Morbidity and mortality of elderly patients with advanced gastric cancer after laparoscopy-assisted or open distal gastrectomy:a randomized–controlled trial

Laparoscopy-assisted distal gastrectomy(LDG)combined with D2 lymphadenectomy may be safely performed in patients with advanced gastric cancer(AGC)by experienced surgeons at specialized high-volume institutions as shown in the Chinese Laparoscopic Gastrointestinal Surgery Study(CLASS)-01.However,studies focusing on the use of LDG in patients with gastric cancer older than 65 years are rare.This study was designed to investigate the morbidity and mortality of elderly patients with gastric cancer who underwent laparoscopic-assisted or open distal gastrectomy(ODG).In this prospective,randomized,open,parallel controlled trial,patients older than 65 years with tumor located at the middle or lower part of the stomach will be enrolled in this study.Patients will be randomly divided into a laparoscopic group and an open surgery group.The early post-operative complications,intra-operative complications and post-operative recovery will be compared between the two groups.This trial will provide valuable clinical evidence for the objective assessment of the feasibility,short-term safety,and potential benefits of LDG compared with ODG for gastric cancer in the elderly patients.This trial has been registered on ClinicalTrials.gov.(Identifier:NCT02246153.)in September 22,2014.

Preoperative malnutrition in elderly gastric cancer patients and adverse postoperative outcomes of radical gastrectomy

Malnutrition is not only a prevalent condition among the elderly but also a common comorbidity in elderly people with gastric cancer(GC).Malnutrition is closely linked to high rates of postoperative complications and poor wound healing in elderly GC patients,which may lead to a higher incidence and mor-tality rate of GC.Malnutrition decreases the physical function of elderly GC patients after surgery,severely affecting their postoperative life quality and hindering subsequent treatments.This retrospective study was conducted by Zhao et al,focusing on the clinical baseline data,postoperative complications,and hospitalization times of elderly GC patients who underwent curative gastrectomy.Additionally,the underlying causes of poor outcomes for patients were discussed.This study may provide a solid basis for the clinical treatment of elderly GC patients in the future.Therefore,malnutrition can serve as a negative prognostic factor for curative surgery in GC patients.Addressing malnutrition and its adverse effects can benefit elderly GC patients from surgical treatment.

Comparison of short-term efficacy between totally laparoscopic gastrectomy and laparoscopic assisted gastrectomy for elderly patients with gastric cancer

BACKGROUND Totally laparoscopic gastrectomy(TLG)entails both gastrectomy and gastrointestinal reconstruction under laparoscopy.Compared with laparoscopic assisted gastrectomy(LAG),TLG has been demonstrated in many studies to require a smaller surgical incision,result in a faster postoperative recovery and less pain and have comparable long-term efficacy,which has been a research hotspot in recent years.Whether TLG is equally safe and feasible for elderly patients remains unclear.AIM To compare the short-term efficacy of and quality of life(QOL)associated with TLG and LAG in elderly gastric cancer(GC)patients.METHODS The clinicopathological data of 462 elderly patients aged≥70 years who underwent LAG or TLG(including distal gastrectomy and total gastrectomy)between January 2017 and January 2022 at the Department of General Surgery,First Medical Center,Chinese PLA General Hospital were retrospectively collected.A total of 232 patients were in the LAG group,and 230 patients were in the TLG group.Basic patient information,clinicopathological characteristics,operation information and QOL data were collected to compare efficacy.Compared with those in the LAG group,intraoperative blood loss in the TLG group was significantly lower(P<0.001),and the time to first flatus and postoperative hospitalization time were significantly shorter(both P<0.001).The overall incidence of postoperative complications in the TLG group was significantly lower than that in the LAG group(P=0.01).Binary logistic regression results indicated that LAG and an operation time>220 min were independent risk factors for postoperative complications in elderly patients with GC(P<0.05).In terms of QOL,no statistically significant differences in various preoperative indicators were found between the LAG group and the LTG group(P>0.05).Compared with the laparoscopic-assisted total gastrectomy group,patients who received totally laparoscopic total gastrectomy had lower nausea and vomiting scores and higher satisfaction with their body image(P<0.05).Patients who underwent laparoscopic-assisted distal gastrectomy were more satisfied with their body image than patients in the totally laparoscopic distal gastrectomy group(P<0.05).CONCLUSION TLG is safe and feasible for elderly patients with GC and has outstanding advantages such as reducing intracorporeal blood loss,promoting postoperative recovery and improving QOL.

