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Jeong SH, Min JS, Kim YW, Yoon HM, An JY, Eom BW, Hur H, Lee YJ, Cho GS, Park YK, Jung MR, Park JH, Hyung WJ, Kook MC, Han M, Nam BH, Ryu KW. Clinicopathological Factors Affecting Stomach Preservation Following Laparoscopic Sentinel Node Navigation Surgery in Patients with Early Gastric Cancer: A Secondary Analysis of the Multicenter Randomized Phase III SENORITA Trial. Ann Surg Oncol 2025; 32:4280-4291. [PMID: 40117015 DOI: 10.1245/s10434-025-17114-1] [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: 12/18/2024] [Accepted: 02/18/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND The SENORITA phase III trial demonstrated the effectiveness of laparoscopic sentinel node navigation surgery (LSNNS) in preserving stomach function for patients with early gastric cancer (EGC), although some patients experienced surgical failure or recurrence. The purpose of this study was to analyze patients' clinicopathologic features from the SENORITA trial who were allocated to LSNNS with stomach-preserving surgery but ultimately did not preserve stomach or experienced recurrence. PATIENTS AND METHODS Patients were categorized into two groups: the failure group (stomach preservation failure or cancer recurrence after LSNNS) and the success group (stomach preservation without recurrence following LSNNS). This study analyzed the detailed clinicopathologic characteristics of patients in the failure group from the SENORITA trial. RESULTS Among 258 patients who underwent LSNNS, 193 patients (74.8%) achieved stomach preservation, while 65 patients (25.2%) failed to preserve. Intraoperative failure was the most common cause of unsuccessful stomach preservation, occurring in 35 of 65 cases (53.8%). Advanced pathological TNM stage was the only independent risk factor by multivariate analysis, with stage IB and IIA patients showing 5.9- and 45.0-fold higher failure risks. The main causes of failure included sentinel basin detection failure, metastatic lymph nodes, positive tumors at resection margins, and complications. The failure group also included five cases of gastric cancer recurrence following LSNNS. CONCLUSION Accurate preoperative staging and patient selection are crucial for optimizing LSNNS outcomes. Ensuring precise resection with an adequate number of harvested sentinel basin nodes is essential to succeed the stomach-preserving surgery.
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Affiliation(s)
- Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jae-Seok Min
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul, and Department of Surgery, Korea University College of Medicine, Seoul, Korea.
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea.
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Korea
- Department of Cancer Policy and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Cherl Kook
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Korea
| | - Mira Han
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Korea
- Medical Research Collaborating Center, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byung-Ho Nam
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
- Clinical Design Research Center, HERINGS The Institution of Advanced Clinical and Biomedical Research, Seoul, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang, Korea
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Seo WJ, Lee S, Jang YJ, Choi SI, Kim JH. Lymphatic invasion as the solitary risk factor for extraperigastric lymph node metastasis in early gastric cancer. Surgery 2025; 181:109157. [PMID: 39919694 DOI: 10.1016/j.surg.2025.109157] [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: 09/19/2024] [Revised: 12/19/2024] [Accepted: 01/08/2025] [Indexed: 02/09/2025]
Abstract
BACKGROUND Lymph node metastasis, particularly to extraperigastric lymph nodes, is an important issue in determining the suitability of minimally invasive treatment for early gastric cancer. However, there is a paucity of research focused on identifying risk factors for extraperigastric lymph node metastasis, which is crucial for optimizing treatment selection. METHODS Patients who underwent radical gastrectomy for early gastric cancer between 2007 and 2023 at Korea University Guro Hospital and Kyung Hee University Hospital at Gandong in Seoul, Korea, were reviewed retrospectively. We compared clinicopathologic characteristics to find out risk factors for lymph node metastasis between the no lymph node metastasis, perigastric lymph node metastasis, and extraperigastric lymph node metastasis groups. RESULTS A total of 1,021 patients were included in the study, with 90.0% in the lymph node metastasis, 7.94% in perigastric lymph node metastasis, and 2.06% in extraperigastric lymph node metastasis groups. Clinicopathologic analysis revealed the lymph node metastasis group exhibited a greater prevalence of mucosal lesions (55.2%), whereas the perigastric lymph node metastasis and extraperigastric lymph node metastasis groups demonstrated a greater incidence of SM3 invasion (55.6% and 52.4%, respectively; P < .001). Lymphatic invasion were found to be significantly different among the groups (P < .001). Multinomial logistic regression identified lymphatic invasion as a sole significant risk factor for the perigastric lymph node metastasis and extraperigastric lymph node metastasis groups. The 5-year relapse-free survival rates were 99.0% (lymph node metastasis), 94.5% (perigastric lymph node metastasis), and 100% (extraperigastric lymph node metastasis) (P = .011). CONCLUSION This multicenter retrospective analysis indicates that lymphatic invasion is the primary independent predictor of extraperigastric lymph node metastasis in patients with early gastric cancer. Future prospective research is warranted to validate this result and establish guidelines for treatment decision-making for early gastric cancer.
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Affiliation(s)
- Won Jun Seo
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sangjun Lee
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - You-Jin Jang
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jong-Han Kim
- Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea.
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Calì M, Aiolfi A, Sato S, Hwang J, Bonitta G, Albanesi F, Bonavina G, Cavalli M, Campanelli G, Biondi A, Bonavina L, Bona D. Effect of Indocyanine Green-Guided Lymphadenectomy During Gastrectomy on Survival: Individual Patient Data Meta-Analysis. Cancers (Basel) 2025; 17:980. [PMID: 40149314 PMCID: PMC11940200 DOI: 10.3390/cancers17060980] [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: 12/29/2024] [Revised: 02/14/2025] [Accepted: 03/12/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND Indocyanine green-guided (ICG-guided) lymphadenectomy during gastrectomy for cancer has been proposed to enhance the accuracy of lymphadenectomy. The impact of ICG-guided lymphadenectomy on patient survival remains debated. METHODS The findings of the systematic review were reconstructed into an individual patient data (IDP) meta-analysis with restricted mean survival time difference (RMSTD). Overall survival (OS) and disease-free (DFS) survival were primary outcomes. RMSTD, standardized mead difference (SMD), and 95% confidence intervals (CI) were used as pooled effect size measures. RESULTS Three studies (6325 patients) were included; 42% of patients underwent ICG-guided lymphadenectomy. The patients' age ranged from 47 to 72 years and 58% were males. Proximal, distal, and total gastrectomy were completed in 6.8%, 80.4%, and 12.8% of patients, respectively. The surgical approach was laparoscopic (62.3%) and robotic (37.7%). ICG-guided lymphadenectomy was associated with a higher number of harvested lymph nodes compared to non-ICG-guided lymphadenectomy (SMD 0.50; 95% CI 0.45-0.55). At the 42-month follow-up, OS and DFS estimates for ICG-guided vs. non-ICG-guided lymphadenectomy were 0.5 months (95% CI -0.01, 1.1) and 1.3 months (95% CI 0.39, 2.15), respectively. CONCLUSIONS Our analysis suggests that ICG-guided lymphadenectomy offers equivalent long-term OS and DFS compared to non-ICG-guided lymphadenectomy.
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Affiliation(s)
- Matteo Calì
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20122 Milan, Italy; (M.C.); (M.C.); (G.C.); (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, 20122 Milan, Italy; (M.C.); (M.C.); (G.C.); (D.B.)
| | - Sho Sato
- Department of Surgery, Minimally Invasive UGI Surgery and Oncology, Yokohama City University Gastroenterological Center, Yokohama 232-0024, Japan;
| | - Jawon Hwang
- Minimally Invasive UGI Surgery, Severance Hospital–Division of General Surgery, Seoul 03722, Republic of Korea;
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20122 Milan, Italy; (M.C.); (M.C.); (G.C.); (D.B.)
| | - Francesca Albanesi
- Department of Oncologic Surgery 1–HPB, Division of General Surgery, Fondazione I.R.C.C.S Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Giulia Bonavina
- Department of Obstetrics and Gynecology, IRCCS MultiMedica, 20138 Milan, Italy;
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20122 Milan, Italy; (M.C.); (M.C.); (G.C.); (D.B.)
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20122 Milan, Italy; (M.C.); (M.C.); (G.C.); (D.B.)
| | - Antonio Biondi
- G. Rodolico Hospital, Surgical Division, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95131 Catania, Italy;
| | - Luigi Bonavina
- IRCCS Policlinico San Donato, Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, 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, 20122 Milan, Italy; (M.C.); (M.C.); (G.C.); (D.B.)
