AIM: To investigate possible predictors for failed self-expandable metallic stent (SEMS) therapy in consecutive patients with benign esophageal perforation-rupture (EPR).
Objective： Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990＇s reported inc...Objective： Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990＇s reported increased morbidity and mortality for D2 compared to D 1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods： A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into DO, D I, or D I ＋/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results： In total, 349 （31.7%） patients had a DO, 494 （44.9%） DI, and 258 （23.4%） DI＋/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2 % （DO, D I and D1 ＋/D2, respectively）, and 90-d mortality rates were 8.3%, 4.3 % and 5.8%. After adjustment for confounders, in mukivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. DO. Conclusions： The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy （DO and DI）. More extensive lymphadenectomy （DI＋/D2） seemed to have no impact on postoperative morbidity or mortality.展开更多
Gastric cancer is one of the major causes of cancer-related deaths,despite the gradual decrease of its incidence in the West.Minimally invasive procedures,such as endoscopic resection and laparoscopic gastrectomy,have...Gastric cancer is one of the major causes of cancer-related deaths,despite the gradual decrease of its incidence in the West.Minimally invasive procedures,such as endoscopic resection and laparoscopic gastrectomy,have been successfully introduced in European high-volume centres,in the treatment of early gastric cancer.Regarding advanced,localized gastric cancer a number of prospective trials have been completed in search of better therapeutic options,aiming to optimize the efficacy vs.adverse effect ratio.From the results of these prospective randomized trials,the therapeutic strategy has in the last decades shifted emphasis from adjuvant therapy to neoadjuvant or perioperative chemotherapy,in curatively intended treatment.Moreover,recent studies have shown promising results in the use of molecular targeted agents,both in perioperative and palliative settings.The introduction of molecularly targeted therapy will enable a personalized approach based on each patient’s and tumor’s characteristics,maximizing the benefits from chemotherapy.The present review article focuses on recent therapeutic trends,as well as future perspectives,of surgical and oncological gastric cancer treatment in the Western setting,mainly based on landmark clinical trials.展开更多
文摘AIM: To investigate possible predictors for failed self-expandable metallic stent (SEMS) therapy in consecutive patients with benign esophageal perforation-rupture (EPR).
基金funded by unrestricted research grants from the County Council of V?sterbotten(VLL-481721)the Stockholm County Council(ALF Project 20140126)
文摘Objective： Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990＇s reported increased morbidity and mortality for D2 compared to D 1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods： A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into DO, D I, or D I ＋/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results： In total, 349 （31.7%） patients had a DO, 494 （44.9%） DI, and 258 （23.4%） DI＋/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2 % （DO, D I and D1 ＋/D2, respectively）, and 90-d mortality rates were 8.3%, 4.3 % and 5.8%. After adjustment for confounders, in mukivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. DO. Conclusions： The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy （DO and DI）. More extensive lymphadenectomy （DI＋/D2） seemed to have no impact on postoperative morbidity or mortality.
文摘Gastric cancer is one of the major causes of cancer-related deaths,despite the gradual decrease of its incidence in the West.Minimally invasive procedures,such as endoscopic resection and laparoscopic gastrectomy,have been successfully introduced in European high-volume centres,in the treatment of early gastric cancer.Regarding advanced,localized gastric cancer a number of prospective trials have been completed in search of better therapeutic options,aiming to optimize the efficacy vs.adverse effect ratio.From the results of these prospective randomized trials,the therapeutic strategy has in the last decades shifted emphasis from adjuvant therapy to neoadjuvant or perioperative chemotherapy,in curatively intended treatment.Moreover,recent studies have shown promising results in the use of molecular targeted agents,both in perioperative and palliative settings.The introduction of molecularly targeted therapy will enable a personalized approach based on each patient’s and tumor’s characteristics,maximizing the benefits from chemotherapy.The present review article focuses on recent therapeutic trends,as well as future perspectives,of surgical and oncological gastric cancer treatment in the Western setting,mainly based on landmark clinical trials.
