s-1-(combination) and Anastomotic-Leak

The patient was a 39-year-old man with type 3 gastric cancer with synchronous multiple liver and lung metastases, who was diagnosed as cStage IV(cT4aN1M1H1). He received induction chemotherapy with S-1 and CDDP. After chemotherapy, the liver and lung metastases had disappeared completely. He underwent total gastrectomy and splenectomy, with D2 nodal dissection. Anastomotic leakage occurred on postoperative day 6, and substantial inflammatory conditions continued for 2 weeks. He died 6 weeks after surgery with multiple liver metastases. This case suggests that elevated inflammatory conditions may cause tumor progression.

Topics: Adult; Anastomotic Leak; Antineoplastic Combined Chemotherapy Protocols; Cisplatin; Combined Modality Therapy; Disease Progression; Drug Combinations; Gastrectomy; Humans; Liver Neoplasms; Lung Neoplasms; Male; Medical Errors; Neoplasm Staging; Oxonic Acid; Splenectomy; Stomach Neoplasms; Tegafur; Treatment Failure

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