Antral Carcinoma Research Articles

Adenocarcinoma of the gastric antrum: does D2 total gastrectomy with splenectomy improve prognosis compared to D1 subtotal gastrectomy? A long-term survival analysis with emphasis on Lauren classification

The purpose of this retrospective study was to evaluate whether a more radical resection, including total gastrectomy (TG), D2 lymphadenectomy and splenectomy, or subtotal gastrectomy (SG), improves the prognosis of patients with an adenocarcinoma located on the distal third of the stomach. Seventy-four consecutive patients with an antral carcinoma underwent gastric resection. Forty-three had a TG and 31 an SG. D2 lymph node dissection was carried out in 70% of all patients (30/43) and 100% (21/21) of patients with curative resection in the TG group, whereas in the SG group the patients had only a standard D1 lymph node dissection. Splenectomy was carried out in 84% (36/43) of patients in the TG group, whereas in the SG group the spleen was preserved in all patients. Follow-up was complete for 100% of the patients, with a median follow-up time of 74 months. MAIN END-POINTS OF INTEREST: Overall survival rates, mortality and morbidity rates. The postoperative 30-day mortality rate was 7% in the TG group and 3.2% in the SG group. The overall morbidity rate was increased from 19% after SG to 37% after TG. There was no microscopic evidence of involvement of proximal resection margins in any of 31 subtotal resected gastric specimens. Lymph node metastases to the splenic hilus (no. 10 nodes) or along the splenic artery (no. 11 nodes) were not found in any of 36 patients who underwent splenectomy and lymphadenectomy. The 5- or 10-year survival rates did not differ significantly between both groups. Analysis of survival showed no significant difference between the TG and SG groups when related to subgroups of patients with curative resection (UICC-RO resection), nodal status (pN), tumour depth (pT-category), tumour stage (pTNM), or Lauren classification (intestinal or diffuse type of carcinoma). The survival rates for patients with curative resection after 5 or 10 years were 58% in the TG group and 66% or 51% in SG group, respectively (P = 0.66). Since D2 total gastrectomy carried an increased overall morbidity risk and did not improve survival in patients with intestinal or diffuse type carcinoma, it seems that with regard to luminal gastric resection, SG is the treatment of choice for carcinomas located in the distal third of the stomach. Whether extensive radical D2 lymphadenectomy should be routinely performed in addition to SG is still controversial.The spleen should be preserved in most cases.

Ultrasound evaluation of gastric antral carcinoma

Ultrasound evaluation of gastric antral carcinoma

Neurilemmoma of the mental nerve

from inflammation, allergy, or malignancy. Many of the signs and symptoms mimic an invasive carcinoma of the sinus and this must be stressed in making the proper diagnosis.’ It may be possible to make this distinction with CT, as mucoceles do not enhance after administration of contrast material, whereas tumors do.9 The more common mucoceles are secondary, and result from past surgical intervention (especially Caldwell-Luc procedures) or trauma. They are referred to as postoperative mucoceles or surgical ciliated cysts of the maxilla.8 These are quite common in Japan, where they often treat sinus disease aggressively with surgery.“’ A mucocele contains sterile mucus and a mucopyocele is simply an infected mucocele.’ The treatment of these lesions is enucleation and curettage to prevent further expansion and destruction due to increased intraluminal pressure.2 The differential diagnosis of bilateral lesions of the maxilla includes basal cell nevus syndrome (multiple odontogenic keratocysts), the brown tumor of hyperparathyroidism, multiple myeloma, cherubism, fibrous dysplasia, central giant cell granuloma, anuerysmal bone cyst, hemangioma, antral carcinoma or other malignancy, cholesteatoma, mucus retention cyst, and odontogenic infection. Only histologic evaluation coupled with clinical behavior assures the proper diagnosis.

Combined Median Mandibulotomy and Weber-Fergusson Maxillectomy

Monoblock surgical resection in combination with radiotherapy remains the most effective method of treatment for advanced carcinoma of the maxillary sinus. Extension of antral carcinoma into the infratemporal and pterygopalatine fossae decreases the probability of achieving an all-encompassing resection via the classic anterolateral Weber-Fergusson approach because of limited posterior access. Temporal and lateral infratemporal fossa approaches have been described and involve either mobilization of the zygomatic arch or a lateral mandibular osteotomy, respectively. We report the use of a median labiomandibulotomy combined with the Weber-Fergusson approach for lesions extending posteriorly. The labiomandibulotomy with paralingual extension along the floor of the mouth allows rotation of the coronoid process laterally and exposes the infratemporal fossa to its posterior margin. We present two cases in which this approach was used to extirpate lesions that had extended posteriorly. Relevant anatomy, operative technique, potential complications, and limitations, as well as a comparison with other methods of exposure, are discussed.

Results of gastric resection for carcinoma of the stomach: the European experience.

