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Tankel J, Sticca G, Kammili A, Dehghani M, Sakalla R, Ahmed N, Meng A, Najmeh S, Spicer J, Cools-Lartigue J, Ferri L, Mueller C. ERAS following Gastrectomy for Octo- and Nonagenarians: A Single-Center Retrospective Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:484-489. [PMID: 38770682 DOI: 10.1089/lap.2024.0058] [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] [Indexed: 05/22/2024] Open
Abstract
Background: The safety and efficacy of enhanced recovery after surgery (ERAS) following elective gastrectomy for gastric cancer in patients >80 years of age are not well described. The aim of this study was to explore whether an ERAS protocol following gastrectomy in this age group can be safely implemented and reduce postoperative length of stay. Methods: A retrospective, single-center analysis was performed. All patients >80 years of age with gastric cancer undergoing elective subtotal and total gastrectomy between January 2010 and December 2021 were identified. With the implementation of an ERAS protocol in January 2016, patients treated beforehand were allocated to Group A (pre-ERAS) and Group B (ERAS). The length of stay, incidence of postoperative complications and representation/readmission to the hospital were compared between the groups. Results: Of the 221 patients identified, 56 met the inclusion criteria with 22 patients (39.3%) allocated to Group A and 34 patients (60.7%) to Group B. There were no differences with regard to the type of resection and surgical approach. Length of stay was shorter in Group B (5 days, range 2-27 versus 10 days, 3-109, P = .040). A trend toward more discharges by postoperative day 3 was noted among patients in Group B (7/34, 20.6% versus 2/22, 9.1%, P = .253). There were no differences in the incidence of postoperative complications or readmission hospital between the groups. Conclusion: Among patients >80 years of age, ERAS following gastrectomy for cancer is associated with a reduced length of stay and can be safely implemented.
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Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Giancarlo Sticca
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Anitha Kammili
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Mehrnoush Dehghani
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Rawan Sakalla
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Nabeel Ahmed
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Andrew Meng
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Sara Najmeh
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Shigeno T, Kajiyama D, Sato K, Fujiwara N, Kinugasa Y, Daiko H, Fujita T. Efficiency of conversion surgery for esophageal squamous cell carcinoma with solitary abdominal para-aortic lymph node metastasis. Surg Today 2024:10.1007/s00595-024-02872-4. [PMID: 38802718 DOI: 10.1007/s00595-024-02872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Abdominal para-aortic lymph nodes (PANs) are sites of distant metastasis in esophageal squamous cell cancer (ESCC). The prognosis of patients with Stage IVB ESCC and abdominal PAN metastasis is extremely poor. However, chemotherapy for ESCC has recently been developed, and the effectiveness of combined induction therapy and conversion surgery remains unclear. The primary objective of this study was to evaluate the short- and long-term outcomes of conversion surgery for ESCC and solitary abdominal PAN metastases after induction therapy. METHODS Thirteen patients who underwent conversion esophagectomy for cStage IVB ESCC with solitary abdominal PAN metastasis after induction therapy between January 2017 and October 2022 at our institution were enrolled. The short- and long-term outcomes of conversion surgery were retrospectively evaluated. RESULTS Three patients (23.1%) had pathological abdominal PAN metastasis, and six patients (46.2%) without pathological abdominal PAN metastasis showed that chemotherapy eliminated the tumors in the abdominal PAN. Three patients (23.1%) had postoperative complications of Clavien-Dindo grade II or higher. The 3-year overall and recurrence-free survival rates were 83.1% and 51.3%, respectively. CONCLUSIONS Our findings showed that conversion surgery for ESCC and solitary abdominal PAN metastasis led to a good prognosis when induction therapy was successful.
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Affiliation(s)
- Takashi Shigeno
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Daisuke Kajiyama
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuma Sato
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naoto Fujiwara
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Hiroyuki Daiko
- Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Takeo Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
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3
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Tsekrekos A, Okumura Y, Rouvelas I, Nilsson M. Gastric Cancer Surgery: Balancing Oncological Efficacy against Postoperative Morbidity and Function Detriment. Cancers (Basel) 2024; 16:1741. [PMID: 38730693 PMCID: PMC11083646 DOI: 10.3390/cancers16091741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Significant progress has been made in the surgical management of gastric cancer over the years, and previous discrepancies in surgical practice between different parts of the world have gradually lessened. A transition from the earlier period of progressively more extensive surgery to the current trend of a more tailored and evidence-based approach is clear. Prophylactic resection of adjacent anatomical structures or neighboring organs and extensive lymph node dissections that were once assumed to increase the chances of long-term survival are now performed selectively. Laparoscopic gastrectomy has been widely adopted and its indications have steadily expanded, from early cancers located in the distal part of the stomach, to locally advanced tumors where total gastrectomy is required. In parallel, function-preserving surgery has also evolved and now constitutes a valid option for early gastric cancer. Pylorus-preserving and proximal gastrectomy have improved the postoperative quality of life of patients, and sentinel node navigation surgery is being explored as the next step in the process of further refining the minimally invasive concept. Moreover, innovative techniques such as indocyanine green fluorescence imaging and robot-assisted gastrectomy are being introduced in clinical practice. These technologies hold promise for enhancing surgical precision, ultimately improving the oncological and functional outcomes.
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Affiliation(s)
- Andrianos Tsekrekos
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden; (A.T.); (Y.O.); (I.R.)
- Department of Surgery, University Hospital of Umeå, 907 19 Umeå, Sweden
| | - Yasuhiro Okumura
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden; (A.T.); (Y.O.); (I.R.)
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 57 Stockholm, Sweden
| | - Ioannis Rouvelas
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden; (A.T.); (Y.O.); (I.R.)
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 57 Stockholm, Sweden
| | - Magnus Nilsson
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery and Oncology, Karolinska Institutet, 141 52 Stockholm, Sweden; (A.T.); (Y.O.); (I.R.)
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 141 57 Stockholm, Sweden
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Nico R, Veziant J, Chau A, Eveno C, Piessen G. Optimal lymph node dissection for gastric cancer: a narrative review. World J Surg Oncol 2024; 22:108. [PMID: 38654357 PMCID: PMC11036764 DOI: 10.1186/s12957-024-03388-4] [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: 01/12/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
The management of gastric cancer has long been debated, particularly the extent of lymph node (LN) dissection required during curative surgery. LN invasion stands out as the most critical prognostic factor in gastric cancer. Historically, Japanese academic societies were the pioneers in defining a classification system for regional gastric LN stations, numbering them from 1 to 16. This classification was later used to differentiate between different types of LN dissection, such as D1, D2 and D3. However, these definitions were often considered too complex to be universally adopted, resulting in wide variations in recommendations from one country to another and making it difficult to compare published studies. In addition, the optimal extent of LN dissection remains uncertain, with initially recommended dissections being extensive but associated with significant morbidity without a clear survival benefit. The aim of this review is to make a case for extending LN dissection based on the existing literature, which includes a comprehensive examination of the current definitions of lymphadenectomy and an analysis of the results of all randomised controlled trials evaluating morbidity, mortality and long-term survival associated with different types of LN dissection. Finally, we provide a summary of the various recommendations issued by organizations such as the Japanese Gastric Research Association, the National Comprehensive Cancer Network, the European Society for Medical Oncology, and the French National Thesaurus of Digestive Oncology.
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Affiliation(s)
- Raphaël Nico
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille, 59000, France
| | - Julie Veziant
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille, 59000, France.
- CNRS, Inserm, UMR9020-U1277-CANTHER-Cancer, University Lille, CHU Lille, Lille, 59000, France.
- FREGAT Network, Claude Huriez University Hospital, Lille, 59000, France.
- Rue Michel Polonowski, Lille Cedex, 59037, France.
| | - Amélie Chau
- Department of Digestive Surgery, Hénin-Beaumont Hospital, Hauts-de-France, France
| | - Clarisse Eveno
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille, 59000, France
- CNRS, Inserm, UMR9020-U1277-CANTHER-Cancer, University Lille, CHU Lille, Lille, 59000, France
- FREGAT Network, Claude Huriez University Hospital, Lille, 59000, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille, 59000, France
- CNRS, Inserm, UMR9020-U1277-CANTHER-Cancer, University Lille, CHU Lille, Lille, 59000, France
- FREGAT Network, Claude Huriez University Hospital, Lille, 59000, France
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5
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Manara M, Aiolfi A, Sozzi A, Calì M, Grasso F, Rausa E, Bonitta G, Bonavina L, Bona D. Short-Term Outcomes Analysis Comparing Open, Laparoscopic, Laparoscopic-Assisted, and Robotic Distal Gastrectomy for Locally Advanced Gastric Cancer: A Randomized Trials Network Analysis. Cancers (Basel) 2024; 16:1620. [PMID: 38730574 PMCID: PMC11083793 DOI: 10.3390/cancers16091620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Minimally invasive surgery for the treatment of locally advanced gastric cancer (AGC) is debated. The aim of this study was to execute a comprehensive assessment of principal surgical treatments for resectable distal gastric cancer. METHODS Systematic review and randomized controlled trials (RCTs) network meta-analysis. Open (Op-DG), laparoscopic-assisted (LapAs-DG), totally laparoscopic (Lap-DG), and robotic distal gastrectomy (Rob-DG) were compared. Pooled effect-size measures were the risk ratio (RR), the weighted mean difference (WMD), and the 95% credible intervals (CrIs). RESULTS Ten RCTs (3823 patients) were included. Overall, 1012 (26.5%) underwent Lap-DG, 902 (23.6%) LapAs-DG, 1768 (46.2%) Op-DG, and 141 (3.7%) Rob-DG. Anastomotic leak, severe complications (Clavien-Dindo > 3), and in-hospital mortality were comparable. No differences were observed for reoperation rate, pulmonary complications, postoperative bleeding requiring transfusion, surgical-site infection, cardiovascular complications, number of harvested lymph nodes, and tumor-free resection margins. Compared to Op-DG, Lap-DG and LapAs-DG showed a significantly reduced intraoperative blood loss with a trend toward shorter time to first flatus and reduced length of stay. CONCLUSIONS LapAs-DG, Lap-DG, and Rob-DG performed in referral centers by dedicated surgeons have comparable short-term outcomes to Op-DG for locally AGC.
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Affiliation(s)
- Michele Manara
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Matteo Calì
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Federica Grasso
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Emanuele Rausa
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, 20097 Milan, Italy;
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (D.B.)
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Li ZW, Luo XJ, Liu F, Liu XR, Shu XP, Tong Y, Lv Q, Liu XY, Zhang W, Peng D. Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients? World J Gastrointest Oncol 2024; 16:1334-1343. [PMID: 38660659 PMCID: PMC11037074 DOI: 10.4251/wjgo.v16.i4.1334] [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: 12/18/2023] [Revised: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery (ERAS) in elderly patients with gastric cancer (GC). AIM To evaluate the safety of ERAS in elderly patients with GC. METHODS The PubMed, EMBASE, and Cochrane Library databases were used to search for eligible studies from inception to April 1, 2023. The mean difference (MD), odds ratio (OR) and 95% confidence interval (95%CI) were pooled for analysis. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores. We used Stata (V.16.0) software for data analysis. RESULTS This study consists of six studies involving 878 elderly patients. By analyzing the clinical outcomes, we found that the ERAS group had shorter postoperative hospital stays (MD = -0.51, I2 = 0.00%, 95%CI = -0.72 to -0.30, P = 0.00); earlier times to first flatus (defecation; MD = -0.30, I² = 0.00%, 95%CI = -0.55 to -0.06, P = 0.02); less intestinal obstruction (OR = 3.24, I2 = 0.00%, 95%CI = 1.07 to 9.78, P = 0.04); less nausea and vomiting (OR = 4.07, I2 = 0.00%, 95%CI = 1.29 to 12.84, P = 0.02); and less gastric retention (OR = 5.69, I2 = 2.46%, 95%CI = 2.00 to 16.20, P = 0.00). Our results showed that the conventional group had a greater mortality rate than the ERAS group (OR = 0.24, I2 = 0.00%, 95%CI = 0.07 to 0.84, P = 0.03). However, there was no statistically significant difference in major complications between the ERAS group and the conventional group (OR = 0.67, I2 = 0.00%, 95%CI = 0.38 to 1.18, P = 0.16). CONCLUSION Compared to those with conventional recovery, elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.
