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Lin Z, Yan M, Lin Z, Xu Y, Zheng H, Peng Y, Li Y, Yang C. Short-term outcomes of distal gastrectomy versus total gastrectomy for gastric cancer under enhanced recovery after surgery: a propensity score-matched analysis. Sci Rep 2024; 14:17594. [PMID: 39080478 PMCID: PMC11289314 DOI: 10.1038/s41598-024-68787-9] [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: 02/09/2024] [Accepted: 07/29/2024] [Indexed: 08/02/2024] Open
Abstract
Enhanced recovery after surgery (ERAS) has been used safely and effectively in patients with gastric cancer. Our aim was to evaluate the short-term outcomes of total gastrectomy (TG) versus distal gastrectomy (DG) for gastric cancer under ERAS. A prospectively collected database of 1349 patients with gastric cancer who underwent TG or DG between January 2016 and September 2022 was retrospectively analyzed. Propensity score matching analysis was used at a ratio of 1:1 to reduce confounding effects, and perioperative clinical outcomes were compared between the two groups. The primary outcome was overall postoperative complications (POCs). Secondary outcomes comprised time to bowel function recovery, postoperative hospital stay, mortality, and 30-day readmission rate. Of 1349 identified patients, 296 (21.9%) experienced overall POCs. Before matching, multivariable analysis revealed that age, body mass index, diabetes, operation time, and extent of gastrectomy were independent risk factors for overall POCs. After matching, each group comprised 495 patients, and no significant differences were observed between the groups for all parameters except tumor location. Compared with TG, DG was associated with significantly earlier days to first flatus and to eating a soft diet, and shorter postoperative hospital stay (P < 0.05). The incidence of overall- and severe POCs (Clavien-Dindo grade ≥ IIIa) in the TG group was significantly higher vs. the DG group (P < 0.05). There was no significant difference in the number of days to eating a liquid diet, or mortality and 30-day readmission rates between the groups (P > 0.05). In the subgroup analysis for middle-third gastric cancer, the TG group experienced higher rates of overall- and severe POCs, with a longer postoperative hospital stay. Compared with DG, patients who underwent TG had higher POC rates, slower recovery of bowel function, and longer duration of hospitalization under ERAS. Therefore, caution is needed when initiating early feeding for patients who undergo TG.
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Affiliation(s)
- Zhenmeng Lin
- Department of Anesthesiology Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Mingfang Yan
- Department of Anesthesiology Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Zhaoyan Lin
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - Yiping Xu
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Huizhe Zheng
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yunzhen Peng
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yangming Li
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China.
| | - Chunkang Yang
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China.
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van der Wielen N, Brenkman H, Seesing M, Daams F, Ruurda J, van der Veen A, van der Peet DL, Straatman J, van Hillegersberg R. Minimally invasive versus open gastrectomy for gastric cancer. A pooled analysis of two European randomized controlled trials. J Surg Oncol 2024; 129:911-921. [PMID: 38173355 DOI: 10.1002/jso.27578] [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: 06/25/2023] [Revised: 11/06/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Minimally invasive techniques have shown better short term and similar oncological outcomes compared to open techniques in the treatment of gastric cancer in Asian countries. It remains unknown whether these outcomes can be extrapolated to Western countries, where patients often present with advanced gastric cancer. MATERIALS AND METHODS A pooled analysis of two Western randomized controlled trials (STOMACH and LOGICA trial) comparing minimally invasive gastrectomy (MIG) and open gastrectomy (OG) in advanced gastric cancer was performed. Postoperative recovery (complications, mortality, hospital stay), oncological outcomes (lymph node yield, radical resection rate, 1-year survival), and quality of life was assessed. RESULTS Three hundred and twenty-one patients were included from both trials. Of these, 162 patients (50.5%) were allocated to MIG and 159 patients (49.5%) to OG. A significant difference was seen in blood loss in favor of MIG (150 vs. 260 mL, p < 0.001), whereas duration of surgery was in favor of OG (180 vs. 228.5 min, p = 0.005). Postoperative recovery, oncological outcomes and quality of life were similar between both groups. CONCLUSION MIG showed no difference to OG regarding postoperative recovery, oncological outcomes or quality of life, and is therefore a safe alternative to OG in patients with advanced gastric cancer.
