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

Herein is presented a case of aplastic anemia associated with adenocarcinoma of the stomach which seem- ed to be coincidental. A 52 year-old man was admitted with a 3 year history of dyspnea. Three years previously, he was diagnosed as bone marrow hypoplasia and had been treated with oxymetholone for 1 year. After confirmation of aplastic anemia during the first admission, he was followed up with fluoxymesterone and steriods. One year later, he was readmitted with melena. Fibergastroscopy and an UGl study revealed a fungating mass on the antrum suggestive of stomach cancer. Following perioperative platelet transfusions and intensive supportive care, a subtotal gastrectomy was performed and there were no postoperative complications. Pathologic examinations disclosed a moderately well differentiated adenocarcinoma. This is the first report in Korea of adenocarcinoma of the stomach occurring in a patient with aplastic anemia. He survived 17.5 months after the surgery and 5.4 years after the onset of aplastic anemia. Gastrointestinal bleeding in aplastic anemia may be incorrectly ascribed to steriod use and overlooked, thus the need to fully investigate gastric pathology by endoscopy as well as radiology is streesed. In a patient with pancytopenia, the major surgical procedures are frequently evaded by both surgeons and internists due to the possibility of morbidity from bleeding and infection. In this case, intensive perioperative supportive care and surgery were combined to prolong the patient's survival time.
Adenocarcinoma/*complications/secondary/surgery ; Anemia, Aplastic/*complications/drug therapy ; Case Report ; Human ; Male ; Middle Age ; Oxymetholone/therapeutic use ; Stomach Neoplasms/*complications/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

OBJECTIVETo enhance the understanding of pulmonary thromboembolism (PTE) in patients with cancer.

METHODSfrom January 2005 to July 2008, sixty patients diagnosed as pulmonary thromboembolism in Peking Union Medical College Hospital were retrospectively reviewed.

RESULTSThe primary cancers were from respiratory system (36.7%), digestive system (26.7%), urogenital system (10.0%), hematological system (8.3%) and nervous system (5.0%), respectively, especially from such organ as lung (30.0%), stomach (8.3%), pancreas (6.7%), liver (5.0%) and so on. 12 of 18 patients (66.7%) with lung cancer were adenocarcinoma. There were 47 patients (78.3%) with advanced cancer. Deep venous thrombosis (DVT) occurred in 30 patients (50.0%). Of them 24 patients (80.0%) occurred in the lower limb, and 3 patients (10%) in the upper limb, 5 patients (16.7%) in other sites including 2 cases with thrombi in both upper and lower limbs, respectively. There were 2 patients (3.3%) accompanied with femoral artery embolism. PTE before tumor diagnosed occurred in 5 patients (8.3%) with an average time of 5.5 months. 22 patients underwent cancer-related operation and 17 patients (77.3%) had PTE in the later 2 weeks. 15 patients (25.0%) showed no symptoms. Arterial oxygen partial pressure was reduced in 49 patients (84.5%). 13 patients (21.7%) died and 6 cases of them were sudden death. 8 patients (13.3%) aggravated. 39 patients (65.0%) improved.

CONCLUSIONPTE is one of the major complications and leading causes of death in patients with cancer. Of which lung cancer is most commonly, pulmonary adenocarcinoma in particular. PTE is often accompanied by DVT in the lower extremity. Risk factors may be old age, cancer progression and cancer-related operation. Other factors include long time in bed, chemotherapy and central vein catheterization, and so on. It should be watchful of PTE in cancer patients undergoing operation, especially within the first two postoperative weeks. Its clinical manifestation is often atypical. Sometimes venous thromboembolism (VTE) is the first signal of malignancy. In patients with unexplained PTE and/or DVT, attention should be paid to the possibility of malignancy. The first choice of anticoagulants is low molecular weight heparin.

