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Keller DS, Curtis N, Burt HA, Ammirati CA, Collings AT, Polk HC, Carrano FM, Antoniou SA, Hanna N, Piotet LM, Hill S, Cuijpers ACM, Tejedor P, Milone M, Andriopoulou E, Kontovounisios C, Leeds IL, Awad ZT, Barber MW, Al-Mansour M, Nassif G, West MA, Pryor AD, Carli F, Demartines N, Bouvy ND, Passera R, Arezzo A, Francis N. EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults. Surg Endosc 2024:10.1007/s00464-024-10977-7. [PMID: 38942944 DOI: 10.1007/s00464-024-10977-7] [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: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery. METHODS Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology. RESULT Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery. CONCLUSIONS MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.
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Affiliation(s)
- Deborah S Keller
- Department of Digestive Surgery, University of Strasbourg, Strasbourg, FR, USA
| | - Nathan Curtis
- Surgical Unit, Dorset County Hospital, Dorchester, Dorset, UK
| | | | | | - Amelia T Collings
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hiram C Polk
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Francesco Maria Carrano
- Department of General and Minimally Invasive Surgery, Busto Arsizio Circolo Hospital, ASST-Valle Olona, Varese, Italy
| | - Stavros A Antoniou
- Department of General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nader Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Sarah Hill
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Anne C M Cuijpers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia Tejedor
- Department of Colorectal Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marco Milone
- Department of Clinical and Surgical Gastrointestinal Diseases, University of Naples "Federico II", Via Pansini 5, Naples, Italy
| | - Eleni Andriopoulou
- Department of Surgery, Hellenic Red Cross Korgialeneio Benakeio NHS, Athens, Greece
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Campus and the Royal Marsden Hospital, London, UK
| | - Ira L Leeds
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Meghan Wandtke Barber
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Mazen Al-Mansour
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - George Nassif
- Department of Colorectal Surgery, AdventHealth, Orlando, FL, USA
| | - Malcolm A West
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
- Complex Cancer and Exenterative Service, University Hospitals Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton, Southampton, UK
| | - Aurora D Pryor
- Long Island Jewish Medical Center and System Chief for Bariatric Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA
| | - Franco Carli
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | - Nicole D Bouvy
- Innovative Surgical Techniques, Endoscopic and Endocrine Surgery, Department of Surgery, Maastricht University Medical Center, Amsterdam, Netherlands
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Turin, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Nader Francis
- Department of Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK.
- The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK.
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Yen HH, Yeh CC, Lai IR. Laparoscopic versus open distal gastrectomy for elderly patients with advanced gastric cancer: a retrospective comparative study. World J Surg Oncol 2022; 20:355. [PMID: 36348420 PMCID: PMC9644532 DOI: 10.1186/s12957-022-02819-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic radical distal gastrectomy (LDG) has been more frequently performed for locally advanced distal gastric cancer (AGC) than open distal gastrectomy (ODG). However, the benefits of LDG for elderly AGC patients (AGC-lap) remain unclear. METHODS Patients aged ≥ 70 years who underwent D2 distal gastrectomy from July 2014 to July 2021 were enrolled consecutively. Perioperative parameters, pathological features, and oncological outcomes of AGC-lap patients (n = 39) were compared with those of elderly AGC patients receiving ODG (AGC-open; n = 37) and elderly early gastric cancer patients receiving LDG (EGC-lap; n = 41) respectively. RESULTS The median age of all AGC patients was 77 years, and 28% of them had an Eastern Cooperative Oncology Group score ≥ 2. Most of the perioperative and pathological features (including the number of lymph nodes harvested) were similar between the AGC-lap and AGC-open groups. AGC-lap patients had longer median operative times (215 min versus 192 min) but significantly less surgical complications (10.3% versus 37.8%) and shorter median hospital stays (11 days versus 13 days) than did AGC-open patients (all p < 0.05). The 3-year recurrence-free and overall survival was 66.2% and 88.8% in the AGC-lap group and 51% and 66.3% in the AGC-open group (both p = 0.1). The perioperative features, including operative time, number of lymph nodes harvested, hospital stay, and complication rates, were similar between the AGC- and EGC-lap groups. CONCLUSIONS LDG was safely and effectively performed in elderly AGC patients, resulting in faster recovery and a lower complication rate than ODG, without compromising oncological outcomes.