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Affiliation(s)
- Nicole van der Wielen
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Hylke Brenkman
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten Seesing
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Jelle Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arjen van der Veen
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Donald L van der Peet
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Zhang C, Zhang P, Yu J, Jiang Q, Shen Q, Mao G, Kargbo AB, Liu W, Zeng X, Yin Y, Tao K. Laparoscopic versus open gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy: a comprehensive contrastive analysis with propensity score matching. World J Surg Oncol 2023; 21:350. [PMID: 37940927 PMCID: PMC10633974 DOI: 10.1186/s12957-023-03221-4] [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: 06/12/2023] [Accepted: 10/14/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) is increasingly applied in locally advanced gastric cancer (LAGC) after neoadjuvant chemotherapy (NC). However, there is no study to comprehensively evaluate the clinicopathological, prognostic, and laboratory data such as nutrition, immune, inflammation-associated indexes, and tumor markers between LG and open gastrectomy (OG) for LAGC following NC. METHODS The clinicopathological, prognostic, and laboratory data of LAGC patients with clinical stage of cT2-4aN1-3M0 who underwent gastrectomy after NC were retrospectively collected. The effects of LG and OG were compared after propensity score matching (PSM). RESULTS This study enrolled 148 cases, of which 110 cases were included after PSM. The LG group had a shorter length of incision (P < 0.001) and was superior to OG group in terms of blood loss (P < 0.001), postoperative first flatus time (P < 0.001), and postoperative first liquid diet time (P = 0.004). No significant difference was found in postoperative complications (P = 0.482). Laboratory results showed that LG group had less reduced red blood cells (P = 0.039), hemoglobin (P = 0.018), prealbumin (P = 0.010) in 3 days after surgery, and less reduced albumin in 1 day (P = 0.029), 3 days (P = 0.015), and 7 days (P = 0.035) after surgery than the OG group. The systemic immune-inflammation index and systemic inflammatory response index were not significantly different between the two groups. As for oncological outcomes, there were no significant differences in postoperative tumor markers of CEA (P = 0.791), CA199 (P = 0.499), and CA724 (P = 0.378). The 5-year relapse-free survival rates (P = 0.446) were 46.9% and 43.3% in the LG and OG groups, with the 5-year overall survival rates (P = 0.742) being 46.7% and 52.1%, respectively; the differences were not statistically significant. Multivariate Cox regression analysis revealed that tumor size ≥ 4 cm (P = 0.021) and the absence of postoperative adjuvant chemotherapy (P = 0.012) were independent risk factors for overall survival. CONCLUSIONS LG has faster gastrointestinal recovery, better postoperative nutritional status, and comparable oncological outcomes than OG, which can serve as an alternative surgical method for LAGC patients after NC.
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Affiliation(s)
- Chenggang Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Jiaxian Yu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Qi Jiang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Qian Shen
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Gan Mao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Abu Bakarr Kargbo
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Weizhen Liu
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Xiangyu Zeng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Yuping Yin
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
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Tian Y, Guo H, Hu Y, Yang P, Liu Y, Zhang Z, Ding P, Zheng T, Fan L, Zhang Z, Li Y, Zhao Q. Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer. Surg Endosc 2023; 37:6761-6770. [PMID: 37221415 DOI: 10.1007/s00464-023-10122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Robot-assisted distal gastrectomy (RADG) has been used in the minimally invasive surgical treatment of gastric cancer, but the research on advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NAC) has not been reported. This study aimed to analyze the outcomes of RADG versus laparoscopic distal gastrectomy (LDG) after NAC for AGC. METHODS This was a retrospective propensity score-matched analysis from February 2020 and March 2022. Patients who underwent RADG or LDG for AGC (cT3-4a/N +) following NAC were enrolled and a propensity score-matched analysis was performed in a 1:1 manner. The patients were divided into RADG group and LDG group. The clinicopathological characteristics and short-term outcomes were observed. RESULTS After propensity score matching, 67 patients each in the RADG and LDG groups. RADG was associated with a lower intraoperative blood loss (35.6 vs. 118.8 ml, P = 0.014) and more retrieved lymph nodes (LNs) (50.7 vs. 39.5, P < 0.001), more extraperigastric (18.3 vs. 10.4, P < 0.001), and suprapancreatic LNs (16.33 vs. 13.70, P = 0.042). The RADG group showed lower VAS scores at postoperative 24 h (2.2 vs 3.3, P = 0.034), earlier ambulation (1.3 vs. 2.6, P = 0.011), aerofluxus time (2.2 vs. 3.6, P = 0.025), and shorter postoperative hospital stay (8.3 vs. 9.8, P = 0.004). There were no significant differences in the operative time (216.7 vs.194.7 min, P = 0.204) and postoperative complications between the two groups. CONCLUSION RADG may be a potential therapeutic option for patients with AGC after NAC considering its advantages in perioperative period compared with LDG.
