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Wang X, Ye H, Yan Y, Wu J, Wang N, Chen M. The Preoperative Enhanced Degree of Contrast-enhanced CT Images: A Potential Independent Predictor in Gastric Adenocarcinoma Patients After Radical Gastrectomy. Cancer Manag Res 2020; 12:11989-11999. [PMID: 33262649 PMCID: PMC7695603 DOI: 10.2147/cmar.s271879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022] Open
Abstract
Aim To discover the value of contrast-enhanced CT parameters in predicting the prognosis of gastric adenocarcinoma (GAC) patients after radical gastrectomy. Methods The patients with a clinical diagnosis of GAC were retrospectively enrolled. Two radiologists drew the regions of interest (ROIs) in CT images and measured the CT attenuate value (CAV) in each phase and the corrected CAV (cCAV) in each contrast-enhanced phase. Patients were divided into two groups (high/low-enhancement) according to receiver operating characteristic (ROC) curve. Kaplan–Meier curve and Cox proportional hazards regression analysis were performed to evaluate correlation between prognosis and variables. Subgroup analysis was used to further analyze the prognostic value of variables. Results In total 435 patients were included. According to ROC curve, the cCAV in delayed phase (DP-cCAV) with maximum AUC and Youden index was chosen. A total of 312 patients (71.7%) entered DP-cCAVlow group and remaining 123 (28.3%) patients were in DP-cCAVhigh group. According to univariate (high vs low, HR=2.120, p<0.001) and multivariate (high vs low, HR=1.623, p<0.001) Cox regression analysis, the low-enhancement state was considered as an independent protective factor. Subgroup analysis was based on age, maximum diameter of tumor, differentiation, vascular invasion status, and TNM staging. In most subgroups, the overall survival (OS) of DP-cCAVlow group was overwhelmingly satisfactory (all HR >1, expect TNM stage I, IV and differentiated type subgroups). Conclusion The prognostic effectiveness of CT parameters as biomarkers for OS in GAC patients treated with radical gastrectomy has potential value.
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Affiliation(s)
- Xinxin Wang
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Huajun Ye
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Ye Yan
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Jiansheng Wu
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Na Wang
- Health Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
| | - Mengjun Chen
- Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325006, People's Republic of China
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Yamada S, Yagi S, Sato K, Shin'e M, Sakamoto A, Utsunomiya D, Okikawa S, Aibara N, Watanabe M, Obatake M, Ono R, Fujii M, Otani H, Kawasaki H. Serum C-reactive protein level on first postoperative day can predict occurrence of postoperative pancreatic fistula after laparoscopic gastrectomy. THE JOURNAL OF MEDICAL INVESTIGATION 2020; 66:285-288. [PMID: 31656290 DOI: 10.2152/jmi.66.285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose : Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy for gastric cancer. The purpose of this study is to identify the risk factor of POPF and evaluate C-reactive protein on postoperative day 1 (POD1) as the predictor for POPF after laparoscopic gastrectomy (LG). Methods : Between May 2013 and September 2016, 226 patients who underwent LG for gastric cancer were investigated. Patients were divided into 2 groups; POPF group (n = 17) and control group (n = 209). Clinicopathological factors were compared between 2 groups. Results : In POPF group, there are more male patients (p = 0.003) compared with control group. Preoperative factors, such as age, BMI, and prevalence of previous operation and comorbidity showed no significant difference between 2 groups. Regarding tumor factors and perioperative data such as blood loss and operative time, there were also no significant difference between 2 groups. POPF group showed longer postoperative hospital stay, and higher serum CRP level on POD1 (p < 0.0001). Multivariate analysis revealed that high CRP level on POD1 ( ≥ 3mg/dl) was independent risk factor of POPF. Conclusions : High serum CRP level on POD1 can predict the occurrence of POPF. J. Med. Invest. 66 : 285-288, August, 2019.
