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Huang ZN, He QC, Qiu WW, Wu J, Zheng CY, Lin GS, Li P, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Zheng CH, Chen QY, Huang CM, Xie JW. OSATS scoring confirms ICG enhancement of performance in laparoscopic radical gastrectomy: a post-hoc analysis of a randomized controlled trial. Int J Surg 2024; 110:342-352. [PMID: 37939147 PMCID: PMC10793768 DOI: 10.1097/js9.0000000000000830] [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: 06/13/2023] [Accepted: 09/28/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Indocyanine green (ICG) fluorescence imaging is effective in increasing the number of lymph node dissections during laparoscopic radical gastrectomy; however, no studies have attempted to explain this phenomenon. METHODS This study utilized the data from a previous randomized controlled trial (FUGES-012 study) investigating ICG-guided laparoscopic radical gastrectomy performed between November 2018 and July 2019. The Objective Structured Assessments of Technical Skills (OSATS) scoring system was used to grade videos from the ICG and non-ICG groups. Patients with an OSATS score greater than 29 were classified as the high-OSATS population, while those with an OSATS score less than or equal to 29 were classified as the low-OSATS population. RESULTS A total of 258 patients were included in the modified intention-to-treat analysis: 129 in the ICG group and 129 in the non-ICG group. The OSATS score of the ICG group was higher than that of the non-ICG group (29.6±2.6 vs. 26.6±3.6; P <0.001). The ICG group underwent a significantly higher mean total number of lymph node dissections than the non-ICG group (50.5±15.9 vs. 42.0±10.3; adjusted P <0.001). The group assigned to ICG use, better OSATS (high-OSATS) scores were observed, which correlated with greater D2 lymph node retrieval (54.1±15.0 vs. 47.2±8.7; adjusted P =0.039). Finally, the ICG group had a lower rate of lymph node noncompliance than that of the non-ICG group (31.8 vs. 57.4%; P <0.001). CONCLUSIONS By applying the ICG fluorescence navigation technique, better OSATS scores were observed, which correlated with greater lymph node retrieval and a lower lymph node noncompliance rate, as recommended for individualized laparoscopic radical gastrectomy.
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Affiliation(s)
- Ze-Ning Huang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Qi-Chen He
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Wen-Wu Qiu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ju Wu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian
| | - Chang-Yue Zheng
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
- Department of Gastrointestinal Surgery, the Affiliated Hospital of Putian University, Putian, People’s Republic of China
| | - Guo-Sheng Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ping Li
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jia-Bin Wang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jian-Xian Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jun Lu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Long-Long Cao
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Mi Lin
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Ru-Hong Tu
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Chao-Hui Zheng
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Qi-Yue Chen
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Chang-Ming Huang
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
| | - Jian-Wei Xie
- Department of Gastric Surgery
- Department of General Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou
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Iwasaki K, Barroga E, Enomoto M, Matsumoto M, Yamada E, Miyoshi K, Shimoda Y, Ota Y, Nakagawa Y. Use of Polyglycolic Acid Sheets for the Prevention of Pancreatic Fistula after Laparoscopic Gastrectomy: A Single-Center Retrospective Study. Am Surg 2023; 89:5318-5324. [PMID: 36534780 DOI: 10.1177/00031348221146971] [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] [Indexed: 12/22/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) indications have been extended to advanced gastric cancer requiring expansive lymph node dissection. Despite the huge benefits of this minimally invasive surgery, major complications such as postoperative pancreatic fistula (POPF) remain a concern. With technical advances in surgical procedures, the treatment outcomes of gastric cancer surgery have improved. However, effective methods for preventing POPF have not yet been established. Herein, we examined the usefulness of polyglycolic acid (PGA) sheets for preventing POPF after LG. METHODS We retrospectively assessed 142 patients who underwent curative LG at our institution between January 2017 and August 2022. The 142 patients were divided into 2 groups; PGA group (n = 61): the site of lymph node dissection at the superior margin of the pancreas and pancreatic head was covered with PGA sheets, and nPGA group (n = 81): the site was not covered. We retrospectively compared the short-term surgical outcomes including POPF incidence. RESULTS There was no significant difference in the background factors between the 2 groups and in the incidence of Grade II or higher postoperative complications according to the Clavien-Dindo (CD) classification. However, the incidence of CD Grade II or higher POPF was significantly lower in the PGA group than in the nPGA group (.0% vs 2.3%, respectively, P = .007). CONCLUSIONS There was no POPF in any of the 61 patients in the PGA group. This outcome suggests that POPF incidence may be reduced by covering the lymph node dissection site with PGA sheets after LG.
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Affiliation(s)
- Kenichi Iwasaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Edward Barroga
- Department of Medical Education, Showa University School of Medicine, Tokyo, Japan
| | - Masaya Enomoto
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Moe Matsumoto
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Erika Yamada
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenta Miyoshi
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yota Shimoda
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiro Ota
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Nakagawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
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Shimizu D, Tanaka C, Kanda M, Nakanishi K, Ito S, Kuwatsuka Y, Ando M, Murotani K, Fujiwara M, Kodera Y. A Multicenter Randomized Phase II Trial Investigating the Effect of Polyglycolic Acid Sheet on the Prevention of Pancreatic Fistula After Gastrectomy with Prophylactic Lymph Node Dissection. Clin Exp Gastroenterol 2023; 16:169-172. [PMID: 37614978 PMCID: PMC10443534 DOI: 10.2147/ceg.s421531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Pancreatic fistula after gastrectomy with lymph node dissection is associated with prolonged hospital stay and critical complications such as intra-abdominal bleeding and sepsis. Polyglycolic acid (PGA) sheets are absorbable suture reinforcement materials. A randomized Phase II trial has been planned to evaluate the effect of PGA sheets on preventing postoperative pancreatic fistula. A total of 320 patients will be recruited from thirteen institutions. Patients who are scheduled to undergo distal or total gastrectomy will be randomly allocated into the PGA group or control group, and the dissected area around the pancreas will be covered by the PGA sheet in the PGA group. The primary endpoint will be the maximum value of drain amylase concentration up to 5 days after surgery. The secondary endpoints will be as follows: transition of value of amylases of drain discharge, incidence of pancreatic fistula, incidence of intra-abdominal abscess, white blood cell count, value of C-reactive protein, incidence of postoperative complication, duration of antibiotic agents administration, duration of abdominal drainage, usage of octreotide, duration of hospital stay, incidence of bleeding in abdominal cavity, mortality, and incidence of reoperation.
