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Li ZW, Qiu YY, Liu F, Liu XR, Zhang W, Peng D. The Effect of Surgical Approach on Clinical Outcomes in 535 Patients with Remnant Gastric Cancer. J Laparoendosc Adv Surg Tech A 2023; 33:915-922. [PMID: 37477897 DOI: 10.1089/lap.2023.0164] [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: 07/22/2023] Open
Abstract
Purpose: This study aimed to evaluate the effect of laparoscopic gastrectomy (LG) and open gastrectomy (OG) on clinical outcomes in patients with remnant gastric cancer (RGC). Materials and Methods: The databases of PubMed, EMBASE, and Cochrane Library were used to search for eligible studies from inception to April 1st, 2023. Hazard ratios (HRs), mean difference (MD), odds ratios (OR), and 95% confidence intervals (CIs) were pooled up to analyze. The Newcastle-Ottawa Scale (NOS) scores were used to evaluate the quality of the included studies. This study was performed with RevMan 5.3 (The Cochrane Collaboration, London, United Kingdom) software. Results: A total of 11 studies involving 535 RGC patients were included in this study. In terms of basic information, we found that the OG group had a higher American Society of Anesthesiologists (ASA) grade (≥2) (OR = 0.24, I2 = 54%, 95% CI = 0.08-0.71, P = .01) than the LG group. In terms of postoperative outcomes, we found that the LG group had longer operative time (MD = 33.95, I2 = 58%, 95% CI = 15.05-52.85, P < .01), shorter postoperative hospital stay (MD = 5.08, I2 = 84%, 95% CI = -9.74 to -0.42, P = .03), shorter length of incision (MD = -7.15, I2 = 94%, 95% CI = -10.99 to -3.31, P < .01), earlier food intake (MD = -3.09, I2 = 76%, 95% CI = -4.84 to -1.35, P < .01), and earlier time to first flatus (MD = -0.84, I2 = 0%, 95% CI = -1.09 to -0.59, P < .01). We found that there was no statistically significant difference in overall survival (HR = 0.96, I2 = 0%, 95% CI = 0.48-1.93, P = .92) between the LG group and the OG group. Conclusion: LG for RGC patients had longer surgical time, shorter postoperative hospital stay, shorter length of incision, earlier food intake, and earlier time to first flatus.
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Affiliation(s)
- Zi-Wei Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan-Yu Qiu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Application of Half-Transected and Self-Pulling Esophagojejunostomy in Total Laparoscopic Gastrectomy for Gastric Cancer: A Safe and Feasible Technique. Can J Gastroenterol Hepatol 2022; 2022:2422274. [PMID: 35734016 PMCID: PMC9208976 DOI: 10.1155/2022/2422274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study introduces a technique for esophagojejunostomy with half transected and self-pulling (HTSP) and evaluates the safety, feasibility, and clinical results of this technique in totally laparoscopic total gastrectomy (TLTG). MATERIALS AND METHODS From May 2019 to March 2021, 42 patients (HTSP group) who underwent HTSP-TLTG surgery in the Department of Abdominal Tumor Surgery of Jiangxi Cancer Hospital were included in this study. The control group consisted of 50 patients undergoing conventional TLTG surgery (conventional anastomosis group) performed by the same surgical team from March 2018 to March 2020. The clinical data of the two groups were retrospectively analyzed and compared. RESULTS The mean operation time of the HTSP-TLTG surgery was 166.7 ± 13.1 minutes and the anastomosis time was 20.8 ± 2.0 minutes, which were significantly shorter than those of traditional TLTG (P < 0.05). There were no significant differences between the two groups in blood loss, time to first exhaust, postoperative hospital stay, and incidence of surgery-related complications. CONCLUSION HTSP is a safe and feasible way of endoscopic esophagojejunal anastomosis, which requires a relatively low suture technique under endoscopy, and is suitable for promotion.
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Bracale U, Merola G, Pignata G, Andreuccetti J, Dolce P, Boni L, Cassinotti E, Olmi S, Uccelli M, Gualtierotti M, Ferrari G, De Martini P, Bjelović M, Gunjić D, Silvestri V, Pontecorvi E, Peltrini R, Pirozzi F, Cuccurullo D, Sciuto A, Corcione F. Laparoscopic gastrectomy for stage II and III advanced gastric cancer: long‑term follow‑up data from a Western multicenter retrospective study. Surg Endosc 2022; 36:2300-2311. [PMID: 33877411 PMCID: PMC8921054 DOI: 10.1007/s00464-021-08505-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/07/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There has been an increasing interest for the laparoscopic treatment of early gastric cancer, especially among Eastern surgeons. However, the oncological effectiveness of Laparoscopic Gastrectomy (LG) for Advanced Gastric Cancer (AGC) remains a subject of debate, especially in Western countries where limited reports have been published. The aim of this paper is to retrospectively analyze short- and long-term results of LG for AGC in a real-life Western practice. MATERIALS AND METHODS All consecutive cases of LG with D2 lymphadenectomy for AGC performed from January 2005 to December 2019 at seven different surgical departments were analyzed retrospectively. The primary outcome was diseases-free survival (DFS). Secondary outcomes were overall survival (OS), number of retrieved lymph nodes, postoperative morbidity and conversion rate. RESULTS A total of 366 patients with stage II and III AGC underwent either total or subtotal LG. The mean number of harvested lymph nodes was 25 ± 14. The mean hospital stay was 13 ± 10 days and overall postoperative morbidity rate 27.32%, with severe complications (grade ≥ III) accounting for 9.29%. The median follow-up was 36 ± 16 months during which 90 deaths occurred, all due to disease progression. The DFS and OS probability was equal to 0.85 (95% CI 0.81-0.89) and 0.94 (95% CI 0.92-0.97) at 1 year, 0.62 (95% CI 0.55-0.69) and 0.63 (95% CI 0.56-0.71) at 5 years, respectively. CONCLUSION Our study has led us to conclude that LG for AGC is feasible and safe in the general practice of Western institutions when performed by trained surgeons.
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Affiliation(s)
- Umberto Bracale
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy.
| | - Giovanni Merola
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery II, Spedali Civili of Brescia, Brescia, Italy
| | - Jacopo Andreuccetti
- Department of General and Mininvasive Surgery, San Camillo Hospital of Trento, Trento, Italy
| | - Pasquale Dolce
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Olmi
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, BG, Italy
| | - Matteo Uccelli
- Department of General and Oncologic Surgery, Centre of Advanced Laparoscopic Surgery, Centre of Bariatric Surgery, San Marco Hospital GSD, Zingonia, BG, Italy
| | - Monica Gualtierotti
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Ferrari
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo De Martini
- Department of Minimally Invasive Oncologic Surgery, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Miloš Bjelović
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Gunjić
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vania Silvestri
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Emanuele Pontecorvi
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Roberto Peltrini
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, NA, Italy
| | - Diego Cuccurullo
- Department of General, Mini-Invasive and Robotic Surgery, Monaldi Hospital, Naples, NA, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria Delle Grazie Hospital, Pozzuoli, NA, Italy
| | - Francesco Corcione
- Department of General Surgery and Specialty, School of Medicine University, Federico II of Naples, Naples, Italy
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Lee S, Kim H. Minimally invasive surgery in advanced gastric cancer. Ann Gastroenterol Surg 2022; 6:336-343. [PMID: 35634188 PMCID: PMC9130905 DOI: 10.1002/ags3.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/12/2022] Open
Abstract
Since Dr. Kitano introduced laparoscopic distal gastrectomy for early gastric cancer in 1994, there have been remarkable advances in minimally invasive surgery (MIS) for gastric cancer, including robotic surgery. With the efforts of many clinical researchers and consenting patients, medical knowledge and evidence for laparoscopic surgery in gastric cancer have accumulated. Although many gastric surgeons are comfortable with the clinical application of laparoscopic surgery for early gastric cancer, the adoption of MISs for advanced gastric cancer remains controversial. In this review article, we describe the current status and evidence of MIS from an evidence‐based medicine viewpoint and explore the feasibility and effectiveness of MIS for advanced gastric cancer in the real world.
