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Coffman TJ. Gastric cancer: Nursing care and impact. Nursing 2025; 55:16-22. [PMID: 39702911 DOI: 10.1097/nsg.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
ABSTRACT Patients with gastric cancer experience symptoms that impact adequate nutritional intake. Delayed diagnosis may result in advanced disease. Surgery, chemotherapy, biologic therapy, and radiotherapy comprise interventions. This article discusses gastric cancer incidence and risks, treatment approaches, and nursing management of patients with gastric cancer, including advanced care planning for patients with terminal diagnoses.
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Affiliation(s)
- Tammie J Coffman
- Tammie Coffman is an assistant professor at Texas Tech University School of Nursing
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Kim HH. KLASS (Korean Laparoendoscopic Gastrointestinal Surgery Study Group) trials: a 20-year great journey in advancing surgical clinical research for gastric cancer. Ann Surg Treat Res 2025; 108:1-11. [PMID: 39823037 PMCID: PMC11735165 DOI: 10.4174/astr.2025.108.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 12/23/2024] [Accepted: 12/23/2024] [Indexed: 01/19/2025] Open
Abstract
The Korean Laparoendoscopic Gastrointestinal Surgery Study Group (KLASS) trial series represents a comprehensive body of surgical clinical trials and studies focused on laparoscopic techniques in the treatment of gastric cancer. These trials, conducted and overseen by the KLASS, began with KLASS 01 in 2006 and have progressed to their 14th series as of December 2024. To date, approximately 36 papers, including pivotal publications, have been featured in high-impact journals, significantly advancing the field of gastric cancer treatment. Their findings have been incorporated into gastric cancer treatment guidelines in Korea, Japan, and China, underscoring their influence and clinical relevance. I take immense pride in being part of this remarkable journey, alongside esteemed seniors, colleagues, and numerous clinical researchers who initiated KLASS in 2004. This paper aims to review the studies conducted within the KLASS series to date and provide insights insight into the ongoing the ongoing research initiatives being developed by this esteemed group on their behalf.
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Affiliation(s)
- Hyung-Ho Kim
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
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Strong JS, Furube T, Takeuchi M, Kawakubo H, Maeda Y, Matsuda S, Fukuda K, Nakamura R, Kitagawa Y. Evaluating surgical expertise with AI-based automated instrument recognition for robotic distal gastrectomy. Ann Gastroenterol Surg 2024; 8:611-619. [PMID: 38957567 PMCID: PMC11216797 DOI: 10.1002/ags3.12784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/11/2023] [Accepted: 02/09/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Complexities of robotic distal gastrectomy (RDG) give reason to assess physician's surgical skill. Varying levels in surgical skill affect patient outcomes. We aim to investigate how a novel artificial intelligence (AI) model can be used to evaluate surgical skill in RDG by recognizing surgical instruments. Methods Fifty-five consecutive robotic surgical videos of RDG for gastric cancer were analyzed. We used Deeplab, a multi-stage temporal convolutional network, and it trained on 1234 manually annotated images. The model was then tested on 149 annotated images for accuracy. Deep learning metrics such as Intersection over Union (IoU) and accuracy were assessed, and the comparison between experienced and non-experienced surgeons based on usage of instruments during infrapyloric lymph node dissection was performed. Results We annotated 540 Cadiere forceps, 898 Fenestrated bipolars, 359 Suction tubes, 307 Maryland bipolars, 688 Harmonic scalpels, 400 Staplers, and 59 Large clips. The average IoU and accuracy were 0.82 ± 0.12 and 87.2 ± 11.9% respectively. Moreover, the percentage of each instrument's usage to overall infrapyloric lymphadenectomy duration predicted by AI were compared. The use of Stapler and Large clip were significantly shorter in the experienced group compared to the non-experienced group. Conclusions This study is the first to report that surgical skill can be successfully and accurately determined by an AI model for RDG. Our AI gives us a way to recognize and automatically generate instance segmentation of the surgical instruments present in this procedure. Use of this technology allows unbiased, more accessible RDG surgical skill.
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Affiliation(s)
- James S. Strong
- Department of SurgeryKeio University School of MedicineTokyoJapan
- Harvard CollegeHarvard UniversityCambridgeMassachusettsUSA
| | - Tasuku Furube
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Masashi Takeuchi
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | | | - Yusuke Maeda
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Satoru Matsuda
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Kazumasa Fukuda
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Rieko Nakamura
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Yuko Kitagawa
- Department of SurgeryKeio University School of MedicineTokyoJapan
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Park SH, Han M, Yoon HM, Ryu KW, Kim YW, Eom BW. Real-world Nationwide Outcomes of Minimally Invasive Surgery for Advanced Gastric Cancer Based on Korean Gastric Cancer Association-Led Survey. J Gastric Cancer 2024; 24:210-219. [PMID: 38575513 PMCID: PMC10995831 DOI: 10.5230/jgc.2024.24.e16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/04/2024] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE The study aimed to investigate real-world surgical outcomes of minimally invasive surgery (MIS) for advanced gastric cancer using Korean Gastric Cancer Association (KGCA)-led nationwide data. MATERIALS AND METHODS A nationwide survey of patients who underwent surgical treatment for gastric cancer in 2019 was conducted by the KGCA. A total of 14,076 patients from 68 institutions underwent surgery, and 4,953 patients diagnosed with pathological stages IB-III gastric cancer were included. Among them, 1,689 patients who underwent MIS (MIS group) and 1,689 who underwent the open approach (open group) were matched using propensity score in a 1:1 ratio. Surgical outcomes were compared, and multivariate analysis was performed to identify the independent factors for overall morbidity. RESULTS The MIS group had a lower proportion of D2 lymphadenectomy, total omentectomy, and combined resection. However, the number of harvested lymph nodes was higher in the MIS group. Better surgical outcomes, including less blood loss and shorter hospital stay, were observed in the MIS group, and the overall morbidity rate was significantly lower in the MIS group (17.5% vs. 21.9%, P=0.001). The mortality rates did not differ significantly between the 2 groups. In the multivariate analysis, the minimally invasive approach was a significant protective factor against overall morbidity (odds ratio, 0.799; P=0.006). CONCLUSIONS Based on the Korean nationwide data, MIS for stage IB-III gastric cancer had better short-term outcomes than the open approach, including lower rates of wound complications, intra-abdominal abscesses, and cardiac problems.
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Affiliation(s)
- Sin Hye Park
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Mira Han
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
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Gu H, Li W, Zhou L. Application of hand-sewn esophagojejunostomy in laparoscopic total gastrectomy. World J Surg Oncol 2024; 22:73. [PMID: 38439060 PMCID: PMC10910664 DOI: 10.1186/s12957-024-03350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/24/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To investigate the clinical efficacy and prognostic implication of hand-sewn anastomosis in laparoscopic total gastrectomy (LTG). METHODS Retrospective analysis is adopted to the clinicopathologic data of 112 patients with gastric cancer (GC) who went through LTG in the Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University between October 2020 and October 2022. Among them, 60 individuals receiving medical care were split into the hand-sewn anastomosis group (Group H, N = 60); while, 52 individuals were split into the circular stapler anastomosis group (Group C, N = 52) The clinical efficacy and prognostic conditions of hand-sewn anastomosis are compared with those of circular stapler anastomosis in the application of LTG. RESULTS The analysis results indicated that no notable difference was observed in intraoperative bleeding volume, time to first flatus (TFF), postoperative hospitalization duration and postoperative complications among the two groups (P > 0.05). Group H had shorter esophagojejunal anastomosis duration (20.0 min vs. 35.0 min) and surgery duration (252.6 ± 19.4 min vs. 265.9 ± 19.8 min), smaller incisions (5.0 cm vs. 10.5 cm), and lower hospitalization costs (58415.0 CNY vs. 63382.5 CNY) compared to Group C (P < 0.05). CONCLUSION The clinical efficacy and the postoperative complications of hand-sewn esophagojejunostomy are basically equivalent in comparison to the circular stapler anastomosis in the application of LTG. Its advantage lies in shorter esophagojejunal anastomosis duration, shorter surgery duration, smaller incisions, lower hospitalization costs and wider adaptability of the location of the tumor.
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Affiliation(s)
- Hao Gu
- Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Weixiang Li
- Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lianbang Zhou
- Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Son SY, Hur H, Hyung WJ, Park YK, Lee HJ, An JY, Kim W, Kim HI, Kim HH, Ryu SW, Kim MC, Kong SH, Cho GS, Kim JJ, Park DJ, Ryu KW, Kim YW, Kim JW, Lee JH, Yang HK, Han SU. Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer: 5-Year Outcomes of the KLASS-02 Randomized Clinical Trial. JAMA Surg 2022; 157:879-886. [PMID: 35857305 PMCID: PMC9301593 DOI: 10.1001/jamasurg.2022.2749] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022]
Abstract
IMPORTANCE The long-term safety of laparoscopic distal gastrectomy for locally advanced gastric cancer (AGC) remains uncertain given the lack of 5-year follow-up results. OBJECTIVE To compare the 5-year follow-up results in patients with clinically AGC enrolled in the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-02 randomized clinical trial who underwent laparoscopic or open distal gastrectomy. DESIGN, SETTING, AND PARTICIPANTS The KLASS-02, a multicenter randomized clinical trial, showed that laparoscopic surgery was noninferior to open surgery for patients with locally AGC. The present study assessed the 5-year follow-up results, including 5-year overall survival (OS) and relapse-free survival (RFS) rates and long-term complications, in patients enrolled in KLASS-02. From November 21, 2011, to April 29, 2015, patients aged 20 to 80 years diagnosed preoperatively with locally AGC were enrolled. Final follow-up was on June 15, 2021. Data were analyzed June 24 to September 9, 2021. INTERVENTIONS Patients were treated with R0 resection either by laparoscopic gastrectomy or open gastrectomy as the full analysis set of the KLASS-02 trial. MAIN OUTCOMES AND MEASURES Five-year OS and RFS rates, recurrence patterns, and long-term surgical complications were evaluated. RESULTS This study enrolled a total of 1050 patients. A total of 974 patients were treated with R0 resection; 492 (50.5%) in the laparoscopic gastrectomy group (mean [SD] age, 59.8 [11.0] years; 351 men [71.3%]) and 482 (49.5%) in the open gastrectomy group (mean [SD] age, 59.4 [11.5] years; 335 men [69.5%]). In patients who underwent laparoscopic and open distal gastrectomy, the 5-year OS (88.9% vs 88.7%) and RFS (79.5% vs 81.1%) rates did not differ significantly. The most common types of recurrence were peritoneal carcinomatosis (73 of 173 [42.1%]), hematogenous metastases (36 of 173 [20.8%]), and locoregional recurrence (23 of 173 [13.2%]), with no between-group differences in types of recurrence at each cancer stage. The correlation between 3-year RFS and 5-year OS at the individual level was highest in patients with stage III gastric cancer (ρ = 0.720). The late complication rate was significantly lower in the laparoscopic than in the open surgery group (32 of 492 [6.5%] vs 53 of 482 [11.0%]). The most common type of complication in both groups was intestinal obstruction (13 of 492 [2.6%] vs 24 of 482 [5.0%]). CONCLUSIONS AND RELEVANCE The 5-year outcomes of the KLASS-02 trial support the 3-year results, which is the noninferiority of laparoscopic surgery compared with open gastrectomy for locally AGC. The laparoscopic approach can be recommended in patients with locally AGC to achieve the benefit of low incidence of late complications. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01456598.