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Affiliation(s)
- Yuan Tian
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Honghai Guo
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yiyang Hu
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Peigang Yang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yang Liu
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Ze Zhang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Pingan Ding
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Tao Zheng
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Liqiao Fan
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Zhidong Zhang
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yong Li
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Qun Zhao
- The Third Department of Surgery, the Fourth Hospital of Hebei Medical University, No.12, Jian-Kang Road, Shijiazhuang, 050011, China.
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China.
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Pang HY, Chen XF, Chen LH, Yan MH, Chen ZX, Sun H. Comparisons of perioperative and long-term outcomes of laparoscopic versus open gastrectomy for advanced gastric cancer after neoadjuvant therapy: an updated pooled analysis of eighteen studies. Eur J Med Res 2023; 28:224. [PMID: 37408041 DOI: 10.1186/s40001-023-01197-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Outcomes of laparoscopic surgery in advanced gastric cancer patients who received neoadjuvant therapy represent a controversial issue. We performed an updated meta-analysis to evaluate the perioperative and long-term survival outcomes of laparoscopic gastrectomy (LG) versus conventional open gastrectomy (OG) in this subset of patients. METHODS Electronic databases including PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure were comprehensively searched up to May 2023. The short-term and long-term outcomes of LG versus OG in advanced gastric cancer patients undergoing neoadjuvant therapy were evaluated. Effect sizes with 95% confidence intervals were always assessed using random-effects model. The prospective protocol was registered with PROSPERO (CRD42022359126). RESULTS Eighteen studies (2 randomized controlled trials and 16 cohort studies) involving 2096 patients were included. In total, 933 patients were treated with LG and 1163 patients were treated with OG. In perioperative outcomes, LG was associated with less estimated blood loss (MD = - 65.15; P < 0.0001), faster time to flatus (MD = - 0.56; P < 0.0001) and liquid intake (MD = - 0.42; P = 0.02), reduced hospital stay (MD = - 2.26; P < 0.0001), lower overall complication rate (OR = 0.70; P = 0.002) and lower minor complication rate (OR = 0.69; P = 0.006), while longer operative time (MD = 25.98; P < 0.0001). There were no significant differences between the two groups in terms of proximal margin, distal margin, R1/R2 resection rate, retrieved lymph nodes, time to remove gastric tube and drainage tube, major complications and other specific complications. In survival outcomes, LG and OG were not significantly different in overall survival, disease-free survival and recurrence-free survival. CONCLUSION LG can be a safe and feasible technique for the treatment of advanced gastric cancer patients receiving neoadjuvant therapy. However, more high-quality randomized controlled trials are still needed to further validate the results of our study.
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Affiliation(s)
- Hua-Yang Pang
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiu-Feng Chen
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Li-Hui Chen
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Meng-Hua Yan
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Zhi-Xiong Chen
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Hao Sun
- Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China.
