1
|
Tuan NA, Van Du N. Assessment of diagnostic value of indocyanine green for lymph node metastasis in laparoscopic subtotal gastrectomy with D2 lymphadenectomy for gastric cancer: a prospective single-center study. J Gastrointest Surg 2024; 28:1078-1082. [PMID: 38705368 DOI: 10.1016/j.gassur.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/31/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Evaluation of diagnostic value for lymph node (LN) metastasis and LN identification using indocyanine green (ICG) fluorescence in laparoscopic subtotal gastrectomy for gastric cancer. METHODS A prospective study on 79 patients who underwent radical subtotal gastrectomy with the use of ICG-guided LN dissection. The sensitivity and specificity of the ICG fluorescence lymphography method in detecting metastatic LNs were evaluated. RESULTS A total of 79 patients underwent surgery. The number of LNs was retrieved: 2992 LNs, of which 2392 were fluorescent (79.9%) and 600 were nonfluorescent (20.1%). The average number of LNs dissected was 37.7 ± 11.8 LNs, and the average number of fluorescent LNs was 30.3 ± 11.1; the LN metastasis rates in the total LNs and in the ICG group were 6.79% and 7.34%, respectively. The median number of retrieved LNs in patients with LN metastases (37 [IQR, 33-47]) was higher than in patients without LN metastases (36 [IQR, 27-43]), (P = .348). The median number of fluorescent LNs was significantly higher in patients with LN metastases (32 [IQR, 26-44]) than in those without LN metastases (26 [IQR, 21-36]; P < .001). The sensitivity of ICG in metastasis detection was 75.86% (22 of 29 patients), with a false-negative rate of 24.14% (7 of 29 patients). For the identification of metastatic LNs, the sensitivity of ICG was 90.7%, with the specificity of 20.8%. The negative predictive value of nonfluorescent LNs was 97%. CONCLUSION ICG fluorescence lymphography-guided lymphadenectomy can clearly visualize the lymphatic system and the LNs alongside the tumor. The high sensitivity in detecting metastatic LNs and the high negative predictive value of a nonfluorescent LNs suggest that this is an effective method for clinically radical gastrectomy for gastric cancer.
Collapse
Affiliation(s)
- Nguyen Anh Tuan
- Department of Gastrointestinal Tract Surgery, 108 Military Central Hospital, Hai Ba Trung District, Hanoi, Vietnam
| | - Nguyen Van Du
- Department of Gastrointestinal Tract Surgery, 108 Military Central Hospital, Hai Ba Trung District, Hanoi, Vietnam.
| |
Collapse
|
2
|
Teh SH, Shiraga S, Kellem AM, Li RA, Le DM, Arsalane SP, Khayat FS, Li Y, Gong IY, Lee JM. A Path to High-Value Gastric Cancer Surgery Care Delivery. ANNALS OF SURGERY OPEN 2024; 5:e408. [PMID: 38911627 PMCID: PMC11192013 DOI: 10.1097/as9.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/26/2024] [Indexed: 06/25/2024] Open
Abstract
Objective To evaluate the feasibility, safety, and effectiveness of a comprehensive regional program, including the Minimally Invasive Recovery and Empowerment Care (MIREC) pathway, that can significantly reduce hospital stays after laparoscopic gastrectomy without increasing adverse events. Background Cost-effectiveness and improving patient outcomes are crucial in providing quality gastric cancer care worldwide. Methods To compare the outcomes of gastric cancer surgery using 2 different models of care within an integrated healthcare system from February 2012 to March 2023. The primary endpoint was the length of hospital stay. The secondary endpoints were the need for intensive care unit care, emergency room (ER) visits, readmission, reoperation, and death within 30 days after surgery. Results There were 553 patients, 167 in the pre-(February 2012-April 2016) and 386 in the post-MIREC period (May 2016-March 2023). Perioperative chemotherapy utilization increased from 31.7% to 76.4% (P < 0.0001). Laparoscopic gastrectomy increased from 17.4% to 97.7% (P < 0.0001). Length of hospitalization decreased from 7 to 2 days (P < 0.0001), with 32.1% and 88% of patients discharged home on postoperative day 1 and postoperative day 2, respectively. When comparing pre- and post-MIREC, intensive care unit utilization (10.8% vs. 2.9%, P < 0.0001), ER visits (34.7% vs. 19.7%, P = 0.0002), and readmission (18.6% vs. 11.1%, P = 0.019) at 30 days were also considerably lower. In addition, more patients received postoperative adjuvant chemotherapy (31.4% to 63.5%, P < 0.0001), and the time between gastrectomy and starting adjuvant chemotherapy was also less (49-41 days; P = 0.002). Conclusion This comprehensive regional program, which encompasses regionalization care, laparoscopic approach, modern oncologic care, surgical subspecialization, and the MIREC pathway, can potentially improve gastric cancer surgery outcomes. These benefits include reduced hospital stays and lower complication rates. As such, this program can revolutionize how gastric cancer surgery is delivered, leading to a higher quality of care and increased value to patients.
Collapse
Affiliation(s)
- Swee H. Teh
- From the The Permanente Medical Group, Gastric Cancer Surgery, Northern California, CA
| | - Sharon Shiraga
- From the The Permanente Medical Group, Gastric Cancer Surgery, Northern California, CA
| | - Aaron M. Kellem
- The Permanente Consulting and Information Technology Group, Northern California, CA
| | - Robert A. Li
- From the The Permanente Medical Group, Gastric Cancer Surgery, Northern California, CA
| | - David M. Le
- From the The Permanente Medical Group, Gastric Cancer Surgery, Northern California, CA
| | - Said P. Arsalane
- From the The Permanente Medical Group, Gastric Cancer Surgery, Northern California, CA
| | - Fawzi S. Khayat
- From the The Permanente Medical Group, Gastric Cancer Surgery, Northern California, CA
| | - Yan Li
- The Permanente Medical Group, Gastrointestinal Oncology, Northern California, CA
| | - I-Yeh Gong
- The Permanente Medical Group, Gastrointestinal Oncology, Northern California, CA
| | - Jessica M. Lee
- From the The Permanente Medical Group, Gastric Cancer Surgery, Northern California, CA
| |
Collapse
|
3
|
Sakurai K, Kubo N, Hasegawa T, Nishimura J, Iseki Y, Nishii T, Inoue T, Nishiguchi Y, Maeda K. The development of a risk assessment tool for patients with postoperative pneumonia after gastrectomy for gastric cancer. J Gastrointest Surg 2024; 28:359-364. [PMID: 38583884 DOI: 10.1016/j.gassur.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/12/2023] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Although frail patients are known to experience increased postoperative complications, this is unclear for postoperative pneumonia (POP). We investigated associations between frailty and POP in patients with gastric cancer (GC) undergoing gastrectomy. METHODS In this prospective study conducted between August 2016 and December 2022, we preoperatively assessed frailty in 341 patients with GC undergoing gastrectomy using a frailty index (FI). Patients were divided into high FI vs low FI groups to examine frailty and pneumonia rates after gastrectomy for GC. RESULTS Of 327 patients, 18 (5.5%) experienced POP after gastrectomy. Multivariate analyses showed that a high FI and total or proximal gastrectomy (TG/PG) were independent risk factors for POP (high FI: odds ratio [OR], 5.00; 95% CI, 1.77-15.54; TG/PG: OR, 3.07; 95% CI, 1.09-8.78). The proportion of patients with POP was 2.4% in those with nonhigh FI and non-TG/PG, 5.3% in those with nonhigh FI and TG/PG, 7.1% in those with high FI and non-TG/PG, and 28.0% in those with high FI and TG/PG (P < .001). The area under the receiver operating characteristic curve for this risk assessment for predicting POP was 0.740. CONCLUSION In patients with GC undergoing gastrectomy, POP was independently associated with preoperatively high FI and TG/PG. Our simple POP risk assessment method, which combines these factors, may effectively predict and prepare patients for POP.
Collapse
Affiliation(s)
- Katsunobu Sakurai
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan.
| | - Naoshi Kubo
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Tsuyoshi Hasegawa
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Junya Nishimura
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yasuhito Iseki
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takafumi Nishii
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toru Inoue
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yukio Nishiguchi
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University, Osaka, Japan
| |
Collapse
|
4
|
Kanda M, Tanaka C, Misawa K, Mochizuki Y, Watanabe T, Sueoka S, Ishiyama A, Yamada T, Oshima T, Hattori M, Koike S, Ishigure K, Teramoto H, Murotani K, Kodera Y. A multi-institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602). World J Surg 2024; 48:681-691. [PMID: 38340062 DOI: 10.1002/wjs.12088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Proximal gastrectomy (PG) has become an increasingly preferred procedure for treating early cancer in the upper third of the stomach. However, advantages of PG in postoperative quality of life (QOL) over total gastrectomy (TG) has not fully proven. METHODS We conducted a multi-institutional prospective observational study (CCOG1602) of patients who undergo TG or PG for cStage I gastric cancer. We used the PGSAS-37 and EORTC-QLQ-C30 to evaluate the changes in body weight and QOL over a 3-year postoperative period. The primary endpoint was the weight loss rate 3 years after surgery. RESULTS We enrolled 109 patients from 18 institutions and selected 65 and 19 patients for inclusion in the TG and PG groups, respectively. Mean postoperative weight loss rates were 16.0% and 11.7% for the TG and PG groups, respectively (p = 0.056, Cohen's d 0.656) during postoperative year 1% and 15.0% and 10.8% for TG and PG (p = 0.068, Cohen's d 0.543), respectively, during postoperative year 3, indicating that the PG group achieved a better trend with a moderate effect size. According to the PGSAS-37, the PG group experienced a better trend in the indigestion subscale (p < 0.001, Cohen's d -1.085) and total symptom score (p = 0.050, Cohen's d -0.59) during postoperative year 3 compared with the TG group. In contrast, the EORTC-QLQ-C30 detected no difference between the groups at any time point during 3-year postoperative period. CONCLUSIONS This prospective study demonstrates that PG tended to be more favorable compared with TG with respect to postoperative weight loss and QOL, particularly regarding indigestion.
Collapse
Affiliation(s)
- Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - Takuya Watanabe
- Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Satoshi Sueoka
- Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | | | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Masashi Hattori
- Department of Surgery, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Shinya Koike
- Department of Surgery, Atsumi Hospital, Tahara, Japan
| | | | - Hitoshi Teramoto
- Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Kenta Murotani
- Graduate School of Medicine, Biostatistics Center, Kurume University, Kurume, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
5
|
Ota M, Oki E, Hu Q, Nonaka K, Nambara S, Nakanishi R, Nakanoko T, Kimura Y, Yoshizumi T. Book-Binding Technique in Totally Laparoscopic Distal Gastrectomy with Billroth I Reconstruction: Clinical Results and Outcomes in 188 Patients with Gastric Cancer. J Am Coll Surg 2024; 238:166-171. [PMID: 38230999 DOI: 10.1097/xcs.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Laparoscopic gastrectomy is widely used as a curative treatment for gastric cancer. Although delta-shaped anastomosis is commonly used for Billroth I anastomosis after totally laparoscopic distal gastrectomy (TLDG), it has some drawbacks. The book-binding technique (BBT) was developed as an alternative, and this study aimed to examine its short-term results in 188 consecutive cases. STUDY DESIGN This retrospective study included patients who underwent BBT reconstruction after TLDG for gastric malignancy between 2011 and 2020. BBT is a technique for intracorporeal gastroduodenostomy, which is a triangular anastomosis with a linear stapler that does not require additional dissection or rotation of the duodenum. The short-term outcomes of BBT reconstruction and postoperative endoscopic findings were analyzed. RESULTS This study evaluated 188 patients who underwent TLDG and BBT reconstruction. Anastomotic stenosis and leakage occurred in 1.1% and 0.5% of the patients, respectively. The median time to the first diet was 3.1 days, and the median postoperative hospital stay was 11.9 days. BBT anastomoses were performed by 19 surgeons and took an average of 32.8 minutes to complete, with completion times decreasing as the surgical team became more proficient. On endoscopy performed 1 year postoperatively, 5.2% had reflux esophagitis (grade A or higher), 67.8% had gastritis (grade 1 or higher), 37.4% had residual food (grade 1 or higher), and 37.4% had bile reflux (grade 1). CONCLUSIONS BBT is a safe and feasible method for intracorporeal gastroduodenostomy in TLDG for patients with gastric malignancy and demonstrates good surgical outcomes.
