Robotic gastrectomy was reliable option for overweight patients with gastric cancer: a propensity score matching study

Clinical Value of Nomograms Integrating Circulating Lipid and Inflammation Risk Score in Predicting Long-Term Outcomes After Radical Gastrectomy in Gastric Cancer: A Multicenter Real-World Study

BACKGROUND

The clinical value of incorporating lipid and inflammatory factors to predict long-term survival in patients with gastric cancer (GC) is unreported. This study aimed to investigate the clinical value of nomograms integrating the Circulating Lipid and Inflammation Risk Score (CLIRS) for predicting the long-term outcome of patients with GC.

METHODS

A retrospective analysis included patients with GC who underwent radical resection at four tertiary medical centers. Patients were divided into training and validation cohorts, with least absolute shrinkage and selection operator regression selecting optimal lipid and inflammatory indicators related to GC prognosis. The CLIRS was developed from six indicators: lymphocyte, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B.

RESULTS

Overall, 2534 patients were studied, including 1910 in the training cohort and 624 in the validation cohort. The CLIRS was an independent risk factor for overall survival (OS; hazard ratio [HR] 1.529, 95% confidence interval [CI] 1.271-1.839; p < 0.001) and disease-free survival (DFS; HR 1.511, 95% CI 1.267-1.801; p < 0.001) in GC patients. The OS nomogram (area under the receiver operating characteristic curve 0.823 vs. 0.785; p < 0.05) and DFS nomogram (AUC 0.804 vs. 0.770; p < 0.05) based on the CLIRS outperformed pTNM stage. High-risk patients had earlier and more sustained recurrence, with higher rates of local, peritoneal, and distant recurrences (p < 0.05).

CONCLUSIONS

The CLIRS, combining circulating lipid and inflammatory factors, is an independent prognostic factor for patients with GC. Nomograms incorporating the CLIRS are superior to pTNM stage in predicting postoperative survival and recurrence in patients with GC.

Evolution from laparoscopic to robotic radical resection for gallbladder cancer: a propensity score-matched comparative study

BACKGROUND

The use of robotic or laparoscopic surgery for gallbladder cancer (GBC) is increasing, with reported advantages over conventional open surgery. The purpose of this study was to compare the perioperative outcomes and postoperative overall survival (OS) associated with robotic radical resection (RRR) and laparoscopic radical resection (LRR) for GBC.

METHOD

A total of 109 patients with GBC who underwent radical resection with the same surgical team between January 2015 and December 2023 were enrolled, with 21 patients in the RRR group and 88 cases in the LRR group. A 1:1 propensity score matching (PSM) algorithm was used to compare the surgical outcomes and postoperative prognosis between the RRR and LRR groups. Logistic regression analysis was used to identify the risk factors of postoperative overall survival (OS) and complications of Clavien-Dindo (C-D) Grades III-IV.

RESULTS

The median follow-up time was 46 (inter-quartile range, IQR 29-70) months for the LRR group and 16 (IQR 12-34) months for the RRR group. After PSM, the baseline characteristics of the RRR and LRR groups were generally well balanced, with 21 patients in each group. RRR was associated with significantly decreased intraoperative bleeding [100.00 (50.00, 200.00) mL vs 200.00 (100.00, 300.00) mL] and higher number of lymph nodes (LNs) yield [12.00 (9.00, 15.50) vs 8.00 (6.00, 12.00)]. The two groups showed comparable outcomes in terms of the incidence of biliary reconstruction, the range of liver resection, the length of operation, the incidence of postoperative morbidity, the incidence of C-D Grades III-IV complications, number of the days of drainage tubes indwelling and postoperative hospital stay, and mortality by postoperative days 30 and 90. After PSM, the 1-, 2-, and 3-year overall survival rates were 78, 70, and 37%, respectively, in the RRR group, and 71, 59, and 48%, respectively, in the LRR group (P = 0.593). Multivariate analysis showed that the preoperative TB level ≥ 72 µmol/L and biliary reconstruction were found to be the independent risk factors of C-D Grades III-IV complications. T3 stage was identified to be the risk factor for postoperative OS.

CONCLUSION

Compared with LRR, RRR showed comparable perioperative outcomes in terms of length of operation, and postoperative complications, recovery, and OS. In our case series, RRR of GBC can be accomplished safely and tends to show less intraoperative bleeding and higher LNs yield.

Prognosis and Treatment of Gastric Cancer: A 2024 Update

Due to the high death rate associated with gastric cancer, a great deal of research has been conducted on this disease. The goal of this paper was to start a trimestral review of 2024 for the year that had just started. The scientific literature from 1 January 2024 was chosen with consideration of the the guidelines of the European Society of Medical Oncology (ESMO), which are updated with new findings but not systematically reviewed annually. We used the search term "gastric cancer" to find the most current publications in the PubMed database related to the prognosis and treatment of gastric cancer. As previously said, the only articles that satisfied the inclusion criteria were those from 2024. Articles with case reports were eliminated since they had nothing to do with our research. The treatment of gastric cancer is the focus of the majority of articles from 2024. The primary research axes include surgery and immunonutrition, immunotherapy and Helicobacter pylori, and therapeutic targets. Patients with GC may experience less psychological, social, and financial hardship if the recently identified markers discovered in circulation are better assessed and validated. This could be achieved by either including the markers in an artificial intelligence-based diagnostic score or by using them in conjunction with traditional diagnostic methods. Due to the rising death rate associated with GC, funding for research into diagnosis, prognosis, therapy, and therapeutic targets is essential.