A multi-center, prospective, clinical study to evaluate the anti-reflux efficacy of laparoscopic double-flap technique (lD-FLAP Study)

Background: Double-flap technique (DFT) is a reconstruction procedure after proximal gastrectomy (PG). We previously reported a multi-center, retrospective study in which the incidence of reflux esophagitis (RE) (Los Angeles Classification ≥Grade B [LA-B]) 1 year after surgery was 6.0%. There have been many reports, but all of them were retrospective. Thus, a multi-center, prospective study was conducted. Methods: Laparoscopic PG + DFT was performed for cT1N0 upper gastric cancer patients. The primary endpoint was the incidence of RE (≥LA-B) 1 year after surgery. The planned sample size was 40, based on an estimated incidence of 6.0% and an upper threshold of 20%. Results: Forty patients were recruited, and 39, excluding one with conversion to total gastrectomy, received protocol treatment. Anastomotic leakage (Clavien–Dindo ≥Grade III) was observed in one patient (2.6%). In 38 patients, excluding one case of postoperative mortality, RE (≥LA-B) was observed in two patients (5.3%) 1 year after surgery, and the upper limit of the 95% confidence interval was 17.3%, lower than the 20% threshold. Anastomotic stricture requiring dilatation was observed in two patients (5.3%). One year after surgery, body weight change was 88.9 ± 7.0%, and PNI Conclusion: Laparoscopic DFT showed anti-reflux efficacy. Taken together with the acceptable incidence of anastomotic stricture, DFT can be an option for reconstruction procedure after PG

Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study)

AIM: As a result of the difficulty in effective prevention of gastroesophageal reflux, no standard reconstruction procedure after proximal gastrectomy (PG) has yet been established. The double-flap technique (DFT), or Kamikawa procedure, is an antireflux reconstruction procedure in esophagogastrostomy. The efficacy of DFT has recently been reported in several studies. However, these were all single-center studies with a limited number of cases. METHODS: We conducted a multicenter retrospective study in which patients who underwent DFT, irrespective of disease type and reconstruction approach, at each participating institution between 1996 and 2015 were registered. Primary endpoint was incidence of reflux esophagitis at 1-year after surgery, and secondary endpoint was incidence of anastomosis-related complications. RESULTS: Of 546 patients who were eligible for this study, 464 patients who had endoscopic examination at 1-year follow up were evaluated for reflux esophagitis. Incidence of reflux esophagitis of all grades was 10.6% and that of grade B or higher was 6.0%. Male gender and anastomosis located in the mediastinum/intra-thorax were independent risk factors for grade B or higher reflux esophagitis (odds ratio [OR]: 4.21, 95% confidence interval [CI]: 1.44-10.9, P = 0.0109). Total incidence of anastomosis-related complications was 7.2%, including leakage in 1.5%, strictures in 5.5% and bleeding in 0.6% of cases. Laparoscopic reconstruction was the only independent risk factor for anastomosis-related complications (OR: 3.93, 95% CI: 1.93-7.80, P = 0.0003). CONCLUSION: Double-flap technique might be a feasible option after PG for effective prevention of reflux, although anastomotic stricture is a complication that must be well-prepared for

Prognostic nutritional index is a prognostic factor for patients with gastric cancer and esophagogastric junction cancer undergoing proximal gastrectomy with esophagogastrostomy by the double-flap technique: A secondary analysis of the rD-FLAP study

Purpose: Although proximal gastrectomy (PG) is commonly used in patients with upper gastric cancer (GC) and esophagogastric junction (EGJ) cancer, long-term prognostic factors in these patients are poorly understood. The double-flap technique (DFT) is an esophagogastrostomy with anti-reflux mechanism after PG; we previously conducted a multicenter retrospective study (rD-FLAP) to evaluate the short-term outcomes of DFT reconstruction. Here, we evaluated the long-term prognostic factors in patients with upper GC and EGJ cancer. Methods: The study was conducted as a secondary analysis of the rD-FLAP Study, which enrolled patients who underwent PG with DFT reconstruction, irrespective of disease type, between January 1996 and December 2015. Results: A total of 509 GC and EGJ cancer patients were enrolled. Univariate and multivariate analyses of overall survival demonstrated that a preoperative prognostic nutritional index (PNI) Conclusions: PNI is a prognostic factor in upper GC and EGJ cancer patients. Preoperative nutritional enhancement and postoperative nutritional maintenance are important for prognostic improvement in these patients