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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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Boczar KE, Boodhwani M, Beauchesne L, Dennie C, Chan K, Wells GA, Coutinho T. Estimated Aortic Pulse Wave Velocity Is Associated With Faster Thoracic Aortic Aneurysm Growth: A Prospective Cohort Study With Sex-Specific Analyses. Can J Cardiol 2022; 38:1664-1672. [PMID: 35948193 DOI: 10.1016/j.cjca.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/04/2022] [Accepted: 07/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thoracic aortic aneurysm (TAA) is associated with high morbidity and mortality, and there is a critical need for improved tools for risk assessment and prognostication. We have previously shown that aortic stiffness, measured from arterial tonometry (carotid-femoral pulse wave velocity [cfPWV]), is independently associated with TAA expansion. To increase clinical applicability, we sought to determine the association of mathematically estimated aortic pulse wave velocity (e-PWV) with TAA expansion. METHODS One-hundred and five consecutive unoperated subjects with TAA were recruited. We used arterial tonometry to measure cfPWV and used mean arterial pressure and age to calculate e-PWV according to validated equations. Multivariable linear regression assessed associations of baseline e-PWV with future aneurysm growth. Given sex differences in TAA outcomes, sex-stratified analyses were performed. RESULTS Seventy-eight percent of subjects were men. Mean ± standard deviation (SD) age, baseline aneurysm size, and follow-up time were 62.6 ± 11.4 years, 46.2 ± 3.8 mm, and 2.9 ± 1.0 years, respectively. Aneurysm growth was 0.43 ± 0.37 mm per year; e-PWV was independently associated with future aneurysm expansion (β ± SE: 0.240 ± 0.085, P = 0.006). In sex-specific analyses, e-PWV was associated with aneurysm growth in both men (β ± standard error (SE) : 0.076 ± 0.022, P = 0.001) and women (β ± SE : 0.145 ± 0.050, P = 0.012), but the strength of association nearly twice as strong in women as in men. CONCLUSIONS Greater aortic stiffness reflects worse aortic health and provides novel insights into disease activity; e-PWV is independently associated with TAA growth. This finding increases clinical applicability, as e-PWV can be estimated simply, quickly, and free of cost without the need for specialized equipment.
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Affiliation(s)
- Kevin E Boczar
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Luc Beauchesne
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Carole Dennie
- Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada; Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kwan Chan
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Thais Coutinho
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Canadian Women's Heart Health Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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8
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Gao G, Liao H, Jiang Q, Liu D, Li T. Surgical and oncological outcomes of robotic- versus laparoscopic-assisted distal gastrectomy with D2 lymphadenectomy for advanced gastric cancer: a propensity score‑matched analysis of 1164 patients. World J Surg Oncol 2022; 20:315. [PMID: 36171631 PMCID: PMC9520837 DOI: 10.1186/s12957-022-02778-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Studies on surgical outcomes after robotic surgery are increasing; however, long-term oncological results of studies comparing robotic-assisted distal gastrectomy (RADG) versus laparoscopic-assisted distal gastrectomy (LADG) for advanced gastric cancer (AGC) are still limited. This study aimed to assess the surgical and oncological outcomes of RADG and LADG for the treatment of AGC. METHODS A total of 1164 consecutive AGC patients undergoing RADG or LADG were enrolled between January 2015 and October 2021. Propensity score-matched (PSM) analysis was performed to minimize selection bias. The perioperative and oncological outcomes between the two groups were compared. RESULTS Patient's characteristics were comparable between the two groups after PSM. RADG group represented a longer operative time (205.2 ± 43.1 vs 185.3 ± 42.8 min, P < 0.001), less operative blood loss (139.3 ± 97.8 vs 167.3 ± 134.2 ml, P < 0.001), greater retrieved lymph nodes (LNs) number (31.4 ± 12.1 vs 29.4 ± 12.3, P = 0.015), more retrieved LNs in the supra-pancreatic areas (13.4 ± 5.0 vs 11.4 ± 5.1, P < 0.001), and higher medical costs (13,608 ± 4326 vs 10,925 ± US $3925, P < 0.001) than LADG group. The overall complication rate was 13.7% in the RADG group and 16.6% in the LADG group, respectively; the difference was not significantly different (P = 0.242). In the subgroup analysis, the benefits of RADG were more evident in high BMI patients. Moreover, the 3-year overall survival (75.5% vs 73.1%, P = 0.471) and 3-year disease-free survival (72.9% vs 71.4%, P = 0.763) were similar between the two groups. CONCLUSION RADG appears to be a safe and feasible procedure and could serve as an alternative treatment for AGC in experienced centers.
