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Zhong X, Wei M, Ouyang J, Cao W, Cheng Z, Huang Y, Liang Y, Zhao R, Yu W. Efficacy and Safety of Totally Laparoscopic Gastrectomy Compared with Laparoscopic-Assisted Gastrectomy in Gastric Cancer: A Propensity Score-Weighting Analysis. Front Surg 2022; 9:868877. [PMID: 36034374 PMCID: PMC9411048 DOI: 10.3389/fsurg.2022.868877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo compare the short- and long-term outcomes of totally laparoscopic gastrectomy (TLG) with laparoscopic-assisted gastrectomy (LAG) in gastric cancer (GC) patients and evaluate the efficacy and safety of TLG.MethodsThis retrospective study was based on GC patients who underwent laparoscopic radical gastrectomy in the Qilu Hospital from January 2017 to December 2020. The groups’ variables were balanced by using the propensity score-based inverse probability of treatment weighting (PS-IPTW). The primary outcomes were 3-year relapse-free survival (RFS) and 3-year overall survival (OS). Postoperative recovery and complications were the secondary outcomes.ResultsA total of 250 GC patients were included in the study. There were no significant differences in baseline and pathological features between the TLG and the LAG groups after the PS-IPTW. TLG took around 30 min longer than LAG, while there were more lymph nodes obtained and less blood loss throughout the procedure. TLG patients had less wound discomfort than LAG patients in terms of short-term prognosis. There were no significant differences between groups in the 3-year RFS rate [LAG vs. TLG: 78.86% vs. 78.00%; hazard ratio (HR) = 1.14, 95% confidence interval (CI), 0.55–2.35; p = 0.721] and the 3-year OS rate (LAG vs. TLG: 78.17% vs. 81.48%; HR = 0.98, 95% CI, 0.42–2.27; p = 0.955). The lymph node staging was found to be an independent risk factor for tumor recurrence and mortality in GC patients with laparoscopic surgery. The subgroup analysis revealed similar results of longer operation time, less blood loss, and wound discomfort in totally laparoscopic distal gastrectomy, while the totally laparoscopic total gastrectomy showed benefit only in terms of blood loss.ConclusionTLG is effective and safe in terms of short- and long-term outcomes, with well-obtained lymph nodes, decreased intraoperative blood loss, and postoperative wound discomfort, which may be utilized as an alternative to LAG.
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Lu S, Yang ZY, Yan C, Liu WT, Ni ZT, Yao XX, Hua ZC, Feng RH, Zheng YN, Wang ZQ, Sah BK, Chen MM, Zhu ZL, He CY, Li C, Yan M, Zhu ZG. A randomized controlled trial to evaluate omentum-preserving gastrectomy for patients with T1-T3 gastric cancer. Future Oncol 2021; 17:3301-3307. [PMID: 34008422 DOI: 10.2217/fon-2021-0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023] Open
Abstract
Although complete omentectomy is traditionally performed in patients with gastric cancer as part of radical gastrectomy to ensure the elimination of micrometastases, the prognostic value of omentectomy during gastrectomy remains unclear. Retrospective studies have shown that the incidence of metastases in the greater omentum is very low in T1-T3 gastric cancer. Thus radical gastrectomy with D2 lymphadenectomy and preservation of the greater omentum may be a proper curative treatment for gastric cancer patients with T1-T3 tumors. The aim of this article is to describe the design and rationale for this prospective, randomized controlled DRAGON-05 trial, conducted to evaluate the prognostic value of omentum-preserving gastrectomy for patients with T1-T3 gastric cancer. Clinical trial registration: ChiCTR2000040045 (ClinicalTrials.gov).
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Affiliation(s)
- Sheng Lu
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zhong-Yin Yang
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Chao Yan
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Wen-Tao Liu
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zhen-Tian Ni
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Xue-Xin Yao
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zi-Chen Hua
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Run-Hua Feng
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Ya-Nan Zheng
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zhen-Qiang Wang
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Birendra Kumar Sah
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Ming-Min Chen
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zheng-Lun Zhu
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Chang-Yu He
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Chen Li
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Min Yan
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
| | - Zheng-Gang Zhu
- Department of General Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, PR China
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Yoneda A, Kanetaka K, Fujita F, Takatsuki M, Kuroki T, Eguchi S. Outcomes Following Surgery for Gastric Cancer at a Single Institution: A 16-Year Experience. Int Surg 2021; 105:308-315. [DOI: 10.9738/intsurg-d-17-00093.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025] Open
Abstract
Objective
We analyzed the cases of gastric cancer patients who underwent surgical treatment during the 16 years from 1997 to 2012 at our department to clarify these trends.
Methods
The subjects were 810 patients who underwent surgery for gastric cancer between 1997 and 2012. We divided the cases into the early-period group (1997–2006) treated before the introduction of laparoscopy, and the late-period group (2007–2012). We compared the clinicopathological factor and survival rates between the early- and late-period groups.
Results
The average patient age was higher in the late-period group than in the early-period group. Tumor localization showed an increased proportion in the U-region in the late period, and histological type in the late period showed a higher proportion of poorly differentiated cases. The cases receiving adjuvant chemotherapy increased in the late period. The five-year survival rate in the late-period group was shown to be equivalent to that in early-period group. Although the proportion of poorly differentiated cases was increased in late-period group, their survival rate was equivalent, probably because of the use of adjuvant chemotherapy.
Conclusions
Distinct characteristics were seen over the period of 16 years. It is important to continue the analysis of surgical outcomes to identify trends that need to be addressed.
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Affiliation(s)
- Akira Yoneda
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Fumihiko Fujita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tamotsu Kuroki
- Department of Surgery, National Hospital Organization, Nagasaki Medical Center, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Yang B, Sun K, Hui Y, Zhu L, Wang S, Ma S, Yu Z, Zhao J, Liu Q, Zhao J, Chen X. Large population-based study using the SEER database: is endoscopic resection appropriate for early gastric cancer patients in the United States? Scand J Gastroenterol 2020; 55:834-842. [PMID: 32649237 DOI: 10.1080/00365521.2020.1786158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To investigate whether endoscopic treatment is applicable to American patients and explores the predictors of lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS Patients with EGC confined to either mucosa (T1a, n = 1799) and submucosa (T1b, n = 1689) were identified from the Surveillance, Epidemiology, and End Result database. Multivariate logistic regression, Kaplan-Meier method, and univariate/multivariate Cox regression were used to assess the correlation between invasion depth and LNM or prognosis. A nomogram for predicting LNM was constructed and internally validated. RESULTS EGC limited to T1a exhibited a 2.4% incidence of LNM, which increased to 11.1% when the depth invaded T1b.LNM was present at 1.4%, 5.2%, and 5.0% for sizes ≤2, 2-5, and >5cm of low-grade T1a EGC, respectively, (p = .019) and at 4.8%, 12.4%, and 28.6% of T1b EGC, respectively (p < .001).The multivariate logistic model revealed that older age, T1b invasion, larger tumor size, and high-grade lesions were associated with a higher risk of LNM. Moreover, the T1a EGC patients had better cancer-specific survival (OS) and overall survival(CSS) compared with the T1b EGC patients (5-year OS: 77.2% versus 67.4%, p < .001; 5-year CSS: 90.6% versus 81.4%, p < .001). The discrimination of the prediction model was 0.745. CONCLUSIONS Endoscopic treatment may only be suitable for patients in the US population who have low-grade T1a lesions of less than 2 cm in size. Patients with T1a lesions of greater than 2 cm in size, lesions with high-grade, and all T1b lesions may benefit from radical surgical resection with lymphadenectomy.
