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Brown LR, Kamarajah SK, Madhavan A, Wahed S, Navidi M, Immanuel A, Hayes N, Phillips AW. The impact of age on long-term survival following gastrectomy for gastric cancer. Ann R Coll Surg Engl 2023; 105:269-277. [PMID: 35446718 PMCID: PMC9974338 DOI: 10.1308/rcsann.2021.0355] [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] [Accepted: 12/08/2021] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Gastrectomy remains the primary curative treatment modality for patients with gastric cancer. Concerns exist about offering surgery with a high associated morbidity and mortality to elderly patients. The study aimed to evaluate the long-term survival of patients with gastric cancer who underwent gastrectomy comparing patients aged <70 years with patients aged ≥70 years. METHODS Consecutive patients who underwent gastrectomy for adenocarcinoma with curative intent between January 2000 and December 2017 at a single centre were included. Patients were stratified by age with a cut-off of 70 years used to create two cohorts. Log rank test was used to compare overall survival and Cox multivariable regression used to identify predictors of long-term survival. RESULTS During the study period, 959 patients underwent gastrectomy, 520 of whom (54%) were aged ≥70 years. Those aged <70 years had significantly lower American Society of Anesthesiologists grades (p<0.001) and were more likely to receive neoadjuvant chemotherapy (39% vs 21%; p<0.001). Overall complication rate (p=0.001) and 30-day postoperative mortality (p=0.007) were lower in those aged <70 years. Long-term survival (median 54 vs 73 months; p<0.001) was also favourable in the younger cohort. Following adjustment for confounding variables, age ≥70 years remained a predictor of poorer long-term survival following gastrectomy (hazard ratio 1.35, 95% confidence interval 1.09, 1.67; p=0.006). CONCLUSIONS Low postoperative mortality and good long-term survival were demonstrated for both age groups following gastrectomy. Age ≥70 years was, however, associated with poorer outcomes. This should be regarded as important factor when counselling patients regarding treatment options.
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Affiliation(s)
- LR Brown
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - SK Kamarajah
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - A Madhavan
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - S Wahed
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - M Navidi
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - A Immanuel
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - N Hayes
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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2
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Chung H, Ko Y, Lee IS, Hur H, Huh J, Han SU, Kim KW, Lee J. Prognostic artificial intelligence model to predict 5 year survival at 1 year after gastric cancer surgery based on nutrition and body morphometry. J Cachexia Sarcopenia Muscle 2023; 14:847-859. [PMID: 36775841 PMCID: PMC10067496 DOI: 10.1002/jcsm.13176] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/31/2022] [Accepted: 01/02/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Personalized survival prediction is important in gastric cancer patients after gastrectomy based on large datasets with many variables including time-varying factors in nutrition and body morphometry. One year after gastrectomy might be the optimal timing to predict long-term survival because most patients experience significant nutritional change, muscle loss, and postoperative changes in the first year after gastrectomy. We aimed to develop a personalized prognostic artificial intelligence (AI) model to predict 5 year survival at 1 year after gastrectomy. METHODS From a prospectively built gastric surgery registry from a tertiary hospital, 4025 gastric cancer patients (mean age 56.1 ± 10.9, 36.2% females) treated gastrectomy and survived more than a year were selected. Eighty-nine variables including clinical and derived time-varying variables were used as input variables. We proposed a multi-tree extreme gradient boosting (XGBoost) algorithm, an ensemble AI algorithm based on 100 datasets derived from repeated five-fold cross-validation. Internal validation was performed in split datasets (n = 1121) by comparing our proposed model and six other AI algorithms. External validation was performed in 590 patients from other hospitals (mean age 55.9 ± 11.2, 37.3% females). We performed a sensitivity analysis to analyse the effect of the nutritional and fat/muscle indices using a leave-one-out method. RESULTS In the internal validation, our proposed model showed AUROC of 0.8237, which outperformed the other AI algorithms (0.7988-0.8165), 80.00% sensitivity, 72.34% specificity, and 76.17% balanced accuracy. In the external validation, our model showed AUROC of 0.8903, 86.96% sensitivity, 74.60% specificity, and 80.78% balanced accuracy. Sensitivity analysis demonstrated that the nutritional and fat/muscle indices influenced the balanced accuracy by 0.31% and 6.29% in the internal and external validation set, respectively. Our developed AI model was published on a website for personalized survival prediction. CONCLUSIONS Our proposed AI model provides substantially good performance in predicting 5 year survival at 1 year after gastric cancer surgery. The nutritional and fat/muscle indices contributed to increase the prediction performance of our AI model.
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Affiliation(s)
- Heewon Chung
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Yousun Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Seob Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jimi Huh
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, College of Electronics and Information, Kyung Hee University, Yongin-si, Gyeonggi-do, Republic of Korea
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3
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Baiocchi GL, Giacopuzzi S, Vittimberga G, De Pascale S, Pastorelli E, Gelmini R, Viganò J, Graziosi L, Vagliasindi A, Rosa F, Steccanella F, Demartini P, Reddavid R, Berselli M, Elmore U, Romario UF, Degiuli M, Morgagni P, Marrelli D, D’Ugo D, Rosati R, De Manzoni G. Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry. Updates Surg 2023; 75:419-427. [PMID: 35788552 PMCID: PMC9852164 DOI: 10.1007/s13304-022-01318-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015-2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien-Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome.