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Affiliation(s)
- Gengmei Gao
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China.,Department of Graduate School, Medical College of Nanchang University, Jiangxi Province, Nanchang, 330006, China
| | - Hualin Liao
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China.,Department of Graduate School, Medical College of Nanchang University, Jiangxi Province, Nanchang, 330006, China
| | - Qunguang Jiang
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China
| | - Dongning Liu
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China
| | - Taiyuan Li
- The Department of Gastrointestinal Surgery, the First Affiliated Hospital of Nanchang University, Jiangxi Province, Nanchang, 330006, China. .,Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China.
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Meta-Analysis of the Effects of Three-Dimensional Visualized Medical Techniques Hepatectomy for Liver Cancer with and without the Treatment of Sorafenib. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4507673. [PMID: 36147647 PMCID: PMC9489363 DOI: 10.1155/2022/4507673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/28/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
Background The application of medical image three-dimensional (3D) reconstruction technology can provide intuitive 3D image data support for accurate preoperative evaluation, surgical planning, and operation safety. However, there is still a lack of high-quality evidence to support whether 3D reconstruction technology is more advantageous in liver resection. Therefore, this study systematically evaluated the clinical effects of 3D reconstruction and two-dimensional (2D) image-assisted hepatectomy. Methods Databases were searched to collect published clinical studies on 3D reconstruction technology and 2D image-assisted liver resection. Data were extracted from the database construction to March 2022 and the risk of bias in the included studies was evaluated. Meta-analysis was performed using RevMan5.3 software. Results A total of 13 clinical studies were included, including 1616 patients, 795 in the 2D group and 819 in the 3D group. The meta-analysis showed that the incidence of postoperative complications was lower in the 3D group than in the 2D group (OR = 0.64, 95% CI = 0.49–0.83, P=0.001) and also reduced operation time (SMD = −0.51, 95% CI = −0.74∼−0.27, P < 0.0001), decreased intraoperative blood loss (SMD = −63.85, 95% CI = −98.66–29.04, P=0.0003), decreased incidence of postoperative liver failure (OR = 2.42, 95% CI = 0.99–5.95, P=0.05), decreased postoperative recurrence rate (OR = 0.29, 95% CI = 0.16–0.53, P < 0.0001), and increased postoperative survival rate (OR = 2.19, 95% CI = 1.49–3.23, P < 0.0001). Conclusions Current data suggest that 3D reconstruction-assisted hepatectomy can reduce intraoperative blood loss, postoperative complications, and recurrence, and improve postoperative survival. Therefore, the 3D reconstruction technique is worthy of application and promotion in assisted liver resection.
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Song J, Xu X, He S, Wang N, Bai Y, Li B, Zhang S. Exosomal hsa_circ_0017252 attenuates the development of gastric cancer via inhibiting macrophage M2 polarization. Hum Cell 2022; 35:1499-1511. [PMID: 35796939 DOI: 10.1007/s13577-022-00739-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/15/2022] [Indexed: 01/07/2023]
Abstract
Gastric cancer (GC) is an aggressive malignant tumor of the digestive system, with high morbidity rates. We previously demonstrated that miR-17-5p can modify tumorigenesis in GC. In addition, other studies have shown that circRNAs can regulate GC progression by sponging various miRNAs. However, the association between circRNAs and miR-17-5p in GC has not yet been explored. Hence, this study aimed to explore the possible interactions between various circRNAs and miR-17-5p using a dual-luciferase assay. CCK-8 was used to determine cell viability, and a Transwell assay was used to measure cell invasion and migration. Gene expression was assessed using quantitative reverse transcription PCR (RT-qPCR), and exosomes were identified using transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). Annexin V/PI staining was also used to detect cell apoptosis. These investigations collectively revealed that miR-17-5p is a target of the circRNA hsa_circ_0017252 and hsa_circ_0017252 is significantly downregulated in GC tissues. In addition, the overexpression of hsa_circ_0017252 inhibited GC cell migration by sponging of miR-17-5p, and GC cell-secreted exosomal hsa_circ_0017252 effectively inhibited macrophage M2-like polarization, which in turn suppressed GC cell invasion. Notably, exosomes containing hsa_circ_0017252 also suppressed GC tumor growth in vivo. Thus, our data suggest that the overexpression of hsa_circ_0017252 suppresses GC malignancy by sponging miR-17-5p. In addition, exosomal hsa_circ_0017252 excreted from GC cells attenuated GC progression by suppressing macrophage M2-like polarization. These findings improve our basic understanding of GC and open a novel avenue for developing more effective GC treatments.
