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1.
Anticancer Res ; 40(1): 81-86, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892555

RESUMO

BACKGROUND/AIM: Zinc finger protein ZKSCAN3 (ZNF306) is a promising oncogene candidate in colon, bladder, breast, uterine cervical, and prostate cancers. The present study aimed to investigate ZKSCAN3 protein expression in gastric carcinoma patient tissues and to evaluate oncological outcomes in these patients. MATERIALS AND METHODS: ZKSCAN3 was detected using the anti-ZKSCAN3 rabbit polyclonal antibody. For immunohistochemical examination, we used paraffin-embedded specimens from 87 consecutive patients with gastric cancer who underwent gastrectomy. We investigated ZKSCAN3 expression in relation with patient prognosis and clinicopathological factors. RESULTS: ZKSCAN3 was detected in 28 (32.2%) tumour specimens, with significant association with lymphatic system invasion and distant metastasis. Patients with ZKSCAN3-positive tumours had worse overall survival (OS) than those with ZKSCAN3-negative tumours based on log-rank testing. Furthermore, multivariate analysis revealed that ZKSCAN3 was an independent prognostic parameter for OS (hazard ratio: 2.6379, p=0.0164). CONCLUSION: ZKSCAN3 is a potential novel prognostic factor in gastric cancer patients.


Assuntos
Biomarcadores Tumorais , Neoplasias Gástricas/genética , Neoplasias Gástricas/mortalidade , Fatores de Transcrição/genética , Idoso , Idoso de 80 Anos ou mais , Linhagem Celular Tumoral , Feminino , Expressão Gênica , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Recidiva , Fatores de Risco , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/metabolismo
2.
Gastric Cancer ; 2020 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-31927674

RESUMO

BACKGROUND: Standard gastrectomy with systematic lymphadenectomy as an additional surgery after endoscopic resection (ER) causes a deterioration in long-term quality of life. If the sentinel lymph node (SN) basin concept can be applied in post-ER gastric cancer, minimal surgery can be applied without reducing the curability. This retrospective multicenter cohort study aimed to verify the validity of the SN basin concept in post-ER gastric cancer. PATIENTS AND METHODS: Individual data of 132 patients who underwent SN mapping after ER were collected from 8 university hospitals in Japan from 2001 to 2016. Tracers were injected endoscopically in the submucosal layer at four sites around the post-ER scar. We compared the SN basin distribution of post-ER gastric cancer with that of 275 patients with non-ER gastric cancer. RESULTS: Two cases of SN were unidentified, both involving a single tracer (SN detection rate: 98.5%). Nine cases (6.8%) of lymph node metastasis were found, of which eight had a metastatic lymph node within the SNs and one had a non-SN metastasis within the SN basin. The diagnostic sensitivity of SN mapping for lymph node metastasis was 88.9% in post-ER group and 95.7% in non-ER group (P = 0.490); the accuracy was 99.2% and 99.6% (P = 0.539), respectively. Regarding the SN basin, no significant intergroup differences were found regardless of the primary tumor location. CONCLUSIONS: Our findings clarified the feasibility of SN mapping based on the SN basin concept in patients with gastric cancer who previously underwent ER.