Collapse
Affiliation(s)
- Mitsuhiko Ota
- From the Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Xu H, Wang L, Qian Y, He Z, Li F, Wang W, Li Z, Li Q, Zhang D, Yang L, Xu Z. Effectiveness of preserved vagal nerve in totally laparoscopy radical distal gastrectomy: a matched-paired cohort analysis. Surg Endosc 2023; 37:7538-7547. [PMID: 37433917 DOI: 10.1007/s00464-023-10254-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The aim of this retrospective matched-paired cohort study was to clarify the effectiveness of preserving the vagus nerve in totally laparoscopic radical distal gastrectomy (TLDG). METHODS One hundred eighty-three patients with gastric cancer who underwent TLDG between February 2020 and March 2022 were included and followed up. Sixty-one patients with preservation of the vagal nerve (VPG) in the same period were matched (1:2) to conventional sacrificed (CG) cases for demographics, tumor characteristics, and tumor node metastasis stage. The evaluated variables included intraoperative and postoperative indices, symptoms, nutritional status, and gallstone formation at 1 year after gastrectomy between the two groups. RESULTS Although the operation time was significantly increased in the VPG compared with the CG (198.0 ± 35.2 vs. 176.2 ± 35.2 min, P < 0.001), the mean time of gas passage in the VPG was significantly lower than that in the CG (68.1 ± 21.7 h vs. 75.4 ± 22.6 h, P = 0.038). The overall postoperative complication rate was similar between the two groups (P = 0.794). There was no statistically significant difference between the two groups hospital stay, total number of harvested lymph nodes, and mean number of examined lymph nodes at each station. During follow-up, the morbidity of gallstones or cholecystitis (8.2% vs. 20.5%, P = 0.036), chronic diarrhea (3.3% vs. 14.8%, P = 0.022), and constipation (4.9% vs. 16.4%, P = 0.032) were significantly lower in the VPG than in the CG in this study. Moreover, injury to the vagus nerve was found to be an independent risk factor for gallstone formation or cholecystitis and chronic diarrhea in univariate analysis and multivariate analysis. CONCLUSION The vagus nerve plays an imperative role in gastrointestinal motility, and hepatic and celiac branch preservation mainly exerts efficacy and safety in patients who undergo TLDG.
Collapse
Affiliation(s)
- Hao Xu
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Linjun Wang
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Yawei Qian
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Zhongyuan He
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Fengyuan Li
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Weizhi Wang
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Zheng Li
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Qingya Li
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Diancai Zhang
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Li Yang
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China
| | - Zekuan Xu
- Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People's Republic of China.
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
| |
Collapse
|
7
|
Effect of blood product transfusion on the prognosis of patients undergoing hepatectomy for hepatocellular carcinoma: a propensity score matching analysis. J Gastroenterol 2023; 58:171-181. [PMID: 36592217 DOI: 10.1007/s00535-022-01946-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hepatectomy, the most common treatment for hepatocellular carcinoma, is associated with greater intraoperative blood loss than is resection of other malignancies. The effect of blood product transfusion (red blood cell [RBC], platelet, fresh frozen plasma [FFP], 5 and 25% albumin) on prognosis remains unclear. This study examined effects of blood product transfusion on prognoses of patients who underwent hepatectomy for hepatocellular carcinoma. METHODS We included 2015 patients with pathologically confirmed hepatocellular carcinoma who underwent hepatectomy at our institution during 1990-2019. Patients (n = 534) who underwent repeat hepatectomy, non-curative hepatectomy, those with synchronous cancer in other organs, those who died within 1 month of surgery, and those with missing data were excluded. Finally, 1481 patients (1142 males, 339 females; median age: 68 years) with curability A or B were included. RESULTS Intraoperative blood loss (> 500 mL) was an independent predictor of RBC transfusion (odds ratio, 8.482; P < 0.001). All transfusion groups had poorer recurrence-free survival (RFS) and overall survival (OS) than non-transfusion groups. After propensity score matching, the 5 year RFS rate was 13.4 and 16.3% in the RBC and no-RBC groups, respectively (P = 0.020). The RBC group had a significantly lower 5 year OS rate than the no-RBC group (42.1 vs. 48.8%, respectively; P = 0.035) and the FFP group (57.0%) than the no-FFP group (63.9%) (p = 0.047). No significant between-subgroup differences were found for other blood transfusion types. CONCLUSIONS RBC transfusion promotes hepatocellular carcinoma recurrence and RBC/FFP transfusions reduced long-term survival and RFS and OS in patients who underwent radical liver resection of HCC.
Collapse
|
8
|
Iino I, Kikuchi H, Suzuki T, Kawabata T, Jindo O, Uno A, Fukazawa A, Matsumoto K, Ochiai H, Sakaguchi T, Takeuchi H, Konno H, Suzuki S. Comprehensive evaluation of three-dimensional anatomy of perigastric vessels using enhanced multidetector-row computed tomography. BMC Surg 2022; 22:403. [PMID: 36404317 PMCID: PMC9677658 DOI: 10.1186/s12893-022-01836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To perform laparoscopic gastrectomy safely, we aimed to comprehensively re-evaluate perigastric vessel anatomies using a three-dimensional angiography reconstructed from enhanced multidetector-row computed tomography data. METHODS Perigastric vessel anatomy was preoperatively analyzed using a multidetector-row computed tomography-based three-dimensional angiography reconstructed in 127 patients undergoing gastric surgery. RESULTS Of the 67 left gastric veins that ran along the dorsal side of the arteries, 59 (88.1%) ran along the dorsal side of the common hepatic artery and flowed into the portal vein. In 18 cases, a common trunk of one to three left gastric arteries and the replaced left hepatic artery was observed. The left inferior phrenic artery ramified from the left gastric artery in 5.5% of the cases. The right gastric artery was classified into distal (73.2%), caudal (18.1%), and proximal (8.7%) types. The infra-pyloric artery was also classified into distal (64.6%), caudal (26.0%), and proximal (9.4%) types. The posterior gastric artery branched as a common trunk with the superior polar artery in the proximal (37.9%) and distal (18.4%) regions of the splenic artery. The left gastroepiploic artery ramified from the splenic (18.1%) and inferior terminal arteries (81.9%). No, one, and two gastric branches of the left gastroepiploic artery, which ramified between the roots of the left gastroepiploic artery and its omental branch, were found in 36.5%, 49.2%, and 14.3% of the cases, respectively. CONCLUSIONS Preoperative 3D angiography is useful for the precise evaluation of perigastric vessel anatomies, and may help us to perform laparoscopic gastrectomy and robotic surgery safely.
Collapse
Affiliation(s)
- Ichirota Iino
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Hirotoshi Kikuchi
- grid.505613.40000 0000 8937 6696Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Toshiyuki Suzuki
- grid.414861.e0000 0004 0378 2386Department of Radiological Technology, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Toshiki Kawabata
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Osamu Jindo
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Akihiro Uno
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Atsuko Fukazawa
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Keigo Matsumoto
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Hideto Ochiai
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Takanori Sakaguchi
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan ,grid.505613.40000 0000 8937 6696Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Hiroya Takeuchi
- grid.505613.40000 0000 8937 6696Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Hiroyuki Konno
- grid.505613.40000 0000 8937 6696Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Shohachi Suzuki
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| |
Collapse
|
9
|
Kurokawa Y, Kawase T, Takeno A, Furukawa H, Yoshioka R, Saito T, Takahashi T, Shimokawa T, Eguchi H, Doki Y. Phase 2 trial of neoadjuvant docetaxel, oxaliplatin, and S‐1 for clinical stage
III
gastric or esophagogastric junction adenocarcinoma. Ann Gastroenterol Surg 2022; 7:247-254. [PMID: 36998295 PMCID: PMC10043771 DOI: 10.1002/ags3.12632] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/05/2022] [Indexed: 04/01/2023] Open
Abstract
Background Although perioperative treatment has been the standard of care for resectable gastric cancer in the West, postoperative adjuvant chemotherapy is still the standard in Japan. We conducted the first phase 2 trial to investigate the efficacy and safety of neoadjuvant docetaxel, oxaliplatin, and S-1 (DOS) chemotherapy for cStage III gastric or esophagogastric junction (EGJ) adenocarcinoma in Japan. Methods Eligibility criteria included cStage III adenocarcinoma of the stomach or EGJ. Patients received docetaxel (40 mg/m2, day 1), oxaliplatin (100 mg/m2, day 1), or S-1 (80 mg/m2, days 1-14) during a 3-week cycle. After two or three cycles of DOS, patients underwent surgical resection. The primary endpoint was progression-free survival (PFS). Results Between June 2015 and March 2019, 50 patients were enrolled from four institutions. Of 48 eligible patients (37 gastric and 11 EGJ adenocarcinoma), 42 (88%) completed two or three DOS cycles. Grade 3-4 neutropenia and diarrhea occurred in 69% and 19% of patients, respectively, but there were no treatment-related deaths. R0 resection was achieved in 44 (92%) patients, and the pathological response rate (≥ grade 1b) was 63% (30/48). The 3-year PFS, overall survival, and disease-specific survival rates were 54.2%, 68.7%, and 75.8%, respectively. Conclusion Neoadjuvant DOS chemotherapy had a sufficient antitumor effect and tolerable safety profile in patients with gastric or EGJ adenocarcinoma. The survival benefit of a neoadjuvant strategy using our DOS regimen should be validated in phase 3 trials.
Collapse
Affiliation(s)
- Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Tomono Kawase
- Department of SurgeryToyonaka Municipal HospitalOsakaJapan
| | - Atsushi Takeno
- Department of SurgeryKansai Rosai HospitalAmagasakiJapan
| | | | - Ryo Yoshioka
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Takuro Saito
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Toshio Shimokawa
- Clinical Study Support CenterWakayama Medical University HospitalWakayamaJapan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| |
Collapse
|
10
|
Kuroda K, Sakurai K, Kunimoto T, Kubo N, Hasegawa T, Inoue T. Ingenuity and tips for laparoscopic local resection for local recurrence of early gastric cancer after endoscopic submucosal dissection: A case report. Int J Surg Case Rep 2022; 99:107650. [PMID: 36115119 PMCID: PMC9568766 DOI: 10.1016/j.ijscr.2022.107650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE The presence of severe comorbidities is associated with poor surgical outcomes in patients who undergo curative resection for gastric cancer. Herein, we present a report of laparoscopic local resection (LLR) for the local recurrence of gastric cancer in a patient with severe comorbidities. CASE PRESENTATION A 73-year-old man underwent endoscopic submucosal dissection (ESD) for an early gastric cancer located at the greater curvature of the gastric antrum. One year after the ESD, follow-up gastroscopy revealed a local recurrence. CLINICAL DISCUSSION LLR was performed owing to severe comorbidities such as chronic heart failure, severe chronic obstructive pulmonary disease, and diabetes mellitus. We confirmed the location of the tumor with an endoscope, and full-thickness stitches were placed outside the tumor to prevent displacement between the submucosal and serosal muscular layers. Full-thickness resection of the stomach wall was performed along the stitch points using an ultrasonic shear. The edge of the resection line was closed using a laparoscopic stapling system. The patient had an uneventful postoperative course and was discharged 8 days after the operation. The patient had no disease recurrence and late complications such as digestive symptom and weight loss at the 9-month follow-up after the operation. CONCLUSION LLR might be a suitable treatment option for high-risk patients with gastric cancer. During full-thickness resection of the stomach wall, our method enables the maintenance of a negative margin without the need for ESD.
Collapse
Affiliation(s)
- Kenji Kuroda
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan.
| | - Katsunobu Sakurai
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | | | - Naoshi Kubo
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Tsuyoshi Hasegawa
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Toru Inoue
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| |
Collapse
|
11
|
Unasa H, Hutchinson A, DeSouza S, Poole L, Knudsen C, Hill A, MacCormick AD. Identifying data‐fields for a gastrointestinal cancer clinical quality and safety registry: a systematic literature review. ANZ J Surg 2022; 92:2881-2888. [DOI: 10.1111/ans.17984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/05/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Hanson Unasa
- Department of Surgery University of Auckland Auckland New Zealand
| | | | - Steve DeSouza
- Department of Surgery University of Auckland Auckland New Zealand
| | - Lydia Poole
- Department of Surgery University of Auckland Auckland New Zealand
| | - Caroline Knudsen
- Department of Surgery University of Auckland Auckland New Zealand
| | - Andrew Hill
- Department of Surgery University of Auckland Auckland New Zealand
| | | |
Collapse
|
12
|
YAMAUCHI SUGURU, ANDO YUJI, KAJI SANAE, JUN CHEN, EGAWA HIROKI, YOSHIMOTO YUTARO, KUBOTA AKIRA, YUBE YUKINORI, ORITA HAJIME, FUKUNAGA TETSU. Postoperative Pyoderma Gangrenosum in a Laparoscopic Gastrectomy Port Site: A Case Report. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:521-525. [PMID: 39081583 PMCID: PMC11284291 DOI: 10.14789/jmj.jmj22-0017-cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/09/2022] [Indexed: 08/02/2024]
Abstract
Background Postoperative pyoderma gangrenosum (PPG) is a rare inflammatory skin disease of unknown etiology characterized by blistering and ulcerative lesions in postoperative wounds. Untreated pyoderma gangrenosum (PG) is potentially life-threatening; therefore, immediate and appropriate treatment is essential. Although PPG and surgical site infection (SSI) present similar clinical findings, they should be differentiated because of their conflicting treatment modalities. Case presentation An 82-year-old man with comorbidities of pulmonary tuberculosis, chronic obstructive pulmonary disease, and diabetes underwent laparoscopic gastrectomy for gastric cancer. On postoperative day 6, fever exceeding 39°C, port wound redness, and pain was observed. Laboratory tests revealed severe inflammatory reactions: white blood cell, 42,800/μL and C-reactive protein, 30.2 mg/mL. The patient was diagnosed with SSI and treatment with antibiotics and drainage was started; however, his general and wound conditions also worsened. Therefore, he was diagnosed with PG because painful skin findings were exacerbated by external stimuli and no significant bacteria were detected in the culture test. Treatment with oral prednisolone was started, which significantly improved his skin and inflammatory conditions. Conclusion We managed a rare case of PPG that occurred in a port wound after laparoscopic gastrectomy. If atypical clinical findings of postoperative SSI are observed, general surgeons should recognize and consider PPG as a differential diagnosis.
