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Ma S, Fang W, Zhang L, Chen D, Tian H, Ma Y, Cai H. Experience sharing on perioperative clinical management of gastric cancer patients based on the "China Robotic Gastric Cancer Surgery Guidelines". Perioper Med (Lond) 2024; 13:84. [PMID: 39054562 PMCID: PMC11271040 DOI: 10.1186/s13741-024-00402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/20/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND With the popularization of robotic surgical systems in the field of surgery, robotic gastric cancer surgery has also been fully applied and promoted in China. The Chinese Guidelines for Robotic Gastric Cancer Surgery was published in the Chinese Journal of General Surgery in August 2021. METHODS We have made a detailed interpretation of the process of robotic gastric cancer surgery regarding the indications, contraindications, perioperative preparation, surgical steps, complication, and postoperative management based on the recommendations of China's Guidelines for Robotic Gastric Cancer Surgery and supplemented by other surgical guidelines, consensus, and single-center experience. RESULTS Twenty experiences of perioperative clinical management of robotic gastric cancer surgery were described in detail. CONCLUSION We hope to bring some clinical reference values to the front-line clinicians in treating robotic gastric cancer surgery. TRIAL REGISTRATION The guidelines were registered on the International Practice Guideline Registration Platform ( http://www.guidelines-registry.cn ) (registration number: IPGRP-2020CN199).
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Affiliation(s)
- Shixun Ma
- The First School of Clinical Medicine, Lanzhou University, 1st West Donggang R.D, Lanzhou, 730000, China
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Wei Fang
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Leisheng Zhang
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Dongdong Chen
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
- The Second School of Clinical Medicine, Lanzhou University, 82st Cuiyingmeng R.D, Lanzhou, 730030, China
| | - Hongwei Tian
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China
| | - Yuntao Ma
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China.
| | - Hui Cai
- The First School of Clinical Medicine, Lanzhou University, 1st West Donggang R.D, Lanzhou, 730000, China.
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor & Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, 204 West Donggang R.D., Lanzhou, 730000, China.
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Fabbi M, Bali CD, Lianos GD, Rausei S. Treatment of Gastric Cancer Means Surgery, but Not Surgery Alone. Cancers (Basel) 2024; 16:1601. [PMID: 38672682 PMCID: PMC11049502 DOI: 10.3390/cancers16081601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Despite numerous studies, gastric cancer (GC) still presents a high mortality rate in Eastern and Western countries, increasing attention for new therapeutic strategies [...].
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Affiliation(s)
- Manrica Fabbi
- Department of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21033 Varese, Italy;
| | - Christina D. Bali
- Department of Surgery, University Hospital of Ioannina, 45332 Ioannina, Greece; (C.D.B.); (G.D.L.)
| | - Georgios D. Lianos
- Department of Surgery, University Hospital of Ioannina, 45332 Ioannina, Greece; (C.D.B.); (G.D.L.)
