrectomy for cancer, one group with straight Roux-en-Y esophagojejunostomy, one with an s-shaped gastric substitute after total gastrectomy, and the third group with subtotal gastrectomy. A large latex balloon was introduced into the proximal jejunum, gastric substitute or gastric remnant and then filled with water at a constant, slow rate. The maximal volume capacity was 400 ml at basal pressure 13.9 cmH2O in the remnant after subtotal gastrectomy and 475 ml at 10.4 cm in the gastric substitute, but only 180 ml at basal pressure 40.4 cmH2O in the proximal Roux limb of the straight esophagojejunostomy. Maximal basal pressure and maximal pressure amplitudes throughout the study period were significantly higher in the patients with straight Roux-en-Y esophagojejunostomy. The results suggest that a gastric substitute constructed as an s-shaped pouch is characterized by pressure and volume typical of a low-pressure reservoir, similar to that achieved by leaving the proximal part of the stomach intact.

Adult↗
PubMed1991

[Postprandial plasma secretin and CCK release in patients with gastrectomy and pancreatoduodenectomy].

Postprandial plasma secretin and CCK release were investigated in patients with gastrectomy and pancreatoduodenectomy reconstructed by Billroth-I, Billroth-II, Roux-en-Y and Child's methods. Plasma secretin response were significantly decreased in patients with B-I and B-II reconstruction after gastrectomy, especially in total gastrectomized patients with Roux-en-Y reconstruction, which might be resulted from the reduced gastric acid secretion following gastrectomy. CCK release was not significantly changed in patients with various reconstructions after gastrectomy compared with control group. In patients with pancreatoduodenectomy reconstructed by Child's method plasma secretin and CCK release were significantly decreased as compared with normal controls.

Animals↗
PubMedDate not supplied

Stomach cancer: a study of 117 consecutive resected cases and results of R2-R3 gastrectomy.

In a consecutive series of 175 patients with gastric carcinoma, 66.8% underwent gastric resection: 74 total gastrectomies with R3 lymphadenectomy and 43 distal subtotal gastrectomies with R2 lymphadenectomy were performed. 73% (86 cases) of resective procedures proved to be "absolute curative" according to Japanese criteria (JRSGC). Nodal involvement was present in 62 out of 117 resected patients (52.9%): 29.9% N1, 9.4% N2, 13.6% N3; a significant relationship (p = 0.012) between depth of invasion of the gastric wall and lymph node metastases was revealed. The hospital mortality after R2-R3 gastrectomy was 4.2%, major surgical complications occurred in 6.8% of cases. The actuarial 5-year survival after curative resection was 59%. The results suggest that extended lymphadenectomy (R2-R3 gastrectomy) is justified in the surgical treatment of gastric cancer; this procedure can be safely performed and permits "absolute curative" resections in a remarkable percentage of cases.

Actuarial Analysis↗
PubMedDate not supplied

[Roux-en-Y gastrectomy. A 12 years' experience].

A review of 161 patients who underwent Roux-en-Y biliary diversion and truncal vagotomy from 1978 to 1989 is performed under the double perspective: clinical and functional (using radionuclide semi-solid and liquid gastric emptying (GE) studies). In 46 patients this solution was adopted to treat different kinds of post-gastrectomy syndromes and in 115 to solve the esophageal-duodeno-gastric peptic disease. Some technical details are considered very important to prevent the nominated post Roux-en-Y Syndrome in relationship with the gastroparesis and gastric retention. The overall operative mortality was 2.5%. Five patients were reoperated: two, to complete vagotomy; 2, to solve gastric retention and one with sub-occlusion due to jejunal stricture. Forty one patients with 7.4 +/- 1.3 years after surgery were graded Visick I or II in 82.9% of the cases and 17.1% Visick III or IV. Gastric emptying studies demonstrated that the problems of gastric fullness detected in the immediate post operative period are quite similar to those observed after other kinds of sub-total gastrectomies. After 6 months, the gastric emptying change to a more rapid pattern in the large majority of patients. In the late post operative period is quite common to have no agreement between gastroparesis complains and the objective measurements of the GE, in symptomatic patients. Roux-en-Y gastrectomy solve the problems of post gastrectomy syndromes in 80% of the cases and in our experience, is a method that can be used with advantage to treat the ulcerative peptic disease resistant to the medical treatment in patients with less than 50 years.