Collapse
Affiliation(s)
- SUGURU YAMAUCHI
- Corresponding author: Suguru Yamauchi, Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan, TEL: +81-3-3813-3111 FAX: +81-3-5802-1557 E-mail:
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Quantitative Comparison of Surgical Device Usage in Laparoscopic Gastrectomy Between Surgeons' Skill Levels: an Automated Analysis Using a Neural Network. J Gastrointest Surg 2022; 26:1006-1014. [PMID: 34755310 DOI: 10.1007/s11605-021-05161-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Whether surgical device usage in laparoscopic gastrectomy differs with respect to operator's skill levels is unknown. Further, device usage analysis using artificial intelligence has not been reported to date. Herein, we compared the patterns of surgical device usage during laparoscopic gastrectomy for gastric cancer among surgeons at different skill levels. The data of device usage was acquired from laparoscopic video recordings using an automated surgical-instrument detection system. METHODS In total, 100 video recordings of infrapyloric lymphadenectomy and 33 of D2 suprapancreatic lymphadenectomy during laparoscopic gastrectomy for gastric cancer were analyzed in this retrospective study. The system's accuracy was evaluated by comparing the automatic and the manual usage time. Surgical device usage patterns were compared between qualified and nonqualified surgeons of The Japan Society for Endoscopic Surgery Endoscopic Surgical Skill Qualification System. RESULTS For every device, the automatic detection time and manual detection time were consistent with each other. In infrapyloric lymphadenectomy, the usage time proportions of dissector forceps and clip applier were higher among nonqualified operators than among qualified operators (dissector, 5.1% vs. 2.3%, P < 0.001; clip applier, 1.6% vs. 1.3%, P < 0.01). In suprapancreatic lymphadenectomy, the usage time proportions of energy devices, clip applier, and grasper forceps were significantly different (energy devices, 59.6% vs. 50.6%, P < 0.001; clip applier, 1.4% vs. 0.9%, P < 0.001; only grasper forceps; 18.3% vs. 27.9%, P = 0.022). CONCLUSIONS Quantitative analysis of laparoscopic device usage using the automated surgical device detection system showed that the patterns of device usage during laparoscopic gastrectomy differed depending on surgeons' skill levels. These differences could suggest how the qualified and nonqualified surgeons performed the procedures.
Collapse
|
14
|
AL-Magedi AA, Wu R, Tao Q. Comparison of postoperative pancreatic fistula between open and laparoscopic surgery in patients with gastric cancer: A meta-analysis. Ann Med Surg (Lond) 2022; 76:103558. [PMID: 35495375 PMCID: PMC9052230 DOI: 10.1016/j.amsu.2022.103558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Open gastrectomy"OG" compared with laparoscopic gastrectomy"LG" in patients with gastric cancer"GC" has been widely discussed over the past years. However, the lack of comparative analysis in postoperative pancreatic fistula "POPF" hinders its severity as surgical procedures developed rapidly. Therefore, there are still moot on whether one of these surgical options is superior in POPF. Objective To compare the incidence of POPF in patients undergoing OG and LG for gastric cancer "GC". Methods Articles from January 2011 to August 2021 that compared LG and OG for GC were reviewed. Cohort studies were included in our study. The quality of enrolled studies was evaluated. Outcomes regarding POPF complication and relative operation results were analyzed. Statistical analysis portrayed the Weighted mean difference"WMD"and the odds ratio"OR"with a 95% confidence interval "CI". The curative effect was analyzed using RevMan 5.4.1 software. Results Totally 7 articles met the inclusion criteria, including 3194 patients with treatment of gastrectomy surgeries for gastric cancer "GC". There was no significant difference observed in POPF incidence (OR, 95% CI = 1.04 [0.74,1.46], P = 0.81) between OG group and LG group in patients undergoing GC gastrectomy. Conclusion We stringently explored the current incidence of POPF after GC gastrectomy, comparing its incidence during LG and OG, there was no significant difference between OG and LG in the incidence of POPF, and surgeons should give more concern for improvement in surgical techniques. Further research is still needed to explore the risk of causes and surgical techniques should be considered cautiously in a clinical procedure.
Collapse
Key Words
- CI, Confidence interval
- GC, Gastric cancer
- Gastric cancer
- HR, Hazard ratio
- LG, Laparoscopic gastrectomy
- LN, Lymph nodes
- Laparoscopic gastrectomy
- MD, Mean difference
- OG, Open gastrectomy
- OR, odds ratio
- Open gastrectomy
- POPF, Postoperative Pancreatic Fistula
- PSM, Propensity score matching
- Postoperative complication
- Postoperative pancreatic fistula
- RCT, Randomized controlled trials
- WMD, Weighted mean difference
Collapse
Affiliation(s)
- Ahmed A.S. AL-Magedi
- Department of General Surgery, Affiliated Zhongda Hospital, School of Medicine, Southeast University, No. 87 dingjiaqiao, Nanjing, Jiangsu 210093, China
| | - Rong Wu
- Department of General Surgery, Affiliated Zhongda Hospital, School of Medicine, Southeast University, No. 87 dingjiaqiao, Nanjing, Jiangsu 210093, China
| | - Qingsong Tao
- Department of General Surgery, Affiliated Zhongda Hospital, School of Medicine, Southeast University, No. 87 dingjiaqiao, Nanjing, Jiangsu 210093, China
| |
Collapse
|
15
|
Reply to: Letter to the Editor “Suprapancreatic nodal dissection should not be uniformly selected in additional gastrectomy for the patients diagnosed as pT1b gastric cancer by endoscopic resection”. Eur J Surg Oncol 2022; 48:1867-1868. [DOI: 10.1016/j.ejso.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 11/23/2022] Open
|
16
|
Otsuka R, Hayashi H, Uesato M, Hayano K, Murakami K, Kano M, Toyozumi T, Suito H, Matsumoto Y, Isozaki T, Kurata Y, Matsubara H. Comparison of estimated treatment effects between randomized controlled trials, case-matched, and cohort studies on laparoscopic versus open distal gastrectomy for advanced gastric cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 2022; 407:1381-1397. [PMID: 35113227 DOI: 10.1007/s00423-022-02454-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/24/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE In actual surgical research, case-matched studies are frequently conducted as an alternative to randomized controlled trials (RCTs). However, it is still unclear what differences there are between RCTs and case-matched studies in upper gastrointestinal surgery, and clarifying them is a very important clinical issue. Thus, the purpose of this study was to investigate estimated treatment effects between RCTs, case-matched studies, and cohort studies regarding laparoscopic distal gastrectomy (LDG) for advanced gastric cancer (AGC). METHODS We searched the PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases for studies that compared LDG versus open distal gastrectomy for AGC published from the inception of the databases until July 2021. A meta-analysis was performed using the Review Manager version 5.3 software program from the Cochrane Collaboration, and six short-term outcomes and three long-term outcomes were assessed. RESULTS Twenty-three studies with 13698 patients were included. There was no difference in estimated treatment effects between RCTs and case-matched studies for all outcomes except for the number of retrieved lymph nodes and postoperative complications. In terms of intraoperative blood loss, postoperative hospital stay, number of retrieved lymph nodes, and recurrence, observational studies tended to overestimate the treatment effects. CONCLUSION The estimated treatment effects of LDG for AGC in the case-matched study were almost the same as in the RCTs. However, to assess the true magnitude of the treatment effect, the design and actual implementation of the analysis must be critically evaluated.
Collapse
Affiliation(s)
- Ryota Otsuka
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
| | - Hideki Hayashi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Masayuki Kano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Hiroshi Suito
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Tetsuro Isozaki
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Yoshihiro Kurata
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| |
Collapse
|
17
|
Wu J, Tang Z, Zhao G, Zang L, Li Z, Zang W, Li Z, Qu J, Yan S, Zheng C, Ji G, Zhu L, Zhao Y, Zhang J, Huang H, Hao Y, Fan L, Xu H, Li Y, Yang L, Song W, Zhu J, Zhang W, Li M, Qin X, Liu F. Incidence and risk factors for postoperative pancreatic fistula in 2089 patients treated by radical gastrectomy: A prospective multicenter cohort study in China. Int J Surg 2022; 98:106219. [PMID: 34990829 DOI: 10.1016/j.ijsu.2021.106219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) following radical gastrectomy and to identify independent risk factors of CR-POPF. BACKGROUND CR-POPF and its sequelae are potential complications following radical gastrectomy. The reported incidence of CR-POPF was quite different across various regions, and no consensus was reached. METHODS Between December 2017 to November 2018, patients who underwent radical gastrectomy from 22 centers across 13 regions in China were prospectively recruited. The primary endpoint was the occurrence of CR-POPF, defined by the International Study Group of Pancreatic Fistula (ISGPF) in 2016. Clinically relevant change and short-term outcomes were recorded to diagnose and grade the POPF. Multivariate regression analyses were performed to identify independent risk factors of clinically relevant postoperative pancreatic fistula (CR-POPF). RESULTS A total of 2089 cases were analyzed. The incidence of biochemical leakage (BL) and CR-POPF were 19.6% and 1.1% respectively. All CR-POPF patients recovered well after appropriate treatment and no Grade C POPF were recorded. Logistic regression analysis showed pTNM III (OR, 2.940; 95% CI 1.180-7.325; P = 0.021) and LigaSure usage (OR, 6.618; 95% CI 1.847-23.707; P = 0.004) were independent risk factors of CR-POPF. LigaSure usage (OR, 4.817; 95% CI 1.184-19.598; P = 0.028), the drain amylase content (D-AMY) on postoperative day 3 (POD3) ≥5 times the upper limit of normal amylase (OR, 3.476; 95% CI 1.240-9.744; P = 0.018) and open surgery (OR, 2.463; 95% CI 1.003-6.050; P = 0.049) were independent predictors for identifying CR-POPF from BL. CONCLUSION In rich-experienced gastric cancer centers, there is high prevalence of BL secondary to radical gastrectomy without clinical impact. Fewer patients suffered Grade B POPF, and Grade C POPF was less common. The patients with pTNM III or LigaSure usage were prone to suffer CR-POPF. Surgery procedure, LigaSure usage combined with D-AMY measurement on POD3 are promising for early identification of CR-POPF.