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Affiliation(s)
- Shinichiro Yamada
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan.,Department of Surgery, Tokushima University, Tokushima, Japan
| | - Shigehiko Yagi
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Koichi Sato
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Mikiya Shin'e
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Akimasa Sakamoto
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Daichi Utsunomiya
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Shohei Okikawa
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Norimasa Aibara
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Miya Watanabe
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Masayoshi Obatake
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Riki Ono
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | | | - Hiromi Otani
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hideki Kawasaki
- Departments of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
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Shi Y, Li L, Xiao H, Guo S, Wang G, Tao K, Dong J, Zong L. Feasibility of laparoscopic gastrectomy for patients with Siewert-type II/III adenocarcinoma of the esophagogastric junction: A propensity score matching analysis. PLoS One 2018; 13:e0203125. [PMID: 30256806 PMCID: PMC6157841 DOI: 10.1371/journal.pone.0203125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 08/15/2018] [Indexed: 12/29/2022] Open
Abstract
Background/Aim The feasibility of using laparoscopic gastrectomy for the treatment of Siewert-type II/III adenocarcinoma of the esophagogastric junction (AEG) has not been addressed. This study aimed to comparatively evaluate the short- and long-term effects on laparoscopic versus open surgery using (propensity score matching) PSM for Siewert-type II/III AEG. Methods We retrospectively collected data from the patients with Siewert-type II/III AEG who were treated in our cancer center between January 2013 and December 2015. Patients undergoing laparoscopic gastrectomy and open gastrectomy were matched via PSM. The cumulative 2-year Overall survival (OS) rate of patients in the two cohorts was estimated by Kaplan-Meier plots. Multi-variable analysis using a Cox regression model was conducted to identify independent risk factors. Results A total of 963 patients with Siewert-type II/III AEG were included, of which 132 cases were in the laparoscopic gastrectomy group, and 831 cases were in the open gastrectomy group. After regrouping with PSM, 132 patients in the laparoscopic gastrectomy group were balanced with 264 similar patients in the open gastrectomy group. As expected, the laparoscopic gastrectomy group had significantly longer operation times, but less blood loss. Furthermore, the two groups showed similar results for post-operative complications, duration of hospital stay and 2-year OS rate. Combined organ resection was an independent risk factor for 2-year OS rate. Conclusion This study suggests that laparoscopic gastrectomy may serve as a safe and feasible treatment for Siewert-type II/III AEG and achieve similar oncologic outcomes as open gastrectomy.
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Affiliation(s)
- Yinan Shi
- Department of minimal invasive gastrointestinal surgery, Shanxi Cancer Hospital, affiliated to Shanxi Medical University, Taiyuan, Shanxi, PR. China
| | - Linjie Li
- Department of minimal invasive gastrointestinal surgery, Shanxi Cancer Hospital, affiliated to Shanxi Medical University, Taiyuan, Shanxi, PR. China
| | - Huashi Xiao
- Department of Gastrointestinal Surgery, Clinical Medical School of Yangzhou university, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, PR. China
- Clinical Medical College, Dalian Medical University, Liaoning, PR. China
| | - Shanshan Guo
- Department of Gastrointestinal Surgery, Clinical Medical School of Yangzhou university, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, PR. China
- Clinical Medical College, Dalian Medical University, Liaoning, PR. China
| | - Guiping Wang
- Department of Gastrointestinal Surgery, Clinical Medical School of Yangzhou university, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, PR. China
- Clinical Medical College, Dalian Medical University, Liaoning, PR. China
| | - Kai Tao
- Department of minimal invasive gastrointestinal surgery, Shanxi Cancer Hospital, affiliated to Shanxi Medical University, Taiyuan, Shanxi, PR. China
| | - Jianhong Dong
- Department of minimal invasive gastrointestinal surgery, Shanxi Cancer Hospital, affiliated to Shanxi Medical University, Taiyuan, Shanxi, PR. China
- * E-mail: (JD); (LZ)
| | - Liang Zong