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Affiliation(s)
- Gian Luca Baiocchi
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy ,UOC General Surgery, ASST Cremona, Cremona, Italy
| | - Simone Giacopuzzi
- grid.5611.30000 0004 1763 1124Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | | | - Stefano De Pascale
- grid.15667.330000 0004 1757 0843Department of Digestive Tract Surgery, IEO, Milan, Italy
| | - Elisabetta Pastorelli
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberta Gelmini
- grid.7548.e0000000121697570Department of Oncological Surgery, University of Modena, Modena, Italy
| | - Jacopo Viganò
- grid.419425.f0000 0004 1760 3027General Surgery, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigina Graziosi
- grid.9027.c0000 0004 1757 3630General and Emergency Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Vagliasindi
- grid.415207.50000 0004 1760 3756UOC General and Emergency Surgery, SSD Emergency Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Fausto Rosa
- grid.411075.60000 0004 1760 4193Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | | | - Paolo Demartini
- grid.414818.00000 0004 1757 8749General, Oncological and Minimally Invasive Surgery, Cà Granda-Niguarda Hospital, Milan, Italy
| | - Rossella Reddavid
- grid.7605.40000 0001 2336 6580Department of Oncology, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Mattia Berselli
- General Surgery Unit, Department of Surgery, ASST Settelaghi, Varese, Italy
| | - Ugo Elmore
- grid.15496.3f0000 0001 0439 0892Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Milan, Italy
| | | | - Maurizio Degiuli
- grid.7605.40000 0001 2336 6580Department of Oncology, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Paolo Morgagni
- GB Morgagni-L Pierantoni Surgical Department, Forlì, Italy
| | - Daniele Marrelli
- grid.9024.f0000 0004 1757 4641Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Domenico D’Ugo
- grid.411075.60000 0004 1760 4193Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Riccardo Rosati
- grid.15496.3f0000 0001 0439 0892Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Milan, Italy
| | - Giovanni De Manzoni
- grid.5611.30000 0004 1763 1124Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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Kim DH, Park JH, Kim TH, Jung EJ, Jeong CY, Ju YT, Kim JY, Park TJ, Lee YJ, Jeong SH. Risk Factors for Reoperation Following Radical Gastrectomy in Gastric Cancer Patients. Am Surg 2021:31348211050842. [PMID: 34814762 DOI: 10.1177/00031348211050842] [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: 11/15/2022]
Abstract
BACKGROUND Reoperation due to elective surgery complications is very mentally, physically, and economically detrimental to patients. This study investigated the potential risk factors associated with early reoperation after radical gastrectomy in gastric cancer patients and included an in-depth analysis of these risk factors. METHODS This retrospective study reviewed 1568 patients with gastric cancer. Grade 3 or greater complications were defined as severe. Any factors related to reoperation after radical gastrectomy were analyzed in patients with severe local complications. RESULTS Among 1537 patients undergoing radical gastrectomy, 115 (7.5%) patients had severe postoperative complications, 98 (6.38%) of whom experienced severe local complications. The most common local complication was anastomotic leakage (31, 2.02%), followed by intra-abdominal abscess (30, 1.95%), pancreatic leakage (22, 1.43%), duodenal stump leakage (18, 1.17%), intra-abdominal bleeding (12, .78%), intraluminal bleeding (8, .52%), small bowel obstruction (5, .32%), and chyle leakage (3, .19%). Of these patients, 26 (1.69%) underwent reoperation, and 6 (.39%) died. In the univariate analysis of clinical factors related to reoperation, intra-abdominal bleeding and small bowel obstruction were risk factors for reoperation, and intra-abdominal bleeding (odds ratio [OR] = 9.57, confidence interval [CI] = 2.65-40.20, P < .001) and small bowel obstruction (OR = 19.14, CI = 2.60-390.13, P = .011) were independent risk factors associated with reoperation in the multivariate analysis. CONCLUSION Intra-abdominal bleeding and small bowel obstruction are independent risk factors for reoperation following radical gastrectomy. Patients with postoperative intra-abdominal bleeding and small bowel obstruction need to be warned about reoperation.
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Affiliation(s)
- Dong-Hwan Kim
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Ji-Ho Park
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Tae Han Kim
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Eun-Jung Jung
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Chi-Young Jeong
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Young-Tae Ju
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Ju-Yeon Kim
- Department Surgery, 90162Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, South Korea
| | - Tae-Jin Park
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Young-Joon Lee
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Sang-Ho Jeong
- Department Surgery, 553954Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, South Korea
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5
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Paredes-Torres OR, García-Ruiz L, Luna-Abanto J, Meza-García K, Chávez-Passiuri I, Berrospi-Espinoza F, Luque-Vásquez Vásquez C, Ruiz-Figueroa E, Payet-Meza E. Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021; 87:149-158. [PMID: 34362678 DOI: 10.1016/j.rgmxen.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND AIMS Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. MATERIALS AND METHODS A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. RESULTS The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥70 years (OR = 1.85, 95% CI: 1.25-2.76), ASA III-IV (OR = 2.06, 95% CI: 1.28-3.34), total gastrectomy (OR = 1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR = 5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age ≥70 years (OR = 4.92, 95% CI:1.78-13.65), lower BMI (OR = 0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR = 0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. CONCLUSIONS D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age ≥70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age ≥70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.
