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PubMed2003

Pseudoaneurysm of gastroduodenal artery following radical gastrectomy for gastric carcinoma patients.

We report a rare case of postoperative pseudoaneurysm of the gastroduodenal artery following radical gastrectomy. Surgical trauma to the gastroduodenal artery during regional lymphadenectomy was considered as the cause of the postoperative pseudoaneurysm. The pseudoaneurysm was successfully managed by ligating the bleeding vessel. We should consider the possibility of pseudoaneurysm formation in a patient with gastrointestinal bleeding in the postoperative period following radical gastrectomy with regional lymph node and perivascular lymphatic dissection.

Aged↗
PubMed2003

Effects of two methods of reconstruction of digestive tract after total gastrectomy on gastrointestinal motility in rats.

AIM: To compare the effects of Roux-en-Y and jejunum interposition reconstruction procedures after total gastrectomy on intestinal motility. METHODS: Fifty male Sprague-Dawley rats were randomly divided into 5 groups: the control group (C), the laparotomy group (L), the jejunal transection group (JT) where the jejunum was transected 10 cm distal from the Treitz ligament and anastomosed, the Roux-en-Y group (RY) and the jejunal interposition group (JI) after total gastrectomy. To evaluate intestinal transit, the animals were given 0.1 ml Evans Blue solution through an orogastric tube. The rats were executed by CO(2) inhalation 30 minutes later and the intestinal transmit was determined as the distance between the site of esophageojejunal anastomosis and the most distal site of small intestine colored with blue. RESULTS: One month after operation, the body weight of rats among JI and RY were almost identical (274.6+/-9.5 vs 270.4+/-10.6, P>0.05), but were significantly lighter than those of JT and L group. Four months after the operation, the body weight in the JI group increased compared to the preoperative level (345.2+/-15.7 g vs 299.5+/-8.3 g, P<0.01). However, the body weight of RY group decreased compared to preoperative (255.1+/-11.3 g vs 295.0+/-12.0 g, P<0.01). The difference was more significant at six months postoperative. Small bowel transmit time in RY was slower than that in JI group and C group (P<0.01). CONCLUSION: Changes of body weight and intestinal motility in JI group are less influenced than in RY group.

Anastomosis, Roux-en-Y↗
PubMed2006

Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results.

BACKGROUND: The objective of our paper is to report on the long-term results of patients with gastric cancer treated by mini-invasive surgery with "intention-to-treat" laparoscopy. PATIENTS AND METHODS: Between June 1993 and January 2006, 130 patients comprising 94 men and 36 women with gastric adenocarcinoma were prospectively selected by two surgical teams in three hospitals based on a prior agreement (CHU Charleroi, Belgium, Centre Hospitalier de Luxembourg and Zumárraga Hospital, Spain). Patients with adenocarcinoma of the cardia were excluded. Mean age of patients was 68 years (range, 37-85 years). RESULTS: Post-operative mortality within 60 days of operation was 6 patients; 109 patients were therefore properly followed up for an average of 49 months (range, 2-153 months).Average survival time for 10 non-resected patients was 4.5 months. Average survival rate for all 14 palliatively resected patients was 6.9 months. Actuarial 5-year survival rate for R0-type surgery was 35%. Global actuarial 5-year survival rate after resective surgery was 31%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a major but safe operation with acceptable mortality and morbility rates in patients with advanced gastric cancer, usually in poor general condition. Laparoscopic gastrectomy for locally advanced cancers is equivalent to laparotomy as far as long-term oncological results are concerned.

Adenocarcinoma↗
PubMed1982

Long-term sequelae of gastrectomy.

The sequelae of gastrectomy are well-known. This paper describes a complicated clinical course which occurred eight years after partial gastrectomy. Initial features included marked weight loss, anaemia, multiple lung and liver abscesses, and cholestatic jaundice. Acalculous cholecystitis with a mucocele of the gallbladder developed later. We emphasise the value of total parenteral nutrition in supporting such critically ill patients.

Abscess↗
PubMed1999

[Initial experience with laparoscopic gastrectomy in benign and malignant tumors].