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Chen H, Jing S, Li Z, Cao L, Guan W, Chen X, Wang M. Impact of distal or pylorus preserving gastrectomy on postoperative quality of life in T1 stage middle third gastric cancer patients. Sci Rep 2025; 15:8632. [PMID: 40082480 PMCID: PMC11906802 DOI: 10.1038/s41598-025-90866-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 02/17/2025] [Indexed: 03/16/2025] Open
Abstract
Pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) are widely utilized surgical approaches for the treatment of gastric cancer. In this study, we employed questionnaire surveys and follow-up assessments to examine the effects of these surgical procedures on postoperative quality of life and pancreatic exocrine function in patients with stage T1 middle-third gastric cancer. A retrospective cohort study was conducted to analyze clinical and follow-up data from 63 gastric cancer patients who underwent distal gastrectomy and 21 who underwent pylorus-preserving gastrectomy at Nanjing University Drum Tower Hospital between January 2019 and January 2023. Patients were categorized into two groups: distal gastrectomy (n = 63) and pylorus-preserving gastrectomy (n = 21). The primary outcome measure was postoperative quality of life assessed at 1 year using the Gastric Resection Syndrome Assessment Scale, Gastroparesis Cardinal Symptom Index (GSCI), and Pancreatic Exocrine Insufficiency Questionnaire (PEI-Q). Secondary outcomes included intraoperative and postoperative conditions, incidence of complications, and changes in nutritional status at 6 and 12 months post-surgery. Compared to the DG group, the PPG group exhibited fewer lymph node dissections [20 (17, 26) vs. 25 (19.5, 32), Z = 2.013, P = 0.052], shorter distances from the upper resection margin [2.0 (1.3, 3.0) vs. 3.5 (2.5, 4.75), Z = 4.664, P = 0.0002], and shorter distances from the lower resection margin [2.0 (1.4, 3.0) vs. 4.5 (4.0, 5.5), Z = 6.691, P < 0.001]. However, they experienced longer operative times [270 (240, 300) vs. 220 (187.5, 257.5), Z = 4.133, P = 0.0002], postoperative gas discharge times [4 (4, 5) vs. 4 (3, 4), Z = 5.96, P < 0.0001], and postoperative hospital stays [12 (10, 14) vs. 10 (9, 12), Z = 1.493, P = 0.0098]. One year postoperatively, patients in the PPG group demonstrated superior quality of life scores compared to the DG group in terms of the dumping symptom scale [1.0 (1.0, 1.33) vs. 2.5 (1.75, 2.5), Z = 7.192, P < 0.001], amount of food intake per meal [6 (6, 7) vs. 6 (4, 6), Z = 4.724, P = 0.0008], and meal quality scale [4.0 (3.67, 4.0) vs. 2.33 (1.67, 2.67), Z = 11.554, P < 0.0001]. Additionally, preoperative serum albumin levels were higher in the PPG group compared to the DG group [41.7 (40.3, 43) vs. 40.2 (39.15, 41.3), Z = 2.916, P = 0.006], and the PPG group had a lower rate of postoperative chemotherapy requirement (P = 0.024). Compared to distal gastrectomy (DG), pylorus-preserving gastrectomy (PPG) results in fewer dumping symptoms and an improved quality of life for patients following surgery. This makes PPG a highly favorable surgical option for treating stage T1 middle-third gastric cancer.
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Affiliation(s)
- Hao Chen
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Siqing Jing
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Zhaoping Li
- Division of Gastric Surgery, Department of General Surgery, Drum Tower Clinical Medical College, Nanjing Drum Tower Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lianlian Cao
- Division of Gastric Surgery, Department of General Surgery, Drum Tower Clinical Medical College, Nanjing Drum Tower Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenxian Guan
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Xin Chen
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
| | - Meng Wang
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
- Division of Gastric Surgery, Department of General Surgery, Drum Tower Clinical Medical College, Nanjing Drum Tower Hospital, Nanjing University of Chinese Medicine, Nanjing, China.
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Van Du N, Anh Tuan N, Ngoc Cuong L. Comparative study of ICG and non-ICG-guided laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis at a single center. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2025; 7:e000313. [PMID: 40051652 PMCID: PMC11883552 DOI: 10.1136/bmjsit-2024-000313] [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: 08/03/2024] [Accepted: 02/03/2025] [Indexed: 03/09/2025] Open
Abstract
ABSTRACT Objectives To investigate the effectiveness of indocyanine green (ICG) lymphography in improving lymph nodes (LNs) harvesting during laparoscopic radical distal gastrectomy for gastric cancer. Design Non-randomized trial, prospective study compared ICG and non-ICG group using 1:1 propensity score matching (PSM) method. Setting Preoperative clinical characteristics, operative outcomes, and follow-up results. Participants 242 patients who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer between 2019 and 2023. After exclusion and PSM, 160 patients (Pts) were included, paired in two groups: ICG (80 Pts) and non-ICG (80 Pts). Interventions Patients in the ICG group underwent ICG injection submucosal via endoscopy 1 day before surgery. Main outcome measures Comparison of the number of retrieved LNs and complications between the ICG and non-ICG group. Results There were no significant differences in age, sex, height, tumor size, pathological Tumor-stage, histological differentiation, and complications between the two groups. There was a shorter operative time in the ICG group compared with the non-ICG group (median: 118 mins (IQR, 105-135) vs 146 mins (IQR, 120-180), respectively). Regarding the effectiveness of LN dissection: the ICG group had a higher median of retrieved LNs than the non-ICG group (36 LNs (IQR, 29-46) vs 27 LNs (IQR, 21-31); p<0.001). The mean number of metastatic LNs in the ICG group was significantly higher than in the non-ICG group, with 2.6±5.4 LNs compared with 0.9±3.1 LNs, respectively (p=0.018). The proportion of patients with more than 25 and 30 retrieved LNs was higher in the ICG group compared with the non-ICG group, with rates of 86% and 71% versus 64% and 31%, respectively (p<0.001). Conclusions Using ICG fluorescence-guided LNs dissection has increased both the number of total LNs and metastatic LNs dissection without increasing complications in laparoscopic distal gastrectomy for gastric cancer.
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Affiliation(s)
- Nguyen Van Du
- Department of Gastrointestinal Tract Surgery, Military Central Hospital, Ha Noi, Viet Nam
| | - Nguyen Anh Tuan
- Department of Gastrointestinal Tract Surgery, Military Central Hospital, Ha Noi, Viet Nam
| | - Luong Ngoc Cuong
- Department of Gastrointestinal and Hepatobiliary Surgery, Thai Nguyen National Hospital, Thai Nguyen, Viet Nam
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Kim J, Lee HJ. Function Preserving Gastrectomy and Quality of Life. J Gastric Cancer 2025; 25:247-260. [PMID: 39822178 PMCID: PMC11739640 DOI: 10.5230/jgc.2025.25.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 12/24/2024] [Accepted: 12/24/2024] [Indexed: 01/19/2025] Open
Abstract
Advances in gastric cancer screening have enabled earlier detection, shifting the focus of treatment toward preserving patients' quality of life (QoL). Function-preserving gastrectomy (FPG), including pylorus-preserving gastrectomy, proximal gastrectomy, and sentinel node navigation surgery, represents a paradigm shift in the surgical management of early gastric cancer. These techniques aim to balance oncological safety with the preservation of gastric function, mitigating postgastrectomy syndromes such as dumping syndrome, bile reflux, and nutritional deficiencies. QoL assessment tools, including EORTC QLQ-STO22, KOQUSS-40, and PGSAS-45, have become integral for evaluating patient-reported outcomes, providing insights into physical, emotional, and functional recovery. Although current evidence underscores the benefits of FPG, most studies are limited to East Asia, highlighting the need for multinational trials to validate these findings globally. FPG has demonstrated comparable short- and long-term oncological outcomes to conventional gastrectomy. Enhanced nutritional recovery and reduced gastrointestinal sequelae make FPG increasingly attractive. However, its widespread adoption is challenged by technical complexity, resource intensity, and the need for adequate surgical experience. The integration of advanced technologies, such as robotic surgery and artificial intelligence, coupled with personalized approaches, is expected to further optimize FPG outcomes. This review underscores the critical role of standardized QoL assessments, collaborative research, and technological innovations in advancing FPG as a cornerstone of patient-centered gastric cancer care.
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Affiliation(s)
- Jeesun Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Yan Z, Wei M, Zhang T, Guo J, Yu A, Liang Y, Huang Y, Cui X, Wang H, Zhou K, Dong Z, Yu W. Vagus Nerve Preservation for Early Distal Gastric Cancer With Monitoring and Indocyanine Green Labeling: A Randomized Clinical Trial. JAMA Surg 2025; 160:85-92. [PMID: 39535740 PMCID: PMC11561724 DOI: 10.1001/jamasurg.2024.5077] [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: 05/23/2024] [Accepted: 08/30/2024] [Indexed: 11/16/2024]
Abstract
Importance Radical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects. Objective To assess the feasibility and effects of vagus nerve preservation using neurophysiologic monitoring and ICG labeling during laparoscopic distal gastrectomy in patients with early distal gastric cancer. Design, Setting, and Participants This open-label, prospective randomized clinical trial initially enrolled 285 patients with clinical stage cT1N0M0 distal gastric cancer from May 2022 to May 2023. This trial was conducted at Qilu Hospital of Shandong University in Jinan, China, and enrolled patients aged 18 to 80 years with histologically proven gastric adenocarcinoma scheduled for distal gastrectomy. The final follow-up examination was performed May 1, 2024. Interventions Eligible participants were randomly assigned 1:1 to vagus nerve preservation distal gastrectomy (VPG) or vagus nerve resection distal gastrectomy (VRG). Main Outcomes and Measures The primary outcome was the incidence of postsurgical gastroparesis. Secondary outcomes included postoperative gallstone formation, quality of life, morbidity, mortality, overall survival, and disease-free survival up to 12 months postoperatively. All analyses were based on both intention-to-treat and per-protocol analyses. Results Of 264 patients included in the intention-to-treat analysis, the median (IQR) patient age was 58.0 (52.0-67.0) years, and 67 patients (25.4%) were female. Both the VPG and VRG groups included 132 patients. Postoperative gastroparesis occurred in 1 patient (0.8%) in the VPG group and in 10 patients (7.6%) in the VRG group. Gallstones developed in 0 patients in the VPG group and in 9 patients (6.8%) in the VRG group. As assessed by mean (SD) score on the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the VRG group experienced more nausea and vomiting at 6 months postsurgery (19.38 [7.62]) than the VPG group (17.15 [9.21]) (P = .03) and had significantly higher rates of persistent appetite loss, reflux symptoms, and eating difficulties at both 6 months and 12 months than the VPG group. Differences in postoperative complications and metastasis were not significant. Conclusions and Relevance Neurophysiologic monitoring and ICG labeling during distal laparoscopic gastrectomy for vagus nerve preservation in patients with early distal gastric cancer are safe and feasible. Preserving the perigastric vagus nerve may retain the function of the remnant stomach and improve quality of life. Trial Registration Chictr.org.cn Identifier: ChiCTR2200059489.
