• NSCLC
• opioid
• outcome
• perioperative factor
• the elderly

• is no funding to report

• haemorrhage
• immunosuppression
• surgical trauma
• tumour growth
• tumour recurrence

• biomedical engineering
• medical imaging
• gastrointestinal bleeding
• gastric cancer

• Humans
• Animals
• Swine
• Blood Loss, Surgical
• Deep Learning
• Neural Networks, Computer
• Algorithms
• Bandages

• 1711179421 Korea Medical Device Development Fund
• 1920230020 Seoul National University Hospital

• D2-lymphadenectomy
• Gastric cancer
• Open gastrectomy
• Robotic gastrectomy

• Humans
• Robotic Surgical Procedures
• Propensity Score
• Laparoscopy
• Gastrectomy
• Lymph Node Excision
• Stomach Neoplasms/surgery
• Treatment Outcome
• Retrospective Studies
• Postoperative Complications/epidemiology
• Postoperative Complications/surgery

• blood transfusion
• hepatocellular carcinoma
• intraoperative blood loss
• surgical resection
• tumor recurrence

• gastrectomy
• gastric cancer
• laparoscopic
• robotic
• short-term

• disease-free survival
• disease-special survival
• gastric cancer
• overall survival
• perioperative blood transfusions
• postoperative complications

• gastrectomy
• gastric cancer
• infectious complications
• inflammatory markers
• patient blood management
• perioperative transfusion

• Chemotherapy compliance
• Gastric cancer
• Prognosis
• Textbook outcome

• Humans
• Aged
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/surgery
• Stomach Neoplasms/pathology
• Retrospective Studies
• Treatment Outcome
• Gastrectomy/adverse effects
• Prognosis

• gastrectomy
• gastric cancer
• postoperative events
• recurrence
• surgical stress response

• 202012 Wellcome Trust

The purpose of the current meta-analysis was to analyze whether intraoperative blood loss (IBL) influenced the complications and prognosis of gastric cancer patients after gastrectomy.

We systematically searched the PubMed, Embase and Cochrane library databases on November 29, 2021. The Newcastle-Ottawa scale was used to evaluate the quality of included studies. This meta-analysis uses RevMan 5.3 for data analysis.

A total of nine retrospective studies were included in this meta-analysis, involving 4653 patients. In terms of short-term outcomes, the Larger IBL group has a higher complication rate (OR = 1.94, 95% CI, 1.44 to 2.61, P < 0.0001) and a longer operation time (OR = 77.60, 95% CI, 41.95 to 113.25, P < 0.0001) compared with the smaller IBL group, but the Larger IBL group had higher total retrieved lymph nodes (OR = 3.68, 95% CI, 1.13 to 6.24, P = 0.005). After pooling up all the HRs, the Larger IBL group has worse overall survival (OS) (HR = 1.80, 95% CI, 1.27 to 2.56, P = 0.001) and disease-free survival (DFS) (HR = 1.48, 95% CI, 1.28 to 1.72, P < 0.00001).

Larger IBL increased operation time and postoperative complications, and decreased OS and DFS of gastric cancer patients. Therefore, surgeons should be cautious about IBL during operation.

• cancer recurrence
• epidural analgesia
• gastric cancer
• inverse probability of treatment weighting
• overall survival

• Analgesia, Epidural
• Cohort Studies
• Humans
• Neoplasm Recurrence, Local/epidemiology
• Prospective Studies
• Retrospective Studies
• Stomach Neoplasms/surgery
• Taiwan/epidemiology

• Blood loss
• Gastrectomy
• Gastric cancer
• Prognosis
• Surgical

• non-intensive care unit patients with type-2 diabetes mellitus
• perioperative blood glucose management
• postoperative complications

This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients.

EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS.

In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m². Multivariate analysis indicated that a BMI ≤ 20.6 kg/m² (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS.

Low BMI (≤ 20.6 kg/m²), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

• Gastrectomy
• Gastric cancer
• Laparoscopy
• Postoperative complications
• Risk factors

• early postoperative complications
• gastric cancer
• nomogram
• prediction model
• total gastrectomy

• Blood loss
• lung cancer
• postoperative complications
• video-assisted thoracic surgery

The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study was to investigate the effect of antithrombotic drugs on intraoperative blood loss in patients with generalized peritonitis using a nationwide surgical registry in Japan.

This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss, ratio of intraoperative blood loss after adjusted for confounding factors, and variable importance of all covariates.

