[Application of Da Vinci surgical robot in the dissection of splenic hilar lymph nodes for gastric cancer patients with total gastrectomy]

OBJECTIVE

To investigate the feasibility and safety of Da Vinci surgical robot in the dissection of splenic hilar lymph nodes for gastric cancer patients with total gastrectomy.

METHODS

Clinical data of two cases who underwent total gastrectomy for cardia cancer at our department in January 2016 were analyzed retrospectively.

RESULTS

Two male patients were 62 and 55 years old respectively, with preoperative diagnosis as cT2-3N0M0 and cT1-2N0M0 gastric cancer by gastroscope and biopsy, and both received robotic total gastrectomy spleen-preserving splenic hilar lymph node dissection successfully. The operative time for splenic hilar lymph node dissection was 30 min and 25 min respectively. The intraoperative estimated blood loss was both 100 ml, while the number of total harvested lymph node was 38 and 33 respectively. One dissected splenic hilar lymph node and fatty tissues in two patients were proven by pathological examinations. There were no anastomotic leakage, pancreatic fistula, splenic infarction, intraluminal bleeding, digestive tract bleeding, aneurysm of splenic artery, and other operation-associated complications. Both patients suffered from postoperative pneumonia, and were cured by conservative therapy.

CONCLUSION

The robotic spleen-preserving splenic hilar lymph node dissection is feasible and safe, but its superiority needs further evaluation.

[Comparison of safety and efficacy between proximal gastrectomy and total gastrectomy for upper third gastric cancer: a Meta-analysis]

Objective: To compare the safety and efficacy between proximal gastrectomy and total gastrectomy and to ascertain the optimized procedure for patients with upper third gastric cancer through meta-analysis. Methods: The English literatures about proximal gastrectomy and total gastrectomy for upper third gastric cancer were searched from PubMed, EMBASE, the Cochrane Library and the Web of Science database and then collected. The quality of enrolled studies was independently assessed by two researchers according to the Newcastle-Ottawa Scale for retrospective studies and Jadad scale for RCT studies. The basic information of the literature and related clinical indicators were extracted. The primary endpoints were 5-year overall survival rate and recurrence rate. The secondary endpoints were operative time, intraoperative blood loss, morbidity of postoperative complication, incidence of anastomotic stenosis and incidence of reflux esophagitis. Considering the influence of tumor staging on postoperative clinicopathological features and prognosis, a subgroup analysis was performed on the literatures including cases of early gastric cancer and those including cases of tumor stage I to IV. Statistical analyses were carried out by the "metafor" and "meta" software packages from RevMan 5.3 software and R software (V3.2.4). Results: Twenty-five literatures involving 3667 patients (proximal gastrectomy for 1483, total gastrectomy for 2184) were finally enrolled for analysis, including 24 retrospective studies with ≥ 5 points and 1 RCT with 3 points, and all the literatures were of high quality. A total of 2516 cases of early gastric cancer were enrolled in 18 articles, including 1027 with proximal gastrectomy and 1489 with total gastrectomy. A total of 1151 cases with stage I to IV were enrolled in 7 articles, including 456 in proximal gastrectomy group and 695 in total gastrectomy group. Five-year survival rate was not significantly different for patients with early gastric cancer between the proximal gastrectomy group and total gastrectomy group (OR=1.16, 95% CI: 0.72 to 1.86, P=0.54). Similarly, there was no significant difference for patients with stage I to IV between the proximal gastrectomy group and the total gastrectomy group (OR=1.19, 95% CI: 0.92 to 1.53, P=0.18). Recurrence rate of early gastric cancer patients was not significantly different between the proximal gastrectomy group and the total gastrectomy group (OR=0.40, 95% CI: 0.05 to 3.16, P=0.39).However, the recurrence rate of the proximal gastrectomy group was higher than that of the total gastrectomy group in patients with stage I to IV (OR=1.55, 95% CI: 1.09 to 2.19, P<0.01), whose difference was statistically significant. There was no significant differences in postoperative complication between the groups, both in patients with early gastric cancer, and in those with stage I to IV (both P>0.05). The incidences of postoperative anastomotic stenosis (OR=3.57, 95% CI: 1.82 to 6.99, P<0.01) and reflux esophagitis (OR=2.83, 95% CI: 1.23 to 6.54, P=0.01) in the proximal gastrectomy group were significantly higher than those in the total gastrectomy group in patients with early gastric cancer. Conclusions: There is no significant difference in long-term survival outcomes between total gastrectomy and proximal gastrectomy for upper gastric tumors. However,incidence of anastomotic stenosis and reflux esophagitis, and tumor recurrence rate after total gastrectomy are significantly lower. The total gastrectomy is recommended as the first choice for advanced upper gastric tumor.

