scholarly journals Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Ken Yuu ◽  
Hiroshi Kawashima ◽  
Sho Toyoda ◽  
Satoshi Okumura ◽  
Kansuke Yamamoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Conservative Treatment ◽  
Epigastric Pain ◽  
Acute Onset ◽  
Gastric Remnant ◽  
R0 Resection ◽  
Upper Gastrointestinal Endoscopy ◽  
Remnant Gastric Cancer ◽  
Lesser Curvature ◽  
Nasogastric Tube Insertion

An 80-year-old man who had undergone distal gastrectomy and Billroth-II gastrojejunostomy 38 years previously, for a benign gastric ulcer, was diagnosed with remnant gastric cancer based on upper gastrointestinal endoscopy findings. He presented at our emergency department with acute-onset epigastric pain due to perforated remnant gastric cancer. Conservative medical management was selected, including nasogastric tube insertion, antibiotics, and proton pump inhibitors, because his peritonitis was limited to his epigastrium and his general condition was stable. Twenty-one days after the perforation occurred, curative total remnant gastrectomy and D2 lymphadenectomy were performed. Adhesion between the lateral segment of the liver and the dissected lesser curvature of the gastric remnant may have contributed to the peritonitis in this case, which was limited to the epigastrium. This is the first report of perforated remnant gastric cancer in which conservative treatment was effective prior to curative resection. The protocol reported here may be of use to other clinicians who may encounter this clinical entity in their practices.

scholarly journals Positive lymph node ratio is an index in predicting prognosis for remnant gastric cancer with insufficient retrieved lymph node in R0 resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Honghu Wang ◽  
Hao Qi ◽  
Xiaofang Liu ◽  
Ziming Gao ◽  
Iko Hidasa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Lymph Node Ratio ◽  
Prognostic Index ◽  
Staging System ◽  
R0 Resection ◽  
Remnant Gastric Cancer ◽  
Curative Intent ◽  
Node Ratio

AbstractThe staging system of remnant gastric cancer (RGC) has not yet been established, with the current staging being based on the guidelines for primary gastric cancer. Often, surgeries for RGC fail to achieve the > 15 lymph nodes needed for TNM staging. Compared with the pN staging system, lymph node ratio (NR) may be more accurate for RGC staging and prognosis prediction. We retrospectively analyzed the data of 208 patients who underwent R0 gastrectomy with curative intent and who have ≤ 15 retrieved lymph nodes (RLNs) for RGC between 2000 and 2014. The patients were divided into four groups on the basis of the NR cutoffs: rN0: 0; rN1: > 0 and ≤ 1/6; rN2: > 1/6 and ≤ 1/2; and rN3: > 1/2. The 5-year overall survival (OS) rates for rN0, rN1, rN2, and rN3 were 84.3%, 64.7%, 31.5%, and 12.7%, respectively. Multivariable analyses revealed that tumor size (p = 0.005), lymphovascular invasion (p = 0.023), and NR (p < 0.001), but not pN stage (p = 0.682), were independent factors for OS. When the RLN count is ≤ 15, the NR is superior to pN as an important and independent prognostic index of RGC, thus predicting the prognosis of RGC patients more accurately.

scholarly journals Successful Conversion Surgery for Stage IV Gastric Cancer after Nivolumab Monotherapy as Third-Line Chemotherapy

2021 ◽  
pp. 562-567
Author(s):  
Hayato Watanabe ◽  
Hirohito Fujikawa ◽  
Keisuke Komori ◽  
Kazuki Kano ◽  
Kosuke Takahashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Liver Metastasis ◽  
Stage Iv ◽  
R0 Resection ◽  
Upper Gastrointestinal Endoscopy ◽  
Conversion Surgery ◽  
Line Treatment ◽  
Stage Iv Gastric Cancer ◽  
Third Line ◽  
Line Chemotherapy

There are few reports of conversion surgery (CS) after nivolumab monotherapy because it is considered as a third-line standard chemotherapy for unresectable or recurrent gastric cancer. Here, we report a rare case of stage IV gastric cancer effectively treated with CS after nivolumab monotherapy as a third-line chemotherapy. A 73-year-old man was referred to our hospital with loss of appetite and abdominal discomfort. Stage IV gastric cancer with liver metastasis was diagnosed via upper gastrointestinal endoscopy and CT. Twelve courses of capecitabine, cisplatin, and trastuzumab were administered as the first-line treatment, 25 courses of paclitaxel plus ramucirumab as the second-line treatment, and 31 courses of nivolumab monotherapy as the third-line treatment. After 31 courses of nivolumab monotherapy, CT showed that the primary tumor shrank with no liver metastasis or ascites. Diagnostic laparoscopy was performed with no peritoneal dissemination (P0), and the peritoneal lavage cytology was negative (CY0). CS was performed with total gastrectomy and D2 lymph node dissection (R0 resection). The pathological diagnosis was U, Ant-Less, Type 2, 70 × 63 mm, poorly differentiated adenocarcinoma (ypT3N0M0 ypStage IIA). R0 resection was performed, and the histological response was grade 1a. The patient did not show recurrence for 9 months after CS.