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Affiliation(s)
- Zhibo Yan
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Meng Wei
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Tongchao Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China
- Clinical Research Center of Shandong University, Jinan, China
| | - Jinghao Guo
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Ao Yu
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yize Liang
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yadi Huang
- Department of General Surgery, Tengzhou Central People’s Hospital, Tengzhou, China
| | - Xiaohan Cui
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Honglei Wang
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Kuiquan Zhou
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zikun Dong
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Wenbin Yu
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
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Kim IH, Kang SJ, Choi W, Seo AN, Eom BW, Kang B, Kim BJ, Min BH, Tae CH, Choi CI, Lee CK, An HJ, Byun HK, Im HS, Kim HD, Cho JH, Pak K, Kim JJ, Bae JS, Yu JI, Lee JW, Choi J, Kim JH, Choi M, Jung MR, Seo N, Eom SS, Ahn S, Kim SJ, Lee SH, Lim SH, Kim TH, Han HS. Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline). J Gastric Cancer 2025; 25:5-114. [PMID: 39822170 PMCID: PMC11739648 DOI: 10.5230/jgc.2025.25.e11] [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: 12/24/2024] [Accepted: 12/24/2024] [Indexed: 01/19/2025] Open
Abstract
Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area. Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version. Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.
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Affiliation(s)
- In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Wonyoung Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bum Jun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Jung An
- Division of Oncology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Ho Cho
- Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Joon Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jungyoon Choi
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jwa Hoon Kim
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Soo Eom
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Soomin Ahn
- Department of Pathology and Translational Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hee Lim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
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9
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Eom SS, Ryu KW, Han HS, Kong SH. A Comprehensive and Comparative Review of Global Gastric Cancer Treatment Guidelines: 2024 Update. J Gastric Cancer 2025; 25:153-176. [PMID: 39822173 PMCID: PMC11739642 DOI: 10.5230/jgc.2025.25.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 12/19/2024] [Accepted: 12/20/2024] [Indexed: 01/19/2025] Open
Abstract
Differences in demographics, medical expertise, and patient healthcare resources across countries have led to significant variations in guidelines. In light of these differences, in this review, we aimed to explore and compare the most recent updates to gastric cancer treatment from five guidelines that are available in English. These English-version guidelines, which have been recently published and updated for journal publication, include those published in South Korea in 2024, Japan in 2021, China in 2023, the United States in 2024, and Europe in 2024. The South Korean and Japanese guidelines provide a higher proportion of content to endoscopic and surgical treatments, reflecting their focus on minimally invasive techniques, function-preserving surgeries, and systemic therapy. The Chinese guidelines provide recommendations addressing not only surgical approaches but also perioperative chemotherapy and palliative systemic therapy. Meanwhile, in the United States and European guidelines, a higher proportion of the content is dedicated to perioperative and palliative systemic therapy, aligning with their approaches to advanced-stage disease management. All guidelines address surgical and systemic chemotherapy treatments; however, the proportion and emphasis of content vary based on the patient distribution and treatment approaches specific to each country. With emerging research findings on gastric cancer treatment worldwide, the national guidelines are being progressively revised and updated. Understanding the commonalities and differences among national guidelines, along with the underlying evidence, can provide valuable insights into the treatment of gastric cancer.
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Affiliation(s)
- Sang Soo Eom
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
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10
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Wei J, Bu Z. Advances in gastric cancer treatment in 2024: Key breakthroughs and emerging trends. Chin J Cancer Res 2024; 36:592-595. [PMID: 39802898 PMCID: PMC11724177 DOI: 10.21147/j.issn.1000-9604.2024.06.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 12/23/2024] [Indexed: 01/16/2025] Open
Affiliation(s)
- Jingtao Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhaode Bu
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
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11
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Park SH, Ryu KW. ASO Author Reflections: Regional Lymphadenectomy for Stomach-Preserving Surgery in Early Gastric Cancer: Is it Clinically Applicable? Ann Surg Oncol 2024; 31:9050-9051. [PMID: 39154159 DOI: 10.1245/s10434-024-16081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Sin Hye Park
- Center of Gastric Cancer, National Cancer Center, Goyang, Korea
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Keun Won Ryu
- Center of Gastric Cancer, National Cancer Center, Goyang, Korea.
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12
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Park SH, Kim YW, Min JS, Yoon HM, An JY, Eom BW, Hur H, Lee YJ, Cho GS, Park YK, Jung MR, Park JH, Hyung WJ, Jeong SH, Kook MC, Han M, Nam BH, Ryu KW. Feasibility of Regional Lymphadenectomy for Stomach-Preserving Surgery in Early Gastric Cancer Omitting Sentinel Node Navigation: A Post Hoc Analysis of the SENORITA Trial. Ann Surg Oncol 2024; 31:6939-6946. [PMID: 39085549 PMCID: PMC11413058 DOI: 10.1245/s10434-024-15950-1] [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: 03/05/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Sentinel node navigation (SNN) has been known as the effective treatment for stomach-preserving surgery in early gastric cancer; however, SNN presents several technical difficulties in real practice. OBJECTIVE This study aimed to evaluate the feasibility of regional lymphadenectomy omitting SNN, using the post hoc analysis of a randomized controlled trial. METHODS Using data from the SENORITA trial that compared laparoscopic standard gastrectomy with lymphadenectomy and laparoscopic SNN, 237 patients who underwent SNN were included in this study. Tumor location was divided into longitudinal and circumferential directions. According to the location of the tumor, the presence or absence of lymph node (LN) metastases between sentinel and non-sentinel basins were analyzed. Proposed regional LN stations were defined as the closest area to the primary tumor. Sensitivities, specificities, positive predictive values, and negative predictive values (NPV) of SNN and regional lymphadenectomy were compared. RESULTS Metastasis to non-sentinel basins with tumor-free in sentinel basins was observed in one patient (0.4%). The rate of LN metastasis to non-regional LN stations without regional LN metastasis was 2.5% (6/237). The sensitivity and NPV of SNN were found to be significantly higher than those of regional lymphadenectomy (96.8% vs. 80.6% [p = 0.016] and 99.5% vs. 97.2% [p = 0.021], respectively). CONCLUSIONS This study showed that regional lymphadenectomy for stomach-preserving surgery, omitting SNN, was insufficient; therefore, SNN is required in stomach-preserving surgery.
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Affiliation(s)
- Sin Hye Park
- Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 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
- Division of Foregut Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hong Man Yoon
- Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bang Wool Eom
- Center of Gastric Cancer, National Cancer Center, Goyang, 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, 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, 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, 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
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Republic of Korea
- Clinical Design Research Center, HERINGS, The Institution of Advanced Clinical and Biomedical Research, Seoul, Republic of Korea
| | - Keun Won Ryu
- Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea.
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13
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Zhou J, Li R, Zhao S, Sun L, Wang J, Fu Y, Wang D. Sentinel Node Navigation Surgery for Early Gastric Cancer: A Narrative Review. Am J Clin Oncol 2024; 47:439-444. [PMID: 38587337 DOI: 10.1097/coc.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Early gastric cancer (EGC) refers to malignant tumor lesions that are limited to the mucosa and submucosa layers, regardless of the presence of lymph node metastasis. Typically, EGC has a low rate of perigastric lymph node metastasis, and long-term survival outcomes are good after radical surgical treatment. The primary objective of surgical treatment for EGC is to achieve functional preservation while ensuring a radical cure. Sentinel node navigation surgery (SNNS) is a surgical technique used in the treatment of EGC. This approach achieves functional preservation by limiting lymph node dissection and performing restrictive gastrectomy guided by intraoperative negative sentinel node (SN) biopsy. Despite the apparent improvement in the detection rate of SN with the emergence of various tracing dyes and laparoscopic fluorescence systems, the oncological safety of SNNS remains a controversial research topic. SNNS, as a true form of stomach preservation surgery that enhances the quality of life, has become a topic of interest in the EGC field. In recent years, scholars from Japan and South Korea have conducted extensive research on the feasibility and safety of SNNS in the treatment of EGC. This article aims to provide reference choices for surgeons treating EGC by reviewing relevant research on SNNS for EGC in recent years.
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Affiliation(s)
- Jiajie Zhou
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Ruiqi Li
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Shuai Zhao
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jie Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yayan Fu
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
- Northern Jiangsu People's Hospital, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Disease, Yangzhou, China
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14
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Liu M, Strong V. Laparoscopic Sentinel Node Navigation Surgery for Quality of Life Gains: When Is Less More? JAMA Surg 2024; 159:908-909. [PMID: 38809564 DOI: 10.1001/jamasurg.2024.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Affiliation(s)
- Marion Liu
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vivian Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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15
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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.
