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Marano L, Verre L, Carbone L, Poto GE, Fusario D, Venezia DF, Calomino N, Kaźmierczak-Siedlecka K, Polom K, Marrelli D, Roviello F, Kok JHH, Vashist Y. Current Trends in Volume and Surgical Outcomes in Gastric Cancer. J Clin Med 2023; 12:jcm12072708. [PMID: 37048791 PMCID: PMC10094776 DOI: 10.3390/jcm12072708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Gastric cancer is ranked as the fifth most frequently diagnosed type of cancer. Complete resection with adequate lymphadenectomy represents the goal of treatment with curative intent. Quality assurance is a crucial factor in the evaluation of oncological surgical care, and centralization of healthcare in referral hospitals has been proposed in several countries. However, an international agreement about the setting of “high-volume hospitals” as well as “minimum volume standards” has not yet been clearly established. Despite the clear postoperative mortality benefits that have been described for gastric cancer surgery conducted by high-volume surgeons in high-volume hospitals, many authors have highlighted the limitations of a non-composite variable to define the ideal postoperative period. The textbook outcome represents a multidimensional measure assessing the quality of care for cancer patients. Transparent and easily available hospital data will increase patients’ awareness, providing suitable elements for a more informed hospital choice.
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Affiliation(s)
- Luigi Marano
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Luigi Verre
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Ludovico Carbone
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Gianmario Edoardo Poto
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Daniele Fusario
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | | | - Natale Calomino
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Karolina Kaźmierczak-Siedlecka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdansk, 80-308 Gdańsk, Poland
| | - Karol Polom
- Department of Surgical Oncology, Medical University of Gdansk, 80-308 Gdańsk, Poland
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Johnn Henry Herrera Kok
- Department of General and Digestive Surgery, Complejo Asistencial Universitario de León, 24071 León, Spain
| | - Yogesh Vashist
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
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Abstract
Surgery is an essential component of curative-intent treatment strategies for gastric cancer. However, the care of each patient with gastric cancer must be individualized based on patient and tumor characteristics. It is important that all physicians who will be caring for patient with gastric cancer understand the current best practices of surgical management to provide patients with the highest quality of care. This article aims to provide this information while acknowledging areas of surgical management that are still controversial.
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Affiliation(s)
- Ian Solsky
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Block Building #112, New York, NY 10461, USA
| | - Haejin In
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue Block Building #112, New York, NY 10461, USA; Department of Surgery, Albert Einstein College of Medicine, New York, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, NY, USA.
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Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Oliveira AF, Lopes Filho GDJ. Health-related quality of life after gastric cancer treatment in Brazil: Narrative review and reflections. World J Clin Cases 2021; 9:4123-4132. [PMID: 34141775 PMCID: PMC8173417 DOI: 10.12998/wjcc.v9.i17.4123] [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: 01/11/2021] [Revised: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
In Brazil, gastric cancer is the third most common type of cancer among men and fifth among women, with an estimated 13360 new cases among men and 7870 among women each year during the 2020-2022 period. This study presents reflections and attempts to add knowledge to the theme of quality of life (QoL) in patients with gastric adenocarcinoma and describes some of its characteristics in three regions of Brazil, with an evaluation of the disease’s impacts in various dimensions of life, as reported by the patients themselves. We performed a narrative review of the literature and a data analysis of studies on QoL in Brazilian patients treated for gastric adenocarcinoma from three different cities in three geographic regions: Brasília (the midwest), Jaú (the southeast), and Macapá (the north).
