1
|
Eom BW, Yoon HM, Kim YW, Min JS, An JY, Hur H, Lee YJ, Cho GS, Park YK, Jung MR, Park JH, Hyung WJ, Jeong SH, Kook MC, Han M, Nam BH, Ryu KW. Quality of Life and Nutritional Outcomes of Stomach-Preserving Surgery for Early Gastric Cancer: A Secondary Analysis of the SENORITA Randomized Clinical Trial. JAMA Surg 2024; 159:900-908. [PMID: 38809537 PMCID: PMC11137655 DOI: 10.1001/jamasurg.2024.1210] [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: 10/19/2023] [Accepted: 03/08/2024] [Indexed: 05/30/2024]
Abstract
Importance The Sentinel Node Oriented Tailored Approach (SENORITA) randomized clinical trial evaluated quality of life (QoL) and nutritional outcomes between the laparoscopic sentinel node navigation surgery (LSNNS) and laparoscopic standard gastrectomy (LSG). However, there has been no report on the QoL and nutritional outcomes of patients who underwent stomach-preserving surgery among the LSNNS group. Objective To compare long-term QoL and nutritional outcomes between patients who underwent stomach-preserving surgery and those who underwent standard gastrectomy and to identify factors associated with poor QoL outcomes in patients who underwent stomach-preserving surgery. Design, Setting, and Participants This study is a secondary analysis of the SENORITA trial, a randomized clinical trial comparing LSNNS with LSG. Patients from 7 tertiary or general hospitals across the Republic of Korea were enrolled from March 2013 to December 2016, with follow-up through 5 years. Data were analyzed between August and September 2022. Among trial participants, patients who underwent actual laparoscopic standard gastrectomy in the LSG group and those who underwent stomach-preserving surgery in the LSNNS group were included. Patients who did not complete the baseline or any follow-up questionnaire were excluded. Intervention Stomach-preserving surgery vs standard gastrectomy. Main Outcomes and Measures Overall European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORTC QLQ-C30) and stomach module (STO22) scores, body mass index, hemoglobin, protein, and albumin levels. Results A total of 194 and 257 patients who underwent stomach-preserving surgery and standard gastrectomy, respectively, were included in this study (mean [SD] age, 55.6 [10.6] years; 249 [55.2%] male). The stomach-preserving group had better QoL scores at 3 months postoperatively in terms of physical function (87.2 vs 83.9), dyspnea (5.9 vs 11.2), appetite loss (13.1 vs 19.4), dysphagia (8.0 vs 12.7), eating restriction (10.9 vs 18.2), anxiety (29.0 vs 35.2), taste change (7.4 vs 13.0), and body image (19.5 vs 27.2). At 1 year postoperatively, the stomach-preserving group had significantly higher body mass index (23.9 vs 22.1, calculated as weight in kilograms divided by height in meters squared) and hemoglobin (14.3 vs 13.3 g/dL), albumin (4.3 vs 4.25 g/dL), and protein (7.3 vs 7.1 g/dL) levels compared to the standard group. Multivariable analyses showed that tumor location (greater curvature, lower third) was favorably associated with global health status (β, 10.5; 95% CI, 3.2 to 17.8), reflux (β, -8.4; 95% CI, -14.7 to -2.1), and eating restriction (β, -5.7; 95% CI, -10.3 to -1.0) at 3 months postoperatively in the stomach-preserving group. Segmental resection was associated with risk of diarrhea (β, 40.6; 95% CI, 3.1 to 78.1) and eating restriction (β, 15.1; 95% CI, 1.1 to 29.1) at 3 years postoperatively. Conclusions and Relevance Stomach-preserving surgery after sentinel node evaluation was associated with better long-term QoL and nutritional outcomes than standard gastrectomy. These findings may help facilitate decision-making regarding treatment for patients with early-stage gastric cancer. Trial Registration ClinicalTrials.gov Identifier: NCT01804998.