| | - Stefano Rausei
- Department of General Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, 21033 Varese, Italy;
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Luo H, Liu S, Huang W, Lei Y, Xing Y, Wesemann L, Luo B, Li W, Hu J, Tian Y. A comparison of the postoperative outcomes between intraoperative leak testing and no intraoperative leak testing for gastric cancer surgery: a systematic review and meta-analysis. Surg Endosc 2024; 38:1709-1722. [PMID: 38413470 DOI: 10.1007/s00464-024-10715-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Postoperative anastomotic leakage (PAL) is a serious complication of gastric cancer surgery. Although perioperative management has made considerable progress, anastomotic leakage (AL) cannot always be avoided. The purpose of this study is to evaluate whether intraoperative leak testing (IOLT) can reduce the incidence of PAL and other postoperative outcomes in gastric cancer surgery. MATERIALS AND METHODS In this meta-analysis, we searched the PubMed, Embase, and Cochrane Library databases for clinical trials to assess the application of IOLT in gastric cancer surgery. All patients underwent laparoscopic radical gastrectomy for gastric cancer surgery. Studies comparing the postoperative outcomes of IOLT and no intraoperative leak testing (NIOLT) were included. Quality assessment, heterogeneity, risk of bias, and the level of evidence of the included studies were evaluated. PAL, anastomotic-related complications, 30-day mortality, and reoperation rates were compared between the IOLT and NIOLT group. RESULTS Our literature search returned 721 results, from which six trials (a total of 1,666 patients) were included in our meta-analysis. Statistical heterogeneity was low. The primary outcome was PAL. IOLT reduced the incidence of PAL [2.09% vs 6.68%; (RR = 0.31, 95% Cl 0.19-0.53, P < 0.0001]. Anastomotic-related complications, which included bleeding, leakage, and stricture, were significantly higher in the NIOLT group than in the IOLT group [3.24% VS 10.85%; RR = 0.30, 95% Cl 0.18-0.53, P < 0.0001]. Moreover, IOLT was associated with lower reoperation rates [0.94% vs 6.83%; RR = 0.18, 95% CI 0.07-0.43, P = 0.0002]. CONCLUSION Considering the observed lower incidence of postoperative anastomotic leakage (PAL), anastomotic-related complications, and reoperation rates, IOLT appears to be a promising option for gastric cancer surgery. It warrants further study before potential inclusion in future clinical guidelines.
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Affiliation(s)
- Heng Luo
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Shunying Liu
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
- Department of Dermatology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wentao Huang
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
- Department of Gastroenterology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Yu Lei
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Yan Xing
- Department of Science &Technology with Teaching, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, China
| | - Luke Wesemann
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Binyu Luo
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Wenjing Li
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, 48201, USA
| | - Yunhong Tian
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China.
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Egami Y, Sugimura K, Masuzawa T, Katsuyama S, Takeda Y, Murata K. Successful treatment of an anastomotic leakage after total gastrectomy using a fully covered self-expandable metal stent with an anchoring thread: A case report. Int J Surg Case Rep 2024; 115:109224. [PMID: 38181655 PMCID: PMC10809106 DOI: 10.1016/j.ijscr.2024.109224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/07/2024] Open
Abstract
INTORODUCTION AND IMPORTANCE The incidence of anastomotic leakage in the esophagojejunostomy after total gastrectomy is a serious complication of this procedure. Here, we report a case in which a fully covered stent was endoscopically placed into a fistula caused by anastomotic leakage after total gastrectomy. CASE PRESENTATION An 88-year-old man diagnosed with advanced gastric cancer had tumor invasion close to the esophagogastric junction. We performed a laparoscopic total gastrectomy and Roux-en-Y reconstruction. On postoperative day (POD) 3, the patient experienced septic shock due to anastomotic leakage and subsequent mediastinitis. Mediastinal irrigation and drainage under laparotomy were performed. Sepsis improved with drainage, but the fistula persisted due to anastomotic leakage. CLINICAL DISCUSSION Based on a diagnosis of refractory fistula, a fully covered self-expandable metal stent (HANAROSTENT® Esophagus) was inserted POD 21 using esophagoscopy. To prevent stent migration, a 3-0 silk thread was attached to the ostial side of the stent and fixed at the nose. The stent was endoscopically removed 36 days. Esophagoscopy after stent removal revealed that the fistula had resolved and that the anastomotic leakage had healed. The patient started oral intake and was discharged home. CONCLUSION This case demonstrates the potential for use of a fully covered self-expandable metal stent with an anchoring thread for anastomotic leakage after total gastrectomy for gastric cancer.
