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1.
BMC Surg ; 20(1): 222, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008379

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) has been declared a global pandemic by the World Health Organization. Patients with cancer are more likely to incur poor clinical outcomes. Due to the prevailing pandemic, we propose some surgical strategies for gastric cancer patients. METHODS: The 'COVID-19' period was defined as occurring between 2020 and 01-20 and 2020-03-20. The enrolled patients were divided into two groups, pre-COVID-19 group (PCG) and COVID-19 group (CG). A total of 109 patients with gastric cancer were enrolled in this study. RESULTS: The waiting time before admission increased by 4 days in the CG (PCG: 4.5 [IQR: 2, 7.8] vs. CG: 8.0 [IQR: 2,20]; p = 0.006). More patients had performed chest CT scans besides abdominal CT before admission during the COVID-19 period (PCG: 22 [32%] vs. CG: 30 [73%], p = 0.001). After admission during the COVID period, the waiting time before surgery was longer (PCG: 3[IQR: 2,5] vs. CG: 7[IQR: 5,9]; p < 0.001), more laparoscopic surgeries were performed (PCG: 51[75%] vs. CG: 38[92%], p = 0.021), and hospital stay period after surgery was longer (7[IQR: 6,8] vs.9[IQR:7,11]; p < 0.001). In addition, the total cost of hospitalization increased during this period, (PCG: 9.22[IQR:7.82,10.97] vs. CG: 10.42[IQR:8.99,12.57]; p = 0.006). CONCLUSION: This study provides an opportunity for our surgical colleagues to reflect on their own services and any contingency plans they may have to tackle the COVID-19 crisis.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Padrões de Prática Médica , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 99(38): e22306, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957392

RESUMO

RATIONALE: Gastric mixed adenoneuroendocrine carcinoma (gMANEC) is a rare malignant tumor. Most gMANECs are diagnosed at an advanced stage and have a worse prognosis than gastric adenocarcinoma. In order to improve the prognosis, it is necessary to diagnose gMANEC at an early stage. However, the endoscopic features of early gMANECs are unclear. We, herein, report a case of early gMANEC that showed characteristic magnifying endoscopic findings. PATIENT CONCERNS: A 78-year-old man was referred to our institution for endoscopic resection of a gastric lesion. He had a medical history of distal gastrectomy due to early gastric cancer with negative surgical margins 9 years previously. DIAGNOSIS: Esophagogastroduodenoscopy showed a reddish depressed lesion on the suture line of the gastric remnant, which was classified as type 0-IIc according to the Paris classification. ME-NBI at the oral side of the lesion revealed the absence of the microsurface pattern (MSP) and scattered microvessels with dilation and caliber variation, while ME-NBI at the anal side showed an irregularly tubular MSP. An endoscopic forceps biopsy showed a well- to moderately differentiated adenocarcinoma. INTERVENTIONS: We performed endoscopic submucosal dissection, and en bloc resection of the tumor was successfully achieved. OUTCOMES: The histological findings showed two distinct components: neuroendocrine carcinoma (NEC) and well-differentiated adenocarcinoma, which comprised ∼60% and 40% of the tumor, respectively. The NEC component corresponded to the site with the absence of an MSP and scattered microvessels on ME-NBI, while the well-differentiated adenocarcinoma component corresponded to the site with an irregularly tubular MSP. The pathological diagnosis was mixed adenoneuroendocrine carcinoma, infiltrating into the deep submucosal layer. LESSONS: We propose that the absence of an MSP plus an irregular MSP is characteristics of gMANEC, which was useful for the diagnosis of gMANEC before treatment.


Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias Gástricas/patologia , Idoso , Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/cirurgia , Endoscopia do Sistema Digestório , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia
3.
Chirurgia (Bucur) ; 115(4): 423-431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876015

RESUMO

Post-gastrectomy complications have been the associated sequelae after curative gastrectomy for long time. They include a conundrum of symptoms ranging from serious metabolic alterations to disorders attributed to mechanical and neural factors after reconstruction of the digestive continuity. Though, with the advancement in the surgical expertise and techniques and shift towards medical and endoscopic management for benign gastro-duodenal ulcer disease, there has been a decline in the incidence of these complications; they continue to raise "red flags" after major oncologic gastric resections. Identification of these symptoms and protocol based management of the same is of utmost importance in the surgical armamentarium of trainees and practicing physicians and surgeons.


