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Meng C, Cao S, Li L, Xia L, Chu X, Jiang L, Wang X, Wang H, Huang S, Duan Q, Sun Z, He Q, Hui X, Yang D, Zhang H, Li Z, Liu X, Tian Y, Sun Y, Li Y, Jiang H, Niu Z, Zhang J, Zhou Y. Short-term outcomes of preoperative computed tomography angiography versus standard assessment in patients with BMI ≥ 25.0 kg/m 2 undergoing laparoscopic gastrectomy: the GISSG20-01 randomized clinical trial. Gastric Cancer 2025; 28:283-293. [PMID: 39786664 DOI: 10.1007/s10120-024-01580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 12/27/2024] [Indexed: 01/12/2025]
Abstract
BACKGROUND Laparoscopic gastrectomy lacks hand-direct tactile sense and has a limited surgical field compared to laparotomy. Apart from textbook classification, there are anatomical variations in the gastric arteries. Laparoscopic gastrectomy presents technical difficulties and necessitates a more comprehensive comprehension of regional anatomy than open surgical procedures. We aimed to compare efficacy and safety of preoperative computed tomography angiography (CTA) associated with surgical decision-making for laparoscopic gastrectomy. METHODS The GISSG 20-01 study was a multicenter, open-label, randomized clinical trial. The enrollment criteria mainly included histologically confirmed gastric cancer patients with BMI ≥ 25 kg/m2. Eligible patients were randomly assigned to the CTA group or the non-CTA group in a 1:1 ratio. The primary endpoint was the volume of intraoperative blood loss. RESULTS Between November 2020 and December 2021, 382 patients were enrolled and randomly assigned. After exclusion of 25 patients, 357 patients were included in the modified intention-to-treat population (179 in the CTA group and 178 in the non-CTA group). The mean intraoperative blood loss (CTA vs non-CTA; 74.2 vs 95.0 mL, P = 0.005) and operation time (215.4 vs 231.2 min, P = 0.004) was significantly lower in the CTA group. Total number of retrieved lymph nodes was similar in two groups (32.2 vs 30.2, P = 0.070). The CTA group had a significantly lower surgery task load index sore than the non-CTA group (36.6 vs 41.7, P < 0.001). There was no significant difference in postoperative complications rate of 14.5% in the CTA group and 22.5% in the non-CTA group (difference, - 8.0% [95% CI, - 16.0 to 0.1]; P = 0.053). CONCLUSION Preoperative CTA associated with surgical decision-making could relieve surgery burden and lead to a better surgical performance compared with non-CTA support, which including decreased blood loss volume, vessel damage and operation time. TRIAL REGISTRATION NCT04636099.
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Affiliation(s)
- Cheng Meng
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan, China
| | - Lijian Xia
- Department of Gastrointestinal Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Xianqun Chu
- Department of Gastrointestinal Surgery, Jining No.1 People's Hospital, Jining, China
| | - Lixin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - XinJian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Hao Wang
- Department of Gastrointestinal Surgery, Dongying People's Hospital, Dongying, China
| | - Shusheng Huang
- Department of Gastrointestinal Surgery, People's Hospital of Jimo Qingdao, Qingdao, China
| | - Quanhong Duan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Zuocheng Sun
- Department of Oncological Surgery, Weifang People's Hospital, Weifang, China
| | - Qingsi He
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xizeng Hui
- Department of Gastrointestinal Surgery, Rizhao People's Hospital, Rizhao, China
| | - Daogui Yang
- Department of Gastrointestinal Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Yuqi Sun
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Yu Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Haitao Jiang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Zhaojian Niu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Jian Zhang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China.
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, China.