From May 1993 to May 1998 at our hospital 12 classic gastric resections were operated on by laparoscopic procedure. A 2/3 distal Billroth resection was performed in 5 patients, for gastric ulcer (2) and for GIST (3). Other 7 patients were curatively operated on for a malignant disease. Any case was resected by oncosurgical gastrectomy including a D2-lymphadenectomy. The histological diagnoses were an adenocarcinoma in 6 cases, and one highly malignant maltoma. The mean operating time was 230 min in Billroth I resections and 295 min in total gastrectomies. As a complication, we saw postoperatively a duodenal leakage in one case, we could successfully manage also laparoscopically on the day after the operation. All the courses were extremely uncomplicated, connected with rapid mobility, early gut motility, little pain, and a comfortable cosmetic result. The resection result in any case of malignoma was R0, the mean lymphonode amount was 34. Tumour cell dissemination and trokar site metastases we could'nt note either. Oncosurgically, there are no disadvantages in comparison to the open approach.

Adenocarcinoma↗
PubMedDate not supplied

[Restoration of digestive continuity after subtotal gastrectomy: comparison of the methods of Billroth I, Billroth II and roux en Y. Randomized prospective study].

UNLABELLED: The aim of this study was to evaluate functional results after Billroth I, Billroth II and Roux en Y reconstruction in subtotal gastrectomy. MATERIAL AND METHODS: 45 patients were randomised between 1990 and 1995 and stratified in 3 different groups: 15 BI, 15 BII and 15 Roux. They were investigated by EGDS with multiple biopsies and upper gastro-intestinal scintiscanning, to evaluate gastro-esophageal reflux (GER) and dynamics of gastric emptying. Besides they answered a questionnaire: "Gastrointestinal Quality of Life Index" (GIQLI). RESULTS: A reflux esophagitis was found in 5 BI, in 7 BII and in 2 Roux (p < 0.001). No gastric lesions were found in 6 BI, in 5 BII and in 12 Roux, (BI vs. Y, p < 0.05; BII vs. Y, p < 0.001). Chronic superficial gastritis was present in 9 BI, in 4 BII and in 3 Roux (BI vs. Y, p < 0.05). Dynamic scintiscan demonstrated the presence of GER in 5 BI and gastric emptying was fast (37' < T 1/2 < 86'), but incomplete (60' residual activity: 49-62%). GER was evident in 7 BII with slow (28' < T 1/2 < 143') and incomplete (60' residual activity: 48-72%) gastric emptying. GER was detected in 2 Roux and radioactive bolus progression in the Roux limb was fast (24' < T 1/2 < 53') and complete (60 residual activity: 42-52%) (BI vs. Y; BII vs. Y, p < 0,001). There was not statistical significance between GIQLI score in the 3 groups. CONCLUSION: The authors affirm the Roux en Y is the technique of choice in subtotal gastrectomy, if compared with BI and BII.

Adult↗
PubMedDate not supplied

Total gastrectomy.

Total gastrectomy with lymph node dissection is one of the standard operations for gastric malignancies without distant metastases. Surgical procedures of total gastrectomy are described with illustrations easy to understand anatomy. Practical application and survival of patients are also shown.

Anastomosis, Surgical↗
PubMedDate not supplied

Post-operative chemotherapy in non-curative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: The definitive effects of post-operative chemotherapy for prolonging survival in patients with non-curative gastrectomy for advanced gastric cancer have not been established. METHODOLOGY: Eighty-three patients with advanced gastric cancer who underwent non-curative gastrectomy were divided into 49 patients with post-operative chemotherapy (chemotherapy group) and 34 patients without post-operative chemotherapy (control group). Chemotherapy regimens were as follows: oral 5-fluorouracil (5-FU) alone (n = 22), intravenous mitomycin (MMC) plus 5-FU (n = 20), intravenous methotrexate (MTX) plus 5-FU (n = 3), intravenous cisplatin plus 5-FU (n = 2), and hepatic arterial infusion of 5-FU plus oral 5-FU (n = 2). No prior chemotherapy or radiation therapy was given. RESULTS: Although the age in the control group (mean: 71.9 years) was significantly older than in the chemotherapy group (mean: 66.1 years), there were no significant differences in the other clinical and pathological background data between the two groups. The 1-year survival rate in the chemotherapy group (71.4%) was significantly higher than in the control group (50.0%). However, the 3-year and 5-year survival rates did not significantly differ in the chemotherapy group versus the control group, 30.6% vs. 32.4% and 24.5% vs. 32.4%, respectively. Although a significant difference did not exist between the two groups, median survival after operation in the chemotherapy group (20.5 months) was longer than that in the control group (16.2 months). Furthermore, median survival of patients with peritoneal dissemination in the chemotherapy group (16.4 months) was significantly longer than that in the control group (7.7 months). CONCLUSIONS: Post-operative chemotherapy may contribute to prolonged survival in patients with non-curable advanced gastric cancer, even when patients had peritoneal dissemination. However, the long-term survival rate was not improved by post-operative chemotherapy. More aggressive chemotherapy may be needed to improve the long-term prognosis for such patients.