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Affiliation(s)
- Hung-Hsuan Yen
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Chuan Yeh
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Rue Lai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
- Graduate Institute of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Outcomes of surgical treatment of non-metastatic gastric cancer in patients aged 70 and older: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1882-1894. [DOI: 10.1016/j.ejso.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/24/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022]
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Jeong SA, Yoo MW, Lee IS, Gong CS, Ko CS, Jheong JH, Lee JB, Kim BS. Comparing surgical and oncologic outcomes between laparoscopic gastrectomy and open gastrectomy in advanced gastric cancer with serosal invasion: A retrospective study with propensity score matching. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:1988-1993. [DOI: 10.1016/j.ejso.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/09/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
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Lao WL, Song QL, Jiang ZM, Chen WD, Zheng XH, Chen ZH. The Effect of Oxycodone on Post-operative Pain and Inflammatory Cytokine Release in Elderly Patients Undergoing Laparoscopic Gastrectomy. Front Med (Lausanne) 2021; 8:700025. [PMID: 34540861 PMCID: PMC8440846 DOI: 10.3389/fmed.2021.700025] [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] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background: To evaluate the effect of oxycodone on post-operative pain and inflammation in elderly patients undergoing laparoscopic gastrectomy. Methods: Sixty patients who were of both sexes, American Society of Anesthesiologists Physical Status (ASA-PS) Class I or II, over 65 years of age and undergoing an elective laparoscopic radical gastrectomy were randomly divided into two groups: an oxycodone group (Group O) including 20 males and 10 females and a sufentanil group (Group S) including 21 males and 9 females. The post-operative analgesia regimen was as follows: 40 mg of parecoxib sodium and 0.1 mg/kg of oxycodone was intravenously injected into Group O before the abdomen closure, while 40 mg of parecoxib sodium and 0.1 μg/kg of sufentanil was injected intravenously into Group S. Both groups were infiltrated with 20 ml of 1% ropivacaine at the end of the operation. The level of serum IL-6 and IL-10 were assayed immediately at the following timepoints: at the conclusion of surgery (T1), 1 h (T2), 6 h (T3), and 24 h (T4) after the completion of the surgery. The numerical rating scale (NRS), the Ramsay sedation score, analgesic-related adverse events, post-operative pulmonary inflammation events and the post-operative stay were recorded. Results: Compared with Group S, the serum IL-6 concentrations of Group O decreased at T3 and T4, while the serum IL-10 concentrations increased (P < 0.05). In Group O, the serum IL-6 concentrations at T3 and T4 were lower than those at T1 (P < 0.05). The incidence of post-operative nausea and vomiting (PONV) and pulmonary inflammation in Group O was lower than that in Group S (P < 0.05). At each time point, the NRS of visceral pain in Group O was lower than that in Group S. At 6 and 24 h after extubation, the NRS of incision pain in Group O was lower than that in Group S (P < 0.05). Conclusion: Oxycodone can regulate the level of inflammatory cytokines and reduce post-operative inflammatory response.
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Affiliation(s)
- Wei-Long Lao
- Shaoxing University School of Medicine, Shaoxing, China
| | - Qi-Liang Song
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China
| | - Zong-Ming Jiang
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China
| | - Wen-di Chen
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China
| | - Xian-He Zheng
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China
| | - Zhong-Hua Chen
- Shaoxing University School of Medicine, Shaoxing, China.,Department of Anesthesia, The First Affiliated Hospital of Shaoxing University, Shaoxing, China
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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.
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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.
