OBJECTIVEThis review discusses the current status and progress in studies on gastric cancer with liver metastasis (GCLM), involving the routes, subtypes, and prognosis of GCLM; the genes and molecules associated with metastasis; the feasibility and value of each imaging modality; and current treatment options.

DATA SOURCESThe data used in this review were mainly from Medline and PubMed published in English from 2005 to August 2010. The search terms were "gastric cancer" and "liver metastasis".

STUDY SELECTIONArticles regarding the characteristics, diagnostic modalities, and various therapeutic options of GCLM were selected.

RESULTSThe prognosis of GCLM is influenced by the clinicopathological characteristics of primary tumors, as well as the presence of liver metastases. Improved understanding of related genes and molecules will lead to the development of methods of early detection and targeted therapies. For the diagnosis of GCLM, each imaging modality has its relative benefits. There remains no consensus regarding therapeutic options.

CONCLUSIONSEarly detection and characterization of liver metastases is crucial for the prognosis of gastric cancer patients. Multidisciplinary team discussions are required to design optimal treatment strategies, which should be based on the clinicopathological characteristics of each patient.

Humans ; Liver Neoplasms ; diagnosis ; drug therapy ; secondary ; surgery ; Stomach Neoplasms ; complications ; diagnosis ; drug therapy ; surgery

The incidence of gastric cancer has declined worldwide in the past decades. However, due to the large number of population in mainland of China, the absolute number of newly-diagnosed patients in this developing country is still very high. Most of the major clinical centers have established multi-disciplinary team, but the strategy in treating this life-threatening disease still needs to be optimized, including the precise preoperative staging by various techniques, perioperative chemotherapy for locally advanced diseases, role of minimally invasive surgical approaches in treating patients with different stages, translational research to fill the gap between clinical trials and basic research, as well as the individualized treatment for gastric cancer. We believe that the biological behaviors and molecular events of gastric cancer in eastern countries are different from that of Western countries, so the clinical evidences derived from Eastern countries need to be strengthened to enrich the unmet demands in the clinical practice in China.
China ; Combined Modality Therapy ; Humans ; Stomach Neoplasms ; drug therapy ; surgery ; therapy

Several studies have demonstrated the benefit of perioperative chemotherapy in the treatment of advanced gastric cancers, especially the neoadjuvant chemotherapy (NAC). Many NAC trials in the United States, UK and Japan have proved that NAC can shrink the tumor and metastatic lymph nodes, downstage the T and N staging, achieve more curative (R0) resection for the unresectable cases, and even improve survival. Various neoadjuvant chemotherapy regimens have different effects on the body, therefore the timing selection of surgery, surgical programs and goals are different accordingly. Optimal surgery after neoadjuvant chemotherapy should be based on full comprehension of the pharmacology and pharmacokinetics. Strict surgical quality control is necessary.
Chemotherapy, Adjuvant ; Gastrectomy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Stomach Neoplasms ; drug therapy ; surgery

To get a better understanding of the location, pathophysiology, etiology and prognosis of multiple malignant tumors (MPMT), we evaluated the medical records of 22 patients with MPMT. Our results suggested that radiotherapy and chemotherapy might play an important role in the pathogenesis of MPMT and follow-up is important in detecting a secondary primary malignant tumor (PMT) at an early stage. Surgical removal of tumors is the first-choice therapy for MPMT.
Adenocarcinoma ; drug therapy ; radiotherapy ; surgery ; Adult ; Aged ; Breast Neoplasms ; drug therapy ; radiotherapy ; surgery ; Carcinoma, Squamous Cell ; drug therapy ; radiotherapy ; surgery ; Colonic Neoplasms ; drug therapy ; radiotherapy ; surgery ; Combined Modality Therapy ; Female ; Humans ; Lung Neoplasms ; drug therapy ; radiotherapy ; surgery ; Male ; Middle Aged ; Neoplasms, Second Primary ; drug therapy ; radiotherapy ; surgery ; Prognosis ; Stomach Neoplasms ; drug therapy ; radiotherapy ; surgery

The overall prognosis of gastric cancer has gradually improved over the past decades with growing awareness of potential carcinogens, surveillance programs and early diagnosis, as well as advances in surgical techniques and multimodality treatments. Nevertheless, the outcome of advanced stage disease still remains poor with currently available treatments, and a worldwide consensus on the standard management thereof has not been established. To improve prognosis and quality of life in gastric cancer patients, both standardization and individualization of managements are imperative. Diagnostic tests and surgical procedures need to be further sophisticated and standardized based on more recent evidences from ongoing and future randomized controlled trials, while comprehensive management should be individualized to each patient. Future challenges lie with how to optimize personalized therapies by deciphering biological complexity of gastric cancer and incorporating molecular biomarkers in clinical practice to forecast prognosis and to guide targeted therapeutics in adjunct to current standards of care.
Disease Management ; Gastrectomy ; Humans ; Lymph Node Excision ; Stomach Neoplasms/*diagnosis/drug therapy/etiology/surgery

