Pub Date : 2019-03-20DOI: 10.5772/INTECHOPEN.80630
Satoshi Kanda, T. Fukunaga
Laparoscopy-assisted distal gastrectomy (LADG) has advanced much in the past 10 years in the eastern countries, due to the high gastric cancer incidences. Reconstruction is the major hurdle for perfect laparoscopic distal gastrectomy (LDG). Initially, hand-associ- ated or small incisional open laparotomy reconstruction, the so-called associated operation, was performed. A full laparoscopic operation is much better for the patient—small wound, less pain, and quick recovery. Several reconstruction methods have been developed by experts during more than 10 years. The question of what method is the best after distal gastrectomy is still controversial. This chapter focuses on the reconstruction methods in the total laparoscopy distal gastrectomy (LDG) operation, explains the merits and demerits of several methods, and introduces our original method, named augmented rectangle technique (ART).
{"title":"Reconstruction after Laparoscopic Distal Gastrectomy","authors":"Satoshi Kanda, T. Fukunaga","doi":"10.5772/INTECHOPEN.80630","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.80630","url":null,"abstract":"Laparoscopy-assisted distal gastrectomy (LADG) has advanced much in the past 10 years in the eastern countries, due to the high gastric cancer incidences. Reconstruction is the major hurdle for perfect laparoscopic distal gastrectomy (LDG). Initially, hand-associ- ated or small incisional open laparotomy reconstruction, the so-called associated operation, was performed. A full laparoscopic operation is much better for the patient—small wound, less pain, and quick recovery. Several reconstruction methods have been developed by experts during more than 10 years. The question of what method is the best after distal gastrectomy is still controversial. This chapter focuses on the reconstruction methods in the total laparoscopy distal gastrectomy (LDG) operation, explains the merits and demerits of several methods, and introduces our original method, named augmented rectangle technique (ART).","PeriodicalId":236926,"journal":{"name":"Gastric Cancer - An Update","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125507315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-20DOI: 10.5772/intechopen.77297
Tamer Saafan
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. The stomach is considered the most common site of GIST, and the most common histopathological type of GISTs is spindle cell. Mutational analysis may help in defining the management of GIST. Multiple stratification modules are available for the estimation of GISTs’ prognosis. Surgery is considered the only curative option for GISTs. The discovery of KIT protein has allowed better identification of GISTs and has allowed creation of selective tyrosine kinase inhibitors which dramatically affected GIST management. Results of trials on neoadjuvant imatinib therapy are promising. Adjuvant imatinib therapy is recommended for 3 years and has proven to improve outcome in high-risk GISTs. New therapeutic agents are now available in case of imatinib resistance. Follow-up of patients with GISTs depends on the type of GIST. This trial compared 36 versus 12 months therapy of adjuvant imatinib (400 mg daily) in 400 patients with a high-risk-resected GIST with a median follow-up of 54 months. A high-risk GIST was defined as a tumor size of >10 cm, a mitotic count of >10/50 high-power fields (HPF), a tumor size of >5 cm with a mitotic rate of >5/HPF, or a tumor rupture. About 50% of the patients had gastric GIST in this study. The study reported prolonged 5-year RFS and OS rates for patients assigned for 36 months imatinib adjuvant therapy compared with patients assigned for the 12-month group, 65.6 versus 47.9% and 92% versus 81.7%, respectively. The results of this trial resulted in NCCN guidelines recommend ing adjuvant imatinib for at least 3 years for patients with intermediate or high risk of GIST recurrence [90 In a latter follow-up report for the trial with a median follow-up of 90 months, patients assigned to a 3-year group a persistent favorable outcome greater RFS versus 52% and overall (92 versus 85%) 91].