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Li ZY, Chen J, Bai B, Xu S, Song D, Lian B, Li JP, Ji G, Zhao QC. Laparoscopic gastrectomy for elderly gastric-cancer patients: comparisons with laparoscopic gastrectomy in non-elderly patients and open gastrectomy in the elderly. Gastroenterol Rep (Oxf) 2020; 9:146-153. [PMID: 34026222 PMCID: PMC8128003 DOI: 10.1093/gastro/goaa041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background The benefits of laparoscopic gastrectomy (LG) in elderly gastric-cancer patients still remain unclear. The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patients. Methods We retrospectively evaluated patients who underwent LG or open gastrectomy (OG) between June 2009 and July 2015 in a single high-volume center. We compared surgical, short-term, and long-term survival outcomes among an elderly (≥70 years old) LG (ELG) group (n = 114), a non-elderly (<70 years old) LG (NLG) group (n = 740), and an elderly OG (EOG) group (n = 383). Results Except for extended time to first flatus, the surgical and short-term outcomes of the ELG group were similar to those of the NLG group. The ELG group revealed comparable disease-specific survival (DSS) rates to the NLG group (64.9% vs 66.2%, P = 0.476), although the overall survival (OS) rate was lower (57.0% vs 65.5%, P < 0.001) in the ELG group than in the NLG group. The ELG group showed longer operation time than the EOG group (236.4 ± 77.3 vs 179 ± 52.2 min, P < 0.001). The ELG group had less estimated blood loss (174.0 ± 88.4 vs 209.3 ± 133.8, P = 0.008) and shorter post-operative hospital stay (8.3 ± 2.5 vs 9.2 ± 4.5, P = 0.048) than the EOG group. The severity of complications was similar between the ELG and NLG groups. Multivariate analysis confirmed that LG was not a risk factor for post-operative complications. Conclusions LG is a feasible and safe procedure for elderly patients with acceptable short- and long-term survival outcomes.
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Affiliation(s)
- Zheng-Yan Li
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China.,Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing, P. R. China
| | - Jie Chen
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China
| | - Bin Bai
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China
| | - Shuai Xu
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China
| | - Dan Song
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China
| | - Bo Lian
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China
| | - Ji-Peng Li
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China
| | - Gang Ji
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China
| | - Qing-Chuan Zhao
- Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shanxi, P. R. China
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Shan F, Gao C, Li XL, Li ZY, Ying XJ, Wang YK, Li SX, Ji X, Ji JF. Short- and Long-Term Outcomes after Laparoscopic Versus Open Gastrectomy for Elderly Gastric Cancer Patients: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2020; 30:713-722. [PMID: 32471317 DOI: 10.1089/lap.2019.0778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: With the rapid aging of global population, the number of elderly patients with gastric cancer is increasing. This study aimed to evaluate short- and long-term outcomes after laparoscopic gastrectomy (LG) versus open gastrectomy (OG) in elderly gastric cancer patients. Materials and Methods: We searched PubMed, EMBASE, and the Cochrane library databases from January 1994 to May 2019. Surgical safety, postoperative complications, number of harvested lymph nodes, and overall survival rate were included and analyzed. The qualities of the included studies were evaluated by Newcastle-Ottawa Quality Assessment Scale. The evidence of outcomes was evaluated using the GRADE approach. The Review Manager® 5.3 (Cochrane, London, UK) and Stata® 14.0 (StataCorp., College Station, Texas) were used to analyze the outcomes. Results: Thirteen studies containing 4768 elderly patients with gastric cancer were included in this meta-analysis. LG was more favorable than OG in terms of overall postoperative morbidity (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.44 to 0.70; P < .00001), the postoperative stay (standardized mean difference [SMD]: -0.56; 95% CI: -0.76 to (-0.37); P < .00001), and the number of harvested lymph nodes (SMD: 0.19; 95% CI: 0.09 to 0.29; P = .0003). No significant difference was found in anastomotic leakage rate (OR: 0.82; 95% CI: 0.59 to 1.12; P = .21), mental disease (OR: 0.79; 95% CI: 0.44 to 1.44; P = .44), or overall survival rate (P = .62) between two groups. However, in the subgroup with a cutoff age of 80 years, the anastomotic leakage rate was higher in LG (OR: 10.27; 95% CI: 1.31 to 80.35; P = .03). Conclusions: LG was more favorable than OG in the elderly patients <80 years old with gastric cancer.
