Cancer Research and Treatment

Original Article

Gastrointestinal Cancer

Double Tract Reconstruction Reduces Reflux Esophagitis and Improves Quality of Life after Radical Proximal Gastrectomy for Patients with Upper Gastric or Esophagogastric Adenocarcinoma: Xin Ji, Chenggen Jin, Ke Ji, Ji Zhang, Xiaojiang Wu, Ziyu Jia, Zhaode Bu, Jiafu Ji; Cancer Res Treat. 2021;53(3):784-794. Published online December 29, 2020; DOI: https://doi.org/10.4143/crt.2020.1064

Purpose
The aim of the present study was to compare the difference between double tract reconstruction and esophagogastrostomy.
Materials and Methods
Patients who underwent radical proximal gastrectomy with esophagogastrostomy or double tract reconstruction were included in this study.
Results
Sixty-four patients were included in this study and divided into two groups according to reconstruction method. The two groups were well balanced in perioperative safety and 3-year overall survival (OS). The rates of postoperative reflux esophagitis in the double tract reconstruction group and esophagogastrostomy group were 8.0% and 30.8%, respectively (p=0.032). Patients in the double tract reconstruction group had a better global health status (p < 0.001) and emotional functioning (p < 0.001), and complained less about nausea and vomiting (p < 0.001), pain (p=0.039), insomnia (p=0.003), and appetite loss (p < 0.001) based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about dysphagia (p=0.030), pain (p=0.008), reflux (p < 0.001), eating (p < 0.001), anxiety (p < 0.001), dry mouth (p=0.007), and taste (p=0.001). The multiple linear regression analysis showed that reconstruction method, postoperative complications, reflux esophagitis, and operation duration had a linear relationship with the global health status score.
Conclusion
Double tract reconstruction could better prevent reflux esophagitis and improve quality of life without scarifying perioperative safety or 3-year OS.

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Case Report

Diffuse Large B-Cell Lymphoma Arising within Ileal Neobladder: An Expanding Spectrum of Diffuse Large B-Cell Lymphoma Associated with Chronic Inflammation: Hyekyung Lee, Hyunbin Shin, Nae Yu Kim, Hyun Sik Park, Jinsung Park; Cancer Res Treat. 2019;51(4):1666-1670. Published online March 22, 2019; DOI: https://doi.org/10.4143/crt.2019.022

Abstract PDF PubReader ePub

Diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI), specifically arising in ileal neobladder, is a rare neoplasm. We present an unusual case of Epstein– Barr virus (EBV)–positive DLBCL-CI arising within neobladder with detailed clinical, histological, and immunophenotypical features in an immunocompetent patient. An 88-year-old male was admitted for gross hematuria. He had undergone radical cystectomy and ileal neobladder 17 years ago for invasive bladder cancer. Computed tomography showed enhancing lesions on dome and posterior wall of neobladder with mucosal thickening and multiple enlarged retroperitoneal lymphadenopathies. Transurethralresection of neobladder lesion revealed the diffuse infiltration of large lymphoid cells which were positive for CD20, CD30, and multiple myeloma oncogen-1 with EBV-encoded small RNAs co-localizing, and diagnosis of EBV-positive DLBCL-CI was made. After multi-agent chemotherapy, the lesion disappeared. We suggest that clinicians should consider the possibility of DLBCL-CI in patients presented with hematuria during follow-up after bladder reconstruction.

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1 Web of Science
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Original Articles

Skin - sparing Mastectomy with Circumareolar Incision and Immediate TRAM & One - stage Star Flap Nipple - areolar Complex Reconstruction: S H Ahn, P C Lee, B H Son, S H Han; J Korean Cancer Assoc. 2000;32(2):261-269.

Abstract PDF: PURPOSE
Breast reconstruction after a mastectomy is being performed using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves a long linear scar after reconstruction. A skin-sparing mastectomy (SSM) with immediate TRAM flap and one-stage star flap nipple-areolar complex reconstruction makes minimal scar tissue and is becoming virtually imperceptible. The purpose of this study is to identify the clinical indications, to evaluate the clinical results, and to encourage the application of this method for the indicated patients. Meterial and Methods: From Apr. 1996 to Mar. 1999, there were 1,027 breast-cancer surgeries. Among them, there were 61 reconstruction cases and a skin-sparing mastectomy (SSM) with immediate reconstruction was performed on 29 cases. Of these patients, 15 underwent SSM and TRAM flap and one-stage star flap nipple-areolar complex reconstruction. Our selection criteria of SSM were as follows; diffuse DCIS that is not candidates for breast conserving surgery, Paget's disease of the nipple, clinically early breast cancer without skin involvement, and the centrally located cancer that would require removal of the nipple-areolar complex.
RESULTS
All of the TRAM flap and star flap were alive. The cosmetic results were fairly acceptable to the patients. The main drawback was bleeding and wound seroma which was managed by conservative management.
CONCLUSION
Skin-sparing mastectomy with immediate TRAM and star flap reconstruction gives markedly improved results by reducing the scars on the reconstructed breast, providing a supple breast with a natural ptotic shape, and aesthetically satisfied.

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Comparison of Nutritional Status after Subtotal Gastrectomy according to Reconstruction Methods: Hang Jong Yu, Han Kwang Yang, Jin Pok Kim; J Korean Cancer Assoc. 1996;28(4):710-718.

Abstract PDF: The purpose of this study is to compare nutritional status in subtotal gastrectomised patients according to reconstruction methods: Billroth I, retrocolic Billroth II and antecolic Billroth II anatomoses. For this study 90 early gastric cancer patients who underwent radical subtotal gastrectomy with Billroth I(B-I: n=30), retrocolic Billrath II(B-IIR: n=30) or antecolic Billroth II(B-IIA: n=30) anastomosis were selected to examine anthropometric and laboratory data. The results were; 1) In all three groups, there were significant weight losses(B-I: 4.5¡¾3.I Kg, B-IIR: 5.0¡¾3.2 Kg, B-IIA: 5.6¡¾4.0 Kg) and there were more weight losses in B-IIA group than B-IIR group and B-I group. 2) Triceps skin fold thickness showed that there were moderate to severe fat malnutrition in about 70% of patients in all three groups. 3) Arm muscle circumference showed that there were moderate to severe protein malnu trition in about 30% of patients in all three groups. 4) Serum albumin and transferrin levels showed normal levels in almost all patients and no differences among three groups. 5) Blood hemoglobin and serum calcium levels showed decrement compared to preoperative levels but no differences among three groups. 6) Serum Vitamine B12 level showed statistically significant decreased level in B-II group, more likely in B-IIA group. In summary, there were more weight losses in B-IIA group, and statistically significant decreased vitamin B12 level in B-II group, more likely in B-IIA group. So we recommend vitamin B12 supplement from 2 years after subtotal gastrectomy with Biillroth II anastomosis.

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