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Affiliation(s)
- Zi-Wei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao-Juan Luo
- Department of Endoscopy Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400012, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin-Peng Shu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yue Tong
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Quan Lv
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Şal O, Sakamoto K, Tamura K, Honjo M, Nishi Y, Hikida T, Sakamoto A, Funamizu N, Ogawa K, Takada Y. A Rare Presentation of Lymph Node Metastasis of VIPoma After Three Years of Resection: A Case Report. Cureus 2024; 16:e57628. [PMID: 38707082 PMCID: PMC11070202 DOI: 10.7759/cureus.57628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Vasoactive intestinal peptide-producing tumor of the pancreas (VIPoma) is one of the rarer subtypes of neuroendocrine tumor (NET) of the pancreas. It usually represents intractable diarrhea, weight loss, and electrolyte abnormalities secondary to diarrhea. The most common site of metastasis of VIPoma is the liver. Furthermore, lymph node metastasis (LNM) is rare, and no metachronous LNM with a resectable situation has been reported before. A 60-year-old male patient (height: 181 cm, body weight: 74 kg) with a history of operated pancreatic VIPoma three years ago was referred to our department due to the detection of lymphadenomegaly which was suggestive of lymph node metastasis by routine follow-up computed tomography (CT). Preoperative CT showed a lymph node on the left side of the abdominal aorta and caudal side of the left renal vein with a size of 1 cm. Lymphadenectomy was performed without significant complications and blood loss. This is the first report of metachronous LNM in a patient with operated VIPoma. Although much rarer than solid organ metastasis of VIPoma, LNM in these patients can also be seen synchronously and metachronously. Close follow-up and vigilance are key to preventing recurrence-related morbidity and mortality in these patients.
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Affiliation(s)
- Oğuzhan Şal
- Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul, TUR
- Department of Hepato-Biliary-Pancreatic Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Masahiko Honjo
- Department of Hepato-Biliary-Pancreatic Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Yusuke Nishi
- Department of Hepato-Biliary-Pancreatic Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Takahiro Hikida
- Department of Hepato-Biliary-Pancreatic Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Akimasa Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Naotake Funamizu
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic Surgery, Ehime University Graduate School of Medicine, Ehime, JPN
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8
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Igaue S, Nozaki R, Utsunomiya D, Kubo Y, Kubo K, Kurita D, Yamamoto S, Ishiyama K, Oguma J, Kato K, Daiko H. Significance of Surgery for Resectable M1 Lymph Node Metastases Without Organ Metastasis in Esophageal Carcinoma in the Era of Neoadjuvant Treatment. Ann Surg Oncol 2024; 31:1525-1535. [PMID: 37996638 DOI: 10.1245/s10434-023-14562-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND M1 esophageal carcinoma goes beyond localized disease and requires treatment with systemic therapy. M1 status is primarily divided into two categories: M1 lymph node metastasis and distant organ metastasis. Oligometastasis is defined as a state of limited metastatic disease, and surgery for oligometastasis of distant organs is reported to be beneficial in limited conditions. The aim of this study was to investigate resected cases of M1 lymph node metastases as the only metastatic site in stage IVB esophageal carcinoma. PATIENTS AND METHODS This study was a single-center retrospective cohort study. Patients with esophageal carcinoma who underwent esophagectomy with curative intent between April 2017 and December 2021 were examined. Neoadjuvant chemotherapy was our standard therapy and administered in almost all cases. We hypothesized that four sites of metastatic M1LN (supraclavicular (no. 104), pretracheal (no. 106pre), posterior thoracic para-aortic (no. 112aoP), and abdominal para-aortic (no. 16a2lat) LNs) were potentially resectable M1LN (rM1LN) metastases with curative intent and compared the prognosis of patients with and without rM1LN metastasis. RESULTS Six hundred eight-two patients were included in the study. Among these patients, 80 had rM1LN metastasis and received surgery for curative intent. Short-term safety outcomes were equivalent between patients with and without rM1LN metastases. After propensity score matching, there were no significant differences in overall survival between patients with and without rM1LN metastasis. Multivariate analyses revealed that the only independent prognostic factor was ypN status. CONCLUSION The present study suggests the feasibility and favorable OS in the patients with resection of rM1LN metastasis.
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Affiliation(s)
- Shota Igaue
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ryoko Nozaki
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Daichi Utsunomiya
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yuto Kubo
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Kentaro Kubo
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Daisuke Kurita
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shun Yamamoto
- Department Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koshiro Ishiyama
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Junya Oguma
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Department Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan.
- Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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9
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Kurokawa Y, Doki Y, Kitabayashi R, Yoshikawa T, Nomura T, Tsuji K, Goto M, Cho H, Hihara J, Hiki N, Nunobe S, Mizusawa J, Boku N, Terashima M. Short-term outcomes of preoperative chemotherapy with docetaxel, oxaliplatin, and S-1 for gastric cancer with extensive lymph node metastasis (JCOG1704). Gastric Cancer 2024; 27:366-374. [PMID: 38180622 PMCID: PMC10896774 DOI: 10.1007/s10120-023-01453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The prognosis for marginally resectable gastric cancer with extensive lymph node metastasis (ELM) remains unfavorable, even after R0 resection. To assess the safety and efficacy of preoperative docetaxel, oxaliplatin, and S-1 (DOS), we conducted a multicenter phase II trial. METHODS Eligibility criteria included histologically proven HER2-negative gastric adenocarcinoma with bulky nodal (bulky N) involvement around major branched arteries or para-aortic node (PAN) metastases. Patients received three cycles of docetaxel (40 mg/m2, day 1), oxaliplatin (100 mg/m2, day 1), and S-1 (80-120 mg/body, days 1-14), followed by gastrectomy with D2 plus PAN dissection. Subsequently, patients underwent postoperative chemotherapy with S-1 for 1 year. The primary endpoint was major (grade ≥ 2a) pathological response rate (pRR) according to the Japanese Classification of Gastric Carcinoma criteria. RESULTS Between October 2018 and March 2022, 47 patients (bulky N, 20; PAN, 17; both, 10) were enrolled in the trial. One patient was ineligible. Another declined any protocol treatments before initiation. Among the 45 eligible patients who initiated DOS chemotherapy, 44 (98%) completed 3 cycles and 42 (93%) underwent R0 resection. Major pRR and pathological complete response rates among the 46 eligible patients, including the patient who declined treatment, were 57% (26/46) and 24% (11/46), respectively. Common grade 3 or 4 toxicities were neutropenia (24%), anorexia (16%), febrile neutropenia (9%), and diarrhea (9%). No treatment-related deaths occurred. CONCLUSIONS Preoperative chemotherapy with DOS yielded favorable pathological responses with an acceptable toxicity profile. This multimodal approach is highly promising for treating gastric cancer with ELM.
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Affiliation(s)
- Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryo Kitabayashi
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Nomura
- Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kunihiro Tsuji
- Department of Medical Oncology, Ishikawa Prefectural Chuo Hospital, Kanazawa, Japan
| | - Masahiro Goto
- Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, IMSUT Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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10
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Yasufuku I, Tsuchiya H, Fujibayashi S, Okumura N, Sengoku Y, Fukada M, Asai R, Sato Y, Tajima JY, Kiyama S, Kato T, Tanaka Y, Murase K, Matsuhashi N. Oligometastasis of Gastric Cancer: A Review. Cancers (Basel) 2024; 16:673. [PMID: 38339424 PMCID: PMC10854838 DOI: 10.3390/cancers16030673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/27/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
The concept of oligometastasis is not yet fully established in the field of gastric cancer. However, metastatic lesions that are localized, technically resectable at diagnosis, present a certain response to preoperative chemotherapy, and present favorable survival outcomes with local treatments, sometimes in combination with chemotherapy, are recognized as oligometastasis in the field of gastric cancer. Oligometastasis is noted in European Society for Medical Oncology guidelines and Japanese gastric cancer treatment guidelines, and local treatment is mentioned as one of the pivotal treatment options for oligometastasis. Solitary liver metastasis or a small number of liver metastases; retroperitoneal lymph node metastasis, especially localized para-aortic lymph node metastasis; localized peritoneal dissemination; and Krukenberg tumor are representative types of oligometastasis in gastric cancer. The AIO-FLOT3 trial prospectively evaluated the efficacy of multimodal treatments for gastric cancer with oligometastasis, including surgical resection of primary and metastatic lesions combined with chemotherapy, confirming favorable survival outcomes. Two phase 3 studies are ongoing to investigate the efficacy of surgical resection combined with perioperative chemotherapy compared with palliative chemotherapy. Thus far, the evidence suggests that multimodal treatment for oligometastasis of gastric cancer is promising.
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Affiliation(s)
- Itaru Yasufuku
- Department of Clinical Anatomy Development Studies, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan;
| | - Hiroshi Tsuchiya
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Seito Fujibayashi
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Naoki Okumura
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Yuki Sengoku
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Masahiro Fukada
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Ryuichi Asai
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Yuta Sato
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Jesse Yu Tajima
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Shigeru Kiyama
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Takazumi Kato
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Yoshihiro Tanaka
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Katsutoshi Murase
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Yanagito 1-1, Gifu City 501-1194, Japan; (H.T.); (S.F.); (N.O.); (Y.S.); (M.F.); (R.A.); (J.Y.T.); (S.K.); (T.K.); (Y.T.); (K.M.)
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11
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Guo Y, Zhang XD, Zhang GT, Song XF, Yuan Y, Zhang P, Song YC. Laparoscopic D2+ lymph node dissection in patients with obesity and gastric cancer: A retrospective study. Oncol Lett 2024; 27:84. [PMID: 38249812 PMCID: PMC10797313 DOI: 10.3892/ol.2024.14218] [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: 06/09/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
D2 lymph node dissection is widely used in laparoscopic radical gastrectomy for gastric cancer, and its efficacy and safety are known for patients with obesity. Currently, D2+ lymph node dissection is also applied to certain patients with gastric cancer of later stages. Due to the high difficulty of D2+ surgery, it is more challenging to perform on patients with obesity. There is currently limited research on the efficacy and safety of D2+ surgery in obese patients with gastric cancer. The present study aimed to retrospectively analyze the clinical data of patients undergoing laparoscopic radical gastrectomy for gastric cancer admitted to a single gastroenterology department. Patients with a body mass index ≥25 kg/m2 were included in the study. A total of 149 patients were selected as the research subjects and divided into two groups. The observation group comprised 74 patients who underwent D2+ lymph node dissection, while the control group comprised 75 patients who underwent standard D2 lymph node dissection. The surgical performance, postoperative recovery and postoperative complications of the two groups were compared. The results showed that the rates of conversion to open surgery in the D2+ and D2 groups were 5.4% (4/74) and 2.7% (2/75), respectively, and were not significantly different. The duration of surgery in the D2+ group (282.55±23.02 min) was significantly longer than that in the D2 group (271.45±20.05 min). The mean number of lymph node dissections in the D2+ group was 28.57±7.19, which was significantly higher than that in the D2 group (25.29±6.41). No statistically significant differences in intraoperative blood loss, time to first flatus, postoperative hospitalization days, total hospitalization expenses or postoperative complications was detected between the two groups. There were no deaths in either group within the 30-day perioperative period. In addition, there was no significant difference in the 3-year overall survival rate between the two groups, while the 5-year overall survival rate of the D2+ group was significantly higher than that of the D2 group. For obese patients with gastric cancer, D2+ surgery may increase the duration of surgery and slightly increase intraoperative blood loss compared with standard D2 radical surgery, but does not increase the incidence of postoperative complications. Moreover, D2+ surgery increases the number of lymph node dissections and improves the 5-year survival rate of patients. Therefore, it may be concluded that laparoscopic D2+ lymph node dissection is safe and feasible for obese patients with gastric cancer.
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Affiliation(s)
- Yu Guo
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Xue Dong Zhang
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Guang Tan Zhang
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Xiao Fei Song
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yuan Yuan
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
| | - Yu Cheng Song
- Department of Gastrointestinal Surgery, People's Hospital of Zhengzhou University, Zhengzhou, Henan 450003, P.R. China
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12
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Cai Z, Lin H, Li Z, Zhou J, Chen W, Liu F, Zhao H, Xu Y. The short- and long-term outcomes of laparoscopic D2 lymphadenectomy plus complete mesogastrium excision for lymph node-negative gastric cancer. Surg Endosc 2024; 38:1059-1068. [PMID: 38082018 DOI: 10.1007/s00464-023-10621-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: 09/22/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Patients with T1-3N0M0 gastric cancer (GC) who undergo radical gastrectomy maintain a high recurrence rate. The free cancer cells in the mesogastric adipose connective tissue (Metastasis V) maybe the reason for recurrence in these individuals. We aimed to evaluate whether D2 lymphadenectomy plus complete mesogastrium excision (D2 + CME) was superior to D2 lymphadenectomy with regard to safety and oncological efficacy for T1-3N0M0 GC. METHODS Patients with T1-3N0M0 GC who underwent radical resection from January 2014 to July 2018 were retrospectively analyzed; there were 323 patients, of whom 185 were in the D2 + CME group and 138 in the D2 group. The primary endpoint was 5-year disease-free survival (DFS). Secondary endpoints include the 5-year overall survival (OS), recurrence pattern, morbidity, mortality, and surgical outcomes. RESULTS D2 + CME was associated with less intraoperative bleeding loss, a greater number of lymph nodes harvested, and less time to first postoperative flatus, but the postoperative morbidity was similar. The 5-year DFS was 95.6% (95% CI 92.7-98.5%) and 90.4% (95% CI 85.5-95.3%) in the D2 + CME group and the D2 group, respectively, with a hazard ratio (HR) of 0.455 (95% CI 0.188-1.097; p = 0.071). In terms of recurrence patterns, local recurrence was more prone to occur in the D2 group (p = 0.031). Subgroup analysis indicated that for patients with T1b-3N0M0 GC, the 5-year DFS in the D2 + CME group was considerably greater than that in the D2 group (95.3% [95% CI 91.6-99.0%] vs. 87.6% [95% CI 80.7-94.5%], HR 0.369, 95% CI 0.138-0.983; log-rank p = 0.043). CONCLUSION Laparoscopic D2 + CME for T1-3N0M0 GC is safe and feasible. Furthermore, it not only reduces the local recurrence rate but also improves the 5-year DFS in cases of T1b-3N0M0 GC.
