Prognostic Value of Preoperative Systemic Inflammatory Parameters in Advanced Gastric Cancer

Background: The predictive value of various systemic inflammatory parameters has been reported. However, it is still unclear which inflammatory parameters are the best predictors of prognosis in advanced gastric cancer and what are their mechanisms of action. The aim of this study was to evaluate the association between preoperative systemic inflammatory parameters and overall survival (OS) in patients with advanced gastric cancer. Methods: This retrospective study included 489 patients with stage II/III advanced gastric cancer treated at the National Cancer Center, Republic of Korea, between January 2012 and December 2015. We divided the patients into survivors and non-survivors and compared their clinicopathological characteristics. Univariate and multivariate analyses using the Cox proportional hazards model were performed to evaluate the prognostic value of inflammatory parameters. Results: The absolute lymphocyte count was significantly higher in survivors (2.07 ± 0.62 × 103/µL vs. 1.88 ± 0.63 × 103/µL, p = 0.001). The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were marginally lower in survivors. Survival analysis revealed that the NLR and PLR were independent prognostic factors for OS. Survival was significantly different depending on NLR and PLR in the same pathologic stages. Conclusions: NLR and PLR were independent prognostic factors for OS in patients with advanced gastric cancer. Regarding single inflammatory parameters, an elevated lymphocyte count was the only factor associated with a favorable prognosis. These results suggest that the enhanced immune function of patients affects their prognosis more than the increased systemic inflammatory response

Necessity of Individualized Approach for Gastric Subepithelial Tumor Considering Pathologic Discrepancy and Surgical Difficulty Depending on the Gastric Location

Background: Depending on the location of gastric subepithelial tumors (SETs), surgical access is difficult with a risk of postoperative complications. This study aimed to evaluate the clinicopathological characteristics of small-sized gastric SETs and their surgical outcomes depending on location and provide considering factors for their treatment plans. Methods: This single-center, retrospective study reviewed patients who underwent surgical resection for gastric SETs (size 65 years (odds ratio (OR), 3.183; 95% confidence interval (CI), 1.310–7.735; p = 0.011), and non-cardiac SETs (OR, 2.472; 95% CI, 1.110–5.507; p = 0.030) were associated with a significant risk of malignancy. Compared to SETs in other locations, cardiac SETs showed more complications (3 versus 0; p = 0.000), and open conversion rates (2 versus 0; p = 0.003). However, the proportion of GISTs of SETs in the cardia is not negligible (52.9%). Conclusions: Considering the malignancy risk of SETs, active surgical resection should be considered in old age and/or location in the non-cardiac area. However, in young patients, SETs located in the gastric cardia have a considerably benign nature and are associated with poor short-term surgical outcomes. An individualized surgical approach for asymptomatic small SETs according to the gastric location is warranted

Gastric choriocarcinoma admixed with an α-fetoprotein-producing adenocarcinoma and separated adenocarcinoma

We report a case of gastric choriocarcinoma admixed with an α-fetoprotein (AFP)-producing adenocarcinoma. A 70-year-old man was hospitalized for gastric cancer that was detected during screening by esophagogastroduodenoscopy (EGD). Initial laboratory data showed the increased serum level of AFP and EGD revealed a 5-cm ulcerofungating mass in the greater curvature of the gastric antrum. The patient underwent radical subtotal gastrectomy with D2 lymph node dissection and Billroth II gastrojejunostomy. Histopathological evaluation confirmed double primary gastric cancer: gastric choriocarcinoma admixed with an AFP-producing adenocarcinoma and separated adenocarcinoma. At 2 wk postoperatively, his human chorionic gonadotropin and AFP levels had reduced and six cycles of adjuvant chemotherapy were initiated. No recurrence or distant metastasis was observed at 4 years postoperatively

Analysis of Esophageal Reflux After Proximal Gastrectomy Measured by Wireless Ambulatory 24-Hr Esophageal pH Monitoring and TC-99m Diisopropyliminodiacetic acid (DISIDA) Scan

