[Status of minimally invasive gastrectomy : Current advancements: robotic surgery and intraoperative imaging for gastric cancer]

Patient-reported gastrointestinal symptoms following surgery for gastric cancer and the relative risk factors

Purpose

The study aims to assess the incidence of short-term patient-reported postoperative gastrointestinal symptoms (PGISs) after gastric cancer surgery and explore the relative risk factors for the symptoms.

Methods

Patients with radical gastrectomy were included for this retrospective and observational study. Symptoms extracted from the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI) were collected in postdischarge week (PDW) 1 and postoperative month (POM) 1. The distributing states of symptoms were analyzed in PDW1 and POM1. Logistic regression models were used to identify risk factors for PGISs.

Results

Among 356 patients with complete interviews, 156 (43.8%) patients reported abdominal distention in PDW1, which was significantly higher than patients in POM1 [103 (28.9%), p < 0.001]. Pain (15.2% vs. 9.8%), dysphagia (5.6% vs. 7.0%), diarrhea (3.7% vs. 3.4%), and vomiting (2.5% vs. 2.8%) had no significant differences between PDW1 and POM1. Logistic models found that risk factors for PGISs were total gastrectomy [odds ratio (OR): 1.948; 95% CI: 1.097–3.459; p = 0.023] and disturbed sleep (OR: 3.116; 95% CI: 1.831–5.303; p < 0.001) in PDW1 and female gender (OR: 1.726; 95% CI: 1.071–2.782; p = 0.025), total gastrectomy (OR: 1.729; 95% CI: 1.055–2.834; p = 0.030), and disturbed sleep (OR: 3.533; 95% CI: 1.757–7.106; p < 0.001) in POM1.

Conclusions

The main symptom after gastric cancer surgery was abdominal distention. The relative risk factors for gastrointestinal symptoms after gastric cancer surgery were total gastrectomy and disturbed sleep. Timely symptom intervention may improve the quality of life of postgastrectomy patients.

Precision Surgery In Rectal Resection With Hyperspectral and Fluorescence Imaging And Pelvic Intraoperative Neuromonitoring (With Video)

Oncologic visceral surgery has recently been revolutionized by robotics, artificial intelligence (AI), sparing of functionally important structures and innovative intraoperative imaging tools. These techniques enable new dimensions of precision surgery and oncology. Currently, data-driven, cognitive operating rooms are standing at the forefront of the latest technical and didactic developments in abdominal surgery. Rectal low anterior resection with total mesorectal excision (TME) for lower- and middle-third rectal cancer is a challenging operation due to the narrow pelvis and the tender guiding structures. Thus, new approaches have been needed to simplify the procedure and to upgrade the results. The combination of robotics with pelvic intraoperative neuromonitoring (pIONM) and new possibilities of visualization, such as multi- and hyperspectral imaging (MSI / HSI) or fluorescence imaging (FI) with indocyanine green (ICG) is a forward-looking modality to enhance surgical precision and reduce postoperative complications while improving oncologic and functional outcomes with a better quality of life. The aim of our video-paper is to show how to achieve maximum precision by combining robotic surgery with pelvic intraoperative neuromonitoring and new imaging devices for rectal cancer.