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Erkul O, Cekic AB, Cansu A, Yildirim R, Guner A. Effects of Sarcopenia on Postoperative Outcomes in Patients Who Underwent Gastrectomy for Gastric Cancer. J Surg Res 2022; 274:196-206. [PMID: 35183030 DOI: 10.1016/j.jss.2021.12.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The relationship between sarcopenia and postoperative outcomes in patients with gastric cancer remains controversial. This study aimed to investigate the impact of sarcopenia on short-term outcomes after surgery for gastric cancer. METHODS Patients who underwent surgical treatment for gastric cancer were evaluated in this prospective observational study. Muscle strength, muscle mass, and physical performance were measured before surgery. Diagnosis of sarcopenia was based on the revised European Working Group on Sarcopenia criteria. Postoperative 30-day outcomes, including complications, reoperation, readmission, and operative mortality, were recorded. RESULTS Sarcopenia was observed in 31 out of 146 patients (21.2%). The overall complication incidence was 31.5%. The postoperative complication rate was higher in the sarcopenic patients compared to the nonsarcopenic patients (54.8% versus 25.2%, P = 0.003). There was no statistically significant difference in terms of surgical complication rates (25.8% versus 14.8%, P = 0.239), although the sarcopenic group had a significantly higher systemic complication rate (38.7% versus 13%, P = 0.003). No statistically significant difference was observed in terms of major complications (3.2% versus 5.2%, P = 1.000). Muscle strength, muscle mass, and physical performance were not identified as independent factors when tested alone at adjusted multivariable analysis. Sarcopenia (Odds ratio: 2.73, 95% CI 1.02-7.52, P = 0.047) and severe sarcopenia (Odds ratio: 4.44, 95% CI 1.57-13.34, P = 0.006) were identified as independent prognostic factors for postoperative complications. CONCLUSIONS Sarcopenia was associated with postoperative complications after gastrectomy for gastric cancer. Severe sarcopenia may serve as a more robust prognostic indicator. The variation in the complication rates between sarcopenic and nonsarcopenic patients was mainly due to difference in systemic complications rather than surgical complications.
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Affiliation(s)
- Oguz Erkul
- Faculty of Medicine, Department of General Surgery, Karadeniz Technical University, Trabzon, Turkey
| | - Arif Burak Cekic
- Faculty of Medicine, Department of General Surgery, Karadeniz Technical University, Trabzon, Turkey
| | - Aysegul Cansu
- Faculty of Medicine, Department of Radiology, Karadeniz Technical University, Trabzon, Turkey
| | - Reyyan Yildirim
- Faculty of Medicine, Department of General Surgery, Karadeniz Technical University, Trabzon, Turkey
| | - Ali Guner
- Faculty of Medicine, Department of General Surgery, Karadeniz Technical University, Trabzon, Turkey; Department of Biostatistics and Medical Informatics, Institute of Medical Science, Karadeniz Technical University, Trabzon, Turkey.
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Ağcaoğlu O, Şengün B, Tarcan S, Aytaç E, Bayram O, Zenger S, Benlice Ç, Özben V, Balık E, Baca B, Hamzaoğlu İ, Karahasanoğlu T, Buğra D. Minimally invasive versus open surgery for gastric cancer in Turkish population. Turk J Surg 2021. [DOI: 10.47717/turkjsurg.2021.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: In this study, it was aimed to compare short-term outcomes of minimally invasive and open surgery for gastric cancer in the Turkish population carrying both European and Asian characteristics.
Material and Methods: Short-term (30-day) outcomes of the patients undergoing minimally invasive and open gastrectomy with D2 lymphadenec- tomy for gastric adenocarcinoma between January 2013 and December 2017 were compared. Patient demographics, history of previous abdominal surgery, comorbidities, short-term perioperative outcomes and histopathological results were evaluated between the study groups.
Results: There were a total of 179 patients. Fifty (28%) patients underwent minimally invasive [laparoscopic (n= 19) and robotic (n= 31)] and 129 (72%) patients underwent open surgery. There were no differences between the two groups in terms of age, sex, body mass index and ASA scores. While operative time was significantly longer in the minimally invasive surgery group (p< 0.0001), length of hospital stay and operative morbidity were com- parable between the groups.