- Department of Gastrointestinal Surgery, Clinical Medical School of Yangzhou university, Northern Jiangsu People’s Hospital, Yangzhou, Jiangsu, PR. China
- * E-mail: (JD); (LZ)
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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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Analysis of postoperative morbidity and mortality following surgery for gastric cancer. Surgeon volume as the most significant prognostic factor. GASTROENTEROLOGY REVIEW 2017; 12:215-221. [PMID: 29123584 PMCID: PMC5672710 DOI: 10.5114/pg.2017.70475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/29/2016] [Indexed: 12/14/2022]
Abstract
Introduction Surgical resection is the only potentially curative modality for gastric cancer and it is associated with substantial morbidity and mortality. Aim To determine risk factors for postoperative morbidity and mortality following major surgery for gastric cancer. Material and methods Between 1.08.2006 and 30.11.2014 in the Department of Oncological Surgery of Gdynia Oncology Centre 162 patients underwent gastric resection for adenocarcinoma. All procedures were performed by 13 surgeons. Five of them performed at least two gastrectomies per year (n = 106). The remaining 56 resections were done by eight surgeons with annual volume lower than two. Perioperative mortality was defined as every in-hospital death and death within 30 days after surgery. Causes of perioperative deaths were the matter of in-depth analysis. Results Overall morbidity was 23.5%, including 4.3% rate of proximal anastomosis leak. Mortality rate was 4.3%. Morbidity and mortality were not dependent on: age, gender, body mass index, tumour location, extent of surgery, splenectomy performance, or pTNM stage. The rates of morbidity (50% vs. 21.3%) and mortality (16.7% vs. 3.3%) were significantly higher in cases of tumour infiltration to adjacent organs (pT4b). Perioperative morbidity and mortality were 37.5% and 8.9% for surgeons performing less than two gastrectomies per year and 16% and 0.9% for surgeons performing more than two resections annually. The differences were statistically significant (p = 0.002, p = 0.003). Conclusions Annual surgeon case load and adjacent organ infiltration (pT4b) were significant risk factors for morbidity and mortality following major surgery for gastric cancer. The most common complications leading to perioperative death were cardiac failure and proximal anastomosis leak.
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Zu G, Zhang T, Li W, Sun Y, Zhang X. Impact of clinicopathological parameters on survival after multiorgan resection among patients with T4 gastric carcinoma: a systematic review and meta-analysis. Clin Transl Oncol 2017; 19:750-760. [PMID: 28054321 DOI: 10.1007/s12094-016-1600-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/16/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND The prognostic factors which can improve the overall survival (OS) of patients with T4 gastric carcinoma (GC) are still controversial: a meta-analysis was conducted to analyze the impact of clinicopathological parameters on survival after MOR among patients with T4 GC. METHODS A systematic search was performed. Odd risks (ORs) of patients with T4 GC were used to calculate the relationship between clinicopathological parameters and OS. RESULTS Nine studies involving 941 patients with T4 GC were identified. Well-moderate differentiation led to increased 1-, 3-, 5-year OS with an OR of 2.63, 1.58 and 1.45. Borrmann type I-II led to increased 1-, 3-year OS with an OR of 1.67 and 2.08. No lymph node metastasis led to increased 1-, 3-, 5-year OS with an OR of 7.16, 3.18 and 3.71. Total gastrectomy led to increased 1-, 3-year OS with an OR of 2.01 and 1.79. ≥2 Organs resected led to increased 1-, 3-year OS with an OR of 2.19 and 2.19. TNM stage II-III led to increased 1-, 3-year OS with an OR of 3.68 and 5.75. Curative resection led to increased 1-, 3-, 5-year OS with an OR of 4.46, 5.80 and 5.98. CONCLUSION Well-moderate differentiation, Borrmann type I-II, no lymph node metastasis, total gastrectomy, ≥2 organs resected, TNM stage II-III and curative resection were positive prognostic factors for OS of patients with T4 GC.
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Affiliation(s)
- G Zu
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China.
| | - T Zhang
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China
| | - W Li
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China
| | - Y Sun
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China
| | - X Zhang
- Department of Gastroenterology Surgery, The Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian Shahekou District Southwest Road No. 826, Dalian, 116033, People's Republic of China.
