Humans ; Hypertension, Portal ; complications ; Male ; Middle Aged ; Stomach Neoplasms ; therapy

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

Acute tumor lysis syndrome (TLS) occurs frequently in hematologic malignancies such as high-grade lymphomas and acute leukemia, which are rapidly proliferating and chemosensitive tumors. It occurs rarely in solid tumors and has never been reported in gastric adenocarcinoma. Typical biochemical findings of acute tumor lysis syndrome are hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia in patients with a malignancy. Rapid changes of these electrolytes may cause cardiac arrhythmia, seizure, acute renal failure and sudden death. Therefore, as soon as it is detected, it should be taken care of immediately. Until now almost all cases of TLS associated with solid tumor have developed after cytoreductive therapy in chemosensitive tumors. We report here a case of spontaneous acute tumor lysis in a patient of advanced gastric cancer with hepatic metastases and multiple lymphadenopathy. The biochemical finding of TLS improved with the management and tumor burden also showed slight response to the one cycled combination chemotherapy but the patient died of progressive pneumonia.
Acute Disease ; Adult ; Case Report ; Human ; Male ; Stomach Neoplasms/pathology ; Stomach Neoplasms/drug therapy ; Stomach Neoplasms/complications* ; Tumor Lysis Syndrome/therapy*

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma represents approximately 40% of gastric lymphomas, and its incidence is increasing. An early diagnosis for gastric MALT lymphoma is important, but not easy due to non-specific symptoms and endoscopic findings. Diagnosis is based on the histopathologic evaluation of multiple, deep and repeated biopsies taken from normal and any abnormal appearing sites of the stomach. In addition, the presence of Helicobacter pylori (H. pylori) infection must be determined to determine therapeutic approach. Endoscopic ultrasonography (EUS) is essential for the evaluation of regional lymph nodes and the depth of tumor invasion in the gastric wall, for predicting response to H. pylori eradication, and for monitoring tumor regression or recurrence. The eradication of H. pylori is recommended as an initial treatment for low-grade gastric MALT lymphoma with H. pylori infection. Both radiation therapy and chemotherapy are suitable alternative options for H. pylori-negative, refractory, or high-grade gastric MALT lymphoma. But, the role of surgery is diminishing. After treatment, strict endoscopic regular follow-up including EUS is recommended with multiple biopsies. However, controversy remains regarding the best diagnosis, treatment and follow-up strategy for this disease.
Biopsy, Fine-Needle ; Endosonography ; Gastroscopy ; Helicobacter Infections/complications/drug therapy ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications/*diagnosis/therapy ; Stomach Neoplasms/complications/*diagnosis/therapy

In recent years, laparoscopic gastrectomy has developed rapidly for both early and advanced gastric cancer. Most studies showed that the operative complication rate is comparable between laparoscopic and open surgery. The common complications related to laparoscopic gastrectomy are anastomotic leakage, stenosis, intra-abdominal bleeding, pancreatic leakage, bowel obstruction, etc. This article provides insights into the reasons, classification, management, and prevention of the complications related to laparoscopic gastrectomy.
Gastrectomy ; adverse effects ; methods ; Humans ; Laparoscopy ; adverse effects ; Postoperative Complications ; therapy ; Stomach Neoplasms ; surgery

PURPOSE: More than half the Korean gastric cancer patients are diagnosed at a late stage. An understanding of the clinicopathological characteristics of advanced cases is warranted, especially in order to give tailor-made treatments. METHODS: Ninety-five Borrmann type 4 gastric cancer patients, who received surgical treatment at the Department of Surgery, Hanyang University Hospital during the period between June 1992 and December 2001, were enrolled in this study. Several clinicopathological profiles of these Borrmann type 4 gastric cancers were compared to those of Borrmann types 1, 2, and 3. Thereafter, univariate and multivariate survival analyses on the type 4 were performed. RESULTS: Compared to the other macroscopic types, Borrmann type 4 gastric cancer patients showed several significant features: as for clinicopathological factors; there was a prominence of female, young-aged patients, a larger tumor size, higher rates of entire stomach cancer and late stage cases, and as for treatment-related factors; there was a higher rate of non-resection cases, combined organ resections, positive marginal state, non-curatively treated case, and more postoperative complications. The prognosis of Borrmann type 4 gastric cancer was found to differ according to the type of operation, depth of invasion, nodal status, distant metastasis, and curability (P=0.0000) from the univariate survival analysis. No independent prognostic factor was found from the multivariate survival analysis. CONCLUSION: The majority of Borrmann type 4 gastric cancer are diagnosed at a late stage, which results in a poor prognosis. To improve the curability of the operation, combined organ resection should be considered, when feasible. There were no long-term survivors in the cases with peritoneal seeding or malignant ascites. It is for these cases that we have to exert our efforts, in order to improve their QOL, but not from over-surgery or intensive chemotherapy.
Ascites ; Drug Therapy ; Female ; Humans ; Neoplasm Metastasis ; Postoperative Complications ; Prognosis ; Stomach Neoplasms* ; Survivors