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Affiliation(s)
- Fei Shan
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Chao Gao
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiao-Long Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Zi-Yu Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang-Ji Ying
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yin-Kui Wang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Shuang-Xi Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xin Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jia-Fu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China
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Vinolas H, Barnetche T, Ferrandi G, Monsaingeon-Henry M, Pupier E, Collet D, Gronnier C, Gatta-Cherifi B. Oral Hydration, Food Intake, and Nutritional Status Before and After Bariatric Surgery. Obes Surg 2020; 29:2896-2903. [PMID: 31102207 DOI: 10.1007/s11695-019-03928-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Bariatric surgery is considered to be the most effective treatment of morbid obesity. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGBP) are the most popular procedures. We evaluated nutritional status, micro- and macronutrient intake, and oral hydration in patients before and regularly during 1 year after RYGBP and SG. METHODS All patients that had been through bariatric surgery with at least 1-year post-surgery were retrospectively included in the study. All participants were evaluated once during the 2 months before the surgery and at 1, 3, 6, and 12 months after surgery. Clinical and biological evaluations as well as dietary investigations were performed. RESULTS Fifty-seven patients were included in this study (28 RYGBP and 29 SG). Patients in the RYGBP group had significantly higher body weight (132.3 ± 22 versus 122.2 ± 22.2 kg, p = 0.039) than patients in the SG group. Before surgery, total energy intake, oral hydration, and vitamin and mineral intakes were not different between the two groups. RYGBP and SG induced significant similar excess weight loss 1 year after surgery, 48.6 29.8% and 57.6 27.6% of body weight respectively. Energy intake significantly decreased 1 month after surgery and slightly increased from 1 to 12 months without reaching baseline intake levels. Macronutrient repartition did not change during follow-up. Oral hydration significantly decreased after RYGBP (- 58%) and showed a trend to be decreased after SG (- 49%). Sixty-five percent of patients still had vitamin D deficiency 1 year after surgery. Whatever the type of surgery, more than 20% had some vitamin deficiency 1 month after surgery. CONCLUSIONS Calories intake decreases after bariatric surgery, whatever the type of procedure. In addition, the prevalence of vitamin deficiency is high after bariatric surgery. Lastly, oral hydration is importantly decreased after bariatric surgery, especially after RYGBP.
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Affiliation(s)
- Hélène Vinolas
- Endocrinology Department, Bordeaux University Hospital, Bordeaux, France
| | - Thomas Barnetche
- Rheumatology Department, FHU ACRONIM, Bordeaux University Hospital, Bordeaux, France
| | - Genevieve Ferrandi
- Endocrinology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Emilie Pupier
- Endocrinology Department, Bordeaux University Hospital, Bordeaux, France
| | - Denis Collet
- Digestive Surgery Department, Bordeaux University Hospital, Bordeaux, France.,University of Bordeaux, F-33000, Bordeaux, France
| | - Caroline Gronnier
- Digestive Surgery Department, Bordeaux University Hospital, Bordeaux, France.,University of Bordeaux, F-33000, Bordeaux, France
| | - Blandine Gatta-Cherifi
- Endocrinology Department, Bordeaux University Hospital, Bordeaux, France. .,University of Bordeaux, F-33000, Bordeaux, France. .,Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, University of Bordeaux, U1215, F-33000, Bordeaux, France.
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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.
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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
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11
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Farrow NE, Freischlag KW, Adam MA, Blazer DG. Impact of minimally invasive gastrectomy on use of and time to adjuvant chemotherapy for gastric adenocarcinoma. J Surg Oncol 2020; 121:486-493. [PMID: 31919862 DOI: 10.1002/jso.25834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/23/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chemotherapy improves outcomes in patients with resectable gastric cancer. Minimally invasive gastrectomy (MIS) rates are increasing, though the impact of MIS on postoperative chemotherapy remains uncertain. This study examines the impact of MIS vs open gastrectomy (OG) on utilization of adjuvant chemotherapy for high-risk gastric cancer. METHODS Patients in the National Cancer Database who underwent resection for high-risk gastric adenocarcinoma between 2010 and 2015 were included. Patients were stratified by surgical approach (MIS vs OG) and analyzed using multivariable regression modeling. Primary endpoints were utilization of and time to initiation of adjuvant chemotherapy. RESULTS Overall, 23 071 patients were included; 16 595 (71.9%) underwent OG and 6476 (28.1%) underwent MIS. After adjusting for patient and tumor characteristics, MIS was not associated with increased use of adjuvant chemotherapy (odds ratio [OR]: 1.027, 95% confidence interval [CI]: 0.95 to 1.11, P = .50), and time to initiation of chemotherapy was similar (-2% change, 95% CI: -5% to +1%, P = .27). MIS was associated with shorter hospital stays (-1 day). Thirty-day readmission rates, 90-day mortality, and overall survival were similar between groups. CONCLUSIONS In this study, while MIS for gastric adenocarcinoma was associated with shorter hospital stays and comparable survival, it was not associated with improved utilization or time to initiation of adjuvant chemotherapy.