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Affiliation(s)
- Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Gwangju, South Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Wan Ryu
- Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University Hospital, Korea, Busan, South Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Jin-Jo Kim
- Department of Surgery, Incheon St Mary’s Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Young Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Jong Won Kim
- Department of Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Joo-Ho Lee
- Department of Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
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Wang L, Deng Y, Yan S, Ma X, Wang C, Miao W, Chen X. Comparison of clinical safety and feasibility between reduced-port laparoscopic radical gastrectomy and conventional laparoscopic radical gastrectomy: A retrospective study. Front Surg 2022; 9:995194. [PMID: 36248360 PMCID: PMC9554253 DOI: 10.3389/fsurg.2022.995194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Traditional open gastric cancer surgery has evolved from porous to reduced-hole, single-hole, or even natural cavity surgery to laparoscopic surgery, due to the continuous development of minimally invasive concepts and medical technologies, as well as awareness for the concept of rapid recovery. Conventional laparoscopic radical gastrectomy is quite mature in age at the moment, but how to progress to minimally invasive surgery without increasing the difficulty of surgery while ensuring clinical safety and feasibility is worth further investigation. Therefore, the clinical safety and feasibility of reduced port laparoscopic radical gastrectomy were assessed in this study. METHODS Information on the clinical data of patients undergoing laparoscopic radical gastric cancer surgery in a single centre between May 2020 and May 2022 was collected, and a total of 232 patients were included in this study according to the study protocol design. The clinical data of 232 patients with gastric cancer treated by two different surgical methods, namely, reduced port laparoscopic surgery (RPLS) or conventional laparoscopic surgery (CLS), were retrospectively analysed. The intraoperative indices, postoperative pathological indices, and short-term postoperative complications (within 30 days) of the two different surgical methods were evaluated, as well as the surgical methods' feasibility and short-term postoperative recovery effect. RESULTS There was no significant difference between the general data of patients with RPLS and CLS (P > 0.05). Compared with CLSG, the operation time, digestive tract reconstruction time and lymph node dissection time of RPLSG are shorter. The intraoperative blood loss was less, and the incision was minimally invasive (P < 0.05). In the short-term postoperative effect, the level of white blood cell count on the first day, the time of getting out of bed, the time of removing drainage tube, the time of hospitalization and the VAS of pain on the first, third and fifth days after operation, RPLSG was obviously superior to CLSG (P < 0.05). There was no significant difference between RPLSG and CLSG in terms of pathological indices (P > 0.05). CONCLUSIONS The treatment of gastric cancer with RPLS has good safety, feasibility and short-term postoperative effects, which is in line with the implementation of the modern concept of rapid rehabilitation surgery.
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Affiliation(s)
- Liang Wang
- Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Yingfang Deng
- Medical-Oncology, Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Su Yan
- Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Xinfu Ma
- Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Cheng Wang
- Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Wei Miao
- Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
| | - Xiaoqian Chen
- Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University & Affiliated Cancer Hospital of Qinghai University, Xining, China
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Kim DJ, Hyung WJ, Park YK, Lee HJ, An JY, Kim HI, Kim HH, Ryu SW, Hur H, Kim MC, Kong SH, Kim JJ, Park DJ, Ryu KW, Kim YW, Kim JW, Lee JH, Yang HK, Han SU, Kim W. Accuracy of preoperative clinical staging for locally advanced gastric cancer in KLASS-02 randomized clinical trial. Front Surg 2022; 9:1001245. [PMID: 36211302 PMCID: PMC9537949 DOI: 10.3389/fsurg.2022.1001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/08/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE The discrepancy between preoperative and final pathological staging has been a long-standing challenge for the application of clinical trials or appropriate treatment options. This study aimed to demonstrate the accuracy of preoperative staging of locally advanced gastric cancer using data from a large-scale randomized clinical trial. MATERIALS AND METHODS Of the 1050 patients enrolled in the clinical trial, 26 were excluded due to withdrawal of consent (n = 20) or non-surgery (n = 6). The clinical and pathological staging was compared. Risk factor analysis for underestimation was performed using univariate and multivariate analyses. RESULTS Regarding T staging by computed tomography, accuracy rates were 74.48, 61.62, 58.56, and 85.16% for T1, T2, T3 and T4a, respectively. Multivariate analysis for underestimation of T staging revealed that younger age, ulcerative gross type, circular location, larger tumor size, and undifferentiated histology were independent risk factors. Regarding nodal status estimation, 54.9% of patients with clinical N0 disease were pathologic N0, and 36.4% of patients were revealed to have pathologic N0 among clinical node-positive patients. The percentage of metastasis involvement at the D1, D1+, and D2 lymph node stations significantly increased with the advanced clinical N stage. Among all patients, 29 (2.8%), including 26 with peritoneal seeding, exhibited distant metastases. CONCLUSIONS Estimating the exact pathologic staging remains challenging. A thorough evaluation is mandatory before treatment selection or trial enrollment. Moreover, we need to set a sufficient case number when we design the clinical trial considering the stage migration.
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Affiliation(s)
- Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University Hospital, Busan, South Korea
| | - Seong-Ho Kong
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Jo Kim
- Department of Surgery, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, South Korea
| | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Young Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, South Korea
| | - Jong Won Kim
- Department of Surgery, Chung-Ang University Hospital, Seoul, South Korea
| | - Joo-Ho Lee
- Department of Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Han-Kwang Yang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, South Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Kim JW, Park JM, Chi KC. Convenience of Adding a Needle Grasper in Single-Incision Laparoscopic Distal Gastrectomy With Billroth I Anastomosis for Clinical Early Gastric Cancer. J Gastric Cancer 2022; 22:248-259. [PMID: 35938370 PMCID: PMC9359886 DOI: 10.5230/jgc.2022.22.e24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To overcome the technical difficulties of single-incision laparoscopic distal gastrectomy (SILDG), needle grasper (Endo ReliefTM)-assisted SILDG (NASILDG) was developed. Here, we compared the operative convenience and postoperative outcomes between SILDG and NASILDG. MATERIALS AND METHODS A needle grasper was inserted into the right upper abdomen and used in the NASILDG. We retrospectively reviewed patients who underwent D1 + dissection and delta-shaped Billroth I anastomosis with SILDG or NASILDG performed by a single surgeon between September 2015 and August 2018. RESULTS The SILDG (male, 50.0%) and NASILDG (male, 60.0%) groups included 10 and 15 patients, respectively. The operative time without combined operation and anastomosis was significantly shorter in the NASILDG group. Early complications and scar characteristics were not significantly different between the two groups. CONCLUSIONS By adding a needle grasper, SILDG became more convenient without decreasing cosmetic results. NASILDG could be a recommended method to reduce the technical difficulty of SILDG.
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Affiliation(s)
- Jong Won Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joong-Min Park
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyong-Choun Chi
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
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Song QY, Li XG, Zhang LY, Wu D, Li S, Zhang BL, Xu ZY, Wu RLG, Guo X, Wang XX. Laparoscopic-assisted vs open transhiatal gastrectomy for Siewert type II adenocarcinoma of the esophagogastric junction: A retrospective cohort study. World J Gastrointest Surg 2022; 14:304-314. [PMID: 35664362 PMCID: PMC9131839 DOI: 10.4240/wjgs.v14.i4.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The studies of laparoscopic-assisted transhiatal gastrectomy (LTG) in patients with Siewert type II adenocarcinoma of the esophagogastric junction (AEG) are scarce.
AIM To compare the surgical efficiency of LTG with the open transhiatal gastrectomy (OTG) for patients with Siewert type II AEG.
METHODS We retrospectively evaluated a total of 578 patients with Siewert type II AEG who have undergone LTG or OTG at the First Medical Center of the Chinese People’s Liberation Army General Hospital from January 2014 to December 2019. The short-term and long-term outcomes were compared between the LTG (n = 382) and OTG (n = 196) groups.
RESULTS Compared with the OTG group, the LTG group had a longer operative time but less blood loss, shorter length of abdominal incision and an increased number of harvested lymph nodes (P < 0.05). Patients in the LTG group were able to eat liquid food, ambulate, expel flatus and discharge sooner than the OTG group (P < 0.05). No significant differences were found in postoperative complications and R0 resection. The 3-year overall survival and disease-free survival performed better in the LTG group compared with that in the OTG group (88.2% vs 79.2%, P = 0.011; 79.7% vs 73.0%, P = 0.002, respectively). In the stratified analysis, both overall survival and disease-free survival were better in the LTG group than those in the OTG group for stage II/III patients (P < 0.05) but not for stage I patients.
CONCLUSION For patients with Siewert type II AEG, LTG is associated with better short-term outcomes and similar oncology safety. In addition, patients with advanced stage AEG may benefit more from LTG in the long-term outcomes.
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Affiliation(s)
- Qi-Ying Song
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Xiong-Guang Li
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Li-Yu Zhang
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Di Wu
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Shuo Li
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Ben-Long Zhang
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Zi-Yao Xu
- Medical School of Chinese People’s Liberation Army, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Ri-Li-Ge Wu
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xin Guo
- Air Force Medical University Xijing Hospital, Xi’an 710000, Shaanxi Province, China
| | - Xin-Xin Wang
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
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Kulasegaran S, Woodhouse B, MacCormick AD, Srinivasa S, Koea J. Quality performance indicators for the surgical treatment of gastric adenocarcinoma: a systematic review. ANZ J Surg 2022; 92:1995-2002. [PMID: 35238137 PMCID: PMC9546246 DOI: 10.1111/ans.17583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
Background A systematic review was undertaken to identify existing quality performance indicators (QPI) for the surgical treatment of gastric adenocarcinoma (GA) with the aim of defining a set of QPIs that can be used to assist in the accreditation of institutions for training, allow cross jurisdiction comparison of treatment and outcomes, as well as provide a basis to develop quality improvement programs. These QPI's capture key components of patient care that are fundamental to overall outcome. Methods A systematic literature review was conducted searching MEDLINE, PubMed, EMBASE, and SCOPUS with all literature available until the date of 1 August 2021 included. Search terms utilized were ‘Quality of health care OR Quality improvement or Quality control OR Quality indicators’, AND ‘Gastrectomy’ OR ‘Stomach neoplasm’ OR ‘Adenocarcinoma’ OR ‘Gastric resection’ OR ‘Gastric cancer’. Results Twelve articles were included in the final analysis. The selected studies included editorials (n = 2), retrospective review of institutional experience (n = 5), cohort studies (n = 2), survey methodology (n = 1), expert guidelines (n = 1) and consensus statement (n = 1). For GC QPIs, process measures included patient discussion at multi‐disciplinary meetings, access to perioperative multimodal diagnostic pathways, and specific surgical metrics (margin negative resections and adequate lymphadenectomy). Outcome measures included the RO resection rate, reoperation, readmission rate, and length of hospital stay. Conclusions There is a relative paucity of internationally agreed QPI for the surgical management of gastric adenocarcinoma. The data from this review will form the basis of a project to develop internationally agreed and feasible QPI for gastric cancer resections.
