Gastric carcinoma

Usefulness of conventional and low-dose hydro-CT in the diagnosis of gastric tumors in comparison to endoscopy

PURPOSE

The aim of this retrospective study was to evaluate the usefulness of hydro-CT in the diagnosis of gastric tumors in comparison to endoscopy.

MATERIAL AND METHODS

The study involved 40 patients with a diagnosis of gastric tumor established by histopathology who underwent endoscopy and conventional or low-dose hydro-CT. Hydro-CT images were retrospectively analyzed based on the consensus of two radiologists who were blinded to the endoscopy findings. The diagnostic accuracy of hydro-CT and endoscopy for the diagnosis of gastric tumors was evaluated using the results of the histopathological examination as the reference standard.

RESULTS

Histopathology confirmed the presence of gastric cancer in 28 patients (70%), while gastrointestinal stromal tumors (GISTs) were recognized in the remaining 12 cases (30%). Correct diagnoses of the type of gastric tumor in hydro-CT were obtained in 37 patients (92.5%). This was not significantly different from the 85% accuracy of endoscopy. Further analysis showed that the correctness of GIST diagnosis in endoscopy and hydro-CT also did not differ significantly (91.7% and 100% respectively). The percentage of correctly diagnosed malignant lesions in hydro-CT was lower than for GISTs at 89.29%, while in endoscopy it was insignificantly lower (82.14%). The diagnostic accuracy of conventional and low-dose hydro-CT in the diagnosis of gastric tumors (95% and 90% respectively) was not significantly different.

CONCLUSIONS

Conventional and low-dose hydro-CT may be a valuable non-invasive diagnostic method in the diagnosis of gastric tumors for patients who have contraindications to endoscopy or who are unable to undergo gastric biopsy.

A new technique for esophagojejunostomy after total gastrectomy for gastric cancer

BACKGROUND

The critical part of any operation involving a proximal gastric resection is the esophageal anastomosis. Leakage from this anastomosis is one of the main reasons for postoperative morbidity and death after gastrectomy. Application of the double-stapling technique affords many of the same advantages that it does for low rectal tumors, especially in obese patients with narrow costal margins.

METHODS

A new technique for esophagojejunostomy after total gastrectomy for gastric cancer is described.

RESULTS

This technique has been used in 3 patients. At a follow-up of 22 months, there have been no anastomotic leaks or evidence of clinical stenoses.

CONCLUSIONS

This technique minimizes manipulation and dissection around the distal esophagus. Not only does this make the operation easier, but it also allows for a longer proximal resection margin. Possibly this will result in lower rates of esophageal breakdown.

A review of carcinoma of the stomach at a tertiary care referral hospital

BACKGROUND

Carcinoma of the stomach continues to cause a significant mortality in the United States. We reviewed the characteristics, treatment modalities, and survival of a group of patients with this cancer at a tertiary care referral hospital.

MATERIALS AND METHODS

A retrospective computer based review of all patients with a diagnosis of carcinoma of the stomach in the Ohio State University (OSU) tumor registry was made. One hundred ninety-two analytical cases were found and the data was entered into a computerized database and analyzed.

RESULTS

The overall median survival in this series of patients is 10 months with a median survival of 16 months (n.s.) in patients who underwent curative surgery (50% of the patients). There was an increased number of cardia lesion (37%) predominately in male patients (P < 0.05). A significantly greater number of female patients presented with linitis plastica and male patients with adenocarcinoma, although there was no difference in the operability, types of operations, and survival between the genders. Patients with signet ring cell cancer were significantly younger than the other two histological types reviewed but this did not alter outcome.

CONCLUSION

Carcinoma of the stomach, despite newer image modalities, continues to present at advanced stages at time of diagnosis with an overall dismal prognosis. The increased incidence of cardia lesions noted require innovative therapies if any progress is to be made.