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Affiliation(s)
- Jin Song
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street, Art Museum, Beijing, 100010, China.,Beijing Institute of Chinese Medicine, Beijing, 100010, China
| | - Xiaolong Xu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street, Art Museum, Beijing, 100010, China.,Beijing Institute of Chinese Medicine, Beijing, 100010, China
| | - Shasha He
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street, Art Museum, Beijing, 100010, China.,Beijing Institute of Chinese Medicine, Beijing, 100010, China
| | - Ning Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street, Art Museum, Beijing, 100010, China.,Beijing Institute of Chinese Medicine, Beijing, 100010, China
| | - Yunjing Bai
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street, Art Museum, Beijing, 100010, China.,Beijing Institute of Chinese Medicine, Beijing, 100010, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street, Art Museum, Beijing, 100010, China. .,Beijing Institute of Chinese Medicine, Beijing, 100010, China.
| | - Shengsheng Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Back Street, Art Museum, Beijing, 100010, China.
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Khorobrykh TV, Abdulkhakimov NM, Agadzhanov VG, Aghayan DL, Kazaryan AM. Laparoscopic versus open surgery for locally advanced and metastatic gastric cancer complicated with bleeding and/or stenosis: short- and long-term outcomes. World J Surg Oncol 2022; 20:216. [PMID: 35752852 PMCID: PMC9233806 DOI: 10.1186/s12957-022-02674-3] [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: 10/19/2021] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Laparoscopic surgery has justified its efficacy in the treatment of early gastric cancer. There are limited data indicating the eligibility of laparoscopic interventions in locally advanced gastric cancer. Publications describing the safety of laparoscopic techniques in the treatment of local and metastatic gastric cancer complicated by bleeding and stenosis are scarce. Methods The study included patients with histologically confirmed locally advanced and disseminated gastric cancer and complicated with bleeding and/or stenosis who underwent gastrectomy with vital indications between February 2012 and August 2018. Surgical and oncologic outcomes after laparoscopic surgery (laparoscopic surgery) and open surgery (OS) were compared. Results In total, 127 patients (LS, n = 52; OS, n = 75) were analyzed. Baseline characteristics were similar between the groups. Forty-four total gastrectomies with resection of the abdominal part of the esophagus, 63 distal subtotal (43 Billroth-I and 20 Billroth-II), and 19 proximal gastrectomies were performed. The median duration of surgery was significantly longer in the LS group, 253 min (interquartile range [IQR], 200–295) versus 210 min (IQR, 165–220) (p < 0.001), while median intraoperative blood loss in the LS group was significantly less, 180 ml (IQR, 146—214) versus 320 ml (IQR, 290–350), (p < 0.001). Early postoperative complications occurred in 35% in the LS group and in 45 % of patients in the OS group (p = 0.227). There was no difference in postoperative mortality rates between the groups (3 [6 %] versus 5 (7 %), p = 1.00). Median intensive care unit stay and median postoperative hospital stay were significantly shorter after laparoscopy, 2 (IQR, 1–2) versus 4 (IQR, 3–4) days, and 8 (IQR, 7–9) versus 10 (IQR, 8–12) days, both p < 0.001. After laparoscopy, patients started adjuvant chemotherapy significantly earlier than those after open surgery, 20 vs. 28 days (p < 0.001). However, overall survival rates were similar between the group. Three-year overall survival was 24% in the LS group and 27% in the OS groups. Conclusions Despite the technical complexity, in patients with complicated locally advanced and metastatic gastric cancer, laparoscopic gastrectomies were associated with longer operation time, reduced intraoperative blood loss, shorter reconvalescence, and similar morbidity, mortality rates and long-term oncologic outcomes compared to conventional open surgery.