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Affiliation(s)
- Dai Shimizu
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koki Nakanishi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan
| | - Michitaka Fujiwara
- Department of Medical Equipment and Supplies Management, Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
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Park SH, Kim JM, Park SS. Current Status and Trends of Minimally Invasive Gastrectomy in Korea. Medicina (B Aires) 2021; 57:medicina57111195. [PMID: 34833413 PMCID: PMC8621245 DOI: 10.3390/medicina57111195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022] Open
Abstract
Since its introduction in the early 1990s, laparoscopic gastrectomy has been widely accepted for the treatment of gastric cancer worldwide. In the last decade, the Korean Laparoendoscopic Gastrointestinal Surgery Study group performed important clinical trials and exerted various efforts to enhance the quality of scientific knowledge and surgical techniques in the field of gastric cancer surgery. Laparoscopic gastrectomy has shifted to a new era in Korea due to recent advances and innovations in technology. Here, we discuss the recent updates of laparoscopic gastrectomy—namely, reduced-port, single-incision, robotic, image-guided, and oncometabolic surgery.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea;
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea
| | - Jong-Min Kim
- Department of Surgery, Min General Surgery Hospital, 155 Dobong-ro, Gangbuk-gu, Seoul 01171, Korea;
| | - Sung-Soo Park
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea;
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Goryeodae-ro 73, Seongbuk-gu, Seoul 02841, Korea
- Correspondence: or ; Tel.: +82-2-920-6772; Fax: +82-2-928-1631
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5
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Martiniuc A, Dumitrascu T, Ionescu M, Tudor S, Lacatus M, Herlea V, Vasilescu C. Pancreatic Fistula after D1+/D2 Radical Gastrectomy according to the Updated International Study Group of Pancreatic Surgery Criteria: Risk Factors and Clinical Consequences. Experience of Surgeons with High Caseloads in a Single Surgical Center in Eastern Europe. J Gastric Cancer 2021; 21:16-29. [PMID: 33854810 PMCID: PMC8020004 DOI: 10.5230/jgc.2021.21.e3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Incidence, risk factors, and clinical consequences of pancreatic fistula (POPF) after D1+/D2 radical gastrectomy have not been well investigated in Western patients, particularly those from Eastern Europe. Materials and Methods A total of 358 D1+/D2 radical gastrectomies were performed by surgeons with high caseloads in a single surgical center from 2002 to 2017. A retrospective analysis of data that were prospectively gathered in an electronic database was performed. POPF was defined and graded according to the International Study Group for Pancreatic Surgery (ISGPS) criteria. Uni- and multivariate analyses were performed to identify potential predictors of POPF. Additionally, the impact of POPF on early complications and long-term outcomes were investigated. Results POPF was observed in 20 patients (5.6%), according to the updated ISGPS grading system. Cardiovascular comorbidities emerged as the single independent predictor of POPF formation (risk ratio, 3.051; 95% confidence interval, 1.161–8.019; P=0.024). POPF occurrence was associated with statistically significant increased rates of postoperative hemorrhage requiring re-laparotomy (P=0.029), anastomotic leak (P=0.002), 90-day mortality (P=0.036), and prolonged hospital stay (P<0.001). The long-term survival of patients with gastric adenocarcinoma was not affected by POPF (P=0.661). Conclusions In this large series of Eastern European patients, the clinically relevant rate of POPF after D1+/D2 radical gastrectomy was low. The presence of co-existing cardiovascular disease favored the occurrence of POPF and was associated with an increased risk of postoperative bleeding, anastomotic leak, 90-day mortality, and prolonged hospital stay. POPF was not found to affect the long-term survival of patients with gastric adenocarcinoma.
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Affiliation(s)
- Alexandru Martiniuc
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Traian Dumitrascu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihnea Ionescu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Stefan Tudor
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica Lacatus
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Vlad Herlea
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Pathology, Titu Maiorescu University, Bucharest, Romania
| | - Catalin Vasilescu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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6
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Total Amylase Value in Drains After Gastrectomy for Predicting Postoperative Pancreatic Fistula. Int Surg 2020. [DOI: 10.9738/intsurg-d-17-00127.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
Postoperative pancreatic fistula (POPF) is defined using the ratio of the amylase concentration in abdominal drainage fluid to the upper normal range of serum amylase level. However, we hypothesized that the total amylase value in discharge (AVD) on postoperative day (POD) 3 may be more sensitive for predicting grade II or higher severe POPF (sPOPF) and compared the predictive power of the conventional definition of POPF and AVD for sPOPF.
Methods
One hundred fifty-one patients who underwent gastrectomy between October 2011 and February 2013 were analyzed. A drainage tube was placed in all the cases through the stump of the right gastroepiploic vein and the front of the pancreas to the back of the anastomotic site. The drainage volume and amylase concentration in the discharge were examined on POD 1, 3, and 5. AVD was calculated by multiplying the volume by the amylase concentration.
Results
Eight patients (5.3%) developed sPOPF. In univariate analysis, both AVD and the amylase concentration ratio was significantly correlated with sPOPF (P = 0.002 and 0.007, respectively). AVD on POD 3 showed the best predictive performance compared with the amylase concentration ratio on POD 3 (area under the curve 0.876 versus 0.844). Based on the cutoff values calculated from the receiver operating characteristic curves, AVD was more specific than amylase concentration ratio in predicting sPOPF (specificity: 97.6% versus 86.0%; positive predictive value: 62.5% vs. 23.1%).
Conclusion
AVD on POD 3 is a more specific parameter than conventional amylase concentration ratio in predicting sPOPF.
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Kulig P, Sierzega M, Pietruszka S, Pach R, Kołodziejczyk P, Kulig J, Richter P. Types and implications of abdominal fluid collections following gastric cancer surgery. Acta Chir Belg 2020; 120:315-320. [PMID: 31060443 DOI: 10.1080/00015458.2019.1615254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Little data are available for abscess and non-abscess abdominal fluid collections (AFCs) after gastric cancer surgery and their clinical implications. We sought to analyse the natural history of such collections in a population of patients subject to routine postoperative imaging.Methods: From 1996 to 2012, 1381 patients underwent gastric resections and routine postoperative monitoring with abdominal ultrasound. As a unit protocol, examinations were carried out in all patients prior to drain removal, immediately before discharge, and at follow-up visits.Results: AFCs were diagnosed in 134 (9.7%) patients after a median time from surgery of seven days (interquartile range (IQR) 5-11 days). Sixty-four of the 134 AFCs (48%) were asymptomatic and resolved spontaneously after a median follow-up of 26.5 days (IQR 14-91 days). Seventy (52%) AFCs required interventional drainage. A stepwise logistic regression model demonstrated that interventional treatment was much more likely among patients with enteric fistula (odds ratio (OR) 9.542, 95% CI 1.418-46.224, p=.003) and pancreatic fistula (OR 7.157, 95% CI 1.340-39.992, p=.012).Conclusions: About one half of AFCs after gastric surgery were asymptomatic and eventually resolved spontaneously without any intervention. However, the need for interventional drainage was significantly increased by coexisting pancreatic or enteric fistula.
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Affiliation(s)
- Piotr Kulig
- Department of Vascular Surgery and Angiology, Brothers of Mercy St. John of God Hospital Cracow, Krakow, Poland
| | - Marek Sierzega
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Pietruszka
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Radosław Pach
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Kołodziejczyk
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jan Kulig
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Richter
- First Department of Surgery, Jagiellonian University Medical College, Krakow, Poland
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8
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Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure infrapyloric lymph node dissection during laparoscopic distal gastrectomy. Surg Today 2020; 50:1187-1196. [PMID: 32246228 DOI: 10.1007/s00595-020-01993-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/06/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE We aimed to investigate the usefulness of near-infrared indocyanine green (ICG)-enhanced fluorescence guidance for infrapyloric LN dissection in laparoscopic distal gastrectomy. METHODS This study enrolled patients with early gastric cancer scheduled for laparoscopic distal gastrectomy. After intraoperative submucosal injection of ICG (0.1 mg/mL), LN dissection was conducted under near-infrared ICG fluorescence guidance. The operation time, bleeding events during infrapyloric LN dissection were analyzed. Cases were retrospectively 1:3 propensity-score matched to patients who underwent laparoscopic distal gastrectomy without ICG injection. RESULTS The mean time from midline omentectomy to exposure of the right gastroepiploic vein was significantly shorter in the ICG group (n = 20) than in the non-ICG group (n = 60) (13.05 ± 5.77 vs 18.68 ± 7.92 min; p = 0.001), and the incidence of bleeding during infrapyloric LN dissection was lower in the ICG group (20% vs 68.3%, p < 0.001). The two groups did not differ significantly regarding the number of LNs retrieved from the infrapyloric area (p = 0.434). CONCLUSIONS Near-infrared ICG fluorescence guidance facilitates safe and fast infrapyloric LN dissection in laparoscopic distal gastrectomy.
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9
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HASBAHÇECİ M, CENGİZ MB, AKÇAKAYA A, MALYA FÜ, KUNDUZ E, BEKTAŞOĞLU HK. Impact of high amylase level in drainage fluid after gastric cancer surgery: Is it a complication or suspicious biochemical measurement? CUKUROVA MEDICAL JOURNAL 2019; 44:594-601. [DOI: 10.17826/cumj.450246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose: Pancreatic fistula is a
potential postoperative complication with variable definitions, incidences and
risk factors. We intended to evaluate its impact after gastric surgery. Materials and Methods: A total of 28 consecutive patients
who underwent curative open gastrectomy with lymphadenectomy for gastric
adenocarcinoma were retrospectively analyzed. Patients’ demographics,
peri-operative and pathological data were collected. Pancreatic fistula that
was diagnosed and graded according to International Study Group of Pancreatic
Fistula’s system was identified as main variable.Results: Mean age of
patients was 58.8±10.1 years with a female to male ratio of 9/19. Grade
A pancreatic fistula was diagnosed in six patients (21.4%). There was no grade B and C pancreatic
fistula. Drain amylase level was significantly higher in patients with
pancreatic fistula (p=0.0001). There was no significant difference with regard
to amount of drainage, length of hospital stay and duration of drains in
patients with and without fistula. No significant association was shown between
development of fistula and patients’ demographics, peri-operative and
pathological data.