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Affiliation(s)
- Sangjun Lee
- Department of Surgery Seoul National University Bundang Hospital Seongnam Korea
| | - Hyung‐Ho Kim
- Department of Surgery Seoul National University Bundang Hospital Seongnam Korea
- Department of Surgery Seoul National University College of Medicine Seoul Korea
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Nakauchi M, Suda K, Shibasaki S, Nakamura K, Kadoya S, Kikuchi K, Inaba K, Uyama I. Prognostic factors of minimally invasive surgery for gastric cancer: Does robotic gastrectomy bring oncological benefit? World J Gastroenterol 2021; 27:6659-6672. [PMID: 34754159 PMCID: PMC8554404 DOI: 10.3748/wjg.v27.i39.6659] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/18/2021] [Accepted: 09/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric cancer is the third leading cause of cancer-related death worldwide and surgical resection remains the sole curative treatment for gastric cancer. Minimally invasive gastrectomy including laparoscopic and robotic approaches has been increasingly used in a few decades. Thus far, only a few reports have investigated the oncological outcomes following minimally invasive gastrectomy. AIM To determine the 5-year survival following minimally invasive gastrectomy for gastric cancer and identify prognostic predictors. METHODS This retrospective cohort study identified 939 patients who underwent gastrectomy for gastric cancer during the study period. After excluding 125 patients with non-curative surgery (n = 77), other synchronous cancer (n = 2), remnant gastric cancer (n = 25), insufficient physical function (n = 13), and open gastrectomy (n = 8), a total of 814 consecutive patients with primary gastric cancer who underwent minimally invasive R0 gastrectomy at our institution between 2009 and 2014 were retrospectively examined. Accordingly, 5-year overall and recurrence-free survival were analyzed using the Kaplan-Meier method with the log-rank test and Cox regression analyses, while factors associated with survival were determined using multivariate analysis. RESULTS Our analysis showed that age > 65 years, American Society of Anesthesiologists (ASA) physical status 3, total or proximal gastrectomy, and pathological T4 and N positive status were independent predictors of both 5-year overall and recurrence-free survival. Accordingly, the included patients had a 5-year overall and recurrence-free survival of 80.3% and 78.2%, respectively. Among the 814 patients, 157 (19.3%) underwent robotic gastrectomy, while 308 (37.2%) were diagnosed with pathological stage II or III disease. Notably, our findings showed that robotic gastrectomy was an independent positive predictor for recurrence-free survival in patients with pathological stage II/III [hazard ratio: 0.56 (0.33-0.96), P = 0.035]. Comparison of recurrence-free survival between the robotic and laparoscopic approach using propensity score matching analysis verified that the robotic group had less morbidity (P = 0.005). CONCLUSION Age, ASA status, gastrectomy type, and pathological T and N status were prognostic factors of minimally invasive gastrectomy, with the robot approach possibly improving long-term outcomes of advanced gastric cancer.
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Affiliation(s)
- Masaya Nakauchi
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Koichi Suda
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Susumu Shibasaki
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Kenichi Nakamura
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Shinichi Kadoya
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8535, Ishikawa, Japan
| | - Kenji Kikuchi
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Kazuki Inaba
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
| | - Ichiro Uyama
- Department of Gastroenterological Surgery, Fujita Health University, Toyoake 470-1192, Aichi, Japan
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Khachfe HH, Salhab HA, Fares MY, Chahrour MA, Jamali FR. Landscape of interventional clinical trials involving gastrectomy for gastric cancer. Ecancermedicalscience 2021; 15:1218. [PMID: 34158822 PMCID: PMC8183643 DOI: 10.3332/ecancer.2021.1218] [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: 11/24/2020] [Indexed: 01/14/2023] Open
Abstract
Background Gastric cancer (GC) is the third most common cause of malignancy associated mortality globally. The cornerstone of curative treatment involves surgical gastrectomy. In this study, we explore clinical trials involving gastrectomy for GC, highlighting inadequacies and underlining promising surgical interventions and strategies. Materials and methods On 1 May 2020, ClinicalTrials.gov was explored for interventional trials related to gastrectomy for GC, without adding limitations for location or date. All data pertaining to the trials were collected. Characteristics such as phase, duration, enrolment size, location, treatment allocation, masking and primary endpoint were analysed. Results One hundred thirty-eight clinical trials met the search criteria. Clinical trials were performed in only 14 countries; most of them occurring in China. Most trials (33%) were still in the recruiting phase. On average, the length of trials was 3.9 years. Most trials had parallel assignment, were randomised and masked. The primary endpoint which was mostly commonly studied was overall survival (33%). The most common intervention studied is laparoscopic gastrectomy in 43 (31%) trials. Conclusions Our study exposed a small number of trials, publication rate, absence of geographic variety in clinical trials involving gastrectomy for GC. Adequate management of trial design can help decrease duration and increase validity of results. More trials comparing different surgical techniques are needed to update the surgical practice of gastrectomy for GC.
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Affiliation(s)
- Hussein H Khachfe
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon.,Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA.,Division of GI Surgical Oncology, UPMC Pancreatic Cancer Center, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, Pittsburgh, PA 15260, USA
| | - Hamza A Salhab
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon.,Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut 00000, Lebanon
| | - Mohamad Y Fares
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon.,Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut 00000, Lebanon
| | - Mohamad A Chahrour
- Faculty of Medicine, American University of Beirut Medical Center, Beirut 00000, Lebanon
| | - Faek R Jamali
- Division of General Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi 11001, UAE
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Trapani R, Rausei S, Reddavid R, Degiuli M. Risk factors for esophago-jejunal anastomosis leakage after total gastrectomy for cancer. A multicenter retrospective study of the Italian research group for gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:2243-2247. [PMID: 32703713 DOI: 10.1016/j.ejso.2020.06.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many Eastern reports attempted to identify predictive variables for esophago-jejunal anastomosis leakage (EJAL) after total gastrectomy for cancer. There are no definitive answers about reliable risk factors for EJAL. This retrospective study shows the largest Western series focused on this topic. METHODS This is a multicenter retrospective study analyzing patients' datasets collected by 18 Italian referral Centres of the Italian Research Group for Gastric Cancer (GIRCG) from 2000 to 2018. The inclusion criteria were pathological diagnosis of gastric and esophageal (Siewert III) carcinoma requiring total gastrectomy. The primary end point of risk analysis was the occurrence of EJAL; secondary end points were post-operative (30-day) morbidity and mortality, length of stay (LoS), and survival. RESULTS Data of 1750 patients submitted to total gastrectomy were collected. EJAL developed in 116 (6.6%) patients and represented the 26.3% of all the 441 observed post-operative surgical complications. EJAL diagnosis was followed by a reoperation in 39 (33.6%) patients and by an endoscopic/radiological procedure in 30 cases (25.9%). In 47 patients (40.5%) EJAL was managed with conservative approach. Post-operative LoS and mortality were significantly higher after EJAL occurrence (27 days versus 12 days and 8.6% versus 1.6%, respectively). At risk analysis, comorbidities (particularly, if respiratory), minimally invasive surgery, extended lymphadenectomy, and anastomotic technique resulted significant predictive factors for EJAL. EJAL did not significantly affect survival. CONCLUSIONS These results were consistent with Asian experiences: the frequency of EJAL and its higher rate observed in patients with comorbidities or after minimally invasive approach were confirmed.
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Affiliation(s)
- Renza Trapani
- Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Turin, Italy.
| | - Stefano Rausei
- Department of Surgery, ASST Valle Olona, Gallarate, Varese, Italy.
| | - Rossella Reddavid
- Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Turin, Italy.
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery Unit, Department of Oncology of San Luigi University Hospital of Orbassano, Orbassano, Turin, Italy.