Background and objectives: Reflux is one of the most common sequela after proximal gastrectomy (PG). The aim of this study was to find a predicting factor related to the character of esophageal reflux after PG. Methods: Wireless ambulatory 24-hr pH monitoring (for acid reflux, AR) and diisopropyliminodiacetic acid hepatobiliary scan (for bile reflux, BR) were performed on 24 patients who had reflux symptoms after PG with esophagogastrostomy from July 2008 to March 2009. Endoscopic examination was done and the length of remnant stomach (LoRS) was measure by postoperative UGI series. Results: Eleven patients (45.8%) had only BR, 7 (29.2%) had AR only, Two patients (8.3%) had both acid and BR, and 3 (12.5%) had neither. The LoRS along greater curvature was significantly shorter in patients with only BR (16.11 +/- 2.87 cm) than in patients with only AR (23.69 +/- 6.15 cm, P=0.003). Severity of symptoms or esophagitis was not significantly correlated with the content of acid or BR. Conclusion: Reflux symptom after PG is caused by either bile or acid rather than both. Character of reflux was related to the LoRS. J. Surg. Oncol. 2010;101:626-633. (C) 2010 Wiley-Liss, Inc.Talaie R, 2009, J GASTROINTEST LIVER, V18, P11Hakanson BS, 2009, SCAND J GASTROENTERO, V44, P276, DOI 10.1080/00365520802588109An JY, 2008, AM J SURG, V196, P587, DOI 10.1016/j.amjsurg.2007.09.040Bechtold ML, 2007, WORLD J GASTROENTERO, V13, P4091Kim JH, 2006, WORLD J SURG, V30, P1870, DOI 10.1007/s00268-005-0703-8Dickman R, 2006, DIGEST DIS, V24, P313, DOI 10.1159/000092885KIM JH, 2006, WORLD J SURG, V30, P1877Katsoulis IE, 2006, DIGEST SURG, V23, P325, DOI 10.1159/000097948des Varannes SB, 2005, GUT, V54, P1682, DOI 10.1136/gut.2005.066274DeVault KR, 2005, AM J GASTROENTEROL, V100, P190, DOI 10.1111/j.1572-0241.2005.41217.xTakahashi T, 2005, WORLD J SURG, V29, P50, DOI 10.1007/s00268-004-7415-3YOO CH, 2004, CANC RES TREAT, V36, P50Pandolfino JE, 2003, AM J GASTROENTEROL, V98, P740, DOI 10.1016/S0002-9270(03)00062-5Hoshikawa T, 2001, ONCOL REP, V8, P1293Booth MI, 2001, BRIT J SURG, V88, P577Lundell LR, 1999, GUT, V45, P172Harrison LE, 1998, SURGERY, V123, P127Kitamura K, 1998, HEPATO-GASTROENTEROL, V45, P281Hsu CP, 1997, AM J GASTROENTEROL, V92, P1347Marshall REK, 1997, GUT, V40, P182Marshall REK, 1997, BRIT J SURG, V84, P21STIPA F, 1997, DIS ESOPHAGUS, V10, P24WANG CY, 1997, CHUNG HUA I HSUEH TS, V59, P348Kitamura K, 1997, SURG TODAY, V27, P993KAUER WK, 1995, AM J SURG, V169, P103KAUER WKH, 1995, AM J SURG, V169, P98JAMIESON JR, 1992, AM J GASTROENTEROL, V87, P1102BUHL K, 1990, EUR J SURG ONCOL, V16, P404STEIN HJ, 1990, ARCH SURG-CHICAGO, V125, P966STEIN HJ, 1990, ARCH SURG-CHICAGO, V125, P970KAIBARA N, 1987, J SURG ONCOL, V36, P110NANO M, 1986, ITAL J SURG SCI, V16, P17PELLEGRINI CA, 1978, AM J SURG, V135, P177

Comparison of two- and three-dimensional camera systems in laparoscopic performance: a novel 3D system with one camera

