A retrospective study was carried out at our institution to compare patients who underwent percutaneous endoscopic gastrostomy (PEG) to those who underwent laparoscopic gastrostomy (LG). There were 17 patients who had a PEG with a mean age of 81 years (43-97 years). The procedure time, including complete esophago-gastroduodenoscopy, averaged 28 min. There were four deaths (23%) in a 30-day period, but none of these were directly related to the procedure. The LG group consisted of 14 patients with a mean age of 66 years (20-94 years). Mean duration of the procedure was 18 minutes. Thirty-day mortality rate was 35% (five patients) with one death (7%) directly related to the tube. Indications for gastrostomy were similar in both groups, being predominantly inability to eat and/or recurrent aspiration. However, LG was done because of 4 technical failures, 5 patients with tumors of the head and neck, 2 patients with esophageal obstruction and radiation stenosis precluding safe PEG, and 1 patient with hiatal hernia; 2 LGs were performed at the surgeon's preference. Outcomes for LG and PEG were comparable. LG is a suitable, safe alternative to PEG in selected patients who cannot undergo gastroscopy and should be considered the procedure of choice in patients with head and neck tumors or intrathoracic pathology that prevents PEG.

The role of cytokines as primary or adjuvant antineoplastic agents has been well established. Interleukin-2 (IL-2) and the interferons have, particularly, proven to be effective antitumor agents when given alone, and seem to act synergistically on the eradication of metastases from immunogenic tumors. Active specific immunotherapy, in the form of viral oncolysates, has also shown effectiveness in cancer therapy. Bearing this in mind, we decided to combine these agents in an adjuvant triple regimen and compare their effectiveness to other treatments in terms of tumor burden and survival in a murine colon cancer hepatic metastases model. BALB/c mice were injected with CC-36, a weakly immunogenic murine colon adenocarcinoma, intrasplenically, to produce artificial liver metastases. The animals were divided into one control group and seven treatment groups receiving either vaccinia colon oncolysate (VCO), IL-2, interferon-alpha (IFN alpha) alone, or combinations of these agents. Half the animals were followed for survival and the other half were sacrificed at the end of the experiment for quantification of tumor burden. The blood of the sacrificed animals was utilized in a series of immunological tests in order to demonstrate the cytolytic potential of the peripheral blood lymphocytes (PBL) in each treatment group, as well as to characterize phenotypically the cells acting as effectors. The triple-adjuvant regimen group was by far the most effective treatment group, demonstrating 100% survival and a significant reduction in tumor burden when compared to other groups. Furthermore, the PBL from the animals in this group showed 69.4% lysis of the CC-36 target cells in vitro. These effector lymphocytes were characterized as ASMG1-/Lyt2.2+ cytolytic lymphocytes. We conclude that these lymphocytes were stimulated by the administration of VCO and further augmented by the immunomodulation of the cytokines given in the triple regimen, and that such a regimen might prove beneficial in the treatment of established hepatic metastases from weakly immunogenic tumors.

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