|
1
|
Basso L, Gallo G, Biacchi D, Carati MV, Cavallaro G, Esposito L, Giuliani A, Izzo L, Izzo P, Lamazza A, Polistena A, Tarallo M, Micarelli A, Fiori E. Role of New Anatomy, Biliopancreatic Reflux, and Helicobacter Pylori Status in Postgastrectomy Stump Cancer. J Clin Med 2022; 11:1498. [PMID: 35329824 PMCID: PMC8952228 DOI: 10.3390/jcm11061498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 01/14/2023] Open
Abstract
Distal gastrectomy for benign gastroduodenal peptic disease has become rare, but it still represents a widely adopted procedure for advanced and, in some countries, even for early distal gastric cancer. Survival rates following surgery for gastric malignancy are constantly improving, hence the residual mucosa of the gastric stump is exposed for a prolonged period to biliopancreatic reflux and, possibly, to Helicobacter pylori (HP) infection. Biliopancreatic reflux and HP infection are considered responsible for gastritis and metachronous carcinoma in the gastric stump after oncologic surgery. For gastrectomy patients, in addition to eradication treatment for cases that are already HP positive, endoscopic surveillance should also be recommended, for prompt surveillance and detection in the residual mucosa of any metaplastic-atrophic-dysplastic features following surgery.
Collapse
Affiliation(s)
- Luigi Basso
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Gaetano Gallo
- Department of Medicine, Surgery and Neurosciences, Operative Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy
| | - Daniele Biacchi
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Maria Vittoria Carati
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Giuseppe Cavallaro
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Luca Esposito
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Andrea Giuliani
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Luciano Izzo
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Paolo Izzo
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Antonietta Lamazza
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Andrea Polistena
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Mariarita Tarallo
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| | - Alessandro Micarelli
- ITER Center for Balance and Rehabilitation Research (ICBRR), 02032 Rome, Italy;
- Eurac Research, Institute of Mountain Emergency Medicine, 39100 Bolzano, Italy
| | - Enrico Fiori
- “Pietro Valdoni” Department of Surgery, Policlinico “Umberto I”, “Sapienza” University of Rome, 00161 Rome, Italy; (D.B.); (M.V.C.); (G.C.); (L.E.); (A.G.); (L.I.); (P.I.); (A.L.); (A.P.); (M.T.); (E.F.)
| |
Collapse
|
|
2
|
Yoon K, Kim N, Kim J, Lee JW, Lee HS, Lee JC, Yoon H, Shin CM, Park YS, Ahn SH, Park DJ, Kim HH, Lee YJ, Lee KH, Kim YH, Lee DH. Dynamic Changes in Helicobacter pylori Status Following Gastric Cancer Surgery. Gut Liver 2017; 11:209-215. [PMID: 27840366 PMCID: PMC5347644 DOI: 10.5009/gnl16224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 12/22/2022] Open
Abstract
Background/Aims Helicobacter pylori eradication is recommended in patients with early gastric cancer. However, the possibility of spontaneous regression raises a question for clinicians about the need for "retesting" postoperative H. pylori status. Methods Patients who underwent curative gastrectomy at Seoul National University Bundang Hospital and had a positive H. pylori status without eradication therapy at the time of gastric cancer diagnosis were prospectively enrolled in this study. H. pylori status and atrophic gastritis (AG) and intestinal metaplasia (IM) histologic status were assessed pre- and postoperatively. Results One hundred forty patients (mean age, 59.0 years; 60.7% male) underwent subtotal gastrectomy with B-I (65.0%), B-II (27.1%), Roux-en-Y (4.3%), jejunal interposition (0.7%), or proximal gastrectomy (4.3%). Preoperative presence of AG (62.9%) and IM (72.9%) was confirmed. The mean period between surgery and the last endoscopic follow-up was 38.0±25.6 months. Of the 140 patients, 80 (57.1%) were found to be persistently positive for H. pylori, and 60 (42.9%) showed spontaneous negative conversion at least once during follow-up. Of these 60 patients, eight (13.3%) showed more complex postoperative dynamic changes between negative and positive results. The spontaneous negative conversion group showed a trend of having more postoperative IM compared to the persistent H. pylori group. Conclusions A high percentage of spontaneous regression and complex dynamic changes in H. pylori status were observed after partial gastrectomy, especially in individuals with postoperative histological IM. It is better to consider postoperative eradication therapy after retesting for H. pylori.
Collapse
Affiliation(s)
- Kichul Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul Adventist Hospital, Seoul, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeyeon Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Won Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung-Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
|
4
|
Lin YS, Chen MJ, Shih SC, Bair MJ, Fang CJ, Wang HY. Management of Helicobacter pylori infection after gastric surgery. World J Gastroenterol 2014; 20:5274-5282. [PMID: 24833857 PMCID: PMC4017042 DOI: 10.3748/wjg.v20.i18.5274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 12/30/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
The Maastricht IV/Florence Consensus Report and the Second Asia-Pacific Consensus Guidelines strongly recommend eradication of Helicobacter pylori (H. pylori) in patients with previous gastric neoplasia who have undergone gastric surgery. However, the guidelines do not mention optimal timing, eradication regimens, diagnostic tools, and follow-up strategies for patients undergoing gastrectomy and do not indicate if eradication of H. pylori reduces the risk of marginal ulcer or stump cancer in the residual stomach after gastrectomy. The purpose of this review is to provide an update which may help physicians to properly manage H. pylori infection in patients who have undergone gastric surgery. This review focuses on (1) the microenvironment change in the stomach after gastrectomy; (2) the phenomenon of spontaneous clearance of H. pylori after gastrectomy; (3) the effects of H. pylori on gastric atrophy and intestinal metaplasia after gastrectomy; (4) incidence and clinical features of ulcers developing after gastrectomy; (5) does eradication of H. pylori reduce the risk of gastric stump cancer in the residual stomach? (6) does eradication of H. pylori reduce the risk of secondary metachronous gastric cancer in the residual stomach? and (7) optimal timing and regimens for H. pylori eradication, diagnostic tools and follow-up strategies for patients undergoing gastrectomy.
Collapse
|