Therapy For Early Gastric Cancer Research Articles

Early gastric cancer: diagnosis, surgical treatment and follow-up of 45 cases.

The 5-year survival rate of early gastric cancer (EGC) is 85%-100% after "curative" resection, as compared to 20%-30% in advanced gastric cancer (AGC). Because of this relatively high cure rate, the interest in the diagnosis and therapy of EGC has been steadily increasing. The present study, based on 45 EGCs, is aimed at a critical evaluation of the diagnostic procedures and surgical options. Forty-five patients with early gastric cancer (27 men and 18 women; median age, 62 years; range, 28-84) were diagnosed and operated on. They represented 22.5% of all patients with gastric cancer (200) treated in the period July 1987 to January 1998. Forty-one patients were from the northeastern part of Italy. The most frequent symptom was epigastric pain (84%). Barium upper gastrointestinal radiography findings were strongly suggestive of malignancy in 41 cases (91%). Preoperative histopathological diagnosis of adenocarcinoma was performed in 43 cases (95.5%). In two cases (4.5%) severe epithelial dysplasia (associated with ulcer) was the first diagnosis, but the final diagnosis on the basis of the resected specimens was a well differentiated adenocarcinoma. The primary surgical procedure included i) subtotal distal resection (37 cases) with Billroth 11 (33) and Billroth I (4) reconstructions; ii) total gastrectomy (3) for proximal neoplastic extension; iii) proximal gastric resection (2) for cardial cancer; iv) degastro-total gastrectomy (3) for cancer of the stump. Two patients, previously treated with conservative surgery, underwent degastro-total gastrectomy for neoplastic microfocal extension to the margin of resection and for early anastomotic recurrence, respectively. Mural infiltration was limited to the mucosa and submucosa in 27 and 18 cases, respectively. Lymph node metastases were found in three mucosal and five submucosal tumor cases, involving either the first or the second echelon. No operative deaths or postsurgical complications occurred in this series. In the follow-up period (median, 36 months; range, 3-120) four patients died due to other causes; one developed liver metastases, another developed oropharyngeal cancer and two died of biopsy-proven lung cancer without evidence of gastric cancer recurrence. The clinical presentation of EGC is aspecific. Preoperative endoscopy with biopsy remains the most sensitive diagnostic procedure. For treatment, subtotal distal gastric resection with lymphadenectomy is the "gold standard" but in some instances total gastrectomy may be indicated. Accurate pathological examination establishes the depth of infiltration, as well as the superficial extension of tumors and the lymph node status. Although the prognosis of EGC is favorable, a medium-term follow-up should be planned.

Early stomach carcinoma--pathologic-anatomic findings and prognosis

The therapy for early gastric cancer (endoscopy, gastric resection, D1/2 dissection) is controversial. In a retrospective study (4/86-12/95) we analyzed the prognosis of 57 early gastric cancer patients with respect to pathological findings and surgical therapy. The R0 resection rate was 100%. In 7% multifocal tumor growth was seen. The 5-year survival rate was 70%. LN-metastases were found in 12% of all cases, more often in pT1b than in pT1 a tumors (17 vs 9%) and more often in large carcinomas than in small carcinomas (> 1000 mm2: 27%; < 300 mm2: 0%). Long-term survival was significantly better in pN0 patients than in patients with LN metastasis (P = 0.020). Prognosis of early gastric cancer after curative resection is good.

Cooperative Clinical Trial of Photodynamic Therapy for Early Gastric Cancer With Photofrin Injection® and YAG-OPO Laser

Background and Objective: Photodynamic therapy (PDT) treats malignant tumors using photosensitizers and light. We employed a new pulse laser as the excitation light source for PDT, i.e. an optical parametric oscillator (OPO) system pumped by a Q-switched Nd:YAG laser, because it provides extremely high peak power. Study Design/Materials and Methods: The effects of PDT using the photosensitizer Photofrin® and the new laser were evaluated in 12 patients with early gastric cancer. Results: Complete responses (CR) were obtained in 75% of 12 assessable patients, CR was observed in all cases with mucosal carcinoma (response rate 100%). Regarding toxicity, mild photosensitivity was seen in one case and it lasted several weeks. The other major side effect was decrease of total protein, which was observed in six patients (40%), lasting several months. There were no serious abnormalities in symptoms or laboratory tests. Conclusion: We conclude that the YAG-OPO laser is suitable as an excitation light source for PDT.