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Affiliation(s)
- Bo Yang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Kaidi Sun
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Yangyang Hui
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Lanping Zhu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Saiyu Wang
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Shuang Ma
- Department of Gastroenterology and Hepatology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Zihan Yu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Jing Zhao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Qinlingfei Liu
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Jingwen Zhao
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, General Hospital, Tianjin Medical University, Tianjin, China
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Chen J, Zhao G, Wang Y. Analysis of lymph node metastasis in early gastric cancer: a single institutional experience from China. World J Surg Oncol 2020; 18:57. [PMID: 32197625 PMCID: PMC7085136 DOI: 10.1186/s12957-020-01834-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 03/17/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) has a strong influence on the prognosis of patients with early gastric cancer (EGC). The aim of this study was to reveal the incidence of LNM and evaluate risk factors for LNM to determine the appropriate treatment for EGC in a Chinese population. METHODS Patients who underwent radical gastrectomy with lymph node dissection for EGC between 2012 and 2017 were retrospectively analyzed. Univariate and multivariate analyses were conducted to identify clinicopathological features that were risk factors for LNM. RESULTS A total of 1033 patients with EGC were enrolled. Of these patients, 668 (64.7%) were men, and 365 (35.3%) were women, ranging in age from 19 to 82 years (mean 56.9 ± 10.9 years). LNM was detected in 173(16.7%) patients with EGC. Among 508 patients with mucosal cancer, 44 (8.7%) patients had LNM. In 525 patients with submucosal cancer, the incidence of LNM was 24.6% (129/525). The age, gender, tumor size, type of differentiation, Lauren classification, and lymphovascular and perineural invasion showed a significant correlation with the rate of LNM in EGC by univariate and multivariate analyses. Patients with submucosal gastric cancer had an older age, a higher proportion of proximal lesion, larger tumor size, more frequent lymphovascular invasion, perineural invasion, and more LNM than patients with mucosal gastric cancer. CONCLUSIONS Our study revealed a relatively high incidence of LNM in EGC, compared with Japanese and Korean cohorts. Female sex, large tumor size, undifferentiated-type, and lymphovascular invasion were independent risk factors for LNM in EGC. Radical gastrectomy with lymphadenectomy should be performed in EGC patients with a high risk of LNM.
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Affiliation(s)
- Jinggui Chen
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Guangfa Zhao
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China
| | - Yanong Wang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dongan Road, Shanghai, 200032, People's Republic of China.
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Predictive Factors for Lymph Node Metastasis and the Effect on Survival in Early Gastric Cancer Patients with Radical Gastric Resection. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:371-378. [PMID: 32377111 PMCID: PMC7192292 DOI: 10.14744/semb.2019.30643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/27/2019] [Indexed: 12/13/2022]
Abstract
Objectives Selected patients with early gastric cancer (GC) are treated endoscopically. Lymph node metastasis (LNM) in the T1 stage may also be detected during surgical resection for early GC. The aim of this study was to determine factors associated with LNM and the effect on survival. Methods A total of 63 patients with tumor invasion stage T1a or T1b who were operated on for early GC between 2010 and 2018 were included in the study. Parameters were investigated retrospectively to identify predictive factors for LNM and overall survival. Significance was defined with a 2-sided p-value of <0.05. Results Among the 63 patients, 21 (33.3%) had LNM. Lymphovascular invasion (LVI) (p=0.02) and a high-grade tumor (p=0.02) were significantly associated with LNM. The overall survival rate was 73.0%. The number of patients with LNM was greater among the deceased patients compared with the censored group (p=0.03). The median follow-up time of the entire group was 28 months (range: 12-55 months) while it was 23 months (range: 7-39 months) in the deceased group and 33.5 months (15.5-60 months) in the censored group (p=0.06). The mean survival was 62.36 months in patients with LNM and 71.99 months in those without LNM (p=0.09). The cut-off value determined for the neutrophil-to-lymphocyte ratio (NLR) was 2.33 and it was an effective value in survival analysis (p<0.05). Conclusion Surgical treatment should be considered for early GC patients with high-grade tumors and cases demonstrating LVI. The overall survival was shorter in patients with a high NLR value and LNM.
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A Novel Selection Model of Surgical Treatments for Early Gastric Cancer Patients Based on Heterogeneous Multicriteria Group Decision-Making. Symmetry (Basel) 2018. [DOI: 10.3390/sym10060223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Kawachi J, Kashiwagi H, Ogino H, Isogai N, Shimoyama R, Fukai R, Miyake K, Sasaki A, Terashima T, Teshima S, Watanabe K. Stomach resection with intraoperative fluoroscopy in laparoscopic distal gastrectomy for early gastric cancer. J Minim Access Surg 2017; 14:236-240. [PMID: 29067944 PMCID: PMC6001300 DOI: 10.4103/jmas.jmas_61_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In Japan, laparoscopic distal gastrectomy (LDG) is common for early gastric cancer. Formerly, we used to verify the location of the marking clip to decide the proximal incisional line with our hand, through a small epigastric incision. In 2015, we introduced intracorporeal reconstruction and started to decide the incisional line using intraoperative fluoroscopy. Herein, we aimed to evaluate the efficacy and safety of intraoperative fluoroscopy in LDG. Patients and Methods: A total of 19 patients were included in this retrospective observational study. On the day before operation, we endoscopically clipped several points located 2 cm proximal to the tumour edge to cover about half of the tumour. After lymph node dissection, we incised the stomach with an endoscopic linear stapling device, including the previously placed clips, guided by intraoperative fluoroscopy. Reconstruction was performed in all patients who underwent Billroth I and Roux-en-Y procedures. Results: No complications were observed during pre-operative endoscopic clipping or intraoperatively. On pathological examination, all resected specimens had negative margins, and the mean distance from the tumour edge was 28.5 ± 16.5 (13–60) mm. Conclusion: Stomach resection with intraoperative fluoroscopic guidance was safe and effective.
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Affiliation(s)
- Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidemitsu Ogino
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryuta Fukai
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Katsunori Miyake
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Akiko Sasaki
- Gastroenterology Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kazunao Watanabe
- Department of Surgery, Tokyo Nishi Tokushukai Hospital, Tokyo, Japan
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Zhu X, Wang Y, Li H, Xue W, Wang R, Wang L, Zhu M, Zheng L. Deficiency of hMLH1 and hMSH2 expression is a poor prognostic factor in Early Gastric Cancer (EGC). J Cancer 2017. [PMID: 28638463 PMCID: PMC5479254 DOI: 10.7150/jca.18487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: The aim of the study was to investigate the effect of deficiency of hMLH1 and hMSH2 expression on the prognosis of early gastric cancer (EGC) in Chinese populations. Methods: A total of 160 EGC patients who underwent curative gastrectomy with lymphadenectomy from January 2011 to July 2014 at Xinhua Hospital were evaluated. The expression rates of hMLH1 and hMSH2 were examined using tissues preserved in paraffin blocks by immunohistochemical staining. The clinicopathological characteristics and prognosis of EGC with deficient hMLH1 and hMSH2 were analyzed. Results: On immunohistochemical staining, the loss expression of hMLH1 and hMSH2 were observed in 89 (55.6%) and 45 (28.1%), respectively. The hMLH1 deficiency was associated with the middle third of tumor location (P = 0.041). According to Kaplan-Meier survival analysis and Log-Rank test, the loss expression of hMLH1 and hMSH2 were associated with worse survival than positive hMLH1 (HR = 0.247, 95% CI = 0.078-0.781, P = 0.017) and hMSH2 (HR = 0.174, 95% CI = 0.051-0.601, P = 0.006) in EGC. Conclusion: The main conclusions were as follows: The hMLH1 deficiency was preferred to the middle third of EGC. Lymph node metastasis (LNM) was a prognostic factor of EGC. And the prognosis of EGC patients with deficient mismatch repair (dMMR, mainly including deficient hMLH1 and hMSH2) was obviously worse than proficient mismatch repair (pMMR).
