J. Bae

Employment status and work-related difficulties in stomach cancer survivors compared with the general population

Little was known about work situation and work-related difficulties, including housework after stomach cancer diagnosis. We aimed to compare employment status and work-related difficulties between stomach cancer survivors and the general population. We enrolled 408 stomach cancer survivors from two hospitals 28 months after diagnosis and 994 representative volunteers from the general population from 15 geographic districts. Working was defined as being employed (including self-employed) and nonworking as being retired or a homemaker. Nonworking was significantly higher among stomach cancer survivors (46.6%) than in the general population (36.5%). Compared with the general population, the survivors had more fatigue in performing both housework (adjusted odds ratio (aOR)=2.08; 95% confidence interval (95% CI)=1.01–4.29) and gainful work (aOR=4.02; 2.55–6.33). More cancer survivors had reduced working hours (aOR=1.42; 95% CI=4.60–28.35) and reduced work-related ability (aOR=6.11; 95% CI=3.64–10.27) than did the general population. The association of nonworking with older age and being female was significantly more positive for survivors than for the general population. Among survivors, poorer Eastern Cooperation Oncology Group Performance Status and receiving total gastrectomy were positively associated with nonworking. Stomach cancer survivors experienced more difficulties in both housework and gainful employment than did the general population. Our findings on stomach cancer survivors’ work-related difficulties and the predictors of nonworking will help physicians guide patients towards more realistic postsurgical employment plans.

Phase II study of docetaxel and irinotecan combination chemotherapy in metastatic gastric carcinoma

The current treatment for metastatic gastric cancer (MGC) consists of cisplatin and/or fluorouracil (5-FU) based combination chemotherapy, but cisplatin-based regimens are associated with considerable toxicity. We evaluated the efficacy and safety of a noncisplatin-, non-5-FU-containing regimen, docetaxel/irinotecan in MGC. Chemo-naive patients with MGC received docetaxel (30 mg m−2) and irinotecan (70 mg m−2) on days 1 and 8 every 3 weeks. The 48 eligible patients (median age 56 years) received a median of four cycles of docetaxel/irinotecan (range 1–18). Of the 46 patients in whom efficacy could be evaluated, 21 showed a partial response (response rate=45.7%; 95% confidence interval (CI) 31.3–60.1%). At a median follow-up of 15.0 months, the median time to progression was 4.5 months (95% CI 3.8–5.2 months) and overall survival was 8.2 months (95% CI, 5.8–10.6 months). Grade 3/4 neutropenia developed in 57.4% of patients, and febrile neutropenia/neutropenic infection in 19.1%. Nonhaematological toxicities were moderate; grade 3/4 diarrhoea occurred in 19.1% of patients, however, was manageable by a dose reduction. There was one possible treatment-related death. In conclusion, weekly docetaxel/irinotecan is a promising outpatient regimen in MGC, with appropriate dose modification.

Compact variant‐rich customized sequence database and a fast and sensitive database search for efficient proteogenomic analyses

In proteogenomic analysis, construction of a compact, customized database from mRNA‐seq data and a sensitive search of both reference and customized databases are essential to accurately determine protein abundances and structural variations at the protein level. However, these tasks have not been systematically explored, but rather performed in an ad‐hoc fashion. Here, we present an effective method for constructing a compact database containing comprehensive sequences of sample‐specific variants—single nucleotide variants, insertions/deletions, and stop‐codon mutations derived from Exome‐seq and RNA‐seq data. It, however, occupies less space by storing variant peptides, not variant proteins. We also present an efficient search method for both customized and reference databases. The separate searches of the two databases increase the search time, and a unified search is less sensitive to identify variant peptides due to the smaller size of the customized database, compared to the reference database, in the target‐decoy setting. Our method searches the unified database once, but performs target‐decoy validations separately. Experimental results show that our approach is as fast as the unified search and as sensitive as the separate searches. Our customized database includes mutation information in the headers of variant peptides, thereby facilitating the inspection of peptide‐spectrum matches.