Assuntos
Gastrectomia/efeitos adversos , Síndromes Pós-Gastrectomia/diagnóstico , Síndromes Pós-Gastrectomia/terapia , Humanos , Gastropatias/cirurgia , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(33): e21085, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871979

RESUMO

The lymph nodal invasion diagnosis is critical for therapeutic-decision and follows up in gastric cancer. However, the number of nodes to be examined for nodal invasion diagnosis is still under controversy, and the model for quantifying risk of missing positive node is currently not reported yet. We analyzed the nodal invasion status of 13,857 gastric cancer samples with records of primary tumor stage, the number of examined and positive lymph nodes in the surveillance, epidemiology, and end results (SEER) database, fitting a beta-binomial model. The nodes need to be examined with different primary tumor stage were determined based on the model. Overall, examining 11 lymph nodes reduces the probability of missing positive nodes to <10%, and the currently median nodes dissected is adequate (12 nodes). While the number of nodes demands to be dissected for T1, T2, T3, and T4 subgroups are 6, 19, 40, and 66, respectively. The currently implemented median value for these samples was 12, 12, 13, and 16, separately. It implies that the number of nodes to be examined is sufficient for early gastric cancer (T1), but it is inadequate for middle and advanced gastric cancer (T2-T3). The clinical significance of nodal staging score was validated with survival information. In summary, we first quantified the lymph nodes to be examined during surgery using a beta-binomial model, and validated with survival information.


Assuntos
Linfonodos/patologia , Metástase Linfática/diagnóstico , Metástase Linfática/patologia , Estadiamento de Neoplasias/métodos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Reações Falso-Negativas , Feminino , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Probabilidade , Estudos Retrospectivos , Programa de SEER , Sensibilidade e Especificidade , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia , Análise de Sobrevida
5.
Medicine (Baltimore) ; 99(33): e21621, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872019

RESUMO

Upper gastrointestinal stenting is a palliative treatment for relieving symptoms such as nausea, vomiting, and dietary intake in patients with obstruction due to inoperable advanced stomach cancer. Self-expandable metal stent (SEMS) implantation for malignant obstruction has recently become more effective, safer, and less expensive than operative modality. It also has better short-term outcomes, particularly a shorter hospital stay and a more rapid return to oral intake, than surgical treatment. However, there is no comparative analysis regarding the efficacy, side effects, and survival rate of stenting between the esophagogastric junction (EGJ) and pyloric obstructions.To compare the prognoses and complications after SEMS implantation between EGJ and pyloric obstructions in advanced gastric cancer.Among advanced gastric cancer patients with gastrointestinal obstruction diagnosed from January 2008 to December 2017 at the Gastroenterology Department of Chungnam National University Hospital, 42 and 76 patients presented with EGJ (EGJ obstruction group) and gastric pyloric obstructions (pyloric obstruction group), respectively. We retrospectively reviewed the survival period, changes in food intake, and complications of these patients before and after SEMS placement.The prevalences of aspiration pneumonia were 11.9% (5/42) and 2.6% (2/76) in the EGJ and pyloric obstruction groups, respectively, before SEMS placement (P value: .041). Other symptoms associated with gastric malignant obstruction were not statistically different between the groups. Success rate and adverse events did not significantly differ between the EGJ and pyloric obstruction groups. There was no difference in frequency of stent reinsertion procedures performed owing to reobstruction, but the reprocedure average period was statistically significantly longer in the EGJ obstruction group [EGJ obstruction: 158.3 days (±42.4); pyloric obstruction: 86.0 days (±29.1)] (P value: .022). As an index of improved dietary status, the Gastric Outlet Obstruction Scoring System score was not significantly different between the groups before and after SEMS placement.The EGJ and pyloric obstruction groups did not significantly differ in prognosis or complication rates. However, EGJ stent was more stable than pyloric stent when reobstruction was considered.


Assuntos
Junção Esofagogástrica/patologia , Piloro/patologia , Stents Metálicos Autoexpansíveis/efeitos adversos , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Dieta , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos , Pneumonia Aspirativa/etiologia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/patologia
6.
Anticancer Res ; 40(10): 5807-5813, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988909

RESUMO

BACKGROUND/AIM: The survival benefit of negative resection margins in patients who undergo gastrectomy with positive peritoneal lavage cytology (CY1) is unknown. PATIENTS AND METHODS: We reviewed the medical records of 128 patients with CY1 but no other distant metastases who had undergone R1 gastrectomy, 21 of whom had positive margins. We compared overall survival (OS) according to margin status. RESULTS: The positive-margin group had poorer performance status scores (p=0.02), higher number of patients had undergone limited lymphadenectomy (p=0.01), had type 4 tumors (p=0.01), and undifferentiated type (p=0.02). Median OS was 19.0 and 16.9 months in the groups with negative and positive margins, respectively (HR=1.26, 95%CI=0.75-2.12, p=0.39). An inverse probability of treatment weighted analysis showed an OS of 13.1 and 11.9 months for the groups with negative and positive margins, respectively (HR=0.83, 95%CI=0.43-1.63, p=0.59). CONCLUSION: The prognoses of patients with CY1 and negative or positive margins may be equivalent.


