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A Case of Sudden Onset Septicemia in Recurred Gastric Cancer Following S1 Plus Docetaxel Treatment.

Sumiya ISHIGAMI ; Takaaki ARIGAMI ; Yoshikazu UENOSONO ; Yasuto UCHIKADO ; Yoshiaki KITA ; Ken SASAKI ; Hiroshi OKUMURA ; Hiroshi KURAHARA ; Yuko KIJIMA ; Akihiro NAKAJO ; Kosei MAEMURA ; Shoji NATSUGOE

Journal of Gastric Cancer.2013;13(2):126-128. doi:10.5230/jgc.2013.13.2.126

Pyogenic liver abscess in patients with malignant disease is a fatal state and is easily diagnosed. We presented a rare case of sudden fatal septicemia following anticancer treatment for recurred gastric cancer due to multiple liver abscesses which could not be diagnosed. A 72-year-old male with recurred gastric cancer received anticancer agents. He had a history of distal gastrectomy with right hepatic lobectomy for hepatic metastasis. He received anticancer treatment in the outpatient's service center periodically, and his performance status was preserved with nothing in particular. After administrating docetaxel, he suddenly developed septicemia and multiple organ failure and died 5 days after strong medical supports. Pathological autopsy revealed that multiple minute abscesses of the liver which could not be detected macroscopically were the causes of fatal septicemia. The etiology, therapies and prognosis of rare entity are being discussed.
Abscess ; Antineoplastic Agents ; Autopsy ; Gastrectomy ; Hepatectomy ; Humans ; Liver ; Liver Abscess ; Liver Abscess, Pyogenic ; Male ; Multiple Organ Failure ; Neoplasm Metastasis ; Prognosis ; Sepsis ; Stomach Neoplasms ; Taxoids

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Advanced Gastric Cancer Associated with Disseminated Intravascular Coagulation Successfully Treated with 5-fluorouracil and Oxaliplatin.

Dong Seok LEE ; Seung Jin YOO ; Ho Suk OH ; Eun Jung KIM ; Kwang Hoon OH ; Sang Jin LEE ; Jong Kyu PARK ; Yong Chel AHN ; Dae Woon EOM ; Heui June AHN

Journal of Gastric Cancer.2013;13(2):121-125. doi:10.5230/jgc.2013.13.2.121

Gastric cancer patients with acute disseminated intravascular coagulation experiences a rare but severe complication resulting in a dismal prognosis. We report a case of advanced gastric cancer complicated with disseminated intravascular coagulation with intractable tumor bleeding which was successfully treated with chemotherapy consisting of 5-fluorouracil and oxaliplatin. The patient was a 63-year-old man who complained of abdominal pain, melena, and dyspnea on 24 November 2010. We diagnosed stage IV gastric cancer complicated by disseminated intravascular coagulation. Gastric tumor bleeding was not controlled after procedures were repeated three times using gastrofiberscopy. With the patient's consent, we selected the 5-fluorouracil and oxaliplatin combination chemotherapy for treatment. After one cycle of 5-fluorouracil and oxaliplatin therapy, symptoms of bleeding improved and the disseminated intravascular coagulation process was successfully controlled. The primary tumor and multiple metastatic bone lesions were remarkably shrunken and metabolically remitted after eight cycles of chemotherapy. In spite of progression, systemic chemotherapy is effective in disease control; further, the patient gained the longest survival time among cases of gastric cancer with disseminated intravascular coagulation.
Abdominal Pain ; Disseminated Intravascular Coagulation ; Drug Therapy, Combination ; Dyspnea ; Fluorouracil ; Hemorrhage ; Humans ; Melena ; Organoplatinum Compounds ; Prognosis ; Stomach Neoplasms

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Adenocarcinoma Occurring in a Gastric Hyperplastic Polyp Treated with Endoscopic Submucosal Dissection.

Hye Won JANG ; Hyun Yong JEONG ; Seok Hyun KIM ; Sun Hyung KANG ; Jae Kyu SEONG ; Kyu Sang SONG ; Hee Seok MOON

Journal of Gastric Cancer.2013;13(2):117-120. doi:10.5230/jgc.2013.13.2.117

Gastric hyperplastic polyps are generally considered benign lesions, although rare cases of adenocarcinoma have been reported. Although, the underlying mechanism of carcinogenesis in gastric hyperplastic polyps is still uncertain, most malignant polyps are seen to originate from dysplastic epithelium rather than from hyperplastic epithelium. Herein, we report the case of a woman diagnosed with adenocarcinoma that originated from a hyperplastic gastric polyp that was successfully removed by endoscopic submucosal dissection. In this case, we observed adenomatous changes around the cancerous component.
Adenocarcinoma ; Epithelium ; Female ; Humans ; Polyps

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Carcinosarcoma of the Stomach: A Case Report.

