The laparoscopic approach is rapidly becoming the preferred method of treatment for patients with early gastric cancer due to advantages of minimally invasive surgery. As laparoscopic experience has accumulated, laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy has become a valuable alternative for the treatment of patients with advanced gastric cancer. However, laparoscopic gastric surgery is demanding from a technical point of view, especially when a D2 lymphadenectomy is performed. Surgeons seeking to undertake LADG are concerned about unpredictable intraoperative bleeding that may occur during LADG. Comprehensive knowledge of the perigastric vascular anatomy is essential for LADG with D2 lymphadenectomy.
Gastroenterostomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Stomach Neoplasms ; blood supply ; pathology ; surgery

OBJECTIVETo investigate the plasma Big endothelin-1 levels in patients with gastric carcinoma before and after radical gastrectomy, and explore its clinical significance.

METHODSOne hundred and six patients with gastric carcinoma and 20 controls were enrolled. The Big ET-1 plasma levels were examined by enzyme-linked immuno absorbent assay before and on the 1st, 3rd, and 10th day after curative surgery, and then were tested every 3 months in the patients with advanced gastric cancer.

RESULTSAll patients, except those with stage I gastric cancer, had significantly higher mean plasma Big ET-1 levels compared with normal controls (P=0.000). Higher plasma Big ET-1 levels were associated with lymph node metastasis (P=0.020) and serosal infiltration (P=0.035). The plasma Big Endothelin-1 levels were markedly increased on the first post-operative day (1st POD) in all patients,but decreased on the 3rd POD with no significant difference compared to the preoperative levels. On the 10th POD, the patients with stage I and II gastric cancer showed marked reduction in plasma Big ET-1 levels (P=0.010 and P=0.000, respectively), whereas no significant difference was observed in stage III and IV patients. During the follow-up, the plasma Big ET-1 levels just before recurrence in stage II patients were significantly higher compared with the levels on the 10th POD (P=0.011).

CONCLUSIONSPlasma Big ET-1 might be a reliable marker to determine the severity of gastric carcinoma. Monitoring plasma Big ET-1 levels after curative resection in stage II gastric cancer patients is valuable to predict recurrence.

Adult ; Aged ; Case-Control Studies ; Endothelin-1 ; blood ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; pathology ; Neoplasm Staging ; Stomach Neoplasms ; blood ; pathology ; surgery

BACKGROUND AND OBJECTIVETransthoracic and transabdominal approaches are commonly used for the surgical treatment of adenocarcinoma of the cardia. Which approach is better has been controversial for quite a long time. Our study aimed to compare the surgical trauma, range of lymph node dissection, and the prognosis of the transthoracic and transabdominal approaches for the treatment of adenocarcinoma of the cardia.

METHODSThe medical records of 331 patients with adenocarcinoma of the cardia treated in our hospital between 1994 and 2003 were analyzed. Of the 331 patients, 284 underwent operation via transthoracic approach and 47 via transabdominal approach. Surgery-related status, postoperative complications, range of removed lymph nodes and prognosis of the two groups were compared.

RESULTSThere was no significant difference in surgery-related status and postoperative complications between the two groups (P >0.05). The mean number of removed lymph nodes from the thoracic cavity was much higher in transthoracic group than in transabdominal group (P < 0.001), while that from the abdominal cavity was similar in both groups (P = 0.404). The thoracic lymph node metastasis rate was 18.8% in transthoracic group and 13.3% in transabdominal group. The median survival time was 29 months in transthoracic group and 28 months in transabdominal group, and the 5-year survival rates were 34.9% and 40.1% (P= 0.599).

CONCLUSIONSFor the surgical treatment of adenocarcinoma of the cardia, the surgical trauma of the transthoracic approach is similar with that of transabdominal approach. The transthoracic approach has the advantage in thoracic lymph node dissection. The two approaches have no obvious effect on the prognosis.