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Affiliation(s)
- Rodrigo Nascimento Pinheiro
- Surgical Oncology Service, Surgical Oncology Residency and Academic League of Oncology, Federal District Base Hospital, Brasília 70330-150, Distrito Federal, Brazil
| | - Samantha Mucci
- Department of Psychiatry, Federal University of São Paulo, Paulista School of Medicine (UNIFESP-EPM), São Paulo 04024-002, São Paulo, Brazil
| | - Renato Morato Zanatto
- Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú 17210-070, São Paulo, Brazil
| | | | | | - Gaspar de Jesus Lopes Filho
- Postgraduate Program in Interdisciplinary Surgical Science, Federal University of São Paulo, Paulista School of Medicine (UNIFESP-EPM), São Paulo 04024-002, São Paulo, Brazil
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Brind'Amour A, Gagné JP, Hogue JC, Poirier É. Impact of the introduction of formal D2 lymphadenectomy for gastric cancer in a Western setting. Can J Surg 2021; 64:E119-E126. [PMID: 33651574 PMCID: PMC8064251 DOI: 10.1503/cjs.019919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Two members from an academic tertiary hospital went to the National Cancer Institute in Tokyo, Japan, to learn how to perform an adequate D2 lymphadenectomy and to then introduce this technique in the surgical care of patients undergoing surgery for gastric cancer at a Western hospital. We aimed to compare the perioperative outcomes and long-term survival of Western patients who underwent gastric resection, performed by these 2 surgeons, before and after the surgeons’ short-course technical training in Japan. Methods We conducted a retrospective comparative study of all patients (n = 27 before training and n = 79 after training) who underwent gastric resection for cancer by the same 2 surgeons between September 2007 and December 2017 at the Centre Hospitalier Universitaire de Québec — Université Laval (Québec, Canada). We collected data on patient demographic, clinical, surgical, pathological and treatment characteristics, as well as long-term survival and complications. Results In the post-training group, the number of sampled lymph nodes was higher (median 33 v. 14, p < 0.0001), but this increase did not result in a higher number of histologically positive lymph nodes (p = 0.35). The rate of complications was lower in the post-training group (15.2% v. 48.2%, p = 0.002). The hospital stay was shorter in the post-training group (11 [standard deviation (SD) 7] v. 23 [SD 45] d, p = 0.03). The median survival was higher in the post-training group (47 v. 29 mo, p = 0.03). Conclusion These results suggest that a short-course technical training in D2 lymphadenectomy, completed in Japan, improved lymph node sampling, decreased postoperative complications and improved survival of patients undergoing surgery for gastric cancer in a Western setting.
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Affiliation(s)
- Alexandre Brind'Amour
- From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier)
| | - Jean-Pierre Gagné
- From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier)
| | - Jean-Charles Hogue
- From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier)
| | - Éric Poirier
- From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier)
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Navidi M, Madhavan A, Griffin SM, Prasad P, Immanuel A, Hayes N, Phillips AW. Trainee performance in radical gastrectomy and its effect on outcomes. BJS Open 2019; 4:86-90. [PMID: 32011816 PMCID: PMC6996638 DOI: 10.1002/bjs5.50219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background This study aimed to determine whether trainee involvement in D2 gastrectomies was associated with adverse outcomes. Methods Data from a prospectively created database of consecutive patients undergoing open D2 total (TG) or subtotal (STG) gastrectomy with curative intent between January 2009 and January 2014 were reviewed. Short‐ and long‐term clinical outcomes were compared in patients operated on by consultants and those treated by trainees under consultant supervision. Results A total of 272 D2 open gastrectomies were performed, 123 (45·2 per cent) by trainees. There was no significant difference between consultants and trainees in median duration of surgery (TG: 240 (range 102–505) versus 240 (170–375) min respectively, P = 0·452; STG: 225 (150–580) versus 212 (125–380) min, P = 0·192), number of resected nodes (TG: 30 (13–101) versus 30 (11–102), P = 0·681; STG: 26 (5–103) versus 25 (1–63), P = 0·171), length of hospital stay (TG: 15 (7–78) versus 15 (8–65) days, P = 0·981; STG: 10 (6–197) versus 14 (7–85) days, P = 0·242), overall morbidity (TG: 44 versus 49 per cent, P = 0·314; STG: 34 versus 25 per cent, P = 0·113) or mortality (TG: 4 versus 2 per cent; P = 0·293). No difference in predicted 5‐year overall survival was noted between the two cohorts (TG: 68 per cent for consultants versus 77 per cent for trainees, P = 0·254; STG: 70 versus 75 per cent respectively, P = 0·512). The trainee cohort had lower median blood loss for both TG (360 (range 90–1200) ml versus 600 (70–2350) ml for consultants; P = 0·042) and STG (235 (50–1000) versus 360 (50–3000) ml respectively; P = 0·053). Conclusion Clinical outcomes were not compromised by supervised trainee involvement in D2 open gastrectomy.
