Objective To investigate the feasibility and safety of laparoscopic-assisted gastrectomy for distant gastric cancer. Methods All 18 patients with distant gastric cancer receiving laparoscopic-assisted gastrectomy were analyzed. Results Laparoscopic-assisted distal gastrectomy was performed successfully in all patients. The mean operation time was (291.33±19.61) min. The mean blood loss was (151.32±71.78) ml. The mean numbers of harvested lymph node were 14.57±3.11. The mean time of gastrointestinal function recovery was (3.46±0.93) d, the mean out of bed activity time was (1.75±0.45) d. All patients were followed up for 1-24 months, mean 11 months. No local recurrence, trocar implant or distant metastasis happened. Conclusion Laparoscopic-assisted gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.
ObjectiveTo evaluate the prognostic significance of serum levels of vascular endothelial growth factor (VEGF) and insulin-like growth factors-Ⅰ (IGF-Ⅰ) in advanced gastric cancer patients who were treated with oxaliplatin/5-fluorouracil (FOLFOX). MethodsNinety-six advanced gastric cancer patients who were treated with FOLFOX in our hospital between March 2007 to August 2010 were enrolled in this study. All of the patients were treated with oxaliplatin (85 mg/m2) as a 2-hour infusion on day 1, and leucovorin (20 mg/m2, about 10 min) on day 1 and day 2, followed by a 5-fluorouracil bolus (400 mg/m2) and 22 hours of continuous infusion of 600 mg/m2. Treatment was repeated in 2-week intervals, and patients received 4 chemotherapy cycle in total. The levels of serum VEGF and IGF-Ⅰ were measured using enzyme-linked immunoassays. The relationship between serum levels of VEGF/IGF-Ⅰ and the clinicopathological characteristics of patients, the relationship between serum levels of VEGF/IGF-Ⅰ and prognosis of patients, were analyzed. ResultsThe serum levels of VEGF and IGF-Ⅰ were (464.4±57.4) pg/mL and (33.5±7.3) ng/mL, respectively. The serum level of VEGF was related with surgical history, Lauren's classification, TNM staging before treatment, and pathological type (P < 0.05), and serum level of IGF-Ⅰ was related with TNM staging before treatment and number of transferred organs (P < 0.05). The serum levels of VEGF and IGF-Ⅰ in stable disease (SD) +progressive disease (PD) patiens were higher than those of complete response (CR) +partial response (PR) patients (P < 0.05). The results of Cox proportional hazard regression model showed that, effect of chemotherapy (HR=1.764, P=0.006), number of transferred organs (HR=1.662, P=0.015), serum level of VEGF (HR=1.834, P=0.012) and IGF-Ⅰ (HR=1.855, P=0.008), were all significantly related with time to progression (TTP); serum level of VEGF (HR=2.205, P=0.002) and IGF-Ⅰ (HR=1.931, P=0.004) were all significantly related with overall survival (OS). ConclusionLevels of serum VEGF and IGF-Ⅰ are independent prognostic factors in patients with advanced gastric cancer who were treated with FOLFOX chemotherapy.
ObjectiveTo summarize advances of neoadjuvant chemotherapy (NACT) in treatment for locally advanced gastric cancer (AGC) in recent years, in order to providing reference for development of NACT and application of clinical research.MethodThe domestic and foreign literatures about the NACT for the AGC were reviewed.ResultsThe efficacy and safety of NACT had been affirmed, but there were still many questions in the clinical practice, such as the selection of NACT regimen, indications, number of chemotherapy cycles, whether to combine targeted therapy, the selection of treatment and restaging after the NACT, and relevant researches were still underway.ConclusionsTherapy methods of AGC are varied and NACT has an obvious effect, which has become one of the most important treatments for AGC. However, there are still many problems in clinical practice, further research is needed.