AbstractA European state of the art in the treatment of gastric cancer is presented from the results of a questionnaire. Data were obtained from 62 centers, 60% of which were from abroad and 40% of which were from Germany, reporting a total of 16,594 patients. A feature was a low portion (8.8%) of early cancer. The operation preferred was total gastrectomy. Only in the case of antral carcinoma of the intestinal type, according to Laurén, would the majority perform subtotal gastrectomy. Staging of lymph nodes was performed by 84% of these centers; however, systematic radical dissection was carried out only by 27%. The preferred type of reconstruction after total gastrectomy was Roux‐en‐Y esophagojejunostomy; 16% of the European centers used some type of pouch in addition. Splenectomy was carried out depending on location of the tumor.The median in‐hospital mortality for early cancer was 0; for carcinoma of the antrum, 6.7%; corpus, 9.6%; and gastroesophageal junction, 11.7%. The median 5‐year survival rate in patients with early cancer was 82.5%; for advanced cancer of the antrum, 30.7%; corpus, 24%; and gastroesophageal junction, 15.5%. Ten‐year survival was 6–10% less.It is concluded that in Europe there is a high rate of advanced gastric cancer affecting the results. Improved results may be expected if gastric cancer can be detected earlier and if there is radical lymph node dissection. Generally, prospective randomized studies presented by standardized documentation and statistics are urgently needed.

Ulcerated ectopic gastric mucosa of the rectum

curvature of the antrum.• The clinical presentation is commonly with epigastric pain and overt or occult gastrointestinal bleeding. Symptoms of gastric outlet obstruction may be a feature during the development of the fistula. Symptoms may abate with the formation of the fistulous double pylorus.• Treatment has primarily been conservative medical management with H2-blockers and antacids. Surgery has only been reported in a few patients. The long-term results of either therapeutic approach have not been recorded. Malignant antroduodenal fistula with formation of a double pylorus appears to be extremely rare. Only one instance of double pylorus associated with carcinoma has been reported,t and in this case the double pylorus was not due to a fistula but resulted from the partitioning of the lumen of the pylorus by a large neoplastic fold. In the present case the endoscopic appearances suggest that a malignant antroduodenal bulb fistula had indeed developed. It is perhaps surprising that carcinoma of the distal antrum is not more frequently complicated by a duodenal fistula since one study reports that, overall, 18% of antral carcinomas extend into the duodenum1o and, if the lesion is less than 1 cm from the pylorus, extension into the duodenum may occur in up to 35 to 40%. It is a curiosity that malignant gastrointestinal fistulas are quite uncommon. l1

Adenocarcinoma of the stomach. Changing patterns over the last 4 decades.

A retrospective study was performed on 255 consecutive patients admitted to a single hospital from 1953-1983 with a follow-up of 100%. The number of proximal esophagogastric junction and fundus tumors increased significantly over the last 4 decades from 21% to 44% (p less than 0.001), accompanied by a significant decrease in antral carcinomas from 60% to 33% (p less than 0.01). Patients with proximal neoplasms were significantly more likely to be white (71% vs. 29%, p less than 0.001), whereas patients with antral cancer were significantly more likely to be black (64% vs. 36%, p less than 0.001). There were no significant differences in nodal status, presence of distant metastases, or the overall 5-year survival rate between these two sites. The 5-year survival rate for the entire group was 6%. Sixty-five patients (30%) underwent curative resection, and the 5-year survival rate in this group was 24%, which was significantly better than palliative procedures. The 5-year survival rate was strongly influenced by TNM stage, local invasiveness, nodal status, and presence or absence of distal metastases (p less than 0.001). Although the overall survival rate has not changed over the past 30 years, there were definite epidemiologic differences between proximal and antral lesions, which suggest that new treatment protocols should be designed to include the location of the neoplasm.

Reconstruction after radical hemimaxillectomy using a free multidimensional latissimus dorsi myocutaneous flap

A series of safe, simple and single-staged reconstructions following radical resection of maxillary antral carcinomas with soft tissue involvement is presented. These reconstructions were performed using free triple-folded latissimus dorsi myocutaneous flaps revascularised via the facial vessels. This technique can be safely used in irradiated patients and, when indicated, allows for the administration of early postoperative radiotherapy, thus improving the potential cure rate. Advantages and disadvantages of the technique are discussed.

Metastatic Lymph Nodes in the Head and Neck

The survival rate of matched pairs of patients, one patient in each pair being submitted to prophylactic neck dissection, the other to a policy of "wait and see" has been measured: there was no significant difference in the survival rates of the two groups. Surgery for most patients with a gland in the neck gives better results than radiotherapy, and can produce satisfactory results with such procedures as supraglottic laryngectomy to epiglottic tumours and replacement with the deltopectoral flap for tonsillar tumours. On the other hand, surgery is probably contraindicated for patients with antral carcinoma and a gland in the neck, whom it rarely cures. Surgery does not increase the survival of patients with bilateral glands in the neck (except those with supraglottic tumours) and its contraindicated. Surgery can prolong the survival of patients with nodes fixed to the skin, the mandible or the external carotid artery, and may occassionally cure such patients.