Kyeong Woon CHOI ; Woo Yong LEE ; Seong Woo HONG ; Yeo Goo CHANG ; Byungmo LEE ; Hye Kyung LEE

Journal of Gastric Cancer.2013;13(1):69-72. doi:10.5230/jgc.2013.13.1.69

Carcinosarcoma is a rare malignant, biphasic tumor comprised of carcinoma and sarcoma components. In the gastrointestinal tract, carcinosarcoma is most frequently seen in the esophagus and rarely in the stomach. We report a 51-year-old female patient with 2-month-history of epigastric pain and dyspepsia. Endoscopic finding revealed a huge ulcerative lesion that infiltrated from the antrum to the mid-body. An endoscopically taken biopsy revealed poorly differentiated malignant round cell neoplasm. After the palliative subtotal gastrectomy, immunohistochemical studies showed two positive reactions for the epithelial marker and mesenchymal marker. Based on the above findings, the patient was diagnosed with gastric carcinosarcoma. The immunohistochemical analysis is a critical method in making an accurate diagnosis of carcinosarcoma.
Biopsy ; Carcinosarcoma ; Dyspepsia ; Esophagus ; Female ; Gastrectomy ; Gastrointestinal Tract ; Humans ; Immunohistochemistry ; Sarcoma ; Stomach ; Ulcer

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Perforated Early Gastric Cancer: Uncommon and Easily Missed a Case Report and Review of Literature.

Raymond Hon Giat LIM ; Clifton Ming TAY ; Benjamin WONG ; Choon Seng CHONG ; Koji KONO ; Jimmy Bok Yan SO ; Asim SHABBIR

Journal of Gastric Cancer.2013;13(1):65-68. doi:10.5230/jgc.2013.13.1.65

Gastric carcinoma rarely presents as a perforation, but when it does, is perceived as advanced disease. The majority of such perforations are Stage III/IV disease. A T1 gastric carcinoma has never been reported to perforate spontaneously in English literature. We present a 56 year-old Chinese male who presented with a perforated gastric ulcer. Intra-operatively, there was no suspicion of malignancy. At operation, an open omental patch repair was performed. Post-operative endoscopy revealed a macroscopic Type 0~III tumour and from the ulcer edge biopsy was reported as adenocarcinoma. Subsequently, the patient underwent open subtotal gastrectomy and formal D2 lymphadenectomy. The final histopathology report confirms T1b N0 disease. The occurrence of a perforated early gastric cancer re-emphasises the need for vigilance, including intra-operative frozen section and/or biopsy, as well as routine post-operative endoscopy for all patients.
Adenocarcinoma ; Asian Continental Ancestry Group ; Biopsy ; Endoscopy ; Frozen Sections ; Gastrectomy ; Humans ; Lymph Node Excision ; Male ; Peritonitis ; Stomach Neoplasms ; Stomach Ulcer ; Ulcer

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Five-Year Survival of Alpha-Fetoprotein-Producing Gastric Cancer with Synchronous Liver Metastasis: A Case Report.

Kenji KONERI ; Yasuo HIRONO ; Daisuke FUJIMOTO ; Katsuji SAWAI ; Mitsuhiro MORIKAWA ; Makoto MURAKAMI ; Takanori GOI ; Atsushi IIDA ; Kanji KATAYAMA ; Akio YAMAGUCHI

Journal of Gastric Cancer.2013;13(1):58-64. doi:10.5230/jgc.2013.13.1.58

Alpha-fetoprotein-Producing gastric cancer is associated with poor prognosis because of frequent liver and lymph node metastasis. We present a case with synchronous liver metastasis who survived for 5 years. A 69-year-old man with upper abdominal pain was referred to our hospital. Gastrointestinal endoscopy revealed a Borrmann II-like tumor in the lower part of the stomach. Computed tomography revealed a tumor in the left lobe of the liver. Serum alpha-fetoprotein levels were markedly increased. We performed distal gastrectomy after administering oral tegafur/gimeracil/oteracil potassium and administered hepatic intra-arterial cisplatin injection. Liver metastasis showed partial response on computed tomography. Despite left hepatic lobectomy, further metastases to the liver and mediastinal lymph nodes became difficult to control. After sorafenib tosylate administration, stabilization of the disease was observed for 4 months. We conclude that hepatic intra-arterial chemotherapy and oral administration of sorafenib tosylate may potentially improve the prognosis in such cases.
Abdominal Pain ; Administration, Oral ; alpha-Fetoproteins ; Cisplatin ; Endoscopy, Gastrointestinal ; Gastrectomy ; Liver ; Lymph Nodes ; Neoplasm Metastasis ; Niacinamide ; Phenylurea Compounds ; Potassium ; Prognosis ; Stomach ; Stomach Neoplasms

