OBJECTIVETo discuss the clinicopathological factors for lymph node metastasis (LNM) in early gastric cancer (EGC), including age, gender, location, size, macroscopic type, depth of invasion, histological type, and lymphatic invasion, and the regulation of LNM in EGC.

DATA SOURCESThe data used in this review were mainly from PubMed articles published in English. The search terms were "early gastric cancer" and "lymph node metastasis".

STUDY SELECTIONArticles were selected if they reported the clinicopathological factors and regulation of LNM in EGC.

RESULTSThe prognosis of EGC is better than advanced gastric cancer, with over 90% 5-year survival rate. The main risk factors for LNM in EGC are tumor size, macroscopic type, depth of invasion, histological type, ulceration, and lymphatic invasion.

CONCLUSIONSLNM in EGC is a critical factor for assessment of prognosis and determination of therapeutic strategy. Endoscopic mucosal resection or endoscopic submucosal dissection should be considered when patients have low risk of LNM.

Female ; Humans ; Lymphatic Metastasis ; Male ; Stomach Neoplasms ; complications ; pathology ; surgery

Gastric stump cancer (GSC) is a carcinoma arising from the remnant stomach following gastric surgery for benign or malignant disease, and is more common in men. The risk of morbidity has an obvious time dependence. GSC incidence is likely to rise with lengthening of the initial operation interval. The GSC time interval after malignant disease is significantly shorter than that of benign disease. GSC etiologies mainly include duodenogastric reflux and denervation of the gastric mucosa resulting in the change of the gastric environment after gastrectomy and the Helicobacter pylori infection. Due to atypical clinical symptoms, GSC is always identified at an advanced stage and the long-term survival rate is low. An optimal endoscopic surveillance system is essential to improve early detection rates. Treatments in GSC and primary gastric cancer are the same and include resection of the lesion and radical lymph node dissection. R0 resection is an important prognostic factor. Here we review previous reports with respect to epidemiological characteristics, etiology, clinical symptoms, treatment, and prognosis of GSC.
Gastrectomy ; Gastric Stump ; pathology ; surgery ; Helicobacter Infections ; complications ; Humans ; Lymph Node Excision ; Male ; Stomach Neoplasms ; surgery

Herein, we report a case of early in-stent occlusion due to the ingrowth of soft oedematous mucosal tissue through the lattices of an uncovered stent, which was used for palliation of a postoperative gastrojejunal anastomotic stricture. The in-stent occulsion was treated with the deployment of a second stent, which was covered, within the first stent. This led to successful resolution of the occlusion.
Anastomosis, Surgical ; methods ; Edema ; pathology ; Gastrectomy ; methods ; Humans ; Jejunum ; surgery ; Male ; Metals ; Middle Aged ; Palliative Care ; Postoperative Complications ; surgery ; Stents ; Stomach ; surgery ; Stomach Neoplasms ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo explore the optimal surgical approach for Siewert II and III adenocarcinoma of esophagogastric junction (AEG).

METHODSClinical data of 135 patients with Siewert II and III AEG treated in our hospital from August 2007 to August 2012 were analyzed retrospectively. Of 135 patients, 57 received transthoracic path for the stomach and proximal gastrectomy, second station lymph node resection (transthoracic group), and 78 cases received transabdominal hiatal approach (transabdominal group). The intraoperative lymph node harvested, postoperative complications and 5-year survival rate were compared between the two groups.

RESULTSThere were no significant differences in the residual tumor positive margin and anastomotic leakage rate between the two groups (both P>0.05). Compared with transthoracic group, transabdominal group had more lymph node dissected (11.1±0.2 vs. 10.4±0.3, P=0.033], less postoperative cardiac [2.6% (2/78) vs. 19.3% (11/57), P<0.01] and pulmonary [7.7% (6/78) vs. 21.1% (12/57), P<0.05] morbidity, and short postoperative hospital stay [(13.4±0.1) d vs. (16.4±0.3) d, P<0.01]. A total of 128 cases were followed up for median 38 months (6 to 72 months). The 5-year survival rate in transthoracic group and transabdominal group was 29.8% and 34.6% respectively, without significant difference (P>0.05).

CONCLUSIONFor the treatment of patients with Siewert II and III AEG, transabdominal hiatal approach can remove more lymph nodes, reduce postoperative cardiopulmonary morbidity and shorten hospital stay.

