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Marano L, Cwalinski T, Girnyi S, Skokowski J, Goyal A, Malerba S, Prete FP, Mocarski P, Kania MK, Świerblewski M, Strzemski M, Suárez-Carreón LO, Herrera Kok JH, Polom K, Kycler W, Calu V, Talento P, Brillantino A, Ciarleglio FA, Brusciano L, Cillara N, Duka R, Pascotto B, Azagra JS, Calomino N, Testini M, Abou-Mrad A, Oviedo RJ, Vashist Y. Evaluating the Role of Robotic Surgery Gastric Cancer Treatment: A Comprehensive Review by the Robotic Global Surgical Society (TROGSS) and European Federation International Society for Digestive Surgery (EFISDS) Joint Working Group. Curr Oncol 2025; 32:83. [PMID: 39996883 PMCID: PMC11854667 DOI: 10.3390/curroncol32020083] [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] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Revised: 01/22/2025] [Accepted: 01/29/2025] [Indexed: 02/26/2025] Open
Abstract
INTRODUCTION Robot-assisted minimally invasive gastrectomy (RAMIG) represents a significant advancement in the surgical management of gastric cancer, offering superior dexterity, enhanced visualization, and improved ergonomics compared to laparoscopic gastrectomy (LG). This review systematically evaluates the current evidence on perioperative outcomes, oncological efficacy, learning curves, and economic considerations, providing insights into RAMIG's potential role in modern gastric cancer surgery. METHODS A thorough analysis of retrospective, prospective, and meta-analytic studies was conducted to compare RAMIG with LG. Key outcomes, including operative time, intraoperative blood loss, lymph node retrieval, postoperative complications, learning curve duration, and cost-effectiveness, were assessed. Emphasis was placed on both short-term and long-term oncological outcomes to determine the clinical value of RAMIG. RESULTS Evidence indicates that RAMIG is associated with reduced intraoperative blood loss, lower morbidity rates, and a shorter learning curve, with proficiency achieved after 11-25 cases compared to 40-60 cases for LG. The robotic platform's articulated instruments and enhanced three-dimensional visualization enable more precise lymphadenectomy, particularly in complex anatomical regions. Despite these advantages, operative time remains longer, and costs remain higher due to system acquisition, maintenance, and consumable expenses. However, emerging data suggest a gradual narrowing of cost disparities. While short-term outcomes are favorable, further high-quality, multicenter studies are needed to validate long-term oncological efficacy and survival outcomes. CONCLUSION RAMIG offers significant technical and clinical advantages over conventional LG, particularly in terms of precision and learning efficiency. However, the long-term oncological benefits and economic feasibility require further validation. Future research should focus on cost optimization, advanced technological integration such as near-infrared fluorescence and artificial intelligence, and multicenter trials to solidify RAMIG's role as a standard approach for gastric cancer surgery.
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Affiliation(s)
- Luigi Marano
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), 52-300 Elbląg, Poland; (J.S.); (S.M.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
- Department of Surgery, Dnipro State Medical University, Volodymyra Vernadskoho St. 9, 49044 Dnipro, Ukraine;
- Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Tomasz Cwalinski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Sergii Girnyi
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Jaroslaw Skokowski
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), 52-300 Elbląg, Poland; (J.S.); (S.M.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Aman Goyal
- Department of General Surgery, Mahatma Gandhi Medical College, Research Institute, Pondicherry, Cuddalore Rd., ECR, Pillayarkuppam 607402, Puducherry, India;
- Department of Medicine, Adesh Institute of Medical Sciences and Research, Bathinda 151001, Punjab, India
| | - Silvia Malerba
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), 52-300 Elbląg, Poland; (J.S.); (S.M.); (K.P.)
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70110 Bari, Italy; (F.P.P.); (M.T.)
| | - Francesco Paolo Prete
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70110 Bari, Italy; (F.P.P.); (M.T.)
| | - Piotr Mocarski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Magdalena Kamila Kania
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Maciej Świerblewski
- Department of General Surgery and Surgical Oncology, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland; (T.C.); (S.G.); (P.M.); (M.K.K.); (M.Ś.)
| | - Marek Strzemski
- Department of Anesthesiology and Intensive Care, “Saint Wojciech” Hospital, “Nicolaus Copernicus” Health Center, 80-000 Gdańsk, Poland;
| | - Luis Osvaldo Suárez-Carreón
- Department of Bariatric Surgery, UMAE Hospital de Especialidades del Centro Medico Nacional de Occidente, Guadalajara 44349, Mexico;
- Department of Surgery, Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Johnn Henry Herrera Kok
- Department of Surgery, Complejo Asistencial Universitario de Palencia, 34401 Palencia, Spain;
| | - Karol Polom
- Department of Medicine, Academy of Applied Medical and Social Sciences—AMiSNS (Akademia Medycznych I Spolecznych Nauk Stosowanych), 52-300 Elbląg, Poland; (J.S.); (S.M.); (K.P.)
- Department of Gastrointestinal Surgical Oncology, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
| | - Witold Kycler
- Department of Gastrointestinal Surgical Oncology, Greater Poland Cancer Centre, 61-866 Poznan, Poland;
| | - Valentin Calu
- Department of Surgery, University of Medicine and Pharmacy Carol Davila, 010001 Bucharest, Romania;
| | - Pasquale Talento
- Department of Surgery, Pelvic Floor Center, AUSL-IRCCS Reggio Emilia, 42122 Reggio Emilia, Italy;
| | | | | | - Luigi Brusciano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Study of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Nicola Cillara
- Department of Surgery, “SS. Trinità” Hospital, 09121 Cagliari, Italy
| | - Ruslan Duka
- Department of Surgery, Dnipro State Medical University, Volodymyra Vernadskoho St. 9, 49044 Dnipro, Ukraine;
| | - Beniamino Pascotto
- Department of General and Minimally Invasive Surgery (Laparoscopy & Robotic), Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg; (B.P.); (J.S.A.)
| | - Juan Santiago Azagra
- Department of General and Minimally Invasive Surgery (Laparoscopy & Robotic), Centre Hospitalier de Luxembourg, 1210 Luxembourg, Luxembourg; (B.P.); (J.S.A.)
| | - Natale Calomino
- Department of Medicine, Surgery, and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, 70110 Bari, Italy; (F.P.P.); (M.T.)
| | - Adel Abou-Mrad
- Department of Surgery, Centre Hospitalier Universitaire d’Orléans, 45000 Orléans, France;
| | - Rodolfo J. Oviedo
- Department of Surgery, Nacogdoches Medical Center, Nacogdoches, TX 75962, USA
- Department of Surgery, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX 77001, USA
- Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, TX 77301, USA
| | - Yogesh Vashist
- Department of Surgery, Organ Transplant Center for Excellence, Center for Liver Diseases and Oncology, King Faisal Specialist Hospital and Research Center, Riyadh 12271, Saudi Arabia;
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Zhang L, Cui J, Cai M, Li B, Ma G, Wang X, Liu Y, Deng J, Zhang R, Liang H, Yang J. Comparison of short‑term outcomes and 3-year overall survival between robotic and laparoscopic gastrectomy for gastric cancer: a propensity score matching analysis. Acta Chir Belg 2024; 124:478-486. [PMID: 38693890 DOI: 10.1080/00015458.2024.2348256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Despite the increasing use of robotic gastrectomy (RG) as an alternative to laparoscopic gastrectomy (LG) in treating gastric cancer, controversy remains over the advantages of RG compared to LG and there is a paucity of studies comparing the two techniques regarding patient survival. METHODS In this retrospective cohort study, 675 patients undergoing minimally invasive gastrectomy were recruited from January 2016 to January 2018 (LG: n = 567; RG: n = 108). A one-to-one propensity score matching (PSM) analysis was applied to minimize the selection bias due to confounding factors, yielding 104 patients in each of the RG and LG groups. After matching, the short-term outcomes and 3-year overall survival were compared in the two groups. RESULTS The PSM cohort analysis showed a similar 3-year overall survival between RG and LG groups (p = .249). Concerning the short-term outcomes, the RG compared to LG resulted in lower blood loss (p = .01), lower postoperative complications (p = .001), lower postoperative pain (p = .016), earlier initiation of soft diet (p = .011), shorter hospital stay (p = .012), but higher hospitalization expenses (p = .001). CONCLUSION Our findings suggest that RG may offer advantages in terms of blood loss, surgical complications, recovery time, and pain management compared to LG while maintaining similar overall survival rates. However, RG is associated with higher hospital costs, potentially limiting its wider adoption. Further research, including large, multi-center randomized controlled trials with longer patient follow-up, particularly for advanced gastric cancer, is needed to confirm these findings.
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Affiliation(s)
- Li Zhang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Jingli Cui
- Department of General Surgery, Weifang People's Hospital, Weifang, P. R. China
| | - Mingzhi Cai
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Bin Li
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Gang Ma
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Xuejun Wang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Yong Liu
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Jingyu Deng
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Rupeng Zhang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Han Liang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
| | - Jilong Yang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, P. R. China
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Kido M, Shoda K, Yan L, Ikoma K, Ichikawa D. Inter-prefectural regional disparities in gastric cancer surgery: A Japanese nationwide population-based cohort study from 2014 to 2019. Ann Gastroenterol Surg 2024; 8:1017-1025. [PMID: 39502726 PMCID: PMC11533019 DOI: 10.1002/ags3.12813] [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: 09/22/2023] [Revised: 04/02/2024] [Accepted: 04/15/2024] [Indexed: 11/08/2024] Open
Abstract
Aim This study aimed to investigate the regional disparities in gastric cancer surgery in Japan. Methods The annual incidence of gastric cancer and number of gastrectomies, board-certified surgeons in gastroenterology by the Japanese Society of Gastroenterological Surgery, and board-certified surgeons by the Japan Society for Endoscopic Surgery were evaluated by prefecture in Japan during 2014-2019. Medium-sized regional disparities were assessed using the Gini coefficient. Gastrectomies were further broken down by site (distal; proximal; total) and approach (open vs laparoscopic). Moreover, we compared the urban and rural regional disparities in all study variables. Results The annual national average incidence of gastric cancer was 127 466 and the number of gastrectomies was 49 128. Gini coefficients for almost all variables, except for board-certified surgeons by the Japan Society of Endoscopic Surgery, were <0.2, indicating low inequality. The incidence of gastric cancer, the number of gastrectomies, and the aging rate were significantly higher in rural prefectures than in urban prefectures. Conclusion Inter-prefectural regional disparities in gastric cancer surgery were generally small; however, both the incidence of gastric cancer and number of gastrectomies were higher in rural prefectures, where the aging rate was also increased. This study provides an overview of the landscape of gastric cancer care in Japan.
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Affiliation(s)
- Masamitsu Kido
- Department of Orthopedic SurgeryInage HospitalChibaJapan
| | - Katsutoshi Shoda
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiYamanashiJapan
| | - Luying Yan
- Department of AnesthesiologyBrigham and Women's HospitalBostonMAUSA
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiYamanashiJapan
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Park SH, Kim YN, Hwang J, Kim KY, Cho M, Kim YM, Hyung WJ, Kim HI. Safety and feasibility of reduced-port robotic distal gastrectomy for gastric cancer: a phase I/II clinical trial using the da Vinci Single Port(SP) robotic system. Sci Rep 2023; 13:18578. [PMID: 37903856 PMCID: PMC10616185 DOI: 10.1038/s41598-023-45655-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/22/2023] [Indexed: 11/01/2023] Open
Abstract
Minimally invasive surgery reduces surgical trauma and the size and number of incisions. The da Vinci SP robotic surgical system was designed to overcome the technical demands of single-incision laparoscopic surgery. This study aimed to demonstrate the safety and feasibility of single-port (SP) robotic distal gastrectomy (SPRDG) for patients with gastric cancer using the da Vinci SP system (Intuitive Surgical Inc., Sunnyvale, CA, USA). This study was designed as a single-arm prospective phase I/II clinical trial of SPRDG (first posted date: 21/09/2021, NCT05051670; clinicaltrials.gov). SPRDG using the da Vinci SP system was performed on 19 patients with gastric cancer between December 2021 and October 2022. The primary outcome was the safety of SPRDG as measured by major postoperative complications. The secondary outcomes were operation time, bleeding amount, bowel motility recovery, and length of hospital stay. SPRDG was performed in all 19 patients without unexpected events, such as use of additional trocars or conversion to laparoscopic or open surgery. No major complications occurred postoperatively (0/19, 0.0%). The mean operation time was 218 min (range 164-286 min). The mean hospital stay duration was 3.2 days (range 2-4 days). This phase I/II clinical trial, performed by a single expert surgeon, demonstrated the safety and feasibility of SPRDG with the da Vinci SP system in selected patients with gastric cancer. SPRDG could be a reasonable alternative to conventional or reduced-port minimally invasive gastrectomy, as it has cosmetic advantages, early recovery, and safe discharge.
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Affiliation(s)
- Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Youn Nam Kim
- Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Jawon Hwang
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Korea.
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.