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Affiliation(s)
- Xueru Zhu
- Department of Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, Shanghai, China
| | - Yiwei Wang
- Department of Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, Shanghai, China
| | - Hongjia Li
- Department of Oncology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, 200092, Shanghai, China
| | - Wenji Xue
- Department of Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, Shanghai, China
| | - Ruifen Wang
- Department of Pathology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, Shanghai, China
| | - Lifeng Wang
- Department of Pathology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, Shanghai, China
| | - Meiling Zhu
- Department of Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, Shanghai, China
| | - Leizhen Zheng
- Department of Oncology, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, Shanghai, China
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The technical outcomes of delta-shaped anastomosis in laparoscopic distal gastrectomy: a single-center safety and feasibility study. Surg Endosc 2016; 31:1257-1263. [PMID: 27444837 DOI: 10.1007/s00464-016-5103-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 07/09/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The indications for laparoscopic gastrectomy for early stomach cancer have spread worldwide, and the short-term outcomes have been favorable. Intraabdominal delta-shaped gastroduodenostomy using endoscopic linear staplers, a technique which was developed by Kanaya et al. is one of the feasible reconstructive procedures. Pure laparoscopic surgery is reported to be associated with several intraoperative and postoperative advantages in comparison with laparoscopy-assisted surgery. However, the clinical results remain uncertain. The present study aimed to evaluate both the technical feasibility and safety of delta-shaped anastomosis with LDG according to the short-term outcomes. METHODS The study group was composed of 229 patients who underwent delta-shaped anastomosis with LDG at Gifu University School of Medicine from December 2004 to December 2014. RESULTS The median total operative blood loss and operative time were 20 ml and 277 min, respectively. Postoperative complications were detected in 20 (8.7 %) patients. The complications included: anastomotic stenosis, n = 3 (1.3 %); anastomotic leakage, n = 3 (1.3 %); pancreatic injury, n = 8 (3.5 %); anastomotic ulcer, n = 1 (0.4 %); bowel obstruction, n = 1 (0.4 %); abdominal abscess, n = 1 (0.4 %); lymphorrhea, n = 1 (0.4 %); cardiac failure, n = 1 (0.4 %); and infection, n = 1 (0.4 %). The complications were classified as grade 2, n = 4 (1.7 %); grade 3a, n = 12 (5.2 %); grade 3b, n = 4 (1.7 %); and grade 4 and 5, n = 0 (0 %). CONCLUSION The findings of the present study indicate the safety of Kanaya's procedure and that it should provide better outcomes in patients who undergo intracorporeal gastroduodenostomy after laparoscopic distal gastrectomy.
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Schwerter M, Lietzmann F, Schad LR. A novel approach for a 2D/3D image registration routine for medical tool navigation in minimally invasive vascular interventions. Z Med Phys 2016; 26:259-69. [PMID: 27157275 DOI: 10.1016/j.zemedi.2016.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
Abstract
Minimally invasive interventions are frequently aided by 2D projective image guidance. To facilitate the navigation of medical tools within the patient, information from preoperative 3D images can supplement interventional data. This work describes a novel approach to perform a 3D CT data registration to a single interventional native fluoroscopic frame. The goal of this procedure is to recover and visualize a current 2D interventional tool position in its corresponding 3D dataset. A dedicated routine was developed and tested on a phantom. The 3D position of a guidewire inserted into the phantom could successfully be reconstructed for varying 2D image acquisition geometries. The scope of the routine includes projecting the CT data into the plane of the fluoroscopy. A subsequent registration of the real and virtual projections is performed with an accuracy within the range of 1.16±0.17mm for fixed landmarks. The interventional tool is extracted from the fluoroscopy and matched to the corresponding part of the projected and transformed arterial vasculature. A root mean square error of up to 0.56mm for matched point pairs is reached. The desired 3D view is provided by backprojecting the matched guidewire through the CT array. Due to its potential to reduce patient dose and treatment times, the proposed routine has the capability of reducing patient stress at lower overall treatment costs.
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Affiliation(s)
- Michael Schwerter
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
| | - Florian Lietzmann
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Zheng Z, Zhang Y, Zhang L, Li Z, Wu X, Liu Y, Bu Z, Ji J. A nomogram for predicting the likelihood of lymph node metastasis in early gastric patients. BMC Cancer 2016; 16:92. [PMID: 26873736 PMCID: PMC4751748 DOI: 10.1186/s12885-016-2132-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/07/2016] [Indexed: 12/17/2022] Open
Abstract
Background Early gastric cancer is defined as a lesion confined to the mucosa or submucosa, regardless of the size or lymph node metastasis. Treatment methods include endoscopic mucosal resection or endoscopic submucosal dissection, wedge resection, laparoscopically assisted gastrectomy and open gastrectomy. Lymph node metastasis is strong related with survival and recurrence. Therefore, the likelihood of lymph node metastasis is one of the most important factors when determining the most appropriate treatment. Methods We retrospectively analyzed 597 patients who underwent D2 gastrectomy for early gastric cancer. The relationship between lymph node metastasis and clinicopathological features was analyzed. Using multivariate logistic regression analyses, we created a nomogram to predict the lymph node metastasis probability for early gastric cancer. Receiver operating characteristic analyses was performed to assess the predictive value of the model. Results In the present study, 58 (9.7 %) early gastric cancer patients were histologically shown to have lymph node metastasis. The multivariate logistic regression analysis demonstrated that the age at diagnosis, differentiation status, the presence of ulcers, lymphovascular invasion and depth of invasion were independent risk factors for lymph node metastasis in early gastric cancer. Additionally, the tumor macroscopic type, size and histology type significantly correlated with these important independent factors. We constructed a predictive nomogram with these factors for lymph node metastasis in early gastric cancer patients, and the discrimination was good with the AUC of 0.860 (95 % CI: 0.809–0.912). Conclusions We developed an effective nomogram to predict the incidence of lymph node metastasis for early gastric cancer patients.
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Affiliation(s)
- Zhixue Zheng
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Yinan Zhang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Lianhai Zhang
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Ziyu Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Xiaojiang Wu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Yiqiang Liu
- Department of Pathology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
| | - Zhaode Bu
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, 100142, Beijing, China.
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Wang YW, Zhu ML, Wang RF, Xue WJ, Zhu XR, Wang LF, Zheng LZ. Predictable factors for lymph node metastasis in early gastric cancer analysis of clinicopathologic factors and biological markers. Tumour Biol 2016; 37:8567-78. [PMID: 26733174 DOI: 10.1007/s13277-015-4721-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/21/2015] [Indexed: 12/29/2022] Open
Abstract
Predicting lymph node metastasis (LNM) accurately is very important to decide treatment strategies preoperatively. The aim of this study was to explore risk factors that predict the presence of LNM in early gastric cancer (EGC). A total of 230 patients with EGC who underwent curative gastrectomy with lymph adenectomy at Xinhua Hospital from January 2006 to July 2014 were retrospectively reviewed. We studied the relationship between clinicopathological factors, biological markers (p53, ki67, nm23, vascular endothelial growth factor (VEGF), epidermal growth factor receptor (EGFR), E-cadherin (E-cad), beta-catenin (b-catenin), glutathione S-transferase (GST), and topoisomerase II (Topo II)), and LNM of EGC patients by chi-square test and logistic regression analysis. Meta-analyses were further conducted to review the effects of the proteins (P53, ki67, E-cad, and b-catenin) on LNM in ECG patients. LNM was detected in 42 (18.3 %) of 230 patients. Incidences of LNM was distinct in different tumor size (p = 0.044), depth of submucosal invasion (p < 0.0001), and P53 overexpression (p = 0.004). Multivariate analysis further indentified that large tumor size (≥20 mm, odds ratio (OR) = 2.168, p = 0.041), submucosa (OR = 4.000, p = 0.0005), and P53 overexpression (OR = 3.010, p = 0.022) were independent risk factors of LNM in EGC patients. The meta-analysis revealed a significantly statistical association of P53, ki67, and b-catenin with an increased risk of LNM in EGC patients (P53, OR = 1.81, p = 0.017; ki67, OR = 2.53, p = 0.0003; b-catenin, OR = 0.53, p = 0.01). Tumor size (≥20 mm), the depth of invasion (submucosa), and P53 overexpression may be helpful predictors of LNM in EGC patients. Furthermore, the results of meta-analysis revealed that P53, ki67 overexpression, and abnormal expression of b-catenin may be associated with LNM in EGC. The results need further validation in single large studies.
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Affiliation(s)
- Yi-Wei Wang
- Department of Oncology, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, NO.1665, Kong Jiang Road, Shanghai, 200092, People's Republic of China
| | - Mei-Ling Zhu
- Department of Oncology, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, NO.1665, Kong Jiang Road, Shanghai, 200092, People's Republic of China
| | - Rui-Fen Wang
- Department of Pathology, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, NO.1665, Kong Jiang Road, Shanghai, 200092, People's Republic of China
| | - Wen-Ji Xue
- Department of Oncology, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, NO.1665, Kong Jiang Road, Shanghai, 200092, People's Republic of China
| | - Xue-Ru Zhu
- Department of Oncology, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, NO.1665, Kong Jiang Road, Shanghai, 200092, People's Republic of China
| | - Li-Feng Wang
- Department of Pathology, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, NO.1665, Kong Jiang Road, Shanghai, 200092, People's Republic of China.
| | - Lei-Zhen Zheng
- Department of Oncology, Xin Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine, NO.1665, Kong Jiang Road, Shanghai, 200092, People's Republic of China.