Assuntos
Citodiagnóstico , Gastrectomia , Prognóstico , Neoplasias Gástricas/cirurgia , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Lavagem Peritoneal/métodos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Taxa de Sobrevida
7.
Anticancer Res ; 40(10): 5815-5821, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988910

RESUMO

BACKGROUND/AIM: Glioma-associated oncogene 1 (GLI1) is an important transcription factor in the hedgehog signalling pathway and tumour formation. We evaluated the clinical significance of GLI1 expression as a prognostic factor in patients with locally advanced gastric cancer (GC). PATIENTS AND METHODS: GLI1 expression levels were measured by quantitative real-time polymerase chain reaction analysis of cancerous and adjacent normal mucosa specimens obtained from 142 patients with Stage II/III GC administered adjuvant chemotherapy with S-1 after curative resection. The associations of GLI1 expression with clinicopathological features and survival were evaluated. RESULTS: Clinicopathological features and GLI1 expression showed no association. Overall survival was significantly poorer in the high compared to the low GLI1 expression group (p=0.04). Multivariate analysis revealed that GLI1 expression was a significant independent prognostic factor [p=0.019, hazard ratio (HR)=1.94, 95% confidence interval (CI)=1.70-3.38]. CONCLUSION: GLI1 expression may be a useful prognostic marker in patients with locally advanced GC.


Assuntos
Biomarcadores Tumorais/genética , Prognóstico , Neoplasias Gástricas/tratamento farmacológico , Proteína GLI1 em Dedos de Zinco/genética , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Combinação de Medicamentos , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Masculino , Estadiamento de Neoplasias , Ácido Oxônico/administração & dosagem , Ácido Oxônico/efeitos adversos , Neoplasias Gástricas/genética , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Tegafur/administração & dosagem , Tegafur/efeitos adversos
8.
Medicine (Baltimore) ; 99(33): e21775, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872077

RESUMO

BACKGROUND: Gastric cancer is a common gastrointestinal tumor, seriously threatening human health. Radical surgery is the preferred treatment for gastric cancer. However, due to the late diagnosis and postoperative recurrence and metastasis, the prognosis is dismal. In China, traditional Chinese medicine (TCM) has been used to treat gastric cancer for many years. The purpose of this study is to explore the efficacy and safety of Yiqi Huayu Jiedu decoction in the treatment of postoperative gastric caner. METHODS/DESIGN: 226 eligibility patients altogether will be randomly allocated to the treatment group and the control group at a ratio of 1:1. After enrollment, every patients will obtain 6 months of treatment, as well as 2 years of follow-up. At the end of this study, primary outcomes including 1-year progression-free survival rate, 2-year progression-free survival rate and disease-free survival, secondary outcomes containing tumor markers, TCM syndrome points, quality of life scale, imageological examination and the safety indicators will be assessed. DISCUSSION: This study will provide the evidence-based evidence for the efficacy of Yiqi Huayu Jiedu decoction reducing the risk of postoperative gastric cancer recurrence and metastasis, which will be beneficial to form the therapeutic regimen in postoperative gastric cancer with integrated TCM and Western medicine. TRAIL REGISTRATION: ChiCTR2000032802.