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Namysł-Kaletka A, Wydmanski J, Tukiendorf A, Bodusz D, Leszczynski W, Kawczynski R, Grabinska K, Polanowski P. Influence of interfraction motion on margins for radiotherapy of gastric cancer. Br J Radiol 2015; 88:20140610. [PMID: 25668485 DOI: 10.1259/bjr.20140610] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate interfraction uncertainties using kilovoltage (kV) radiographs for patients with gastric cancer during chemoradiotherapy and to calculate the planning target volume (PTV) margins. METHODS 1284 measurements of set-up errors were analysed for treated patients. The measurements of craniocaudal (axis y), laterolateral (axis x) and anteroposterior (axis z) shifts in kV radiographs were performed. Interfraction clinical target volume (CTV)-PTV margins for all directions were calculated using the van Herk formula. RESULTS The main shift for the y-axis was 0.7 mm [standard deviation (SD), ±7.6], for the x-axis was 0.4 mm (SD, ±3.7) and for the z-axis was 0.6 mm (SD, ±3.5). The CTV-PTV margin in the x, y and z directions was 8.3, 15.5 and 8.0 mm, respectively. We observed that the interfractional motion for patients increased approximately 0.0034 cm along the x direction with each subsequent fraction, whereas a 0.0058-cm reduction in length along the y-axis was observed. No time effects for the z direction were noticed. CONCLUSION According to our experience, a PTV margin of 9 mm along the x-axis, 16 mm along the y-axis and 8 mm along the z direction should be considered in the absence of image-guided radiotherapy. ADVANCES IN KNOWLEDGE This knowledge concerning PTV set-up margins could be particularly useful for centres without a kV on-board imaging system.
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Affiliation(s)
- A Namysł-Kaletka
- 1 Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
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Chen K, Pan Y, Cai JQ, Xu XW, Wu D, Mou YP. Totally laparoscopic gastrectomy for gastric cancer: A systematic review and meta-analysis of outcomes compared with open surgery. World J Gastroenterol 2014; 20:15867-15878. [PMID: 25400474 PMCID: PMC4229555 DOI: 10.3748/wjg.v20.i42.15867] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/09/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To systematically review the surgical outcomes of totally laparoscopic gastrectomy (TLG) vs open gastrectomy (OG) for gastric cancer.
METHODS: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted. All original studies comparing TLG with OG were included for critical appraisal. Data synthesis and statistical analysis were carried out using RevMan 5.1 software.
RESULTS: One RCT and 13 observational studies involving 1532 patients were included (721 TLG and 811 OG). TLG was associated with longer operation time [weighted mean difference (WMD) = 58.04 min, 95%CI: 37.77-78.32, P < 0.001], less blood loss [WMD = -167.57 min, 95%CI: -208.79-(-126.34), P < 0.001], shorter hospital stay [WMD = -3.75 d, 95%CI: -4.88-(-2.63), P < 0.001] and fewer postoperative complications (RR = 0.71, 95%CI: 0.58-0.86, P < 0.001). The number of harvested lymph nodes, surgical margin, mortality and cancer recurrence rate were similar between the two groups.
CONCLUSION: TLG may be a technically safe, feasible and favorable approach in terms of better cosmesis, less blood loss and faster recovery compared with OG.
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Kim MG, Lee JH, Ha TK, Kwon SJ. The distance of proximal resection margin dose not significantly influence on the prognosis of gastric cancer patients after curative resection. Ann Surg Treat Res 2014; 87:223-31. [PMID: 25368847 PMCID: PMC4217255 DOI: 10.4174/astr.2014.87.5.223] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/11/2014] [Accepted: 03/14/2014] [Indexed: 12/11/2022] Open
Abstract
Purpose It is well known that the curative resection with an adequate proximal margin length is the most effective treatment in gastric cancer. However, despite surgeon's effort to achieve a sufficient proximal margin length, it is often difficult to obtain a recommended proximal margin length in some cases. Therefore, this study was planned to investigate the impact of the length of proximal margin on prognosis of overall survival. Methods Between June 1992 and December 2010, 1,888 gastric cancer patients who underwent gastrectomy with curative intent were reviewed. According to tumor's location (total vs. subtotal gastrectomy), pathologic T staging, and differentiation, univariate and multivariate analyses were performed to evaluate the impact of the discrepancies of proximal margin length on overall survival. Also, the impact of the discrepancies of proximal margin length on local recurrence was assessed. Results The 5-year survival rate of positive proximal margin group was 5.9%. In negative proximal margin groups, multivariate analysis showed that the discrepancies of proximal margin length have no impact on overall survival. Kaplan-Meier analyses showed that there is no association between discrepancy of proximal margin length and local recurrence. Conclusion It takes effort to secure a negative proximal margin in the surgical treatment of gastric cancer because of the poor prognosis of positive proximal margin. In negative proximal margin patients, there's no need to achieve an additional proximal margin length for long-term survival benefit because there was no impact of proximal margin length on overall survival and local recurrence.