Decision-Making Process for the Place of Death of Elderly Patients with Advanced Cancer and Their Families

Purpose: This study aims to understand how elderly patients with advanced cancer and their families make a decision for a place of death for the patient. Methods: Semi-structured interviews were conducted with 17 pairs of elderly patients and members of their family. The patients had finished anticancer treatment and made some decision about the preferred place of death. A modified grounded-theory approach was used for the data analysis. Results: Making a “tentative” decision for the place of death of the elderly patients is a process with the core category [carefully choosing the final place for self-fulfillment]. The patients were “conducting a comprehensive review of the place of death” and “embracing the wishes for a way of life without difficulty”. Involving the family in making a “tentative” decision about the place of death of the elderly patients is the process with the core category [realizing the wish of patients in the terminal condition for the way for death]. The families were “examining the place of death from different aspects” and “respecting the patient’s intention as far as possible”. Conclusions: When the patients [carefully choosing the final place for self-fulfillment], it was important to reconcile their wishes with the burden on the families. When the families were trying to [realize the wish of patients in the terminal condition for the way for dying], it was important to balance the respect for the patient intentions and homecare they can provide for the patient. For the patients and their families, it is essential to mutually understand the intentions and wishes of the other party in decision making about the place of death.

Study on treatment and nursing of elderly patients with gastric cancer complicated with diabetes

Objective To study and analyze the treatment and nursing of elderly patients with gastric cancer complicated with diabetes.Methods:different data were analyzed and summarized.Conclusion:the elderly patients with gastric cancer and diabetes can cooperate with the control of blood glucose during the surgical treatment,and strengthen the nursing before and after the operation.

Clinical Application and Research Progress of Accelerated Rehabilitation Surgery in Perioperative Period of Advanced Gastric Cancer in the Elderly

Enhanced recovery after surgery (ERAS) has been used in various surgical professions in recent years and is widely accepted by doctors. This concept not only helps patients speed up postoperative recovery, reduce the incidence of related complications and shorten hospital stays, but also has been proved to be effective and safe in the perioperative application of gastric cancer. This article reviews the clinical application and research progress of enhanced recovery after surgery in the perioperative period of advanced gastric cancer in the elderly.

Newly emerging standard chemotherapies for gastric cancer and clinical potential in elderly patients

With the increase in average life expectancy,the rate of occurrence of gastric cancer in elderly patients is also rising.While many clinical trials have been conducted to examine the effect of chemotherapy treatment on gastric cancer,age limits for eligible subjects have prevented the establishment of standards for chemotherapy in elderly patients with gastric cancer.As of March 2009,evidence-based standard chemotherapy regimens were established.In the Western world,debates centered on the ECF(Epirubicin/cisplatin/5FU) or DCF(Docetaxel/cisplatin/5-FU) regimens based on the phase □ randomized controlled trial at the Royal Marsden Hospital(RMH) or the V325 study,respectively.The JCOG9912 and SPIRITS trials emerged from Japan indicating attractive regimens that include S-1 for advanced gastric cancer patients.Using these active anticancer drugs,the trials that studied the eff icacy of adjuvant therapies or surgical approaches,such as the Int-116/MAGIC/ACTS-GC trials,have actually succeeded in demonstrating the benefits of adjuvant therapies in gastric cancer patients.For cases of gastric cancer in elderly patients,treatment policies should consider these studies while analyzing not only the therapeutic effects but also drug toxicity,individual general health conditions,and social factors to select treatments that emphasize quality of life.