Adenocarcinoma↗
PubMed1999

Remote partial gastrectomy as a risk factor for pancreatic cancer: potential for preventive strategies.

BACKGROUND: Pancreatic cancer is the fifth leading cause of cancer death mainly because of an advanced disease stage at the time of diagnosis. Patients with a remote partial gastrectomy for benign ulcer disease may constitute a high risk group for pancreatic cancer; an increased index of suspicion could potentially lead to early detection in these patients. METHODS: The risk of developing pancreatic cancer following partial gastrectomy was evaluated by reviewing the literature. Furthermore, the risk of pancreatic cancer in an Amsterdam cohort of 2633 postgastrectomy patients has recently been assessed. The presence and type of K-ras codon 12 mutations in 15 postgastrectomy pancreatic cancer cases were also determined and compared to the conventional spectrum of these mutations in sporadic pancreatic cancer. RESULTS: After a follow-up time of 20 years or more since peptic ulcer surgery, the relative risk reported in the literature varies from 1.65 to 5-fold. In the Amsterdam cohort of 2633 postgastrectomy patients an overall increased risk of 1.8 was observed. The risk gradually increases to 3.6 after a postoperative interval of 35 years or more. A comparable frequency and type of K-ras codon 12 mutations was found in the postgastrectomy pancreatic cancer cases as reported in sporadic pancreatic cancer in non-operated patients, suggesting a similar carcinogenesis in the two groups and indicating a potential utility of this molecular marker for surveillance strategies. CONCLUSIONS: Patients who underwent peptic ulcer surgery are at higher risk of developing subsequent pancreatic cancer, especially after a prolonged (> 20 yrs) postoperative interval. An increased index of suspicion may contribute to early detection in these patients. The similar K-ras codon 12 mutation pattern in conventional and postgastrectomy pancreatic cancers makes this a suitable target for molecular diagnosis in these patients.

Gastrectomy↗
PubMed1999

Post-gastrectomy bone disease undiagnosed for forty years.

Polya partial gastrectomy was performed for peptic ulcer in a previously healthy woman aged 28 years. She complained afterwards of a variety of non-specific symptoms including weakness, tiredness, debility, slowness of walking, poor appetite and constipation. Within ten years her back became bent. She was treated for intercurrent hypertension and epilepsy. Bone fractures on low-impact trauma occurred in her fifties. At 57 years, she was unable to care for herself and had to be admitted to a nursing home. She could still walk slowly with the aid of a stick. For three months at the age of 65 years, she was unable to rise from her chair. Investigations disclosed severe post-gastrectomy bone disease. At no time had she complained of bone pains.

Absorptiometry, Photon↗
PubMedDate not supplied

Efficacy of extended lymphadenectomy in the noncurative gastrectomy for advanced gastric cancer.

BACKGROUND/AIMS: We retrospectively analyzed clinicopathologic data on 83 patients with advanced gastric cancer who underwent noncurative gastrectomy, with respect to the relation between the extent of lymphadenectomy and survival benefit. METHODOLOGY: These 83 patients were divided into 44 patients with limited or simple lymph node dissection (D0 in 14 and D1 in 30: Group A) and 39 patients with extended lymph node dissection (D2: Group B). RESULTS: The 1-year survival rate in Group B (82.1%) was significantly higher than in Group A (49.0%). However, the 3-year and 5-year survival rates did not significantly differ between Group A versus Group B, 39.7% versus 25.7% and 39.7% versus 20.5%, respectively. Median survival time after surgery with and without distant metastasis in Group B (21.5 months) was longer than in Group A (16.4 months), although not significant. CONCLUSIONS: While gastrectomy with extended lymphadenectomy did not contribute to improve long-term survival in patients with noncurable advanced gastric cancer, the utility of extended lymph node dissections may be relevant to improved locoregional control, at least in the prognosis within 1 year after surgery. Not only extended lymphadenectomy but also aggressive chemotherapy may be needed to improve the long-term survival for such patients.