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Affiliation(s)
- Min Gyu Kim
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Kyung Ha
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Joon Kwon
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
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Wang W, Zhang X, Shen C, Zhi X, Wang B, Xu Z. Laparoscopic versus open total gastrectomy for gastric cancer: an updated meta-analysis. PLoS One 2014; 9:e88753. [PMID: 24558421 PMCID: PMC3928285 DOI: 10.1371/journal.pone.0088753] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/12/2014] [Indexed: 02/07/2023] Open
Abstract
Objective To expand the current knowledge on the feasibility and safety of laparoscopic total gastrectomy (LTG) for gastric cancer in comparison with open total gastrectomy (OTG). Background Additional studies comparing laparoscopic versus open total gastric resection have been published, and it is necessary to update the meta-analysis of this subject. Methods Original articles compared LTG and OTG for gastric cancer, which published in English from January 1990 to July 2013 were searched in PubMed, Embase, and Web of Knowledge by two reviewers independently. Operative time, blood loss, harvested lymph nodes, proximal resection margin, analgesic medication, first flatus day, first oral intake, postoperative hospital stay, postoperative complications, hospital mortality, 5-year overall survival (OS) and disease-free survival (DFS) were compared using STATA version 10.1. Results 17 studies were selected in this analysis, which included a total of 2313 patients (955 in LTG and 1358 in OTG). LTG showed longer operative time, less blood loss, fewer analgesic uses, earlier passage of flatus, quicker resumption of oral intake, earlier hospital discharge, and reduced postoperative morbidity. The number of harvested lymph nodes, proximal resection margin, hospital mortality, 5-year OS and DFS were similar. Conclusion LTG had the benefits of less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay and lower postoperative morbidity, at the price of longer operative time. There were no statistical differences in lymph node dissection, resection margin, hospital mortality, and long-term outcomes, which indicated the similar oncological safety with OTG. A positive trend was indicated towards LTG. So LTG can be performed as an alternative to OTG by the experienced surgeons in high-volume centers. Whereas, due to the relative small sample size of long-term outcomes and lack of randomized control trials, more studies are required.
