RESUMEN
BACKGROUND/AIMS: There is little information about the clinical and pathological features of patients with gastric cancer aged 85 years old and older. METHODOLOGY: We analyzed data of 197 gastric cancer patients aged 75 years and older. The patients were dividing into three age groups and we retrospectively studied 25 gastric cancer patients aged 85 years old and older and compared their clinical courses with those of 94 patients in their late 70s and 78 patients in their early 80s. RESULTS: The patients aged 85 years and older had a significantly higher rate of symptoms on admission such as gastric outlet obstruction and progressive anemia (64%), than did the other two age groups (p<0.05). Twenty-five percent of the oldest age group did not have surgery, and none had a D2 lymph node dissection. Perioperative complications were more frequent in the oldest group than in the youngest group (p<0.05). Survival in the oldest patients was not affected by surgical resection. CONCLUSIONS: These results indicate curative gastric surgery has a less positive impact in patients aged 85 years and older than younger patients. Treatment for gastric cancer in patients 85 years old and older should emphasize the palliation of symptoms but not curative resection.
Asunto(s)
Gastrectomía , Neoplasias Gástricas/cirugía , Anciano , Anciano de 80 o más Años , Causas de Muerte , Femenino , Mortalidad Hospitalaria , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Cuidados Paliativos , Complicaciones Posoperatorias/mortalidad , Factores de Riesgo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidad , Tasa de SupervivenciaRESUMEN
BACKGROUND: Lymphatic invasion is a risk factor for lymph node metastases in patients with gastric cancer. No studies have been reported, however, on the correlation between lymphatic invasion and lymph node metastasis in early gastric cancer invading into the submucosa. METHODS: We performed a retrospective analysis of lymphatic invasion in 170 patients with early gastric cancer invading into the submucosa. RESULTS: Lymphatic invasion was found in 76 patients. Lymphatic invasion correlated significantly with the presence of lymph node metastasis and vascular invasion (P < .05) and with the degree of cancerous submucosal involvement (P < .05). The presence of lymph node metastasis also correlated with the grade of submucosal invasion and lymphatic invasion. The 5-year survival of patients with lymphatic invasion was poorer than that of patients without lymphatic invasion (P < .05). Node-negative patients had similar survival, regardless of the presence of lymphatic invasion. All patients with severe lymphatic invasion had sm3 invasion and lymph node metastases. CONCLUSION: Although lymphatic invasion is the first stage of lymph node metastasis, lymphatic invasion in itself does not have clinical importance except for severe invasion in early gastric cancer. It is possible to predict lymph node metastases from the combined evaluation of degree of lymphatic invasion and submucosal involvement of the tumor in patients with early gastric cancer invading into the submucosa.
Asunto(s)
Mucosa Gástrica/patología , Ganglios Linfáticos/patología , Neoplasias Gástricas/patología , Anciano , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estudios Retrospectivos , Estadísticas no Paramétricas , Neoplasias Gástricas/cirugía , Tasa de SupervivenciaRESUMEN
The clinicopathologic features of 114 patients with resectable early gastric cancer (EGC) invading the submucosa were examined retrospectively with respect to lymph node involvement and the possibility of performing a minimally invasive operation. Patients were divided into node-positive (n = 25) and node-negative (n = 81) groups. Among several pathologic factors, the diameter of the tumor and lymphatic involvement were significantly correlated with nodal involvement. Within the submucosal layer the depth of invasion and the horizontal cancerous expansion also correlated with lymph node disease (p < 0.05). The size of the tumor did not correlate with the length of submucosal infiltration (r = 0.12, p = 0.1). Patients with both slight invasion into the submucosa and less than 5 mm of horizontal expansion were often negative for lymph node involvement and thus may benefit from local surgery as an alternative to gastrectomy.