{"title":"Gastric GIST","authors":"Tamer Saafan","doi":"10.5772/intechopen.77297","DOIUrl":"https://doi.org/10.5772/intechopen.77297","url":null,"abstract":"Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. The stomach is considered the most common site of GIST, and the most common histopathological type of GISTs is spindle cell. Mutational analysis may help in defining the management of GIST. Multiple stratification modules are available for the estimation of GISTs’ prognosis. Surgery is considered the only curative option for GISTs. The discovery of KIT protein has allowed better identification of GISTs and has allowed creation of selective tyrosine kinase inhibitors which dramatically affected GIST management. Results of trials on neoadjuvant imatinib therapy are promising. Adjuvant imatinib therapy is recommended for 3 years and has proven to improve outcome in high-risk GISTs. New therapeutic agents are now available in case of imatinib resistance. Follow-up of patients with GISTs depends on the type of GIST. This trial compared 36 versus 12 months therapy of adjuvant imatinib (400 mg daily) in 400 patients with a high-risk-resected GIST with a median follow-up of 54 months. A high-risk GIST was defined as a tumor size of >10 cm, a mitotic count of >10/50 high-power fields (HPF), a tumor size of >5 cm with a mitotic rate of >5/HPF, or a tumor rupture. About 50% of the patients had gastric GIST in this study. The study reported prolonged 5-year RFS and OS rates for patients assigned for 36 months imatinib adjuvant therapy compared with patients assigned for the 12-month group, 65.6 versus 47.9% and 92% versus 81.7%, respectively. The results of this trial resulted in NCCN guidelines recommend ing adjuvant imatinib for at least 3 years for patients with intermediate or high risk of GIST recurrence [90 In a latter follow-up report for the trial with a median follow-up of 90 months, patients assigned to a 3-year group a persistent favorable outcome greater RFS versus 52% and overall (92 versus 85%) 91].","PeriodicalId":236926,"journal":{"name":"Gastric Cancer - An Update","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121911757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.75591
N. Ignjatovic, T. Randjelović, M. Stojanović, G. Stanojevic, M. Djordjevic
Till this day, there are more than 60 described surgical procedures of the intestinal reconstructions after a total gastrectomy. In 1897, Schlatter reconstructed the digestive tract by creating a termino-lateral esophagojejunostomies that was the first successful total gastrectomy. Many of the total gastrectomy pioneers did the reconstruction by esophagoduodenostomy or by forming a loop esophagojejunostomy. The main reconstruction modalities after a total gastrectomy are a restitution of the intestinal continuity, without a preservation of the duodenal food passage (esophagojejunostomy with a Roux-en-Y configuration) and a restitution of the intestinal continuity with a preservation of the duodenal passage (esophagojejunostomy with Roux-en-Y configuration and forming of the lateral-terminal jejunoduodenal anastomosis double tract and jejunal interposition by Longmire). The surgeries in these categories can be combined with forming of an enteral pouch or a stomach reservoir which would simulate a reservoir of a normal intact stomach. The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. Preservation of duodenal transit with replacement of the jejunal segment, the so-called physiological route, is now believed to be preferential for postoperative nutritional condition, prevents persistent postgastrectomy syndrome, and improves the quality of life. Reconstructive procedures which allow duodenal passage should be regarded as a key to physiological reconstruction.
{"title":"Reconstructive Procedures after Total Gastrectomy for Gastric Cancer","authors":"N. Ignjatovic, T. Randjelović, M. Stojanović, G. Stanojevic, M. Djordjevic","doi":"10.5772/INTECHOPEN.75591","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.75591","url":null,"abstract":"Till this day, there are more than 60 described surgical procedures of the intestinal reconstructions after a total gastrectomy. In 1897, Schlatter reconstructed the digestive tract by creating a termino-lateral esophagojejunostomies that was the first successful total gastrectomy. Many of the total gastrectomy pioneers did the reconstruction by esophagoduodenostomy or by forming a loop esophagojejunostomy. The main reconstruction modalities after a total gastrectomy are a restitution of the intestinal continuity, without a preservation of the duodenal food passage (esophagojejunostomy with a Roux-en-Y configuration) and a restitution of the intestinal continuity with a preservation of the duodenal passage (esophagojejunostomy with Roux-en-Y configuration and forming of the lateral-terminal jejunoduodenal anastomosis double tract and jejunal interposition by Longmire). The surgeries in these categories can be combined with forming of an enteral pouch or a stomach reservoir which would simulate a reservoir of a normal intact stomach. The ideal reconstruction procedure after total gastrectomy should replace all lost functions of the stomach. Preservation of duodenal transit with replacement of the jejunal segment, the so-called physiological route, is now believed to be preferential for postoperative nutritional condition, prevents persistent postgastrectomy syndrome, and improves the quality of life. Reconstructive procedures which allow duodenal passage should be regarded as a key to physiological reconstruction.","PeriodicalId":236926,"journal":{"name":"Gastric Cancer - An Update","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115266094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.79824
