Survival Benefits of Laparoscopic Gastrectomy in Elderly Patients With Gastric Cancer: Focusing on Preoperative Nutritional and Inflammatory Status

BACKGROUND/AIM

Laparoscopic gastrectomy (LG) may have greater clinical benefits as a less invasive surgery for elderly patients with gastric cancer (GC). Therefore, we aimed to evaluate the survival benefit of LG in elderly patients with GC, especially focusing on preoperative comorbidities, and nutritional and inflammatory status.

PATIENTS AND METHODS

Data collected from 115 patients aged ≥75 years with primary GC who underwent curative gastrectomy, comprising 58 patients who underwent open gastrectomy (OG) and 57 patients who underwent LG, were retrospectively reviewed (total cohort), and 72 propensity-matched patients (matched cohort) were selected for survival analysis. The aim of the study was to determine short- and long-term outcomes, and the clinical markers to identify a population who may benefit from LG in elderly patients.

RESULTS

The complication and mortality rates as a short-term outcome in the total cohort and overall survival (OS) as a long-term outcome in the matched cohort did not differ significantly between the groups. In the total cohort, advanced tumor stage and ≥3 comorbidities were independent factors for poor prognosis in terms of OS [hazard ratio (HR)=3.73, 95% confidence interval (CI)=1.78-7.78, p<0.001 and HR=2.50, 95% CI=1.35-4.61, p<0.01, respectively]. The surgical approach was not an independent risk factor for postoperative complications (grade ≥III) and OS. In subgroup analysis of the total cohort, patients with a neutrophil-lymphocyte ratio (NLR) ≥3 in the LG group demonstrated a trend toward greater OS (HR=0.26, 95% CI=0.10-0.64, interaction p<0.05).

CONCLUSION

LG might offer greater survival benefits than OG in frail patients such as those with high NLR.

Solitary fibrous tumor of the lung: a case report

Solitary fibrous tumors (SFTs) are relatively rare neoplasms that commonly occur in the pleura. The pathological feature of SFTs is a proliferation of spindle-shaped cells in interlacing or storiform fascicles. SFTs appear to derived from pluripotential submesothelial cells, but not the covering mesothelium. SFTs distinctively show diffuse staining for CD34 but lack staining for smooth muscle markers. We herein report a relatively rare case of a 68-year-old male patient without symptoms, who underwent resection for what was considered to be SFT.

Peritoneal tuberculosis with gastric cancer: a case report

This is a report of a case with both peritoneal tuberculosis and gastric cancer. Physicians should have a high index of suspicion of peritoneal tuberculosis if the patient is febrile with a past history of tuberculosis.

Rectal expander-assisted transanal endoscopic microsurgery in rectal tumors

Rectal expander-assisted transanal endoscopic microsurgery (RE-TEM) was performed for two cases of early rectal cancer and a case of villous tumor under saddle block anesthesia. RE-TEM is the new technique for local excision of rectal tumors with a rectal expander that we developed. The rectal expander expands the rectum after insertion through the anus and provides adequate vision for microsurgery with standard video monitors. Tumors were located 8, 8, and 5 cm from the anal verge, and all of them were excised completely with no difficulty. Minor bleeding was noted in all cases and was controlled by electric coagulation and/or sutures. Average operative time for the three cases was 105 min. We conclude that RE-TEM is useful for rectal tumors and/or early rectal cancer that cannot be removed by endoscopy.

[Japan Surgical Society recertification: the viewpoint of surgeons in a local area]

The system of recertification is evaluated from the view point of the surgeons in a local area. The system only requires attendance at the national meeting of the Japan Surgical Society and/or meetings that are designated by the Japan Surgical Society for recertification. Half of such meetings have been held in the Kanto area over the past 10 years, resulting in an imbalance in the status of recertification between surgeons in the Kanto area and in local areas. In questionnaires about surgical recertification in local areas, many respondents pointed out this imbalance and the necessity for changing the conditions of recertification. The aim of recertification must be clarified and a new system of recertification investigated based upon the purpose of certification without imbalances between areas.

Chemolipiodolization and prostaglandin E1 administration with use of hepatic arterial infusion port for the treatment of hepatocellular carcinoma and liver cirrhosis

Frequent chemolipiodolization and prostaglandin E1 (PGE1) administered through a hepatic arterial infusion port were used for treatment in 2 cases of hepatocellular carcinoma (HCC) with liver cirrhosis. Chemolipiodolization was performed every 4 weeks with 6 ml lipiodol, 3 ml Optilay and 30 mg Epirubicin or 10 mg Mytomycin C. PGE1 (10 ug) was administrated to the hepatic artery once every week after the first 7 days administration. The treatment resulted in a decrease of the AFP level, an arrest of HCC growth and a reduction in ascites with an improvement of clinical and biochemical parameters in both cases. These encouraging preliminary results show that frequent lipiodolization is effective for unresectable HCC and frequent PGE1 administration via the hepatic artery is a safe and efficient treatment for liver cirrhosis.

Endoscopic findings and clinical manifestation of gastric anisakiasis

OBJECTIVES

To identify the endoscopic findings and clinical manifestations of anisakiasis, we studied 87 cases of gastric anisakiasis.

METHODS

Patient information was analyzed by means of patient records. The interval between the day of intake of Anisakis and endoscopic examination was determined in 86 cases. Then the endoscopic findings of each interval were elucidated.

RESULTS

Moderate to severe gastric mucosal edema tends to occur within 1 or 2 days after Anisakis infection, accompanied by leukocytosis. As to the sites of penetration of Anisakis, 55% of cases were found in the greater curvature with severe mucosal edema. Among 87 cases, four patients experienced anisakiasis twice during the interval examined, and six patients had past histories of anisakiasis before the investigated interval.

CONCLUSIONS

Gastric anisakiasis may be caused by an allergic reaction to the Anisakis antigen. There is a classic relationship between clinical and endoscopic findings and the interval after Anisakis administration. Anisakis usually is found in the greater curvature.

Percutaneous transhepatic portacaval shunt for high-risk esophageal varices

Percutaneous transhepatic portacaval shunt (PTPS) was performed in a patient with high-risk esophageal varices prior to sclerotherapy. PTPS was accomplished with the aid of two catheters. The first catheter was placed in the right hepatic vein under ultrasonographic guidance, and the second was placed in the portal vein. The two catheters were then connected together. The color of the esophageal varices changed from blue to white, and serum protein levels were increased 8 weeks after PTPS. Sclerotherapy was then performed without any difficulty. PTPS is the easy and quick method of performing a portacaval shunt and may have importance for the management of patients with high-risk esophageal varices prior to the treatment of sclerotherapy or liver transplantation.

A small pedunculated adenomatous polyp of the colon found to contain the focus of invasive carcinoma extending to the serosa: report of a case

A small pedunculated polyp was detected among other polyps in the transverse colon of a 64-year-old man, the resected specimen of which showed an adenomatous polyp 1 cm in diameter, containing the foci of adenocarcinoma invading the submucosa, muscularis, and serosa. This case report stresses the importance of performing careful pathologic examination of resected specimens obtained from endoscopic polypectomy, even for small pedunculated colon polyps.