Collapse
Affiliation(s)
- Bang Wool Eom
- Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hong Man Yoon
- Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Young-Woo Kim
- Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Republic of Korea
- Currently with Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Young Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Ji Ho Park
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Myeong-Cherl Kook
- Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Mira Han
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Republic of Korea
- Department of Medical Research Collaborating Center, Seoul Metropolitan Government–Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Byung-Ho Nam
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
- Clinical Design Research Center, HERINGS The Institution of Advanced Clinical & Biomedical Research, Seoul, Republic of Korea
| | - Keun Won Ryu
- Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| |
Collapse
|
2
|
van Oosterom MN, Diaz-Feijóo B, Santisteban MI, Sánchez-Izquierdo N, Perissinotti A, Glickman A, Marina T, Torné A, van Leeuwen FWB, Vidal-Sicart S. Steerable DROP-IN radioguidance during minimal-invasive non-robotic cervical and endometrial sentinel lymph node surgery. Eur J Nucl Med Mol Imaging 2024; 51:3089-3097. [PMID: 38233608 PMCID: PMC11300633 DOI: 10.1007/s00259-023-06589-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/08/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE The recently introduced tethered DROP-IN gamma probe has revolutionized the way robotic radioguided surgery is performed, fully exploiting the nature of steerable robotic instruments. Given this success, the current first-in-human study investigates if the DROP-IN can also provide benefit in combination with steerable non-robotic instruments during conventional laparoscopic surgery, showing equivalence or even benefit over a traditional rigid gamma probe. METHODS The evaluation was performed in ten patients during laparoscopic cervical (n = 4) and endometrial (n = 6) cancer sentinel lymph node (SLN) procedures. Surgical guidance was provided using the hybrid, or bi-modal, SLN tracer ICG-99mTc-nanocolloid. SLN detection was compared between the traditional rigid laparoscopic gamma probe, the combination of a DROP-IN gamma probe and a steerable laparoscopic instrument (LaproFlex), and fluorescence imaging. RESULTS The gynecologists experienced an enlarged freedom of movement when using the DROP-IN + LaproFlex combination compared to the rigid laparoscopic probe, making it possible to better isolate the SLN signal from background signals. This did not translate into a change in the SLN find rate yet. In both cervical and endometrial cancer combined, the rigid probe and DROP-IN + LaproFlex combination provided an equivalent detection rate of 96%, while fluorescence provided 85%. CONCLUSION We have successfully demonstrated the in-human use of steerable DROP-IN radioguidance during laparoscopic cervical and endometrial cancer SLN procedures, expanding the utility beyond robotic procedures. Indicating an improved surgical experience, these findings encourage further investigation and consideration on a path towards routine clinical practice and improved patient outcome. TRIAL REGISTRATION HCB/2021/0777 and NCT04492995; https://clinicaltrials.gov/study/NCT04492995.
