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Zhang C, Wang K, Zhang Z, Zhao X, Yao B, Zhang W. Safety and short‑term outcomes of a modified tubular esophagogastrostomy versus double tract reconstruction after proximal gastrectomy: a propensity score matching analysis. BMC Cancer 2025; 25:908. [PMID: 40399830 PMCID: PMC12096559 DOI: 10.1186/s12885-025-14284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Accepted: 05/07/2025] [Indexed: 05/23/2025] Open
Abstract
OBJECTIVE To comparatively evaluate the short-term clinical efficacy and quality of life (QoL) between modified tubular esophagogastrostomy (mTEG) and double tract reconstruction (DTR) following proximal gastrectomy (PG), aiming to establish evidence-based recommendations for reconstruction method selection. METHODS The mTEG technique involved three essential steps: 1) tubular reconstruction of gastric remnant, 2) 3-cm artificial gastric fornix creation, and 3) His angle sharpening with posterior mediastinal fixation. This retrospective study included 288 PG patients (2021-2024). Propensity score matching (1:1, caliper = 0.03) balanced baseline characteristics, and thirty-three matched pairs were analyzed. Outcomes encompassed operative metrics, postoperative complications (Clavien-Dindo ≥ II), nutritional status (prealbumin, albumin, hemoglobin, BMI at 1/3/6 months), and QoL (EORTC QLQ-STO22 at 6 months). RESULTS The mTEG group demonstrated shorter median operative time (163.7 vs 247.9 min, p < 0.001) and postoperative hospitalization (8.3 vs 9.9 days, p = 0.001). Intraoperative outcomes including blood loss and lymph node yield were comparable. Early complications (≤ 30 days) occurred exclusively in the DTR group (4 cases: 2 anastomotic leakage, 1chylous leakage and 1 pulmonary related). complication rates showed no statistical difference (p > 0.05). Endoscopic findings demonstrated comparable incidence of reflux esophagitis in Los Angeles Grade B or higher (11.1% vs 4.5%, p = 0.457). Nutritional parameters and QoL scores remained equivalent between groups at all timepoints (p > 0.05). CONCLUSION mTEG represents a technically optimized reconstruction method that achieves equivalent nutritional preservation and reflux prevention compared to DTR, while offering distinct advantages in surgical efficiency and postoperative recovery. These findings support mTEG as a viable reconstruction option for PG patients.
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Affiliation(s)
- Chaoyang Zhang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Kaixing Wang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Zhidong Zhang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China.
| | - Xuefeng Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Bin Yao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Weishuai Zhang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
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Han H, Li Z, Li Y, Zhang L, Chen J, Li Q, Fan X. Comparison of clinical efficacy between π-shaped esophagojejunostomy and overlap method in treating upper gastric cancer with double-tract reconstruction in proximal gastrectomy under total laparoscopy. World J Surg Oncol 2025; 23:120. [PMID: 40189553 PMCID: PMC11974127 DOI: 10.1186/s12957-025-03768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Accepted: 03/23/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND This study aimed to analyze the clinical efficacy of π-shaped esophagojejunostomy and the overlap method in treating upper gastric cancer with double-tract reconstruction in proximal gastrectomy under total laparoscopy. METHOD Clinical data were collected from patients with upper gastric cancer who underwent surgery in the General Surgery Department of Jiangsu University Affiliated Hospital from June 1, 2017, to January 1, 2023. Patients were categorized into the overlap method group and the π-shaped esophagojejunostomy group. We collected perioperative and gastroscopy follow-up data from both groups 1 year after surgery. RESULTS Seventy-nine patients were included, with 46 in the overlap anastomosis group and 33 in the π-shaped esophagojejunostomy group. Both groups were evaluated for age, sex, body mass index, tumor diameter, tumor pathological Tumor, Node, Metastasis staging, intraoperative bleeding volume, number of lymph node dissections, postoperative hospitalization days, postoperative hospitalization days, catheter removal time, drainage tube removal time, recovery time, anal defecation time, postoperative bedtime activity time, hospitalization cost, Visual Analog Scale (VAS) score at rest on the first day after surgery, VAS score at activity on the first day after surgery, short-term postoperative complications and 1-year gastroscopy follow-up. No significant difference was observed in these factors (P > 0.05). However, the π-shaped esophagojejunostomy group had a significantly lower surgical time and anastomosis time than the overlap anastomosis group (P < 0.05). CONCLUSION Both overlap anastomosis and π-shaped esophagojejunostomy are safe for double-tract reconstruction in proximal gastrectomy under total laparoscopy without increasing the incidence of perioperative and short-term complications in patients. π-shaped esophagojejunostomy has shorter surgical time and anastomosis time than overlap anastomosis.
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Affiliation(s)
- He Han
- Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang, 212000, Jiangsu, China
| | - Zhiyuan Li
- Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang, 212000, Jiangsu, China
| | - Yunfan Li
- Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang, 212000, Jiangsu, China
| | - Liwen Zhang
- Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang, 212000, Jiangsu, China
| | - Jixiang Chen
- Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang, 212000, Jiangsu, China
| | - Qinjin Li
- Zhenjiang Renji Hospital, Jingba Road, Dingmao Development Zone, Zhenjiang, 212000, Jiangsu, China
| | - Xin Fan
- Affiliated Hospital of Jiangsu University, No. 438 Jiefang Road, Zhenjiang, 212000, Jiangsu, China.
