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Chemotherapy and targeted therapy in liver metastasis from gastric cancer.

Chinese Journal of Gastrointestinal Surgery.2014;17(2):112-116.

Gastric cancer remains one of the most common malignancies and leading causes of cancer death in China with a complex biological behavior. The incidence of liver metastasis from gastric cancer is particularly high. The indication of hepatectomy is controversial, however, surgery should be considered. How to choose the right regimen to obtain macroscopically complete resections represents a controversial subject. Newer generation cytotoxic agents such as docetaxel, S-1 and irinotecan as well as targeted therapy agent trastuzumab exhibit promising activity in gastric cancer. Further study and clinical trials are needed to confirm the benefits of systemic treatment in gastric cancer patients with liver metastasis.
Antibodies, Monoclonal, Humanized ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Camptothecin ; analogs & derivatives ; Hepatectomy ; Humans ; Liver Neoplasms ; drug therapy ; secondary ; Molecular Targeted Therapy ; Stomach Neoplasms ; drug therapy ; pathology ; Taxoids ; Trastuzumab

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Risk factors and prognosis of liver metastasis from gastric cancer.

Xiang HU

Chinese Journal of Gastrointestinal Surgery.2014;17(2):108-111.

Liver metastasis from gastric cancer is a major cause of cancer-related death. Since liver metastasis from gastric cancer is usually associated with other non-curative factors, such as peritoneal metastasis, lymph node metastasis and extensive intrahepatic metastasis, the hepatic resection rate was low and the prognosis was poor. The main risk factors of liver metastasis were serosal invasion, p(+), N3-N4, differentiated histologic type, medullary type of poorly differentiated adenocarcinoma, vascular invasion, and overexpression and mutation of VEGF, P53 and c-erbb-2. The 5-year survival rate after hepatic resection of synchronous and metachronous liver metastasis from gastric cancer ranged from 11% to 42%. Appropriate patient selection for hepatic resection may confer a better prognosis of liver metastasis from gastric cancer.
Adenocarcinoma ; Humans ; Liver Neoplasms ; diagnosis ; secondary ; Lymphatic Metastasis ; Prognosis ; Risk Factors ; Stomach Neoplasms ; pathology ; Survival Rate

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Role of surgery in the treatment of liver metastases from gastric cancer.

Yulong HE

Chinese Journal of Gastrointestinal Surgery.2014;17(2):105-107.

The development of liver metastases is a fatal event for gastric cancer patients, and remains a major cause of cancer-related death. Many studies showed that the 5-year survival rate is as low as about 10% in these cases. The management of liver metastases from gastric adenocarcinoma remains controversial. The different therapeutic modalities used are surgery, radiofrequency ablation, hepatic arterial infusion and palliative gastrectomy. Surgery is a good indication for single liver metastasis of gastric carcinoma less than 5 cm and not associated with another extra-hepatic metastasis. In this article we discuss the role of surgery in the treatment of liver metastases from gastric cancer.
Adenocarcinoma ; Humans ; Liver Neoplasms ; secondary ; surgery ; Stomach Neoplasms ; pathology ; Survival Rate

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Multidisciplinary therapy for gastric cancer with liver metastasis.

Lin CHEN ; Hongqing XI ; Weisong SHEN

Chinese Journal of Gastrointestinal Surgery.2014;17(2):101-104.

Gastric cancer with liver metastasis (GCLM) is the leading cause of death in patients with advanced gastric cancer. Multiple metastasis was common in GCLM and usually complicated with lesions outside the liver, especially peritoneal metastasis. Most of liver metastasis lesions could not be resected radically. Currently, main treatments for GCLM included radical operation, palliative resection of gastric cancer, ablation of metastatic lesions, intervention and systemic chemotherapy. Based on the current progress in the treatment for GCLM and our clinical experience, the general status of patients, the type of gastric cancer and the degree of liver metastasis should be analyzed, and a cooperative multidisciplinary team (MDT) should be applied to conduct and to choose active and suitable comprehensive treatment for GCLM patients based on individualized therapy principle.
Humans ; Liver Neoplasms ; secondary ; therapy ; Stomach Neoplasms ; pathology ; therapy

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Advances in new chemotherapeutic drugs for preoperative chemoradiation of locally advanced rectal cancer.

Lin XIAO ; Yuanhong GAO ; Mengzhong LIU

Chinese Journal of Gastrointestinal Surgery.2014;17(1):93-97.