Conclusion: The development of grade A
pancreatic fistula after gastric surgery does not appear to be a major
complication with clinical consequences. High amylase level in the drainage
fluid can be considered as a biochemical measure only.
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Affiliation(s)
| | | | - Adem AKÇAKAYA
- bezmialem vakıf üniversitesi tıp fakültesi genel cerrahi AD
| | | | - Enver KUNDUZ
- bezmialem vakıf üniversitesi tıp fakültesi genel cerrahi AD
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10
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Watanabe M, Kinoshita T, Tokunaga M, Kaito A, Sugita S. Complications and their correlation with prognosis in patients undergoing total gastrectomy with splenectomy for treatment of proximal advanced gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:1181-1185. [PMID: 29610022 DOI: 10.1016/j.ejso.2018.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 12/25/2017] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Spleen-preserving surgery is a mainstay in the treatment of proximal advanced gastric cancer according to the results of several clinical studies. However, total gastrectomy with splenectomy (TGS) still plays a role in the treatment of aggressive tumors invading the greater curvature line or adjacent structures, in spite of its high morbidity. The aim of this study was to identify the risk factors for morbidity and the association between the occurrence of postoperative complications and long-term outcomes. METHODS We retrospectively analyzed 430 patients with gastric cancer who underwent curative TGS from 1992 to 2010. In total, 134 patients encountered grade ≥III postoperative complications (C group), and risk factors for morbidity were analyzed. Patients in the C group were matched 1:1 with patients selected from among 296 patients without complications (matched non-C group, n = 134) using propensity score estimation, to compare relapse-free survival (RFS) between the two groups. RESULTS The overall grade ≥III complication rate was 31.2%. Multivariable analysis identified pancreatic resection (odds ratio [OR], 5.65), male sex (OR, 1.77), and an operation time of ≥240 min (OR, 1.69) as independent predictors of postoperative complications after TGS. The RFS was not significantly different between the C-group and matched non-C group (46.9% vs. 45.0%, respectively; hazard ratio, 0.98). CONCLUSIONS Pancreatic resection, male sex, and a longer operation time are risk factors for morbidity after TGS, and a precise surgical technique is required for such patients. However, postoperative complications of TGS may have little impact on long-term outcomes.
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Affiliation(s)
- Masahiro Watanabe
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Takahiro Kinoshita
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Masanori Tokunaga
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Akio Kaito
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Shizuki Sugita
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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11
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Intraoperative Pancreatic Injury Gives Rise to Severe Postoperative Pancreatic Fistula: Results of a Review of Unedited Videos of the Laparoscopic Surgical Procedures. Int Surg 2018. [DOI: 10.9738/intsurg-d-16-00174.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
To examine risk factors for and causes of severe postoperative pancreatic fistula (sPOPF) after laparoscopic gastrectomy (LG).
Summary of Background Data
There are few reports on POPF after LG.
Methods
Between February 2012 and March 2014, we examined 86 patients who underwent LG, comparing them with 33 patients who underwent open gastrectomy (OG) for gastric cancer. Risk factors for severe POPF (sPOPF) of Clavien–Dindo grade IIIa or higher were examined. To investigate causes of sPOPF, we reviewed unedited video recordings of laparoscopic surgical procedures.
Results
sPOPF occurred in 3 patients (3.5%) after LG and 1 patient (3.0%) after OG, indicating no significant difference (P = 0.901). Univariate analysis showed no significant risk factors for sPOPF after LG. By reviewing video recordings, all 3 patients with sPOPF after LG had direct pancreatic injury by ultrasonically activated device (USAD) during peripancreatic lymphadenectomy. In 2 patients, pancreas was injured while the contour of pancreas was obscured by bleeding. Durations of drain placement and postoperative hospitalization were longer for patients with sPOPF than for those without POPF or grades I and II POPF (P = 0.003, 0.018; respectively).
Conclusions
No risk factors for sPOPF after LG could be identified. USAD-induced direct pancreatic injury resulted in sPOPF, which significantly complicated the postoperative clinical course. Direct pancreatic injury can occur whether patient has previously reported risk factors (i.e., male, high body mass index, distal pancreatectomy) or not. To prevent pancreatic injury, surgeons should manage hemostasis and keep good surgical field to recognize the contour of pancreas accurately.
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12
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Hughes TM, Shah K, Noria S, Pawlik T. Is BMI associated with post-operative complication risk among patients undergoing major abdominal surgery for cancer? A systematic review. J Surg Oncol 2018; 117:1009-1019. [DOI: 10.1002/jso.24999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/01/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Tasha M. Hughes
- The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Kejal Shah
- The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Sabrena Noria
- The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Timothy Pawlik
- The Ohio State University Wexner Medical Center; Columbus Ohio
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13
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Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database. Surg Endosc 2017; 32:2766-2773. [PMID: 29218676 DOI: 10.1007/s00464-017-5976-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/03/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Controversy persists regarding the technical feasibility of laparoscopic total gastrectomy (LTG), and to our knowledge, no prospective study with a sample size sufficient to investigate its safety has been reported. We aimed to compare the postoperative morbidity and mortality rates in patients undergoing LTG and open total gastrectomy (OTG) for gastric cancer in prospectively enrolled cohort using nationwide web-based registry. METHODS From August 2014 to July 2015, consecutive patients undergoing LTG or OTG (925 and 1569 patients, respectively) at the participating institutions were enrolled prospectively into the National Clinical Database registration system. We constructed propensity score (PS) models separately in four facility yearly case-volume groups, and evaluated the postoperative morbidity and mortality in PS-matched 1024 patients undergoing LTG or OTG. RESULTS The incidence of overall morbidity were 84 (16.4%) in the OTG and 54 (10.3%) in the LTG groups (p = 0.01).The incidence of anastomotic leakage and pancreatic fistula grade B or above were not significantly different between the two groups (LTG 5.3% vs. OTG 6.1%, p = 0.59, LTG 2.7% vs. OTG 3.7%, p = 0.38, respectively). There were also no significant differences in the 30-day and in-hospital mortality rates between the two groups (LTG 0.2% vs. OTG 0.4%, p = 0.56; LTG 0.4% vs. OTG 0.4%, p = 1.00, respectively). CONCLUSION The results from our nationally representative data analysis showed that LTG could be a safe procedure to treat gastric cancer compared to OTG. The indication for LTG should be considered carefully in a clinical setting.
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14
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Matsunaga T, Saito H, Murakami Y, Kuroda H, Fukumoto Y, Osaki T. Serum level of C-reactive protein on postoperative day 3 is a predictive indicator of postoperative pancreatic fistula after laparoscopic gastrectomy for gastric cancer. Asian J Endosc Surg 2017; 10:382-387. [PMID: 28470943 DOI: 10.1111/ases.12374] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/24/2016] [Accepted: 02/23/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy for gastric cancer. It is vitally important to detect signs of POPF in the early postoperative period and perform adequate management to avoid patient death. The aim of this study was to investigate the predictive indicators of POPF after laparoscopic gastrectomy for gastric cancer. METHODS The current study included 197 patients who were pathologically diagnosed with adenocarcinoma and underwent laparoscopic gastrectomy between January 2010 and December 2014 in our hospital. RESULT Nine patients (5.6%) developed POPF of grade III or higher according to the Clavien-Dindo classification. There was no statistical difference between POPF and various clinicopathological indicators, including age, gender, BMI, extent of lymph node dissection, and operative procedure. With respect to postoperative laboratory data, however, the serum level of C-reactive protein on postoperative day 3 was significantly related to the development of POPF. Receiver-operating characteristic analysis indicated that optimal cut-off value of the serum level of C-reactive protein on postoperative day 3 was 17.0 mg/dL, with a sensitivity of 74.0, specificity of 88.0, positive predictive value of 0.14, and negative predictive value of 0.99. CONCLUSION An elevated C-reactive protein level on postoperative day 3 can help physicians predict the likelihood of POPF and facilitate decision making regarding prompt clinical evaluation and therapeutic approaches for POPF.