Assuntos
Recidiva Local de Neoplasia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Gástricas/prevenção & controle , Humanos , Metástase Neoplásica/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/cirurgia
9.
Medicine (Baltimore) ; 99(36): e21883, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899018

RESUMO

To investigate the expression and clinical significance of aquaporin-1 (AQP1), vascular endothelial growth factor (VEGF) and microvessel density (MVD) in gastric cancer.A total of 79 gastric cancer patients who were admitted into Beijing Chao-Yang Hospital from January, 2018 to December, 2019 were involved in this study. Tumor specimens and para-cancerous normal tissues (> 2 cm away from the tumor) of all the enrolled patients were collected. Immunohistochemistry were performed to identify the expression of AQP1, VEGF, and MVD and the correlation between AQP1, VEGF, MVD, and clinicopathological parameters was analyzed.The expression of AQP1, VEGF and MVD in gastric cancer tissue was increased significantly compared with those in para-cancerous tissue (P < .05). AQP1, VEGF, and MVD were closely correlated with gastric cancer differentiation, lymph node metastasis, vascular tumor thrombosis and clinical stage (P < .05). Spearman correlation analysis showed that AQP1 was positively associated with VEGF expression (r = 0.497, P < .05). MVD was enhanced in VEGF or AQP1 positive cancer tissues compared with that in VEGF or AQP1 negative tissue (P < .05).Synergistic effect among AQP1, VEGF, and MVD is involved in occurrence and development of gastric cancer.


Assuntos
Aquaporina 1/metabolismo , Microvasos/patologia , Neoplasias Gástricas/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
10.
Medicine (Baltimore) ; 99(36): e22125, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899097

RESUMO

RATIONALE: Primary gastric squamous cell carcinoma (SCC) is rarely encountered clinically. SCC, which presents as a submucosal tumor, is even rarer. Without the support of pathological evidence, it is difficult to make a correct preoperative diagnosis. Due to limited clinical data, the pathogenesis and treatment of gastric SCC remain unclear. PATIENT CONCERNS: A 69-year-old man was admitted to our hospital with unexplained weight loss. Endoscopy revealed a submucosal mass without any ulcer on its surface located on the body of the stomach. The results of 2 gastroscopic mucosal biopsies were chronic inflammation. DIAGNOSES: The clinical diagnosis by computed tomography (CT) and gastroscopy was gastrointestinal stromal tumor (GIST) preoperatively. The postoperative pathological examination demonstrated this tumor as moderately differentiated SCC. INTERVENTIONS: Total gastrectomy, distal pancreatectomy, and splenectomy were performed. OUTCOMES: The patient was discharged 7 days after the surgery without any complications. The follow-up CT scan showed no evidence of metastatic disease 6 months after surgery. LESSONS: Large primary gastric SCC could present as a submucosal mass. Gastroscopic mucosal biopsy may not be able to get tumor tissue due to inflammatory reaction.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/patologia , Idoso , Carcinoma de Células Escamosas/cirurgia , Diagnóstico Diferencial , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Masculino , Neoplasias Gástricas/cirurgia
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(8): 757-765, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32810947

RESUMO

Objective: To understand the perceptions, attitudes and treatment selection of Chinese surgeons for proximal gastrectomy (PG) and digestive tract reconstruction. Methods: A cross-sectional survey was used in this study. Selection of subjects: (1) Domestic public grade IIIA (provincial and prefecture-level) tumor hospitals or general hospitals possessing the diagnosis and treatment qualifications for gastric cancer.(2) Surgeons with senior attending physician, associate chief physician and chief physician. The "Questionnaire Star" platform was used to design a questionnaire about cognition, attitude and treatment choice of "proximal gastrectomy and digestive tract reconstruction". The questionnaire contained 32 questions, such as the basic information of surgeons, the current status of gastric cancer surgery, the selection and management of surgical methods and related details for proximal gastric cancer, the choice of proximal gastrectomy and reconstruction of digestive tract, the related complications and nutritional status monitoring after proximal gastrectomy. A total of 76 questionnaires were linked to the respondents via WeChat between July 29 and August 25, 2019. Statistical analysis was performed using Chi-square test or Kruskal-Wallis test for categorical variables. Results: A total of 47 grade IIIA hospitals were included, and 76 questionnaires were sent out. The proportions of recovered and valid questionnaires were both 100%. For early and middle stage adenocarcinoma of esophagogastric junction (AEG), especially those smaller than 4 cm, 72.37% (55/76) of surgeons preferred proximal gastrectomy, while 22.37% (17/76) of surgeons chose total gastrectomy. For early AEG, 90.79% (69/76) of surgeons thought that endoscopic submucosal dissection (ESD) or proximal gastrectomy could be considered. For AEG below T3 stage and shorter than 4 cm, 60.53% (46/76) of surgeons gave priority to proximal gastrectomy, and 60.53% (46/76) of the surgeons believed that the advanced AEG with a higher radical cure should be treated with proximal gastrectomy, and the residual stomach should not be less than half stomach. Considering anti-reflux effect, postoperative weight recovery, clinical efficacy, wide application and easy popularization, surgeons preferred double-tract reconstruction. The surgeons in tumor hospitals had a higher approval rate for the application of proximal gastrectomy and the fact that the Kamikawa anastomosis was the most difficult to promote than the surgeons in provincial/municipal general hospitals. The surgeons with an annual surgical volume of more than 200 were more likely to choose proximal gastrectomy for early and middle stage AEG patients and the proportion was as high as 8/9. From the perspective of good clinical results, wide range of application, and easy popularization, the surgeons with a higher ratio (60.00%, 15/25) of double-tract reconstruction were those surgeons with 50-100 operations per year. Conclusions: The general level of cognition and acceptability of Chinese surgeons for proximal gastrectomy and reconstruction of digestive tract is suboptimal. In the future, it is urgent to promote the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy" so as to guide and optimize treatment in proximal gastric cancer.