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Affiliation(s)
- Zhiming Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Huimei Lin
- Department of Anorectal Surgery, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, 361021, Fujian, China
| | - Zhixiong Li
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
| | - Jinfeng Zhou
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Weixiang Chen
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Feng Liu
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Hongrui Zhao
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China
- Putian University, Putian, 351100, Fujian, China
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, The First Hospital of Putian City, Putian, 351100, Fujian, China.
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13
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Wang F, Zhang X, Tang L, Wu Q, Cai M, Li Y, Qu X, Qiu H, Zhang Y, Ying J, Zhang J, Sun L, Lin R, Wang C, Liu H, Qiu M, Guan W, Rao S, Ji J, Xin Y, Sheng W, Xu H, Zhou Z, Zhou A, Jin J, Yuan X, Bi F, Liu T, Liang H, Zhang Y, Li G, Liang J, Liu B, Shen L, Li J, Xu R. The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2023. Cancer Commun (Lond) 2024; 44:127-172. [PMID: 38160327 PMCID: PMC10794017 DOI: 10.1002/cac2.12516] [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: 12/08/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
The 2023 update of the Chinese Society of Clinical Oncology (CSCO) Clinical Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China, reflecting the latest advancements in evidence-based medicine, healthcare resource availability, and precision medicine. These updates address the differences in epidemiological characteristics, clinicopathological features, tumor biology, treatment patterns, and drug selections between Eastern and Western gastric cancer patients. Key revisions include a structured template for imaging diagnosis reports, updated standards for molecular marker testing in pathological diagnosis, and an elevated recommendation for neoadjuvant chemotherapy in stage III gastric cancer. For advanced metastatic gastric cancer, the guidelines introduce new recommendations for immunotherapy, anti-angiogenic therapy and targeted drugs, along with updated management strategies for human epidermal growth factor receptor 2 (HER2)-positive and deficient DNA mismatch repair (dMMR)/microsatellite instability-high (MSI-H) patients. Additionally, the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer. The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice, particularly in the heterogeneous healthcare landscape of China, while maintaining a commitment to scientific rigor, impartiality, and timely revisions.
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Affiliation(s)
- Feng‐Hua Wang
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
| | - Xiao‐Tian Zhang
- Department of Gastrointestinal OncologyKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer HospitalBeijingP. R. China
| | - Lei Tang
- Department of RadiologyPeking University Cancer HospitalBeijingP. R. China
| | - Qi Wu
- Department of Endoscopy CenterPeking University Cancer HospitalBeijingP. R. China
| | - Mu‐Yan Cai
- Department of PathologySun Yat‐sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer MedicineGuangzhouGuangdongP. R. China
| | - Yuan‐Fang Li
- Department of Gastric SurgerySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
| | - Xiu‐Juan Qu
- Department of Medical OncologyThe First Hospital of China Medical UniversityShenyangLiaoningP. R. China
| | - Hong Qiu
- Department of Medical OncologyTongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and TechnologyWuhanHubeiP. R. China
| | - Yu‐Jing Zhang
- Department of RadiotherapySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
| | - Jie‐Er Ying
- Department of Medical OncologyZhejiang Cancer HospitalHangzhouZhejiangP. R. China
| | - Jun Zhang
- Department of Medical OncologyRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiP. R. China
| | - Ling‐Yu Sun
- Department of Surgical OncologyThe Fourth Affiliated Hospital of Harbin Medical UniversityHarbinHeilongjiangP. R. China
| | - Rong‐Bo Lin
- Department of Medical OncologyFujian Cancer HospitalFuzhouFujianP. R. China
| | - Chang Wang
- Tumor CenterThe First Hospital of Jilin UniversityChangchunJilinP. R. China
| | - Hao Liu
- Department of General SurgeryNanfang HospitalSouthern Medical UniversityGuangzhouGuangdongP. R. China
| | - Miao‐Zhen Qiu
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
| | - Wen‐Long Guan
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
| | - Sheng‐Xiang Rao
- Department of RadiologyZhongshan HospitalFudan UniversityShanghaiP. R. China
| | - Jia‐Fu Ji
- Department of Gastrointestinal SurgeryPeking University Cancer HospitalBeijingP. R. China
| | - Yan Xin
- Pathology Laboratory of Gastrointestinal TumorThe First Hospital of China Medical UniversityShenyangLiaoningP. R. China
| | - Wei‐Qi Sheng
- Department of PathologyZhongshan Hospital Affiliated to Shanghai Fudan UniversityShanghaiP. R. China
| | - Hui‐Mian Xu
- Department of Gastrointestinal Oncology Surgery. The First Hospital of China Medical UniversityShenyangLiaoningP. R. China
| | - Zhi‐Wei Zhou
- Department of Gastric SurgerySun Yat‐sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer MedicineGuangzhouGuangdongP. R. China
| | - Ai‐Ping Zhou
- Department of OncologyNational Cancer CenterNational Clinical Research Center for CancerCancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingP. R. China
| | - Jing Jin
- Department of Radiation OncologyShenzhen hospitalCancer Hospital of Chinese Academy of Medical SciencesBeijingP. R. China
| | - Xiang‐Lin Yuan
- Department of OncologyTongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and TechnologyWuhanHubeiP. R. China
| | - Feng Bi
- Department of Abdominal OncologyWest China Hospital of Sichuan UniversityChengduSichuanP. R. China
| | - Tian‐Shu Liu
- Department of Medical OncologyZhongshan Hospital Affiliated to Fudan UniversityShanghaiP. R. China
| | - Han Liang
- Department of Gastric SurgeryTianjin Medical University Cancer Institute & HospitalTianjinP. R. China
| | - Yan‐Qiao Zhang
- Department of Medical OncologyCancer Hospital of Harbin Medical UniversityHarbinHeilongjiangP. R. China
| | - Guo‐Xin Li
- Department of General SurgeryNanfang HospitalSouthern Medical UniversityGuangzhouGuangdongP. R. China
| | - Jun Liang
- Department of Medical OncologyPeking University International HospitalBeijingP. R. China
| | - Bao‐Rui Liu
- Department of Medical OncologyNanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingP. R. China
| | - Lin Shen
- Department of GI OncologyKey Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer HospitalBeijingP. R. China
| | - Jin Li
- Department of OncologyEaster Hospital affiliated to Shanghai Tongji UniversityShanghaiP. R. China
| | - Rui‐Hua Xu
- Department of Medical OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdongP. R. China
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14
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Iwasaki K, Barroga E, Enomoto M, Matsumoto M, Yamada E, Miyoshi K, Shimoda Y, Ota Y, Nakagawa Y. Use of Polyglycolic Acid Sheets for the Prevention of Pancreatic Fistula after Laparoscopic Gastrectomy: A Single-Center Retrospective Study. Am Surg 2023; 89:5318-5324. [PMID: 36534780 DOI: 10.1177/00031348221146971] [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] [Indexed: 12/22/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) indications have been extended to advanced gastric cancer requiring expansive lymph node dissection. Despite the huge benefits of this minimally invasive surgery, major complications such as postoperative pancreatic fistula (POPF) remain a concern. With technical advances in surgical procedures, the treatment outcomes of gastric cancer surgery have improved. However, effective methods for preventing POPF have not yet been established. Herein, we examined the usefulness of polyglycolic acid (PGA) sheets for preventing POPF after LG. METHODS We retrospectively assessed 142 patients who underwent curative LG at our institution between January 2017 and August 2022. The 142 patients were divided into 2 groups; PGA group (n = 61): the site of lymph node dissection at the superior margin of the pancreas and pancreatic head was covered with PGA sheets, and nPGA group (n = 81): the site was not covered. We retrospectively compared the short-term surgical outcomes including POPF incidence. RESULTS There was no significant difference in the background factors between the 2 groups and in the incidence of Grade II or higher postoperative complications according to the Clavien-Dindo (CD) classification. However, the incidence of CD Grade II or higher POPF was significantly lower in the PGA group than in the nPGA group (.0% vs 2.3%, respectively, P = .007). CONCLUSIONS There was no POPF in any of the 61 patients in the PGA group. This outcome suggests that POPF incidence may be reduced by covering the lymph node dissection site with PGA sheets after LG.
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Affiliation(s)
- Kenichi Iwasaki
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Edward Barroga
- Department of Medical Education, Showa University School of Medicine, Tokyo, Japan
| | - Masaya Enomoto
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Moe Matsumoto
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Erika Yamada
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kenta Miyoshi
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yota Shimoda
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yoshihiro Ota
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuichi Nakagawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
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15
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Huang Y, Zhang Y, Zhang Y, Liu W, Fang Y, Motlagh M. Novel biogenic preparation of gold nanoparticles decorated on sepiolite clay and evaluation of anti-cancer effect on gastric cancer cell and electrochemical sensing of nitrite. ENVIRONMENTAL RESEARCH 2023; 238:117260. [PMID: 37775012 DOI: 10.1016/j.envres.2023.117260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/01/2023]
Abstract
An environmentally friendly strategy was used in this study to synthesize gold nanoparticles decorated on sepiolite clay (GNPs-SC) using Heracleum persicum grass extract. The physicochemical characters of the prepared composite were characterized using transmission electron microscopy (TEM), scanning electron microscopy (SEM), and X-ray diffraction (XRD). A GNPs-SC modified carbon pate electrode (CPE) was used to study the electrochemical oxidation of nitrite. The proposed nitrite sensor exhibits excellent performance, including a broad linear range (1.0-150 μM), a low limit of detection (0.4 μM), and acceptable reproducibility (RSD = 2.6%). As well, the prepared GNPs-SC was tested for its effectiveness against human gastric adenocarcinoma (AGS) cell line. The MTT assay protocol revealed that the bio-synthesized product displayed significant cytotoxic activity against gastric cancer in human subjects. The findings of this study indicate that GNPs-SC, synthesized using environmentally friendly protocol, exhibit great potential for use in electrochemical sensing and treatment of human cancer.
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Affiliation(s)
- Yakai Huang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Yingjing Zhang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yu Zhang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Wenping Liu
- The Third People's Hospital of Mianyang (Sichuan Mental Health Center), Mianyang, 621000, Sichuan, China
| | - Yantian Fang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Masoud Motlagh
- Department of Chemistry, Faculty of Science, Hakim Sabzevari University, Sabzevar, Iran
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16
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Kamada Y, Hida K, Yonemura Y, Nakakura A, Kitai T, Mizumoto A, Yoshida S, Tokoro Y, Obama K. Analysis of the characteristics and outcomes of patients with pseudomyxoma peritonei of appendiceal origin treated with curative-intent surgery. Surg Oncol 2023; 51:102012. [PMID: 37972508 DOI: 10.1016/j.suronc.2023.102012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND There are no previous studies on pseudomyxoma peritonei regarding the details of surgical procedures included in cytoreductive surgery and quantitative evaluation for peritoneal metastases by region in the abdominal cavity. This study aimed to describe the characteristics and procedural details involved in cytoreductive surgery, and survival outcomes of patients with pseudomyxoma peritonei originating from appendiceal mucinous neoplasm, and identify differences in the difficulty of cytoreductive surgery based on tumor location. METHODS Patient characteristics and survival outcomes were studied through a retrospective review. The complete cytoreduction rate (i), the 5-year survival rate for patients with complete cytoreduction (ii), and an index as a complement (i × ii × 100) were described for patients who had tumors larger than 50 mm in one of the 13 regions of the abdominal cavity. RESULTS A total of 989 patients were treated with curative-intent cytoreductive surgery. The median peritoneal cancer index was 18 (interquartile range, 6-29), with complete cytoreduction achieved in 702 patients (71%); the major complication rate was 17%. The median overall survival was 92.9 months, compared to 53.8 months for patients who underwent total gastrectomy and 30.4 months for those who underwent total colectomy. In the 13 abdominal regions, the index scores indicating cytoreduction difficulty were categorized into three risk groups: upper and mid-abdominal (>20), lateral abdominal (10-20), and small bowel (<10). CONCLUSIONS Cytoreductive surgery offered favorable survival outcomes, even in cases involving total gastrectomy. The difficulty of achieving complete cytoreduction varied across abdominal regions and was classified into three levels.