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Abdelhamed MA, Abdellatif A, Touny A, Mahmoud AM, Ahmed IS, Maamoun S, Shalaby M. Laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer: initial Egyptian experience at the National Cancer Institute. J Egypt Natl Canc Inst 2020; 32:10. [PMID: 32372263 DOI: 10.1186/s43046-020-00023-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/07/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy has been used as a superior alternative to open gastrectomy for the treatment of early gastric cancer. However, the application of laparoscopic D2 lymphadenectomy remains controversial. This study aimed to evaluate the feasibility and outcomes of laparoscopic gastrectomy with D2 lymphadenectomy for gastric cancer. RESULTS Between May 2016 and May 2018, twenty-five consecutive patients with gastric cancer underwent laparoscopic D2 gastrectomy: eighteen patients (72%) underwent distal gastrectomy, four patients (16%) underwent total gastrectomy, and three patients (12%) underwent proximal gastrectomy. The median number of lymph nodes retrieved was 18 (5-35). A positive proximal margin was detected in 2 patients (8%). The median operative time and amount of blood loss were 240 min (200-330) and 250 ml (200-450), respectively. Conversion to an open procedure was performed in seven patients (28%). The median hospital stay period was 8 days (6-30), and the median time to start oral fluids was 4 days (3-30). Postoperative complications were detected in 4 patients (16%). There were two cases of mortality (8%) in the postoperative period, and two patients required reoperation (8%). CONCLUSIONS Laparoscopic gastrectomy with D2 lymphadenectomy can be carried out safely and in accordance with oncologic principles.
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Affiliation(s)
- Mohamed Aly Abdelhamed
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Ahmed Abdellatif
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Touny
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Mostafa Mahmoud
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ihab Saad Ahmed
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sherif Maamoun
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Shalaby
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
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Short-term and Long-term Outcomes Following Laparoscopic Gastrectomy for Advanced Gastric Cancer Compared With Open Gastrectomy. Surg Laparosc Endosc Percutan Tech 2020; 29:297-303. [PMID: 30969195 DOI: 10.1097/sle.0000000000000660] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION To investigate the oncological feasibility and technical safety of laparoscopic gastrectomy with D2 lymphadenectomy for advanced gastric cancer. METHODS A total of 186 advanced gastric cancer patients treated by gastrectomy with D2 lymphadenectomy were eligible for inclusion including those with invasion into the muscularis propria, subserosa, and serosa without involvement of other organs, and stages N0-2 and M0. We retrospectively compared the short-term and long-term outcomes between laparoscopic gastrectomy and open gastrectomy. RESULTS We analyzed short-term outcomes by comparing distal with total gastrectomy results. We found no significant difference for distal gastrectomy for postoperative morbidity [laparoscopic vs. open: n=4 (4.6%) vs. n=1 (3.6%); P=1.00]. We also found no significant difference in postoperative morbidity for total gastrectomy [laparoscopic vs. open: n=2 (4.0%) vs. n=1 (4.0%); P=1.00]. No deaths occurred in any group.The entire cohort analysis revealed no statistically significant differences in overall-free or recurrence-free survival between the laparoscopic and open groups. For overall survival, there were no significant differences between open and laparoscopic groups for clinical stage II or III (P=0.29 and 0.27, respectively), and for pathologic stage II or III (P=0.88 and 0.86, respectively). For recurrence-free survival, there were no significant differences between open and laparoscopic groups for clinical stage II or III (P=0.63 and 0.60, respectively), and for pathologic stage II or III (P=0.98 and 0.72, respectively). CONCLUSION Laparscopic gastrectomy for advanced gastric cancer compared favorably with open gastrectomy regarding short-term and long-term outcomes.
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Min SH, Won Y, Kim G, Lee Y, Park YS, Ahn SH, Park DJ, Kim HH. 15-year experience of laparoscopic gastrectomy in advanced gastric cancer: analysis on short-term and long-term oncologic outcome. Surg Endosc 2019; 34:4983-4990. [PMID: 31820153 DOI: 10.1007/s00464-019-07292-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/28/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) is now a widely accepted treatment option for gastric cancer. However, there is insufficient evidence for LG for advanced gastric cancer (AGC). Many retrospective studies have shown that LG for AGC is safe and feasible, but very few studies have shown the actual outcome in general practice. The aim of this study is to analyze our last 15 years of experience in LG for AGC. METHODS This is a retrospective review from May 2003 to May 2017 in Seoul National University Bundang Hospital. A total of 1592 patients who had LG for AGC were enrolled of which 109 patients with open conversion were excluded. We evaluated the short-term and long-term oncologic outcomes of LG for AGC. RESULTS A total of 1483 patients were analyzed. There were 432 cases of total gastrectomy, 982 cases of distal gastrectomy, and 69 cases of proximal gastrectomy. The total complication rate was 9.1% (135/1483), which included wound-related complications (0.7%), postoperative bleeding (0.5%), anastomosis or stump leakage (2.2%), intestinal obstruction (0.9%), pancreatic fistula (0.1%), intra-abdominal abscess (1.6%), and lung morbidity (3.0%). The rate of Clavien-Dindo grade 3 and above complications was 4.9%. Age was the only significant risk factor in multivariate analysis (OR 1.02; 95% CI, 1.01-1.04, P = 0.01). 5-year overall survival stratified by stage was as follows: stage IB 88.9%, stage IIA 88.7%, stage IIB 84.2%, stage IIIA 71.7%, stage IIIB 56.8%, stage IIIC 45.4%, and stage IV 25%. Total recurrence rate was 14.4%, which included local recurrence (1.1%) and distant metastases (13.3%). CONCLUSIONS During our 15 years of experience, we have successfully performed 1483 cases of AGC with laparoscopy. Our results showed short-term and long-term oncologic outcomes that were comparable with other studies. LG is safe and feasible in general practice for advanced gastric cancer when performed by experienced surgeons.
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Affiliation(s)
- Sa-Hong Min
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Yongjoon Won
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Guowei Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Yoontaek Lee
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea.,Department of Surgery, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea. .,Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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11
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Ahn SH, Kang SH, Lee Y, Min SH, Park YS, Park DJ, Kim HH. Long-term Survival Outcomes of Laparoscopic Gastrectomy for Advanced Gastric Cancer: Five-year Results of a Phase II Prospective Clinical Trial. J Gastric Cancer 2019; 19:102-110. [PMID: 30944763 PMCID: PMC6441772 DOI: 10.5230/jgc.2019.19.e6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Despite an increased acceptance of laparoscopic gastrectomy (LG) in early gastric cancer (EGC), there is insufficient evidence for its oncological safety in advanced gastric cancer (AGC). This is a prospective phase II clinical trial to evaluate the feasibility of LG with D2 lymph node dissection (LND) in AGC. Materials and Methods The primary endpoint was set as 3-year disease-free survival (DFS). The eligibility criteria were as follows: 20-80 years of age, cT2N0-cT4aN3, American Society of Anesthesiologists score of 3 or less, and no other malignancy. Patients were enrolled in this single-arm study between November 2008 and May 2012. Exclusion criteria included cT4b or M1, or having final pathologic results as EGC. All patients underwent D2 lymphadenectomy. Three-year DFS rates were estimated by the Kaplan-Meier method. Results A total of 157 patients were enrolled. The overall local complication rate was 10.2%. Conversion to open surgery occurred in 11 patients (7.0%). The mean follow-up period was 55.0±20.4 months (1–81 months). The cumulative 3-year DFS rates were 76.3% for all stages, and 100%, 89.3%, 100%, 88.0%, 71.4%, and 35.3% for stage IB, IIA, IIB, IIIA, IIIB, and IIIC, respectively. Recurrence was observed in 37 patients (23.6%), including hematogenous (n=6), peritoneal (n=13), locoregional (n=1), distant node (n=8), and mixed recurrence (n=9). Conclusions In addition to being technically feasible for treatment of AGC in terms of morbidity, LG with D2 LND for locally advanced gastric cancer showed acceptable 3-year DFS outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT01441336
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Affiliation(s)
- Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoontaek Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sa-Hong Min
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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12
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Booka E, Kaihara M, Mihara K, Nishiya S, Handa K, Ito Y, Shibutani S, Egawa T, Nagashima A. Laparoscopic total gastrectomy for remnant gastric cancer: A single-institution experience. Asian J Endosc Surg 2019; 12:58-63. [PMID: 29745474 DOI: 10.1111/ases.12495] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/12/2018] [Accepted: 03/25/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence of remnant gastric cancer is increasing because of past use of subtotal gastrectomy to treat peptic ulcer and increased survival rates after radical gastrectomy for gastric cancer. The feasibility and advantages of laparoscopic total gastrectomy (LTG) for remnant gastric cancer remain unclear. Therefore, we aimed to investigate the safety, feasibility, and clinical short-term outcomes of LTG for remnant gastric cancer. METHODS Patients who underwent completion total gastrectomy for remnant gastric cancer between April 2007 and October 2017 were divided into two groups: the open total gastrectomy (OTG) group and the LTG group. Clinicopathological data and short-term outcomes were analyzed. RESULTS A total of 31 remnant gastrectomies (23 OTG, 8 LTG) were performed. Blood loss was significantly lower in the LTG group than in the OTG group (135.5 vs 568.3 mL, P = 0.013). However, there was no significant difference in the operation time, days to food intake, or length of hospital stay between the two groups. Additionally, there was no significant difference in the postoperative complications, number of retrieved lymph nodes, or pathological findings. Two LTG patients (25.0%) required conversion to open surgery. There was no mortality in either group. CONCLUSIONS LTG for remnant gastric cancer can be a safe treatment option and may have an advantage of less blood loss than OTG.
