Is adjuvant chemotherapy necessary in pT1N1 gastric cancer?

BACKGROUND: Due to a lack of consensus on adjuvant treatments for pT1N1 gastric cancer, surgeons face a dilemma when deciding treatments for patients with pT1N1 gastric cancer after gastrectomy. The objective of this study was to determine survival benefits of adjuvant chemotherapy and risk factors for tumor recurrence in gastric cancer patients with pT1N1. METHODS: Between 1996 and 2010, 510 patients who underwent curative resection for pT1N1 gastric cancer at three institutes were divided into two groups: adjuvant chemotherapy group (N = 150) and surgery-only group (N = 360). Disease-free survival rates and risk factors for tumor recurrence were analyzed. RESULTS: During the median follow-up of 78 months, 7.5% of patients experienced tumor recurrence (7.3% in adjuvant chemotherapy group and 7.5% in surgery-only group). The 5-year disease-free survival rate was 91.8% in the adjuvant chemotherapy group and 94.6% in the surgery-only group without significant difference between the two. In univariate analysis, older age (>65 years), male gender, body mass index <25 kg/m2, elevated gross type, and differentiated histology were associated with tumor recurrence. Multivariate analysis showed that advanced age and male gender were independent risk factors for tumor recurrence. In addition, adjuvant chemotherapy showed no benefitial effect on tumor recurrence in pT1N1 gastric cancer. CONCLUSIONS: Adjuvant chemotherapy did not show any oncologically benefitial effect on tumor recurrence, it might be unnecessary for pT1N1 gastric cancer after curative surgery.

Chemoresponse after non-curative gastrectomy for M1 gastric cancer.

BACKGROUND: M1 gastric cancer has a poor oncologic outcome with a median survival of less than 1 year despite aggressive chemotherapy. Recent trials include chemotherapy combined non-curative gastrectomy. This study evaluated the chemoresponse after non-curative gastrectomy in M1 gastric cancer and the survival benefit. METHODS: Between January 2000 and December 2010, 660 patients received chemotherapy for gastric cancer at the Department of Hemato-Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea. Data was collected retrospectively from the medical records. Patients who received preoperative or adjuvant chemotherapy, who underwent other surgeries like gastrojejunal bypass or exploratory laparotomy, who died within 3 months due to seriously advanced gastric cancer, who were lost to follow-up, or whose medical records were unsuitable for data collection were excluded. The remaining 101 patients had received chemotherapy only (CTx group, n = 76) or chemotherapy after non-curative gastrectomy (NCG + CTx group, n = 25). Clinicopathologic characteristics, chemoresponse, and overall survival were compared between the two groups. RESULTS: There were no significant differences between the two groups in clinicopathologic characteristics including age, sex, body mass index (BMI), comorbidity, histologic differentiation, tumor location, clinical T stage, and initial site of distant metastasis. Chemoresponse was checked on two separate occasions from the initiation of chemotherapy: first chemotherapy regimen and until the third regimen change. The NCG + CTx group showed more favorable chemoresponse than the CTx group in both checks (60% and 72% vs. 18.4% and 23.7%). The NCG + CTx group showed longer overall survival than the CTx group (26 vs. 11 months). CONCLUSIONS: Non-curative gastrectomy in M1 gastric cancer could improve chemoresponse and extend overall survival.

Successful treatment of invasive gastric mucormycosis in a patient with alcoholic liver cirrhosis: A case report.

Gastrointestinal (GI) mucormycosis is a rare and life-threatening invasive fungal infection. GI mucormycosis occur in all parts of the alimentary tract, with the stomach being the most common site. Diabetes mellitus and other types of conditions associated with immunodeficiency, including hematologic malignancies, solid organ transplantation and glucocorticoid therapy, are risk factors for GI mucormycosis. There are few studies reporting cases of gastric mucormycosis in patients with liver cirrhosis, and even fewer reporting the successful treatment of invasive gastric mucormycosis in a patient with liver cirrhosis. This study presents a case of invasive gastric mucormycosis in a patient with liver cirrhosis, which was treated successfully by prompt diagnosis, metabolic support, surgical debridement of involved tissues and antifungal therapy.

Jejunogastric intussusception: a rare complication of gastric cancer surgery.

Jejunogastric intussusception (JGI) is a rare condition and less than 200 cases have been published since its first description in 1914. In addition, JGI is potentially lethal complication of gastrectomy or gastrojejunostomy. We report the case of a 73-year-old man with a history of a Billroth II procedure who presented to the emergency department after 6 hours of epigastric pain and hematemesis. Endoscopy and computed tomography showed intussuscepted jejunum through a gastrojejunostomy that required emergency operation. At laparotomy a retrograde type II, JGI was confirmed and managed by resection of involved intestine. Postoperative recovery was uneventful. This case presents the rare complication of acute jejunogastric intussusception more than 25 years after a Billroth II procedure.