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Affiliation(s)
- Yasuyuki Kamada
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Yutaka Yonemura
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan; Department of Peritoneal Surface Malignancy Treatment, Omi Medical Center, Kusatsu City, Shiga, Japan
| | - Akiyoshi Nakakura
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiyuki Kitai
- Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Treatment Center, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
| | - Akiyoshi Mizumoto
- Department of Peritoneal Surface Malignancy Treatment, Omi Medical Center, Kusatsu City, Shiga, Japan
| | - Shinya Yoshida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinari Tokoro
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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17
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Takashima Y, Komatsu S, Nishibeppu K, Ohashi T, Kosuga T, Konishi H, Shiozaki A, Kubota T, Fujiwara H, Otsuji E. A shorter distal resection margin is a surrogate marker of nodal metastasis and poor prognosis in distal gastrectomy for advanced gastric cancer. BMC Cancer 2023; 23:1075. [PMID: 37936119 PMCID: PMC10629168 DOI: 10.1186/s12885-023-11570-2] [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: 01/12/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Although a 3-5 cm surgical margin distance is recommended for advanced gastric cancer (GC) in Japanese guidelines, little is known about the clinical effects of the surgical margin, especially the distal resection margin (DM). This study aims to clarify the clinical significance of DM in GC. METHODS A total of 415 GC patients who underwent curative distal gastrectomy between 2008 and 2018 were analyzed retrospectively. RESULTS The DM significantly stratified recurrence-free survival (P = 0.002), and a DM < 30 mm was an independent factor of a poor prognosis (P = 0.023, hazard ratio: 1.91). Lymphatic recurrence occurred significantly more frequently in the DM < 30 mm group than in the DM ≥ 30 mm group (P = 0.019, 6.9% vs. 1.9%). Regarding the station No.6 lymph node metastases in advanced GC (DM < 30 mm vs. 30 mm ≤ DM ≤ 50 mm vs. DM > 50 mm), the number (P < 0.001, 1.42 ± 1.69 vs. 1.18 ± 1.80 vs. 0.18 ± 0.64), the positive rate (P < 0.001, 59.0% vs. 46.7% vs. 11.3%) and therapeutic value index (43.3 vs. 14.5 vs. 8.0) were significantly higher in the DM < 30 mm group. By subdivision using the DM distance of 30 mm, more segmented prognostic stratifications were possible (P < 0.001). CONCLUSIONS A DM of less than 30 mm could be a surrogate marker of poor RFS, especially increasing nodal recurrence. More intensive treatment strategies, including lymphadenectomy and chemotherapy, are needed for patients with this condition.
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Affiliation(s)
- Yusuke Takashima
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Shuhei Komatsu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Keiji Nishibeppu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Takuma Ohashi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachihirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
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18
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Fujita M, Nakauchi M, Suzuki K, Serizawa A, Akimoto S, Tanaka T, Shibasaki S, Inaba K, Tochio T, Hirooka Y, Uyama I, Suda K. Incidence and clinical relevance of postoperative diarrhea after minimally invasive gastrectomy for gastric cancer: a single institution retrospective study of 1476 patients. Langenbecks Arch Surg 2023; 408:364. [PMID: 37725176 DOI: 10.1007/s00423-023-03097-8] [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: 02/20/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Postoperative diarrhea (PD) remains one of the significant complications. Only a few studies focused on PD after minimally invasive surgery. We aimed to investigate PD after minimally invasive gastrectomy for gastric cancer. METHODS A total of 1476 consecutive patients with gastric cancer undergoing laparoscopic or robotic gastrectomy between 2009 and 2019 at our institution were retrospectively reviewed. PD was defined as continuous diarrhea for ≥ 2 days, positive stool culture, or positive clostridial antigen test. The incidence, causes, and related clinical factors were analyzed. RESULTS Of the 1476 patients, the median age was 69 years. Laparoscopic and robotic approaches were performed in 1072 (72.6%) and 404 (27.4%), respectively. Postoperative complications with Clavien-Dindo classification grade of ≥ IIIa occurred in 108 (7.4%) patients. PD occurred in 89 (6.0%) patients. Of the 89 patients with PD, Clostridium difficile, enteropathogenic Escherichia coli, and methicillin-resistant Staphylococcus aureus were detected in 24 (27.0%), 16 (33.3%), and 7 (14.6%) patients, respectively. Multivariate analysis revealed that age ≥ 75 years (OR 1.62, 95% CI [1.02-2.60], p = 0.042) and postoperative complications (OR 6.04, 95% CI [3.54-10.32], p < 0.001) were independent risk factors for PD. In patients without complications, TG (OR 1.88) and age of ≥ 75 years(OR 1.71) were determined as independent risk factors. CONCLUSION The incidence of PD following minimally invasive gastrectomy for gastric cancer was 6.0%. Older age and TG were obvious risk factors in such a surgery, with the latter being a significant risk even in the absence of complications.
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Affiliation(s)
- Masahiro Fujita
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Masaya Nakauchi
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan.
| | | | - Akiko Serizawa
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Shingo Akimoto
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | - Tsuyoshi Tanaka
- Department of Surgery, Fujita Health University, Toyoake, Japan
| | | | - Kazuki Inaba
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
| | - Takumi Tochio
- Collaborative Laboratory for Medical Research On Prebiotics and Probiotics, Fujita Health University, Kutsukake, Toyoake, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University, Toyoake, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, Toyoake, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Japan
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Lin C, Ma J, Zhu C, Zhao X, Chen Y, Zang L, Liu F. Is Pathologic Complete Response a Good Predictor for the Long-Term, Clinical Outcome in Patients with Gastric Cancer After Neoadjuvant Chemotherapy? A Retrospective, Multi-institution Study in China. Ann Surg Oncol 2023; 30:5534-5542. [PMID: 37332025 DOI: 10.1245/s10434-023-13728-5] [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: 04/04/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Many studies have used pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) as the primary endpoint for the short-term efficacy in gastric cancer, but whether it is a good indicator for overall survival is poorly understood. METHODS This study reviewed a multi-institution database of patients who underwent radical gastrectomy and achieved pCR after NAC. Cox regression models were used to identify clinicopathologic predictors of overall survival (OS) and disease-free survival (DFS). Survival curves were calculated by using the Kaplan-Meier method and compared by means of the log-rank test. RESULTS OS and DFS in patients with pCR were significantly higher than in those with non-pCR (both P < 0.001). Multivariable analysis confirmed pCR was an independent prognostic factor for OS and DFS (P = 0.009 and P = 0.002 for OS and DFS, respectively). However, the survival benefit for pCR was present only for ypN0 tumors (P = 0.004 and P = 0.001 for OS and DFS, respectively), and OS (P = 0.292) and DFS (P = 0.285) among patients with ypN+ gastric cancer could not be stratified by pCR. CONCLUSIONS In our study, pCR is an independent prognostic factor for OS and DFS, but the survival benefit for pCR is present only for ypN0 tumors but not ypN+ tumors.
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Affiliation(s)
- Chao Lin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Chunchao Zhu
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xuan Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yueda Chen
- Department of General Surgery, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China.
| | - Fenglin Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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20
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Shimizu D, Tanaka C, Kanda M, Nakanishi K, Ito S, Kuwatsuka Y, Ando M, Murotani K, Fujiwara M, Kodera Y. A Multicenter Randomized Phase II Trial Investigating the Effect of Polyglycolic Acid Sheet on the Prevention of Pancreatic Fistula After Gastrectomy with Prophylactic Lymph Node Dissection. Clin Exp Gastroenterol 2023; 16:169-172. [PMID: 37614978 PMCID: PMC10443534 DOI: 10.2147/ceg.s421531] [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: 05/18/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
Pancreatic fistula after gastrectomy with lymph node dissection is associated with prolonged hospital stay and critical complications such as intra-abdominal bleeding and sepsis. Polyglycolic acid (PGA) sheets are absorbable suture reinforcement materials. A randomized Phase II trial has been planned to evaluate the effect of PGA sheets on preventing postoperative pancreatic fistula. A total of 320 patients will be recruited from thirteen institutions. Patients who are scheduled to undergo distal or total gastrectomy will be randomly allocated into the PGA group or control group, and the dissected area around the pancreas will be covered by the PGA sheet in the PGA group. The primary endpoint will be the maximum value of drain amylase concentration up to 5 days after surgery. The secondary endpoints will be as follows: transition of value of amylases of drain discharge, incidence of pancreatic fistula, incidence of intra-abdominal abscess, white blood cell count, value of C-reactive protein, incidence of postoperative complication, duration of antibiotic agents administration, duration of abdominal drainage, usage of octreotide, duration of hospital stay, incidence of bleeding in abdominal cavity, mortality, and incidence of reoperation.
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Affiliation(s)
- Dai Shimizu
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koki Nakanishi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Yachiyo Kuwatsuka
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan
| | - Michitaka Fujiwara
- Department of Medical Equipment and Supplies Management, Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
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21
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Miyai H, Fujita K, Saito M, Fujii Y, Saito T, Kato J, Sawai M, Eguchi Y, Hirokawa T, Yamamoto M, Kobayashi K, Takiguchi S. Solo surgery in robot-assisted gastrectomy versus laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis. Surg Endosc 2023:10.1007/s00464-023-10113-x. [PMID: 37308761 DOI: 10.1007/s00464-023-10113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/03/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Robot-assisted gastrectomy (RG) for gastric cancer is still not well standardized. This study aimed to explore the feasibility and effectiveness of solo surgery in robot-assisted gastrectomy (SRG) for gastric cancer compared to laparoscopic gastrectomy (LG). METHODS This was a single-center retrospective comparative study between SRG and conventional LG. Between April 2015 and December 2022, 510 patients underwent gastrectomy, and data from a prospectively collected database were analyzed. We identified 372 patients who underwent LG (n = 267) and SRG (n = 105) and the remaining 138 patients were excluded because of remnant gastric cancer, esophagogastric junction cancer, open gastrectomy, concurrent surgery for concomitant malignancies, RG before starting SRG, or cases in which the author was unable to perform or supervise gastrectomy. Propensity score matching was performed at a ratio of 1:1 to reduce bias from confounding patient-related variables, and short-term outcomes were compared between the groups. RESULTS After propensity score matching, 90 pairs of patients who underwent LG and SRG were selected. In the propensity-matched cohort, the operation time was significantly shorter in the SRG group than that in the LG group (SRG = 305.7 ± 74.0 min vs. LG = 340.3 ± 91.65 min, p < 0.0058), less estimated blood loss was observed in the SRG group than that in the LG group (SRG = 25.6 ± 50.6 mL vs. LG = 76.1 ± 104.2 mL, p < 0.0001) and postoperative hospital stay was shorter in the SRG group than that in the LG group (SRG = 7.1 ± 0.8 days vs. LG = 9.1 ± 7.7 days, p = 0.015). CONCLUSION We found that SRG for gastric cancer was technically feasible and effective with favorable short-term outcomes, including shorter operative time, less estimated blood loss, shorter hospital stays, and lower postoperative morbidity than those in LG.
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Affiliation(s)
- Hirotaka Miyai
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan.
| | - Kohei Fujita
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Masaki Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Yoshiaki Fujii
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Tsuyoshi Saito
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Jyunki Kato
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Misato Sawai
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Yuki Eguchi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Takahisa Hirokawa
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Minoru Yamamoto
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Kenji Kobayashi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
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22
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Gao Z, Chen X, Bai D, Fahmy L, Qin X, Peng Y, Ren M, Tian Y, Hu J. A Novel Intraoperative Leak Test Procedure (GAM Procedure) to Prevent Postoperative Anastomotic Leakage in Gastric Cancer Patients Who Underwent Gastrectomy. Surg Laparosc Endosc Percutan Tech 2023; 33:224-230. [PMID: 37172005 DOI: 10.1097/sle.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/21/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Anastomotic leakage following a radical gastrectomy is a serious complication of gastric cancer and esophagogastric junction cancer. The benefit of intraoperative leak testing for the prevention of postoperative anastomotic leakage has been controversial. We introduce a new procedure, which combines the techniques of gastroscopy, air, and methylene blue (GAM) for intraoperative leakage testing. Our objective was to evaluate the efficacy and safety of the GAM procedure for intraoperative leak testing and to compare the surgical complications of gastric cancer patients who underwent gastrectomy with and without intraoperative leak testing using the GAM procedure. MATERIALS AND METHODS A total of 210 patients who underwent radical gastrectomy for gastric cancer were included. Patients were divided into 2 groups: the intraoperative leak testing group using the GAM procedure (IOLT), and the group for which no intraoperative leak testing was done (NIOLT). Clinical and pathologic characteristics, the incidence of postoperative anastomotic leakage, and other surgical complications were compared between the 2 groups. RESULTS There were 82 patients in the IOLT group and 82 patients in the NIOLT group after propensity score matching. In the IOLT group, 4 (4.9%) patients were found to have anastomotic discontinuity during the operation; we repaired these anastomotic discontinuities intraoperatively. The incidence of postoperative anastomotic leakage was higher in the NIOLT group compared with the IOLT group, 6 (7.3%) versus 0 (0%), respectively ( P =0.01). The average time of the GAM procedure was 4.99±1.75 minutes. The surgical time was prolonged by 30 minutes in the IOLT group compared with the NIOLT group, 302.2±79.9 versus 272.1±85.2, respectively ( P =0.02). The length of hospital stay, 15.80±4.55 versus 17.00±6.20 ( P =0.16) was reduced in the IOLT group compared with the NIOLT group. The logistic regression model suggested that IOLT, sex, age, Eastern Cooperative Oncology Group, cT stage, tumor diameter, pT stage, pN stage, and Lauren classification were not risk factors for postoperative complication. CONCLUSIONS The GAM procedure of intraoperative leakage testing can effectively reduce the incidence of postoperative anastomotic leakage in gastric cancer patients undergoing gastrectomy.