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Affiliation(s)
- Eisuke Booka
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Masaki Kaihara
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Koki Mihara
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Shin Nishiya
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kan Handa
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yasuhiro Ito
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Shintaro Shibutani
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Tomohisa Egawa
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Atsushi Nagashima
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.,Department of Surgery, Saiseikai Kanagawaken Hospital, Yokohama, Japan
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13
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Abstract
BACKGROUND The development of clinical guidelines for the surgical management of gastric cancer should be based on robust evidence from well-designed trials. Being able to reliably compare and combine the outcomes of these trials is a key factor in this process. OBJECTIVES To examine variation in outcome reporting by surgical trials for gastric cancer and to identify outcomes for prioritisation in an international consensus study to develop a core outcome set in this field. DATA SOURCES Systematic literature searches (Evidence Based Medicine, MEDLINE, EMBASE, CINAHL, ClinicalTrials.gov and WHO ICTRP) and a review of study protocols of randomised controlled trials, published between 1996 and 2016. INTERVENTION Therapeutic surgical interventions for gastric cancer. Outcomes were listed verbatim, categorised into groups (outcome themes) and examined for definitions and measurement instruments. RESULTS Of 1919 abstracts screened, 32 trials (9073 participants) were identified. A total of 749 outcomes were reported of which 96 (13%) were accompanied by an attempted definition. No single outcome was reported by all trials. 'Adverse events' was the most frequently reported 'outcome theme' in which 240 unique terms were described. 12 trials (38%) classified complications according to severity, with 5 (16%) using a formal classification system (Clavien-Dindo or Accordion scale). Of 27 trials which described 'short-term' mortality, 15 (47%) used one of five different definitions. 6 out of the 32 trials (19%) described 'patient-reported outcomes'. CONCLUSION Reporting of outcomes in gastric cancer surgery trials is inconsistent. A consensus approach to develop a minimum set of well-defined, standardised outcomes to be used by all future trials examining therapeutic surgical interventions for gastric cancer is needed. This should consider the views of all key stakeholders, including patients.
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Affiliation(s)
- Bilal Alkhaffaf
- Department of Oesophago-Gastric Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Department of Oesophago-Gastric Surgery, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jane M Blazeby
- Centre for Surgical Research, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, Bristol, UK
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Iain A Bruce
- Paediatric ENT Department, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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14
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Huang L, Li TJ. Laparoscopic surgery for gastric cancer: where are we now and where are we going? Expert Rev Anticancer Ther 2018; 18:1145-1157. [PMID: 30187785 DOI: 10.1080/14737140.2018.1520098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Minimally-invasive surgery is gaining increasing popularity for the management of gastric cancer (GC). Areas covered: The authors hereby comprehensively and systematically reviewed the randomized and/or prospective evidence on laparoscopic gastrectomy (LG) for GC. For early GC located in the distal stomach, various randomized trials have demonstrated the superiority/non-inferiority of LG especially in reducing surgical trauma and enhancing postoperative recovery without compromising surgical safety and oncologic efficacy. For advanced GC, while multicenter large-scale randomized evidence has demonstrated the safety and feasibility of LG by experienced hands, the long-term survival which is to be clarified by several ongoing trials are crucial to determine whether a more widespread application is acceptable. Randomized evidence regarding the application of laparoscopic total or proximal gastrectomy, which is technically challenging, is scarce. Various attempts in modification of the traditional laparoscopic approach to further reduce the trauma have been evaluated, such as single-incision and totally LG. LG is becoming increasingly individualized and precise. Expert commentary: The current randomized and/or prospective evidence supports the non-inferiority of laparoscopic surgery especially for the management of early GC located in the distal stomach, while the definitive efficacy of the laparoscopic approach for more surgically challenging situations remains largely explorative and investigative.
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Affiliation(s)
- Lei Huang
- a Department of Gastrointestinal Surgery, Department of General Surgery , First Affiliated Hospital of Anhui Medical University , Hefei , China
| | - Tuan-Jie Li
- b Department of General Surgery , Nanfang Hospital of Southern Medical University , Guangzhou , China
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15
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Nakamura K, Suda K, Suzuki A, Nakauchi M, Shibasaki S, Kikuchi K, Nakamura T, Kadoya S, Inaba K, Uyama I. Intracorporeal Isosceles Right Triangle-shaped Anastomosis in Totally Laparoscopic Distal Gastrectomy. Surg Laparosc Endosc Percutan Tech 2018; 28:193-201. [PMID: 29738380 DOI: 10.1097/sle.0000000000000535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to evaluate the feasibility and safety of intracorporeal anastomosis with Billroth I, Billroth II, or Roux-en-Y reconstructions in totally laparoscopic distal gastrectomy. MATERIALS AND METHODS A single-institution, retrospective, cohort study including 553 patients was conducted. Intracorporeal isosceles right triangle-shaped anastomosis without slack and torsion was created using linear staplers. Billroth I was primarily used. Surgical outcomes and perioperative nutritional status were assessed. RESULTS Morbidity was 11.5%. Postoperative early complications related to anastomosis occurred in 13 patients (2.4%). Operative time and reconstruction type (Billroth I vs. others) were the only significant independent risk factors determining postoperative early and late complications, respectively. No difference was observed in postoperative changes in nutritional status across the groups, although Billroth II increased reflux esophagitis requiring medication. CONCLUSIONS Intracorporeal isosceles right triangle-shaped anastomosis using linear staplers in totally laparoscopic distal gastrectomy, in combination with our selection algorithm for type of reconstruction, is feasible and safe.
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Affiliation(s)
| | - Koichi Suda
- Departments of Surgery, Division of Upper GI
- Department of Surgery, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Atsushi Suzuki
- Internal Medicine, Division of Endocrinology and Metabolism, Fujita Health University, Aichi
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16
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Shao XX, Tian YT. Evolution trends of indications for laparoscopic surgery in patients with gastric cancer. Shijie Huaren Xiaohua Zazhi 2017; 25:2754-2760. [DOI: 10.11569/wcjd.v25.i31.2754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Xin-Xin Shao
- Department of Oncological Surgery, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, China
| | - Yan-Tao Tian
- Department of Pancreatic and Stomach Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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17
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Cai ZH, Zang L, Yang HK, Kitano S, Zheng MH. Survey on laparoscopic total gastrectomy at the 11th China-Korea-Japan Laparoscopic Gastrectomy Joint Seminar. Asian J Endosc Surg 2017; 10:259-267. [PMID: 28186365 DOI: 10.1111/ases.12362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/01/2017] [Accepted: 01/09/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Laparoscopic total gastrectomy (LTG) has been widely performed for gastric cancer in China, Korea, and Japan. The current status of this surgical approach needs to be investigated. METHODS During the 11th China-Korea-Japan Laparoscopic Gastrectomy Joint Seminar in Shanghai, China, on 5 March 2016, a questionnaire was completed by 65 experts in LTG. The survey included questions on surgical indication, operation team, laparoscopic instruments, and operative procedures. RESULTS Of the 65 respondents, 35 (53.8%) were from China, 18 (27.7%) were from Korea, and 12 (18.5%) were from Japan. Surgeons have various indications for LTG. Among respondents, stage II gastric cancer (42.9%) was the most acceptable indication, but Japanese surgeons were more cautious on this issue (P = 0.005). Using a flexible scope was more popular with Japanese surgeons than with others (P = 0.003). A goose-neck curved grasper was used more often in China and Korea than in Japan (P = 0.006). Chinese surgeons preferred vertical subxiphoid mini-laparotomy rather than vertical transumbilical laparotomy. Intracorporeal reconstruction (73.0%) was most frequently adopted for LTG. Linear staplers (53.8%) and circular staplers (42.1%) were both popular for esophagojejunostomy. However, jejunojejunostomy was more often conducted extracorporeally (67.7%), in which case a linear stapler (86.4%) was usually selected. Significant differences were observed between the three countries with regard to reinforcement of the duodenal stump (P = 0.018) and closure of Peterson's space (P < 0.001). CONCLUSION This survey on LTG involving surgeons from China, Korea, and Japan clearly informed the current practice of this surgical approach and will likely aid future research studies as well as clinical treatment for gastric cancer.