Objective To evaluate clinical efficacy of mFOLFOX6 combined with aspirin in treatment of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy. Methods One hundred and seven patients with advanced gastric cancer were assigned to observation group (57 cases) and control group (50 cases). The patients in the observation group received the mFOLFOX6 chemotherapy and regular intake of aspirin (100 mg/d) and the control group received the mFOLFOX6 chemotherapy alone. The recurrence or metastasis rate, rate of disease progress, toxicity, median survival time, and 3-year survival rate were compared between the observation group and the control group. Results ① There were no significant differences in the gender, age, pathological type, and so on between the observation group and the control group (P>0.05). ② The rates of toxicity such as the white blood cell reduction, granulocyte reduction, thrombocytopenia had no significant differences in these two groups (P>0.05). ③ The follow-up time was 4–45 months with an average 3.5 years, the rate of disease progress was lower (P=0.032), the median survival time was longer (P=0.043), the cumulative 3-year overall survival (P=0.015) and the cumulative 3-year disease-free survival (P=0.037) were better in the observation group as compared with the control group. Conclusion Preliminary results in this study show that mFOLFOX6 regimen combined with low-dose aspirin could significantly improve efficacy of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy, reduce rate of disease progress, and improve survival rate without increasing side effects.
ObjectiveTo recognize the latest research progress of immunotherapy for advanced gastric cancer (AGC). MethodThe domestic and international literature on immunotherapy for AGC in recent years were retrieved and reviewed. ResultsThe immunotherapy for AGC mainly focused on immune checkpoint inhibitors (ICIs), cellular immunity, and antitumor vaccines. The most immunotherapy researched was ICIs, especially for programmed death protein-1 / programmed death protein ligand 1, cytotoxic T lymphocyte associated antigen 4, and lymphocyte activating gene 3. The cellular immunotherapy and tumor vaccine therapy were less relatively. Although immunotherapy alone did not have a particularly good effect, its therapeutic effect was not inferior to that of chemotherapy alone and the incidence of adverse reactions was lower. Moreover, most studies had concluded that the use of immunotherapy in combination with other therapy had shown a good clinical efficacy, especially in combination with anti-human epidermal growth factor receptor 2 antibody, and chimeric antigen receptor T cells targeting Claudin 18.2 site had promising results in the AGC. ConclusionsWith the development of immunotherapy research, the strategies of immunotherapy for AGC are also constantly improving. Precision medicine is important in the process of immunotherapy. Targeted screening suitable patients and adopting precise treatment can further benefit the survival of patients with AGC.
Objective To explore the feasibility, safety, efficacy and mechanism of intraoperative regional chemotherapy of advanced gastric cancer.Methods The related literatures were reviewed and analyzed. Results Compared with systemic chemotherapy, intraoperative regional chemotherapy of advanced gastric cancer could increase blood drug concentration of cancerous tissue, reduce the systemic toxic side effects, increase survival rate and improve the quality of life. Conclusion Intraoperative regional chemotherapy, as an adjuvant treatment of advanced gastric cancer, has been gradually applied to clinic because of the definite curative effect, which is worth popularizing. However, it needs systemic researches and accumulation of cases.
ObjectiveTo evaluate clinical effect of neoadjuvant chemotherapy combined with laparoscopic gastrectomy in treatment of local advanced gastric cancer. MethodsThe clinical data of 24 patients with local advanced gastric cancer undergoing 2 courses of FLEEOX neoadjuvant chemotherapy from July 2012 to July 2015 were analyzed. The efficacy of neoadjuvant chemotherapy based on radiographic results was evaluated. The gastrectomy was performed on week 2 after neoadjuvant chemotherapy. Patients were treated with XELOX regimen as adjuvant chemotherapy after laparoscopic gastrectomy. Results① Complete response occurred in 4 cases (16.6%), partial response in 18 cases (75.0%), stable disease in 1 case (4.2%), disease progressive in 1 case (4.2%). The total effective rate of neoadjuvant chemotherapy was 91.6% (22/24). ② The serum tumor markers CEA, CA19-9, and CA125 levels after neoadjuvant chemotherapy were significantly lower than those before neoadjuvant chemotherapy (P < 0.001) and reached