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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
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16
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Park SH, Chung SY, Lee JH, Kim HK, Lee D, Kim H, Kim JH, Kim MS, Lee JH, Park JY, Yoon HM, Ryu KW, Kook MC. Feasibility of intraoperative pathologic examination for sentinel lymph nodes during sentinel node navigation surgery in early gastric cancer: results of pathologic protocol for SENORITA trial. Gastric Cancer 2024; 27:858-868. [PMID: 38647977 DOI: 10.1007/s10120-024-01497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND During sentinel node navigation surgery in patients with gastric cancer, intraoperative pathologic examination of sentinel nodes is crucial in determining the extent of surgery. In this study, we evaluated the feasibility and accuracy of intraoperative pathologic protocols using data from a prospective, multicenter, randomized trial. METHODS A retrospective analysis was conducted using data from the SEntinel Node ORIented Tailored Approach trials from 2013 to 2016. All sentinel lymph nodes were evaluated during surgery with hematoxylin-eosin (HE) staining using a representative section at the largest plane for lymph nodes. For permanent histologic evaluation, sentinel basin nodes were stained with HE and cytokeratin immunohistochemistry in formalin-fixed, paraffin-embedded (FFPE) sections and examined with HE for three deeper-step sections at 200-μm intervals. The failure rate of identification by frozen section and the metastasis rate in non-sentinel basins were investigated. RESULTS Of the 237 patients who underwent sentinel node basin dissection, 30 had lymph node metastases on permanent pathology. Thirteen patients had macrometastasis confirmed in frozen sections as well as FFPE sections (failure rate: 0%). Patients with negative sentinel nodes in frozen sections but micrometastasis in FFPE sections had no lymph node recurrence during the follow-up period (0%, 0/6). However, in cases with tumor-positive nodes in frozen sections, metastases in non-sentinel basins were detected in the paraffin blocks (8.3%, 2/24). CONCLUSIONS The single-section HE staining method is sufficient for detecting macrometastasis via intraoperative pathological examination. If a negative frozen-section result is confirmed, sentinel basin dissection can be performed safely. Otherwise, standard surgery is required.
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Affiliation(s)
- Sin Hye Park
- Center for Gastric Cancer, National Cancer Center, Ilsan-Ro 323, Ilsandong-Gu, Goyang-Si, 10408, Republic of Korea
- Department of Surgery, The Catholic University of Korea, Eunpyeong St Mary's Hospital, Seoul, Republic of Korea
| | - Soo Young Chung
- Department of Pathology, Cancer Center, Dongnam Institute of Radiological and Medical Sciences (DIRAMS), Busan, Republic of Korea
| | - Jeong-Hee Lee
- Department of Pathology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Institute of Health Science, Jinju, Republic of Korea
| | - Hee Kyung Kim
- Department of Pathology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Dakeun Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyunki Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jo-Heon Kim
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Min Seok Kim
- Department of Pathology, Cancer Center, Dongnam Institute of Radiological and Medical Sciences (DIRAMS), Busan, Republic of Korea
| | - Jae Hyuk Lee
- Department of Pathology, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Republic of Korea
| | - Ji Yeon Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Ilsan-Ro 323, Ilsandong-Gu, Goyang-Si, 10408, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Ilsan-Ro 323, Ilsandong-Gu, Goyang-Si, 10408, Republic of Korea
| | - Myeong-Cherl Kook
- Center for Gastric Cancer, National Cancer Center, Ilsan-Ro 323, Ilsandong-Gu, Goyang-Si, 10408, Republic of Korea.
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17
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Jeong SH, Park M, Seo KW, Kim RB, Min JS. A Comparative Study of Postoperative Complications Associated with Distal Gastrectomy and Pylorus-Preserving Gastrectomy among Gastric Cancer Patients Based on Nationwide Survey Data and Propensity Score Weighting. Cancers (Basel) 2024; 16:2203. [PMID: 38927908 PMCID: PMC11202269 DOI: 10.3390/cancers16122203] [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: 04/24/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND/OBJECTIVE This study aimed to compare complication rates between pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) using Korean nationwide survey data and propensity score weighting (PSW). PPG preserves gastric function but may lead to more postoperative complications than DG. METHODS AND RESULTS We analyzed 9424 gastric cancer patients who underwent either DG (n = 9183) or PPG (n = 241). PSW balanced variables such as age, sex, TNM stage, comorbidities, ASA score, and surgical approach. Before PSW, 87.8% of DG patients and 87.1% of PPG patients had no complications (p = 0.053). Severe complications (Clavien-Dindo IIIa or higher) were more frequent in PPG (6.6%) than in DG (3.8%) (p = 0.039). After PSW, overall complication rates (p = 0.960) and severe complication rates (p = 0.574) were similar between groups. Incidence rates of anastomotic stricture and leakage were higher in PPG (2.9% and 1.7%) compared to DG (0.6% and 0.5%) (p = 0.001 and 0.036) before PSW, but these differences were not significant after PSW (p = 0.999 and 0.123). CONCLUSION The PSW-adjusted analysis indicates no significant difference in overall and severe complication rates between PPG and DG in gastric cancer patients.
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Affiliation(s)
- Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea;
| | - Miyeong Park
- Department of Anesthesiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea;
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan 49267, Republic of Korea;
| | - Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea;
| | - Jae-Seok Min
- Department of Surgery, Korea University College of Medicine, and Division of Foregut Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea
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18
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Shen Y, Yu S, Zhang Y, Wang S, Chen J, Xu Y, Hu X, Li J, Jiang S, Wang L, Xu L, Zhou Z, Deng J, Chen B, Xu X. The exploration of surgery and survival prediction in patients with peritoneal metastasis from gastric adenocarcinoma based on the SEER database. J Gastrointest Oncol 2024; 15:597-611. [PMID: 38756631 PMCID: PMC11094495 DOI: 10.21037/jgo-23-886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/02/2024] [Indexed: 05/18/2024] Open
Abstract
Background As one of the most common diseases in terms of cancer-related mortality worldwide, gastric adenocarcinoma (GA) frequently develops peritoneal metastases (PMs) in advanced stages. Systemic therapy or optimal supportive care are recommended for advanced GA; however, patients frequently develop drug resistance. Surgical resection is not recommended for stage IV patients, and there have been some controversies regarding the role of it in GA patients with PMs. The aim of the study was to preliminarily evaluate the possible effect of surgical treatments on patients with only PMs from GA. Methods Data were collected from the Surveillance, Epidemiology and End Results (SEER) database (year 2000-2022). A propensity score matching (PSM) was performed to reduce the influence of selection bias and confounding variables on comparisons. Then Cox proportional hazard regression, Kaplan-Meier analysis, and log-rank test were performed to assess the efficacy of surgical treatment in patients with PMs from GA. Results A total of 399 patients diagnosed with PMs from GA were enrolled for our analysis, of which, 180 (45.1%) patients did not receive surgery and 219 (54.9%) patients received surgery. Multivariate Cox regression analysis before PSM indicated higher rates of overall survival (OS) outcome for patients who had received surgery [hazard ratio (HR) =0.4342, 95% confidence interval (CI): 0.3283-0.5742, P<0.001]. After PSM, a total of 172 patients were enrolled, with 86 in each group. Multivariate Cox analysis showed that surgery was the independent factor reflecting patients' survival (HR =0.4382, 95% CI: 0.3037-0.6324, P<0.001). Subgroup survival analysis revealed that surgery may bring advantages to patients with grades I-IV, stages T1-T4, stage N0, and tumor size less than 71 mm (P<0.05). We also found that the OS of chemotherapy patients who had undergone surgery was better than that of chemotherapy patients who had not undergone surgery (P<0.01). Conclusions Based on the SEER database, surgery has better OS for patients only with PMs from GA. Patients without lymph node metastasis and those who received chemotherapy before may benefit from surgery. These specific groups of patients may have surgery as an option to improve the prognosis.
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Affiliation(s)
- Yang Shen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuhong Yu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuefeng Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Siyu Wang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiayu Chen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yangtao Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xinyao Hu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiayi Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shan Jiang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Wang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Le Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhuolin Zhou
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Junjian Deng
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Biao Chen
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ximing Xu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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Lee JH, Kim SG, Cho SJ. Long-term Outcomes of Patients With Early Gastric Cancer Who Had Lateral Resection Margin-Positive Tumors Based on Pathology Following Endoscopic Submucosal Dissection. J Gastric Cancer 2024; 24:199-209. [PMID: 38575512 PMCID: PMC10995830 DOI: 10.5230/jgc.2024.24.e15] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Long-term outcomes of patients with positive lateral margins (pLMs) after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). This study aimed to evaluate the remnant cancer and survival rates of patients with pLMs compared with those who underwent curative resection. MATERIALS AND METHODS A retrospective analysis was performed on consecutive patients with pLMs as the only non-curative factor of expanded indication who underwent ESD for EGC with a follow-up duration of 5 years or more. The rates of remnant cancer, recurrence, and survival were analyzed and compared to those of control patients who underwent curative resection by propensity score matching. RESULTS Among 3,515 patients treated with ESD between 2005 and 2018, 123 non-curative EGCs were retrospectively analyzed. A total of 108 patients were followed up without endoscopic or surgical resection for 8.2 years. The control group was matched in a 1:1 ratio with patients with EGC who underwent curative resection after ESD. The observation group with pLMs had a higher incidence of remnant cancer (25.9%; 28/108) compared to that in the curative resection group (0/108; P=0.000). The remaining tumors were treated with surgical or endoscopic resection, and no additional recurrences were observed. The overall survival analysis demonstrated no significant difference between the observation and curative resection groups (P=0.577). CONCLUSIONS No difference was observed in the overall survival rate between observation and curative resection groups. Therefore, observation may be a possible option for incomplete ESD with pLMs if continuous follow-up is performed.