Risk Factors and Survival Outcomes for Postoperative Pulmonary Complications in Gastric Cancer Patients

BACKGROUND/AIMS

Facing with the high incidence rate and the poor outcomes of the postoperative pulmonary complications (PPCs), we sought to evaluate potential risk factors for developing the PPCs of gastric cancer patients.

METHODOLOGY

Retrospective study was carried out to analyze consecutive gastric cancer patients who had a preoperative pulmonary function test and underwent gastrectomy in the West China Hospital (January, 2000 - December, 2009). Potential risk factors to the development of the PPCs and the survival outcomes of these patients were also analyzed.

RESULTS

Totally, one hundred and twenty four patients (18.1%) were developed the PPCs after gastrectomy. For the development of the PPCs, univariate analysis identified the following risk factors is associated with the development of the PPCs: age ≥ 70 years (p < 0.001); male patients (p = 0.041); FEV1/FVC < 60 (p < 0.001); with the history of pulmonary disease (p < 0.001); hemoglobin < 90g/L (p = 0.025); serum albumin < 35g/L (p = 0.002); combined organoectomy (p = 0.036). Multivariate analysis identified FEV1/FVC < 60 (p = 0.004); with the history of pulmonary disease (p < 0.002); serum albumin < 35g/L (p = 0.004) were risk factors for the incidence of the PPCs.

CONCLUSIONS

For the early detection of the PPCs, extra attention should be paid to those gastric cancer patients with FEV1/FVC < 60; history of pulmonary disease and .serum albumin < 35g/L.

Incidence and mortality of liver cancer in mainland China: changes in first decade of 21st century

BACKGROUND/AIMS

To longitudinally analyze changes of primary liver cancer incidence and mortality in mainland China during the first decade of 21st century.

METHODOLOGY

Available data of crude incidence and mortality of primary liver cancer from annual reports of the National Central Cancer Registry in mainland China were retrieved and analyzed.

RESULTS

Either the incidence or mortality of primary liver cancer in mainland China kept increasing and didn't reach peaks during the first decade of the 21st century, particularly among the female population with great incremental rates of incidence (8.76%) and mortality (11.99%) at 2007-2008 and 2009-2010, respectively. The crude incidence increased from 26.18/100,000 persons at 2004 to 29.00/100,000 persons at 2010, while the crude mortality from 25.08/100,000 persons to 28.10/100,000 persons (r=0.857, p=0.014). The incidence and mortality in males kept 2.5-2.9 folds to those in females. The incidence and mortality in rural region were always higher than those in urban regions, but among males both tended to decline in rural region, while in contrast increased in urban region.

CONCLUSIONS

Liver cancer still has high incidence and mortality in mainland China, and further effort is required to prevent and control liver cancer, particularly for male and rural population.

Comparison of hand-assisted laparoscopic gastrectomy vs. laparoscopy assisted gastrectomy for gastric cancer

BACKGROUND/AIMS

This study aimed to compare the short and long-term outcomes of hand-assisted laparoscopic gastrectomy (HALG) to those of laparoscopy assisted gastrectomy (LAG).

METHODOLOGY

From June 2009 to October 2011, fifteen pairs of patients with gastric carcinoma who underwent LAG or HALG were included for analysis retrospectively. Overall survival, morbidity and mortality, and operative variables were analyzed.

RESULTS

The characteristics baselines were comparable between two groups. There was no difference in morbidity or mortality between two groups. There were also no significant differences in terms of mean number of harvested lymph nodes, postoperative hospital stay, intraoperative blood lost volume, operation time, reoperation, intraoperative conversion, mean time to first flatus and mean time to liquid diet intake between the two groups. The median survival months for patients were 28.9 and 31.7 in HALG and LAG group respectively, and the estimated 3 year overall survival rates were 73.3% in HALG group and in 80.0% LAG group without any statistic significant (P=0.779).

CONCLUSIONS

There was no difference in overall morbidity and mortality, postoperative recovery or overall survival between the HALG group and LAG group. Well-designed randomized controlled trials should be needed to prove the results further.