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Affiliation(s)
- Tomoyuki Matsunaga
- Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan
| | - Hiroaki Saito
- Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan
| | - Yuki Murakami
- Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan
| | - Hirohiko Kuroda
- Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan
| | - Yoji Fukumoto
- Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan
| | - Tomohiro Osaki
- Department of Surgery, Division of Surgical Oncology, Tottori University School of Medicine, Yonago, Japan
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15
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Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature. World J Surg Oncol 2017; 15:106. [PMID: 28545537 PMCID: PMC5445509 DOI: 10.1186/s12957-017-1173-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/16/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND For proximal gastric cancer invading the greater curvature, concomitant splenectomy is frequently performed to secure the clearance of lymph node metastases. However, prognostic impact of prophylactic splenectomy remains unclear. The aim of this study was to clarify the oncological significance of prophylactic splenectomy for advanced proximal gastric cancer invading the greater curvature. METHODS Retrospective review of 108 patients who underwent total or subtotal gastrectomy for advanced proximal gastric cancer involving the greater curvature was performed. Short-term and long-term outcomes were compared between the patients who underwent splenectomy (n = 63) and those who did not (n = 45). RESULTS Patients who underwent splenectomy showed higher amount of blood loss (538 vs. 450 mL, p = 0.016) and morbidity rate (30.2 vs. 13.3, p = 0.041) compared with those who did not undergo splenectomy. In particular, pancreas-related complications were frequently observed among patients who received splenectomy (17.4 vs. 0%, p = 0.003). However, no significant improvement of long-term outcomes were confirmed in the cases with splenectomy (5-year recurrence-free rate, 60.2 vs. 67.3%; p = 0.609 and 5-year overall survival rates, 63.7 vs. 73.6%; p = 0.769). On the other hand, splenectomy was correlated with marginally better survival in patients with Borrmann type 1 or 2 gastric cancer (p = 0.072). CONCLUSIONS For advanced proximal gastric cancer involving the greater curvature, prophylactic splenectomy may have no significant prognostic impact despite the increased morbidity rate after surgery. Such surgical procedure should be avoided as long as lymph node involvement is not evident.
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16
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Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery. Surg Endosc 2017; 31:4346-4356. [PMID: 28378074 DOI: 10.1007/s00464-017-5507-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/08/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative pancreas-related complications are quite uncommon but potentially life-threatening occurrences that may occasionally complicate the postoperative course of gastrectomy. A number of reports have described such conditions after both standard open and minimally invasive surgery. Our study has the purpose to systematically determine the pooled incidence of pancreatic events following radical gastrectomy. We also aimed to elucidate whether any difference in incidence exists between patients operated via conventional open or minimally invasive surgery. METHODS PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized or well-matched studies comparing conventional with minimally invasive oncological gastrectomy and reporting pancreas-related postoperative complications. We evaluated possible differences in outcomes between open and minimally invasive surgery. A meta-analysis of relevant comparisons was performed using RevMan 5.3. RESULTS A total of 20 studies, whereby 6 randomized and 14 non-randomized comparative studies including a total of 7336 patients, were considered eligible for data extraction. Globally, more than 1% of patients experienced some pancreatic occurrences during the postoperative course. The use of minimally invasive surgery showed a trend toward increased overall pancreatic morbidity (OR 1.39), pancreatitis (OR 2.69), and pancreatic fistula (OR 1.13). CONCLUSIONS Although minimally invasive radical gastrectomy is currently established as a valid alternative to open surgery for the treatment of gastric cancer, a higher risk of pancreas-related morbidity should be taken into account.
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17
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Taniguchi Y, Kurokawa Y, Mikami J, Tanaka K, Miyazaki Y, Makino T, Takahashi T, Yamasaki M, Nakajima K, Takiguchi S, Mori M, Doki Y. Amylase concentration in drainage fluid as a predictive factor for severe postoperative pancreatic fistula in patients with gastric cancer. Surg Today 2017; 47:1378-1383. [PMID: 28365893 DOI: 10.1007/s00595-017-1521-y] [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: 12/24/2016] [Accepted: 03/16/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Postoperative pancreatic fistula (PPF) sometimes occurs after gastrectomy. We examined the risk factors for severe PPF and evaluated the predictive value of amylase concentration in drainage fluid. METHODS We retrospectively reviewed 591 patients who underwent curative gastrectomy for gastric cancer. A multivariate analysis was conducted to identify the risk factors for severe PPF. Receiver operating characteristic curves were used to identify the appropriate amylase cut-off value to predict severe PPF. RESULTS Severe PPF occurred in 23 (3.9%) cases. The multivariate analysis indicated that splenectomy (P = 0.009) was the only significant risk factor. The area under the curve of amylase in drainage fluid for predicting severe PPF on postoperative day (POD) 3 was much greater than that on POD 1 (0.972 vs. 0.894). When the cut-off values for amylase were determined to be 2900 U/L on POD 1 and 2100 U/L on POD 3, the risk ratio for severe PPF on POD 3 was higher than that on POD 1 (99.2 vs. 30.2). CONCLUSIONS Splenectomy was an independent risk factor for severe PPF. An amylase level of 2100 U/L on POD 3 may be a reliable cut-off value for the early diagnosis of patients at high risk of severe PPF.
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Affiliation(s)
- Yoshiki Taniguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
| | - Jota Mikami
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan
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18
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Barchi LC, Charruf AZ, de Oliveira RJ, Jacob CE, Cecconello I, Zilberstein B. Management of postoperative complications of lymphadenectomy. Transl Gastroenterol Hepatol 2016; 1:92. [PMID: 28138657 DOI: 10.21037/tgh.2016.12.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 12/09/2016] [Indexed: 02/03/2023] Open
Abstract
Gastric cancer remains a disease with poor prognosis, mainly due to its late diagnosis. Surgery remains as the only treatment with curative intent, where the goal is radical resection with free-margin gastrectomy and extended lymphadenectomy. Over the last two decades there has been an improvement on postoperative outcomes. However, complications rate is still not negligible even in high volume specialized centers and are directly related mainly to the type of gastric resection: total or subtotal, combined with adjacent organs resection and the extension of lymphadenectomy (D1, D2 and D3). The aim of this study is to analyze the complications specific-related to lymphadenectomy in gastric cancer surgery.
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Affiliation(s)
- Leandro Cardoso Barchi
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Amir Zeide Charruf
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Rodrigo José de Oliveira
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Carlos Eduardo Jacob
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Ivan Cecconello
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Bruno Zilberstein
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
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19
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Migita K, Matsumoto S, Wakatsuki K, Ito M, Kunishige T, Nakade H, Nakatani M, Kitano M, Nakajima Y. The anatomical location of the pancreas is associated with the incidence of pancreatic fistula after laparoscopic gastrectomy. Surg Endosc 2016; 30:5481-5489. [PMID: 27126620 DOI: 10.1007/s00464-016-4909-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/02/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is one of the major complications after laparoscopic gastrectomy (LG). We investigated the impact of the anatomical location of the pancreas, especially in relation to the suprapancreatic lymph nodes, on the incidence of POPF after LG. METHODS We retrospectively reviewed the preoperative computed tomography (CT) images of 246 patients who underwent LG with the suprapancreatic lymph node dissection between November 2008 and November 2015. The length between the levels of the pancreatic body surface and the root of the common hepatic artery (LPC) was measured on a CT image with an axial view. A receiver operating characteristics (ROC) curve analysis was performed to determine the cutoff LPC value. A multivariate analysis was performed to determine the predictive factors for POPF. RESULTS POPF occurred in 11 patients (4.5 %). The median LPC was significantly longer in the patients with POPF than in those without (26 mm vs. 21 mm, p = 0.026). The ROC curve analysis revealed that the optimal cutoff LPC value for predicting POPF was 25 mm. The POPF rate was significantly higher in the long LPC group than in the short LPC group (10 vs. 1.3 %, p = 0.002). A multivariate analysis demonstrated that a long LPC (p = 0.018) and dissection of the lymph nodes along the distal splenic artery (p = 0.042) were independent predictors of POPF. The amylase level in the drainage fluid on postoperative day 1 was significantly higher in the long LPC group than in the short LPC group. CONCLUSIONS The LPC is a simple and reliable predictor of POPF after LG. Surgeons should take the anatomical location of the pancreas into consideration when performing LG with suprapancreatic lymph node dissection.