3.
Gan To Kagaku Ryoho ; 46(5): 901-905, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31189812

RESUMO

Hypoalbuminemia is often observed in patients receiving chemotherapy for gastric cancer. The risk of hematologic toxicity is increased by the pharmacokinetic alteration of paclitaxel(PTX)owing to high serum protein binding in patients with hypoalbuminemia. Here, we examined the relationshipbetween the frequency of GradeB3 neutropenia and serum albumin concentration in 30 patients receiving PTX monotherapy, and 29 patients receiving PTX plus ramucirumab(RAM)combination therapy-a second-line treatment for advanced/recurrent gastric cancer. The number of patients who developed GradeB3 neutropenia was 8(27%)and 14(48%)of those who received monotherapy and combination therapy, respectively, with mean serum albumin concentrations of 3.31 g/dL and 3.15 g/dL, respectively. Serum albumin concentrations were significantly lower in the GradeB3 neutropenia group than in the non-GradeB3 neutropenia group in both regimens. When the serum albumin concentration of patients receiving PTX or PTX plus RAM was below the cut-off values of 3.75 g/dL and 3.45 g/dL, respectively, the odds ratio of GradeB3 neutropenia was 12.25 and 7.33, respectively. Hypoalbuminemia was associated with the development of chemotherapy-induced GradeB3 neutropenia, in patients with gastric cancer treated with either PTX monotherapy or PTX plus RAM combination therapy. Therefore, not only neutrophils but also serum albumin concentration should be monitored during chemotherapy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Hipoalbuminemia , Neutropenia , Paclitaxel/efeitos adversos , Neoplasias Gástricas , Anticorpos Monoclonais , Anticorpos Monoclonais Humanizados , Humanos , Hipoalbuminemia/induzido quimicamente , Recidiva Local de Neoplasia , Neutropenia/induzido quimicamente , Neoplasias Gástricas/tratamento farmacológico
4.
Anticancer Res ; 39(6): 3227-3230, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177172

RESUMO

BACKGROUND: We advocated the usefulness of pylorus-reconstruction gastrectomy (PRG) to improve quality of life following surgery for gastric cancer. The current study assessed gastric emptying following PRG in comparison with those who underwent conventional Billroth-I (B-I) reconstruction and in healthy controls using a 13C breath test. PATIENTS AND METHODS: The study group consisted of 24 patients who underwent PRG from September 20, 2007 to July 26, 2012 at the Department of Surgery at Daisan Hospital (affiliated with The Jikei University School of Medicine). These patients underwent the 'standard' version of a gastric-emptying study using a 13C breath test at 20.5±11.8 months after surgery. During the study, the half gastric-emptying time (T1/2) and gastric retention at 5 min after ingestion (RR5) were measured. The data of the PRG group were compared to those for 26 patients who underwent conventional B-I reconstruction and with a group consisting of 20 healthy controls. RESULTS: RR5 was 69.6±21.8% in the patients who underwent PRG, 45.3±28.6% in those who underwent B-I reconstruction, and 93.7±5.7% in healthy controls. T1/2 was 17.0±13.0 min in patients who underwent PRG, 5.9±4.0 min in those who underwent B-I reconstruction, and 23.3±4.9 min in healthy controls. Gastric emptying was delayed in patients who underwent PRG compared to those who underwent B-I reconstruction (RR5: p<0.0014, T1/2: p<0.0002), and was comparable to that of healthy controls. CONCLUSION: Gastric emptying improved significantly after PRG compared to B-I reconstruction, and approached that of healthy controls.


Assuntos
Testes Respiratórios , Gastrectomia/métodos , Esvaziamento Gástrico , Gastroenterostomia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Gastrectomia/efeitos adversos , Gastroenterostomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
Esophagus ; 15(4): 231-238, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30225744

RESUMO

AIM: The purpose of this study was to investigate modifiable predisposing factors associated with anastomotic leak in the anterior mediastinal (AM) reconstruction route. METHODS: We reviewed the data on 154 patients who underwent esophagectomy and gastric tube reconstruction using the AM route between 2008 and 2016. The data included computed tomography (CT) scans with sagittal reconstruction of the thoracic section. The level of the esophagogastric anastomosis (LEA) and pretracheal distance (PTD) was measured from sagittal reconstructed CT images. Vascularization of the gastric tube was evaluated by postoperative endoscopy. Variables associated with anastomotic leak were determined using univariate and multivariate analyses. RESULTS: Anastomotic leak developed in 13 patients (8%). The cut-off level at which the anastomosis was less likely to develop a leak, as determined by Chi-square tests, was 1.5 cm for LEA and 1.3 cm for PTD. On univariate analysis, the factors that were significantly associated with the risk of anastomotic leak included diabetes, hand-sewn anastomosis, the LEA ≥ 1.5 cm, and severe mucosal degeneration. On multivariate analysis, diabetes (OR 4.7, 95% CI 1.29-17.2), LEA ≥ 1.5 cm (OR 20.1, 95% CI 3.15-128), and severe mucosal degeneration (OR 7.2, 95% CI 1.42-36.8) were found to be statistically significant independent risk factors. CONCLUSION: Use of the AM route to place the cervical anastomosis within 1.5 cm above the suprasternal notch might avoid excessive pressure on the gastric tube from the surrounding structures, resulting in a reduction in the risk of an anastomotic leak.