Clinical observation of docetaxel in treating advanced non-small cell lung cancer in the elderly patients

Objective:The aim of our study was to evaluate the clinical efficacy and side effects of docetaxel as single chemotherapy for elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods: Forty-two elderly patients with advanced NSCLC who were chemotherapy-naive were enrolled in this study. Docetaxel at the doses of 70 mg/m2 was administrated intravenously every 21 days as a cycle, each patient received 2-4 cycles. All patients were followed up until disease progressed or patients died. Results: Among 42 patients, 40 could be evaluated, 1 complete response (CR), 9 partial response (PR), 13 stable disease (SD), 17 progress disease (PD). The overall response rate (CR+PR) was 35% and disease control rate (CR+PR+SD) was 57.5%. The median time to progress (TTP) was 4.2 months, median survival time was 6.1 months and 1-year survival rate was 35.8%. The main toxicity was myelosuppression and decreasing platelet. Conclusion: Single agent docetaxel for elderly patients with advanced NSCLC is an efficient and well-tolerated chemotherapeutic approach with a low toxicity level.

Effect of kanglaite injection and docetaxel in treating advanced stage esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients

Objective:To investigate the effect of Kanglaite injection combined with docetaxel in advanced esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients.Method:A total of 130 patients with advanced esophageal cancer admitted in our hospital from October 2014 to July 2017were selected and divided into two groups according to the time of admission, 65 cases in each group, set as observation group and control group, all patients were treated with conventional radiotherapy (cisplatin combined with 5-fluorouracil), the observation group was given Kanglaite injection combined with docetaxel on the basis of this, while the control group only was given docetaxel treatment, the treatment period was 6 weeks, tumor markers, VEGF and immune function of both group after treatment were compared.Result: After treatment, the levels of carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9) and carcino-embryonic antigen (CEA) in the observation group were lower than those in the control group, the difference was statistically significant;VEGF level in the observation group after treatment was lower than the control group, the difference was statistically significant;After treatment, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were higher than those in the control group, while the levels of CD8+ in the observation group was lower than those in the control group, the difference was statistically significant.Conclusion: Kanglaite injection combined with docetaxel in the treatment of elderly patients with advanced esophageal cancer is better, effectively reducing the level of tumor markers and vascular endothelial growth factor, improve immune function, it isworthy of clinical application.

Adjuvant radiochemotherapy for gastric cancer:should weuse prognostic factors to select patients?

Radiotherapy has a not well-established role in the pre-operative and in the post-operative setting in gastric cancer(GC) patients. Randomized trials report controversial outcomes and impact on survival. In the D2 loco-regional node resection era, after a wellperformed radical surgery, local treatment using radiotherapy combined to chemotherapy should be considered for locally advanced GC. Prognostic factors could help the better selection of subgroups that present high risk of loco-regional recurrence. Then, the addition of radiotherapy could improve the diseasefree survival and also quality of life. There are no large prospective studies that have assessed specific factors predicting for recurrence or survival, but only retrospective series, some of them including high number of patients with homogeneous characteristics. In locally advanced GC adding radiotherapy to the postoperative chemotherapy seems to improve outcomes and quality of life. Prognostic factors such as T-stage, N-status, nodal ratio, and other histological factors should be considered to submit patients to postoperative combined treatment. Larger prospective series are necessary to investigate the role of combined chemoradiation after radical D2-resection, especially in locally advanced GC. Further prospective investigations are needed to suggest prognostic factors that have significant impact on survival and recurrence, improving the management and outcomes, particularly in locally advanced GC patients.

Distal gastric tube resection with vascular preservation for gastric tube cancer:A case report and review of literature

BACKGROUND Survival rates in patients with esophageal cancer undergoing esophagectomy have improved,but the prevalence of gastric tube cancer(GTC)has also increased.Total resection of the gastric tube with lymph node dissection is considered a radical treatment,but GTC surgery is more invasive and involves a higher risk of severe complications or death,particularly in elderly patients.CASE SUMMARY We report an elderly patient with early GTC that had invaded the duodenum who was successfully treated with resection of the distal gastric tube and Roux-en-Y(R-Y)reconstruction.The tumor was a type 0-IIc lesion with ulcer scars surrounding the pyloric ring.Endoscopic submucosal resection was not indicated because the primary lesion was submucosally invasive,was undifferentiated type,surrounded the pyloric ring,and had invaded the duodenum.Resection of distal gastric tube with R-Y reconstruction was safely performed,with preservation of the right gastroepiploic artery(RGEA)and right gastric artery(RGA).CONCLUSION Distal resection of the gastric tube with preservation of the RGEA and RGA is a good treatment option for elderly patients with cT1bN0 GTC in the lower part of the gastric tube.

