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Kawaguchi Y, Murotani K, Hayashi N, Kamoshita S. Changes in nutritional management after gastrointestinal cancer surgery over a 12-year period: a cohort study using a nationwide medical claims database. BMC Nutr 2025; 11:19. [PMID: 39844275 PMCID: PMC11753049 DOI: 10.1186/s40795-025-01006-4] [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: 09/24/2024] [Accepted: 01/14/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Nutritional management in patients after gastrointestinal cancer surgery has changed throughout the 2000s. However, its evolution has not been formally studied. This study aimed to evaluate changes in nutritional management using real-world data. METHODS Patient data from 2011 to 2022 were extracted from a nationwide medical claims database. Patients were divided into four groups based on their year of hospital admission: period I, 2011-2013; II, 2014-2016; III, 2017-2019; IV, 2020-2022. For each period, feeding routes in all patients and prescribed doses of parenteral energy and amino acids in fasting patients during postoperative days (POD) 1-7 were determined. The results of the four different periods were compared using statistical trend tests. RESULTS The study cohort was comprised of 365,125 patients. During POD 1-3, the proportion of patients administered any oral intake increased over time (I, 40.3%; II, 47.1%; III, 49.4%; IV, 54.2%; P < 0.001), while that of patients receiving parenteral nutrition (PN) decreased (I, 60.1%; II, 55.0%; III, 50.3%; IV, 45.5%; P < 0.001). Of 19,661 patients with PN alone (i.e., neither oral intake nor enteral nutrition) during POD 1-7, the median (interquartile range) prescribed doses on POD 7 of energy (kcal/kg) [I, 15.3 (10.3-21.9); II, 13.9 (8.4-20.0); III, 13.2 (7.7-19.2); IV, 12.9 (7.0-18.7); P < 0.001] and amino acids (g/kg) [I, 0.65 (0.30-0.94); II, 0.58 (0.24-0.89); III, 0.56 (0.00-0.86); IV, 0.56 (0.00-0.87); P < 0.001] both decreased over time. CONCLUSION From 2011 to 2022, more patients who underwent gastrointestinal cancer surgery in Japan were administered early oral intake, while fewer patients were administered early PN. Overall, the energy and amino acid doses prescribed in PN were far below the guideline recommendations.
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Affiliation(s)
- Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
| | - Kenta Murotani
- School of Medical Technology, Kurume University, 777-1 Higashikushihara-Machi, Kurume, Fukuoka, Japan
- Biostatistics Center, Kurume University, 67 Asahi-Machi, Kurume, Fukuoka, Japan
| | - Nahoki Hayashi
- Medical Affairs Department, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 2-9 Kandatsukasa-Machi, Chiyoda-Ku, Tokyo, Japan
| | - Satoru Kamoshita
- Medical Affairs Department, Research and Development Center, Otsuka Pharmaceutical Factory, Inc., 2-9 Kandatsukasa-Machi, Chiyoda-Ku, Tokyo, Japan.
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Park JH, Lee HJ, Kim J, Cho YS, Lee S, Park S, Choe H, Song E, Kim Y, Kong SH, Park DJ, Nam BH, Yang HK. Development and Feasibility Assessment of Mobile Application-Based Digital Therapeutics for Postoperative Supportive Care in Gastric Cancer Patients Following Gastrectomy. J Gastric Cancer 2024; 24:420-435. [PMID: 39375057 PMCID: PMC11471326 DOI: 10.5230/jgc.2024.24.e37] [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: 06/17/2024] [Revised: 08/14/2024] [Accepted: 08/17/2024] [Indexed: 10/09/2024] Open
Abstract
PURPOSE This study aimed to develop and assess the feasibility and effectiveness of digital therapeutics for supportive care after gastrectomy. MATERIALS AND METHOD The study included 39 patients with gastric cancer who underwent minimally invasive gastrectomy and were able to use a mobile application (app) on their smartphones. The developed research app automatically calculates and provides daily targets for calorie and protein intake based on the patient's body mass index (BMI). Patients recorded their daily diets, weights, and symptoms in the app and completed special questionnaires to assess the feasibility of the app in real-world clinical practice. RESULTS At the 10-week follow-up, the mean questionnaire scores for ease of learning, usability, and effectiveness of the app (primary endpoint) were 2.32±0.41, 2.35±0.43, and 2.4±0.39 (range: 0-3), respectively. Patients were classified as underweight (<18.5, n=4), normal (18.5-24.9, n=24), or overweight (≥25.0, n=11) according to predischarge BMI. Underweight patients showed higher compliance with app usage and a higher rate of achieving the target calorie and protein intake than normal weight and overweight patients (98% vs. 77% vs. 81%, p=0.0313; 102% vs. 75% vs. 61%, P=0.0111; 106% vs. 79% vs. 64%, P=0.0429). Two patients transitioned from underweight to normal weight (50.0%), one patient (4.3%) transitioned from normal weight to underweight, and two patients (22.2%) transitioned from overweight to normal weight. CONCLUSIONS The mobile app is feasible and useful for postoperative supportive care in terms of ease of learning, usability, and effectiveness. Digital therapeutics may be an effective way to provide supportive care for postgastrectomy patients, particularly in terms of nutrition. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04800991.