Long term clinical results of the endoscopic microwave coagulation therapy for early gastric cancer

About 17 years passed since we started clinical application of the endoscopic microwave coagulation therapy (EMCT) in 1981.In this report, we give an outline of recent equipments and techniques of the endoscopic microwave coagulation therapy (EMCT) for early gastric cancer and investigate its position in terms of long term clinical results in our hospital.

Progress of therapy for early gastric cancer

胃癌に対する外科治療の基本は癌巣を完全に除去することである. これまで, 治療成績向上のために, 早期進行を問わず, いかなる病期の胃癌に対しても広範な切除と徹底的なリンパ節郭清が標準手術として行われてきた. その結果, 胃癌の術後治療成績はいちじるしく向上した. 一方, 近年の胃癌に対する診断学の進歩はいちじるしく, 微小癌や早期癌が多く発見されるようになり, 年々増加傾向を示している. これら早期胃癌に対する臨床病理学的, かつ統計学的研究から, その生物学的特性が明らかとなった. その結果, 切除範囲やリンパ節郭清について再検討がなされ, さらに機能温存やQOLの点からも, これまで行われてきた画一的な外科的治療法の見直しがなされるようになった. そこで, 早期胃癌に対する外科的治療としては合理的手術, すなわち, 転移のないリンパ節に対して無意味な郭清は行わない縮小手術・機能温存を目的とした幽門保存胃切除術について述べる. また, 内視鏡的治療としては内視鏡的粘膜切除術・腹腔鏡下胃局所切除術, およびレーザー治療について述べたい.

早期胃癌に対するパルス波レーザーを用いた光線力学療法(PDT)の検討

早期胃癌に対するパルス波レーザーを用いた光線力学療法(PDT)の検討

ICG enhanced Diode-Laser Therapyにおける固有筋層保護効果に関する基礎的検討

For selective treatment of early gastric cancer,we developed the ICG enhanced Diode-Laser Therapy. This new therapeutic modality is safer, because submucosally injected ICG will be able to protect the muscle layer from injury due to laser beam. The purpose of this animal study was to evaluate penatration time of laser beam and to find sutable concentrarion of ICG solution in this method.We injected 2ml of ICG solution (0.125, 0.25, 0.5, 1.0, 2.0mg/ml) into submucosal layer and removed it from mucosa and muscle layer_The laser beam with 3mm in diameter was irradiated continuously on the surface of the submucosal layer with the power of 15W. We measured temperature under the submucosal layer and laser power penetrated through it.With the concentration of more than 0.5mg/ml of ICG solution,penetration time was about 30 seconds and almost all the layer was ablated when laser beam was penetrated. Below 0.5mg/ml, penetration time was shorter and the submucosal layer was ablated incompletely.In the diode laser ablation therapy for early gastric cancer, submucosal injection of ICG solution with the concentration of more than 0.5mg/ml is recommended, to treat mucosal and submucosal lesions selectively without any injury of muscule layer.

Utility of Endosonography and Evaluation of Prognosis

We analyzed 30 endoscopically treated patients with early gastric cancer in terms of the utility of endoscopic ultrasonography (EUS) and the evaluation of prognosis. Endoscopic therapy for early gastric cancer included strip biopsy, laser irradiation, and OK-432 injection. Examination of the depth of cancer invasion in the strip biopsy specimens showed that the diagnostic accuracy of EUS was 85.7%. Complete resection rate in strip biopsy was 82.8%, and the patients with incompletely resected cancer were successfully treated with laser irradiation and/or OK432 injection. The prognosis of the patients treated with strip biopsy was good. Three patients died of causes other than gastric cancer. Local recurrence and a heterochronous new lesion developed in six patients, but all of these cases were successfully treated with additional strip biopsy. All but one patient treated with laser irradiation and/or OK 432 injection survived during the study period. These results suggest that EUS is useful in determining the indication of endoscopic therapies and that prognosis is good in patients with early gastric cancer treated endoscopically.

早期胃癌の光化学治療, 広汎な sm 癌病巣への適応拡大

早期胃癌の光化学治療, 広汎な sm 癌病巣への適応拡大

Endoscopic Diagnosis and Treatment of Early Gastric Cancer

Endoscopic diagnosis and treatment for early carcinoma of the stomach is discussed. Endoscopic ultrasonography (EUS) for diagnosing the depth of cancer invasion is investigated. Accuracy rate was 79% for 268 lesions. Mucosal cancer diagnosed by EUS was correctly determined in 91%. Endoscopic treatment by YAG laser irradiation and mucosal resection were evaluated by pretreatment and posttreatment EUS examination. With the incorporation of EUS for staging and the use of mucosal resection and YAG laser techniques, initial results of endoscopic curative therapy for early gastric cancer appear promising.