Collapse
Affiliation(s)
- Jianzhang Wu
- Zhongshan Hospital, Department of General Surgery, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200217, China Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China The First Ward of Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing Institute for Cancer Research, Beijing, 100142, China Department of Gastrointestinal Oncology Surgery, Fujian Provincial Cancer Hospital, Fuzhou, 350011, China Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China Department of Oncology Surgery, Weifang People' s Hospital, Weifang, 261000, Shandong Province, China Department of Gastrointestinal Oncology Surgery, The Affiliated Hospital of Qinghai University, Xining, 810001, China Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China Department of General Surgery, The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China Department of Gastrointestinal Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China Department of Vascular Surgery, The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China Department of General Surgery, The First Affiliated Hospital of Xi' an Jiaotong University, Xi'an, 710061, China Department of General Surgery, Lishui Municipal Central Hospital, Lishui, 323000, Zhejiang Province, China Department of General Surgery, Guangdong Provincial People's Hospital, Guangzhou, 510000, China Department of General Surgery, Jiangsu Province Hospital, Nanjing, 210029, China Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, 130022, China Department of General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Suda K, Yamamoto H, Nishigori T, Obama K, Yoda Y, Hikage M, Shibasaki S, Tanaka T, Kakeji Y, Inomata M, Kitagawa Y, Miyata H, Terashima M, Noshiro H, Uyama I. Safe implementation of robotic gastrectomy for gastric cancer under the requirements for universal health insurance coverage: a retrospective cohort study using a nationwide registry database in Japan. Gastric Cancer 2022; 25:438-449. [PMID: 34637042 PMCID: PMC8505217 DOI: 10.1007/s10120-021-01257-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Robotic gastrectomy (RG) has increased since being covered by universal health insurance in 2018. However, to ensure patient safety the operating surgeon and facility must meet specific requirements. We aimed to determine whether RG has been safely implemented under the requirements for universal health insurance in Japan. METHODS Data of consecutive patients with primary gastric cancer who underwent minimally invasive total or distal gastrectomy-performed by a surgeon certified by the Japan Society for Endoscopic Surgery (JSES) endoscopic surgical skill qualification system (ESSQS) between October 2018 and December 2019-were extracted from the gastrointestinal surgery section of the National Clinical Database (NCD). The primary outcome was morbidity over Clavien-Dindo classification grade IIIa. Patient demographics and hospital volume were matched between RG and laparoscopic gastrectomy (LG) using propensity score-matched analysis (PSM), and the short-term outcomes of RG and LG were compared. RESULTS After PSM, 2671 patients who underwent RG and 2671 who underwent LG were retrieved (from a total of 9881), and the standardized difference of all the confounding factors reduced to 0.07 or less. Morbidity rates did not differ between the RG and LG patients (RG, 4.9% vs. LG, 3.9%; p = 0.084). No difference was observed in 30-day mortality (RG, 0.2% vs. LG, 0.1%; p = 0.754). The reoperation rate was greater following RG (RG, 2.2% vs. LG, 1.2%; p = 0.004); however, the duration of postoperative hospitalization was shorter (RG, 10 [8-13] days vs. LG, 11 [9-14] days; p < 0.001). CONCLUSIONS Insurance-covered RG has been safely implemented nationwide.
Collapse
Affiliation(s)
- Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Japan.
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukie Yoda
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Makoto Hikage
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tsuyoshi Tanaka
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Masafumi Inomata
- Academic Committee, The Japan Society for Endoscopic Surgery, Tokyo, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Ichiro Uyama
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| |
Collapse
|
19
|
Hoshino N, Endo H, Hida K, Kumamaru H, Hasegawa H, Ishigame T, Kitagawa Y, Kakeji Y, Miyata H, Sakai Y. Laparoscopic Surgery for Acute Diffuse Peritonitis Due to Gastrointestinal Perforation: A Nationwide Epidemiologic Study Using the National Clinical Database. Ann Gastroenterol Surg 2021; 6:430-444. [PMID: 35634193 PMCID: PMC9130886 DOI: 10.1002/ags3.12533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nobuaki Hoshino
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Hideki Endo
- Department of Healthcare Quality Assessment Tokyo University Graduate School of Medicine Tokyo Japan
| | - Koya Hida
- Department of Surgery Kyoto University Graduate School of Medicine Kyoto Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment Tokyo University Graduate School of Medicine Tokyo Japan
| | - Hiroshi Hasegawa
- Project Management Subcommittee The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Teruhide Ishigame
- Project Management Subcommittee The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Yoshihiro Kakeji
- Database Committee The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment Tokyo University Graduate School of Medicine Tokyo Japan
| | | |
Collapse
|
20
|
Itamoto K, Hikage M, Fujiya K, Kamiya S, Tanizawa Y, Bando E, Terashima M. The impact of pancreas compression time during minimally invasive gastrectomy on the postoperative complications in gastric cancer. Ann Gastroenterol Surg 2021; 5:785-793. [PMID: 34755010 PMCID: PMC8560619 DOI: 10.1002/ags3.12488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
AIM Pancreas compression during minimally invasive gastrectomy causes blunt injury to the pancreas and leads to postoperative complications. However, the extent of practical compression associated with the incidence of postoperative complications remains unknown. This study aimed to evaluate the impact of pancreas compression, particularly the duration of compression, on short-term outcomes in minimally invasive gastrectomy for gastric cancer. METHODS This study included 178 patients who underwent laparoscopic or robotic gastrectomy at the Shizuoka Cancer Center in 2018. The total time of pancreas compression during gastrectomy was measured using video-reviews, and the correlation between the time and surgical outcomes was evaluated. RESULTS A duration of 3 min was selected as the cutoff value of pancreas compression time to predict high drain amylase concentration on postoperative day 1 (≥1000 U/L). The incidence of clinically relevant pancreatic fistula (1.5% vs 12.4%, P = .011) and all postoperative complications (12.3% vs 30.1%, P = .010) were significantly higher in the longer-compression group than in the shorter-compression group. The multivariable analysis identified longer compression as the only independent risk factor for postoperative complications. CONCLUSION More than a few minutes of pancreas compression during minimally invasive gastrectomy was associated with a higher incidence of postoperative complications.
Collapse
Affiliation(s)
- Kota Itamoto
- Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Makoto Hikage
- Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Keiichi Fujiya
- Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Satoshi Kamiya
- Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Yutaka Tanizawa
- Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Etsuro Bando
- Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan
| | | |
Collapse
|
21
|
Takahashi T, Nishiura H. Increasing rates of laparoscopic gastrointestinal surgery and decreasing rates of surgical site infections: an observational study in Japan from 2012-2017. BMC Surg 2021; 21:370. [PMID: 34670525 PMCID: PMC8527652 DOI: 10.1186/s12893-021-01373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical site infections (SSI) are the most common healthcare-associated infection, and gastrointestinal surgery is frequently followed by a high incidence of SSI. Epidemiological analysis of the temporal trends in SSI following gastrointestinal surgery has yet to be performed in Japan. Our purpose was to descriptively investigate these trends. METHODS Extracting national surveillance data from the Japan Nosocomial Infections Surveillance (JANIS) system, we analyzed the frequency of SSI events following gastrointestinal surgery, which consisted of seven surgical procedures, from 2012-2017. We calculated the standardized infection ratio to compute risk-adjusted SSI frequency, and used the trend test to detect time-dependent changes. RESULTS The frequency of SSI events, except for those associated with surgery of the upper gastrointestinal tract, revealed a decreasing time-dependent trend. The use of laparoscopic surgery increased dramatically over time (p < 0.01 for the six applicable surgical sites), while the frequency of SSI events during laparoscopic surgery remained unchanged. CONCLUSIONS The increasing use of laparoscopic surgery was identified, and the observation coincided with the decreasing trend in SSI, especially in lower gastrointestinal tract surgery. If the relationship is causal, the overall SSI incidence among previously healthy individuals is expected to decrease, because the use of laparoscopic surgery has large growth potential in Japan.
Collapse
Affiliation(s)
- Tomoko Takahashi
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8638, Japan.,Infection Control Team, Sapporo Kousei Hospital, Kita3-Higashi8, Chuo-Ku, Sapporo, Hokkaido, 060-0033, Japan
| | - Hiroshi Nishiura
- Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Kita-ku, Sapporo-shi, Hokkaido, 060-8638, Japan. .,Kyoto University School of Public Health, Yoshida-konoecho, Sakyoku, Kyoto, 606-8501, Japan.
| |
Collapse
|
22
|
Maemoto R, Noda H, Ichida K, Tamaki S, Kanemitsu R, Machida E, Kikuchi N, Sakio R, Aizawa H, Fukui T, Kakizawa N, Muto Y, Iseki M, Fukuda R, Watanabe F, Kato T, Saito M, Tsujinaka S, Miyakura Y, Rikiyama T. Superiority trial comparing intraoperative wound irrigation with aqueous 10% povidone-iodine to saline for the purpose of reducing surgical site infection after elective gastrointestinal surgery: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e051374. [PMID: 34135056 PMCID: PMC8211046 DOI: 10.1136/bmjopen-2021-051374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is one of the most common complications after gastrointestinal surgery, with a reported incidence of approximately 10%-25%, which is higher than the rates after other types of surgery. Intraoperative wound irrigation (IOWI) is a simple intervention for SSI prevention, and recent studies have reported that IOWI with aqueous povidone-iodine (PVP-I) is significantly more effective at reducing the incidence of SSI than saline. However, the evidence level of previous trials evaluating the efficacy of aqueous PVP-I solution for preventing SSI has been low. METHODS AND ANALYSES We propose a single-institute, prospective, randomised, blinded-endpoint trial to assess the superiority of IOWI with aqueous 10% PVP-I solution compared with normal saline for reducing SSI in clean-contaminated wounds after elective gastrointestinal surgery. In the study group, IOWI with 40 mL of aqueous 10% PVP-I solution is performed for 1 min before skin suture, and in the control group, IOWI with 100 mL of saline is performed for 1 min before skin suture. We hypothesise that IOWI with aqueous 10% PVP-I solution will achieve a 50% reduction in the incidence of SSIs. The target number of cases is set at 950. The primary outcome is the incidence of incisional SSI up to postoperative day 30 and will be analysed in the modified intention-to-treat set. ETHICS AND DISSEMINATION This trial was designed and is being conducted by Saitama Medical Center, Jichi Medical University, with approval from the Bioethics Committee for Clinical Research, Saitama Medical Center, Jichi Medical University. Participant recruitment began in June 2019. The final results will be reported in international peer-reviewed journals immediately after trial completion. TRIAL REGISTRATION NUMBER UMIN000036889.
Collapse
Affiliation(s)
- Ryo Maemoto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sawako Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rina Kanemitsu
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Erika Machida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Nozomi Kikuchi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryotaro Sakio
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidetoshi Aizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Nao Kakizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masahiro Iseki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rintaro Fukuda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takaharu Kato
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaaki Saito
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| |
Collapse
|
23
|
Advantages of Laparoscopic Surgery for Gastric Cancer in Elderly Patients Aged Over 80 Years: A Propensity Score Matching Analysis. World J Surg 2021; 45:2830-2839. [PMID: 34019135 DOI: 10.1007/s00268-021-06157-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The short- and long-term efficacy of laparoscopic surgery for elderly patients with gastric cancer has not been evaluated. We aimed to use propensity score matching to clarify the efficacy of laparoscopic gastrectomy (LG) for elderly patients with gastric cancer aged ≥80 years. METHODS We retrospectively collected data from 159 consecutive patients with gastric cancer aged ≥80 years who underwent gastrectomy with curative intent at our institution between 2004 and 2015. Propensity score matching was applied to compare the open gastrectomy (OG) and LG. Short- and long-term outcomes were evaluated between the propensity-matched groups. RESULTS Patients' backgrounds and surgical factors were similar in both groups except for blood loss. The median time to first flatus was significantly shorter in the LG group than in the OG group (P = 0.002). The postoperative hospital stay was significantly shorter in the LG group (P = 0.014). The complication rate of Clavien-Dindo grade III or higher was significantly lower in the LG group (3% vs. 23%, P = 0.023). The 5-year overall survival and 5-year disease-specific survival rates were better in the LG group than in the OG group, but the differences were not significant (45% vs. 42% and 67% vs 57%, respectively). CONCLUSION LG was associated with good short-term outcomes and acceptable oncologic outcomes compared with OG in these propensity-matched patients aged ≥80 years.
Collapse
|
24
|
Terashima M. The 140 years' journey of gastric cancer surgery: From the two hands of Billroth to the multiple hands of the robot. Ann Gastroenterol Surg 2021; 5:270-277. [PMID: 34095716 PMCID: PMC8164465 DOI: 10.1002/ags3.12442] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/18/2022] Open
Abstract
After the initial achievement by Billroth in 1881, surgery for gastric cancer has become increasingly extended. However, it turned out to be limited in Western countries after the publication that denied the role of extended surgery in the 1960s. While surgeons in Japan were still enthusiastic about extended surgery, the Japan Clinical Oncology Group (JCOG) conducted clinical trials to validate the role of extended surgery. Contrary to expectations, the efficacy of extended surgery was not demonstrated. In gastric cancer surgery, postoperative complications were reported to be associated with poor survival. A survival benefit could not be obtained by extended surgery, with high morbidity. Therefore, the paradigm had been changed from extended surgery to minimally invasive surgery (MIS). As an MIS for gastric cancer, laparoscopic surgery has been considered a practical method. Initial laparoscopic gastrectomy (LG) was first performed by Kitano in 1991. Thereafter, LG became increasingly common. Several clinical trials demonstrated the noninferiority of LG to open gastrectomy. LG is now regarded as the standard for cStage I gastric cancer, and the indication is expanding to advanced cancer. However, LG has some drawbacks owing to the restriction of movement caused by straight-shaped forceps. Robotic gastrectomy (RG) is considered a major breakthrough to circumvent the drawbacks in LG using articulated devices. However, the solid evidence demonstrating the advantage of RG has not been proved yet. The JCOG is now conducting a randomized controlled trial to evaluate the superiority of RG to LG in terms of reducing morbidity.