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Affiliation(s)
- M Navidi
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - A Madhavan
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - S M Griffin
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - P Prasad
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - A Immanuel
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - N Hayes
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - A W Phillips
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
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Pinheiro RN, Mucci S, Zanatto RM, Picanço Junior OM, Bottino AAG, Fontoura RP, Lopes Filho GDJ. Quality of life as a fundamental outcome after curative intent gastrectomy for adenocarcinoma: lessons learned from patients. J Gastrointest Oncol 2019; 10:989-998. [PMID: 31602337 DOI: 10.21037/jgo.2019.06.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Gastric cancer has an important epidemiologic impact, and the main curative therapeutic modality for gastric cancer is surgical resection. However, even curative intent therapy can have negative effects on the quality of life (QoL) of these patients, which is undesirable; thus, it is difficult to balance the standardized treatment reported in the literature and treatment response to achieve full patient satisfaction. The purpose of our study was to evaluate the QoL and identify the association of scores on the Functional Assessment of Cancer Therapy-Gastric (FACT-Ga) and Short Form 36 Health Survey version 2 (SF36v2) questionnaires with sociodemographic, clinical and anatomopathological aspects of gastric adenocarcinoma patients undergoing curative surgery. Methods This was a cross-sectional study involving 104 patients from three regions of Brazil. Inferential analyses were used to compare (multiple regression and Mann-Whitney or Kruskal-Wallis tests) the relationships between these scores and variables (Spearman's coefficient). Results In the multiple regression analysis, we found correlations between Helicobacter pylori status and physical well-being (PWB) (P=0.026), between gender and emotional well-being (EWB) (P=0.008), between Lauren's histology and physical functioning (P=0.009), as well as the Short Form 36 Health Survey version 2 (SF-36v2) role-physical (P=0.027), between the tumor site and EWB (P=0.038), between the SF-36v2 mental health and N (the lower the staging, the better the score, P=0.006) and between the SF-36v2 mental health and lymph nodes removed (P=0.029). According to the Mann-Whitney or Kruskal-Wallis test, women had worse FACT-Ga total (P=0.049), PWB (P=0.005), EWB (P=0.007), gastric cancer subscale (GaCS, P=0.011), trial outcome index (TOI, P=0.030) and mental health scores than men (P=0.011). Patients with distal tumors had better scores (FACT-Ga, P=0.018; GaCS, P=0.014; TOI, P=0.020) than patients with proximal tumors. Patients with tumors located in the cardia had better physical functioning than those with proximal tumors (P=0.042). Patients who underwent partial gastrectomy had better FACT-Ga total scores (P=0.011), PWB (P=0.033), GaCS scores (P=0.006) and TOI scores (P=0.008) than those who underwent total gastrectomy. Patients who did not receive adjuvant therapy had worse bodily pain as reported on the SF-36v2 than those who received therapy (P=0.048). According to Spearman's coefficient, a higher lymph node stage corresponded to worse FACT-Ga total (s=-0.200, P=0.034), GaCS (s=-0.206, P=0.037), TOI (s=-0.216; P=0.028) and vitality (s=-0.215, P=0.029) scores. A longer time after treatment corresponded to a better SF-36v2 role-physical domain score (s=0.223; P=0.023). Conclusions The type of treatment instituted, postoperative time and sociodemographic and anatomopathological factors influence the QoL.