Laparoscopic gastrectomy for elderly gastric-cancer patients:comparisons with laparoscopic gastrectomy in non-elderly patients and open gastrectomy in the elderly

Background:The benefits of laparoscopic gastrectomy(LG)in elderly gastric-cancer patients still remain unclear.The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patients.Methods:We retrospectively evaluated patients who underwent LG or open gastrectomy(OG)between June 2009 and July 2015 in a single high-volume center.We compared surgical,short-term,and long-termsurvival outcomes among an elderly(-70 years old)LG(ELG)group(n=114),a non-elderly(<70 years old)LG(NLG)group(n=740),and an elderly OG(EOG)group(n=383).Results:Except for extended time to first flatus,the surgical and short-term outcomes of the ELG group were similar to those of the NLG group.The ELG group revealed comparable disease-specific survival(DSS)rates to the NLG group(64.9%vs 66.2%,P=0.476),although the overall survival(OS)rate was lower(57.0%vs 65.5%,P<0.001)in the ELG group than in the NLG group.The ELG group showed longer operation time than the EOG group(236.4677.3 vs 179652.2 min,P<0.001).The ELG group had less estimated blood loss(174.0688.4 vs 209.36133.8,P=0.008)and shorter post-operative hospital stay(8.362.5 vs 9.264.5,P=0.048)than the EOG group.The severity of complications was similar between the ELG and NLG groups.Multivariate analysis confirmed that LG was not a risk factor for post-operative complications.Conclusions:LG is a feasible and safe procedure for elderly patients with acceptable short-and long-term survival outcomes.

Bevacizumab in combination with pemetrexed and platinum for elderly patients with advanced non-squamous non-small-cell lung cancer:a retrospective analysis

Bevacizumab,an anti-VEGF monoclonal antibody,has significantly improved the clinical outcomes of patients with advanced non-squamous NSCLC(ns-NSCLC).However,the safety and efficacy of bevacizumab for elderly patients with advanced NSCLC require further investigation.Thus,59 patients were included in the present retrospective study,22 patients in the bevacizumab plus pemetrexed and platinum(B+PP)group,and 37 patients in the pemetrexed and platinum(PP)group.For the entire cohort of patients,the median OS was 33.3 months,and the 1-year and 2-year overall survival rates were 88.5%and 67.8%,respectively.The median OS and 1-year and 2-year OS rates were 20.5 months,70.3%and 0%,respectively,in the B+PP group and 33.4 months,97.0%and 89.4%,respectively,in the PP group(P<0.001).The incidence of grade≥3 adverse events was higher in the B+PP group than in the PP group(27.3%vs.10.8%,respectively;P=0.204).Univariate and multivariate analyses suggested that the receipt of≥5 cycles of first-line chemotherapy was an independent favorable prognostic factor for OS,whereas the addition of bevacizumab was an unfavorable prognostic factor.With increased toxicities,the addition of bevacizumab to PP does not improve the overall survival of elderly patients with advanced ns-NSCLC.

An Elderly Patient with Advanced Lung Cancer Achieved Long-Term Survival Using Chinese Medicine:An Alternative Treatment Strategy for Cancer Patients Aged 80 or Older without A Tissue Confirmed Diagnosis

Lung cancer is the leading cause of cancerrelated mortality in China.（1＇2） Meanwhile, the average life expectancy in the aging population has increased from 46 years in 1950 to 75 years in 2010.