Collapse
|
25
|
Impact of chronic kidney disease on the short- and long-term outcomes of laparoscopic gastrectomy for gastric cancer patients. PLoS One 2021; 16:e0250997. [PMID: 33930090 PMCID: PMC8087092 DOI: 10.1371/journal.pone.0250997] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/18/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUNDS This study was undertaken to investigate the impact of coexisting chronic kidney disease (CKD) on short- and long-term outcomes of laparoscopic gastrectomy in patients with gastric cancer (GC). METHODS We reviewed the data of 798 patients treated for GC by laparoscopic gastrectomy. All procedures took place between January 2010 and December 2017. Patients were divided into three groups according to their estimated glomerular filtration rate (eGFR): severe CKD group, 44 patients with eGFR < 45 mL/min/1.73 m2; moderate CKD group, 117 patients with 45 ≤ eGFR < 60; control group, 637 patients with eGFR ≥ 60. RESULTS Based on multivariate analysis, severe CKD (eGFR < 45) emerged as an independent predictor of anastomotic leak (Hazard ratio 4.63, 95% confidence interval [CI] 1.62-11.54). The 5-year overall survival (OS) rates by group were 46.3% (severe CKD), 76.6% (moderate CKD), and 81.5% (control). Multivariate analysis likewise identified severe CKD (eGFR < 45) as an independent correlate of poor 5-year OS. The 5-year cancer-specific survival (CSS) rates did not differ significantly by group. CONCLUSIONS An eGFR value less than 45 mL/min/1.73 m2 is a useful factor for predicting both anastomotic leak and 5-year OS in GC patients undergoing laparoscopic gastrectomy. Clinical care to improve eGFR should be reinforced before and after gastrectomy for GC patients with severe CKD.
Collapse
|
26
|
Abstract
BACKGROUND The aim of this study was to systematically review the current evidence on laparoscopic and robotic distal and total gastrectomy in comparison to open surgery. MATERIAL AND METHODS A systematic search of EMBASE and PubMed was conducted and 197 randomized (RCT) and non-randomized (non-RCT) studies were identified. An evaluation of early gastric cancer (EGC) and advanced (AGC) gastric cancer was carried out. RESULTS For EGC and laparoscopic distal resection (LDG) and total gastrectomy (LTG) a total of 10 RCT and 6 non-RCT, including 4329 patients (laparoscopic 2010 vs. open 2319) were identified. At a high evidence level (1+, 1++) there was no significant difference in terms of feasibility, intraoperative outcome and oncological quality, mortality and long-term oncological outcome compared to open gastrectomy (OG). After LDG and LTG patients showed a significantly faster early postoperative recovery and lower total morbidity. In contrast, the operation times were significant longer compared to ODG and OTG. For distal AGC and LDG in 6 RCT, including 2806 patients (LDG 1410 vs. ODG 1369) comparable results could be found also with a high evidence level (1++). The evidence for LTG in cases of AGC was lower (2-, 2+). Currently ,only 6 non-RCT with a total of 1090 patients (LTG 539 vs. OTG 551) are available, which showed comparable results to LDG but further high-quality RCTs are necessary. Robotic gastrectomy (RG) is currently being evaluated. According to the first studies RG for EGC seems to be equivalent to LDG; however, the evidence is currently low (3 to 2-).
Collapse
Affiliation(s)
- Kaja Ludwig
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland.
| | - Christian Barz
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland
| | - Uwe Scharlau
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Klinikum Südstadt Rostock, Südring 81, 18059, Rostock, Deutschland
| |
Collapse
|
27
|
Hikage M, Fujiya K, Kamiya S, Tanizawa Y, Bando E, Terashima M. Efficacy of minimally invasive distal gastrectomy for elderly patients with clinical stage I/IIA gastric cancer: a propensity-score matched analysis. Surg Endosc 2021; 35:7082-7093. [PMID: 33755787 DOI: 10.1007/s00464-020-08224-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/03/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Phase III trials have shown the non-inferiority of minimally invasive distal gastrectomy (MIDG) comparison with open distal gastrectomy (ODG) in patients with gastric cancer; however, it remains unclear whether MIDG is also effective in the elderly. This study aimed to clarify the efficacy of MIDG in elderly gastric cancer patients. PATIENTS AND METHODS This study included 316 patients older than 75 years with clinical stage I/IIA gastric cancer who underwent distal gastrectomy from August 2008 to December 2016 at the Shizuoka Cancer Centre. The long-term outcomes between MIDG and ODG were compared after propensity score matching. RESULTS After propensity score matching, there were 97 patients each in the MIDG and ODG groups, with an improved balance of confounding factors between the two groups. MIDG was associated with significantly longer operative time and a lower level of blood loss than ODG. The incidence of complications was comparable between the two groups. Survival outcomes were better in the MIDG group than in the ODG group (overall survival; P = 0.034, relapse-free survival; P = 0.027). In the multivariable analysis, ODG [hazard ratio (HR) 1.971, P = 0.046], being 80 years or older (HR 2.285, P = 0.018), male sex (HR 2.428, 95% P = 0.024), and poor physical status (HR 2.324, P = 0.022) were identified as independent prognostic factors for overall survival. CONCLUSIONS We found that MIDG showed better efficacy than ODG in elderly gastric cancer patients. MIDG is an acceptable option for elderly patients.
Collapse
Affiliation(s)
- Makoto Hikage
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Satoshi Kamiya
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| |
Collapse
|
28
|
Jung MK, Cho M, Roh CK, Seo WJ, Choi S, Son T, Kim HI, Hyung WJ. Assessment of diagnostic value of fluorescent lymphography-guided lymphadenectomy for gastric cancer. Gastric Cancer 2021; 24:515-525. [PMID: 32945996 DOI: 10.1007/s10120-020-01121-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Indocyanine green fluorescent lymphography helps visualize the lymphatic drainage pattern in gastric cancer; however, it is unknown whether fluorescent lymphography visualizes all metastatic lymph nodes. This study aimed to evaluate the sensitivity of fluorescent lymphography to detect metastatic lymph node stations and lymph nodes and the risk of false-negative findings. METHODS Patients with clinical T1-4a gastric cancer were included. Indocyanine green was peritumorally injected the day prior to surgery by endoscopy. Gastrectomy with systematic D1+ or D2 lymphadenectomy was performed. Stations and lymph nodes were retrieved at the back-table using near-infrared imaging and classified as "fluorescent" or "non-fluorescent" and later matched with histopathological findings. RESULTS Among 592 patients who underwent minimally invasive gastrectomy from September 2013 until December 2016, lymph node metastases were present in 150. The sensitivity of fluorescent lymphography in detecting all metastatic lymph node stations was 95.3% (143/150 patients), with a false-negative rate of 4.7% (7/150 patients) and the sensitivity in detecting all metastatic lymph nodes was 81.3% (122/150 patients). The negative predictive value was 99.3% for non-fluorescent stations and 99.2% for non-fluorescent LNs. For detecting all metastatic LN stations, subgroup analysis revealed 100% sensitivity for pT1a, 96.8% for pT1b, 100% for pT2, 91.3% for pT3, and 93.6% for pT4a tumors. CONCLUSIONS Fluorescent lymphography-guided lymphadenectomy can be a useful method for radical lymphadenectomy by facilitating the complete dissection of all potentially positive LN stations. Fluorescent lymphography-guided lymphadenectomy appears to be a reasonable alternative to conventional systematic lymphadenectomy for gastric cancer.
Collapse
Affiliation(s)
- Minoa K Jung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Department of Surgery, Division of Visceral Surgery, University of Geneva, Geneva, Switzerland
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Chul Kyu Roh
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Won Jun Seo
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Seohee Choi
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea. .,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.
| |
Collapse
|
29
|
Okabe H, Sunagawa H, Saji M, Hirai K, Hisamori S, Tsunoda S, Obama K. Comparison of short-term outcomes between robotic and laparoscopic gastrectomy for gastric cancer: a propensity score-matching analysis. J Robot Surg 2021; 15:803-811. [PMID: 33389606 DOI: 10.1007/s11701-020-01182-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/17/2020] [Indexed: 12/23/2022]
Abstract
Robotic gastrectomy (RG) is increasingly performed based on expected benefits in short-term outcomes. However, it is still unclear if RG has any advantages over laparoscopic gastrectomy (LG). A retrospective cohort study was performed in patients who underwent minimally invasive gastrectomy between January 2012 and January 2020. A total of 366 patients were enrolled and short-term outcomes were compared between RG and LG. Propensity score matching was conducted to reduce selection bias based on age, sex, body mass index, performance status, physical status, clinical T, clinical N, clinical M, tumor location, neoadjuvant chemotherapy, type of gastrectomy, and extent of lymphadenectomy. A propensity score-matching algorithm was used to select 93 patients for each group. Estimated blood loss was smaller (0 vs. 37 mL, P = 0.001), length of hospital stay was shorter (10 vs. 12 days, P = 0.012), and the time until starting a soft diet was shorter (3 vs. 4 days, P = 0.001) in RG compared to LG. The overall complication rate was also lower in RG (9.7% vs 14.0%), but the difference was not significant. There was no mortality in either group. Total gastrectomy was an independent risk factor for postoperative complications. RG can be safely performed with a similar complication rate to that in LG and may permit faster postoperative recovery and a shorter hospital stay.
Collapse
Affiliation(s)
- Hiroshi Okabe
- Department of Gastroenterological Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan.
| | - Hideki Sunagawa
- Department of Gastroenterological Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Masashi Saji
- Department of Gastroenterological Surgery, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba, 270-2232, Japan
| | - Kenjiro Hirai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | |
Collapse
|
30
|
Fujiya K, Kumamaru H, Fujiwara Y, Miyata H, Tsuburaya A, Kodera Y, Kitagawa Y, Konno H, Terashima M. Preoperative risk factors for postoperative intra-abdominal infectious complication after gastrectomy for gastric cancer using a Japanese web-based nationwide database. Gastric Cancer 2021; 24:205-213. [PMID: 32440807 DOI: 10.1007/s10120-020-01083-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative intra-abdominal infectious complication (PIIC) after gastrectomy for gastric cancer worsens in-hospital death or long-term survival. However, the methodology for PIIC preoperative risk assessment remains unestablished. We aimed to develop a preoperative risk model for postgastrectomy PIIC. METHODS We collected 183,936 patients' data on distal or total gastrectomy performed in 2013-2016 for gastric cancer from the Japanese National Clinical Database and divided into development (2013-2015; n = 140,558) and validation (2016; n = 43,378) cohort. The primary outcome was the incidence of PIIC. The risk model for PIIC was developed using 18 preoperative factors: age, sex, body mass index, activities of daily living, 12 comorbidity types, gastric cancer stage, and surgical procedure in the development cohort. Secondarily, we developed another model based on the new scoring system for clinical use using selected factors. RESULTS The overall incidence of PIIC was 4.7%, including 2.6%, 1.7%, and 1.3% in anastomotic leakage, pancreatic fistula, and intra-abdominal abscess, respectively. Among the 18 preoperative factors, male [odds ratio, (OR) 1.92], obesity (OR, 1.52-1.96), peripheral vascular disease (OR, 1.55), steroid use (OR, 1.83), and total gastrectomy (OR, 1.89) strongly correlated with PIIC incidence. The entire model using the 18 factors had good discrimination and calibration in the validation cohort. We selected eight relevant factors to create a simple scoring system, using which we categorized the patients into three risk groups, which showed good calibration. CONCLUSION Using nationwide clinical practice data, we created a preoperative risk model for postgastrectomy PIIC for gastric cancer.