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Affiliation(s)
- Rodrigo Nascimento Pinheiro
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Federal District Surgical Oncology Unity, Base Hospital Institute, Brasília, Brazil.,Academic League of Oncology, Base Hospital Institute, Brasília, Brazil
| | - Samantha Mucci
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Psychiatry Department, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Renato Morato Zanatto
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,Amaral Carvalho Cancer Hospital, Jaú, São Paulo, Brazil
| | - Olavo Magalhães Picanço Junior
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.,High Complexity Unity in Oncology, Alberto Lima Hospital, Federal University of Amapá, Macapá, Brazil
| | | | | | - Gaspar de Jesus Lopes Filho
- Postgraduate Program in Interdisciplinary Surgical Science, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
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Outcomes of the Learning Curve in Our First 100 Consecutive Laparoscopic Gastrectomies. Surg Laparosc Endosc Percutan Tech 2019; 29:126-132. [DOI: 10.1097/sle.0000000000000622] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Bencivenga M, Verlato G, Mengardo V, Weindelmayer J, Allum WH. Do all the European surgeons perform the same D2? The need of D2 audit in Europe. Updates Surg 2018; 70:189-195. [PMID: 29869322 DOI: 10.1007/s13304-018-0542-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/13/2018] [Indexed: 12/26/2022]
Abstract
Although D2 lymphadenectomy is the standard of care for radical intent surgical treatment of gastric cancer, the real compliance with D2 dissection in Europe is still unknown. The aim of the present study is to analyze the variation in lymph-node harvesting reported after D2 dissection in European series and to present a European project aiming at evaluating the real compliance with D2 lymphadenectomy. A PubMed search for papers using the key words "D2 lymphadenectomy" and "gastric cancer" from 2008 to 2017 was undertaken. Only studies by European authors in English language reporting the number of retrieved lymph nodes after D2 lymphadenectomy were included. The results of literature review were descriptively reported. The literature survey yielded 16 studies: 2 RCTs, 3 observational multicentre studies, and 11 observational monocentric studies. A large variability was found in the number of retrieved nodes, which, overall, was the lowest in the surgical series from Eastern Europe (16.6 and 19.9 in the Lithuanian and Hungarian series, respectively) and the highest in an Italian RCT. The within-study variability was also quite high, especially in multicentre RCTs and observational studies. Sample size tended to have a larger effect on the variability of lymph nodes retrieved than on its actual value. However, in both cases, the relation was not significant, due to the low number of studies considered. There is a large variability in the number of retrieved nodes after D2 dissection in European series. This reflects, at least partly, different approaches to D2 lymphadenectomy by European surgeons and may be responsible of the different outcomes observed in patients with gastric cancer across Europe. Therefore, there is the need to standardize the practice of D2 gastrectomy in Europe and to define possible variations of D2 procedures according to tumour's characteristics.
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Affiliation(s)
- Maria Bencivenga
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Valentina Mengardo
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Jacopo Weindelmayer
- General and Upper GI Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - William H Allum
- Department of Upper Gastrointestinal Surgery, Royal Marsden Hospital, London, UK
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Yang K, Hu JK. Gastric cancer treatment: similarity and difference between China and Korea. Transl Gastroenterol Hepatol 2017; 2:36. [PMID: 28529990 DOI: 10.21037/tgh.2017.04.02] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/28/2017] [Indexed: 02/05/2023] Open
Abstract
Chinese populations have many demographic similarities to Korean populations. However, the long-term survival rates of gastric cancer patients in China are still not satisfactory when compared with Korea, especially for the advanced cases. In this article, we discuss about the similarity and difference of gastric cancer treatment in terms of screening, surgical approach, stomach resection, digestive tract reconstruction, lymphadenectomy, harvested lymph nodes, operative morbidity and mortality, postoperative chemotherapy as well as follow-up between China and Korea. Given that a variety of factors ranging from tumor characteristics to different treatment strategies are seen between the two countries, the reasons accounting for the differences in survival should be focused and the corresponding strategy should be considered and finally promote to improve the prognosis of gastric cancer.