Optimal timing of surgery for gastric cancer after neoadjuvant chemotherapy: a systematic review and meta-analysis

BACKGROUND

Following neoadjuvant chemotherapy, surgical resection is one of the most preferred treatment options for locally advanced gastric cancer patients. However, the optimal time interval between chemotherapy and surgery is unclear. This review aimed to identify the optimal time interval between neoadjuvant chemotherapy and surgery for advanced gastric cancer.

METHODS

Beginning on November 12, 2022, we searched the PubMed, Cochrane Library, Web of Science databases, and Embase.com databases for relevant English-language research. Two authors independently screened the studies, assessed their quality, extracted the data, and analyzed the results. The primary goal was to investigate the relationship between the time interval to surgery (TTS) and long-term survival outcomes for patients. This study has been registered with PROSPERO (CRD42022365196).

RESULTS

After an initial search of 4880 articles, the meta-analysis review ultimately included only five retrospective studies. Ultimately, this meta-analysis included 1171 patients, of which 411 patients had TTS of < 4 weeks, 507 patients had TTS of 4-6 weeks, and 253 patients had TTS of > 6 weeks. In survival analysis, patients with TTS of > 6 weeks had poorer overall survival outcomes than patients with TTS of 4-6 weeks (HR = 1.34, 95% CI: 1.03-1.75, P = 0.03). No significant differences were found in terms of disease-free survival the groups.

CONCLUSION

Based on the current clinical evidence, patients with locally advanced gastric cancer may benefit better with a TTS of 4-6 weeks; however, this option still needs additional study.

The postoperative quality of life of two anastomosis methods of gastric tube reconstruction for proximal gastrectomy

BACKGROUND/AIMS

Compare the postoperative quality of life between the anastomosis of anterior gastric wall to the esophagus (AGE) and posterior gastric wall to the esophagus (PGE) for gastric tube reconstruction of proximal gastrectomy.

METHODOLOGY

Retrospectively matched-pair study collected patients who underwent anterior and posterior gastric wall anastomosis to the esophagus after proximal gastrectomy. Surgical related parameters and postoperative 3-month, 6-month, 9-month, 12-month quality of life were according to EORTC QLQ-C30 and EORTC QLQ-STO22 questionnaires during the out-patient visit.

RESULTS

Eleven pair cases included in the study and finished postoperative quality of life evaluation. General characteristics, such as age, surgical duration, blood loss, postoperative complications existed no significant difference between the two groups. The AEG reconstruction existed advantage in the pain scale (EORTC QLQ-C30 and EORTC QLQ-STO22) and reflux symptom scale (EORTC QLQ-STO22) at the 3-month postoperative evaluation. However, there was no difference between the two groups in the assessment of quality of life in the postoperative 6-month, 9-month, 12-month.

CONCLUSIONS

Although there were some subtle differences between the two reconstruction methods. Both of these two reconstruction methods can as a selection of gastric tube reconstruction. Further study and other reconstruction method are expected for the proximal gastrectomy.

[Comparison of postoperative mid-term and long-term quality of life between Billroth-I gastroduodenostomy and Billroth-II gastrojejunostomy after radical distal gastrectomy in patients with gastric cancer: a cohort study based on a case registry database]