A total of 70,105 of the eligible 75,666 patients were included in this study, and 2947 patients were taking antithrombotic drugs. Propensity score matching yielded 2864 well-balanced pairs. The blood loss volume was slightly higher in the antithrombotic drug group (100 [10–349] vs 70 [10–299] ml). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16–1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery.

This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in patients undergoing emergency surgery for generalized peritonitis, the effect is likely of minimal clinical significance.

The online version contains supplementary material available at 10.1186/s13017-021-00374-z.

• Antithrombotic drug
• Emergency gastrointestinal surgery
• Generalized peritonitis
• Intraoperative blood loss

• Gastric cancer
• Laparoscopy
• Prospective multicenter feasibility study
• Spleen-preserving total gastrectomy

• Adult
• Aged
• Conversion to Open Surgery
• Feasibility Studies
• Female
• Gastrectomy/methods
• Humans
• Laparoscopy/methods
• Lymph Node Excision/methods
• Lymph Nodes/pathology
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Staging
• Prospective Studies
• Risk Factors
• Single-Blind Method
• Spleen/surgery
• Stomach Neoplasms/diagnosis
• Stomach Neoplasms/secondary
• Stomach Neoplasms/surgery

• Blood loss
• Gastric cancer
• Neoadjuvant chemotherapy

• Antithrombotic agents
• Paradoxical embolism
• Patent foramen ovale
• Stroke
• Surgery

Elderly patients with gastric cancer (GC) are at increased risk of infectious complications following gastrectomy. A limited set of risk factors has been identified to predict complications in these patients. To improve the safety of gastrectomy in this population, we investigated the incidence of infectious complications and associated clinicopathologic, nutritional and surgical risk factors in a cohort of elderly patients with GC.

Elderly GC patients (≥70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included in the study. Clinicopathologic data were collected retrospectively. Severity of complications was classified using the Clavien–Dindo system. Infectious complications were assessed based on clinical diagnosis of health care-associated infection as defined by the US Centers for Disease Control and Prevention. Multivariate logistic regression analyses were performed to determine the risk factors for infectious complications.

Three hundred thirty-one consecutive patients were included, with a median age of 74 years (range 70–88). The rate of surgical morbidity was 37.5% and the mortality rate was 1.2%. The incidence of infectious complications was 19.6%, with the most common infectious complication being pulmonary infection (11.5%). Preoperative weight loss ≥5% (odds ratio [OR] = 2.21; 95% CI, 1.15–4.28; p = 0.018), Charlson comorbidity index score ≥3 (OR = 2.83; 95% CI, 1.30–6.16; p = 0.009) and preoperative hsCRP level ≥10 mg/L (OR = 2.48; 95% CI, 1.14–5.38; p = 0.022) were independently associated with infectious complications.

Preoperative weight loss, elevated hsCRP level and comorbidity burden can be used to predict postoperative infectious complications in elderly GC patients. It is recommended to pay more attention to the treatment of elderly GC patients with these risk factors.

• complications
• elderly
• gastric cancer
• risk factors
• weight loss

The use of antithrombotic drugs is increasing with the aging population. Prior to elective procedures, antithrombotic drugs are often discontinued. For emergency procedures in patients taking antithrombotic drugs, their effect cannot be attenuated which may lead to an increased risk of hemorrhagic events. However, there are few studies showing increased intraoperative blood loss in patients taking antithrombotic drugs who undergo emergency gastrointestinal surgery. The aim of this study is to determine whether the use of antithrombotic agents increases intraoperative blood loss in emergency gastrointestinal surgery.

A retrospective review of patients who underwent emergency abdominal surgery between January 2013 and December 2017 was conducted. The primary outcome measure was intraoperative blood loss. Patients were divided into the antithrombotic drug group and a control group, and a propensity score was developed using multivariate logistic regression. We use 1:1 propensity score matching analysis to compare outcomes between the two groups.

Of 1555 patients included in this study, 1184 patients, including 170 patients taking antithrombotic drugs, were eligible for propensity score matching analysis. A 1:1 matching yielded 117 well-balanced pairs. There was no statistically significant difference in intraoperative blood loss (antithrombotic drug group vs control group, median (interquartile): 60 (225–10) vs 100 (243–10) ml, p = 0.43).

This study suggests that antithrombotic drugs do not increase intraoperative blood loss in patients undergoing emergency gastrointestinal surgery. Emergency gastrointestinal surgery for patients currently taking antithrombotic drugs can be performed safely, and the use of antithrombotic drugs is not a reason to delay surgical intervention.