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Affiliation(s)
- O R Paredes-Torres
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru.
| | - L García-Ruiz
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - J Luna-Abanto
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - K Meza-García
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - I Chávez-Passiuri
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - F Berrospi-Espinoza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - C Luque-Vásquez Vásquez
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - E Ruiz-Figueroa
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
| | - E Payet-Meza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Peru
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Müller B, García C, Sola JA, Fernandez W, Werner P, Cerda M, Slater J, Benavides C, Arancibia J, Ascui R, Reyes F, Stevens MA, Miranda JP, Buchholtz M, Corvalan AH. Perioperative chemotherapy in locally advanced gastric cancer in Chile: from evidence to daily practice. Ecancermedicalscience 2021; 15:1244. [PMID: 34267800 PMCID: PMC8241457 DOI: 10.3332/ecancer.2021.1244] [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: 02/08/2021] [Indexed: 11/04/2022] Open
Abstract
Gastric cancer (GC) is a leading cause of cancer death in Chile. Although recommended in international guidelines since 2006, perioperative chemotherapy was not available to patients in the public health system in Chile until 2016. We conducted an observational study to assess the feasibility of this strategy in public hospitals in Chile (Observational Study of Perioperative Chemotherapy in Locally Advanced Gastric Cancer – PRECISO). Patients with locally advanced, operable GC were offered to receive preoperative chemotherapy with Epirubicin + Cisplatin + Capecitabine (ECX) for three cycles followed by curative surgery. Staging included abdominal CT scan and laparoscopy if peritoneal carcinomatosis was suspected. Postoperative ECX for three cycles was recommended. Between August 2010 and March 2013, 110 patients were screened and 61 enrolled. Median age was 62 years (23–76 years) and most patients had good performance status at baseline (Eastern Cooperative Oncology Group performance status score (ECOG) 0: 42, ECOG 1: 19). Tumour site was proximal in 32 (52%) and medial and distal in 29 (48%) patients. All but four patients (n = 57, 93%) completed three cycles of preoperative chemotherapy. Fifty-six patients were operated and 54 (89%) had a curative resection. Thirty-three patients (54%) had pT0-2, and 18 (30%) had pN0 tumours, with two patients achieving a complete response. As of 20 December 2020, 39 patients died, 32 due to GC, one within 30 days of surgery, two due to intestinal obstruction at 5 and 3 months after surgery and four due to other causes. Five-year survival rate was 38%. We conclude that perioperative chemotherapy is feasible in public hospitals in Chile and should be offered to patients with locally advanced GC.
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Affiliation(s)
- Bettina Müller
- Medical Oncology Department, Instituto Nacional del Cáncer, Profesor Zañartu 1010, 8380455 Santiago, Chile.,Chilean Cooperative Oncology Group (GOCCHI), José Manuel Infante 125, Oficina 11, 7500641 Santiago, Chile
| | - Carlos García
- Digestive Surgery Department, Hospital San Borja Arriarán, Santa Rosa 1234, 8360160 Santiago, Chile
| | - José A Sola
- Department for Medical Oncology, Clinica Alemana de Santiago, Vitacura 5951, 7650568 Santiago, Chile
| | - Wanda Fernandez
- Pathology Department, Hospital San Borja Arriarán, Santa Rosa 1234, 8360160 Santiago, Chile
| | - Patrick Werner
- MOLIT Institute Heilbronn, Im Zukunftspark 10, 74076 Heilbronn, Germany
| | - Mauricio Cerda
- Integrative Biology Program, Institute of Biomedical Sciences, Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Independencia 1027, 8380453 Santiago, Chile.,Biomedical Neuroscience Institute, Independencia 1027, 8380453 Santiago, Chile
| | - Jeannie Slater
- Pathology Department, Clinica Alemana de Santiago, Vitacura 5951, 7650568 Santiago, Chile
| | - Carlos Benavides
- Digestive Surgery Department, Hospital San Borja Arriarán, Santa Rosa 1234, 8360160 Santiago, Chile
| | - Jorge Arancibia
- Medical Oncology Department, Hospital Naval Almirante Nef, Valparaiso, Alessandri s/n, 2520000 Viña del Mar, Chile
| | - Rodrigo Ascui
- Medical Oncology Department, Hospital Regional de Concepción, San Martín 1436, 4070038 Concepcion, Chile
| | - Felipe Reyes
- Medical Oncology Department, Instituto Nacional del Cáncer, Profesor Zañartu 1010, 8380455 Santiago, Chile
| | - Mary Ann Stevens
- Medical Oncology Department, Hospital del Salvador, Salvador 364, 7500922 Santiago, Chile
| | - Juan Pablo Miranda
- Medical Oncology Department, Instituto Nacional del Cáncer, Profesor Zañartu 1010, 8380455 Santiago, Chile
| | - Martin Buchholtz
- Surgery Department, Instituto Nacional del Cáncer, Profesor Zañartu 1010, 8380455 Santiago, Chile
| | - Alejandro H Corvalan
- Chilean Cooperative Oncology Group (GOCCHI), José Manuel Infante 125, Oficina 11, 7500641 Santiago, Chile.,Hematology and Oncology Department, Advanced Center for Chronic Diseases (ACCDiS), Pontificia Universidad Católica de Chile, Portugal 61, 8330034 Santiago, Chile
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7