Objective: The pattern of digestive tract reconstruction in radical gastrectomy for gastric cancer is still inconclusive. This study aims to compare mid-term and long-term quality of life after radical gastrectomy for distal gastric cancer between Billroth-I (B-I) and Billroth-II (B-II) reconstruction. Methods: A retrospective cohort study was conducted.Clinicopathological and follow-up data of 859 gastric cancer patients were colected cellected from the surgical case registry database of Gastrointestinal Surgery Center of Sichuan University West China Hospital, who underwent radical distal gastric cancer resection between January 2016 and December 2020. Inclusion criteria: (1) gastric cancer confirmed by preoperative gastroscopy and biopsy; (2) elective radical distal major gastrectomy performed according to the Japanese Society for Gastric Cancer treatment guidelines for gastric cancer; (3) TNM staging referenced to the American Cancer Society 8th edition criteria and exclusion of patients with stage IV by postoperative pathology; (4) combined organ resection only involving the gallbladder or appendix; (5) gastrointestinal tract reconstruction modality of B-I or B-II; (6) complete clinicopathological data; (7) survivor during the last follow-up period from December 15, 2021 to January 15, 2022. Exclusion criteria: (1) poor compliance to follow-up; (2) incomplete information on questionnaire evaluation; (3) survivors with tumors; (4) concurrent malignancies in other systems; (5) concurrent psychiatric and neurological disorders that seriously affected the objectivity of the questionnaire or interfered with patient's cognition. Telephone follow-up was conducted by a single investigator from December 2021 to January 2022, and the standardized questionnaire EORTC QLQ-C30 scale (symptom domains, functional domains and general health status) and EORTC QLQ-STO22 scale (5 symptoms of dysphagia, pain, reflux, restricted eating, anxiety; 4 single items of dry mouth, taste, body image, hair loss) were applied to evaluate postoperative quality of life. In 859 patients, 271 were females and 588 were males; the median age was 57.0 (49.5, 66.0) years. The included cases were divided into the postoperative follow-up first year group (202 cases), the second year group (236 cases), the third year group (148 cases), the fourth year group (129 cases) and the fifth year group (144 cases) according to the number of years of postoperative follow-up. Each group was then divided into B-I reconstruction group and B-II reconstruction group according to procedure of digestive tract reconstruction. Except for T-stage in the fourth year group, and age, tumor T-stage and tumor TNM-stage in the fifth year group, whose differences were statistically significant between the B-I and B-II reconstruction groups (all P<0.05), the differences between the B-I and B-II reconstruction groups in terms of demographics, body mass index (BMI), tumor TNM-stage and tumor pathological grading in postoperative follow-up each year group were not statistically significant (all P>0.05), suggesting that the baseline information between B-I reconstruction group and the B-II reconstruction group in postoperative each year group was comparable. Evaluation indicators of quality of life (EORTC QLQ-C30 and EORTC QLQ-STO22 scales) and nutrition-related laboratory tests (serum hemoglobin, albumin, total protein, triglycerides) between the B-I reconstruction group and B-II reconstruction group in each year group were compared. Non-normally distributed continuous variables were presented as median (Q(1),Q(3)), and compared by using the Wilcoxon rank sum test (paired=False). The χ(2) test or Fisher's exact test was used for comparison of categorical variables between groups. Results: There were no statistically significant differences in all indexes EORTC QLQ-30 scale between the B-I reconstruction group and the B-II reconstruction group among all postoperative follow-up year groups (all P>0.05). The EORTC QLQ-STO22 scale showed that significant differences in pain and eating scores between the B-I reconstruction group and the B-II reconstruction group were found in the second year group, and significant differences in eating, body and hair loss scores between the B-I reconstruction group and the B-II reconstruction group were found in the third year group (all P<0.05), while no significant differences of other item scores between the B-I reconstruction group and the B-II reconstruction group were found in postoperative follow-up of all year groups (P>0.05). Triglyceride level was higher in the B-II reconstruction group than that in the B-I reconstruction group (W=2 060.5, P=0.038), and the proportion of patients with hyperlipidemia (triglycerides >1.85 mmol/L) was also higher in the B-II reconstruction group (19/168, 11.3%) than that in the B-I reconstruction group (0/34) (χ(2)=0.047, P=0.030) in the first year group with significant difference. Albumin level was lower in the B-II reconstruction group than that in the B-I reconstruction group (W=482.5, P=0.036), and the proportion of patients with hypoproteinemia (albumin <40 g/L) was also higher in the B-II reconstruction group (19/125, 15.2%) than that in the B-I reconstruction group (0/19) in the fifth year group, but the difference was not statistically significant (χ(2)=0.341, P=0.164). Other nutrition-related clinical laboratory tests were not statistically different between the B-I reconstruction and the B-II reconstruction in each year group (all P>0.05). Conclusions: The effects of both B-I and B-II reconstruction methods on postoperative mid-term and long-term quality of life are comparable. The choice of reconstruction method after radical resection of distal gastric cancer can be based on a combination of patients' condition, sugenos' eoperience and operational convenience.

[Laparoscopy-assisted distal gastrectomy for gastric cancer]

Laparoscopy-assisted distal gastrectomy (LADG) is a minimally invasive surgical technique, and also an important development of modern surgery. According to Japanese Gastric Cancer Treatment Guideline, indications of LADG must be strictly limited in early gastric cancer patients, while it should be investigated in advanced gastric cancer. Based on available studies, the short-term advantage of LADG for early gastric cancer has been generally accepted, but the totally laparoscopic technique for early gastric cancer is still to be further studied. LADG for advanced gastric cancer continues to be controversial, which needs the relevant final results of randomized controlled trials from China, Japanese, and Korean to determine, although some current studies have demonstrated similar efficacy of LADG plus D2 lymphadenectomy as compared to open gastrectomy.