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Affiliation(s)
- Yosuke Egami
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki city, Hyogo 660-8511, Japan
| | - Keijiro Sugimura
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki city, Hyogo 660-8511, Japan.
| | - Toru Masuzawa
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki city, Hyogo 660-8511, Japan
| | - Shinnsuke Katsuyama
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki city, Hyogo 660-8511, Japan
| | - Yutaka Takeda
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki city, Hyogo 660-8511, Japan
| | - Kohei Murata
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki city, Hyogo 660-8511, Japan
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D'Souza J, McCombie A, Roberts R. The influence of short-term postoperative outcomes on overall survival after gastric cancer surgery. ANZ J Surg 2023; 93:2875-2884. [PMID: 37489633 DOI: 10.1111/ans.18613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Gastrectomy with lymphadenectomy in combination with perioperative chemotherapy is the cornerstone of modern curative treatment for gastric adenocarcinoma. The primary objective of this study was to assess the influence of textbook outcome, postoperative complications, and readmission on survival in patients who underwent gastric cancer surgery. METHODS Consecutive patients who underwent curative and prophylactic gastric resections from 2014 to 2022 at Christchurch Hospital were identified from the hospital database. Multivariable analyses were performed to assess risk factors for each postoperative outcome. A survival analysis was performed to evaluate the influence of these outcomes on overall survival. RESULTS Seventy-seven patients underwent a gastric resection during the study period. Thirteen were prophylactic resections for E-cadherin gene mutations and 64 were for malignancy. The overall postoperative complication rate was 34%, with an anastomotic leak rate of 8% (n = 6). The 30-day readmission rate, 30-day mortality rate and 90-day mortality rate were 17%, 1%, and 5% respectively. No sociodemographic differences were identified in each outcome. An increasing day-4 CRP trajectory was observed in patients with an anastomotic leak. Postoperative complications and nodal disease were independent prognostic factors for reduced survival. CONCLUSIONS Textbook outcome, postoperative complications, and readmission are validated quality performance indicators of gastric cancer surgery. Postoperative complications are associated with poor overall survival independent of severity or type. The underlying mechanisms of this influence remain elusive. The aggressive biology of gastric cancer, combined with the surgical morbidity and its negative influence on survival, highlights the importance of ongoing quality improvement.
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Affiliation(s)
- Joel D'Souza
- Department of General Surgery, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
| | - Andrew McCombie
- Department of General Surgery, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
| | - Ross Roberts
- Department of General Surgery, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
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Ding X, Zhang C, Li X, Liu T, Ma Y, Yin M, Li C, Zhou G, Wu G. The three-tube method via precise interventional placement for esophagojejunal anastomotic fistula after gastrectomy: a single-center experience. World J Surg Oncol 2023; 21:236. [PMID: 37528403 PMCID: PMC10391983 DOI: 10.1186/s12957-023-03105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/12/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Esophagojejunal anastomotic leakage is a serious complication after total gastrectomy. This study evaluated the safety and efficacy of transnasal placement of drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy for treatment of esophagojejunal anastomotic fistula after gastrectomy in gastric cancer patients. METHODS This is retrospective review of patients with esophagojejunal anastomotic fistula treated with transnasal placement of abscess drainage catheter, decompression tube, and jejunal nutrition tube under fluoroscopy. Fistula healing time, patient survival, and Eastern Cooperative Oncology Group (ECOG) performance status before and after treatment were evaluated. RESULTS Sixty-four patients were included in the study. Insertion of the transnasal abscess drainage catheter, decompression tube, and jejunal nutrition tube was successful on the first attempt in all patients, while 35 patients received transnasal abscess drainage, 13 received percutaneous abscess drainage, and 16 received transnasal drainage plus percutaneous abscess drainage. Immediately after placement of the tube, the mean volume of drainage was 180 mL (range, 10-850 mL); the amount steadily decreased from then on. The clinical success rate was 84.3% (54/64). Median time to fistula healing was 58 days (range, 7-357 days). CONCLUSIONS Transnasal insertion of transnasal abscess drainage catheter, jejunal decompression tube, and jejunal nutrition tube under fluoroscopy appears to be a simple, minimally invasive, effective, and safe method for treating esophagojejunal anastomotic fistula after gastrectomy.