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Park JH, Lee SH, Park JM, Park CS, Park KS, Kim ES, Cho KB. Prediction of the indication criteria for endoscopic resection of early gastric cancer. World J Gastroenterol 2015; 21:11160-11167. [PMID: 26494970 PMCID: PMC4607913 DOI: 10.3748/wjg.v21.i39.11160] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/18/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To find risk factors of lymph node metastasis (LNM) in early gastric cancer (EGC) and to find proper endoscopic therapy indication in EGC.
METHODS: We retrospectively reviewed the 2270 patients who underwent curative operation for EGC from January 2001 to December 2008. EGC was defined as malignant lesions that do not invade beyond the submucosal layer of the stomach wall irrespective of presence of lymph node metastasis.
RESULTS: Among 2270 enrolled patients, LNM was observed in 217 (9%) patients. LNM in intramucosal (M) cancer and submucosal (SM) cancer was detected in 38 (2.8%, 38/1340) patients and 179 (19%, 179/930) patients, respectively. In univariate analysis, the risk factors for LNM in EGC were size of tumor, Lauren classification, ulcer, lymphatic invasion, vascular invasion, and depth of invasion. However, in multivariate analysis, size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in EGC. Size of tumor, lymphatic invasion, vascular invasion, and depth of invasion were risk factors for LNM in cases of intramucosal cancer and submucosal cancer. In particular, there was no lymph node metastasis in cases of well differentiated early gastric cancer below 1 cm in size without ulcer regardless of lymphovascular invasion.
CONCLUSION: Tumor size, perilymphatic-vascular invasion, and depth of invasion were risk factors for LNM in EGC. There was no LNM in EGC below 1 cm regardless risk factors.
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Wang Z, Ma L, Zhang XM, Zhou ZX. Long-term outcomes after D2 gastrectomy for early gastric cancer: survival analysis of a single-center experience in China. Asian Pac J Cancer Prev 2015; 15:7219-22. [PMID: 25227817 DOI: 10.7314/apjcp.2014.15.17.7219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early gastric cancer (EGC) is well accepted as having a favorable prognosis, but some patients experience an ominous outcome after curative resection. This study was aimed at evaluating predictive factors associated with prognosis of D2 gastrectomies in patients with early gastric cancer. MATERIALS AND METHODS A total of 518 patients with early gastric cancer who underwent D2 gastrectomies were reviewed in this study. The clinicopathological features and surgical outcomes were analyzed. The survival rate was estimated using the Kaplan-Meier method and compared by log rank test. Prognostic factors were analyzed using a multivariate Cox proportional hazards model. RESULTS The 5-year survival rate was 90.3%. Tumor infiltration, lymph node metastasis and lymphovascular invasion were significant prognostic factors for survival. Gender, age, tumor size, tumor location, macroscopic type and histological type were not significant prognostic factors. Multivariate analysis indicated that lymph node metastasis was an independent poor prognosis factor. CONCLUSIONS Early gastric cancers with lymph node metastasis have a relatively poor prognosis after standard surgery. Even after curative resection, patients with EGC with positive lymph nodes should be closely followed and be considered as candidates for comprehensive therapies.
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Affiliation(s)
- Zheng Wang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China E-mail :
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Wang Z, Ma L, Zhang XM, Zhou ZX. Risk of lymph node metastases from early gastric cancer in relation to depth of invasion: experience in a single institution. Asian Pac J Cancer Prev 2015; 15:5371-5. [PMID: 25041004 DOI: 10.7314/apjcp.2014.15.13.5371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of early gastric cancers. Therefore, this study analyzed predictive factors associated with lymph node metastasis and identified differences between mucosal and submucosal gastric cancers. MATERIALS AND METHODS A total of 518 early gastric cancer patients who underwent radical gastrectomy were reviewed in this study. Clinicopathological features were analyzed to identify predictive factors for lymph node metastasis. RESULTS The rate of lymph node metastasis in early gastric cancer was 15.3% overall, 3.3% for mucosal cancer, and 23.5% for submucosal cancer. Using univariate analysis, risk factors for lymph node metastasis were identified as tumor location, tumor size, depth of tumor invasion, histological type and lymphovascular invasion. Multivariate analysis revealed that tumor size >2 cm, submucosal invasion, undifferentiated tumors and lymphovascular invasion were independent risk factors for lymph node metastasis. When the carcinomas were confined to the mucosal layer, tumor size showed a significant correlation with lymph node metastasis. On the other hand, histological type and lymphovascular invasion were associated with lymph node metastasis in submucosal carcinomas. CONCLUSIONS Tumor size >2 cm, submucosal tumor, undifferentiated tumor and lymphovascular invasion are predictive factors for lymph node metastasis in early gastric cancer. Risk factors are quite different depending on depth of tumor invasion. Endoscopic treatment might be possible in highly selective cases.
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Affiliation(s)
- Zheng Wang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China E-mail :
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Surgical outcomes in the newly introduced phase of intracorporeal anastomosis following laparoscopic distal gastrectomy is safe and feasible compared with established procedures of extracorporeal anastomosis. Surg Endosc 2014; 28:1250-5. [PMID: 24232135 DOI: 10.1007/s00464-013-3315-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 11/01/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Totally laparoscopic distal gastrectomy (TLDG) with intracorporeal anastomosis has been introduced to achieve safer anastomosis with good vision, and a small wound. However, little is known about the surgical outcomes of newly introduced TLDG compared with established procedures of laparoscopy-assisted gastrectomy (LADG) with extracorporeal anastomosis. METHODS This retrospective study included 114 patients who underwent laparoscopic distal gastrectomy (LDG) between January 2010 and September 2012. The patients were classified into two groups according to the approach of reconstruction (LADG group: n = 74; TLDG group: n = 40). The parameters analyzed included patients, operation details, and operative outcomes. RESULTS No complication was observed in the TLDG group. Surgical outcomes of the TLDG group, such as mean operation time, estimated blood loss, and rate of conversion to laparotomy were not inferior to the LADG group. Furthermore, postoperative hospital stay of the TLDG group was significantly shorter than the LADG group (p < 0.05). CONCLUSION Surgical outcomes in the newly introduced phase of TLDG were safe as well as feasible compared with established LADG. TLDG has several advantages over LADG, such as shorter post-hospital stay, no incidence of operative complication, adequate working space, and small wound size. Although prospective, randomized control studies are warranted, we submit that TLDG can be used as a standard procedure for LDG.
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Feasibility and safety of single-incision laparoscopic surgery in gastric benign and malignant diseases. Gastroenterol Res Pract 2014; 2014:782035. [PMID: 24971092 PMCID: PMC4058137 DOI: 10.1155/2014/782035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/03/2014] [Indexed: 12/21/2022] Open
Abstract
We systematically searched Medline and Cochrane Library and the related references occurred in the citations until February 2013 and included all the cases who suffered from gastric benign and malignant diseases where single incision laparoscopic surgery was performed. A total of 69 cases with gastric diseases undergoing SILS surgery were reviewed to evaluate the feasibility, safety, and potential benefits of SILS for the gastric diseases. Demographic data, morphologic characterisation of the lesion, and perioperative parameters were analyzed retrospectively. The initial experience with SILS for benign gastric diseases and early gastric cancer showed that it is feasible and safe when performed by experienced laparoscopic surgeons. Despite the limited number and technical difficulties it can be proposed in selected patients.
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Wang Z, Zhang X, Hu J, Zeng W, Liang J, Zhou H, Zhou Z. Predictive factors for lymph node metastasis in early gastric cancer with signet ring cell histology and their impact on the surgical strategy: analysis of single institutional experience. J Surg Res 2014; 191:130-3. [PMID: 24768142 DOI: 10.1016/j.jss.2014.03.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The prognosis of early gastric cancer (EGC) with signet ring cell histology is more favorable than other undifferentiated gastric adenocarcinomas. An accurate assessment of potential lymph node metastasis is important for the appropriate treatment of EGC with signet ring cell histology. Therefore, this study analyzed the predictive factors associated with lymph node metastasis in patients with this type of EGC. METHODS A total of 136 EGC with signet ring cell histology patients who underwent D2 radical gastrectomy were reviewed in this study. The clinicopathologic features were analyzed to identify predictive factors for lymph node metastasis. RESULTS The overall rate of lymph node metastasis in EGC with signet ring cell histology was 10.3%. Using a univariate analysis, the risk factors for lymph node metastasis were identified as the tumor size, depth of tumor invasion, and lymphovascular invasion. The multivariate analysis revealed that tumor size >2 cm, submucosal invasion, and lymphovascular invasion were independent risk factors of lymph node metastasis (P < 0.05). CONCLUSIONS The risk of lymph node metastasis of EGC with signet ring cell histology was high in those with tumor sizes ≥2 cm, submucosal tumors, and lymphovascular invasion. A minimally invasive treatment, such as endoscopic resection, might be possible in highly selective cases of EGC with signet ring cell histology with intramucosal invasion, tumor size <2 cm, and no lymphovascular invasion.