• Antithrombotic drug
• Emergency gastrointestinal surgery
• Intraoperative blood loss

Gastric cancer (GC) is the third-leading cause of cancer-related deaths. Several pivotal clinical trials of adjuvant treatments were performed during the previous decade; however, the optimal regimen for adjuvant treatment of GC remains controversial.

We developed a novel deep learning–based survival model (survival recurrent network [SRN]) in patients with GC by including all available clinical and pathologic data and treatment regimens. This model uses time-sequential data only in the training step, and upon being trained, it receives the initial data from the first visit and then sequentially predicts the outcome at each time point until it reaches 5 years. In total, 1,190 patients from three cohorts (the Asian Cancer Research Group cohort, n = 300; the fluorouracil, leucovorin, and radiotherapy cohort, n = 432; and the Adjuvant Chemoradiation Therapy in Stomach Cancer cohort, n = 458) were included in the analysis. In addition, we added Asian Cancer Research Group molecular classifications into the prediction model. SRN simulated the sequential learning process of clinicians in the outpatient clinic using a recurrent neural network and time-sequential outcome data.

The mean area under the receiver operating characteristics curve was 0.92 ± 0.049 at the fifth year. The SRN demonstrated that GC with a mesenchymal subtype should elicit a more risk-adapted postoperative treatment strategy as a result of its high recurrence rate. In addition, the SRN found that GCs with microsatellite instability and GCs of the papillary type exhibited significantly more favorable survival outcomes after capecitabine plus cisplatin chemotherapy alone.

Our SRN predicted survival at a high rate, reaching 92% at postoperative year 5. Our findings suggest that SRN-based clinical trials or risk-adapted adjuvant trials could be considered for patients with GC to investigate more individualized adjuvant treatments after curative gastrectomy.

Gastrectomy with radical lymph node dissection is the most promising treatment avenue for patients with gastric cancer. However, this procedure sometimes induces excessive intraoperative blood loss and requires perioperative allogeneic blood transfusion. There are lasting discussions and controversies about whether intraoperative blood loss or perioperative blood transfusion has adverse effects on the prognosis in patients with gastric cancer. We reviewed laboratory and clinical evidence of these associations in patients with gastric cancer. A large amount of clinical evidence supports the correlation between excessive intraoperative blood loss and adverse effects on the prognosis. The laboratory evidence revealed three possible causes of such adverse effects: anti-tumor immunosuppression, unfavorable postoperative conditions, and peritoneal recurrence by spillage of cancer cells into the pelvis. Several systematic reviews and meta-analyses have suggested the adverse effects of perioperative blood transfusions on prognostic parameters such as all-cause mortality, recurrence, and postoperative complications. There are two possible causes of adverse effects of blood transfusions on the prognosis: Anti-tumor immunosuppression and patient-related confounding factors (e.g., preoperative anemia). These factors are associated with a worse prognosis and higher requirement for perioperative blood transfusions. Surgeons should make efforts to minimize intraoperative blood loss and transfusions during gastric cancer surgery to improve patients’ prognosis.

• Gastric cancer
• Blood loss
• Prognosis
• Transfusion
• Adverse effect
• Immunosuppression
• Mortality
• Recurrence
• Complication

• Blood Loss, Surgical
• Blood Transfusion/statistics & numerical data
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Lymph Node Excision/adverse effects
• Lymph Node Excision/methods
• Neoplasm Recurrence, Local/diagnosis
• Neoplasm Recurrence, Local/immunology
• Perioperative Care/statistics & numerical data
• Prognosis
• Stomach Neoplasms/immunology
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery
• Transfusion Reaction/immunology
• Transplantation, Homologous/adverse effects
• Tumor Escape/immunology
• Tumor Microenvironment/immunology

Background: To investigate prognostic factors and recurrence patterns in T4 gastric cancer (GC) patients after curative resection.

Methods: Between January 2004 and December 2014, 249 patients with T4 gastric cancer undergoing curative resection were recruited. Patient characteristics, survival, prognostic factors and recurrence patterns were analyzed.

Results: Our results showed that the median survival time (MST) for T4 gastric cancer after curative resection was 55.47 months, with 59.47 months for T4a (tumor perforating serosa) and 25.90 months for T4b (tumor invasion of the adjacent structure). Multivariate analysis indicated that age (hazard ratio [HR], 1.86; P = 0.006), location of tumor (HR, 1.25, 0.90 - 5.64; P < 0.001) and intraoperative blood loss (HR, 1.85; P = 0.010) were independent prognostic factors for overall survival (OS). After a median follow-up of 25.87 months, a total of 109 (43.8%) patients suffered from recurrence, and 90 patients had been observed specific recurrence sites, among which peritoneal metastasis was the most common recurrence pattern, 59.0% for T4a and 88.3% for T4b, respectively.