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Paredes-Torres OR, García-Ruiz L, Luna-Abanto J, Meza-García K, Chávez-Passiuri I, Berrospi-Espinoza F, Luque-Vásquez Vásquez C, Ruiz-Figueroa E, Payet-Meza E. Risk factors associated with postoperative morbidity and mortality in D2 radical gastrectomy for gastric cancer. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2021; 87:S0375-0906(21)00013-6. [PMID: 33752940 DOI: 10.1016/j.rgmx.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/30/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND AIMS Surgery is the main treatment for gastric cancer. D2 radical gastrectomy is associated with a variable postoperative morbidity and mortality rate worldwide. The aim of the present study was to identify the risk factors associated with the postoperative morbidity and mortality of D2 radical gastrectomy, with curative intent, for gastric cancer. MATERIALS AND METHODS A retrospective case series was conducted, in which the medical records were reviewed of patients with gastric cancer that underwent D2 radical gastrectomy, within the time frame of January 2014 and December 2018. Univariate and multivariate analyses were carried out to identify the risk factors related to postoperative morbidity and mortality within 90 days. RESULTS The percentages of postoperative morbidity and mortality in 691 patients were 23.3% and 3.3%, respectively. In the multivariate analysis, age ≥ 70 years (OR=1.85, 95% CI: 1.25-2.76), ASA III-IV (OR=2.06, 95% CI: 1.28-3.34), total gastrectomy (OR=1.96, 95% CI:1.19-3.23), and pancreatosplenectomy (OR=5.41, 95% CI: 1.42-20.61) were associated with greater postoperative morbidity, and age≥70 years (OR=4.92, 95% CI:1.78-13.65), lower BMI (OR=0.81, 95% CI: 0.71-0.92), and hypoalbuminemia (OR=0.91, 95% CI: 0.85-0.98) were associated with greater mortality in distal and total D2 radical gastrectomy. CONCLUSIONS D2 radical gastrectomy for gastric cancer was shown to be a safe treatment, with low postoperative morbidity and mortality rates. Age≥70 years, ASA III-IV, total gastrectomy, and pancreatosplenectomy were factors associated with a higher complication rate. Age≥70 years, lower BMI, and hypoalbuminemia were mortality predictors in distal and total radical gastrectomy.
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Affiliation(s)
- O R Paredes-Torres
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú.
| | - L García-Ruiz
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - J Luna-Abanto
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - K Meza-García
- Oncología Quirúrgica, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - I Chávez-Passiuri
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - F Berrospi-Espinoza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - C Luque-Vásquez Vásquez
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - E Ruiz-Figueroa
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
| | - E Payet-Meza
- Departamento de Cirugía Abdominal, Instituto Nacional de Enfermedades Neoplásicas INEN, Lima, Perú
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8
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Mori M, Shuto K, Hirano A, Kosugi C, Narushima K, Hosokawa I, Fujino M, Yamazaki M, Shimizu H, Koda K. A Novel Parameter Identified Using Indocyanine Green Fluorescence Angiography may Contribute to Predicting Anastomotic Leakage in Gastric Cancer Surgery. World J Surg 2021; 44:2699-2708. [PMID: 32227275 DOI: 10.1007/s00268-020-05488-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anastomotic leak is one of the most serious postoperative complications, and intraoperative adequate perfusion plays a key role in preventing its development in gastric cancer surgery. This study aimed to investigate the relationships between anastomotic leak and the parameters defined by an assessment of intraoperative anastomotic perfusion using a near-infrared indocyanine green (ICG) fluorescence system and to evaluate the usefulness of this ICG fluorescence assessment in gastric cancer surgery. METHODS We retrospectively reviewed data of 100 patients who underwent gastric cancer surgery. In a visual assessment based on fluorescence intensity, we classified ICG fluorescence image patterns as homogeneous, heterogeneous, or faint. In a chronological assessment, the first or second time point of ICG fluorescence appearance on one or the other side of the anastomosis was defined as FT or ST, respectively. The time difference in ICG fluorescence appearance between FT and ST was defined as TD. The relationships between anastomotic leak and the evaluated clinical factors, including the parameters identified by the ICG fluorescence assessment, were evaluated using univariate or multivariate analysis. RESULTS Although no signs of leak were found by surgeons' subjective judgments, four patients developed postoperative anastomotic leak of Clavien-Dindo grade III or IV. Multivariate analysis revealed that TD was an independent predictor of anastomotic leak (odds ratio 35.361, 95% confidence interval 1.489-839.923, p = 0.027). CONCLUSIONS A novel parameter identified using near-infrared ICG fluorescence assessment may be useful to predict anastomotic leak in gastric cancer surgery. TRIAL REGISTRATION UMIN Clinical Trials Registry: #UMIN000030747 ( https://www.umin.ac.jp/ctr/index.htm ).
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Affiliation(s)
- Mikito Mori
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan. .,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan.