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Affiliation(s)
- Norma E Farrow
- Department of Surgery, Duke University, Durham, North Carolina
| | | | - Mohamed A Adam
- Department of Surgical Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dan G Blazer
- Department of Surgery, Duke University, Durham, North Carolina
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Panduro-Correa V, Dámaso-Mata B, Loza-Munárriz C, Herrera-Matta J, Arteaga-Livias K. Comparación de gastrectomía abierta frente a laparoscópica en cáncer gástrico avanzado. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2020; 85:32-41. [PMID: 31171390 DOI: 10.1016/j.rgmx.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/15/2018] [Accepted: 01/14/2019] [Indexed: 02/08/2023]
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13
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Panduro-Correa V, Dámaso-Mata B, Loza-Munárriz C, Herrera-Matta J, Arteaga-Livias K. Comparison of open gastrectomy and the laparoscopic procedure in advanced gastric cancer. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2020. [DOI: 10.1016/j.rgmxen.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Long-term Outcomes of Laparoscopy-assisted Gastrectomy for T4a Advanced Gastric Cancer: A Single-center Retrospective Study. Surg Laparosc Endosc Percutan Tech 2019; 29:476-482. [DOI: 10.1097/sle.0000000000000684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Li Z, Zhao Y, Liu Y, Yu D, Zhao Q. Laparoscopic versus open gastrectomy for high-risk patients with gastric cancer: A systematic review and meta-analysis. Int J Surg 2019; 65:52-60. [PMID: 30867126 DOI: 10.1016/j.ijsu.2019.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/08/2019] [Accepted: 03/01/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND It is still remains unclear whether high-risk patients with gastric cancer can benefit from the application of laparoscopic gastrectomy (LG). The aim of this systematic review was to evaluate the surgical and long-term outcomes after LG and open gastrectomy (OG) for high-risk patients with gastric cancer. METHODS We performed a systematic literature search in various databases from January 1994 to June 2018. Patients who had≥1 of the following conditions were defined as high-risk patients: (1) age≥70 years; (2) BMI≥30 kg/m2; (3) ASA (American Society of Anesthesiologists) grade≥3; or (4) clinical T4 stage (cT4). The results were analyzed according to predefined criteria. RESULTS In the present meta-analysis, the outcomes of 12 non-randomized controlled studies enrolling 1651 patients (873 in the LG group and 778 in the OG group) were pooled. The estimated blood loss was significantly lower in the LG group than those in the OG group (P < 0.01). There was no significant difference between two groups in operative time (P = 0.17) and number of harvested lymph nodes (P = 0.21). In the LG group, the time to flatus (P < 0.01), time to food intake (P < 0.01), and postoperative hospital stay (P < 0.01) were significantly shorter than those in the OG group. A lower overall postoperative complication rate was observed in the LG group (P < 0.01). The incidence of surgical (P < 0.01) and non-surgical (P < 0.01) complication was significantly lower in the LG group than that in the OG group. The pooled analysis showed no significant difference in overall survival (OS) between LG and OG groups (P = 0.98). CONCLUSIONS LG can be a safe and feasible procedure for high-risk patients with gastric cancer.
