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Xie H, Wei J, Ma Z, Ge W. Predictive Factors for Acute Postoperative Pain After Open Radical Gastrectomy for Gastric Cancer. Front Public Health 2022; 10:907222. [PMID: 35719680 PMCID: PMC9200059 DOI: 10.3389/fpubh.2022.907222] [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: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 01/17/2023] Open
Abstract
Background Pain has become an important factor in evaluating patients' quality of life and clinical treatment. For gastric cancer (GC) patients, open radical gastrectomy (OG) causes significant trauma to the body, increases patients' pain after operation, and delays early recovery. The aim of this study was to investigate the predictive factors of acute pain after OG within postoperative 72 h. Methods From March 2020 to September 2021, 307 patients who underwent OG were included in the study in Nanjing Drum Tower Hospital. The predictors included demographic predictors, pathological data, surgical predictors, and intraoperative predictors. The pain scores at 12, 24, 48, and 72 h after operation were evaluated by numeric rating scale (NRS). The predictors of acute pain were determined by univariate and multivariate analysis. Results The average pain score (NRS) of patients showed a downward trend over time within 72 h after OG. Multivariate analysis indicated that total gastrectomy (OR 1.823, 95% CI 1.094–3.040, P < 0.05), AJCC TNM stage (II) (OR.232, 95% CI 0.062–0.872, P < 0.05), AJCC TNM stage(III) (OR.185, 95% CI 0.049–0.698, P < 0.05), BMI (kg/m2) (OR 1.75, 95% CI 1.029–2.976, P < 0.05), distant metastasis (OR 3.054, 95% CI 1.019–9.155, P < 0.05), intraoperative transfusion (OR 2.246, 95% CI 1.267–3.982, P < 0.01) were significant predictive factors for acute pain after OG. Conclusion Reasonable postoperative acute pain control was the prerequisite for accelerating the postoperative rehabilitation of patients. In order to reduce the occurrence of excessive or insufficient analgesia, it was necessary for patients who underwent OG to formulate appropriate analgesics according to risk factors.
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Affiliation(s)
- Han Xie
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, Macau SAR, China
| | - Jingxuan Wei
- Department of Pharmacy, Nanjing Drum Tower Hospital Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhengliang Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Weihong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Neutrophil extracellular traps promote metastasis in gastric cancer patients with postoperative abdominal infectious complications. Nat Commun 2022; 13:1017. [PMID: 35197446 PMCID: PMC8866499 DOI: 10.1038/s41467-022-28492-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/27/2022] [Indexed: 02/07/2023] Open
Abstract
Postoperative abdominal infectious complication (AIC) is associated with metastasis in locally advanced gastric cancer (GC) patients after radical gastrectomy. However, the underlying mechanism remains unclear. Herein, we report that neutrophil extracellular traps (NETs), the DNA meshes released by neutrophils in response to infection, could promote GC cells proliferation, invasion, migration and epithelial–mesenchymal transition dependent on TGF-β signaling. Then we model nude mice with cecal puncture without ligation to simulate postoperative AIC and find that NETs in peripheral blood and ascites fluid facilitate GC cells extravasation and implantation into liver and peritoneum for proliferation and metastasis. Notably, TGF-β signaling inhibitor LY 2157299 could effectively impede liver and peritoneal metastasis but not concurrently aggravate sepsis in those AIC-bearing nude mice. These findings implicate that targeting downstream effectors of NETs such as TGF-β signaling might provide potential therapeutic prospect to reduce the risk of GC metastasis. Postoperative abdominal infections have been associated with tumor recurrence and metastasis in patients treated for locally advanced gastric cancer. Here the authors show that infectious complications are associated with the release of neutrophil extracellular traps that facilitate gastric cancer cell extravasation and metastasis formation.
