Incidental Gallbladder Cancer on Cholecystectomy: Strategy for Re-resection of Presumed Benign Diseases from a Retrospective Multicenter Study by the Yokohama Clinical Oncology Group.

BACKGROUND/AIM: Current expert consensus recommends re-resection for incidental gallbladder cancer (IGBC) of pT1b-3. This study examined whether this consensus was reasonably applicable to patients with IGBC in one Japanese region. PATIENTS AND METHODS: This was a multicenter, retrospective analysis of cholecystectomies for presumed benign diseases between January 2000 and December 2009. RESULTS: IGBC was diagnosed in 70 (1.0%) out of 6,775 patients undergoing cholecystectomy. Five-year disease-specific cumulative survival was 100% in 19 patients with pT1a, 80.0% in five with pT1b, 49.5% in 33 with pT2, and 23.1% in 13 with pT3. Re-resection was not performed for the 24 patients with pT1a/1b disease, whereas 24 out of 46 patients with pT2/3 underwent re-resection. Regardless of re-resection, independent factors associated with a poor prognosis on multivariate analysis were grade 2 or poorer disease and bile spillage at prior cholecystectomy. In the 24 patients with pT2/3 re-resection, 11 patients without either of these two factors had significantly better 5-year disease-specific cumulative survival than the 13 patients with one or two independent factors associated with a poor prognosis (72.7% vs. 30.8%, p=0.009). CONCLUSION: This Japanese regional study suggests that indication of re-resection for IGBC should not be determined by pT-factor alone and that much more attention should be paid to pathological and intraoperative findings at prior cholecystectomy.

Treatment of hepatocellular carcinoma with hepatic vein tumor thrombosis protruding into the inferior vena cava by conversion surgery following chemotherapy with regorafenib: a case report.

Regorafenib is an oral multikinase inhibitor affecting angiogenesis, oncogenesis, metastasis, and tumor immunity. As a systemic treatment, it has been shown to provide survival benefits in hepatocellular carcinoma (HCC) patients progressing on sorafenib treatment. We report herein a case of HCC with hepatic vein tumor thrombosis protruding into the inferior vena cava (IVC-HVTT) which was successfully treated by surgery following second-line chemotherapy with regorafenib. A 79-year-old man with chronic hepatitis was diagnosed with HCC. Computed tomography revealed a solitary tumor in segments 7 and 8 and an IVC-HVTT from the right hepatic vein. Since IVC-HVTT removal is a difficult procedure, the tumor was diagnosed as unresectable, and administration of sorafenib was started. Five weeks later, the lesion had increased in size by 15.3%; subsequently, regorafenib was given as second-line therapy for 12 months. After shrinkage of the IVC-HVTT, the patient was referred to our hospital for surgery. One month after the cessation of regorafenib, an extended resection of segment 8 and total removal of the IVC-HVTT was successfully performed without using total hepatic vascular exclusion. There were no serious postoperative complications. Additionally, there has been no recurrence for about 2 years since the initial therapy.

Abdominal drain straying into right atrium: a case report.

BACKGROUND: A drain exchange with the use of a guidewire may be accompanied by serious complications. CASE PRESENTATION: This case involved an 86-year-old man with overlapping cancers of intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma. A left hepatectomy, a left caudal lobectomy (with a medial hepatic vein preservation), an extrahepatic bile duct resection, and a right hepatojejunostomy were performed. The abdominal drain was placed into the hepatectomy side. Bile leakage occurred on the seventh day after the surgery, and the drain was exchanged. Since the bile leakage was still detectable via a computed tomography (CT) scan on the 15th postoperative day, the drain was exchanged again. On the next day, blood had discharged from the drain. A CT scan revealed that the tip of the drain was straying into the right atrium (RA) and the drain was removed from the inferior vena cava (IVC) under general anesthesia. One week later, a fiburin thrombus was observed from the IVC to the RA via the use of transthoracic echocardiography. A right atrial incision, a thrombus removal, and a middle hepatic vein merging section closure surgery were performed. Afterward, the patient's general condition gradually improved, and he was transferred to the hospital for rehabilitation. CONCLUSION: More careful guidewire operations are necessary at the time of the exchange of the drain to prevent the drain from being placed too close to blood vessels.