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Liu M, Feng B, He N, Yan R, Qin J. Efficacy of fluorouracil combined with paclitaxel and oxaliplatin for the treatment of advanced gastric signet ring cell carcinoma. World J Gastrointest Surg 2025; 17:94286. [PMID: 40162413 PMCID: PMC11948113 DOI: 10.4240/wjgs.v17.i3.94286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 09/17/2024] [Accepted: 12/25/2024] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND Gastric signet ring cell carcinoma (GSRC) is a distinctive type of gastric cancer. It is a mucus-secreting adenocarcinoma that may progress to distant metastasis at an early stage. Because of poor differentiation, aggressive invasion, rapid progression, and other high-risk characteristics, early surgical intervention should be prioritized. AIM To explore the clinical efficacy of fluorouracil (5-FU) combined with paclitaxel and oxaliplatin for the treatment of advanced GSRC. METHODS A total of 85 patients with advanced GSRC were selected between January 2020 and June 2021 and randomly divided into a control group (n = 42, receiving standard chemotherapy) and a treatment group (n = 43, receiving monotherapy with oxaliplatin, 5-FU, and paclitaxel). Patients in the treatment group received a 135 mg/m2 infusion of paclitaxel for 3 hours, a 400 mg/m2 infusion of calcium folate (or 200 mg/m2 of levocalcium folate) for 2 hours, and an 85 mg/m2 infusion of oxaliplatin for 2 hours. This was followed by a continuous intravenous infusion of 2200-2400 mg/m2 5-FU for 46 hours using a portable pump. RESULTS The treatment group showed a median survival time of 11.7 months and an objective response rate (ORR) of 32.5%, significantly higher than the control group (P < 0.05). Serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and albumin levels were correlated with treatment effectiveness in advanced GSRC (P < 0.01), but total serum protein was not correlated (P > 0.05). Safety and survival were assessed in all patients. Short-term efficacy was evaluated in 66 patients, with a disease control rate of 89.4% and an ORR of 48.5%. Median progression-free survival was 7.0 months (95% confidence interval [CI]: 6.85-7.15), and median overall survival was 10.6 months (95%CI: 9.86-11.3). Primary grade III/IV adverse events included neutropenia (22.1%) and peripheral neurotoxicity (10.3%). CONCLUSION This treatment regimen is more effective for patients with advanced GSRC. Serum levels of CEA, CA19-9, and albumin predicted chemotherapy efficacy, while total protein concentration correlated minimally and insignificantly.
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Affiliation(s)
- Mi Liu
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710077, Shaanxi Province, China
| | - Bei Feng
- Department of Oncology, The Affiliated Hospital of Yan’an University, Yan’an 716000, Shaanxi Province, China
| | - Na He
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
| | - Rong Yan
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
| | - Jie Qin
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, Shaanxi Province, China
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Inokuchi M, Yamaguchi K, Ogo T, Masuda T, Nagano H, Irie T. The Safety and Anti-Reflex Effect of Robotic Double-Tract Reconstruction After Proximal Gastrectomy for Gastric Cancer. Asian J Endosc Surg 2025; 18:e70001. [PMID: 39675837 DOI: 10.1111/ases.70001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 11/09/2024] [Accepted: 12/01/2024] [Indexed: 12/17/2024]
Abstract
PURPOSE Double-tract reconstruction (DTR) is one of the major procedures following proximal gastrectomy (PG) with anti-reflex function for the esophagus. Although many studies demonstrated the feasibility of laparoscopic DTR, there is a lack of research on robotic DTR. We aimed to assess the safety and feasibility of robotic DTR following PG. METHODS Esophagojejunostomy was performed with a robotic stapler under endoscopic observation using the TilePro function of the Davinci Xi surgical system. The gastrojejunostomy procedure slightly differed depending on the size of the remnant stomach. Along with short-term surgical outcomes, long-term outcomes were compared based on the size of the remnant stomach. RESULT Thirty patients underwent robotic DTR. The median value of operative bleeding was 10 mL, although the median operative and reconstruction times were 398 and 119 min, respectively. Anastomotic complications were absent, and reflux esophagitis was not observed endoscopically 1 year after operation. Body weight loss, symptoms, and blood test findings did not differ significantly. CONCLUSION Robotic DTR may be a safe and favorable procedure in terms of the postoperative course and incidence of reflux esophagitis.
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Affiliation(s)
- Mikito Inokuchi
- Department of Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Kazuya Yamaguchi
- Department of Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Taichi Ogo
- Department of Esophageal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taiki Masuda
- Department of Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Hiroto Nagano
- Department of Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takumi Irie
- Department of Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
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Nishiguchi R, Shimakawa T, Asaka S, Ogawa M, Yamaguchi K, Murayama M, Sagawa M, Kuhara K, Usui T, Yokomizo H, Shiozawa S. Remnant Stomach Influx Reduces Esophageal Reflux and Malnutrition After Proximal Gastrectomy With Double Tract Reconstruction. CANCER DIAGNOSIS & PROGNOSIS 2025; 5:62-71. [PMID: 39758241 PMCID: PMC11696333 DOI: 10.21873/cdp.10413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 11/27/2024] [Accepted: 11/28/2024] [Indexed: 01/07/2025]
Abstract
Background/Aim Remnant stomach influx (RSI) from the anastomotic jejunal-remnant stomach, a physiological food passage, develops after proximal gastrectomy with double-tract reconstruction (PGDT). Sometimes, food passes into the jejunal-loop (JL). We investigated the association of the food passage route in PGDT (RSI/JL) with postoperative esophageal reflux and malnutrition. Patients and Methods We retrospectively collected data for 50 patients with upper-third gastric cancer and esophagogastric junction cancer with PGDT. Using one-year postoperative fluoroscopy findings, 40 propensity score-matched patients were classified into RSI and JL groups (n=20/group), respectively. The groups were comparatively evaluated for: clinicopathological characteristics [age, sex, body mass index (BMI), visceral fat index (VFI), subcutaneous fat index (SFI), skeletal muscle index, pathological stage]; perioperative factors [approach, postoperative complications ≥ Clavien-Dindo Grade 2, postoperative food passage); and esophageal reflux (reflux esophagitis frequency ≥ Grade A, degree of reflux based on fluoroscopy findings). Univariate and multivariate analysis identified predictive factors for post-operative malnutrition in all 50 patients. Results After propensity score matching, grade of reflux esophagitis and degree of reflux was significantly lower (p=0.014, p<0.001) in the RSI versus JL group. The RSI group showed significantly attenuated percent decrease in BMI, VFI, and SFI (p=0.049, p=0.002, p=0.006). Multivariate analysis identified food passage route (JL) and pathological stage as predictive factors for postoperative malnutrition. Conclusion Postoperative esophageal reflux and malnutrition were attenuated by food passage mainly via the RSI after PGDT. Improved jejunal-remnant stomach is requisite to ensure satisfactory remnant stomach influx.