Is Complete Resection has a Better Survival in Remnant Gastric Cancer and What Are the Prognositic Factors Affecting These Results?

2021 ◽  
Author(s):  
Yigit Mehmet Ozgun ◽  
Volkan Oter ◽  
Erol Piskin ◽  
Muhammet Kadri Colakoglu ◽  
Osman Aydin ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Complete Resection ◽  
Remnant Gastric Cancer ◽  
Factors Affecting

scholarly journals De novo gastric cancer developing after liver transplantation from deceased donor for biliary atresia: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naruki Higashidate ◽  
Suguru Fukahori ◽  
Shinji Ishii ◽  
Nobuyuki Saikusa ◽  
Naoki Hashizume ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Liver Transplantation ◽  
Biliary Atresia ◽  
De Novo ◽  
Epigastric Pain ◽  
Gastroesophageal Junction ◽  
Deceased Donor ◽  
Lymphoproliferative Disease ◽  
Endoscopic Examination ◽  
De Novo Malignancy

Abstract Background Apart from Kasai’s procedure, liver transplantation (LTx) has dramatically improved the outcome of children with biliary atresia (BA). However, de novo malignancy has been reported to be one of the major causes of late mortality after LTx among adults. We report a rare case of de novo gastric cancer developing after LTx for BA received during childhood. Case presentation A 21-year-old male patient who had undergone LTx for BA at age 2 years occasionally visited our outpatient clinic due to symptoms of epigastric pain and dysphagia. Endoscopic examination and computed tomography revealed advanced gastric cancer at the gastroesophageal junction with multiple liver metastases. Despite systemic chemotherapy, the disease progressed, resulting in patient’s death 2 years after the diagnosis. Conclusions De novo malignancy in the absence of post-transplant lymphoproliferative disease is rare in pediatric patients who received LTx. To the best of our knowledge, no report has been available on the development of gastric cancer after LTx for BA during childhood. Primary physicians should therefore establish a follow-up plan for patients receiving LTx for BA considering the potential for the development of de novo malignancy, including gastric cancer, despite its rarity.

scholarly journals Endoscopic Insufflation–Induced Gastric Barotrauma during Percutaneous Endoscopic Gastrostomy: A Report of Three Patients and Review of Literature

2021 ◽  
Vol 12 (02) ◽  
pp. 103-106
Author(s):  
Avnish Kumar Seth ◽  
Rinkesh Kumar Bansal
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Gastrointestinal Endoscopy ◽  
Gastroesophageal Junction ◽  
Upper Gastrointestinal Endoscopy ◽  
Proximal Stomach ◽  
Endoscopic Gastrostomy ◽  
Lesser Curvature ◽  
Upper Gastrointestinal ◽  
New Onset

Abstract Background We report three patients with endoscopic insufflation–induced gastric barotrauma (EIGB) during upper gastrointestinal endoscopy (UGIE) for percutaneous endoscopic gastrostomy (PEG). A definition and classification of EIGB is proposed. Materials and Methods Records of patients undergoing UGIE over 7 years (April 2013–March 2020) were reviewed. Patients who developed new onset of bleeding or petechial spots in proximal stomach, in an area previously documented to be normal during the same endoscopic procedure, were studied. Results New onset of bleeding or petechial spots in proximal stomach occurred in 3/286 (0.1%) patients undergoing PEG and in none of the 19,323 other UGIE procedures during the study period. All patients were men with median age 76 years (range 68–80 years), with no coagulopathy. Aspirin and apixaban were discontinued 1 week and 3 days prior to the procedure. Fresh blood was noted in the stomach at a median of 275 seconds (range 130–340) seconds after commencement of endoscopy. At retroflexion, multiple linear mucosal breaks of up to 3 cm, with oozing of blood, were noted in the proximal stomach along the lesser curvature, close to the gastroesophageal junction in two patients. In the third patient, multiple petechial spots were noticed in the fundus. The plan for PEG was abandoned and the stomach deflated by endoscopic suction. There was no subsequent hematemesis, melena, or drop in hemoglobin. One week later, repeat UGIE in the first two patients revealed multiple healing linear ulcers of 1 to 3 cm in the lesser curvature and PEG was performed. Conclusion Overinsufflation over a short duration during UGIE may lead to EIGB. Early detection is key and in the absence gastric perforation, patients can be managed conservatively.

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