Phase II clinical trial to study the safety and efficacy of combined S-1 + oxaliplatin therapy as neoadjuvant chemotherapy for locally advanced gastric cancer in older patients.

BACKGROUND: Gastrectomy with D2 dissection and adjuvant chemotherapy is the standard treatment for locally advanced gastric cancer (LAGC) in Asia. However, administering chemotherapy with sufficient intensity after gastrectomy is challenging. Several trials demonstrated the efficacy of neoadjuvant chemotherapy (NAC). However, limited studies explored the feasibility of NAC-SOX for older patients with LAGC. This phase II study (KSCC1801) evaluated the safety and efficacy of NAC-SOX in patients with LAGC aged ≥ 70 years. METHODS: Patients received three cycles of SOX130 (oxaliplatin 130 mg/m2 on day 1, oral S-1 40-60 mg twice daily for two weeks every three weeks) as NAC, followed by gastrectomy with lymph node dissection. The primary endpoint was the dose intensity (DI). The secondary endpoints were safety, R0 resection rate, pathological response rate (pRR), overall survival, and relapse-free survival. RESULTS: The median age of 26 enrolled patients was 74.5 years. The median DI in NAC-SOX130 was 97.2% for S-1 and 98.3% for oxaliplatin. Three cycles of NAC were administered in 25 patients (96.2%), of whom 24 (92.3%) underwent gastrectomy with lymphadenectomy. The R0 resection rate was 92.3% and the pRR (≥ grade 1b) was 62.5%. The major adverse events (≥ grade 3) were neutropenia (20.0%), thrombocytopenia (11.5%), anorexia (11.5%), nausea (7.7%), and hyponatremia (7.7%). Postoperative complications of abdominal infection, elevated blood amylase, and bacteremia occurred in one patient each. Severe diarrhea and dehydration caused one treatment-related death. CONCLUSIONS: NAC-SOX130 is a feasible therapy for older patients, although systemic management and careful monitoring of adverse events are necessary.

Easy modified wells method for rectal prolapse with using bilayer mesh.

BACKGROUND: In recent years, many laparoscopic procedures have been reported for the treatment of rectal prolapse, and the Wells method is safe and has relatively good results for rectal prolapse, which is common in the elderly. In this report, we have developed a simpler method to perform the Wells method. METHODS: In our procedures, easy modified Wells method is performed laparoscopically, but the use of a bilayer mesh makes it easier to perform without the need to suture the retroperitoneum. We performed the method for six cases. All patients are female and average age is 86 ± 4.6. Max length of rectal prolapse is 3 cm-7 cm. RESULTS: The median operative time was 191 ± 26 min. No recurrent rectal prolapse was encountered during follow-up period. The average defecation frequency per week before surgery was 5.3 ± 1.9 and after surgery was 3.7 ± 2.1. CONCLUSION: Easy modified Wells method can be performed with safety and without difficulty. This method has shown acceptable results in recurrence rates and defecation frequency after surgery.

Flexible tack for ventral hernia repair.

A mesh repair of a ventral hernia from the anterior approach is relatively difficult because it is necessary to fix the edge of the mesh from the hernial orifice. We developed a flexible tack for hernia repair, and used it for five lesions in four patients. The flexible tack allowed us to fix the edge of the mesh to the abdominal wall through the peritoneum without any complications. The durations of surgery were 123, 76, 124, and 89 min. We conclude that the flexible tack is useful device to perform hernia repair that provides an alternative to using mesh under the anterior approach.

Ultrasound assisted percutaneous endoscopic jejunostomy.

The percutaneous endoscopic gastrostomy (PEG) cannot be performed for the patient after total gastrectomy. We design the new procedure to make jejunostomy with using an ultrasonography and a regular PEG kit. We name the procedure Ultrasound assisted Percutaneous Endoscopic Jejunostomy (USPEJ). Three cases has been performed USPEJ. Operating time is 30 minutes, 45 minutes and 10 minutes respectively. All cases were performed without any troubles. We conclude that the USPEJ is a useful method for the patient with dysphagia who has the past-history of total gastrectomy.

Personal experience of laparoscopic cholecystectomy.

BACKGROUND/AIMS: We performed laparoscopic cholecystectomy with a surgical team consisting of the same operator and the same first assistant to evaluate a personal learning curve of laparoscopic cholecystectomy. METHODOLOGY: In the 135 patients who underwent the laparoscopic cholecystectomy, operative complications, postoperative complications and operative time were evaluated on the basis of using different camera assistants and the chronological advancement of the same operator and the same first assistant. RESULTS: The average operative time was 120 +/- 54 minutes. The operative time was statistically longer in the first ten cases. The major complication during operation, which was ligation of the common bile duct, occurred in the 7th case. The other operative complications, such as minor bile duct injury or mild bleeding, occurred occasionally in spite of experience or inexperience; the operative complications, however, tended to occur under the same camera assistant. On the other hand, the operative time was not related to the use of different camera assistants. CONCLUSIONS: From the personal learning curve of laparoscopic cholecystectomy, operative time is relatively longer in the early 10 cases. Complications tend to occur under the same camera assistant.