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Ito Y.,Aichi Cancer Center Chuo Hospital | Yoshikawa T.,Kanagawa Cancer Center | Fujiwara M.,Nagoya University | Kojima H.,Aichi Cancer Center Research Institute | And 13 more authors.
Gastric Cancer | Year: 2015

Background: Total gastrectomy has detrimental effects on postoperative nutritional status and quality of life (QOL), but it is often unavoidable in the treatment of gastric cancer. Roux-en-Y (RY) is the most common reconstruction method following total gastrectomy. Trials to explore other means of reconstruction have been conducted but have failed to identify a method that is globally accepted. Methods: Aboral pouch reconstruction (AP), in which an anisoperistaltic jejunal pouch is created in the Y limb of the RY reconstruction, is considered effective and technically feasible. A prospective randomized trial was conducted to compare AP with RY. Gastric cancer patients requiring total gastrectomy for R0 resection were randomly assigned during surgery to receive either RY (n = 51) or AP (n = 49). Postoperative QOL as assessed by the EORTC QLQ-C30 and STO22, body composition, and morbidity were compared between the two reconstruction methods. The physical functioning score of the QLQ-C30 was selected as the primary endpoint. Results: The incidences of postoperative complications were similar between the two groups (29 % in the RY group and 27 % in the AP group). No significant difference was observed in the physical functioning score, and the superiority of AP was demonstrated only for the nausea and vomiting score at 12 months (p = 0.041) and the reflux score at 1 month (p = 0.036). No significant differences were observed in body composition or serum biochemistry. Conclusions: Although AP was safely implemented, no increased benefits in nutritional or QOL-related parameters were observed for this method over RY within 12 months postoperatively. © 2015 The International Gastric Cancer Association and The Japanese Gastric Cancer Association

Kodera Y.,Nagoya University | Ito S.,Aichi Cancer Center Chuo Hospital | Mochizuki Y.,Komaki Municipal Hospital | Ohashi N.,Nagoya University | And 6 more authors.
Gastric Cancer | Year: 2012

Background In gastric cancer patients who have positive results for peritoneal lavage cytology the disease is defined as CY1, and classified as stage IV, and this population has generally suffered a dismal outcome. For this population, we had conducted a phase II trial, with the 2-year survival rate as the primary endpoint, to test the strategy of D2 dissection followed by chemotherapy with single-agent S-1 (1 M tegafur-0.4 M gimestat-1 M otastat potassium). Forty-eight patients were enrolled, of whom 47 were found to have been eligible for analysis. The 2-year survival rate of 46 % exceeded our expectations. Methods Further follow up was conducted to confirm whether radical surgery could be recommended for the CY1 population. Results The 5-year overall and relapse-free survival rates were 26 and 21 %, respectively. Conclusions Gastrectomy with curative intent could be considered for patients with CY1 disease provided they are scheduled to receive effective postoperative chemotherapy. © 2011 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

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