Isolated breast metastasis from gastric cancer in a male patient.

A 72-year-old man underwent total gastrectomy for gastric cancer (por2, T3, N2, Stage IIIA). Eleven courses of postoperative chemotherapy with TS-1 (tegafur/gimeracil/oteracil) were administered. Five months after surgery, the serum carcinoembryonic antigen value was slightly elevated. However, computed tomography did not reveal any metastatic lesions in other organs. Two years after surgery, the patient felt a mass in the left mammary. A 2-cm tumor was palpable in the central portion of the breast. Ultrasonography revealed a hypoechoic tumor, which was Class 3 on aspiration biopsy cytological examination. No mass was detected on positron emission tomography-computed tomography. The mammary gland tumor increased in size to 3 cm, and a core needle biopsy procedure was performed. Histological examination findings revealed breast metastasis of gastric cancer. No other recurrence was found, and radical mastectomy was performed 2 years and 5 months after gastrectomy. Immunohistological analysis of the resected material confirmed breast metastasis of the gastric cancer. Two courses of TS-1 + cisplatin were administered, but this treatment was subsequently terminated because the patient experienced Grade 3 diarrhea and neutropenia. Three years and 1 month after the gastrectomy, the tumor recurred in the pelvic area. Chemotherapy and radiation therapy were performed, but the patient's overall condition became progressively worse, and he died 3 years and 9 months after gastrectomy.

Macroscopic type is a prognostic factor for recurrence-free survival after resection of gastric GIST.

BACKGROUND: Accurate evaluation of the biological behavior of Gastrointestinal stromal tumor and careful selection of patients with a high risk for tumor recurrence are necessary. In the present study, we analyzed prognostic factors in patients with GIST. PATIENTS AND METHODS: A total of 214 patients who had undergone curative resection of a localized primary gastric GIST without adjuvant therapy were enrolled in this retrospective study. Prognostic factors were analyzed. The growth pattern was classified as intramural, endoluminal, exoluminal, or mixed- type. RESULTS: On univariate and multivariate analyses, recurrence was predicted by exoluminal or mixed-type (hazard ratio [HR]=3.7, p=0.043), tumor size of >3.5 cm (HR=7.1, p=0.01), and mitotic rate of >5/50 high-power fields (HR=7.9, p<0.001). CONCLUSION: It is suggested that exoluminal or mixed-type is independently associated with recurrence of surgically resected gastric GIST in addition to tumor size and mitotic rate.

Phase II study of weekly paclitaxel as a second-line treatment for S-1-refractory advanced gastric cancer.

BACKGROUND: We retrospectively evaluated the efficacy of weekly paclitaxel therapy as second-line treatment for patients with advanced gastric cancer that was refractory to S-1. PATIENTS AND METHODS: In total, 33 patients received intravenous paclitaxel (80 mg m(-2)) on days 1, 8 and 15 as part of a 4-week cycle. RESULTS: Eight patients showed a partial response, 11 showed stable disease and 14 showed disease progression. In total, 171 courses (mean=5.2; range=3-16) were administered. Thirteen cases subsequently underwent third-line treatment. The median survival time and time to progression from the time of second-line treatment was 8.0 months and 4.2 months, respectively. The most common haematological toxicities were leukopenia and neutropenia. Non-haematological toxicities were generally mild to moderate and controllable. CONCLUSION: This study showed favourable therapeutic outcomes for advanced gastric cancer patients. However, it will be necessary to confirm the advantages of paclitaxel treatment for S-1-refractory advanced gastric cancer in a larger population.

Modified POSSUM to predict postoperative morbidity following gastrectomy.