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Affiliation(s)
- Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea.
| | - JeeSun Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Yo-Seok Cho
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sunjoo Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seongmin Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hwinyeong Choe
- Department of Nursing, Seoul National University Hospital, Seoul, Korea
| | - Eunhwa Song
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Youngran Kim
- Department of Food Service and Nutrition Care, Seoul Metropolitan Government (SMG) Seoul National University (SNU) Boramae Medical Center, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Byung-Ho Nam
- HERINGS, The Institute of Advanced Biomedical and Clinical Research, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
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Matsushima J, Sato T, Yoshimura Y, Mizutani H, Koto S, Matsusaka K, Ikeda JI, Sato T, Fujii A, Ono Y, Mitsui T, Ban S, Matsubara H, Hayashi H. Clinical utility of artificial intelligence assistance in histopathologic review of lymph node metastasis for gastric adenocarcinoma. Int J Clin Oncol 2023; 28:1033-1042. [PMID: 37256523 DOI: 10.1007/s10147-023-02356-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Advances in whole-slide image capture and computer image analyses using deep learning technologies have enabled the development of computer-assisted diagnostics in pathology. Herein, we built a deep learning algorithm to detect lymph node (LN) metastasis on whole-slide images of LNs retrieved from patients with gastric adenocarcinoma and evaluated its performance in clinical settings. METHODS We randomly selected 18 patients with gastric adenocarcinoma who underwent surgery with curative intent and were positive for LN metastasis at Chiba University Hospital. A ResNet-152-based assistance system was established to detect LN metastases and to outline regions that are highly probable for metastasis in LN images. Reference standards comprising 70 LN images from two different institutions were reviewed by six pathologists with or without algorithm assistance, and their diagnostic performances were compared between the two settings. RESULTS No statistically significant differences were observed between these two settings regarding sensitivity, review time, or confidence levels in classifying macrometastases, isolated tumor cells, and metastasis-negative. Meanwhile, the sensitivity for detecting micrometastases significantly improved with algorithm assistance, although the review time was significantly longer than that without assistance. Analysis of the algorithm's sensitivity in detecting metastasis in the reference standard indicated an area under the curve of 0.869, whereas that for the detection of micrometastases was 0.785. CONCLUSIONS A wide variety of histological types in gastric adenocarcinoma could account for these relatively low performances; however, this level of algorithm performance could suffice to help pathologists improve diagnostic accuracy.
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Affiliation(s)
- Jun Matsushima
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-Ku, Chiba, Chiba, 263-8522, Japan
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan
| | - Tamotsu Sato
- Toshiba Digital Solutions Corporation, 72-34 Horikawa-Cho, Saiwai-Ku, Kawasaki, Kanagawa, Japan
| | - Yuichiro Yoshimura
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-Ku, Chiba, Chiba, 263-8522, Japan
| | - Hiroyuki Mizutani
- Toshiba Digital Solutions Corporation, 72-34 Horikawa-Cho, Saiwai-Ku, Kawasaki, Kanagawa, Japan
| | - Shinichiro Koto
- Toshiba Digital Solutions Corporation, 72-34 Horikawa-Cho, Saiwai-Ku, Kawasaki, Kanagawa, Japan
| | - Keisuke Matsusaka
- Department of Pathology, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan
| | - Jun-Ichiro Ikeda
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan
| | - Taiki Sato
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Akiko Fujii
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Yuko Ono
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Shimotusugagun, Mibu, Tochigi, Japan
| | - Takashi Mitsui
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Japan
| | - Shinichi Ban
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan
| | - Hideki Hayashi
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-Ku, Chiba, Chiba, 263-8522, Japan.
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, Chiba, Japan.