Conclusion: While both laparoscopic and robotic surgery is safe and feasible in terms of short-term outcomes in selected patients, long operating time and increased cost are the major drawbacks of the robotic technique preventing its widespread use.
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Aktas A, Aytac E, Bas M, Gunes O, Tarcan SH, Esen E, Gokler C, Aghayeva A, Uylas U, Ozben V, Zengin A, Sumer F, Baca B, Hamzaoglu I, Kayaalp C, Karahasanoglu T. Totally minimally invasive radical gastrectomy with the da Vinci Xi ® robotic system versus straight laparoscopy for gastric adenocarcinoma. Int J Med Robot 2020; 16:1-9. [PMID: 32757483 DOI: 10.1002/rcs.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data regarding the outcomes of pure minimally invasive techniques of radical gastrectomy are scarce. We aimed to compare short-term post-operative outcomes in patients undergoing totally minimally invasive radical gastrectomy with the da Vinci Xi® robotic system versus straight laparoscopy for gastric adenocarcinoma. METHODS Between December 2013 and March 2018, robotic and laparoscopic radical gastrectomy performed in two centres were included. Both groups were compared with respect to perioperative short-term outcomes. RESULTS Ninety-four patients were included in the study. Anticoagulant and neoadjuvant chemotherapy use were higher in the robotic group (p = 0.02, p = 0.02). There were conversions in the laparoscopy group whereas no conversions occurred in the robotic group (p = 0.052). Operating time in the robotic group was longer (p = 0.001). The number of harvested lymph nodes in the laparoscopic group was higher (p = 0.047). CONCLUSION Totally robotic technique with the da Vinci Xi® robotic system provides similar short-term results compared to laparoscopic surgery in radical gastrectomy.
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Affiliation(s)
- Aydin Aktas
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Erman Aytac
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mustafa Bas
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Orgun Gunes
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Serim Hande Tarcan
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Eren Esen
- Langone Medical Center, New York University, New York, New York, USA
| | - Cihan Gokler
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Afag Aghayeva
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ufuk Uylas
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Volkan Ozben
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Akile Zengin
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Fatih Sumer
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Bilgi Baca
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ismail Hamzaoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Cuneyt Kayaalp
- Department of Gastrointestinal Surgery, Inonu University, Malatya, Turkey
| | - Tayfun Karahasanoglu
- Department of General Surgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Güner A. The efficacy of clinical pathway in gastric cancer surgery. Turk J Surg 2020; 36:39-47. [PMID: 32637874 DOI: 10.5578/turkjsurg.4547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 12/24/2022]
Abstract
Objectives Clinical pathways are useful tools for surgical quality improvement and better peri-operative clinical outcomes for patients undergoing major surgery. This study aimed to evaluate the influence of clinical pathway on early postoperative outcomes for gastric cancer patients. Material and Methods The study was designed as a retrospective cohort observational study. Patients who had undergone curative gastrectomy for gastric cancer were evaluated by using the gastric cancer database, which was prospectively maintained. The patients were divided into two groups based on the date when the clinical pathway was first used: The control group (May 2015-May 2016) and the clinical pathway group (June 2016-December 2017). Early postoperative outcomes including the length of hospital stay, start of the day of diet, and 30-day complications including reoperation, and operative mortality were compared after propensity score matching. Results A total of 101 patients were analyzed, and the data of 70 patients (35 patients in each group) were compared after matching. Clinical pathway group demonstrated shorter hospital stay, earlier nasogastric tube removal, and start of earlier liquid/soft diet. Overall complication rate was lower in the clinical pathway group, while there was no statistically significant difference in major complication rates. No statistically significant difference was observed between the groups in terms of reoperation and operative mortality. Conclusion Clinical pathway may shorten the postoperative length of hospital stay and reduce the overall complication rate without increasing major morbidity in patients undergoing elective gastric cancer surgery.