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Affiliation(s)
- Zheng Wang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Xingmao Zhang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Junjie Hu
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Weigen Zeng
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Jianwei Liang
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Haitao Zhou
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China
| | - Zhixiang Zhou
- Department of Abdominal Surgical Oncology, Cancer Hospital of the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R.China.
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Kong J, Wu SD, Su Y. Translumenal single-incision laparoscopy radical gastrectomy with D2 lymph node dissection for early gastric cancer--primary experience with less invasive surgery in China. J Laparoendosc Adv Surg Tech A 2013; 23:141-5. [PMID: 23374012 DOI: 10.1089/lap.2012.0332] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In this article we report our initial clinical experience about umbilical single-incision laparoscopic surgery (SILS) radical gastrectomy with D2 lymph node dissection for early gastric cancer with conventional laparoscopic instruments. SUBJECTS AND METHODS Preliminary experiences with umbilical SILS radical gastrectomy in 4 patients with early gastric cancer were described. RESULTS Umbilical SILS radical gastrectomy with D2 lymph node dissection was performed successfully with conventional laparoscopic instruments in these 4 patients. Average operative time was 280 minutes, and average blood loss was 162 mL. No intraoperative or postoperative complications, such as secondary hemorrhage, anastomotic leakage, or obstruction, were recorded. The patients recovered fully, and the single umbilical scar was well healed. CONCLUSIONS Our initial experience showed that transumbilical SILS radical gastrectomy with D2 lymph node dissection for early gastric cancer is feasible and safe when performed by experienced laparoscopic surgeons.
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Affiliation(s)
- Jing Kong
- Departments of Minimally Invasive Surgery and the Second General Surgery, Sheng Jing Hospital of China Medical University, Shenyang City, Liaoning Province, People's Republic of China
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Ishigami S, Arigami T, Uchikado Y, Setoyama T, Kita Y, Sasaki K, Okumura H, Kurahara H, Kijima Y, Harada A, Ueno S, Natsugoe S. IL-32 expression is an independent prognostic marker for gastric cancer. Med Oncol 2013; 30:472. [PMID: 23479179 DOI: 10.1007/s12032-013-0472-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/15/2013] [Indexed: 12/16/2022]
Abstract
A strong link between inflammation and gastrointestinal cancer has been demonstrated. Interleukin (IL)-32 is a recently described pro-inflammatory cytokine characterized by the induction of nuclear factor kappa B (NF-κB) activation. We investigated whether IL-32 expression has clinical significance in gastric cancer. A total of 182 gastric cancer patients who received curative gastrectomy were enrolled in our study. IL-32 expression was detected by immunohistochemistry, and the correlation between clinicopathological features and IL-32 expression was analyzed. Tumor depth and lymph node metastases developed more frequently in IL-32-positive gastric cancer patients than those who were negative for IL-32 expression (p < 0.01). Lymphatic- and venous invasion in the IL-32-positive group were more severe than in cancer cells lacking IL-32 expression (p < 0.05). Multivariate analysis demonstrated that IL-32 is one of the prognostic markers (p < 0.03) for gastric cancer, in addition to nodal involvement and tumor depth. IL-32 positivity significantly affected clinicopathological factors. Thus, IL-32 expression in gastric cancer may serve as a preferential metastatic condition that allows cells to escape host antitumor immunity. Pro-inflammatory cytokines induce immunosuppression in a paracrine manner, thereby facilitating the metastasis of tumor cells.
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Affiliation(s)
- Sumiya Ishigami
- Digestive Surgery Surgical Oncology, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, Kagoshima 890-8520, JAPAN.
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Ren G, Cai R, Zhang WJ, Ou JM, Jin YN, Li WH. Prediction of risk factors for lymph node metastasis in early gastric cancer. World J Gastroenterol 2013; 19:3096-3107. [PMID: 23716990 PMCID: PMC3662950 DOI: 10.3748/wjg.v19.i20.3096] [Citation(s) in RCA: 52] [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: 11/27/2012] [Revised: 12/19/2012] [Accepted: 03/12/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore risk factors for lymph node metastases in early gastric cancer (EGC) and to confirm the appropriate range of lymph node dissection.
METHODS: A total of 202 patients with EGC who underwent curative gastrectomy with lymphadenectomy in the Department of Surgery, Xinhua Hospital and Ruijin Hospital of Shanghai Jiaotong University Medical School between November 2003 and July 2009, were retrospectively reviewed. Both the surgical procedure and the extent of lymph node dissection were based on the recommendations of the Japanese gastric cancer treatment guidelines. The macroscopic type was classified as elevated (type I or IIa), flat (IIb), or depressed (IIc or III). Histopathologically, papillary and tubular adenocarcinomas were grouped together as differentiated adenocarcinomas, and poorly differentiated and signet-ring cell adenocarcinomas were regarded as undifferentiated adenocarcinomas. Univariate and multivariate analyses of lymph node metastases and patient and tumor characteristics were undertaken.
RESULTS: The lymph node metastases rate in patients with EGC was 14.4%. Among these, the rate for mucosal cancer was 5.4%, and 8.9% for submucosal cancer. Univariate analysis showed an obvious correlation between lymph node metastases and tumor location, depth of invasion, morphological classification and venous invasion (χ2 = 122.901, P = 0.001; χ2 = 7.14, P = 0.008; χ2 = 79.523, P = 0.001; χ2 = 8.687, P = 0.003, respectively). In patients with submucosal cancers, the lymph node metastases rate in patients with venous invasion (60%, 3/5) was higher than in those without invasion (20%, 15/75) (χ2 = 4.301, P = 0.038). Multivariate logistic regression analysis revealed that the depth of invasion was the only independent risk factor for lymph node metastases in EGC [P = 0.018, Exp (B) = 2.744]. Among the patients with lymph node metastases, 29 cases (14.4%) were at N1, seven cases were at N2 (3.5%), and two cases were at N3 (1.0%). Univariate analysis of variance revealed a close relationship between the depth of invasion and lymph node metastases at pN1 (P = 0.008).
CONCLUSION: The depth of invasion was the only independent risk factor for lymph node metastases. Risk factors for metastases should be considered when choosing surgery for EGC.
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Lee SW, Tanigawa N, Nomura E, Tokuhara T, Kawai M, Yokoyama K, Hiramatsu M, Okuda J, Uchiyama K. Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol 2012; 10:267. [PMID: 23232031 PMCID: PMC3546847 DOI: 10.1186/1477-7819-10-267] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/24/2012] [Indexed: 12/13/2022] Open
Abstract
Background Laparoscopic gastrectomy has recently been gaining popularity as a treatment for cancer; however, little is known about the benefits of intracorporeal (IC) gastrointestinal anastomosis with pure laparoscopic distal gastrectomy (LDG) compared with extracorporeal (EC) anastomosis with laparoscopy-assisted distal gastrectomy (LADG). Methods Between June 2000 and December 2011, we assessed 449 consecutive patients with early-stage gastric cancer who underwent LDG. The patients were classified into three groups according to the method of reconstruction LADG followed by EC hand-sewn anastomosis (LADG + EC) (n = 73), using any of three anastomosis methods (Billroth-I (B-I), Billroth-II (B-II) or Roux-en-Y (R-Y); LDG followed by IC B-I anastomosis (LDG + B-I) (n = 248); or LDG followed by IC R-Y anastomosis (LDG + R-Y) (n = 128)). The analyzed parameters included patient and tumor characteristics, operation details, and post-operative outcomes. Results The tumor location was significantly more proximal in the LDG + R-Y group than in the LDG + B-I group (P < 0.01). Mean operation time, intra-operative blood loss, and the length of post-operative hospital stay were all shortest in the LDG + B-I group (P < 0.05). Regarding post-operative morbidities, anastomosis-related complications occurred significantly less frequently in with the LDG + B-I group than in the LADG + EC group (P < 0.01), whereas there were no differences in the other parameters of patients’ characteristics. Conclusions Intracorporeal mechanical anastomosis by either the B-I or R-Y method following LDG has several advantages over at the LADG + EC, including small wound size, reduced invasiveness, and safe anastomosis. Although additional randomized control studies are warranted to confirm these findings, we consider that pure LDG is a useful technique for patients with early gastric cancer.