Adenocarcinoma ; complications ; surgery ; Aged ; Anticoagulants ; therapeutic use ; Female ; Heparin ; therapeutic use ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Liver Neoplasms ; complications ; surgery ; Lung Neoplasms ; complications ; surgery ; Male ; Middle Aged ; Pulmonary Embolism ; complications ; drug therapy ; etiology ; Retrospective Studies ; Stomach Neoplasms ; complications ; surgery ; Venous Thrombosis ; complications ; drug therapy ; etiology

Dihydropyrimidine dehydrogenase (DPD) is the initial and rate-limiting enzyme in the catabolism of 5-fluorouracil (5-FU). Thus, patients with a DPD deficiency are at risk of developing severe 5-FU-associated toxicity. A 37-year-old female with gastric cancer underwent a curative operation, followed by adjuvant chemotherapy consisting of 5-FU and epirubicin. After the first cycle of chemotherapy, the patient manifested grade 2 mucositis and febrile neutropenia, and when her treatment was subsequently continued with doxifluridine she developed severe mucositis and febrile neutropenia. A PCR study revealed that her DPD mRNA level was lower than that in a control group. Thus, when considering the routine use of 5-FU for the treatment of cancer patients, an analysis of DPD activity or screening for DPD mutations is warranted in confined patients who experience unpredicted severe toxicity after initial 5-FU administration, even though DPD deficiency is a rare metabolic defect.
Stomach Neoplasms/complications/*drug therapy/surgery ; Risk Factors ; Risk Assessment ; Humans ; Fluorouracil/*adverse effects ; Female ; *Drug Toxicity ; Dihydrouracil Dehydrogenase (NADP)/*deficiency ; Chemotherapy, Adjuvant ; Antimetabolites, Antineoplastic/*adverse effects ; Adult ; Adenocarcinoma/complications/*drug therapy/surgery

Endoscopic mucosal resection (EMR) is widely accepted as a standard treatment for early gastric cancer or gastric adenoma. However, EMR inevitably results in the formation of large iatrogenic ulcer at the resected area. Although the characteristics of EMR-induced ulceration are not fully understood, this type of ulcer is thought to heal faster and to recur less often than non-iatrogenic gastric ulcer. Current available evidences have suggested that EMR-induced ulcers heal within 2-3 months. Herein, we report two cases of non-healing persistent gastric ulcers after EMR. One is a case of gastric carcinoma which developed at the same site of previous EMR site for the low grade dysplasia. The other is a case in which persistent EMR-induced ulcer was healed in the long run after Helicobacter pylori eradication therapy.
Aged ; Endoscopy, Gastrointestinal ; Gastric Mucosa/pathology/*surgery ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Humans ; Iatrogenic Disease ; Male ; Middle Aged ; Stomach Neoplasms/complications/diagnosis/*surgery ; Stomach Ulcer/diagnosis/*etiology/pathology

Gastric cancer patients with severe liver dysfunction secondary to hepatic metastases have limited treatment options. Most cytotoxic drugs have a narrow therapeutic index. Although both capecitabine and oxaliplatin have been well tolerated as single agents for patients with severe hepatic dysfunction, the combination of these drugs has not been investigated. We report here on a case of successful treatment of a patient suffering with severe liver dysfunction and metastatic gastric cancer; the patient was treated with a combination of capecitabine and oxaliplatin (XELOX). The initial bilirubin level of the patient was 10.9 mg/dL. After two cycles of treatment, his bilirubin level decreased to 2.1 mg/dL. He has experienced an excellent radiological response and he has received six cycles of XELOX chemotherapy. XELOX chemotherapy is feasible and it can be associated with positive outcomes for the patients suffering with metastatic gastric cancer and severe liver dysfunction.
Stomach Neoplasms/complications/*pathology/surgery ; Prodrugs ; Organoplatinum Compounds/*therapeutic use ; Middle Aged ; Male ; Liver Neoplasms/complications/*drug therapy/secondary ; Liver Function Tests ; Liver Failure/diagnosis/drug therapy/*etiology ; Humans ; Gastrectomy ; Follow-Up Studies ; Fluorouracil/*analogs & derivatives/therapeutic use ; Drug Therapy, Combination ; Deoxycytidine/*analogs & derivatives/therapeutic use ; Antineoplastic Agents/*therapeutic use ; Adenocarcinoma/complications/secondary/*therapy

OBJECTIVETo evaluate the effect of the combined use of Shenmai Injection (SMI) and enteral nutrition on postoperative fatigue syndrome (POFS) in patients with gastric cancer (GC).

METHODSFifty-eight GC patients were randomized into the parenteral nutrition group (PNG, 19 cases), enteral nutrition group (ENG, 19 cases) and combined treatment group (CTG, 20 cases). The post-operative recovery in patients was observed; patients' conditions of fatigue, mood and sleep were evaluated respectively by visual analogue scale of fatigue, profile of mood states (POMS) and Pittsburgh sleep quality index (PSQI). Meanwhile, nutritional variables, such as serum contents of total protein, albumin, pre-albumin, were measured at different time points: before operation (d0) and the 1st, 5th, and 9th day (d1, d5 and d9) after operation. Immune variables such as subsets of lymphocytes (CD3, CD4, CD8), serum immunoglobulins (IgG, IgM, IgA) were also determined.

