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PubMedDate not supplied

Apoptosis in Helicobacter pylori gastritis and residual gastritis after distal gastrectomy.

BACKGROUND/AIMS: Active gastritis, accelerated cell turnover followed by apoptosis, DNA damage and hyperplasia are often seen in the anastomosis area after gastrectomy. Recently, it has been reported that H. pylori induces apoptosis on gastric cells. Until now, the surgical effect itself and H. pylori infection have not been well differentiated as causes of apoptosis associated with gastritis. Our aim is to clarify the relationship of residual gastritis after gastrectomy and H. pylori gastritis. METHODOLOGY: Residual gastritis model using the Mongolian gerbil has been established with microsurgical technique. Residual gastritis with and without H. pylori infection was studied by histopathological examination and quantitated by Rauws' score. Elevation of pH in gastric juice after surgery was confirmed. Stimulation of downstream events leading to apoptosis, cleavage of poly-ADP-ribose polymerase as a result of activation of caspase-3, was evaluated using Western blotting. RESULTS: Histopathologically, H. pylori infection led to deterioration after surgery. The postoperative Rauws' score with infection was higher than without infection. Cleavage of poly-ADP-ribose polymerase was increased after surgery in gerbils with and without H. pylori infection. Densitometric study showed a greater increase in the animals with H. pylori infection than those without infection that was enhanced after surgery (0.59 vs. 1.04, 0.73 vs. 1.17, respectively). CONCLUSIONS: Apoptosis is increased both in residual gastritis and H. pylori gastritis. Both enterogastric reflux and H. pylori infection may be linked to tumorigenesis in anastomosis sites followed by accelerated epithelial cell turnover followed by apoptosis.

Animals↗
PubMedDate not supplied

Reevaluation of routine gastrointestinal decompression after gastrectomy for gastric cancer.

BACKGROUND/AIMS: We reviewed postoperative courses of patients with gastric cancer who underwent gastrectomy to evaluate the need for routine postoperative gastrointestinal decompression. METHODOLOGY: Three hundred patients who underwent gastrectomy during 1998 and 1999 were enrolled in this study. A nasogastric tube was placed in all patients just after induction of the anesthesia. The patients were divided into two groups, 150 patients for each. In group 1, the nasogastric tube was maintained until the passage of flatus per rectum. In group 2, the nasogastric tube was removed immediately after the operation. RESULTS: The return of bowel function, return to a diet and postoperative length of hospital stay were similar in both groups. In group 1, only one patient (0.7%) had abdominal distension and no patient vomited, while four patients (2.7%) had abdominal distension and one patient (0.7%) vomited in group 2. There were no significant differences in the incidence of respiratory complications, anastomotic leakage and wound complications between the two groups. Postoperative death was rare, with the incidence of 0.7% in each group. There was a significantly high incidence of patient's discomfort in group 1. The major complaint was sore throat and it caused sleep disturbance when severe. CONCLUSIONS: It is desirable to insert a nasogastric tube while the patient is in the anesthetized state and keep it during operation and remove it immediately after operation, when no active bleeding is detected.

Decompression, Surgical↗
PubMedDate not supplied

[The treatment of advanced gastric cancer: total gastrectomy "extended" as needed].

Extended resections do play a definite role in the surgical approach to advanced gastric malignancy. Local extension of distant spread of the tumor is no longer to be considered as a contraindication to aggressive surgery based on the evidence that even for palliation, extensive operations, when feasible, have proved to be beneficial in preventing complications related to the natural history of the disease. Over a nine-year period 105 patients with gastric cancer were surgically treated. Out of the 88 patients undergoing tumor excision, 53 were submitted to total gastrectomy (there were 35 males and 18 females, mean age 63 years). This procedure was considered potentially curative in 37 cases and palliative in 16. In 8 of the patients treated with palliation. An extensive procedure, including splenectomy in 7 cases (1 of which with concomitant distal pancreatic resection) and a colonic resection in 1 case, was undertaken. Alimentary continuity following total gastrectomy was restored by jejunal interposition (Mouchet-type reconstruction) in 3 cases, Roux-en-Y esophagojejunostomy in 7 and simple: end-to-side esophagojejunostomy (Sweet and Allen-type) in 6. No postoperative complications have occurred and mean survival time was 8 months with a maximum of 20 months in a patient with a good nutritional status and quality of life (Karnofsky index 78%) who developed no complications related to tumor recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1992

[Gastrectomy at the peak of gastric bleeding].

