The nutritional advantages of proximal gastrectomy for early gastric cancer.
Eiji HinoshitaIkuo TakahashiToshihiro OnoharaTakashi NishizakiT MatsusakaKenzo WakasugiTetsuo IshikawaKazuhiro KumeYoshihiko MaeharaKeizō Sugimachi
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Total gastrectomy has generally been performed for the treatment of early gastric cancers involving the upper third of the stomach. However, proximal gastrectomy has also been used for the treatment of cardial early gastric cancer.To compare the nutritional parameters after proximal gastrectomy with the parameters after total gastrectomy, and to also determine the advantages of the postoperative nutritional states, a retrospective analysis was made to evaluate the nutritional status of patients with early gastric cancer who underwent proximal gastrectomy with those undergoing total gastrectomy. Forty-nine patients were studied for one year after surgery; 9 underwent proximal gastrectomy while 40 had a total gastrectomy.Proximal gastrectomy allowed the patient to better maintain both their nutritional parameters and body weight.Proximal gastrectomy was thus found to be a beneficial modality for early gastric cancer patients regarding terms of the postoperative nutritional status, in comparison to total gastrectomy.Cite
There are two definite classes of lesions of the stomach in which gastrectomy may be indicated. One is malignancy, and the other is peptic ulcer with its complications or sequelae. The first indication, malignancy, admits of no discussion. Gastrectomy is the only known cure for cancer of the stomach. Unfortunately, many patients suffering from this disease come too late for a radical operation, and there is sometimes a tendency to wait too long under medical treatment while the cancer continues to develop. Just what proportion of benign gastric ulcers become cancerous it is difficult to state. The percentage of gastric cancers arising from a peptic ulcer base is estimated at from 10 to as high as 70, the latter being the figures given by the Mayo Clinic. That a certain proportion of gastric peptic ulcers do apparently develop into cancer is admitted by all pathologists interested in the study of
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Stomach cancer is the third most deadly cancer in the world. Undoubtedly, the operative method is a priority in the treatment of stomach cancer. The history of development, formation and improvement of gastric cancer surgery dates back almost 140 years. During this time, the priority of numerous studies was to develop the most reliable and physiological method of reconstruction after gastrectomy. To date, the literature describes more than 70 different options for reconstruction after gastrectomy, many of which are used in practice. Globally, there are two main types of reconstructive stages after gastrectomy: without preservation and with preservation of the duodenal passage. The advantages and disadvantages of these stages after gastrectomy continue to be the subject of heated discussions among surgeons, as studies of the immediate and long-term results of various types of these operations are extremely contradictory. We did a historical literature review to identify the most optimal reconstruction method in patients with gastric cancer after gastrectomy.
Stomach cancer
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Gastric remnants are an inevitable consequence of partial gastrectomy following resection for gastric cancer.The presence of gastric stumps is itself a risk factor for redevelopment of gastric cancer. Helicobacter pylori(H. pylori) infection is also a well-known characteristic of gastric carcinogenesis. H. pylori colonization in the remnant stomach therefore draws special interest from clinicians in terms of stomach cancer development and pathogenesis; however,the H. pylori-infected gastric remnant is quite different from the intact organ in several aspects and researchers have expressed conflicting opinions with respect to its role in pathogenesis.For instance,H. pylori infection of the gastric stump produced controversial results in several recent studies. The prevalence of H. pylori infection in the gastric stump has varied among recent reports. Gastritis developing in the remnant stomach presents with a unique pattern of inflammation that is different from the pattern seen in ordinary gastritis of the intact organ. Bile refluxate also has a significant influence on the colonization of the stomach stump,with several studies reporting mixed results as well. In contrast,the elimination of H. pylori from the gastric stump has shown a dramatic impact on eradication rate. H. pylori elimination is recognized to be important for cancer prevention and considerable agreement of opinion is seen among researchers. To overcome the current discrepancies in the literature regarding the role of H. pylori in the gastric stump,further research is required.
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Gastric remnants are an inevitable consequence of partial gastrectomy following resection for gastric cancer.The presence of gastric stumps is itself a risk factor for redevelopment of gastric cancer.Helicobacter pylori(H.pylori)infection is also a well-known characteristic of gastric carcinogenesis.H.pylori colonization in the remnant stomach therefore draws special interest from clinicians in terms of stomach cancer development and pathogenesis;however,the H.pylori-infected gastric remnant is quite different from the intact organ in several aspects and researchers have expressed conflicting opinions with respect to its role in pathogenesis.For instance,H.pylori infection of the gastric stump produced controversial results in several recent studies.The prevalence of H.pylori infection in the gastric stump has varied among recent reports.Gastritis developing in the remnant stomach presents with a unique pattern of inflammation that is different from the pattern seen in ordinary gastritis of the intact organ.Bilerefluxate also has a significant influence on the colonization of the stomach stump,with several studies reporting mixed results as well.In contrast,the elimination of H.pylori from the gastric stump has shown a dramatic impact on eradication rate.H.pylori elimination is recognized to be important for cancer prevention and considerable agreement of opinion is seen among researchers.To overcome the current discrepancies in the literature regarding the role of H.pylori in the gastric stump,further research is required.