Assuntos
Gastrectomia , Neoplasias Gástricas , Estudos Transversais , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Cirurgiões , Inquéritos e Questionários , Resultado do Tratamento
12.
Dis Esophagus ; 33(9)2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32816020

RESUMO

BACKGROUND: The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular surgical intervention, in patients with esophago-gastric cancer at a high-volume tertiary center. METHODS: All patients undergoing potential management for esophago-gastric cancer from 12 March to 22 May 2020 had their outcomes reviewed. Multi-disciplinary team (MDT) decisions, volume of cases, and outcomes following resection were evaluated. RESULTS: Overall 191 patients were discussed by the MDT, with a 12% fall from the same period in 2019, including a fall in new referrals from 120 to 83 (P = 0.0322). The majority of patients (80%) had no deviation from the pre-COVID-19 pathway. Sixteen patients had reduced staging investigations, 4 had potential changes to their treatment only, and 10 had a deviation from both investigation and potential treatment. Only one patient had palliation rather than potentially curative treatment. Overall 19 patients underwent surgical resection. Eight patients (41%) developed complications with two (11%) graded Clavien-Dindo 3 or greater. Two patients developed COVID-19 within a month of surgery, one spending 4 weeks in critical care due to respiratory complications; both recovered. Twelve patients underwent endoscopic resections with no complications. CONCLUSION: Care must be taken not to compromise cancer treatment and outcomes during the COVID-19 pandemic. Excellent results can be achieved through meticulous logistical planning, good communication, and maintaining high-level clinical care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Neoplasias Esofágicas/cirurgia , Pneumonia Viral/epidemiologia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/prevenção & controle , Procedimentos Clínicos , Endoscopia , Feminino , Humanos , Controle de Infecções , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Reino Unido/epidemiologia
13.
Geriatr Gerontol Int ; 20(10): 927-931, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32830911

RESUMO

AIM: This study aimed to investigate the potential risk factors for postoperative cognitive dysfunction (POCD) in elderly patients with gastric cancer (GC) after radical gastrectomy. METHODS: In total, 221 elderly patients with GC who were scheduled to undergo selective radical gastrectomy in our hospital were enrolled in this study. To define early POCD, the neuropsychological assessment was carried out 1 day before surgery and 7 days after surgery. Receiver operating characteristic curve analysis was carried out to evaluate the predicative and cut-off values of risk factors, including neutrophil-lymphocyte ratio (NLR) for early POCD. The univariate and multivariate logistic regression analyses were performed to investigate risk factors for early POCD. RESULTS: Of the 221 enrolled elderly patients with GC, 42 were identified as early POCD with an incidence of 19.0% (42 of 221). Receiver operating characteristic curve analysis indicated that NLR was a significant predictor for POCD with a cut-off value of 2.50 and an area under the curve of 0.711 (95% confidence interval: 0.624-0.798, P < 0.001). Preoperative NLR (≥2.50) was the only independent risk factor associated with POCD (odds ratio: 2.44, 95% confidence interval: 1.52-3.68, P = 0.013) by the multivariate logistic regression analysis. CONCLUSIONS: Preoperative NLR level was an independent risk factor for POCD in elderly patients with GC undergoing curative resection. Geriatr Gerontol Int 2020; 20: 927-931.