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Affiliation(s)
- Zheng-Hao Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Han-Kwang Yang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | - Min-Hua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
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18
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Spleen-preserving lymphadenectomy versus splenectomy in laparoscopic total gastrectomy for advanced gastric cancer. Surg Oncol 2017; 26:207-211. [PMID: 28577727 DOI: 10.1016/j.suronc.2017.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/22/2017] [Accepted: 04/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND To investigate the optimal approach for laparoscopic splenic hilum lymph node dissection in proximal advanced gastric cancer, we compared the operative outcomes between laparoscopic spleen-preserving total gastrectomy (sp-LTG) and laparoscopic total gastrectomy with splenectomy (sr-LTG). METHODS A retrospective case-cohort study was conducted between February 2006 and December 2012. The operative outcomes, the number of retrieved splenic hilum lymph node, complication, and patients' survivals were analyzed. RESULTS 112 patients who underwent laparoscopic total gastrectomy with or without splenectomy for advanced gastric cancer were enrolled (68 sp-LTGs and 44 sr-LTGs). The mean operation time (227 min vs. 224 min, p = 0.762), estimated blood loss (157 ml vs. 164 ml, p = 0.817), and complication rate (17.6% vs. 13.6%, p = 0.572) were not different between two groups. Regarding splenic lymph node dissection, there were significantly differences in the mean number of retrieved lymph nodes between sp-LTG and sr-LTG (LN no.10; 1.78 vs. 3.21, p = 0.033, LN no.11d; 1.41 vs. 2.76, p = 0.004). The 5-year survivals were 77.3% in sp-LTG and 65.9% in sr-LTG (p = 0.240). The hazard ratio of splenectomy was 1.139 (95% confidence interval 0.514-2.526, p = 0.748). CONCLUSION In laparoscopic total gastrectomy for proximal advanced gastric cancer, spleen-preserving hilar dissection showed comparable short-term and long-term outcomes.
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19
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Outcomes From an Enhanced Recovery Program for Laparoscopic Gastric Surgery. Surg Laparosc Endosc Percutan Tech 2017; 26:e50-5. [PMID: 27258917 DOI: 10.1097/sle.0000000000000277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the outcomes from an enhanced recovery after surgery (ERAS) program for laparoscopic gastric surgery. MATERIALS AND METHODS This was a prospective study of patients undergoing elective laparoscopic gastric resection in an ERAS protocol at a single institution between 2008 and 2012. Outcomes included the length of hospital stay, intraoperative and postoperative complications, the readmission rate, the reoperation rate, and the 30-day mortality. RESULTS Of the 86 patients, 60 underwent partial gastrectomy and 26 underwent total gastrectomy. Median lymph nodes sampled was 15 (range, 9 to 47). The median length of hospital stay was 4 (range, 1 to 44) days. The conversion rate to open surgery was 11.6%. Four patients (4.7%) had an anastomotic leak. Three patients had postoperative bleeding (4.7%). About 4.7% (n=4) of the patients required readmission and 8.1% required reoperation (n=7). The 30-day mortality rate was 2.3% (n=2) due to complications from anastomotic leak. CONCLUSIONS Laparoscopic gastrectomy within an ERAS protocol results in a short hospital stay with an acceptable morbidity and mortality rate.
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20
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De Manzoni G, Marrelli D, Baiocchi GL, Morgagni P, Saragoni L, Degiuli M, Donini A, Fumagalli U, Mazzei MA, Pacelli F, Tomezzoli A, Berselli M, Catalano F, Di Leo A, Framarini M, Giacopuzzi S, Graziosi L, Marchet A, Marini M, Milandri C, Mura G, Orsenigo E, Quagliuolo V, Rausei S, Ricci R, Rosa F, Roviello G, Sansonetti A, Sgroi G, Tiberio GAM, Verlato G, Vindigni C, Rosati R, Roviello F. The Italian Research Group for Gastric Cancer (GIRCG) guidelines for gastric cancer staging and treatment: 2015. Gastric Cancer 2017; 20:20-30. [PMID: 27255288 DOI: 10.1007/s10120-016-0615-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/01/2016] [Indexed: 02/07/2023]
Abstract
This article reports the guidelines for gastric cancer staging and treatment developed by the GIRCG, and contains comprehensive indications for clinical management, including radiological, endoscopic, surgical, pathological, and oncological paths.
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Affiliation(s)
- Giovanni De Manzoni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Daniele Marrelli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy.
| | - Gian Luca Baiocchi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Paolo Morgagni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Luca Saragoni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Maurizio Degiuli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Annibale Donini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Uberto Fumagalli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Maria Antonietta Mazzei
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Fabio Pacelli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Anna Tomezzoli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Mattia Berselli
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Filippo Catalano
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Alberto Di Leo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Massimo Framarini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Simone Giacopuzzi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Luigina Graziosi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Alberto Marchet
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Mario Marini
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Carlo Milandri
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Gianni Mura
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Elena Orsenigo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Vittorio Quagliuolo
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Stefano Rausei
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Riccardo Ricci
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Fausto Rosa
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giandomenico Roviello
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Andrea Sansonetti
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giovanni Sgroi
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Guido Alberto Massimo Tiberio
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Giuseppe Verlato
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Carla Vindigni
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Riccardo Rosati
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
| | - Franco Roviello
- GIRCG Secretary: Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100, Siena, Italy
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A novel method of self-pulling and latter transected reconstruction in totally laparoscopic total gastrectomy: feasibility and short-term safety. Surg Endosc 2016; 31:2968-2976. [DOI: 10.1007/s00464-016-5314-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/25/2016] [Indexed: 02/06/2023]
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22
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Zhou J, Hiki N, Mine S, Kumagai K, Ida S, Jiang X, Nunobe S, Ohashi M, Sano T, Yamaguchi T. Role of Prealbumin as a Powerful and Simple Index for Predicting Postoperative Complications After Gastric Cancer Surgery. Ann Surg Oncol 2016; 24:510-517. [PMID: 27638673 DOI: 10.1245/s10434-016-5548-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preoperative factors, including nutritional status, may have strong correlations with postoperative morbidities. The current study evaluated preoperative prealbumin concentrations as a predictor of postoperative complications after gastric surgery. METHODS A retrospective study of 1798 patients who underwent gastrectomy for gastric adenocarcinoma was performed. Information was collected on basic patient characteristics, preoperative laboratory findings, and 30 day postoperative complications. The patients were divided into three groups based on prealbumin concentrations (≥22 mg/dL, <22 to ≥15 mg/dL, and <15 mg/dL) for analysis. RESULTS The overall complication rate was 21.7 %, and the infection rate was 16 %. Subgroup analysis based on prealbumin concentrations showed that complication rates were markedly elevated with decreasing concentrations of prealbumin. Multivariate analysis using a logistic regression model showed that both overall and infectious complications were strongly associated with male gender, elevated C-reactive protein (CRP), and decreased prealbumin levels (p < 0.05). Even in patients with a CRP level higher than 0.1 mg/dL, male gender and low prealbumin concentrations (<15 mg/dL) were significantly correlated with overall and infectious morbidities (p < 0.05). CONCLUSIONS Preoperative prealbumin concentrations are useful predictors of short-term postoperative outcomes after gastrectomy.