Assuntos
Fístula Anastomótica/etiologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Estômago/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/diagnóstico por imagem , Endoscopia/métodos , Neoplasias Esofágicas/complicações , Feminino , Humanos , Japão/epidemiologia , Masculino , Mediastino/anatomia & histologia , Mediastino/diagnóstico por imagem , Mediastino/cirurgia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Estômago/irrigação sanguínea , Estômago/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
7.
Anticancer Res ; 38(3): 1563-1567, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29491086

RESUMO

BACKGROUND: There have been only sporadic reports on intraoperative nerve monitoring (IONM) during esophageal cancer surgery. We aimed to establish a strategy for the use of IONM during esophagectomy. PATIENTS AND METHODS: Forty-one cases enrolled in this study. The IONM was performed before and after lymph node dissection in the thoracic cavity and cervical area. Occurrence of recurrent laryngeal nerve (RLN) palsy was assessed on the seventh postoperative day. RESULTS: The identification of nerves using IONM was possible in all cases. The positive and negative predictive values of IOMN were 80% and 92%, respectively. Loss of response was observed during the thoracic procedure in 14 out of 16 cases, with the predominance of left RLN palsy (n=12). CONCLUSION: In esophageal cancer surgery, identification of the RLN using IONM can be carried out safely, simply, and promptly. Using IONM systematically, the prediction of RLN palsy and detection of nerve injury point seems feasible.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Monitorização Intraoperatória/métodos , Nervo Laríngeo Recorrente/fisiopatologia , Paralisia das Pregas Vocais/fisiopatologia , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/prevenção & controle
8.
Gastric Cancer ; 21(6): 1014-1023, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29536296

RESUMO

BACKGROUND: Intraperitoneal administration of paclitaxel had been considered a promising option to treat peritoneal metastasis, the most frequent pattern of recurrence in gastric cancer after D2 gastrectomy, but its safety and efficacy after gastrectomy had not been fully explored. METHODS: A phase II randomized comparison of postoperative intraperitoneal (IP) vs. intravenous (IV) paclitaxel was conducted. Patients with resectable gastric linitis plastica, cancer with minimal amount of peritoneal deposits (P1), or cancer positive for the peritoneal washing cytology (CY1) were eligible. After intraoperative confirmation of the above disease status and of resectability, patients were randomized to be treated either by the IP therapy (paclitaxel 60 mg/m2 delivered intraperitoneally on days 0, 14, 21, 28, 42, 49, and 56) or the IV therapy (80 mg/m2 administered intravenously using the identical schedule) before receiving further treatments with evidence-based systemic chemotherapy. The primary endpoint was 2-year survival rate. RESULTS: Of the 86 patients who were randomized intraoperatively, 83 who actually started the protocol treatment were eligible for analysis (n = 39, IP group; n = 44, IV group). The 2-year survival rate of the IP and IV groups was 64.1% (95% CI 47.9-76.9) and 72.3% (95% CI 56.3-83.2%), respectively (p = 0.5731). The IP treatment did not confer significant overall or progression-free survival benefits, and was associated with particularly poor performance in patients with residual disease, including the CY1 P0 population. CONCLUSIONS: We were unable to prove superiority of the IP paclitaxel over IV paclitaxel delivered after surgery to control advanced gastric cancer with high risk of peritoneal recurrence.