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Meng C, Cao S, Yu Q, Tian Y, Li Z, Liu X, Sun Y, Liu Q, Zhong H, Niu Z, Zhou Y. Short- and long-term comparison of robotic versus laparoscopic gastrectomy for gastric cancer patients with BMI≥30 kg/m 2: A propensity score matched analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107312. [PMID: 38071764 DOI: 10.1016/j.ejso.2023.107312] [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: 06/13/2023] [Revised: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Although minimally invasive surgery (MIS) for gastric patients has gained popularity in recent decades, reports on the comparison of short and long clinical outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer patients with BMI≥30 kg/m2 are still limited. METHODS A total of 226 obese gastric cancer patients who underwent either RG (n = 81) or LG (n = 145) were enrolled in this study between October 2014 and September 2022. Propensity score matching (PSM) (1:1) was performed to reduce confounding bias. Short-term and long-term outcomes were compared between the RG and LG groups. RESULTS The clinicopathological characteristics of 156 patients in the RG group (n = 79) and LG group (n = 79) were well balanced after PSM. Compared with the LG group, the RG group had a significantly shorter operation time, less estimated blood loss, more harvested lymph nodes, a faster postoperative recovery course, reduced surgical morbidity, and a shorter postoperative hospital stay. The long-term outcomes were comparable between the two groups. CONCLUSIONS RG is a safe and feasible approach for gastric cancer with a BMI≥30 kg/m2 and has better short-term clinical outcomes than LG. However, RG is similar to LG in terms of long-term prognosis.
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Affiliation(s)
- Cheng Meng
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Shougen Cao
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Qin Yu
- General Internal Medicine, Jimo People's Hospital, Qingdao, China
| | - Yulong Tian
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Zequn Li
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Xiaodong Liu
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Yuqi Sun
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Qi Liu
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Hao Zhong
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Zhaojian Niu
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China
| | - Yanbing Zhou
- Affiliated Hospital of Qingdao University, Department of Gastrointestinal Surgery, China; Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational Medicine, China.
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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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Jia Z, Cao S, Meng C, Liu X, Li Z, Tian Y, Yu J, Sun Y, Xu J, Liu G, Zhang X, Yang H, Zhong H, Wang Q, Zhou Y. Intraoperative performance and outcomes of robotic and laparoscopic total gastrectomy for gastric cancer: A high-volume center retrospective propensity score matching study. Cancer Med 2023; 12:10485-10498. [PMID: 36924361 PMCID: PMC10225175 DOI: 10.1002/cam4.5785] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/04/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Studies on robotic total gastrectomy (RTG) are currently limited. This study aimed to compare the intraoperative performance as well as short- and long-term outcomes of RTG and laparoscopic total gastrectomy (LTG). METHODS A total of 969 patients underwent robotic (n = 161) or laparoscopic (n = 636) total gastrectomy between October 2014 and October 2021. The two groups of patients were matched 1:3 using the propensity score matching (PSM) method. The intraoperative performance as well as short- and long-term outcomes of the robotic (n = 147) and the laparoscopic (n = 371) groups were compared. RESULTS After matching, the estimated intraoperative blood loss was lower (80.51 ± 68.77 vs. 89.89 ± 66.12, p = 0.008), and the total number of lymph node dissections was higher (34.74 ± 12.44 vs. 29.83 ± 12.22, p < 0.001) in the RTG group compared with the LTG group. More lymph node dissections at the upper edge of the pancreas were performed in the RTG group than in the LTG (12.59 ± 4.18 vs. 10.33 ± 4.58, p = 0.001). Additionally, postoperative recovery indicators and laboratory data were greater in the RTG group than those in the LTG group, while postoperative complications were comparable between the two groups (19.0% vs. 18.9%, p = 0.962). For overweight or obese patients with body mass indexes (BMIs) ≥25, certain clinical outcomes of the RTG remained advantageous, and no significant differences in three-year overall survival (OS) or relapse-free survival (RFS) were observed. CONCLUSIONS Robotic total gastrectomy demonstrated better intraoperative performance, could improve the short-term clinical outcomes of patients, and was more conducive to patient recovery. However, the long-term efficacies of the two approaches were similar. Robotic surgical systems may reduce surgical stress responses in patients, allowing them to receive postoperative chemotherapy sooner.
