Abstract Gastric cancer (GC) is one of the most common malignancies worldwide. Most patients are diagnosed at advanced stages due to the subtle symptoms of earlier disease and the low rate of regular screening. Systemic therapies for GC, including chemotherapy, targeted therapy and immunotherapy, have evolved significantly in the past few years. For resectable GC, perioperative chemotherapy has become the standard treatment. Ongoing investigations are exploring the potential benefits of targeted therapy or immunotherapy in the perioperative or adjuvant setting. For metastatic disease, there have been notable advancements in immunotherapy and biomarker-directed therapies recently. Classification based on molecular biomarkers, such as programmed cell death ligand 1 (PD-L1), microsatellite instability (MSI), and human epidermal growth factor receptor 2 (HER2), provides an opportunity to differentiate patients who may benefit from immunotherapy or targeted therapy. Molecular diagnostic techniques have facilitated the characterization of GC genetic profiles and the identification of new potential molecular targets. This review systematically summarizes the main research progress in systemic treatment for GC, discusses current individualized strategies and presents future perspectives. 

/pdf/gastric-cancer-treatment-recent-progress-and-future-89bjetd0.pdf

Gastric cancer treatment: recent progress and future perspectives

Background/Aims 
Total gastrectomy (TG) has shown to be superior regarding low risk of recurrence and readmission to distal subtotal gastrectomy (DG) for treatment of distal stomach cancer, but the incidence of postoperative morbidity and mortality in TG cannot be ignored Therefore, we performed a meta-analysis to compare the effectiveness between TG and DG for distal stomach cancer


Methodology 
A search in PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database through January 2016 was performed Eligible studies in comparing of TG and DG for distal gastric cancer were included in this meta-analysis Review Manager 52 software from the Cochrane Collaboration was used for the performance of meta-analysis and STATA 120 software for meta-regression analysis


Results 
Ten retrospective cohort studies and one randomized control trial involving 5447 patients were included The meta-analysis showed no significant difference of postoperative mortality (RR = 148, 95%CI = 0 90–244,p = 012), intraoperative blood loss (MD = 2434, 95%CI = -331–5199, p = 008) and length of hospital stay(MD = 076, 95%CI:-026–179, p = 015) TG procedure could retrieve more lymph nodes than DG(MD = 433, 95% CI = 234–631, p 005) We pooled the data together, the accumulated 5-year Overall Survival rates of TG and DG groups were 496% (919/1852) vs559%(721/1290) respectively Meta-analysis revealed a favoring trend to DG procedure and there was a statistical difference between the two groups (RR = 091,95% CI = 085–097,p = 0006)


Conclusion 
Based on current retrospective evidences, we found that in spite of similar postoperative mortality, TG for distal gastric cancer provided a high risk of five-year Overall Survival rate DG procedure can be a recommendation for distal gastric cancer, whereas due to lack of high quality RCTs in multicenter and the relatively small sample size of long-term outcomes, further comparative studies are still needed

/pdf/does-total-gastrectomy-provide-better-outcomes-than-distal-219usxfo2w.pdf

Does Total Gastrectomy Provide Better Outcomes than Distal Subtotal Gastrectomy for Distal Gastric Cancer? A Systematic Review and Meta-Analysis.

At the end of the last century, a far-sighted 'working party' held in Sydney, Australia addressed the clinicopathological issues related to gastric inflammatory diseases. A few years later, an international conference held in Houston, Texas, USA critically updated the seminal Sydney classification. In line with these initiatives, Kyoto Global Consensus Report, flanked by the Maastricht-Florence conferences, added new clinical evidence to the gastritis clinicopathological puzzle.The most relevant topics related to the gastric inflammatory diseases have been addressed by the Real-world Gastritis Initiative (RE.GA.IN.), from disease definitions to the clinical diagnosis and prognosis. This paper reports the conclusions of the RE.GA.IN. consensus process, which culminated in Venice in November 2022 after more than 8 months of intense global scientific deliberations. A forum of gastritis scholars from five continents participated in the multidisciplinary RE.GA.IN. consensus. After lively debates on the most controversial aspects of the gastritis spectrum, the RE.GA.IN. Faculty amalgamated complementary knowledge to distil patient-centred, evidence-based statements to assist health professionals in their real-world clinical practice. The sections of this report focus on: the epidemiology of gastritis; Helicobacter pylori as dominant aetiology of environmental gastritis and as the most important determinant of the gastric oncogenetic field; the evolving knowledge on gastric autoimmunity; the clinicopathological relevance of gastric microbiota; the new diagnostic horizons of endoscopy; and the clinical priority of histologically reporting gastritis in terms of staging. The ultimate goal of RE.GA.IN. was and remains the promotion of further improvement in the clinical management of patients with gastritis.

RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates.

Though a number of studies have been conducted to explore the association between myeloperoxidase (MPO)-463G > A polymorphism and cancer risk, the results remain inconsistent. Therefore, we performed a meta-analysis to derive a more systematic estimation of this relationship. Relevant studies were searched by PubMed, EMBASE, CNKI, Google Scholar, Ovid, and Cochrane library prior to December 2015. The strength of the association between MPO-463G > A polymorphism and cancer risk was estimated by odds ratios (OR) with 95% confidence interval (95%CI). Cumulative analysis was used to evaluate the stability of results through time. The current analysis consisted of 16,858 cases and 21,756 controls from 60 studies. Pooled results showed that MPO-463G > A polymorphism were associated with the overall decreased cancer susceptibility in all the genetic models included in this study (additive model: OR = 0.84, 95%CI = 0.76–0.94; allele genetic model: OR = 0.90, 95%CI = 0.840–0.954; recessive genetic model: OR = 0.89, 95%CI = 0.83–0.95). However, in the stratified analysis of cancer type, the significant results were only found in lung cancer (dominant model: OR = 0.93, 95%CI = 0.87–0.99) and digestive system cancer groups (dominant model: OR = 0.67 0.53–0.84; allele frequency model = 0.71, 95%CI = 0.57–0.87), but not in the blood system cancer or breast cancer group. When we further stratified the digestive system cancer group into digestive tract and digestive gland cancer groups, results showed a significant association between allele A of MPO-463G > A and digestive gland cancer in all the genetic models (allele frequency model: OR = 0.63, 95%CI = 0.40–0.99; additive model: OR = 0.41, 95%CI = 0.23–0.73; recessive model: OR = 0.51, 95%CI = 0.29–0.89; dominant model: OR = 0.58, 95%CI = 0.35–0.96), digestive tract cancers in allele frequency model (OR = 0.75, 95%CI = 0.59–0.95), and dominant model (OR = 0.72, 95%CI = 0.56–0.92). When stratified by ethnicity, results demonstrated that the genotype A might be a protect factor for both Caucasians and Asians. In group analysis according to source of controls, significant results were found in population from hospital in all the genetic models. In cumulative analysis, result of allele contrast showed a declining trend and increasingly narrower 95% overall, while the inclination toward non-significant association with lung cancer risk. This meta-analysis suggested that MPO-463G > A polymorphism was associated with the overall reduced cancer susceptibility significantly. It might be a more reliable predictor of digestive system cancer instead of lung cancer, blood system cancer, and breast cancer. In cumulative analysis, the stable trend indicated that evidence was sufficient to show the association between MPO-463G > A polymorphism and cancer risk.

/pdf/association-between-mpo-463g-a-polymorphism-and-cancer-risk-3obmr7bcbr.pdf

Association between MPO-463G > A polymorphism and cancer risk: evidence from 60 case-control studies

The Surgical Infection Society (SIS) published evidence-based guidelines for the management of intra-abdominal infection (IAI) in 1992, 2002, 2010, and 2017. Here, we present the most recent guideline update based on a systematic review of current literature. 