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Atsushi Hirano
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Kazuo Narushima
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan
| | - Isamu Hosokawa
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Masafumi Fujino
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Masato Yamazaki
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Hiroaki Shimizu
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
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9
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Dias AR, Pereira MA, Ramos MFKP, Ribeiro U, Zilberstein B, Cecconello I. IMPACT OF AGING IN THE SURGICAL OUTCOMES OF GASTRIC CANCER PATIENTS. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:93-99. [PMID: 33909804 DOI: 10.1590/s0004-2803.202100000-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/27/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND As age advances, a higher burden of comorbidities and less functional reserve are expected, however, the impact of aging in the surgical outcomes of gastric cancer (GC) patients is unknown. OBJECTIVE The aim of this study is to evaluate surgical outcomes of GC patients according to their age group. METHODS Patients submitted to gastrectomy with curative intent due to gastric adenocarcinoma were divided in quartiles. Each group had 150 patients and age limits were: ≤54.8, 54.9-63.7, 63.8-72, >72. The outcomes assessed were: postoperative complications (POC), 90-day postoperative mortality, disease-free survival (DFS) and overall survival (OS). RESULTS Major surgical complications were 2.7% in the younger quartile vs 12% for the others (P=0.007). Major clinical complications raised according to the age quartile: 0.7% vs 4.7% vs 5.3% vs 7.3% (P<0.042). ASA score and age were independent risk factors for major POC. The 90-day mortality progressively increased according to the age quartile: 1.3% vs 6.0% vs 7.3% vs 14% (P<0.001). DFS was equivalent among quartile groups, while OS was significantly worse for those >72-year-old. D2 lymphadenectomy only improved OS in the three younger quartiles. Age >72 was an independent risk factor for worse OS (hazard ratio of 1.72). CONCLUSION Patients <55-year-old have less surgical complications. As age progresses, clinical complications and 90-day mortality gradually rise. OS is worse for those above age 72, and D2 lymphadenectomy should be individualized after this age.
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Affiliation(s)
- Andre Roncon Dias
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brasil
| | - Marina Alessandra Pereira
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brasil
| | | | - Ulysses Ribeiro
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brasil
| | - Bruno Zilberstein
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brasil
| | - Ivan Cecconello
- Instituto do Câncer, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. São Paulo, SP, Brasil
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10
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Incidence and Grading of Complications After Gastrectomy for Cancer Using the GASTRODATA Registry: A European Retrospective Observational Study. Ann Surg 2020; 272:807-813. [PMID: 32925254 DOI: 10.1097/sla.0000000000004341] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Utilizing a standardized dataset based on a newly developed list of 27 univocally defined complications, this study analyzed data to assess the incidence and grading of complications and evaluate outcomes associated with gastrectomy for cancer in Europe. SUMMARY BACKGROUND DATA The absence of a standardized system for recording gastrectomy-associated complications makes it difficult to compare results from different hospitals and countries. METHODS Using a secure online platform (www.gastrodata.org), referral centers for gastric cancer in 11 European countries belonging to the Gastrectomy Complications Consensus Group recorded clinical, oncological, and surgical data, and outcome measures at hospital discharge and at 30 and 90 days postoperatively. This retrospective observational study included all consecutive resections over a 2-year period. RESULTS A total of 1349 gastrectomies performed between January 2017 and December 2018 were entered into the database. Neoadjuvant chemotherapy was administered to 577 patients (42.8%). Total (46.1%) and subtotal (46.4%) gastrectomy were the predominant resections. D2 or D2+ lymphadenectomy was performed in almost 80% of operations. The overall complications' incidence was 29.8%; 402 patients developed 625 complications, with the most frequent being nonsurgical infections (23%), anastomotic leak (9.8%), other postoperative abnormal fluid from drainage and/or abdominal collections (9.3%), pleural effusion (8.3%), postoperative bleeding (5.6%), and other major complications requiring invasive treatment (5.6%). The median Clavien-Dindo score and Comprehensive Complications Index were IIIa and 26.2, respectively. In-hospital, 30-day, and 90-day mortality were 3.2%, 3.6%, and 4.5%, respectively. CONCLUSIONS The use of a standardized platform to collect European data on perioperative complications revealed that gastrectomy for gastric cancer is still associated with heavy morbidity and mortality. Actions are needed to limit the incidence of, and to effectively treat, the most frequent and most lethal complications.