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Affiliation(s)
- Ryohei Nishiguchi
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Takeshi Shimakawa
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Shinichi Asaka
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masako Ogawa
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kentaro Yamaguchi
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Minoru Murayama
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masano Sagawa
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Kotaro Kuhara
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Takebumi Usui
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hajime Yokomizo
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
| | - Shunichi Shiozawa
- Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital, Tokyo, Japan
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Irino T, Ohashi M, Hayami M, Makuuchi R, Ri M, Sano T, Yamaguchi T, Nunobe S. Updated Review of Proximal Gastrectomy for Gastric Cancer or Cancer of the Gastroesophageal Junction. J Gastric Cancer 2025; 25:228-246. [PMID: 39822177 PMCID: PMC11739649 DOI: 10.5230/jgc.2025.25.e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 12/18/2024] [Accepted: 12/18/2024] [Indexed: 01/19/2025] Open
Abstract
Proximal gastrectomy (PG) has reemerged as a viable surgical option for managing proximal gastric cancer and gastroesophageal junction cancer, particularly for early-stage tumors, offering potential advantages over total gastrectomy (TG). This review examines the evolution of PG, emphasizing surgical techniques and outcomes. Although PG was initially abandoned due to postoperative complications such as reflux esophagitis, advances in reconstruction methods, such as the double-flap technique and double-tract reconstruction, have significantly improved patient quality of life and reduced complications. Modern techniques focus on preserving gastric function, enhancing postoperative nutritional status, and minimizing morbidity, especially compared to TG. However, debates persist regarding the optimal extent of lymphadenectomy, oncological safety, and the risk of metachronous gastric cancer after surgery. Various international guidelines support PG for specific cases, particularly where lymph node involvement is limited, and functional preservation is prioritized. Despite promising survival and quality-of-life outcomes, certain risks, such as anastomotic stenosis and metachronous cancer, remain. The role of PG in treating cancer of the gastroesophageal junction continues to be investigated, with ongoing studies further clarifying its effectiveness. The evolving techniques and increased focus on patient-centered outcomes suggest a renewed role of PG in the surgical management of gastric cancer.
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Affiliation(s)
- Tomoyuki Irino
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, Tokyo, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, Tokyo, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, Tokyo, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, Tokyo, Japan
| | - Motonari Ri
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, Tokyo, Japan
| | - Toshiharu Yamaguchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital Ariake, Tokyo, Japan.
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Dai W, Wen F, Li X, Fu Z. The Long-Term Results of Proximal Gastrectomy for Proximal Gastric Cancer: A Propensity Score Matching Analysis Based on SEER Database. Am Surg 2024; 90:3015-3023. [PMID: 38867409 DOI: 10.1177/00031348241260273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Proximal gastrectomy (PG) is one of function-preserving gastrectomy (FPG). In this study, we compared the long-term results of proximal gastric cancer (PGC) patients undergoing proximal gastrectomy and total gastrectomy (TG). METHOD Patients diagnosed with PGC and receiving PG or TG between 2004 and 2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was applied to minimize confounding factors. Kaplan-Meier analysis and log-rank test were used to compare overall survival (OS) and cancer-specific survival (CSS) between the PG and TG groups. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS. RESULT A total of 3916 patients were recruited according to the inclusion and exclusion criteria, with 2614 undergoing PG and 1302 undergoing TG. After 1:1 PSM matching, 912 pairs of data were included for analysis. Before PSM matching, PG group tended to have better OS and CSS outcomes. However, after PSM matching, both surgical approaches showed similar long-term results. CONCLUSION PG for PGC yields comparable long-term outcomes to TG and demonstrates safety in terms of oncologic outcomes.
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Affiliation(s)
- Wei Dai
- Chongqing University FuLing Hospital, Chongqing, China
| | - Feng Wen
- Chongqing University FuLing Hospital, Chongqing, China
| | - Xiang Li
- Chongqing University FuLing Hospital, Chongqing, China
- The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongxue Fu
- The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Su PJ, Huang YT, Liao TK, Lu WH, Wang CJ, Chao YJ, Shan YS. Comparing survival after proximal gastrectomy vs. total gastrectomy in advanced gastric cancer: A systematic review and meta‑analysis. Oncol Lett 2024; 28:427. [PMID: 39021734 PMCID: PMC11253084 DOI: 10.3892/ol.2024.14560] [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: 02/21/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
The present systematic review and meta-analysis aimed to compare long-term survival after proximal gastrectomy (PG) and total gastrectomy (TG) for locally advanced proximal gastric cancer (GC). The PubMed, EMBASE and Cochrane CENTRAL databases were searched from their inception to May 2023. Only published two-arm prospective or retrospective studies were included. The selected studies included patients with locally advanced GC who underwent PG or TG and reported quantitative survival outcomes. The primary outcome was overall survival (OS) after gastrectomy. Three studies involving a total of 4,815 patients met the inclusion criteria. The age of the patients ranged from 57.03-64.46 years and 78.80% were male. The estimated 5-year OS probability after TG varied from 30.14 to 72.0%, and from 42.06 to 74.9% after PG. Results of the meta-analyses revealed a significant association between PG and improved OS compared with that of TG, with a pooled hazard ratio of 1.15 (95% CI, 1.05-1.25). No heterogeneity was observed in the included studies (I2=0%). Overall, in managing locally advanced GC, PG demonstrated comparable or marginally improved OS compared with TG during postoperative follow-up; however, further meta-analyses are required to provide stronger evidence.
