Biomedical subjects

Jonathan D Barry

Publications and source records attributed to Jonathan D Barry.

6 recordsLinked to original sources

PubMed2004

Prognostic significance of acute presentation with emergency complications of gastric cancer.

BACKGROUND: Although acute complications necessitating emergency hospital admission are well documented in patients with carcinoma of the colon, comparable data for patients with gastric carcinoma is thin. The aim of this study, therefore, was to examine the outcomes of patients presenting to hospital as acute admissions with emergency complications of previously undiagnosed gastric cancer. METHODS: Three hundred consecutive patients with gastric adenocarcinoma were studied prospectively, and subdivided into two groups according to whether the patients were referred as acute emergencies ( n = 116) or as outpatients ( n = 184). RESULTS: The commonest emergency complications were: abdominal pain (57%), vomiting (41%), gastrointestinal bleeding (37%), dysphagia (26%), and a palpable mass (18%). Stages of disease were significantly more advanced in patients presenting acutely (I : II : III : IV = 7 : 11 : 27 : 71) compared with patients referred via outpatients (20 : 23 : 50 : 91, Chi(2) = 3.955; DF, 1; P = 0.047). R0 gastrectomy was significantly less likely after acute presentation (23 patients; 20%) compared with patients referred via outpatients (70 patients; 38%; Chi(2) = 11.037; DF, 1; P = 0.001). Cumulative 5-year survival for patients referred acutely was 9%, compared with 22% after outpatient referral (Chi(2) = 9.11; DF, 1; P = 0.0025). Multivariate analysis revealed two factors to be significantly and independently associated with durations of survival: stage of disease (hazard ratio [HR], 1.742; 95% confidence interval [CI], 1.493-2.034; P = 0.0001) and presentation with acute complications (HR, 1.561; 95% CI, 1.151-2.117; P = 0.004). CONCLUSION: Emergency complications of gastric cancer are a significant and independent prognostic marker of poor outcome.

Acute Disease↗

PubMed2004

Prospective evaluation of nutritional status related to body mass indices and outcomes after modified D2 gastrectomy for carcinoma.

AIMS: The aim of this study was to examine the perioperative nutritional status, body mass indices (BMI) and nutritional intakes of patients undergoing a modified D2 gastrectomy (preserving pancreas and spleen) for carcinoma to determine whether a relationship exists between the above and outcomes. METHODS: Fifty consecutive patients [median age 71 years, 38 male] with gastric adenocarcinoma were studied prospectively. RESULTS: Seven patients (14%) were obese (BMI > 30 kg/m2), 16 patients (32%) were overweight (BMI > 25 kg/m2), 21 patients (42%) were of normal weight (BMI 20-25 kg/m2), and six patients (12%) were underweight (BMI < 20 kg/m2). Operative morbidity was commoner in underweight patients (33%) when compared with overweight patients (17%, P = 0.391) and patients of normal weight (14%, P = 0.289). Fatal complications, however (two patients, 4%) were confined to overweight patients (P = 0.118). Preoperative serum albumin levels were significantly higher in overweight patients (43 g/dl) compared to underweight patients (34.5 g/dl; P = 0.003), though no correlation was found between patients' serum albumin levels and postoperative morbidity (r = -0.023, P = 0.877). Overweight patients were significantly less likely to achieve their protein requirements postoperatively than underweight patients (P = 0.037). Early enteral feeding contributed to 56% of the median energy requirements and 45% of the median protein requirements on the seventh postoperative day. CONCLUSION: BMI alone is a poor indicator of outcomes after modified D2 gastrectomy for carcinoma. The role of early enteral nutrition in patients undergoing gastrectomy for cancer deserves further evaluation.

Adenocarcinoma↗

PubMed2003

Western body mass indices need not compromise outcomes after modified D2 gastrectomy for carcinoma.

BACKGROUND: To determine the role of body mass index (BMI) in a Western population on outcomes after modified D2 gastrectomy (preserving pancreas and spleen where possible) for gastric cancer. METHODS: Eighty-four consecutive patients undergoing an R0 modified D2 gastrectomy for gastric cancer were studied prospectively. Male patients with a BMI of greater than 24.7 kgm(-2) and female patients with a BMI of greater than 22.6 kgm(-2) were classified as overweight and compared with control patients with BMIs below these reference values. RESULTS: Thirty-eight of the patients (45%) were classified as overweight. The median BMI of the overweight patients was 27.0 kgm(-2) (range, 22.7-34.7 kgm(-2); 27 males) compared with 21.2 kgm(-2) (range, 15.2-24.7 kgm(-2), 31 males) for control patients. Operative morbidity and mortality were 26% and 7.9% in overweight patients compared with 22% and 6.5% in control patients (morbidity, chi(2) = 0.240; df = 1; P = 0.624; mortality, chi(2) = 0.059; df = 1; P = 0.808). Cumulative survival at 5 years was 52% for overweight patients compared with 55% for control patients (chi(2) = 0.15; df = 1; P = 0.7002). In a multivariate analysis, the number of lymph node metastases (hazard ratio, 1.441; 95% confidence interval [CI], 1.159-1.723; P = 0.009) and splenectomy (hazard ratio, 12.111; 95% CI, 9.645-14.577; P = 0.043) were independently associated with the duration of survival. CONCLUSION: High BMIs were not associated with increased operative risk, and longterm outcomes were similar in the two groups after modified D2 gastrectomy.