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Affiliation(s)
| | - Braden Woodhouse
- Discipline of Oncology, School of Medical Sciences, The University of Auckland, Auckland, New Zealand
| | | | - Sanket Srinivasa
- The Department of Surgery, North Shore Hospital, Auckland, New Zealand
| | - Jonathan Koea
- The Department of Surgery, North Shore Hospital, Auckland, New Zealand
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12
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Sakamoto E, Kodama Pertille Ramos MF, Dias AR, Safatle-Ribeiro AV, Zilberstein B, Nahas SC, Junior UR. Indocyanine green imaging to guide lymphadenectomy in laparoscopic distal gastrectomy - With vídeo. Ann Med Surg (Lond) 2021; 69:102657. [PMID: 34408870 PMCID: PMC8361283 DOI: 10.1016/j.amsu.2021.102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 10/25/2022] Open
Abstract
Gastric cancer (GC) is one of the most lethal malignancies and Gastrectomy with D2 lymphadenectomy is considered the standard surgical treatment. Adequate lymph node dissection is necessary for patients' prognosis, but D2 lymphadenectomy is technically demanding due to the complexity of anatomy, even more so if performed laparoscopically. The learning curve requires a high degree of training with a considerable number of cases and standardization of the technique. Recently, Indocyanine Green (ICG) and Near-Infrared (NIR) Fluorescence Imaging have been presented as promising image-guided surgery techniques, providing real-time anatomy assessment and intra-operative visualization of blood flow, lymph nodes and lymphatic vessels. ICG fluorescence imaging has been studied in GC surgery, especially for real-time lymphatic mapping. At present, we are conducting a prospective, open-label, single-arm clinical trial (Clinical trial - NCT03021200) to evaluate the feasibility and outcomes of ICG and NIR Fluorescence Imaging in GC surgery. In this technical note, we present one approach to the use of this technique to guide lymphadenectomy in laparoscopic distal gastrectomy.
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Affiliation(s)
- Erica Sakamoto
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Marcus Fernando Kodama Pertille Ramos
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Andre Roncon Dias
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Bruno Zilberstein
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Sergio Carlos Nahas
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Ulysses Ribeiro Junior
- Digestive Surgery and Colorectal Division, Department of Gastroenterology, Instituto Do Câncer Do Estado de São Paulo, Hospital Das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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Brind'Amour A, Gagné JP, Hogue JC, Poirier É. Impact of the introduction of formal D2 lymphadenectomy for gastric cancer in a Western setting. Can J Surg 2021; 64:E119-E126. [PMID: 33651574 PMCID: PMC8064251 DOI: 10.1503/cjs.019919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Two members from an academic tertiary hospital went to the National Cancer Institute in Tokyo, Japan, to learn how to perform an adequate D2 lymphadenectomy and to then introduce this technique in the surgical care of patients undergoing surgery for gastric cancer at a Western hospital. We aimed to compare the perioperative outcomes and long-term survival of Western patients who underwent gastric resection, performed by these 2 surgeons, before and after the surgeons’ short-course technical training in Japan. Methods We conducted a retrospective comparative study of all patients (n = 27 before training and n = 79 after training) who underwent gastric resection for cancer by the same 2 surgeons between September 2007 and December 2017 at the Centre Hospitalier Universitaire de Québec — Université Laval (Québec, Canada). We collected data on patient demographic, clinical, surgical, pathological and treatment characteristics, as well as long-term survival and complications. Results In the post-training group, the number of sampled lymph nodes was higher (median 33 v. 14, p < 0.0001), but this increase did not result in a higher number of histologically positive lymph nodes (p = 0.35). The rate of complications was lower in the post-training group (15.2% v. 48.2%, p = 0.002). The hospital stay was shorter in the post-training group (11 [standard deviation (SD) 7] v. 23 [SD 45] d, p = 0.03). The median survival was higher in the post-training group (47 v. 29 mo, p = 0.03). Conclusion These results suggest that a short-course technical training in D2 lymphadenectomy, completed in Japan, improved lymph node sampling, decreased postoperative complications and improved survival of patients undergoing surgery for gastric cancer in a Western setting.
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Affiliation(s)
- Alexandre Brind'Amour
- From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier)
| | - Jean-Pierre Gagné
- From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier)
| | - Jean-Charles Hogue
- From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier)
| | - Éric Poirier
- From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier)
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Incidence and treatment outcomes of leakage after gastrectomy for gastric cancer: Experience of 14,075 patients from a large volume centre. Eur J Surg Oncol 2021; 47:2304-2312. [PMID: 33663943 DOI: 10.1016/j.ejso.2021.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/15/2021] [Accepted: 02/09/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Leakage is a serious and potentially fatal complication of gastrectomy for gastric cancer. However, comprehensive reports regarding leakage after gastrectomy remain limited. We aimed to evaluate the incidence and treatment outcomes of leakage after gastrectomy for cancer. METHODS We reviewed the prospectively collected data of 14,075 Patients who underwent gastrectomy for gastric cancer between 2005 and 2017. Outcomes included incidence, risk factors of leakage, and leakage treatment outcomes. RESULTS The median day of leakage detection was postoperative day 7 (range 1-29days). The overall leakage incidence was 1.51% (213/14,075), and the most frequent location was the oesophagojejunostomy (2.07%). Leakage after total gastrectomy was more frequent with minimally invasive surgery (open:1.64%, laparoscopic:3.56%, robotic:5.83%; P < 0.001). Leakage incidence was higher in the surgeon's initial 100 cases than in later cases (2.4 vs. 1.3%; P < 0.001), especially with minimally invasive surgery. Early leakage (within 4 days of surgery) occurred more often after minimally invasive surgery (open:12.7%, laparoscopic:35.4%, robotic:29.0%; P = 0.006). The success rate for initial treatment of leakage was 70.4% (150/213). Surgery after initial treatment failure demonstrated a higher success rate for early leakage than for late leakage (80.0 vs. 22.2%). Among 213 patients who experienced leakage, fifteen patients (7.0%) died, and leakage-related mortality accounted for 38.5% (15/39) of all surgery-related mortality after gastrectomy. CONCLUSIONS Leakage after gastric cancer surgery is associated with high mortality. Improved surgeon experience using minimally invasive techniques is required to reduce the risk of leakage. Surgery is an effective treatment for early leakage, although further studies are needed to establish the most appropriate treatment strategies.
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Han SU, Hur H, Lee HJ, Cho GS, Kim MC, Park YK, Kim W, Hyung WJ. Surgeon Quality Control and Standardization of D2 Lymphadenectomy for Gastric Cancer: A Prospective Multicenter Observational Study (KLASS-02-QC). Ann Surg 2021; 273:315-324. [PMID: 33064386 DOI: 10.1097/sla.0000000000003883] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To qualify surgeons to participate in a randomized trial comparing laparoscopic and open distal D2 gastrectomy for advanced gastric cancer. SUMMARY OF BACKGROUND DATA No studies have sought to qualify surgeons for a randomized trial comparing laparoscopic and open D2 gastrectomy for advanced gastric cancer. METHODS We conducted a multicenter prospective observational study evaluating unedited videos of laparoscopic and open D2 gastrectomy performed by 27 surgeons. Surgeons performed 3 of each laparoscopic and open distal gastrectomies with D2 lymphadenectomy for gastric cancer. Five peers reviewed each unedited video using a video assessment form. Based on experts' review of videos, a separate review committee decided surgeons as "Qualified" or "Not-qualified." RESULTS Twelve surgeons (44.4%) were qualified on initial evaluation whereas the other 15 surgeons were not. Another 9 surgeons were finally qualified after re-evaluation. The median score for Qualified was significantly higher than Not-qualified (P < 0.001).Significant differences between Qualified and Not-qualified were noted both in operation type and in all evaluation area of surgical skill, perigastric, and extra-perigastric lymphadenectomy, although the inter-rater variability of the assessment score was low (kappa = 0.285). However, Not-qualified surgeons' scores improved upon re-evaluation of resubmitted videos.When compared laparoscopy with open surgery, median scores were similar between the 2 groups (P = 0.680). However, open gastrectomy scores for surgical skills were significantly higher than for laparoscopic surgery (P = 0.016). CONCLUSIONS Our surgeon quality control study for gastrectomy represents a milestone in surgical standardization for surgical clinical trials. Our methods could also serve as a system for educating surgeons and assessing surgical proficiency.
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Affiliation(s)
- Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Wook Kim
- Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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16
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Huang HP, Xiong WJ, Peng YH, Zheng YS, Luo LJ, Li J, Cui ZM, Zhu XF, Wan J, Wang W. Safety and Feasibility of No.12a Lymph Node Dissection by Portal Vein Approach in Radical Laparoscopic Gastrectomy for Gastric Cancer. Technol Cancer Res Treat 2020; 19:1533033820971277. [PMID: 33251973 PMCID: PMC7705191 DOI: 10.1177/1533033820971277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Traditional laparoscopic No.12a lymph node dissection in radical gastrectomy for gastric cancer may damage the peripheral blood vessels, and is not conducive to the full exposure of the portal vein and the root ligation of the left gastric vein. We recommend a new surgical procedure, the portal vein approach, to avoid these problems. Methods: 25 patients with advanced gastric cancer underwent radical laparoscopic gastrectomy and No.12a lymph node were dissected by portal vein approach, including 7 cases with total gastrectomy, 18 cases with distal gastric resection, 14 males and 11 females. Operative time, intraoperative blood loss, time to first flatus, postoperative hospital stay, number of total lymph node dissection and No.12a lymph node dissection, No.12a lymph node metastasis rate and postoperative complications were statistically observed. Results: All the patients were operated successfully and No.12a lymph node were cleaned by portal vein approach. A total of 683 lymph nodes were dissected, with the average number of lymph nodes dissection and positive lymph nodes were (27.3 ± 12.7) and (3.8 ± 5.6) respectively. The average number of No.12a lymph node dissection was (2.4 ± 1.95) and the metastasis rate of No.12a lymph node was 16% (4/25). The average operation time of radical laparoscopic distal and total gastrectomy were (239.2 ± 51.4) min and (295.1 ± 27.7) min respectively. The mean intraoperative blood loss was (134.0 ± 65.7) ml, and postoperative first anal exhaust time was (2.24 ± 0.86) d. The mean time to fluid intake was (4.2 ± 1.7) d, and postoperative hospitalization time was (9.6 ± 5.0) d. Without portal vein injure, anastomotic leakage, gastrointestinal bleeding, intestinal obstruction and other complications were observed in all patient. Conclusion: Our results show that the laparoscopic No.12a lymph node dissection by portal vein approach for gastric cancer is safe, feasible and has certain clinical application value.
