Evaluation of a pylorus-preserving gastrectomy for patients preoperatively diagnosed with early gastric cancer located in the middle third of the stomach.

PURPOSE: Patients diagnosed with early gastric cancer located in the middle third of the stomach have two major surgical options, namely a conventional distal gastrectomy with Billroth I anastomosis (DG) or a pylorus-preserving gastrectomy (PPG). Pyloruspreserving gastrectomy is thought to have greater functional benefits than DG, but the evaluation of its prognosis and outcome has so far been insufficient. METHODS: Between 1997 and 2007, 133 patients were diagnosed with early gastric cancer located in the middle third of the stomach. Distal gastrectomy was performed in 87 and PPG was performed in 46 of these patients. The clinicopathological characteristics were compared between the groups. RESULTS: There were fewer dissected lymph nodes in PPG (mean: 21.9) than in DG (mean: 30.4, P = 0.001). Complications were detected in 16.1% of DG patients and in 6.5% of PPG patients. The occurrence of stasis after PPG (6.5%) was similar to that observed after DG (6.9%). One patient in the DG group died from cancer recurrence, but cancer recurrence was not detected in the PPG group. Although the difference was not significant, the overall 5-year survival rate in the 46 PPG patients (95%) was better than that in the 87 DG patients (86%, P = 0.087). CONCLUSIONS: Pylorus-preserving gastrectomy patients had fewer postoperative complications than DG patients. The long-term follow-up of these patients will clarify the nutritional and prognostic benefits of PPG.

[Intra-peritoneal chemotherapy for scirrhous gastric cancer].

Preoperative intra-peritoneal chemotherapy (IPC) for scirrhous gastric cancer (SGC) has been performed and followed after laparoscopic diagnosis of peritoneal metastasis (P) or washing cytology (CY) in our hospital. Between 2002 and 2005, 15 SGC patients were treated with 3 times of IPC using CDDP (50 mg/body) before operation (CDDP group). Between 2006 and 2008, 9 SGC patients were treated with IPC using docetaxel: DOC (40 mg/m2) and treated with systemic chemotherapy using S-1 (80 mg/m2) before operation (DOC group). Cases with P (+) or CY (+) were detected in 80% in CDDP group and in 89% in DOC group. Gastrectomy was performed in 67% of CDDP group and in 56% of DOC group. All of the 15 patients died in CDDP group but 4 of 9 were still alive in DOC group. The median survival time of DOC group (22 months) was longer than that of CDDP group (10 months, p=0.123). Thus, preoperative IPC using DOC combined with systemic chemotherapy using S-1 should be effective treatment for SGC.

Serum interleukin-6 and -10 levels in patients with gastric cancer.

BACKGROUND: Interleukin-6 (IL-6) is known to be a multifunctional cytokine and IL-10 is an immunosuppressive factor. Both have been reported to be related to the disease prognosis in some human solid tumors. In the present study, we evaluated the clinical significance of preoperative serum IL-6 and IL-10 levels as new tumor markers in patients with gastric cancer (GC). METHODS: Preoperative serum samples from 90 patients with GC and 9 normal healthy volunteers were assayed. Levels of IL-6 and IL-10 were determined by enzyme-linked immunosorbent assay (ELISA). The clinical significance of serum IL-6 and IL-10 levels was evaluated and compared with serum carcinoembryonic antigen (CEA) levels and serum C-reactive protein (CRP) levels in these patients. RESULTS: The serum level of IL-6 was significantly higher in the GC patients than in the healthy subjects. Serum IL-6 levels were strongly correlated with CRP levels, but did not correlate with CEA or carbohydrate antigen (CA) 19-9 levels. Serum IL-10 levels did not correlate with CEA, CA19-9, or CRP. Strong positive correlations between serum IL-6 levels and tumor size and tumor stage were observed. On the other hand, IL-10 did not correlate with such clinicopathological findings of tumors. However, high serum IL-10 levels were associated with a worse prognosis in the GC patients, independently of their tumor stage. CONCLUSION: These findings indicate that serum IL-6 may suggest gastric cancer progression. On the other hand, IL-10 may play an important role in host immunity and the prognosis of GC patients.