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Affiliation(s)
- J Zhou
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - N Hiki
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - S Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - K Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - S Ida
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - X Jiang
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Gastroenterological Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - S Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - M Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological Center, Japanese Foundation for Cancer Research, Tokyo, Japan
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23
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Minimally Invasive Versus Open Total Gastrectomy for Gastric Cancer: A Systematic Review and Meta-analysis of Short-Term Outcomes and Completeness of Resection : Surgical Techniques in Gastric Cancer. World J Surg 2016; 40:148-57. [PMID: 26350821 PMCID: PMC4695500 DOI: 10.1007/s00268-015-3223-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Minimally invasive surgical techniques for gastric cancer are gaining more acceptance worldwide as an alternative to open resection. In order to assess the role of minimally invasive and open techniques in total gastrectomy for cancer, a systematic review and meta-analysis was performed. Articles comparing minimally invasive versus open total gastrectomy were reviewed, collected from the Medline, Embase, and Cochrane databases. Two different authors (JS and NW) independently selected and assessed the articles. Outcomes regarding operative results, postoperative recovery, morbidity, mortality, and oncological outcomes were analyzed. Statistical analysis portrayed the weighted mean difference (WMD) with a 95 % confidence interval and odds ratio (OR). Out of 1242 papers, 12 studies were selected, including a total of 1360 patients, of which 592 underwent minimally invasive total gastrectomy (MITG). Compared to open total gastrectomy (OTG), MITG showed a longer operation time (WMD: 48.06 min, P < 0.00001), less operative blood loss (WMD: −160.70 mL, P < 0.00001), faster postoperative recovery, measured as shorter time to first flatus (WMD −1.05 days, P < 0.00001), shorter length of hospital stay (WMD: −2.43 days, P = 0.0002), less postoperative complications (OR 0.66, P = 0.02), similar mortality rates (OR 0.60, P = 0.52), and similar rates in lymph node yield (WMD −2.30, P = 0.06). Minimally invasive total gastrectomy showed faster postoperative recovery and less postoperative complications, whereas completeness of the resection was similar in both groups. Duration of surgery was longer in the minimally invasive group. Only comparative non-randomized studies were available, further emphasizing the need for a prospective randomized trial comparing MITG and OTG.
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24
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Ntutumu R, Liu H, Zhen L, Hu YF, Mou TY, Lin T, I BA, Yu J, Li GX. Risk factors for pulmonary complications following laparoscopic gastrectomy: A single-center study. Medicine (Baltimore) 2016; 95:e4567. [PMID: 27512884 PMCID: PMC4985339 DOI: 10.1097/md.0000000000004567] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/27/2016] [Accepted: 07/18/2016] [Indexed: 01/26/2023] Open
Abstract
The risk factors associated with postoperative pulmonary complications (PPCs) following laparoscopic gastrectomy have not been well studied. We sought to identify the risk factors for PPCs following gastric cancer surgery.A retrospective analysis was performed on all gastric cancer patients in a prospective database who underwent a laparoscopic gastrectomy from 2004 to 2014. The potential risk factors for PPCs were evaluated.PPCs occurred in 6.8% (83/1205) of patients and included pneumonia in 56 (67.5%) patients, pleural effusion in 26 (31.3%) patients, and pulmonary embolism in 1 (1.2%) patient. The multivariate analysis identified the following significant risk factors for PPCs: advanced age (odds ratio [OR] = 1.043, 95% confidence interval [CI] = 1.021%, 1.066%), chronic obstructive pulmonary disease (COPD) (OR = 17.788, 95% CI = 2.618%, 120.838%), total gastrectomy (OR = 2.781, 95% CI = 1.726%, 4.480%), time to first diet (OR = 1.175, 95% CI = 1.060%, 1.302%), and postoperative hospital stay (OR = 1.015, 95% CI = 1.002%, 1.028%). The risk factors for pneumonia included advanced age (OR = 1.036, 95% CI = 1.010%, 1.063%), total gastrectomy (OR = 3.420, 95% CI = 1.960%, 5.969%), and time to first diet (OR = 1.207, 95% CI = 1.703%, 1.358%). Only pancreatectomy was a risk factor for pleural effusion (OR = 9.082, 95% CI = 2.412%, 34.206%).The frequency of PPCs in patients with gastric cancer who underwent laparoscopic surgery was relatively high. Patients with cardiac and pulmonary comorbidities and those who undergo total gastrectomy and combined resection should be considered at high risk.
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25
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Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, Yu B, Min Z. Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer 2016. [PMID: 26216579 DOI: 10.1007/s10120-015-0516-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. METHODS Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. RESULTS Overall, 26 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P < 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P < 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P < 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P < 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P < 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. CONCLUSIONS For AGCs, LG appeared comparable with OG in short- and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.
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Affiliation(s)
- Yingjun Quan
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ao Huang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Min Ye
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ming Xu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Biao Zhuang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Bo Yu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Zhijun Min
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
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26
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Aurello P, Sagnotta A, Terrenato I, Berardi G, Nigri G, D'Angelo F, Ramacciato G. Oncologic value of laparoscopy-assisted distal gastrectomy for advanced gastric cancer: A systematic review and meta-analysis. J Minim Access Surg 2016; 12:199-208. [PMID: 27279389 PMCID: PMC4916744 DOI: 10.4103/0972-9941.181283] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 10/02/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The oncologic validity of laparoscopic-assisted distal gastrectomy (LADG) in the treatment of advanced gastric cancer (AGC) remains controversial. This study is a systematic review and meta-analysis of the available evidence. MATERIALS AND METHODS A comprehensive search was performed between 2008 and 2014 to identify comparative studies evaluating morbidity/mortality, oncologic surgery-related outcomes, recurrence and survival rates. Data synthesis and statistical analysis were carried out using RevMan 5.2 software. RESULTS Eight studies with a total of 1456 patients were included in this analysis. The complication rate was lower in LADG [odds ratio (OR) 0.59; 95% confidence interval (CI) = 0.42-0.83; P < 0.002]. The in-hospital mortality rate was comparable (OR 1.22; 95% CI = 0.28-5-29, P = 0.79). There was no significant difference in the number of harvested lymph nodes, resection margins, cancer recurrence rate, cancer-related mortality or overall and disease-free survival (OS and DFS, respectively) rates between the laparoscopic and the open groups (P > 0.05). CONCLUSION The current study supports the view that LADG for AGC is a feasible, safe and effective procedure in selected patients. Adequate lymphadenectomy, resection margins, recurrence, cancer-related mortality and long-term outcomes appear equivalent to open distal gastrectomy (ODG).
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Affiliation(s)
- Paolo Aurello
- Department of General Surgery, Sant'Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Andrea Sagnotta
- Department of General Surgery, Sant'Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Irene Terrenato
- Biostatistic Unit, Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Giammauro Berardi
- Department of General Surgery, Sant'Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Giuseppe Nigri
- Department of General Surgery, Sant'Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Francesco D'Angelo
- Department of General Surgery, Sant'Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Giovanni Ramacciato
- Department of General Surgery, Sant'Andrea Hospital, “Sapienza” University of Rome, Rome, Italy
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27
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Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S. A Multi-institutional, Prospective, Phase II Feasibility Study of Laparoscopy-Assisted Distal Gastrectomy with D2 Lymph Node Dissection for Locally Advanced Gastric Cancer (JLSSG0901). World J Surg 2016; 39:2734-41. [PMID: 26170158 DOI: 10.1007/s00268-015-3160-z] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The efficacy and safety outcomes of laparoscopy-assisted distal gastrectomy (LADG) with D2 lymph node dissection for locally advanced gastric cancer remain unclear. Therefore, we conducted a randomized, controlled phase II trial to confirm the feasibility of LADG in terms of technical safety, and short-term surgical outcomes were investigated. METHODS Eligibility criteria included pre-operatively diagnosed advanced gastric cancer that could be treated by distal gastrectomy with D2 lymph node dissection; MP, SS, and SE without involvement of other organs; and N0-2 and M0. Patients aged 20-80 years were pre-operatively randomized. RESULTS In total, 180 patients were registered and randomized to the open (89 patients) and laparoscopic arms (91 patients). Among 91 patients in the laparoscopic arm, 86 underwent laparoscopic gastrectomy according to the study protocol. Regarding the primary endpoint of the phase II trial, the proportion of patients with either anastomotic leakage or pancreatic fistula was 4.7 % (4/86). The grade 3 or higher morbidity rate, including systemic and local complications, was 5.8 %. Conversion to open surgery was required for 1 patient (1.2 %), without any intra-operative complication. The post-operative mortality rate was 0, and no patient required readmission for surgical complications within 6 months after initial discharge. CONCLUSIONS The technical safety of LADG with D2 lymph node dissection for locally advanced gastric cancer was demonstrated. A phase III trial to confirm the non-inferiority of this procedure to open gastrectomy in terms of long-term outcomes is ongoing. Registered Number: UMIN 000003420 ( www.umin.ac.jp/ctr/).