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Affiliation(s)
- Hai-Peng Huang
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Jun Xiong
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yao-Hui Peng
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan-Sheng Zheng
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li-Jie Luo
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin Li
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zi-Ming Cui
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Feng Zhu
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin Wan
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei Wang
- Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Hyung WJ, Yang HK, Park YK, Lee HJ, An JY, Kim W, Kim HI, Kim HH, Ryu SW, Hur H, Kim MC, Kong SH, Cho GS, Kim JJ, Park DJ, Ryu KW, Kim YW, Kim JW, Lee JH, Han SU. Long-Term Outcomes of Laparoscopic Distal Gastrectomy for Locally Advanced Gastric Cancer: The KLASS-02-RCT Randomized Clinical Trial. J Clin Oncol 2020; 38:3304-3313. [PMID: 32816629 DOI: 10.1200/jco.20.01210] [Citation(s) in RCA: 248] [Impact Index Per Article: 49.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE It is unclear whether laparoscopic distal gastrectomy for locally advanced gastric cancer is oncologically equivalent to open distal gastrectomy. The noninferiority of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer compared with open surgery in terms of 3-year relapse-free survival rate was evaluated. PATIENTS AND METHODS A phase III, open-label, randomized controlled trial was conducted for patients with histologically proven locally advanced gastric adenocarcinoma suitable for distal subtotal gastrectomy. The primary end point was the 3-year relapse-free survival rate; the upper limit of the hazard ratio (HR) for noninferiority was 1.43 between the laparoscopic and open distal gastrectomy groups. RESULTS From November 2011 to April 2015, 1,050 patients were randomly assigned to laparoscopy (n = 524) or open surgery (n = 526). After exclusions, 492 patients underwent laparoscopic surgery and 482 underwent open surgery and were included in the analysis. The laparoscopy group, compared with the open surgery group, suffered fewer early complications (15.7% v 23.4%, respectively; P = .0027) and late complications (4.7% v 9.5%, respectively; P = .0038), particularly intestinal obstruction (2.0% v 4.4%, respectively; P = .0447). The 3-year relapse-free survival rate was 80.3% (95% CI, 76.0% to 85.0%) for the laparoscopy group and 81.3% (95% CI, 77.0% to 85.0%; log-rank P = .726) for the open group. Cox regression analysis after stratification by the surgeon revealed an HR of 1.035 (95% CI, 0.762 to 1.406; log-rank P = .827; P for noninferiority = .039). When stratified by pathologic stage, the HR was 1.020 (95% CI, 0.751 to 1.385; log-rank P = .900; P for noninferiority = .030). CONCLUSION Laparoscopic distal gastrectomy with D2 lymphadenectomy was comparable to open surgery in terms of relapse-free survival for patients with locally advanced gastric cancer. Laparoscopic distal gastrectomy with D2 lymphadenectomy could be a potential standard treatment option for locally advanced gastric cancer.
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Affiliation(s)
- Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Wan Ryu
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University Hospital, Korea, Busan, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jin-Jo Kim
- Department of Surgery, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Young Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Jong Won Kim
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
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Ikeda T, Kanaji S, Takiguchi G, Urakawa N, Hasegawa H, Yamamoto M, Matsuda Y, Yamashita K, Matsuda T, Oshikiri T, Nakamura T, Suzuki S, Kakeji Y. Significance of prediction of the dorsal landmark using three-dimensional computed tomography during laparoscopic lymph node dissection along the proximal splenic artery in gastric cancer. SAGE Open Med 2020; 8:2050312120936918. [PMID: 32647576 PMCID: PMC7328210 DOI: 10.1177/2050312120936918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 05/29/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives: Dissection of the No. 11p lymph nodes is technically challenging because of
variations in anatomical landmarks. This study aimed to determine the
accuracy and efficacy of predicting the dorsal landmark of No. 11p lymph
node using three-dimensional computed tomography simulation. Methods: Laparoscopic gastrectomy with No. 11p lymph node dissection with preoperative
simulation using three-dimensional computed tomography was performed in 24
patients at our institution from October 2016 to May 2018. Initially,
preoperative three-dimensional computed tomography findings with operative
videos in these 24 patients were compared. The dorsal landmark was defined
as an anatomical structure behind the splenic artery on preoperative
three-dimensional computed tomography and operative videos. The dorsal
landmark of No. 11p lymph node was divided into four types: (1) splenic vein
type, (2) splenic vein and pancreas type, (3) pancreas type, and (4) unclear
type. Then, to investigate the efficacy of three-dimensional computed
tomography, we compared the clinical and pathological features and surgical
outcomes of nine patients who underwent preoperative three-dimensional
computed tomography simulation (three-dimensional computed tomography group)
and 23 patients who did not undergo three-dimensional computed tomography
simulation from August 2014 to September 2016 (non-three-dimensional
computed tomography group). All procedures were performed by one surgeon
certified by the Endoscopic Surgical Skill Qualification System in
Japan. Results: The concordance rate between three-dimensional computed tomography and
operative videos of the dorsal landmark using three-dimensional computed
tomography was 79% (19/24). The operative time of No. 11p lymph node
dissection was significantly shorter in the three-dimensional computed
tomography group than in the non-three-dimensional computed tomography group
(7.7 versus 15.8 min, P = 0.044). Conclusion: The accuracy of predicting the dorsal landmark of No. 11p lymph node using
three-dimensional computed tomography was extremely high. Preoperative
simulation with three-dimensional computed tomography was useful in
shortening the operative time of No. 11p lymph node dissection.
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Affiliation(s)
- Taro Ikeda
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Gosuke Takiguchi
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Naoki Urakawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Masashi Yamamoto
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshiko Matsuda
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takeru Matsuda
- Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Satoshi Suzuki
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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Wang YP, Hong J, Wang J, Bei YB, Hao HK, Hua LC. Clinicopathological Characteristics and Prognostic Factors of Patients with Gastric Cancer Accompanying Neuroendocrine Differentiation (NEDGC). Cancer Manag Res 2020; 12:4217-4225. [PMID: 32581593 PMCID: PMC7276378 DOI: 10.2147/cmar.s253175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 12/23/2022] Open
Abstract
Aim Gastric carcinoma with neuroendocrine differentiation (NEDGC) is a relatively rare pathologic diagnosis in clinical practice, which has no specific guidelines or treatment recommendations yet. In this study, we aim to investigate the clinicopathological characteristics and prognostic factors of this disease. Patients and Methods We retrospectively analyzed clinicopathological data from a series of 82 NEDGC patients who underwent surgery for gastrectomy at Huashan Hospital Fudan University between January 2007 and December 2018. Furthermore, a series of 50 cases were used to analyze 3-year overall survival (OS). Results Ages of the patients ranged from 26 to 83 years (M:F, 4.8:1). The majority of patients suffered from some symptoms (97.6%), as the most common one was abdominal pain (48.8%). Most of the tumors were ≥5 cm (53.7%), in the lower part of the stomach (47.5%), and with advanced T (87.8% ≥T3) and N (67.1% ≥N1) stage. As to the neuroendocrine markers, Syn showed a slight advantage on sensitivity than CgA (79.3 and 75.6%, respectively). The 3-year OS was 54%. Advanced T stage (≥T3) of the primary tumor, positive lymphovascular invasion (LVI), large tumor size (5.5cm), high neutrophil-to-lymphocyte ratio (NLR, 2.51), and low prealbumin level (173.87 mg/L) were associated with inferior OS based on the univariate analysis. Low preoperative hemoglobin level (113.87g/L), laparoscopic-assisted gastrectomy, and advanced N stage (N3) were three independent risk factors for 3-year OS of NEDGC patients in both univariate and multivariate analysis. Conclusion The TN staging system for gastric adenocarcinoma also has a prognostic value for NEDGC patients, while N3 stage works as an independent predictor of patients’ survival. Since most of the NEDGC patients were in advanced stage, proper indications to perform operative laparoscopy should be selected.
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Affiliation(s)
- Ya-Ping Wang
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Jun Hong
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Jian Wang
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Yi-Bing Bei
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Han-Kun Hao
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
| | - Lu-Chun Hua
- Department of Surgery, Huashan Hospital, Fudan University, Shanghai 200040, People's Republic of China
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Roh CK, Son SY, Lee SY, Hur H, Han SU. Clinical pathway for enhanced recovery after surgery for gastric cancer: A prospective single-center phase II clinical trial for safety and efficacy. J Surg Oncol 2020; 121:662-669. [PMID: 31930513 DOI: 10.1002/jso.25837] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/02/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND We aimed to evaluate the safety and efficacy of a clinical pathway (CP) for enhanced recovery after surgery (ERAS) in gastric cancer patients, including early oral feeding and discharge on postoperative day 4. METHODS We performed a prospective, single-center, phase II clinical trial. Based on proposed indications for an ERAS CP in our retrospective study, we enrolled 133 patients younger than 65 years who were undergoing minimally invasive subtotal gastrectomy. The primary endpoint was the ERAS CP completion rate. Secondary endpoints included complication, mortality, hospital stay, and readmission. RESULTS Among 133 patients, six patients were dropped out from this study. The ERAS CP completion rate (77.2%, 98 of 127) was comparable to the historical control group that completed a conventional CP (85.4%, P = .085). The postoperative complication incidence (13.4%, 15 of 127) was also similar to that of the conventional CP group (9.5%, P = .174). We identified reduced hospital stays (4.7 ± 1.3 vs 7.2±2.3 days; P < .001) and lower hospital costs ($7771 vs 8539; P < .001) in the ERAS CP group compared with the conventional CP group. CONCLUSIONS An ERAS CP can be safely and effectively adopted for patients with gastric cancer without increasing the complication rate and could shorten hospital stays. TRIAL REGISTRATION ClinicalTrials.gov (NCT01642953).
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Affiliation(s)
- Chul Kyu Roh
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sook Young Lee
- Department of Anesthesiology, Ajou University School of Medicine, Suwon, Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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21
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Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Hyung WJ. Effect of Laparoscopic Distal Gastrectomy vs Open Distal Gastrectomy on Long-term Survival Among Patients With Stage I Gastric Cancer: The KLASS-01 Randomized Clinical Trial. JAMA Oncol 2020; 5:506-513. [PMID: 30730546 DOI: 10.1001/jamaoncol.2018.6727] [Citation(s) in RCA: 363] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Laparoscopic distal gastrectomy is gaining popularity over open distal gastrectomy for gastric cancer because of better early postoperative outcomes. However, to our knowledge, no studies have proved whether laparoscopic distal gastrectomy is oncologically equivalent to open distal gastrectomy. Objective To examine whether the long-term survival among patients with stage I gastric cancer undergoing laparoscopic distal gastrectomy is noninferior to that among patients undergoing open distal gastrectomy. Design The Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) group, which includes 15 surgeons from 13 institutes, conducted a phase 3, multicenter, open-label, noninferiority, prospective randomized clinical trial (KLASS-01) of patients with histologically proven, preoperative clinical stage I gastric adenocarcinoma from January 5, 2006, to August 23, 2010. Survival and recurrence status of the patients was determined in December 2016. Interventions Patients were randomly assigned (1:1) to laparoscopic distal gastrectomy (n = 705) or open distal gastrectomy (n = 711). Of these patients, 85 received a surgical approach opposite the one to which they were randomized (63 randomized to the open surgery group and 22 to the laparoscopic group). Main Outcomes and Measures Difference in 5-year overall survival between the laparoscopic and open distal gastrectomy groups. The noninferiority margin was prespecified as -5% (corresponding hazard ratio of 1.54), with an assumed survival of 90% after 5 years in the open surgery group. Results Among the 1416 patients (mean [SD] age, 57.3 [11.1] years; 940 [66.4%] male) included in the study, the 5-year overall survival rates were 94.2% in the laparoscopic group and 93.3% in the open surgery group (log-rank P = .64). Intention-to-treat analysis confirmed the noninferiority of the laparoscopic approach compared with the open approach (difference, 0.9 percentage points; 1-sided 97.5% CI, -1.6 to infinity). The 5-year cancer-specific survival rates were similar between the 2 groups (97.1% in the laparoscopic group and 97.2% in the open surgery group, log-rank P = .91; difference, -0.03 percentage points; 1-sided 97.5% CI, -1.8 to infinity). Per-protocol analysis results were consistent with the intention-to-treat results for overall and cancer-specific survival rates. Conclusions and Relevance The KLASS-01 trial revealed similar overall and cancer-specific survival rates between patients receiving laparoscopic and open distal gastrectomy. Laparoscopic distal gastrectomy is an oncologically safe alternative to open surgery for stage I gastric cancer. Trial Registration ClinicalTrials.gov identifier: NCT00452751.