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Affiliation(s)
- Ping-Jui Su
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
| | - Ting-Kai Liao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
| | - Wei-Hsun Lu
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
| | - Chih-Jung Wang
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
| | - Ying-Jui Chao
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
| | - Yan-Shen Shan
- Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan, R.O.C
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Yamana I, Fujikawa T, Kawamura Y, Hasegawa S. Robotic-Assisted Total Gastrectomy for Gastric Cancer After Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery: A Case Report. Cureus 2024; 16:e67446. [PMID: 39314567 PMCID: PMC11417419 DOI: 10.7759/cureus.67446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2024] [Indexed: 09/25/2024] Open
Abstract
The right gastroepiploic artery (RGEA) is frequently used in coronary artery bypass grafting (CABG) for right coronary artery bypass requiring long-term patency. We experienced a case of upper-third advanced gastric cancer after CABG using RGEA. The absence of enlarged lymph nodes (LNs) or distant metastasis was confirmed through computed tomography (CT), and the RGEA graft remained patent according to coronary CT angiography. Based on these findings, the patient underwent robotic total gastrectomy while preserving the RGEA graft without infra-pyloric LN dissection. We suggested that caution should be exercised to avoid injury to the graft during gastrectomy, and robotic surgery could contribute to safely preserving the RGEA. We should consider the decision to dissect the infra-pyloric LN for the patient's safety and curability.
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Affiliation(s)
- Ippei Yamana
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
| | | | | | - Suguru Hasegawa
- Gastroenterological Surgery, Fukuoka University Hospital, Fukuoka, JPN
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10
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Qi X, Liu M, Xu K, Tan F, Gao P, Yao Z, Zhang N, Yang H, Zhang C, Xing J, Cui M, Su X. Risk factors and clinical significance of lower perigastric lymph node metastases in Siewert type II and III esophagogastric junction adenocarcinoma: a retrospective cohort study. Surg Endosc 2024; 38:3828-3837. [PMID: 38822144 PMCID: PMC11219428 DOI: 10.1007/s00464-024-10875-y] [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: 02/26/2024] [Accepted: 04/20/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND No consensus has been concluded with regarding to the scope of lymph node (LN) dissection for Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). This study aimed to explore risk factors for lower perigastric LN (LPLN) metastases (including no. 4d, 5, 6, and 12a LN stations) and analyze the indications for LPLN dissection. METHODS In total, 302 consecutive patients with Siewert type II and III AEG who underwent total gastrectomy (TG) were enrolled. The logistic regression model was used to perform uni- and multivariate analyses of risk factors for LPLN metastases. Kaplan-Meier curves were used for survival analysis, and log-rank tests were used for group comparisons. Basing on the guidelines of Japanese Gastric Cancer Association, the LN metastases (LNM) as well as the efficiency index (EI) of each LN station was further evaluated. RESULTS The independent risk factors for LPLN metastases in patients with Siewert type II and III AEG were distance from the esophagogastric junction (EGJ) to the distal end of the tumor (> 4.0 cm), preoperative carcinoembryonic antigen (CEA) ( +), pT4 stage, and HER-2 ( +). LPLN metastases was an independent risk factor for overall survival following TG. The LNM and EI of LPLN were 8.6% and 2.31%, respectively. The LNM of LPLN > 10% under the stratification of the distance from the EGJ to the distal end of the tumor (> 4.0 cm), pT4, preoperative CEA ( +), and HER-2 ( +) exhibited EI values of 3.55%, 2.09%, 2.51%, and 3.64%, respectively. CONCLUSIONS LPLN metastases was a malignant factor for the prognosis of patients with Siewert type II and III AEG. For patients with preoperative CEA ( +), pT4 stage, HER-2 ( +), and the distance from the EGJ to the distal end of the tumor (> 4.0 cm), TG with LPLN dissection is prioritized for clinical recommendation.
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Affiliation(s)
- Xinyu Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Maoxing Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Kai Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Fei Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Pin Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Zhendan Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Nan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Hong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Chenghai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Jiadi Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China.
| | - Ming Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Xiangqian Su
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China.
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11
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Rawicz-Pruszyński K, Endo Y, Tsilimigras D, Munir MM, Katayama E, Sędłak K, Pelc Z, Pawlik TM. Proximal gastric cancer-time for organ-sparing approach? J Gastrointest Surg 2024; 28:870-876. [PMID: 38538476 DOI: 10.1016/j.gassur.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/26/2024] [Accepted: 03/09/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND A steady increase in gastroesophageal junction and proximal gastric cancer (GC) incidence has been observed in the West. Given recent advances in neoadjuvant chemotherapy (NAC), we sought to characterize short- and long-term outcomes of patients with proximal GC who underwent total (TG) vs proximal gastrectomy (PG). METHODS Patients with stage II/III proximal GC who underwent curative-intent treatment between 2009 and 2019 were identified using National Cancer Database. Multivariable analysis was used to identify oncologic outcomes after TG vs PG. RESULTS Among 7616 patients with GC who underwent surgical resection, PG and TG were performed on 5246 (68.8%) and 2370 patients (31.2%), respectively. Patients who underwent PG were more likely to receive NAC (TG 52.3% vs PG 64.5%) (P < .001). On pathologic analysis, patients who underwent TG were more likely to have pT4 tumors (TG 11.7% vs PG 3.1%), metastatic lymph nodes (LNs) (TG 64.6% vs PG 60.4%), and >16 LNs evaluated (TG 64.1% vs PG 53.1%), yet a lower likelihood of negative resection margins (TG 86.6% vs PG 90.0%) (all P < .001). Although gastrectomy procedure type did not affect long-term survival, receipt of NAC was associated with overall survival (OS) among patients who underwent TG (5-year OS, NAC 43.5% vs no NAC 24.6%) and PG (5-year OS, NAC 43.1% vs no NAC 26.7%) (both P < .001). CONCLUSION PG may be an alternative surgical approach to TG in well-selected patients with proximal GC after administration of preoperative systemic chemotherapy.