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Affiliation(s)
- Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Oita, 879-5593, Japan.
| | - Tetsuji Ohyama
- Department of Mathematics and Statistics, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Natsuya Katada
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keisuke Koeda
- Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan
| | | | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Kazuyuki Kojima
- Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Bunkyō, Japan
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Comprehensive Cancer Center, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Norio Shiraishi
- Center for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
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28
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Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G. Morbidity and Mortality of Laparoscopic Versus Open D2 Distal Gastrectomy for Advanced Gastric Cancer: A Randomized Controlled Trial. J Clin Oncol 2016; 34:1350-1357. [PMID: 26903580 DOI: 10.1200/jco.2015.63.7215] [Citation(s) in RCA: 522] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The safety and efficacy of radical laparoscopic distal gastrectomy (LG) with D2 lymphadenectomy for the treatment of advanced gastric cancer (AGC) remain controversial. We conducted a randomized controlled trial to compare laparoscopic and conventional open distal gastrectomy with D2 lymph node dissections for AGC. PATIENTS AND METHODS Between September 2012 and December 2014, 1,056 patients with clinical stage T2-4aN0-3M0 gastric cancer were eligible for inclusion. They were randomly assigned to either the LG with D2 lymphadenectomy group (n = 528) or the open gastrectomy (OG) with D2 lymphadenectomy group (n = 528). Fifteen experienced surgeons from 14 institutions in China participated in the study. The morbidity and mortality within 30 days after surgery between the LG (n = 519) and the OG (n = 520) groups were compared on the basis of the modified intention-to-treat principle. Postoperative complications were stratified according to the Clavien-Dindo classification. RESULTS The compliance rates of D2 lymphadenectomy were similar between the LG and OG groups (99.4% v 99.6%; P = .845). The postoperative morbidity was 15.2% in the LG group and 12.9% in OG group with no significant difference (difference, 2.3%; 95% CI, -1.9 to 6.6; P = .285). The mortality rate was 0.4% for the LG group and zero for the OG group (difference, 0.4%; 95% CI, -0.4 to 1.4; P = .249). The distribution of severity was similar between the two groups (P = .314). CONCLUSION Experienced surgeons can safely perform LG with D2 lymphadenectomy for AGC.
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Affiliation(s)
- Yanfeng Hu
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Changming Huang
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yihong Sun
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiangqian Su
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hui Cao
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jiankun Hu
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yingwei Xue
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jian Suo
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Kaixiong Tao
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xianli He
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongbo Wei
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Mingang Ying
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Weiguo Hu
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaohui Du
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Pingyan Chen
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hao Liu
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Chaohui Zheng
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Fenglin Liu
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jiang Yu
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ziyu Li
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Gang Zhao
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xinzu Chen
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Kuan Wang
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ping Li
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Jiadi Xing
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Guoxin Li
- Yanfeng Hu, Hao Liu, Jiang Yu, and Guoxin Li, Nanfang Hospital, Southern Medical University; Hongbo Wei, The Third Affiliated Hospital of Sun Yat-Sen University; Pingyan Chen, Southern Medical University, Guangzhou; Changming Huang, Chaohui Zheng, and Ping Li, Fujian Medical University Union Hospital; Mingang Ying, Fujian Provincial Cancer Hospital, Fuzhou; Yihong Sun and Fenglin Liu, Zhongshan Hospital, Fudan University; Hui Cao and Gang Zhao, Renji Hospital, Shanghai Jiao Tong University School of Medicine; Weiguo Hu, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai; Xiaohui Du, General Hospital of the People's Liberation Army; Xiangqian Su, Ziyu Li, and Jiadi Xing, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing; Jiankun Hu and Xinzu Chen, West China Hospital, Sichuan University, Chengdu; Yingwei Xue and Kuan Wang, The Affiliated Tumor Hospital of Harbin Medical University, Harbin; Jian Suo, The First Hospital, Jilin University, Changchun; Kaixiong Tao, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Xianli He, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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Procopiuc L, Tudor Ş, Mănuc M, Diculescu M, Vasilescu C. Robot-assisted surgery for gastric cancer. World J Gastrointest Oncol 2016; 8:8-17. [PMID: 26798433 PMCID: PMC4714148 DOI: 10.4251/wjgo.v8.i1.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 11/25/2015] [Accepted: 12/11/2015] [Indexed: 02/05/2023] Open
Abstract
Minimally invasive surgery for gastric cancer is a relatively new research field, with convincing results mostly stemming from Asian countries. The use of the robotic surgery platform, thus far assessed as a safe procedure, which is also easier to learn, sets the background for a wider spread of minimally invasive technique in the treatment of gastric cancer. This review will cover the literature published so far, analyzing the pros and cons of robotic surgery and highlighting the remaining study questions.
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Park YS, Son SY, Oo AM, Jung DH, Shin DJ, Ahn SH, Park DJ, Kim HH. Eleven-year experience with 3000 cases of laparoscopic gastric cancer surgery in a single institution: analysis of postoperative morbidities and long-term oncologic outcomes. Surg Endosc 2015; 30:3965-75. [PMID: 26694185 DOI: 10.1007/s00464-015-4708-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The present study summarizes the 11-year laparoscopic gastric cancer surgery experience of a single institution in South Korea and evaluates the current trends of laparoscopic gastric cancer surgery through our experience. METHODS A total of 3000 minimally invasive gastric cancer surgeries were performed at Seoul National University Bundang Hospital between May 2003 and January 2014. The types of laparoscopic gastrectomy used, surgical techniques, postoperative morbidities, and long-term oncologic outcomes were analyzed. RESULTS The proportion of challenging procedures such as laparoscopic total gastrectomy and laparoscopic gastrectomy for patients with advanced gastric cancer increased during the study period. The frequency of laparoscopic function-preserving gastrectomy for patients with early-stage cancer also increased. The overall rate of complications was 16.7 %; surgical and systemic complication rates were 11.8 and 6.2 %, respectively. There was one case of postoperative mortality due to delayed bleeding after discharge. Male gender, high BMI, long operating times, combined resection of other organs, and total and proximal gastrectomies were independent predictors of surgical morbidities; however, pathologic T-stage was not a predictable factor. Accumulated experience in laparoscopic surgery decreased the surgical complication rates of total and proximal gastrectomies more than it did in distal gastrectomy over time. The 5-year overall survival rates of patients in advanced stages and those who underwent laparoscopic total gastrectomy were comparable to those reported previously. CONCLUSIONS Our results indicate the trends toward the expansion of laparoscopic approaches to technically demanding procedures and an increased use of laparoscopic function-preserving surgeries for patients with EGC with acceptable outcomes.
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Affiliation(s)
- Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea
| | - Sang-Yong Son
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea
| | - Aung Myint Oo
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.,Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Do Hyun Jung
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea
| | - Dong Joon Shin
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea.,Department of Surgery, College of Medicine, Seoul National University, Seoul, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-shi, Kyeonggi-do, 463-707, South Korea. .,Department of Surgery, College of Medicine, Seoul National University, Seoul, South Korea.