健脾养胃法对老年胃癌晚期患者肿瘤标志物水平、免疫功能及长期疗效影响研究

目的 探究健脾养胃法对老年胃癌晚期患者肿瘤标志物水平、免疫功能及长期疗效影响。方法 收集我院2019年6月—2022年6月肿瘤科收治的晚期胃癌患者95例,随机分为对照组(47例)与试验组(48例)。对照组予以FOLFOX4方案进行化疗,试验组在对照组的基础上予以健脾养胃法。两组均治疗9周,治疗结束后比较2组中医症状积分、血清肿瘤标志物、免疫功能指标、治疗期间胃肠道反应、远期生存率。结果 治疗后与对照组相比,试验组临床有效率较高(P<0.05)。治疗后与治疗前相比2组脘腹痞闷、胸胁胀痛、食欲缺乏、便溏及神疲乏力等中医症状积分降低;与对照组相比,试验组所有中医症状积分均较低(P<0.05)。治疗后与治疗前相比2组CEA、CA12-5、CA19-9及CA72-4降低;与对照组相比,试验组CEA、CA12-5、CA19-9及CA72-4较低(P<0.05)。治疗后与治疗前相比2组CD_(4)^(+)/CD_(8)^(+)、C_(3)^(+)升高,IgG、IgM降低(P<0.05);与对照组相比,试验组CD_(4)^(+)/CD_(8)^(+)、C_(3)^(+)较高,IgG、IgM较低(P<0.05)。2组6个月及1年生存率相比无统计学意义(P>0.05);试验组3年内生存率高于对照组(P<0.05)。结论 健脾养胃法应用于老年胃癌晚期胃癌患者的治疗中近远期治疗效果显著,能提高免疫功能,下调肿瘤标志物水平,适宜临床应用。

基于行为分阶段改变理论的护理联合营养干预对晚期胃癌患者护理效果的影响

目的探讨基于行为分阶段改变理论的护理联合营养干预对晚期胃癌患者癌痛情况、生活质量及癌因性疲乏的影响。方法选取2020年1月至2023年1月福建省肿瘤医院收治的90例晚期胃癌患者,随机分为对照组(45例)和观察组(45例)。对照组在常规护理下进行干预,观察组接受基于行为分阶段改变理论的护理联合营养干预。比较两组患者的营养水平、癌因性疲乏、生活质量、疼痛程度。结果护理后,观察组血浆总蛋白、白蛋白水平均高于对照组,差异有统计学意义(P<0.05);观察组行为、认知、躯体、情感方面的癌因性疲乏评分均低于对照组,差异有统计学意义(P<0.05);观察组生活质量评分高于对照组,差异有统计学意义(P<0.05);观察组数字评分量表(NRS)评分低于对照组,差异有统计学意义(P<0.05)。结论基于行为分阶段改变理论的护理联合营养干预有助于提高晚期胃癌患者营养水平,降低癌因性疲乏感,减轻疼痛程度,并提高患者生活质量。

不同化疗方案治疗老年晚期胃癌患者的疗效和安全性比较

目的:分析对比不同化疗方案治疗晚期胃癌老年患者的疗效和安全性。方法:将我院2012年2月至2014年2月收治的60例胃癌晚期老年患者作为研究对象,根据化疗方案的不同分为试验组和对照组,试验组患者给予替吉奥联合奥沙利铂(SOX)治疗,对照组患者接受奥利沙伯、亚叶酸钙和氟尿嘧啶(FOLFOX6)治疗。对比分析两组患者2个周期以上化疗后的疗效。结果 :通过化疗,两组的近期有效率和疾病控制率没有显著差别(P>0.05);乏力虚弱、胃肠道反应、手足综合征、口腔黏膜炎等不良反应的发生率也没有显著差异(P>0.05)。结论:试验组的SOX和对照组的FOLFOX6化疗方案在治疗晚期胃癌老年患者时疗效相当,并且不良反应的发生率没有显著差异。

