ObjectiveTo summarized the clinical experience on laparoscopic radical surgery in patients with advanced distal gastric cancer. MethodsThe clinical data of 26 patients with advanced distant gastric cancer undergoing laparoscopic gastrectomy were retrospectively analyzed. ResultsLaparoscopic distal gastrectomy was performed successfully in all patients. The operation time was (283.2±27.6) min (270-450 min) and the blood loss was (178.4±67.4) ml (80-350 ml). The time of gastrointestinal function recovery was (2.8±1.2) d (2-4 d), out of bed activity time was (1.5±0.4) d (1-3 d) and liquid diet feeding was (3.5±1.4) d (3-4 d). The hospital stay was (10.0±2.6) d (7-13 d). The number of harvested lymph nodes was 11 to 34 (17.8±7.3). The distance from proximal surgical margin to tumor was (7.0±2.1) cm (5-12 cm) and the distance from distal surgical margin to tumor was (5.5±1.8) cm (4-8 cm), thus surgical margins were negative in all samples. All patients were followed up for 3-48 months (mean 18.5 months), two patients with poorly differentiated adenocarcinoma died of extensive metastasis in 13 and 18 months, respectively, and other patients survived well. ConclusionsLaparoscopic radical gastrectomy with D2 lymphadenectomy for advanced gastric cancer is safe and feasible. However, the advantage of laparoscopic technique over the conventional open surgery requires further study.
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.
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.
Objective To evaluate the effectiveness and safety of lentinan on immune function in patients with advanced gastric cancer. Methods We searched MEDLINE (1969-2006), EMBASE (1984-2006), OVID (1969-2006), CENTRAL (Cochrane Central Register of Controlled Trials in The Cochrane Library) (Issue 4, 2006), the Chinese Biomedicine Database (1978-2006) and CNKI (1978-2006). We also handsearched relevant journals. Pharmaceutical companies were contacted to identify additional randomized controlled trials. We assessed the identified studies in order to include high quality studies. Results Ten studies (containing 786 patients) met the inclusion criteria. Six trials shown that lentinan+FAM had significant efficacy upon patients with advanced gastric cancer compared with FAM in overall response [Plt;0.01, RR1.70, 95%CI (1.39,2.09)]. In three trials, a significant effect of lentinan+FAM group compared with FAM group in quantity of CD3+ T, T4/T8, NK was found, but lower than FAM group in side- effect of digestive system [RR0.71, 95%CI (0.55,0.91)]. The other trail identified there were fewer side effects in lentinan+FAM group compared with FAM group, though did not discribe the overall response. In case the significant heterogeneity, meta-analysis could not be used for the other three trails included, since the components of chemotherapeutic agents (ATP+Co-A+Vc; DDP+ Epirubicin+5FU; 5FU+CF+VP16) were not the same. In the three trials, overall response was statistically significant better in the lentinan group than in the control group, and lentinan group could significantly increase the quantity of CD3+ T, T4/T8, NK compared with control group. Conclusions The present meta-analysis suggested that addition of lentinan to standard chemotherapy provided a significant advantage over chemotherapy alone in terms of efficacy for patients with advanced gastric cancer. However, most of trials included in the review were of low quality, therefore, it is of necessity to conduct multi-center randomized-controlled trials of high quality.
ObjectiveTo compare the clinical recovery and immune response between laparoscopic-assisted and open D2 gastrectomy for advanced gastric cancer.
MethodsThe clinical data of 53 patients with advanced gastric cancer from January 2012 to October 2013 were studied prospectively. According to random number table, patients were randomly divided into laparoscopic-assisted group(LA group, n=27) and open operation group(OO group, n=26). Operative time, blood loss, time to passage of flatus, time to resume soft diet, after bed time, postoperative hospital stay, and number of retrieved lymph nodes were compared respectively between the two groups. The changes in CD3, CD4+, CD8+, IgG, IgA, IgM, and CRP were examined respectively by using flow cytometry and immunoturbidimetric assays on the preoperative day 1, and on the postoperative day 1 and 7.
ResultsThe operative time was longer significantly in LA group than that in OO group(P < 0.05). The mean blood loss, the first flatus time, after bed time, and postoperative hospital stay in the two groups were all different statistically(P < 0.05), and all were better in LA group. However, the mean number of retrieved lymph nodes and the time to resume soft diet were not significantly different in the two groups(P > 0.05). On the day 1 and 7 after operation, the CD3, CD4+, and CD8+ significantly decreased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). On the day 1 after operation, the levels of IgG, IgA, and IgM significantly decreased as compared with those preoperatively in two groups(P < 0.05). Those immunoglobulin in LA group recovered to close to the level before surgery, but in OO group sustained lower level(P < 0.05). On the day 1 and 7 after operation, CRP level significantly increased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). Those changes of above index were not significantly different between the LA group and OO group on the day 1 after operation(P > 0.05). All index recovered gradually in the two groups on the day 7 after operation and were better in LA group(P < 0.05, except IgA).
ConclusionLaparoscopic radical gastrectomy for advanced gastric cancer resulted in a quicker clinical recovery and a lesser depression to the perioperative cellular and humoral immune function.