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Affiliation(s)
- Zhengyan Li
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
| | - Yan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Yezhou Liu
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Deliang Yu
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Qingchuan Zhao
- Department of Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
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Liao G, Wang Z, Li H, Min J, Zhong J, Mariella S, Qian K, Zhang W. Learning curve and short-term outcomes of modularized LADG for advanced gastric cancer: A retrospective study. Medicine (Baltimore) 2019; 98:e14670. [PMID: 30855456 PMCID: PMC6417604 DOI: 10.1097/md.0000000000014670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Laparoscopy-assisted distal gastrectomy (LADG) is a complicated procedure. To reduce the difficulty of the operation and standardize the surgical procedure, we explored a new operation mode, which we termed modularized LADG (MLADG). To further extend the new operation mode, we conducted this study to evaluate the short-term outcomes of MLADG for advanced gastric cancer, and determine the learning curve.Data from 100 consecutive patients who received LADG between October 2016 and October 2017 were retrospectively analyzed. Short-term outcomes, such as operation time and intraoperative blood loss, were evaluated, and the learning curve was calculated.For MLADG, the mean operation time was 168.2 ± 13.0 minutes, the mean intraoperative blood loss was 93.6 ± 29.1 ml, the mean number of harvested lymph nodes was 28.6 ± 4.2, and conversion to open surgery occurred in only 1 case. In addition, MLADG had an acceptable postoperative complication incidence and fast postoperative recovery. After the first 20 cases, the operation skill reached a mature and stable level.Our results indicate that MLADG is an oncologically feasible and technically safe surgical procedure. For the trainees with rich experience in open distal gastrectomy, the learning curve is considered to be completed after 20 MLADG cases.
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17
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Sheng S, Chen Y, Li C. Outcomes of Laparoscopic Total Gastrectomy for Elderly Gastric Cancer Patients. J Cancer 2018; 9:4398-4403. [PMID: 30519345 PMCID: PMC6277644 DOI: 10.7150/jca.26858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose: The purpose of this study was to compare the short- and long-term outcomes after laparoscopic total gastrectomy (LTG) between elderly and non-elderly patients with gastric cancer. Methods: A retrospective analysis was performed using clinical and follow-up data from 168 patients treated with LTG for gastric cancer at our institution from January 2010 to December 2017. For this study, the short- and long-term outcomes (including tumor recurrence rate, disease-free survival rate, and overall survival rate) were compared between the elderly group (≥70 years) and non-elderly group (<70 years). Results: The preoperative American Society of Anesthesiologists score and Charlson Comorbidity Index were higher in the elderly group than in the non-elderly group, while there was no significant difference between the two groups in terms of operation duration, intraoperative blood loss, and rate of conversion to laparotomy. The incidence of postoperative 30-day complications in the elderly group was higher than that in the non-elderly group due to a higher incidence of pulmonary infection, while the incidence of major complications was similar in both groups. The tumor recurrence rate was also similar in both groups. There was no statistically significant difference between the two groups in terms of 5-year disease-free survival and 5-year overall survival rate. Conclusions: LTG is safe and feasible for elderly patients with gastric cancer and is associated with relatively good long-term outcomes.
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Affiliation(s)
- Shihou Sheng
- Department of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130000, People's Republic of China
| | - Yahong Chen
- Department of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130000, People's Republic of China
| | - Chunsheng Li
- Department of Gastrointestinal Surgery, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130000, People's Republic of China
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18
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Is thoracoscopic-laparoscopic esophagectomy a better alternative to thoracoscopic esophagectomy? Int J Surg 2017; 48:105-109. [PMID: 29061388 DOI: 10.1016/j.ijsu.2017.10.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is gaining rapid popularity as an alternative to conventional open esophagectomy. However, whether incorporating laparoscopy into MIE can further help the patients with esophageal cancer has rarely been studied. The aim of this study was to evaluate the short-term clinical efficacy of thoracoscopic-laparoscopic esophagectomy (TLE) compared with thoracoscopic esophagectomy (TE) in treating esophageal cancer. METHODS From September 2014 to December 2016, a total of 131 patients with esophageal cancer who had consecutively undergone MIE were included in the analysis; of them, TLE was performed in 71 patients and TE in 60 patients. Characteristics and perioperative outcomes of all patients were collected and compared to determine differences between the 2 groups. RESULTS Operation time (p = 0.172), chest drainage volume (p = 0.656), and pathologic staging (p = 0.671) were similar in the 2 groups. Compared with the TE approach, the TLE approach was associated with less blood loss during the operation (median, 100 vs 150 ml, p < 0.001), shorter chest drainage time (median, 2 vs 3 days, p < 0.001), a larger number of harvested lymph nodes (median, 24 vs 20, p < 0.001), and shorter postoperative hospital stay (median, 10 vs 11 days, p = 0.008). There was no significant difference between groups with regard to the major (grade ≥ III) and minor (grade < III) complications. CONCLUSIONS TLE is a safe and effective alternative to TE. Patients undergoing TLE may benefit from less blood loss, a larger number of harvested lymph nodes and faster postoperative recovery. Additional randomized controlled trial with longer follow-up is needed.