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Affiliation(s)
- Zhenguo Gao
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong
| | - Xin Chen
- Department of General Surgery, The First People's Hospital Shuangliu District, Chengdu[West China (Airport) Hospital Sichuan University], Chengdu, Sichuan, China
| | - Dan Bai
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong
| | - Lara Fahmy
- Department of Radiology, Wayne State University, Detroit, MI
| | - Xiangzhi Qin
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong
| | - Yong Peng
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong
| | - Mingyang Ren
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong
| | - Yunhong Tian
- Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI
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23
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Li Z, Wu H, Lin H, Li J, Guo Z, Pan G, Guo Y, Zheng P, Cai Z, Ren J, Zhou J, Ye J, Xu Y. The short- and long-term effect of membrane anatomy-guided laparoscopic D2 lymphadenectomy plus regional complete mesogastrium excision for locally advanced gastric cancer. Surg Endosc 2023:10.1007/s00464-023-10089-8. [PMID: 37157036 DOI: 10.1007/s00464-023-10089-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Retrospectively analyzed the short- and long-term efficacy between laparoscopic D2 lymphadenectomy plus regional complete mesogastrium excision (D2 + rCME) and traditional laparoscopic D2 in the treatment of patients with locally advanced gastric cancer (LAGC), in order to obtain more evidence for D2 + rCME gastrectomy. METHODS A total of 599 LAGC patients who underwent laparoscopy-assisted radical gastrectomy from January 2014 to December 2019, including 367 cases in the D2 + rCME group and 232 cases in the D2 group. Intraoperative and postoperative clinicopathological parameters, postoperative complications and long-term survival in the two groups were statistically analyzed. RESULTS No significant differences in the positive rate of mesogastric tumor deposits, the number of positive lymph nodes and postoperative length of stay were found between the two groups (P > 0.05). In the D2 + rCME group, intraoperative blood loss was significantly reduced (84.20 ± 57.64 ml vs. 148.47 ± 76.97 ml, P < 0.001), the time to first postoperative flatus and first liquid diet intake were significantly shortened (3[2-3] days vs. 3[3-3] days, P < 0.001; 7[7-8] days vs. 8[7-8] days, P < 0.001), and the number of lymph nodes dissected was greater (43.57 ± 16.52 pieces vs. 36.72 ± 13.83 pieces, P < 0.001). The incidence of complications did not significantly differ between the D2 + rCME group (20.7%) and D2 group (19.4%) (P > 0.05). Although there was no statistically difference in 3-year OS and DFS between the two groups. However, the trend was better in D2 + rCME group. In subgroup analysis, patients with positive tumor deposits (TDs) in the D2 + rCME group had significantly better 3-year DFS compared With D2 group (P < 0.05). CONCLUSION Laparoscopic D2 + rCME is safe and feasible for the treatment of LAGC and is characterized by less bleeding, greater lymph node dissection and rapid recovery, without increasing postoperative complications. D2 + rCME group showed a better trend of long-term efficacy, especially significant beneficial for LAGC patients who with positive TDs.
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Affiliation(s)
- Zhixiong Li
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Haiyan Wu
- Department of Pathology, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Huimei Lin
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Junpeng Li
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Zipei Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Guofeng Pan
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Yihong Guo
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Peng Zheng
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Zhiming Cai
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jie Ren
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jinfeng Zhou
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China
| | - Jianxin Ye
- Gastrointestinal Surgery Unit 2, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China.
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China.
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, 350122, Fujian, China.
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Santocchi P, Tirelli F, Persiani R, Laurino A, Belia F, Agnes A, Lorenzon L, D’Ugo D, Biondi A. Pseudoaneurysms after curative-aim gastrectomy for gastric carcinoma: clinical presentation and management. Eur Surg 2023. [DOI: 10.1007/s10353-023-00794-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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25
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Magyar CTJ, Rai A, Aigner KR, Jamadar P, Tsui TY, Gloor B, Basu S, Vashist YK. Current standards of surgical management of gastric cancer: an appraisal. Langenbecks Arch Surg 2023; 408:78. [PMID: 36745231 DOI: 10.1007/s00423-023-02789-5] [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: 05/27/2022] [Accepted: 12/02/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastric cancer (GC) is the fifth most common malignancy worldwide and portends a grim prognosis due to a lack of appreciable improvement in 5-year survival. We aimed to analyze the available literature and summarize the current standards of surgical care for curative and palliative intent treatment of GC. METHODS We conducted a systematic search on the PubMed database for studies on the management of GC. RESULTS Endoscopic resection is an acceptable treatment option for T1a tumors. The role of optimal resection margin for GC remains unclear. D2 lymph node dissection remains the standard of care with splenectomy needed selectively for splenic hilum involvement. A distal pancreatic resection should be avoided. The advantage of bursectomy and omentectomy in GC surgery is not clear. Multi-visceral resection may be considered for locally advanced GC in carefully selected patients. Minimally invasive approaches are non-inferior to open surgery. Surgery should be abandoned prior even in metastatic GC within the frame of multimodal therapy approach. CONCLUSION Various trials have conclusively shown improved patient outcomes when well-established surgical standards are followed.
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Affiliation(s)
- Christian T J Magyar
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Ankit Rai
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Karl R Aigner
- Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany
| | | | - Tung Y Tsui
- Department of Surgery, Asklepios Harzklinik, Goslar, Germany
| | - Beat Gloor
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Somprakas Basu
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Yogesh K Vashist
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India.
- Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany.
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Shigeno T, Kizuki M, Tokunaga M, Fushimi K, Kinugasa Y, Fujiwara T. A comparison of the short-term outcomes between laparoscopic and robotic distal gastrectomy: A retrospective study using a nationwide inpatient database. Surgery 2023; 173:1169-1175. [PMID: 36754740 DOI: 10.1016/j.surg.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/24/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although the safety of robotic distal gastrectomy has been studied in several single-center trials, the nationwide outcomes of robotic distal gastrectomy that meet the requirements of Japanese national health insurance, such as facility case volume and skill level of the surgeon, are still not clear. The objective of this study was to evaluate the short-term outcomes of robotic distal gastrectomy, which was covered by national health insurance, compared to laparoscopic distal gastrectomy. METHODS We retrieved gastric cancer cases with cStage I to III who underwent laparoscopic distal gastrectomy (15,539 patients) and robotic distal gastrectomy (1,312 patients) between April 2018 and March 2020 from the Diagnosis Procedure Combination database. We compared the frequency of postoperative complications, anesthesia time, and postoperative hospitalization days between laparoscopic distal gastrectomy and robotic distal gastrectomy using propensity score matching analysis. RESULTS The postoperative complication rate were not different between laparoscopic distal gastrectomy and robotic distal gastrectomy (odds ratio = 0.90, 95% confidence interval: 0.66 to 1.23, P = .52). The anesthesia time (minutes) was significantly longer (coefficient = 70.2, 95% confidence interval: 63.8 to 76.7, P < .001) and postoperative hospitalization (days) was significantly shorter (coefficient = -0.89, 95% confidence interval: -1.48 to -0.31, P = .003) in robotic distal gastrectomy than laparoscopic distal gastrectomy. CONCLUSIONS Robotic distal gastrectomy that met strict national health insurance coverage requirements in Japan was performed as safely as laparoscopic distal gastrectomy with reduced hospitalization days.
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Affiliation(s)
- Takashi Shigeno
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Japan
| | - Masashi Kizuki
- Department of Tokyo Metropolitan Health Policy Advisement, Tokyo Medical and Dental University, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Japan.
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27
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Li Z, Wu H, Lin H, Pan G, Ren J, Li J, Xu Y. The short- and long-term effect of laparoscopic total gastrectomy in D2 radical treatment combined with spleno-pancreatectomy under membrane anatomy. Surg Endosc 2023; 37:1551-1561. [PMID: 36050612 DOI: 10.1007/s00464-022-09461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the short- and long-term effect of laparoscopic total gastrectomy in D2 radical treatment combined with spleno-pancreatectomy under membrane anatomy. METHODS From June 2013 to June 2018, 70 patients with gastric cancer underwent total gastrectomy combined with spleno-pancreatectomy involving 37 cases in laparoscopy group and 33 cases in laparotomy group. The intraoperative and postoperative conditions of patients in the two groups were compared and analyzed. RESULTS In the laparoscopy group, the operation time and the number of positive lymph node dissection was similar to the laparotomy group. Statistical difference was found in intraoperative bleeding [(79.19 ± 39.63)ml vs (214.39 ± 152.47)m1], the number of lymph node dissection [(47.27 ± 13.94) vs (35.45 ± 9.81)], the first time of aerofluxus [(2.92 ± 0.76)d vs (3.76 ± 1.09)d], the first fluid intake time [(7.49 ± 0.96)d vs (8.27 ± 1.91)d] and the postoperative hospital stay [(11.95 ± 1.90)d vs (15.39 ± 4.07)d] (P < 0.05), So the laparoscopy group was significantly superior to the laparotomy group. The incidences of postoperative complications in laparoscopy group and the laparotomy group were 35.13% and 27.27%, and the difference was not statistically significant. (P > 0.05). No stark difference in postoperative complications of Clavien-Dindo Classification (P > 0.05). The K-M survival curve showed no significant difference in 3-year overall survival (OS) and 3-year disease-free survival (DFS) between the two groups (P > 0.05). CONCLUSION The laparoscopic total gastrectomy in D2 radical treatment combined with spleno-pancreatectomy under membrane anatomy is feasible and safe, which can remove more perigastric lymph nodes. With advantages of less intraoperative blood loss and fast postoperative recovery, it cannot increase postoperative complications and long-term survival are comparable to open surgery.
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Affiliation(s)
- Zhixiong Li
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China.,Institute of Minimally Invasive Surgery, Putian University, Putian, 351100, Fujian, China
| | - Haiyan Wu
- Department of Pathology, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Huimei Lin
- Fujian Medical University, Fujian, 363000, China
| | - Guofeng Pan
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Jie Ren
- Fujian Medical University, Fujian, 363000, China
| | - Junpeng Li
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China
| | - Yanchang Xu
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, 351100, Fujian, China. .,Institute of Minimally Invasive Surgery, Putian University, Putian, 351100, Fujian, China.
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28
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Baiocchi GL, Giacopuzzi S, Vittimberga G, De Pascale S, Pastorelli E, Gelmini R, Viganò J, Graziosi L, Vagliasindi A, Rosa F, Steccanella F, Demartini P, Reddavid R, Berselli M, Elmore U, Romario UF, Degiuli M, Morgagni P, Marrelli D, D’Ugo D, Rosati R, De Manzoni G. Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry. Updates Surg 2023; 75:419-427. [PMID: 35788552 PMCID: PMC9852164 DOI: 10.1007/s13304-022-01318-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015-2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien-Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome.
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Affiliation(s)
- Gian Luca Baiocchi
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy ,UOC General Surgery, ASST Cremona, Cremona, Italy
| | - Simone Giacopuzzi
- grid.5611.30000 0004 1763 1124Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | | | - Stefano De Pascale
- grid.15667.330000 0004 1757 0843Department of Digestive Tract Surgery, IEO, Milan, Italy
| | - Elisabetta Pastorelli
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberta Gelmini
- grid.7548.e0000000121697570Department of Oncological Surgery, University of Modena, Modena, Italy
| | - Jacopo Viganò
- grid.419425.f0000 0004 1760 3027General Surgery, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigina Graziosi
- grid.9027.c0000 0004 1757 3630General and Emergency Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Vagliasindi
- grid.415207.50000 0004 1760 3756UOC General and Emergency Surgery, SSD Emergency Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Fausto Rosa
- grid.411075.60000 0004 1760 4193Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | | | - Paolo Demartini
- grid.414818.00000 0004 1757 8749General, Oncological and Minimally Invasive Surgery, Cà Granda-Niguarda Hospital, Milan, Italy
| | - Rossella Reddavid
- grid.7605.40000 0001 2336 6580Department of Oncology, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Mattia Berselli
- General Surgery Unit, Department of Surgery, ASST Settelaghi, Varese, Italy
| | - Ugo Elmore
- grid.15496.3f0000 0001 0439 0892Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Milan, Italy
| | | | - Maurizio Degiuli
- grid.7605.40000 0001 2336 6580Department of Oncology, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Paolo Morgagni
- GB Morgagni-L Pierantoni Surgical Department, Forlì, Italy
| | - Daniele Marrelli
- grid.9024.f0000 0004 1757 4641Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Domenico D’Ugo
- grid.411075.60000 0004 1760 4193Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Riccardo Rosati
- grid.15496.3f0000 0001 0439 0892Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Milan, Italy
| | - Giovanni De Manzoni
- grid.5611.30000 0004 1763 1124Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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Parra-Lara LG, Falla-Martínez JC, Isaza-Pierotti DF, Mendoza-Urbano DM, Tangua-Arias AR, Bravo JC, Bravo LE, Zambrano ÁR. Gastric adenocarcinoma burden, trends and survival in Cali, Colombia: A retrospective cohort study. Front Oncol 2023; 13:1069369. [PMID: 36959805 PMCID: PMC10028196 DOI: 10.3389/fonc.2023.1069369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023] Open
Abstract
Background Gastric adenocarcinoma (GA) has changed in recent decades. Cancer estimates are often calculated from population-based cancer registries, which lack valuable information to guide decision-making (clinical outcomes). We describe the trends in clinical practice for GA using a hospital-based cancer registry over a timespan of 15 years. Methods A retrospective cohort study was conducted. Data were gathered from adults diagnosed and treated for GA at Fundación Valle del Lili (FVL), between 2000 and 2014, from the hospital's own cancer registry and crossed with Cali's Cancer Registry. Additional data were obtained directly from clinical records, pathology reports and the clinical laboratory. Patients younger than 18 years and those for whom limited information was available in the medical history were excluded. A survival analysis was conducted using Kaplan-Meier method. Results A total of 500 patients met eligibility criteria. Median age was 64 years (IQR: 54-74 years), 39.8% were female, 22.2% were at an early stage, 32.2% had a locally advanced disease, and 29% a metastatic disease, 69% had intestinal subtype, 48.6% had a positive H. pylori test, 85.2% had a distal lesion, 62% underwent gastrectomy, 60.6% lymphadenectomy, and 40.6% received chemotherapy. Survival at 5 years for all cases was 39.9% (CI 95% 35.3-44.5). Survival decreased over time in all groups and was lower in age-groups <39 and 60-79 with either locally advanced or metastatic disease. Prognostic factors that were significant in the Cox proportional-hazards model were late stages of the tumor (locally advanced: HR=2.52; metastatic: HR=4.17), diffuse subtype (HR=1.40), gastrectomy (subtotal: HR=0.42; total: 0.44) and palliative chemotherapy (HR=0.61). Conclusions The treatment of GA has changed in recent decades. GA survival was associated with clinical staging, diffuse subtype, gastrectomy and palliative chemotherapy. These findings must be interpreted in the context of a hospital-based study.