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Affiliation(s)
- Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7, Daigaku-Machi, Takatsuki City Osaka 569-8686, Japan.
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Etoh T, Inomata M, Shiraishi N, Kitano S. Minimally invasive approaches for gastric cancer-Japanese experiences. J Surg Oncol 2012; 107:282-8. [PMID: 22504947 DOI: 10.1002/jso.23128] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 03/23/2012] [Indexed: 12/16/2022]
Abstract
Since development of laparoscopy-assisted distal gastrectomy with lymph node dissection in 1991 in Japan, laparoscopic gastrectomy (LAG) is improving and evolving. Recently, advanced LAG techniques including D2 lymph node dissection or anastomosis after total gastrectomy have been developed. Retrospective and prospective multicenter studies have been conducted for early and non-early gastric cancers to establish high-quality evidence. This review summarizes the current trends of minimally invasive approaches for gastric cancer based on current Japanese experiences.
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Affiliation(s)
- Tsuyoshi Etoh
- Department of Surgery I, Oita University, Oita, Japan.
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Pavlidis TE, Pavlidis ET, Sakantamis AK. The role of laparoscopic surgery in gastric cancer. J Minim Access Surg 2012; 8:35-38. [PMID: 22623823 PMCID: PMC3353610 DOI: 10.4103/0972-9941.95524] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 04/19/2011] [Indexed: 02/05/2023] Open
Abstract
The laparoscopic surgery in gastric cancer is applied with increasing frequency nowadays; noticeable reports come mainly from Korea and Japan with satisfactory results. This review presents briefly the issue by evaluating its role. A PubMed search of relevant articles published up to 2010 was performed to identify current information. Most data come from Far East, where gastric cancer occurs more often, and the proportion of early gastric cancer is high. Laparoscopic approach includes both the diagnostic laparoscopy and laparoscopic resection. Laparoscopic gastrectomy has currently limited application for gastric cancer in the West; it is not widely accepted and raises important considerations necessitating the planning of multicentre randomised control trials based mainly on the long-term results.
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Affiliation(s)
- Theodoros E Pavlidis
- Second Propedeutical Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Efstathios T Pavlidis
- Second Propedeutical Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
| | - Athanasios K Sakantamis
- Second Propedeutical Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Konstantinoupoleos 49, 546 42 Thessaloniki, Greece
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Lee H, Lee YC, Shin S, Park JC, Shin SK, Lee SK, Noh SH. Participation and conflict in the decision-making process for endoscopic resection or surgical gastrectomy for early gastric cancer. J Surg Oncol 2012; 106:101-6. [DOI: 10.1002/jso.23049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/04/2012] [Indexed: 12/13/2022]
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Affiliation(s)
- Taeil Son
- Department of Surgery, Eulji University School of Medicine, Deajeon, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Korea
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Kim MC, Kim KH, Jung GJ, Rattner DW. Comparative study of complete and partial omentectomy in radical subtotal gastrectomy for early gastric cancer. Yonsei Med J 2011; 52:961-6. [PMID: 22028160 PMCID: PMC3220242 DOI: 10.3349/ymj.2011.52.6.961] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Curative surgery for patients with advanced or even early gastric cancer can be defined as resection of the stomach and dissection of the first and second level lymph nodes, including the greater omentum. The aim of this study was to evaluate the short- and long- term outcomes of partial omentectomy (PO) as compared with complete omentectomy (CO). MATERIALS AND METHODS Seventeen consecutive open distal gastrectomies with POs were initially performed between February and July in 2006. The patients' clinicopathologic data and post-operative outcomes were retrospectively compared with 20 patients who underwent open distal gastrectomies with COs for early gastric cancer in 2005. RESULTS The operation time in PO group was significantly shorter than that in CO group (142.4 minutes vs. 165.0 minutes, p=0.018). The serum albumin concentration on the first post-operative day in PO group was significantly higher than CO group (3.8 g/dL vs. 3.5 g/dL, p=0.018). Three postoperative minor complications were successfully managed with conservative treatment. Median follow-up period between PO and CO was 38.1 and 37.7 months. All patients were alive without recurrence until December 30, 2009. CONCLUSION PO during open radical distal gastrectomy can be considered a more useful procedure than CO for treating early gastric cancer. To document the long-term technical and oncologic safety of this procedure, a large-scale prospective randomized trial will be needed.
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Affiliation(s)
- Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea.
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Zhang Y, Peng Z, Wei B, Chen L. Predictive factors associated with lymph node metastasis in early gastric cancer with submucosal invasion: an analysis of 290 cases. Shijie Huaren Xiaohua Zazhi 2011; 19:2970-2973. [DOI: 10.11569/wcjd.v19.i28.2970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the predictive risk factors for lymph node metastasis in early gastric cancer with submucosal invasion.
METHODS: The clinical data for 290 patients surgically treated for early gastric cancer with submucosal invasion between 1996 and 2010 were reviewed retrospectively. The clinico-pathological variables predicting lymph node metastasis were evaluated.
RESULTS: Lymph node metastasis was observed in 21.4% of patients included. Univariate analysis showed that tumor size, histologic type, depth of invasion and presence of vascular or lymphatic invasion were positively correlated with lymph node metastasis. Multivariate analyses revealed that tumor size (≥2 cm), histologic type and vascular or lymphatic involvement were independently related to lymph node metastasis. Histologic type was the strongest predictive factor for lymph node metastasis in early gastric cancer with submucosal invasion.
CONCLUSION: Tumor size, histologic type and presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in early gastric cancer with submucosal invasion. Minimally invasive treatment, such as endoscopic mucosal resection, may be possible in differentiated submucosal cancer of small size (<2 cm).
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Predictable factors for lymph node metastasis in early gastric cancer-analysis of single institutional experience. J Gastrointest Surg 2011; 15:1783-8. [PMID: 21796460 DOI: 10.1007/s11605-011-1624-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 07/12/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Prediction of lymph node metastasis in early gastric cancer (EGC) is very important to decide treatment strategies preoperatively. The aim of this study was to evaluate factors that predict the presence of lymph node metastasis and to identify the differences between mucosal and submucosal gastric cancers. METHODS A total of 376 patients with EGC who underwent gastrectomy from March 1999 through December 2007 were retrospectively identified. The clinopathological factors and biological markers (p53, Ki67) were analyzed. RESULTS The rate of lymph node metastasis was 9.6% (mucosal cancer 2.8%, submucosal cancer 18.4%). Tumor size, depth of invasion, macroscopic type, and lymphovascular invasion were related to lymph node metastasis in EGC. When the carcinomas were confined to the mucosal layer, tumor size and lymphovascular invasion showed significant correlation with lymph node metastasis. On the other side, macroscopic type and lymphovascular invasion were association with lymph node metastasis in submucosal carcinoma. CONCLUSION The risk factors for lymph node metastasis in EGC are quite different depending on depth of tumor invasion. To predict lymph node metastasis in EGC, it is recommended that distinct assessment according to individual situation should be clearly established.
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Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg 2011; 253:928-33. [PMID: 21358534 DOI: 10.1097/sla.0b013e3182117b24] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) was introduced as a function-preserving and minimally invasive operation for early gastric cancer (EGC) in Japan. This study investigated the postoperative outcomes, complications, and associated risk factors of the procedure. METHODS From January 2005 to December 2009, 307 patients with EGC diagnosed before surgery underwent LAPPG. The postoperative outcomes and complications were assessed in this study. Postoperative complications were classified according to the Clavien-Dindo classification of surgical complications, and risk factors related to complications were analyzed. RESULTS The mean operation time for LAPPG was 229.4 ± 47.5 minutes and estimated blood loss was 49.1 ± 62.0 mL. The mean total number of dissected lymph nodes was 31.6 ± 10.4, with nodal involvement observed in 25 patients (8.5%). The preoperative diagnostic accuracy of EGC was 93.2%. Complications developed in 53 patients (17.3%), and major complications, classified as grades greater than Clavien-Dindo classification IIIa, were observed in 4 patients (1.3%). The most frequent complication was gastric stasis, occurring in 19 patients (6.2%). Body mass index (BMI) and surgical experience of LAPPG were identified as significant risk factors of postoperative complications. Body mass index was related to severity of the complications. The patients' serum total protein and albumin did not change significantly after surgery. CONCLUSIONS Laparoscopy-assisted pylorus-preserving gastrectomy is a safe operation with excellent postoperative outcomes in terms of minimized major complications based on the Clavien-Dindo classification in patients with EGC in the middle third of the stomach. To prevent postoperative complications, surgeons need to ensure an extra leaning period for LAPPG, and LAPPG should be performed cautiously in patients with high BMI.