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Inokuchi M, Tanioka T, Nakagawa M, Okuno K, Gokita K, Kojima K. Laparoscopic Distal Gastrectomy is Feasible in Very Elderly Patients as Compared with Open Distal Gastrectomy. J INVEST SURG 2017; 31:539-545. [DOI: 10.1080/08941939.2017.1355025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Mikito Inokuchi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Toshiro Tanioka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Masatoshi Nakagawa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Keisuke Okuno
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Kentaro Gokita
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Kazuyuki Kojima
- Department of Minimally Invasive Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
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Bao H, Xu N, Li Z, Ren H, Xia H, Li N, Yu H, Wei J, Jiang C, Liu L. Effect of laparoscopic gastrectomy on compliance with adjuvant chemotherapy in patients with gastric cancer. Medicine (Baltimore) 2017; 96:e6839. [PMID: 28538373 PMCID: PMC5457853 DOI: 10.1097/md.0000000000006839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study was designed to investigate the effect of laparoscopic gastrectomy on adjuvant chemotherapy in patients with gastric cancer.Patients with gastric cancer who underwent radical gastrectomy at our institution from January 2008 to January 2015 with R0 resection, as determined by a pathological examination, were included in this study. According to the surgical approach, patients were divided into the laparoscopic gastrectomy (LG) group and open gastrectomy (OG) group. Short-term and long-term outcomes were compared between the 2 groups.Of the 206 patients enrolled in the study, 114 patients were included in the LG group and 92 patients were included in the OG group. There was no significant difference in patients' general data, including age, sex, medical comorbidities, and pathological staging, between the 2 groups. However, patients in the LG group had less intraoperative blood loss, fewer postoperative complications, and a shorter hospital stay compared with patients in the OG group. There was no significant difference in the start time of adjuvant chemotherapy between the groups. However, compared with OG, LG had the following advantages: patients received more cycles of adjuvant chemotherapy, more patients received a full dose of on-schedule adjuvant chemotherapy, and more patients completed ≥75% of the planned dose. Long-term survival and disease-free survival rates were higher in the LG than in the OG.In summary, LG can improve compliance with adjuvant chemotherapy and long-term outcomes in patients with gastric cancer.
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Affiliation(s)
- Huizheng Bao
- Jilin Cancer Hospital, Changchun, Jilin, People's Republic of China
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Zong L, Wu A, Wang W, Deng J, Aikou S, Yamashita H, Maeda M, Abe M, Yu D, Jiang Z, Seto Y, Ji J. Feasibility of laparoscopic gastrectomy for elderly gastric cancer patients: meta-analysis of non-randomized controlled studies. Oncotarget 2017; 8:51878-51887. [PMID: 28881697 PMCID: PMC5584298 DOI: 10.18632/oncotarget.16691] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/12/2017] [Indexed: 12/18/2022] Open
Abstract
The aim of this meta-analysis was to determine the feasibility of laparoscopic gastrectomy (LG) for elderly gastric cancer patients by comparing laparoscopic and conventional open gastrectomies (OG). Comprehensive search of the PubMed, EMBASE, and Cochrane Library databases revealed nine non-randomized controlled studies that compared LG and OG in elderly gastric cancer patients We then analyzed dichotomous or continuous parameters using odds ratios (ORs) or weighted mean differences (WMDs). Overall survival was estimated using hazard ratios (HRs) with a fixed effects or random effects model. We observed that the age distribution was similar between the LG and OG patient groups (WMD -0.22 95% CI, -1.26-0.82). LG patients experienced less blood loss (WMD -119.14 95% CI, -204.17--34.11) and had shorter hospital stays (WMD -3.48 95% CI, -5.41--1.56), but endured longer operation times (WMD 10.87 95% CI, 2.50-19.24). Postoperatively, LG patients exhibited lower incidences of postoperative morbidities (OR 0.59 95% CI, 0.43-0.79), surgery related morbidities (OR 0.58 95% CI, 0.41-0.81) and systemic morbidities (OR 0.56 95% CI, 0.38-0.82). We observed no differences between the LG and OG patient groups regarding anastomotic leakage (OR 0.69 95% CI, 0.34-1.41), mental disease (OR 0.72 95% CI, 0.37-1.41) and long term effects (HR 0.98 95% CI, 0.74-1.32). We therefore conclude that laparoscopic gastrectomy might be technically feasible for elderly gastric cancer patients.