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Affiliation(s)
- Luis Gabriel Parra-Lara
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | | | | | | | | | | | - Luis Eduardo Bravo
- Registro Poblacional de Cáncer de Cali, Departamento de Patología, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Ángela R. Zambrano
- Servicio de Hemato-Oncología, Departamento de Medicina Interna, Fundación Valle del Lili, Cali, Colombia
- *Correspondence: Ángela R. Zambrano,
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Zhang Y, Wang Z, Basharat Z, Hu M, Hong W, Chen X. Nomogram of intra-abdominal infection after surgery in patients with gastric cancer: A retrospective study. Front Oncol 2022; 12:982807. [PMID: 36263227 PMCID: PMC9574043 DOI: 10.3389/fonc.2022.982807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Surgical resection is still the primary way to treat gastric cancer. Therefore, postoperative complications such as IAI (intra-abdominal infection) are major problems that front-line clinical workers should pay special attention to. This article was to build and validate IAI’s RF (regression function) model. Furthermore, it analyzed the prognosis in patients with IAI after surgery for stomach cancer. The above two points are our advantages, which were not involved in previous studies. Methods The data of this study was divided into two parts, the training data set and the validation data set. The training data for this article were from the patients treated surgically with gastric cancer in our center from December 2015 to February 2017. We examined IAI’s morbidity, etiological characteristics, and prognosis in the training data set. Univariate and multivariate logistic regression analyses were used to screen risk factors, establish an RF model and create a nomogram. Data from January to March 2021 were used to validate the accuracy of the RF model. Results The incidence of IAI was 7.2%. The independent risk factors for IAI were hypertension (Odds Ratio [OR] = 3.408, P = 0.001), history of abdominal surgery (OR = 2.609, P = 0.041), combined organ excision (OR = 4.123, P = 0.010), and operation time ≥240 min (OR = 3.091, P = 0.005). In the training data set and validation data set, the area under the ROC curve of IAI predicted by the RF model was 0.745 ± 0.048 (P<0.001) and 0.736 ± 0.069 (P=0.003), respectively. In addition, IAI significantly extended the length of hospital stay but had little impact on survival. Conclusions Patients with hypertension, combined organ excision, a history of abdominal surgery, and a surgical duration of 240 min or more are prone to IAI, and the RF model may help to identify them.
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Affiliation(s)
- Yue Zhang
- Department of Otolaryngology, Wenzhou People’s Hospital, Wenzhou, China
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhengfei Wang
- Department of Hepato-biliary Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
| | - Zarrin Basharat
- Jamil-ur-Rahman Center for Genome Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Mengjun Hu
- Department of Pathology, Zhuji Affiliated Hospital of Wenzhou Medical University, Shaoxing, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
| | - Wandong Hong
- Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
| | - Xiangjian Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Mengjun Hu, ; Wandong Hong, ; Xiangjian Chen,
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A good surgical field for para-aortic nodal dissection in gastric cancer by the Cattell-Braasch maneuver. Langenbecks Arch Surg 2022; 407:3141-3146. [PMID: 35978050 DOI: 10.1007/s00423-022-02657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Gastric cancer patients with para-aortic lymph node metastases may achieve long-term survival with radical gastrectomy and para-aortic lymph nodal dissection (PAND) following neoadjuvant therapy. We introduced the Cattell-Braasch maneuver to facilitate safe and complete PAND for advanced gastric cancer with extensive lymph node metastases. METHODS Between January 2014 and March 2020, 7 patients with highly advanced gastric cancer received preoperative chemotherapy followed by radical gastrectomy and PAND using the Cattell-Braasch maneuver. This maneuver consists of mobilization of the right hemi-colon and the total small intestine. RESULTS Five patients received preoperative chemotherapy for para-aortic lymph node metastases and 2 for bulky lymph node metastases around the supra-pancreatic area. All patients received S-1 + cisplatin therapy, and one was additionally treated with paclitaxel chemotherapy followed by nivolumab. After chemotherapy, 2 patients with para-aortic lymph node metastases achieved down-staging on imaging tests. Total gastrectomy with PAND by the Cattell-Braasch maneuver was performed on all patients and was accompanied by splenectomy (n = 5) and distal pancreatectomy (n = 1). Pathological assessments revealed that 3 patients had para-aortic lymph node metastases, and the median number of retrieved para-aortic lymph nodes was 16. Three patients without para-aortic lymph node metastasis survived for more than 5 years without recurrence. CONCLUSION The Cattell-Braasch maneuver provides a good surgical field and is useful for complete PAND for gastric cancer.
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Zhi X, Kuang X, Li J. The Impact of Perioperative Events on Cancer Recurrence and Metastasis in Patients after Radical Gastrectomy: A Review. Cancers (Basel) 2022; 14:cancers14143496. [PMID: 35884557 PMCID: PMC9319233 DOI: 10.3390/cancers14143496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 02/04/2023] Open
Abstract
Radical gastrectomy is a mainstay therapy for patients with locally resectable gastric cancer (GC). GC patients who are candidates for radical gastrectomy will experience at least part of the following perioperative events: surgery, anesthesia, pain, intraoperative blood loss, allogeneic blood transfusion, postoperative complications, and their related anxiety, depression and stress response. Considerable clinical studies have shown that these perioperative events can promote recurrence and decrease the long-term survival of GC patients. The mechanisms include activation of neural signaling and the inflammatory response, suppression of antimetastatic immunity, increased release of cancer cells into circulation, and delayed adjuvant therapy, which are involved in every step of the invasion-metastasis cascade. Having appreciated these perioperative events and their influence on the risk of GC recurrence, we can now use this knowledge to find strategies that might substantially prevent the deleterious recurrence-promoting effects of perioperative events, potentially increasing cancer-free survival in GC patients.
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Affiliation(s)
- Xing Zhi
- Department of General Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, China;
| | - Xiaohong Kuang
- Department of Hematology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, China;
| | - Jian Li
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, China
- Correspondence: ; Tel.:+86-0816-2271901
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Shibasaki S, Nakauchi M, Serizawa A, Nakamura K, Akimoto S, Tanaka T, Inaba K, Uyama I, Suda K. Clinical advantage of standardized robotic total gastrectomy for gastric cancer: a single-center retrospective cohort study using propensity-score matching analysis. Gastric Cancer 2022; 25:804-816. [PMID: 35298742 DOI: 10.1007/s10120-022-01288-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although recent studies have shown that robotic gastrectomy offers clinical advantages over laparoscopic gastrectomy in decreasing gastric cancer (GC) morbidity, studies focusing on robotic total gastrectomy (RTG) remain limited. The current study aimed to clarify whether the use of a robotic system could clinically improve short-term outcomes. METHODS Between January 2009 and June 2021, 371 patients diagnosed with both clinical and pathological Stage III or lower GC and underwent RTG or laparoscopic total gastrectomy (LTG) were enrolled in this study. The primary outcome was the incidence of intra-abdominal infectious complications over Clavien-Dindo classification grade IIIa. Demographic characteristics of those who underwent the RTG and LTG were matched using propensity-score matching (PSM), after which short-term outcomes were compared retrospectively. RESULTS After PSM, 100 patients were included in each group. The RTG group had a significantly shorter duration of hospitalization following surgery [RTG 13 (11-16) days vs. LTG 14 (11-19) days; p = 0.032] and a greater number of dissected LNs [RTG 48 (39-59) vs. LTG 43 (35-54) mL; p = 0.025], despite having a greater total operative time [RTG 511 (450-646) min vs. LTG 448 (387-549) min; p < 0.001]. In addition, the RTG group had significantly fewer total complications (3% vs. 13%, p = 0.019) and intra-abdominal infectious complications (1% vs. 9%; p = 0.023). CONCLUSIONS The current study showed that robotic surgery might improve short-term outcomes following minimally invasive radical total gastrectomy by reducing intra-abdominal infectious complications.
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Affiliation(s)
- Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Masaya Nakauchi
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Akiko Serizawa
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Shingo Akimoto
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tsuyoshi Tanaka
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
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Teranishi R, Takahashi T, Kurokawa Y, Sugase T, Saito T, Yamamoto K, Yamashita K, Tanaka K, Makino T, Yamasaki M, Motoori M, Omori T, Nakajima K, Eguchi H, Doki Y. Robotic Distal Gastrectomy Reduces Drain Amylase Values in Patients With a Small Pancreas-left Gastric Artery Angle. Surg Laparosc Endosc Percutan Tech 2022; 32:311-318. [PMID: 35583613 PMCID: PMC9162270 DOI: 10.1097/sle.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Pancreatic fistula is a severe complication after laparoscopic distal gastrectomy (LDG). We previously evaluated the pancreas-left gastric artery angle (PLA) as a risk indicator for developing a pancreatic fistula after LDG. This study evaluated the incidence of pancreatic fistula with robotic distal gastrectomy (RDG) in comparison to LDG from the view of the PLA. MATERIALS AND METHODS An association between the PLA and the incidence of pancreatic fistula in 165 patients who underwent either RDG (n=45) or LDG (n=120) was investigated retrospectively. RESULTS RDG patients had significantly lower drain amylase values (postoperative day 2) than LDG patients. As opposed to LDG patients, drain amylase values were similar for patients with small (PLA <62 degrees) and large (PLA ≥62 degrees) PLA in RDG patients. CONCLUSION Robotic surgery may reduce the risk of postoperative pancreatic fistula in patients with a small PLA.
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Affiliation(s)
- Ryugo Teranishi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | | | - Takuro Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Osaka Prefecture, Japan
| | - Takeshi Omori
- Department of Surgery, Osaka International Cancer Institute
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita
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Takebayashi K, Murata S, Kaida S, Yamaguchi T, Otake R, Miyake T, Ueki T, Kojima M, Iida H, Maehira H, Mori H, Shimizu T, Tani M. Adverse impact of postoperative intra-abdominal infectious complications on cancer recurrence-related survival after curative gastric cancer surgery. Am J Surg 2022; 224:949-954. [PMID: 35599072 DOI: 10.1016/j.amjsurg.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study aimed to evaluate the impact of postoperative intra-abdominal infectious complications (PICs) on survival after surgery for gastric cancer. METHODS A total of 152 patients who underwent curative gastrectomy for gastric cancer were included. The effect of clinicopathological features and PICs on recurrence-free survival (RFS) and overall survival (OS) were investigated. RESULTS The median age was 67 years. The pathological stage was stage I (61), II (40), and III (51). Thirty-two patients (21.1%) had PICs: 9, pancreatic fistula; 14, anastomotic leakage; and 17, intra-abdominal abscess. The five-year RFS and OS rates were significantly lower in patients with PICs than in those without PICs (63.4 vs. 85.6%; p < 0.01 and 56.4 vs. 80.3%; p < 0.01, respectively). In multivariate analysis, intraoperative blood loss was an independent prognostic factor for PICs. CONCLUSIONS Patients with PICs had worse clinical outcomes. Reducing intraoperative bleeding may improve the prognosis of gastric cancer.