Collapse
Affiliation(s)
- Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Tokyo Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiyuki Fujiwara
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Tokyo Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Hiroyuki Konno
- Database Committee, The Japanese Society of Gastroenterological, Surgery, Tokyo, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| |
Collapse
|
31
|
Akagi T, Endo H, Inomata M, Yamamoto H, Mori T, Kojima K, Kuroyanagi H, Sakai Y, Nakajima K, Shiroshita H, Etoh T, Saida Y, Yamamoto S, Hasegawa H, Ueno H, Kakeji Y, Miyata H, Kitagawa Y, Watanabe M. Clinical impact of Endoscopic Surgical Skill Qualification System (ESSQS) by Japan Society for Endoscopic Surgery (JSES) for laparoscopic distal gastrectomy and low anterior resection based on the National Clinical Database (NCD) registry. Ann Gastroenterol Surg 2020; 4:721-734. [PMID: 33319163 PMCID: PMC7726689 DOI: 10.1002/ags3.12384] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 01/11/2023] Open
Abstract
AIM This study aimed to evaluate the association between surgeons certified via the Endoscopic Surgical Skill Qualification System (ESSQS) of the Japan Society for Endoscopic Surgery (JSES) and surgical outcomes of laparoscopic distal gastrectomy (LDG) and laparoscopic low anterior resection (LLAR). METHODS Japanese National Clinical Database data on the patients undergoing LDG and LLAR between 2014-2016 were analyzed retrospectively. The proportion of cases performed by ESSQS-certified surgeons was calculated for each procedure, and clinicopathological factors with or without participation of ESSQS-certified surgeons as an operator were assessed. Then, effects of operations performed by ESSQS-certified surgeons on short-term patient outcomes were analyzed using generalized estimating equations logistic regression analysis. RESULTS There were 110 610 and 65 717 patients who underwent LDG and LLAR, respectively. The operations performed by ESSQS-certified surgeons in each procedure totaled 28 467 (35.3%) and 12 866 (31.2%), respectively. A multivariable logistic regression model showed that odds ratios of mortality for LDG and LLAR performed by ESSQS-certified surgeons were 0.774 (95% CI, 0.566-1.060, P = 0.108) and 0.977 (0.591-1.301, P = 0.514), respectively. Odds ratios for secondary endpoints of anastomotic leakage in LDG and LLAR performed by ESSQS-certified surgeons were 0.835 (95% CI, 0.723-0.964, P = 0.014) and 0.929 (0.860-1.003, P = 0.059), respectively, whereas that of ileus/bowel obstruction for LLAR performed by ESSQS-certified surgeons was 1.265 (1.132-1.415, P < 0.001). There were no significant associations between the two operations performed by ESSQS-certified surgeons and other factors such as mortality and overall complications. CONCLUSIONS ESSQS certification did not affect postoperative mortality following LDG and LLAR, but annual experience of laparoscopic surgery was associated with it. ESSQS certification may contribute to favorable outcomes regarding anastomotic leakage following LDG and LLAR.
Collapse
Affiliation(s)
- Tomonori Akagi
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuOitaJapan
| | - Hideki Endo
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Masafumi Inomata
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuOitaJapan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Toshiyuki Mori
- Department of SurgeryKyorin University School of MedicineTokyoJapan
| | - Kazuyuki Kojima
- First Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Hiroya Kuroyanagi
- Department of Gastroenterological SurgeryToranomon HospitalTokyoJapan
| | - Yoshiharu Sakai
- Department of SurgeryGraduate School of MedicineKyoto UniversityKyotoJapan
| | | | - Hidefumi Shiroshita
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuOitaJapan
| | - Tsuyoshi Etoh
- Gastroenterological and Pediatric SurgeryOita University of Faculty of MedicineYufuOitaJapan
| | - Yoshihisa Saida
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | | | - Hirotoshi Hasegawa
- Department of SurgeryTokyo Dental College Ichikawa General HospitalChibaJapan
| | - Hideki Ueno
- Department of SurgeryNational Defense Medical CollegeSaitamaJapan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal SurgeryDepartment of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yuko Kitagawa
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Masahiko Watanabe
- Department of SurgeryKitasato University Kitasato Institute HospitalTokyoJapan
| |
Collapse
|
32
|
Chen X, Feng X, Wang M, Yao X. Laparoscopic versus open distal gastrectomy for advanced gastric cancer: A meta-analysis of randomized controlled trials and high-quality nonrandomized comparative studies. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1998-2010. [PMID: 32758382 DOI: 10.1016/j.ejso.2020.06.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/01/2020] [Accepted: 06/29/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Controversy persists about the effects of laparoscopic distal gastrectomy (LDG) versus open distal gastrectomy (ODG) on short-term surgical outcomes and long-term survival within the field of advanced gastric cancer (AGC). METHODS Studies published from January 1994 to February 2020 that compare LDG and ODG for AGC were identified. All randomized controlled trials (RCTs) were included. The selection of high-quality nonrandomized comparative studies (NRCTs) was based on a validated tool (Methodological Index for Nonrandomized Studies, MINORS). The short- and long-term outcomes of both procedures were compared. RESULTS Overall, 30 studies were included in this meta-analysis, which comprised of 8 RCTs and 22 NRCTs involving 16,029 patients (7864 LDGs, 8165 ODGs). The recurrence, 3-year disease-free survival (DFS), 3-year overall survival (OS), and 5-year OS rates for LDG and ODG were comparable. LDG was associated with a lower postoperative complication rate (OR 0.79; P < 0.00001), lower estimated volume of blood loss (WMD -102.21 mL; P < 0.00001), shorter postoperative hospital stay (WMD -1.96 days; P < 0.0001), shorter time to first flatus (WMD -0.54 day; P = 0.0007) and shorter time to first liquid diet (WMD -0.66 day; P = 0.001). The number of lymph nodes retrieved, mortality, intraoperative complications, intraoperative blood transfusion, and time to ambulation were similar. However, LDG was associated with a longer surgical time (WMD 33.57 min; P < 0.00001). CONCLUSIONS LDG with D2 lymphadenectomy is a safe and effective technique for patients with AGC when performed by experienced surgeons at high-volume specialized centers.
Collapse
Affiliation(s)
- Xin Chen
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China; Shantou University Medical College, Shantou, 515041, Guangdong Province, PR China
| | - Xingyu Feng
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China
| | - Muqing Wang
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China; School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong Province, PR China
| | - Xueqing Yao
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China; Shantou University Medical College, Shantou, 515041, Guangdong Province, PR China; School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong Province, PR China.
| |
Collapse
|
33
|
Washio M, Yamashita K, Niihara M, Hosoda K, Hiki N. Postoperative pancreatic fistula after gastrectomy for gastric cancer. Ann Gastroenterol Surg 2020; 4:618-627. [PMID: 33319151 PMCID: PMC7726690 DOI: 10.1002/ags3.12398] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/16/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022] Open
Abstract
Postoperative pancreatic fistula is one of the most severe complications after gastric cancer surgery, and can cause critical patient conditions leading to surgery-related death. Fortunately, the incidence of postoperative pancreatic fistula after gastrectomy seems to be decreasing with changes in operative procedures. The rate was reported at about 30% after open gastrectomy with Appleby's method in 1997, but lately has improved below 1% for robotic gastrectomy in 2019. For the diagnosis of postoperative pancreatic fistula, drain amylase concentration has been demonstrated to be beneficial and some reports have proposed the optimal cut-off values of drain amylase to predict major postoperative pancreatic fistula. There have been many reports identifying risk factors for postoperative pancreatic fistula, including overweight patients, pancreatic anatomy, blunt trauma from compression of the pancreas, and thermal injuries caused by the continuous use of energy devices. And importantly, laparoscopic gastrectomy has been shown to be more often associated with postoperative pancreatic fistula than open gastrectomy in the prospective national clinical database in Japan. Hence, further sophistication of surgical techniques to reduce pancreas compression would have great promise in reducing postoperative pancreatic fistula after laparoscopic gastrectomy.
Collapse
Affiliation(s)
- Marie Washio
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Keishi Yamashita
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
- Division of Advanced Surgical OncologyDepartment of Research and Development Center for New Medical FrontiersKitasato University School of MedicineSagamiharaJapan
| | - Masahiro Niihara
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Kei Hosoda
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Naoki Hiki
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| |
Collapse
|
34
|
Shibasaki S, Suda K, Nakauchi M, Nakamura K, Tanaka T, Kikuchi K, Inaba K, Uyama I. Impact of the Endoscopic Surgical Skill Qualification System on the safety of laparoscopic gastrectomy for gastric cancer. Surg Endosc 2020; 35:6089-6100. [PMID: 33090314 DOI: 10.1007/s00464-020-08102-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND We hypothesized that the Endoscopic Surgical Skill Qualification System (ESSQS) can shorten operative time, resulting in a decrease in postoperative morbidity. Here, we aimed to clarify whether ESSQS-qualified surgeons could decrease the incidence of complications. METHODS Between January 2009 and June 2019, 1042 patients diagnosed with both clinical and pathological Stage ≤ III gastric cancer and undergoing LG were enrolled. In all LG procedures involving ESSQS-qualified surgeons, these served as the operator or the instructive assistant. The short-term outcomes were retrospectively compared between the ESSQS-qualified and the non-ESSQS-qualified surgeons using a propensity-score matched analysis. RESULTS After propensity-score matching, 321 patients were included in each group. No significant differences were observed in morbidity rate, and length of hospitalization following surgery, although the non-ESSQS-qualified surgeon group had a significantly longer total operative time (Non-ESSQS-qualified group, 368 [170-779] min vs. ESSQS-qualified group, 316 [147-772] min; p < 0.001), and larger estimated blood loss (Non-ESSQS-qualified group, 28 [0-702] mL vs. ESSQS-qualified group 25, [0-1069] mL; p = 0.042). Multivariate analysis revealed that operative time ≥ 360 min (OR 1.818 [1.069-3.094], p = 0.027) was identified as the only significant independent risk factor determining morbidity. CONCLUSIONS The incidence of postoperative morbidity did not differ between patients operated by the qualified and nonqualified surgeons, as long as ESSQS-qualified surgeons provide intraoperative instructions.
Collapse
|
35
|
Kakeji Y, Yamamoto H, Ueno H, Eguchi S, Endo I, Sasaki A, Takiguchi S, Takeuchi H, Hashimoto M, Horiguchi A, Masaki T, Marubashi S, Yoshida K, Miyata H, Konno H, Gotoh M, Kitagawa Y, Mori M, Seto Y. Development of gastroenterological surgery over the last decade in Japan: analysis of the National Clinical Database. Surg Today 2020; 51:187-193. [PMID: 32681353 DOI: 10.1007/s00595-020-02075-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022]
Abstract
The National Clinical Database (NCD) of Japan was established in 2010 with the board certification system. A joint committee of 16 gastroenterological surgery database-affiliated organizations has been nurturing this nationwide database and utilizing its data for various analyses. Stepwise board certification systems have been validated by the NCD and are used to improve the surgical outcomes of patients. The use of risk calculators based on risk models can be particularly helpful for establishing appropriate and less invasive surgical treatments for individual patients. Data obtained from the NCD reflect current developments in the surgical approaches used in hospitals, which have progressed from open surgery to endoscopic and robot-assisted procedures. An investigation of the data acquired by the NCD could answer some relevant clinical questions and lead to better surgical management of patients. Furthermore, excellent surgical outcomes can be achieved through international comparisons of the national databases worldwide. This review examines what we have learned from the NCD of gastroenterological surgery and discusses what future developments we can expect.
Collapse
Affiliation(s)
- Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan.
- National Clinical Database, Tokyo, Japan.
| | - Hiroyuki Yamamoto
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Hideki Ueno
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Susumu Eguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Itaru Endo
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Akira Sasaki
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Shuji Takiguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Hiroya Takeuchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Masaji Hashimoto
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Akihiko Horiguchi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Tadahiko Masaki
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Shigeru Marubashi
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Kazuhiro Yoshida
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Hiroaki Miyata
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Hiroyuki Konno
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
| | - Mitsukazu Gotoh
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | - Yuko Kitagawa
- Database Committee, The Japanese Society of Gastroenterological Surgery, 3-1-17 Mita, Minato-ku, Tokyo, Japan
- National Clinical Database, Tokyo, Japan
| | | | | |
Collapse
|
36
|
Evaluation of negative-pressure wound therapy for surgical site infections after ileostomy closure in colorectal cancer patients: a prospective multicenter study. Surg Today 2020; 50:1687-1693. [PMID: 32638132 DOI: 10.1007/s00595-020-02068-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Surgical site infection (SSI) occurs at a high rate after ileostomy closure. The effect of preventive negative-pressure wound therapy (NPWT) on SSI development in closed wounds remains controversial. We conducted a prospective multicenter study to evaluate the usefulness of preventive NPWT for SSI after ileostomy closure. METHODS From January 2018 to November 2018, 50 patients who underwent closure of ileostomy created after surgery for colorectal cancer participated in this study. An NPWT device was applied to each wound immediately after surgery and then treatment was continued for 3 days. The primary endpoint was 30-day SSI, and the secondary endpoints were the incidence of seroma, hematoma, and adverse events related to NPWT. RESULTS No patients developed SSI, seroma, or hematoma. Adverse events that may have been causally linked with NPWT were contact dermatitis in two patients and wound pain in one patient, and there were no cases of discontinuation or decompression of NPWT. CONCLUSION The use of NPWT following ileostomy closure may be useful for reducing the development of SSI in colorectal cancer patients. This is a prospective multicenter pilot study and we are planning a comparative study based on these successful results. TRAIL REGISTRATION Registration number: UMIN000032053 ( https://www.umin.ac.jp/ ).