BACKGROUND/AIMS: In order to predict morbidity after gastrectomy for gastric cancer in aged patients, the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) scoring system was applied. METHODOLOGY: A total of 123 patients who had gastrectomies for gastric cancer at the age of 75 or above, between 1994 and 2002, were enrolled in this study. Postoperative morbidities and mortalities were analyzed and POSSUM scores were calculated. RESULTS: The predicted mortality and morbidity rates according to the POSSUM scores in this series were 47.9% and 14.1% respectively. The observed morbidity and mortality rates were 39.8% and 1.6% respectively. Using these results, we created a modified POSSUM equation to predict the morbidity in this population, expressed as ln[R/(1-R)] = -2.59 + (0.087 x PS) + (0.013 x OS), where PS: Physiological Severity, OS: Operative Severity, R=predicted morbidity rate. We applied this equation prospectively to 26 patients who underwent gastrectomies in 2003. The figures for predicted morbidity and observed morbidity were 37.3% and 38.5% respectively, indicating that our modified equation predicted morbidity more accurately than the POSSUM. CONCLUSIONS: The POSSUM over-predicted the morbidity of patients who underwent gastrectomy. However, after creating a modified equation using data from retrospective analysis, a modified POSSUM was found to predict the prospective morbidity rate accurately.

Gastrointestinal fiberscopic findings after simple closure for perforated duodenal ulcer in the early postoperative phase: from experience to evidence by evaluation of the healing process.

BACKGROUND/AIMS: Today, in light of widespread adoption of H2-RA and PPI, the standard surgical procedure for perforated duodenal ulcer (PDU) is simple closure and/or omental patch (SC). However, the healing process after these techniques has not been fully examined. We have not yet confirmed the propriety of simple suture of the bottom of the ulcer. This technique has been performed based only on experience, and there is insufficient evidence to conclude that this procedure can be definitively considered a safe therapeutic technique for the majority of patients with PDU. The aim of this study is to clarify the macroscopic findings of the healing process after SC for PDU. METHODOLOGY: Thirteen patients with PDU who were treated with SC underwent postoperative gastroduodenal fiberscopy (GF) at the 7th-16th postoperative day and the healing process was monitored under sufficient informed consent. Patients with severe preoperative disease were excluded from the study. Healing condition of the ulcer and stitches, deformity, and stenosis were evaluated by postoperative endoscopy. Possible adverse effects that were evaluated included: perforation, rise in fever, worsening of inflammation on laboratory data, gastrointestinal symptoms such as abdominal pain, sense of fullness, and vomiting. The indications for SC were as follows: PDU with 1) no stenosis and 2) no prominent ulcer ridge. The surgical technique was as follows: 1) interrupted simple closure with no trimming and debridement of wound (4-5 stitches) with absorbable monofilament suture, and/or 2) omental patch, 3) administration of H2-RA (or PPI) just after operation, and 4) oral feeding 4-5 days after operation independent of postoperative GF. RESULTS: GF findings in 2 patients showed active and healing stage, in whom surgical technique was thought to be insufficient; the ulcer had been large and included a descending portion, or a small perforation had occurred in the large ulcer bottom (the distance between the stitches and the edge of the ulcer was insufficient). In the other 11 patients, GF findings showed scar phase. There was no morbidity related to endoscopic procedure. CONCLUSIONS: Sutured PDU with SC will be in the scar phase in 1 or 2 weeks. Postoperative GF 1 week after SC for PDU is thought to be a safe examination. This study is a primitive study of a small group, and more cases that can adequately show the frequency of complications and indicate the overall safety of the procedure are needed.

Lymph node status in patients with submucosal gastric cancer.