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Affiliation(s)
- Kazuhiro Migita
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Sohei Matsumoto
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kohei Wakatsuki
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiro Ito
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tomohiro Kunishige
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Hiroshi Nakade
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuhiro Nakatani
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mutsuko Kitano
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yoshiyuki Nakajima
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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20
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Kobayashi D, Iwata N, Tanaka C, Kanda M, Yamada S, Nakayama G, Fujii T, Koike M, Fujiwara M, Kodera Y. Factors related to occurrence and aggravation of pancreatic fistula after radical gastrectomy for gastric cancer. J Surg Oncol 2015; 112:381-6. [PMID: 26256914 DOI: 10.1002/jso.24001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 07/21/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Pancreatic fistula (PF) and subsequent intra-abdominal abscess is a serious complication after gastrectomy for gastric cancer. The study aims to evaluate amylase concentration of drainage fluid (d-AMY) and serum C-reactive protein (CRP) as the predictive factors related to PF amounting to Clavien-Dindo (CD) grade III. METHODS 448 patients who underwent gastrectomy for gastric cancer were analyzed. Closed drains were placed in the left subphrenic cavity and/or Winslow's cavity depending on the procedures. The cutoff values of d-AMY and CRP were determined, and their roles as predictive factors for CD grade III PF were evaluated. RESULTS PF, diagnosed in 58 patients, was stratified according to the CD classification. Consequently, grade III PF which includes PF-related abscesses was observed in 32 patients. The cutoff value of d-AMY on the first postoperative day for predicting grade III PF was 1949 IU/l. The cutoff value of CRP on the third postoperative day for the same purpose was 20.44 mg/dl. Multivariate analysis demonstrated that d-AMY and CRP were significant predictive factors for grade III PF. CONCLUSIONS The d-AMY on the first postoperative day and CRP on the third postoperative day might be useful for predicting CD grade III PF after gastrectomy.
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Affiliation(s)
- Daisuke Kobayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Naoki Iwata
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Suguru Yamada
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Goro Nakayama
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Tsutomu Fujii
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Masahiko Koike
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
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21
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Kawamura Y, Satoh S, Suda K, Ishida Y, Kanaya S, Uyama I. Critical factors that influence the early outcome of laparoscopic total gastrectomy. Gastric Cancer 2015; 18:662-8. [PMID: 24906557 DOI: 10.1007/s10120-014-0392-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic distal gastrectomy (LDG) is a routinely performed procedure. However, clinical expertise in laparoscopic total gastrectomy (LTG) is insufficient, and it is only performed at specialized institutions. This study aimed to identify critical factors associated with complications after laparoscopic gastrectomy (LG), particularly LTG. METHODS A large-scale database was used to identify critical factors influencing the early outcomes of LTG. Of 1248 patients with resectable gastric cancer who underwent LG, 259 underwent LTG. Predictive risk factors were determined by analyzing relationships between clinical characteristics and postoperative complications. Major complications after LTG were analyzed in detail. RESULTS Multivariate analysis of all LG procedures revealed LTG as a risk factor for complications. Morbidity in the LDG and LTG groups was 6.2 % (52 of 835 patients) and 22.4 % (58 of 259 patients), respectively. Major post-LTG complications included anastomotic leakages and pancreatic fistulae. The rate of anastomotic leakage was significantly higher in the LTG group (5.0 %) than in the LDG group (1.2 %); however, it showed a tendency to decrease in more recent cases. Pancreatic fistulae occurred frequently after LTG with D2 lymphadenectomy (LTG-D2), particularly in cases of concomitant pancreatosplenectomy. Obesity was also associated with pancreatic fistula formation after LTG with pancreatosplenectomy. CONCLUSIONS Compared with LDG, LTG is a developing procedure. Advances in the surgical techniques associated with the LTG procedure will improve the short-term outcomes of esophagojejunostomy. With regard to LTG-D2, establishing optimal and safe #10 node dissection is one of the most urgent issues. Pancreatic fistula after LTG with pancreatosplenectomy must be investigated in the future.
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Affiliation(s)
- Yuichiro Kawamura
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan,
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22
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Shinohara H, Haruta S, Ohkura Y, Udagawa H, Sakai Y. Tracing Dissectable Layers of Mesenteries Overcomes Embryologic Restrictions when Performing Infrapyloric Lymphadenectomy in Laparoscopic Gastric Cancer Surgery. J Am Coll Surg 2015; 220:e81-7. [PMID: 25998088 DOI: 10.1016/j.jamcollsurg.2015.02.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/22/2015] [Accepted: 02/22/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Hisashi Shinohara
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan; Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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23
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Takahashi T, Takeuchi H, Kitagawa Y. What factors are necessary for the safe and feasible performance of total gastrectomy? Ann Surg Oncol 2014; 22:704-5. [PMID: 25361889 DOI: 10.1245/s10434-014-4227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Indexed: 11/18/2022]
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24
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Migita K, Takayama T, Matsumoto S, Wakatsuki K, Tanaka T, Ito M, Nakajima Y. Impact of bacterial culture positivity of the drainage fluid during the early postoperative period on the development of intra-abdominal abscesses after gastrectomy. Surg Today 2014; 44:2138-45. [PMID: 24633956 DOI: 10.1007/s00595-014-0881-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/14/2014] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of this study was to evaluate the impact of positive bacterial cultures of the drainage fluid (D-cultures) during the early postoperative period on the incidence of intra-abdominal abscess formation following gastrectomy. METHODS From January 2012 to June 2013, we prospectively performed D-cultures on postoperative day (POD) 1 in consecutive gastric cancer patients who underwent gastrectomy. The univariate and multivariate analyses were performed to identify the risk factors for intra-abdominal abscess formation without anastomotic leakage. RESULTS The rate of positive D-cultures was 6.4 % on POD 1. According to a univariate analysis, the use of combined organ resection (P = 0.011), the drain amylase level on POD 1 (P = 0.016) and the D-culture status on POD 1 (P = 0.004) were found to be significantly associated with the incidence of intra-abdominal abscesses. A multivariate analysis demonstrated that D-culture positivity on POD 1 was the only independent predictor of intra-abdominal abscess formation (P = 0.011). CONCLUSIONS The present study demonstrated that bacterial culture positivity of drainage fluid during the early postoperative period has a significant impact on the development of intra-abdominal abscesses after gastrectomy.
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Affiliation(s)
- Kazuhiro Migita
- Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan,
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Shinohara H, Kurahashi Y, Kanaya S, Haruta S, Ueno M, Udagawa H, Sakai Y. Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery. Gastric Cancer 2013; 16:615-20. [PMID: 23314832 DOI: 10.1007/s10120-012-0229-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 12/17/2012] [Indexed: 02/07/2023]
Abstract
We focused on the embryology and topographic anatomy of the infrapyloric lymph region, which is frequently involved in node metastases but technically complicated for dissection in gastric cancer surgery. Gastrointestinal organs possess their own mesenteries composed of double layers of peritoneum that enclose the intermediate adipose layer providing pathways for vessels, nerves, and lymphatic channels. The frontal layer of the mesoduodenum, in which no. 6 infrapyloric nodes lie, directly faces the pancreas and during gestation is overlain by the greater omentum and transverse mesocolon through the membranous connective tissue called the fusion fascia. Therefore, we performed no. 6 node dissection using the following process: (1) we traced out the mesoduodenum by detachment of the greater omentum and transverse mesocolon; (2) we transected the fusion fascia and (3) removed the adipose layer on the anterior face of the pancreas with its included lymph nodes together with the right gastroepiploic and infrapyloric vessels. The described technique is feasible and in keeping with the anatomical logic for oncologically reliable dissection of no. 6 infrapyloric nodes.