The technique for performance of gastrectomy under conditions of emergency surgery permitting to shorten the duration of intervention and increase its effectiveness is presented. Gastrectomy was performed in 7 patients with gastric cancer complicated by profuse bleeding. All the patients are alive, no anastomotic suture failure occurred.

Aged↗
PubMedDate not supplied

New method for Billroth I reconstruction after distal gastrectomy.

Authors report a new technique for Billroth I reconstruction after distal gastrectomy using linear stapling devices, which is easier than conventional methods. The duodenum is divided 0.5 cm distal to the pyrolus ring, with a 55-mm linear stapler. The anterior wall of the duodenum is cut along the planned line of anastomosis with the gastric remnant. The anterior wall of the stomach is cut along the planned suture line having a length similar to that of the duodenum. The posterior walls of the stomach and the duodenum are placed back to back on the planned anastomotic line. End-to-end posterior anastomosis between the gastric remnant and the duodenum is simultaneously performed with gastrectomy using a 100-mm linear stapler. End-to-end anterior anastomosis is performed by hand. This technique has been used in 7 patients, and there have been no complications related to this procedure. Operative time was 152 +/- 16 min (range 130 to 180 min) on average. It is an economical and easy procedure for Billroth I reconstruction.

Anastomosis, Surgical↗
PubMed1992

[Survival after gastrectomy for cancer. 209 cases].

The long-term results of 209 gastrectomies performed for adenocarcinoma, including 117 which were prospectively collected, are presented. Resection was curative in 154 cases (73.6 percent). The TNM distribution of the tumours was: stage I (TxNOMO) 75 cases, stage II (TxN1MO) 46 cases, stage III (TxN2MO) 33 cases and stage IV (TxNxM1) 55 cases. Lymph node involvement was more frequent in the prospective than in the retrospective study. With a more than 5 years' follow-up of 80 percent of the patients operated upon, the actuarial survival rate at 5 years (operative mortality included) was 38 percent for all lesions, 52 percent for curative resection and 2 percent for palliative resection. Following curative resection, the survival rates for tumours of the upper, middle and lower thirds of the stomach were 40, 60 and 55 percent respectively. These rates were 60 percent for stage I tumours, 54 percent for stage II tumours and 25 percent for stage III tumours. The results obtained in this series, where most of the curative gastrectomies included excision of N1 and N2 lymph nodes, show that lymph node involvement has no significant importance for the prognosis when it is proximal (N1) and is not incompatible with prolonged survival when it is pedicular (N2).

Actuarial Analysis↗
PubMed2003

[From endoscopic mucosa ressection to gastrectomy. How radical must surgery be for stomach cancer?].

The aim of surgical treatment is complete resection (Ro-resection) of the tumor in all dimensions of its growth, i.e. resection of the tumor infiltrated stomach including the locoregional lymph nodes. This can be achieved by stage- or histology adapted surgery resulting in subtotal distal and total gastrectomy as complementary procedures. Local excision of gastric carcinoma in curative intent is indicated only in mucosal carcinoma of the intestinal type. The extent of lymph node dissection is still under discussion; the results depend on the experiences of the surgeon. Several studies have shown a prognostic improvement after systematic (D2) lymphadenectomy in stage II/IIIA-disease or in patients with a low incidence of lymph node metastases. Pancreas preserving splenectomy is suggested in tumors of the proximal stomach or after direct infiltration of these organs. The Roux-en-Y procedure represents the most commonly used method of reconstruction after subtotal distal or total gastrectomy. The importance of the duodenal passage as well as of the pouch construction must be investigated in prospective studies in the future. This is true for the value of perioperative multimodal treatment options.

Gastrectomy↗
PubMedDate not supplied

[Paracoccidioidomycosis and gastrectomy].

In a review of the clinical records of 757 cases of paracoccidioidomycosis 11 (1.5%) of the patients had been previously submitted to gastrectomy. It is suggested that after gastrectomy individuals present a higher risk for the development of such infections, similar to that which occurs in tuberculosis.

Adult↗
PubMedDate not supplied

The role of extended total gastrectomy in advanced gastric cancer.

