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Meng C, Cao S, Tian Y, Shen S, Liu X, Li Z, Li Y, Sun Y, Xu J, Zhang X, Kong Y, Wang X, Yang H, Zhong H, Jia Z, Zhang D, Zhou Y. Short- and long-term outcomes of laparoscopic or robotic radical gastrectomy based on preoperative perigastric artery CTA surgical decision-making: a high-volume center retrospective study with propensity score matching. Surg Endosc 2023; 37:6930-6942. [PMID: 37328591 DOI: 10.1007/s00464-023-10170-2] [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: 11/04/2022] [Accepted: 04/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Some studies have demonstrated the short-term recovery course for patients who underwent laparoscopic gastrectomy according to preoperative computed tomography angiography (CTA) assessment. However, reports of the long-term oncological outcomes are still limited. METHODS The data of 988 consecutive patients who underwent laparoscopic or robotic radical gastrectomy between January 2014 and September 2018 were analyzed retrospectively at our center, and propensity score matching was used to eliminate bias. Study cohorts were divided into the CTA group (n = 498) and the non-CTA group (n = 490) depending on whether preoperative CTA was available. The primary and secondary endpoints were the 3-year overall survival (OS) and disease-free survival (DFS) rates and the intraoperative course and short-term outcomes, respectively. RESULTS 431 patients were included in each group after PSM. Compared with the non-CTA group, the CTA group had more harvested lymph nodes and less operative time, blood loss, intraoperative vascular injury and total cost, especially in the subgroup analysis with BMI ≥ 25 kg/m2 patients. There was no difference in the 3 year OS and DFS between the CTA group and the non-CTA group. When further stratified by BMI < 25 or ≥ 25 kg/m2, the 3-year OS and DFS were significantly higher in the CTA group than in the non-CTA group in terms of BMI ≥ 25 kg/m2. CONCLUSIONS Laparoscopic or robotic radical gastrectomy based on preoperative perigastric artery CTA surgical decision-making has the possibility of improving short-term outcomes. However, there is no difference in the long-term prognosis, except for a subgroup of patients with BMI ≥ 25 kg/m2.
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Affiliation(s)
- Cheng Meng
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Shuai Shen
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
- Department of Gastrointestinal Surgery, Weifang People's Hospital, Weifang, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Yu Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Yuqi Sun
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Jianfei Xu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Xingqi Zhang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Ying Kong
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
- Department of Gastrointestinal Surgery, Jining People's Hospital, Jining, China
| | - Xujie Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Hao Yang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Hao Zhong
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Zhuoyu Jia
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China.
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, Qingdao, China.
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Ikeda T, Kanaji S, Takiguchi G, Urakawa N, Hasegawa H, Yamamoto M, Matsuda Y, Yamashita K, Matsuda T, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y. Significance of prediction of the dorsal landmark using three-dimensional computed tomography during laparoscopic lymph node dissection along the proximal splenic artery in gastric cancer. SAGE Open Med 2020; 8:2050312120936918. [PMID: 32647576 PMCID: PMC7328210 DOI: 10.1177/2050312120936918] [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: 08/22/2019] [Accepted: 05/29/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: Dissection of the No. 11p lymph nodes is technically challenging because of
variations in anatomical landmarks. This study aimed to determine the
accuracy and efficacy of predicting the dorsal landmark of No. 11p lymph
node using three-dimensional computed tomography simulation. Methods: Laparoscopic gastrectomy with No. 11p lymph node dissection with preoperative
simulation using three-dimensional computed tomography was performed in 24
patients at our institution from October 2016 to May 2018. Initially,
preoperative three-dimensional computed tomography findings with operative
videos in these 24 patients were compared. The dorsal landmark was defined
as an anatomical structure behind the splenic artery on preoperative
three-dimensional computed tomography and operative videos. The dorsal
landmark of No. 11p lymph node was divided into four types: (1) splenic vein
type, (2) splenic vein and pancreas type, (3) pancreas type, and (4) unclear
type. Then, to investigate the efficacy of three-dimensional computed
tomography, we compared the clinical and pathological features and surgical
outcomes of nine patients who underwent preoperative three-dimensional
computed tomography simulation (three-dimensional computed tomography group)
and 23 patients who did not undergo three-dimensional computed tomography
simulation from August 2014 to September 2016 (non-three-dimensional
computed tomography group). All procedures were performed by one surgeon
certified by the Endoscopic Surgical Skill Qualification System in
Japan. Results: The concordance rate between three-dimensional computed tomography and
operative videos of the dorsal landmark using three-dimensional computed
tomography was 79% (19/24). The operative time of No. 11p lymph node
dissection was significantly shorter in the three-dimensional computed
tomography group than in the non-three-dimensional computed tomography group
(7.7 versus 15.8 min, P = 0.044). Conclusion: The accuracy of predicting the dorsal landmark of No. 11p lymph node using
three-dimensional computed tomography was extremely high. Preoperative
simulation with three-dimensional computed tomography was useful in
shortening the operative time of No. 11p lymph node dissection.
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Affiliation(s)
- Taro Ikeda
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Gosuke Takiguchi
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Naoki Urakawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Masashi Yamamoto
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshiko Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takeru Matsuda
- Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Satoshi Suzuki
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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