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.
Objectives
To systematically review the efficacy and safety of docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer.
Methods
We searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to March 2017, to collect randomized controlled trials (RCTs) on docetaxel or epirubicin based regimens in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.
Results
A total of 12 RCTs involving 984 advanced gastric cancer patients were included. The results of meta-analysis showed that docetaxel based regimens were superior to epirubicin based regimens in ORR (RR=1.21, 95%CI 1.02 to 1.43, P=0.03), DCR (RR=1.13, 95%CI 1.01 to 1.26, P=0.03), 1-year survival rate (RR=1.26, 95%CI 1.01 to 1.56, P=0.04) and 2-year survival rate (RR=3.03, 95%CI 1.59 to 5.75, P=0.000 7), while there was no statistical difference between two groups in the incidence of grade Ⅲ to Ⅳ adverse events. The results of sensitivity analysis showed that docetaxel based regimens were superior to epirubicin based regimens in 2-year survival rate (RR=2.56, 95%CI 1.06 to 6.19, P=0.04), but there were no statistical differences in ORR (RR=1.13, 95%CI 0.88 to 1.45, P=0.34), DCR (RR=1.02, 95%CI 0.85 to 1.21, P=0.84) and 1-year survival rate (RR=1.29, 95%CI 0.92 to 1.80, P=0.14). The results of sensitivity analysis indicated that the overall outcomes might be affected by the risk bias of included studies. The comparision between docetaxel based regimens and epirubicin based regimens was consistent with the overall outcomes in the incidence of grade Ⅲ to Ⅳ adverse events.
Conclusions
Compared with epirubicin based regimens, docetaxel based regimens may have more clinical benefits for advanced gastric cancer patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
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 systematically review the efficacy and safety of neoadjuvant chemotherapy containing tegafur gimeracil oteracil potassium (S-1) combined with surgery in the treatment of advanced gastric cancer.MethodsWe searched EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI and WanFang Data from inception to February 2017, to collect randomized controlled trials (RCTs) about neoadjuvant chemotherapy containing S-1 combined with surgery in the treatment of advanced gastric cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 11 RCTs involving 971 advanced gastric cancer patients were included. The results of meta-analysis showed that the neoadjuvant chemotherapy containing S-1 combined with surgery group was superior to the control group in R0 resection rate (OR=2.75, 95%CI 1.91 to 3.95, P<0.000 01), 2 year survival rate (OR=1.72, 95%CI 1.01 to 2.93, P=0.05) and 3 year survival rate (OR=1.64, 95%CI 1.12 to 2.41, P=0.01), while there were no statistical differences in response rate (OR=1.33, 95%CI 0.70 to 2.51, P=0.39), 1 year survival rate (OR=1.50, 95%CI 0.64 to 3.53, P=0.35) and the incidence of postoperative complications (OR=1.00, 95%CI 0.66 to 1.51, P=0.98).ConclusionNeoadjuvant chemotherapy containing S-1 combined with surgery can improve the R0 resection rate, 2-year survival rate and 3-year survival rate without increase postoperative complications rate. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo evaluate the efficacy and safety of docetaxel (DOC) combined with oxaliplatin (OXA) regimen in the treatment of advanced gastric cancer.
MethodsSixty patients with advanced gastric cancer treated in our hospital from January 2008 to January 2011 were randomly divided into two groups. The treatment group (n=30) was given DOC combined with OXA regimen. Patients in this group were treated with DOC 75 mg/m2, ivgtt, d1; OXA 130 mg/m2, ivgtt, d4; with 21 days as a cycle. The control group (n=30) was given DCF regimen. Patients in the control group were treated with DOC 75 mg/m2, ivgtt, d1; cisplatin 75 mg/m2, ivgtt, d1; calcium folinate 200/m2, ivgtt, 2 h, d1-2; fluorouracil 400 mg/m2, bolus 10 minutes, fluorouracil 600 mg/m2 civ 22 h d1-2; also with 21 days as a cycle. All patients received two cycles of chemotherapy at least. The effective rate (complete remission+partial remission), adverse reactions, median survival time and quality of life were analyzed and compared between the two groups.
ResultsThe effective rates in the treatment group and the control group were 60.0% and 46.7% respectively, showing a non-significant difference (P>0.05). The appetite increasing rate (70.0% vs 43.3%), the weight gain rate (60.0% vs 33.3%), and the Karnofsky score improvement rate (63.3% vs 30.0%) of the treatment group were significantly higher than those of the control group (P<0.05). The adverse reactions were fewer in the treatment group, and most of them were between grade Ⅰ and Ⅱ. The median time of disease progression (5.8 months vs 5.6 months) and the median survival period (11.8 months vs 9.2 months) of the treatment group were longer than those in the control group.
ConclusionDOC combined with OXA regimen is effective in treating advanced gastric cancer. It can significantly improve the quality of life of the patients, and it has fewer adverse reactions. Meanwhile, the median survival period is prolonged. DOC combined with OXA regimen is worth to be applied in clinic.