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Affiliation(s)
- Weizhi Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyu Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Shen
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaofei Zhi
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Baolin Wang
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail: (BW); (ZX)
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail: (BW); (ZX)
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Laparoscopic versus open total gastrectomy with D2 dissection for gastric cancer: a meta-analysis. J Cancer Res Clin Oncol 2013; 139:1721-34. [PMID: 23990014 DOI: 10.1007/s00432-013-1462-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/14/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To elucidate the feasibility and safety of laparoscopic total gastrectomy with D2 dissection (LTGD2) for gastric cancer in comparison with open total gastrectomy with D2 dissection (OTGD2). BACKGROUND More surgeons have chosen laparoscopic total gastrectomy as an alternative to open total gastrectomy. But no meta-analysis has been performed to evaluate the value of LTGD2. METHODS Original articles compared LTGD2 and OTGD2 for gastric cancer, which published in English from January 1990 to March 2013 were searched in PubMed, Embase, and Web of Knowledge by two reviewers independently. Operative time, blood loss, harvested lymph nodes, analgesic medication, first flatus day, postoperative hospital stay, postoperative complications, and hospital mortality were compared using STATA version 10.1. RESULTS 8 studies were selected in this analysis. A total of 1,498 patients were included (559 in LTG and 939 in OTG). LTGD2 showed longer operative time (WMD 39.29; 95 % CI 20.52, 58.06; P < 0.001), less blood loss (WMD -157.94; 95 % CI -245.25 -70.62; P < 0.001), fewer analgesic requirements (WMD -2.01; 95 % CI -3.10, -0.93; P < 0.001), earlier passage of flatus (WMD -0.73; 95 % CI -1.19, -0.27; P = 0.002), earlier hospital discharge (WMD -2.69; 95 % CI -3.42, -1.97; P < 0.001), and reduced postoperative morbidity (RR 0.70; 95 % CI 0.50, 0.98; P = 0.035). The number of harvested lymph nodes (WMD 0.27; 95 % CI -1.43, 1.98; P = 0.752) and hospital mortality rate (RR 0.57; 95 % CI 0.11, 3.09; P = 0.513) were similar. CONCLUSION LTGD2 was associated with less blood loss, less postoperative pain, quicker bowel function recovery, shorter hospital stay, and reduced postoperative morbidity, at the expense of longer operative time. No statistical differences were observed in lymph node dissection, and hospital mortality, which indicated the similar ability of lymph nodes clearance and short-term outcomes with OTGD2. A positive trend was indicated toward LTGD2. So we encourage the experienced surgeons to achieve LTGD2 instead of OTGD2. Whereas, due to non-randomized control trails and lack of long-term outcomes, more studies are required.
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Tanizawa Y, Bando E, Kawamura T, Tokunaga M, Kondo J, Taki Y, Terashima M. Influence of a positive proximal margin on oral intake in patients with palliative gastrectomy for far advanced gastric cancer. World J Surg 2011; 35:1030-4. [PMID: 21384243 DOI: 10.1007/s00268-011-1018-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resection margin involvement is one of the most significant risk factors for local recurrence in curative gastrectomy, and local recurrence results in anastomotic stenosis. In the present study, the effects of a positive resection margin in palliative gastrectomy on the symptoms of anastomotic stenosis and the amount of oral intake were analyzed. METHODS Between September 2002 and December 2009, 2,228 patients underwent resection for gastric cancer at Shizuoka Cancer Center, Japan, of whom 18 underwent palliative gastrectomy with a positive proximal margin because of urgent symptoms such as tumor bleeding, stenosis, or perforation. These 18 patients were analyzed retrospectively in this study. RESULTS Twelve patients had a positive proximal margin, and six patients had both proximal and distal margin involvement. Anastomotic leakage occurred in 2 patients. The median overall survival was 7.5 months, and the median time from operation to a decrease in oral intake was 5.5 months. Anastomotic recurrence developed in 3 patients, and in all of them, anastomotic stricture was found 2-3 months after gastrectomy. One of these patients, who was in good general condition, was treated by endoscopic balloon dilatation. The other 2 patients did not undergo balloon dilatation because their general condition was poor, with peritonitis carcinomatosa. CONCLUSIONS It does not appear necessary for palliative gastrectomy to achieve a negative proximal margin, because salvage therapies resulted in maintaining a tolerable oral intake in patients who were in good general condition.
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Affiliation(s)
- Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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Gastric cancer: Patterns of disease spread via the perigastric ligaments shown by CT. AJR Am J Roentgenol 2010; 195:398-404. [PMID: 20651196 DOI: 10.2214/ajr.09.3070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The stomach is suspended in the abdominal cavity by perigastric ligaments, which are derived from the dorsal and ventral mesogastrium. These ligaments provide a direct contiguous pathway for the peritoneal spread of gastric cancer. In this article, we discuss the embryology and anatomy of the stomach and describe the specific ligamentous routes along which gastric cancers may spread by direct invasion. CONCLUSION Extragastric disease alters the prognosis and treatment options available to patients with gastric cancer. Familiarity with the stomach's embryology will help the radiologist understand its anatomy and, therefore, the patterns of regional spread of gastric cancer. The location of the primary tumor can predict involvement of specific perigastric ligaments because locoregional spread of gastric cancer occurs along the arteries, veins, nerves, and lymphatic channels within those ligaments. Thus, identifying the location of the primary tumor can potentially improve patient outcomes.