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Outcomes of Laparoscopic Gastrectomy after Endoscopic Treatment for Gastric Cancer: A Comparison with Open Gastrectomy.

Hye Youn KWON ; Woo Jin HYUNG ; Joong Ho LEE ; Sang Kil LEE ; Sung Hoon NOH

Journal of Gastric Cancer.2013;13(1):51-57. doi:10.5230/jgc.2013.13.1.51

PURPOSE: Additional gastrectomy is needed after endoscopic resection for early gastric cancer when pathology confirms any possibility of lymph node metastasis or margin involvement. No studies depicted the optimal type of surgery to apply in these patients. We compared the short-term and long-term outcomes of laparoscopic gastrectomy with those of open gastrectomy after endoscopic resection to identify the optimal type of surgery. MATERIALS AND METHODS: From 2003 to 2010, 110 consecutive patients who underwent gastrectomy with lymphadenectomy either by laparoscopic (n=74) or by open (n=36) for gastric cancer after endoscopic resection were retrospectively analyzed. Postoperative and oncological outcomes were compared according to types of surgical approach. RESULTS: Clinicopathological characteristics were comparable between the two groups. Laparoscopic group showed significantly shorter time to gas passing and soft diet and hospital day than open group while operation time and rate of postoperative complications were comparable between the two groups. All specimens had negative margins regardless of types of approach. Mean number of retrieved lymph nodes did not differ significantly between the two groups. During the median follow-up of 47 months, there were no statistical differences in recurrence rate (1.4% for laparoscopic and 5.6% for open, P=0.25) and in overall (P=0.22) and disease-free survival (P=0.19) between the two groups. Type of approach was not an independent risk factor for recurrence and survival. CONCLUSIONS: Laparoscopic gastrectomy after endoscopic resection showed comparable oncologic outcomes to open approach while maintaining benefits of minimally invasive surgery. Thus, laparoscopic gastrectomy can be a treatment of choice for patients previously treated by endoscopic resection.
Diet ; Disease-Free Survival ; Follow-Up Studies ; Gastrectomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms

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Comparison of Laparoscopy-Assisted and Totally Laparoscopic Distal Gastrectomy: The Short-Term Outcome at a Low Volume Center.

Byung Seo CHOI ; Heung Kwon OH ; Sei Hyeog PARK ; Jong Min PARK

Journal of Gastric Cancer.2013;13(1):44-50. doi:10.5230/jgc.2013.13.1.44

PURPOSE: Laparoscopic gastrectomy has been adopted for the treatment of gastric cancer, and despite the technical difficulties, totally laparoscopic distal gastrectomy has been considered less invasive than laparoscopy-assisted distal gastrectomy. Although there have been many reports regarding the feasibility and safety of totally laparoscopic distal gastrectomy at large volume centers, few reports have been conducted at low-volume centers. The purpose of this study is to try to assess the feasibility and safety of totally laparoscopic distal gastrectomy at a low volume center through the analysis of short-term outcomes of totally laparoscopic distal gastrectomy compared with laparoscopy-assisted distal gastrectomy. MATERIALS AND METHODS: The clinical data and short-term surgical outcomes of 35 patients who had undergone laparoscopy-assisted distal gastrectomy between April 2007 and March 2010, and 37 patients who underwent totally laparoscopic distal gastrectomy between April 2010 and August 2012 were retrospectively reviewed. RESULTS: There was no significant difference in the demographic and clinical data. However the reconstruction method and extent of lymphadenectomy showed statistically significant differences. Operation time and estimated blood loss did not show significant differences. Surgical and medical complications did not show significant differences but postoperative courses including time-to-first oral intake and postoperative hospital stay were significantly increased. CONCLUSIONS: Our study shows that totally laparoscopic distal gastrectomy is technically feasible at a low volume center. Therefore, totally laparoscopic distal gastrectomy can be considered as one of the surgical treatment for early gastric cancer. However the possibility that totally laparoscopic distal gastrectomy may have less benefit should also be considered.
Gastrectomy ; Humans ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Retrospective Studies ; Stomach Neoplasms

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Comparison of Intracorporeal Reconstruction after Laparoscopic Distal Gastrectomy with Extracorporeal Reconstruction in the View of Learning Curve.