The Surgical Infection Society Guidelines on the Management of Intra-Abdominal Infection: 2024 Update

Diagnosis and treatment of acute phlegmonous gastritis: A case report

https://doi.org/10.1016/j.heliyon.2023.e15578

The effect of antibiotic prophylaxis on the incidence of surgical site infection after laparoscopic appendectomy for chronic appendicitis

Objective To compare surgical efficacy after three different reconstruction techniques after radical resection of distal gastric cancer.Methods Clinical data of 169 cases of distal gastric cancer operated in our hospital from 2007 to 2010 were retrospectively analyzed.The reconstruction techniques included Billroth Ⅰ anastomosis (n=60),Billroth Ⅱ anastomosis (n =41 ),and Roux-en-Y anastomosis (n=68).Efficacy among 3 groups was compared.Specific synptoms scale was used to evaluate the quality of life in three methods after three months.Results Compared to Billroth Ⅰ anastomosis and Billroth Ⅱ anastomosis,Roux-en-Y anastomosis had longer operative time[ (266.3±70.4) min vs.(196.2±54.3) min,and (228.5±67.7) min],more blood loss[(220.9±67.6) ml vs.(170.5±61.5) ml and (188.5±76.7) ml],and shorter time to gastric tube removal [(2.6±1.5) d vs.(3.1±1.3) d and (3.6±1.2) d],milder postoperative reflux and heartburn sensation (specific symptoms scale,1.8±0.4 vs.1.9±0.6 and 2.6±0.4,P＜0.05).Conclusions Although Roux-en-Y anastomosis is not consistent with physiological route and the procedure is more complex to perform,it can effectively prevent reflux complications.Roux-en-Y anastomosis is a better reconstruction technique after radical resection of distal gastric cancer.

Key words: 
Stomach neoplasms;  Distal subtotal gastrectomy;  Digestive tract reconstruction; Quality of life

Comparison among three reconstruction techniques after distal radical gastrectomy

Objective To investigate the association of myeloperoxidase (MPO) genetic polymorphism and gastric cancer. Methods A case-control study was performed including 62 patients with gastric cancer and 61 healthy controls. Peripheral blood was collected for genetic analysis of MPO-463. Results There were no significant differences in gender, age, and smoking between the two groups (P>0.05). However, the two groups differed in drinking, family history of gastric cancer, and Helicobacter pylori(HP) infection(P<0.05). The frequencies of MPO-463GG, GA and AA were 87.1%, 11.3% and 1.6%in the study group, and were 72.1% , 23.0% , and 4.9% in the control group, respectively. Carriers of MPO-463 GA or AA had a significantly higher risk of gastric cancer than those of MPO-463 GG (x2=4.253, P<0.05, OR=0.383, 95% CI:0.151-0.972). Carriers of G allele had a significantly lower risk of gastric cancer compared to carriers of A allele (x2=4.935,P<0.05, OR =0.399,95% CI:0.174-0.916). Conclusion MPO-463 G/A polymorphism is associated with gastric cancer with A being a protective gene. 

Key words: 
Stomach neoplasms;  Myeloperoxidase;  Genetic polymorphism

Analysis for myeloperoxidase genetic polymorphism in gastric cancer

Abstract Currently, effective therapies for advanced gastric cancer with systemic metastasis are lacking. Pharmacological research has been slowly progressing over the past decades. Here, we report the case of a 56-year-old female with human epidermal growth factor receptor 2 (HER2) expression (IHC 2+/FISH-) in gastric cancer with systemic metastasis. The first-line therapeutic regime consisted of systemic administration of camrelizumab, local arterial infusion of oxaliplatin and arterial embolization, oral apatinib, and PS scheme (oral tegafur-gimeracil-oteracil (S-1) and paclitaxel (PTX), which was administered both intraperitoneally and systemically). After the treatment, a 3-month progression-free survival (PFS) was observed. Due to the occurrence of CTCAE grade 4 adverse reactions, the patient could not tolerate chemotherapy. In the second line of treatment, we replaced the PS scheme with disitamab vedotin and continued the use of carrilizumab and apatinib. After four cycles, efficacy evaluation showed that it was stable disease (SD), only CTCAE 1/2 grade adverse reactions occurred, and endoscopy examination showed local tumor control with a reduction in the ulcer lesion. At the time of submission of the current manuscript, a 6-month PFS was achieved and the treatment was continued. Due to the safety and efficacy of disitamab vedotin observed in our case, we propose that disitamab vedotin could be a promising drug for the treatment of advanced gastric cancer patients with HER2 expression.

Efficacy of Disitamab Vedotin in Treating HER2 2+/FISH- Gastric Cancer

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