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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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Gillen S, Friess H, Kleeff J. Palliative cardia resection with gastroesophageal reconstruction for perforated carcinoma of the gastroesophageal junction. World J Gastroenterol 2009; 15:3065-7. [PMID: 19554663 PMCID: PMC2702118 DOI: 10.3748/wjg.15.3065] [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] [Indexed: 02/06/2023] Open
Abstract
Iatrogenic perforation of esophageal cancer or cancer of the gastroesophageal (GE) junction is a serious complication that, in addition to short term morbidity and mortality, significantly compromises the success of any subsequent oncological therapy. Here, we present an 82-year-old man with iatrogenic perforation of adenocarcinoma of the GE junction. Immediate surgical intervention included palliative resection and GE reconstruction. In the case of iatrogenic tumor perforation, the primary goal should be adequate palliative (and not oncological) therapy. The different approaches for iatrogenic perforation, i.e. surgical versus endoscopic therapy are discussed.
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Gong DJ, Miao CF, Bao Q, Jiang M, Zhang LF, Tong XT, Chen L. Risk factors for operative morbidity and mortality in gastric cancer patients undergoing total gastrectomy. World J Gastroenterol 2008; 14:6560-3. [PMID: 19030212 PMCID: PMC2773346 DOI: 10.3748/wjg.14.6560] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the risk factors for morbidity and mortality following total gastrectomy.
METHODS: We retrospectively reviewed the records of 125 consecutive patients who underwent total gastrectomy for gastric cancer at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2003 and March 2008.
RESULTS: The overall morbidity rate was 20.8% (27 patients) and the mortality rate was 3.2% (4 patients). Morbidity rates were higher in patients aged over 60 [odds ratio (OR) 4.23 (95% confidence interval (CI) 1.09 to 12.05)], with preoperative comorbidity [with vs without, OR 1.25 (95% CI 1.13 to 8.12)], when the combined resection was performed [combined resection vs total gastrectomy only, OR 2.67 (95% CI 1.58 to 5.06)].
CONCLUSION: Age, preoperative comorbidity and combined resection were independently associated with the rate of morbidity after total gastrectomy for gastric cancer.
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Topal B, Leys E, Ectors N, Aerts R, Penninckx F. Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma. Surg Endosc 2007; 22:980-4. [PMID: 17690934 DOI: 10.1007/s00464-007-9549-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 05/26/2007] [Accepted: 06/13/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of laparoscopic total gastrectomy (LTG) in the treatment of gastric cancer is controversial. The present study analyzed the morbidity and adequacy of resection in LTG versus open total gastrectomy (OTG) for gastric adenocarcinoma. METHODS Between 2003 and 2006, clinical data of 38 consecutive patients who underwent LTG for gastric adenocarcinoma were collected prospectively. The same data-entry form was used for retrospective data collection from 22 consecutive patients who underwent OTG within the same time period. Logistic regression models were used in univariate and multivariate analyses to identify the optimally combined factors related to the occurrence of postoperative complications and to the number of harvested lymph nodes. RESULTS Postoperative complications occurred in 24 patients with subsequent mortality in two. Median (range) length of hospital stay was 11 (6-73) days and comparable after LTG versus OTG (p = 0.847). The occurrence of postoperative complications was related (p = 0.004) to the first year of surgery and patients' medical condition before surgery [American Society of Anaesthesiologists (ASA) physical status III]. Microscopic tumor-free margins were obtained in all but two patients. The number of harvested lymph nodes was 17 (0-90), and determined by tumor wall penetration (p = 0.001). CONCLUSIONS The occurrence of complications after total gastrectomy is determined by the patients' medical condition before surgery and the surgical expertise, but not by the approach. LTG and OTG can result in adequate tumor-free resection margins and lymph node yield, which is related to the tumor wall penetration. The role of LTG in gastric cancer needs further evaluation in randomized controlled trials with large patient series.
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Affiliation(s)
- B Topal
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
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