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An JY, Pak KH, Inaba K, Cheong JH, Hyung WJ, Noh SH. Relevance of lymph node metastasis along the superior mesenteric vein in gastric cancer. Br J Surg 2011; 98:667-72. [PMID: 21294111 DOI: 10.1002/bjs.7414] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the prognostic value of lymph node metastasis along the superior mesenteric vein (station 14v) to determine the need for 14v dissection in gastric cancer surgery. METHODS A total of 1104 patients with gastric cancer who underwent gastrectomy including 14v dissection were enrolled. Patients were categorized into two groups: those with and those without 14v lymph node involvement by metastasis. RESULTS Of the total study population, 73 patients (6·6 per cent) had 14v-positive gastric cancer. These patients were more likely to have advanced tumour (T), node (N) and distant metastatic (M) status, and histologically undifferentiated gastric cancers. The 3- and 5-year survival rates of patients with 14v-positive disease were 24 and 9 per cent respectively. Survival in this group was similar to that of patients who had gastric cancer with distant metastasis (M1). Multivariable analysis demonstrated that 14v status was a significant prognostic factor for gastric cancer (hazard ratio 2·13; P < 0·001). After histologically complete (R0) resection, the overall survival of 14v-positive patients with any stage of cancer was significantly worse than that for 14v-negative patients with stage IV cancer (P = 0·006). CONCLUSION 14v status is an independent prognostic factor for gastric cancer, with 14v-positive gastric cancer having a poor prognosis, similar to that of M1 disease. The exclusion of 14v in regional lymph node dissection should be considered.
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Affiliation(s)
- J Y An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Kim HI, Hyung WJ, Lee CR, Lim JS, An JY, Cheong JH, Choi SH, Noh SH. Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy. Surg Endosc 2010; 25:958-63. [PMID: 20725742 DOI: 10.1007/s00464-010-1288-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 07/26/2010] [Indexed: 12/29/2022]
Abstract
BACKGROUND During laparoscopic gastrectomy, it is impossible to identify early gastric cancer (EGC) lesions; therefore, a precise localization technique is required. In this study, we evaluated a novel method of intraoperative portable abdominal radiograph for localization of EGC lesions after preoperative endoscopic clipping. METHODS A retrospective study of 80 patients who had undergone laparoscopic gastrectomies with our intraoperative abdominal radiographic method of tumor localization was performed. During preoperative endoscopy, endoscopic metal clips were applied just proximal to the tumor. A plain abdominal radiograph taken immediately after oral administration of effervescent agents was employed to select candidates for intraoperative localization. Intraoperative vessel clips were laparoscopically applied along the greater and lesser curvatures, and a portable abdominal radiograph was taken to identify the location of endoscopic clips relative to laparoscopic vessel clips. RESULTS In all patients, endoscopic clips were applied proximal to the lesion without complications. Both intraluminally and extraluminally placed clips were successfully detected by intraoperative portable abdominal radiograph in all patients. Mean ± standard deviation (SD) proximal margin length was 34.2 ± 20.2 mm. All patients had tumor-free resection margin. CONCLUSIONS Preoperative endoscopic clipping and intraoperative portable abdominal radiograph is an accurate and simple tumor localization method in laparoscopic gastrectomy.
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Affiliation(s)
- Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul, 120-752, Korea
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Hyung WJ, Kim YS, Lim JS, Kim MJ, Noh SH, Kim KW. Preoperative imaging of sentinel lymph nodes in gastric cancer using CT lymphography. Yonsei Med J 2010; 51:407-13. [PMID: 20376894 PMCID: PMC2852797 DOI: 10.3349/ymj.2010.51.3.407] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Preoperative identification of the sentinel lymph node (SLN) in gastric cancer (GC) patients may have great advantages for the minimally invasive treatment. This study was performed to evaluate the possibility of preoperative SLN detection using CT lymphography. MATERIALS AND METHODS Fourteen patients with early GC were enrolled. CT images were obtained before and at 1, 3, and 5 minutes after endoscopic submucosal peritumoral injection of 2 mL iopamidol. For patients with clearly identified SLNs, to make comparisons with the CT lymphography results, intraoperative SLN detection was performed using subserosally injected Indocyanine green (ICG) lymphography and ex vivo ICG and iopamidol lymphography using mammography was also performed. RESULTS CT lymphography clearly visualized draining lymphatics and SLNs in 4 (28.6%) out of 14 patients. All clearly visualized SLNs (one to three SLNs per patient) under preoperative imaging were detected in the same location by intraoperative ICG lymphography and ex vivo ICG and iopamidol lymphography using mammography. All preoperative SLN detections were observed with the primary tumors in the lower third of the stomach. CONCLUSION Although our study demonstrated a SLN detection rate of less than 30%, CT lymphography with radio-contrast showed potential as a method of preoperative SLN detection for GC.
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Affiliation(s)
- Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Insititute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Soo Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seok Lim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
- Insititute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
- Insititute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Insititute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Whang Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
- Insititute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Noh SH. Conventional Open Surgery in Early Gastric Cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2010; 53:306. [DOI: 10.5124/jkma.2010.53.4.306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
- Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Korea.
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Clinicopathological features associated with lymph node metastasis in early gastric cancer: analysis of a single-institution experience in China. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:353-6. [PMID: 19440566 DOI: 10.1155/2009/462678] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND An accurate assessment of potential lymph node metastasis is an important issue for the appropriate treatment of early gastric cancer. Minimizing the number of invasive procedures used in cancer therapy is critical for improving the patient's quality of life. OBJECTIVE To evaluate the clinicopathological features associated with lymph node metastasis of early gastric cancer in patients from a single institution in China. METHODS A retrospective review of data from 410 patients surgically treated for early gastric cancer at the First Affiliated Hospital (Nanjing, China) between 1998 and 2007, was conducted. The clinicopathological variables associated with lymph node metastasis were evaluated. RESULTS Lymph node metastasis was observed in 12.20% of patients. The macroscopic type, tumour size, location in the stomach, depth of gastric carcinoma infiltration, and presence of vascular or lymphatic invasion showed a positive correlation with the incidence of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion to be significantly and independently related to lymph node metastasis. The depth of gastric carcinoma infiltration was the strongest predictive factor for lymph node metastasis. For intramucosal cancer, tumour size was the unique risk factor for lymph node metastasis. For submucosal cancer, histological classification and tumour size were independent risk factors for lymph node metastasis. CONCLUSIONS Histological classification, macroscopic type, tumour size, depth of gastric carcinoma infiltration, and the presence of vascular or lymphatic invasion are independent risk factors for lymph node metastasis in patients with early gastric cancer in China. Minimal invasive treatment, such as endoscopic mucosal resection, may be possible for highly selected cancers.
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Song KY, Hyung WJ, Kim HH, Han SU, Cho GS, Ryu SW, Lee HJ, Kim MC. Is gastrectomy mandatory for all residual or recurrent gastric cancer following endoscopic resection? A large-scale Korean multi-center study. J Surg Oncol 2008; 98:6-10. [PMID: 18521830 DOI: 10.1002/jso.21074] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To clarify optimal treatment guidelines for residual or local recurrence after endoscopic resection (ER). METHODS Eighty-six patients underwent gastrectomy due to incomplete ER and local recurrence after ER. The pathological findings of ER and gastrectomy specimens were analyzed. RESULTS The cause of gastrectomy was categorized into five groups; submucosal (sm) invasion without margin involvement, positive margin, margin not evaluable, high risk of lymph node metastasis and local recurrence after ER. According to the pathological findings of gastrectomy specimens, remnant cancer and lymph node metastases were found in 56 (65.1%) and in 5 patients (5.8%), respectively. At 10 gastrectomy specimens which were sm invasion without margin involvement, the scattered residual cancer cells were found around the ulcer scar in 2 (20%) patients. In 11 of 44 margin involvement specimens, no residual cancer or lymph node metastasis was found. In patients with local recurrence, mean duration from ER to surgery was 14.8 months, and 19% of patients were found to have sm or deeper depth of invasion. CONCLUSION Gastrectomy with lymph node dissection should be performed in patients with sm invasion with or without margin involvement. However, minimal approach other than gastrectomy could further be applied to selected patients.