Endoscopic Therapy of Early Gastric Cancer —Comparison of Endoscopic Mucosal Coagulation and Resection—

Abstract: The clinical efficacy of various methods of endoscopic treatment was evaluated in 70 patients with early gastric cancer. The treatments included using an Nd‐ YAG laser on 22 patients (2 IIa cases, 3 IIa + IIc cases and 17 IIc cases), a heater probe on 2 patients (IIc) and endoscopic mucosal resection (EMR) on 46 patients (13 I cases, 15 IIa cases, 2 IIa + IIc cases and 16 IIc cases). Laser irradiation and the heater probe method (endscopic mucosal coagulation; EMC), which cause coagulation and necrosis to lesions using heat energy, were found to be successful for well differentiated adenocarcinoma confined to the mucosa even if the size of the lesions was 20 mm and over. Poorly differentiated adenocarcinoma with lesions 20 mm or smaller reoccurred, and only well differentiated adenocarcinoma with infiltration limited to the mucosa seemed to be treatable endoscopically by EMR. Whether or not total resection was possible was determined with respect to the size and site of lesions in patients treated by EMR. Great therapeutic efficacy was achieved when the lesions were 10 mm or smaller and located in the anterior wall or the greater curvature. Piecemeal resection had to be made in a majority of cases when the lesions measured 10 mm or more or were located in the lesser curvature or the posterior wall. Therefore, endoscopic EMR is recommended if the size of the lesions is 10 mm or less, while EMC must also be considered if the lesions are larger or piecemeal resection is required.

早期胃癌に対するレーザー治療の経過観察例についての検討

In Kurume University Hospital, follow-up study more than 1 year in the endoscopic Laser therapy for early gastric cancer (34 leseions, 26 cases) was analysed on the size and endoscopic features of lesions.Disappearance rate of cancer cells seemed higher in the protruded type and/or small lesions than the depressed and/or large ones after initial Laser irradiation. Cancer cells was detected in none of protruded lesions less than 10mm in diameter.These findings suggested that the endoscopic Laser therapy would be a curative therapy in these cases. Moreover, additional Laser irradiation was effective in the case of recidual cancer cells.

Development of and clinical experience with a new TV monitoring system in electronic endoscopy. Bi-plane TV monitoring system.

We developed a bi-plane TV monitoring system using a TV endoscope (Electronic endoscope manufactured by Toshiba-Machida, Tokyo, Japan) that permits simultaneous display of real-time and prerecorded images. Various findings of the two examinations can be precisely compared using this system, and a detailed evaluation of the progress of peptic ulcers obtained. In addition, the effects of various endoscopic therapies can be accurately evaluated. In endoscopic injection sclerotherapy of esophageal varices, new varices (or recurrent varices) were differentiated. In laser therapy for early gastric cancer, precise delimitation of the lesion for radiation was possible, and the therapeutic effects were more accurately evaluated. These results show the diagnostic as well as therapeutic usefulness of this system. Furthermore, for the examination of the lower digestive tract, X-ray images were incorporated into this system. This is a useful modality for diagnostic and therapeutic procedures in colonic disease.

Endoscopic microwave coagulation therapy for early gastric cancer: A study on local cure

Endoscopic microwave coagulation therapy for early gastric cancer: A study on local cure

Chronic Myelogenous Leukemia Following the Therapy of Early Gastric Cancer

Chronic Myelogenous Leukemia Following the Therapy of Early Gastric Cancer

The Indication of Endoscopic Therapy for Early Gastric Cancer

The Indication of Endoscopic Therapy for Early Gastric Cancer

Therapy of early gastric cancer by endoscopic or surgical polypectomy.

Therapy of early gastric cancer by endoscopic or surgical polypectomy.

Clinical aspects and therapy of early gastric cancer.

AbstractIn the last 10 years, 130 patients with early gastric carcinoma were operated on at the Surgical University Clinic of Erlangen. The ulcerous type was the most frequent (85%) and had the best prognosis with a 5‐year survival rate of 87% excluding operative mortality, and 100% when agecorrected.