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11
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Zhu C, Badach J, Lin A, Mathur N, McHugh S, Saracco B, Adams A, Gaughan J, Atabek U, Spitz FR, Hong YK. Omental patch versus gastric resection for perforated gastric ulcer: Systematic review and meta-analysis for an unresolved debate. Am J Surg 2020; 221:935-941. [PMID: 32943177 DOI: 10.1016/j.amjsurg.2020.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2020] [Accepted: 07/26/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Perforated gastric ulcers are surgical emergencies with paucity of data on the preferred treatment modality of resection versus omental patch. We aim to compare outcomes with ulcer repair and gastric resection surgeries in perforated gastric ulcers after systematic review of literature. METHODS A systematic literature search was performed for publications in PubMed Medline, Embase, and Cochrane Central Register of Controlled Trials. We included all studies which compared ulcer repair vesus gastric resection surgeries for perforated gastric ulcers. We excluded studies which did not separate outcomes gastric and duodenal ulcer perforations. RESULTS The search included nine single-institution retrospective reviews comparing ulcer repair (449 patients) versus gastric resection surgeries (212 patients). Meta-analysis was restricted to perforated gastric ulcers and excluded perforated duodenal ulcers. The majority of these studies did not control for baseline characteristics, and surgical strategies were often chosen in a non-randomized manner. All of the studies included were at high risk of bias. The overall odds ratio of mortality in ulcer repair surgery compared to gastric resection surgery was 1.79, with 95% CI 0.72 to 4.43 and p-value 0.209. CONCLUSION In this meta-analysis, there was no difference in mortality between the two surgical groups. The overall equivalence of clinical outcomes suggests that gastric resection is a potentially viable alternative to ulcer repair surgery and should not be considered a secondary strategy. We would recommend a multicenter randomized control trial to evaluate the surgical approach that yields superior outcomes. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.
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Affiliation(s)
- Clara Zhu
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Jeremy Badach
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Andrew Lin
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Natasha Mathur
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Sean McHugh
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Benjamin Saracco
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Amanda Adams
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - John Gaughan
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Umur Atabek
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Francis R Spitz
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States
| | - Young K Hong
- Department of General Surgery, Cooper University Hospital, Camden, NJ, United States.
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12
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Dias AR, Pereira MA, Ramos MFKP, Oliveira RJ, Ribeiro U, Zilberstein B, Cecconello I. Prediction scores for complication and recurrence after multivisceral resection in gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:1097-1102. [PMID: 31987704 DOI: 10.1016/j.ejso.2020.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/29/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multivisceral resection (MVR) is indicated in T4b gastric cancer (GC) when R0 can be achieved. Patient's selection for MVR is imperative, since it carries an increased risk for postoperative complications (POC) and disease recurrence. This study aims to elaborate prediction scores for POC and recurrence after MVR for cT4b GC. METHODS Patients who underwent MVR with curative intent due to cT4b gastric adenocarcinoma were selected from our prospective database. Scoring models were based on the variables identified as risk factors for the studied outcome. Through binary regression the model that best predicted the outcome was created. RESULTS From 237 MVRs, 58 fulfilled the inclusion criteria. Males were 70.7%, mean age was 61.8 years. A pT4b was confirmed in 34 patients, 29 had 2 or more adjacent organs removed. Major POC occurred in 25.9%, mortality was 8.6%. Overall survival (OS) and disease-free survival (DFS) were similar for pT4b and non-pT4b. DFS was worse for pN+ and when >2 adjacent organs were removed. Scoring models included 5 and 6 parameters for POC and recurrence, respectively, and their accuracy was 80.6% (95%CI = 0.69-0.92) and 78% (95%CI = 0.66-0.90). The POC and recurrence rates in low- and high-score groups were statistically different (p < 0.001 and p = 0.004, respectively). Patients with high-risk for POC had lower OS (p = 0.036) and DFS was worse in the high-recurrence risk group (p = 0.008). CONCLUSION The proposed scoring systems accurately predict POC and recurrence in GC patients undergoing MVR. These models are easy to use and can assist in the adoption of an individualized approach.
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Affiliation(s)
- Andre Roncon Dias
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil.
| | - Marina Alessandra Pereira
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | | | - Rodrigo Jose Oliveira
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Ulysses Ribeiro
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Bruno Zilberstein
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Ivan Cecconello
- Cancer institute, Hospital das Clinicas, University of São Paulo School of Medicine, Sao Paulo, Brazil
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13
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Norero E, Quezada JL, Cerda J, Ceroni M, Martinez C, Mejía R, Muñoz R, Araos F, González P, Díaz A. RISK FACTORS FOR SEVERE POSTOPERATIVE COMPLICATIONS AFTER GASTRECTOMY FOR GASTRIC AND ESOPHAGOGASTRIC JUNCTION CANCERS. ACTA ACUST UNITED AC 2019; 32:e1473. [PMID: 31859926 PMCID: PMC6918748 DOI: 10.1590/0102-672020190001e1473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. AIM To identify the predictors of severe postoperative morbidity. METHODS This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. RESULTS Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. CONCLUSION Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.