Assuntos
Adenocarcinoma/cirurgia , Antineoplásicos Fitogênicos/administração & dosagem , Paclitaxel/administração & dosagem , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/cirurgia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Gastrectomia , Humanos , Infusões Intravenosas , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Peritoneais/mortalidade , Cuidados Pós-Operatórios , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Resultado do Tratamento
9.
World J Surg ; 42(3): 766-772, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28920152

RESUMO

BACKGROUND AND PURPOSE: We started performing sentinel node navigation surgery (SNNS) for patients with early gastric cancer (EGC) using infrared ray electronic endoscopy (IREE) with indocyanine green injection from year 2000. The EGCs usually have complex lymphatic drainage, unidirectional or multidirectional lymphatic flow. In this study, we investigated and clarified factors that affect the direction of gastric lymphatic drainage. PATIENTS AND METHOD: Consecutive 60 patients with EGC who underwent SNNS by IREE from year 2006 to 2014 were enrolled to this study. Patients' age, gender, location of tumors, operative method, previous treatment by endoscopic submucosal dissection (ESD), presence of pathological ulcerative scar and maximum tumor diameter were enrolled as parameters which may affect direction of lymphatic drainage and analyzed. RESULT: Bivariate analysis demonstrated that the presence of pathological ulcerative scar (P = 0.01), tumor location (g.c vs. a.w vs. p.w vs. l.c, P = 0.01), and maxim tumor diameter (P = 0.0003) were relevant to direction of gastric lymphatic drainage. Multivariate analysis showed that tumor location (g.c/a.w/p.w vs. l.c, odds ratio 8.227, P = 0.011) and the maximum tumor diameter (odds ratio 1.057, P = 0.037) are independent factors that affect direction of gastric lymphatic flow. Of tumors, 78% located at lesser curvature had unidirectional lymphatic drainage, and 93% of tumors whose diameter was 40 mm and more had multidirectional lymphatic drainage. CONCLUSION: Our investigation revealed that the tumor location and tumor diameter were the key factors which affect the direction of lymphatic drainage, which is useful fact to understand the complexity of gastric lymphatic drainage.


Assuntos
Vasos Linfáticos/anatomia & histologia , Biópsia de Linfonodo Sentinela , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Feminino , Gastroscopia/métodos , Humanos , Verde de Indocianina , Raios Infravermelhos , Excisão de Linfonodo/métodos , Metástase Linfática , Vasos Linfáticos/fisiopatologia , Masculino , Pessoa de Meia-Idade , Neoplasias Gástricas/patologia
10.
In Vivo ; 31(4): 683-687, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28652439

RESUMO

BACKGROUND/AIM: In colon surgery, the anastomotic method is generally selected by surgeon's preferences or by local conditions. In this study, we retrospectively analyzed anastomotic complications to assess safe methods of anastomosis in colonic resection. PATIENTS AND METHODS: We retrospectively analyzed a total of 684 cases, performed between July 2003 and June 2013 in our Hospital. Anastomosis complications, such as leakage, stricture and bleeding, were analyzed in relation to the three methods of anastomosis, hand-sewn (HS), functional end-to-end (FEEA) and triangulating anastomosis (TRI). RESULTS: Univariate analysis indicated that the incidence of leakage was significantly lower in laparoscopic surgeries (p=0.034) and TRI (p=0.047). The results of the multivariable analysis indicated that anastomotic leakage was significantly less with TRI (p=0.029). CONCLUSION: In colon surgery, TRI seems to be associated with a low risk of anastomotic leakage compared to HS and FEEA.