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Affiliation(s)
- Jun Hee Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. ,
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20
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Kinami S, Kaida D, Okamoto K, Fujimura T, Iida Y, Inaki N, Takamura H. Long‑term survival prognosis of function‑preserving curative gastrectomy for early gastric cancer. Oncol Lett 2024; 27:115. [PMID: 38304174 PMCID: PMC10831417 DOI: 10.3892/ol.2024.14248] [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: 11/04/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
Segmental gastrectomy, mini-distal gastrectomy and local resection of the stomach are function-preserving curative gastrectomies (FPGs), which are used to treat gastric cancer in specialized centers. These surgical options are less invasive and can alleviate postgastrectomy symptoms more than standard gastrectomy; however, their association with prognosis remains to be fully elucidated. The present study aimed to compare the survival prognosis of patients diagnosed as node-negative by sentinel node biopsy (SNB) treated via FPG with reduced lymph node dissection with that of patients who underwent guideline gastrectomy (GL). This retrospective study was conducted between April 1999 and March 2016. The inclusion criteria were a diagnosis of gastric cancer type 0, of ≤5 cm, located in L or M areas, and pT1N0. Patients who underwent distal gastrectomy and pylorus-preserving gastrectomy were included as controls in the GL group. Among the 146 and 300 patients in the FPG and GL groups, respectively, only 1 patient in the GL group experienced recurrence. The overall survival (OS) of the FPG group was 96.6% at 5 years and 92.5% at 10 years, which was significantly higher than that of the GL group (P<0.05). In addition, the cumulative incidence of non-cancer-related deaths, especially pulmonary diseases, was lower in the FPG group than that in the GL group (P<0.05). Notably, the OS and non-cancer death rate in the FPG group remained significantly better after propensity score-matching analysis. In conclusion, for early gastric cancer located in M or L areas, patients treated via FPG guided by SNB have a better prognosis and fewer deaths caused by respiratory disease than those treated via GL. The present clinical trial was registered under the following trial registration numbers: UMIN000010154 (2013/3/4), UMIN000023828 (2016/8/29), jRCTs041180006 (2018/10/9).
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Affiliation(s)
- Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku, Ishikawa 920-0293, Japan
| | - Daisuke Kaida
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku, Ishikawa 920-0293, Japan
| | - Koichi Okamoto
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku, Ishikawa 920-0293, Japan
| | - Takashi Fujimura
- Department of Surgery, Toyama City Hospital, Toyama, Toyama 939-8511, Japan
| | - Yasuo Iida
- Department of Mathematics, Division of General Education, Kanazawa Medical University, Kahoku, Ishikawa 920-0293, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku, Ishikawa 920-0293, Japan
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21
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Hur H, Lee YJ, Kim YW, Min JS, Yoon HM, Yeong An J, Eom BW, Seok Cho G, Park YK, Jung MR, Park JH, Hyung WJ, Jeong SH, Kook MC, Han M, Nam BH, Ryu KW. Clinical Efficacy of Laparoscopic Sentinel Node Navigation Surgery for Stomach Preservation in Patients With Early Gastric Cancer: 5-year Results of the SENORITA Trial. Ann Surg 2024; 281:00000658-990000000-00762. [PMID: 38269605 DOI: 10.1097/sla.0000000000006219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE This study aimed to compare laparoscopic standard gastrectomy (LSG) and laparoscopic sentinel node navigation surgery (LSNNS) for EGC in terms of 5-year long-term oncologic outcomes. SUMMARY BACKGROUND DATA The oncological safety of LSNNS for early gastric cancer (EGC) has not been confirmed. Three-year disease-free survival (DFS), which is the primary endpoint of the phase III multicenter randomized controlled clinical trial (SEntinel Node ORIented Tailored Approach [SENORITA] trial), did not show the non-inferiority of LSNNS relative to LSG. METHODS The SENORITA trial, a multicenter randomized clinical trial, was designed to show that LSNNS is non-inferior to LSG in terms of 3-year DFS. In the present study, we collected 5-year follow-up data from 527 patients recruited in the SENORITA trial as the full analysis set (FAS). Disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS), and recurrence patterns were evaluated using the FAS of both LSG (n=269) and LSNNS (n=258). RESULTS The 5-year DFS was not significantly different between the LSG and LSNNS groups (P=0.0561). During the 5-year follow-up, gastric cancer-related events, such as metachronous cancer, were more frequent in the LSNNS group than in the LSG group. However, ten recurrent cancers in the remnant stomach of both groups were curatively resected by additional gastrectomy and one by additional endoscopic resection. Two of the 198 patients who underwent local resection for stomach preservation based on the LSNNS results developed distant metastasis. However, there was no statistically significant difference in the 5-year OS and DSS (P=0.7403 and P=0.9586, respectively) between the two groups. CONCLUSION The 5-year DFS, DSS and OS did not differ significantly between the two groups. Considering the benefits of LSNNS on postoperative quality of life, LSNNS could be recommended as an alternative treatment option for EGC.
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Affiliation(s)
- Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Young Joon Lee
- Department of Surgery, Gyeongsang National University, Jinju, Korea
| | - Young-Woo Kim
- Center of Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea
| | - Hong Man Yoon
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, 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, Korea
| | - Bang Wool Eom
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University, Jinju, 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, Jinju, Korea
| | | | - Mira Han
- Medical Research Collaborating Center, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Byung-Ho Nam
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
- Clinical Design Research Center, HERINGS The Institution of Advanced Clinical & Biomedical Research, Seoul, Korea
| | - Keun Won Ryu
- Center of Gastric Cancer, National Cancer Center, Goyang, Korea
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22
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Sestito M, Pratt H, Schmidt C, Thomay A. Recent advances for treatment of upper gastrointestinal malignancy. J Surg Oncol 2024; 129:48-62. [PMID: 38010879 DOI: 10.1002/jso.27530] [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: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
Recent prospective trials for esophageal cancer, gastric cancer, and gastrointestinal stromal tumor (GIST) are encouraging. This manuscript reviews selected recently published studies. Not surprisingly, immunotherapy dominates the current clinical trial landscape. However, targeted biologic therapies and standard chemotherapy remain critical to the treatment of gastric and esophageal cancer while imatinib remains the backbone for advanced or metastatic GISTs. For all three cancers, surgical resection remains important when intent of treatment is potential cure.
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Affiliation(s)
- Michael Sestito
- Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Hillary Pratt
- Cancer Cell Biology, West Virginia University, Morgantown, West Virginia, USA
- WVU Cancer Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Carl Schmidt
- Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
- WVU Cancer Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Alan Thomay
- Department of Surgery, West Virginia University, Morgantown, West Virginia, USA
- WVU Cancer Institute, West Virginia University, Morgantown, West Virginia, USA
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23
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Kim SG, Lee SE, Eom BW, Yoon HM, Kim YW, Ryu KW. Gastric cancer surgery in South Korea: Past, present, and future. Chin J Cancer Res 2023; 35:627-635. [PMID: 38204450 PMCID: PMC10774143 DOI: 10.21147/j.issn.1000-9604.2023.06.07] [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: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Gastric cancer remains a significant global health concern and its surgical management approaches have undergone significant changes in South Korea and worldwide. Subtotal or total gastrectomy with D2 lymph node dissection is well established as a standard surgical procedure for gastric cancer. With the active implementation of cancer screening in South Korea, the proportion of early gastric cancer cases has significantly increased over the past few decades, leading to a steady increase in the survival rate among patients. Furthermore, recent advances in surgical instruments and techniques have made minimally invasive surgery increasingly prevalent, not only for early but also for advanced gastric cancer. We aim to provide a comprehensive overview of the evolution and current status of gastric cancer surgery in South Korea.
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Affiliation(s)
- Sung Gon Kim
- Department of Surgery, Konyang University Hospital, Daejeon 35365, Republic of Korea
| | - Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Daejeon 35365, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, Goyang-si 410-769, Republic of Korea
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24
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Dong ZB, Xiang HT, Wu HM, Cai XL, Chen ZW, Chen SS, He YC, Li H, Yu WM, Liang C. LncRNA expression signature identified using genome-wide transcriptomic profiling to predict lymph node metastasis in patients with stage T1 and T2 gastric cancer. Gastric Cancer 2023; 26:947-957. [PMID: 37691031 PMCID: PMC10640531 DOI: 10.1007/s10120-023-01428-8] [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: 04/04/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Lymph node (LN) status is vital to evaluate the curative potential of relatively early gastric cancer (GC; T1-T2) treatment (endoscopic or surgery). Currently, there is a lack of robust and convenient methods to identify LN metastasis before therapeutic decision-making. METHODS Genome-wide expression profiles of long noncoding RNA (lncRNA) in primary T1 gastric cancer data from The Cancer Genome Atlas (TCGA) was used to identify lncRNA expression signature capable of detecting LN metastasis of GC and establish a 10-lncRNA risk-prediction model based on deep learning. The performance of the lncRNA panel in diagnosing LN metastasis was evaluated both in silico and clinical validation methods. In silico validation was conducted using TCGA and Asian Cancer Research Group (ACRG) datasets. Clinical validation was performed on T1 and T2 patients, and the panel's efficacy was compared with that of traditional tumor markers and computed tomography (CT) scans. RESULTS Profiling of genome-wide RNA expression identified a panel of lncRNA to predict LN metastasis in T1 stage gastric cancer (AUC = 0.961). A 10-lncRNA risk-prediction model was then constructed, which was validated successfully in T1 and T2 datasets (TCGA, AUC = 0.852; ACRG, AUC = 0.834). Thereafter, the clinical performance of the lncRNA panel was validated in clinical cohorts (T1, AUC = 0.812; T2, AUC = 0.805; T1 + T2, AUC = 0.764). Notably, the panel demonstrated significantly better performance compared with CT and traditional tumor markers. CONCLUSIONS The novel 10-lncRNA could diagnose LN metastasis robustly in relatively early gastric cancer (T1-T2), with promising clinical potential.