Collapse
Affiliation(s)
- Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Berta Diaz-Feijóo
- Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Isabel Santisteban
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
- Nuclear Medicine Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Núria Sánchez-Izquierdo
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ariel Glickman
- Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Tiermes Marina
- Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Aureli Torné
- Gynecology Oncology Unit, Institute Clínic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sergi Vidal-Sicart
- Fundació de Recerca Clínic Barcelona - Institut d'Investigacions Biomèdiques August Pi I Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Sadeghi R, Taheri R, Jangjoo A, Pakdel A, Arjmand MH, Motiei MR, Memar B, Aliakbarian M. Evaluation of the diagnostic value of Sentinel Lymph Node in patients with gastric adenocarcinoma. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2024; 12:21-26. [PMID: 38164234 PMCID: PMC10757058 DOI: 10.22038/aojnmb.2023.70461.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 01/03/2024]
Abstract
Objectives Sentinel lymph node biopsy (SLNB) has been proven as a safe and efficient procedure in some cancers like breast cancer and melanoma with a reduction of complications and side effects of unnecessary lymphadenectomy in many patients. However, the diagnostic value of SLNB in gastric cancer is a point of debate. This study evaluated the diagnostic value of SLNB using radiotracer and isosulphan blue dye injection in patients with Gastric Adenocarcinomas (GA). Methods This descriptive study was performed at Imam-Reza HOSPITAL on 39 patients diagnosed with GA with no lymphatic metastasis using two methods: the combination of radionuclide with isosulphan together (R&I) method compared with the isosulphan alone method. Lymphatic dissection was performed in all patients. The pathological results were compared between the sentinel lymph nodes (SLN) and other lymph nodes and their accordance rate was calculated. Results In the T1 group, the sentinel lymph node biopsy detection rate was 100% for the combination of the R&I method and 60% for the isosulphan method and the false negative rate was zero. These values respectively were 88.8% and 88.8% in the T2 group with a false negative rate of 75%. In the T3 group, the values were 100% for the combination of the R&I method and 93.7% for the isosulphan method with a false negative rate of 40%. In the combination of the R&I method, the sensitivity, specificity, and positive and negative predictive values were 57.9, 100, 100, and 69.2 percent respectively. Conclusion Based on the false negative rate (47.4%), SLNB by injection of isosulphan blue dye alone is not a diagnostic enough value for predicting lymph node metastasis in GA. Although, SLNB by combination of the R&I had better accuracy compared to the isosulphan alone, more studies with larger samples are needed to prove this result.
Collapse
Affiliation(s)
- Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Taheri
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Jangjoo
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akbar Pakdel
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad-Hassan Arjmand
- Transplant Research Center, Clinical research institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Motiei
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahram Memar
- Department of Pathology, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Aliakbarian
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Transplant Research Center, Clinical research institute, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
4
|
Yoo HJ, Lee H, Lee HH, Lee JH, Jun KH, Kim JJ, Song KY, Kim DJ. A Nomogram for Predicting Extraperigastric Lymph Node Metastasis in Patients With Early Gastric Cancer. J Gastric Cancer 2023; 23:355-364. [PMID: 37129158 PMCID: PMC10154132 DOI: 10.5230/jgc.2023.23.e18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND There are no clear guidelines to determine whether to perform D1 or D1+ lymph node dissection in early gastric cancer (EGC). This study aimed to develop a nomogram for estimating the risk of extraperigastric lymph node metastasis (LNM). MATERIALS AND METHODS Between 2009 and 2019, a total of 4,482 patients with pathologically confirmed T1 disease at 6 affiliated hospitals were included in this study. The basic clinicopathological characteristics of the positive and negative extraperigastric LNM groups were compared. The possible risk factors were evaluated using univariate and multivariate analyses. Based on these results, a risk prediction model was developed. A nomogram predicting extraperigastric LNM was used for internal validation. RESULTS Multivariate analyses showed that tumor size (cut-off value 3.0 cm, odds ratio [OR]=1.886, P=0.030), tumor depth (OR=1.853 for tumors with sm2 and sm3 invasion, P=0.010), cross-sectional location (OR=0.490 for tumors located on the greater curvature, P=0.0303), differentiation (OR=0.584 for differentiated tumors, P=0.0070), and lymphovascular invasion (OR=11.125, P<0.001) are possible risk factors for extraperigastric LNM. An equation for estimating the risk of extraperigastric LNM was derived from these risk factors. The equation was internally validated by comparing the actual metastatic rate with the predicted rate, which showed good agreement. CONCLUSIONS A nomogram for estimating the risk of extraperigastric LNM in EGC was successfully developed. Although there are some limitations to applying this model because it was developed based on pathological data, it can be optimally adapted for patients who require curative gastrectomy after endoscopic submucosal dissection.
Collapse
Affiliation(s)
- Hyun Joo Yoo
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hayemin Lee
- Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Han Hong Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Hyun Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Kyong-Hwa Jun
- Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jin-Jo Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Kyo-Young Song
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jin Kim
- Division of Gastrointestinal Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|