BACKGROUND/AIMS: Extended total gastrectomy represents, in our experience, 52 out of 443 (11.7%) surgical resections for gastric cancer (1976-1998, 269 total gastrectomies). METHODOLOGY: Enlarged resections were performed on left liver lobe (5 cases), transverse colon (8 cases), pancreas body-tail (35 cases), mesocolon (4 cases), diaphragm (6 cases), jejunum (1 case), and adrenal gland (1 case). RESULTS: Morbidity rate was 18 out of 52 cases (34.60%); 1 esophagus-jejunum anastomosis leakage, 6 cases of pneumonia, 1 pancreatic fistula, 1 p.o. pancreatitis, 3 subphrenic abscesses, 4 cardiocirculatory complications, successfully resolved with conservative therapy. There was one case of postoperative death (1.9% due to cardiac failure). There was a 5-year survival rate for 36.5% of the patients, with follow-ups from 6 months to 11 years. The authors, based on their data, international literature (Roder 1993, Cordiano 1996, Shchepotin 1998) and taking into account mortality and morbidity rates estimate a 5-year survival rate in 30-52% of the cases. CONCLUSIONS: In conclusion, we believe that major surgical procedures for gastric cancer are indicated for every case of suspected neoplastic infiltration of contiguous organs.

Adult↗
PubMedDate not supplied

[Completion gastrectomy associated with pancreaticoduodenectomy].

The authors present the case of a male patient, aged 56, operated (partial gastrectomy) for peptic ulcer 20 years ago, who is admitted for epigastric pain and distension, frequent vomiting, asthenia and weight loss. Physical examination, barium meal and upper digestive endoscopy with biopsy established the diagnosis of carcinoma of the gastric stump, due to malignant transformation of adenomatous polyps, with duodenal invasion. Completion of gastrectomy and pancreaticoduodenectomy was performed, with good postoperative results. Although the extent of resection may appear excessive, our attitude was justified by the features of the lesion and good biological condition of the patient.

Carcinoma, Papillary↗
PubMedDate not supplied

Complication of jejunal pouch interposition after proximal gastrectomy: case report.

Interposition of a jejunal pouch after proximal gastrectomy is a popular reconstruction method in Japan, because it produces a good quality of life soon after surgery. Many reports have described its usefulness. However, there are few reports describing its complications. We report here for the first time a case of pouch stasis needing surgery. A 23-year-old man underwent proximal gastrectomy with interposed jejunal pouch for traumatic strangulated diaphragmatic hernia. Three years later, he complained of persistent vomiting. Since surgery, he had eaten as much as other young people. An upper gastrointestinal series showed dilatation of the jejunal pouch and stasis of contrast medium. Since conservative therapy was not effective, surgery was performed. In the operative findings, the jejunal pouch was extremely dilated, the remaining stomach had become atrophic, and moreover, the anastomosis was severely distorted. It was considered that frequent excessive ingestion caused irreversible dilatation of the jejunal pouch, resulting in pouch stasis. Even though the jejunal pouch is interposed for reconstruction, it is very important to give nutritional guidance to patients, especially young patients, to prevent pouch stasis caused by excessive food ingestion.

Colonic Pouches↗
PubMed2004

[Thiamine deficiency polyneuropathy after gastrectomy associated with high level of serum vascular endothelial growth factor (VEGF). A case report].

We report a 66-year-old man who developed vitamin B1 deficiency polyneuropathy long after a gastrectomy. After a preceding bronchial infection, the patient noticed numbness and weakness in his extremities, followed by generalized edema and exertional dyspnea. He had undergone subtotal gastrectomy due to duodenal ulcer at age 19. His daily oral intake of food was normal without any alcoholic abuse. He was admitted to our hospital with rapidly progressive gait disturbance due to muscle weakness, and sensory disturbance. Neurological examination showed peripheral polyneuropathy with distal dominant muscular weakness and sensory disturbance. Chest X-ray film showed marked cardiomegaly and pleural effusion. Nerve conduction studies showed decreases in the action potentials of both the motor and sensory nerves, with the sensory nerves being more severely affected than the motor nerves. Sural nerve biopsy demonstrated severe axonal degeneration without any inflammatory change. The blood concentration of thiamine (vitamin B1) was slightly decreased below the normal range (19 ng/ml; normal, 20-50), and the serum vascular endothelial growth factor (VEGF) was high (890 pg/ml; normal < 200 pg/ml). Intravenous administration of vitamin B1 (50 mg per day) dramatically improved his symptoms in a few days and the level of VEGF returned to nearly normal. In this gastrectomized patient many years ago, vitamin B1 deficiency neuropathy is warranted in view of a prompt response to thiamine administration. This case suggests that VEGF is involved in the pathogenesis of vitamin B1 deficiency polyneuropathy.