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Affiliation(s)
- Xiaolong Ding
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chenchen Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiaobing Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Tao Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yaozhen Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Meipan Yin
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Chunxia Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Gang Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Gang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Aiolfi A, Sozzi A, Bonitta G, Lombardo F, Cavalli M, Campanelli G, Bonavina L, Bona D. Short-term outcomes of different esophagojejunal anastomotic techniques during laparoscopic total gastrectomy: a network meta-analysis. Surg Endosc 2023:10.1007/s00464-023-10231-6. [PMID: 37400689 DOI: 10.1007/s00464-023-10231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/17/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Different techniques have been described for esophagojejunostomy (EJ) during laparoscopic total gastrectomy (LTG) for gastric cancer. Linear stapled techniques include overlap (OL) and functional end-to-end anastomosis (FEEA) while single staple technique (SST), hemi-double staple technique (HDST), and OrVil® are circular stapled approaches. Nowadays, the choice among techniques for EJ depends on operating surgeon personal preference. PURPOSE To compare short-term outcomes of different EJ techniques during LTG. METHODS Systematic review and network meta-analysis. OL, FEEA, SST, HDST, and OrVil® were compared. Primary outcomes were anastomotic leak (AL) and stenosis (AS). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to measure relative inference. RESULTS Overall, 3177 patients (20 studies) were included. The technique for EJ was SST (n = 1026; 32.9%), OL (n = 826; 26.5%), FEEA (n = 752; 24.1%), OrVil® (n = 317; 10.1%), and HDST (n = 196; 6.4%). AL was comparable for OL vs. FEEA (RR = 0.82; 95% CrI 0.47-1.49), OL vs. SST (RR = 0.55; 95% CrI 0.27-1.21), OL vs. OrVil® (RR = 0.54; 95% CrI 0.32-1.22), and OL vs. HDST (RR = 0.65; 95% CrI 0.28-1.63). Similarly, AS was similar for OL vs. FEEA (RR = 0.46; 95% CrI 0.18-1.28), OL vs. SST (RR = 0.89; 95% CrI 0.39-2.15), OL vs. OrVil® (RR = 0.36; 95% CrI 0.14-1.02), and OL vs. HDST (RR = 0.61; 95% CrI 0.31-1.21). Anastomotic bleeding, time to soft diet resumption, pulmonary complications, hospital length of stay, and mortality were comparable while operative time was reduced for FEEA. CONCLUSIONS This network meta-analysis shows similar postoperative AL and AS risk when comparing OL, FEEA, SST, HDST, and OrVil® techniques. Similarly, no differences were found for anastomotic bleeding, operative time, soft diet resumption, pulmonary complications, hospital length of stay and 30-day mortality.
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Affiliation(s)
- Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy.
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Luigi Bonavina
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
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Aiolfi A, Bonitta G, Campanelli G, Bona D. Impact of postoperative NSAIDs administration on anastomotic leak after esophago-gastric surgery: systematic review and meta-analysis. Updates Surg 2023:10.1007/s13304-023-01515-6. [PMID: 37186272 DOI: 10.1007/s13304-023-01515-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
Anastomotic leak (AL) is a feared complication of esophago-gastric surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat postoperative pain. Previous analyses conveyed heterogeneous data for colorectal surgery with a tendency toward high risk for AL after NSAIDs administration. In the setting of upper gastrointestinal (GI) surgery data are even more puzzled. The purpose of the present study was to assess whether an association exists between postoperative NSAIDs administration and AL after esophago-gastric surgery. PubMed, MEDLINE, Scopus, and Web of Science were searched up to November 2022. The included studies evaluated outcomes for NSAIDs vs. no NSAIDs administration after esophago-gastric surgery. The primary outcome was anastomotic leak (AL). Risk ratio (RR) and 95% confidence intervals (95% CI) were used to assess pooled effect size and relative inference. Six studies (43,784 patients) were included. The patient age ranged from 31 to 84 years, 82.4% were males and preoperative BMI ranged from 15 to 31 kg/m2. Esophagectomy was performed in 95% of patients. NSAIDs were administered in 18,075 (41.3%) patients. The cumulative incidence of AL was similar for NSAIDs vs. no NSAIDs (13.6% vs. 13.4%). The risk for postoperative AL was similar for NSAIDs vs. no NSAIDs administration (RR 1.49; 95% CI 0.81-2.75; p = 0.19). The cumulative incidence of postoperative gastrointestinal bleeding (0.36% vs. 0.39%), acute kidney injury (0.62% vs. 0.71%), and in-hospital mortality (2.39% vs. 2.66%) were comparable. NSAIDs administration for postoperative analgesia seems not associated with an increased risk for AL after esophago-gastric surgery.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Via C. Belgioioso N.173, 20151, Milan, Italy.