Preoperative concurrent chemoradiotherapy based on 5-fluorouracil (5-FU) is an standard treatment mode for patients with locally advanced rectal cancer (LARC). Currently, more and more interests has now focused on new chemotherapeutic drugs, such as capecitabine, oxaliplatin, irinotecan, bevacizumab, and cetuximab in this treatment mode. Many prospective phase I-III clinical trials have been developed to explore these new drugs efficacy in the neoadjuvant chemoradiation (nCRT) for patients with LARC. Some results are very encouraging, yet others are undesirable. Capecitabine has been widely recognized in the nCRT for patients with LARC, and has the tendency to replace 5-FU. However, there are some controversies for oxaliplatin, irinotecan, and biologically targeted drugs in the nCRT mode because of their limited clinical benefits. It is potentially the development direction to study the mutual interaction mechanism among concurrent drugs or radiation and biologically targeted drugs, find new predicatively responsive targets, and screen the appropriate patient in the treatment of neoCRT for patients with LARC in the future.
Antineoplastic Agents ; therapeutic use ; Camptothecin ; analogs & derivatives ; therapeutic use ; Capecitabine ; Chemotherapy, Adjuvant ; Deoxycytidine ; analogs & derivatives ; therapeutic use ; Fluorouracil ; analogs & derivatives ; therapeutic use ; Humans ; Organoplatinum Compounds ; therapeutic use ; Rectal Neoplasms ; drug therapy ; surgery

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Research progress of circumferential resection margin of colon cancer.

Long HAN ; Zhidong GAO ; Zhanlong SHEN ; Xiaodong YANG ; Yingjiang YE ; Shan WANG

Chinese Journal of Gastrointestinal Surgery.2014;17(1):90-92.

Circumferential resection margin(CRM) is the closest distance from the deepest of tumor invasion to the surgical margin of mesentery. It has been well known that CRM has significant impact on the prognosis and treatment of rectal cancer. However, the significance of CRM of colon cancer is just brought to the forefront recently. Current evidence showed positive rate of CRM is 10%, and the patients with positive CRM have worse survival. The factors influencing CRM include tumor stage, differentiation, vascular cancer embolus, etc. Standard surgical procedure can lower the positive rate of colon CRM, and adjuvant therapy applied to the patients with positive colon CRM can improve the survival of colon cancer patients. CRM may become a new factor guiding the treatment in colon cancer patients.
Colectomy ; methods ; Colonic Neoplasms ; surgery ; Humans ; Prognosis

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Rectal mucosa stripping and pull-through from rectal muscle sheath of blind pouch in the treatment of congenital high anal atresia in the newborn.

Baobiao ZHUO ; Hongwei ZHANG ; Yiyu YIN ; Tongsheng MA ; Fengli LIU ; Hui CAO ; Huaxin ZOU

Chinese Journal of Gastrointestinal Surgery.2014;17(1):81-84.

OBJECTIVETo explore the value of rectal mucosa stripping and pull-through from rectal muscle sheath of blind pouch in the treatment of congenital high anal atresia in the newborn.

METHODSClinical data of 232 newborns diagnosed as congenital high anal atresia undergoing operation from January 2001 to December 2010 were retrospectively analyzed. Among these patients, 168 underwent rectal mucosa stripping and pull-through from rectal muscle sheath of blind pouch through the previous of sagittal approach (intrathecal pull-through group), and 64 cases underwent the Pena procedure (Pena group). Patients were followed up for two years. Kelly score was used to estimate postoperative anorectal function. Defecography was used to examine the morphology of anorectum. Rectal pressure was measured as well.

RESULTSTwo years after operation, Kelly score revealed that 126 (75.0%) cases in the intrathecal pull-through group and 54 cases (84.4%) in the Pena group had good control defecation (P>0.05), while constipation rate was significantly lower in intrathecal pull-through group [8.3% (14/168) vs. 21.9% (14/64), P<0.05]. Postoperative barium defecography showed that defecation rectum maximum diameter was (2.2±0.3) cm in intrathecal pull-through group and (2.3±0.8) cm in the Pena group (P>0.05). Anorectal manometry showed rectal maximum capacity threshold value was (91.4±15.2) ml in the intrathecal pull-through group and (95.1±18.6) ml in the Pena group (P>0.05). There were no significant differences in defecography, anal bowel function and anorectal manometry between the two groups postoperatively (all P>0.05).

CONCLUSIONSRectal mucosa stripping and pull-through from rectal muscle sheath of blind pouch through the former sagittal can be completed with one-stage operation in newborn for the treatment of congenital high anal atresia, the efficacy of which is similar to the classic Pena operation. This procedure can avoid other operations, ameliorate the pains of newborns, decrease the burden of family, and has lower constipation rate, therefore it is a valid surgical option.

Anus, Imperforate ; surgery ; Female ; Humans ; Infant, Newborn ; Male ; Mucous Membrane ; surgery ; Rectum ; surgery ; Retrospective Studies

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A meta-analysis of feasibility and safety in complete mesocolic excision for colon cancer.

Yong XIE ; Junfu WANG ; Lin HU ; Honglang LI

Chinese Journal of Gastrointestinal Surgery.2014;17(1):74-80.

OBJECTIVETo systemically assess the feasibility and safety of complete mesocolic excision (CME) for colon cancer.

METHODSA computer-based online research of prospective, randomized or nonrandomized, controlled studies addressing CME versus traditional surgery published in the last five years was performed in electronic databases (Wanfang Database, China National Knowledge Infrastructure, Chinese Medical Current Contents, VIP, PubMed, Medline, Ovid, Elsevier, ISI Web of Knowledge, Cochrane Database of Systematic Reviews). With strictly screening according to the standard, the quality of studies was evaluated. Selective trials were analyzed by the Review Manager 5.1 software.