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Affiliation(s)
- Zhe-Bin Dong
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Han-Ting Xiang
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Heng-Miao Wu
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Xian-Lei Cai
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Zheng-Wei Chen
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Sang-Sang Chen
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Yi-Chen He
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Hong Li
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Wei-Ming Yu
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China
| | - Chao Liang
- Department of General Surgery, The Affiliated Lihuili Hospital, Ningbo University, 57 Xingning Road, Ningbo, 315000, People's Republic of China.
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25
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Lee S, Kim SG, Cho SJ. Decision to perform additional surgery after non-curative endoscopic submucosal dissection for gastric cancer based on the risk of lymph node metastasis: a long-term follow-up study. Surg Endosc 2023; 37:7738-7748. [PMID: 37567980 DOI: 10.1007/s00464-023-10324-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Radical surgery after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) may be excessive, since only 5-10% of patients have lymph node metastasis (LNM). This study investigated the suitability of the eCura system for determining the need for radical surgery after non-curative ESD. METHODS We retrospectively investigated 343 patients who underwent non-curative ESD for EGC from 2006 to 2021 at a tertiary hospital in Korea. These patients were divided into surgery (n = 191) and observation (n = 152) groups based on whether they underwent additional surgery post-ESD. Each group was further classified into low-risk (eCura score 0-1), intermediate-risk (eCura score 2-4) and high-risk (eCura score 5-7). All patients were regularly followed-up at least annually after the initial treatment. The cumulative overall and recurrence-free survival rates were calculated for each category and compared between the surgery and observation groups. RESULTS No significant differences in overall survival were found between the surgery and observation groups in low-risk (p = 0.168) and intermediate-risk patients (p = 0.306); however, high-risk patients had better 5-year overall survival rate in the surgery group than in the follow-up group (95.2% vs. 71.4%, p < 0.001). The 5-year recurrence-free survival rate was higher in the surgery group than in the observation group for low-risk (100% vs. 84.3%; p = 0.034), intermediate-risk (96.1% vs. 88.4%; p = 0.081) and high-risk patients (100% vs. 83.3%; p = 0.023). CONCLUSIONS Follow-up without additional surgery after non-curative ESD can be a reasonable option for low-risk and even intermediate-risk patients according to the eCura system. However, surgery is warranted for eCura high-risk patients.
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Affiliation(s)
- Seunghan Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Lu J, Wu D, Huang JB, Lin J, Xu BB, Xue Z, Zheng HL, Lin GS, Shen LL, Li P, Wang JB, Lin JX, Chen QY, Cao LL, Xie JW, Zheng CH, Huang CM. Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation. Surg Endosc 2023; 37:7472-7485. [PMID: 37395806 DOI: 10.1007/s00464-023-10147-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/20/2023] [Indexed: 07/04/2023]
Abstract
IMPORTANCE It is largely unclear whether robotic distal gastrectomy (RDG) is cost-effective for locally advanced gastric cancer (LAGC). OBJECTIVE To evaluate the cost-effectiveness of RDG, laparoscopic distal gastrectomy (LDG), and open distal gastrectomy (ODG) for patients with LAGC. DESIGN, SETTING, AND PARTICIPANTS Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. A decision-analytic model was constructed to evaluate the cost-effectiveness of RDG, LDG, and ODG. EXPOSURES RDG, LDG, and ODG. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio (ICER) and quality-adjusted life year (QALY). RESULTS This pooled analysis of two randomized controlled trials included 449 patients: 117, 254, and 78 patients in the RDG, LDG, and ODG groups, respectively. After IPTW, RDG demonstrated its priority in terms of less blood loss, postoperative length, and complication rate (all P < 0.05). RDG also showed higher QOL with more cost, representing an ICER of $85,739.73 per QALY and $42,189.53 per QALY compared to LDG and ODG, respectively. In probabilistic sensitivity analysis, RDG achieved the best cost-effectiveness for patients with LAGC only when the willingness-to-pay threshold was > $85,739.73 per QALY, which significantly exceeded 3 times Chinese per capita GDP. Furthermore, one of the most important factors was the indirect costs of robotic surgery in terms of the cost-effectiveness of RDG compared to that of LDG or ODG. CONCLUSIONS AND RELEVANCE Although improved short-term outcomes and QOL were seen in patients underwent RDG, the economic burden should be considered in the clinical decision-making regarding robotic surgery use for patients with LAGC. Our findings may vary in different health care settings and affordability. Trial registration CLASS-01 trial (ClinicalTrials.gov, CT01609309) and FUGES-011 trial (ClinicalTrials.gov, NCT03313700).
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Affiliation(s)
- Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiao-Bao Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bin-Bin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guo-Sheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Li-Li Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Yanagimoto Y, Kurokawa Y, Doki Y. Essential updates 2021/2022: Perioperative and surgical treatments for gastric and esophagogastric junction cancer. Ann Gastroenterol Surg 2023; 7:698-708. [PMID: 37663969 PMCID: PMC10472390 DOI: 10.1002/ags3.12711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 09/05/2023] Open
Abstract
In recent years, important clinical trials for gastric cancer (GC) and esophagogastric junction cancer (EGJC) have been reported, changing the strategies of surgical and perioperative treatment. Although laparoscopic gastrectomy has already been shown to be effective for early-stage cancer, recent evidence from both Asia (JLSSG0901, CLASS-01 and KLASS-02) and Europe (LOGICA and STOMACH trials) has demonstrated that it is useful for advanced GC. Robotic surgery has been rapidly gaining popularity in recent years, and randomized controlled trials are ongoing to evaluate its efficacy. A prospective nationwide multicenter study mapped sites with frequent metastasis and revealed lymphatic flow specific to EGJC, thus establishing the optimal lymph node dissection area and surgical approach based on esophageal involvement. Perioperative chemotherapy, the mainstay of treatment in Europe, also has been established in Asia by the PRODIGY and RESOLVE studies. New clinical trials have been conducted to evaluate the efficacy of combining immunotherapy or molecular-targeted therapy with perioperative chemotherapy or chemoradiotherapy. In this review, we present important recent clinical trials regarding the treatment of GC and EGJC published in 2021 or 2022.
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Affiliation(s)
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
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Su H, Bu Z. Research progress of minimally invasive surgery for gastric cancer. Chin J Cancer Res 2023; 35:343-353. [PMID: 37691896 PMCID: PMC10485916 DOI: 10.21147/j.issn.1000-9604.2023.04.02] [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: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023] Open
Abstract
Since the first laparoscopic radical surgery for early gastric cancer 30 years ago, there has been a gradual shift from "open" to "minimally invasive" surgery for gastric cancer. This transition is due to advancements in refined anatomy, enlarged field of view, faster recovery, and comparable oncological outcomes. Several high-quality clinical studies have demonstrated the safety and effectiveness of laparoscopy in the treatment of both early and locally advanced gastric cancer. The role of perioperative chemotherapy in managing locally advanced gastric cancer has been widely recognized, and there have been continuous breakthroughs in the exploration of targeted therapy and immunotherapy for perioperative treatment. Additionally, the application of indocyanine green near-infrared imaging technology, 3D laparoscopic technology, and robotic surgery systems has further improved the accuracy and minimally invasive nature of gastric cancer surgeries. Looking ahead, the field of minimally invasive surgery for gastric cancer is expected to become more standardized, resulting in a significant enhancement in the quality of life for gastric cancer patients.
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Affiliation(s)
- Hao Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhaode Bu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
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29
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Shen J, Feng X, Li Z, Wang Y. Comparison of short-term outcomes between robotic and laparoscopic distal gastrectomy performed by the same surgical team during the same period. Front Oncol 2023; 13:1174396. [PMID: 37483520 PMCID: PMC10357816 DOI: 10.3389/fonc.2023.1174396] [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] [Received: 03/01/2023] [Accepted: 05/22/2023] [Indexed: 07/25/2023] Open
Abstract
Objective To evaluate the short-term outcomes of laparoscopic distal gastrectomy and robotic distal gastrectomy performed during the same period. Methods This study enrolled 46 cases of laparoscopic distal gastrectomy and 67 cases of robotic distal gastrectomy that were performed by a single surgeon between April 2020 to October 2021. Baseline characteristics and short-term outcomes of these two groups were then compared. Moreover, the robotic distal gastrectomy group was further divided into two subgroups according to the learning curve. Finally, the baseline characteristics and short-term outcomes of both subgroups were compared with the laparoscopic group, respectively. Results The baseline characteristics and short-term outcomes of the LDG group and RDG group were comparable. In contrast, the operation time in the laparoscopic group was significantly shorter than that in the early experience robotic group (191.3 ± 37.6 VS 225.1 ± 49, P=0.001). However, the operation time (191.3 ± 37.6 VS 185.3 ± 25.3, P=0.434) was comparable between the laparoscopic group and the late experience robotic group. Likewise, the bleeding volume was comparable between the laparoscopic and early experience robotic groups. However, bleeding volume was significantly lower in the late experience robotic group compared to that in the laparoscopic group (37.5 ± 18.8 VS 49.2 ± 29.0, P=0.049). Conclusions With surgeons stepping into the stable stage of the robotic learning curve, RDG showed a comparable operation time and lower volume of blood loss compared with LDG. Collectively, our study supports the application of robotic distal gastrectomy in patients diagnosed with gastric cancer.