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Affiliation(s)
- Enrique Norero
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
| | - Jose Luis Quezada
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
| | - Jaime Cerda
- Epidemiology Department, Department of Public Health, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Chile
| | - Marco Ceroni
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
| | - Cristian Martinez
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
| | - Ricardo Mejía
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
| | - Rodrigo Muñoz
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
| | - Fernando Araos
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
| | - Paulina González
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
| | - Alfonso Díaz
- Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Digestive Surgery Department, Pontificia Universidad Catolica de Chile, Chile
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14
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Identification of c.1531C>T Pathogenic Variant in the CDH1 Gene as a Novel Germline Mutation of Hereditary Diffuse Gastric Cancer. Int J Mol Sci 2019; 20:ijms20204980. [PMID: 31600923 PMCID: PMC6829381 DOI: 10.3390/ijms20204980] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 12/24/2022] Open
Abstract
Germline pathogenic variants in the CDH1 gene are a well-established cause of hereditary diffuse gastric cancer (HDGC) syndrome. The aim of this study was to characterize CDH1 mutations associated with HDGC from Chile, a country with one of the highest incidence and mortality rates in the world for gastric cancer (GC). Here, we prospectively include probands with family history/early onset of diffuse-type of GC. The whole coding sequence of the CDH1 gene was sequenced from genomic DNA in all patients, and a multidisciplinary team managed each family member with a pathogenic sequence variant. Thirty-six cases were included (median age 44 years/male 50%). Twenty-seven (75%) patients had diffuse-type GC at ≤50 years of age and 19 (53%) had first or second-degree family members with a history of HDGC. Two cases (5.5%) carried a non-synonymous germline sequence variant in the CDH1 gene: (a) The c.88C>A missense variant was found in a family with three diffuse-type GC cases; and (b) c.1531C>T a nonsense pathogenic variant was identified in a 22-year-old proband with no previous family history of HDGC. Of note, six family members carry the same nonsense pathogenic variant. Prophylactic gastrectomy in the proband's sister revealed stage I signet-ring cell carcinoma. The finding of 1531C>T pathogenic variant in the CDH1 in proband with no previous family history of HDGC warrants further study to uncover familial clustering of disease in CDH1 negative patients. This finding may be particularly relevant in high incidence countries, such as the case in this report.
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15
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Zhang CD, Yamashita H, Seto Y. Gastric cancer surgery: historical background and perspective in Western countries versus Japan. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:493. [PMID: 31700929 DOI: 10.21037/atm.2019.08.48] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastrectomy plus D2 lymphadenectomy plays a decisive role in the management of resectable gastric cancer in Japan. Before recent advances in chemotherapy, Japanese surgeons considered that extensive surgery involving extended lymphadenectomy with combined resection of neighboring organ(s) was required to eliminate any possible lymphatic cancer spread and improve patient survival. This approach differs radically from that in Western countries, which aim to improve survival outcomes by multidisciplinary approaches including perioperative chemotherapy and/or radiotherapy with limited lymph node dissection. However, a randomized controlled trial conducted in Japan found that more extensive lymphadenectomy including the para-aortic lymph nodes provided no survival benefit over D2 lymphadenectomy. Splenic hilum dissection with splenectomy also failed to show superiority over the procedure without splenectomy in patients with proximal gastric cancer, except in cases with tumor invasion of the greater curvature. Furthermore, bursectomy recently demonstrated similar outcomes to omentectomy alone. Although "D2 lymphadenectomy" as carried out in Japan contributes to low local recurrence rates and good survival outcomes, the results of randomized controlled trials have led to a decreased extent of surgical resection, with no apparent adverse effects on survival outcome. Notably, gastrectomy with D2 dissection has tended to become acceptable for advanced gastric cancer in Western countries, based on the latest results of the Dutch D1D2 trial. Differences in surgical practices between the West and Japan have thus lessened and procedures are becoming more standardized. Japanese D2 lymphadenectomy for advanced gastric cancer is evolving toward more minimally invasive approaches, while consistently striving to achieve the optimal surgical extent, thereby promoting consensus with Western counterparts.
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Affiliation(s)
- Chun-Dong Zhang
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Norero E, Vargas C, Achurra P, Ceroni M, Mejia R, Martinez C, Muñoz R, Gonzalez P, Calvo A, Díaz A. SURVIVAL AND PERIOPERATIVE MORBIDITY OF TOTALLY LAPAROSCOPIC VERSUS OPEN GASTRECTOMY FOR EARLY GASTRIC CANCER: ANALYSIS FROM A SINGLE LATIN AMERICAN CENTRE. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2019; 32:e1413. [PMID: 30624522 PMCID: PMC6323630 DOI: 10.1590/0102-672020180001e1413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. AIM To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. METHODS This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. RESULTS Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. CONCLUSION The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.
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Affiliation(s)
- Enrique Norero
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Vargas
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Ceroni
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Mejia
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Martinez
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Muñoz
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Gonzalez
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso Calvo
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alfonso Díaz
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
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17
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Ramos MFKP, Pereira MA, Yagi OK, Dias AR, Charruf AZ, de Oliveira RJ, Zaidan EP, Zilberstein B, Ribeiro-Júnior U, Cecconello I. Surgical treatment of gastric cancer: a 10-year experience in a high-volume university hospital. Clinics (Sao Paulo) 2018; 73:e543s. [PMID: 30540120 PMCID: PMC6256993 DOI: 10.6061/clinics/2018/e543s] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 09/11/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Surgery remains the cornerstone treatment modality for gastric cancer, the fifth most common type of tumor in Brazil. The aim of this study was to analyze the surgical treatment outcomes of patients with gastric cancer who were referred to a high-volume university hospital. METHODS We reviewed all consecutive patients who underwent any surgical procedure due to gastric cancer from a prospectively collected database. Clinicopathological characteristics, surgical and survival outcomes were evaluated, with emphasis on patients treated with curative intent. RESULTS From 2008 to 2017, 934 patients with gastric tumors underwent surgical procedures in our center. Gastric adenocarcinoma accounted for the majority of cases. Of the 875 patients with gastric adenocarcinoma, resection with curative intent was performed in 63.5%, and palliative treatment was performed in 22.4%. The postoperative surgical mortality rate for resected cases was 5.3% and was related to D1 lymphadenectomy and the presence of comorbidities. Analysis of patients treated with curative intent showed that resection extent, pT category, pN category and final pTNM stage were related to disease-free survival (DFS) and overall survival (OS). The DFS rates for D1 and D2 lymphadenectomy were similar, but D2 lymphadenectomy significantly improved the OS rate. Additionally, clinical factors and the presence of comorbidities had influence on the OS. CONCLUSIONS TNM stage and the type of lymphadenectomy were independent factors related to prognosis. Early diagnosis should be sought to offer the optimal surgical approach in patients with less-advanced disease.