Abdomen ; surgery ; Adenocarcinoma ; pathology ; surgery ; Blood Loss, Surgical ; Cardia ; pathology ; surgery ; Female ; Gastrectomy ; methods ; Humans ; Length of Stay ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Postoperative Complications ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate ; Thoracotomy

BACKGROUND AND OBJECTIVEWith the application of laparoscopy, laparoscopic gastrectomy for the treatment of patients with early gastric cancer has been performed, but the safety and effectiveness of this method need to be explored. This study evaluated the safety and effectiveness of laparoscopy-assisted and conventional open distal gastrectomy for patients with early gastric cancer.

METHODSA search of MEDLINE, EMBASE, the Chinese Biomedical Database (CBM), and Cochrane Central Register of Controlled Trials (CENTRAL) identified all the randomized clinical trials that compared laparoscopy-assisted gastrectomy with open distal gastrectomy for patients with early gastric cancer published in the last 10 years. Quality assessment was done on each trial and relevant data were extracted from qualified trials. Meta-analysis was performed using RevMan 4.2.2 software (Cochrane).

RESULTSSix randomized controlled trials (RCTs) involving 218 patients were included. Comparing laparoscopic resection with open resection, results showed less estimated blood loss (WMD (weighted mean difference): -121.86; 95% CI (confidence interval): -145.61, -98.11; P < 0.001), earlier postoperative first flatus (WMD: -0.95; 95% CI: -1.09, -0.81; P < 0.001), and shorter durations of hospital stays (WMD: -2.27; 95%CI: -3.47, -1.06; P = 0.0002), but longer surgery times (WMD: 58.71; 95% CI: 52.69, 64.74; P < 0.001) and fewer lymph nodes dissected (WMD: -3.64; 95% CI: -5.80,-1.47; P = 0.001). There was no significant difference between the two groups in postoperative complications (OR (odds ratio): 0.57; 95% CI: 0.31,1.03; P = 0.06).

CONCLUSIONSThe short-term outcome of laparoscopy-assisted distal gastrectomy for patients with early gastric cancer is superior to the open procedure, but its long-term outcome should be proven by further outcomes of RCTs.

Blood Loss, Surgical ; Confidence Intervals ; Databases, Bibliographic ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; pathology ; Neoplasm Staging ; Postoperative Complications ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo evaluate the effect of a novel blockade technique for gastric cancer on blood-borne metastasis of gastric cancer cells to portal vein.

METHODSTwenty-three cases of gastric cancer were divided into routine operation group (8 cases intraoperatively without blockade technique) and blockade group (15 cases with blockade technique). Blood samples from portal vein pre- and intraoperatively, as well as gastroepiploic vein limited within the blockade area were obtained to detect CK19 mRNA expression by using RT-PCR technique.

RESULTSBefore the dissection of gastric lesion, the overall positive rate of CK19 mRNA expression in portal vein blood is 34.7% (9/23), including 37.5% (3/8) in routine operation group and 33.3% (5/15) in blockade group. While the course of tumor resection, those positive rates were 87.5% (7/8) in routine operation group and 6.7% (1/15) in blockade group respectively (P < 0.05). CK19 mRNA expression in the right gastroepiploic venous blood limited within the blocking area was all positive in 15 cases of blockade group.

CONCLUSIONThis blockade technique can be used effectively to block the intraoperative spread of gastric cancer cells, thus prevent blood-borne metastasis due to operative manipulation.

Aged ; Biomarkers, Tumor ; blood ; genetics ; Female ; Gastrectomy ; Humans ; Keratins ; blood ; genetics ; Ligation ; Male ; Middle Aged ; Neoplasm Metastasis ; prevention & control ; Neoplastic Cells, Circulating ; pathology ; RNA, Messenger ; blood ; Reverse Transcriptase Polymerase Chain Reaction ; Stomach Neoplasms ; blood ; pathology ; surgery ; Vascular Surgical Procedures ; methods