Granular Cell Tumors (“Myohlastomas”) of the Esophagus

A 48-year-old man suffering from antral carcinoma is submitted to endoscopy, whereby, beside of the antral carcinoma, unexpectedly and fortuitously two small granular cell tumors are found in the distal and proximal esophagus. Cases of esophageal granular cell myoblastomas published up to this date are reviewed and histological peculiarities of these otherwise histologically welldifined tumors are discussed.

The Significance and Management of Metastatic Lymph Nodes in the Neck

It is suggested that the last major improvement in the surgical treatment of head and neck cancer was Crile's description of radical neck dissection in 1906, and that modifications of this procedure, including extended surgery, have made little or no difference to survival rates. It is hoped that some means may soon be found of identifying those patients with head and neck cancer who do badly--the majority. As a start, it is proposed that patients with an antral carcinoma and a gland in the neck, and patients with hypopharyngeal carcinoma and bilateral neck glands should not be treated by surgery. A retrospective analysis is made of matched pairs drawn from a personal series, one patient in each pair having had a prophylactic neck dissection, and one having been submitted to a policy of 'wait and see'. The survival rate for patients undergoing prophylactic neck dissection was worse than that of the wait and see group; this difference was statistically significant.

Maxillary Antral Cancers

Cancer in the paranasal sinuses and nasal cavities in a relatively rare tumor disease, with an annual incidence of about one case per 100,000 inhabitants in Europe and the United States.1The majority of these tumors start in the mucous membrane of the maxillary antrum or the ethmoid labyrinth. A few cases originate from the nasal cavities, while primary cancers in the sphenoid and frontal sinuses are extremely rare. The age-specific incidence of the disease continuously increases with age; it is predominately a disease of the middle aged and aging. The only known etiologic factor of some importance in antral carcinoma is chronic sinusitis. Long-standing sinusitis causes a squamous cell metaplasia of the respiratory epithelium, which probably is the origin of most antral cancers. Some patients have a long history with signs of chronic sinusitis, prior to the signs of progressive tumor. Squamous cell carcinoma is the most frequent

Carcinoma of the maxillary antrum and its relationship to trace metal content of snuff.

Social habits and customs are related to different disease patterns. Snuff inserted in the nares has been shown to be associated with the incidence of antral carcinoma in the Bantu. Carcinoma of the maxillary antrum constitutes 45.5% of all the respiratory tract cancers in the Bantu. A pilot study was conducted to examine the trace metal content in samples of Swazi snuff by atomic absorption spectrometry. The metals analyzed were zinc, chromium, copper, lead, nickel, and cadmium. Samples of soot from Swazi huts were also analyzed for the same metals. The Swazi snuff showed high concentrations of nickel, chromium, and zinc. Since nickel and chromium in some forms are known carcinogens, the association between carcinoma of the maxillary antrum and snuff may be prevented if the source of trace metal contamination is eliminated.

Topographical distribution of sinonasal malignancy

Objective: In this study forty patients of sinonasal malignancy were studied to observe the topographical distribution of the disease. Methods: This cross sectional study was done in the Otolaryngology-Head & Neck Surgery Department of Bangabandhu Sheikh Mujib Medical University during the period of January 2007 to December 2008. The diagnosis was made by detailed history, clinical examination, investigation. Analyzed data presented by various tables, graphs and figures. Results: In this study majority of the patients were within 51-60 years of age. Male to female ratio was 3:1 and came from rural area (62.5%). Most of them were farmers (37.5%), illiterate (35%), poor socioeconomic condition (55%) and habits were smoker (37.5%). Most of the patients presented with multiple symptoms and multiple sinuses involvement (70%) and among single sinus involvement maxillary (58.34%) followed by nasal cavity (33.33%), ethmoidal sinuses (8.33%), primary frontal and sphenoid tumours were not found. About T stage of tumour T3 (42.5%), T4 (37.5%), T2 (15%) and T1 (5%). 08 cases were nodal involvement (20%), submandibular node metastasis were most common (62.5%), squamous cell carcinoma (55%), followed by adenocystic carcinoma (10%). Adenocarcinoma (7.5%), mucoepidermal carcinoma (5%), non Hodgkin’s lymphoma (5%), transitional cell carcinoma (5%), small cell carcinoma (5%), chondosarcoma (2.5%) and malignant fibrous histocytoma (2.5%). Radiological finding with bone destruction (12.5%), without bone destruction (87.5%), intracranial involvement (45%) and orbital extension (17.5%). Conclusion: From the review of the series it is obvious that sinonasal malignancy usually presented at advanced stage with multiple sinus involvement. In case of single sinus involvement maxillary antral carcinoma is significantly common than other sinuses. Key words: Topographical Distribution; Sinonasal Malignancy. DOI: 10.3329/bjo.v17i1.7619 Bangladesh J Otorhinolaryngol 2011; 17(1): 21-28

A Critical Evaluation of Radical Subtotal Gastric Resection as a Definite Procedure for Antral Gastric Carcinoma*

A Critical Evaluation of Radical Subtotal Gastric Resection as a Definite Procedure for Antral Gastric Carcinoma*