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Affiliation(s)
- Karol Rawicz-Pruszyński
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States; Department of Surgical Oncology, Medical University of Lublin, Poland
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Diamantis Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Poland
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States.
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12
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Imai Y, Tanaka R, Matsuo K, Asakuma M, Lee SW. Oncological relevance of proximal gastrectomy in advanced gastric cancer of upper third of the stomach. Surg Open Sci 2024; 18:23-27. [PMID: 38312305 PMCID: PMC10832503 DOI: 10.1016/j.sopen.2024.01.003] [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: 08/27/2023] [Revised: 11/22/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Background The oncological relevance of proximal gastrectomy in advanced gastric cancer remains unclear. We aimed to examine the frequency of lymph node metastasis in advanced gastric cancer to determine the oncological validity of proximal gastrectomy selection. Materials and methods This study included consecutive 71 patients with locally advanced gastric cancer in the upper third of the stomach who underwent total gastrectomy at our institution between 2001 and 2017. Lymph node metastasis and its therapeutic value index were examined to identify candidates for proximal gastrectomy. Metastatic and 3-year overall survival rates of numbers 3a and 3b lymph nodes were examined from 2010 to 2019. Results The metastatic rate and therapeutic value index of numbers 4d, 5, 6, and 12a lymph nodes were zero or low. The number 3 lymph node had a metastatic rate and therapeutic value index of 36.6 % and 31.1, respectively. The metastatic and 3-year overall survival rates of the number 3a lymph node were 32.7 % and 89 %, respectively, whereas those of the number 3b lymph node were 3.8 % and 100 %, respectively. All patients with positive metastasis to the number 3b lymph node received adjuvant chemotherapy. Histopathological findings of positive metastasis to the number 3b lymph node were located in the lesser curvature, and the tumor diameter exceeded 40 mm. Conclusion For advanced gastric cancer of the upper third of the stomach, the indications of localization to the lesser curvature and a tumor diameter of >40 mm should be considered cautiously.
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Affiliation(s)
- Yoshiro Imai
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Ryo Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Kentaro Matsuo
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Mitsuhiro Asakuma
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
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13
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Chen Y, Chen X, Lin Y, Zhang S, Zhou Z, Peng J. Oncological risk of proximal gastrectomy for proximal advanced gastric cancer after neoadjuvant chemotherapy. BMC Cancer 2024; 24:255. [PMID: 38395845 PMCID: PMC10885455 DOI: 10.1186/s12885-024-11993-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE This study assesses the metastasis rate of the key distal lymph nodes (KDLN) that are not routinely dissected in proximal gastrectomy, aiming to explore the oncological safety of proximal gastrectomy for upper gastric cancer who underwent neoadjuvant chemotherapy. METHODS We analyzed a cohort of 150 patients with proximal locally advanced gastric cancer (cT3/4 before chemotherapy) from two high-volume cancer centers in China who received preoperative neoadjuvant chemotherapy (NAC) and total gastrectomy with lymph node dissection. Metastasis rate of the KDLN (No.5/6/12a) and the risk factors were analyzed. RESULTS Key distal lymph node metastasis was detected in 10% (15/150) of patients, with a metastasis rate of 6% (9/150) in No. 5 lymph nodes, 6.7% (10/150) in No. 6 lymph nodes, and 2.7% (2/75) in No. 12a lymph nodes. The therapeutic value index of KDLN as one entity is 5.8. Tumor length showed no correlation with KDLN metastasis, while tumor regression grade (TRG) emerged as an independent risk factor (OR: 1.47; p-value: 0.04). Of those with TRG3 (no response to NAC), 80% (12/15) was found with KDLN metastasis. CONCLUSION For cT3/4 proximal locally advanced gastric cancer patients, the risk of KDLN metastasis remains notably high even after NAC. Therefore, proximal gastrectomy is not recommended; instead, total gastrectomy with thorough distal lymphadenectomy is the preferred surgical approach.
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Affiliation(s)
- Yonghe Chen
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, 510655, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, Chinaf, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, China
| | - Xiaojiang Chen
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, China
| | - Yi Lin
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, 510655, Guangzhou, China
| | - Shenyan Zhang
- Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, China
| | - Zhiwei Zhou
- Department of Gastric Surgery, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, China.
| | - Junsheng Peng
- Department of General Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, 510655, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, Chinaf, China.
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, 510655, Guangzhou, China.
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14
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Yamashita H, Toyota K, Kunisaki C, Seshimo A, Etoh T, Ogawa R, Baba H, Demura K, Kaida S, Oshio A, Nakada K. Current status of gastrectomy and reconstruction types for patients with proximal gastric cancer in Japan. Asian J Surg 2023; 46:4344-4351. [PMID: 36464591 DOI: 10.1016/j.asjsur.2022.11.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/20/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Surgical procedures for proximal gastric cancer remain a highly debated topic. Total gastrectomy (TG) is widely accepted as a standard radical surgery. However, subtotal esophagectomy, proximal gastrectomy (PG) or even subtotal gastrectomy, when a small upper portion of the stomach can technically be preserved, are alternatives in current clinical practice. METHODS Using a cohort of the PGSAS NEXT trial, consisting of 1909 patients responding to a questionnaire sent to 70 institutions between July 2018 and December 2019, gastrectomy type, reconstruction method, and furthermore the remnant stomach size and the anti-reflux procedures for PG were evaluated. RESULTS TG was the procedure most commonly performed (63.0%), followed by PG (33.4%). Roux-en-Y was preferentially employed following TG irrespective of esophageal tumor invasion, while jejunal pouch was adopted in 8.5% of cases with an abdominal esophageal stump. Esophagogastrostomy was most commonly selected after PG, followed by the double-tract method. The former was preferentially employed for larger remnant stomachs (≧3/4), while being used slightly less often for tumors with as compared to those without esophageal invasion in cases with a remnant stomach 2/3 the size of the original stomach. Application of the double-tract method gradually increased as the remnant stomach size decreased. Anti-reflux procedures following esophagogastrostomy varied markedly. CONCLUSIONS TG is the mainstream and PG remains an alternative in current Japanese clinical practice for proximal gastric cancer. Remnant stomach size and esophageal stump location appear to influence the choice of reconstruction method following PG.