Aged↗
PubMed1999

[Result of Panzytrat 25000 therapy following total gastrectomy].

Thirteen patients who had undergone total gastrectomy because of gastric cancer in 11 cases and gastric lymphoma in 2 cases (6 female, 7 male) at the 3rd Department of Surgery, Semmelweis University, Medical School have been followed up. The length of follow up period varied between 7.5 months and six years. Vitamin B12 substitution was applied in each case (300 micrograms/month). In 6 cases early temporary iron substitution was necessary. Regular pancreatic enzyme substitution (pancreatin) was used during meals in these patients. At the beginning Kreon (Chinoin) or Neo-Panpur (Egis) treatment was applied. Since April 1996 the patients have been treated by Panzytrat 25,000 (Knoll) which has higher enzyme content comparing with the previous ones. Following gastrectomy the digestion and absorption improved due to pancreatic enzyme substitution and the body weight increased. The serum albumin and cholesterol levels elevated significantly, while the serum uric acid levels did not changed. The iron absorption improved, patients did not require iron substitution later, except two cases. One of them needed transitoric and the other continuous iron substitution. Side effects were recorded in six cases. One of the 13 patients stopped application of Panzytrat 25,000 because of epigastric pain among other side effects (2 epigastric pain, 2 hyperuric state, 2 frequent discharge of stool) and returned to well tolerated Neo-Panpur.

Female↗
PubMed1999

[Cancer of the cardia: value of total gastrectomy with partial esophagectomy by laparotomy-right thoracotomy approach].

INTRODUCTION: Surgical resection of cardial and subcardial cancers is often associated with pathological involvement of esophageal section margin, resulting in early anastomotic recurrences. Total gastrectomy associated with partial esophagectomy through combined abdominal and right thoracic approach allows esophageal section under azygos vein. PATIENTS AND METHODS: We studied, in 17 patients operated on using this procedure, post-operative morbidity, mortality and anastomotic relapse. RESULTS: No post-operative death, fistula or anastomotic relapse have been observed. Two patients exhibited benign infectious post-operative complication. CONCLUSION: Total gastrectomy with partial esophagectomy through combined abdominal and right thoracic approach seems therefore to be considered as a good alternative in the surgical management of cardial and subcardial carcinomas.

Adenocarcinoma↗
PubMed1999

[Gastrectomy in the treatment of gastric hemorrhage].

The results of gastrectomies performed in 7 women and 13 men (aged from 41 to 73) with various diseases of the stomach (cancer, non-epithelial tumors, erosive and ulcerous gastritis, ulcer and phlegmonous gastritis) are analyzed. The surgical interventions included operations from gastrectomy to gastropancreatosplenoduodenocholecystectomy with phleboplasty of the portal vein and extended parietal lymphadenectomy. Ten operations were made for profuse bleedings with 4 fatal outcomes. During the first 48 hours after the appearance of the complication 10 patients were operated upon for the recurrence of the risk of recurrent hemorrhage. The formation of muff-like variants of esophagojejunostomy was preferred. The results are considered to be promising.

Adult↗
PubMed2000

The National Cancer Data Base Report on poor survival of U.S. gastric carcinoma patients treated with gastrectomy: Fifth Edition American Joint Committee on Cancer staging, proximal disease, and the "different disease" hypothesis.