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Affiliation(s)
- Liang Zong
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.,Department of Gastrointestinal Surgery, Su Bei People's Hospital of Jiangsu Province, Yangzhou University, Yangzhou, China
| | - Aiwen Wu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Wenyue Wang
- Department of Gastrointestinal Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jingyu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Hospital, City Key Laboratory of Tianjin Cancer Center and National Clinical Research Center for Cancer, Tianjin, China
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masahiro Maeda
- Department of Gastrointestinal Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masanobu Abe
- Division for Health Service Promotion, University of Tokyo, Tokyo, Japan
| | - Duonan Yu
- Institute of Comparative Medicine, Yangzhou University, Yangzhou, China
| | - Zhiwei Jiang
- Research Institute of General Surgery, Jinling Hospital, Nanjing, China
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
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Liu G, Jian F, Wang X, Chen L. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial. Onco Targets Ther 2016; 9:3345-51. [PMID: 27330314 PMCID: PMC4898437 DOI: 10.2147/ott.s107443] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim To study the efficacy of the fast-track surgery (FTS) program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC) patients. Methods Eighty-four elderly patients diagnosed with GC between September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21), FTS + laparotomy group (Group B, n=21), conventional perioperative care (CC) + laparoscopic group (Group C, n=21), and CC + laparotomy group (Group D, n=21). Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators. Results Preoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05). There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05). Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest. Conclusion FTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more effectively reduce postoperative stress reaction, and hence is safe and effective for elderly GC patients.
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Affiliation(s)
- Guozheng Liu
- Department of General Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Fengguo Jian
- Second Department of General Surgery, Changyi People's Hospital, Shandong, People's Republic of China
| | - Xiuqin Wang
- Second Department of General Surgery, Changyi People's Hospital, Shandong, People's Republic of China
| | - Lin Chen
- Department of General Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
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Li HZ, Chen JX, Zheng Y, Zhu XN. Laparoscopic-assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. J Surg Oncol 2016; 113:756-67. [PMID: 27076039 DOI: 10.1002/jso.24243] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/21/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies comparing laparoscopic-assisted to open gastrectomy (OG) for resectable gastric cancer were inexhaustive, so an updated meta-analysis was performed to clarify quality of life, patient satisfaction, safety and effectiveness associated with laparoscopic-assisted gastrectomy (LAG). METHODS Pubmed, Embase, and The Cochrane Library were searched from inception to December 2015 for randomized controlled trials (RCTs) comparing LAG with OG for resectable gastric cancer. Relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were pooled with random-effects model. Furthermore, trial sequential analysis (TSA) was employed to indicate the credibility of pooled estimate. RESULTS Fourteen RCTs totaling 2,307 gastric cancer patients (1,163 in laparoscopic and 1,144 in open) were included. Compared with OG, LAG showed higher patient satisfaction and quality of life, less blood loss, hospital stay and overall postoperative morbidity, and longer operating time, which were confirmed by TSA. LAG also accelerated time to first flatus, first walking and first intake and reduced frequency of analgesic administration and days of fever. There were no significant difference between the two groups in number of retrieved lymph nodes, mortality, recurrence, long-term overall survival and disease-free survival. CONCLUSION For patients with resectable gastric cancer, LAG decreased blood loss, length of hospital stay and overall postoperative morbidity and improved postsurgical recovery. J. Surg. Oncol. 2016;113:756-767. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hui-Zi Li
- Department of General Surgery, The Fourth Affiliated Hospital of Nan Chang University, Nanchang, Jiangxi, China
| | - Jia-Xi Chen
- Department of General Surgery, The Fourth Affiliated Hospital of Nan Chang University, Nanchang, Jiangxi, China
| | - Yang Zheng
- Department of General Surgery, The Fourth Affiliated Hospital of Nan Chang University, Nanchang, Jiangxi, China
| | - Xiang-Nan Zhu
- Department of General Surgery, The Fourth Affiliated Hospital of Nan Chang University, Nanchang, Jiangxi, China
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