Chang Wook AHN ; Hoon HUR ; Sang Uk HAN ; Yong Kwan CHO

Journal of Gastric Cancer.2013;13(1):34-43. doi:10.5230/jgc.2013.13.1.34

PURPOSE: The intracorporeal reconstruction after laparoscopic gastrectomy can minimize postoperative pain, and give better cosmetic effect, while it may have technical difficulties and require the learning curve. This study aimed to analyze the surgical outcome of intracorporeal reconstruction according to the surgeon's experience comparing with extracorporeal procedure. MATERIALS AND METHODS: From January 2009 to September 2011, intracorporeal reconstruction in laparoscopic surgery for gastric cancer was performed for 71 patients (Intra group). During same period, 231 patients underwent laparoscopy-assisted gastrectomy (Extra group). These patients were classified into initial (1st to 20th case of intra group), intermediate (21th to 46th case), and experienced (after 47th case) phases. RESULTS: Intracorporeal procedures included 35 cases of Billroth-I, 30 Billroth-II and 6 Roux en Y reconstructions. In the initial phase, operation time (P=0.022) were significantly longer for the patients of intra group than them of extra group. Although the difference was not significant, the length of hospital stay was longer and complication rate was higher in the intra group. In intermediate and experienced phases, there was no difference between two groups in operation time and hospital stay. In these phases, complication rate was lower in the intra group than the extra group (3.9% versus 9.7%). The pain scale was significantly lower post operation day 5 in the intra group. CONCLUSIONS: Intracorporeal reconstruction after laparoscopic distal gastrectomy was feasible and safe, and the technique was stabilized after 20th case if the surgeon has sufficient experiences when we compared it with extracorporeal reconstruction.
Cosmetics ; Gastrectomy ; Gastroenterostomy ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Pain, Postoperative ; Stomach Neoplasms

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Totally Laparoscopic Distal Gastrectomy after Learning Curve Completion: Comparison with Laparoscopy-Assisted Distal Gastrectomy.

Han Gil KIM ; Ji Ho PARK ; Sang Ho JEONG ; Young Joon LEE ; Woo Song HA ; Sang Kyung CHOI ; Soon Chan HONG ; Eun Jung JUNG ; Young Tae JU ; Chi Young JEONG ; Taejin PARK

Journal of Gastric Cancer.2013;13(1):26-33. doi:10.5230/jgc.2013.13.1.26

PURPOSE: The aims are to: (i) display the multidimensional learning curve of totally laparoscopic distal gastrectomy, and (ii) verify the feasibility of totally laparoscopic distal gastrectomy after learning curve completion by comparing it with laparoscopy-assisted distal gastrectomy. MATERIALS AND METHODS: From January 2005 to June 2012, 247 patients who underwent laparoscopy-assisted distal gastrectomy (n=136) and totally laparoscopic distal gastrectomy (n=111) for early gastric cancer were enrolled. Their clinicopathological characteristics and early surgical outcomes were analyzed. Analysis of the totally laparoscopic distal gastrectomy learning curve was conducted using the moving average method and the cumulative sum method on 180 patients who underwent totally laparoscopic distal gastrectomy. RESULTS: Our study indicated that experience with 40 and 20 totally laparoscopic distal gastrectomy cases, is required in order to achieve optimum proficiency by two surgeons. There were no remarkable differences in the clinicopathological characteristics between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy groups. The two groups were comparable in terms of open conversion, combined resection, morbidities, reoperation rate, hospital stay and time to first flatus (P>0.05). However, totally laparoscopic distal gastrectomy had a significantly shorter mean operation time than laparoscopy-assisted distal gastrectomy (P<0.01). We also found that intra-abdominal abscess and overall complication rates were significantly higher before the learning curve than after the learning curve (P<0.05). CONCLUSIONS: Experience with 20~40 cases of totally laparoscopic distal gastrectomy is required to complete the learning curve. The use of totally laparoscopic distal gastrectomy after learning curve completion is a feasible and timesaving method compared to laparoscopy-assisted distal gastrectomy.
Abdominal Abscess ; Flatulence ; Gastrectomy ; Humans ; Laparoscopy ; Learning ; Learning Curve ; Length of Stay ; Reoperation ; Stomach Neoplasms

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