BACKGROUND: The aim of this study was to clarify the lymph node status in patients with submucosal gastric cancer. METHODS: Between April 1994 and December 1999, 615 patients with histologically proven submucosal gastric cancer who underwent curative resection were included in this study. The results of the surgery and predictive factors for lymph node metastasis were evaluated by univariate and multivariate analyses. The accuracy of the predictive factors was assessed in a second population of a further 186 patients. RESULTS: Lymph node metastasis was observed in 119 patients (19.3%). Multivariate analysis showed that pathologic tumor diameter (> or = 20 mm) and lymphatic invasion were independent predictive factors for lymph node metastasis. The incidence of lymph node metastasis without these 2 predictive factors was 1.8% (2 of 113), and it was 51.2% (85 of 166) with the 2 predictive factors, 9.5% (14 of 148) in tumors < 20 mm in diameter, and 5.3% (22 of 414) in tumors without lymphatic invasion. Among patients with a tumor < 20 mm in diameter, the incidence of lymph node metastasis was significantly reduced in those with a differentiated tumor: 4.2% (4 of 95). These results were almost identical to those observed in the second population. CONCLUSIONS: Lymph node status can be accurately predicted on the basis of pathologic tumor diameter < 20 mm, lymphatic invasion (absence), and histological type (differentiated) in patients with submucosal gastric cancer. Less extensive surgery for these patients might be reconsidered after confirmation of the reproducibility of the results of this study by an appropriately designed prospective clinical trial.

Therapeutic strategy for patients with pN0 gastric carcinoma.

BACKGROUND AND OBJECTIVES: The prognosis for patients with pN0 gastric cancer is moderately hopeful (expected 5-year survival: 80%). However, the relevant prognostic factors and most appropriate surveillance protocol have not been identified. METHODS: We investigated 733 gastric cancer patients without lymph node metastasis for prognostic factors by uni- and multi-variate analysis and by documenting causes of death and recurrence patterns. RESULTS: Univariate analysis revealed that age, tumor location, macroscopic appearance, tumor diameter, invasion depth, lymphatic invasion, and venous invasion affected prognosis. Multivariate analysis showed that age (> or = 60 years), ill-defined macroscopic appearance, and undifferentiated histological type independently reduced survival rates. Age (> or = 60 years) and undifferentiated histological type adversely influenced prognosis in 507 early gastric cancer patients whereas ill-defined macroscopic appearance adversely affected prognosis in 226 advanced cancer patients. Recurrence patterns in these patients were similar to those produced by lymph node metastasis. The predominant recurrence pattern was peritoneal dissemination, observed 2-3 years post-resection. CONCLUSIONS: This study identified adverse prognostic factors in pN0 gastric cancer patients. Randomized controlled studies of adjuvant chemotherapy are necessary to assess whether such therapy is beneficial for patients with adverse prognostic factors.

Clinicopathological features of gastric carcinoma in younger and middle-aged patients: a comparative study.

Gastric carcinoma is relatively rare in patients under the age of 40. This study was undertaken to clarify the clinicopathological characteristics and surgical outcomes of gastric carcinoma in younger patients compared with those of middle-aged patients. The surgical results from 131 younger patients (aged < or = 40 years) and 918 middle-aged patients (aged 55-65 years) were compared retrospectively. Female gender, undifferentiated tumor type and lymphatic invasion were significantly more common in the younger patients. Survival time did not differ between the two groups. The depth of tumor invasion was the only prognostic factor in younger patients, whereas macroscopic appearance, tumor diameter, depth of invasion, lymph node metastasis, and venous invasion were all significant prognostic factors in middle-aged patients. Peritoneal recurrence was significantly more common in younger patients. A family history of gastric adenocarcinoma was observed in 25.9% of younger patients, but this did not affect survival outcomes. As depth of invasion affects prognosis independently, and peritoneal metastasis is the predominant pattern of recurrence, it is essential to establish an optimal prophylactic treatment for peritoneal metastasis to improve surgical outcomes in younger patients with advanced gastric cancer.

Prognostic factors after chemoradiotherapy for patients with inoperable esophageal squamous cell carcinoma.