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Affiliation(s)
- Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Wook Kim
- Department of Surgery, Yeouido St Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Chan Young Kim
- Department of Surgery, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea
| | - Sang-Il Lee
- Department of Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seong Yeob Ryu
- Department of Surgery, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery. Ann Surg 2020; 270:115-120. [PMID: 29578907 DOI: 10.1097/sla.0000000000002741] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the relationship between technical performance and patient outcomes in laparoscopic gastric cancer surgery. BACKGROUND Laparoscopic gastrectomy for cancer is an advanced procedure with high rate of postoperative morbidity and mortality. Many variables including patient, disease, and perioperative management factors have been shown to impact postoperative outcomes; however, the role of surgical performance is insufficiently investigated. METHODS A retrospective review was performed for all patients who had undergone laparoscopic gastrectomy for cancer at 3 teaching institutions between 2009 and 2015. Patients with available, unedited video-recording of their procedure were included in the study. Video files were rated for technical performance, using Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments. The main outcome variable was major short-term complications. The effect of technical performance on patient outcomes was assessed using logistic regression analysis with backward selection strategy. RESULTS Sixty-one patients with available video recordings were included in the study. The overall complication rate was 29.5%. The mean Charlson comorbidity index, type of procedure, and the global OSATS score were included in the final predictive model. Lower performance score (OSATS ≤29) remained an independent predictor for major short-term outcomes (odds ratio 6.49), while adjusting for comorbidities and type of procedure. CONCLUSIONS Intraoperative technical performance predicts major short-term outcomes in laparoscopic gastrectomy for cancer. Ongoing assessment and enhancement of surgical skills using modern, evidence-based strategies might improve short-term patient outcomes. Future work should focus on developing and studying the effectiveness of such interventions in laparoscopic gastric cancer surgery.
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23
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Shen J, Ma X, Yang J, Zhang JP. Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer. World J Gastrointest Oncol 2020; 12:21-36. [PMID: 31966911 PMCID: PMC6960078 DOI: 10.4251/wjgo.v12.i1.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023] Open
Abstract
In addition to the popularity of laparoscopic gastrectomy (LG), many reconstructive procedures after LG have been reported. Surgical resection and lymphatic dissection determine long-term survival; however, the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer (GC). Presently, no consensus exists regarding the optimal reconstructive procedure. In this review, the current state of digestive tract reconstruction after LG is reviewed. According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction, we divide these reconstruction procedures into three categories consistent with the resection procedures. We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes (length of surgery and blood loss) and postoperative complications (anastomotic leakage and stricture) to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.
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Affiliation(s)
- Jian Shen
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang Ma
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jing Yang
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jian-Ping Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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24
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Lee HJ, Hyung WJ, Yang HK, Han SU, Park YK, An JY, Kim W, Kim HI, Kim HH, Ryu SW, Hur H, Kong SH, Cho GS, Kim JJ, Park DJ, Ryu KW, Kim YW, Kim JW, Lee JH, Kim MC. Short-term Outcomes of a Multicenter Randomized Controlled Trial Comparing Laparoscopic Distal Gastrectomy With D2 Lymphadenectomy to Open Distal Gastrectomy for Locally Advanced Gastric Cancer (KLASS-02-RCT). Ann Surg 2019; 270:983-991. [PMID: 30829698 DOI: 10.1097/sla.0000000000003217] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the short-term outcomes of KLASS-02-RCT, a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy (LDG) with D2 lymphadenectomy with open distal gastrectomy (ODG). SUMMARY BACKGROUND DATA Although several benefits of laparoscopic gastric cancer surgery have been reported, strong evidence is still limited, especially in locally advanced gastric cancer which requires extensive lymph node dissection. METHODS Enrollment criteria included histologically confirmed cT2-4a and N0-1 gastric adenocarcinoma. Thirty-day morbidity, 90-day mortality, postoperative pain, and recovery were compared between LDG and ODG groups. RESULTS A total of 1050 patients were randomly assigned to LDG (n = 526) or ODG group (n = 524) between November 2011 and April 2015. After excluding patients who received bypass or no surgery, 1011 patients were analyzed as actual treatment group. Mean number of totally retrieved lymph nodes was similar in both groups (LDG = 46.6 vs ODG = 47.4, P = 0.451). Early morbidity rate was significantly lower after LDG (16.6%) than after ODG (24.1%; P = 0.003). Postoperative analgesics use and patients' reported pain score were significantly lower after LDG. First day of flatus was earlier after LDG (3.5 vs 3.7 d, P = 0.025) and postoperative hospital stay was shorter in LDG group (8.1 vs 9.3 d, P = 0.005). Ninety days' mortality rate was similar in both groups (LDG = 0.4% vs ODG = 0.6%, P = 0.682). CONCLUSIONS Laparoscopic distal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer shows benefits in terms of lower complication rate, faster recovery, and less pain compared with open surgery.
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Affiliation(s)
- Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Woo Jin Hyung
- Department of Surgery Yonsei University Severance Hospital, Seoul
| | - Han-Kwang Yang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Sang Uk Han
- Department of Surgery, Ajou University Hospital, Suwon, Gyeonggi
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Jeonnam
| | - Ji Yeong An
- Department of Surgery Yonsei University Severance Hospital, Seoul
| | - Wook Kim
- Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul
| | - Hyoung-Il Kim
- Department of Surgery Yonsei University Severance Hospital, Seoul
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University Dongsan Medical Center, Daegu
| | - Hoon Hur
- Department of Surgery, Ajou University Hospital, Suwon, Gyeonggi
| | - Seong-Ho Kong
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Gyu Seok Cho
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Gyeonggi
| | - Jin-Jo Kim
- Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi
| | - Keun Won Ryu
- Center for Gastric Center, National Cancer Center, Goyang, Gyeonggi
| | - Young Woo Kim
- Center for Gastric Center, National Cancer Center, Goyang, Gyeonggi
| | - Jong Won Kim
- Department of Surgery, Yonsei University Gangnam Severance Hospital, Seoul
- Department of Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul
| | - Min-Chan Kim
- Department of Surgery, Dong-A University Hospital, Busan
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25
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Beyer K, Baukloh AK, Kamphues C, Seeliger H, Heidecke CD, Kreis ME, Patrzyk M. Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a systematic review and meta-analysis of randomized controlled studies. World J Surg Oncol 2019; 17:68. [PMID: 30987645 PMCID: PMC6466673 DOI: 10.1186/s12957-019-1600-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/18/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This meta-analysis sought to evaluate the potential benefits and harms of laparoscopic gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer versus open surgery. METHODS A comprehensive search for randomized controlled studies that compared laparoscopic versus open gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer published until December 31, 2018, was conducted. Operative outcomes, early postoperative outcomes, and long-term results were analyzed using a random effects model. RESULTS Five randomized controlled trials containing a collective total of 2157 patients were included. In comparison with open surgery, laparoscopic gastrectomy for locally advanced gastric cancer showed similar risks of short-term mortality and serious adverse events within 30 days after surgery. Regarding intraoperative outcomes, operative time was increased for the laparoscopic approach, whereas the estimated intraoperative blood loss tended to be less. However, the amount of evidence was low for most outcomes. In addition, the results for the length of hospital stay and time to first flatus did not show statistically significant differences. The number of harvested lymph nodes and compliance with D2 lymphadenectomy did not significantly differ between the two groups, indicating oncological equivalence of both approaches. However, long-term oncological results could not be evaluated due to a lack of relevant data in four of the trials. CONCLUSION Laparoscopic gastrectomy with D2 lymphadenectomy can be performed with equivalent overall short-term morbidity and mortality versus the open approach for locally advanced gastric cancer. However, further well-designed randomized controlled trials are necessary to assess the possible advantages and risks of the laparoscopic approach as well as the long-term results.
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Affiliation(s)
- Katharina Beyer
- Klink für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany.
| | - Ann-Kathrin Baukloh
- Klink für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Carsten Kamphues
- Klink für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Hendrik Seeliger
- Klink für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Claus-Dieter Heidecke
- Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Martin E Kreis
- Klink für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Maciej Patrzyk
- Klinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
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Mazzone E, Preisser F, Nazzani S, Tian Z, Fossati N, Gandaglia G, Gallina A, Soulieres D, Tilki D, Montorsi F, Shariat SF, Saad F, Briganti A, Karakiewicz PI. More Extensive Lymph Node Dissection Improves Survival Benefit of Radical Cystectomy in Metastatic Urothelial Carcinoma of the Bladder. Clin Genitourin Cancer 2018; 17:105-113.e2. [PMID: 30527745 DOI: 10.1016/j.clgc.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Radical cystectomy (RC) may occasionally be performed in individuals with metastatic urothelial carcinoma of the bladder (mUCB). However, the role of lymph node dissection (LND) for such cases is unknown. Thus, we tested the effect of RC on cancer-specific mortality (CSM) and overall mortality in mUCB patients and the effect of LND and its extent on CSM. PATIENTS AND METHODS Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2013), we identified patients with mUCB who underwent RC with or without LND or non-RC management. Kaplan-Meier analyses and multivariable Cox regression models (CRMs) were used, after propensity score matching. The number of removed nodes best predicting CSM was identified using cubic splines and then was tested in multivariable CRMs. RESULTS Of 2314 patients, 319 (13.8%) underwent RC. After 2:1 propensity score matching, CSM-free survival was 14 versus 8 months (P < .001), and overall mortality-free survival was 12 versus 7 months (P < .001) for, respectively, RC and non-RC patients. In multivariable CRMs, lower CSM (hazard ratio = 0.48; P < .001) and lower overall mortality (hazard ratio = 0.49; P < .001) rates were recorded in RC patients. LND status did not affect CSM-free survival (13 vs. 10 months; P = .1). Cubic splines-derived cutoff of ≥ 13 number of removed nodes showed better CSM-free survival (20 vs. 11 months; P = .02) and reduced CSM in CRMs (hazard ratio = 0.67; P = .02). CONCLUSION Our study validates the survival benefit of RC in mUCB and highlights the importance of more extensive LND. These findings may corroborate the hypothesis of potential cytoreductive effect of surgery in the context of metastatic disease.
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Affiliation(s)
- Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Gallina
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Denis Soulieres
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Derya Tilki
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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He H, Li H, Su X, Li Z, Yu P, Huang H, Huang C, Ye J, Li Y, Suo J, Yu J, Li G, Xu Z, Zhao G, Cao H, Hu J, Du X, Liu F, Sun Y. Study on safety of laparoscopic total gastrectomy for clinical stage I gastric cancer: the protocol of the CLASS02-01 multicenter randomized controlled clinical trial. BMC Cancer 2018; 18:944. [PMID: 30285673 PMCID: PMC6171153 DOI: 10.1186/s12885-018-4846-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The safety of laparoscopic total gastrectomy (LTG) for the treatment of gastric cancer remains lack of clinical evidence. The Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group recently launched a multicenter randomized clinical trial (CLASS02-01) to compare the safety of LTG for clinical stage I gastric cancer with the conventional open total gastrectomy (OTG). METHODS This CLASS02-01 trial is a prospective, multicenter, randomized, controlled, open, and non-inferiority trial. Two hundred patients who met the inclusion criteria and did not accord with the exclusion criteria will be randomly divided into LTG group (n = 100) and OTG group (n = 100). The primary purpose of this study is to evaluate the early operative morbidity and mortality of LTG compared with OTG for clinical stage I gastric adenocarcinoma. The second purpose is to evaluate the recovery course and compare the postoperative hospital stay of the patients enrolled in this study. DISCUSSION This CLASS02-01 trial is the first prospective randomized two-arm controlled study to determine the safety of LTG compared with OTG. Through this trial, we hope to show that experienced surgeons can safely perform LTG with lymphadenectomy for gastric cancer. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03007550 . December 30, 2016.
