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Background and Objectives Gastroduodenal stents for gastric outlet obstruction due to unresectable advanced gastric cancer are increasingly used; however, their effects have not been fully evaluated. Methods A multicenter prospective observational study was performed. Patients were eligible if they had stage IV gastric cancer with a gastric outlet obstruction scoring system (GOOSS) score of 0 (no oral intake) or 1 (liquids only). Self-expandable metallic stents were delivered endoscopically. The effects of stents were evaluated. Results Twenty patients were enrolled and 18 were eligible (15 men, three women; median age, 70 years). Stent placement was successfully performed in all patients, with no complications. After stenting, a GOOSS score of 2 (soft solids only) or 3 (low-residue or full diet) was achieved in 13 (72%) patients. An improvement in the GOOSS score by one or more points was obtained in 16 (94%) patients. The median duration of fasting and hospital stay was 3 (range, 0–9) days and 18 (6–168) days, respectively. Chemotherapy was performed after stenting in 13 (72%) patients. Conclusions Gastroduodenal stents are thought to be feasible, safe, and effective for gastric outlet obstruction due to unresectable advanced gastric cancer, with rapid clinical relief and a short hospital stay. J. Surg. Oncol. 2014 109:208–212. © 2013 Wiley Periodicals, Inc.

Background and Objectives Although salvage surgery after definitive chemoradiotherapy (CRT) is common, the safety and indication has not yet been established. Methods We retrospectively compared the mortality and morbidity of 24 patients who underwent salvage surgery with those of historical controls treated with neoadjuvant CRT followed by planned esophagectomy during the same period, and analyzed the prognostic factor of salvage surgery. Results Preoperative serum albumin (3.7 vs. 4.1 g/dl, P = 0.0157) and lymphocyte count (763 vs. 964/mm3, P = 0.0111) in the salvage group were significantly lower than those in the neoadjuvant group. A significant difference was also observed in operation time (567 vs. 474 min, P = 0.0381), C-reactive protein (CRP) on postoperative day 1 (11.2 vs. 8.7 mg/dl, P = 0.0021), and postoperative systemic inflammatory response syndrome (SIRS) duration (3.5 vs. 2.9 days, P = 0.0486). There were three hospital deaths in the salvage group, whereas no patient died in the neoadjuvant group. Multivariate analysis showed curability (R0 vs. R1 + R2) to be the strongest prognostic factor of salvage surgery (P = 0.0064). R1 + R2 operation was more frequently performed in the salvage group (33% vs. 13%), and the reason for all cases was unresectable T4, which had been underestimated preoperatively. Conclusions Salvage surgery is a highly invasive and morbid operation, which is performed on immunocompromized hosts. The indication must be carefully considered, with care taken to avoid non-curative surgery. J. Surg. Oncol. 2006;93:422–428. © 2006 Wiley-Liss, Inc.

Gastroduodenal stents for gastric outlet obstruction due to unresectable advanced gastric cancer are increasingly used; however, their effects have not been fully evaluated.A multicenter prospective observational study was performed. Patients were eligible if they had stage IV gastric cancer with a gastric outlet obstruction scoring system (GOOSS) score of 0 (no oral intake) or 1 (liquids only). Self-expandable metallic stents were delivered endoscopically. The effects of stents were evaluated.Twenty patients were enrolled and 18 were eligible (15 men, three women; median age, 70 years). Stent placement was successfully performed in all patients, with no complications. After stenting, a GOOSS score of 2 (soft solids only) or 3 (low-residue or full diet) was achieved in 13 (72%) patients. An improvement in the GOOSS score by one or more points was obtained in 16 (94%) patients. The median duration of fasting and hospital stay was 3 (range, 0-9) days and 18 (6-168) days, respectively. Chemotherapy was performed after stenting in 13 (72%) patients.Gastroduodenal stents are thought to be feasible, safe, and effective for gastric outlet obstruction due to unresectable advanced gastric cancer, with rapid clinical relief and a short hospital stay.

Purpose Currently, preoperative chemoradiotherapy followed by surgery is the only promising strategy for patients with T4 esophageal cancer. This study retrospectively analyzed the prognostic factors in patients with curatively resected cancer after chemoradiotherapy. Patients and Methods Between September 1989 and December 2003, 42 patients with T4 esophageal cancer received preoperative chemoradiotherapy (CRT) followed by curative surgery. Chemotherapy consisted of 5-fluorouracil/cisplatin (FP) or 5-fluorouracil/adriamycin/cisplatin (FAP). A total dose of 40 Gy of radiation was delivered concurrently. Surgery was scheduled 4 weeks after the completion of CRT. The treatment response was categorized using general criteria. Toxicities of the CRT were assessed according to National Cancer Institute of Common Toxicity Criteria (NCI-CTC). Univariate and multivariate analyses were performed to identify significant prognostic clinicopathological factors. Results The overall survival rate was 38.4% at 5 years. The toxic grade for leukopenia (grade 0–2/3–4) and pathological effect (grade 3/1–2) were significantly different by univariate analysis (P = 0.03 and 0.05, respectively). Multivariate analysis identified the toxic grade for leukopenia as the only significant and independent determinant of prognosis (P = 0.05). Conclusion In patients with T4 esophageal cancer who receive CRT followed by curatively resection, myelogenic chemotoxicity is a significant prognostic factor. J. Surg. Oncol. 2009;99:302–306. © 2009 Wiley-Liss, Inc.

Background Total removal of the gastric conduit (TRGC) due to gastric cancer after esophagectomy often results in high operative morbidity and mortality rates, especially when done in the posterior mediastinum. This is one of the reasons for the retro-sternal or subcutaneous route being preferred for gastric conduit replacement in esophageal cancer operation. Patients Five out of 680 post-operative esophageal cancer patients underwent TRGC via thoracotomy and laparotomy due to posterior mediastinal gastric conduit cancers. Results In these patients, advanced gastric cancers were found at an average of 84 months (ranging 57–136 months) after esophageal cancer surgery and preoperative risk factors for TRGC were found in age, nutrition, and pulmonary function. The operative time for TRGC was long (average 670 min) but not associated with operative complications, while blood loss varied among patients, with one with the most operative blood loss dying after surgery due to pyothorax and renal failure. This case, and another early case subjected to TRGC first with thoracotomy then followed by laparotomy, showed more operative blood loss (10,895 and 3,260 ml) than the later three patients (2,370, 1,900, and 1,780 ml), who underwent laparotomy before thoracotomy with ligation of the blood supply of the gastric conduit and lysis of adhesion around gastric conduit in the lower mediastinum from the abdomen. Conclusion TRGC in the posterior mediastinum would be safer if operative manipulation were started from laparotomy in order to reduce operative blood loss. J. Surg. Oncol. 2004;85:204–208. © 2004 Wiley-Liss, Inc.