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Affiliation(s)
- Hisashi Shinohara
- Department of Gatroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan,
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Goto H, Tokunaga M, Sugisawa N, Tanizawa Y, Bando E, Kawamura T, Niihara M, Tsubosa Y, Terashima M. Value of splenectomy in patients with Siewert type II adenocarcinoma of the esophagogastric junction. Gastric Cancer 2013. [PMID: 23179369 DOI: 10.1007/s10120-012-0214-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of adenocarcinoma of the esophagogastric junction (AEG) has been increasing recently in both Western and Eastern countries. However, an optimal treatment strategy for Siewert type II AEG is still unclear. The aim of this study was to clarify the value of splenectomy in patients with Siewert type II AEG. METHODS From September 2002 to November 2011, 42 patients underwent total gastrectomy with D2 lymph node dissection for Siewert type II AEG and were included in this study. We used the index of estimated benefit from lymph node dissection (IEBLD) to assess the efficacy of lymph node dissection of each station. Surgical complications were graded by the Clavien-Dindo classification. RESULTS The overall 5-year survival rate of the 42 patients was 57.5 %. The incidence of splenic hilar lymph node metastasis was 4.8 % and the 5-year survival rate of patients with splenic hilar lymph node involvement was zero. Consequently, the IEBLD of splenic hilar lymph nodes was zero. Postoperative morbidities occurred in 25 patients (59.5 %). Pancreas-related complications were the most frequently observed (28.5 %), followed by intraabdominal abscess (14.3 %) and anastomotic leakage (9.5 %). CONCLUSIONS Splenic hilar lymph node dissection may be omitted without decreasing curability in patients with Siewert type II AEG, although a prospective study is necessary for more conclusive results.
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Affiliation(s)
- Hironobu Goto
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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Yu HW, Jung DH, Son SY, Lee CM, Lee JH, Ahn SH, Park DJ, Kim HH. Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery. J Gastric Cancer 2013; 13:179-84. [PMID: 24156038 PMCID: PMC3804677 DOI: 10.5230/jgc.2013.13.3.179] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 09/15/2013] [Accepted: 09/16/2013] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Postoperative pancreatic fistula is a dreadful complication after gastric cancer surgery. The purpose of this study is to evaluate the actual incidence and risk factors of postoperative pancreatic fistula after curative gastrectomy for gastric cancer. MATERIALS AND METHODS A total of 900 patients who underwent gastrectomy for gastric cancer (laparoscopic gastrectomy, 594 patients; open gastrectomy 306 patients) were enrolled between January 2009 and December 2010. Clinical outcomes, including postoperative pancreatic fistula grade based on the International Study Group on Pancreatic Fistula, were investigated. RESULTS Overall, the postoperative pancreatic fistula rate was 3.3% (30/900) (1.5% in laparoscopic gastrectomy versus 6.9% in open gastrectomy, P<0.001). Patients who underwent D2 lymphadenectomy, total gastrectomy, splenectomy or distal pancreatectomy showed higher postoperative pancreatic fistula rates (4.7%, 13.8%, 13.6%, or 57.1%, respectively, P<0.001). Patients with postoperative pancreatic fistula had higher morbidity (46.7% versus 13.1%, P<0.001), delayed gas out (4.9 days versus 3.8 days, P<0.001), belated diet start (5.8 days versus 3.5 days, P<0.001) and longer postoperative hospital stay (13.7 days versus 6.8 days, P<0.001). On the multivariate analysis, total gastrectomy (odds ratio 9.751, 95% confidence interval: 3.348 to 28.397, P<0.001), distal pancreatectomy (odds ratio 7.637, 95% confidence interval: 1.668 to 34.961, P=0.009) and open gastrectomy (odds ratio 2.934, 95% confidence interval: 1.100 to 7.826, P=0.032) were the independent risk factors of postoperative pancreatic fistula. CONCLUSIONS Laparoscopic gastrectomy had an advantage over open gastrectomy in terms of the lower postoperative pancreatic fistula rate. Total gastrectomy and combined resection, such as distal pancreatectomy, should be performed carefully to minimize postoperative pancreatic fistula in gastric cancer surgery.
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Affiliation(s)
- Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Hiura Y, Takiguchi S, Yamamoto K, Kurokawa Y, Yamasaki M, Nakajima K, Miyata H, Fujiwara Y, Mori M, Doki Y. Use of fibrin glue sealant with polyglycolic acid sheets to prevent pancreatic fistula formation after laparoscopic-assisted gastrectomy. Surg Today 2012; 43:527-33. [PMID: 22797962 DOI: 10.1007/s00595-012-0253-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 02/21/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE A pancreatic fistula is a serious postoperative complication that can occur after gastrectomy with lymphadenectomy for gastric cancer. The aim of this prospective study was to analyze the usefulness of the local application of fibrin glue sealant (FG) and polyglycolic acid sheets (PAS) in preventing pancreatic fistula formation after gastrectomy. PATIENTS AND METHODS The surface of the pancreas was covered with FG and PAS after peri-pancreatic lymph node dissection in 34 patients (F/P group). The postoperative outcome was compared with historical control subjects who did not receive the same application (control group, 64 patients). RESULTS A pancreatic fistula occurred in three patients in the control group but in none the F/P group (P = 0.049). The volume of drainage fluid on postoperative day (POD) 1 and 3 was smaller in the F/P group than in the control group (POD1: F/P group, 80 ml; control: 150 ml, P < 0.001; POD3: 60 vs. 120 ml, P < 0.001). The amylase levels in the drainage fluid on POD1 and 3 were also significantly lower in the F/P group than in the control group (POD1: F/P group, 660 U/L; control: 1220 U/L, P = 0.030; POD2: 270 vs. 830 U/L, P = 0.038; POD3, 160 vs. 630 U/L, P = 0.041). CONCLUSION The application of FG and PAS after LAG helps to prevent pancreatic fistula formation.
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Affiliation(s)
- Yuichiro Hiura
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2, E2, Yamadaoka, Suita, Osaka 565-0871, Japan
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Risk factors for surgical site infections after elective gastrectomy. J Gastrointest Surg 2012; 16:1107-15. [PMID: 22350727 DOI: 10.1007/s11605-012-1838-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 02/02/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of this study was to identify the risk factors for surgical site infections (SSIs) after elective gastrectomy. METHODS This study reviewed the medical records of 842 patients who underwent elective gastrectomy. Multivariate analyses were performed to determine the risk factors for SSIs. RESULTS Superficial incisional, deep incisional, and organ/space SSIs were detected in 50 (5.9%) patients, 2 (0.2%) patients, and 90 (10.7%) patients, respectively. A multivariate analysis demonstrated that female gender (p = 0.0332) and allogenic blood transfusion (p = 0.0266) were independent predictors for superficial incisional SSIs, while a male gender (p = 0.0355), corticosteroid therapy (p = 0.037), total gastrectomy (p < 0.0001), and a duration of operation ≥300 min (p = 0.0062) were independent predictors for organ/space SSIs. The median length of postoperative hospital stay was significantly longer in patients with organ/space SSIs in comparison to those without SSIs (p < 0.0001) and with superficial incisional SSIs (p < 0.0001). The patients with organ/space SSIs had a significantly higher re-operation rate in comparison to those without SSIs (p < 0.0001). CONCLUSIONS The risk factors both for incisional SSIs and for organ/space SSIs are strongly associated with surgical results. Meticulous surgical techniques are therefore required to prevent SSIs.
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Sugisawa N, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat. Gastric Cancer 2012; 15:206-12. [PMID: 21993853 DOI: 10.1007/s10120-011-0099-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 09/11/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive visceral fat may be a better predictor of the development of postoperative morbidity after gastrectomy than body mass index (BMI). The aim of the present study was to clarify the most appropriate fat parameter to predict pancreas-related infection and anastomotic leakage following gastrectomy. METHODS The study was performed in 206 patients who underwent curative gastrectomy at the Shizuoka Cancer Center between April 2008 and March 2009. Relationships between fat parameters, including visceral fat area (VFA), and early surgical outcomes were investigated. The risk factors for pancreas-related infection and anastomotic leakage were identified using univariate and multivariate analyses. RESULTS There was no strong association between any of the fat parameters and operating time, intraoperative blood loss, the number of lymph nodes retrieved, or the duration of the postoperative hospital stay. Pancreas-related infection occurred in 18 patients (8.7%), whereas anastomotic leakage was observed in 10 patients (4.9%). Of all the fat parameters, only VFA was found to be an independent risk factor for both pancreas-related infection and anastomotic leakage, with odds ratios (95% confidence intervals) of 1.015 (1.005-1.025) and 1.010 (1.000-1.021), respectively. CONCLUSIONS Excessive visceral fat, represented by the VFA, was found to be an independent risk factor for both pancreas-related infection and anastomotic leakage following gastrectomy.