Aged↗
PubMed2004

Laparoscopically assisted total gastrectomy with sentinel node biopsy for early gastric cancer: preliminary results.

This study sought to describe a procedure involving laparoscopically assisted total gastrectomy (LATG) with sentinel node biopsy (SNB) and to evaluate the results of the first three patients. LATG for early gastric cancer was performed with sentinel node (SN) identification using a combined patent blue-violet dye and 99mtechnetium-labeled tin colloid technique. Laparoscopically resected SNs were processed for frozen section examination by routine hematoxylin and eosin (H&E) and immunohistochemical cytokeratin (IHC-CK) stains. LATG consists of a four-surgical port technique, removal of the specimen through a small 5-cm laparotomy, and stapled Roux-en-Y esophagojejunostomy. Five patients were candidates for LATG with SNB between March 2001 and June 2003; two had open surgery because of a tumor extending the serosal surface and peritoneal dissemination, whereas in the remaining three, SNs were successfully identified and evaluated with no evidence of sentinel node (micro) metastases intraoperatively. Based on the results of SNB, three patients underwent LATG with adequate lymphadenectomy. Mean operative time and blood loss were 375 min and 219 mL, respectively. No dissected lymph nodes had evidence of metastasis by H&E and IHC-CK on permanent sections. LATG with SNB followed by adequate lymphadenectomy is technically feasible, and with its acceptable operative time and blood loss, presents an excellent therapeutic option for early gastric cancer; while SNB and subsequent frozen section analysis by H&E and IHC-CK staining is a rapid and reliable diagnostic method for intraoperative detection of SN (micro) metastasis. This combination treatment is a promising alternative to laparoscopic gastrectomy with conventional lymphadenectomy.

Adenocarcinoma↗
PubMed1992

[Previous history of gastrectomy in the aged: a malnutrition with malignant aspect].

Between 1979 and 1986 a prospective study was performed on 15 gastrectomized (Billroth II) patients, who were above 65 years old, with evidence of clinical malnutrition as defined by anthropometric criteria. Gastrectomy had been performed between 2 and 55 years before the study (29 +/- 12.87 years). In twelve patients weight loss was observed ranging from 5.85 and 11.91 kg in a mean period of 12.7 months immediately prior to admission. In 8 cases the initial diagnosis was of malignancy, in 2 cases of severe anemia, and in 1 case of severe malnutrition. Intestinal malabsorption (IMB) was observed in 5 cases and intestinal bacterial overgrowth (IBO) in 2 cases, and both diagnosis in 4 cases using stool fat test and D-xylose test for the diagnosis of IMB and urine determination of Urican for the diagnosis of IBO. In two patients the test were normal and they could not be performed in two other. In 3 patients malignancy could not be observed however one of them presented IMB and the other IMB and IBO. We conclude that gastrectomy when performed in earlier ages can cause malnutrition at an older age, provoking a sudden malnutrition suggestive of malignancy. Most of these patients present IMB and/or IBO. Since IBO can cause irreversible mucosal damage, it is discussed whether this could be the cause of this clinical picture.

Aged↗
PubMed1992

Stomach cancer after partial gastrectomy for benign ulcer disease. A critical analysis of epidemiological reports.

The controversy about the risk of cancer in patients surgically treated for peptic ulcer is debated in the literature. We analyzed published epidemiological studies, in an attempt to answer the following questions: 1) is there an increased risk of cancer in patients who underwent partial gastrectomy for ulcer disease?; 2) is such a risk influenced by the type of operation performed and by the original pathological lesion?; 3) are there any recommendations for peptic ulcer surgery and for a specific follow-up schedule of the patients? Twelve "prospective" studies have been published on patients operated on for peptic ulcer. These studies are based on the follow-up of a cohort over a certain period of time. Results are expressed and analyzed using the incidence ratio observed in the cohort, comparing observed with expected cases in a similar general population. The results of seven of these studies favor the hypothesis of an increased risk of stomach cancer in patients operated on for peptic ulcer disease, while those of five do not support this hypothesis. The results of two of these studies were obtained by multivariate analyses, which represent the best statistical methodology known for assessing the respective role of confounding variables. We therefore believe that the evidence is good enough to identify patients who underwent partial gastrectomy more than 20 years previously as a high-risk group for the development of carcinoma. We therefore recommend that these patients should be offered regular endoscopy, especially if they underwent a Billroth II surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Delayed gastric emptying after distal gastrectomy for gastric cancer.

