Extended surgery—Left upper abdominal exenteration plus Appleby's method—For type 4 gastric carcinoma

Furukawa, Hiroshi; Hiratsuka, Masahiro; Iwanaga, Takeshi; Imaoka, Shingi; Ishikawa, Osamu; Kabuto, Toshiyuki; Sasaki, Yo; Kameyama, Masao; Ohigashi, Hajime; Nakamori, Shoji; Yasuda, Takushi

doi:10.1007/bf02306612

Cited by 31 publications

(20 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A retrospective analysis of this particular population failed to reveal a survival benefi t of bursectomy [17]. In addition to the standard bursectomy procedure, a more thorough resection of all components of the retroperitoneum could be accomplished by extensive surgery such as left upper abdominal evisceration, with or without Appleby's procedure [18,19]. However, even these procedures have been reported not to reduce the incidence of peritoneal metastasis.…”

Section: Discussionmentioning

confidence: 99%

Distribution of free cancer cells in the abdominal cavity suggests limitations of bursectomy as an essential component of radical surgery for gastric carcinoma

et al. 2007

View full text Add to dashboard Cite

Background. Bursectomy, which has been performed so as to resect peritoneal deposits disseminated within the omental bursa, is considered as an essential component of radical surgery for gastric carcinoma in Japan. Bursectomy has also been described in the Japanese Treatment Guidelines for Gastric Carcinoma as a mandatory procedure for the treatment of serosa-positive cancer. However, no evidence to support the prognostic signifi cance of this procedure has been reported to date. Methods. Cytologic examination and real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis of the peritoneal washes obtained from the Douglas pouch, left subphrenic cavity, and inside the omental bursa were performed for 136 patients who underwent potentially curative surgery for gastric carcinoma. Results. Carcinoembryonic antigen (CEA) or cytokeratin (CK) 20 mRNA was detected in one or more samples from the three different sites of peritoneal washes in 43 of the 136 patients. In 14 patients, the mRNAs were detected in samples obtained from the bursa omentalis (10.3% of all patients and 32.6% of patients with positive RT-PCR results). In 12 of these 14 patients, the mRNAs were also detected in samples taken from either or both of the remaining two sites. Only in the 2 other patients was the sample only from inside the omental bursa positive for CEA. Conclusion. It is unlikely that viable cancer cells disseminated into the bursa remain restricted to this cavity without migrating into the free abdominal cavity. Routine bursectomy may not be an essential procedure for resecting gastric cancer, from the viewpoint of eliminating microscopic peritoneal deposits within the omental bursa.

show abstract

Section: Discussionmentioning

confidence: 99%

Distribution of free cancer cells in the abdominal cavity suggests limitations of bursectomy as an essential component of radical surgery for gastric carcinoma

et al. 2007

View full text Add to dashboard Cite

show abstract

“…At our institution, survival was significantly longer in the P1 group than in the P2 or P3 group (P ϭ 0.0057). In stage IV gastric cancer, studies have shown the effects of total visceral resection in the left upper abdomen, proposed by Oyama et al [15] and some studies suggested improvement in prognosis brought about by total visceral resection in the left upper abdomen ϩ Appleby operation, proposed by Furukawa et al [16]. We have used a technique in which P1 lesions are resected en bloc together with the epiploic foramens, such as by combined resection of the spleen and pancreatic tail.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors in stage IV gastric cancer: univariate and multivariate analyses

2000

View full text Add to dashboard Cite

“…In advanced cases, adrenal metastasis from gastric cancer is not rare. On the other hand, Furukawa et al [6] reported that, in 3 (5.5%) of 54 surgically resected cases with Borrmann 4 gastric cancer, the left adrenal gland was involved. Such involvement is considered to occur in the manner of direct invasion or by lymphangitic routes.…”

Section: Offprint Requests To: T Kosakamentioning

confidence: 98%

A long surviving case of resected gastric cancer presenting with a synchronous adrenal metastasis

et al. 1999

View full text Add to dashboard Cite

Case reportThe patient, a 75-year-old man, consulted us because of epigastric discomfort in February 1993. Upper GI series and gastroscopy revealed a Borrmann 3 gastric tumor in the proximal stomach. Laboratory data showed slight anemia, 10.5 g/dl of hemoglobin, and elevation of tumor markers (174 ng/ml of CA 19-9 and 298 ng/ml of Sialyl Tn). Computed tomography (CT) indicated a giant gastric tumor that invaded the pancreatic tail; the left adrenal gland seemed normal (Fig. 1). He was subjected to a total gastrectomy and a distal pancreatosplenectomy. Although the left adrenal gland was within normal limits in size, it was intraoperatively palpated as a hard mass. Therefore it was also removed during an abdominal paraaortic lymph node dissection.The postoperative course was uneventful. Histopathological examinations revealed that the gastric tumor, which measured 8.7 ϫ 8.5 cm, was predominantly a poorly differentiated adenocarcinoma with scirrhous invasion with a partial component of tubular adenocarcinoma that invaded the pancreas and involved nine lymph nodes [perigastric: #1, #2, #3, #4s, and #4d; along splenic artery: #11(n2)]. The histopathological findings of the left adrenal tumor revealed that there were adenocarcinoma cells nested within the normal adrenal gland and that this was compatible with those of gastric cancer (Fig. 2). At present, 6 years after the operation, the patient is still alive with no evidence of recurrence of cancer. DiscussionAdrenal metastases occur most commonly in patients with kidney, lung, and colon carcinomas. Recently, there have been three articles on adrenalectomy for metastatic carcinomas. Lo et al.[1] performed adrenalectomy in 52 patients with metastatic adrenal carciAbstract: Clinically curable adrenal metastases are rare. We treated a patient with gastric cancer and a synchronous adrenal metastasis who underwent curative resection. Upper GI examinations of a 75-year-old man revealed a Borrmann 3 gastric tumor in the proximal stomach. CT indicated a giant gastric tumor that invaded the pancreatic tail, and the left adrenal gland seemed normal. He was subjected to a total gastrectomy and a distal pancreatosplenectomy. Because a mass was palpated intraoperatively in the left adrenal gland, it was also removed. The gastric tumor was histopathologically a poorly differentiated adenocarcinoma with scirrhous invasion that invaded the pancreas, and the histopathological findings of the left adrenal tumor were compatible with those of gastric cancer. At present, 6 years after the operation, there has been no clear sign of cancer recurrence. It may be rational to excise the left adrenal gland en bloc in patients with serosa-positive Borrmann 3-4 gastric cancer.

show abstract

Extended surgery—Left upper abdominal exenteration plus Appleby's method—For type 4 gastric carcinoma

Abstract: LUAE + Apl improved the survival of patients with scirrhous cancer in stage III, but it was not effective for those in stage IV. To improve the survival of patients in stage IV, a new concept of treatment and supportive therapy needs to be used.

Cited by 31 publications

References 9 publications

Distribution of free cancer cells in the abdominal cavity suggests limitations of bursectomy as an essential component of radical surgery for gastric carcinoma

Distribution of free cancer cells in the abdominal cavity suggests limitations of bursectomy as an essential component of radical surgery for gastric carcinoma

Prognostic factors in stage IV gastric cancer: univariate and multivariate analyses

A long surviving case of resected gastric cancer presenting with a synchronous adrenal metastasis

Contact Info

Product

Resources

About