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Jeong SH, Yoo MW, Park M, Seo KW, Min JS. Complication After Gastrectomy for Gastric Cancer According to Hospital Volume: Based on Korean Gastric Cancer Association-Led Nationwide Survey Data. J Gastric Cancer 2023; 23:462-475. [PMID: 37553132 PMCID: PMC10412979 DOI: 10.5230/jgc.2023.23.e24] [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: 04/25/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE This study aimed to analyze the incidence and risk factors of complications following gastric cancer surgery in Korea and to compare the correlation between hospital complications based on the annual number of gastrectomies performed. MATERIALS AND METHODS A retrospective analysis was conducted using data from 12,244 patients from 64 Korean institutions. Complications were classified using the Clavien-Dindo classification (CDC). Univariate and multivariate analyses were performed to identify the risk factors for severe complications. RESULTS Postoperative complications occurred in 14% of the patients, severe complications (CDC IIIa or higher) in 4.9%, and postoperative death in 0.2%. The study found that age, stage, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) score, hospital stay, approach methods, and extent of gastric resection showed statistically significant differences depending on hospital volumes (P<0.05). In the univariate analysis, patient age, comorbidity, ASA score, ECOG score, approach methods, extent of gastric resection, tumor-node-metastasis (TNM) stage, and hospital volume were significant risk factors for severe complications. However, only age, sex, ASA score, ECOG score, extent of gastric resection, and TNM stage were statistically significant in the multivariate analysis (P<0.05). Hospital volume was not a significant risk factor in the multivariate analysis (P=0.152). CONCLUSIONS Hospital volume was not a significant risk factor for complications after gastric cancer surgery. The differences in the frequencies of complications based on hospital volumes may be attributed to larger hospitals treating patients with younger age, lower ASA scores, better general conditions, and earlier TNM stages.
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Affiliation(s)
- Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Moon-Won Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miyeong Park
- Department of Anesthesiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea.
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Crafa F, Vanella S, Morante A, Catalano OA, Pomykala KL, Baiamonte M, Godas M, Antunes A, Costa Pereira J, Giaccaglia V. Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors: Personal experience and literature review. World J Gastroenterol 2023; 29:3883-3898. [PMID: 37426319 PMCID: PMC10324533 DOI: 10.3748/wjg.v29.i24.3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Laparoscopic and endoscopic cooperative surgery is a safe, organ-sparing surgery that achieves full-thickness resection with adequate margins. Recent studies have demonstrated the safety and efficacy of these procedures. However, these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity, which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal cavity. Non-exposed endoscopic wall-inversion surgery (NEWS) is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal cavity. Accurate intraoperative assessment of the nodal status could allow stratification of the extent of resection. One-step nucleic acid amplification (OSNA) can provide a rapid method of evaluating nodal tissue, whilst near-infrared laparoscopy together with indocyanine green can identify relevant nodal tissue intraoperatively.
AIM To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node (LN) assessment with OSNA.
METHODS The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the St. Giuseppe Moscati Hospital (Avellino, Italy). Patients with early-stage gastric or colon cancer (diagnosed via endoscopy, endoscopic ultrasound, and computed tomography) were included. All lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October 2022. LNs were examined intraoperatively with OSNA and postoperatively with conventional histology. We analyzed patient demographics, lesion features, histopathological diagnoses, R0 resection (negative margins) status, adverse events, and follow-up results. Data were collected prospectively and analyzed retrospectively.
RESULTS A total of 10 patients (5 males and 5 females) with an average age of 70.4 ± 4.5 years (range: 62-78 years) were enrolled in this study. Five patients were diagnosed with gastric cancer. The remaining 5 patients were diagnosed with early-stage colon cancer. The mean tumor diameter was 23.8 ± 11.6 mm (range: 15-36 mm). The NEWS procedure was successful in all cases. The mean procedure time was 111.5 ± 10.7 min (range: 80-145 min). The OSNA assay revealed no LN metastases in any patients. Histologically complete resection (R0) was achieved in 9 patients (90.0%). There was no recurrence during the follow-up period.
CONCLUSION NEWS combined with sentinel LN biopsy and OSNA assay is an effective and safe technique for the removal of selected early gastric and colon cancers in which it is not possible to adopt conventional endoscopic resection techniques. This procedure allows clinicians to acquire additional information on the LN status intraoperatively.
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Affiliation(s)
- Francesco Crafa
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Serafino Vanella
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Aristide Morante
- Division of Gastorenterology and Endoscopy, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Onofrio A Catalano
- Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Kelsey L Pomykala
- Department of Nuclear Medicine, Department of Radiological Sciences, University Hospital Essen, University of Duisburg-Essen, Essen 45141, Germany
| | - Mario Baiamonte
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Maria Godas
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Alexandra Antunes
- Department of General Surgery, Braga Hospital, Braga 4710-243, Portugal
| | | | - Valentina Giaccaglia
- Department of Surgery, Medclinic City Hospital, Dubai 505004, United Arab Emirates
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Akiyama Y, Katai H, Kitabayashi R, Nunobe S, Koeda K, Yura M, Sato Y, Yoshikawa T, Terashima M. Frequency of lymph node metastasis according to tumor location in clinical T1 early gastric cancer: supplementary analysis of the Japan Clinical Oncology Group study (JCOG0912). J Gastroenterol 2023; 58:519-526. [PMID: 36867237 DOI: 10.1007/s00535-023-01974-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The frequency of lymph node metastases per lymph node site in early gastric cancer has not been well clarified from the data based on prospective studies. This exploratory analysis aimed to determine the frequency and location of lymph node metastases in clinical T1 gastric cancer using the data from JCOG0912 to investigate the validity of the extent of standard lymph node dissection defined in Japanese guidelines. METHODS This analysis included 815 patients with clinical T1 gastric cancer. The proportion of pathological metastasis was identified for each lymph node site per tumor location (middle third and lower third) and four equal parts of the gastric circumference. The secondary aim was identification of the risk factor for lymph node metastasis. RESULTS Eighty-nine patients (10.9%) had pathologically positive lymph node metastases. Although the overall frequency of metastases was low (0.3-5.4%), metastases were widely located in each lymph node sites when primary lesion was in the middle third of the stomach. No. 4sb and 9 showed no metastasis when primary lesion was in the lower third of the stomach. Lymph node dissection of metastatic nodes resulted in a 5-year survival in more than 50% of patients. A tumor greater than 3 cm and a T1b tumor were associated with lymph node metastasis. CONCLUSIONS This supplementary analysis demonstrated that nodal metastasis from early gastric cancer is widely and disorderly not depending on the location. Thus, systematic lymph node dissection is necessary to cure the early gastric cancer.
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Affiliation(s)
- Yuji Akiyama
- Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba-Cho, Shiwa-Gun, Yahaba, Iwate, 028-3695, Japan.
| | - Hitoshi Katai
- Department of Gastrointestinal Surgery, Tachikawa Hospital, Tokyo, Japan
| | - Ryo Kitabayashi
- JCOG Data Center, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, Koto-Ku, Tokyo, Japan
| | - Keisuke Koeda
- Department of Medical Safety Science, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan
| | - Masahiro Yura
- Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Yuya Sato
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo-Ku, Tokyo, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Chuo-Ku, Tokyo, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
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Oh SE, An JY, Min JS, Jeong SH, Ryu KW. Determining the precise extent of sentinel basins during laparoscopic gastrectomy for early gastric cancer. World J Surg Oncol 2023; 21:60. [PMID: 36823624 PMCID: PMC9948514 DOI: 10.1186/s12957-023-02953-7] [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] [Received: 11/01/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE By analyzing sentinel basin dissection (SBD) data from the SEntinel Node ORIented Tailored Approach (SENORITA) trial, we sought to determine the precise extent of the sentinel basin (SB) without a tracer. MATERIALS AND METHODS This study investigated SB length in patients (n = 25) who underwent laparoscopic SBD for early gastric cancer (EGC) in the SENORITA trial. SB length along the greater curvature (GC) and lesser curvature (LC) was measured intraoperatively before performing SBD. RESULTS In all 25 cases, along the LC of the stomach, the lengths of the SB were 3.7 cm [2.0-5.0] (median [min-max]) proximally and 3.0 cm [2.3-5.5] distally; along the GC side, the lengths of the SB were 6.8 cm [3.5-11.0] proximally and 7.0 cm [3.8-9.5] distally from the tumors. The SB length at the GC or LC side was not significantly different between subgroups categorized by tumor depth, size, and longitudinal location. When tumors were located at the anterior wall of the stomach, the length of the proximal SB (10.0 cm [9.0-11.0]) at the GC side was the longest. In cases with several sentinel lymph nodes (SLNs), the lengths of the SB at the GC side were significantly longer than those with fewer SLNs. However, the lengths of the SB were similar on the LC side regardless of the number of SLNs. CONCLUSIONS This pilot study had some limitations of a small number of enrolled patients, the lack of research on the specific station of SLNs, and the inaccurate indication for sentinel node navigation surgery (SNNS) without tracer. Nevertheless, the present study which reported the extents of SBs might be the first step towards simplifying procedures in laparoscopic SNNS for stomach preservation in EGC.