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Affiliation(s)
- Hongyong He
- Department of General Surgery, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Haojie Li
- Department of General Surgery, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China
| | - Xiangqian Su
- Department of General Surgery, Beijing Cancer Hospital, Peking University, Beijing, 100142, China
| | - Ziyu Li
- Department of General Surgery, Beijing Cancer Hospital, Peking University, Beijing, 100142, China
| | - Peiwu Yu
- Department of General Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Hua Huang
- Department of General Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Changming Huang
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Jianxin Ye
- Department of General Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350009, China
| | - Yong Li
- Department of General Surgery, Guangdong General Hospital, Guangzhou, 510080, China
| | - Jian Suo
- Department of General Surgery, The First Bethune Hospital of Jilin University, Changchun, 130021, China
| | - Jiren Yu
- Department of General Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, 310003, China
| | - Guoxin Li
- Department of General Surgery, Nangfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital With Nanjing Medical University, Nanjing, 210029, China
| | - Gang Zhao
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, 200240, China
| | - Hui Cao
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, 200240, China
| | - Jiankun Hu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaohui Du
- Department of General Surgery, Chinese PLA General Hospital, Beijing, 10853, China
| | - Fenglin Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China.
| | - Yihong Sun
- Department of General Surgery, Zhongshan Hospital, Fudan University, Fenglin Road 180, Shanghai, 200032, China.
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Yamamoto H, Murata S, Kaida S, Yamaguchi T, Ishida M, Kushima R, Tani M. Presence of cancer cells in the periarterial tissues of patients with advanced gastric cancer. Oncol Lett 2018; 16:1226-1230. [PMID: 29963196 DOI: 10.3892/ol.2018.8704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 04/26/2018] [Indexed: 11/06/2022] Open
Abstract
Lymphadenectomy with gastrectomy is considered a curative surgical treatment for gastric cancer. Periarterial connective tissue-preserving lymphadenectomy has become a common procedure following developments in laparoscopic surgery. However, the presence of cancer cells in the periarterial tissue, including neural invasion, has not been examined. In the present study, the periarterial tissues from the vessel roots of the left gastric artery (LGA) and right gastroepiploic artery (RGEA) after gastrectomy were evaluated for the presence of cancer cells. The study included 28 consecutive patients who underwent gastrectomy for gastric cancer. The vessel roots of the RGEA and LGA were obtained from surgically resected specimens and examined by two independent pathologists to determine the presence of cancer cells in the periarterial tissues. The collected specimens included 23 RGEA roots and 26 LGA roots from 28 patients. In 8 cases of early gastric cancer, no cancer cells were indicated in the periarterial tissues. By contrast, cancer cells, including neural invasion in 2 cases, were identified in the periarterial tissues from the roots of examined gastric arteries in 3/20 (15%) cases of advanced gastric cancer. Notably, all 3 cases featured multiple regional lymph node (LN) metastases. Cancer cells were detected in the perivascular tissue of the major gastric arteries from cases with advanced gastric cancer with LN metastases, suggesting the requirement for oncologic evaluation to ensure adequate vascular tissue margins and an adequate periarterial layer during lymphadenectomy.
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Affiliation(s)
- Hiroshi Yamamoto
- Department of Gastrointestinal Surgery, Kusatsu General Hospital, Kusatsu, Shiga 525-8585, Japan
| | - Satoshi Murata
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.,Cancer Center, Shiga University of Medical Science Hospital, Otsu, Shiga 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Tsuyoshi Yamaguchi
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Mitsuaki Ishida
- Division of Diagnostic Pathology, Kansai Medical University, Hirakata, Osaka 573-1191, Japan
| | - Ryoji Kushima
- Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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Compliance to D2 lymphadenectomy in laparoscopic gastrectomy. Updates Surg 2018; 70:197-205. [PMID: 29926307 PMCID: PMC6060987 DOI: 10.1007/s13304-018-0553-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/06/2018] [Indexed: 12/23/2022]
Abstract
The objective of this study is to describe the compliance to D2 lymphadenectomy in laparoscopic gastrectomy. Radical partial or total gastrectomy with modified D2 lymphadenectomy is the standard of care for locally advanced gastric cancer. It is unclear whether compliance to D2 lymphadenectomy in laparoscopy is comparable to that in open surgery. A review of the literature was performed and results are described in a descriptive review. Available randomized trials are mostly performed for early gastric cancer, for which formal D2 lymphadenectomy is usually not required. Most trials report no differences in number of retrieved lymph nodes between open and laparoscopic gastrectomy. Only one trial used adherence to D2 lymphadenectomy as primary outcome parameter, and found no difference between laparoscopic and open gastrectomy. Results from randomized trials in advanced gastric cancer are awaited. In the meantime, the laparoscopic approach can be used in experienced centers.
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Minimal-invasive gastrectomy: what the west can learn from the east? Updates Surg 2018; 70:181-187. [PMID: 29916040 DOI: 10.1007/s13304-018-0547-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/13/2018] [Indexed: 12/14/2022]
Abstract
Minimal-invasive gastrectomy has been established as commonly used method for the early gastric cancer in Korea and Japan. From the first laparoscopic cancer gastrectomy in 1992 in Japan, numerous prospective randomized trials from these two countries have gained the evidence for non-inferiority or even specific benefits compared to open surgery. In Korea, the "Korean Laparoscopic Gastrointestinal Surgical Study Group" (KLASS group) founded, in 2004, successfully gained evidence not only in regards of oncological safety of laparoscopic gastrectomy, but also for the impact of different reconstruction methods and alternative extents of luminal resection on postoperative outcome and quality of life. Awaited results of latest studies from Korea, Japan, and China may suggest laparoscopic approaches as an option even in advanced gastric cancers. These studies could potentially be the starting point to find the role of laparoscopic gastrectomy in the west, where the incidence of gastric cancer is rather lower; the cancers are mostly diagnosed in advanced stages, and often, a perioperative chemotherapy is applied. Robotic (-assisted) gastrectomy was not shown to be superior to laparoscopic resection in Korea, but new technological developments should continuously be evaluated in clinical trials regarding a potentially favorable learning curve, which might play a key role in regards of the limited case load per center of gastric cancer in the west. This review summarizes the history of laparoscopic cancer gastrectomy in Asia and points out the important steps of establishing a nation-wide scientific network to support the surgical routine by the necessary evidence with a focus on Korea.
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31
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Zhu C, Kong SH, Kim TH, Park SH, Ang RRG, Diana M, Soler L, Suh YS, Lee HJ, Marescaux J, Cao H, Yang HK. The anatomical configuration of the splenic artery influences suprapancreatic lymph node dissection in laparoscopic gastrectomy: analysis using a 3D volume rendering program. Surg Endosc 2018; 32:3697-3705. [PMID: 29725766 DOI: 10.1007/s00464-018-6201-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
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32
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Preisser F, Bandini M, Marchioni M, Nazzani S, Tian Z, Pompe RS, Fossati N, Briganti A, Saad F, Shariat SF, Heinzer H, Huland H, Graefen M, Tilki D, Karakiewicz PI. Extent of lymph node dissection improves survival in prostate cancer patients treated with radical prostatectomy without lymph node invasion. Prostate 2018; 78:469-475. [PMID: 29460290 DOI: 10.1002/pros.23491] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/23/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the effect of pelvic lymph node dissection (PLND) extent on cancer-specific mortality (CSM) in prostate cancer (PCa) patients without lymph node invasion (LNI) treated with radical prostatectomy (RP). METHODS Within the Surveillance, Epidemiology, and End results (SEER) database (2004-2014), we identified patients with D'Amico intermediate- or high-risk characteristics who underwent RP with PLND, without evidence of LNI. First, multivariable logistic regression models tested for predictors of more extensive PLND, defined as removed lymph node count (NRN) ≥75th percentile. Second, Kaplan-Meier analyses and multivariable Cox regression models tested the effect of NRN ≥75th percentile on CSM. Finally, survival analyses were repeated using continuously coded NRN. RESULTS In 28 147 RP and PLND patients without LNI, 67.3% versus 32.7% exhibited D'Amico intermediate- or high-risk characteristics. The median NRN was 6 (IQR 3-10), the 75th percentile defined patients with NRN ≥11. Patients with NRN ≥11 had higher rate of cT2/3 stage (29.8 vs 26.1%), GS ≥8 (25.7 vs 22.4%), and respectively more frequently exhibited D'Amico high-risk characteristics (34.6 vs 32.1%). In multivariable logistic regression models predicting the probability of more extensive PLND (NRN ≥11), higher biopsy GS, higher cT stage, higher PSA, more recent year of diagnosis, and younger age at diagnosis represented independent predictors. At 72 months after RP, CSM-free rates were 99.5 versus 98.1% for NRN ≥11 and NRN ≤10, respectively and resulted in a HR of 0.50 (P = 0.01), after adjustment for all covariates. Similarly, continuously coded NRN achieved independent predictor status (HR: 0.955, P = 0.01), where each additional removed lymph node reduced CSM risk by 4.5%. CONCLUSION More extensive PLND at RP provides improved staging information and consequently is associated with lower CSM in D'Amico intermediate- and high-risk PCa patients without evidence of LNI. Hence, more extensive PLND should be recommended in such individuals.
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Affiliation(s)
- Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Marco Bandini
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Raisa S Pompe
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | | | - Hans Heinzer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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Coburn N, Cosby R, Klein L, Knight G, Malthaner R, Mamazza J, Mercer CD, Ringash J. Staging and surgical approaches in gastric cancer: A systematic review. Cancer Treat Rev 2018; 63:104-115. [DOI: 10.1016/j.ctrv.2017.12.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 02/07/2023]
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Li M, Wang XA, Wang L, Wu X, Wu W, Song X, Zhao S, Zhang F, Ma Q, Liang H, Xiang S, Wang Z, Gong W, Dong P, Liu Y. A three-step method for modular lymphadenectomy in gastric cancer surgery: The ability to retrieve sufficient lymph nodes and improve survival. Am J Surg 2018; 215:91-96. [PMID: 28985891 DOI: 10.1016/j.amjsurg.2017.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/17/2017] [Accepted: 01/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Systematic lymphadenectomy for the resection of sufficient lymph nodes is the most important part of curative resection in gastric cancer surgery. Here, we explore the outcomes of the three-step method for modular lymphadenectomy (TSMML) and determine its safety and efficacy, compared with the conventional method for lymphadenectomy (CML). METHODS From 2008 to 2011, 270 patients with gastric cancer were divided into 2 subgroups: the TSMML group and the CML group. RESULTS Patients in the TSMML group had a significantly higher median number of retrieved lymph nodes (rLNs), lower median metastatic lymph node ratios (MLRs), and superior 5-year relapse-free survival (RFS) than the CML group. Moreover, the use of the TSMML procedure was an independent protective factor for RFS. No significant intergroup differences were found in morbidity or mortality in these two groups. CONCLUSION The TSMML procedure is safe and effective and is easy to learn.