Role of bursectomy for advanced gastric cancer: Result of a case–control study from a large volume hospital

AIMS According to the recent Japanese Gastric Cancer Associations gastric cancer treatment guidelines, bursectomy is recommended for tumors penetrating the serosa of the posterior gastric wall. However, there is still little data to show whether bursectomy improves patient survival. The aim of this study is to evaluate the efficacy of bursectomy for subserosa or serosa-positive gastric cancer in terms of overall survival. METHOD From April 2001 to December 2006, 470 patients underwent curative resection for macroscopically subserosa or serosa-positive gastric cancer. These patients were grouped according to whether bursectomy was performed or not (bursectomy+/bursectomy-). Clinicopathological characteristics and incidence of complications were compared between the groups. The overall survival rates were analyzed using a Cox proportional hazards model. RESULTS There was no significant difference in morbidity and mortality between the bursectomy+ and bursectomy- groups. In the multivariable analysis for overall survival, bursectomy was not a significant independent factor (p = 0.978). In the subgroup analysis for clinical and pathological stage III and IV, and tumors penetrating the serosa of the posterior gastric wall, bursectomy did not have significant effect on overall survival as well (p = 0.582, 0.453, and 0.532, respectively). In the propensity score-matched patients, bursectomy still showed no significant effect on overall survival (p = 0.804). CONCLUSIONS Bursectomy is unlikely to improve overall survival in patients with macroscopically subserosa or serosa-positive gastric cancer.

Standard Surgical Boundary, Surgical Results, and Outcomes of Systemic Laparoscopic Para-Aortic Lymphadenectomy Up to the Left Renal Vein Level for Women With Gynecologic Cancers

Patients: 104 patients had laparoscopic hysterectomy(uteri>500g) with manual morcellation technique. Intervention: The uterus is placed into a polyurethane endoscopic bag intracorporeally. The edges of the bag opening are exteriorized via suprapubic port incision for abdominal extraction or through the vaginal orifice for vaginal extraction. The surgeon uses Lehey clamps to hold the specimen and a scalpel to circumferentially core the specimen. The specimen is extracted in small fragments. The decision for abdominal or vaginal extraction is dependent of the type of hysterectomy performed, specimen size, and presence of vaginal stenosis. Measurements and Main Results: Demographic data for mean age 48.1 years(range 34-69) and BMI 36.94 kg/m2(range 19.1-56.7) were identified. The mean operative time was 216 minutes(range 110-410), mean estimated blood loss was 274.7 mL(range 20-1200 mL), and the mean specimen weight was 806.7 g(range 500-1930). Morcellation was performed by an abdominal approach in 58.7%(61/104) and by a vaginal approach in 41.3%(43/104) of patients. Occult malignancy was identified in 2 patients(1 endometrial adenocarcinoma, 1 uterine sarcoma). There were no complications related to the morcellation technique and no instance of bag rupture or specimen spillage. Conclusion: Manual morcellation within an endoscopic bag is safe and feasible. It allows for large uteri to be approached via a laparascopic route without the risk of vascular and bowel injury from the morcellator blade, spillage of specimen into the abdomen, or tumor dissemination in the case of occult malignancy.

Laparoscopic Fertility-Saving Staging Surgery for Woman With Huge Pelvic Mass

Bladder endometriosis is a rare pathological identity with an estimated prevalence of 1-2 %. We present a surgical video of a 40 year female who presented with symptoms of dysuria,frequency and urgency suprapubic pain during menstruation since last 3 years.Cystoscopy revealed an endometriotic nodule . Laparoscopic resection was planned which included cystoscopy and bilateral uretric stenting and resection of the entire lesion. The lesion approximately 4cm by 3 cm near the left ureteric orifice identified and marked cystoscopically . Simultaneously laparoscopy showed scarring and puckering over the lower part of uterus and bladder. Prevesical spaces were accessed using sharp and careful dissection. Thereafter bladder was distended and nodule excised with Harmonic scalpel. The bladder was sutured in three layers with polygalactin 2-0 in running, non-locking fashion. Patient was kept on foleys catheter drainage for 3 weeks and stents were removed after 6 weeks.