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Affiliation(s)
- Hiroharu Yamashita
- Department of Digestive Surgery, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan.
| | - Kazuhiro Toyota
- Department of Surgery, Hiroshima Memorial Hospital, 1-4-3, Honkawa-cho, Naka-ku, Hiroshima, Hiroshima, Japan
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Akiyoshi Seshimo
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasamamachi, Yufu City, Oita, Japan
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Banchi Kawasumi cho, Mizuho, Nagoya, Aichi, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1, Honjyo, Chuo-ku, Kumamoto, Japan
| | - Koichi Demura
- Department of Surgery, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, Japan
| | - Atsushi Oshio
- Faculty of Letters, Arts and Sciences, Waseda University, 1-24-1 Toyama, Shinjuku, Tokyo, Japan
| | - Koji Nakada
- Department of Laboratory Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, Japan
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15
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Harada H, Hayami M, Makuuchi R, Ida S, Kumagai K, Ohashi M, Nunobe S. A sandwiching method that simplifies hepatic left lateral segment inversion to secure an optimal surgical view around the esophageal hiatus in laparoscopic and robotic gastrectomy for upper gastric and esophagogastric junction cancers. Langenbecks Arch Surg 2023; 408:159. [PMID: 37093285 DOI: 10.1007/s00423-023-02901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE In laparoscopic surgery for upper gastric and esophagogastric junction (EGJ) cancer, it is important to achieve optimal exposure of the esophageal hiatus to secure an appropriate workspace. In recent years, hepatic left lateral segment (HLLS) inversion has been used to achieve an optimal surgical field. We present a simple technique to perform a modified HLLS inversion. METHODS As a simple modified method, suturing a 2-0 straight needle to the peritoneum of the round ligament and pulling it to the outside of the abdominal cavity, the falciform, left triangular, and coronary ligaments were dissected. The HLLS was inverted by moving it to the right through the space of the transected falciform ligament. By ligating the thread through the round ligament, the HLLS was sandwiched between the rest of the liver and abdominal wall. The short-term surgical outcomes of patient who underwent simple modified HLLS inversion were retrospectively reviewed. RESULTS This study investigated consecutive 24 patients who underwent laparoscopic proximal and total gastrectomies using the simple modified HLLS inversion technique between June 2021 and April 2022. This series of procedures could be completed in approximately 16 min. A Nathanson liver retractor was used in three patients due to difficulties in completing the HLLS inversion in our institution. Postoperative serum liver enzyme levels indicated there was a small effect on the liver. CONCLUSIONS The simple modified HLLS inversion technique may be a safe and useful procedure and can provide an enhanced surgical field during laparoscopic surgery for upper gastric and EGJ cancers.
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Affiliation(s)
- Hiroki Harada
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
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16
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Hipp J, Hillebrecht HC, Kalkum E, Klotz R, Kuvendjiska J, Martini V, Fichtner-Feigl S, Diener MK. Systematic review and meta-analysis comparing proximal gastrectomy with double-tract-reconstruction and total gastrectomy in gastric and gastroesophageal junction cancer patients: Still no sufficient evidence for clinical decision-making. Surgery 2023; 173:957-967. [PMID: 36543733 DOI: 10.1016/j.surg.2022.11.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND To compare proximal gastrectomy with double-tract reconstruction and total gastrectomy in patients with gastroesophageal junction (AEG II-III) and gastric cancer. METHODS We conducted systematic searches in Medline, Web of Science, and Cochrane Library until December 20, 2021 (PROSPERO registration number: CRD42021291500). Risk of bias was assessed using the revised Cochrane risk of bias tool and the ROBINS-I tool, as applicable. Evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS One randomized controlled trial (RCT) and 13 non-RCTs with 1,317 patients (715 patients with total gastrectomy and 602 patients with proximal gastrectomy with double-tract reconstruction) were included. Patients treated by total gastrectomy had a significantly higher proportion of advanced cancer stages International Union Against Cancer IB-III (odds ratio: 0.68, 95% confidence interval: 0.51-0.91, P = .01). This heterogeneity biases the observed improved overall survival of patients after proximal gastrectomy with double-tract reconstruction (odds ratio: 0.67, 95% confidence interval: 0.44-1.01, P = .05). Both procedures were comparably efficient regarding perioperative parameters. Postoperative/preoperative bodyweight ratio (mean difference: 3.56, 95% confidence interval: 1.32-5.79, P = .002), postoperative/preoperative serum-hemoglobin ratio (mean difference 3.73, 95% confidence interval: 1.59-5.88, P < .001), and postoperative serum vitamin B12 levels (mean difference 42.46, 95% confidence interval: 6.37-78.55, P = .02) were superior after proximal gastrectomy with double-tract reconstruction, while postoperative/preoperative serum-albumin ratio (mean difference 1.24, 95% confidence interval: -4.76 to 7.24, P = .69) and postoperative/preoperative serum total protein ratio (mean difference 1.12, 95% confidence interval: -2.77 to 5.00, P = .57) were not different. Health-related quality of life data were reported in only 2 studies, which found no significant advantages for proximal gastrectomy with double-tract reconstruction. CONCLUSION Proximal gastrectomy with double-tract reconstruction offers advantages in postoperative nutritional parameters compared to total gastrectomy (GRADE: moderate quality of evidence). Oncological effectiveness of proximal gastrectomy with double-tract reconstruction cannot be assessed (GRADE: very low quality of evidence). Further thoroughly planned randomized controlled trials in Western patient cohorts are necessary to improve treatment for gastric cancer patients.