BACKGROUND/AIMS: It is important to clarify the predictive and prognostic factors for chemoradiotherapy (CRT) in patients with inoperable esophageal cancer. METHODOLOGY: Forty-one patients with inoperable advanced esophageal cancer were evaluated. The predictive factors for the response to CRT (low-dose 5-FU and Cisplatin (FP) therapy plus 60 Gy of radiation) and the prognostic factors after CRT were analyzed. RESULTS: Of the 41 patients, seven achieved complete remission, 21 achieved partial remission, nine showed no change and four showed progressive disease. The median survival time was 19 months in patients with a tumor response, compared to 7 months in patients with non-responsive tumors. Only the serum cytokeratin (CYFRA) level independently predicted the responsiveness to treatment. In the multivariate analysis, the serum CYFRA level and the p53 gene mutation independently influenced prognosis. CONCLUSIONS: The presence of a p53 mutation in the biopsy specimen or a high serum CYFRA level may be predictive of an adverse therapeutic outcome.

Distribution of lymph node metastasis in gastric carcinoma.

BACKGROUND/AIMS: In gastric cancer, appropriate lymph node dissection increases survival, and hence it is of value to determine lymph node metastasis distribution in the early phase of progression. METHODOLOGY: This study involved a series of 274 consecutive patients with 1-6 lymph node metastases occurring after resection. The pattern of lymph node metastases was analyzed retrospectively. RESULTS: Of 102 patients with single lymph node metastasis, over 60% of metastases occurred in specific lymph nodes for each tumor. However, the remainder was scattered in an unpredictable manner including the para-aortic lymph nodes. Despite variations in invasiveness of tumors in patients with a single lymph node, the distribution remained unchanged. Nor was there any change in patients with an increased number of metastatic lymph nodes. However, in the latter group a higher proportion of metastases were widespread. About 85-90% of node was located within paragastric lymph nodes. CONCLUSIONS: Over 60% of metastatic lymph nodes would be eliminated by the dissection of specific areas determined by the site of the tumor. If the concept of sentinel lymph nodes in gastric cancer is valid, navigation surgery will be necessary for patients with early gastric cancer to locate such unpredictable metastasis.

Therapeutic outcomes of continuous hyperthermic peritoneal perfusion against advanced gastric cancer with peritoneal carcinomatosis.

BACKGROUND/AIMS: To clarify the efficacy of therapeutic continuous hyperthermic peritoneal perfusion in peritoneal carcinomatosis of gastric cancer. METHODOLOGY: The subjects of this study were 73 advanced gastric cancer patients who underwent palliative surgery between 1992 and 1999. Therapeutic continuous hyperthermic peritoneal perfusion (T-CHPP) was performed in 21 patients, who had macroscopic peritoneal carcinomatosis or positive lavage cytology, were under 65 years old, had no concomitant disease, and gave informed consent. Fifty-two patients who did not meet the inclusion criteria formed the control group. After reconstruction of the alimentary tract, T-CHPP was carried out for 40 min with 300 mg of Cisplatin, 30 mg of mitomycin C, and 300 mg of etoposide in 5-6 L of physiological saline maintained at 42 degrees C to 43 degrees C. RESULTS: The survival of patients who had CY1, P1, P2, P3 was not affected by T-CHPP. Univariate analysis revealed that the degree of peritoneal carcinomatosis and adjuvant chemotherapy were prognostic factors. Furthermore, ill-defined macroscopic appearance and P3 independently affected prognosis, according to multivariate analysis. Patients treated by T-CHPP had higher incidences of respiratory failure (76.2% vs. 17.3%; p < 0.0001) and renal failure (14.3% vs. 0%; p < 0.0054) than those undergoing T-CHPP. CONCLUSIONS: As T-CHPP had no efficacy, a new therapeutic strategy such as chemosensitivity assessment or a well-structured randomized controlled trial is necessary to obtain good therapeutic results with T-CHPP.