Assuntos
Linfócitos , Neutrófilos , Complicações Cognitivas Pós-Operatórias/epidemiologia , Neoplasias Gástricas/cirurgia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Gastrectomia , Humanos , Incidência , Masculino , Testes Neuropsicológicos , Razão de Chances , Curva ROC , Fatores de Risco
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(5): 492-498, 2020 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842430

RESUMO

Objective: To explore the diagnostic value of laparoscopy in the postoperative recurrence of peritoneal metastasis in gastric cancer, and to investigate the efficacy of bidirectional intraperitoneal and systemic (BIPS) chemotherapy for the recurrence. Methods: The descriptive case series study was conducted. Case inclusion criteria: (1) gastric cancer patients without synchronous distant metastasis received D2 radical gastrectomy; (2) postoperative adjuvant chemotherapy was administered; (3) no other distant metastasis except recurrence of peritoneal metastasis; (4) age of 18-75 years; (5) Eastern Cooperative Oncology Group (ECOG) performance-status score≤2; (6) pretreatment evaluation suggested that surgery and chemotherapy could be tolerated. Eight consecutive gastric cancer patients with postoperative recurrence of peritoneal metastasis who met the above criteria at Department of Gastrointestinal Surgery of Ruijin Hospital from September 2015 to September 2016 were enrolled into the study. There were 6 males and 2 females with the median age of 52 (38-68) years. They received laparoscopy or laparotomy first, and then were evaluated with reference to the Sugarbaker peritoneal cancer index (PCI) and the peritoneal metastasis classification of gastric cancer developed by the Japanese Gastric Cancer Research Association. A peritoneal access port was implanted in the subcutaneous space of the lower abdomen and the patients received chemotherapy for 21 days as a course of treatment. All the patients received intraperitoneal 20 mg/m(2) of paclitaxel (PTX) via implanted subcutaneous peritoneal access ports and intravenous 50 mg/m(2) of PTX at day 1 and day 8, meanwhile 80 mg/m(2) of Tigio was orally administered per day for 14 consecutive days, followed by 7 days of interval. Follow-up ended on December 15, 2019. Results: Of these 8 patients with recurrence of peritoneal metastasis after gastric cancer surgery, 1 case underwent laparotomy and loop stoma of terminal ileum because of complete colonic obstruction, and the remaining 7 cases underwent laparoscopy successfully and the recurrence of peritoneal metastasis was clearly diagnosed. Two patients with ovarian metastasis underwent laparoscopic bilateral adnexectomy. The median follow-up time was 17.5 (1.5 to 39.0) months, the median number of BIPS chemotherapy course was 11 (1 to 30), and the median survival time (MST) after BIPS chemotherapy was 17.0 months. The major adverse reaction in BIPS treatment was mainly myelosuppression, of which grade 3/4 leukopenia and neutropenia developed in 1 and 2 cases respectively. No BIPS-related death occurred. The MST of gastric cancer after radical gastrectomy was 40.0 months. Conclusions: Laparoscopy is a safe and feasible method for diagnosing the recurrence of peritoneal metastasis of gastric cancer. BIPS chemotherapy is effective and safe for its treatment and deserves further study.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias Gástricas/patologia , Administração Oral , Adulto , Idoso , Antineoplásicos Fitogênicos/administração & dosagem , Feminino , Gastrectomia , Humanos , Infusões Parenterais , Laparoscopia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/tratamento farmacológico , Paclitaxel/administração & dosagem , Neoplasias Peritoneais/secundário , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
15.
Rev Med Suisse ; 16(699): 1292-1299, 2020 Jul 01.
Artigo em Francês | MEDLINE | ID: mdl-32608586

RESUMO

Esophageal cancer remains an oncological burden with a low survival rate. Multidisciplinary management is essential to offer an adjusted treatment to the patient general condition and the tumor stage. New minimally invasive surgical treatments help to reduce the surgical trauma and improve post-operative patient recovery. Oncological treatments have also evolved and definitive treatment by radio-chemotherapy can be proposed in specific cases.


Assuntos
Neoplasias Esofágicas/terapia , Terapia Combinada , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/terapia
16.
Anticancer Res ; 40(8): 4271-4279, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727754

RESUMO

BACKGROUND/AIM: Skeletal muscle mass (SMM) is often depleted in patients with gastric cancer undergoing gastrectomy. Using a novel method, we evaluated the effect of SMM depletion after gastrectomy on disease prognosis. PATIENTS AND METHODS: The maximum cross-sectional area of the psoas-muscle (MCA-PM) was measured before surgery and at 1 year after in 233 patients with gastric cancer who underwent radical gastrectomy to determine the ratio (MCA-PMR) as an indicator of SMM depletion. RESULTS: The MCA-PMR cutoff value was set at 90%, and patients were divided into the groups with <90% and ≥90%. MCA-PMR <90% was an independent prognostic factor for all patients. In 88 patients who received adjuvant chemotherapy including S-1, the 5-year cancer-specific survival rate was significantly better for those with MCA-PMR ≥90% than for those with MCA-PMR <90% (84.1% vs. 59.1%; p=0.010; hazard ratio=2.974; 95% confidence interval=1.241-7.124). CONCLUSION: SMM depletion after gastrectomy can be measured using the MCA-PMR. This novel measurement can be easily implemented in the clinical setting.