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Affiliation(s)
- Norihiko Sugisawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan
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Miki Y, Tokunaga M, Bando E, Tanizawa Y, Kawamura T, Terashima M. Evaluation of postoperative pancreatic fistula after total gastrectomy with D2 lymphadenectomy by ISGPF classification. J Gastrointest Surg 2011; 15:1969-76. [PMID: 21833745 DOI: 10.1007/s11605-011-1628-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 07/12/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) is a serious complication of total gastrectomy (TG) with D2 lymphadenectomy (D2). However, the actual incidence and risk factors are not yet completely understood, due in part to the absence of the widely accepted criteria for POPF following gastrectomy. PATIENTS AND METHODS One hundred and four patients who underwent TG with D2 between March 2007 and December 2009 were included in this study. The incidence and severity of POPF were evaluated according to the International Study Group on Pancreatic Fistula (ISGPF) classification. In addition, risk factors for POPF of ISGPF grade B or higher were investigated. RESULTS POPFs of ISGPF grade B or higher were observed in 23 patients (22.1%). Univariate analysis found that sex, body mass index, and amylase concentration of drainage fluid (D: -AMY) on the first postoperative day (1POD) were significant predictors of POPF grade B or higher. The appropriate cutoff level of D: -AMY on 1POD was calculated as 3398 IU/l. Multivariate analysis showed that D: -AMY ≥3,398 IU/l on 1POD was the only independent risk factor. CONCLUSIONS High D: -AMY on 1POD (≥3,398 IU/l) can predict a grade B or higher POPF, and this value may be useful in the early detection of POPF following TG with D2.
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Affiliation(s)
- Yuichiro Miki
- Department of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan
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Jiang X, Hiki N, Nunobe S, Kumagai K, Nohara K, Sano T, Yamaguchi T. Postoperative pancreatic fistula and the risk factors of laparoscopy-assisted distal gastrectomy for early gastric cancer. Ann Surg Oncol 2011; 19:115-21. [PMID: 21739317 DOI: 10.1245/s10434-011-1893-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoscopy-assisted distal gastrectomy (LADG) was introduced as minimally invasive surgery for early gastric cancer (EGC) in Japan. This study investigated postoperative pancreatic fistula (POPF) and associated risk factors of the procedure. METHODS From January 2005 to December 2009, 798 patients with EGC diagnosed before surgery underwent LADG. Thirty-four patients developed postoperative pancreatic fistula (POPF group), whereas the other 764 patients did not experience POPF (NPOPF group). POPF was defined and graded according to the International Study Group on Pancreatic Fistula Definition (ISGPF). Patient characteristics and operative and postoperative outcomes were compared between the two groups. Risk factors associated with POPF were analyzed. RESULTS POPF occurred in 34 (4.3%) patients; among them 3 developed grade C POPF, a complication that required aggressive clinical intervention, and only 1 underwent reoperation. Compared with the NPOPF group, the POPF group had higher percentage of male patients (88.2% vs. 60.5%, P = 0.001), higher mean body mass index (24.8 ± 2.5 kg/m(2) vs. 22.5 ± 3.2 kg/m(2), P < 0.001), longer mean operation time (251.3 ± 46.7 min vs. 229.7 ± 53.9 min, P = 0.022), higher postoperative complications (100% vs. 8.6%, P < 0.001), and longer mean postoperative hospital stay (29.6 ± 19.9 days vs. 12.6 ± 6.7 days, P < 0.001). Univariate and multivariate analysis identified sex and body mass index as risk factors associated with POPF after LADG. CONCLUSIONS LADG can be performed safely in patients with EGC in terms of the low incidence of POPF. To decrease the risk of POPF, LADG should be performed cautiously in male patients with high body mass index.
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Affiliation(s)
- Xiaohua Jiang
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Tomimaru Y, Miyashiro I, Kishi K, Motoori M, Yano M, Shingai T, Noura S, Ohue M, Ohigashi H, Ishikawa O. Is routine measurement of amylase concentration in drainage fluid necessary after total gastrectomy for gastric cancer? J Surg Oncol 2011; 104:274-7. [PMID: 21495031 DOI: 10.1002/jso.21938] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 03/16/2011] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Measurement of amylase level in drainage fluid (D-AMY) is often performed for detection of pancreatic fistula (PF) formation after total gastrectomy. However, PF incidence has decreased and PF formation can be judged by changes in drainage fluid properties. The aim of study is to compare the significance of drainage fluid inspection for PF formation with D-AMY measurement. METHODS PF incidence, drainage fluid properties, and D-AMY level in drainage fluid were investigated retrospectively in 173 patients undergoing total gastrectomy for gastric cancer. The sensitivity and specificity of changes in fluid properties for PF detection were compared to D-AMY measurement. RESULTS PF incidence in patients with dark-red colored drainage fluid (16/51) was higher than in those without dark-red fluid (0/122, P < 0.0001). The sensitivity and specificity of diagnosis by fluid properties were 100% and 77.7%, respectively. PF formation also correlated with D-AMY level, with sensitivity and specificity of diagnosis by D-AMY level of 5,000 U of 100% and 82.2%, respectively. There were no differences in the above parameters between the two diagnostic methods. CONCLUSIONS Drainage fluid inspection can provide accurate diagnosis of PF formation, similar to D-AMY measurement, suggesting that routine D-AMY measurement is probably not necessary in every patient.
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Affiliation(s)
- Yoshito Tomimaru
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Revisional surgery after gastrectomy for gastric cancer: review of the literature. Surg Laparosc Endosc Percutan Tech 2011; 20:332-7. [PMID: 20975505 DOI: 10.1097/sle.0b013e3181f39ff1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent reports have shown that morbidity and mortality after gastrectomy for gastric cancer vary between authors, countries, and procedures. Common complications related to gastrectomy are postoperative bleeding, anastomotic leakage, pancreatic juice leakage, intra-abdominal abscess, intestinal obstruction, wound dehiscence, and so on. Recently, laparoscopic gastrectomy for gastric cancer has developed, especially in Japan and East Asian countries because it is less invasive. Several retrospective studies have shown that the operative complication rate is similar to that of conventional open surgery. Although most postoperative complications can be successfully treated by conservative therapies, surgical management is occasionally needed to prevent a fatal outcome. This review article provides insight into how surgeons can make efforts to reduce postoperative complications through proper preoperative evaluation and improved surgical skills during the initial gastrectomy. In addition, it reviews guidance for timely revisional surgery to allow salvage of patients with serious acute operative complications based on clinical findings made by a group of experienced surgeons.
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Kulig J, Sierzega M, Kolodziejczyk P, Dadan J, Drews M, Fraczek M, Jeziorski A, Krawczyk M, Starzynska T, Wallner G. Implications of overweight in gastric cancer: A multicenter study in a Western patient population. Eur J Surg Oncol 2010; 36:969-76. [PMID: 20727706 DOI: 10.1016/j.ejso.2010.07.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 07/10/2010] [Accepted: 07/19/2010] [Indexed: 02/06/2023] Open
Abstract
AIMS The purpose of this study was to evaluate the effects of overweight on surgical and long-term outcomes in a Western population of patients with gastric cancer (GC). METHODS An electronic database of all patients with resectable GC treated between 1986 and 1998 at seven university surgical centres cooperating in the Polish Gastric Cancer Study Group was reviewed. Overweight was defined as a body mass index (BMI) of 25 kg/m(2) or higher. RESULTS Four hundred and ninety-two of 1992 (25%) patients were overweight. Postoperatively, higher BMI was associated with higher rates of cardiopulmonary complications (16% vs 12%, P = 0.001) and intra-abdominal abscess (6.9% vs 2.9%, P < 0.001). However, other complications and mortality rates were unaffected. The median disease-specific survival of overweight patients was significantly higher (36.7 months, 95% confidence interval (CI) 29.0-44.4) than those with BMI<25 kg/m(2) (25.7 months, 95%CI 23.2-28.1; P = 0.003). These differences were due to the lower frequencies of patients with T3 and T4 tumours, metastatic lymph nodes, distant metastases, and non-curative resections. A Cox proportional hazards model identified age, depth of infiltration, lymph node metastases, distant metastases, and residual tumour category as the independent prognostic factors. CONCLUSIONS Overweight is not the independent prognostic factor for long-term survival in a Western-type population of GC.