Clinicopathological properties of poorly-differentiated adenocarcinoma of the stomach: comparison of solid- and non-solid-types.

BACKGROUND: The purpose of this study was to clarify the clinicopathological and biological properties of the poorly-differentiated types of gastric carcinoma (solid-type and non-solid-type). PATIENTS AND METHODS: A total of 1,558 patients with primary gastric adenocarcinomas were enrolled in this study. The surgical results were compared. RESULTS: Patients with non-solid-type tumors tended to be younger females with peritoneal or lymph node metastases and lymphatic invasion, and with tumors that were ill-defined, of larger diameter and deeper. Those patients with differentiated tumors tended to have the opposite characteristics of those patients with non-solid-type tumors. Patients with solid-type tumors had intermediate characteristics. The survival in patients with non-solid-type tumors was poor compared to those with differentiated or solid-type tumors. There was a significant difference in the survival of stage III tumors with either solid- or non-solid-type tumors (p=0.0480). CONCLUSION: Therapeutic strategies should be based on the histological type of the tumor in patients with poorly-differentiated gastric adenocarcinoma.

Comparison of results of surgery in the upper third and more distal stomach.

The results of surgery for gastric cancer in the upper third of the stomach and the more distal region were compared to explain the comparatively poor outcomes in the former. Characteristics and therapeutic results of 1245 patients who underwent curative gastrectomy (244 with tumors in the upper third of the stomach and 1001 with more distal cancers) were compared. Survival was significantly lower in patients with cancer of the upper third of the stomach than in patients with more distal cancers. There was a significant difference between the two groups in the survival of patients with advanced gastric cancer, particularly in those with pN1. Among patients with tumors deeper than T2 and pN1, survival was significantly reduced in those aged

Clinicopathologic characteristics and surgical outcomes of mucinous gastric carcinoma.

BACKGROUND: The clinicopathologic characteristics of mucinous gastric carcinoma (MGC), an uncommon subtype of gastric carcinoma, were examined by comparing 45 MGC and 1255 non-MGC (NGC) cases. METHODS: Of 1300 gastric cancer patients, 1184 (early, n=568; advanced, n=616) underwent potentially curative or palliative resection. Age, sex, tumor location, tumor diameter, macroscopic appearance, depth of invasion, lymph node metastasis, lymphatic invasion, and venous invasion were monitored. RESULTS: In all registered patients, MGC patients' characteristics were as follows: advanced-stage disease (P=.0293), macroscopically ill-defined tumors (P=.0051), deeper invasion (P=.0046), and more lymph node involvement (P=.0008). Although there were no significant differences between curatively resected MGC and NGC advanced-cancer patients, in curatively resected early-cancer patients, depth of invasion (P=.0060) and lymphatic invasion (P=.0374) were significantly different. Survival time in all registered patients was shorter for MGC patients (P=.0489). Survival of curatively resected advanced and early gastric cancer patients was not significantly different. Age, macroscopic appearance, tumor diameter, depth of invasion, lymph node metastasis, and curability, but not histological type, were independent prognostic factors in all registered patients. Histological type also did not influence prognosis after curative resection. MGC patients had significantly more metastatic lymph nodes and lymphatic and venous invasion. Survival was significantly different (P=.0450) between all patients with undifferentiated and differentiated MGC, but not in curatively resected patients. CONCLUSIONS: MGC patients' poor prognosis correlates with advanced disease at diagnosis. Therapeutic and follow-up plans after curative resected MGC and NGC should remain the same, possibly with alterations according to the former's histological subtype.

Comparison of surgical results of D2 versus D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric carcinoma: a multi-institutional study.