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Effect of Early Enteral Nutrition Support Combined with Chemotherapy on Related Complications and Immune Function of Patients after Radical Gastrectomy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1531738. [PMID: 35126900 PMCID: PMC8813239 DOI: 10.1155/2022/1531738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/18/2022]
Abstract
Objective The purpose was to analyze the effect of early enteral nutrition (EEN) support combined with chemotherapy on related complications and immune function in patients after radical gastrectomy. Methods 80 patients with gastric cancer treated in our hospital from March 2019 to March 2020 were selected as the research objects and divided into the experimental group and control group according to the random number table, with 40 cases in each group. The control group received chemotherapy only after surgery, while the experimental group received EEN on this basis. The total protein (TP), transferrin (TF), albumin (ALB), immune cells, and other indexes were measured in the two groups before and after treatment to analyze the effect of different treatment methods on the complications and immune function of patients after radical gastrectomy. Results There were no significant differences in gender ratio, average age, average BMI, pathological types, disease staging, and residence between the two groups (P > 0.05). The exhaust recovery time, total gastric tube drainage, fluid intake time, and hospitalization time in the experimental group were significantly lower than those in the control group (P < 0.05). There were no significant differences in the TP, TF, and ALB levels between the two groups before treatment (P > 0.05), and the TP, TF, and ALB levels in the experimental group were significantly higher than those in the control group after treatment (P < 0.05). The CD4+/CD8+, CD3+, and CD4+ levels in the experimental group after treatment were significantly higher than those in the control group (P < 0.001). After treatment, the growth hormone levels in both groups significantly increased (P < 0.001), and the growth hormone level in the experimental group was significantly higher than that in the control group (P < 0.001). There was no significant difference in the KPS scores between the two groups before treatment (P > 0.05), and the KPS score in the experimental group was significantly higher than that in the control group after treatment (P < 0.001). The incidence of postoperative complications in the experimental group was significantly lower than that in the control group (P < 0.05). Conclusion EEN combined with chemotherapy is a reliable method to improve the immune function of patients after radical gastrectomy for gastric cancer, which plays an important role in improving the physical state of patients and reducing the incidence of complications. Therefore, its further research will help to establish a better treatment plan for such patients.
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Hosseini SV, Maleknejad A, Salem SA, Pourahmad S, Zabangirfard Z, Zamani M. The pre- and postoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios: The comparison of laparoscopy and laparotomy in colorectal cancer patients. Asian J Endosc Surg 2022; 15:44-50. [PMID: 34159727 DOI: 10.1111/ases.12962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/27/2021] [Accepted: 06/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The management of inflammation after colorectal surgery is important to decrease the susceptibility to postoperative complications. Platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in the peripheral blood are known as two important inflammatory markers. In this study we evaluated and compared colorectal laparoscopy and laparotomy based on the PLR and NLR. METHODS Totally, 76 patients were divided into two groups including patients who underwent laparoscopy (45 cases) or laparotomy (31 cases). The PLR and NLR were calculated based on cell blood count analysis of preoperative and postoperative day (POD) one and three in both groups. Statistical analysis was performed using SPSS software version 22. RESULTS The PLR and NLR have no significant association with age, gender and tumor site (p > 0.05). However, both ratios were significantly increased in laparotomy patients at POD1 compared with the laparoscopy patients (p < 0.05). According to the two by two comparisons, the preoperative and postoperative PLR were significantly different in the laparotomy group (p < 0.05) but not in the laparoscopy group (p > 0.05). However, the preoperative and postoperative NLR were significantly different in both laparoscopy and laparotomy groups (p < 0.05). CONCLUSION The NLR and PLR markers indicated that laparoscopy can be a better choice for colorectal surgery due to lower induction of inflammation compared with laparotomy.
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Affiliation(s)
- Seyed V Hosseini
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Saeedeh Pourahmad
- Department of Biostatistics, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zabangirfard
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhdeh Zamani
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Autophagy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Zhou J, Lin S, Sun S, Zheng C, Wang J, He Q. Effect of single-incision laparoscopic distal gastrectomy guided by ERAS and the influence on immune function. World J Surg Oncol 2021; 19:307. [PMID: 34666774 PMCID: PMC8527799 DOI: 10.1186/s12957-021-02422-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022] Open
Abstract
Background To evaluate the immune function of gastric cancer patients after single-incision laparoscopic distal gastrectomy (SIDG) or multiport laparoscopic distal gastrectomy (MLDG) guided by enhanced recovery after surgery (ERAS). Methods A retrospective cohort study was performed on 120 patients who underwent laparoscopic distal gastrectomy for gastric cancer. The patients were divided into two groups according to operation method: group A (MLDG) and group B (SIDG), both guided by ERAS concept. The indicators reflecting immune function and inflammation, such as CD3+, CD4+, CD8+ and NK cell count, CD4+/CD8+ cell ratios, IgA, IgM and IgG levels, C-reactive protein (CRP), total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) were tested 3 days and 7 days after surgery. Results The skin incision length of patients in group B was significantly shorter than that in group A, but the operation time was significantly longer in group B than that in group A (P < 0.05). There were no significant differences in preoperative CD3+, CD4+, CD8+, natural killer (NK) cells, CD4+/CD8+, IgA, IgM and IgG levels between two groups (P < 0.05). Three days after surgery, the immune function indices were decreased in both groups, but with no significant difference between two groups (P > 0.05). On the 7th day after surgery, the immune indexes of both groups recovered somewhat, approaching the preoperative level (P > 0.05). Inflammation indexes increased 3 days after surgery and decreased 7 days after surgery in both groups, among them the CRP level in group A was higher than that in group B (P < 0.05). The 3-year survival rate were 96.7% in group A and 91.7% in group B, respectively, with no statistically significant difference. Conclusion Compared with MLDG guided by ERAS, SIDG under the guidance of the ERAS concept has better cosmetic effect and similar effect on immune function of gastric cancer patients.