B. Suh
Adjuvant chemotherapy is a standard treatment for operable gastric cancer. However, the preferred treatment varies by geographical region. Southwestern Oncology Group (SWOG) conducted a, randomized trial of adjuvant chemotherapy for patients with surgi- cally resected gastric cancer. The 3-year survival rates were 50% in the chemoradiothera-pygroup and 41% in the surgery group. The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial that compared perioperative chemotherapy with the ECF regimen (epirubicin, cisplatin, and 5-fluorouracil) and patients with surgery alone had a 5-year survival rate of 36 and 23%. The Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer (ACTS-GC) showed that the 3-year overall survival rate was 80.1% in the S-1 group and 70.1% in the surgery-only group in stage II or III gastric cancer patients who underwent a D2 gastrectomy. An analysis of the Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer (CLASSIC) study showed 3-year disease-free survival, 74% in the chemotherapy and surgery group and 59% in the surgery-only group in the patients with stage II–IIIB gastric cancer who had D2 gastrectomy. In conclusion, for all patients with stage II and III gastric cancer, standard D2 gastrectomy and adjuvant chemotherapy are strongly recommended for improved
{"title":"Adjuvant Chemotherapy of Gastric Cancer","authors":"B. Suh","doi":"10.5772/INTECHOPEN.79824","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.79824","url":null,"abstract":"Adjuvant chemotherapy is a standard treatment for operable gastric cancer. However, the preferred treatment varies by geographical region. Southwestern Oncology Group (SWOG) conducted a, randomized trial of adjuvant chemotherapy for patients with surgi- cally resected gastric cancer. The 3-year survival rates were 50% in the chemoradiothera-pygroup and 41% in the surgery group. The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial that compared perioperative chemotherapy with the ECF regimen (epirubicin, cisplatin, and 5-fluorouracil) and patients with surgery alone had a 5-year survival rate of 36 and 23%. The Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer (ACTS-GC) showed that the 3-year overall survival rate was 80.1% in the S-1 group and 70.1% in the surgery-only group in stage II or III gastric cancer patients who underwent a D2 gastrectomy. An analysis of the Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer (CLASSIC) study showed 3-year disease-free survival, 74% in the chemotherapy and surgery group and 59% in the surgery-only group in the patients with stage II–IIIB gastric cancer who had D2 gastrectomy. In conclusion, for all patients with stage II and III gastric cancer, standard D2 gastrectomy and adjuvant chemotherapy are strongly recommended for improved","PeriodicalId":236926,"journal":{"name":"Gastric Cancer - An Update","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128065460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-11-05DOI: 10.5772/INTECHOPEN.76983
Shunsuke Sakuraba
Laparoscopic endoscopic cooperative surgery (LECS) is now performed worldwide as a result of the invention of new operative techniques. It is seromuscular resection by laparoscopy for gastric submucosal tumors such as gastrointestinal stromal tumors (GISTs). Endoscopic dissection of the mucosal to the submucosal layer determines the appropriate incision line, resects the tumor, and closes the visceral wall defect. Various minimally invasive LECS techniques are now well established. LECS-associated techniques, adaptation of them, and challenges for the future are reviewed in this chapter.
{"title":"Laparoscopic Endoscopic Cooperative Surgery: Current Status and Perspective","authors":"Shunsuke Sakuraba","doi":"10.5772/INTECHOPEN.76983","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.76983","url":null,"abstract":"Laparoscopic endoscopic cooperative surgery (LECS) is now performed worldwide as a result of the invention of new operative techniques. It is seromuscular resection by laparoscopy for gastric submucosal tumors such as gastrointestinal stromal tumors (GISTs). Endoscopic dissection of the mucosal to the submucosal layer determines the appropriate incision line, resects the tumor, and closes the visceral wall defect. Various minimally invasive LECS techniques are now well established. LECS-associated techniques, adaptation of them, and challenges for the future are reviewed in this chapter.","PeriodicalId":236926,"journal":{"name":"Gastric Cancer - An Update","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134039253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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