BACKGROUND: Curative gastrectomy is a promising approach for the treatment of gastric cancer; however, the optimal extent of lymph node dissection for advanced cancer remains controversial. The aim of this multi-institutional study was to evaluate the feasibility of D3 gastrectomy (para-aortic lymph node dissection) for advanced gastric cancer. The surgical results of D2 and D3 gastrectomy (para-aortic lymph node dissection) were retrospectively compared. METHODS: A series of 580 advanced gastric cancer patients were registered between 1992 and 2000. Of these, 430 underwent D2 gastrectomy and 150 underwent D3 gastrectomy. Survival time, prognostic factors, postoperative morbidity/mortality, and pattern of recurrence were compared. RESULTS: There was no significant difference in survival time between D2 and D3 patients. However, the survival times of D3 patients with tumor diameters measuring 50 to 100 mm or with pN1 disease were significantly longer than those of the corresponding D2 patients. Analysis of the survival of patients with tumor diameters measuring 50 to 100 mm revealed that D3 gastrectomy conferred a survival advantage only to patients with pN2 disease. The incidence of lymphatic recurrence was lower in D3 patients with 50- to 100-mm tumors than in the corresponding D2 patients. CONCLUSIONS: D3 gastrectomy might be beneficial in patients with advanced pN2 gastric cancer within the group with tumors measuring 50 to 100 mm. A randomized controlled trial of patients with 50- to 100-mm tumors should be performed to test the validity of this preliminary result.

Significance of long-term follow-up of early gastric cancer.

BACKGROUND: Therapeutic outcomes for most patients with early gastric cancer are favorable. However, mortality among these patients remains a concern. Improvements in therapeutic outcomes are being sought by studying the timing and causes of death. Here, the results of surgery were evaluated to assess the appropriate treatment and follow-up schedule for early gastric cancer. METHODS: A total of 1169 patients with early gastric cancer underwent curative gastrectomy between 1992 and 1999. Survival time, prognostic factors, cause of death, and time of death were evaluated retrospectively. RESULTS: Multivariate analysis of disease-specific survival identified lymph node metastasis as an independent prognostic factor. The anatomical extent of lymph node metastasis and the number of metastatic lymph nodes influenced the rate of recurrence. Multivariate analysis of overall survival identified age as a prognostic factor. A total of 91 patients (7.8%) from the study group died: 56 from comorbid diseases, 21 from gastric cancer, and 14 from other second primary cancers. Death from gastric cancer was frequently observed within 5 years of surgical resection, whereas death from other diseases usually occurred after 5 years. Patients who died as a result of diseases other than gastric cancer tended to be older. CONCLUSIONS: Appropriate lymph node dissection is necessary for patients with early gastric cancer, particularly those with risk factors associated with lymph node metastasis. Meticulous follow-up protocols that can detect second primary cancers, together with the development of treatments for comorbid diseases, are required to improve survival.

Outcomes of mass screening for gastric carcinoma.

BACKGROUND: Therapeutic results of gastric cancer have been improved by early detection of gastric cancer with the mass screening system in Japan. The objective of our study was to assess the efficacy of mass screening for gastric cancer by using a barium meal. METHODS: A series of 1050 patients (364 in the screened group and 686 in the nonscreened group) were included in this study from April 1992 to March 2000. Patient characteristics, therapeutic results, and prognostic factors were compared in the two groups. RESULTS: The screened patients tended to be younger and male, with tumors in the middle third of the stomach that were of a macroscopically superficial type, with a smaller diameter, and at an earlier stage. They had fewer metastatic lymph nodes and underwent more frequent curative resection. Among the screened patients with curatively resected disease, tumors tended to be of a smaller diameter, and there were fewer metastatic lymph nodes in both early and advanced cases. Disease-specific survival was significantly better in the screened cases among all registered and curatively resected patients. Mass screening achieved significantly better surgical results in early or advanced gastric cancer patients who received curative resection. Multivariate analysis revealed that mass screening was an independent prognostic factor (hazard ratio, .3949; P < .0001), together with depth of invasion, lymph node metastasis, age, and tumor diameter. CONCLUSIONS: Mass screening by using barium meal examination for gastric cancer detects cancer at an early stage and produces good therapeutic results.