Gastric yolk sac tumors are extremely rare and their prognosis is poor; most patients have widespread metastases at the time of diagnosis. The treatment of gastric yolk sac tumors consists of aggressive chemotherapy combined with radiotherapy and surgery. Here, we first report a case of gastric yolk sac tumor presenting as an early gastric cancer that was cured after a gastrectomy with lymphadenectomy.
Biopsy ; Endodermal Sinus Tumor/blood/*pathology/surgery ; Gastrectomy ; Gastroscopy ; Humans ; Immunohistochemistry ; Lymph Node Excision ; Male ; Middle Aged ; Stomach Neoplasms/blood/*pathology/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; alpha-Fetoproteins/analysis

OBJECTIVETo conduct a systemic review of the safety and efficacy of fast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer.

METHODSThe databases, including CNKI, Wangfang, VIP, PubMed, EMBASE and Cochrane Library, were searched to collect randomized controlled trials(RCTs) or clinical controlled trials(CCTs) on the comparison of fast-track surgery combined with laparoscopy versus fast-track surgery or laparoscopy separately used in radical gastrectomy for gastric cancer between January 1994 and December 2012. After data were extracted, meta-analysis was conducted by using RevMan 5.1.0 software.

RESULTSA total of 3 RCTs and 2 CCTs, involving 524 patients, were included. There were 257 patients in the study group and 267 patients in the control group. Compared with the control group, the study group had earlier first flatus(SMD=-1.29, 95%CI:-2.17 to -0.40, P<0.05), shorter postoperative hospital stay(WMD=-1.72,95%CI:-2.56 to -0.89, P<0.05) and lower postoperative complication rate(OR=0.51, 95%CI:0.31 to 0.84, P<0.05). However, no significant differences were found in operation time, harvested lymph node number, intraoperative blood loss and hospital charge(P>0.05).

CONCLUSIONFast-track surgery combined with laparoscopy in radical gastrectomy for gastric cancer can accelerate postoperative rehabilitation by promoting postoperative bowel function recovery, and decreasing postoperative hospital stay and complication rate.

Blood Loss, Surgical ; Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Operative Time ; Postoperative Complications ; Postoperative Period ; Randomized Controlled Trials as Topic ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo explore the association of perioperative blood transfusion (PBT) with survival of gastric cancer after surgery.

METHODSWe retrospectively reviewed the medical records of 1 000 gastric cancer patients, including 738 non-transfused (73.8%) and 262 transfused (26.2%) cases. A one to one match was created using propensity score analysis, except preoperative hemoglobin level and operative blood loss. The survival was analyzed by Kaplan-Meier survival model.

RESULTSThe 5-year survival rate of the 1 000 cases of gastric cancer patients was 39.9%. Before matching, there was a significant difference between transfused group (33.6%) and non-transfused group (49.1%, P<0.005). Univariate analysis showed that age, tumor size, hemoglobin level, albumin level, depth of invasion, lymph node metastasis, lymph node dissection, surgery mode, adjuvant chemotherapy, blood loss and blood transfusion during perioperative period were associated with prognosis in the gastric cancer patients (all P<0.05). Multivariate analysis showed that tumor invasion, lymph node metastasis, lymph node dissection, chemotherapy and perioperative blood transfusion were independent prognostic factors in gastric cancer (all P<0.05). After matching, the 5-year survival rate of the 262 non-transfused patients was 37.7%, while that of the 262 transfused patients was 33.6% (P>0.05).

CONCLUSIONSPerioperative blood transfusion has no significant effect on the prognosis of gastric cancer patients.

Analysis of Variance ; Blood Transfusion ; mortality ; Humans ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymphatic Metastasis ; Perioperative Period ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; mortality ; pathology ; surgery ; Survival Rate

OBJECTIVETo evaluate the correlation of CD44v6 and sCD44v6 expression with the biological activity of gastric carcinoma.

METHODSMucosa samples from 103 gastric carcinoma patients and 10 healthy persons (control) were examined using immunohistochemical SP method; sCD44v6 level in peripheral blood samples was detected with ELISA in 86 gastric cancer patients, 30 gastric ulcer patients and 30 healthy controls. The follow-up period was 3-91 months for 88 patients in CD44v6 group and 1-91 months for 55 patients in sCD44v6 group.