Collapse
|
37
|
Nakanishi K, Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K, Murai T, Asada T, Ishiyama A, Matsushita H, Shimizu D, Tanaka C, Kobayashi D, Fujiwara M, Murotani K, Kodera Y. Propensity-score-matched analysis of a multi-institutional dataset to compare postoperative complications between Billroth I and Roux-en-Y reconstructions after distal gastrectomy. Gastric Cancer 2020; 23:734-745. [PMID: 32065304 DOI: 10.1007/s10120-020-01048-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few well-controlled studies have compared postoperative complications between Billroth I (B-I) and Roux-en-Y (R-Y). The aim of the present study was to compare the incidence of overall and severe postoperative complications by reconstruction method after distal gastrectomy. METHODS We performed a multi-institutional dataset study of patients who underwent distal gastrectomy with B-I or R-Y reconstruction from 2010 to 2014. Using propensity scores to strictly balance the significant variables, we compared postoperative complications between the techniques. RESULTS After matching, we enrolled 1014 patients (n = 507 in each group). The incidence of postoperative complications in the R-Y group was significantly higher vs the B-I group (29% vs 17%, P < 0.0001). The incidence of intra-abdominal abscess (4.3% vs 1.8%, P = 0.0177), bowel obstruction (2.6% vs 0.6%, P = 0.0203), and delayed gastric emptying (5.3% vs 1.0%, P < 0.0001) in the R-Y group was significantly higher vs the B-I group, respectively; we saw no significant difference in leakage (3.4% vs 4.1%, P = 0.5084). The incidence of grade ≥ III severe postoperative complications in the R-Y group was significantly higher vs the B-I group (13% vs 7.1%, P = 0.0013). Multivariable analysis showed that R-Y reconstruction was a strong independent risk factor for overall postoperative complications (odds ratio 1.58, P = 0.0044) and grade ≥ III severe postoperative complications (odds ratio 1.75, P = 0.0127). A forest plot revealed that R-Y reconstruction was associated with a greater risk of both overall and grade ≥ III severe postoperative complications in any subgroups. CONCLUSIONS R-Y reconstruction was associated with increasing overall postoperative complications, as well as severe postoperative complications.
Collapse
Affiliation(s)
- Koki Nakanishi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan
| | | | - Hitoshi Teramoto
- Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | | | - Toshifumi Murai
- Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takahiro Asada
- Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | | | | | - Dai Shimizu
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Daisuke Kobayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
38
|
Kakeji Y, Takahashi A, Hasegawa H, Ueno H, Eguchi S, Endo I, Sasaki A, Takiguchi S, Takeuchi H, Hashimoto M, Horiguchi A, Masaki T, Marubashi S, Yoshida K, Gotoh M, Konno H, Yamamoto H, Miyata H, Seto Y, Kitagawa Y. Surgical outcomes in gastroenterological surgery in Japan: Report of the National Clinical Database 2011-2018. Ann Gastroenterol Surg 2020; 4:250-274. [PMID: 32490340 PMCID: PMC7240139 DOI: 10.1002/ags3.12324] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 12/23/2022] Open
Abstract
The National Clinical Database (NCD) of Japan grew rapidly, harvesting over 11 million cases of data between 2011 and 2018 from more than 5000 facilities. This is the Report of the NCD based upon gastrointestinal surgery information in 4 420 175 cases from 2011 to 2018. More than 70% of all gastrointestinal surgeries were performed at certified institutions, and the percentage of surgeries performed at certified institutions was particularly high for the esophagus (93.8% in 2018), liver (89.4%), pancreas (91.3%), and spleen (86.9%). Also, more than 70% of the surgeries were performed with the participation of the board-certified surgeon. As the patients have been getting older, the morbidities have been increasing. However, the mortalities have been kept at a low level. The rates of endoscopic surgery have been increasing year by year, especially high in low anterior resection (67.0%) and esophagectomy (61.0%). Nationwide, this database is surely expecting to ensure the quality of board certification system and surgical outcomes in gastroenterological surgery.
Collapse
Affiliation(s)
| | - Arata Takahashi
- Department of Health Policy and Management School of Medicine Keio University Tokyo Japan
- Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan
| | | | - Hideki Ueno
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Susumu Eguchi
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Itaru Endo
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Akira Sasaki
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Shuji Takiguchi
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Hiroya Takeuchi
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | | | | | - Tadahiko Masaki
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | | | | | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Hiroyuki Konno
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Hiroyuki Yamamoto
- Department of Health Policy and Management School of Medicine Keio University Tokyo Japan
- Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management School of Medicine Keio University Tokyo Japan
- Department of Healthcare Quality Assessment Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery Tokyo Japan
| |
Collapse
|
39
|
Kinoshita T. Minimally invasive approaches for early gastric cancer in East Asia: current status and future perspective. Transl Gastroenterol Hepatol 2020; 5:20. [PMID: 32258524 DOI: 10.21037/tgh.2019.10.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/16/2019] [Indexed: 12/12/2022] Open
Abstract
East Asia is well known as a region with higher incidences of gastric cancer compared with the rest of the world. This region has also experienced a rise in the detection of early gastric cancer (EGC) for the past three decades. The success of nationwide screening programs conducted in Japan or South Korea, increasing public awareness of gastric cancer, improved diagnostic ability of gastroenterologists and the aging population of modern societies may all contribute to the increase in EGC detection rates. Along with the increasing diagnosis of EGC, several key advances in the minimally invasive approach to EGC treatment have been made. Endoscopic resection is an ideal procedure for lesions without lymph node involvement, and its indications have expanded based on the results of prospective studies. Laparoscopic surgery with lymph node dissection has been becoming a standard treatment for EGC patients. Additionally, robot-assisted surgery is penetrating the field of gastric cancer surgery as surgeons pursue a more accurate minimally invasive approach with reduced morbidity rates. However, prolonged operation time and high cost remain problems to be solved for robot-assisted surgery. In this context, function-preserving surgery has become ever more important and should be considered as a method to enhance patients' quality of life after a gastrectomy for EGC. Pylorus-preserving gastrectomy or proximal gastrectomy is more frequently employed in East Asia and strategies that employ sentinel node (SN) navigation to personalize function-preserving surgery in clinical practice are emerging as several prospective studies investigate its efficacy.
Collapse
Affiliation(s)
- Takahiro Kinoshita
- Division of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
40
|
Shibasaki S, Suda K, Nakauchi M, Nakamura K, Kikuchi K, Inaba K, Uyama I. Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center, retrospective and propensity score-matched analysis. World J Gastroenterol 2020; 26:1172-1184. [PMID: 32231421 PMCID: PMC7093317 DOI: 10.3748/wjg.v26.i11.1172] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Minimally invasive surgery for gastric cancer (GC) has gained widespread use as a safe curative procedure especially for early GC.
AIM To determine risk factors for postoperative complications after minimally invasive gastrectomy for GC.
METHODS Between January 2009 and June 2019, 1716 consecutive patients were referred to our division for primary GC. Among them, 1401 patients who were diagnosed with both clinical and pathological Stage III or lower GC and underwent robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) were enrolled. Retrospective chart review and multivariate analysis were performed for identifying risk factors for postoperative morbidity.
RESULTS Morbidity following minimally invasive gastrectomy was observed in 7.5% of the patients. Multivariate analyses demonstrated that non-robotic minimally invasive surgery, male gender, and an operative time of ≥ 360 min were significant independent risk factors for morbidity. Therefore, morbidity was compared between RG and LG. Accordingly, propensity-matched cohort analysis revealed that the RG group had significantly fewer intra-abdominal infectious complications than the LG group (2.5% vs 5.9%, respectively; P = 0.038), while no significant differences were noted for other local or systemic complications. Multivariate analyses of the propensity-matched cohort revealed that non-robotic minimally invasive surgery [odds ratio = 2.463 (1.070–5.682); P = 0.034] was a significant independent risk factor for intra-abdominal infectious complications.
CONCLUSION The findings showed that robotic surgery might improve short-term outcomes following minimally invasive radical gastrectomy by reducing intra-abdominal infectious complications.
Collapse
Affiliation(s)
- Susumu Shibasaki
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Masaya Nakauchi
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Kenji Kikuchi
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, Toyoake 470-1192, Aichi, Japan
| | - Kazuki Inaba
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| |
Collapse
|
41
|
Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients. Surg Endosc 2020; 35:1202-1209. [PMID: 32152675 DOI: 10.1007/s00464-020-07487-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Preoperative nutritional assessment of cancer patients is important to reduce postoperative complications. Several studies have reported the Geriatric Nutritional Risk Index (GNRI) to be useful in assessing underlying diseases and long-term outcomes of hospitalized patients. The present study aimed to evaluate the impact of preoperative GNRI on short- and long-term outcomes in elderly gastric cancer patients who underwent laparoscopic gastrectomy. METHODS We retrospectively reviewed consecutive patients aged ≥ 65 years who underwent laparoscopy-assisted gastrectomy and had R0 resection for histologically confirmed gastric adenocarcinoma. The cutoff value for preoperative GNRI was determined to be 85.7 based on the incidence of postoperative complications. Patients were categorized into two groups: low GNRI group and normal GNRI group. RESULTS Univariate analyses of the 303 patients revealed that the incidence of postoperative complications was significantly associated with the American Society of Anesthesiologists Physical Status classification (ASA-PS), C-reactive protein (CRP), GNRI (p < 0.001), and operative procedure. Multivariate analyses revealed that preoperative GNRI (odds ratio [OR] 2.716; 95% confidence interval [CI] 1.166-6.328; p = 0.021) and operative procedure (OR 2.459; 95% CI 1.378-4.390; p = 0.002) were independently associated with the incidence of postoperative complications. Univariate analyses showed that overall survival (OS) was significantly associated with ASA-PS, tumor size, tumor differentiation, pathological tumor node metastasis (TNM) stage, carcinoembryonic antigen (CEA), CRP, GNRI, and postoperative complications. Multivariate analysis demonstrated that ASA-PS (hazard ratio [HR], 3.755; 95% CI 2.141-6.585; p < 0.001), tumor differentiation (HR 1.898; 95% CI 1.191-3.025; p = 0.007), CEA (HR 1.645; 95% CI 1.024-2.643; p = 0.040), and GNRI (HR 2.093; 95% CI 1.105-3.963; p = 0.023) independently predicted OS. CONCLUSION GNRI is an important predictor of postoperative complications and overall survival in elderly gastric cancer patients. It is a reliable and cost-effective prognostic indicator that should be routinely evaluated.
Collapse
|
42
|
Liu D, Liang L, Liu L, Zhu Z, Liu S, Hu L, He Y, Fang Y, Wan X. Short-term outcomes and prognosis of laparoscopy-assisted total gastrectomy in elderly patients with stomach cancer. Surg Endosc 2020; 34:5428-5438. [PMID: 31993813 DOI: 10.1007/s00464-019-07338-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 12/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the short-term outcomes and prognosis of laparoscopy-assisted total gastrectomy (LTG) in elderly patients with gastric cancer. METHODS The clinical data of 275 patients aged over 65 years undergoing open total gastrectomy (OTG, n = 184) or laparoscopy-assisted total gastrectomy (LTG, n = 91) were reviewed from January 2015 to August 2017 at the First Affiliated Hospital of the University of Science and Technology of China. Short-term outcomes were compared between the two groups, and risk factors for postoperative complications were explored. In addition, the 2-year overall survival (OS) and disease-free survival (DFS) were investigated for both groups. RESULTS Except for the ASA score (P = 0.01), there was no significant difference regarding patient baselines between the two groups. Patients in the LTG group had a longer operative time (P < 0.001), less intraoperative blood loss (P = 0.004), a shorter time of resumption to a semi-liquid diet (P < 0.001) and a shorter postoperative hospital stay (P = 0.001). The incidence of pulmonary complications was significantly lower in the LTG group than in the OTG group (4.4% vs. 13%, P = 0.026). The number of lymph nodes harvested in the LTG group was higher than that in the OTG group (20.7 ± 7.4 vs. 17.5 ± 6.9, P = 0.001), and the proportion of patients with TNM stage III gastric cancer was higher in the LTG group than in the OTG group (P = 0.035). There was no significant difference in the 2-year OS rate or 2-year DFS rate between the two groups (P = 0.057 and P = 0.344). Sex, age, preoperative comorbidity, intraoperative blood loss, and TNM stage were identified as independent prognostic factors for postoperative survival. CONCLUSION Comparing with OTG, LTG is feasible and contributes to less surgical trauma and a faster recovery after total gastrectomy. In addition, LTG contributes to a lower risk of postoperative pulmonary complications. Regarding oncological results, LTG is more effective for lymph node dissection and has a comparable long-term prognosis as OTG.