Assuntos
Anastomose Cirúrgica/métodos , Colo/cirurgia , Laparoscopia/métodos , Grampeamento Cirúrgico/métodos , Idoso , Colectomia/métodos , Colo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia
11.
Surg Today ; 47(10): 1195-1200, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28251373

RESUMO

PURPOSE: Laparoscopic fundoplication (LF) has become a standard operative procedure for GERD-related diseases in Japan, although meta-analyses have mainly evaluated findings from Western countries. The propensity score matching method was used to compare and investigate the treatment outcomes of two fundoplication procedures (the Nissen and Toupet methods). METHODS: Among 474 patients who underwent initial LF from December 1994 to April 2016, we extracted 401 cases (Nissen: 92 cases, Toupet: 309 cases), excluding 73 patients in whom follow-up was insufficient. We then matched 126 of these patients (63 per group). RESULTS: The esophageal acid reflux time (%) was 12.2:2.8, being higher in the Nissen group than in the Toupet group (p < 0.001). Regarding the surgical outcome, the amount of bleeding was higher in the Nissen group (p = 0.001), and the number of hospitalization days following surgery was longer (p = 0.003). Furthermore, a significantly rate of postoperative difficulty in swallowing (%) was observed in the Nissen group, at 13:0 (p = 0.004). The recurrence rate (%) was 8:3, with no difference between the two groups (p = 0.243). CONCLUSIONS: Although there was no marked difference in the recurrence rate between the two procedures, postoperative dysphagia was observed at a higher frequency with the Nissen method than the Toupet method.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Pontuação de Propensão , Adulto , Transtornos de Deglutição/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Recidiva , Resultado do Tratamento
12.
Langenbecks Arch Surg ; 402(1): 27-32, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27999935

RESUMO

BACKGROUND: Prospective multicenter trials have shown the feasibility of sentinel node (SN) navigation surgery using a dual tracer of dye and radioisotope for early gastric cancer. However, comparable trials using the indocyanine green (ICG) and the infrared ray laparoscopic system (IRLS) have not been reported. On the basis of our cohort studies, we assumed that the ICG imaging with the IRLS is as effective as the dual tracer in detecting SNs. Therefore, we conducted a prospective multicenter trial to assess the effectiveness and generalizability of the infrared ICG technique in patients with early gastric cancer. PATIENTS AND METHODS: Patients with previously untreated cT1 gastric adenocarcinomas less than 4 cm in gross diameter were eligible for inclusion in this study. SN mapping was performed by using ICG combined with IRLS technique. Following biopsy of the identified SNs, D2 or modified D2 laparoscopic gastrectomy was performed according to the current Japanese Gastric Cancer Association guidelines. RESULTS: Among the 47 patients who gave written informed consent, 44 were eligible from the surgical findings, for whom SN biopsy was performed. The detection rate of the lymphatic basin by the ICG with IRLS was 100% (44/44). The accuracy was also 100% (7/7) for detecting metastatic lymph node, which was verified on the permanent pathologic examination. Following the median follow-up of 114 months (range, 60 to 120 months), no recurrence (0/40) was observed. Although the number of patients was unequally distributed among the hospitals participating in the trial, the detection rates of SNs in low-volume hospitals were comparable to those in high-volume hospitals. Consequently, there was no learning curve in this trial. CONCLUSION: The infrared ICG imaging accurately detected the lymphatic basin and SNs with occult metastasis in SN-navigated gastrectomy for gastric cancer. This method was feasible even for low-volume surgeons and hospitals.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia , Laparoscopia , Biópsia de Linfonodo Sentinela , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Detecção Precoce de Câncer , Feminino , Humanos , Verde de Indocianina , Raios Infravermelhos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
13.
Case Rep Gastroenterol ; 10(2): 344-351, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27920639

RESUMO

A 76-year-old man presented to our hospital with abdominal distention and loss of appetite. The 10% of weight lost relative to this patient in 1 month. Abdominal computed tomography and magnetic resonance imaging revealed a giant mass, with a major axis of 23 cm, containing solid components, not involving the upper abdominal organs. Esophagogastroduodenoscopy showed extramural compression from the middle gastric body to the antrum, as well as a normal mucosal surface. These findings were suggestive of a gastrointestinal stromal tumor attached to the anterior wall of the stomach without metastasis or invasion. Partial gastrectomy was performed for tumor resection, and the patient was subsequently treated with adjuvant imatinib. We report a rare case of a large extramural gastrointestinal stromal tumor of the stomach that was larger than 20 cm in diameter and present a pertinent literature review.