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Affiliation(s)
- Maolan Li
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Xu-An Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Lei Wang
- Department of Hepatobiliary Surgery, Nanjing Medical University Affiliated Wuxi No2 Hospital, Jiangsu, China
| | - Xiangsong Wu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Wenguang Wu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Xiaoling Song
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Shuai Zhao
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Fei Zhang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Qiang Ma
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Haibin Liang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Shanshan Xiang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Zheng Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China
| | - Wei Gong
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China.
| | - Ping Dong
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China.
| | - Yingbin Liu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center of Biliary Tract Disease, Shanghai, China.
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35
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Xiao S, Feng F, Sun L, Cai L, Liu Z, Liu S, Fan D, Zhang H. Blood type AB predicts promising prognosis in gastric cancer patients with positive preoperative serum CEA. Medicine (Baltimore) 2017; 96:e8496. [PMID: 29381925 PMCID: PMC5708924 DOI: 10.1097/md.0000000000008496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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
Little is known about association between ABO blood groups and tumor markers in gastric cancer (GC) patients. The aim of the present study was to assess the prognostic value of ABO blood groups in GC patients with different levels of preoperative serum carcinoembryonic antigen (CEA).From September 2008 to April 2015, a total of 3234 GC patients who received radical gastrectomy were retrospectively analyzed. The clinicopathological characteristics including ABO blood groups and preoperative CEA were recorded. The prognostic value of ABO blood groups within different levels of serum CEA was analyzed.Overall, the ratio of male to female patients was 3.5:1; the median age was 57.4 years (range 20-87). The median overall survival (OS) for GC patients with blood type A, B, AB, and O were 52.6, 52.8, 53.8, and 53.6 months, respectively. There was no significant difference for the survival of patients among the 4 groups (P = .736). Also, no significant difference was found among the OS of the 4 blood types with negative (P = .875) and positive (P = .131) preoperative serum CEA. Further, we found that the OS of patients with positive preoperative serum CEA and blood type AB was significantly higher than that with blood type non-AB (P = .026). For patients with positive preoperative serum CEA, multivariate analysis showed that ABO blood groups were an independent prognostic factor.Blood type AB was a favorable prognostic factor for GC patients with positive preoperative serum CEA.
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Huh YJ, Lee JH. The Advances of Laparoscopic Gastrectomy for Gastric Cancer. Gastroenterol Res Pract 2017; 2017:9278469. [PMID: 29018482 PMCID: PMC5605869 DOI: 10.1155/2017/9278469] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/19/2017] [Indexed: 12/18/2022] Open
Abstract
Laparoscopic gastrectomy is evolving. With the increasing expertise and experience of oncologic surgeons in the minimally invasive surgery for gastric cancer, the indication for laparoscopic gastrectomy is expanding to advanced cases. Many studies have demonstrated the benefits of minimally invasive surgery, including reduced risk of surgery-related injury, reduced blood loss, less pain, and earlier recovery. In order to establish concrete evidence for the suitability of minimal invasive surgery for gastric cancer, many multicenter RCTs, comparing the short- and long-term outcomes of laparoscopic versus open surgery, are in progress. Advances in laparoscopic gastrectomy are moving toward increasingly minimally invasive approaches that enable the improvement of the quality of life of patients, without compromising on oncologic safety.
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Affiliation(s)
- Yeon-Ju Huh
- Department of Surgery, Ewha Womans University Mokdong Hospital, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Joo-Ho Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Yangcheon-gu, Seoul 07985, Republic of Korea
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37
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Kim SM, An JY. Editorial concerning "Long-term outcomes of laparoscopic versus open surgery for clinical stage I gastric cancer: the LOC-1 study". Transl Gastroenterol Hepatol 2017; 2:12. [PMID: 28275744 DOI: 10.21037/tgh.2017.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Su Mi Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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38
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Shrikhande S, Bhandare M, Kumar N, Batra S, Chaudhari V. Radical gastrectomy for gastric cancer at Tata Memorial Hospital. Indian J Cancer 2017; 54:605-608. [DOI: 10.4103/ijc.ijc_665_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Park JH, Son YG, Kim TH, Huh YJ, Yang JY, Suh YJ, Suh YS, Kong SH, Lee HJ, Yang HK. Identification of Candidates for Early Discharge After Gastrectomy. Ann Surg Oncol 2016; 24:159-166. [DOI: 10.1245/s10434-016-5447-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 12/30/2022]
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40
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Okabe H, Tsunoda S, Obama K, Tanaka E, Hisamori S, Shinohara H, Sakai Y. Feasibility of Laparoscopic Radical Gastrectomy for Gastric Cancer of Clinical Stage II or Higher: Early Outcomes in a Phase II Study (KUGC04). Ann Surg Oncol 2016; 23:516-523. [PMID: 27401443 DOI: 10.1245/s10434-016-5383-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE A phase II study was performed to evaluate the safety and efficacy of laparoscopic gastrectomy (LG) for gastric cancer of clinical stage II or higher. METHODS The eligibility criteria were gastric cancer of clinical stage II or higher that was amenable to potentially curative resection. Patients with prior chemotherapy, tumors requiring total gastrectomy (TG), tumors that invaded adjacent organs, and patients with bulky lymph node metastasis were included. The primary endpoint was incidence of postoperative complications of grade II or higher in the Clavien-Dindo classification. The sample size was determined to be 73, based on an expected rate of complications of 19 % and a threshold of 30 %. Gastrectomy was performed by expert surgeons who were certified by the Japan Society for Endoscopic Surgery. RESULTS A total of 73 patients were enrolled; 54 patients (74 %) had clinical T stage T4a/T4b, and 47 patients (64 %) were administered preoperative chemotherapy. The type of surgery was distal gastrectomy in 41 patients and TG in 31 patients. Dissection of D2 or more was performed in 62 patients (85 %). Of the 25 patients who underwent D2/D2+ TG, 15 underwent splenectomy or pancreaticosplenectomy. R0 resection was performed in 64 patients (88 %). The median number of resected lymph nodes was 56, and postoperative complications occurred in 15 patients (20.5 %), which was significantly lower than the threshold value (p = 0.039). One in-hospital death occurred (1.4 %). CONCLUSION LG for gastric cancer of clinical stage II or higher can be safely performed by experienced surgeons.
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Affiliation(s)
- Hiroshi Okabe
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. .,Department of Surgery, Otsu Municipal Hospital, Otsu, Japan.
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Eiji Tanaka
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Kobe City Medical Center, West Hospital, Kobe, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisashi Shinohara
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Quan Y, Huang A, Ye M, Xu M, Zhuang B, Zhang P, Yu B, Min Z. Comparison of laparoscopic versus open gastrectomy for advanced gastric cancer: an updated meta-analysis. Gastric Cancer 2016. [PMID: 26216579 DOI: 10.1007/s10120-015-0516-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic gastrectomy (LG) has been used as an alternative to open gastrectomy (OG) to treat early gastric cancer. However, the use of LG for advanced gastric cancer (AGC) has been in debate. METHODS Literature retrieval was performed by searching PubMed, EMBASE, and the Cochrane library up to July 2014. Potential studies comparing the surgical effects between LG with OG were evaluated and data were extracted accordingly. Meta-analysis was carried out using RevMan. The pooled risk ratio and weighted mean difference (WMD) with 95 % confidence interval (95 % CI) were calculated. RESULTS Overall, 26 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD, -3.63, 95 % CI, -4.66 to -2.60; P < 0.01), less blood loss (WMD, -161.37, 95 % CI, -192.55 to -130.18; P < 0.01), faster bowel recovery (WMD, -0.78, 95 % CI, -1.05 to -0.50; P < 0.01), and earlier ambulation (WMD, -0.95, 95 % CI, -1.47 to -0.44; P < 0.01). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.49, 95 % CI, -1.78 to 0.81; P = 0.46), a lower complication rate [odds ratio (OR), 0.71, 95 % CI, 0.59 to 0.87; P < 0.01], and overall survival (OS) and disease-free survival (DFS) comparable to OG. CONCLUSIONS For AGCs, LG appeared comparable with OG in short- and long-term results. Although more time was needed to perform LG, it had some advantages over OG in achieving faster postoperative recovery. Ongoing trials and future studies could help to clarify this controversial issue.
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Affiliation(s)
- Yingjun Quan
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ao Huang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Min Ye
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Ming Xu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Biao Zhuang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Bo Yu
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Zhijun Min
- Department of Gastrointestinal Surgery, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
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Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S. A Multi-institutional, Prospective, Phase II Feasibility Study of Laparoscopy-Assisted Distal Gastrectomy with D2 Lymph Node Dissection for Locally Advanced Gastric Cancer (JLSSG0901). World J Surg 2016; 39:2734-41. [PMID: 26170158 DOI: 10.1007/s00268-015-3160-z] [Citation(s) in RCA: 239] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The efficacy and safety outcomes of laparoscopy-assisted distal gastrectomy (LADG) with D2 lymph node dissection for locally advanced gastric cancer remain unclear. Therefore, we conducted a randomized, controlled phase II trial to confirm the feasibility of LADG in terms of technical safety, and short-term surgical outcomes were investigated. METHODS Eligibility criteria included pre-operatively diagnosed advanced gastric cancer that could be treated by distal gastrectomy with D2 lymph node dissection; MP, SS, and SE without involvement of other organs; and N0-2 and M0. Patients aged 20-80 years were pre-operatively randomized. RESULTS In total, 180 patients were registered and randomized to the open (89 patients) and laparoscopic arms (91 patients). Among 91 patients in the laparoscopic arm, 86 underwent laparoscopic gastrectomy according to the study protocol. Regarding the primary endpoint of the phase II trial, the proportion of patients with either anastomotic leakage or pancreatic fistula was 4.7 % (4/86). The grade 3 or higher morbidity rate, including systemic and local complications, was 5.8 %. Conversion to open surgery was required for 1 patient (1.2 %), without any intra-operative complication. The post-operative mortality rate was 0, and no patient required readmission for surgical complications within 6 months after initial discharge. CONCLUSIONS The technical safety of LADG with D2 lymph node dissection for locally advanced gastric cancer was demonstrated. A phase III trial to confirm the non-inferiority of this procedure to open gastrectomy in terms of long-term outcomes is ongoing. Registered Number: UMIN 000003420 ( www.umin.ac.jp/ctr/).
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Affiliation(s)
- Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Hasama-machi, Oita, 879-5593, Japan.
| | - Tetsuji Ohyama
- Department of Mathematics and Statistics, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Japan
| | - Natsuya Katada
- Department of Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keisuke Koeda
- Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan
| | | | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Kazuyuki Kojima
- Center for Minimally Invasive Surgery, Tokyo Medical and Dental University, Bunkyō, Japan
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Comprehensive Cancer Center, Saitama International Medical Center, Saitama Medical University, Saitama, Japan
| | - Norio Shiraishi
- Center for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
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Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I. Minimally invasive surgery for upper gastrointestinal cancer: Our experience and review of the literature. World J Gastroenterol 2016; 22:4626-4637. [PMID: 27217695 PMCID: PMC4870070 DOI: 10.3748/wjg.v22.i19.4626] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023] Open
Abstract
Minimally invasive surgery (MIS) for upper gastrointestinal (GI) cancer, characterized by minimal access, has been increasingly performed worldwide. It not only results in better cosmetic outcomes, but also reduces intraoperative blood loss and postoperative pain, leading to faster recovery; however, endoscopically enhanced anatomy and improved hemostasis via positive intracorporeal pressure generated by CO2 insufflation have not contributed to reduction in early postoperative complications or improvement in long-term outcomes. Since 1995, we have been actively using MIS for operable patients with resectable upper GI cancer and have developed stable and robust methodology in conducting totally laparoscopic gastrectomy for advanced gastric cancer and prone thoracoscopic esophagectomy for esophageal cancer using novel technology including da Vinci Surgical System (DVSS). We have recently demonstrated that use of DVSS might reduce postoperative local complications including pancreatic fistula after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy. In this article, we present the current status and future perspectives on MIS for gastric and esophageal cancer based on our experience and a review of the literature.