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Via C. Belgioioso N.173, 20151, Milan, Italy
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Via C. Belgioioso N.173, 20151, Milan, Italy
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Salvador-Rosés H, Escartín A, Muriel P, Santamaría M, González M, Jara J, Vela F, Olsina JJ. Robotic versus open approach in total gastrectomy for gastric cancer: a comparative single-center study of perioperative outcomes. J Robot Surg 2023:10.1007/s11701-023-01591-1. [PMID: 37004708 DOI: 10.1007/s11701-023-01591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/26/2023] [Indexed: 04/04/2023]
Abstract
The robotic approach to gastric cancer has been gaining interest in recent years; however, its benefit over the open procedure in total gastrectomy with D2 lymphadenectomy is still controversial. The aims of the study were to compare postoperative morbidity and mortality, hospital stay, and anatomopathological findings between the robotic and open approaches to oncologic total gastrectomy. We analyzed a prospectively collected database, which included patients who underwent total gastrectomy with D2 lymphadenectomy in our center using a robotic or an open approach between 2014 and 2021. Comparative analysis of clinicopathological, intraoperative, postoperative and anatomopathological variables between the robot-assisted group and the open group was performed. Thirty patients underwent total gastrectomy with D2 lymphadenectomy by a robotic approach and 48 patients by an open procedure. Both groups were comparable. The robot-assisted group presented a lower rate of Clavien-Dindo complications ≥ stage II (20 vs. 48%, p = 0.048), a shorter hospital stay (7 days vs. 9 days, p = 0.003) and had a higher total number of lymph nodes resected (22 nodes vs. 15 nodes, p = 0.001) compared to the open approach. Operative time was longer in the robotic group (325 min vs. 195 min, p < 0.001) compared to the open group. The robotic approach is associated with a longer surgical time, a lower rate of Clavien-Dindo complications ≥ stage II and a shorter hospital stay, and more lymph nodes were resected compared to the open approach.
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Affiliation(s)
- Helena Salvador-Rosés
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain.
| | - Alfredo Escartín
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Pablo Muriel
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Maite Santamaría
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Marta González
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Jimy Jara
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Fulthon Vela
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
| | - Jorge-Juan Olsina
- General Surgery Department, IRBLleida-University Hospital Arnau de Vilanova, Avda Alcalde Rovira Roure 80, 25198, Lérida, Spain
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Marano L, Carbone L, Poto GE, Restaino V, Piccioni SA, Verre L, Roviello F, Marrelli D. Extended Lymphadenectomy for Gastric Cancer in the Neoadjuvant Era: Current Status, Clinical Implications and Contentious Issues. Curr Oncol 2023; 30:875-896. [PMID: 36661716 PMCID: PMC9858164 DOI: 10.3390/curroncol30010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Despite its decreasing incidence, gastric cancer remains an important global healthcare problem due to its overall high prevalence and high mortality rate. Since the MAGIC and FNLCC/FFCD trials, the neoadjuvant chemotherapy has been recommended throughout Europe in gastric cancer. Potential benefits of preoperative treatments include a higher rate of R0 resection achieved by downstaging the primary tumor, a likely effect on micrometastases and isolated tumor cells in the lymph nodes, and, as a result, improved cancer-related survival. Nevertheless, distortion of anatomical planes of dissection, interstitial fibrosis, and sclerotic tissue changes may increase surgical difficulty. The collection of at least twenty-five lymph nodes after neoadjuvant therapy would seem to ensure removal of undetectable node metastasis and reduce the likelihood of locoregional recurrence. It is not what you take but what you leave behind that defines survival. Therefore, para-aortic lymph node dissection is safe and effective after neoadjuvant chemotherapy, in both therapeutic and prophylactic settings. In this review, the efficacy of adequate lymph node dissection, also in a neoadjuvant setting, has been investigated in the key studies conducted to date on the topic.