14.
World J Gastroenterol ; 22(33): 7431-9, 2016 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-27672266

RESUMO

Accurate prediction of lymph node (LN) status is crucially important for appropriate treatment planning in patients with early gastric cancer (EGC). However, consensus on patient and tumor characteristics associated with LN metastasis are yet to be reached. Through systematic search, we identified several independent variables associated with LN metastasis in EGC, which should be included in future research to assess which of these variables remain as significant predictors of LN metastasis. On the other hand, even if we use these promising parameters, we should realize the limitation and the difficulty of predicting LN metastasis accurately. The sentinel LN (SLN) is defined as first possible site to receive cancer cells along the route of lymphatic drainage from the primary tumor. The absence of metastasis in SLN is believed to correlate with the absence of metastasis in downstream LNs. In this review, we have attempted to focus on several independent parameters which have close relationship between tumor and LN metastasis in EGC. In addition, we evaluated the history of sentinel node navigation surgery and the usefulness for EGC.


Assuntos
Gastrectomia , Metástase Linfática/diagnóstico , Biópsia de Linfonodo Sentinela , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Humanos , Excisão de Linfonodo , Linfonodo Sentinela/patologia
15.
Surgery ; 160(5): 1294-1301, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27521045

RESUMO

BACKGROUND: Early postoperative endoscopy after esophagectomy is assumed to be effective in detection and prediction of anastomotic complications, but overall effects of early postoperative endoscopy remain uncertain. The aim of this study was to investigate whether mucosal status assessed by early postoperative endoscopy could offer an approach to individualized management after esophagectomy. METHODS: Endoscopy was performed in 176 of 214 patients who underwent esophagectomy at either 1 week or 2 weeks postoperatively. Mucosal damage in the proximal region of the graft was classified as follows: intact mucosa, mild mucosal degeneration, and severe mucosal degeneration. We examined the association of the severity of mucosal damage and the incidence of anastomotic complications. RESULTS: Twenty-eight patients (16%) developed anastomotic stricture. Symptomatic anastomotic leaks occurred in 15 patients (8.5%), including 6 with stricture. The frequency of intact mucosa, mild mucosal degeneration, and severe mucosal was 7%, 20%, and 73% for leaks; 4%, 11%, and 85% for strictures; and 28%, 62%, and 10% for no complications, respectively (P <.001). Asymptomatic leaks were found in 4 patients in the 1-week endoscopy group. Sensitivity and specificity for the development of stricture in 1-week/2-week were 0.88/0.83 and 0.85/0.98, respectively. Positive and negative predictive values were 0.52/0.91 and 0.97/0.96, respectively. Early postoperative endoscopy could be carried out without any adverse events in all patients. CONCLUSION: Assessment of the anastomosis and graft with early postoperative endoscopy was safe and resulted in a high predictive value for subsequent anastomotic complications. Early postoperative endoscopy may lead to targeted management for a subset of patients undergoing esophagectomy.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Neoplasias Esofágicas/cirurgia , Estenose Esofágica/diagnóstico , Esofagectomia/métodos , Esofagoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Fístula Anastomótica/diagnóstico , Fístula Anastomótica/etiologia , Fístula Anastomótica/terapia , Estudos de Coortes , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Estenose Esofágica/etiologia , Estenose Esofágica/terapia , Esofagectomia/efeitos adversos , Feminino , Seguimentos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Cuidados Pós-Operatórios/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Surg Laparosc Endosc Percutan Tech ; 26(4): 319-23, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27438173