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Li Z, Ji J. Application of laparoscopy in the diagnosis and treatment of gastric cancer. ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207254 DOI: 10.3978/j.issn.2305-5839.2015.03.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ziyu Li
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
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The diagnostic value of monoclonal gastric cancer 7 antigen: a systematic review with meta-analysis. Clin Exp Med 2015; 14:337-43. [PMID: 23797567 DOI: 10.1007/s10238-013-0246-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/08/2013] [Indexed: 12/20/2022]
Abstract
The aim of this study is to explore the clinical characteristic and the diagnostic role of MG7-Ag in detecting gastric cancer (GC) through a systematic review and meta-analysis. Relevant manuscripts aiming at the application of serum MG7-Ag level in GC diagnosis were searched in PubMed, Embase, Chinese National Knowledge Infrastructure, VIP, and Wan Fang Data independently,which were published between January 1, 1980 and February 28, 2013. The pooled sensitivity, specificity,positive diagnostic likelihood ratio (DLR+), negative diagnostic likelihood ratio (DLR-), diagnostic odds ratio,and the area under the summary receiver operating characteristic(AUC) were used to evaluate the value of serum MG7-Ag in diagnosis of GC by using the Meta-DiSc and STATA 11.0 statistical software. 410 manuscripts were retrieved, and 7 manuscripts of high quality including 652 patients were of high quality in this meta-analysis. Overall,the pooled sensitivity, specificity, DLR+, DLR-, and AUC were 0.73 (95 % CI 0.63-0.82), 0.91 (95 % CI 0.84-0.94), 8.59 (95 % CI 5.62-13.11), 0.29 (95 % CI 0.21-0.42), and 0.92 (95 % CI 0.89-0.94), respectively. MG7-Ag is a potential biomarker for the diagnosis of GC.However, more studies are needed to confirm the standard criteria.
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Son SY, Lee CM, Jung DH, Lee JH, Ahn SH, Park DJ, Kim HH. Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience. Gastric Cancer 2015; 18:177-82. [PMID: 24477417 DOI: 10.1007/s10120-014-0339-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/30/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the feasibility of laparoscopic completion total gastrectomy (LCTG) in patients with remnant gastric cancer. METHODS Patients who underwent completion total gastrectomy for remnant gastric cancer between May 2003 and December 2012 were divided into two groups: an open completion total gastrectomy (OCTG) group and an LCTG group. Clinicopathological data, operative data, and patient survival rates were analyzed. RESULTS Thirty-four remnant gastrectomies (17 OCTG and 17 LCTG) were performed. The mean time interval between the prior gastrectomy and the remnant gastrectomy was 17.2 years, and benign disease showed a longer time interval than malignancy (30.9 vs. 8.1 years; p < 0.0001). LCTG required a longer operation time than OCTG (234.4 vs. 170.0 min; p = 0.002); however, there were no significant differences in the estimated blood loss, the number of retrieved lymph nodes, the time to first flatus passage, the length of hospital stay, complication rates, and postoperative analgesia between the two groups. Eight patients (47.1%) required conversion to open surgery during LCTG. The median overall survival was 69.1 months. There was no difference in 5-year survival between the two groups (p = 0.085). CONCLUSION LCTG was technically feasible; however, it showed no definitive clinical advantage over OCTG.
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Affiliation(s)
- Sang-Yong Son
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, Korea
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Antonakis PT, Ashrafian H, Isla AM. Laparoscopic gastric surgery for cancer: Where do we stand? World J Gastroenterol 2014; 20:14280-14291. [PMID: 25339815 PMCID: PMC4202357 DOI: 10.3748/wjg.v20.i39.14280] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/06/2014] [Accepted: 05/29/2014] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.
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Zhang XM, Wang Z, Liang JW, Zhou ZX. Analysis of laparoscopy-assisted gastric cancer operations performed by inexperienced junior surgeons. Asian Pac J Cancer Prev 2014; 15:5077-81. [PMID: 24998589 DOI: 10.7314/apjcp.2014.15.12.5077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
To clarify whether gastric cancer patients can benefit from laparoscopy-assisted surgery completed by junior surgeons under supervision of expert surgeons, data of 232 patients with gastric cancer underwent operation performed by inexperienced junior surgeons were reviewed. Of the 232 patients, 137 underwent laparoscopy- assisted resection and in 118 cases this approach was successful. All of these 118 patients were assigned to laparoscopic group in this study, 19 patients who were switched to open resection were excluded. All laparoscopic operations were performed under the supervision of expert laparoscopic surgeons. Some 95 patients receiving open resection were assigned to the open group. All open operations were completed independently by the same surgeons. Short-term outcomes including oncologic outcomes, operative time intra-operative blood loss, time to first flatus, time to first defecation, postoperative hospital stay and perioperative complication were compared between the two groups. The numbers of lymph nodes harvested in the laparoscopic and open groups were21.1±9.6 and 18.2±9.7 (p=0.029). There was no significant difference in the length of margins. The mean operative time was 215.9±32.2 min in laparoscopic group and 220.1±34.6min in the open group (p=0.866), and the mean blood loss in laparoscopic group was obviously less than that in open group (200.9±197.0ml vs 291.1±191.4ml; p=0.001). Time to first flatus in laparoscopic and open groups was 4.0±1.0 days and 4.3±1.2days respectively and the difference was not significant (p=0.135). Similarly no statically significant difference was noted for time to first defecation (4.7±1.6 vs 4.8±1.6, p=0.586). Eleven patients in the laparoscopic group and 19 in the open group suffered from peri-operative complications and the difference between the two groups was significant (9.3% vs 20.0%, p=0.026). The conversion rate for laparoscopic surgery was 13.9%. Patients with gastric cancer can benefit from laparoscopy-assisted operations completed by inexperienced junior surgeons under supervision of expert laparoscopic surgeons.
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Affiliation(s)
- Xing-Mao Zhang
- Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China E-mail :
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Bencini L, Bernini M, Farsi M. Laparoscopic approach to gastrointestinal malignancies: toward the future with caution. World J Gastroenterol 2014; 20:1777-1789. [PMID: 24587655 PMCID: PMC3930976 DOI: 10.3748/wjg.v20.i7.1777] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/07/2013] [Accepted: 11/28/2013] [Indexed: 02/06/2023] Open
Abstract
After the rapid acceptance of laparoscopy to manage multiple benign diseases arising from gastrointestinal districts, some surgeons started to treat malignancies by the same way. However, if the limits of laparoscopy for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies. Cancerous patients represent an important group with peculiar aspects including reduced survival expectancy, worsened quality of life due to surgery itself and adjuvant therapies, and challenging psychological impact. All these issues could, potentially, receive a better management with a laparoscopic surgical approach. In order to confirm such aspects, similarly to testing the newest weapons (surgical or pharmacologic) against cancer, long-term follow-up is always recommendable to assess the real benefits in terms of overall survival, cancer-free survival and quality of life. Furthermore, it seems of crucial importance that surgeons will be correctly trained in specific oncologic principles of surgical oncology as well as in modern miniinvasive technologies. Therefore, laparoscopic treatment of gastrointestinal malignancies requires more caution and deep analysis of published evidences, as compared to those achieved for inflammatory bowel diseases, gastroesophageal reflux disease or diverticular disease. This review tries to examine the evidence available to date for the use of laparoscopy and robotics in malignancies arising from the gastrointestinal district.
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Abstract
Laparoscopic gastrectomy for gastric cancer is rapidly becoming popular because of the technical developments and the accumulated data of laparoscopic surgery in gastric cancer patients. The aim of this review is to present the current body of evidence and to highlight controversial issues of laparoscopic gastrectomy for gastric cancer. Laparoscopic distal gastrectomy (LDG) provides better or comparable outcomes compared to conventional open distal gastrectomy (ODG) in terms of short-term results. The long-term survival of LDG is expected to be comparable to that of ODG in early-stage gastric cancer, and an ongoing Korean multicenter randomized controlled trial (KLASS-01) will provide more clear evidence. Laparoscopic total gastrectomy is still selectively performed compared to LDG, and there is still debate on the safety of the laparoscopic esophagojejunostomy technique. Laparoscopic pylorus-preserving gastrectomy seems to be preferred for early gastric cancer in the middle third of the stomach in terms of functional advantages and comparable oncologic outcome. Evidence for LDG for advanced gastric cancer is still insufficient and the issue of lack of generalization still remains, even after ongoing multicenter randomized controlled trials have revealed clinical evidence. Laparoscopic sentinel node navigation surgery is still experimental and the surgical procedure has yet to be standardized. Robotic gastrectomy is feasible for early gastric cancer in terms of similar outcome, but is much more expensive in comparison to laparoscopic surgery. Its benefit over the conventional laparoscopic gastrectomy has not yet been proven.
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Affiliation(s)
- Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul 110-744, Korea
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