This study evaluated the effects of a three-dimensional (3D) imaging system on laparoscopy performance compared with the conventional 2D system using a novel one-camera 3D system. In this study, 21 novices and 6 experienced surgeons performed two tasks with 2D and 3D systems in 4 consecutive days. Performance time and error as well as subjective parameters such as depth perception and visual discomforts were assessed in each session. Electromyography was used to evaluate the usage of muscles. The 3D system provided significantly greater depth perception than the 2D system. The errors during the two tasks were significantly lower with 3D system in novice group, but performance time was not different between the 2D and 3D systems. The novices had more dizziness with the 3D system in first 2 days. However, the severity of dizziness was minimal (less than 2 of 10) and overcome with the passage of time. About 54% of the novices and 80% of the experienced surgeons preferred the 3D system. Electromyography (EMG) showed a tendency toward less usage of the right arm and more usage of the left arm with the 3D system. The new 3D imaging system increased the accuracy of laparoscopy performance, with greater depth perception and only minimal dizziness. The authors expect that the 3D laparoscopic system could provide good depth perception and accuracy in surgery.Fishman JM, 2008, SURG ENDOSC, V22, P2396, DOI 10.1007/s00464-008-0032-8Gofrit ON, 2008, UROLOGY, V71, P404, DOI 10.1016/j.urology.2007.07.077Votanopoulos K, 2008, WORLD J SURG, V32, P110, DOI 10.1007/s00268-007-9253-6Vlaovic PD, 2008, JSLS-J SOC LAPAROEND, V12, P1Hagiike M, 2007, SURG ENDOSC, V21, P1849, DOI 10.1007/s00464-007-9541-0Patel HRH, 2007, UROLOGY, V70, P47, DOI 10.1016/j.urology.2007.03.014Byrn JC, 2007, AM J SURG, V193, P519, DOI 10.1016/j.amjsurg.2006.06.042Guru KA, 2007, J AM COLL SURGEONS, V204, P96, DOI 10.1016/j.jamcollsurg.2006.09.016Galleano R, 2006, ANN SURG, V243, P329, DOI 10.1097/01.sla.0000201481.08336.dcBlehm C, 2005, SURV OPHTHALMOL, V50, P253, DOI 10.1016/j.survophthal.2005.02.008Jourdan IC, 2004, BRIT J SURG, V91, P879, DOI 10.1002/bjs.4549Gallagher AG, 2003, SURG ENDOSC, V17, P1468, DOI 10.1007/s00464-002-8569-4Yohannes P, 2002, UROLOGY, V60, P39Berguer R, 2001, SURG ENDOSC-ULTRAS, V15, P1204Tevaearai HT, 2000, ENDOSCOPY, V32, P464Hanna GB, 2000, WORLD J SURG, V24, P444Sun CC, 2000, UROL INT, V64, P154HANNA GB, 2000, WORLD J SURG, V24, P448Berguer R, 1999, ERGONOMICS, V42, P1634Taffinder N, 1999, SURG ENDOSC-ULTRAS, V13, P1087Herron DM, 1999, SURG ENDOSC, V13, P751Mueller MD, 1999, SURG ENDOSC-ULTRAS, V13, P469van Bergen P, 1998, SURG ENDOSC-ULTRAS, V12, P948Hanna GB, 1998, LANCET, V351, P248Chan ACW, 1997, SURG ENDOSC-ULTRAS, V11, P438TENDICK F, 1997, COMPUT AIDED SURG, V2, P24Peitgen K, 1996, GASTROINTEST ENDOSC, V44, P262McDougall EM, 1996, J ENDOUROL, V10, P371Voorhorst FA, 1996, MED PROG TECHNOL, V21, P211BIRKETT DH, 1994, SURG ENDOSC-ULTRAS, V8, P1448PEROTTO AO, 1994, ANATOMICAL GUIDE ELEBECKER H, 1993, ENDOSC SURG ALLIED T, V1, P40

Development of resistance to reinfection by Clonorchis sinensis in rats

We investigated the induction of resistance to Clonorchis sinensis infection by prior infection in rat and hamster models. Animals were challenged with C. sinensis metacercariae, then treated with praziquantel and reinfected. Worm recovery rate in reinfected animals was used to estimate resistance to reinfection. The determined resistance rates to reinfection in rats and hamsters were 97.7% and 10.3%, respectively. In rats, cure from the primary infection of C. sinensis increased resistant to reinfection, and the greatert the worm burden and the longer the duration of primary infection, the higher was the resistance rate. For primary infection doses of 10, 40 and 100 metacercariae per rat, the resistance rates were 87.4%, 93.8% and 98.4%, respectively. The resistance rates in rats after 2 or 8-week primary infection were 78.7% and 95.3%, respectively. All worms recovered from reinfected rats were immature. When cured rats were administered with methylprednisolone, resistance to reinfection became impaired. These findings indicate that rats develop a high degree of resistance to reinfection by C. sinensis after cure. The growths and maturations of reinfected worms were also impaired