Adult↗
PubMed1990

[Bone disorder after gastrectomy--clinical & experimental studies].

To study the pathophysiology of bone disorder after gastrectomy, 320 patients and 40 Wistar male rats were used. Clinically, patients who had received gastrectomy 1-15 years previously, were examined for skeletal symptoms, serum biochemistry, microdensitometry of second metacarpal bone, and 20 of them were then studied in a calcium infusion test. Using microdensitometry, abnormality of bone metabolism was observed in 38% of the patients. In severe cases, a significant decrease of serum Ca. and increase of alkaline phosphatase were observed (p less than 0.05), 65% complained of joint pain. In the calcium infusion test, severe cases showed a low urinary excretion of Ca, like osteomalacia, and unlike osteoporosis. Experimentally, body weight & amount of food intake decreased and fatty diarrhea was observed in rats after total gastrectomy. Skeletal changes including thinning of the cortex, loss of medullary trabeculation & decrease of bone ash and biochemical changes such as low serum Ca. 25(OH)D3, 24, 25(OH)2D3 and high iPTH levels were observed. Also the bone formation rate was lower than control as detected by tetracycline double labelling method. As low food intake & fatty diarrhea after gastrectomy which result in Ca. & vit. D insufficiency may be the major etiology of bone disorder.

Alkaline Phosphatase↗
PubMed1989

[Indications for total gastrectomy combined with pancreaticosplenectomy in the treatment of middle gastric cancer].

Of 1725 patients with middle gastric cancer (M, MA, MC) on whom radical surgery was performed (except for absolute non-curative resection) from 1960 to 1984 at the Cancer Institute Hospital, 238 patients in whom total gastrectomy or proximal partial gastrectomy combined with pancreaticosplenectomy was carried out, were submitted for both clinico-pathological and prognostic examination. The following results were obtained: 1. There are few indications for total gastrectomy plus pancreaticosplenectomy in patients with middle gastric cancer in which the lesions are superficial or semi-superficial. 2. For patients in whom the cancer occupies portions of the greater curvature, on posterior wall of the stomach, the whole stomach, or is of a non-localized type, the metastatic rate of lymph nodes No (10) or lymph nodes No (11) is high, then total gastrectomy plus pancreaticosplenectomy should be considered. 3. Lymph nodes No (2), (4d), (4sb) (7) and (9) can be good indices indicating presence or absence of metastasis of lymph nodes No (10) and lymph nodes No (11). 4. Radical surgery as well as effective adjuvant therapy are required for gastric cancer with invasion of the serosa.

Gastrectomy↗
PubMed1989

[Cancer of the stomach, the choice of surgery based on correct staging: total or subtotal gastrectomy?].

On the basis of the literature and of personal experience, the problem of the extent of demolition time, total gastrectomy or subtotal gastrectomy for patients suffering from stomach cancer is analysed. It is considered that total gastrectomy does not always lead to longer survival by comparison with subtotal gastrectomy and that in certain cases the latter, after careful consideration of a series of variables, may be the operation of choice.

Adenocarcinoma↗
PubMed1989

Outcome of failure in clearing the oesophageal margin in total gastrectomy for adenocarcinoma.

Failure to clear the oesophageal margin in total gastrectomy for adenocarcinoma is believed to be a major cause of mortality and morbidity. The incidence of histologically positive margin could range from 7.3 to 74%. Forty nine cases of total gastrectomy for adenocarcinoma were reviewed and nine (18%) had a positive oesophageal margin. One of the nine patients died on the second postoperative day from technical difficulty: the rest did not have anastomotic leaks. They all eventually died of metastatic disease in 3-20 months. Two had mild dysphagic symptoms which did not require active intervention. It is concluded that a histologically positive oesophageal margin in total gastrectomy does not preclude good anastomotic healing. Sound surgical judgement is required to balance the risk of leaving a positive margin and the risk of an extended operative procedure particularly when majority of the total gastrectomies are palliative rather than curative.

Adenocarcinoma↗