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Affiliation(s)
- Zhuoyu Jia
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Shougen Cao
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Cheng Meng
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Xiaodong Liu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Zequn Li
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yulong Tian
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Junjian Yu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yuqi Sun
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Jianfei Xu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Gan Liu
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Xingqi Zhang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Hao Yang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Hao Zhong
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Qingrui Wang
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
| | - Yanbing Zhou
- Department of Gastrointestinal SurgeryAffiliated Hospital of Qingdao UniversityQingdaoChina
- Shandong Provincial Key Laboratory of Gastrointestinal Tumor Basic and Translational MedicineQingdaoChina
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Liu P, Wei M, Sun D, Zhong X, Liang Y, Ouyang J, Zhang Y, Yu W. Study on the application of preoperative three-dimensional CT angiography of perigastric arteries in laparoscopic radical gastrectomy. Sci Rep 2022; 12:6026. [PMID: 35410341 PMCID: PMC9001703 DOI: 10.1038/s41598-022-09584-0] [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: 01/01/2022] [Accepted: 03/24/2022] [Indexed: 11/09/2022] Open
Abstract
To investigate the clinical value and significance of preoperative three-dimensional computerized tomography angiography (CTA) in laparoscopic radical gastrectomy for gastric cancer. The clinical data were analyzed retrospectively from 214 gastric cancer patients. We grouped according to whether to perform CTA, and we compared and analyzed the difference of the data between the two groups. The perigastric arteries were classified according to CTA images of patients in the CTA group. The celiac trunk was classified according to Adachi classification: Type I (118/125, 94.4%), Type II (3/125, 2.4%), Type III (0/125, 0%), Type IV (1/125, 0.8%), Type V (2/125, 1.6%), Type VI (1/125, 0.8%). Hepatic artery classification was performed according to Hiatt classification: Type I (102/125, 81.6%), Type II (9/125, 7.2%), Type III (6/125, 4.8%), Type IV (2/125, 1.6%), Type V (3/125, 2.4%), Type VI (0, 0%), Others (3/125, 2.4%). And this study combined vascular anatomy and surgical risk to establish a new splenic artery classification model. In comparison, the operation time, first exhaust time, and estimated blood loss in the CTA group were significantly lower than those in the non-CTA group. In addition, the blood loss in the CTA group combined with ICG (Indocyanine Green) labeled fluorescence laparoscopy was significantly less than that in the group without ICG labeled. Preoperative CTA could objectively evaluate patients' vascular route and variation and then help us avoid or decrease the risk of vascular injury and bleeding. When combined with ICG labeled fluorescence laparoscopy, it could further reduce the risk of iatrogenic injury during the operation and improve postoperative recovery.
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Tian Y, Cao S, Liu X, Li L, He Q, Jiang L, Wang X, Chu X, Wang H, Xia L, Ding Y, Mao W, Hui X, Shi Y, Zhang H, Niu Z, Li Z, Jiang H, Kehlet H, Zhou Y. Randomized Controlled Trial Comparing the Short-term Outcomes of Enhanced Recovery After Surgery and Conventional Care in Laparoscopic Distal Gastrectomy (GISSG1901). Ann Surg 2022; 275:e15-e21. [PMID: 33856385 PMCID: PMC8683257 DOI: 10.1097/sla.0000000000004908] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to compare the effects of ERAS and conventional programs on short-term outcomes after LDG. SUMMARY OF BACKGROUND DATA Currently, the ERAS program is broadly applied in surgical areas. Although several benefits of LDG with the ERAS program have been covered, high-level evidence is still limited, specifically in advanced gastric cancer. METHODS The present study was designed as a randomized, multicenter, unblinded trial. The enrollment criteria included histologically confirmed cT2-4aN0-3M0 gastric adenocarcinoma. Postoperative complications, mortality, readmission, medical costs, recovery, and laboratory outcomes were compared between the ERAS and conventional groups. RESULTS Between April 2019 and May 2020, 400 consecutive patients who met the enrollment criteria were enrolled. They were randomly allocated to either the ERAS group (n = 200) or the conventional group (n = 200). After excluding patients who did not undergo surgery or gastrectomy, 370 patients were analyzed. The patient demographic characteristics were not different between the 2 groups. The conventional group had a significantly longer allowed day of discharge and postoperative hospital stay (6.96 vs 5.83 days, P < 0.001; 8.85 vs 7.27 days, P < 0.001); a longer time to first flatus, liquid intake and ambulation (3.37 vs 2.52 days, P < 0.001; 3.09 vs 1.13 days, P < 0.001; 2.85 vs 1.38 days, P < 0.001, respectively); and higher medical costs (6826 vs 6328 $, P = 0.027) than the ERAS group. Additionally, patients in the ERAS group were more likely to initiate adjuvant chemotherapy earlier (29 vs 32 days, P = 0.035). There was no significant difference in postoperative complications or in the mortality or readmission rates. Regarding laboratory outcomes, the procalcitonin and C-reactive protein levels on postoperative day 3 were significantly lower and the hemoglobin levels on postoperative day 5 were significantly higher in the ERAS group than in the conventional group. CONCLUSION The ERAS program provides a faster recovery, a shorter postoperative hospitalization length, and lower medical costs after LDG without increasing complication and readmission rates. Moreover, enhanced recovery in the ERAS group enables early initiation of adjuvant chemotherapy.