BACKGROUND/AIMS: Gastric surgery may potentiate delayed gastric emptying. The aims of the study were to determine the frequency and causes of delayed gastric emptying in patients who had undergone distal gastrectomy for gastric carcinoma and to assess which factors predispose to its development. METHODOLOGY: 209 patients, who had undergone gastrectomy, were evaluated. RESULTS: Delayed gastric emptying occurred in 4.3% of patients receiving a Billroth-I, and 15.5% of patients receiving a Roux-Y reconstruction (p = 0.01). The patients who had these consecutive symptoms following Roux-Y operation were all clinically diagnosed as having Roux stasis syndrome. The delayed gastric emptying after Roux-Y operation was more frequent in patients receiving extensive lymph node dissection than those receiving conventional dissection (p<0.05). The symptoms spontaneously subsided, and postoperative body weight loss was not significant. CONCLUSIONS: In spite of the strong association between delayed gastric emptying and the Roux-Y procedure, it enables a relatively early return to oral intake.

Adenocarcinoma↗
PubMedDate not supplied

Inhibitory remnant stomach motility by duodenal distention after B-I gastrectomy.

BACKGROUND/AIMS: Although control of gastric motility is a highly regulated process, B-I gastrectomy causes accelerated gastric emptying. We found few reports so far concerned with the mechanical effect of balloon distention of the duodenum on the remnant stomach in B-I dogs. METHODOLOGY: Four weeks after conventional distal gastrectomy with B-I reconstruction procedure, a balloon was inserted into the duodenum, and strain gauge force transducers (SGTs) were sutured onto the wall of the gastric remnant and duodenal serosa in beagles. After a two-week postoperative recovery period, gastro-duodenal motility was measured with SGTs prior to distention, during distention, and after evacuation of the balloon. The motility index (MI) was calculated every 30 minutes. RESULTS: Upon duodenal distention with 4 mL of water, motility of gastric remnant was significantly inhibited, however, no reduction in duodenal MI was observed. The response was maintained for as long as duodenal distension continued. Ninety minutes after evacuation of the balloon, MI returned to predistension levels. Increased plasma levels of cholecystokinin (CCK) were observed upon distention of the duodenal balloon. CONCLUSIONS: Motility of the remnant stomach in B-I dogs was inhibited by duodenal distension. Increased levels of plasma CCK during distention might play a role in this feedback mechanism.

Animals↗
PubMedDate not supplied

Successful pancreatoduodenectomy for carcinoma of the ampulla of vater after esophagectomy with remnant gastrectomy.

A 59-year-old man was admitted to our hospital because his serum hepatobiliary enzymes were elevated on the medical check-up in September 2003. In his past history, he had undergone distal gastrectomy for a gastric adenoma 17 years before. Furthermore, he had undergone subtotal esophagectomy with remnant gastrectomy, the right colon and ileum were used for the reconstruction, and a cervical esophago-ileostomy and an abdominal colo-duodenostomy were made in the fashion of an interposition. Duodenoscopy was performed and showed the protruded lesion of the ampulla of Vater, biopsied specimens from this tumor revealed adenocarcinomas. Accordingly, we performed pancreaticoduodenectomy with regional lymph nodes dissection. The problem in this case was that the rt middle colic artery (MCA), and the middle colic vein (MCV) tend to be injured because these vessels are situated near the caudal region of the pancreas. We were able to identify the superior mesenteric vein (SMV) safely due to approaching this vein from the flank and mobilizing the duodenum, dissecting behind the mesenteric trunk from right to left. Double cancer of the ampulla of Vater and the esophagus are extremely rare, with only 4 cases reported. And we recommended the use of the dorsal approach to the SMV to avoid injuring the MCV such as in this case.

Adenocarcinoma↗