Assuntos
Gastrectomia/efeitos adversos , Músculo Esquelético/patologia , Sarcopenia/etiologia , Neoplasias Gástricas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sarcopenia/patologia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Adulto Jovem
17.
Medicine (Baltimore) ; 99(29): e21087, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702853

RESUMO

BACKGROUND: Side effects after surgical therapy and chemotherapy of gastric cancer substantially reduce patients' quality of life. This systematic review aims to investigate whether moxibustion, as a complementary treatment, is effective in alleviating side effects in patients with gastric cancer who underwent surgical therapy or chemotherapy. METHODS: We will systematically search nine English and Chinese electronic databases to find relevant randomized controlled trials (RCTs) that compare basic treatment with and without moxibustion for treating the side effects induced by surgical therapy or chemotherapy in patients with gastric cancer. The time frame of the search will be from inception to July 1, 2020, and the publication language will not be limited. The literature screening and data extraction will be completed independently by 2 reviewers. The Cochrane risk of bias tool will be used to assess the risk of bias. For the analyses of the side effects of both surgical therapy and chemotherapy, the primary outcomes are defined as the incidence of any side effect, response rate, and quality of life. For the analyses of the side effects of surgical therapy, the secondary outcomes include the incidence of each individual side effect, time to first flatus/defecation/bowel sounds, and length of in-hospital stay. For the analysis of the side effects of chemotherapy, the secondary outcomes include incidence of each individual side effect, white blood cell/red blood cell/platelets counts, and hemoglobin level. R v3.6.2 software will be used to perform the meta-analyses. The quality of evidence will be classified using the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: This study will provide the first systematic review evidence on the efficacy of moxibustion as adjuvant management for gastric cancer by rigorous quality assessment and appropriate data synthesis. The results will be submitted to a peer-reviewed journal for publication. CONCLUSION: The findings of this study will provide currently best evidence on moxibustion for patients with gastric cancer who underwent surgical therapy or chemotherapy and may impact clinical practice.PROSPERO registration number: CRD42020169511.


Assuntos
Protocolos Clínicos , Moxibustão/normas , Neoplasias Gástricas/cirurgia , Tratamento Farmacológico/métodos , Humanos , Metanálise como Assunto , Moxibustão/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Gástricas/complicações , Revisões Sistemáticas como Assunto
18.
Anticancer Res ; 40(7): 4067-4074, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620654

RESUMO

BACKGROUND: The aim of this study was to evaluate the impact of postoperative infectious complications on long-term outcomes after curative resection of gastric cancer. PATIENTS AND METHODS: Patients who underwent curative gastrectomy with lymphadenectomy for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015 were retrospectively selected from medical records. Clinicopathological factors between patients with and without infectious complications were compared. Prognostic factors of long-term survival were analyzed by univariate and multivariate Cox proportional hazards analyses. RESULTS: A total of 2,254 patients were eligible for inclusion in the present study. Fifty-eight patients had postoperative infectious complications (IC group); 2,196 had no postoperative infectious complications (NC group). In the IC group, the median age (p=0.031), body mass index (p=0.004), American Society of Anesthesiologists physical status (p=0.006) and percentage of male patients (p<0.001) were higher in comparison to the NC group. The operation time was longer (p<0.001) and the incidence of intestinal-type histology was higher (p=0.017) in the IC group. The 5-year overall survival rates of the IC and NC groups were 59.8% and 83.2%, respectively (p<0.001). Univariate and multivariate analyses demonstrated that postoperative infectious complications were a significant risk factor for poorer overall survival (hazard ratio=2.38; 95% confidence interval=1.47-3.85, p<0.001). CONCLUSION: Perioperative management is necessary to reduce the incidence of postoperative infectious complications and improve the survival of patients after curative resection of gastric cancer.