The outcome of surgery alone for advanced gastric cancer is unsatisfactory. Local recurrence rate and distant metastasis rate are still high in postoperative patients. In recent years, people have paid more attention to neo- adjuvant chemotherapy, because it can reduce tumor loading, degrade the staging, increase the surgery excision rate and improve the long-term survival. Preoperative regional arterial infusion chemotherapy can directly act on the tumor endothelial cells with higher local drug concentration, but with fewer systemic side effects. So it may offer an effective treatment for advanced gastric cancer. The indications, complications, therapeutic evaluation, timing of surgery, chemotherapy regimens and pathomorphological changes and so on of the preoperative regional arterial infusion chemotherapy are summarized in this review.
Chemotherapy, Adjuvant ; Humans ; Infusions, Intra-Arterial ; Preoperative Care ; Stomach Neoplasms ; drug therapy ; surgery

Colonic Neoplasms ; drug therapy ; surgery ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Medicine, Chinese Traditional ; Phytotherapy ; Stomach Neoplasms ; drug therapy ; surgery ; Yin-Yang

The Japanese Gastric Cancer Treatment Guidelines (the Guidelines), as a guiding and programmatic document in the treatment for gastric cancer, has drawn high attention worldwide. The treatment selection and determination is mainly based on the T staging. Endoscopic therapy, laparoscopic surgery and minimal extent surgery have consisted of the main clinical practice for T1 cancer. D2 dissection is a standard procedure for advanced cancer(T2-T4). Extensive resection or neoadjuvant preoperative chemotherapy is recommended for highly advanced cancer. Progress in gastric cancer treatment has been acquired recently due to high-level clinical trials, new anti-cancer drugs application, and efficiency of chemotherapy. Therefore, traditional extensive resection has been abandoned gradually. Comprehensive treatment based on chemotherapy could improve survival for patients with unresectable and recurrent gastric cancer.
Gastrectomy ; methods ; Humans ; Laparoscopy ; Lymph Node Excision ; Neoadjuvant Therapy ; Neoplasm Staging ; Practice Guidelines as Topic ; Stomach Neoplasms ; drug therapy ; surgery

Among malignant tumors of the stomach, adenocarcinoma takes up about 95% and the remaining are mostly lymphomas, being less than 5%. The majority of lymphomas are B cell lymphomas, and the most common types are low-grade B cell lymphoma of mucosa-associated lymphoid tissue and diffuse large B cell lymphoma (DLBL). The synchronous occurrence of adenocarcinoma and lymphoma in the stomach is being reported rarely. Especially the concurrence of adenocarcinoma and DLBL is very scarce and less than 10 cases have been reported inside and outside this country. In the past, the general treatment for cases of concurrence of adenocarcinoma and DLBL when surgery is possible according to cancer stages was gastrectomy, followed by single or combined chemotherapy and radiation treatment. However, when considering that most cases of concurrent adenocarcinoma were early gastric cancer which is limited to the mucosa, endoscopic submucosal dissection (ESD) can become an alternative treatment method for gastrectomy. We report the experience with chemotherapy and ESD done together instead of surgery, in patients concurrently diagnosed with early gastric cancer and gastric lymphoma.
Adenocarcinoma/*drug therapy/surgery ; Anti-Bacterial Agents/therapeutic use ; Antineoplastic Agents/therapeutic use ; Drug Therapy, Combination ; Helicobacter Infections/drug therapy ; Humans ; Lymphoma, Large B-Cell, Diffuse/*drug therapy/pathology ; Male ; Middle Aged ; Stomach Neoplasms/*drug therapy/surgery

OBJECTIVETo evaluate the effect of neoadjuvant chemotherapy on the postoperative pulmonary infection of patient with gastric cancer.

METHODSBetween January 2009 and January 2011, 139 patients with curable stage T2N2 or T3N2 gastric cancer were randomly assigned to group 1(69 cases, neoadjuvant chemotherapy with combined preoperative intraarterial infusion and intravenous chemotherapy before gastrectomy and D2 lymphadenectomy) and group 2(70 cases,gastrectomy and D2 lymphadenectomy alone). The morbidity of postoperative pneumonia in the two groups were recorded respectively.

RESULTSThe two groups were similar with respect to various clinical or pathological characteristics. All the patients underwent gastrectomy and D2 lymphadenectomy successfully. Eight patients in group 1 suffered from the postoperative pneumonia, accounting for 11.6%. Nine patients in group 2 suffered from the postoperative pneumonia, accounting for 12.9%. There was no significant difference between the two groups about the incidence of postoperative pneumonia.

CONCLUSIONSurgery following neoadjuvant chemotherapy with combined preoperative intraarterial infusion and intravenous chemotherapy is safe with similar morbidity of postoperative pneumonia to immediate surgery in patients with locally-advanced resectable gastric carcinoma.

Aged ; Chemotherapy, Adjuvant ; Female ; Humans ; Male ; Middle Aged ; Pneumonia ; etiology ; Postoperative Complications ; Stomach Neoplasms ; drug therapy ; surgery