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Fan X, Shi C, Lu D. High risk factors related to lymph node metastasis in early gastric cancer: A retrospective observational study. Medicine (Baltimore) 2023; 102:e33431. [PMID: 37000054 PMCID: PMC10063287 DOI: 10.1097/md.0000000000033431] [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: 02/09/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
Lymph node metastasis (LNM) is a key factor affecting the prognosis of patients with early gastric cancer. This is a retrospective study, conducted between January 20, 2010 and January 30, 2019 and included 402 patients with early-stage gastric cancer who underwent radical gastrectomy at The Affiliated People Hospital of Ningbo University. Clinical and pathological data including patients' gender, age, tumor location, gross typing, depth of invasion, tumor maximum diameter, type of differentiation, vascular invasion, presence or absence of signet ring cells, and LNM data were collected and analyzed. Univariate analysis identified positive relationships between patient gender, tumor invasion depth, tumor size, presence or absence of vascular involvement, and differentiation type with LNM (P < .05). Multivariate analysis subsequently confirmed tumor size (odds ratio [OR]: 2.38, 95% confidence interval [CI]:1.15-4.92, P = .02), vascular involvement (OR: 4.35, 95% CI: 2.00-9.47, P < .001), and depth of invasion (OR: 6.63, 95% CI: 2.19-20.06, P = .001) as independent risk factors for LNM (P < .05). Tumor size, vascular involvement, and depth of invasion are independent risk factors for LNM in cases of early-stage gastric cancer.
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Affiliation(s)
- Xiaoyuan Fan
- Department of Gastroenterology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Chihong Shi
- Department of Gastroenterology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Dewen Lu
- Department of Gastroenterology, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
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Milone M, Vertaldi S, Alfano MS, Agrusa A, Anania G, Baiocchi GL, Bianchi PP, Biondi A, Bracale U, Buscemi S, Chiozza M, Corcione F, D'Ugo D, Degiuli M, De Simone G, Elmore U, Galli F, Giuliani G, Maida P, Maione F, Manigrasso M, Marte G, Olmi S, Rausei S, Reddavid R, Rosati R, Uccelli M, De Palma GD, Cassinotti E, Boni L. Enterotomy Closure after Minimally Invasive Distal Gastrectomy with Intracorporeal Anastomosis: A Multicentric Study. Dig Surg 2022; 39:232-241. [PMID: 36198281 DOI: 10.1159/000526348] [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: 09/06/2021] [Accepted: 06/30/2022] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Despite progressive improvements in technical skills and instruments that have facilitated surgeons performing intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging tasks is handsewn knot tying. We analysed the better way to fashion a handsewn intracorporeal enterotomy closure after a stapled anastomosis. METHODS All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic versus laparoscopic approach; laparoscopic high definition versus three-dimensional versus 4K technology; single-layer versus double-layer enterotomies. Double-layer enterotomies were analysed layer by layer, comparing running versus interrupted suture; the presence versus absence of deep corner suture; and type of suture thread. RESULTS Significantly lower rates of bleeding (p = 0.011) and leakage (p = 0.048) from gastro-jejunal anastomosis were recorded in the double-layer group. Barbed suture thread was significantly associated with reduced intraluminal bleeding and leakage rates both in the first (p = 0.042 and p = 0.010) and second layer (p = 0.002 and p = 0.029). CONCLUSIONS Double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure result in lower intraluminal bleeding and anastomotic leak rates.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Marie Sophie Alfano
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Palermo, Italy
| | - Gabriele Anania
- Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Pietro Paolo Bianchi
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Umberto Bracale
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, Section of General and Urgent Surgery, University of Palermo, Palermo, Italy
| | - Matteo Chiozza
- Department of Morphology, Surgery and Experimental Medicine, Sant'Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Francesco Corcione
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Naples, Italy
| | - Domenico D'Ugo
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Italy
| | - Giuseppe De Simone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Federica Galli
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
| | - Giuseppe Giuliani
- Department of General and Minimally Invasive Surgery, Misericordia Hospital, Grosseto, Italy
| | - Pietro Maida
- Department of General Surgery, Evangelic Hospital Betania, Naples, Italy
| | - Francesco Maione
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, University "Federico II" of Naples, Naples, Italy
| | - Giampaolo Marte