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Affiliation(s)
- Marcus Fernando Kodama Pertille Ramos
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Marina Alessandra Pereira
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Osmar Kenji Yagi
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Andre Roncon Dias
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Amir Zeide Charruf
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rodrigo Jose de Oliveira
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Evelise Pelegrinelli Zaidan
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Zilberstein
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ulysses Ribeiro-Júnior
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Ivan Cecconello
- Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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18
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Kim CH, Park SM, Kim JJ. The Impact of Preoperative Low Body Mass Index on Postoperative Complications and Long-term Survival Outcomes in Gastric Cancer Patients. J Gastric Cancer 2018; 18:274-286. [PMID: 30276004 PMCID: PMC6160530 DOI: 10.5230/jgc.2018.18.e30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/29/2018] [Accepted: 09/05/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the impact of preoperative low body mass index (BMI) on both the short- and long-term outcomes in patients with gastric cancer. MATERIALS AND METHODS A total of 510 patients with gastric cancer were divided into the following 3 groups: low BMI group (≤18.5 kg/m2, n=51), normal BMI group (18.6-24.9 kg/m2, n=308), and high BMI group (≥25.0 kg/m2, n=151). RESULTS There were significantly more stage III/IV patients in the low BMI group than in the other groups (P=0.001). Severe postoperative complications were more frequent (P=0.010) and the survival was worse (P<0.001) in the low BMI group. The subgroup analysis indicated that survival was worse in the low BMI group of the stage I/II subgroup (P=0.008). The severe postoperative complication rate was higher in the low BMI group of the stage III/IV subgroup (P=0.001), although the recurrence rate and survival did not differ in the stage III/IV subgroup among all the BMI groups. Low BMI was an independent poor prognostic factor in the stage I/II subgroup (disease-free survival: hazard ratio [HR], 13.521; 95% confidence interval [CI], 1.186-154.197; P=0.036 and overall survival: HR, 5.130; 95% CI, 1.644-16.010; P=0.005), whereas low BMI was an independent risk factor for severe postoperative complications in the stage III/IV subgroup (HR, 17.158; 95% CI, 1.383-212.940; P=0.027). CONCLUSIONS Preoperative low BMI in patients with gastric cancer adversely affects survival among those with stage I/II disease and increases the severe postoperative complication rate among those with stage III/IV disease.
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Affiliation(s)
- Chang Hyun Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seung-Man Park
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jin-Jo Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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19
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Norero E, Funke R, Garcia C, Fernandez JI, Lanzarini E, Rodriguez J, Ceroni M, Crovari F, Pinto G, Musleh M, Gonzalez P. National Trend in Laparoscopic Gastrectomy for Gastric Cancer: Analysis of the National Register in Chile. Dig Surg 2018; 35:461-468. [PMID: 29669338 DOI: 10.1159/000485197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The laparoscopic approach for the treatment of gastric cancer has many advantages. However, outside Asia there are few large case series. AIM To evaluate postoperative morbidity, long-term survival, changes in indication, and the results of laparoscopic gastrectomy. METHODS We included all patients treated with a laparoscopic gastrectomy from 2005 to 2014. We compared results across 2 time periods: 2005-2011 and 2012-2014. Median follow-up was 39 months. RESULTS Two hundred and eleven patients underwent a laparoscopic gastrectomy (median age 64 years, 55% male patients). In 135 (64%) patients, a total gastrectomy was performed. Postoperative morbidity occurred in 29%. A significant increase in the indication of laparoscopic surgery for stages II-III (32 vs. 45%; p = 0.04) and higher lymph node count (27 vs. 33; p = 0.002) were observed between the 2 periods. The 5-year overall survival was 72%. According to the stage, the 5-year overall survival was 85, 63, and 54% for stage I, II, and III respectively (p < 0.001). CONCLUSIONS There was an acceptable rate of postoperative complications and the long-term survival was in accordance with the disease stage. There was a higher indication of laparoscopic surgery in stages II-III disease, and higher lymph node count in the latter period of this study.
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Affiliation(s)
- Enrique Norero
- Digestive Surgery Department, Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Funke
- Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Garcia
- Hospital San Borja Arriaran, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Enrique Lanzarini
- Hospital Clínico Universidad de Chile, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Marco Ceroni
- Digestive Surgery Department, Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gerardo Pinto
- Hospital El Pino, Faculty of Medicine, Universidad Andres Bello, Santiago, Chile
| | - Maher Musleh
- Hospital Clínico Universidad de Chile, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paulina Gonzalez
- Digestive Surgery Department, Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
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