s-1-(combination) and Abdominal-Abscess

Laparoscopic gastrectomy (LG) is reported to be associated with faster recovery than open gastrectomy (OG); however, the influence of the surgical approach on initiation timing of adjuvant chemotherapy (AC) remains unclear.. This was a single-institutional retrospective observational study. Patients with pathological stage II/III gastric cancer undergoing LG with D2 lymphadenectomy (LG group: n = 74) were matched 1:1 with patients selected from 214 similar patients undergoing OG (OG group: n = 74), identically matching gender, age, pathological stage, and type of gastrectomy, and comparing AC initiation timing between the two groups. Factors associated with delayed initiation of AC were investigated in a multivariable analysis.. AC was performed in 86.5% (LG) and 83.8% (OG) of patients (p = 0.64). The median time interval before AC was significantly shorter in the LG vs. OG group (5.7 vs. 6.6 weeks, respectively, p < 0.001), and significantly more patients received AC within 6 weeks (60.8% vs. 27.0%, p < 0.001). Independent factors associated with delayed initiation of AC (>6 weeks) were: morbidity (≥grade 3a; odds ratio (OR): 16.1, 95% confidence interval (CI): 1.86-143), open surgery (OR: 5.17, 95% CI: 2.50-13.1), and postoperative weight loss ≥ 8% (OR: 2.47, 95% CI: 1.07-5.71).. LG may be associated with shorter intervals before AC. Postoperative morbidity should be reduced as much as possible.

Topics: Abdominal Abscess; Adult; Aged; Aged, 80 and over; Anastomotic Leak; Antineoplastic Combined Chemotherapy Protocols; Capecitabine; Case-Control Studies; Chemotherapy, Adjuvant; Cisplatin; Deoxycytidine; Drug Combinations; Female; Fluorouracil; Gastrectomy; Humans; Laparoscopy; Laparotomy; Lymph Node Excision; Male; Middle Aged; Organoplatinum Compounds; Oxaliplatin; Oxaloacetates; Oxonic Acid; Pancreatic Fistula; Postoperative Complications; Retrospective Studies; Stomach Neoplasms; Tegafur; Time Factors; Time-to-Treatment

We report a case of a patient with resection margin involvement gastric carcinoma that recurred 5.5 years after additional resection. A 64-year-old man underwent distal gastrectomy for advanced gastric carcinoma (sig+por2, pSE, pN0, pStage IIB) in January 2008. A total gastrectomy was performed 2 months after the initial gastrectomy because of proximal resection line involvement, and curative resection was obtained. Adjuvant chemotherapy with S-1 was completed, and follow-up surveillance was finished 5 years after the additional surgery. In November 2013, the patient experienced bouts of vomiting, and a computed tomography (CT) scan showed an abdominal abscess that had spread to the liver and communicated with the intestine. Despite abscess drainage and antibiotic therapy, infection control was difficult and the patient died 20 days after hospitalization. An autopsy showed the recurrence lesions had diffusely spread to the peritoneum and was also disseminated around the Roux-Y jejunum. These findings suggest that peritoneal recurrence might lead to penetration of the intestine and abscess formation.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Antimetabolites, Antineoplastic; Chemotherapy, Adjuvant; Drainage; Drug Combinations; Fatal Outcome; Gastrectomy; Humans; Male; Middle Aged; Oxonic Acid; Recurrence; Stomach Neoplasms; Tegafur