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Affiliation(s)
- Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Satoshi Murata
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan; Cancer Center, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Reiko Otake
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tomoyuki Ueki
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masatsugu Kojima
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Tomoharu Shimizu
- Medical Safety Section, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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Sakamoto S, Takata N, Noda Y, Ozaki K, Okabayashi T. Postoperative chylous ascites after total gastrectomy successfully treated using peritoneovenous (Denver) shunt: a case report. Surg Case Rep 2022; 8:92. [PMID: 35534589 PMCID: PMC9086017 DOI: 10.1186/s40792-022-01447-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Background Chylous ascites (CA) is a rare complication of gastrectomy for gastric cancer. While most cases of postoperative CA improve with medication or nutritional support, some are refractory to conservative treatment. A peritoneovenous shunt (PVS) may help patients who are poor candidates for surgery. However, PVS placement for postoperative CA after gastroenterological surgery has been rarely reported. Herein, we present a case of postoperative CA following total gastrectomy with para-aortic lymphadenectomy, treated successfully by PVS placement. Case presentation A 74-year-old man who underwent total gastrectomy with para-aortic lymph node dissection was hospitalised because of insufficient oral intake and dehydration. His abdomen was markedly distended with severe bilateral lower extremity oedema. On admission, abdominal computed tomography (CT) showed a high volume of ascites and no signs of cancer recurrence. Accordingly, postoperative CA resulting from drainage of fluid on paracentesis was diagnosed. Despite nutritional support, diuretics, and octreotide administration, his abdominal distension and nutritional status did not improve. We could not identify the sites of lymphatic leakage in the three intranodal lymphangiographies followed by CT. Although we considered a surgical treatment in our patient, we decided against it. Because we could not identify lymphatic leakage site during lymphangiography, surgical treatment might have a potential failure of detection and closure of leakage site. Furthermore, the patient’s general condition was poor because of malnutrition resulting from the loss of lymphatic fluid. Consequently, we decided to place PVS. After PVS placement, his abdominal distension improved rapidly, and he was discharged without serious complications. Thirteen months after PVS, patient has no relapse of abdominal distention and nutrition status has improved. Conclusion PVS might be a good option to manage refractory postoperative CA, as the leakage point cannot be detected on lymphangiography.
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Prasad P, Sivaharan A, Navidi M, Fergie BH, Griffin SM, Phillips AW. Significance of neoadjuvant downstaging in gastric adenocarcinoma. Surgery 2022; 172:593-601. [DOI: 10.1016/j.surg.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/21/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022]
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Abstract
Importance Surgery plays a critical role in the management of all stages of gastric cancer. Observations For patients with early gastric cancer and low risk of lymph node metastasis, endoscopic therapy or surgery alone is potentially curative. Novel techniques, such as sentinel lymph node biopsy, may allow for greater use of stomach-sparing procedures that could improve quality of life without compromising oncologic outcomes; however, experience with these techniques is rare outside of East Asia, and studies of long-term outcomes are still ongoing. Patients with later-stage localized gastric cancer benefit from more extensive lymphadenectomy and multimodality therapy, as they are at risk for nodal and distant metastases. There have been recent advances in chemotherapy that have led to improved survival, but the optimal sequencing of multimodality therapy is still being investigated. Better systemic therapy may also increase the role of surgery for patients with oligometastatic disease. There are ongoing studies examining the efficacy of peritoneal-directed therapies in both patients with low-volume peritoneal disease and patients at high risk of peritoneal recurrence. Conclusions and Relevance The management of gastric cancer continues to evolve. Surgeons should be aware of novel surgical approaches currently under investigation as well as how surgery fits into the contemporary multidisciplinary approach to this disease.
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Affiliation(s)
- George Z Li
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jiping Wang
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Gastrointestinal Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Caruso S, Giudicissi R, Mariatti M, Cantafio S, Paroli GM, Scatizzi M. Laparoscopic vs. Open Gastrectomy for Locally Advanced Gastric Cancer: A Propensity Score-Matched Retrospective Case-Control Study. Curr Oncol 2022; 29:1840-1865. [PMID: 35323351 PMCID: PMC8947505 DOI: 10.3390/curroncol29030151] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Minimally invasive surgery has been increasingly used in the treatment of gastric cancer. While laparoscopic gastrectomy has become standard therapy for early-stage gastric cancer, especially in Asian countries, the use of minimally invasive techniques has not attained the same widespread acceptance for the treatment of more advanced tumours, principally due to existing concerns about its feasibility and oncological adequacy. We aimed to examine the safety and oncological effectiveness of laparoscopic technique with radical intent for the treatment of patients with locally advanced gastric cancer by comparing short-term surgical and oncologic outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy at two Western regional institutions. Methods: The trial was designed as a retrospective comparative matched case-control study for postoperative pathological diagnoses of locally advanced gastric carcinoma. Between January 2015 and September 2021, 120 consecutive patients who underwent curative-intent laparoscopic gastrectomy with D2 lymph node dissection were retrospectively recruited and compared with 120 patients who received open gastrectomy. In order to obtain a comparison that was as homogeneous as possible, the equal control group of pairing (1:1) patients submitted to open gastrectomy who matched those of the laparoscopic group was statistically generated by using a propensity matched score method. The following potential confounder factors were aligned: age, gender, Body Mass Index (BMI), comorbidity, ASA, adjuvant therapy, tumour location, type of gastrectomy, and pT stage. Patient demographics, operative findings, pathologic characteristics, and short-term outcomes were analyzed. Results: In the case-control study, the two groups were clearly comparable with respect to matched variables, as was expected given the intentional primary selective criteria. No statistically significant differences were revealed in overall complications (16.7% vs. 20.8%, p = 0.489), rate of reoperation (3.3% vs. 2.5%, p = 0.714), and mortality (4.2% vs. 3.3%, p = 0.987) within 30 days. Pulmonary infection and wound complications were observed more frequently in the OG group (0.8% vs. 4.2%, p < 0.01, for each of these two categories). Anastomotic and duodenal stump leakage occurred in 5.8% of the patients after laparoscopic gastrectomy and in 3.3% after open procedure (p = 0.072). The laparoscopic approach was associated with a significantly longer operative time (212 vs. 192 min, p < 0.05) but shorter postoperative length of stay (9.1 vs. 11.6 days, p < 0.001). The mean number of resected lymph nodes after D2 dissection (31.4 vs. 33.3, p = 0.134) and clearance of surgical margins (97.5% vs. 95.8%, p = 0.432) were equivalent between the groups. Conclusion: Laparoscopic gastrectomy with D2 nodal dissection appears to be safe and feasible in terms of perioperative morbidity for locally advanced gastric cancer, with comparable oncological equivalency with respect to traditional open surgery.
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Affiliation(s)
- Stefano Caruso
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
- Correspondence: ; Tel.: +39-55-9508373 or +39-349-8312397
| | - Rosina Giudicissi
- Department of General and Oncologic Surgery, Unit of General Surgery, Santo Stefano Hospital, Central Tuscany Local Health Company, 59100 Prato, Italy; (R.G.); (S.C.)
| | - Martina Mariatti
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
| | - Stefano Cantafio
- Department of General and Oncologic Surgery, Unit of General Surgery, Santo Stefano Hospital, Central Tuscany Local Health Company, 59100 Prato, Italy; (R.G.); (S.C.)
| | - Gian Matteo Paroli
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
| | - Marco Scatizzi
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
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Eto K, Yoshida N, Iwatsuki M, Iwagami S, Nakamura K, Morita K, Ikeshima S, Horino K, Shimada S, Baba H. Clinical impact of perirenal thickness on short‐ and long‐term outcomes of gastric cancer after curative surgery. Ann Gastroenterol Surg 2022; 6:496-504. [PMID: 35847439 PMCID: PMC9271023 DOI: 10.1002/ags3.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/18/2021] [Accepted: 01/02/2022] [Indexed: 12/09/2022] Open
Abstract
Background A variety of factors for short‐ and long‐term outcomes have been reported after radical resection for gastric cancer (GC). Obesity and emaciation had been reported to be a cause of poor short‐ and long‐term outcomes with gastrointestinal cancer. However, the indicators are still controversial. The purpose of this study was to evaluate the relationship between perirenal thickness (PT) and short‐ and long‐term outcomes after radical surgery for GC. Methods We analyzed the data of 364 patients with GC who underwent radical surgery. We evaluated the distance from the anterior margin of the quadratus lumborum muscle to the dorsal margin of the left renal pole using computed tomography (CT) as an indicator of PT. The association between PT and clinicopathological factors and short‐ and long‐term outcomes was evaluated. Results The PT data were divided into low, normal, and high groups by gender using the tertile value. We found that the PT low group was 121 patients, normal group was 121 patients, and high group was 122 patients. Multivariate analyses showed that the high PT group was an independent risk factor for a short‐outcome after curative surgery in GC patients (odds ratio 2.163; 95% confidence interval [CI] 1.156–4.046; P = .016). And the low PT group was an independent risk factor for overall survival (hazard ratio 2.488; 95% CI 1.400–4.421; P = .0019) and relapse‐free survival (hazard ratio 2.342; 95% CI 1.349–4.064; P = .0025) after curative surgery in GC patients. Conclusion Perirenal thickness is a simple and useful factor for predicting short‐ and long‐term outcomes after radical surgery for GC.
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Affiliation(s)
- Kojiro Eto
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Nakamura
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Keisuke Morita
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Satoshi Ikeshima
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Kei Horino
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Shinya Shimada
- Department of Surgery Japan Community Health care Organization Kumamoto General Hospital Yatsushiro Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery Graduate School of Medical Sciences Kumamoto University Kumamoto Japan
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Prognostic factors in patients who received paraaortic lymph node dissection for locally advanced gastric cancer with extensive lymph node metastasis. Langenbecks Arch Surg 2022; 407:1027-1037. [PMID: 35022832 DOI: 10.1007/s00423-021-02397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE While paraaortic lymph node (PAN) dissection (PAND) has been found to be efficacious for patients with extensive lymph node metastasis (ELM) of locally advanced gastric cancer (LGC), the optimal indications for PAND remain to be elucidated. Thus, the prognostic factors among these patients were evaluated. METHODS A total of 35 patients with ELM of LGC who underwent gastrectomy with D2 and PAND between August 2008 and December 2019 were included and evaluated for long-term outcomes and prognostic factors. RESULTS Preoperative chemotherapy was administered to 33 patients [neoadjuvant chemotherapy (NAC), n = 26; palliative chemotherapy followed by conversion surgery, n = 7], none of whom suffered surgical mortality. The pathological analysis identified PAN metastasis in 11 patients (31.4%). The 5-year overall and relapse-free survival (RFS) survival were 66.4% and 52.6%, respectively. Locoregional recurrence was found in one patient. The multivariate analysis revealed that NAC (P = 0.011) and < 3 metastatic PANs on preoperative imaging (P = 0.017) were independently associated with RFS. CONCLUSION D2 and PAND after NAC can be a promising approach for patients with ELM of LGC. In particular, patients with a limited number of metastatic PANs can be considered good candidates for PAND.
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Kinami S, Saito H, Takamura H. Significance of Lymph Node Metastasis in the Treatment of Gastric Cancer and Current Challenges in Determining the Extent of Metastasis. Front Oncol 2022; 11:806162. [PMID: 35071010 PMCID: PMC8777129 DOI: 10.3389/fonc.2021.806162] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
The stomach exhibits abundant lymphatic flow, and metastasis to lymph nodes is common. In the case of gastric cancer, there is a regularity to the spread of lymph node metastasis, and it does not easily metastasize outside the regional nodes. Furthermore, when its extent is limited, nodal metastasis of gastric cancer can be cured by appropriate lymph node dissection. Therefore, identifying and determining the extent of lymph node metastasis is important for ensuring accurate diagnosis and appropriate surgical treatment in patients with gastric cancer. However, precise detection of lymph node metastasis remains difficult. Most nodal metastases in gastric cancer are microscopic metastases, which often occur in small-sized lymph nodes, and are thus difficult to diagnose both preoperatively and intraoperatively. Preoperative nodal diagnoses are mainly made using computed tomography, although the specificity of this method is low because it is mainly based on the size of the lymph node. Furthermore, peripheral nodal metastases cannot be palpated intraoperatively, nodal harvesting of resected specimens remains difficult, and the number of lymph nodes detected vary greatly depending on the skill of the technician. Based on these findings, gastrectomy with prophylactic lymph node dissection is considered the standard surgical procedure for gastric cancer. In contrast, several groups have examined the value of sentinel node biopsy for accurately evaluating nodal metastasis in patients with early gastric cancer, reporting high sensitivity and accuracy. Sentinel node biopsy is also important for individualizing and optimizing the extent of uniform prophylactic lymph node dissection and determining whether patients are indicated for function-preserving curative gastrectomy, which is superior in preventing post-gastrectomy symptoms and maintaining dietary habits. Notably, advancements in surgical treatment for early gastric cancer are expected to result in individualized surgical strategies with sentinel node biopsy. Chemotherapy for advanced gastric cancer has also progressed, and conversion gastrectomy can now be performed after downstaging, even in cases previously regarded as inoperable. In this review, we discuss the importance of determining lymph node metastasis in the treatment of gastric cancer, the associated difficulties, and the need to investigate strategies that can improve the diagnosis of lymph node metastasis.