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Affiliation(s)
- Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.,Institute of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, China
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Role of Hydro-Dissection Facilitated Monopolar Cauterization Dissection Technique on Separation of the Greater Omentum From the Superior Layer of the Transverse Mesocolon During D2 Radical Gastrectomy. Int Surg 2017. [DOI: 10.9738/intsurg-d-14-00288.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Adequate separation of the omentum from the transverse colon mesentery, during D2 radical gastrectomy, is usually difficult and often time-consuming due to anatomic variations. The aim of this prospective study was to compare the electrocautery dissection technique with hydrodissection-facilitated electrocauterization for the separation of the greater omentum from the superior layer of the transverse mesocolon in gastric cancer patients undergoing D2 radical gastrectomy. The time taken to separate the greater omentum from the superior layer of the transverse mesocolon, and the number and extension of iatrogenically-created mesocolonic defects were assessed. Forty patients were prospectively randomized into 2 groups. Separation of the greater omentum from the superior layer of the transverse mesocolon was achieved in Group I (n = 20) patients by the monopolar cauterization dissection technique whereas in Group II (n = 20) patients by the hydrodissection-facilitated monopolar cauterization. No significant difference was found between the 2 groups in terms of age, gender, body mass index (BMI), type of surgical technique, or the number of resected lymph nodes (P > 0.05). The difference between the 2 dissection techniques was not statistically significant when compared according to the number of iatrogenic mesocolonic defects, extension of the defects, or the time period required for the separation of greater omentum from the superior layer of the transverse mesocolon (P > 0.05). The overall survival was not significantly different between the 2 dissection techniques (P > 0.05). Hydrodissection is a safe technique that can be applied as an adjunct to electrocauterization to facilitate the dissection in the correct plane during resection of the mesogastrium.
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Zhao LY, Zhang WH, Sun Y, Chen XZ, Yang K, Liu K, Chen XL, Wang YG, Song XH, Xue L, Zhou ZG, Hu JK. Learning curve for gastric cancer patients with laparoscopy-assisted distal gastrectomy: 6-year experience from a single institution in western China. Medicine (Baltimore) 2016; 95:e4875. [PMID: 27631257 PMCID: PMC5402600 DOI: 10.1097/md.0000000000004875] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Laparoscopy-assisted distal gastrectomy (LADG) is widely used for gastric cancer (GC) patients nowadays. This study aimed to investigate the time trend of outcomes so as to describe the learning curve for GC patients with LADG at a single medical institution in western China over a 6-year period.A total of 246 consecutive GC patients with LADG were divided into 5 groups (group A: 46 patients from 2006 to 2007; group B: 47 patients in 2008; group C: 49 patients in 2009; group D: 73 patients in 2010; and group E: 31 patients in 2011). All surgeries were conducted by the same surgeon. Comparative analyses were successively performed by Mann-Whitney U test or Student t test among the 5 different groups for the clinical data, including clinicopathologic characteristics, surgical parameters, postoperative course, and survival outcomes, through which the learning curve was described.There were no differences in the baseline information among the 5 groups (P > 0.05), and the proportion of advanced GC patients with LADG slightly increased from 58.7% to 77.4% during the 6 years. Besides, the proportion of D2/D2+ lymphadenectomy and the number of retrieved lymph nodes gradually grew from 60.9% to 80.6% and from 20.0 to 28.8, respectively. In addition, the operation time decreased from 299.2 to 267.8 minutes, while the estimated blood loss dropped from 175.2 to 146.8 mL. Furthermore, some surgical parameters (surgical duration and blood loss) and postoperative course (such as postoperative complications, the time to ambulation, to first flatus, and to first liquid intake as well as the length of hospital stay) were all observed to be significantly different between group A and other groups (P < 0.05), illustrating a similar downward trend and remaining stable to form a plateau after 46 cases in group A. However, no difference on overall survival was found among these 5 groups, and multivariate analysis indicated that factors, such as age, tumor differentiation, tumor size, and T stage as well as N stage, were independent prognostic factors for patients with LADG.Improvement on surgical parameters and postoperative course can be seen over the past years, and the cutoff value of the learning curve of LADG for surgeons with rich experience in open operation might be 46 cases.