normal levels. ③ Two courses of neoadjuvant chemotherapy and laparoscopic exploration were completed successfully in these 24 patients. Two patients with intraabdominal metastasis were underwent palliative gastrojejunostomy, the other 22 patients were underwent laparoscopic D2 radical gastrectomy. The operative time was (236±45) min, the intraoperative blood loss was (150±50) mL, the number of lymph node dissected was 17.4 ± 5.3, the postoperative gastrointestinal function recovery time was (3.1±0.8) d. ④ There was no death due to surgery. One case suffered anastomotic leakage, 1 case intestinal obstruction, and 1 case pulmonary infection after surgery. The postoperative complications were cured by conservative treatment. ⑤ The haematological adverse events included anemia (9 patients), leukopenia (14 patients), thrombocytopenia (8 patients), aminotransferase abnormality (5 in elevated ALT, 6 in elevated AST), the most common toxicity was nausea (19 patients), 10 patients suffered nerve toxicity. All the patients were relieved after treatment. ⑥ The patients were followed up for 4-39 months, 1 case died of cachexia as the result of extensive abdominal metastasis, 1 case died of liver failure as the result of multiple liver metastases, 1 case was death as the result of brain metastasis, 1 case was death as the result of the other cause, the other 20 patients were alive. ConclusionsThe preliminary results of limited cases in this study show that FLEEOX neoadjuvant chemotherapy combined with laparoscopic gastrectomy for local advanced gastric cancer is safe and effective. It has advantages of minimal invasion and fast recovery.
ObjectiveTo summarize the research progress of preoperative regional-arterial chemotherapy in advanced gastric cancer. MethodThe literatures about the research progress of preoperative regional-arterial chemotherapy in the advanced gastric cancer were reviewed. ResultsThe preoperative regional-arterial chemotherapy in the advanced gastric cancer could decrease the tumour stage, improve the R0 resection rate and the long-term survival rate, effectively improve the drug concentrations of tumor and portal vein, and not only kill or damage cancer cells directly, but also prevent the metastasis of liver and lymph nodes effectively, and reduce the side effects, cause the nuclear pyknosis and fracture of cancer cells in a short time. The course of preoperative regional-arterial chemotherapy in the advanced gastric cancer generally was 4-9 weeks, and then whether the surgery treatment was decided to undergo according to the results of the curative effect evaluation. ConclusionsThe preoperative regional-arterial chemotherapy in the advanced gastric cancer has more advantages than intravenous chemotherapy, further research of multicenter and large clinical trials, would inaugurate a wider application prospects.
ObjectiveTo investigate the risk factors of hepatoduodenal lymph node (HDLN) metastasis in patients with advanced gastric cancer and its effect on prognosis. MethodsClinical datas of patients with advanced gastric cancer who underwent D2 radical gastrectomy for gastric cancer and HDLN dissection between Jan 2011 and Nov 2013 in department of general surgery of Ankang Central Hospital were retrospectively reviewed. Multivariate logistic regression analysis was performed to identify the independent risk factors associated with HDLN metastasis. Survival curves were performed to compare the survival rate of patients with or without HDLN metastasis and of patients with HDLN metastasis or with other lymph node metastasis. A Cox proportional hazards model was used for the multivariate analysis of risk factors for death in advanced gastric cancer. ResultsThe incidence of HDLN metastasis was 10.7% in patients with advanced gastric cancer. Multivariate logistic regression analyses revealed that the middle or lower stomach cancer (OR=6.014, P=0.002) and stage T3 or T4 (OR=5.133, P=0.021) were independent risk factors for HDLN metastasis. The 2-year overall survival (OS) rate was 36.7% in patients with HDLN metastasis. It was lower in patients with HDLN metastasis compared with those without (P=0.002). Limited to node-positive patients, patients with HDLN metastasis demonstrated decreased 2-year OS rate compared with node-positive patients without HDLN metastasis (P=0.027). Cox proportional hazard analysis identified poorly differentiated or undifferentiated cancer, stage of T3 or T4, and HDLN metastasis were independent poor prognostic factors in the patients with advanced gastric cancer (P < 0.05). ConclusionsCancer located in the middle or lower stomach, and stage T3 or T4 were independent risk factors for HDLN metastasis in patients with advanced gastric cancer. HDLN metastasis demonstrated a poor prognosis.