Asunto(s)
Carcinoma/patología , Mucosa Gástrica/patología , Ganglios Linfáticos/patología , Neoplasias Gástricas/patología , Adenocarcinoma/patología , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Anciano , Carcinoma/secundario , Carcinoma/cirugía , Endoscopía , Femenino , Predicción , Gastrectomía , Mucosa Gástrica/cirugía , Gastroscopía , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática/patología , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Invasividad Neoplásica , Estudios Retrospectivos , Neoplasias Gástricas/cirugíaRESUMEN
BACKGROUND/AIMS: The purpose of this study was to review the Clinicopathologic features of early gastric cancer in elderly patients. METHODOLOGY: Three hundred and seventy-two patients who underwent resection for early gastric cancer were divided into groups of patients younger and older than 70 years. The clinical and pathologic findings surgical treatment, and perioperative complications in the group of elderly patients with early gastric cancer were reviewed and compared to those of the younger group. RESULTS: Gastric cancer involving the lower third of the stomach, as well as histopathologically well-differentiated carcinomas, were significantly more prevalent in the older group. Pre-operatively, the older patients had a higher incidence of respiratory dysfunction and hypertension. D1 lymph node dissections were chosen frequently for older patients. Six older patients died within 2 months of hospitalization, while no younger patients died within this period. The mortality rate mas 11% in older patients undergoing D2 or greater extents of node dissection, although the mortality rate was only 2% in older patients undergoing a D1 or less dissection. The 5-year survival rate for older patients, including deaths unrelated to cancer, was 71%, which was significantly lower than that in the younger group. However, when only mortality from gastric cancer was considered, patient survival did not differ according to age. CONCLUSION: Given the high mortality in elderly patients unrelated to early gastric cancer, we concluded that node dissection should be limited to perigastric nodes according to tumor location in such patients.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Gástricas/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/cirugía , Anciano , Comorbilidad , Femenino , Estudios de Seguimiento , Gastrectomía/métodos , Humanos , Escisión del Ganglio Linfático , Masculino , Invasividad Neoplásica , Complicaciones Posoperatorias/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/cirugía , Tasa de SupervivenciaRESUMEN
We undertook a comparative histologic study of early stage carcinoma of the esophagus and stomach, with tumor invasion limited to the submucosa. Here we analyze lymph node metastasis, lymphatic invasion, and vascular invasion. Our study is based on a retrospective review of 77 patients with early stage carcinoma of the esophagus and 192 patients with early stage carcinoma of the stomach treated during the period from 1973 through 1991. The incidence of lymph node metastasis and lymphatic invasion was significantly higher in intramucosal or submucosal esophageal cancer than in intramucosal or submucosal gastric cancer. However, there was no significant difference between intramucosal esophageal cancer and submucosal gastric cancer. The metastatic site of lymph nodes in esophageal cancer tended to be distant from the location of primary tumor compared with lymph nodes invaded by gastric cancer. Lymphatic invasion and vessel invasion between submucosal esophageal cancer and submucosal gastric cancer was statistically significant. From these results, we conclude that intraepithelial or intramucosal esophageal cancer is comparable to early stage carcinoma of the stomach, whereas submucosal esophageal cancer is actually an advanced lesion.
Asunto(s)
Adenocarcinoma/patología , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Neoplasias Gástricas/patología , Humanos , Metástasis Linfática , Invasividad Neoplásica , Estudios RetrospectivosAsunto(s)
Antineoplásicos/farmacología , Neoplasias del Colon/patología , Ensayo de Unidades Formadoras de Colonias , Recurrencia Local de Neoplasia/patología , Neoplasias del Recto/patología , Ensayo de Tumor de Célula Madre , Animales , Línea Celular , Evaluación Preclínica de Medicamentos , Femenino , Humanos , Metástasis Linfática , Ratones , Neoplasias del Recto/secundarioRESUMEN
Development of effective chemotherapy for patients with peritonitis carcinomatosa is considered to be very important in cancer management. In this study, intraperitoneal injection (ip) of cisdichlorodiammineplatinum (II) (CDDP, cisplatin) together with subcutaneous injection (sc) of sodium thiosulfate (STS), abbreviated as 2-channel chemotherapy, were discussed with regard to its safety and efficacy on peritonitis carcinomatosa using nude mice inoculated intraperitoneally with SCK-8 tumor cells derived from human gastric cancer. A single ip lethal dose (16 mg/kg) of CDDP reproducibly caused weight loss in nude mice and killed 100% of the nude mice by day 5 after injection. However, sc of STS (1,200 mg/kg) protected nude mice against a lethal dose of CDDP, and reduced CDDP-induced weight loss. Two-channel chemotherapy (CDDP 16 mg/kg ip + STS 1200 mg/kg sc) using nude mice with advanced peritonitis carcinomatosa produced a 45% increase of life span with a survival of 74.6 +/- 6.2 days (n = 8), compared with control nude mice with peritonitis carcinomatosa surviving 51.5 +/- 13.3 days (n = 11). Therefore, it is conceivable that 2-channel chemotherapy can be applied to the management of cancer patients with peritonitis carcinomatosa.