RESULTSConditions of recovery, POMS and PSQI were better and the postoperative fatigue reduced more significantly in CTG than those in the other two groups (P < 0.05). On d9, levels of pre-albumin, CD3, CD4, CD4/CD8 in CTG were significantly higher than those in the PNG and ENG (P < 0.05), meantime, levels of albumin and IgA were higher in CTG than those in PNG (P < 0.05).

CONCLUSIONCombined treatment of SMI and enteral nutrition can regulate mood and sleep to some extents, and reduce the postoperative fatigue through improving nutritional status and immune function, thus speeding up the recovery of patients.

Adult ; Aged ; Combined Modality Therapy ; Drug Combinations ; Drugs, Chinese Herbal ; therapeutic use ; Enteral Nutrition ; Fatigue ; therapy ; Female ; Gastrectomy ; methods ; Humans ; Male ; Middle Aged ; Parenteral Nutrition ; Phytotherapy ; Postoperative Complications ; therapy ; Stomach Neoplasms ; surgery

Since the Korean College of Helicobacter and Upper Gastrointestinal Research has first developed the guideline for the diagnosis and treatment of Helicobacter pylori infection in 1998, the revised guideline was proposed in 2009 by the same group. Although the revised guideline was made by comprehensive review of previous articles and consensus of authoritative expert opinions, the evidence-based developmental process was not applied in the revision of the guideline. This new guideline has been revised especially in terms of changes in the indication and treatment of H. pylori infection in Korea, and developed by the adaptation process as evidence-based method; 6 guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation (AGREE) II process, 21 statements were made with grading system and revised by modified Delphi method. After revision, 11 statements for the indication of test and treatment, 4 statements for the diagnosis and 4 statements for the treatment have been developed, respectively. The revised guideline has been reviewed by external experts before the official endorsement, and will be disseminated for usual clinical practice in Korea. Also, the scheduled update and revision of the guideline will be made periodically.
Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Aspirin/therapeutic use ; Bismuth/therapeutic use ; Breath Tests ; Clarithromycin/therapeutic use ; Gastroesophageal Reflux/etiology ; Gastroscopy ; Helicobacter Infections/complications/*diagnosis/drug therapy ; *Helicobacter pylori ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications ; Metaplasia/complications ; Metronidazole/therapeutic use ; Peptic Ulcer/complications/drug therapy ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Stomach Neoplasms/complications/surgery ; Tetracycline/therapeutic use

Korea and Japan show the highest incidence of gastric cancer and Helicobacter pylori infection. New 2013 guidelines on H. pylori infection differ between the two countries with regard to the indications for H. pylori eradication, diagnostic methods, and treatment regimens. Indications for eradication in Korean guideline focus on specific diseases such as peptic ulcer disease, low-grade gastric mucosa-associated lymphoid tissue lymphoma, and after resection of early gastric cancer, while Japanese guideline includes all H. pylori-associated gastritis for the prevention of dissemination. With regard to the diagnosis, either noninvasive or invasive method (except for bacterial culture) is recommended in Korea, while two noninvasive tests including serum anti-H. pylori IgG antibody level are preferred in Japan. As for the treatment regimens, second-line treatment (quadruple bismuth-containing regimen) is recommended without first-line triple therapy in areas of high clarithromycin resistance in Korea. However, there is no bismuth-based second-line treatment in Japan, and the Japanese regimen consists of a lower dose of antibiotics for a shorter duration (7 days). Such discrepancies between the two countries are based not only on the differences in the literature search and interpretation, but also on the different approvals granted by the national health insurance system, manufacturing process of the antibiotics, and diagnostic techniques in each country. Collaborations are required to minimize the discrepancies between the two countries based on cost-effectiveness.
Anti-Bacterial Agents/pharmacology/*therapeutic use ; Antibodies/blood ; Bismuth/pharmacology/therapeutic use ; Disease Eradication/trends ; Drug Administration Schedule ; Guidelines as Topic ; Helicobacter Infections/complications/diagnosis/*drug therapy ; *Helicobacter pylori/drug effects/immunology ; Humans ; Japan ; Lymphoma, B-Cell, Marginal Zone/complications/surgery ; Republic of Korea ; Stomach Neoplasms/complications/surgery