Assuntos
Adenocarcinoma/cirurgia , Infecções/etiologia , Complicações Pós-Operatórias , Neoplasias Gástricas/cirurgia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia , Humanos , Infecções/mortalidade , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/mortalidade , Análise de Sobrevida , Adulto Jovem
19.
Anticancer Res ; 40(8): 4537-4545, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32727784

RESUMO

BACKGROUND/AIM: Altered connexin expression has been associated with cancer development and progression. This study evaluated connexin 26, 32, and 43 expression in association with the long-term outcomes of gastric cancer after gastrectomy. PATIENTS AND METHODS: Pathological specimens were collected from 113 patients who underwent gastrectomy for gastric cancer, of whom 104 were included in the study. The expression levels of the connexins were assessed by immunohistochemistry. The patients were classified into low and high groups according to the median histoscore of connexin. RESULTS: Cancer-specific survival (CSS) was significantly longer in the high than low connexin 43 group (p=0.030), particularly in patients >65 years old (p=0.030). A multivariate analysis identified pathological stage, differentiation type, and connexin 43 expression as possible predictors of CSS in patients (difference in the area under the curve=0.232, 0.090, and 0.094). CONCLUSION: Low connexin 43 expression predicted a poor CSS in gastric cancer patients after gastrectomy.


Assuntos
Conexina 43/metabolismo , Conexinas/metabolismo , Neoplasias Gástricas/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Regulação para Baixo , Feminino , Gastrectomia , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/patologia , Análise de Sobrevida , Resultado do Tratamento
20.
Zhonghua Wai Ke Za Zhi ; 58(8): 614-618, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727193

RESUMO

Objective: To compare the accuracy of abdominal enhanced CT and endoscopic ultrasound in the staging of gastric cancer after neoadjuvant chemotherapy (yc stage). Methods: Clinic data of 86 locally advanced gastric cancer patients admitted in Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute from April 2015 to November 2017 were analyzed retrospectively. Totally 86 patients completed both abdominal enhanced CT and endoscopic ultrasound after neoadjuvant chemotherapy. There were 60 males and 26 females, aged (57.8±9.7) years (range: 32 to 76 years). The diagnostic accuracy of abdominal enhanced CT and endoscopic ultrasound for yc stage were calculated by the area under the multiclass receiver operation characteristic curve (M-AUC), retrospectively. McNemar test was used to compared the diagnostic sensitivity. Results: The M-AUC of ycT stage evaluated by abdominal enhanced CT (CT-ycT stage) and by endoscopic ultrasound (EUS-ycT stage) was 0.614 and 0.704, respectively. For middle and lower gastric cancer, the M-AUC of CT-ycT stage was 0.599 and 0.613, respectively, while EUS-ycT stage was 0.558 and 0.709, respectively. For tumor in the lesser and non-lesser curvature, the M-AUC of CT-ycT stage was 0.630 and 0.607, respectively, while EUS-ycT stage was 0.616 and 0.749, respectively. For patients in CT-ycT1-CT-ycT4, there was no statistically significant difference in the sensitivity between CT-ycT stage and EUS-ycT stage (2/18, 2/15, 52.8%(19/36), 8/13 vs. 0, 4/15, 55.6%(20/36), 7/13; χ(2)=2.00, P=0.157; χ(2)=2.00, P=0.157; χ(2)=0.08, P=0.782; χ(2)=0.33, P=0.564). The M-AUC of ycN stage evaluated by abdominal enhanced CT (CT-ycN stage) was 0.654, while ycN stage evaluated by endoscopic ultrasound (EUS-ycN stage) was 0.533. For patients in CT-ycN0, there was statistically significant difference in the sensitivity between CT-ycN stage and EUS-ycN stage (12.7%(7/55) vs. 5.5%(3/55); χ(2)=4.00, P=0.046). For patients in CT-ycN1, N2, and N3, there was no statistically significant difference in the sensitivity between CT-ycN stage and EUS-ycN stage (2/19, 1/10, 0 vs. 1/19, 1/10, 0; χ(2)=1.00, P=0.317; the other P cannot be estimated). Conclusions: There was no significant difference between the diagnostic efficacy of abdominal enhanced CT and endoscopic ultrasound for yc stage of gastric cancer. Considering the invasiveness of ultrasound gastroscopy, it should not be recommend for patients after neoadjuvant chemotherapy routinely.


Assuntos
Antineoplásicos/administração & dosagem , Endossonografia , Estadiamento de Neoplasias/métodos , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Endossonografia/métodos , Endossonografia/normas , Feminino , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias/normas , Reprodutibilidade dos Testes , Estudos Retrospectivos , Neoplasias Gástricas/tratamento farmacológico , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas
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