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Affiliation(s)
- Sung Eun Oh
- grid.264381.a0000 0001 2181 989XDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- grid.264381.a0000 0001 2181 989XDepartment of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Republic of Korea.
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Keun Won Ryu
- grid.410914.90000 0004 0628 9810Center of Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
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Booka E, Takeuchi H. Recent Advances in Sentinel Node Navigation Surgery for Early Gastric Cancer. J Gastric Cancer 2023; 23:159-170. [PMID: 36750996 PMCID: PMC9911613 DOI: 10.5230/jgc.2023.23.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023] Open
Abstract
Maintaining the postoperative quality of life (QOL) while ensuring curability without overtreatment is important in the treatment of early gastric cancer. Postoperative QOL is anticipated to be maintained through minimally invasive function-preserving gastrectomy in early gastric cancer. The concept of the sentinel lymph node (SN) basin is essential to maintain the curability of early gastric cancer using minimally invasive function-preserving gastrectomy. However, additional resection after surgery is difficult to perform in gastric cancer. Thus, the SN basin theory is important. Recently, a multicenter randomized phase III trial in South Korea (SENORITA trial) proved that laparoscopic sentinel node navigation surgery (LSNNS) for stomach preservation results in better postoperative QOL compared with standard gastrectomy in patients with early gastric cancer. LSNNS contributes to patients' QOL based on the concept that curability is not impaired. A multicenter nonrandomized phase III trial is ongoing in Japan, and oncologic safety is expected to be demonstrated. LSNNS has been established as a treatment option for selected patients with early gastric cancer, and its application will become widespread in the future.
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Affiliation(s)
- Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan.
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35
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Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, Kim BJ, Min BH, Choi CI, Shin CM, Tae CH, Gong CS, Kim DJ, Cho AEH, Gong EJ, Song GJ, Im HS, Ahn HS, Lim H, Kim HD, Kim JJ, Yu JI, Lee JW, Park JY, Kim JH, Song KD, Jung M, Jung MR, Son SY, Park SH, Kim SJ, Lee SH, Kim TY, Bae WK, Koom WS, Jee Y, Kim YM, Kwak Y, Park YS, Han HS, Nam SY, Kong SH. Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach. J Gastric Cancer 2023; 23:3-106. [PMID: 36750993 PMCID: PMC9911619 DOI: 10.5230/jgc.2023.23.e11] [Citation(s) in RCA: 152] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.
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Affiliation(s)
- Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center Seoul, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Pusan, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seungnam, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Woman's University College of Medicine, Seoul, Korea
| | - Chung Sik Gong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University, Cheonan, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Lim
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Ji Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jwa Hoon Kim
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Shin-Hoo Park
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeseob Jee
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Yoo Min Kim
- Department of Surgery, Severance Hospital, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Su Youn Nam
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
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Sakamoto E, Safatle-Ribeiro AV, Jr UR, Ribeiro Jr U. Advances in surgical techniques for gastric cancer: Indocyanine green and near-infrared fluorescence imaging. Is it ready for prime time? Chin J Cancer Res 2022; 34:587-591. [PMID: 36714345 PMCID: PMC9829491 DOI: 10.21147/j.issn.1000-9604.2022.06.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
Surgery is still the primary curative treatment for gastric cancer, which includes resection of the tumor with adequate margins and extended lymphadenectomy. In order to improve the operative results and the quality of life of patients, several endeavors have been made toward precision medicine through image-guided surgery, allowing access to real-time intraoperative anatomy and accurate tumor staging. The goal of the surgeon is to achieve a more precise, individualized, and less invasive surgery without compromising oncological efficiency and safety. In this perspective, we have demonstrated the role of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging method in gastric cancer surgery. This technique may be used to improve localization of the tumor, detection of sentinel lymph nodes (SLN), real-time lymphatic mapping, and blood flow assessment (anastomosis perfusion).
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Affiliation(s)
- Erica Sakamoto
- Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, (ICESP-HCFMUSP) São Paulo, SP 01246-000, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, (ICESP-HCFMUSP) São Paulo, SP 01246-000, Brazil
| | - Ulysses Ribeiro Jr
- Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, (ICESP-HCFMUSP) São Paulo, SP 01246-000, Brazil,Ulysses Ribeiro Jr. Department of Gastroenterology, Instituto do Cancer do Estado de São Paulo, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, (ICESP-HCFMUSP) São Paulo, SP 01246-000, Brazil.
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Song JH, Han SU. Perspectives of laparoscopic surgery for gastric cancer. Chin J Cancer Res 2022; 34:533-538. [PMID: 36398120 PMCID: PMC9646463 DOI: 10.21147/j.issn.1000-9604.2022.05.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 08/30/2023] Open
Abstract
Gastrectomy is the main treatment option for gastric cancer patients. Laparoscopic approach has become popular as an alternative to open method during the last decades, and clinical trials have revealed safety and feasibility in the short- and long-term outcomes of laparoscopic gastrectomy. The aim of this review is to summarize the results of prospective clinical trials and propose future perspectives for laparoscopic gastrectomy.
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Affiliation(s)
- Jeong Ho Song
- Department of Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea
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Feng M, Wei J, Ji K, Zhang Y, Yang H, Wu X, Zhang J, Bu Z, Ji J. Characteristics of lymph node stations/basins metastasis and construction and validation of a preoperative combination prediction model that accurately excludes lymph node metastasis in early gastric cancer. Chin J Cancer Res 2022; 34:519-532. [PMID: 36398119 PMCID: PMC9646451 DOI: 10.21147/j.issn.1000-9604.2022.05.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/12/2022] [Indexed: 08/10/2023] Open
Abstract
Objective To explore the candidate indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery in early gastric cancer (EGC). Methods The clinicopathological data of 561 patients with EGC who underwent radical gastrectomy for gastric cancer at Peking University Cancer Hospital from November 2010 to November 2020 with postoperative pathological stage pT1 and complete examination data, were collected. Pearson's Chi-square test was used and binary logistic regression was employed for univariate and multivariate analyses. Combined analysis of multiple risk and protective factors for lymph node metastasis (LNM) of EGC was performed. A negative predictive value (NPV) combination model was built and validated. Results LNM occurred in 85 of 561 patients with EGC, and the LNM rate was 15.15%. NPV for LNM reached 100% based on three characteristics, including ulcer-free, moderately well differentiation and patient <65 years old or tumor located at the proximal 1/3 of the stomach. Regarding lymphatic basin metastasis, multivariate analysis showed that the metastatic proportion of the left gastric artery lymphatic basin was significantly higher in male patients compared with female patients (65.96% vs. 38.89%, P<0.05). The proportion of right gastroepiploic artery lymphatic basin metastasis in patients with a maximum tumor diameter >2 cm was significantly greater than that noted in patients with a maximum tumor diameter ≤2 cm (60.78% vs. 28.13%, P<0.05). Conclusions Characteristics of lymph node stations/basins metastasis will facilitate precise lymph node resection. The NPV for LNM reaches 100% based on the following two conditions: young and middle-aged EGC patients, well-differentiated tumors, and without ulcers; or well-differentiated tumors, without ulcers, and tumors located in the proximal stomach. These findings can be used as the recommended indications for function-preserving curative gastrectomy and sentinel lymph node navigation surgery.
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Affiliation(s)
- Mengyu Feng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jingtao Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ke Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yinan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Heli Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiaojiang Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ji Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhaode Bu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Zhao PY, Ma ZF, Jiao YN, Yan Y, Li SY, Du XH. Laparoscopic and endoscopic cooperative surgery for early gastric cancer: Perspective for actual practice. Front Oncol 2022; 12:969628. [PMID: 36263224 PMCID: PMC9574332 DOI: 10.3389/fonc.2022.969628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Early gastric cancer (EGC) has a desirable prognosis compared with advanced gastric cancer (AGC). The surgical concept of EGC has altered from simply emphasizing radical resection to both radical resection and functional preservation. As the mainstream surgical methods for EGC, both endoscopic resection and laparoscopic resection have certain inherent limitations, while the advent of laparoscopic and endoscopic cooperative surgery (LECS) has overcome these limitations to a considerable extent. LECS not only expands the surgical indications for endoscopic resection, but greatly improves the quality of life (QOL) in EGC patients. This minireview elaborates on the research status of LECS for EGC, from the conception and development of LECS, to the tentative application of LECS in animal experiments, then to case reports and retrospective clinical studies. Finally, the challenges and prospects of LECS in the field of EGC are prospected and expounded, hoping to provide some references for relevant researchers. With the in-depth understanding of minimally invasive technology, LECS remains a promising option in the management of EGC. Carrying out more related multicenter prospective clinical researches is the top priority of promoting the development of this field in the future.
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Affiliation(s)
| | | | | | | | | | - Xiao-hui Du
- *Correspondence: Xiao-hui Du, ; Peng-yue Zhao,
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