Immunohistochemical HER2 expression not associated with clinicopathological characteristics of stage I-III gastric cancer patients

BACKGROUND/AIMS

The aim of this study was to investigate the association of human epidermal growth factor receptor 2 (HER2) expression with clinicopathological characteristics of resectable gastric cancer patients.

METHODOLOGY

A total of 394 stage I-III surgical gastric cancer patients who were detected of immunohistochemical (IHC) HER2 expression postoperatively were included in this retrospective study. Association of IHC HER2 over-expression (3+) rate with clinicopathological characteristics was tested by univariate and multivariate analyses.

RESULTS

IHC HER2 over-expression rate was 5.1% (95% CI 3.1%-7.7%). By univariate analyses, none of the clinicopathological characteristics was associated with the IHC HER2 over-expression compared to negative expression (0/1+) (p>0.05), with the exception of a higher rate (12.2%) of IHC HER2 (3+) in moderate differentiation subset (p=0.02). However, the multivariate analyses didn’t selected any characteristic as an independent risk factor of IHC HER2 over-expression or the combination of IHC HER2 (2/3+).

CONCLUSIONS

IHC HER2 over-expression rate is relatively low among stage I-III gastric cancer patients, and might be generally not associated with clinicopathological characteristics.

Safety and Survival Benefit of Surgical Management for Elderly Gastric Cancer Patients

BACKGROUND/AIMS

To study the safety and survival outcome of surgical management for elderly gastric cancer patients.

METHODOLOGY

Patients proven of gastric cancer who aged 80 years during November 2002 to July 2011 were retrospectively analyzed. The detailed information of patients' characteristics and surgical management was retrieved. Follow-up of overall survival status was performed to analyze the surgical effectiveness.

RESULTS

Totally, 92 (48 in surgery and 44 in non-surgery group) out of 187 eligible patients recorded adequate information and analyzed finally. Median ages were 81 years in surgery group and 83 year in non-surgery group. There were 34 patients undergone radical gastrectomy, 6 palliative gastrectomy, 1 gastrojejunostomy and 7 exploratory laparotomy. Median follow-up durations were 25 (9-111) and 28 (8-114) months in surgery and non-surgery groups, respectively (p = 0.797). Clinical-pathological T stage was 6 T1, 5 T2, 14 T3 and 23 T4 cases for surgery and 7 T1, 6 T2, 3 T3, 7 T4 and 21 TX cases for non-surgery. Clinical-pathological node status was 18 N0, 7 N1, 6 N2, 7 N3 and 10 NX cases for surgery and 10 N0, 3 N1, 3 N2, 3 N3 and 25 NX cases for non-surgery. Clinical-pathological distal metastasis status was 15 and 26 M1 cases for surgery and non-surgery, respectively (p = 0.006). Incidence of postoperative complications was 25.0% and postoperative hospital mortality was 2.1%. The 2-year survival rates were 30.8% and 8.0% for surgery and none-surgery, respectively (HR = 3.023, p = 0.001), and the 3-year survival rates were 17.6% and 0% for surgery and non-surgery, respectively (HR = 3.680, p = 0.001). In M0 subgroup, 2-year survival rate was 35.7% and 0.0% for surgery and non-surgery groups, respectively (HR = 3.98, p = 0.022).

CONCLUSION

The safety of surgery for well-selected ≥ 80-year elderly gastric cancer patients was potentially acceptable and the patients of early or locally advanced diseases could obtain survival benefits by surgery.

Intraperitoneal chemotherapy for gastric carcinoma

This is a protocol for a Cochrane Review (intervention). The objectives are as follows:

To assess the efficacy and safety of intraperitoneal chemotherapy for gastric carcinoma.

[Utilizing Academic Clubs to Foster Practical Research Ability of Medical Students-Volunteer Team of Gastric Cancer Surgery of West China Hospital, Sichuan University]

The cultivation of medical students'research ability promotes in them high-quality career development. In addition to classroom instruction of the theoretical knowledge concerning research, the systematic training and practice of scientific research skills outside the classroom is also vitally important. We established the Volunteer Team of Gastric Cancer Surgery with the features of standardization, progressiveness, and practicality in order to cultivate the thinking skills concerning research and the research ability of medical students. Our team is supported by the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. Taking clinical and basic research skills training as the focus of our work, we have organized systematic workshops focused on theoretical knowledge and research skills practice programs of divers forms. Our work helps improve the research ability of medical students, suggesting that research-oriented clubs play an active role in the cultivation of practical research ability of medical students and should be widely promoted.