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Affiliation(s)
| | - Ludovico Carbone
- Unit of Surgical Oncology, Department of Medicine Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
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11
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Bracale U, Peltrini R, De Luca M, Ilardi M, Di Nuzzo MM, Sartori A, Sodo M, Danzi M, Corcione F, De Werra C. Predictive Factors for Anastomotic Leakage after Laparoscopic and Open Total Gastrectomy: A Systematic Review. J Clin Med 2022; 11:jcm11175022. [PMID: 36078954 PMCID: PMC9457286 DOI: 10.3390/jcm11175022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this systematic review is to identify patient-related, perioperative and technical risk factors for esophago-jejunal anastomotic leakage (EJAL) in patients undergoing total gastrectomy for gastric cancer (GC). A comprehensive literature search of PubMed/MEDLINE, Embase and Scopus databases was performed. Studies providing factors predictive of EJAL by uni- and multivariate analysis or an estimate of association between EJAL and related risk factors were included. All studies were assessed for methodological quality, and a narrative synthesis of the results was performed. A total of 16 studies were included in the systematic review, with a total of 42,489 patients who underwent gastrectomy with esophago-jejunal anastomosis. Age, BMI, impaired respiratory function, prognostic nutritional index (PNI), alcohol consumption, chronic renal failure, diabetes and mixed-type histology were identified as patient-related risk factors for EJAL at multivariate analysis. Likewise, among operative factors, laparoscopic approach, anastomosis type, additional organ resection, blood loss, intraoperative time and surgeon experience were found to be predictive factors for the development of EJAL. In clinical setting, we are able to identify several risk factors for EJAL. This can improve the recognition of higher-risk patients and their outcomes.
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Affiliation(s)
- Umberto Bracale
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
| | - Roberto Peltrini
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7462734
| | - Marcello De Luca
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Mariangela Ilardi
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | | | - Alberto Sartori
- Department of Surgery, San Valentino Montebelluna Hospital, 31044 Treviso, Italy
| | - Maurizio Sodo
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Michele Danzi
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Francesco Corcione
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Carlo De Werra
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
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Deng C, Liu Y, Zhang ZY, Qi HD, Guo Z, Zhao X, Li XJ. How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks. World J Gastrointest Surg 2022; 14:315-328. [PMID: 35664361 PMCID: PMC9131837 DOI: 10.4240/wjgs.v14.i4.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/20/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intraoperative methylene blue testing (IMBT), air leak testing, or endoscopy is used to assess the anastomotic integrity of esophagojejunostomy during open total gastrectomy for gastric cancer. Totally laparoscopic radical gastrectomy has been widely used to treat gastric cancer in the last few decades. However, reports on testing anastomotic integrity in totally laparoscopic radical gastrectomy are limited.
AIM To explore the effects of IMBT on the incidence of postoperative anastomotic leaks (PALs) and identify the risk factors for PALs in totally laparoscopic radical gastrectomy.
METHODS From January 2017 to December 2019, patients who underwent totally laparoscopic radical gastrectomy at the Shaanxi Provincial People's Hospital were retrospectively analyzed. According to whether or not they experienced an IMBT, the patients were divided into an IMBT group and a control group. If the IMBT was positive, an intraoperative suture was required to reinforce the anastomosis. The difference in the incidence of PALs was compared, and the risk factors were investigated.