RESUMO

BACKGROUND AND PURPOSE: Validation of laparoscopic total gastrectomy (LTG) for patients with gastric cancer has not been fully investigated. In particular, the technique for esophagojejunostomy remains controversial. We performed 103 cases of LTG for patients with gastric cancer between 2007 and 2013, in which all esophagojejunostomy reconstruction was performed with intracorporeal circular stapling esophagojejunostomy using the OrVil system except for the first 3 cases. The purpose of this study is to retrospectively analyze the clinical usefulness of LTG with intracorporeal circular stapling esophagojejunostomy using the OrVil system and oncological feasibility of LTG as compared with open total gastrectomy (OTG). PATIENTS AND METHOD: We retrospectively analyzed clinical course of consecutive 100 operations with LTG in comparison with consecutive 53 operations with OTG for patients with gastric cancer. As an estimation of short-term outcome, operative time, blood loss, postoperative hospital days and postoperative data of blood and drain examination were included. Moreover, relapse-free survival time and overall survival time stratified by each stage were calculated by log-rank test as an estimation of prognostic relevance. RESULTS: Blood loss and postoperative hospital stay of LTG were significantly less than that of OTG. Postoperative complications were equivalent between the 2 groups and no patient died within 1 month post-LTG. Only 1 patient had recurrence and died for carcinomatosa peritonitis 50 months after LTG (median follow-up period: 44 mo). CONCLUSIONS: Our experience revealed that LTG with intracorporeal circular stapling esophagojejunostomy using the OrVil system could be performed safely and with acceptable oncological outcome for patients with gastric cancer.


Assuntos
Gastrectomia/métodos , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Idoso , Perda Sanguínea Cirúrgica , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Humanos , Tempo de Internação , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Neoplasias Gástricas/tratamento farmacológico , Resultado do Tratamento
17.
Anticancer Res ; 36(8): 4139-44, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27466522

RESUMO

BACKGROUND/AIM: Laparoscopic surgery has made possible anterior resections with small incisions suitable for creating stomas. We retrospectively compared surgical results and stomal complications between transumbilical defunctioning ileostomy (TDI) and conventional defunctioning ileostomy (CDI) in laparoscopic anterior resections for rectal cancer. PATIENTS AND METHODS: We compared patients who underwent laparoscopic anterior resection with TDI (n=47) with those undergoing CDI (n=27) for rectal cancer between February 2011 and January 2015. RESULTS: For the initial operations, the TDI group had significantly less intraoperative blood loss (30.3 ml vs. 117.0 ml; p=0.014). For stomal closure, the TDI group experienced significantly fewer wound infections (2 vs. 8 cases; p=0.002) and bowel obstructions (none vs. 3 cases; p=0.039). No significant differences in stomal complication rates were observed. CONCLUSION: TDI is associated with better surgical results and fewer complications than CDI after laparoscopic anterior resection for rectal cancer.


Assuntos
Neoplasias Retais/cirurgia , Idoso , Feminino , Humanos , Ileostomia/métodos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Umbigo/cirurgia
18.
World J Surg ; 40(11): 2713-2718, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27357933

RESUMO

BACKGROUND: Postgastrectomy syndrome (PGS) remains a common complication after gastrectomy that affects patients' quality of life. Although impaired gastrointestinal (GI) function by gastrectomy procedures is thought to be the cause, the precise pathophysiology of PGS is yet to be clarified. AIM: The aim of this study was to investigate relationships between GI function and various symptoms or alimentary status in patients after gastrectomy. METHODS: Fifty-one patients who underwent total or distal gastrectomy at least 1 year previously were studied. All patients replied to a questionnaire that asked presence of symptoms (esophageal reflux, nausea, abdominal pain, early satiation, diarrhea, early dumping general, early dumping abdominal, and late dumping symptoms) and alimentary status (change in body weight, food intake per meal, frequency of meals per day). They also underwent assessment of GI function consisting of gastric emptying study by 13C-acetate breath test to examine reservoir capacity and gastric emptying, and water load drink test to evaluate tolerance to volume loading (TVL). The relationships between GI function and each symptom or alimentary status were examined. RESULTS: The patients with nausea and early dumping general symptoms had significantly smaller reservoir capacity*, the patients with diarrhea and early dumping general symptoms had significantly faster gastric emptying*, and the patients with early satiation and early dumping abdominal symptoms had significantly impaired TVL*. Significant correlations were identified between TVL and body weight changes* or food intake per meal* (* p < 0.05). CONCLUSION: Impaired postoperative GI function was closely related to symptoms or worse alimentary status.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/efeitos adversos , Síndromes Pós-Gastrectomia/diagnóstico , Síndromes Pós-Gastrectomia/fisiopatologia , Neoplasias Gástricas/cirurgia , Adenocarcinoma/fisiopatologia , Idoso , Anastomose Cirúrgica/efeitos adversos , Feminino , Gastrectomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Pós-Gastrectomia/etiologia , Qualidade de Vida , Neoplasias Gástricas/fisiopatologia , Inquéritos e Questionários
19.
BMC Surg ; 16(1): 35, 2016 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-27245664