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Affiliation(s)
- Julian Hipp
- Department of General and Visceral Surgery, Medical Centre-University of Freiburg, Germany
| | | | - Eva Kalkum
- Study Centre of the German Society of Surgery (SDGC), University of Heidelberg, Germany
| | - Rosa Klotz
- Study Centre of the German Society of Surgery (SDGC), University of Heidelberg, Germany
| | - Jasmina Kuvendjiska
- Department of General and Visceral Surgery, Medical Centre-University of Freiburg, Germany
| | - Verena Martini
- Department of General and Visceral Surgery, Medical Centre-University of Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Centre-University of Freiburg, Germany
| | - Markus K Diener
- Department of General and Visceral Surgery, Medical Centre-University of Freiburg, Germany.
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17
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Kano Y, Ohashi M, Nunobe S. Laparoscopic Function-Preserving Gastrectomy for Proximal Gastric Cancer or Esophagogastric Junction Cancer: A Narrative Review. Cancers (Basel) 2023; 15:311. [PMID: 36612308 PMCID: PMC9818997 DOI: 10.3390/cancers15010311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Function-preserving procedures to maintain postoperative quality of life are an important aspect of treatment for early gastric cancer. Laparoscopic proximal gastrectomy (LPG) and laparoscopic distal gastrectomy with a small remnant stomach, namely laparoscopic subtotal gastrectomy (LsTG), are alternative function-preserving procedures for laparoscopic total gastrectomy of early proximal gastric cancer. In LPG, esophagogastrostomy with techniques to prevent reflux and double-tract and jejunal interposition including esophagojejunostomy is usually chosen for reconstruction. The double-flap technique is currently a preferred reconstruction technique in Japan as an esophagogastrostomy approach to prevent reflux esophagitis. However, standardized reconstruction methods after LPG have not yet been established. In LsTG, preservation of the esophagogastric junction and the fundus prevents reflux and malnutrition, which may maintain quality of life. However, whether LsTG is an oncologically and nutritionally acceptable procedure compared with laparoscopic total gastrectomy or LPG is a concern. In this review, we summarize the status of reconstruction in LPG and the oncological and nutritional aspects of LsTG as a function-preserving gastrectomy for early proximal gastric or esophagogastric junction cancer.
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Affiliation(s)
- Yosuke Kano
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
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18
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Kolozsi P, Varga Z, Toth D. Indications and technical aspects of proximal gastrectomy. Front Surg 2023; 10:1115139. [PMID: 36874448 PMCID: PMC9978003 DOI: 10.3389/fsurg.2023.1115139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
According to the World Health Organization, gastric cancer is the fifth most common type of tumor, and is the third most common cause of tumor-associated death. Although gastric cancer incidence rates have decreased in the past few decades, the prevalence of proximal gastric cancer has been steadily rising in developed countries. Techniques regarding the improvement of treatment options must thus be developed. This can be achieved through incorporating both a wider use of endoscopic surgery (endoscopic mucosal resection-EMR, endoscopic submucosal dissection-ESD) and a review of applied surgical interventions. Even though there is no single international consensus available, the Japanese Gastric Cancer Association (JGCA) recommends proximal gastrectomy with D1+ lymphadenectomy in early gastric tumors. Despite recommendations from Asian guidelines and the short term outcomes of the KLASS 05 trial, surgical treatments in Western countries still rely on total gastrectomy. This is mostly due to technical and oncological challenges regarding surgical interventions in a proximal gastrectomy. However, the residual stomach after a proximal gastrectomy has been shown to diminish the incidence of dumping syndrome and anemia, and even improve postoperative quality of life (QoL). Therefore, it is necessary to define the place of proximal gastrectomy in the treatment of gastric cancers.
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Affiliation(s)
- Peter Kolozsi
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Zsolt Varga
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Dezso Toth
- Department of Surgery, University of Debrecen, Debrecen, Hungary
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19
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Ding S, Zheng X, Wang S, Wu M, Wu Y, Sun C, Yang L, Xue L, Wang B, Wang C, Xie Y. Long-term nutritional status after total gastrectomy was comparable to proximal gastrectomy but with much less reflux esophagitis and anastomotic stenosis. Front Oncol 2022; 12:973902. [PMID: 36387202 PMCID: PMC9641152 DOI: 10.3389/fonc.2022.973902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/20/2022] [Indexed: 08/30/2023] Open
Abstract
AIM To compare the long-term nutritional status, reflux esophagitis and anastomotic stenosis, between total gastrectomy (TG) and proximal gastrectomy (PG). METHODS Patients who underwent PG or TG in this single institution between January 2014 and December 2016 were included in this study. The inclusion and exclusion criteria were defined. One-to-one propensity score matching (PSM) by the demographic and pathological characteristics was performed to compare the long-term outcomes between the two groups. The primary endpoint was long-term nutritional status, and the second endpoints were reflux esophagitis and anastomotic stenosis. Long-term nutritional status was valued by percentage of body mass index (%BMI), body weight, and blood test including total protein, prealbumin, hemoglobin and total leukocytes. RESULTS Totally 460 patients received PG or TG in our institution for the treatment between January 2014 and December 2016 and according to the inclusion and exclusion criteria 226 cases were included in this study finally. There was no significant difference as to nutritional status in the end of first 5 years after PG or TG. While reflux esophagitis and anastomotic stenosis were significantly higher in the PG group than in the TG group (54.4% versus 26.8%, p < 0.001; 14.9% versus 4.5%, p=0.015; respectively). Overall survival rates were similar between the two groups after PSM (5-year survival rates: 65.4% versus 61.5% in the PG and TG groups, respectively; p = 0.54). The rate of carcinoma of remnant stomach after PG was 3.5% in this group of patients. CONCLUSIONS TG should be more aggressively recommended for the similar nutritional status, significantly lower reflux esophagitis and anastomotic stenosis, and free of carcinoma of remnant stomach compared with PG.