[Effect of standardized surgical treatment and multidisciplinary treatment strategy on the prognosis of gastric cancer patients: report of a single-center cohort study]

Objective: To explore the effect of standardized surgical treatment and multidisciplinary treatment strategy on the treatment outcomes of gastric cancer patients. Methods: A single-center cohort study was carried out. Clinicopathological and long-term follow up data of primary gastric cancer patients were retrieved from the database of Surgical Gastric Cancer Patient Registry (SGCPR) in West China Hospital of Sichuan University. Finally, 4516 gastric cancer patients were included and were divided into three groups according to time periods (period 1 group: exploration stage of standardized surgical treatment, 2000 to 2006, 967 cases; period 2 group: application stage of standardized surgical treatment, 2007 to 2012, 1962 cases; period 3 group: optimization stage of standardized surgical treatment and application stage of multidisciplinary treatment strategy, 2013 to 2016, 1587 cases). Differences in clinical data, pathologic features, and prognosis were compared among 3 period groups. Follow-up information was updated to January 1, 2020. The overall follow-up rate was 88.9% (4016/4516) and median follow-up duration was 51.58 months. Survival curve was drawn by Kaplan-Meire method and compared with log-rank test. Univariate and multivariate analyses were performed by Cox proportional hazards model. Results: There were significant differences among period 1, period 2 and period 3 groups in the rates of D2/D2+ lymphadenectomy [14.4%(139/967) vs. 47.2%(927/1962) vs. 75.4%(1197/1587), χ(2)=907.210, P<0.001], in the ratio of proximal gastrectomy [19.8%(191/967) vs. 16.6%(325/1962) vs. 8.2%(130/1587), χ(2)=100.020, P<0.001], and in the median intraoperative blood loss (300 ml vs. 100 ml vs. 100 ml, H=1126.500, P<0.001). Besides, the increasing trend and significant difference were also observed in the median number of examined lymph nodes among period 1, period 2 and period 3 groups (14 vs. 26 vs. 30, H=987.100, P<0.001). Survival analysis showed that the 5-year overall survival rate was 55.3% in period 1, 55.2% in period 2 and 62.8% in period 3, and significant difference existed between period 3 and period 1 (P=0.004). The Cox proportional hazards model analysis showed that treatment period (period 3, HR=0.820, 95%CI: 0.708 to 0.950, P=0.008), postoperative chemotherapy (HR=0.696, 95%CI: 0.631 to 0.768, P<0.001) and mid-low gastric cancer (HR=0.884, 95%CI: 0.804 to 0.973, P=0.011) were good prognostic factors. Whereas old age (≥65 years, HR=1.189, 95%CI: 1.084 to 1.303, P<0.001), palliative resection (R1/R2, HR=1.538,95%CI: 1.333 to 1.776, P<0.001), large tumor size (≥5 cm, HR=1.377, 95%CI: 1.239 to 1.529, P<0.001), macroscopic type III to IV (HR=1.165, 95%CI: 1.063 to 1.277, P<0.001) and TNM stage II to IV(II/I:HR=1.801,95%CI:1.500~2.162,P<0.001;III/I:HR=3.588, 95%CI: 3.028~4.251, P<0.001; IV/I: HR=6.114, 95%CI: 4.973~7.516, P<0.001) were independent prognostic risk factors. Conclusion: Through the implementation of standardized surgical treatment technology and multidisciplinary treatment model, the quality of surgery treatment and overall survival increase, and prognosis of gastric cancer patients has been improved.

The role of TRAIL signal pathway in acute pancreatitis

BACKGROUND/AIMS

The incidence of acute pancreatitis has been increasing recently. This study aims to elucidatethe role of TRAIL signal pathway in the process of acute pancreatitis.

METHODOLOGY

Pancreatitis models were constructed by cerulein or cerulein plus lipopolysaccharide. Amylase and lipidase were measured in different groups. The mRNA expression of TRAIL, DR5, DcR1 and DcR2 were studied by means of relative Quantitative-Real-Time PCR. In addition, the expression of TUNEL and Caspase 3 was studied by immunohistochemistry.