RESUMO

BACKGROUND: Although the infrared indocyanine green (ICG) imaging is an effective method to identify sentinel lymph nodes (SLNs) of gastric cancer, its objectivity has not been verified. METHODS: We studied 563 lymph nodes under infrared light observation from the ICG-positive lymphatic basins of 36 patients who underwent SLN-navigated gastrectomy for clinically node-negative gastric cancer. First, the rate of SLN detection, the number of SLNs and sensitivities were compared between ordinary light observation and infrared light observation. Second, 563 lymph nodes were grouped into ICG-positive and -negative under infrared light observation. The intensities of the region of interest for each lymph node defined as the lymph node on which digital imaging was performed using an imaging-software, and the region of reference defined as its surrounding background, were compared and quantified. RESULTS: In the comparison of ordinary light observation with infrared light observation, the SLN identification rates were 28/36 (78 %) vs. 36/36 (100 %), the mean ± SD (minimum to maximum) number of SLNs was 3.4 ± 3.7 (0-16) vs. 9.2 ± 5.9 (2-25), and the sensitivities were 1/5 (20 %) vs. 5/5 (100 %). The ICG-positive group contained 358 lymph nodes with an intensity of 0.323 ± 1.56 (mean ± SD), and the ICG-negative group contained 205 lymph nodes with an intensity of 0.639 ± 1.93 (mean ± SD), demonstrating a significant difference between these two groups (P < 0.0001). CONCLUSIONS: The significant difference in the intensity as measured by an imaging-software between ICG-positive and ICG-negative lymph nodes would erase the concern about the objectivity of the infrared ICG method for SLN-navigated surgery for early gastric cancer.


Assuntos
Verde de Indocianina/farmacologia , Linfonodos/patologia , Estadiamento de Neoplasias/métodos , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Gástricas/secundário , Corantes/farmacologia , Humanos , Metástase Linfática , Neoplasias Gástricas/diagnóstico
20.
Anticancer Res ; 36(4): 1937-42, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27069183

RESUMO

AIM: The aim of this study was to assess the response rate and find improvements. PATIENTS AND METHODS: Fifty-five patients with esophageal cancer were enrolled. Neoadjuvant chemotherapy (one or two courses) consisted of 60 mg/m(2)docetaxel on day 1, 70 mg/m(2)cisplatin on day 1 and continuous infusion of 5-fluorouracil at 600 mg/m(2)/day on day 1-5. All patients were examined for clinical response by computed tomography and endoscopy at each course. RESULTS: Grade 3/4 hematological toxicity was observed in 63.6% and grade 3/4 non-hematological toxicity in 41.8% of patients. The clinical response rate was 71% and histological complete response rate was 7.8%. We divided patients into three groups by clinical response to the first course of chemotherapy: partial response (PR), incomplete response (IR) and stable disease (SD). The final clinical response rate in those with SD to the first course was significantly lower (vs. those with PR p<0.001, vs. IR p<0.001). CONCLUSION: A high response rate was obtained and tolerability was good. Moreover, the presence of sensitivity to therapy was reflected in the initial clinical response.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Fluoruracila/uso terapêutico , Taxoides/uso terapêutico , Abdome , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/efeitos adversos , Docetaxel , Endoscopia , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Fluoruracila/efeitos adversos , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Taxoides/efeitos adversos , Tórax , Tomografia Computadorizada por Raios X
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