- Department of General Surgery, Evangelic Hospital Betania, Naples, Italy
| | - Stefano Olmi
- General and Oncologic Surgery Department - Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Italy
| | - Rossella Reddavid
- Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Matteo Uccelli
- General and Oncologic Surgery Department - Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, Italy
| | | | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS-Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS-Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Jin Kim S, Kim TU, Woong Choi C, Gon Ryu D. Extragastric recurrence in patients who underwent surgical resection of stage I gastric cancer: Incidence, risk factors, and value of abdominal computed tomography as a postoperative surveillance method. Medicine (Baltimore) 2022; 101:e30335. [PMID: 36123838 PMCID: PMC9478289 DOI: 10.1097/md.0000000000030335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extragastric recurrence after radical resection of stage I gastric cancer is very rare. We investigated the incidence of extragastric recurrence and risk factors in patients who underwent surgical resection of stage I gastric cancer and evaluated the value of abdominal CT as a surveillance tool. This retrospective study enrolled 914 patients with stage I gastric cancer who underwent surgical resection at a single tertiary hospital. We investigated extragastric recurrence during the follow-up period, and disease-free survival (DFS) was assessed. Over a median follow-up period of 39 months, the overall incidence of extragastric recurrence was 2.2% (20/914). Risk factors for extragastric recurrence included deep submucosal invasion (SM2-3), muscularis propria invasion, and lymph node metastasis (hazard ratio [HR]=10.37, 28.101, and 6.843; P = .028, .002, and .001, respectively). Based on the number of risk factors, patients were stratified into 3 subgroups: low-risk (pT1aN0, pT1b(SM1)N0, 496/914), moderate-risk (pT1aN1, pT1b(SM1)N1, pT1b(SM2-3)N0, pT2N0, 369/914), and high-risk (pT1b(SM2-3)N1, 49/914). DFS was significantly longer in the low-risk group, followed by the moderate-risk and high-risk groups. We propose that postoperative CT surveillance should be omitted for stage 1A cases involving the mucosa and SM1 because of the extreme rarity of extragastric recurrence.
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Affiliation(s)
- Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Un Kim
- Department of Radiology, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- *Correspondence: Tae Un Kim, Department of Radiology, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 50612, Republic of Korea (e-mail: )
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Feng Q, Long D, Du MS, Wang XS, Li ZS, Zhao YL, Qian F, Wen Y, Yu PW, Shi Y. Short-Term Clinical Efficacy of Neoadjuvant Chemotherapy Combined With Laparoscopic Gastrectomy for Locally Advanced Siewert Type II and III Adenocarcinoma of the Esophagogastric Junction: A Retrospective, Propensity Score-Matched Study. Front Oncol 2021; 11:690662. [PMID: 34660265 PMCID: PMC8511681 DOI: 10.3389/fonc.2021.690662] [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: 04/03/2021] [Accepted: 08/24/2021] [Indexed: 02/03/2023] Open
Abstract
Background Laparoscopic gastrectomy (LG) has been increasingly used for the treatment of locally advanced Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). However, whether LG can achieve the same short-term efficacy in the treatment of patients who receive neoadjuvant chemotherapy (NACT) remains controversial. Thus, the aim of this study was to investigate the clinical outcomes of NACT combined with LG for Siewert type II and III AEG. Methods This retrospective study identified patients with locally advanced Siewert type II and III AEG diagnosed between May 2011 and October 2020 using the clinical tumor-node-metastasis (cTNM) staging system. The short-term outcomes were compared between the matched groups using a 1:3 propensity score matching (PSM) method, which was performed to reduce bias in patient selection. Results After PSM, 164 patients were selected, including 41 in the NACT group and 123 in the LG group. The baseline characteristics were similar between the two groups. Compared with the LG group, the NACT group exhibit a smaller tumor size and significantly less advanced pathological tumor classification and nodal classification stages. The time to first flatus of the NACT group was significantly shorter, but the hospital stay was significantly longer than that of the LG group. The NACT group showed similar overall (29.3% vs 25.2%, P=0.683), systemic (24.4% vs 21.1%, P=0.663), local (12.2% vs 9.8%, P=0.767), minor (19.5% vs 19.5%, P=1.000) and major (9.8% vs 5.7%, P=0.470) complications as the LG group. Subgroup analyses showed no significant differences in most stratified parameters. Operation time≥ 300 minutes was identified as an independent risk factor for overall complications. Age≥ 60 years was identified as an independent risk factor for major complications. Conclusion NACT combined with LG for AEG does not increase the risk of postoperative morbidity and mortality compared with LG.