BACKGROUND: A high proportion of U.S. patients with gastric carcinoma do not receive surgical treatment. To sharpen staging criteria and facilitate comparisons with surgical series, an analysis of patients whose treatment included gastrectomy was undertaken. In addition, to evaluate the "different disease" hypothesis as an explanation for superior Japanese results, outcomes for Japanese Americans were examined. METHODS: Data were obtained from National Cancer Data Base (NCDB) reports of 50,169 gastric carcinoma cases diagnosed during the years 1985-1996 and treated with gastrectomy. In addition to demographic and treatment information, 5-year and 10-year relative survival rates are presented, with stage defined according to fifth edition American Joint Committee on Cancer (AJCC) staging procedures. RESULTS: Stage-stratified 5-year and 10-year relative survival rates were as follows: Stage IA, 78%/65%; Stage IB, 58%/42%; Stage II, 34%/26%; Stage IIIA, 20%/14%; Stage IIIB, 8%/3%; and Stage IV, 7%/5%. Stage-stratified survival for Japanese Americans was higher. Males had a poorer prognosis than females, and the male-to-female ratio for Japanese Americans was lower. Proximal tumors were associated with a worse prognosis than distal tumors; the proportion of Japanese Americans with proximal disease was less than in the overall patient group. Japanese Americans underwent resection of adjacent organs less frequently. In this series, adjuvant therapy did not substantially affect survival. Overall, 20% were 10-year survivors; of these, 67% were lymph node negative and 98% had </= 8 involved lymph nodes. Five-year stage-stratified survival increased for cases with >/= 15 lymph nodes analyzed. Stage migration was evident in cases with </= 15 nodes examined. CONCLUSIONS: The current AJCC/International Union Against Cancer TNM staging system fails to accommodate the effect of proximal location on prognosis. Largely because Japanese Americans present with fewer proximal tumors, have a lower male-to-female ratio, and undergo adjacent organ resection less frequently, stage- stratified survival for Japanese Americans appears to be superior. In the U.S., surgical undertreatment of patients with this disease appears to be a problem.

Aged↗
PubMed2000

Chylous ascites: a rare complication of radical gastrectomy.

Chylous ascites is the accumulation of lymphatic fluid within the peritoneal cavity, due to trauma or obstruction to the lymphatic system. Postoperative chylous ascites is a rare complication of abdominal surgery. This is frequently reported after retroperitoneal dissections, and results in high morbidity and mortality. The treatment options are varied and include total parenteral nutrition (TPN), elemental diet with medium chain triglycerides (MCT), repeated paracentesis and surgical ligation. We report a case of post-operative chylous ascites after D2 distal gastrectomy. Treatment by fasting, TPN followed by fat-free diet resulted in complete resolution of ascites within 3 weeks. To our knowledge this is the first report of such a complication following radical gastrectomy. We review the literature and briefly discuss the management options.

Aged↗
PubMed2000

[Copper deficiency anemia and neutropenia secondary to total gastrectomy].

We report a case of copper deficiency with anemia and neutropenia due to dumping syndrome after total gastrectomy. Parenteral nutrition containing cupric sulfate promptly improved the dumping syndrome, anemia and neutropenia. This case suggests that total gastrectomy with dumping syndrome can cause copper deficiency, and that copper deficiency should be considered when encountering similar patients with severe anemia and neutropenia.

Anemia↗
PubMedDate not supplied

Jejunal pouch interposition with an antiperistaltic conduit as a pyloric ring substitute after standard distal gastrectomy: a comparison with the use of an isoperistaltic conduit.

BACKGROUND/AIMS: We performed jejunal pouch interposition with a short antiperistaltic conduit as a pylorus substitute after gastrectomy for gastric cancer and compared the outcome with an isoperistaltic conduit. METHODOLOGY: After a standard distal gastrectomy and lymph node dissection, a 15-cm-long pouch was formed using 3 linear staples (Endo-GIA) and interposed between the residual stomach and duodenum. The distal jejunal limb was made into a 3-cm-long isoperistaltic conduit in the isoperistaltic group (n = 17), and the proximal jejunal limb was made into a 3-cm-long antiperistaltic conduit in the antiperistaltic group (n = 8). Postoperatively, the patients were interviewed periodically to document any complaints. A dual-phase, dual-isotope radionuclide gastro-pouch-emptying study was performed 1 and 6 months after surgery. RESULTS: None of the patients developed postoperative complications and showed discomforts of dumping, stasis or reflux esophagitis. The dietary volume and body weight of patients gradually increased in both groups after 6 months. The combined radioisotope retention rate for the pouch and residual stomach was 31% for liquid food and 35% for solid food in the isoperistaltic group after 120 min, and 41% and 57%, respectively, in the antiperistaltic group. The pattern and emptying rate for solid food in the antiperistaltic group were more similar to those in healthy individuals than in the isoperistaltic group. CONCLUSIONS: The gastro-pouch-emptying test in the antiperistaltic group demonstrated acceptable emptying for a pyloric ring substitute. A reasonably good quality of life has been obtained for patients having an antiperistaltic jejunal conduit.

Aged↗