RESULTS This study consisted of 513 patients, 211 in the IMBT group and 302 in the control group. Positive IMBT was shown in seven patients (3.3%) in the IMBT group, and no PAL occurred in these patients after suture reinforcement. Multivariate analysis showed that risk factors for predicting positive IMBT were body mass index (BMI) > 25 kg/m2 (hazard ratio [HR] = 8.357, P = 0.009), operation time > 4 h (HR = 55.881, P = 0.002), and insufficient surgical experience (HR = 15.286, P = 0.010). Moreover, 15 patients (2.9%) developed PALs in 513 patients, and the rates of PALs were significantly lower in the IMBT group than in the control group [2 of 211 patients (0.9%) vs 13 of 302 patients (4.3%), P = 0.0026]. Further analysis demonstrated that preoperative complications (HR = 13.128, P = 0.017), totally laparoscopic total gastrectomy (HR = 9.075, P = 0.043), and neoadjuvant chemotherapy (HR = 7.150, P = 0.008) were independent risk factors for PALs.
CONCLUSION IMBT is an effective method to evaluate the integrity of anastomosis during totally laparoscopic radical gastrectomy, thus preventing technical defect-related anastomotic leaks. Preoperative complications, totally laparoscopic total gastrectomy, and neoadjuvant chemotherapy are independent risk factors for PALs.
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Affiliation(s)
- Chun Deng
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Yang Liu
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Zhen-Yu Zhang
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Heng-Duo Qi
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Zhi Guo
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Xu Zhao
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
| | - Xiao-Jun Li
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China
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Carboni F, Valle M. Letter to Editor of Annals of Surgical Oncology Concerning "Early Diagnosis of Anastomotic Leakage after Gastric Cancer Surgery via Analysis of Inflammatory Factors in Abdominal Drainage". Ann Surg Oncol 2022; 29:5107-5108. [PMID: 35296976 DOI: 10.1245/s10434-022-11612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Fabio Carboni
- IRCCS, Regina Elena National Cancer Institute, Peritoneal Neoplasms Unit, Rome, Italy.
| | - Mario Valle
- IRCCS, Regina Elena National Cancer Institute, Peritoneal Neoplasms Unit, Rome, Italy
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Christodoulidis G, Samara AA, Floros T, Karakantas KS, Zotos PA, Koutras A, Tepetes K. The Contribution of a Collagen Patch Coated With Fibrin Glue in Sealing Upper Gastrointestinal Defects: An Experimental Study. In Vivo 2021; 35:2697-2702. [PMID: 34410958 DOI: 10.21873/invivo.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to evaluate the safety and efficacy of sealing primary upper gastrointestinal (GI) perforations with a collagen patch coated with fibrin glue (Tachosil®). MATERIALS AND METHODS Thirty New Zealand rabbits were used in this study. An iatrogenic gastric perforation was created, and primary repair was performed on the control group. Tachosil®, without suturing the deficit, was used in the intervention group. RESULTS Leakage was observed in 3 (20%) and 2 rabbits (13.3%) in the control and intervention group, respectively; however, the difference was not statistically significant (p=0.62). Moreover, adhesions formed in 10/15 and all rabbits in the intervention and control group, respectively (p=0.014); however, based on the Zuhlke adhesion's classification, there was no statistically significant difference between the two groups. CONCLUSION A collagen patch coated with fibrin glue is not a replacement but can be considered a safe option for the reinforcement of suturing, preventing leakages in the upper GI tract.
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Affiliation(s)
| | - Athina A Samara
- Laboratory of Experimental Surgery, University of Thessaly, Larissa, Greece;
| | - Theodoros Floros
- Laboratory of Experimental Surgery, University of Thessaly, Larissa, Greece
| | | | | | - Antonios Koutras
- 1 Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Carboni F, Valle M. Letter to Roh CK et al. 'Incidence and treatment outcomes of leakage after gastrectomy for gastric cancer: Experience of 14,075 patients from a large volume centre'. Eur J Surg Oncol 2021; 47:2468-2469. [PMID: 34112561 DOI: 10.1016/j.ejso.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Fabio Carboni
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy.
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
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Abstract
Surgery represents the only method for potentially curative intent for gastric cancer (GC) [...].
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