Adenocarcinoma ; surgery ; Esophageal Neoplasms ; surgery ; Esophagogastric Junction ; pathology ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Survival Rate

Objective: To investigate the effect of visceral fat area (VFA) on the surgical efficacy and early postoperative complications of radical gastrectomy for gastric cancer. Methods: A retrospective cohort study method was used. Clinicopathological data and preoperative imaging data of 195 patients who underwent D2 radical gastric cancer surgery at the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2017 were analyzed retrospectively. Inclusion criteria: (1) complete clinicopathological and imaging data; (2) malignant gastric tumor diagnosed by preoperative pathology, and gastric cancer confirmed by postoperative pathology; (3) no preoperative complications such as bleeding, obstruction or perforation, and no distant metastasis. Those who had a history of abdominal surgery, concurrent malignant tumors, poor basic conditions, emergency surgery, palliative resection, and preoperative neoadjuvant therapy were excluded. The VFA was calculated by software and VFA ≥ 100 cm² was defined as visceral obesity according to the Japan Obesity Association criteria . The patients were divided into high VFA (VFA-H, VFA≥100 cm², n=96) group and low VFA (VFA-L, VFA<100 cm², n=99) group . The clinicopathological characteristics, surgical outcomes and early postoperative complications were compared between the two groups. Univariate and multivariate Logistic regression models were used to analyze the risk factors of early complications. Receiver operating characteristic (ROC) curve was used to analyze predictive values of VFA for early complications. Pearson's χ² test was used to analyze the correlation between BMI and VFA. Results: There were no significant differences in terms of gender, age, American Society of Anesthesiologists physical status classification, preoperative comorbidities, preoperative anemia, tumor TNM staging, N staging, T staging and tumor differentiation, surgical method, extent of resection, and tumor location between the VFA-L group and the VFA-H group (all P>0.05). However, patients in the VFA-H group had higher BMI, larger tumor, lower rate of hypoalbuminemia and greater subcutaneous fat area (SFA) (all P<0.05). The VFA-H group presented significantly longer operation time and significantly less number of harvested lymph nodes as compared to the VFA-L group (both P<0.05). However, there were no significant differences in intraoperative blood loss, conversion to laparotomy and postoperative hospital stay (all P>0.05). Complications of Clavien-Dindo grade II and above within 30 days after operation were mainly anastomosis-related complications (leakage, bleeding, infection and stricture), intestinal obstruction and incision infection. The VFA-H group had a higher morbidity of early complications compared to the VFA-L group [24.0% (23/96) vs 10.1% (10/99), χ²=6.657, P=0.010], and the rates of anastomotic complications and incision infection were also higher in the VFA group [10.4% (10/96) vs. 3.0% (3/99), χ²=4.274, P=0.039; 7.3% (7/96) vs. 1.0% (1/99), P=0.033]. Multivariate logistic analysis showed that high BMI (OR=3.688, 95%CI: 1.685-8.072, P=0.001) and high VFA (OR=2.526, 95%CI: 1.148-5.559,P=0.021) were independent risk factors for early complications. The area under the ROC curve (AUC) of VFA for predicting early complications was 0.645, which was higher than that of body weight (0.591), BMI (0.624) and SFA (0.626). Correlation analysis indicated that there was a significantly positive correlation between BMI and VFA (r=0.640, P<0.001). Conclusion: VFA ≥ 100 cm² is an independent risk factor for early complications after radical gastrectomy for gastric cancer.It can better predict the occurrence of above early postoperative complications.
Gastrectomy/methods* ; Humans ; Laparoscopy/methods* ; Lipids ; Obesity/surgery* ; Obesity, Abdominal/surgery* ; Postoperative Complications/epidemiology* ; Retrospective Studies ; Stomach Neoplasms/pathology*

Adenocarcinoma of esophagogastric junction (AEG) is at a special anatomic site with obviously higher morbidity of postoperative complication than gastric cancers at other sites. Postoperative quality of life and survival rate are influenced by the occurrence of complications. Moreover, the perioperative complications are associated with multiple factors such as patient factors (advanced age, obesity and preoperative nutritional status), surgical factors (surgical route, surgical procedure, resection range and prophylactic multivisceral resection), tumor factors (size, stage) etc. Optimizing perioperative management and formulating standardized surgical methods are the key points to prevent postoperative complications of AEG. In conclusion, we should strive to ensure the radical resection and reduce the occurrence of postoperative complications in order to truly benefit patients.
Adenocarcinoma/pathology* ; Esophageal Neoplasms/pathology* ; Esophagogastric Junction/surgery* ; Gastrectomy ; Humans ; Neoplasm Staging ; Postoperative Complications/surgery* ; Quality of Life ; Retrospective Studies ; Stomach Neoplasms/pathology*

Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma.
Carcinoma/*diagnosis/pathology/therapy ; Combined Modality Therapy ; Humans ; Lymphoma/radiography/surgery ; Male ; Middle Aged ; Pneumoperitoneum/etiology/radiography/surgery ; Rupture, Spontaneous ; Stomach Neoplasms/*complications/*diagnosis/pathology/therapy ; Stomach Rupture/*complications/radiography/surgery ; Tomography, X-Ray Computed