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Wu CY, Lin JA, Huang QZ, Xu JH, Zhong WJ, Kang WG, Wang JT, Chen JX, Zheng HD, Ye K. Comparison of short-term and long-term clinical effects of modified overlap anastomosis and conventional incision-assisted anastomosis in laparoscopic total gastrectomy. BMC Surg 2023; 23:306. [PMID: 37817168 PMCID: PMC10566090 DOI: 10.1186/s12893-023-02212-2] [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: 06/30/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND To compare short-term and long-term clinical effects of modified overlap anastomosis and conventional incision-assisted anastomosis for laparoscopic total gastrectomy. METHODS This retrospective cohort study included patients with gastric cancer admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to March 2020. Quality of life, intraoperative and postoperative conditions were analyzed. RESULTS Compared with the conventional assisted group, the modified overlap group showed a shorter auxiliary incision, milder postoperative pain, shorter time to the first postoperative anal exhaust, shorter time to the first postoperative liquid food intake, and shorter postoperative stay. There were no differences between the two groups regarding operation time, esophagus-jejunum anastomosis time, intraoperative blood loss, number of lymph nodes dissected, and length of the upper incision margin. There were no differences between the two groups regarding postoperative early and late complications. There were no differences between the two groups regarding the QLQ-C30 scale three years after the operation. The scores of the QLQ-STO22 scale 3 years after the operation showed significantly lower scores for dysphagia and feeding limit in the modified overlap group than those in the conventional assisted anastomosis group. There was no recurrence in the modified overlap group but one patient in the conventional assisted group. CONCLUSIONS Patients undergoing totally laparoscopic total gastrectomy with modified overlap anastomosis have better minimal invasiveness and faster post-operative recovery than conventional incision-assisted anastomosis.
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Affiliation(s)
- Chu-Ying Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jian-An Lin
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Qiao-Zhen Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jian-Hua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Wen-Jin Zhong
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Wen-Gui Kang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jin-Tian Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jun-Xing Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Hui-Da Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China.
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SU L, HAO J, ZHANG N, WU S, WU X, WEI W. SMPDL3B contributes to gastric adenocarcinoma cells progression by promoting the infiltration of M2 macrophages. Turk J Med Sci 2023; 53:1635-1647. [PMID: 38813495 PMCID: PMC10760593 DOI: 10.55730/1300-0144.5732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/12/2023] [Accepted: 10/04/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim The common disease gastric adenocarcinoma (GAC) has a high morbidity and mortality, so there is an urgent need for research to explore new diagnostic markers and therapeutic targets. This investigation was carried out to investigate the expression of sphingomyelin phosphodiesterase acid-like 3b (SMPDL3B) in GAC and its effects on tumor progression. Materials and methods Samples were collected from patients who underwent radical gastrectomy from January 2021 to December 2022. Along with the normal gastric epithelial cell lines GES-1 and SGC-7901, the AGS, MGC-803, and MSN-45 human gastric cancer cell lines were used to confirm SMPDL3B expression. RT-qPCR, Western blot, immunohistochemical, cell proliferation, assay of wound healing, transwell migration assay, invasion assay, flow cytometry, and immune evaluation experiments were carried out. Results SMPDL3B was found to be substantially expressed in GAC, and this condition has a bad prognosis. By establishing SMPDL3B knockdown and overexpression of GAC cell lines, this study confirmed that SMPDL3B promoted tumor cell proliferation, migration, and invasion. Additional bioinformatics research revealed a connection between SMPDL3B and immune cell infiltration in the GAC immunological microenvironment, which enhanced tumor cell proliferation by promoting the infiltration content of M2 macrophages. Conclusion This study determined the function of SMPDL3B for the clinical diagnosis, prediction, and novel management of GAC.
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Affiliation(s)
- Li SU
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin,
China
| | - Jian HAO
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin,
China
| | - Na ZHANG
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin,
China
| | - Shan WU
- Department of Oncology, Tianjin Union Medical Center, Nankai University, Tianjin,
China
| | - Xiuhua WU
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin,
China
| | - Wei WEI
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin,
China
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Lianos GD, Bali CD, Vlachos K, Drosou P, Rausei S, Mitsis M, Schizas D. Complete mesogastric excision for gastric cancer: is it the future of gastric cancer surgery? Per Med 2023; 20:461-466. [PMID: 37811582 DOI: 10.2217/pme-2023-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Gastric cancer remains undoubtedly one of the most common and deadly cancers worldwide. The global incidence shows wide geographic variation with a high prevalence in Asia. Besides that, there are evident differences in epidemiology, histopathology, tumor location, diagnosis and treatment strategy between east and west countries. Gastric cancer represents an aggressive disease, with many factors influencing its development and also recurrence after surgical resection. New knowledge of disease spread and new routes of metastases are now emerging and the 'novel' concept of complete mesogastric excision for gastric cancer is under consideration and debate. This article aims to analyze and highlight this new concept after a careful literature review, offering also a view toward the future.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Christina D Bali
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | | | - Panagiota Drosou
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Stefano Rausei
- Department of Surgery, Cittiglio-Angera Hospital, ASST Settelaghi, Cittiglio, 21033, Italy
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina, Ioannina, 45500, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, 11527, Greece
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Deng D, Zhang Y, Zhang R, Yi J, Dong J, Sha L, Yan M. Circulating Proteins and Metabolite Biomarkers in Gastric Cancer: A Systematic Review and Meta-analysis. Arch Med Res 2023; 54:124-134. [PMID: 36759293 DOI: 10.1016/j.arcmed.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 12/08/2022] [Accepted: 12/20/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Gastric cancer (GC) is often diagnosed at an advanced stage and thus patients have a poor prognosis. This implies that early detection of this cancer will improve patient prognosis and survival. This systematic review explored the association of circulating protein and metabolite biomarkers with GC development. METHODS A literature search was conducted until November 2021 on Medline, Embase, Cochrane library, and Web of Science databases. Studies were included if they assessed circulating proteins and metabolites in blood, urine, or saliva and determined their association with GC risk. Quality of identified studies was determined using the Newcastle-Ottawa scale for cohort studies. Random and fixed effects meta-analyses were performed to calculate pooled odds ratio. RESULTS A total of 53 studies were included. High levels of anti-Helicobacter pylORi IgG levels, pepsinogen I (PGI) <30 µg/L and serum pepsinogen I/ pepsinogen II (PGI/II) ratio<3 were positively associated with risk of developing GC (pooled odds ratio (OR): 2.70; 95% CI: 1.44-5.04, 5.96, 95% CI: 2.65-13.42 and 4.43; 95% CI: 3.04-6.47). In addition, an inverse relationship was found between ferritin, iron and transferrin levels and risk of developing GC (OR: 0.62; 95% CI: 0.38-1,0.97; 95% CI: 0.94-1 and 0.85; 95% CI: 0.76-0.94). However, there was no association between levels of glucose, cholesterol, vitamin C, vitamin B12, vitamin A, α-Carotene, β-Carotene, α-Tocopherol, γ-Tocopherol, and GC risk. CONCLUSION The pooled analysis demonstrated that high levels of anti-Helicobacter pylORi IgG, PGI<30µg/L and serum PGI/II ratio <3 and low levels of ferritin, iron and transferrin were associated with risk of GC.
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Affiliation(s)
- Dawei Deng
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yuhan Zhang
- Department of Nursing, School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China.
| | - Rongzhi Zhang
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jing Yi
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jianli Dong
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, China
| | - Liyan Sha
- Department of Nursing, The Second Hospital of Dalian Medical University, Dalian, China
| | - Meiqin Yan
- Department of Science and Education, Children's Hospital of Shanxi and Women Health Center of Shanxi, China
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Fu J, Lin F, Zheng S, Hong W, Zhang M. Laparoscopic D2 radical gastrectomy improves postoperative inflammation and gastric function in elderly patients with advanced gastric cancer. Am J Transl Res 2022; 14:8695-8702. [PMID: 36628208 PMCID: PMC9827309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the effect of laparoscopic radical gastrectomy on the inflammation and recovery of gastrointestinal function in elderly patients with advanced gastric cancer (GC). METHODS Data of 80 elderly patients with advanced GC admitted to the Taizhou First people's Hospital from May 2014 to January 2019 were collected for this retrospective analysis. Among them, 34 patients underwent open D2 radical gastrectomy were regarded as control group. The other 46 patients underwent laparoscopic D2 radical gastrectomy were considered as observation group. Both groups underwent 2/3 or more mid-segment gastrectomy with D2 regional lymphatic dissection. The operative time, intraoperative bleeding, postoperative ventilation time, length of stay (LOS) and perioperative complication rates were compared between the two groups. Peripheral blood was drawn before and after surgery to detect the inflammatory factors C-reactive protein (CRP), calcitoninogen (PCT), tumor necrosis factor-α (TNF-α), gastric function gastrin 17 (G-17), and pepsinogen (PG) I and II. Subsequently, patients were followed up for 3-year prognosis to document the survival of patients. RESULTS The operative time and LOS were shorter and intraoperative bleeding was lower in the observation group than those in the control group (P<0.05). There was no statistical difference in treatment costs and incidence of perioperative complications between the two groups (P>0.05). After surgery, CRP, PCT and TNF-α were elevated in both groups but were lower in the observation group than that in the control group (P<0.05). PG I was dramatically higher (P<0.05), while PG II and G-17 were lower (P<0.05) in both groups after treatment. Also, the posttreatment PG I and G-17 were higher (P<0.05) and PG II was lower (P<0.05) in the observation group than those in the control group. Prognostic follow-up revealed no statistical difference between groups in terms of the 1-year and 3-year overall survival (P>0.05). CONCLUSION Laparoscopic D2 radical surgery is more effective in the treatment of advanced GC in the elderly, because it can effectively suppress the postoperative inflammation and improve recovery of gastric function. Hence, it has a high clinical application value.
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Analysis of the Preventive Action of Rivaroxaban against Lower Extremity Deep Venous Thrombosis in Patients after Laparoscopic Radical Gastrectomy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7140066. [PMID: 36124169 PMCID: PMC9482470 DOI: 10.1155/2022/7140066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 12/09/2022]
Abstract
Background Gastric carcinoma (GC) is a common lethal cancer in the world. Patients are prone to develop lower extremity deep venous thrombosis (LEDVT) after laparoscopic radical gastrectomy (LRG), which threatens their life and health. Purpose This research is to clarify the preventive action of rivaroxaban (Riv) against LEDVT in patients undergoing LRG. Methods A retrospective study was conducted on 70 patients with GC admitted for LRG between January 2019 and January 2022, including 40 patients (observation group) receiving Riv treatment and 30 patients (conventional group) treated with air wave pressure therapy apparatus. Quality of life, coagulation function, LEDVT formation, and complications were compared between groups. Results The observation group had better recovery of life quality than the control group, along with more effective inhibition of coagulation disorders, less DVT formation, and fewer complications. Conclusions Compared with air wave pressure therapy apparatus, Riv has better preventive action against LEDVT in GC patients after LRG.
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Zhao J, Li K, Wang Z, Ke Q, Li J, Zhang Y, Zhou X, Zou Y, Song C. Efficacy and safety of indocyanine green tracer-guided lymph node dissection in minimally invasive radical gastrectomy for gastric cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:884011. [PMID: 35992827 PMCID: PMC9388933 DOI: 10.3389/fonc.2022.884011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The implementation of indocyanine green (ICG) tracer-guided lymph node dissection is still in the preliminary stages of laparoscopic surgery, and its safety and efficacy for gastric cancer remain unclear. Methods A systematic review was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and Scopus to identify relevant subjects from inception to June 2022. The core indicators were the total number of harvested lymph nodes and the safety of the laparoscopic gastrectomy with ICG. A meta-analysis was performed to estimate the pooled weighted mean difference (WMD) and 95% confidence interval (CI). Results Thirteen studies and 2,027 participants were included (642 for the ICG-group and 1,385 for the non-ICG group). The mean number of lymph nodes dissected in the ICG group was significantly greater than that in the non-ICG group (WMD = 6.24, 95% CI: 4.26 to 8.22, P <0.001). However, there was no significant difference in the mean number of positive lymph nodes dissected between the ICG and the non-ICG groups (WMD = 0.18, 95% CI: −0.70 to 1.07, P = 0.879). Additionally, ICG gastrectomy did not increase the risk in terms of the operative time, estimated blood loss, and postoperative complications. Conclusion ICG tracer with favorable safety increases the number of harvested lymph nodes but not the number of positive lymph nodes in laparoscopic gastrectomy. More high-quality, large-sample-size randomized controlled trials are still needed to enhance this evidence.
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Affiliation(s)
- Jixiang Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ke Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Surgical Oncology, Capital Medical University, Beijing, China
| | - Zikang Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Gastroenterolog, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingqing Ke
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiapu Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yizhen Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaojiang Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunzhi Zou
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Surgical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Yunzhi Zou, ; Conghua Song,
| | - Conghua Song
- Department of Gastroenterology, The Affiliated Hospital (Group) of Putian University, Putian, China
- *Correspondence: Yunzhi Zou, ; Conghua Song,
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Kim KH, Lee SH, Choi CW, Kim SJ, In Choi C, Kim DH, Jeon TY, Hwang SH. Actual 3-Year Survival After Reduced-Port Laparoscopic Distal Gastrectomy for Gastric Cancer (RpLDG): a Propensity Score Matching Analysis. J Gastrointest Surg 2022; 26:550-557. [PMID: 34668159 DOI: 10.1007/s11605-021-05097-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 07/17/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Total laparoscopic distal gastrectomy for early gastric cancer has been widely accepted; however, reduced-port laparoscopic distal gastrectomy has not gained the same popularity because of technical difficulties and oncologic safety issues. This study aimed to analyze the oncologic safety and short-term surgical outcomes of patients who underwent reduced-port laparoscopic distal gastrectomy (RpLDG) for gastric cancer. METHODS Consecutive patients who underwent surgical treatment between January 2016 and May 2018 were included in this study. Of the 833 patients enrolled, 158 underwent RpLDG and were propensity-matched with 158 patients who underwent conventional port laparoscopic distal gastrectomy (CpLDG). The groups were compared in terms of short-term outcomes and disease-free and overall survival rates. RESULTS The RpLDG group had shorter operation times (161.8 min vs. 189.0 min, p < 0.00) and shorter postoperative hospital stays (7.6 days vs. 9.1 days, p = 0.04) compared to the CpLDG group. Estimated blood loss was lower in the RpLDG group than in the CpLDG group (52.6 mL vs. 73.7 mL, p < 0.00), while hospital costs incurred by the RpLDG group were lower than those of the CpLDG group (10,033.7 vs. 11,016.8 USD, p < 0.00). No statistical differences were found regarding overall morbidity and occurrence of surgical complications of grade III or higher, as defined by the Clavien-Dindo classification. Furthermore, no significant differences between RpLDG and CpLDG were found in 3-year disease-free (99.4% vs. 98.1%; p = 0.42) and 3-year overall survival rates (98.7% vs. 96.8%; p = 0.25). CONCLUSION Patients who underwent RpLDG had better short-term surgical outcomes than those who underwent CpLDG in terms of operation time, estimated blood loss, duration of hospital stay, and hospital costs. The oncologic safety of RpLDG was satisfactory.
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Affiliation(s)
- Ki Hyun Kim
- Department of Surgery, Kosin University College of Medicine, Busan, Republic of Korea
| | - Si-Hak Lee
- Department of Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, 50612, Republic of Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University, Pusan, Republic of Korea
| | - Dae-Hwan Kim
- Department of Surgery, Pusan National University, Pusan, Republic of Korea
| | - Tae-Yong Jeon
- Department of Surgery, Pusan National University, Pusan, Republic of Korea
| | - Sun-Hwi Hwang
- Department of Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, 50612, Republic of Korea.
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Pan C, Deng D, Wei T, Wu Z, Zhang B, Yuan Q, Liang G, Liu Y, Yin P. Metabolomics study identified bile acids as potential biomarkers for gastric cancer: A case control study. Front Endocrinol (Lausanne) 2022; 13:1039786. [PMID: 36465663 PMCID: PMC9715751 DOI: 10.3389/fendo.2022.1039786] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022] Open
Abstract
Gastric cancer (GC) is a common lethal malignancy worldwide. Gastroscopy is an effective screening technique for decreasing mortality. However, there are still limited useful non-invasive markers for early detection of GC. Bile acids are important molecules for the modulation of energy metabolism. With an in-depth targeted method for accurate quantitation of 80 bile acids (BAs), we aimed to find potential biomarkers for the early screening of GC. A cohort with 280 participants was enrolled, including 113 GC, 22 benign gastric lesions (BGL) and 145 healthy controls. Potential markers were identified using a random forest machine algorithm in the discovery cohort (n=180), then validated in an internal validation cohort (n=78) and a group with 22 BGL. The results represented significant alterations in the circulating BA pool between GC and the controls. BAs also exhibited significant correlations with various clinical traits. Then, we developed a diagnostic panel that comprised six BAs or ratios for GC detection. The panel showed high accuracy for the diagnosis of GC with AUC of 1 (95%CI: 1.00-1.00) and 0.98 (95%CI: 0.93-1.00) in the discovery and validation cohort, respectively. This 6-BAs panel was also able to identify early GC with AUC of 1 (95%CI: 0.999-1.00) and 0.94 (95%CI: 0.83-1.00) in the discovery and validation cohort, respectively. Meanwhile, this panel achieved a good differential diagnosis between GC and BGL and the AUC was 0.873 (95%CI: 0.812-0.934). The alternations of serum bile acids are characteristic metabolic features of GC. Bile acids could be promising biomarkers for the early diagnosis of GC.
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Affiliation(s)
- Chen Pan
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of General Surgery, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dawei Deng
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Department of Hepato-Biliary-Pancreas, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tianfu Wei
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zeming Wu
- iPhenome Biotechnology (Yun Pu Kang) Inc., Dalian, China
| | - Biao Zhang
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qihang Yuan
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guogang Liang
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yanfeng Liu
- Department of General Surgery, First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Yanfeng Liu, ; Peiyuan Yin,
| | - Peiyuan Yin
- Clinical Laboratory of Integrative Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
- Institute of Integrative Medicine, Dalian Medical University, Dalian, China
- *Correspondence: Yanfeng Liu, ; Peiyuan Yin,
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Wang F, Zhang S, Zhao W, Wang D, Tang S, Zhang Q. Open distal gastrectomy versus laparoscopic distal gastrectomy for early gastric cancer: a retrospective study. J Gastrointest Oncol 2021; 12:2743-2748. [PMID: 35070403 PMCID: PMC8748056 DOI: 10.21037/jgo-21-782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Laparoscopic distal gastrectomy (LDG) is gaining popularity because its early postoperative effect has been shown to be better than open distal gastrectomy (ODG). However, to our knowledge, there are no studies demonstrating ODG is oncologically equivalent to LDG. METHODS This is a retrospective study based on the prospectively maintained database of the People's Hospital of Jinan City. Patients with operable, pathologically confirmed early-stage gastric cancer were included, while those with advanced disease or carcinoma in situ were excluded. Extracted data included age, body mass index (BMI), sex, clinical TNM stage, and pathologic stage. The primary outcome was 5-year overall survival, and the secondary outcomes included cancer-specific survival, cost-effectiveness, and quality of life. RESULTS A total of 126 patients were finally enrolled and included 61 in the ODG group and 65 in the LDG group. Baseline clinical and pathological characteristics were generally balanced between the two groups. After a median follow-up of 8.31 years, the 5-year overall survival rate was estimated to be 82.8% (95% CI: 69.4-90.7%) for the ODG group and 86.7% (95% CI: 73.9-93.5%) for the LDG group and the recurrence patterns were similar between the two groups. CONCLUSIONS Our data showed that the surgical results of both approaches are satisfactory, and LDG offers a reasonable option to ODG in patients with early gastric cancer.
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Affiliation(s)
- Feng Wang
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
| | - Shengbo Zhang
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
| | - Wei Zhao
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
| | - Deyou Wang
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
| | - Sifeng Tang
- Department of Gastrointestinal Surgery, The People’s Hospital of Jinan City, Jinan, China
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Wang S, Gao R, Zhao S, Zhu H, Zhang W, Kong X, Li P, Ma D, Gao J, Sun W. Safety and effectiveness of laparoscopic intratumoral resection facilitated by coagulation of giant hepatic hemangioma: a matched case-control study and literature review. Surg Endosc 2021; 36:5149-5159. [PMID: 34845546 DOI: 10.1007/s00464-021-08891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To report the safety and effectiveness of laparoscopic intratumoral resection facilitated by coagulation (LIRC) compared with laparoscopic hepatectomy (LH) in treating giant hepatic hemangioma. METHODS From 2017 to 2020, 19 consecutive patients with giant hepatic hemangioma (≥ 10 cm) received LIRC in one center. We selected a subgroup of 103 patients treated by LH in other four centers who well matched the 19 consecutive patients treated with LIRC, in a 1:1 fashion based on the tumor location, tumor size, and body mass index. Furthermore, the differences in technical success, operative time, operative blood loss, change of laboratory indexes, hospital stays, complication and clinical responds are compared between the two groups. RESULTS Technical success was achieved in all 38 patients. Patients in the LIRC group had a relative shorter operative time (P < 0.001) and less operative blood loss (P = 0.003). The serum levels of C-reactive protein (CRP), total bilirubin (TBil), alanine aminotransferase (ALT), and aspartate transaminase (AST) were elevated significantly (P < 0.05) 1 day after the resection and returned to normal within 7 days in both groups; however, relatively lower serum levels of those indexes were observed in the LIRC group (P < 0.05). The total complication rate was relatively lower in the LIRC group compared with the LH group (P = 0.029). Patients in the LIRC group had shorter hospital stays than those in the LH group (P = 0.010). The clinical response was similar in the two groups. CONCLUSIONS LIRC is safe and effective for treating giant hepatic hemangioma.
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Affiliation(s)
- Shaohong Wang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China
| | - Ruize Gao
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China
| | - Shuchao Zhao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China
| | - Huaqiang Zhu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China
| | - Wenxuan Zhang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China
| | - Xinliang Kong
- Department of Hepatobiliary Surgery, Rizhao Central Hospital, Rizhao, 276801, Shandong Province, China
| | - Peng Li
- Department of General Surgery, Binzhou Second People's Hospital, Binzhou, 256800, Shandong Province, China
| | - Demin Ma
- Department of Hepatobiliary Surgery, Dezhou People's Hospital, Dezhou, 253000, Shandong Province, China
| | - Jun Gao
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China.
| | - Wenbing Sun
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China.
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Omarov N, Uymaz D, Azamat IF, Ozoran E, Ozata IH, Bırıcık FS, Taskin OC, Balik E. The Role of Minimally Invasive Surgery in Gastric Cancer. Cureus 2021; 13:e19563. [PMID: 34796082 PMCID: PMC8590860 DOI: 10.7759/cureus.19563] [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] [Accepted: 11/14/2021] [Indexed: 12/09/2022] Open
Abstract
Objective: This study aims to investigate the efficacy and safety of minimally invasive surgery (MIS) in gastric cancer and to compare MIS versus open gastrectomy (OG) in terms of early mortality and morbidity, long-term oncological outcomes, and recurrence rates. Methods: A total of 75 patients who underwent MIS or OG for gastric cancer at Koç University School of Medicine between December 2014 and December 2019 were retrospectively analyzed. Postoperative complications and disease-specific survival were compared between surgical approaches. Results: Of the patients, 44 were treated with MIS and 31 with OG. In the MIS group, 33 patients underwent laparoscopic surgery, and 11 patients underwent robotic gastrectomy. Duration of operation was significantly longer in the MIS group than in the OG group (p<0.0001). The median amount of blood loss was 142.5 (range, 110 to 180) mL in the MIS group and 180.4 (range, 145 to 230) mL in the OG group (p<0.706). The median number of lymph node dissection was 38.9 (range, 15 to 66) and 38.7 (range, 12 to 70) in the MIS and OG groups, respectively (p<0.736). The median length of hospitalization, twelve days in the OG group and nine days in the MIS group. Median follow-up was 19.1 (range, 2 to 61) months in the MIS group and 22.1 (range, 2 to 58) months in the OG group. The median OS and DFS rates were 56.8 months and 39.6 months in the MIS group, respectively (log-rank; p=0.004) and 31.6 months and 23.1 months in the OG group, respectively (log-rank; p=0.003). Conclusion: Our study results suggest that, despite its technical challenges, MIS is an effective and safe method in treating gastric cancer with favorable early mortality and morbidity rates and long-term oncological outcomes, and acceptable recurrence rates.
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Affiliation(s)
- Nail Omarov
- General Surgery, Koç University Hospital, İstanbul, TUR
| | - Derya Uymaz
- General Surgery, Koç University Hospital, Istanbul, TUR
| | | | - Emre Ozoran
- General Surgery, Koç University Hospital, Istanbul, TUR
| | | | | | | | - Emre Balik
- General and Colorectal Surgery, Koç University Hospital, Istanbul, TUR
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Kim SJ, Jeon CH, Jung YJ, Seo HS, Lee HH, Song KY. Hybrid Robotic and Laparoscopic Gastrectomy for Gastric Cancer: Comparison with Conventional Laparoscopic Gastrectomy. J Gastric Cancer 2021; 21:308-318. [PMID: 34691814 PMCID: PMC8505116 DOI: 10.5230/jgc.2021.21.e30] [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: 09/04/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose The benefits of robotic gastrectomy remain controversial. We designed this study to elucidate the advantages of a hybrid robot and laparoscopic gastrectomy over conventional laparoscopic surgery. Materials and Methods A total of 176 patients who underwent gastrectomy for gastric cancer were included in this study. We compared 88 patients treated with hybrid robotic and laparoscopic gastrectomy (HRLG) and 88 patients who underwent conventional laparoscopic gastrectomy (CLG). In HRLG, suprapancreatic lymph node (LN) dissection was performed in a robotic setting. Clinicopathological characteristics, operative details, and short-term outcomes were analyzed for the patients. Results The number of LNs retrieved from the suprapancreatic area was significantly greater in the HRLG group (11.27±5.46 vs. 9.17±5.19, P=0.010). C-reactive protein levels were greater in the CLG group on both postoperative day (POD) 1 (5.11±2.64 vs. 4.29±2.38, P=0.030) and POD 5 (9.86±6.51 vs. 7.75±5.17, P=0.019). In addition, the neutrophil-to-lymphocyte ratio was significantly greater in the CLG group on both POD 1 (7.44±4.72 vs. 6.16±2.91, P=0.031) and POD 5 (4.87±3.75 vs. 3.81±1.87, P=0.020). Pulmonary complications occurred only in the CLG group (4/88 [4.5%] vs. 0/88 [0%], P=0.043). Conclusions HRLG is superior to CLG in terms of suprapancreatic LN dissection and postoperative inflammatory response.
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Affiliation(s)
- So Jung Kim
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Hyo Jeon
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Ju Jung
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Robotic Surgery Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Song
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Robotic Surgery Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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18
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Kim CH, Kim DJ, Kim W. The role of laparoscopic management in perforated gastric cancer. Ann Surg Treat Res 2021; 101:151-159. [PMID: 34549038 PMCID: PMC8424433 DOI: 10.4174/astr.2021.101.3.151] [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: 03/25/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Perforated gastric cancer is an extremely rare condition and usually presents in advanced stage with poor prognosis. Surgical strategies are still controversial regarding the extent to which complete resection or primary repair is performed and the application of laparoscopic techniques. We aim to determine the role of laparoscopic 2-stage approach in perforated gastric cancer. Methods Among 2,318 gastric cancers in Yeouido St. Mary's Hospital from January 1990 to December 2017, 20 patients with perforated gastric cancer were enrolled, and 5 patients underwent 2-stage gastrectomy consisting of primary closure on perforation followed by curative gastrectomy. Clinicopathological features, surgical outcomes, and survival analysis were evaluated. Results Two-stage approach for perforated gastric cancer was all performed by laparoscopic approach except 1 patient who needed paraaortic lymph node dissection (LND). Those were first treated on peritonitis with laparoscopic primary closure with or without Foley gastrostomy. Compared to 1-stage gastrectomy, more D2 LND was performed (60.0% vs. 100.0%, P = 0.260) and retrieved lymph nodes were significantly higher (median [range]: 17.0 [12.0–27.0] vs. 33.0 [26.5–43.5], P = 0.019]. Two patients of stage II and 3 patients of stage III were included in the 2-stage gastrectomy group. During the 38 months of median follow-up period, there were 8 and 1 recurrence among 1-stage and 2-stage gastrectomies, respectively. Except for 1 patient, 4 other 2-stage patients survived around 5 years without recurrence (5-year disease-free survival, 80%). Conclusion Laparoscopic 2-stage surgery for perforated gastric cancer is safe and might increase the curability of gastrectomy with extended LND.
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Affiliation(s)
- Chang Hwan Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wook Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Vasavada B, Patel H. Laparoscopic vs Open Gastrectomy: an Updated Meta-analysis of Randomized Control Trials for Short-Term Outcomes. Indian J Surg Oncol 2021; 12:587-597. [PMID: 34658589 PMCID: PMC8490556 DOI: 10.1007/s13193-021-01396-4] [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: 05/08/2020] [Accepted: 07/20/2021] [Indexed: 10/20/2022] Open
Abstract
The aim of this meta-analysis was to compare short-term outcomes of laparoscopic and open gastrectomy for gastric cancer. EMBASE, MEDLINE, PubMed, and the Cochrane Database were searched for randomized control trials comparing outcomes in patients undergoing laparoscopic gastrectomies with those patients undergoing open gastrectomies. The primary outcome was 30-day morbidity and mortality. Secondary outcomes studied included length of stay, blood loss, d2 gastrectomies, lymph node retrieval, operative time, wound complications, and intraabdominal complications. Systemic review and meta-analysis were done according to MOOSE and PRISMA guidelines. Eleven RCTs consisting of 4614 patients were included in the study. A total of 2452 patients were there in laparoscopic gastrectomy group while 2162 patients were included in open gastrectomy group. Morbidity was significantly low in laparoscopic group (p = 0.003). There was no significant difference in mortality between the two groups (P = 0.75). There were fewer wound complications in laparoscopic group and no difference intra-abdominal complications in both groups. Blood loss was significantly lesser in laparoscopic group (p < 0.001). Hospital stay was similar in both groups (p = 0.30). Operative time was significantly higher in laparoscopic group (p < 0.001). Laparoscopic group patients had a lesser number of lymph node retrieval compared to open group (p = 0.002). Laparoscopic group also contained similar advanced staged gastric cancer than open gastrectomies (p = 0.64). Laparoscopic gastrectomies were associated with lesser wound-related complications without decreasing hospital stay with a smaller number of lymph nodes retrieval.
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20
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Xu W, Wang L, Yan C, He C, Lu S, Ni Z, Hua Z, Zhu Z, Sah BK, Yang Z, Zheng Y, Feng R, Li C, Yao X, Chen M, Liu W, Yan M, Zhu Z. Neoadjuvant Chemotherapy Versus Direct Surgery for Locally Advanced Gastric Cancer With Serosal Invasion (cT4NxM0): A Propensity Score-Matched Analysis. Front Oncol 2021; 11:718556. [PMID: 34497768 PMCID: PMC8419416 DOI: 10.3389/fonc.2021.718556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/02/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND For locally advanced gastric cancer (LAGC) with serosal invasion (cT4NxM0), adjuvant chemotherapy (AC) after D2 gastrectomy is the standard therapy in Asia. However, perioperative chemotherapy (PCT) combined with D2 gastrectomy is mostly suggested in Europe and America. As a part of PCT, the value of neoadjuvant chemotherapy (NAC) is unclear. We investigated whether NAC could further improve survival and other outcomes for these patients. METHODS Patients with cT4NxM0 gastric cancer who underwent D2 gastrectomy were analyzed. The patients were divided into two groups based on whether they received NAC: the neoadjuvant chemotherapy (NAC) and direct surgery (S) groups. After propensity score matching (1:1 ratio), survival and perioperative outcomes were analyzed between the two groups. RESULTS A total of 902 patients met all the eligibility criteria and were enrolled. After propensity score matching, 221 matched pairs of patients were identified. The median overall survival (OS) and disease-free survival (DFS) of all patients were 75.10 and 43.67 months, respectively. The median OS of patients in the NAC and S groups were undefined and 29.80 months, respectively (P<0.0001). The median DFS of patients in the NAC and S groups were undefined and 22.60 months (P<0.0001). There were no significant differences in the radical degrees of operation between the two groups (P=0.07). However, there were significant differences in postoperative hospital stay (P<0.001) and complications (P=0.037) between the two groups. CONCLUSION This study suggested NAC can further improve prognosis and prevent recurrence in LAGC (cT4NxM0) patients. NAC is feasible and safe for LAGC (cT4NxM0) patients, and does not increase the risk of perioperative surgery.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Wentao Liu
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Yan
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenggang Zhu
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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21
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East meets West: the initial results of laparoscopic gastric cancer resections with Eastern principles in a single Western centre - a propensity score-matched study. Langenbecks Arch Surg 2021; 406:2699-2708. [PMID: 34331126 DOI: 10.1007/s00423-021-02283-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND We compared the initial experience of totally laparoscopic gastric cancer surgery with Eastern principles with the results of propensity score-matched counterparts operated with open surgery. METHODS From 1163 patients stored in our database, 62 PSM patients were selected for this study. The quality control was assured with video documentation and standardisation of the procedures. RESULTS According to the distribution of age, comorbidities, and general health, patients in the LG and OG were well-balanced. Most of the patients in both groups had advanced gastric cancer (69.3%). In the OG, 67.8% of patients received a total gastrectomy, as well as 54.8% of patients in the LG. There was no significant difference in the postoperative mortality between groups. The recovery of bowel function was significantly faster, and postoperative pain was significantly decreased in the LG. Compared to the OG, the inflammatory response was significantly smaller in the LG. There was no significant difference in the overall survival between LG and OG patients. CONCLUSION We have shown that laparoscopic gastrectomy with Eastern principles can be safely introduced in a high-volume Western centre with sufficient laparoscopic training. We have also shown that laparoscopy offers a significant faster bowel function recovery, less postoperative pain, and a smaller inflammatory response.
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22
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Khaled I, Priego P, Soliman H, Faisal M, Saad Ahmed I. Oncological outcomes of laparoscopic versus open gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer: a retrospective multicenter study. World J Surg Oncol 2021; 19:206. [PMID: 34243773 PMCID: PMC8272390 DOI: 10.1186/s12957-021-02322-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The oncological outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) following neoadjuvant chemotherapy have been investigated in a few studies. Our purpose was to evaluate the oncological outcomes of LG and OG after neoadjuvant chemotherapy in patients with locally advanced gastric cancer (GC) and to determine the advantages, preferences, and ease of use of the two techniques after chemotherapy. METHODS We conducted a retrospective chart review of all patients who underwent either OG (n = 43) or LG (n = 41). The neoadjuvant treatment regimen consisted of capecitabine plus oxaliplatin for three cycles, which was then repeated 6 to 12 weeks after the operation for four cycles. RESULTS The hospital stay time and intraoperative blood loss in the LG group were significantly lower than those in the OG group. The mortality rate and the 3-year survival rate for patients in the LG group were comparable to those of patients in the OG group (4.6% vs. 9.7% and 68.3% vs. 58.1%, respectively). Similar trends were observed regarding the 3-year recurrence rate and metastasis. The mean survival time was 52.9 months (95% confidence interval [CI], 44.2-61.6) in the OG group compared with 43.3 (95% CI, 36.6-49.8) in the LG group. Likewise, the mean disease-free survival was 56.1 months (95% CI, 46.36-65.8) in the LG group compared with 50.9 months (95% CI, 44.6-57.2) in the OG group. CONCLUSION LG is a feasible and safe alternative to OG for patients with locally advanced GC receiving neoadjuvant chemotherapy.
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Affiliation(s)
- Islam Khaled
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Kilo 4.5, Ring Road, Ismailia, Egypt.
| | - Pablo Priego
- Department of Oesophagogastric, Bariatric and Minimally Invasive Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - Hany Soliman
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Faisal
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Kilo 4.5, Ring Road, Ismailia, Egypt
| | - Ihab Saad Ahmed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Peng D, Cheng YX, Liao G. Effect of endoscopic resection on short-term surgical outcomes of subsequent laparoscopic gastrectomy: a meta-analysis. World J Surg Oncol 2021; 19:119. [PMID: 33853622 PMCID: PMC8048215 DOI: 10.1186/s12957-021-02230-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Endoscopic resection (ER) might affect subsequent laparoscopic gastrectomy (LG) because of the electrical coagulation, but the effect remains controversial. The purpose of this meta-analysis was to analyze the effect of ER on the short-term surgical outcomes of subsequent LG. MATERIALS AND METHODS The PubMed, EMBASE, and Cochrane Library databases were searched to find eligible studies published from inception to March 21, 2021. Short-term surgical outcomes were compared between the ER-LG group and the LG-only group. The registration ID of this current meta-analysis on PROSPERO is CRD42021238031. RESULTS Nine studies involving 3611 patients were included in this meta-analysis. The LG-only group had a higher T stage (T1-T2: OR=2.42, 95% CI=1.09 to 5.34, P=0.03; T3-T4: OR=0.41, 95% CI=0.19 to 0.91, P=0.03) than the ER-LG group. The ER-LG group showed a shorter operation time than the LG-only group (MD=-5.98, 95% CI=-10.99 to -0.97, P=0.02). However, no difference was found in operation time after subgroup analysis of propensity score matching studies. No significant difference was found in intraoperative blood loss, time to first oral feeding, or postoperative hospital stay between the ER-LG group and the LG-only group. And no significance was found in overall complications (OR=1.16, 95% CI=0.89 to 1.50, P=0.27), complications of grade ≥ II (OR=1.11, 95% CI=0.71 to 1.73, P=0.64), complications of grade ≥ III b (OR=1.47, 95% CI=0.49 to 4.43, P=0.49) between the ER-LG group and the LG-only group. CONCLUSIONS ER did not affect subsequent LG in terms of short-term outcomes, and the ER-LG group might have a shorter operation time than the LG-only group.
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Affiliation(s)
- Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yu-Xi Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Gang Liao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Incidence and treatment outcomes of leakage after gastrectomy for gastric cancer: Experience of 14,075 patients from a large volume centre. Eur J Surg Oncol 2021; 47:2304-2312. [PMID: 33663943 DOI: 10.1016/j.ejso.2021.02.013] [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] [Received: 10/20/2020] [Revised: 01/15/2021] [Accepted: 02/09/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Leakage is a serious and potentially fatal complication of gastrectomy for gastric cancer. However, comprehensive reports regarding leakage after gastrectomy remain limited. We aimed to evaluate the incidence and treatment outcomes of leakage after gastrectomy for cancer. METHODS We reviewed the prospectively collected data of 14,075 Patients who underwent gastrectomy for gastric cancer between 2005 and 2017. Outcomes included incidence, risk factors of leakage, and leakage treatment outcomes. RESULTS The median day of leakage detection was postoperative day 7 (range 1-29days). The overall leakage incidence was 1.51% (213/14,075), and the most frequent location was the oesophagojejunostomy (2.07%). Leakage after total gastrectomy was more frequent with minimally invasive surgery (open:1.64%, laparoscopic:3.56%, robotic:5.83%; P < 0.001). Leakage incidence was higher in the surgeon's initial 100 cases than in later cases (2.4 vs. 1.3%; P < 0.001), especially with minimally invasive surgery. Early leakage (within 4 days of surgery) occurred more often after minimally invasive surgery (open:12.7%, laparoscopic:35.4%, robotic:29.0%; P = 0.006). The success rate for initial treatment of leakage was 70.4% (150/213). Surgery after initial treatment failure demonstrated a higher success rate for early leakage than for late leakage (80.0 vs. 22.2%). Among 213 patients who experienced leakage, fifteen patients (7.0%) died, and leakage-related mortality accounted for 38.5% (15/39) of all surgery-related mortality after gastrectomy. CONCLUSIONS Leakage after gastric cancer surgery is associated with high mortality. Improved surgeon experience using minimally invasive techniques is required to reduce the risk of leakage. Surgery is an effective treatment for early leakage, although further studies are needed to establish the most appropriate treatment strategies.
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25
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Long D, Feng Q, Li ZS, Zhao YL, Qian F, Tang B, Chen J, Li PA, Shi Y, Yu PW. Laparoscopic versus open gastrectomy for serosa-invasive gastric cancer: A single-center retrospective cohort study. Surgery 2021; 169:1486-1492. [PMID: 33558067 DOI: 10.1016/j.surg.2020.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/31/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Whether laparoscopic gastrectomy is suitable for patients with serosa-invasive gastric cancer remains controversial. We performed this study to evaluate the short- and long-term outcomes after laparoscopic gastrectomy compared with after open gastrectomy. METHODS We retrospectively analyzed 906 consecutive patients with serosa-invasive gastric cancer from January 2004 to December 2014 in our center, who underwent laparoscopic gastrectomy or open gastrectomy with D2 lymphadenectomy. After propensity score matching, 334 patients were included in each group. Surgical conditions and short- and long-term results were compared. RESULTS Laparoscopic gastrectomy was associated with less estimated blood loss and longer operation time, while the number of harvested lymph nodes was not significantly different between laparoscopic gastrectomy and open gastrectomy. Patients who underwent laparoscopic gastrectomy had an earlier time to first flatus, first diet, and first ambulation and were discharged earlier. Overall and pulmonary postoperative complication rates were lower in the laparoscopic gastrectomy group. With a minimum follow-up of 60 months, the 5-year overall survival was 39.3% in the laparoscopic gastrectomy group and 34.3% in the open gastrectomy group, and the 5-year disease-free survival was 36.4% in the laparoscopic gastrectomy group and 32.7% in the open gastrectomy group. Laparoscopic gastrectomy was associated with better 5-year overall survival in patients aged ≥60 years. The overall recurrence rates and patterns were not significantly different between the 2 groups. CONCLUSION Laparoscopic gastrectomy is an alternative surgical approach for patients with serosa-invasive gastric cancer in terms of short-term outcomes and long-term survival, and it might be more advantageous for certain populations.
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Affiliation(s)
- Du Long
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Qing Feng
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhen-Shun Li
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Feng Qian
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Bo Tang
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jun Chen
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ping-Ang Li
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yan Shi
- Department of General Surgery, the First Affiliated Hospital of Army Medical University, Chongqing, China.
| | - Pei-Wu Yu
- Department of General Surgery, the First Affiliated Hospital of 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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Trends in Oncology: an Updated Review of Minimally Invasive Surgery vs. Traditional Open Surgery. JOURNAL OF INTERDISCIPLINARY MEDICINE 2020. [DOI: 10.2478/jim-2020-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: To review the recent trends in methodology for the most frequent oncological surgeries. More specifically, this paper will compare the minimally invasive methods to the conventional open method. It aims to find out whether minimally invasive surgeries are feasible treatments for certain types of cancers.
Methods: A review of retrospective studies searched in PubMed, Cochrane Library etc. was used to identify the studies published on this topic within a period of 6 years. Oncologic outcomes, postoperative complications/outcomes, and intraoperative outcomes were the main variables in the comparison to the surgical methods under review.
Conclusion: Despite the recent controversy with minimally invasive surgery being contraindicated for cervical cancer, it is still an acceptable method for other types of common cancers. However, there are limitations to the approach, and the surgeon should make a prudent selection between minimally invasive and open surgery depending on the type of tumor and patient characteristics. Further studies, especially with randomized control trials, must be conducted.
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Braghetto I, Lanzarini E, Musleh M, GutiÉrrez L, Molina JC, Korn O, Figueroa M, Lasnibat JP, Orellana O. LESSONS LEARNED ANALYZING COMPLICATIONS AFTER LAPAROSCOPIC TOTAL GASTRECTOMY FOR GASTRIC CANCER. ACTA ACUST UNITED AC 2020; 33:e1539. [PMID: 33331434 PMCID: PMC7747491 DOI: 10.1590/0102-672020200003e1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/19/2020] [Indexed: 12/02/2022]
Abstract
Background:
Laparoscopic surgery has been gradually accepted as an option for the
surgical treatment ofgastric cancer. There are still points that are
controversial or situations that are eventually associated with
intra-operative difficulties or postoperative complications.
Aim:
To establish the relationship between the difficulties during the execution
of total gastrectomy and the occurrence of eventual postoperative
complications.
Method:
The operative protocols and postoperative evolution of 74 patients operated
for gastriccancer, who were subjected to laparoscopic total gastrectomy
(inclusion criteria) were reviewed. The intraoperative difficulties recorded
in the operative protocol and postoperative complications of a surgical
nature wereanalyzed (inclusion criteria). Postoperative medical
complications were excluded (exclusion criteria). For the discussion, an
extensive bibliographical review was carried out.
Results:
Intra-operative difficulties or complications reported correspond to 33/74
and of these; 18 events (54.5%) were related to postoperative complications
and six were absolutely unexpected. The more frequent were leaks of the
anastomosis and leaks of the duodenal stump; however, other rare
complications were observed. Seven were managed with conservative measures
and 17 (22.9%) required surgical re-exploration, with a postoperative
mortality of two patients (2.7%).
Conclusion:
We have learned that there are infrequent and unexpected complications; the
treating team must be mindful of and, in front of suspicion of
complications, anappropriate decision must be done which includes early
re-exploration. Finally, after the experience reported, some complications
should be avoided.
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Affiliation(s)
- Italo Braghetto
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Enrique Lanzarini
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Maher Musleh
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis GutiÉrrez
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Juan Carlos Molina
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Owen Korn
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Manuel Figueroa
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Juan Pablo Lasnibat
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Omar Orellana
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
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Park SH, Hyung WJ. Current perspectives on the safety and efficacy of robot-assisted surgery for gastric cancer. Expert Rev Gastroenterol Hepatol 2020; 14:1181-1186. [PMID: 32842781 DOI: 10.1080/17474124.2020.1815531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Robotic gastrectomy is performed worldwide as part of the treatment for gastric cancer and is associated with good clinical outcome. This review aims to describe the current issues, debates, and future directions associated with the use of robotic gastrectomy for gastric cancer. AREA COVERED Here, we review the current evidence surrounding the safety and efficacy of robotic gastrectomy, including our institutional experience. Current issues associated with robotic gastrectomy, including feasibility, perioperative outcomes, and oncological outcomes, are described. EXPERT OPINION Sophisticated movements, articulating instruments, and the rapid introduction of fast-developing novel technology make robotic gastrectomy use more frequent. However, the need for well-designed prospective randomized trials is warranted.
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Affiliation(s)
- Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine , Seoul, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System , Seoul, Republic of Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System , Seoul, Republic of Korea
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30
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Hyung WJ, Yang HK, Park YK, Lee HJ, An JY, Kim W, Kim HI, Kim HH, Ryu SW, Hur H, Kim MC, Kong SH, Cho GS, Kim JJ, Park DJ, Ryu KW, Kim YW, Kim JW, Lee JH, Han SU. Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial. J Clin Oncol 2020; 38:3304-3313. [PMID: 32816629 DOI: 10.1200/jco.20.01210] [Citation(s) in RCA: 257] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE It is unclear whether laparoscopic distal gastrectomy for locally advanced gastric cancer is oncologically equivalent to open distal gastrectomy. The noninferiority of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer compared with open surgery in terms of 3-year relapse-free survival rate was evaluated. PATIENTS AND METHODS A phase III, open-label, randomized controlled trial was conducted for patients with histologically proven locally advanced gastric adenocarcinoma suitable for distal subtotal gastrectomy. The primary end point was the 3-year relapse-free survival rate; the upper limit of the hazard ratio (HR) for noninferiority was 1.43 between the laparoscopic and open distal gastrectomy groups. RESULTS From November 2011 to April 2015, 1,050 patients were randomly assigned to laparoscopy (n = 524) or open surgery (n = 526). After exclusions, 492 patients underwent laparoscopic surgery and 482 underwent open surgery and were included in the analysis. The laparoscopy group, compared with the open surgery group, suffered fewer early complications (15.7% v 23.4%, respectively; P = .0027) and late complications (4.7% v 9.5%, respectively; P = .0038), particularly intestinal obstruction (2.0% v 4.4%, respectively; P = .0447). The 3-year relapse-free survival rate was 80.3% (95% CI, 76.0% to 85.0%) for the laparoscopy group and 81.3% (95% CI, 77.0% to 85.0%; log-rank P = .726) for the open group. Cox regression analysis after stratification by the surgeon revealed an HR of 1.035 (95% CI, 0.762 to 1.406; log-rank P = .827; P for noninferiority = .039). When stratified by pathologic stage, the HR was 1.020 (95% CI, 0.751 to 1.385; log-rank P = .900; P for noninferiority = .030). CONCLUSION Laparoscopic distal gastrectomy with D2 lymphadenectomy was comparable to open surgery in terms of relapse-free survival for patients with locally advanced gastric cancer. Laparoscopic distal gastrectomy with D2 lymphadenectomy could be a potential standard treatment option for locally advanced gastric cancer.
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Affiliation(s)
- Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Wan Ryu
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University Hospital, Korea, Busan, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jin-Jo Kim
- Department of Surgery, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Young Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Jong Won Kim
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
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Hwang H, Myung JE, Yi JW, Lee SS, Park J. Laparoscopic surgery versus open surgery for gastric cancer: big data analysis based on nationwide administrative claims data. Ann Surg Treat Res 2020; 99:138-145. [PMID: 32908845 PMCID: PMC7463040 DOI: 10.4174/astr.2020.99.3.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/09/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Accumulated evidence indicates laparoscopic surgery (LS) has the advantages of less wound pain, less blood loss, shorter hospitalization, and faster functional recovery than open surgery (OS). Previous studies have analyzed the advantages of LS based on hospital data. This study is the first to compare surgical outcomes and health economic data using nationwide administrative claims datasets for gastric cancer. Methods The claims datasets of the Health Insurance Review and Assessment Service for patients that underwent gastrectomy from May 2012 to April 2017 were analyzed. A total of 76,445 cases (LS, 42,395 and OS, 34,050) were included. Postoperative complications and medical costs were included in the analysis. Results We analyzed 76,445 cases of gastrectomy. Analysis showed LS was associated with fewer surgical wound infections (2,114 [6.21%] vs. 1,057 [2.49%], P < 0.001), minor abdominal infections and abscesses (826 [2.43%] vs. 390 [0.92%], P < 0.001), cases of surgery-related peritonitis (50 [0.15%] vs. 31 [0.07%], P = 0.0019), repair surgeries (28 [0.08%] vs. 3 [0.01%], P < 0.001), reoperations (504 [1.48%] vs. 343 [0.81%], P < 0.001), less antibiotic use (1,717 [5.04%] vs. 1,268 [2.99%], P < 0.001), and shorter hospital stays (13.61 days vs. 9.97 days, P < 0.001). However, average medical cost was 510,734 Korean Won (444 US dollar) higher for LS than OS. Conclusion The study confirms the clinical benefits of LS over OS for gastrectomy in terms of fewer postoperative complications and shorter hospital stays. However, the average medical cost of LS was higher than that of OS.
