Laparoscopy-assisted Distal Gastrectomy for Gastric Cancer in Elderly Patients: Surgical Outcomes and Prognosis.

BACKGROUND/AIM: Elderly patients usually have various comorbidities. Laparoscopic gastrectomy as a minimally-invasive treatment might be feasible for these patients. The aim of this study was to evaluate the safety and efficacy of laparoscopy-assisted distal gastrectomy (LADG) in elderly patients with gastric cancer by comparing the surgical outcomes and prognosis. PATIENTS AND METHODS: We analyzed 136 patients who had undergone LADG between January 2013 and December 2014. We compared elderly patients (75 years old or more) with non-elderly patients. RESULTS: The incidence of all postoperative complications did not differ between groups, and there were no significant differences in the time to first oral intake or the duration of postoperative hospital stay. The 3-year overall and recurrence-free survival rates were not significantly different between the groups. CONCLUSION: LADG is a safe and less invasive treatment for gastric cancer in elderly patients, who have a greater incidence of comorbidity.

[The Efficacy of Definitive Chemoradiotherapy for Thoracic Esophageal Cancer on the Point of View Salvage Surgery].

INTRODUCTION: Salvage surgery(S-surgery)was performed for residual or relapse tumor after definitive chemoradiotherapy (dCRT)for resectable esophageal cancer. When it becomes possible to perform surgery after dCRT for unresectable cases is called conversion surgery(C-surgery). OBJECTIVE: To examine the outcomes of S-surgery and C-surgery after dCRT for thoracic esophageal cancer and clarify the significance as a multidisciplinary treatment. MATERIAL AND METHODS: We reviewed 27 patients who underwent S-surgery for thoracic esophageal cancer in our hospital. 23 cases were residual tumor, 4 were relapse after complete response. Sixteen cases(59%)were C-surgery. RESULTS: Five cases(19%)had non-radical resection. Two cases were postoperative hospital death(7%). Postoperative complications(Clavien-Dindo classification Grade II and more) 11 cases(41%). Four cases were anastomotic leakage, 4 cases vocal cord paralysis, etc. Pathological complete response cases 6 cases(22%). The recurrence cases were 7 except for 5 cases of non-radical resection. Three-year overall survival rate was 47%. Twelve cases(75%)in C-surgery could perform radical resection by down stage. CONCLUSIONS: The postoperative hospital mortality and complications can be considered as acceptable. dCRT is a powerful pre-operative treatment for such cases, and S-surgery plays an important role.

[A Case Report of Laparoscopy Assisted Distal Gastrectomy for Gastric Cancer with an Adachi Type VI Anomaly (Group 27)Institution].

We report the case of a 79-year-old man, with gastric cancer detected on upper gastrointestinal endoscopic examination performed by a nearby medical clinic, and referred to our hospital, in April 201X. He was diagnosed with gastric cancer(ML, less, 0- II a+ II c, tub 1-2, cT1bN0M0, cStage I A). We performed laparoscopy assisted distal gastrectomy, D1+lymph node dissection, and Billroth I (B- I )reconstruction. Abdominal CT scan before surgery confirmed vascular anomaly of the celiac artery. We diagnosed Adachi type VI, preserved hepato-gastric artery trunk, and performed D1 plus dissection plus B- I reconstruction with small incision in the epigastrium. The operation time was 244 minutes and the blood loss was 5 mL. There were no postoperative complications, and the patient was discharged from hospital 7 days after the surgery. Pathological findings revealed pT4aN0M0, pStage II B, and the patient has been treated with TS-1®postoperative adjuvant chemotherapy. At present, there is no recurrence. As vascular anomalies of the celiac artery branch exhibit various forms, occasional blood vessel preventing surgery is required. Examining blood vessels through CT scan before the surgery made it possible to perform Laparoscopic gastrectomy safely.

[A Case of Laparoscopic Remnant Gastrojejunal Bypass Surgery for Postoperative Peritoneal Recurrence of Gastric Cancer].

A 77-year-old female case who underwent laparoscopic distal gastrectomy with D2 dissection, Billroth I reconstruction for gastric cancer. Since the stage was III A, she received an adjuvant chemotherapy with S-1 after surgery. However, about 2 years after surgery, she was referred to our hospital for anorexia and vomiting. As a result of the examination, we diagnosed stenosis due to peritoneal recurrence near the anastomotic site. We performed laparoscopic remnant gastrojejunal bypass (Billroth II method, with Braun anastomosis). A camera port was inserted into a median umbilical incision. Following this, 4 additional ports(1 ports of 12mm in diameter and 3 ports of 5mm in diameter)were inserted under laparoscopic imaging into the right lower, right upper, left upper, and left lower quadrants. We first detached the adhesion considered as the influence of the previous surgery, and the anastomosis of remnant stomach and jejunum and the Braun anastomosis were performed by the linear stapler. The postoperative course was good. She started oral intake from the day after surgery, was discharged on the 6 days after operation, and received chemotherapy promptly. This procedure was effective for recurrent gastric cancer with stenosis which is difficult to resect and it was considered to be a minimally invasive method with a view to initiating chemotherapy early after operation.