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Affiliation(s)
- Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan, China
| | - Qingsi He
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lixin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Xinjian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Xianqun Chu
- Department of Gastrointestinal Surgery, Jining People's Hospital, Jining, China
| | - Hao Wang
- Department of Gastrointestinal Surgery, Dongying People's Hospital, Dongying, China
| | - Lijian Xia
- Department of Gastrointestinal Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Yinlu Ding
- Department of Gastrointestinal Surgery, Second Hospital of Shandong University, Jinan, China
| | - Weizheng Mao
- Department of Gastrointestinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xizeng Hui
- Department of Gastrointestinal Surgery, Rizhao People's Hospital, Rizhao, China
| | - Yiran Shi
- Department of Oncological Surgery, Weifang People's Hospital, Weifang, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, China
| | - Zhaojian Niu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haitao Jiang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Henrik Kehlet
- Section of Surgical Pathophysiology 7621, Rigshospitalet Copenhagen University, Copenhagen, Denmark
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
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Meng C, Cao S, Liu X, Li L, He Q, Xia L, Jiang L, Chu X, Wang X, Wang H, Hui X, Sun Z, Huang S, Duan Q, Yang D, Zhang H, Tian Y, Li Z, Zhou Y. Effect of preoperative CT angiography examination on the clinical outcome of patients with BMI ≥ 25.0 kg/m 2 undergoing laparoscopic gastrectomy: study protocol for a multicentre randomized controlled trial. Trials 2021; 22:912. [PMID: 34895320 PMCID: PMC8666026 DOI: 10.1186/s13063-021-05887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric cancer, which is the fifth most common malignancy and the third most common cause of cancer-related death, is particularly predominant in East Asian countries, such as China, Japan and Korea. It is a serious global health issue that causes a heavy financial burden for the government and family. To our knowledge, there are few reports of multicentre randomized controlled trials on the utilization of CT angiography (CTA) for patients who are histologically diagnosed with gastric cancer before surgery. Therefore, we planned this RCT to verify whether the utilization of CTA can change the short- and long-term clinical outcomes. METHOD The GISSG 20-01 study is a multicentre, prospective, open-label clinical study that emphasises the application of CTA for patients who will undergo laparoscopic gastrectomy to prove its clinical findings. A total of 382 patients who meet the inclusion criteria will be recruited for the study and randomly divided into two groups in a 1:1 ratio: the CTA group (n = 191) and the non-CTA group (n = 191). Both groups will undergo upper abdomen enhanced CT, and the CTA group will also receive CT angiography. The primary endpoint of this trial is the volume of blood loss. The second primary endpoints are the number of retrieved lymph nodes, postoperative recovery course, hospitalization costs, length of hospitalization days, postoperative complications, 3-year OS and 3-year DFS. DISCUSSION It is anticipated that the results of this trial will provide high-level evidence and have clinical value for the application of CTA in laparoscopic gastrectomy. TRIAL REGISTRATION ClinicalTrials.gov , NCT04636099. Registered November 19, 2020.