Collapse
Affiliation(s)
- Dongliang Liu
- Department of General Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Lichuan Liang
- Department of General Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Liu Liu
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Lujiang Road 17, Lu Yang District, Hefei, Anhui, China.
| | - Zhiqiang Zhu
- Department of General Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China. .,Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Lujiang Road 17, Lu Yang District, Hefei, Anhui, China.
| | - Shaojun Liu
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Lujiang Road 17, Lu Yang District, Hefei, Anhui, China
| | - Lei Hu
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Lujiang Road 17, Lu Yang District, Hefei, Anhui, China
| | - Yiren He
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Lujiang Road 17, Lu Yang District, Hefei, Anhui, China
| | - Yu Fang
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Lujiang Road 17, Lu Yang District, Hefei, Anhui, China
| | - Xiao Wan
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Lujiang Road 17, Lu Yang District, Hefei, Anhui, China
| |
Collapse
|
43
|
Shibasaki S, Suda K, Obama K, Yoshida M, Uyama I. Should robotic gastrectomy become a standard surgical treatment option for gastric cancer? Surg Today 2019; 50:955-965. [PMID: 31512060 DOI: 10.1007/s00595-019-01875-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023]
Abstract
Robotic gastrectomy (RG) using the da Vinci Surgical System for gastric cancer was approved for national medical insurance coverage in Japan in April, 2018, and has been used increasingly since. We reviewed the current evidence on RG, open gastrectomy (OG), and conventional laparoscopic gastrectomy (LG) to identify differences in surgical outcomes between Japan and other countries. Briefly, three independent reviewers systematically reviewed the data collected from a comprehensive literature search by an independent organization and focused on the following nine endpoints: mortality, morbidity, operative time, estimated volume of blood loss, length of postoperative hospital stay, long-term oncologic outcome, quality of life, learning curve, and cost. Overall, the mortality rate of the three approaches did not differ, but RG and LG had less intraoperative blood loss and resulted in a shorter postoperative hospital stay than OG. RG had longer operative times and incurred higher costs than LG and OG. However, in Japan, RG may be more effective than LG and OG for decreasing morbidity. Further studies are needed to establish the specific indications for RG, optimal robotic setup, and dissection methods to best utilize the surgical robot.
Collapse
Affiliation(s)
- Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, 6-1-14 Konodai, Ichikawa, Chiba, 272-0827, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| |
Collapse
|
44
|
Hasegawa H, Takahashi A, Kakeji Y, Ueno H, Eguchi S, Endo I, Sasaki A, Takiguchi S, Takeuchi H, Hashimoto M, Horiguchi A, Masaki T, Marubashi S, Yoshida K, Konno H, Gotoh M, Miyata H, Seto Y. Surgical outcomes of gastroenterological surgery in Japan: Report of the National Clinical Database 2011-2017. Ann Gastroenterol Surg 2019; 3:426-450. [PMID: 31346582 PMCID: PMC6635689 DOI: 10.1002/ags3.12258] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/16/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Japanese National Clinical Database (NCD) is a large-scale, nationwide, web-based data entry system that is linked to the surgical board certification system and covers almost all surgical cases carried out in Japan. AIM To evaluate outcomes according to the gastroenterological section of the NCD. METHODS The 115 surgical procedures stipulated by the "Training Curriculum for Board-Certified Surgeons in Gastroenterology" were registered from 2011 to 2017. The number of surgeries, preoperative comorbidities, and short-term outcomes were compared between registration periods. RESULTS In total, 3 818 414 cases have been registered. More than 70% of all surgeries were carried out at certified institutions. The annual number of cases has been increasing year after year, and the aged population has also been increasing. Although the rates of preoperative comorbidities and postoperative complications have been increasing, the postoperative mortality rate has remained relatively low; in 2017, the 30-day mortality rate was 1.0% among those who underwent esophagectomy, 0.7% among those who underwent distal gastrectomy, 1.1% among those who underwent total gastrectomy, 1.3% among those who underwent right hemicolectomy, 0.5% among those who underwent low anterior resection, 1.3% among those who underwent hepatectomy, and 1.3% among those who underwent pancreaticoduodenectomy. The annual rate of endoscopic surgery dramatically increased over 7 years between 2011 and 2017, especially for low anterior resection (29.5%-62.6%) and esophagectomy (31.0%-56.1%). CONCLUSION This database is expected to ensure the quality of the board-certification system and surgical outcomes in gastroenterological surgery.
Collapse
Affiliation(s)
| | - Arata Takahashi
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
| | | | - Hideki Ueno
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Susumu Eguchi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Itaru Endo
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Akira Sasaki
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Shuji Takiguchi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroya Takeuchi
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | | | - Tadahiko Masaki
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | | | | | - Hiroyuki Konno
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Mitsukazu Gotoh
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroaki Miyata
- Department of Health Policy and ManagementSchool of MedicineKeio UniversityTokyoJapan
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoTokyoJapan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| |
Collapse
|
45
|
Surgical risk and benefits of laparoscopic surgery for elderly patients with gastric cancer: a multicenter prospective cohort study. Gastric Cancer 2019; 22:845-852. [PMID: 30539321 DOI: 10.1007/s10120-018-0898-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) might have greater clinical benefits for elderly patients as less invasive surgery; however, there is still little evidence to support its benefit. We evaluated the surgical outcomes of elderly patients in a nationwide prospective cohort study. METHODS One hundred and sixty-nine participating institutions were identified by stratified random sampling, and were adjusted for hospital volume, type and location. During 1 year from 2014 to 2015, consecutive patients who underwent gastrectomy for gastric cancer were prospectively enrolled. 'Elderly' was defined as ≥ 75 years of age, based on the prevalence of comorbidities and the activities of daily living of patients of this age. We compared the surgical outcomes of LG to those of open gastrectomy (OG) in non-elderly and elderly patients. The primary outcome was the incidence of severe morbidities (Grade ≥ 3). RESULTS Eight thousand nine hundred and twenty-seven patients were enrolled [non-elderly, n = 6090 (OG, n = 2602; LG, n = 3488); elderly, n = 2837 (OG, n = 1471; LG, n = 1366)]. Grade ≥ 3 complications occurred in 161 (10.9%) patients who underwent OG and 98 (7.2%) who underwent LG (p < 0.001). After adjusting for confounding factors, we confirmed that laparoscopic surgery was not an independent risk factor (odds ratio = 0.81, 0.60-1.09). OG was associated with a significantly longer median length of postoperative stay in comparison to LG (16 versus 12 days, p < 0.001). There were no significant differences in the incidence of other postoperative comorbidities. CONCLUSION The safety of LG in elderly patients was demonstrated. LG shortened the length of postoperative hospital stay.
Collapse
|
46
|
Niitsuma T, Kusachi S, Takesue Y, Mikamo H, Asai K, Watanabe M. Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015. Ann Gastroenterol Surg 2019; 3:276-284. [PMID: 31131356 PMCID: PMC6524110 DOI: 10.1002/ags3.12236] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/08/2018] [Accepted: 01/03/2019] [Indexed: 01/27/2023] Open
Abstract
AIM To survey postoperative infections (PI) after digestive surgery. METHODS This survey, conducted by the Japan Society of Surgical Infection, included patients undergoing digestive surgery at 28 centers between September 2015 and March 2016. Data collected included patient background characteristics, type of surgery, contamination status, and type of PI, including surgical site infection (SSI), remote infection (RI), and antimicrobial-resistant (AMR) bacterial infections and colonization. RESULTS Postoperative infections occurred in 10.7% of 6582 patients who underwent digestive surgery (6.8% for endoscopic surgery and 18.7% for open surgery). SSI and RI, including respiratory tract infection, urinary tract infection, antibiotic-associated diarrhea, drain infection, and catheter-related bloodstream infection, occurred in 8.9% and 3.7% of patients, respectively. Among all PI, 13.2% were overlapping infections. The most common overlapping infections were incisional and organ/space SSI, which occurred in 4.2% of patients. AMR bacterial infections occurred in 1.2% of patients after digestive surgery and comprised 11.5% of all PI. Rate of AMR bacterial colonization after digestive surgery was only 0.3%. CONCLUSION Periodic surveillance of PI, including AMR bacteria, is necessary for a detailed evaluation of nosocomial infections.
Collapse
Affiliation(s)
- Toru Niitsuma
- Department of SurgeryToho University Graduate School of MedicineTokyoJapan
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Shinya Kusachi
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Yoshio Takesue
- Department of Infection Prevention and ControlHyogo College of MedicineHyogoJapan
| | - Hiroshige Mikamo
- Department of Clinical Infectious DiseasesAichi Medical UniversityAichiJapan
| | - Koji Asai
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Manabu Watanabe
- Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| |
Collapse
|
47
|
Misawa K, Yoshikawa T, Ito S, Cho H, Ito Y, Ogata T. Safety and Feasibility of Linear Stapling Device with Bioabsorbable Polyglycolic Acid Sheet for Duodenal Closure in Gastric Cancer Surgery: A Multi-institutional Phase II Study. World J Surg 2019; 43:192-198. [PMID: 30105634 DOI: 10.1007/s00268-018-4748-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Duodenal stump fistula (DSF) after gastrectomy is of low frequency but a critical complication in gastric cancer surgery. Manual oversewing for reinforcement of the duodenal stump is not applicable when free longitudinal margin is short and has technical difficulties in laparoscopic surgery. This trial evaluated the safety and feasibility of using a linear stapler with bioabsorbable polyglycolic acid (PGA) sheet for duodenal stump closure and reinforcement in gastric cancer surgery. METHODS This multi-institutional, prospective phase II trial included gastric cancer patients who were scheduled to undergo distal or total gastrectomy with R-Y reconstruction. In all cases, duodenum was transected using a linear stapler with PGA sheet. The primary endpoint was the incidence of postoperative DSF. Sample size was set at 100 patients considering an expected value of 3% and threshold value of 8% with one-sided testing at a 10% significance level. RESULTS Between June 2014 and June 2015, a total of 100 patients were registered in this trial. Postoperative DSF was observed in two cases (2.0%, 90% CI 0.4-6.2%) which was developed on postoperative days 13 and 20. Intraoperative bleeding at the duodenal stump staple line was observed in one case but was easily controlled without additional suturing. Postoperative bleeding was not observed in any of the cases. CONCLUSION This study suggested that the use of PGA sheet as a reinforcement material for closure of the duodenal stump during gastrectomy for gastric cancer is both safe and feasible. Trial registration number UMIN 000014398.
Collapse
Affiliation(s)
- Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan.
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan
| | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan
| |
Collapse
|
48
|
Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system. Gastric Cancer 2019; 22:190-201. [PMID: 30302654 DOI: 10.1007/s10120-018-0883-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite interest in surgeon and hospital volume effects on distal gastrectomy, clinical significance has not been confirmed in a large-scale population. We studied to clarify the effects of surgeon and hospital volume on postoperative mortality after distal gastrectomy for gastric cancer among Japanese patients in a nationwide web-based data entry system. METHODS We extracted data on distal gastrectomy for gastric cancer from the National Clinical Database between 2011 and 2015. The primary outcome was operative mortality. Hospital volume was divided into 3 tertiles: low (1-22 cases per year), medium (23-51) and high (52-404). Surgeon volume was divided into the 5 groups: 0-3, 4-10, 11-20, 21-50, 51 + cases per year. We calculated the 95% confidence interval (CI) for the mortality rate based on odds ratios (ORs) estimated from a hierarchical logistic regression model. RESULTS We analyzed 145,523 patients at 2182 institutions. Operative mortality was 1.9% in low-, 1.0% in medium- and 0.5% in high-volume hospitals. The operative mortality rate decreased definitively with surgeon volume, 1.6% in the 0-3 group and 0.3% in the 51 + group. After risk adjustment for surgeon and hospital volume and patient characteristics, hospital volume was significantly associated with operative morality (medium: OR 0.64, 95% CI 0.56-0.73, P < 0.001; high: OR 0.42, 95% CI 0.35-0.51, P < 0.001). CONCLUSIONS We demonstrate that hospital volume can have a crucial impact on postoperative mortality after distal gastrectomy compared with surgeon volume in a nationwide population study. These findings suggest that centralization may improve outcomes after distal gastrectomy.
Collapse
|
49
|
Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, Honda M, Miyata H, Yamashita Y, Seto Y, Kitano S, Konno H. Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer 2019; 22:202-213. [PMID: 29427039 DOI: 10.1007/s10120-018-0795-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. METHODS A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II-IV cohort. RESULTS There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p < 0.01). In the Stage II-IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p < 0.001). CONCLUSION LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.
Collapse
Affiliation(s)
- Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Medical and Surgical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Yuichi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Hiroyuki Konno
- Hamamatsu University School of Medicine, Hamamatsu, Japan
| |
Collapse
|