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Lee JH. Ongoing surgical clinical trials on minimally invasive surgery for gastric cancer: Korea. Transl Gastroenterol Hepatol 2016; 1:40. [PMID: 28138607 DOI: 10.21037/tgh.2016.05.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 03/15/2016] [Indexed: 12/26/2022] Open
Abstract
Since Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) group was activated in 2003, several randomized controlled trials (RCTs) have finished or are ongoing in Korea to evaluate oncologic safety and feasibility of minimally invasive surgery (MIS) for gastric cancer by KLASS group as well as other expert surgeons. MIS in gastric cancer is regarded as one of standard treatment modality for early gastric cancer (EGC) and the indication is going expansion with the accumulation of evidence. This review covers current status of ongoing clinical trials on MIS for gastric cancer in Korea.
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Affiliation(s)
- Ju-Hee Lee
- Department of Surgery, Hanyang University Hospital, Seoul, Republic of Korea
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Suh YS, Lee HJ, Yang HK. Single incision gastrectomy for gastric cancer. Transl Gastroenterol Hepatol 2016; 1:41. [PMID: 28138608 PMCID: PMC5244807 DOI: 10.21037/tgh.2016.05.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/12/2016] [Indexed: 12/26/2022] Open
Abstract
Based on rapid development of laparoscopic techniques and instruments, single-incision laparoscopic surgery (SILS) is expected to be the next step of "more" minimally invasive surgery. A few institutions gradually started to report their experience of single incision gastrectomy (SIG) for gastric cancer, but it is still difficult to accept that SIG can be performed as a popular procedure because of its technical difficulty. For wide adoption of SIG, the simplicity, safety and reproducibility of not only lymph node dissection but also reconstruction should be evaluated compared to a conventional procedure. With a thorough understanding of unique characteristics of SILS, single incision distal gastrectomy (SIDG) for early gastric cancer performed by laparoscopic surgeons with advanced technique is expected to have promising potential about excellent cosmesis, comparable morbidity and mortality in carefully selected patients. For appropriate adoption and steady progress of this state-of-the art surgery, scientific evaluation with healthy critics is necessary with new generation of SILS instrument platform.
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Affiliation(s)
- Yun-Suhk Suh
- Department of Surgery Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Mrena J, Mattila A, Böhm J, Jantunen I, Kellokumpu I. Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer. World J Gastroenterol 2015; 21:13294-13301. [PMID: 26715812 PMCID: PMC4679761 DOI: 10.3748/wjg.v21.i47.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/17/2015] [Accepted: 10/26/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the quality of surgical care and long-term oncologic outcome after D2 gastrectomy for gastric cancer.
METHODS: From 1999 to 2008, a total of 109 consecutive patients underwent D2 gastrectomy without routine pancreaticosplenectomy in a multimodal setting at our institution. Oncologic outcomes together with clinical and histopathologic data were analyzed in relation to the type of surgery performed. Staging was carried out according to the Union for International Cancer Control criteria of 2002. Patients were followed-up for five years at the outpatient clinic. The primary measure of outcome was long-term survival with the quality of surgery as a secondary outcome measure. Clinical data were retrospectively collected from the patient records, and causes of death were obtained from national registries.
RESULTS: A total of 109 patients (58 men) with a mean age of 67.4 ± 11.2 years underwent total gastrectomy or gastric resection with D2 lymph node dissection. The tumor stage distribution was as follows: stage I, (27/109) 24.8%; stage II, (31/109) 28.4%; stage III, (41/109) 37.6%; and stage IV, (10/109) 9.2%. Forty patients (36.7%) received chemotherapy or chemoradiotherapy. The five-year overall survival rate for all 109 patients was 45.0%, and was 47.1% for the 104 patients treated with curative R0 resection. The five-year disease-specific survival rates were 53.0% and 55.8%, respectively. In a multivariate analysis, body mass index and tumor stage were independent prognostic factors for overall survival (both P < 0.01), whereas body mass index, tumor stage, tumor site, Lauren classification, and lymph node invasion were prognostic factors for cancer-specific survival (all P < 0.05). Postoperative 30-d mortality was 1.8% and 30-d, surgical (including three anastomotic leaks, two of which were treated conservatively), and general morbidities were 26.6%, 12.8%, and 14.7%, respectively.
CONCLUSION: D2 dissection is a safe surgical option for gastric cancer, providing quality surgical care and long-term oncologic outcomes that are in line with current Western standards.
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Takiguchi S, Miyazaki Y, Murakami K, Makino T, Takahashi T, Kurokawa Y, Yamasaki M, Nakajima K, Miyata H, Mori M, Doki Y. Laparoscopic lymphadenectomy around the left renal vein (16a2lat) by tunneling under the pancreas for advanced Siewert type II adenocarcinoma. Surg Today 2015; 46:1108-13. [PMID: 26482844 DOI: 10.1007/s00595-015-1264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
The para-aortic lymph nodes around the left renal vein (16a2lat) are now considered important to target in the treatment of advanced adenocarcinoma of the esophagogastric junction. We describe a laparoscopic approach for resecting these nodes. This new tunneling approach starts from the ligament of Treitz and then enters the retroperitoneal space. The left renal vein and left adrenal vein are dissected to identify the anatomy of the 16a2lat area. After this dissection, the 16a2lat nodes are retrieved through the suprapancreatic area. Six patients with advanced type II junctional cancer underwent laparoscopic 16a2lat lymph node dissection. The median operative time and estimated blood loss were 479 (390-750) min and 250 (130-500) ml, respectively. The median hospital stay was 22 (17-54) days and there were no deaths or serious complications. Although this series was relatively small, our technique proved effective and feasible.
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Affiliation(s)
- Shuji Takiguchi
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yasuhiro Miyazaki
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kohei Murakami
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Makino
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tsuyoshi Takahashi
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yukinori Kurokawa
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Makoto Yamasaki
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kiyokazu Nakajima
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroshi Miyata
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Mori
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Li G, Hu Y, Liu H. Current status of randomized controlled trials for laparoscopic gastric surgery for gastric cancer in China. Asian J Endosc Surg 2015; 8:263-7. [PMID: 26042475 DOI: 10.1111/ases.12198] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/26/2014] [Accepted: 04/30/2015] [Indexed: 01/25/2023]
Abstract
China alone accounts for nearly 42% of all new gastric cancer cases worldwide, and gastric cancer is the third leading cause of cancer deaths in China nowadays. Without mass screening programs, unfortunately over 80% of all Chinese patients have been diagnosed as advanced diseases. As in other Asian countries, especially Japan and Korea, laparoscopic gastrectomy for the treatment of gastric cancer has gained increasingly popularity in China during the past decade. Whether laparoscopic surgery can be safely and effectively performed in the treatment of gastric cancer remains controversial, particularly with regard to curative intent in advanced diseases. Given the high incidence of these cancers, and their advanced stage at diagnosis, China has a significant interest in determining the safety and effectiveness of laparoscopic gastrectomy. A well-designed randomized controlled trial (RCT) is considered the only feasible way to provide conclusive evidence. To date, China has not played a significant role in terms of conducting RCT concerning laparoscopic surgery for gastric cancer. However, an effort has been made by the Chinese researchers, with the great help from our colleagues in neighboring countries such as Korea and Japan, through the establishment of the Chinese Laparoscopic Gastrointestinal Surgery Study Group. In this review, we present the current status of RCT for laparoscopic gastric surgery for gastric cancer in China, including published and ongoing registered RCT.
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Affiliation(s)
- Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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49
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Li Z, Ji J. Application of laparoscopy in the diagnosis and treatment of gastric cancer. ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207254 DOI: 10.3978/j.issn.2305-5839.2015.03.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ziyu Li
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
| | - Jiafu Ji
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China
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Hur H, Lee HY, Lee HJ, Kim MC, Hyung WJ, Park YK, Kim W, Han SU. Efficacy of laparoscopic subtotal gastrectomy with D2 lymphadenectomy for locally advanced gastric cancer: the protocol of the KLASS-02 multicenter randomized controlled clinical trial. BMC Cancer 2015; 15:355. [PMID: 25939684 PMCID: PMC4432816 DOI: 10.1186/s12885-015-1365-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 04/24/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the well-described benefits of laparoscopic surgery such as lower operative blood loss and enhanced postoperative recovery in gastric cancer surgery, the application of laparoscopic surgery in patients with locally advanced gastric cancer (AGC) remains elusive owing to a lack of clinical evidence. Recently, the Korean Laparoscopic Surgical Society Group launched a new multicenter randomized clinical trial (RCT) to compare laparoscopic and open D2 lymphadenectomy for patients with locally AGC. Here, we introduce the protocol of this clinical trial. METHODS/DESIGN This trial is an investigator-initiated, randomized, controlled, parallel group, non-inferiority trial. Gastric cancer patients diagnosed with primary tumors that have invaded into the muscle propria and not into an adjacent organ (cT2-cT4a) in preoperative studies are recruited. Another criterion for recruitment is no lymph node metastasis or limited perigastric lymph node (including lymph nodes around the left gastric artery) metastasis. A total 1,050 patients in both groups are required to statistically show non-inferiority of the laparoscopic approach with respect to the primary end-point, relapse-free survival of 3 years. Secondary outcomes include postoperative morbidity and mortality, postoperative recovery, quality of life, and overall survival. Surgeons who are validated through peer-review of their surgery videos can participate in this clinical trial. DISCUSSION This clinical trial was designed to maintain the principles of a surgical clinical trial with internal validity for participating surgeons. Through the KLASS-02 RCT, we hope to show the efficacy of laparoscopic D2 lymphadenectomy in AGC patients compared with the open procedure. TRIAL REGISTRATION ClinicalTrial.gov, NCT01456598.
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Affiliation(s)
- Hoon Hur
- Department of Surgery, Ajou University Medical Center, Ajou University School of Medicine, 206 Worldcup-ro, Youngtong-gu, Suwon, 443-749, Korea.
| | - Hyun Yong Lee
- Clinical Trial Center, Ajou University Medical Center, Ajou University School of Medicine, Suwon, 443-749, Korea.
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, 110-799, Korea.
| | - Min Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, 602-715, Korea.
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, 120-749, Korea.
| | - Young Kyu Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, 519-763, Korea.
| | - Wook Kim
- Department of Surgery, The Catholic University, Yeouido St. Mary's Hospital, Seoul, 150-713, Korea.
| | - Sang-Uk Han
- Department of Surgery, Ajou University Medical Center, Ajou University School of Medicine, 206 Worldcup-ro, Youngtong-gu, Suwon, 443-749, Korea.
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