RESULTS

The establishment of pancreatitis model was successful. There were significant differences of amylase and lipidase in the three groups (p<0.05), with highest in MAP group. The mRNA expression of TRAIL was upregulated in SAP group and downregulated in MAP group. The expressions of DcR1 were detected to be statistically upregulated in MAP group and SAP group. The expressions of DR5 and DcR2 were not significant different from each other among the three groups (p>0.05). There were no siginificant differences among the three groups for the expression of Caspase 3 which indicated the apoptosis of acinar cell. The correlation coefficient between the expression of TUNEL and Caspase 3 was 0.383 (p=0.037).

CONCLUSIONS

TRAIL signal pathway might play a role in the process of acute pancreatitis which needs to be explored further.

Path planning algorithm for percutaneous puncture lung mass biopsy procedure based on the multi-objective constraints and fuzzy optimization

Objective. The percutaneous puncture lung mass biopsy procedure, which relies on preoperative CT (Computed Tomography) images, is considered the gold standard for determining the benign or malignant nature of lung masses. However, the traditional lung puncture procedure has several issues, including long operation times, a high probability of complications, and high exposure to CT radiation for the patient, as it relies heavily on the surgeon's clinical experience.Approach.To address these problems, a multi-constrained objective optimization model based on clinical criteria for the percutaneous puncture lung mass biopsy procedure has been proposed. Additionally, based on fuzzy optimization, a multidimensional spatial Pareto front algorithm has been developed for optimal path selection. The algorithm finds optimal paths, which are displayed on 3D images, and provides reference points for clinicians' surgical path planning.Main results.To evaluate the algorithm's performance, 25 data sets collected from the Second People's Hospital of Zigong were used for prospective and retrospective experiments. The results demonstrate that 92% of the optimal paths generated by the algorithm meet the clinicians' surgical needs.Significance.The algorithm proposed in this paper is innovative in the selection of mass target point, the integration of constraints based on clinical standards, and the utilization of multi-objective optimization algorithm. Comparison experiments have validated the better performance of the proposed algorithm. From a clinical standpoint, the algorithm proposed in this paper has a higher clinical feasibility of the proposed pathway than related studies, which reduces the dependency of the physician's expertise and clinical experience on pathway planning during the percutaneous puncture lung mass biopsy procedure.

Helicobacter pylori eradication following endoscopic resection might prevent metachronous gastric cancer: a systematic review and meta-analysis of studies from Japan and Korea

OBJECTIVES

A systematic review and meta-analysis was performed to evaluate the preventive effectiveness of Helicobacter pylori eradication against metachronous gastric cancer (MGC) or dysplasia following endoscopic resection (ER) for early gastric cancer (EGC) or dysplasia.

METHODS

PubMed, Cochrane Library, MEDLINE, and EMBASE were searched until 31 October 2023, and randomized controlled trials or cohort studies were peer-reviewed. The incidence of metachronous gastric lesions (MGLs) including MGC or dysplasia was compared between Helicobacter pylori persistent and negative groups, eradicated and negative groups, and eradicated and persistent groups.

RESULTS

Totally, 21 eligible studies including 82,256 observations were analyzed. Compared to those never infected, Helicobacter pylori persistent group (RR = 1.58, 95% CI = 0.98-2.53) trended to have a higher risk of MGLs and significantly in partial subgroups, while the post-ER eradicated group (RR = 0.79, 95% CI = 0.43-1.45) did not increase the risk of MGLs. Moreover, successful post-ER eradication could significantly decrease the risk of MGLs (RR = 0.54, 95% CI = 0.44-0.65) compared to those persistently infected. Sensitivity analysis obtained generally consistent results, and no significant publication bias was found.

CONCLUSION

The persistent Helicobacter pylori infection trends to increase the post-ER incidence of MGC or dysplasia, but post-ER eradication can decrease the risk correspondingly. Post-ER screening and eradication of Helicobacter pylori have preventive effectiveness on MGC, and the protocol should be recommended to all the post-ER patients.Systematic review registration: The PROSPERO registration identification was CRD42024512101.

Safety and survival benefit of surgical management for elderly gastric cancer patients

OBJECTIVE

To study the safety and survival outcome of surgical management for elderly gastric cancer patients. Methods: Patients proven of gastric cancer who aged ≥80 years during November 2002 to July 2011 were retrospectively analyzed. The detailed information of patients’ characteristics and surgical management was retrieved. Follow-up of overall survival status was performed to analyze the surgical effectiveness.