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Affiliation(s)
- Kyo Young Song
- Department of Surgery, KangNam St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Hyung WJ, Kim SS, Choi WH, Cheong JH, Choi SH, Kim CB, Noh SH. Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution. Yonsei Med J 2008; 49:409-15. [PMID: 18581590 PMCID: PMC2615336 DOI: 10.3349/ymj.2008.49.3.409] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Although many studies have demonstrated improvements in short-and long-term outcomes of gastric cancer surgery, changes in long-term survival over time are not well-established. This study was conducted to evaluate changes in host, tumor, and treatment factors in patients treated at a single institution over a period of 45-yr. PATIENTS AND METHODS We retrospectively evaluated 9282 patients with gastric cancer from 1955 to 1999, and divided the 45-yr into 4 time frames based on published articles: 1955 to 1962 (n=228), 1963 to 1972 (n=891), 1973 to 1988 (n=2789), and 1989 to 1999 (n=5374). RESULTS Remarkable changes were noted in host, tumor, treatment factors, and prognosis. Among host factors, patients of more advanced age were identified in the 4th period and mean age shifted from 49 to 55 yrs. Among tumor factors, early gastric cancers and upper body tumors increased up to 32% and from 7% to 13%, respectively. An increase in the annual number of patients (from 29 to 649), gastrectomies (from 14 to 600), rate of resection (from 50% to 90%), rate of curative resection (up to 92%), and proportion of total gastrectomy (from 8% to 29%) was noted. Operative mortality was reduced from 6.1% to 0.7%. The overall 5-yr survival rate significantly increased from 22% to 65%. CONCLUSION Treatment results of gastric cancer surgery have improved remarkably over the 45-year period. Increase of early stage gastric cancer with early diagnosis considerably influenced the improved survival of patients with gastric cancer.
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Affiliation(s)
- Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
- Insititute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Hyuk Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Ho Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Choong Bai Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Cancer Metastasis Research Center, Yonsei University College of Medicine, Seoul, Korea
- Insititute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Value of nonvisualized primary lesions of gastric cancer on preoperative MDCT. AJR Am J Roentgenol 2007; 189:W315-9. [PMID: 18029842 DOI: 10.2214/ajr.07.2672] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study was to retrospectively determine the value of nonvisualized primary lesions on preoperative MDCT of patients with gastric cancer. MATERIALS AND METHODS The records of patients who had undergone radical gastrectomy for gastric cancer between August 2004 and August 2006 were retrospectively reviewed. Each patient was given 500-1,000 mL of water to drink, and 16-MDCT for preoperative staging was performed with i.v. contrast agents. Transverse and coronal reconstructed images had been prospectively interpreted as a part of daily practice. TNM stage, gross and histologic types, and location and size of the lesions were retrospectively analyzed for patients with primary lesions not visualized on preoperative MDCT. RESULTS In 44 patients with nonvisualized primary lesions, most (98%) of the lesions were stage pT1 confined to the mucosa (n = 27) or involving the submucosal layer (n = 16). Only one (2%) of the lesions had regional lymph node metastasis (pN1). Most (64%) of the lesions were located in the lower third of the stomach. Forty-one early gastric cancer lesions were flat, depressed, or excavated, and only two were elevated. Depending on the depth of invasion (mucosa or submucosa), there were no statistical differences (p > 0.05) in size, location, and gross or histologic type. CONCLUSION Almost all primary lesions of gastric cancer not visualized on preoperative MDCT with an optimized imaging protocol are early gastric cancer without regional lymph node metastasis. This negative finding may be helpful in planning minimally invasive management of gastric cancer.
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Kim HJ, D'Angelica M, Hiotis SP, Shoup M, Weber SM. Laparoscopic staging for liver, biliary, pancreas, and gastric cancer. Curr Probl Surg 2007; 44:228-69. [PMID: 17467404 DOI: 10.1067/j.cpsurg.2007.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Hong Jin Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, USA
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Shehzad K, Mohiuddin K, Nizami S, Sharma H, Khan IM, Memon B, Memon MA. Current status of minimal access surgery for gastric cancer. Surg Oncol 2007; 16:85-98. [PMID: 17560103 DOI: 10.1016/j.suronc.2007.04.012] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 03/12/2007] [Accepted: 04/17/2007] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim was to conduct a systematic review of the literature on the subject of laparoscopic gastrectomy (LG) and determine the relative merits of laparoscopic (LG) and open gastrectomy (OG) for gastric carcinoma. MATERIAL AND METHODS A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified individual retrospective and prospective series on LG (proximal, distal and total). Furthermore, all clinical trials that compared LG and OG published in the English language between January 1990 and the end of December 2006 were also identified. A large number of outcome variables were analysed for individual series and comparative trials between LG and OG and results discussed and tabulated. RESULTS The majority of the literature is published from Japan showing both oncological adequacy and safety of LG. The majority of early series and comparative studies have utilized laparoscopic resection for early and distal gastric cancer. However, with increasing advanced laparoscopic experience, advancement in digital technology and improvement in instrumentation, more advanced gastric cancers and more extensive procedures such as laparoscopic-assisted total gastrectomy and laparoscopy-assisted D2 dissection are becoming more common. To date lymph node harvesting, resection margins and complication rates seem to be equivalent to open procedures. Furthermore, the earlier fears of port-site metastases have not been borne out. CONCLUSIONS The available data suggests that LG seems to be associated with quicker return of gastrointestinal function, faster ambulation, earlier discharge from hospital, and comparable complications and recurrence rate to OG. However, the operating time for LG remains significantly longer compared to its open counterpart, although with experience it is achieving parity with OG. However, the majority of the comparative trials (if not all) probably do not have the power to detect differences in the outcome. As far as the RCT's (LG vs. OG) are concerned, the numbers of patients in such trials are small and the majority of patients were operated upon for early distal gastric cancer and, therefore, any meaningful conclusions regarding the advantages or disadvantages of LG for both the ECGs and extensive and advanced gastric tumours are difficult to justify.
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Affiliation(s)
- Khalid Shehzad
- Department of Surgery, Whiston Hospital, Warrington Road, Prescot, Merseyside, UK
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Hyung WJ, Song C, Cheong JH, Choi SH, Noh SH. Factors influencing operation time of laparoscopy-assisted distal subtotal gastrectomy: Analysis of consecutive 100 initial cases. Eur J Surg Oncol 2007; 33:314-9. [PMID: 17174511 DOI: 10.1016/j.ejso.2006.11.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2006] [Accepted: 11/09/2006] [Indexed: 01/20/2023] Open
Abstract
AIMS There is little information on patient selection criteria for laparoscopy-assisted distal gastrectomy (LADG) that would facilitate a successful initial experience for a surgeon new to the procedure. This study aimed to establish patient selection criteria that will allow increased proficiency and shorter operation times for the LADG procedure. METHOD One hundred LADG with lymphadenectomy and no other combined procedures were consecutively performed by one surgeon. These 100 consecutive LADG procedures were analyzed retrospectively from a prospectively designed computer database. Uni- and multivariate analyses were performed to identify factors influencing operation time. RESULTS According to univariate analysis, operation time was influenced by sex, BMI, surgical experience, and tumor location, whereas multivariate analysis indicated that operation time was significantly influenced only by BMI and surgical experience. The same analyses of only the first 50 cases showed that sex, BMI, surgical experience, and tumor location were independently associated with operation time. As BMI increased, so did operation time, whereas operation time decreased with increasing surgical experience. CONCLUSION This study suggests that surgeons who have limited experience with this advanced procedure may shorten operation time by considering patient and tumor characteristics in their early attempts at LADG. With a shortened operation time, surgeon with limited experience may become proficient to LADG rapidly.
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Affiliation(s)
- W J Hyung
- Department of Surgery, Yonsei University College of Medicine, 134 Shinchon-dong Seodaemun-ku, Seoul 120-752, Republic of Korea.
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