Adult↗

PubMed2003

Laparoscopy significantly improves the perceived preoperative stage of gastric cancer.

BACKGROUND: The aim of this study was to examine the accuracy of laparoscopy is staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination. METHODS: One hundred patients out of a consecutive series of 258 patients with gastric adenocarcinoma underwent a preoperative staging CT followed by a staging laparoscopy. The strengths of the agreement between the CT stage, the laparoscopic stage, and the final histopathological stage were determined by the weighted Kappa statistic (Kw). RESULTS: The strengths of agreement between the CT stage and the final histopathological stage were Kw = 0.336 (95% confidence interval [CI]; 0.172-0.5; P = 0.0001) for T stage and 0.378 (95% CI; 0.226-0.53; P = 0.0001) for M stage, compared with 0.455 (95% CI; 0.301-0.609; P = 0.0001) and 0.73 (95% CI; 0.596-0.864; P = 0.0001) for the laparoscopic T and M stages, respectively. Unsuspected metastases that were not detected by CT, were found in 21 patients at laparoscopy, all of whom had T3 or T4 locally advanced tumors evident on CT. CONCLUSIONS: Preoperative laparoscopic staging of gastric cancer is indicated for potential surgical candidates with locally advanced disease in the absence of metastases on CT. The aim of this study was to examine the accuracy of laparoscopy in staging patients with gastric cancer in comparison with preoperative computed tomography (CT) examination.

Adenocarcinoma↗

PubMed2003

Open-access gastroscopy is associated with improved outcomes in gastric cancer.

OBJECTIVE: To examine whether patients with gastric cancer diagnosed via open-access gastroscopy (OAG) differ in their outcomes compared with patients referred conventionally to outpatient clinics or as acute emergencies. DESIGN AND SETTING: Prospective observational study in the gastroenterology and surgical units of a large district general hospital. PARTICIPANTS: One hundred consecutive patients with gastric adenocarcinoma. MAIN OUTCOME MEASURES: Data were collected prospectively and subdivided into two groups according to whether the patients were referred via the open-access route or the conventional route. RESULTS: Diagnostic delay from onset of symptoms was shorter for patients referred via OAG compared with those referred conventionally. Stages of disease were significantly earlier in patients referred via OAG compared with patients referred conventionally. Potentially curative resection was significantly more likely following OAG than after conventional referral. Cumulative five-year survival for patients referred via OAG was 30% compared with 12% after conventional outpatient referral and 13% after acute referral. Multivariate analysis revealed three factors to be associated with survival: stage of disease, distant metastases and referral via the open-access route. CONCLUSIONS: Gastric cancers presenting at OAG were diagnosed at an earlier stage than cancers diagnosed after conventional referral. This led to a higher proportion of potentially curative resections and better five-year survival.

Adenocarcinoma↗

PubMed2002

D2 or not D2? The gastrectomy question.

BACKGROUND: The best reported long-term survival following surgery for gastric cancer is from centers performing radical D2 gastrectomy. Yet comparative studies from European centers report higher rates of postoperative complications following D2 gastrectomy than after the less radical D1 gastrectomy, without any benefit in survival. We aimed to compare the outcome after modified D2 gastrectomy (preserving spleen and pancreas where possible), performed by specialist surgeons, with that after conventional D1 gastrectomy performed by general surgeons for gastric cancer in a large United Kingdom cancer unit. METHODS: Two groups of patients were studied: a historical control group of 245 consecutive patients with gastric cancer, of whom 50 underwent a potentially curative D1 resection (median age, 69 years; 35 males) was compared with 200 consecutive patients, 72 of whom underwent a potentially curative D2 resection (median age, 71 years; 47 males). RESULTS: Among the 122 patients judged to have curable cancers, patients who underwent a D2 gastrectomy had lower operative mortality (8.3% vs 12%; chi(2) = 0.48; P = 0.50) and experienced fewer complications (28% vs 36%; chi(2) = 0.93; P = 0.35) than patients who underwent a D1 gastrectomy. Cumulative survival at 5 years was 56% after D2 resections, compared with 11% after D1 resections ( P < 0.00001). In a multivariate analysis, only the stage of disease (stage I, hazard ratio [HR], 0.068; P = 0.0001; stage II, HR, 0.165; P = 0.001; stage III, HR, 0.428; P = 0.053) and the level of lymphadenectomy (HR, 0.383; P = 0.00001) were independently associated with the duration of survival. CONCLUSION: Modified D2 gastrectomy without pancreatico-splenectomy, performed by specialist surgeons, can improve survival after R0 resections without increasing operative morbidity and mortality, when compared with D1 gastrectomy performed by general surgeons.

Aged↗