Primary gastric low-grade fibromyxoid sarcoma with FUS-CREB3L1 fusion – A hitherto undescribed origin of Evans tumor

Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue neoplasm with a deceptively benign histological appearance. Only several LGFMS cases originating from the gastrointestinal tract have been reported, but all of them are from the small intestine or colon. Here, we describe a case of gastric LGFMS that was proven to have a characteristic FUS-CREB3L1 fusion gene. A 54-year-old Japanese female complained of epigastralgia. Abdominal computed tomography revealed a solid mass probably originating from the lessercurvature of the gastric body and protruding outside the gastric wall. Under the clinical diagnosis of suspicious gastrointestinal stromal tumor of the stomach, gastric wedge resection including the tumor was done. The macroscopic finding showed a mass approximately 8.0cm in maximal diameter with white-tan cut surface, arising from the gastric wall. Histological examination revealed a mesenchymal tumor consisting of blunt spindle cells with occasional collagen rosettes and inflammatory cells. Tumor was immunohistochemically positive for MUC4 and the molecular analysis using formalin-fixed paraffin embedded tissue detected FUS-CREB3L1 fusion which is a minor fusion gene type in LGFMS. Thus, the pathological diagnosis of gastric LGFMS was confirmed. To the best of our knowledge, the present case is the first one of LGFMS arising from the stomach in the English literature. Keywords: Low-grade fibromyxoid sarcoma, FUS-CREB3L1 fusion, Stomac

Prognostic nutritional index is a prognostic factor for patients with gastric cancer and esophagogastric junction cancer undergoing proximal gastrectomy with esophagogastrostomy by the double-flap technique: A secondary analysis of the rD-FLAP study

Purpose: Although proximal gastrectomy (PG) is commonly used in patients with upper gastric cancer (GC) and esophagogastric junction (EGJ) cancer, long-term prognostic factors in these patients are poorly understood. The double-flap technique (DFT) is an esophagogastrostomy with anti-reflux mechanism after PG; we previously conducted a multicenter retrospective study (rD-FLAP) to evaluate the short-term outcomes of DFT reconstruction. Here, we evaluated the long-term prognostic factors in patients with upper GC and EGJ cancer. Methods: The study was conducted as a secondary analysis of the rD-FLAP Study, which enrolled patients who underwent PG with DFT reconstruction, irrespective of disease type, between January 1996 and December 2015. Results: A total of 509 GC and EGJ cancer patients were enrolled. Univariate and multivariate analyses of overall survival demonstrated that a preoperative prognostic nutritional index (PNI) Conclusions: PNI is a prognostic factor in upper GC and EGJ cancer patients. Preoperative nutritional enhancement and postoperative nutritional maintenance are important for prognostic improvement in these patients

REIDAC - A Software Package for Retrospective Dose Assessment in Internal Contamination with Radionuclides

For cases of internal contamination with radionuclides, it is necessary to perform an internal dose assessment to facilitate radiation protection. For this purpose, the ICRP has supplied the dose coefficients and the retention and excretion rates for various radionuclides. However, these dosimetric quantities are calculated under typical conditions and are not necessarily detailed enough for dose assessment situations in which specific information on the incident or/and individual biokinetic characteristics could or should be taken into account retrospectively. This paper describes a newly developed PC-based software package called REIDAC (Retrospective Internal Dose Assessment Code) that meets the needs of retrospective dose assessment. REIDAC is made up of a series of calculation programs and a package of software. The former calculates the dosimetric quantities for any radionuclide being assessed and the later provides a user with the Graphical User Interface (GUI) for executing the programs, editing parameter values and displaying results. The accuracy of REIDAC was verified by comparisons with dosimetric quantities given in the ICRP publications. This paper presents the basic structure of REIDAC and its calculation methods. Sensitivity analysis of the aerosol size for 239Pu compounds and provisional calculations for wound contamination with 241Am were performed as examples of the practical application of REIDAC