Background Preoperative wait time is affected by various factors, and a certain time is needed before surgery. There is a concern that cancer treatment delay can lead to poor survival. The present study aimed to evaluate the impact of preoperative wait time on survival in patients with clinical stage (cStage) II/III gastric cancer. Methods The study included patients with cStage II/III primary gastric cancer undergoing surgery between 2002 and 2012. Preoperative wait time was defined as the time from endoscopy for initial diagnosis to surgery. Patients were divided into the following three groups according to wait time: short wait group (≤ 30 days), intermediate wait group (> 30 and ≤ 60 days), and long wait group (> 60 and ≤ 90 days). Patient characteristics and survival were compared among the groups. Results This study included 467 male (67%) and 229 female (33%) patients, and the median patient age was 67 years. The numbers of cStage II and III patients were 332 (48%) and 364 (52%), respectively. The median wait time was 45 days. The body mass index was lower in the short wait group than in the other groups. A shorter wait time tended to be associated with a more advanced cStage. Although survival was significantly worse in the short wait group than in the long wait group, wait time was not identified as an independent prognostic factor in multivariate analysis. Conclusion Preoperative wait time up to 90 days does not affect survival in patients with cStage II/III gastric cancer.
The case of a neuroendocrine tumor arising from an upside-down stomach due to a large hiatal hernia is rare but occasionally encountered in clinical practice. As we experienced such a case and successfully treated by simultaneous laparoscopic distal gastrectomy and hernia repair with fundoplication, we here report our experience.
A 79-year-old woman was referred to our hospital with suspicion of a stomach submucosal tumor. Detailed examination revealed the submucosal tumor in diameter of 20mm located on the middle third of stomach, and the pathology of biopsy showed the positivity for Chromogranin-A and Synaptophysin. CT scan also demonstrated the large hiatal hernia with prolapsing the almost whole stomach and transverse colon to the left thoracic cavity. We diagnosed that as Rindi classification type III neuroendocrine tumor and complex esophageal hiatal hernia, and we planned laparoscopic distal gastrectomy and hernia repair with fundoplication.
Laparoscopy showed the prolapse of almost whole stomach and colon through the esophageal hilum to left thoracic cavity. We pull them back to abdominal cavity and divided the hernia sac at the level of hilum. After distal gastrectomy, we managed to close the enlarged esophageal hilum without using artificial mesh by suturing the crus of diaphragm. We added the Toupet fundoplication to remnant stomach, and reconstructed the digestive tract by means of Roux-en-Y method. There were no findings of passage obstruction or regurgitation in the peroral contrast examination. The patient was discharged 7 days after surgery with good postoperative course.
Simultaneous laparoscopic gastrectomy and esophageal hiatus hernia repair was successfully performed. Enlarged esophageal hilum could be closed without using the artificial mesh even for the patient with an upside-down stomach, and Toupet fundoplication could be added for a small remnant stomach after distal gastrectomy. Therefore, our procedure was considered to be a safe and feasible minimally invasive surgery for such patients.
468 Background: The American Joint Committee on Cancer (AJCC) has increasingly recognized the need for individual risk prediction model for the era of tailored therapy. This study aimed to develop a postoperative gastric cancer nomogram for prediction of overall survival (OS). Methods: The nomogram was developed using data of 4,990 patients with primary gastric cancer who underwent macroscopically complete resection (residual tumor: R0 or R1) at Shizuoka Cancer Center (Shizuoka, Japan), and it was created with a multivariable Cox proportional hazard regression model. Fifteen pathological or host-related variables (age, sex tumor location, tumor size, macroscopic type, histology, depth (pT), number of positive nodes (pN), number of negative nodes, location of positive nodes, lymphovascular invasion, lavage cytology (CY), tumor margin, serum CEA and serum CA19-9) were collected. They are recommended to collect and register by the AJCC. The model was validated internally using measures of discrimination (Harrell’s C-index), calibration and decision curve analysis. A stage-specific subset survival analysis of the three risk groups (low, intermediate, high) calculated using the nomogram was performed. Results: In the development procedure, multivariable analysis for OS selected 11 variables for constructing the nomogram. The developed nomogram showed good discrimination, with a C-index of 0.812; that of the American Joint Committee on Cancer (AJCC) pathological stage was 0.756. The nomogram performed well in the calibration and decision curve analyses. A stage-specific subset survival analysis of the three risk groups calculated using the nomogram also showed the superiority of nomogram-prediction when compared to AJCC ordinal staging. Conclusions: This new postoperative risk model accurately predicts OS in gastric cancer and can be used for patient counseling in clinical practice and clinical trial eligibility determination.
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