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Affiliation(s)
- Ali Güner
- Department of General Surgery, Karadeniz Technical University School of Medicine, Trabzon, Turkey.,Department of Biostatistics and Medical Informatics, Karadeniz Technical University Institute of Medical Science, Trabzon, Turkey
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Aytaç E, Aslan F, Çicek B, Erdamar S, Gürses B, Güven K, Falay O, Karahasanoğlu T, Selçukbiricik F, Selek U, Atalar B, Balık E, Tözün N, Rozanes İ, Arıcan A, Hamzaoğlu İ, Baca B, Molinas Mandel N, Saruç M, Göksel S, Demir G, Ağaoğlu F, Yakıcıer C, Özbek U, Özben V, Özyar E, Güner AL, Er Ö, Kaban K, Bölükbaşı Y, Buğra D, Group Tİ. Dealing with the gray zones in the management of gastric cancer: The consensus statement of the İstanbul Group. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 30:584-598. [PMID: 30541724 DOI: 10.5152/tjg.2018.18737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes. The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized a consensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practice for this challenging disease. The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determined in the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions. The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patient selection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues in the management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results section with related data.
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Affiliation(s)
- Erman Aytaç
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Fatih Aslan
- Koç University School of Medicine, İstanbul, Turkey
| | - Bahattin Çicek
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Sibel Erdamar
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Bengi Gürses
- Koç University School of Medicine, İstanbul, Turkey
| | - Koray Güven
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Okan Falay
- Koç University School of Medicine, İstanbul, Turkey
| | | | | | - Uğur Selek
- Koç University School of Medicine, İstanbul, Turkey
| | - Banu Atalar
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Emre Balık
- Koç University School of Medicine, İstanbul, Turkey
| | - Nurdan Tözün
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | | | - Ali Arıcan
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - İsmail Hamzaoğlu
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Bilgi Baca
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | | | - Murat Saruç
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Süha Göksel
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Gökhan Demir
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Fulya Ağaoğlu
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Cengiz Yakıcıer
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Uğur Özbek
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Volkan Özben
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Enis Özyar
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Ahmet Levent Güner
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Özlem Er
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Kerim Kaban
- Koç University School of Medicine, İstanbul, Turkey
| | - Yasemin Bölükbaşı
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Dursun Buğra
- Koç University School of Medicine, İstanbul, Turkey
| | - The İstanbul Group
- Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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Guner A, Yildirim R. Surgical management of metastatic gastric cancer: moving beyond the guidelines. Transl Gastroenterol Hepatol 2019; 4:58. [PMID: 31559339 DOI: 10.21037/tgh.2019.08.03] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/05/2019] [Indexed: 01/27/2023] Open
Abstract
Despite decreasing incidence, gastric cancer remains a major health problem worldwide and is associated with poor survival. The poor survival is mainly attributed to delayed presentation which may cause local or systemic metastases. The standard of care for patients with metastatic gastric cancer (MGC) is palliative chemotherapy with best supportive care. Although the survival has improved owing to advances in chemotherapeutic agents, it is still unsatisfactory, and some perspective changes are needed in the management of MGC to improve the outcomes. Therefore, various alternative treatment strategies for MGC have formed the most important research topics. Liver-directed treatment (LDT) options such as liver resection, radiofrequency ablation (RFA), microwave ablation (MWA), and hepatic artery infusion chemotherapy (HAIC) have been studied in the management of liver metastasis from gastric cancer (LMGC). Intraperitoneal chemotherapy (IPC) in addition to cytoreductive surgery (CRS) aiming to remove all macroscopic tumor focus resulting from peritoneal dissemination is the treatment option for peritoneal metastasis, while para-aortic lymph node dissection is the treatment option for para-aortic lymph node metastasis which is considered to be M1 disease. Conversion surgery is a novel concept aiming at R0 resection for originally unresectable or marginally resectable tumors after a remarkably good response to the chemotherapy. Large amounts of data in the literature have demonstrated the benefits of individualized approaches such as the combination of systemic and local treatment options in selected patient groups. In this review, we aimed to explore the current and future treatment options by reviewing the literature on this controversial topic.
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Affiliation(s)
- Ali Guner
- Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.,Department of Biostatistics and Medical Informatics, Institute of Medical Science, Karadeniz Technical University, Trabzon, Turkey
| | - Reyyan Yildirim
- Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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