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Affiliation(s)
- Hyojung Hwang
- Department of Health Policy, Graduate School of Public Health, Yonsei University, Seoul, Korea.,Department of Healthcare Economics & Government Affairs, Medtronic Korea, Seoul, Korea
| | - Jae-Eun Myung
- Department of Healthcare Economics & Government Affairs, Medtronic Korea, Seoul, Korea
| | - Jeong Woo Yi
- Department of Healthcare Economics & Government Affairs, Medtronic Korea, Seoul, Korea
| | - Sang-Soo Lee
- Department of Healthcare Economics & Government Affairs, Medtronic Korea, Seoul, Korea.,Department of Medical Device Management & Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Korea
| | - Joonbeom Park
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
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32
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Alzahrani SM, Ko CS, Yoo MW. Validation of the ACS NSQIP Surgical Risk Calculator for Patients with Early Gastric Cancer Treated with Laparoscopic Gastrectomy. J Gastric Cancer 2020; 20:267-276. [PMID: 33024583 PMCID: PMC7521978 DOI: 10.5230/jgc.2020.20.e27] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/14/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator is useful in predicting postoperative adverse events. However, its accuracy in specific disorders is unclear. We validated the ACS NSQIP risk calculator in patients with gastric cancer undergoing curative laparoscopic surgery. Materials and Methods We included 207 consecutive early gastric cancer patients who underwent laparoscopic gastrectomy between January 2018 and January 2019. The preoperative characteristics and risks of the patients were reviewed and entered into the ACS NSQIP calculator. The estimated risks of postoperative outcomes were compared with the observed outcomes using C-statistics and Brier scores. Results Most of the patients underwent distal gastrectomy with Roux-en-Y reconstruction (74.4%). We did not observe any cases of mortality, venous thromboembolism, urinary tract infection, renal failure, or cardiac complications. The other outcomes assessed were complications such as pneumonia, surgical site infections, any complications requiring re-operation or hospital readmission, the rates of discharge to nursing homes/rehabilitation centers, and the length of stay. All C-statistics were <0 and the highest was for pneumonia (0.65; 95% confidence interval: 0.58–0.71). Brier scores ranged from 0.01 for pneumonia to 0.155 for other complications. Overall, the risk calculator was inconsistent in predicting the outcomes. Conclusions The ACS NSQIP surgical risk calculator showed low predictive ability for postoperative adverse events after laparoscopic gastrectomy for patients with early gastric cancer. Further research to adjust the risk calculator for these patients may improve its predictive ability.
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Affiliation(s)
- Saleh M Alzahrani
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Seok Ko
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon-Won Yoo
- Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Machlowska J, Baj J, Sitarz M, Maciejewski R, Sitarz R. Gastric Cancer: Epidemiology, Risk Factors, Classification, Genomic Characteristics and Treatment Strategies. Int J Mol Sci 2020; 21:4012. [PMID: 32512697 PMCID: PMC7312039 DOI: 10.3390/ijms21114012] [Citation(s) in RCA: 814] [Impact Index Per Article: 162.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer (GC) is one of the most common malignancies worldwide and it is the fourth leading cause of cancer-related death. GC is a multifactorial disease, where both environmental and genetic factors can have an impact on its occurrence and development. The incidence rate of GC rises progressively with age; the median age at diagnosis is 70 years. However, approximately 10% of gastric carcinomas are detected at the age of 45 or younger. Early-onset gastric cancer is a good model to study genetic alterations related to the carcinogenesis process, as young patients are less exposed to environmental carcinogens. Carcinogenesis is a multistage disease process specified by the progressive development of mutations and epigenetic alterations in the expression of various genes, which are responsible for the occurrence of the disease.
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Affiliation(s)
- Julita Machlowska
- Center for Medical Genomics OMICRON, Jagiellonian University Medical College, 31-034 Kraków, Poland;
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (J.B.); (R.M.)
| | - Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (J.B.); (R.M.)
| | - Monika Sitarz
- Department of Conservative Dentistry with Endodontics, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Ryszard Maciejewski
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (J.B.); (R.M.)
| | - Robert Sitarz
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (J.B.); (R.M.)
- Department of Surgery, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-090 Lublin, Poland
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Zhang H, Li L, Yuan C, Wang C, Gao T, Zheng Z. MiR-489 inhibited the development of gastric cancer via regulating HDAC7 and PI3K/AKT pathway. World J Surg Oncol 2020; 18:73. [PMID: 32284070 PMCID: PMC7155329 DOI: 10.1186/s12957-020-01846-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/30/2020] [Indexed: 02/08/2023] Open
Abstract
Background Mounting evidences have displayed that the dysregulation of miRNAs plays important roles in the pathogenesis of gastric cancer (GC). The purpose of this study was to explore the biological functions and potential mechanism of miR-489 in GC progression. Methods Quantitative real-time PCR (qRT-PCR) and western blot were performed to examine the mRNA expression and protein levels of miR-489 and HDAC7. The relationship between miR-489 and HDAC7 was analyzed by Spearman rank correlation. 3-(4,5-dimethylthiazolyl-2)-2,5-diphenyltetrazolium bromide (MTT) assay and transwell assays were conducted for determining the effect of miR-489 and HDAC7 on GC cell viability, migration, and invasion. TargetScan and luciferase reporter assay were used to confirm the target gene of miR-489 in GC cells. Results The findings showed that miR-489 was dramatically decreased in GC tissues and GC cell lines (SGC-7901 and MKN45). Moreover, it was closely correlated with overall survival (OS) and progression-free survival (PFS) of GC patients. Downregulation of miR-489 significantly promoted GC cell proliferation, invasion, and migration. Additionally, HDAC7 was confirmed as the direct target of miR-489. Knockdown of HDAC7 exerted inhibited effect on GC progression and it markedly overturned miR-489 inhibitor-medicated effect on GC cells. More interestingly, via targeting HDAC7, miR-489 blocked the activation of PI3K/AKT pathway in GC cells. Conclusions Correctively, miR-489 played as a tumor suppressor in GC cell growth by targeting HDAC7, and miR-489 might function as a novel biomarker for diagnosis or therapeutic targets of human GC.
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Affiliation(s)
- Haiyan Zhang
- Department of Gastroenterology, People's Hospital of Rizhao, Rizhao, 276800, China
| | - Lingyun Li
- Department of Internal Medicine, Laishan Branch Hospital of Yantai Yuhuangding Hospital, Yantai, 264003, China
| | - Cuicui Yuan
- Department of Cardiovascular Medicine, The People's Hospital of zhangqiu area, Jinan, 250200, China
| | - Congcong Wang
- Department of Operation Room, The People's Hospital of zhangqiu area, Jinan, 250200, China
| | - Tiantian Gao
- Department of Nephrology, The People's Hospital of zhangqiu area, Jinan, 250200, China
| | - Zhiwei Zheng
- Department of General Surgery, People's Hospital of Rizhao, 126, Tai'an Road, Rizhao, 276800, China.
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Luo H, Yin D, Zhang S, Xiao D, He B, Meng F, Zhang Y, Cai W, He S, Zhang W, Hu Q, Guo H, Liang S, Zhou S, Liu S, Sun L, Guo X, Fang C, Liu L, Jia F. Augmented reality navigation for liver resection with a stereoscopic laparoscope. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 187:105099. [PMID: 31601442 DOI: 10.1016/j.cmpb.2019.105099] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/14/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Understanding the three-dimensional (3D) spatial position and orientation of vessels and tumor(s) is vital in laparoscopic liver resection procedures. Augmented reality (AR) techniques can help surgeons see the patient's internal anatomy in conjunction with laparoscopic video images. METHOD In this paper, we present an AR-assisted navigation system for liver resection based on a rigid stereoscopic laparoscope. The stereo image pairs from the laparoscope are used by an unsupervised convolutional network (CNN) framework to estimate depth and generate an intraoperative 3D liver surface. Meanwhile, 3D models of the patient's surgical field are segmented from preoperative CT images using V-Net architecture for volumetric image data in an end-to-end predictive style. A globally optimal iterative closest point (Go-ICP) algorithm is adopted to register the pre- and intraoperative models into a unified coordinate space; then, the preoperative 3D models are superimposed on the live laparoscopic images to provide the surgeon with detailed information about the subsurface of the patient's anatomy, including tumors, their resection margins and vessels. RESULTS The proposed navigation system is tested on four laboratory ex vivo porcine livers and five operating theatre in vivo porcine experiments to validate its accuracy. The ex vivo and in vivo reprojection errors (RPE) are 6.04 ± 1.85 mm and 8.73 ± 2.43 mm, respectively. CONCLUSION AND SIGNIFICANCE Both the qualitative and quantitative results indicate that our AR-assisted navigation system shows promise and has the potential to be highly useful in clinical practice.
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Affiliation(s)
- Huoling Luo
- Research Lab for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Dalong Yin
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Hepatobiliary Surgery, Shengli Hospital Affiliated to University of Science and Technology of China, Hefei, China
| | - Shugeng Zhang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Hepatobiliary Surgery, Shengli Hospital Affiliated to University of Science and Technology of China, Hefei, China
| | - Deqiang Xiao
- Research Lab for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Baochun He
- Research Lab for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Fanzheng Meng
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanfang Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital, Shenzhen, China
| | - Wei Cai
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shenghao He
- Research Lab for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Wenyu Zhang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qingmao Hu
- Research Lab for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Hongrui Guo
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuhang Liang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuo Zhou
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shuxun Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Linmao Sun
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao Guo
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Lianxin Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, China; Department of Hepatobiliary Surgery, Shengli Hospital Affiliated to University of Science and Technology of China, Hefei, China.
| | - Fucang Jia
- Research Lab for Medical Imaging and Digital Surgery, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China.
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Agnes A, Biondi A, Laurino A, Persiani R, D'Ugo D. Global updates in the treatment of gastric cancer: a systematic review. Part 1: staging, classification and surgical treatment. Updates Surg 2020; 72:341-353. [PMID: 32157635 DOI: 10.1007/s13304-020-00736-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023]
Abstract
Gastric cancer (GC) is the fifth malignancy and the third cause of cancer death worldwide, according to the global cancer statistics presented in 2018. Its definition and staging have been revised in the eight edition of the AJCC/TNM classification, which took effect in 2018. Novel molecular classifications for GC have been recently established and the process of translating these classifications into clinical practice is ongoing. The cornerstone of GC treatment is surgical, in a context of multimodal therapy. Surgical treatment is being standardized, and is evolving according to new anatomical concepts and to the recent technological developments. This is leading to a massive improvement in the use of mini-invasive techniques. Mini-invasive techniques aim to be equivalent to open surgery from an oncologic point of view, with better short-term outcomes. The persecution of better short-term outcomes also includes the optimization of the perioperative management, which is being implemented on large scale according to the enhanced recovery after surgery principles. In the era of precision medicine, multimodal treatment is also evolving. The long-time-awaited results of many trials investigating the role for preoperative and postoperative management have been published, changing the clinical practice. Novel investigations focused both on traditional chemotherapeutic regimens and targeted therapies are currently ongoing. Modern platforms increase the possibility for further standardization of the different treatments, promote the use of big data, and open new possibilities for surgical learning. This systematic review in two parts assesses all the current updates in GC treatment.
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Affiliation(s)
- Annamaria Agnes
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Alberto Biondi
- General Surgery Unit, Abdominal Surgery Area, Dipartimento Di Scienze Gastroenterologiche, Nefrourologiche Ed Endocrinometaboliche, IRCSS Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy. .,Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy. .,General Surgery Unit, Abdominal Surgery Area, Dipartimento Di Scienze Gastroenterologiche, Nefro-Urologiche Ed Endocrinometaboliche, IRCSS Fondazione Policlinico Universitario Agostino Gemelli, Largo Francesco Vito n. 1, 00168, Rome, Italy.
| | - Antonio Laurino
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Roberto Persiani
- General Surgery Unit, Abdominal Surgery Area, Dipartimento Di Scienze Gastroenterologiche, Nefrourologiche Ed Endocrinometaboliche, IRCSS Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy
| | - Domenico D'Ugo
- General Surgery Unit, Abdominal Surgery Area, Dipartimento Di Scienze Gastroenterologiche, Nefrourologiche Ed Endocrinometaboliche, IRCSS Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy.,Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Largo A. Gemelli n. 8, 00168, Rome, Italy
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Chen Q, Liu S, Zhang S, Cao X, Li B, Quan P, Guo L, Dong L, Sun X, Zhang Y, Zhang J. The relative survival and cure fraction of gastric cancer estimated through flexible parametric models using data from population-based cancer registration during 2003-2012 in Linzhou, China. Cancer Med 2020; 9:2243-2251. [PMID: 31994324 PMCID: PMC7064094 DOI: 10.1002/cam4.2831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/19/2019] [Accepted: 12/22/2019] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The proportion of cured gastric cancer patients has drawn the attention of patients, physicians, and healthcare providers after comprehensive prevention and control measures were carried out for several years. Therefore, the relative survival and cure fraction were estimated in our study. METHODS Population-based cancer registration data were used to estimate survival and cure fraction. A total of 7585 gastric cancer cases (ICD10:C16.0 ~ C16.9) were extracted and included in the final analysis. Cases were diagnosed in 2003-2012 and followed until the end of 2017. Relative survival was calculated as the ratio between the observed survival through the life-table method. The expected survival was estimated by the Ederer II method. The cure fraction was estimated using flexible parametric cure models stratified by age and calendar period when the cases were diagnosed. RESULTS The 5-year relative survival of cardia gastric cancer increased with the calendar period of 2003-2004, 2005-2006, 2007-2008, 2009-2010, and 2011-2012 (27.5%, 28.3%, 33.5%, 38.2%, and 46.8%, respectively). The increasing trend along with the calendar periods was also observed in cure proportion of cardia gastric cancer (24.8%, 25.2%, 31.7%, 36.0%, and 43.1%, respectively). Notable improvement of cure proportion was observed in the period of 2011-2012, compared with the initial period of 2003-2004. There was an improvement of 79.8% among all gastric cancer subjects, and it was 74.1% and 55.7% in cardia gastric and noncardia gastric cancer subjects, respectively. The median survival of "uncured" patients showed no significant improvement along with the calendar periods in all age groups. CONCLUSIONS Notable improvement of gastric cancer relative survival and cure proportion was observed in Linzhou during 2003-2012.
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Affiliation(s)
- Qiong Chen
- Department of EpidemiologyAffiliated Cancer Hospital of Zhengzhou University/ Henan Provincial Cancer HospitalZhengzhouChina
| | - Shu‐Zheng Liu
- Department of EpidemiologyAffiliated Cancer Hospital of Zhengzhou University/ Henan Provincial Cancer HospitalZhengzhouChina
| | - Shao‐kai Zhang
- Department of EpidemiologyAffiliated Cancer Hospital of Zhengzhou University/ Henan Provincial Cancer HospitalZhengzhouChina
| | - Xiao‐Qin Cao
- Department of EpidemiologyAffiliated Cancer Hospital of Zhengzhou University/ Henan Provincial Cancer HospitalZhengzhouChina
| | - Bian‐Yun Li
- Linzhou Cancer RegistryLinzhou Cancer HospitalLinzhouChina
| | - Pei‐Liang Quan
- Department of EpidemiologyAffiliated Cancer Hospital of Zhengzhou University/ Henan Provincial Cancer HospitalZhengzhouChina
| | - Lan‐Wei Guo
- Department of EpidemiologyAffiliated Cancer Hospital of Zhengzhou University/ Henan Provincial Cancer HospitalZhengzhouChina
| | - Lee Dong
- University of ChicagoChicagoILUSA
| | - Xi‐Bin Sun
- Department of EpidemiologyAffiliated Cancer Hospital of Zhengzhou University/ Henan Provincial Cancer HospitalZhengzhouChina
| | - Yawei Zhang
- Department of SurgeryYale University School of MedicineNew HavenCTUSA
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
| | - Jian‐Gong Zhang
- Department of EpidemiologyAffiliated Cancer Hospital of Zhengzhou University/ Henan Provincial Cancer HospitalZhengzhouChina
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Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Hyung WJ. Effect of Laparoscopic Distal Gastrectomy vs Open Distal Gastrectomy on Long-term Survival Among Patients With Stage I Gastric Cancer: The KLASS-01 Randomized Clinical Trial. JAMA Oncol 2020; 5:506-513. [PMID: 30730546 DOI: 10.1001/jamaoncol.2018.6727] [Citation(s) in RCA: 366] [Impact Index Per Article: 73.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Laparoscopic distal gastrectomy is gaining popularity over open distal gastrectomy for gastric cancer because of better early postoperative outcomes. However, to our knowledge, no studies have proved whether laparoscopic distal gastrectomy is oncologically equivalent to open distal gastrectomy. Objective To examine whether the long-term survival among patients with stage I gastric cancer undergoing laparoscopic distal gastrectomy is noninferior to that among patients undergoing open distal gastrectomy. Design The Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) group, which includes 15 surgeons from 13 institutes, conducted a phase 3, multicenter, open-label, noninferiority, prospective randomized clinical trial (KLASS-01) of patients with histologically proven, preoperative clinical stage I gastric adenocarcinoma from January 5, 2006, to August 23, 2010. Survival and recurrence status of the patients was determined in December 2016. Interventions Patients were randomly assigned (1:1) to laparoscopic distal gastrectomy (n = 705) or open distal gastrectomy (n = 711). Of these patients, 85 received a surgical approach opposite the one to which they were randomized (63 randomized to the open surgery group and 22 to the laparoscopic group). Main Outcomes and Measures Difference in 5-year overall survival between the laparoscopic and open distal gastrectomy groups. The noninferiority margin was prespecified as -5% (corresponding hazard ratio of 1.54), with an assumed survival of 90% after 5 years in the open surgery group. Results Among the 1416 patients (mean [SD] age, 57.3 [11.1] years; 940 [66.4%] male) included in the study, the 5-year overall survival rates were 94.2% in the laparoscopic group and 93.3% in the open surgery group (log-rank P = .64). Intention-to-treat analysis confirmed the noninferiority of the laparoscopic approach compared with the open approach (difference, 0.9 percentage points; 1-sided 97.5% CI, -1.6 to infinity). The 5-year cancer-specific survival rates were similar between the 2 groups (97.1% in the laparoscopic group and 97.2% in the open surgery group, log-rank P = .91; difference, -0.03 percentage points; 1-sided 97.5% CI, -1.8 to infinity). Per-protocol analysis results were consistent with the intention-to-treat results for overall and cancer-specific survival rates. Conclusions and Relevance The KLASS-01 trial revealed similar overall and cancer-specific survival rates between patients receiving laparoscopic and open distal gastrectomy. Laparoscopic distal gastrectomy is an oncologically safe alternative to open surgery for stage I gastric cancer. Trial Registration ClinicalTrials.gov identifier: NCT00452751.
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Affiliation(s)
- Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Chan Young Kim
- Department of Surgery, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Sang-Il Lee
- Department of Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seong Yeob Ryu
- Department of Surgery, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sun P, Wang XS, Liu Q, Luan YS, Tian YT. Natural orifice specimen extraction with laparoscopic radical gastrectomy for distal gastric cancer: A case report. World J Clin Cases 2019; 7:4314-4320. [PMID: 31911913 PMCID: PMC6940342 DOI: 10.12998/wjcc.v7.i24.4314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/11/2019] [Accepted: 11/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This article introduces the surgical method and early experience in performing totally laparoscopic radical gastrectomy with transrectal specimen extraction for gastric cancer, and we evaluate the short-term effects and feasibility of this new procedure for gastric cancer in a 64-year-old male patient. This approach may provide new possibilities for gastric natural orifice specimen extraction (NOSE) surgery. In addition, we believe that this new procedure may further relieve pain, speed up recovery, and cause minimal physiological and psychological impact. CASE SUMMARY We performed NOSE gastrectomy in a male patient. Tumor resection, digestive tract reconstruction, and lymph node dissection were performed totally laparoscopically; the specimen was extracted from the natural orifice of the rectum-anus. This procedure reduced damage to the abdominal wall and decreased postoperative pain. We successfully performed radical gastrectomy without conversion and complications. Total operative time and blood loss were 176 min and 50 mL, respectively. The patient resumed normal activities of daily living on day 1 without pain, and passed flatus within 48 h. Postoperative hospital stay was 10 d. The number of resected lymph nodes was 0/43. During the follow-up, no stricture or anastomotic leakage was detected. Three months postoperatively, colonoscopy showed full recovery of the rectum without stricture or scar contracture. Computed tomography and laboratory test results showed no signs of tumor recurrence. There was no visible scar on the abdominal wall. CONCLUSION It is safe and reliable to perform totally laparoscopic radical gastrectomy with transrectal specimen extraction for distal gastric cancer patients.
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Affiliation(s)
- Peng Sun
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
| | - Xi-Shan Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, Heilongjiang Province, China
| | - Qi Liu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu-Song Luan
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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40
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Qi Y, Lv J, Liu S, Sun L, Wang Y, Li H, Qi W, Qiu W. TSPAN9 and EMILIN1 synergistically inhibit the migration and invasion of gastric cancer cells by increasing TSPAN9 expression. BMC Cancer 2019; 19:630. [PMID: 31242895 PMCID: PMC6595627 DOI: 10.1186/s12885-019-5810-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/07/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Globally, the incidence and mortality rates of gastric cancer are high, and its poor prognosis is closely related to tumor recurrence and metastasis. Therefore, the molecular mechanisms associated with the migration and invasion of gastric cancer cells are important for gastric cancer treatment. Previously, TSPAN9 has been reported to inhibit gastric cancer cell migration; however, the underlying molecular mechanism remains unclear. METHODS Human gastric adenocarcinoma cell lines, SGC7901 and AGS, were cultured in vitro. TSPAN9 expression was determined by RT-PCR, western blot analysis, and immunohistochemistry in gastric cancer and tumor-adjacent tissues. Following the over-expression and knockdown of TSPAN9, wound healing and cell invasion assays were performed and EMT-related protein expression was evaluated to analyze the invasion and migration of gastric cancer cells. TSPAN9 expression and the invasion and metastasis of gastric cancer cells were observed by the functional assays following EMILIN1 over-expression. RESULTS Inhibiting TSPAN9 expression significantly promoted the migration and invasion of gastric cancer cells. In addition, immunofluorescence co-localization and co-immunoprecipitation analysis revealed closely related expression of EMILIN1 and TSPAN9. Moreover, EMILIN1 can synergistically boost the tumor suppressive effect of TSPAN9, which may be produced by promoting TSPAN9 expression. CONCLUSIONS We have demonstrated that EMILIN1 induces anti-tumor effects by up-regulating TSPAN9 expression in gastric cancer. Hence, membrane proteins TSPAN9 and EMILIN1 may represent novel therapeutic targets for the treatment of gastric cancer.
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Affiliation(s)
- Yaoyue Qi
- Qingdao University, Qingdao, Shandong, China
| | - Jing Lv
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shihai Liu
- Central Laboratory, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Libin Sun
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yixuan Wang
- Qingdao University, Qingdao, Shandong, China
| | - Hui Li
- Qingdao University, Qingdao, Shandong, China
| | - Weiwei Qi
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Wensheng Qiu
- Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Wang WK, Tu CY, Shao CX, Chen W, Zhou QY, Zhu JD, Xu HT. Impact of enhanced recovery after surgery on postoperative rehabilitation, inflammation, and immunity in gastric carcinoma patients: a randomized clinical trial. Braz J Med Biol Res 2019; 52:e8265. [PMID: 31116313 PMCID: PMC6526747 DOI: 10.1590/1414-431x20198265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 03/08/2019] [Indexed: 01/04/2023] Open
Abstract
We determined the effects of enhanced recovery after surgery (ERAS) in patients undergoing radical surgery for gastric carcinoma. Sixty patients undergoing radical gastrectomy for gastric carcinoma in Lishui Hospital between March and October 2016 were randomized to receive either ERAS (30 patients) or conventional care (30 patients, controls). Clinical, economic, and laboratory indices were analyzed. ERAS patients showed faster recovery and shorter postoperative hospital stays than the controls (P<0.05). Some clinical indices (i.e., time to first flatus and defecation, time to removal of drainage tubes, time to resumption of oral feeding, time to postoperative mobilization, and postoperative complications) were significantly better in ERAS patients than in controls. Duration of postoperative infusion was lower in ERAS patients than in controls (P<0.05). In ERAS patients, serum albumin and prealbumin were higher on postoperative day 7, C-reactive protein was lower on postoperative days 3 and 7, and neutrophil count was lower on postoperative day 3 compared to the values in controls (P<0.05 for all). IgM levels were higher in ERAS patients on postoperative days 3 and 7 (P<0.05), while IgG levels were higher on postoperative day 3 (P<0.05). Total T lymphocytes were higher in ERAS patients on postoperative day 3, while helper T cells and CD4+/CD8+ ratio were higher on postoperative days 3 and 7 (P<0.05 for all). In gastric carcinoma patients, ERAS may reduce perioperative inflammation, improve immunity and postoperative nutrition, shorten hospitalization, and enhance rehabilitation.
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Affiliation(s)
- Wu-Ke Wang
- Department of General Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Department of General Surgery, Ningbo No. 2 Hospital of Zhejiang University, Ningbo, Zhejiang, China
| | - Chao-Yong Tu
- Department of General Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of General Surgery, Lishui Hospital, Zhejiang University School of Medicine, Lishui, Zhejiang, China
| | - Chu-Xiao Shao
- Department of General Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of General Surgery, Lishui Hospital, Zhejiang University School of Medicine, Lishui, Zhejiang, China
| | - Wei Chen
- Cancer Institute of Integrated Traditional Chinese and Western Medicine, Key Laboratory of Cancer Prevention and Therapy Combining Traditional Chinese and Western Medicine, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- Department of Medical Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Qing-Yun Zhou
- Department of General Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of General Surgery, Lishui Hospital, Zhejiang University School of Medicine, Lishui, Zhejiang, China
| | - Jing-De Zhu
- Department of General Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of General Surgery, Lishui Hospital, Zhejiang University School of Medicine, Lishui, Zhejiang, China
| | - Hong-Tao Xu
- Department of General Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of General Surgery, Lishui Hospital, Zhejiang University School of Medicine, Lishui, Zhejiang, China
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Yamagata Y, Yoshikawa T, Yura M, Otsuki S, Morita S, Katai H, Nishida T. Current status of the "enhanced recovery after surgery" program in gastric cancer surgery. Ann Gastroenterol Surg 2019; 3:231-238. [PMID: 31131351 PMCID: PMC6524106 DOI: 10.1002/ags3.12232] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
Since the late 1990s, perioperative care through the enhanced recovery after surgery (ERAS, European Society for Clinical Nutrition and Metabolism [ESPEN]) program has spread. ERAS protocols aim to reduce surgical complications, improving postoperative outcomes and thereby saving resources by addressing various clinical elements through a multidisciplinary approach or based on evidence. In the field of gastric cancer, the philosophy of ERAS has gradually become accepted and, in 2014, consensus guidelines for enhanced recovery after gastrectomy were published. These guidelines consist of "procedure-specific" guidelines and "general (not procedure-specific) enhanced recovery items." In this review, we focused on the procedure-specific guidelines and tried to update the contents of every element of the procedure-specific guidelines. The procedure-specific guidelines consist of the following eight elements: "Preoperative nutrition," "Preoperative oral pharmaconutrition," "Access (of gastrectomy)," "Wound catheters and transversus abdominis plane block," "Nasogastric/Nasojejunal decompression," "Perianastomotic drains," "Early postoperative diet and artificial nutrition," and "Audit." On reviewing papers supporting these elements, it was reconfirmed that the recommendations of the guidelines are pertinent and valid. Four meta-analyses concerning the evaluation of ERAS protocols for gastric cancer were included in this review. Every study showed that the ERAS protocol reduced the cost and duration of hospital stay without increasing surgical complication rates, suggesting that ERAS is effective for gastric cancer surgery. However, it cannot be said that ERAS has achieved full penetration in Japan because most evidence is established in Western countries. Future studies must focus on developing a new ERAS protocols appropriate to Japanese conditions of gastric cancer.
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Affiliation(s)
- Yukinori Yamagata
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Takaki Yoshikawa
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Masahiro Yura
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Sho Otsuki
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Shinji Morita
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Hitoshi Katai
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Toshiro Nishida
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
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Comparison of robotic- and laparoscopic-assisted gastrectomy in advanced gastric cancer: updated short- and long-term results. Surg Endosc 2018; 33:528-534. [DOI: 10.1007/s00464-018-6327-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022]
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You X, Wang Y, Wu J, Liu Q, Chen D, Tang D, Wang D. Prognostic significance of galectin-1 and vasculogenic mimicry in patients with gastric cancer. Onco Targets Ther 2018; 11:3237-3244. [PMID: 29881296 PMCID: PMC5985771 DOI: 10.2147/ott.s165899] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION We evaluated the expression of galectin-1 (Gal-1) and vasculogenic mimicry (VM) in gastric cancer (GC) and investigated their relationships with the clinicopathological factors and prognostic significance in GC. MATERIALS AND METHODS Immunohistochemical (IHC) staining and CD34-periodic acid-Schiff double stain were used to investigate Gal-1 expression and VM in paraffin-embedded sections from 127 patients with GC of all tumor stages. The relationships between Gal-1 expression and VM, clinicopathological variables, and survival were analyzed. P < 0.05 was considered statistically significant. RESULTS Among the 127 cases, 86 (67.7%) were positive for Gal-1; VM was detected in 29 cases (22.8%). There was a significant association between VM and the Gal-1 IHC staining; all cases with VM were positive for Gal-1 staining. Gal-1 expression and VM in primary GC tissue were associated with tumor size, differentiation, depth of tumor invasion, stage, lymph node metastases, and tumor emboli in microvessels (all, P < 0.05). Kaplan-Meier analysis revealed that the overall survival time was 52.56 ± 2.44 months (95% confidence interval [CI]: 47.77-57.35) for patients with Gal-1-negative and VM-negative primary GC tissue, 43.83 ± 2.17 months (95% CI: 39.58-48.08) for patients with Gal-1-positive but VM-negative primary GC tissue, and 23.97 ± 2.44 months (95% CI: 19.18-28.76) for patients with Gal-1-positive and VM-positive primary GC tissue (χ2 = 60.21, P < 0.01). Gal-1 expression was positively associated with VM in primary GC tissue. CONCLUSION Both Gal-1 expression and VM in primary GC tissue are indicators of poor prognosis for GC after gastrectomy, and Gal-1 may be a novel target for treating VM in GC.
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Affiliation(s)
- Xiaolan You
- Department of Integrated Traditional Chinese and Western Medicine, Medical College of Yangzhou University, Yangzhou, Jiangsu Province, People’s Republic of China
- Department of Gastrointestinal Surgery, Taizhou People’s Hospital, Taizhou, Jiangsu Province, People’s Republic of China
| | - Yuanjie Wang
- Department of Gastrointestinal Surgery, Taizhou People’s Hospital, Taizhou, Jiangsu Province, People’s Republic of China
| | - Jian Wu
- Department of Gastrointestinal Surgery, Taizhou People’s Hospital, Taizhou, Jiangsu Province, People’s Republic of China
| | - Qinghong Liu
- Department of Gastrointestinal Surgery, Taizhou People’s Hospital, Taizhou, Jiangsu Province, People’s Republic of China
| | - Dehu Chen
- Department of Gastrointestinal Surgery, Taizhou People’s Hospital, Taizhou, Jiangsu Province, People’s Republic of China
| | - Dong Tang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University (Subei People’s Hospital of Jiangsu Province), Yangzhou, Jiangsu Province, People’s Republic of China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University (Subei People’s Hospital of Jiangsu Province), Yangzhou, Jiangsu Province, People’s Republic of China
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Lianos GD, Hasemaki N, Glantzounis GK, Mitsis M, Rausei S. Assessing safety and feasibility of 'pure' laparoscopic total gastrectomy for advanced gastric cancer in the West. Review article. Int J Surg 2018; 53:275-278. [PMID: 29602017 DOI: 10.1016/j.ijsu.2018.03.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastric cancer is reported to be the fourth most common cancer and the second leading cause of cancer-related death worldwide. Minimally invasive surgical treatment for gastric cancer is a very challenging approach which offers undoubtedly important advantages. MATERIALS AND METHODS There is intense debate concerning the minimally invasive surgical approach for advanced gastric cancer especially in the Western population. A careful literature search was conducted in order to clarify the feasibility and safety of pure laparoscopic total gastrectomy in the West. RESULTS Herewith we aim to summarize the current scientific evidence assessing the feasibility and short-term outcomes of laparoscopic gastrectomy for advanced gastric cancer in the West. A lack of data from Western institutions regarding minimally invasive surgical approach for gastric cancer is yet a reality. Nevertheless, the laparoscopic procedure appears to provide satisfactory short-term oncologic outcomes and improved postoperative outcomes. CONCLUSION It is obvious that future well-conducted trials on long-term results are necessary for Western patients in order safe conclusions to be reached regarding a potential definitive 'place' for laparoscopy in the curative gastric cancer treatment.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece; Department of Surgery, General Hospital of Preveza, Preveza, Greece.
| | - Natasha Hasemaki
- Department of Surgery, General Hospital of Preveza, Preveza, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece
| | - Stefano Rausei
- Department of Surgery, University of Insubria, Varese, Italy
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Obama K, Kim YM, Kang DR, Son T, Kim HI, Noh SH, Hyung WJ. Long-term oncologic outcomes of robotic gastrectomy for gastric cancer compared with laparoscopic gastrectomy. Gastric Cancer 2018. [PMID: 28639136 DOI: 10.1007/s10120-017-0740-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Initial experiences with robotic gastrectomy (RG) for gastric cancer have demonstrated favorable short-term outcomes, suggesting that RG is an effective alternative to laparoscopic gastrectomy (LG). However, data on long-term survival and recurrence after RG for gastric cancer have yet to be reported. The objective of this study was to assess long-term outcomes after RG compared with LG. METHODS We retrospectively evaluated 313 and 524 patients who underwent RG or LG, respectively, for gastric cancer between July 2005 and December 2009. We compared long-term outcomes using the entire and a propensity-score matched cohort. RESULTS The entire cohort analysis revealed no statistically significant differences in 5-year overall survival(OS) or relapse-free survival(RFS) (p = 0.4112 and p = 0.8733, respectively): 93.3% [95% confidence interval (CI) 89.9-95.6] and 90.7% (95% CI, 86.9-93.5) after RG and 91.6% (95% CI 88.9-93.7) and 90.5% (95% CI 87.6-92.7) after LG, respectively; hazard ratios for death and recurrence in the robotic group were 0.828 (95% CI, 0.528-1.299; p = 0.4119) and 0.968 (95% CI, 0.649-1.445; p = 0.8741), respectively. The propensity-matched cohort analysis demonstrated no statistically significant differences for 5-year OS or RFS (p = 0.5207 and p = 0.2293, respectively): 93.2% and 90.7% after RG and 94.2% and 92.6% after LG, respectively; hazard ratios for death and recurrence in the robotic group were 1.194 (95% CI, 0.695-2.062; p = 0.5214) and 1.343 (95% CI, 0.830-2.192; p = 0.2321), respectively. CONCLUSION The potential technical superiority of robotic system over laparoscopy did not improve oncological outcomes after gastrectomy. Long-term oncological outcomes were not different between RG and LG. Nevertheless, robotic applications in minimally invasive gastric cancer surgery may be an oncologically safe alternative.
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Affiliation(s)
- Kazutaka Obama
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoo-Min Kim
- Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Korea
| | - Dae Ryong Kang
- Office of Biostatistics, Ajou University School of Medicine, Suwon, Korea
| | - Taeil Son
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea.,Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Korea.,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea.,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 120-752, Republic of Korea. .,Department of Surgery, Graduate School, Yonsei University College of Medicine, Seoul, Korea. .,Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea. .,Robot and MIS Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.
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Rumba R, Vanags A, Kalva A, Bogdanova T, Drike I, Mezale D, Vitola M, Gardovskis J, Strumfa I. Surgical Management of Malignant Gastric Tumours: A Practical Guide. Gastric Cancer 2017. [DOI: 10.5772/intechopen.69825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Alhossaini RM, Altamran AA, Seo WJ, Hyung WJ. Robotic gastrectomy for gastric cancer: Current evidence. Ann Gastroenterol Surg 2017; 1:82-89. [PMID: 29863139 PMCID: PMC5881341 DOI: 10.1002/ags3.12020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/16/2017] [Indexed: 12/14/2022] Open
Abstract
The robotic system has gained wide acceptance in specialties such as urological and gynecological surgery. It has also been applied in the field of upper gastrointestinal surgery. Since the first implementation of the robotic system for the treatment of gastric adenocarcinoma, the procedure has been found to be safe and feasible. Although robotic gastrectomy does not meet our expectations and yield better results than laparoscopic gastrectomy, this procedure seems to provide several advantages over laparoscopy such as reduced blood loss, shorter learning curves and increased number of retrieved lymph nodes. However, as many case series, including a recent multicenter study, have revealed, higher cost and longer operation time are the major limitations of robotic gastrectomy. Furthermore, there are no results from well-designed randomized clinical trials comparing the two procedures. New procedures in much more technically demanding cases will test the genuine benefits of robotic gastrectomy.
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Affiliation(s)
- Rana M Alhossaini
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Abdulaziz A Altamran
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Won Jun Seo
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
| | - Woo Jin Hyung
- Department of Surgery Yonsei University College of Medicine Seoul Korea.,Gastric Cancer Center Yonsei Cancer Center Yonsei University Health System Seoul Korea.,Robot and MIS Center Severance Hospital Yonsei University Health System Seoul Korea
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Affiliation(s)
- Jill K J Gaidos
- McGuire VA Medical Center, GI/Hepatology Service (111-N), Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA
| | - Michael Fuchs
- McGuire VA Medical Center, GI/Hepatology Service (111-N), Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA, 23249, USA.
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Bao H, Xu N, Li Z, Ren H, Xia H, Li N, Yu H, Wei J, Jiang C, Liu L. Effect of laparoscopic gastrectomy on compliance with adjuvant chemotherapy in patients with gastric cancer. Medicine (Baltimore) 2017; 96:e6839. [PMID: 28538373 PMCID: PMC5457853 DOI: 10.1097/md.0000000000006839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study was designed to investigate the effect of laparoscopic gastrectomy on adjuvant chemotherapy in patients with gastric cancer.Patients with gastric cancer who underwent radical gastrectomy at our institution from January 2008 to January 2015 with R0 resection, as determined by a pathological examination, were included in this study. According to the surgical approach, patients were divided into the laparoscopic gastrectomy (LG) group and open gastrectomy (OG) group. Short-term and long-term outcomes were compared between the 2 groups.Of the 206 patients enrolled in the study, 114 patients were included in the LG group and 92 patients were included in the OG group. There was no significant difference in patients' general data, including age, sex, medical comorbidities, and pathological staging, between the 2 groups. However, patients in the LG group had less intraoperative blood loss, fewer postoperative complications, and a shorter hospital stay compared with patients in the OG group. There was no significant difference in the start time of adjuvant chemotherapy between the groups. However, compared with OG, LG had the following advantages: patients received more cycles of adjuvant chemotherapy, more patients received a full dose of on-schedule adjuvant chemotherapy, and more patients completed ≥75% of the planned dose. Long-term survival and disease-free survival rates were higher in the LG than in the OG.In summary, LG can improve compliance with adjuvant chemotherapy and long-term outcomes in patients with gastric cancer.
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Affiliation(s)
- Huizheng Bao
- Jilin Cancer Hospital, Changchun, Jilin, People's Republic of China
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