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Affiliation(s)
- Cheng Meng
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan, China
| | - Qingsi He
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lijian Xia
- Department of Gastrointestinal Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Lixin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Xianqun Chu
- Department of Gastrointestinal Surgery, Jining No.1 People's Hospital, Jining, China
| | - Xinjian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Hao Wang
- Department of Gastrointestinal Surgery, Dongying People's Hospital, Dongying, China
| | - Xizeng Hui
- Department of Gastrointestinal Surgery, Rizhao People's Hospital, Rizhao, China
| | - Zuocheng Sun
- Department of Oncological Surgery, Weifang People's Hospital, Weifang, China
| | - Shusheng Huang
- Department of Gastrointestinal Surgery, People's Hospital of Jimo District, Qingdao, China
| | - Quanhong Duan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Daogui Yang
- Department of Gastrointestinal Surgery, Liaocheng People's Hospital, Liaocheng, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, China
| | - Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China.
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Tian Y, Cao S, Li L, He Q, Xia L, Jiang L, Ding Y, Wang X, Wang H, Mao W, Hui X, Shi Y, Zhang H, Chu X, Kehlet H, Zhou Y. Effects of perioperative enhanced recovery after surgery pathway management versus traditional management on the clinical outcomes of laparoscopic-assisted radical resection of distal gastric cancer: study protocol for a randomized controlled trial. Trials 2020; 21:369. [PMID: 32357913 PMCID: PMC7193340 DOI: 10.1186/s13063-020-04272-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/20/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The incidence of gastric cancer in East Asia is much higher than the international average. Therefore, improving the prognosis of patients and establishing effective clinical pathways are important topics for the prevention and treatment of gastric cancer. At present, the enhanced recovery after surgery (ERAS) pathway is widely used in the field of gastric surgery. Many randomized controlled trial (RCT) studies have proven that the ERAS regimen can improve the short-term clinical outcomes of patients with gastric cancer. However, a prospective study on the effect of the ERAS pathway on the prognosis of patients with gastric cancer has not yet been reported. This trial aims to confirm whether the ERAS pathway can improve the disease-free survival and overall survival of patients undergoing laparoscopic-assisted radical resection for distal gastric cancer. METHODS/DESIGN This study is a prospective, multicentre RCT. This experiment will consist of two groups - an experimental group and a control group - randomly divided in a 1:1 ratio. The perioperative period of the experimental group will be managed according to the ERAS pathway and that of the control group will be managed according to the traditional management mode. An estimated 400 patients will be enrolled. The main endpoint for comparison is the 3-year overall survival and disease-free survival between the two groups. DISCUSSION The results of this RCT should clarify whether the ERAS pathway is superior to traditional treatment on inflammatory indexes, short-term clinical outcome and survival for laparoscopic-assisted radical resection of distal gastric cancer. It is hoped that our data will provide evidence that the ERAS pathway improves survival in patients with gastric cancer. TRIAL REGISTRATION Chinese Clinical Trial Registry, CHiCTR1900022438. Registered on 11 April 2019.
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Affiliation(s)
- Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Jinan, China
| | - Qingsi He
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lijian Xia
- Department of Gastrointestinal Surgery, Qianfoshan Hospital of Shandong Province, Jinan, China
| | - Lixin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Yinlu Ding
- Department of Gastrointestinal Surgery, Second Hospital of Shandong University, Jinan, China
| | - Xinjian Wang
- Department of Gastrointestinal Surgery, Weihai Central Hospital, Weihai, China
| | - Hao Wang
- Department of Gastrointestinal Surgery, Dongying People's Hospital, Dongying, China
| | - Weizheng Mao
- Department of Gastrointestinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xizeng Hui
- Department of Gastrointestinal Surgery, Rizhao People's Hospital, Rizhao, China
| | - Yiran Shi
- Department of Oncological Surgery, Weifang People's Hospital, Weifang, China
| | - Huanhu Zhang
- Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Weihai, China
| | - Xianqun Chu
- Department of Gastrointestinal Surgery, Jining People's Hospital, Jining, China
| | - Henrik Kehlet
- Section of Surgical Pathophysiology 4074, Rigshospitalet Copenhagen University, Copenhagen, Denmark
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, China.
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