Enhanced recovery after surgery (ERAS) has deeply influenced the clinical practice of surgery, anesthesia and nursing since its inception in 1997. The successful implementation of perioperative ERAS in gastric cancer depends on continually boosting the awareness and acceptance of ERAS among medical staff, carrying out multidisciplinary collaboration, improving patients' compliance and combining key items to the clinical pathways. Future efforts should be made to explore the most appropriate implementation strategy of perioperative ERAS in gastric cancer.
Critical Pathways ; Enhanced Recovery After Surgery ; Humans ; Perioperative Care ; Postoperative Complications/prevention & control* ; Stomach Neoplasms/therapy*

Gastric cancer is one of the most common digestive malignant tumors. More and more elderly gastric cancer patients are diagnosed and need to undergo surgical treatment as the population ages. Since the elderly patients decrease in organ function and increase in internal diseases, the tolerance to anesthesia and surgery is poor. As a result, the incidence of surgical and postoperative complications is obviously higher. Complications can be divided into surgical complications and non-surgical related complications. Surgical complications consist mainly of hemorrhage, anastomotic leakage, anastomotic dehiscence and intestinal obstruction, while non-surgical related complications include deep venous thrombosis, pulmonary infection, anesthesia-related complication, abdominal infection, urinary infection, incision infection, poor wound healing, gastroparesis, gastroesophageal reflux disease, dumping syndrome and so on. Hence, we should consider more about the elderly patients' physical condition instead of the extent of radical operation. To reduce complications, we should evaluate the organ function and take an active role in underlying diseases before operation. Meanwhile, high quality nursing, powerful analgesia, anti-inflammation, keeping water electrolyte balance and nutrition support are also required postoperatively. Moreover, laparoscopic surgery and enhanced recovery after surgery (ERAS) can reduce the postoperative complications in elderly patients with gastric cancer as well. Further prospective randomized controlled trials about elderly gastric cancer should be carried out in the future, which can provide advanced evidences for treatment.
Aged ; Anastomotic Leak ; therapy ; Hemorrhage ; therapy ; Humans ; Laparoscopy ; Postoperative Complications ; therapy ; Postoperative Period ; Stomach Neoplasms ; complications ; surgery ; Surgical Wound Infection ; therapy

Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Drugs, Chinese Herbal ; therapeutic use ; Evidence-Based Medicine ; Humans ; Lung Neoplasms ; complications ; therapy ; Neoplasms ; complications ; drug therapy ; Pain, Intractable ; drug therapy ; Phytotherapy ; Stomach Neoplasms ; complications ; therapy

PURPOSE: It has been reported that the survival of patients with locally advanced gastric cancer (LAGC) is better in East Asia countries than in developed western countries; however, the prognosis of LAGC remains poor. This study aimed to evaluate the effects of perioperative chemotherapy on the long-term survival of East Asia patients with LAGC. MATERIALS AND METHODS: From October 2006 through August 2008, 43 patients with LAGC received perioperative S-1 combined with weekly docetaxel in a phase II study (neoadjuvant group). These patients were matched using propensity scores to patients who underwent surgery without neoadjuvant chemotherapy during the same period (surgery group). The surgical outcomes and long-term survivals were compared between the 2 groups. RESULTS: After matching, 43 and 86 patients were included in the neoadjuvant and surgery groups, respectively, and there was no significant difference in their baseline characteristics. Although the operating time was longer in the neoadjuvant group, there was no significant difference in postoperative complications between the 2 groups. The neoadjuvant group had a significantly higher 5-year overall survival (OS) rate (73.3% vs. 51.1%, P=0.005) and a trend towards higher 5-year progression-free survival (PFS) (62.8% vs. 49.9%, P=0.145). In the multivariate analysis, perioperative chemotherapy was an independent factor for OS, with a hazard ratio of 0.4 (P=0.005) and a marginal effect on the PFS (P=0.054). CONCLUSIONS: Perioperative chemotherapy was associated with better long-term survival without increasing postoperative complications in the setting of D2 surgery for patients with LAGC, suggesting that perioperative chemotherapy can be a therapeutic option in East Asia countries.
Disease-Free Survival ; Drug Therapy* ; Far East ; Humans ; Multivariate Analysis ; Neoadjuvant Therapy ; Postoperative Complications ; Prognosis ; Propensity Score* ; Stomach Neoplasms*