Conclusions: For T4 gastric cancer patients after curative resection, older age, gastric cancer of the entire stomach and more intraoperative blood loss were associated with poor OS. The recurrence rate after curative resection for T4 was high, and the most common recurrence pattern was peritoneal metastasis.

• T4 gastric cancer
• curative resection
• prognosis
• recurrence
• survival

• Gastrectomy
• Gastric cancer
• Laparoscopy
• Long term
• Oncologic outcome

• Adult
• Aged
• Blood Loss, Surgical/statistics & numerical data
• Blood Transfusion/statistics & numerical data
• Female
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Kaplan-Meier Estimate
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Male
• Middle Aged
• Operative Time
• Postoperative Complications/etiology
• Retrospective Studies
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery

The purpose of our study was to estimate the influence of estimated intraoperative blood loss (EIBL) on postoperative cardiopulmonary complications (PCCs) in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC).

We conducted a single-center retrospective analysis on the clinical data of consecutive patients in our institution between April 2015 and February 2016. Demographic differences between PCC group and non-PCC group were initially assessed. Receiver operating characteristic (ROC) analysis was performed to determine the threshold value of EIBL for the prediction of PCCs. Demographic differences in the PCC rates and length of stay between two groups of patients divided by this cutoff were further evaluated. A multivariable logistic-regression model involving the clinicopathological parameters with P-value< 0.05 was finally established to identify independent risk factors for PCCs.

A total of 429 patients with operable NSCLC were included and 80 of them developed PCCs (rate = 18.6%). The mean EIBL in PCC group was significantly higher than that in non-PCC group (133.3 ± 191.3 vs. 79.1 ± 107.1 mL; P < 0.001). The ROC analysis showed an EIBL of 100 mL as the threshold value at which the joint sensitivity (50.0%) and specificity (73.4%) was maximal. The PCC rate in patients with EIBL≥100 mL was significantly higher than that in patients with EIBL< 100 mL (30.1 vs. 13.5%; P < 0.001). Both the length of stay and chest tube duration were significantly prolonged in the patients with EIBL≥100 mL. Finally, EIBL≥100 mL was identified to be predictive of PCCs by multivariable logistic-regression analysis (odds ratio = 3.01; 95% confidence interval = 1.47–6.16; P = 0.003).

EIBL serves as a significant categorical predictor for cardiopulmonary complications following VATS lobectomy for NSCLC. Thoracic surgeons should minimize the EIBL and strive for the ‘bloodless’ goal to optimize surgical outcomes.

The online version of this article (10.1186/s12893-018-0360-0) contains supplementary material, which is available to authorized users.

• Blood loss
• Cardiopulmonary complications
• Non-small-cell lung cancer
• Prediction
• Video-assisted thoracoscopic surgery

• advanced gastric cancer
• laparoscopic gastrectomy
• robotic gastrectomy

• Adenocarcinoma/surgery
• Aged
• Blood Loss, Surgical/statistics & numerical data
• China/epidemiology
• Female
• Gastrectomy/methods
• Gastrectomy/statistics & numerical data
• Humans
• Imaging, Three-Dimensional
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Male
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Prospective Studies
• Stomach Neoplasms/surgery

• Blood transfusions
• Confounding
• Gastrectomy
• Gastric cancer
• Meta-analysis
• Surgery

• Aged
• Blood Loss, Surgical
• Female
• Gastrectomy/adverse effects
• Humans
• Laparoscopy/adverse effects
• Length of Stay
• Male
• Malnutrition/complications
• Middle Aged
• Operative Time
• Postoperative Complications
• Retrospective Studies
• Stomach Neoplasms/complications
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate
• Treatment Outcome

• 3D Laparoscopic gastrectomy
• Gastric cancer
• Randomized, controlled trial

• Adenocarcinoma/diagnostic imaging
• Adenocarcinoma/mortality
• Adenocarcinoma/surgery
• Adult
• Aged
• Blood Loss, Surgical/statistics & numerical data
• Female
• Gastrectomy/methods
• Humans
• Imaging, Three-Dimensional
• Laparoscopy/methods
• Length of Stay/statistics & numerical data
• Lymph Node Excision
• Male
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Postoperative Period
• Prospective Studies
• Stomach Neoplasms/diagnostic imaging
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery
• Treatment Outcome