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The prognosis of type IV scirrhous gastric cancer (SGC) is extremely poor. Linitis plastica (LP), the so-called 'leather bottle stomach', is believed to be a typical case of SGC, which is usually diagnosed as a far-advanced gastric cancer. The pathogenesis of this disease remains unclear. Although typical SGC often invades the entire stomach, atypical cases show SGC localized to one region of the stomach. The aim of the present study was to investigate localized SGC (LSGC) and its biological significance. A total of 509 patients with advanced gastric cancer who underwent gastrectomy were evaluated. These patients were divided into three groups as follows: 19 patients with type IV scirrhous lesions invading the whole stomach (defined as LP), 60 patients with type IV scirrhous lesions localized in less than two thirds of the stomach (defined as LSGC) and the remaining 430 patients with all other types of gastric cancer (OGC), and then clinicopathologically compared. Results showed that LP had deeper invasion (p=0.006), more frequent peritoneal dissemination including positive cytology (p=0.01 and p=0.018) and lower curability (p=0.03) compared with LSGC, whereas LSGC showed a higher malignant potential in a number of clinicopathological factors compared with OGC. Univariate analysis showed that survival in patients with LP was significantly poorer than in those with LSGC (p=0.002) whose survival was, in turn, inferior to those with OGC. By contrast, LSGC was not a prognostic factor in SGC according to the multivariate analysis. The findings of this study suggested that the malignant status of LSGC differs from that of LP, and that curative gastrectomy is effective in improving the outcome for LSGC but not for LP, as LSGC may represent the prelinitis condition.
Univariate analysis
Stomach cancer
Linitis plastica
Pathogenesis
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Gastric remnants are an inevitable consequence of partial gastrectomy following resection for gastric cancer. The presence of gastric stumps is itself a risk factor for redevelopment of gastric cancer. Helicobacter pylori (H. pylori) infection is also a well-known characteristic of gastric carcinogenesis. H. pylori colonization in the remnant stomach therefore draws special interest from clinicians in terms of stomach cancer development and pathogenesis; however, the H. pylori-infected gastric remnant is quite different from the intact organ in several aspects and researchers have expressed conflicting opinions with respect to its role in pathogenesis. For instance, H. pylori infection of the gastric stump produced controversial results in several recent studies. The prevalence of H. pylori infection in the gastric stump has varied among recent reports. Gastritis developing in the remnant stomach presents with a unique pattern of inflammation that is different from the pattern seen in ordinary gastritis of the intact organ. Bile refluxate also has a significant influence on the colonization of the stomach stump, with several studies reporting mixed results as well. In contrast, the elimination of H. pylori from the gastric stump has shown a dramatic impact on eradication rate. H. pylori elimination is recognized to be important for cancer prevention and considerable agreement of opinion is seen among researchers. To overcome the current discrepancies in the literature regarding the role of H. pylori in the gastric stump, further research is required.
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Stomach cancer
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The mechanism of remnant gastric cancer development has not yet been well established. In this study, we compared the background gastric mucosa of remnant gastric cancer with that of upper lesion-restricted gastric cancer to determine the difference in the pathogenesis of naive gastric cancer and remnant gastric cancer.Twenty-five patients with gastric remnant cancer after distal gastrectomy and a control group of 29 patients with naive gastric cancer restricted to the upper part of the stomach who underwent gastrectomy were enrolled in this study. We evaluated the gastric mucosa adjacent to cancerous tissues using the updated Sydney score system.The surrounding gastric mucosa in the remnant gastric cancer group was significantly less atrophic than that of the group with gastric cancer restricted to the upper part of the stomach. In remnant gastric cancer, patients who underwent Billroth II (B-II) reconstruction at first gastrectomy developed cancer at the anastomotic site more frequently than those with Billroth I (B-I) reconstruction.The surrounding gastric mucosa was significantly less atrophic in remnant gastric cancer than naïve gastric cancer, which indicates that remnant gastric cancer might possess a different pathogenesis.
Billroth II
Billroth I
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