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Affiliation(s)
- Qing Feng
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Du Long
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Ming-Shan Du
- Radiology Department, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xiao-Song Wang
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Zhen-Shun Li
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Feng Qian
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yan Wen
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Pei-Wu Yu
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, The First Affiliated Hospital, Army Medical University, Chongqing, China
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Kim YM, Hyung WJ. Current status of robotic gastrectomy for gastric cancer: comparison with laparoscopic gastrectomy. Updates Surg 2021; 73:853-863. [PMID: 33394356 DOI: 10.1007/s13304-020-00958-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/24/2022]
Abstract
Robotic systems were developed to overcome limitations of laparoscopic surgery with its mechanical advantages. Along with the technical advances, robotic gastrectomy for gastric cancer is increasing. However, the evidence regarding safety and efficacy for robotic gastrectomy for gastric cancer is not mature yet. Although studies are limited, it is evident that robotic gastrectomy has a longer operation and less blood loss compared with laparoscopic gastrectomy. Studies revealed long-term oncological outcomes after robotic gastrectomy was comparable to those after laparoscopic gastrectomy. Taken together, robotic gastrectomy with systemic lymph node dissection is suggested as a safe procedure with equivalent short- and long-term oncologic outcomes to either laparoscopic or open gastrectomy for the surgical treatment of gastric cancer. However, high cost is the most significant barrier to justify robotic surgery as a routine and standard treatment for patients with gastric cancer. In the meanwhile, robotic surgery will be expansively used as long as technologic developments continue.
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Affiliation(s)
- Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
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Koulis A, Busuttil RA, Boussioutas A. Premalignant lesions of the stomach and management of early neoplastic lesions. RESEARCH AND CLINICAL APPLICATIONS OF TARGETING GASTRIC NEOPLASMS 2021:185-216. [DOI: 10.1016/b978-0-323-85563-1.00013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Liu XY, Zhang J. A protocol of systematic review and meta-analysis of narrow band imaging endoscopy in detection of early gastric cancer. Medicine (Baltimore) 2020; 99:e21269. [PMID: 32702914 PMCID: PMC7373608 DOI: 10.1097/md.0000000000021269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Although previous studies have utilized narrow band imaging endoscopy diagnosis (NBIED) in detection of patients with early gastric cancer (EGC), there are still inconsistent results. Thus, this study will explore the accuracy of NBIED in detection of patients with EGC. METHODS We propose to perform literature search of potential studies investigating the accuracy of NBIED in detection of patients with EGC in MEDLINE, EMBASE, Cochrane Library, Web of Science, WANGFANG, VIP database and China National Knowledge Infrastructure from the beginning of each database to January 31, 2020 without restrictions to language and publication time. Two authors will independently scrutinize these databases to identify studies that satisfy all predefined eligibility criteria. We will check study quality and analyze outcome data using Quality Assessment of Diagnostic Accuracy Studies tool, and RevMan 5.3 software respectively. RESULTS We anticipate the results of this study will afford additional insight into the appraising of the accuracy of NBIED in patients with EGC. CONCLUSION The findings of this study will be useful informing diagnostic decisions for the diagnosis of patients with EGC.PROSPERO registration number: PROSPERO CRD42020171053.
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Affiliation(s)
- Xiao-yu Liu
- Department of Endoscopy Center, Yulin No.2 Hospital, Yulin
| | - Jun Zhang
- Department of Gastroenterology, Second Affiliated Hospital of Xi’an Jiaotong University School of Medicine, Xi’an, China
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He XL, Cao ZM. Effect of high-quality nursing intervention on the psychological disorder in patients with gastric cancer during perioperative period: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20381. [PMID: 32501983 PMCID: PMC7306291 DOI: 10.1097/md.0000000000020381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study will be proposed for investigating the effects of high-quality nursing intervention (HQNI) on the psychological disorder in patients with gastric cancer during perioperative period (GC-PPP). METHODS A cumulative search from inception up to the March 31, 2020 will be performed in the following databases: Cochrane Library, MEDLINE, EMBASE, Web of Science, VIP database, and China National Knowledge Infrastructure. We will search all potential studies from those electronic databases regardless their language and publication status. We will only consider randomized controlled trials (RCTs) for inclusion, which explores the effect of HQNI on the psychological disorder in patients with GC-PPP. Study identification, information extraction, and study quality appraisal will be independently and respectively done by 2 researchers. Any different opinions between 2 researchers will be disentangled by a third researcher after discussion. Cochrane risk of bias tool will be used for study quality assessment, and RevMan 5.3 software will be utilized for statistical analysis. RESULTS This study will provide a high-quality synthesis of psychological disorder outcomes to evaluate the effects and safety of HQNI for patients with GC-PPP. CONCLUSION The findings of this study will provide reference and evidence to appraise whether HQNI is an effective on the psychological disorder in patients with GC-PPP STUDY REGISTRATION NUMBER:: INPLASY202040080.
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Affiliation(s)
- Xiu-Li He
- Department of Nursing Care, Yan’an People's Hospital
| | - Zhi-Min Cao
- Department of Nursing Care, Yan’an Second People's Hospital, Yan’an, China
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