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Affiliation(s)
- Shikang Ding
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohao Zheng
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shenghui Wang
- Department of General Surgery, Civil Aviation General Hospital, Beijing, China
| | - Ming Wu
- Department of Gastrointestinal Surgery, Yun Cheng Center Hospital, Yuncheng, China
| | - Yunzi Wu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunyang Sun
- Department of General Surgery, The Central Hospital of Jia Mu Si City, Jiamusi, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chengfeng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yibin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China
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Signature and Prediction of Perigastric Lymph Node Metastasis in Patients with Gastric Cancer and Total Gastrectomy: Is Total Gastrectomy Always Necessary? Cancers (Basel) 2022; 14:cancers14143409. [PMID: 35884470 PMCID: PMC9319199 DOI: 10.3390/cancers14143409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The signature and prediction of perigastric lymph node metastasis (pLNM) is clinically important, but evidence is still lacking. Here, we aimed to identify an informative signature for the prediction of pLNMs in gastric cancer patients after total gastrectomy, and reassess the current indications for proximal gastrectomy and pylorus-preserving gastrectomy (PPG). We found that proximal gastrectomy may be expanded to patients with stage T1–T2 GC and/or tumor diameter < 4 cm in the upper-third stomach, while PPG may be expanded to include T1–T2/N0 and/or tumors < 4 cm in the middle-third stomach. Furthermore, we developed a new predictive factor, the shortest distance from the pylorus ring to the distal edge of the tumor, which showed good predictive performance for pLNMs. Abstract Background: A growing number of studies suggest that the current indications for partial gastrectomy, including proximal gastrectomy and pylorus-preserving gastrectomy (PPG), may be expanded, but evidence is still lacking. Methods: We retrospectively analyzed 300 patients with gastric cancer (GC) who underwent total gastrectomy. We analyzed the incidence of pLNMs in relation to tumor location, tumor size and T stage. We further identified predictive factors for perigastric lymph node metastasis (pLNM) in stations 1, 2, 3, 4sa, 4sb, 4d, 5, and 6. Results: No patients with upper-third T1–T2 stage GC had pLNMs in stations 4sa, 4sb, 4d, 5, or 6, but 3.8% of patients with stage T3 had 4d pLNM. No patients with upper-third GC < 4 cm in diameter had pLNMs in 2, 4sa, 4d, 5, or 6, and 2.3% of patients had pLNMs in 4sb. For middle-third GCs, 2.9% of patients with T1 stage had pLNMs in 4sa and 5, but no patients with T2 stage or tumors < 4 cm had pLNMs in 2, 4sa, or 5. The shortest distance from pylorus ring to distal edge of tumor (sDPD) was a new predictive factor for pLNMs in 2, 4d, 5, and 6. Conclusions: Proximal gastrectomy may be expanded to patients with stage T1–T2 GC and/or tumor diameter < 4 cm in the upper-third stomach, whereas PPG may be expanded to include T1–T2/N0 and/or tumors < 4 cm in the middle-third stomach. A new predictive factor, sDPD, showed good predictive performance for pLNMs, especially in stations 4d, 5, and 6.
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Yang X, Zheng Y, Feng R, Zhu Z, Yan M, Li C. Feasibility of Preserving No. 5 and No. 6 Lymph Nodes in Gastrectomy of Proximal Gastric Adenocarcinoma: A Retrospective Analysis of 395 Patients. Front Oncol 2022; 12:810509. [PMID: 35296021 PMCID: PMC8919512 DOI: 10.3389/fonc.2022.810509] [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] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/31/2022] [Indexed: 12/17/2022] Open
Abstract
Objective The extent of regional lymphadenectomy for proximal gastric cancer (PGC) has remained a controversy and a matter of considerable debate for a long time. We retrospectively analyzed the clinicopathological features to investigate the predictive factors for No. 5 and/or No. 6 lymph node metastases (LNMs) and evaluate the feasibility of performing proximal gastrectomy (PG) with preservation of No. 5 and/or No. 6 lymph nodes for these patients. Method Patients who had undergone total gastrectomy plus D2 lymphadenectomy in the Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, from January 2008 to December 2017 were retrospectively collected and analyzed. Results Among the 395 eligible patients in our study, 34 patients (8.61%) had No. 5 and No. 6 LNM. The degree of differentiation, Borrmann classification, vascular or perineural invasion, tumor diameter, depth of invasion, and other perigastric LNM were associated with No. 5 and/or No. 6 LNM. Multivariate analyses showed that tumor diameter ≥4 cm, No. 4 LNM positive, and No. 7, No. 8, No. 9 LNM positive were independent risk factors of No. 5 and/or No. 6 LNM. No. 5 and/or No. 6 LNM was not observed in the 105 patients who were staged from T1 to T3 and were found to be without independent risk factors. Conclusion The metastatic rate of No. 5 and/or No. 6 lymph node of the proximal gastric adenocarcinoma was closely associated with the diameter of the tumor and other perigastric LNMs. It is feasible to preserve No. 5 and No. 6 lymph nodes with PG for the T1-T3 patients with lower risk of No. 5 and/or No. 6 LNM.
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Affiliation(s)
- Xiao Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai, China.,Department of Gastrointestinal and Hernia Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanan Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai, China
| | - Runhua Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai, China
| | - Zhenggang Zhu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai, China
| | - Min Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai, China
| | - Chen Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Institute of Digestive Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai, China
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