Impact of anastomotic complications on outcome after laparoscopic gastrectomy for early gastric cancer.

BACKGROUND: The effects of anastomotic complications after laparoscopically assisted gastrectomy (LAG) have not been studied widely. The aims of this observational study were to identify potential factors that predict anastomotic complications and investigate the impact of anastomotic complications in patients undergoing gastrectomy for early gastric cancer. METHODS: The study included consecutive patients with histologically proven T1 gastric adenocarcinoma treated by LAG with regional lymphadenectomy between August 1997 and March 2008, who had not received neoadjuvant chemotherapy. Anastomotic complications included anastomotic leakage, stricture and remnant gastric stasis of grade II or higher (modified Clavien classification) and were identified by clinical assessment and confirmatory investigation. Predictive factors for the development of anastomotic complications were identified by univariable and multivariable analyses. Long-term survival with or without anastomotic complications was examined. RESULTS: Anastomotic complications occurred in 37 (9·3 per cent) of 400 patients. Multivariable analysis indicated surgeon experience as the only independent predictor of anastomotic complications (hazard ratio 4·40, 95 per cent confidence interval 2·04 to 9·53; P < 0·001). Patients with anastomotic complications had a significantly worse overall 5-year survival rate than those without (81 versus 94·2 per cent; P = 0·009). CONCLUSION: Anastomotic complications after LAG lead to worse long-term survival.

[Studies on postoperative arterial infusion chemotherapy using implanted reservoir for hepatocellular carcinoma].

The effect of postoperative arterial infusion therapy using implanted reservoir was evaluated in 28 cases of resected hepatocellular carcinoma which showed at least one of those findings as Vp (+), Vv (+), IM (+) and more than 5 cm in tumor diameter. Ten of them underwent arterial infusion therapy with combination ADM and CDDP after hepatic resection (IA group) and the rest underwent no regional chemotherapy (control group). The one-, two- and three-year cumulative disease-free survival rates between control group and IA group were 55.6% against 80.0%, 25.4% against 70.0%, and 16.9% against 37.3%, respectively. The one-, two- and three-year cumulative survival rates between control group and IA group were 71.8% against 90.0%, 51.8% against 70.0% and 41.5% against 56.0%, respectively, a difference that was not statistically significant. We suggest this therapy can prevent intrahepatic recurrence, although it does not improve prognosis. To achieve a better prognosis, a new arterial infusion chemotherapy more effective than this one must be developed.

Iron-binding properties of bovine lactoferrin in iron-rich solution.

The iron-binding properties of bovine lactoferrin in iron-rich solution were investigated. Ferrous iron was not stable in solution and was easily changed to the insoluble ferric state, but solubility of ferrous iron was stabilized by the presence of lactoferrin. However, casein hydrolysate or BSA was not effective in stabilizing iron in solution. As indicated by use of cibacron blue affinity gel, iron bound to lactoferrin, and the charge of supersaturated lactoferrin was higher than that of normal iron-saturated lactoferrin according to native PAGE electrophoresis. The evidence suggests that lactoferrin can bind iron at sites other than its chelate-binding sites, thereby stabilizing iron in solution.