RESULTS(1) Positive expression of CD44v6 was found in 60.2% of gastric carcinoma, where as 0% in the normal gastric mucosa. CD44v6 protein expression was positively correlated with TNM stage, perigastric lymph node metastasis, presence of cancerous embolic angiopathy and Borrmann classification (P <0.05), but was not correlated with invasion depth, differentiation, metastasis and survival (P > 0.05); 77.8% of the patient with liver metastasis had a strong CD44v6 protein expression. (2) sCD44v6 level in the peripheral blood of gastric carcinoma patient was significantly higher than that in gastric ulcer patient or healthy control; Compared with palliative gastrectomy, sCD44v6 level significantly went down after radical operation. No relationship between sCD44v6 level and the pathological features was found, which included invasion depth, perigastric lymph node metastasis, presence of cancerous embolic angiopathy, differentiation and Borrmann classification; The survival in the high sCD44v6 level group was longer than that in low sCD44v6 level group ( P = 0.0281), but no significant difference was observed by Cox Regression analysis (P = 0.415). (3) No apparent correlation was observed between CD44v6 expression in gastric cancer and sCD44v6 concentration in peripheral blood (P>0.05).

CONCLUSIONDetection of CD44v6 expression in the gastric cancer may be helpful in evaluating the biological features and the survival in gastric carcinoma. The level of sCD44v6 in the blood may be also helpful in differential diagnosis, evaluation of surgical treatment and biological activity for gastric cancer. No apparent correlation is observed between CD44v6 expression in the cancer and that of sCD44v6 in the blood.

Adenocarcinoma ; blood ; metabolism ; secondary ; surgery ; Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Gastric Mucosa ; metabolism ; Humans ; Hyaluronan Receptors ; blood ; metabolism ; Liver Neoplasms ; metabolism ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Neoplastic Cells, Circulating ; Proportional Hazards Models ; Stomach Neoplasms ; blood ; metabolism ; pathology ; surgery ; Stomach Ulcer ; blood ; Survival Rate ; Young Adult

OBJECTIVETo evaluate the effect of surgical manipulation on the dissemination of cancer cells into blood circulation in patients with gastric cancer and to analyze its risk factors.

METHODSThis study included 45 consecutive patients with gastric cancer undergoing curative resection and 13 control cases (10 healthy persons and 3 patients with peptic ulcer receiving gastrectomy). Peripheral blood was obtained preoperatively and just after surgical manipulation. The mRNA levels of carcinoembryonic antigen (CEA) from the blood samples were assayed by reverse transcription-polymerase chain reaction(RT-PCR) and compared between the 2 groups.

RESULTSCEA mRNA was negative in all control cases. Of the 45 gastric cancer patients, the preoperative positive rate of CEA mRNA was 8.9%, while the postoperative positive rate was 48.9%, which was significantly higher than that of preoperation (P=0.000). Multivariable Logistic regression analysis showed that operative duration (P=0.014) and tumor depth (P=0.010) were independent risk factors for cancer cell dissemination. Furthermore, the operative duration in patients with positive postoperative CEA mRNA was markedly longer than that in patients with negative postoperative CEA mRNA (P=0.000), and positive rate of postoperative CEA mRNA in advanced gastric cancer was higher compared with that in early gastric cancer (P=0.034).

CONCLUSIONSSurgical manipulation of curative gastrectomy can provoke dissemination of cancer cells into blood circulation, and the operative duration and tumor invasion depth may be 2 of the risk factors for cancer cell dissemination.

Adult ; Aged ; Carcinoembryonic Antigen ; blood ; Case-Control Studies ; Female ; Gastrectomy ; adverse effects ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Neoplastic Cells, Circulating ; pathology ; RNA, Messenger ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Risk Factors ; Stomach Neoplasms ; blood ; pathology ; surgery