• Gastric cancer
• Machine learning
• Positive lymph nodes ratio
• Prognostic staging system
• Tumor differentiation

• Humans
• Stomach Neoplasms/pathology
• Stomach Neoplasms/mortality
• Stomach Neoplasms/diagnosis
• Retrospective Studies
• Neoplasm Staging/methods
• Machine Learning
• Male
• Female
• Middle Aged
• Prognosis
• Aged
• Lymphatic Metastasis/pathology
• Lymphatic Metastasis/diagnosis
• Lymph Nodes/pathology
• Neoplasm Grading
• SEER Program/statistics & numerical data
• Predictive Value of Tests
• Adult

• Interpretable
• Machine learning
• Multicenter
• Prediction model
• Prognosis
• Remnant gastric cancer

• Humans
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Stomach Neoplasms/mortality
• Male
• Machine Learning
• Female
• Middle Aged
• Prognosis
• Retrospective Studies
• Aged
• Gastrectomy
• Gastric Stump/pathology
• ROC Curve
• Risk Assessment/methods
• Algorithms

• 2021Y9204 Joint Funds for the innovation of science and Technology, Fujian province

• cervical lymph node metastasis
• occult metastasis
• optimal neck dissection extent
• remote primary
• survival

• Esophageal squamous carcinoma
• Positive lymph node ratio
• SEER database

• biochemical recurrence
• lymph node ratio
• papillary thyroid carcinoma
• structural recurrence
• total thyroidectomy

• Humans
• Thyroid Cancer, Papillary/diagnosis
• Thyroid Cancer, Papillary/surgery
• Thyroid Neoplasms/diagnosis
• Thyroid Neoplasms/surgery
• Thyroid Neoplasms/pathology
• Retrospective Studies
• Lymph Node Ratio
• Thyroidectomy
• Neoplasm Recurrence, Local/pathology

• Carcinoma
• Endoscopic surveillance
• Gastric cancer
• Gastric stump cancer
• Gastritis
• Remnant gastric carcinoma

• lymph nodes
• metastasis
• prognosis
• remnant gastric cancer
• splenectomy
• treatment

Three-dimensional (3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach (CRS), but its clinical efficacy remains controversial.

To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy (3DLAG) with open gastrectomy (OG) for CRS.

The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up, we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival (OS) rates were compared between the two groups.

Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score, initial disease state (benign or malignant), primary surgical anastomosis method, interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss (188.33 ± 191.35 mL vs 305.83 ± 303.66 mL; P = 0.045) and smaller incision (10.86 ± 3.18 cm vs 20.06 ± 5.17 cm; P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG (14.0 ± 7.17 vs 10.73 ± 6.82; P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups (1.56 ± 2.84 vs 2.35 ± 5.28; P = 0.413). The complication rate (8.3% vs 20.8%; P = 0.207) and intensive care unit admission rate (5.6% vs 14.5%; P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval (CI): 72.4%-95.6%] and 73.3% (95%CI: 60.0%-89.5%) respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3% (95%CI: 76.4%-99.8%) and 75.6% (95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups (P = 0.68).

Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.

• Carcinoma in the remnant stomach
• Remnant gastric cancer
• 3D laparoscopic-assisted gastrectomy
• Open gastrectomy
• Safe
• Effective

• Gastric cancer
• Geriatry
• Metastatic lymph node ratio
• Prognostic
• Survival

Appropriate lymph node harvesting for patients with gastric cancer is fundamental for a correct staging and is strongly related to survival. In this study, we present a new protocol for on-site macroscopic evaluation and sampling of lymph nodes for gastric cancer patients. With the joint collaboration of surgeons and pathologists, our method aims to provide the largest possible number of analyzed lymph nodes per patient, allowing for a better staging. We are convinced that this approach is routinely feasible, and our preliminary results seem to confirm better patient stratification compared to other lymph node dissection methods.

The downstaging of gastric cancer has recently gained particular attention in the field of gastric cancer surgery. The phenomenon is mainly due to an inappropriate sampling of lymph nodes during standard lymphadenectomy. Hence, collection of the maximum number of lymph nodes is a critical factor affecting the outcome of patients. None of the techniques proposed so far have demonstrated a real efficiency in increasing the number of identified lymph nodes. To harvest the maximum number of lymph nodes, we designed a protocol for on-site macroscopic evaluation and sampling of lymph nodes according to the Japanese Gastric Cancer Association protocol. The procedure was carried out by a surgeon/pathologist team in the operating room. We enrolled one hundred patients, 50 of whom belonged to the study group and 50 to a control group. The study group included patients who underwent lymph node dissection following the proposed protocol; the control group encompassed patients undergoing standard procedures for sampling. We compared the number and maximum diameter of lymph nodes collected in both groups, as well as some postoperative variables, the 30-day mortality and the overall survival. In the study group, the mean number of lymph nodes harvested was higher than the control one (p = 0.001). Moreover, by applying the proposed technique, we sampled lymph nodes with a very small diameter, some of which were metastatic. Noticeably, no difference in terms of postoperative course was identified between the two groups, again supporting the feasibility of an extended lymphadenectomy. By comparing the prognosis of patients, a better overall survival (p = 0.03) was detected in the study group; however, to date, no long-term follow-up is available. Interestingly, patients with metastasis in node stations number 8, 9, 11 or with skip metastasis, experienced a worse outcome and died. Based on our preliminary results, the pathologist/surgeon team approach seems to be a reliable option, despite of a slight increase in sfaff workload and technical cost. It allows for the harvesting of a larger number of lymph nodes and improves the outcome of the patients thanks to more precise staging and therapy. Nevertheless, since a higher number of patients are necessary to confirm our findings and assess the impact of this technique on oncological outcome, our study could serve as a proof-of-concept for a larger, multicentric collaboration.

• downstaging
• gastric cancer
• lymph node harvesting
• skip metastasis

• Meta-analysis
• Remnant gastric cancer
• Subtotal gastrectomy
• Systematic review
• Total gastrectomy