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Affiliation(s)
- Tatyana V Khorobrykh
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Nuriddin M Abdulkhakimov
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vadim G Agadzhanov
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Davit L Aghayan
- The Intervention Centre, Oslo University Hospital, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Airazat M Kazaryan
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia. .,The Intervention Centre, Oslo University Hospital, Oslo, Norway. .,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia. .,Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway. .,Department of Surgery, Helse Fonna Hospital Trust, Odda, Norway. .,Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
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Effects of Laparoscopic versus Open Surgery for Advanced Gastric Cancer after Neoadjuvant Chemotherapy: A Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2022. [DOI: 10.1155/2022/3255403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective. To evaluate the efficacy of laparoscopy and laparotomy after neoadjuvant chemotherapy in the treatment of advanced gastric cancer by meta-analysis. Methods. Cochrane Library, Embase, and PubMed were searched by computer until December 1, 2021. Literature was screened according to inclusion and exclusion criteria, and relevant data were extracted for meta-analysis using RevMan 5.3. Results. A total of 1027 patients from 11 literature studies were included in this study, including 413 patients in the laparoscopic group and 614 patients in the open group. Meta-analysis showed that the laparoscopic group had less intraoperative bleeding (SMD = −1.11; 95% CI: −1.75–0.47;
), early postoperative exhaust (SMD = −0.45; 95% CI: −0.70–0.20;
), and shorter postoperative hospital stay (SMD = 0.97; 95% CI: 1.69∼0.26;
), but had longer the operation time (SMD = 0.65; 95% CI: 0.52∼0.79;
). There was no significant difference in the number of lymph nodes dissected during operation (SMD = −0.45; 95% CI: −0.42–0.19;
), the incidence of surgical complications 30 days after operation (OR = 0.78; 95% CI: 0.53∼1.13;
), time of first defecation (MD = 0.00; 95% CI: −0.10∼0.10;
), and time of first postoperative feeding (MD = −0.05; 95% CI: −0.22∼0.12;
) between the two groups. For long-term prognosis, there was no significant difference in the 3-year overall survival rate after operation between the two groups (RR = 0.84; 95% CI: 0.63–1.12;
). Conclusion. Compared with the open stomach cancer surgery, laparoscopic gastric cancer surgery has less intraoperative blood loss, shorter hospitalization time, and advantages such as early rehabilitation, postoperative complications rate, and long-term survival, which confirmed the validity and security of the laparoscopic surgery.
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The Safety and Feasibility of Laparoscopic Gastrectomy after Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer. JOURNAL OF ONCOLOGY 2022; 2022:9511066. [PMID: 35685425 PMCID: PMC9174009 DOI: 10.1155/2022/9511066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/05/2023]
Abstract
Background Neoadjuvant chemotherapy is incrementally applied to remedy locally advanced gastric cancer. However, NACT also enhances the difficulty of laparoscopic lymph node dissection. The objective of our study was to evaluate the safety and feasibility of laparoscopic gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy. Methods From July 2017 to December 2019, 153 patients who received neoadjuvant chemotherapy and underwent the subsequent surgical procedure were retrospectively enrolled and analyzed in the Gastrointestinal Surgery Department of West China Hospital. According to surgical methods, all the patients were sectionalized into two groups: laparoscopic assistant gastrectomy (LAG, 77 patients) and traditional open gastrectomy (OG, 76 patients). The demographic parameters, preoperative, surgical, pathological, and neoadjuvant chemotherapy features were compared between the two groups. Results A total of 153 patients accepted neoadjuvant chemotherapy and surgical resection in our study. There was no statistically significant difference in demographic parameters and preoperative and neoadjuvant chemotherapy characteristics between the two groups. The LAG group illustrated less intraoperative blood loss (91.1 ± 53.1 ml vs. 125.7 ± 116.9 ml, p=0.010) and shorter postoperative hospital stays (7.9 ± 2.1 days vs. 125.7 ± 116.9 days, p=0.009), when compared to the OG group. Moreover, there was no disparity with respect to operative duration, number of harvested lymph nodes, and postoperative complication rates between the two groups. When considering the Clavien–Dindo classification, no statistically significant difference was indicated in all stratifications with regard to postoperative complications. Conclusion Laparoscopic gastrectomy for locally advanced gastric cancer after neoadjuvant chemotherapy is safe and feasible without increasing postoperative adverse events.
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