Weight loss and malnutrition are common in cancer patients. Although weight loss is predominantly due to loss of fat mass, the morbidity risk is given by the decrease in muscle mass. The assessment of nutritional status is essential for a diagnosis of nutritional compromise and required for the multidisciplinary approach. Subjective global assessment (SGA) is made by the patients nutritional symptoms and weight loss. The objective assessment, a significant weight loss (>10%) for 6 months is considered an indicator of nutritional deficiency. The mean body index, body fat mass and body protein mass are decreased as cancer stage increases. The biochemical data of albumin, cholesterol, triglyceride, Zn, transferrin, total lymphocyte count are decreased in advanced cancer stage. Daily energy intake, cabohyderate and Vit B1 intake is decreased according to cancer stage. The patients are divided into three groups according to SGA. The three groups showed a significant difference in body weight, 1 month weight loss%, 6 month weight loss%, body mass index, mid arm circumference, albumin, energy intake, as well as carbohyderate intake protein and energy malnutrition. Nutritional assessment is of great importance because undernutrition has been shown to be associated with increase in stomach cancer associated morbidity and mortality. The authors concluded that nutritional assessment should be done in cancer patients preoperatively, and with adequate nutritional support, the morbidity and mortality would be decreased.
Humans ; Neoplasm Staging ; *Nutrition Assessment ; Nutritional Status ; *Nutritional Support ; Postoperative Complications ; Preoperative Care ; Stomach Neoplasms/mortality/*pathology/surgery ; Weight Loss

OBJECTIVETo summarize the experience of lymph node dissection patterns in hand-assisted laparoscopic radical gastrectomy.

METHODSOne hundred and eleven patients with gastric carcinoma between December 2010 and September 2012 were operated by hand-assisted laparoscopic system designed by us. Clinical data were analyzed retrospectively. The lymph nodes were dissected from left to right together with total tumor resection(reverse lymph nodes scavenge pattern), then digestive tract was reconstructed.

RESULTSTotal gastrectomy, distal gastrectomy and proximal gastrectomy were performed in 57, 46 and 8 cases respectively. Combined cholecystectomy and lateral segment of left liver lobe were needed in 4 and 2 patients respectively, and 1 case underwent combined splenectomy and pancreatic body and tail resection. TNM staging of patients in I(, II(, III(A, III(B, and IIII( were 16, 8, 35, 14, and 38, respectively. Histological type was poorly differentiated in 78 cases, moderate differentiation in 26 cases and good differentiation in 7 cases. The incision length was(6.8±0.3) cm, blood loss was(238.4±113.6) ml, operative time was (171.9±23.3) min, number of removed lymph node was 17.2±5.7, hospital stay was (10.1±3.7) d, postoperative complication rate was 9.0%. One case died during perioperative time.

CONCLUSIONSHand-assisted laparoscopic D2 radical gastrectomy(reverse lymph nodes scavenge pattern) can avoid the multiple conversion of open-laparoscopic operation model, and is beneficial to the standardization for surgical procedure.

Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery

BACKGROUNDLaparoscopy-assisted radical gastrectomy is gaining acceptance for treating early gastric cancer. However, few reports concerning the effectiveness of laparoscopy-assisted D2 radical distal gastrectomy (LADG) for advanced gastric cancer or data comparing the results obtained after open distal gastrectomy (ODG) are yet available. The aim of this study was to evaluate the method, feasibility and clinical result of LADG for advanced gastric cancer.

METHODSA retrospective study was performed comparing LADG and ODG for advanced gastric cancer. Seventy-eight patients who underwent LADG were compared with 90 patients who underwent ODG in terms of pathologic findings, operative outcome, and complications.

RESULTSThere was no conversion to open surgery in the LADG group and no postoperative mortality of any patients. There were no significant differences between LADG and ODG in operative time ((245 +/- 35) vs (220 +/- 20) minutes), complication rate (7.7% vs 10.0%), and number of lymph nodes (23.5 +/- 6.0 vs 21.0 +/- 7.5), while the blood loss was less after LADG ((110 +/- 25) vs (196 +/- 30) ml, P < 0.05). The time to postoperative flatus and postoperative hospital stay were shorter after LADG ((73.0 +/- 8.5) vs (102.0 +/- 10.5) hours, and (8.6 +/- 1.2) vs (12.1 +/- 2.5) days, P < 0.05, respectively).

CONCLUSIONLADG for advanced gastric cancer is feasible, safe, and minimally invasive.

Aged ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery