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Query: UMLS:C0024623 (gastric cancer)
 36,219 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

33 cases of cancer of the gastric stump after gastrectomy for peptic ulcer observed between 1963 and 1972 are reviewed. In 26 patients the average interval between operation and carcinoma detection was over 20 years. No cases of carcinoma occurred in less than 10 years. All patients came too late for surgery, since they had attributed their symptoms to the previous operation. The gradual increase in the gastric-cancer risk of operated patients with time suggests a continuous carcinogenic influence. Regurgitation of duodenal contents through the Billroth II anastomosis seems to be the most important cause of postoperative atrophic gastritis, which is now considered by many authors to be a condition predisposing to gastric cancer. Gastric resection patients should be regarded as a high gastric-cancer risk group. The periodic use of modern procedures for early gastric cancer detection in this group of patients is therefore justified.
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PMID:[Gastric stump carcinoma after resection for benign gastric or duodenal ulcer (author's transl)]. 101 10

The Authors report their initial experience with the construction of a J-pouch as restorative surgery following total gastrectomy (TG) for malignant neoplasms. In the last 10 months of the 1990 upon 52 interventions for gastric cancer 31 TG were performed, and in 13 cases a J-pouch on the proximal end of the jejunal segment was constructed. No mortality or specific morbidity was registered using the totally stapled technique. Within one month 3/4 of the patients had normal meals as far as quantity and quality; also the foamy regurgitation seemed to be minimal. The ease of the reconstructive technique and the short term results obtained encourage the use of such approach.
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PMID:[J-pouch after total gastrectomy]. 163 31

From April 1987 to October 1989, 32 patients with mitral stenosis (MS) were treated, of whom percutaneous transvenous mitral commissurotomy (PTMC) was performed in 14. PTMC was indicated by the surgeons in 5 patients including 1) 2 patients who refused reoperation, 2) one with early gastric cancer, 3) one with severe hyperthyroidism and cardiac cachexia, and 4) one with acute renal failure and aortic stenosis. In the other 9 patients, PTMC was indicated by the cardiologists, because it is less invasive. Thirteen patients underwent open mitral commissurotomy (OMC) and 5 patients were treated with mitral valve replacement (MVR). PTMC group: Symptoms were alleviated in 10 of 14. The mitral valve areas (MVA) changed from 1.03 +/- 0.47 cm2 to 1.90 +/- 0.67 cm2 (p < 0.001), and the mean pressure gradient between the left atrium and left ventricle decreased from 10.2 +/- 3.6 mmHg to 4.9 +/- 1.7 mmHg (p < 0.001). No significant mitral valve regurgitation (MR) was induced by PTMC. OMC group: Symptomatic improvement was observed in all patients. The MVA changed from 1.54 +/- 0.46 cm2 to 3.06 +/- 1.34 cm2 (p < 0.001) and the mean left atrial pressures were reduced from 17.6 +/- 7.8 mmHg to 10.5 +/- 4.2 mmHg (p < 0.001). MVR group: There was one hospital death, and the other 4 patients were discharged with satisfactory results. It is concluded that although PTMC has been routinely performed for mild cases, this method is also very helpful in treating patients having various complications which impede open heart surgery.
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PMID:[Percutaneous transvenous mitral commissurotomy in managing rheumatic mitral stenosis]. 184 50

To prevent regurgitation esophagitis in esophagogastrostomy after proximal gastrectomy, valvuloplasty plus fundoplasty was carried out in 17 patients with stomach cancer or cancer of the abdominal esophagus. For this purpose, an equilateral triangular flap of 2.5 cm per side was formed at the upper margin of the remaining stomach along the greater curvature. The flap was inverted into the stomach only to serve as a valve. After the esophagogastrostomy was properly performed, fundoplasty was carried out, lifting and suturing the uppermost edge of the stomach to the esophagus along the greater curvature. To prevent pylorospasm as a result of reduced gastric volume, pyloromyotomy was also performed. The results were excellent in those followed for more than 1 year. The technique is simple and effective and, we believe, deserves further clinical evaluation.
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PMID:Valvuloplasty plus fundoplasty to prevent esophageal regurgitation in esophagogastrostomy after proximal gastrectomy. 375 83

A retrospective study of the value of reconstructive surgery after total gastrectomy of gastric carcinoma in 118 patients who underwent different types of reconstructive procedures is presented. Dissatisfaction with established methods of reconstruction led to the development of a new technique. The new method was associated with less regurgitation, less dumping and functioned as a reservoir without undue delay in emptying time. It was associated with an improved quality of life in the postoperative period, with minimal dumping symptoms, maintenance of weight and the ability to return to work. The mortality and morbidity of the new method are acceptable and it thus offers not only an improved reconstructive procedure for total gastrectomy after resection for gastric cancer, but offers potential for reconstructive surgery after total gastrectomy carried out for other reasons.
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PMID:Total gastrectomy for gastric carcinoma: a retrospective study of different procedures and assessment of a new technique of gastric reconstruction. 727 92

Early postoperative evaluation was prospectively performed in 35 gastric cancer patients after pylorus-preserving gastrectomy (PPG) between 1989 and 1991, comparing the results with those of 29 patients who underwent conventional distal gastrectomy (CDG). Surgical stress, including the duration of operation (149.0 +/- 4.3 minutes) and the total volume of bleeding at operation (97.0 +/- 11.2 g), was significantly less in the PPG patients. Early postoperative complications were seen in 31% after PPG and in 35% after CDG. The most frequent complication in PPG patients was remnant gastric stasis (23%). Endoscopy showed redness or erosion (or both) of the gastric remnant in 17% after PPG and in 81% after CDG. Bile regurgitation was demonstrated in 11% after PPG and in 62% after CDG. In PPG patients, the pyloric ring opened and closed during the examination. Gastric pH was 4.2 +/- 0.4 in PPG patients but was significantly lower in CDG patients. The resting gallbladder area, examined by ultrasonography, demonstrated no changes after PPG but was significantly enlarged after CDG (from 11.3 +/- 1.2 cm2 to 15.8 +/- 1.5 cm2 at 2 weeks). The percentage of the original resting gallbladder area at 20 minutes after injection of cerulein increased slightly in PPG patients but recovered thereafter, whereas in CDG patients it increased significantly (from 39.4 +/- 8.3% to 66.7 +/- 9.1% at 2 weeks). No gallstone formation was detected throughout the observation period after PPG, whereas after CDG it was detected in two patients at 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early postoperative evaluation of pylorus-preserving gastrectomy for gastric cancer. 763 6

Although reflux esophagitis after subtotal gastrectomy has been noticed by surgeons, the mechanism of its development is obscure. This study was undertaken with the aim of clarifying the role of the lower esophageal sphincter in the development of this abnormality. Manometric studies were carried out on 42 patients with gastric cancer, and on 19 with cholelithiasis. The lower esophageal sphincter pressure was measured using a catheter tip pressure transducer and a rapid pull-through technique, and the results presented as the mean of three measurements. The technical error of this experiment was estimated to be within 2 mmHg by a study of the cholecystectomy patients. After gastrectomy, the lower esophageal pressure decreased in 17 patients, increased in 4 and remained unchanged in 21. A more pronounced decrease in the lower esophageal sphincter pressure was found after Billroth II. Clinical evaluation of the 42 patients revealed symptoms of postgastrectomy regurgitation in 10. Preoperatively, these 10 had lower values of the lower esophageal sphincter pressure followed by a more marked postoperative decrease, as compared with the patients with no regurgitation symptoms. Oral administration of a test meal revealed regurgitation after subtotal gastrectomy. This study suggests that a low value of the pre-operative lower esophageal sphincter pressure, a marked decrease in the pressure after gastrectomy, and Billroth II anastomosis, may be factors that predispose to regurgitation.
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PMID:Lower esophageal sphincter pressure after subtotal gastrectomy and postoperative reflux esophagitis. 772 Dec 50

A 66-yr-old man had undergone a total gastrectomy with esophagojejunostomy for gastric cancer 29 yr previously. Soon after the operation, he began to suffer frequent bile regurgitation and subsequent alkaline reflux esophagitis. A small esophageal tumor was found incidentally above the esophagojejunostomy at a follow-up endoscopy, and he subsequently underwent a lower esophagectomy in 1995. The resected specimen revealed evidence of an early adenocarcinoma arising in a short segment of columnar cell-lined esophagus which had not been grossly evident prior to the esophagectomy. The present case indicates that columnar metaplasia with a neoplastic potential can be induced in the esophagus by the chronic reflux of duodenal contents in the absence of gastric acid.
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PMID:Early esophageal adenocarcinoma arising in a short segment of Barrett's mucosa after total gastrectomy. 879 16

To resolve the disadvantages of jejunal Roux-en-Y reconstruction following total gastrectomy, we attempted the use of left colon substitution with all anastomoses conducted using mechanical stapling devices. A His' angle was formed to reduce regurgitation esophagitis. About 25 cm of the left colon with the ascending branch of the left colic artery with an adequate blood supply was brought up to the remnant esophagus without tension on the mesentery. The colon graft was interposed between the esophagus and duodenum in an isoperistaltic fashion. Three anastomoses, esophagocolic, duodenocolic and colocolic, were completed with a circular stapling device. An end-to-side esophagocolonostomy was positioned about 3 cm distal from the blind end of the proximal colon stump. The proximal end of the left colon was pexied to the esophagus using 3-4 stitches to make a new His' angle. Gastrointestinal continuity was restored by a side-to-end colonoduodenostomy and an end-to-end colonocolonostomy. Fifteen gastric cancer patients underwent left colon substitution following total gastrectomy. The circular staple used for esophagocolonostomy and colonoduodenostomy was 25 mm in all patients, and for colonocolonostomy was 29 mm in 9 patients and 33 mm in 6 patients. No problems were encountered in any steps of the procedure, and faulty stapling was avoided. Neither anastomotic leakage nor necrosis of the interposed colon segment was seen, nor was late anastomotic stricture, in any patient. Barium radiograms of the interposed colon segment showed that the capacity and passage of the interposed colon were adequate, and regurgitation did not occur. Diet volume was satisfactory and weight loss minimal.
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PMID:Left colon substitution with His' angle following total gastrectomy. Surgical technique using stapling devices. 994 61

A total of 40 patients (28 males, 12 females; mean age, 56.6 years; range, 41-72 years), 1-1.5 years (mean, 1.4 years) after subtotal gastrectomy for early gastric cancer (Billroth I, D2 lymph node dissection, curability A) were divided into 2 groups according to the occurrence of interdigestive migrating motor complex (IMMC), phase III from the duodenum, and their postoperative quality of life was compared. Results were as follows: (i) patients in the IMMC, phase III positive group (28 patients) had evidently more appetite and ate more food, with less decrease in body weight compared with the IMMC, phase III negative group (12 patients); and (ii) patients in the IMMC, phase III positive group had clearly less symptoms, such as early dumping symptoms (systemic symptoms), symptoms of reflux esophagitis (e.g. heartburn, feeling of regurgitation, difficult swallowing), nausea, abdominal pain, diarrhea, abdominal distention, and borborygmus, compared with the negative group. These results showed more satisfactory quality of life in the IMMC, phase III positive group compared with the negative group.
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PMID:Relationship between gastroduodenal interdigestive migrating motor complex and quality of life in patients with distal subtotal gastrectomy for early gastric cancer. 1107 27


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