RESULTSA total of eight nonrandomized clinical trials, involving a total of 1209 patients (615 patients in CME group and 594 patients in control group), were identified. Meta-analysis showed that the intraoperative blood loss in CME group was less than that in control group [WMD=-13.05, 95%CI:-25.03 to -1.07, P=0.03]. No significant difference in the operation time was found [WMD=0.46, 95%CI:-26.50 to 27.41, P=0.97], and significant differences in the number of lymph node retrieved from postoperative pathologic specimens, the average length of large bowel resected, the area of mesentery resected, and the high vascular ligation were revealed between two groups. Besides there were no significant differences in the time to first flatus and the hospital stay between two groups (P=0.87, P=0.05). The postoperative complication morbidity did not increase in CME group as compared to control group (P=0.74).

CONCLUSIONCME is safe and effective in accordance with the concept of embryonic anatomy, oncological surgery and delicate surgery, and is expected to become a standardization operation method for colon cancer.

Clinical Trials as Topic ; Colonic Neoplasms ; surgery ; Feasibility Studies ; Humans ; Mesentery ; surgery

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Evaluation of the application of endoscopic submucosal dissction in gastrointestinal cysts.

Wenzheng QIN ; Pinghong ZHOU ; Quanlin LI ; Meidong XU ; Yiqun ZHANG ; Yunshi ZHONG ; Weifeng CHEN ; Lili MA ; Jianwei HU ; Mingyan CAI ; Liqing YAO

Chinese Journal of Gastrointestinal Surgery.2014;17(1):71-73.

OBJECTIVETo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of gastrointestinal cysts.

METHODSClinicopathological data of 40 patients with gastrointestinal cyst undergoing ESD in our center during January 2008 and February 2012 were analyzed retrospectively. Complications, en bloc resection rate, and local recurrence were assessed.

RESULTSEight lesions located in the esophagus, 11 in the stomach, 5 in the duodenum, and 16 in the colorectum. Thirty-seven lesions were successfully resected with ESD in an en bloc fashion (92.5%). During the operation, one perforation was encountered in the ascending colon and was clipped; one massive hemorrhage occurred in the esophagus and was treated with balloon compression. Postoperative pathological examination revealed cyst samples were intact without lesions in lateral and basal resection margins. Local recurrence was not found in 36 patients during a median postoperative follow-up of 9.7 months (range, 6-12 months).

CONCLUSIONESD is a safe and effective procedure for the treatment of gastrointestinal cysts.

Adult ; Aged ; Cysts ; surgery ; Digestive System Neoplasms ; surgery ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Mucous Membrane ; surgery ; Retrospective Studies

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Analysis on pathology features and prognosis of appendiceal mucinous neoplasm.

Mei ZHANG ; Fengjuan GAO ; Fanqing MENG ; Yifen ZHANG ; Gang CHEN ; Ping ZENG ; Ming CHEN ; Qiang ZHOU ; Xiangshan FAN

Chinese Journal of Gastrointestinal Surgery.2014;17(1):65-70.

OBJECTIVETo explore the pathological features and prognosis of appendiceal mucinous neoplasms (AMN) based on WHO classification 2010.

METHODSSeventy consecutive cases of AMN were classified into 5 groups according to WHO classification of digestive system tumors in 2010 including mucinous adenomas/cystadenoma (MA), low grade appendiceal mucinous neoplasms (LAMN), low grade pseudomyxoma peritoneum originated from appendix (PMP-L), invasive mucinous adenocarcinomas (MAC) and high grade pseudomyxoma peritoneum originated from appendix (PMP-H). Clinicopathological features, classification, treatment and prognosis of AMN were investigated retrospectively.

RESULTSThere were 11 cases of MA with neoplastic epithelium and mucin being defined in lumen and mucosa but without invasive lesions, and no relapse or death was found. In 41 LAMN cases, mucin was found in submucosa, muscularis proparis, or serosa of appendix, no or only scant mucinous epithelium with low grade dysplasia presented in mucinous pools in most cases (39/41). Among 41 LAMN cases, 3 developed relapse or PMP-L, and no death was observed. In 7 PMP-L cases, low grade dysplastic mucinous epithelium in mucinous pools could be found easily in 3 cases and was very scanty in 4 cases, with 1 relapse and 1 death. Eleven invasive carcinomas were found, including 7 MAC cases and 4 PMP-H cases, with local high grade dysplastic epithelium at least. In these invasive lesions, 4 cases recurred and 3 case died (including 2 recurred cases above). MA and LAMN were both non-invasive neoplasms histologically, however, PMP-L, MAC and PMP-H were regarded as adenocarcinomas according to their biological behavior.

CONCLUSIONAMN displays a relatively homogeneous group of neoplasms that pursues a predictable clinical course based on their nature, so it is necessary to diagnose and administrative accurately with consistently standards for these neoplastic entities.

Adenocarcinoma, Mucinous ; pathology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Appendiceal Neoplasms ; classification ; pathology ; Child ; Female ; Humans ; Male ; Middle Aged ; Myxoma ; pathology ; Prognosis ; Young Adult

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