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Affiliation(s)
- Lin-Yong Zhao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Yan Sun
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Xin-Zu Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Kai Liu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Xiao-Long Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Yi-Gao Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Xiao-Hai Song
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Lian Xue
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
| | - Zong-Guang Zhou
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy, West China Hospital
- Correspondence: Prof Jian-Kun Hu, Department of Gastrointestinal Surgery, and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu 610041, Sichuan Province, China (e-mail: )
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Proximal segmentation of the dorsal mesogastrium reveals new anatomical implications for laparoscopic surgery. Sci Rep 2015; 5:16287. [PMID: 26542081 PMCID: PMC4635343 DOI: 10.1038/srep16287] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/07/2015] [Indexed: 12/18/2022] Open
Abstract
Generally, the gold standard of radical surgery for gastrointestinal (GI) tumors is en bloc resection of primary lesions and their related tissues. For gastric cancer, the ideal surgical treatment should be D2 radical gastrectomy plus complete mesogastrium excision. Complete mesogastrium excision is rarely done or mentioned since little is known about the mesogastrium and its presence is still with controversy. Topographically, the “mesogastrium” refers to a peri-gastric structure composed of “fascia propria”, enveloping lymph nodes, blood vessels and adipose tissues, which by connecting to the stomach, suspends from the posterior abdominal wall. In this study, by employing video laparoscopy, a number of proximal segments of dorsal mesogastrium were found being extensively scattered around the pancreas. The structure of the mesogastrium was further identified intraoperatively and then confirmed both grossly and histologically after the operation. Our results demonstrated the existence of mesogastrium (gastric mesentery) and its architecture. We suggest for the first time a “Table model” to describe the relationship between the stomach and gastric mesenteries enveloped by fascia propria, which might provide an improvement in the surgical methods for excision of gastric cancer.
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Zhang WH, Chen XZ, Liu K, Chen XL, Yang K, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. Outcomes of surgical treatment for gastric cancer patients: 11-year experience of a Chinese high-volume hospital. Med Oncol 2014; 31:150. [PMID: 25112468 DOI: 10.1007/s12032-014-0150-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/27/2014] [Indexed: 02/05/2023]
Abstract
Gastric cancer is one of the leading causes of cancer-related deaths worldwide. We report our experience with surgery-related parameters and survival outcomes at a single Chinese center. This study analyzed patients following gastric resection between 2000 and 2010, and overall survival was the primary end point. In this study, 1,936 patients who underwent gastrectomy were collected from 2000 to 2010. Curative gastrectomy (R0 resection) was performed in 86.6 % of patients. D1/D1+ lymphadenectomy was frequently performed from 2000 to 2005, and the proportion of D2/D2+ lymphadenectomy increased after 2006. The number of harvested lymph nodes was 10.1 ± 6.0 in 2000 and increased to 28.0 ± 10.5 in 2010. Serosa-invasive lesions (pT4) accounted for 67.9 % of all cases. The 1-year overall survival (OS), 2-year OS, and 3-year OS rates were 89, 74, and 63 %, respectively. Multivariate analysis identified R status, tumor location, macroscopic type, and tumor stage (pT stage and pN stage) as the independent risk factors for overall survival. The prognosis of gastric cancer patients in China remains dismal. To improve the survival outcomes, further efforts toward early detection and multi-disciplinary treatment are needed.
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Affiliation(s)
- Wei-Han Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang Street, Chengdu, 610041, Sichuan Province, China
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