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Affiliation(s)
- Junfeng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Sheng Lin
- Department of Pediatric Surgery, Fujian Children's Hospital, Fujian, 350005, Fuzhou, PR China
| | - Sida Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Chengying Zheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Jiaxing Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Qingliang He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China.
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Wu HY, Lin XF, Yang P, Li W. Pooled analysis of the oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer. J Minim Access Surg 2021; 17:287-293. [PMID: 33047686 PMCID: PMC8270045 DOI: 10.4103/jmas.jmas_69_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: Robotic gastrectomy (RG) is more and more widely used in the treatment of gastric cancer. However, the long-term oncological outcomes of RG have not been well evaluated. The aim of this study was to evaluate the long-term oncological outcomes of RG and laparoscopic gastrectomy (LG) in the treatment of gastric cancer. Materials and Methods: PubMed, China National Knowledge Infrastructure, Cochrane Library and EMBASE electronic databases were searched until August 2019. Eligible studies were analysed for comparison of oncological outcomes between RG and LG in patients with gastric cancer. Results: Eleven retrospective comparative studies, which included 1347 (32.52%) patients in the RG group and 2795 (67.48%) patients in the LG group, were selected for the analysis. Meta-analysis of the 11 included studies showed that there was no statistically significant difference in the OS between the RG and LG groups (hazard ratios [HRs] = 0.97, 95% confidence intervals [CIs] = 0.80–1.19, P = 0.80). Six studies evaluated disease-free survival (DFS), and pooled analysis showed that there was no statistically significant difference in DFS between RG group and LG group (HR = 0.94, 95% CIs = 0.72–1.23, P = 0.65). According to the odds ratio (OR) analysis, there was no significant difference in 3-year OS, 5-year OS, 3-year DFS and 5-year DFS between the RG and LG groups. Nine articles reported the recurrence rate, and the meta-analysis showed that there was no statistically significant difference between the RG and LG groups (OR = 0.88, 95% CIs = 0.69–1.12, P = 0.31). Conclusions: This meta-analysis indicated that the long-term oncological outcomes in the RG group were similar to that in the LG group.
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Affiliation(s)
- Hong-Ying Wu
- Department of Geriatric Medicine II, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan Province, China
| | - Xiu-Feng Lin
- Department of Gastrointestinal Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan Province, China
| | - Ping Yang
- Department of Gastrointestinal Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan Province, China
| | - Wei Li
- Department of Gastrointestinal Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan Province, China
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Xia X, Xu J, Zhu C, Cao H, Yu F, Zhao G. Objective evaluation of clinical outcomes of laparoscopy-assisted pylorus-preserving gastrectomy for middle-third early gastric cancer. BMC Cancer 2019; 19:481. [PMID: 31117975 PMCID: PMC6532154 DOI: 10.1186/s12885-019-5695-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/08/2019] [Indexed: 02/08/2023] Open
Abstract
Background Laparoscopic-assisted pylorus-preserving gastrectomy (LAPPG) is a minimally invasive function-preserving surgery for early gastric cancer. This study was designed to investigate the clinical outcomes between LAPPG and laparoscopy-assisted distal gastrectomy (LADG) by objective evaluation. Methods A total 167 pT1N0M0 gastric cancer patients underwent LAPPG(n = 70) and LADG(n = 97) were retrospectively analyzed. By evaluating the functional advantages, objective short-term and one year follow-up outcomes were compared. Results There is no significant difference in perioperative clinical characteristics as well as pathologic results between LAPPG and LADG group while the cost is higher in latter(p = 0.004). The Clavien–Dindo grade II or higher complications were 15.7 and 13.4% in LAPPG and LADG group respectively(p = 0.824). In one year follow-up, nutritional status was significantly better in LAPPG group accompanied by better pylorus function preserving. Conclusion LAPPG is an acceptable surgical procedure for pT1N0M0 middle portion gastric cancer patients in terms of nutritional and economic advantage. Trial registration Chinese Clinical Trial Registry (ChiCTR-PIC-17012358, Date of Registration:2017-08-14).
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Affiliation(s)
- Xiang Xia
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630, Dongfang Road, Shanghai, 200127, People's Republic of China
| | - Jia Xu
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630, Dongfang Road, Shanghai, 200127, People's Republic of China
| | - Chunchao Zhu
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630, Dongfang Road, Shanghai, 200127, People's Republic of China
| | - Hui Cao
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630, Dongfang Road, Shanghai, 200127, People's Republic of China
| | - Fengrong Yu
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630, Dongfang Road, Shanghai, 200127, People's Republic of China.
| | - Gang Zhao
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630, Dongfang Road, Shanghai, 200127, People's Republic of China.
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