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Affiliation(s)
- Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Japan
- Department of General and Gastroenterologic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi City, Japan
| | - Hitoshi Saito
- Department of General and Gastroenterologic Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi City, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Japan
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Yu Y, Zhang Z, Meng Q, Wang K, Li Q, Ma Y, Yao Y, Sun J, Wang G. Efficacy of Different Number of XELOX or SOX Chemotherapy Cycles After D2 Resection for Stage III Gastric Cancer. J Gastric Cancer 2022; 22:107-119. [PMID: 35534448 PMCID: PMC9091457 DOI: 10.5230/jgc.2022.22.e11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/21/2022] [Accepted: 03/17/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yuanyuan Yu
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zicheng Zhang
- School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, China
| | - Qianhao Meng
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Ke Wang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qingwei Li
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yue Ma
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yuanfei Yao
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jie Sun
- School of Biomedical Engineering, Wenzhou Medical University, Wenzhou, China
| | - Guangyu Wang
- Department of Gastrointestinal Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
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44
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Survival outcomes of management in metastatic gastric adenocarcinoma patients. Sci Rep 2021; 11:23142. [PMID: 34848751 PMCID: PMC8633380 DOI: 10.1038/s41598-021-02391-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022] Open
Abstract
Chemotherapy is generally considered as the main treatment for metastatic gastric adenocarcinoma. The role of gastrectomy for metastatic gastric cancer without obvious symptoms is controversial. The objective of this study is to investigate survival outcomes of treatment modalities using a real-world data setting. A retrospective cohort study was designed using the Taiwan Cancer Registry database. We identified the treatment modalities and used Kaplan–Meier estimates and Cox regressions to compare patient survival outcomes. From 2008 to 2015, 5599 gastric adenocarcinoma patients were diagnosed with metastatic disease (M1). The median overall survival (OS) of patients with surgery plus chemotherapy had the longest survival of 14.2 months. The median OS of the patients who received chemotherapy alone or surgery alone was 7.0 and 3.9, respectively. Age at diagnosis, year of diagnosis, tumor grade, and treatment modalities are prognostic factors for survival. The hazard ratios for patients who received surgery plus chemotherapy, surgery alone, and supportive care were 0.47 (95% CI 0.44–0.51), 1.22 (95% CI 1.1–1.36), and 3.23 (95% CI 3.01–3.46), respectively, by multivariable Cox regression analysis when using chemotherapy alone as a referent. Chemotherapy plus surgery may have a survival benefit for some selected gastric adenocarcinoma patients with metastatic disease.
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45
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Pang HY, Zhao LY, Wang H, Chen XL, Liu K, Zhang WH, Yang K, Chen XZ, Hu JK. Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China. Front Oncol 2021; 11:587309. [PMID: 34707984 PMCID: PMC8542852 DOI: 10.3389/fonc.2021.587309] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/20/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the impact of postoperative complication and its etiology on long-term survival for gastric cancer (GC) patients with curative resection. METHODS From January 2009 to December 2014, a total of 1,667 GC patients who had undergone curative gastrectomy were analyzed. Patients with severe complications (SCs) (Clavien-Dindo grade III or higher complications or those causing a hospital stay of 15 days or longer) were separated into a "complication group." Univariate and multivariate analyses were performed to reveal the relationship between postoperative complications and long-term survival. A 2:1 propensity score matching (PSM) was used to balance baseline parameters between the two groups. RESULTS SCs were diagnosed in 168 (10.08%) patients, including different etiology: infectious complications (ICs) in 111 (6.66%) and non-infectious complications (NICs) in 71 (4.26%) patients. Multivariate analysis showed that presence of SCs (P=0.001) was an independent prognostic factor for overall survival, and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P=0.004) rather than NICs (P=0.068). After PSM, patients with SCs (p=0.002) still had a significantly decreased overall survival, and the presence of ICs (P=0.002) rather than NICs (P=0.067) showed a negative impact on long-term survival. CONCLUSION Serious complications, particularly of an infectious type, may have a negative impact on overall survival of GC patients. However, additional multicenter prospective studies with larger sample size are required to verify this issue.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jian-Kun Hu
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, Chengdu, China
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46
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Ozmen MM, Zulfikaroglu B, Ozmen F, Moran M, Ozalp N, Seckin S. D2 vs D2 Plus Para-aortic Lymph Node Dissection for Advanced Gastric Cancer. Turk J Surg 2021; 37:49-58. [PMID: 34585094 DOI: 10.47717/turkjsurg.2020.4931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
Objectives Gastric cancer is a common malignancy worldwide. Effective treatment by interdisciplinary cooperation is important, and surgery still plays an important role. Material and Methods In a ten-year period, 355 patients were diagnosed to have gastric cancer. One hundred and sixty-two patients with a median (range) age of 58 (23-83) years were eligible for the study. There were 107 patients in D2 and 55 patients in D2 lymphadenectomy plus para-aortic lymph node (PALN) dissection group. The two groups were compared in terms of complications, morbidity, mortality and long-term survival. Results Length of stay was 12 (8-34) days for D2 and 14 (8-42) days for D2 plus PALND. Total number of operative mortality was 8/162 (5%), and it was not different between the groups. Twenty patients (18%) had complications in D2 group and 9 (17%) patients in D2 plus PALND group. Overall survival was also similar between the groups, but patients with T3-T4 tumors, patients with stage IIIA and IIIB disease had better survival with D2 plus PALN dissection. We found that the depth of invasion, PLN, ratio (PLN/TLN), stage and LND were all prognostic variables. Conclusion This study showed that D2 plus PALN dissection for advanced gastric cancer can be performed as safely as a standard D2 dissection by experienced surgeons without increasing postoperative morbidity and mortality. D2 plus PALN dissection should be preferred in the advanced stage of the disease (IIIA-IIIB) as it increases the rate of survival.
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Affiliation(s)
- Mehmet Mahir Ozmen
- Department of Surgery, Medical School, Istinye University, Istanbul, Turkey.,General Surgery, Liv Hospital, Ankara, Turkey.,General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Baris Zulfikaroglu
- General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Fusun Ozmen
- Department of Basic Oncology, Cancer Institute, Hacettepe University, Ankara, Turkey.,Medical Oncology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Munevver Moran
- General Surgery, Liv Hospital, Ankara, Turkey.,General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Necdet Ozalp
- General Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Selda Seckin
- Pathology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
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47
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Wang C, Lin S, Zhang X, Yang C, Li W. Laparoscopic Gastrojejunostomy with Conversion Therapy in Gastric Outlet Obstruction Caused by Incurable Advanced Gastric Cancer. Cancer Manag Res 2021; 13:6847-6857. [PMID: 34512024 PMCID: PMC8420554 DOI: 10.2147/cmar.s322569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/14/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose The benefits of laparoscopic gastrojejunostomy (LGJ) combined with conversion therapy for malignant gastric outlet obstruction (GOO) caused by incurable advanced gastric cancer (AGC) are unclear. This study aimed to examine the feasibility and efficacy of LGJ followed by enteral nutrition and conversion therapy in malignant GOO. Patients and Methods The clinical outcomes for 66 patients with GOO due to incurable AGC were retrospectively evaluated. The patients were classified into multimodal therapy (LGJ, enteral nutrition, and chemotherapy, n = 35) and chemotherapy alone (n = 31) groups. Conversion surgery was defined as surgery aimed at R0 resection in initially incurable tumours. Results Compared to the chemotherapy group, multimodal therapy patients had improved oral intake, more chemotherapy cycles, better nutritional indices, less sarcopenia, and improved quality of life (QOL) post-treatment. Conversion surgery was performed in 17 multimodal therapy patients, with no perioperative mortality, and R0 resection achieved in 15 patients (88.2%). The median survival time of multimodal therapy patients was 16.7 months, compared to 4.5 months for chemotherapy patients. Multimodal therapy patients with conversion surgery had significantly longer overall survival than those without surgery (44.2 vs 8.5 months, respectively, P< 0.001). Multivariate analysis identified multimodal therapy and improved or stable QOL as independent prognostic factors. Conclusion Multimodal therapy was associated with better nutritional and metabolic status, a safely induced high conversion surgery rate with a high R0 resection rate, and a good prognosis. LGJ with enteral nutrition and conversion therapy may improve long-term survival in obstructive incurable AGC.
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Affiliation(s)
- Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, 350001, People's Republic of China
| | - Changshun Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China
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48
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Franceschilli M, Vinci D, Di Carlo S, Sensi B, Siragusa L, Guida A, Rossi P, Bellato V, Caronna R, Sibio S. Central vascular ligation and mesentery based abdominal surgery. Discov Oncol 2021; 12:24. [PMID: 35201479 PMCID: PMC8777547 DOI: 10.1007/s12672-021-00419-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022] Open
Abstract
In the nineteenth century the idea of a correct surgical approach in oncologic surgery moved towards a good lymphadenectomy. In colon cancer the segment is removed with adjacent mesentery, in gastric cancer or pancreatic cancer a good oncologic resection is obtained with adequate lymphadenectomy. Many guidelines propose a minimal lymph node count that the surgeon must obtain. Therefore, it is essential to understand the adequate extent of lymphadenectomy to be performed in cancer surgery. In this review of the current literature, the focus is on "central vascular ligation", understood as radical lymphadenectomy in upper and lower gastrointestinal cancer, the evolution of this approach during the years and the improvement of laparoscopic techniques. For what concerns laparoscopic surgery, the main goal is to minimize post-operative trauma introducing the "less is more" concept whilst preserving attention for oncological outcomes. This review will demonstrate the importance of a scientifically based standardization of oncologic gastrointestinal surgery, especially in relation to the expansion of minimally invasive surgery and underlines the importance to further investigate through new randomized trials the role of extended lymphadenectomy in the new era of a multimodal approach, and most importantly, an era where minimally invasive techniques and the idea of "less is more" are becoming the standard thought for the surgical approach.
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Affiliation(s)
- M Franceschilli
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - D Vinci
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy.
| | - S Di Carlo
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - B Sensi
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - L Siragusa
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - A Guida
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - P Rossi
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - V Bellato
- Department of Surgical Sciences, Minimally Invasive Surgery Unit, University of Rome "Tor Vergata", Rome, Italy
| | - R Caronna
- Department of Surgery Pietro Valdoni Unit of Oncologic and Minimally Invasive Surgery, Rome, Italy
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
| | - S Sibio
- Department of Surgery Pietro Valdoni Unit of Oncologic and Minimally Invasive Surgery, Rome, Italy
- Department of Surgical Science, Sapienza University of Rome, Rome, Italy
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49
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Wang F, Zhang X, Li Y, Tang L, Qu X, Ying J, Zhang J, Sun L, Lin R, Qiu H, Wang C, Qiu M, Cai M, Wu Q, Liu H, Guan W, Zhou A, Zhang Y, Liu T, Bi F, Yuan X, Rao S, Xin Y, Sheng W, Xu H, Li G, Ji J, Zhou Z, Liang H, Zhang Y, Jin J, Shen L, Li J, Xu R. The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2021. Cancer Commun (Lond) 2021; 41:747-795. [PMID: 34197702 PMCID: PMC8360643 DOI: 10.1002/cac2.12193] [Citation(s) in RCA: 350] [Impact Index Per Article: 116.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 02/05/2023] Open
Abstract
There exist differences in the epidemiological characteristics, clinicopathological features, tumor biological characteristics, treatment patterns, and drug selections between gastric cancer patients from the Eastern and Western countries. The Chinese Society of Clinical Oncology (CSCO) has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually. Taking into account regional differences, giving full consideration to the accessibility of diagnosis and treatment resources, these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China. The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis, treatment, follow-up, and screening of gastric cancer. Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines, this updated guideline integrates the results of major clinical studies from China and overseas for the past year, focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations. For the comprehensive treatment of non-metastatic gastric cancer, attentions were paid to neoadjuvant treatment. The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated. For the comprehensive treatment of metastatic gastric cancer, recommendations for immunotherapy were included, and immune checkpoint inhibitors from third-line to the first-line of treatment for different patient groups with detailed notes are provided.
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50
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Ludmir EB, Das P. Shifting sands: the role of radiotherapy for patients with gastric and gastroesophageal adenocarcinoma. Transl Gastroenterol Hepatol 2021; 6:50. [PMID: 34423171 PMCID: PMC8343419 DOI: 10.21037/tgh.2020.03.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/11/2020] [Indexed: 12/26/2022] Open
Abstract
Gastric adenocarcinoma, a leading cause of cancer-related mortality worldwide, is treated primarily with surgical resection in the non-metastatic setting. However, the optimal role and sequencing of adjunctive therapies, including radiotherapy (RT) as well as systemic therapy, remains unclear. A complex milieu of trials spanning several decades has evaluated different treatment strategies for gastric cancer, including the role of RT. In this review, we summarize the trial-level evidence for the diverse gastric cancer treatment paradigms. Despite initial success, postoperative RT has not shown a clear benefit in modern prospective studies in the setting of more aggressive surgical nodal dissection. On the other hand, the role of preoperative RT in optimizing oncologic outcomes for gastric cancer patients remains relatively under-explored; ongoing trials assessing preoperative RT aim to illuminate the optimal treatment strategy for non-metastatic gastric cancer patients.
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Affiliation(s)
- Ethan B Ludmir
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Prajnan Das
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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