68例高龄中晚期胃癌姑息性三维适形放疗结果分析

目的:总结3年来我科经病理证实的高龄中晚期胃癌患者接受三维适形放疗的长期随访数据,评价姑息性三维适形放射治疗对中晚期胃癌的价值。方法:回顾性分析我科2010年1月-2012年12月三维适形放疗的68例高龄中晚期胃癌患者的病理分期、放疗的靶区和剂量、放疗后病灶控制的情况、复发转移的情况及生存时间。结果:本组患者男44例,女24例,年龄54-83岁(平均64岁)。病理分期为T2-4N1-3M0-1。全部患者采用直线加速器三维适形放疗。放射靶区为胃癌病灶及胃左动脉淋巴结,放疗总剂量45-55Gy,6MV或15MV-X射线,每次2.0-2.5Gy,18-22次,每周5次。放疗后1-3个月86.4%(19/22)患者进食困难明显减轻或正常进食;91.3%(42/46)患者上腹部疼痛明显减轻。胃镜提示39.7%(27/68)患者胃部病灶缩小甚至消失;72.1%(49/68)患者腹部CT提示胃部病灶及胃左淋巴结缩小。放疗后CR 16.2%(11/68),PR61.7%(42/68)。本组患者生存期为3-18个月,中位生存期为13.5个月。放疗后4.4%(3/68)患者有轻-中度胃痛。结论:对中晚期胃癌三维适形放疗具有与手术类似的控癌作用,又能避免手术引起的创伤等不良反应,尤其是对已有周围脏器浸润的高龄、体质差的中晚期患者姑息性三维适形放射治疗可起到局部肿瘤控制、镇痛、改善生存质量、延长生存期的作用。但姑息性三维适形放疗的靶区确定、治疗剂量的选择以及综合治疗方面尚需进一步研究。

单药替吉奥胶囊治疗老年晚期胃癌的临床观察

目的:观察单药替吉奥胶囊治疗晚期胃癌的临床疗效及毒副反应。方法:选择50例经病理证实的老年晚期胃癌患者,随机分为治疗组32例及对照组18例。治疗组根据体表面积给予替吉奥胶囊治疗,对照组给予营养等最佳支持治疗。每2周期后行影像学检查评价疗效、记录不良反应及随访情况。结果:治疗组32例患者CR(完全缓解)0例,PR(部分缓解)10例,SD(病情稳定)12例,PD(病情进展)10例,临床总缓解率31.3%,临床获益率68.8%。治疗组中位无疾病进展时间及中位生存期分别为5.7及11.5个月,对照组分别为3.1及7.6个月。毒副反应主要为I-III度骨髓抑制、消化道反应、肝功能损伤及手足综合症。结论:单药替吉奥胶囊治疗老年晚期胃癌效果肯定,生活质量高、毒副作用小。

氟尿嘧啶化疗方案联合苦参注射液对晚期胃癌患者血清MMP-2、肿瘤标志物水平及S100A4水平影响研究

目的:探究氟尿嘧啶化疗方案联合苦参注射液对晚期胃癌患者血清MMP-2、肿瘤标志物水平及S100A4水平影响研究。方法:收集入住肿瘤科确诊为晚期胃癌的患者52例,采用随机数字分配法,随机分配为治疗组与对照组,对照组实施氟尿嘧啶联合多西紫杉醇化疗方案;治疗组在对照组的基础上采用复方苦参注射液,治疗后对患者MMP-2、肿瘤标志物水平、S100A4水平以及临床疗效进行对比。结果:治疗后两组血清MMP-2表达水平明显下降,差异有统计学意义(P<0.05);肿瘤标志物TNF-α、CEA、CA724以及CA199水平均呈下降趋势,差异有统计学意义(P<0.05);两组S100A4水平明显降低,差异有统计学意义(P<0.05);两组临床疗效明显升高,差异有统计学意义(P<0.05);治疗组与对照组相比,血清MMP-2表达水平较小,差异有统计学意义(P<0.05);TNF-α、CEA、CA724以及CA199水平呈降低趋势,差异有统计学意义(P<0.05);S100A4水平较小,差异有统计学意义(P<0.05);临床疗效较高,差异有统计学意义(P<0.05)。结论:氟尿嘧啶化疗方案联合苦参注射液治疗恶性肿瘤临床疗效佳,预后良好,适宜临床推广使用。