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Affiliation(s)
- J Kulig
- 1st Department of Surgery, Jagiellonian University Medical College, 40 Kopernika Street, 31-501 Krakow, Poland.
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Obama K, Okabe H, Hosogi H, Tanaka E, Itami A, Sakai Y. Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery 2010; 149:15-21. [PMID: 20627337 DOI: 10.1016/j.surg.2010.04.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 04/16/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is little evidence for the technical feasibility of laparoscopic gastrectomy (LG) with peripancreatic lymphadenectomy in terms of postoperative complications. To evaluate the technical feasibility of LG with radical lymphadenectomy, we focused on pancreas-related complications in LG and open gastrectomy (OG), and then investigated whether such complications increased in LG. METHODS We reviewed the surgical outcomes of 138 consecutive patients with gastric cancer who underwent LG with peripancreatic lymphadenectomy in our hospital between July 2005 and February 2009. As a control group, we used 95 consecutive OG cases with peripancreatic lymphadenectomy without splenectomy or para-aortic lymphadenectomy. LG and OG were compared for clinicopathologic characteristics, operative outcomes, postoperative morbidities and mortalities, and amylase concentration of drainage fluid (d-AMY). RESULTS The overall operative morbidity rates were 15% in the LG and 20% in the OG group. Rates of postoperative pancreatic fistula (POPF), Grade B and C in the International Study Group on Pancreatic Fistula definition, were 7% in the LG group and 2% in the OG group, indicating no statistical difference (P = .149). There were no in-hospital deaths. The median value of d-AMY in LG was 934.5 IU/L, while that in OG was 349 IU/L; d-AMY after LG was significantly higher than that after OG (P < .01). CONCLUSION Considering low morbidity and mortality rates, LG with peripancreatic lymphadenectomy is technically feasible. Although POPF after LG was infrequent, d-AMY level was higher than after OG. We should pay attention to the potential risk of pancreatic leakage when carrying out LG with peripancreatic lymphadenectomy.
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Affiliation(s)
- Kazutaka Obama
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Nobuoka D, Gotohda N, Konishi M, Nakagohri T, Takahashi S, Kinoshita T. Prevention of postoperative pancreatic fistula after total gastrectomy. World J Surg 2009; 32:2261-6. [PMID: 18670802 DOI: 10.1007/s00268-008-9683-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pancreatic fistula (PF) is still one of the serious complications after total gastrectomy (TG). The purpose of this study was to identify risk factors for PF after TG and to evaluate our attempts to prevent PF. METHODS From August 1992 to July 2006, 740 consecutive patients with gastric neoplasm underwent TG at the National Cancer Center Hospital East. Univariate and multivariate analyses of potential risk factors for the development of PF and the effectiveness of operative procedures to prevent PF were performed. RESULTS Postoperative PF was identified in 130 patients (18%). On multivariate analysis, body mass index (P < 0.001) and the operative procedure (TG with pancreaticosplenectomy) (P = 0.001) were independent risk factors. In TG with splenectomy (pancreas-preserving method), total preservation of the splenic artery was significantly correlated with a lower incidence of PF (P < 0.001). In TG with pancreaticosplenectomy, the use of a linear stapling device was an effective surgical technique for closure of the cut end of the pancreas, but there was no significant difference from conventional methods. Recently, the incidence decreased significantly for TG overall and TG with splenectomy. CONCLUSIONS PF after TG is more likely to occur in obese patients undergoing TG with pancreaticosplenectomy. When TG with splenectomy (pancreas-preserving method) is performed, the splenic artery should be totally preserved. If TG with pancreaticosplenectomy is performed, the use of a linear stapling device for closure of the cut end of the pancreas should be suggested. These improvements in surgical techniques are useful to prevent PF.
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Affiliation(s)
- Daisuke Nobuoka
- Department of Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan.
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Cheong O, Kim BS, Yook JH, Oh ST, Park YK, Ryu SY. Modified radical lymphadenectomy without splenectomy in patients with proximal gastric cancer: comparison with standard D2 lymphadenectomy for distal gastric cancer. J Surg Oncol 2009; 98:500-4. [PMID: 18770520 DOI: 10.1002/jso.21137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES We assessed the optimal extent of lymph node dissection and the effect of splenectomy in patients with proximal gastric cancer. METHOD Recurrence and survival rates were compared between 881 patients with proximal gastric cancer who underwent modified radical lymphadenectomy and 3,098 patients with distal gastric cancer who underwent standard D2 lymphadenectomy. RESULTS The recurrence rate was significantly higher in the total than in the distal gastrectomy group (32.5% vs. 16.5%, P < 0.001), but the rates were similar after adjustment for TNM stage. The overall 5-year survival rate was significantly higher in the distal than in the total gastrectomy group (80.4% vs. 66.2%, P < 0.001), but this difference was not observed after adjustment for TNM stage. Multivariate analysis showed that patient age, number of retrieved lymph nodes, depth of invasion, and nodal metastasis were independent prognostic determinants for survival, whereas type of lymphadenectomy was not. CONCLUSION Long-term outcomes were similar in patients with proximal gastric cancer who underwent modified lymphadenectomy without splenectomy and in patients with distal gastric cancer who underwent standard D2 lymphadenectomy. These findings indicate that modified radical lymphadenectomy without splenectomy is sufficient for optimal lymph node dissection in patients with proximal gastric cancer.
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Affiliation(s)
- Oh Cheong
- Department of Surgery, Chonnam National University College of Medicine, Hwasun Cancer Center, Gwangju, Korea
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Taguchi M, Nishikawa S, Matsuoka H, Narita R, Abe S, Fukuda K, Miyamoto H, Taniguchi H, Otsuki M. Pancreatic abscess caused by Corynebacterium coyleae mimicking malignant neoplasm. Pancreas 2006; 33:425-9. [PMID: 17079950 DOI: 10.1097/01.mpa.0000236730.08747.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
A 50-year-old female was referred to our hospital because of postprandial epigastric pain and pancreatic head mass. On admission, an elastic hard mass with tenderness was palpable in the epigastric region. Laboratory findings showed no abnormalities, except for a slightly elevated C-reactive protein value and iron deficiency anemia. Serum levels of pancreatic enzymes and tumor markers were also within the reference range. Computed tomography (CT) demonstrated a 5-cm heterogenous mass at the head of the pancreas. Angiography showed that gastroduodenal artery was transformed and narrowed by the mass. Smooth stenosis of portal vein was also observed. Fusion CT-positron emission tomography with 2-deoxy-2-[F]fluoro-D-glucose demonstrated a focus of increased uptake in the pancreatic head mass. We suspected the mass of malignancy but, surprisingly, tumor size was gradually decreased without any therapies. Biopsy specimens from the mass of the pancreas showed marked inflammatory cell infiltration and marked interstitial fibrosis without malignant cells. Thereafter, we could isolate Corynebacterium coyleae from the biopsy specimen. We diagnosed the mass as a pancreatic abscess caused by C. coyleae and started with the intravenous antibiotics therapy. Subsequent follow-up CT and ultrasonography showed dramatic improvement in pancreatic mass. We present here a case of pancreatic abscess which was difficult to differentiate from malignant lesion by various imaging studies. Moreover, we could culture and identify C. coyleae which had never been reported to be the source of pancreatic abscess.
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Affiliation(s)
- Masashi Taguchi
- Third Department of Internal Medicine, University of Occupational and Environmental Health, Japan School of Medicine, Kitakyushu, Japan
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