RESULTS

Totally, 92 (48 in surgery and 44 in non-surgery group) out of 187 eligible patients recorded adequate information and analyzed finally. There were 34 patients undergone radical gastrectomy, 6 palliative gastrectomy, 1 gastrojejunostomy and 7 exploratory laparotomy. Median follow-up durations were 25 (9-111) and 28 (8-114) months in surgery and non-surgery groups, respectively (p=0.797). Clinical-pathological T stage and node status were comparable. Clinical-pathological distal metastasis status was 15 and 26 M1 cases for surgery and nonsurgery, respectively (p=0.006). Incidence of postoperative complications and hospital mortality were 25.0% and 2.1%, respectively. The 2-year survival rates of M0 subgroups were 35.7% and 0% for surgery and nonesurgery, respectively (HR=3.98, p=0.022).

CONCLUSIONS

The safety of surgery for well-selected ≥ 80-year elderly gastric cancer patients was potentially acceptable and the patients of early or locally advanced diseases could obtain survival benefits by surgery.

[Application of multimodal analgesia in radical gastrectomy for gastric cancer patients: a prospective nonrandomized controlled study]

OBJECTIVE

To compare the postoperative analgesia efficacy, rehabilitation parameters and complication between multimodal analgesia and traditional analgesia after radical gastrectomy for gastric cancer patients.

METHODS

Patients with gastric cancer who underwent surgery in our hospital from October 2016 to December 2016 were enrolled in this prospective study. According to the non-randomized method, patients were assigned to multimodal analgesia group(n=32) and traditional analgesia group(n=33) in gastric cancer treatment team A and B in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. The treatment measures of group A were as follows: (1) The ratio of 1/1 diluted ropivacaine (100 mg, 10 ml) was infiltrated around the incision before abdomen closure, with incision sutured layer by layer. (2) Parecoxib sodium (40 mg) was injected intravenously every 12 hours after operation for 5 days. (3) Oxycodone-acetaminophen tablet was given orally on the first day or the second day after operation, 50 mg twice a day. (4) Patient-controlled analgesia was not used after operation. Patients in group B received direct suture of incision and patient-controlled analgesia. The pain score, postoperative rehabilitation and 30-day postoperative complications were collected and analyzed.

RESULTS

Multimodal analgesia group had lower pain scores at 1 d (4.8±0.9), 2 d (4.3±1.0), 3 d (2.9±0.8), 4 d (2.4±0.7) and 5 d (1.7±0.7) after surgery, as compared to traditional analgesia group (5.9±0.9, P=0.000), (5.1±0.7, P=0.001), (3.9±0.8, P=0.000), (3.0±0.6, P=0.000), (2.6±0.7, P=0.000), with significant difference. Postoperative hospital stay [(8.2±1.6) days vs. (10.6±2.2) days, P=0.000], time to ambulation [(47.5±13.8) days vs. (66.2±16.8) days, P=0.000], time to first flatus [(76.4±25.2) days vs. (120.0±29.9) days, P=0.000], time to first defecate [(117.3±42.2) days vs. (159.7±30.7) days, P=0.000] and time to first fluid diet [(83.8±21.6) days vs. (141.9±33.9) days, P=0.000] in the multimodal analgesia group were significantly shorter than those in the traditional analgesia group. There was no significant difference between the two groups with respect to 30-day postoperative complication rate(9.4% vs. 9.1%, P=1.000).

CONCLUSIONS

Multimodal analgesia can significantly reduce the postoperative pain and is beneficial to rehabilitation, meanwhile it does not increase the risk of postoperative complications. Multimodal analgesia is safe and effective for gastric cancer patients undergoing radical gastrectomy.

[Interpretation of Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2018 edition)]

The surgical treatment for adenocarcinoma of esophagogastric junction (AEG) involves thoracic and abdominal cavities. With no general consensus on the surgical treatment modality for AEG in China, the understanding and surgical practice of AEG are controversial between thoracic and gastrointestinal surgeons. Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2018 edition) was released in September 2018 by the Chinese expert panel including 19 thoracic surgeons and 20 gastrointestinal surgeons. The formulation and publication of this consensus has increased homogeneity of the understanding of the disease in different disciplines to a certain extent, and has facilitated standardized surgical treatment for adenocarcinoma of esophagogastric junction. The consensus was based on the best available clinical evidence and the latest national and international guidelines and consensus. Several rounds of discussion and voting were conducted. Finally, 27 statements on surgery-related recommendations and 9 issues requiring further investigation were reached in the consensus, which basically cover the fields and research hotspots of surgical treatment for adenocarcinoma of esophagogastric juncton. This review will explain in details the Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction.