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Jing S, Chen H, Bao L, Lyu R, Xu B, Pu L, Bian X, Tao L, Wang M. Effects of perioperative ω-3 fish oil fat emulsion on postoperative gastric emptying function following Roux-en-Y reconstruction for gastric cancer. J Gastrointest Surg 2025; 29:102066. [PMID: 40268084 DOI: 10.1016/j.gassur.2025.102066] [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: 01/15/2025] [Revised: 04/12/2025] [Accepted: 04/14/2025] [Indexed: 04/25/2025]
Abstract
PURPOSE Despite standardized surgical techniques, delayed gastric emptying (DGE) remains a major complication after Roux-en-Y reconstruction in patients with gastric cancer. This study aimed to evaluate the efficacy of ω-3 fish oil fat emulsion in reducing DGE incidence and improving postoperative outcomes. METHODS In this retrospective cohort study, 210 patients undergoing radical gastrectomy with Roux-en-Y reconstruction (Nanjing Drum Tower Hospital, 2018-2020) were stratified into 2 groups: the intervention group (n = 139) received parenteral nutrition (PN) with ω-3 fish oil emulsion (0.2 g/kg/d), whereas controls (n = 71) received standard PN. DGE diagnosis required persistent symptoms (>72 h postoperatively) and objective evidence of impaired motility (computed tomography contrast retention ≥ 50% at 4 h or scintigraphic T½ > 90 min), excluding mechanical obstructions (luminal stenosis < 8 mm). RESULTS The ω-3 group exhibited significantly lower DGE incidence (4.3% vs 15.5%; P =.005) and shorter median postoperative hospital stay (10 vs 13 days; P <.001). Multivariate analysis identified ω-3 supplementation as an independent protective factor against DGE (odds ratio, 0.32; 95% CI, 0.11-0.96; P =.042). Symptom severity (Gastroparesis Cardinal Symptom Index) showed progressive improvement in the ω-3 cohort, with significant reductions in nausea and vomiting scores by week 4 (P <.05). CONCLUSION Perioperative ω-3 fish oil fat emulsion supplementation reduces DGE risk by 71%, accelerates recovery, and improves surgical outcomes in patients with gastric cancer undergoing Roux-en-Y reconstruction. These findings support its integration into enhanced recovery protocols, particularly in high-risk populations.
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Affiliation(s)
- Siqing Jing
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hao Chen
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Linsen Bao
- Department of Pediatric and Hernia Abdominal Wall Surgery, The Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, Anhui Province, China
| | - Ruohan Lyu
- Department of Statistics, Beijing Forestry University, Beijing, China
| | - Boqi Xu
- Department of General Surgery, Suzhou Municipal Hospital, Suzhou, China
| | - Lingxiao Pu
- Department of General Surgery Ⅰ, Jiangyin People's Hospital, Affiliated Jiangyin Hospital of Nantong University, Jiangyin, Jiangsu, China
| | - Xiaojie Bian
- Department of Pharmacy, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Liang Tao
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
| | - Meng Wang
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Ye YX, Wu CY, Chen LQ, Wu SJ, Ye K. Controversies and consensus surrounding laparoscopic pylorus-preserving gastrectomy for early gastric cancer. World J Gastrointest Surg 2025; 17:105295. [DOI: 10.4240/wjgs.v17.i5.105295] [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: 01/17/2025] [Revised: 02/28/2025] [Accepted: 03/10/2025] [Indexed: 05/23/2025] Open
Abstract
In recent years, the detection rate of early gastric cancer in China has significantly increased. Early gastric cancer is associated with a favourable prognosis; thus, enhancing the postoperative quality of life for patients has become an increasingly pressing issue in treating gastric cancer. Consequently, function-preserving gastrectomy has emerged as a viable option. This surgical approach aims to minimize the extent of resection while preserving some gastric function, all within the framework of radical tumour excision. Pylorus-preserving gastrectomy (PPG) serves as a representative example of a function-preserving technique and is particularly suitable for early-stage gastric cancer of the middle segment of the stomach. Compared with distal gastrectomy, laparoscopic PPG offers several advantages: (1) Results in less surgical trauma; and (2) Reduces the incidence of postoperative complications such as dumping syndrome, bile reflux gastritis, and gallstones while also improving nutritional status postsurgery. However, the implementation of PPG remains contentious within the medical community. In light of new Japanese guidelines for gastric cancer treatment and informed by current research trends along with relevant evidence-based medicine principles, this review examines various aspects related to laparoscopic PPG, including its definition and indications, safety profile, benefits, technical considerations, methods for digestive tract reconstruction and postoperative complications.
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Affiliation(s)
- Ying-Xuan Ye
- School of Medicine, South China University of Technology, Guangzhou 510000, Guangdong Province, China
| | - Chu-Ying Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Li-Quan Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Si-Jia Wu
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Xia X, Zhang P, Yu F, Zhao G, Zhao E, Zhang Z, Zhu C. Long-term outcomes and quality of life of laparoscopic-assisted pylorus-preserving gastrectomy compared to laparoscopic-assisted distal gastrectomy with billroth I anastomosis for early gastric cancer(pT1N0M0): A Randomized Controlled Trial. Am J Surg 2025; 245:116349. [PMID: 40318389 DOI: 10.1016/j.amjsurg.2025.116349] [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: 01/10/2025] [Revised: 04/06/2025] [Accepted: 04/10/2025] [Indexed: 05/07/2025]
Abstract
OBJECTIVE Clarify the long-term outcomes of laparoscopic-assisted pylorus-preserving gastrectomy (LAPPG) compared to conventional laparoscopic-assisted distal gastrectomy with billroth I anastomosis (LADGBI) for early gastric cancer(pT1N0M0). METHODS Patients with cT1N0M0 cancer located in the middle third of the stomach and not suitable for endoscopic submucosal dissection were randomized to undergo LAPPG or LADGBI. RESULTS Between August 2017 and October 2019, a total 88 patients (pT1N0M0) were analyzed. The 5-year overall survival rate and disease-free survival rate were 95.5 % and 93.2 % for LAPPG and 93.2 % (P = 0.46) and 91.0 % (P = 0.64) for LADGBI. During postoperative 5-year follow up, LAPPG tended to present better functions and less symptoms scales than LADGBI accompanied by effective gallbladder emptying and pylorus function preserving. CONCLUSION Surgical and oncological outcomes was comparable in pT1N0M0 patients undergoing LAPPG and LADGBI. LAPPG had advantages in long-term QOL over LADGBI in terms of C30 and STO22 questionnaire.
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Affiliation(s)
- Xiang Xia
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Puhua Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fengrong Yu
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Zhao
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Enhao Zhao
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Zizhen Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Chunchao Zhu
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Chen H, Jing S, Li Z, Cao L, Guan W, Chen X, Wang M. Impact of distal or pylorus preserving gastrectomy on postoperative quality of life in T1 stage middle third gastric cancer patients. Sci Rep 2025; 15:8632. [PMID: 40082480 PMCID: PMC11906802 DOI: 10.1038/s41598-025-90866-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 02/17/2025] [Indexed: 03/16/2025] Open
Abstract
Pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) are widely utilized surgical approaches for the treatment of gastric cancer. In this study, we employed questionnaire surveys and follow-up assessments to examine the effects of these surgical procedures on postoperative quality of life and pancreatic exocrine function in patients with stage T1 middle-third gastric cancer. A retrospective cohort study was conducted to analyze clinical and follow-up data from 63 gastric cancer patients who underwent distal gastrectomy and 21 who underwent pylorus-preserving gastrectomy at Nanjing University Drum Tower Hospital between January 2019 and January 2023. Patients were categorized into two groups: distal gastrectomy (n = 63) and pylorus-preserving gastrectomy (n = 21). The primary outcome measure was postoperative quality of life assessed at 1 year using the Gastric Resection Syndrome Assessment Scale, Gastroparesis Cardinal Symptom Index (GSCI), and Pancreatic Exocrine Insufficiency Questionnaire (PEI-Q). Secondary outcomes included intraoperative and postoperative conditions, incidence of complications, and changes in nutritional status at 6 and 12 months post-surgery. Compared to the DG group, the PPG group exhibited fewer lymph node dissections [20 (17, 26) vs. 25 (19.5, 32), Z = 2.013, P = 0.052], shorter distances from the upper resection margin [2.0 (1.3, 3.0) vs. 3.5 (2.5, 4.75), Z = 4.664, P = 0.0002], and shorter distances from the lower resection margin [2.0 (1.4, 3.0) vs. 4.5 (4.0, 5.5), Z = 6.691, P < 0.001]. However, they experienced longer operative times [270 (240, 300) vs. 220 (187.5, 257.5), Z = 4.133, P = 0.0002], postoperative gas discharge times [4 (4, 5) vs. 4 (3, 4), Z = 5.96, P < 0.0001], and postoperative hospital stays [12 (10, 14) vs. 10 (9, 12), Z = 1.493, P = 0.0098]. One year postoperatively, patients in the PPG group demonstrated superior quality of life scores compared to the DG group in terms of the dumping symptom scale [1.0 (1.0, 1.33) vs. 2.5 (1.75, 2.5), Z = 7.192, P < 0.001], amount of food intake per meal [6 (6, 7) vs. 6 (4, 6), Z = 4.724, P = 0.0008], and meal quality scale [4.0 (3.67, 4.0) vs. 2.33 (1.67, 2.67), Z = 11.554, P < 0.0001]. Additionally, preoperative serum albumin levels were higher in the PPG group compared to the DG group [41.7 (40.3, 43) vs. 40.2 (39.15, 41.3), Z = 2.916, P = 0.006], and the PPG group had a lower rate of postoperative chemotherapy requirement (P = 0.024). Compared to distal gastrectomy (DG), pylorus-preserving gastrectomy (PPG) results in fewer dumping symptoms and an improved quality of life for patients following surgery. This makes PPG a highly favorable surgical option for treating stage T1 middle-third gastric cancer.
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Affiliation(s)
- Hao Chen
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Siqing Jing
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Zhaoping Li
- Division of Gastric Surgery, Department of General Surgery, Drum Tower Clinical Medical College, Nanjing Drum Tower Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lianlian Cao
- Division of Gastric Surgery, Department of General Surgery, Drum Tower Clinical Medical College, Nanjing Drum Tower Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenxian Guan
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China
| | - Xin Chen
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
| | - Meng Wang
- Division of Gastric Surgery, Department of General Surgery, Affiliated Hospital of Medical School, Nanjing Drum Tower Hospital, Nanjing University, Nanjing, China.
- Division of Gastric Surgery, Department of General Surgery, Drum Tower Clinical Medical College, Nanjing Drum Tower Hospital, Nanjing University of Chinese Medicine, Nanjing, China.
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Zhang HY, Aimaiti M, Bai L, Yuan MQ, Zhu CC, Yan JJ, Cai JH, Dong ZY, Zhang ZZ. Bi-phase CT radiomics nomogram for the preoperative prediction of pylorus lymph node metastasis in non-pyloric gastric cancer patients. Abdom Radiol (NY) 2025; 50:608-618. [PMID: 39225717 DOI: 10.1007/s00261-024-04537-9] [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: 06/08/2024] [Revised: 08/12/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The expansion of function-preserving surgery became possible due to a more profound understanding of gastric cancer (GC), and T1N + or T2N + gastric cancer patients might be potential beneficiaries. However, ways to evaluate the possibility of function-preserving pylorus surgery are still unknown. METHODS A total of 288 patients at Renji Hospital and 58 patients at Huadong Hospital, pathologically diagnosed with gastric cancer staging at T1 and T2 with tumors located in the upper two-thirds of the stomach, were retrospectively enrolled from March 2015 to October 2022. Tumor regions of interest (ROIs) were manually delineated on bi-phase CT images, and a nomogram was built and evaluated. RESULTS The radiomic features distributed differently between positive and negative pLNm groups. Two radiomic signatures (RS1 and RS2) and one clinical signature were constructed. The radiomic signatures exhibited good performance for discriminating pLNm status in the test set. The three signatures were then combined into an integrated nomogram (IN). The IN showed good discrimination of pLNm in the Renji cohort (AUC 0.918) and the Huadong cohort (AUC 0.649). The verification models showed high values. CONCLUSION For GC patients with T1 and T2 tumors located in the upper two-thirds of the stomach, a nomogram was successfully built for predicting pylorus lymph node metastasis, which would guide the surgical indication extension of conservative gastrectomies.
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Affiliation(s)
- Hao-Yu Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Muerzhate Aimaiti
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Long Bai
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meng-Qing Yuan
- The Hongkong University of Science and Technology, Hongkong, China
| | - Chun-Chao Zhu
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jia-Jun Yan
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Hua Cai
- Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| | - Zhong-Yi Dong
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Zi-Zhen Zhang
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Ito N, Tsujimoto H, Kumano I, Fujishima S, Kariya R, Uehata N, Fukuoka Y, Suzuki T, Itazaki Y, Horiguchi H, Yaguchi Y, Ueno H. Significance of resected stomach measurements in postoperative delayed gastric emptying following laparoscopic pylorus-preserving gastrectomy. Asian J Endosc Surg 2024; 17:e13392. [PMID: 39379049 DOI: 10.1111/ases.13392] [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: 08/19/2024] [Revised: 09/18/2024] [Accepted: 09/22/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE We investigated the relationship between the resected stomach measurements, the incidence of delayed gastric emptying (DGE), and food residue 1 year after surgery in patients who underwent laparoscopic pylorus-preserving gastrectomy (PPG). MATERIALS AND METHODS The DGE group included 10 patients fasting due to nausea, vomiting, abdominal distension, or remnant stomach distension on radiographs; the control group included 36 patients without these symptoms. We compared the size and length of lesser and greater curvatures of the resected stomach and endoscopic findings after 1 year. RESULTS No significant differences were observed between groups in terms of sex, body mass index, gross type, histology, tumor progression, number of dissected lymph nodes, operating time, or blood loss. The DGE group was older, had a longer postoperative stay, and showed a smaller size and shorter greater curvature of the resected stomach than the control group (p < 0.01 for all). No difference was observed in the length of the lesser curvature of the resected stomach. In addition, there were no disparities in residual food, degree and extent of gastritis, or bile reflux 1 year after gastrectomy. CONCLUSIONS Measurements of the resected stomach suggest that preventing DGE may be achievable by removing a larger area of the greater curvature and/or stomach during laparoscopic PPG. This implies potential surgical strategy improvements for better outcomes. Further multicenter trials are needed to validate and refine techniques.
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Affiliation(s)
- Nozomi Ito
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Isao Kumano
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | | | - Risa Kariya
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Naoyuki Uehata
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yusuke Fukuoka
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Takafumi Suzuki
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yujiro Itazaki
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hiroyuki Horiguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Yoshihisa Yaguchi
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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Jeong SH, Park M, Seo KW, Kim RB, Min JS, Information Committee of the Korean Gastric Cancer Association. A Comparative Study of Postoperative Complications Associated with Distal Gastrectomy and Pylorus-Preserving Gastrectomy among Gastric Cancer Patients Based on Nationwide Survey Data and Propensity Score Weighting. Cancers (Basel) 2024; 16:2203. [PMID: 38927908 PMCID: PMC11202269 DOI: 10.3390/cancers16122203] [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: 04/24/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND/OBJECTIVE This study aimed to compare complication rates between pylorus-preserving gastrectomy (PPG) and distal gastrectomy (DG) using Korean nationwide survey data and propensity score weighting (PSW). PPG preserves gastric function but may lead to more postoperative complications than DG. METHODS AND RESULTS We analyzed 9424 gastric cancer patients who underwent either DG (n = 9183) or PPG (n = 241). PSW balanced variables such as age, sex, TNM stage, comorbidities, ASA score, and surgical approach. Before PSW, 87.8% of DG patients and 87.1% of PPG patients had no complications (p = 0.053). Severe complications (Clavien-Dindo IIIa or higher) were more frequent in PPG (6.6%) than in DG (3.8%) (p = 0.039). After PSW, overall complication rates (p = 0.960) and severe complication rates (p = 0.574) were similar between groups. Incidence rates of anastomotic stricture and leakage were higher in PPG (2.9% and 1.7%) compared to DG (0.6% and 0.5%) (p = 0.001 and 0.036) before PSW, but these differences were not significant after PSW (p = 0.999 and 0.123). CONCLUSION The PSW-adjusted analysis indicates no significant difference in overall and severe complication rates between PPG and DG in gastric cancer patients.
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Affiliation(s)
- Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea;
| | - Miyeong Park
- Department of Anesthesiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea;
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan 49267, Republic of Korea;
| | - Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea;
| | - Jae-Seok Min
- Department of Surgery, Korea University College of Medicine, and Division of Foregut Surgery, Korea University Anam Hospital, Seoul 02841, Republic of Korea
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Harada H, Eto K, Ohashi M, Kurihara N, Ri M, Makuuchi R, Ida S, Hayami M, Kumagai K, Sano T, Nunobe S. Equal short-term outcomes of intracorporeal mechanical gastrogastrostomy in laparoscopic pylorus-preserving gastrectomy for cT1N0 gastric cancer in the middle stomach compared with the extracorporeal hand-sewing method. Surg Endosc 2024; 38:3115-3125. [PMID: 38619559 DOI: 10.1007/s00464-024-10823-w] [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: 01/02/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Intracorporeal mechanical gastrogastrostomy (IMG) techniques have recently been developed and their short-term safety was presented in their initial evaluation. However, whether they are comparable to extracorporeal hand-sewing gastrogastrostomy (EHG) remains unclear. The aim of the study is to establish the safety of IMG in totally laparoscopic pylorus-preserving gastrectomy (TLPPG) compared to EHG in laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG). METHODS We retrospectively analyzed the short-term outcomes of patients with middle-third early gastric cancer who underwent LAPPG or TLPPG between 2005 and 2022. The primary objective of this study was to evaluate the non-inferiority of IMG to EHG in terms of safety, with the primary endpoint being the risk difference in anastomosis-related complications (ARCs). The sample size required to achieve a statistical power of 80% for the non-inferiority test was 971 with a one-sided alpha level of 5% and non-inferiority of 5%. RESULTS The analysis included a total of 1,021 patients who underwent LAPPG or TLPPG during the study period. Among them, 488 patients underwent EHG, while 533 underwent IMG. The incidences of ARCs were 11.3% and 11.4% in EHG and IMG, respectively. The observed difference in incidence was 0.0017 (90% confidence interval - 0.0313 to 0.0345), which statistically demonstrated the non-inferiority of IMG to EHG in the incidence of ARCs. Among other complications, the incidence of wound infection in IMG was lower than that in EHG. CONCLUSION IMG is safe regarding ARCs compared with EHG. These results will encourage surgeons to introduce IMG for patients with early middle gastric cancer.
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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
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, 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.
| | - Nozomi Kurihara
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Motonari Ri
- 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
| | - 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
| | - 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
| | - Takeshi Sano
- 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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Sun KK, Wu YY. Pylorus-preserving gastrectomy for early gastric cancer. World J Gastrointest Oncol 2024; 16:653-658. [PMID: 38577445 PMCID: PMC10989389 DOI: 10.4251/wjgo.v16.i3.653] [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: 12/21/2023] [Revised: 01/15/2024] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Pylorus-preserving gastrectomy (PPG) has been widely accepted as a function-preserving gastrectomy for middle-third early gastric cancer (EGC) with a distal tumor border at least 4 cm proximal to the pylorus. The procedure essentially preserves the function of the pyloric sphincter, which requires to preserve the upper third of the stomach and a pyloric cuff at least 2.5 cm. The suprapyloric and infrapyloric vessels are usually preserved, as are the hepatic and pyloric branches of the vagus nerve. Compared with distal gastrectomy, PPG has significant advantages in preventing dumping syndrome, body weight loss and bile reflux gastritis. The postoperative complications after PPG have reached an acceptable level. PPG can be considered a safe, effective, and superior choice in EGC, and is expected to be extensively performed in the future.
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Affiliation(s)
- Ke-Kang Sun
- Department of Gastrointestinal Surgery, The Affiliated Kunshan Hospital to Jiangsu University, Suzhou 215300, Jiangsu Province, China
| | - Yong-You Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215008, Jiangsu Province, China
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Mitsui T, Saito K, Hakozaki Y, Miwa Y, Noro T, Takeshita E, Urahashi T, Seto Y, Okuyama T, Yoshitomi H. Novel Clean End-to-End Anastomosis Method, Without Opening the Stomach Lumen, in Totally Laparoscopic or Robotic Pylorus-Preserving Gastrectomy. J Gastric Cancer 2023; 23:523-534. [PMID: 37932220 PMCID: PMC10630557 DOI: 10.5230/jgc.2023.23.e33] [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: 07/15/2022] [Revised: 12/02/2022] [Accepted: 01/04/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Intra-abdominal infection is a common postoperative complication of laparoscopic pylorus-preserving gastrectomies (PPGs). Many studies have reported that intra-abdominal infectious complications after gastrectomy adversely affect patient survival outcomes. To prevent gastric fluid leakage into the abdominal cavity, we developed a novel anastomosis method in which the stomach lumen is not opened (termed the non-opened clean end-to-end anastomosis method [NoCEAM]) and evaluated its feasibility. MATERIALS AND METHODS Subsequent to lymphadenectomy, the oral and anal resection lines were sutured using an intraoperative endoscope. After closing the stomach circumferentially with clips, the specimen was rolled outward like a "donut." We resected the specimen circumferentially using a linear stapler, and anastomosis was completed simultaneously. We examined the feasibility of this procedure ex vivo, using three porcine stomachs, and in vivo, using one pig. Subsequently, we applied the procedure to 13 consecutive patients with middle-third early gastric cancer utilizing laparotomic, laparoscopic, and robotic PPG. RESULTS NoCEAM was completed in all porcine models and human cases. In the human cases, the mean operation time (±standard deviation) was 279±51 minutes, and mean blood loss volume was 22±45 mL. The mean number of linear staples used was 5.06±0.76. None of the patients had complications, and all were discharged on the eighth postoperative. The serum total protein, serum albumin, and hemoglobin levels did not change significantly after surgery. CONCLUSIONS NoCEAM is feasible and safe for performing totally laparoscopic or robotic PPG. It may reduce postoperative complications, such as intra-abdominal infections.
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Affiliation(s)
- Takashi Mitsui
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.
| | - Kazuyuki Saito
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yuhei Hakozaki
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yoshiyuki Miwa
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Takuji Noro
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Emiko Takeshita
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Taizen Urahashi
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Okuyama
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideyuki Yoshitomi
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
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Yu Z, Zhao X, Qiu S, Liu N, Li P, Zhou S. Risk Factor Analysis of Gastroparesis Syndrome in 2652 Patients with Radical Distal Gastrectomy. J Gastrointest Surg 2023; 27:1568-1577. [PMID: 37127770 DOI: 10.1007/s11605-022-05538-z] [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: 08/26/2022] [Accepted: 11/13/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the risk factors of postoperative gastroparesis syndrome (PGS) in patients with gastric cancer who underwent radical distal gastrectomy. METHODS The clinical data of 2652 patients with gastric cancer who underwent radical distal gastrectomy in the past 10 years were retrospectively analyzed. Furthermore, the incidence of PGS was set as the dependent variable, and the risk factors for PGS were screened using univariate and multivariate logistic regression analyses. Risk factor analysis for the different digestive tract reconstruction methods was also performed. RESULTS Univariate analysis revealed that preoperative pyloric obstruction (p = 0.001), digestive tract reconstruction (p = 0.001), jejunum nutrition tube application (p = 0.001), intraperitoneal chemotherapy drug application (p = 0.002), age (≥ 66 years or < 66 years) (p = 0.042), operative time (≥ 184.5 min or < 184.5 min) (p = 0.049), and postoperative indwelling catheter time (≥ 4.5 days or < 4.5 days) (p = 0.045) were related to PGS. Multivariate logistic regression analysis showed that preoperative pyloric obstruction (odds ratio (OR) = 2.830, p = 0.004), application of a jejunum nutrition tube (OR = 3.309, p = 0.011), intraperitoneal chemotherapy (OR = 0.482, p = 0.010), and digestive tract reconstruction were independent risk factors for PGS. CONCLUSION This study identified risk factors associated with PGS, which could be further applied in clinical practice.
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Affiliation(s)
- Zhiyuan Yu
- School of Medicine, Nankai University, Weijin Road 94, Nankai District, Tianjin, 300071, China
- Medical School of Chinese PLA, Fuxing Road 28, Haidian District, Beijing, 100039, China
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Xudong Zhao
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Shuzhong Qiu
- Medical School of Chinese PLA, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Na Liu
- Medical School of Chinese PLA, Fuxing Road 28, Haidian District, Beijing, 100039, China
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Peiyu Li
- School of Medicine, Nankai University, Weijin Road 94, Nankai District, Tianjin, 300071, China
- Medical School of Chinese PLA, Fuxing Road 28, Haidian District, Beijing, 100039, China
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China
| | - Sixin Zhou
- Senior Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100039, China.
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12
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Otake R, Kumagai K, Ohashi M, Makuuchi R, Ida S, Sano T, Nunobe S. Reflux Esophagitis After Laparoscopic Pylorus-Preserving Gastrectomy for Gastric Cancer. Ann Surg Oncol 2023; 30:2294-2303. [PMID: 36509874 DOI: 10.1245/s10434-022-12902-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic pylorus-preserving gastrectomy (LPPG) is performed for cT1N0 gastric cancer as a function-preserving surgery, but reflux esophagitis can develop as a mid- to long-term complication postoperatively. We aimed to clarify the incidence rate of this complication and the factors correlated with it. METHODS Patients with gastric cancer who underwent LPPG between 2005 and 2017 were analyzed. Postoperative reflux esophagitis was evaluated with esophagogastroduodenoscopy; patients were diagnosed as having reflux esophagitis with erosive esophagitis using the modified Los Angeles classification. The incidence rate of postoperative reflux esophagitis was estimated; factors correlated with postoperative reflux esophagitis were analyzed using the logistic regression model. RESULTS During the study period, 813 patients underwent LPPG for gastric cancer, and 127 (15.6%) of them developed grade B or more severe postoperative reflux esophagitis. The factors correlated with postoperative reflux esophagitis were male sex (odds ratio, 2.68; 95% confidence interval, 1.77-4.05; P < 0.001), preoperative grade A reflux esophagitis (odds ratio, 3.05; 95% confidence interval, 1.28-7.27; P = 0.012), body mass index of ≥ 23 kg/m2 at 1 year postoperatively (odds ratio, 2.18; 95% confidence interval, 1.34-3.53; P = 0.002), postoperative hiatal hernia (odds ratio, 4.35; 95% confidence interval, 2.35-8.04; P < 0.001), and long-term stasis (odds ratio, 1.58; 95% confidence interval, 1.01-2.47; P = 0.044). CONCLUSIONS Careful attention should be paid in performing LPPG and in postoperative management after LPPG for gastric cancer patients with those risk factors.
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Affiliation(s)
- Reiko Otake
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
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13
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Terayama M, Ohashi M, Makuuchi R, Hayami M, Ida S, Kumagai K, Sano T, Nunobe S. A continuous muscle-sparing advantage of pylorus-preserving gastrectomy for older patients with cT1N0M0 gastric cancer in the middle third of the stomach. Gastric Cancer 2023; 26:145-154. [PMID: 36207477 DOI: 10.1007/s10120-022-01345-2] [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: 07/03/2022] [Accepted: 09/30/2022] [Indexed: 02/07/2023]
Abstract
In older patients with cT1N0M0 gastric cancer in the middle third of the stomach, LPPG has advantages over LDGB1 in maintaining skeletal muscle mass. BACKGROUND Laparoscopic pylorus-preserving gastrectomy (LPPG) for early gastric cancer in the middle third of the stomach is expected to be an alternative procedure to laparoscopic distal gastrectomy (LDG). However, whether LPPG is safe and more useful than LDG in older patients is unclear because of their comorbidities and organ dysfunctions. METHODS We retrospectively analyzed the data of consecutive patients aged 75 or over who underwent LDG with Billroth I reconstruction (LDGB1) or LPPG for cT1N0M0 gastric cancer in the middle third of the stomach between 2005 and 2019. After propensity score matching was used to improve the comparability between the LDGB1 and LPPG groups, we compared surgical and postoperative nutritional outcomes, including the postoperative trends of bodyweight (%BW) and skeletal muscle index (%SMI). RESULTS A total of 132 patients who underwent LDGB1 (n = 88) and LPPG (n = 44) were collected for this study. No significant difference in postoperative complications was observed. The total protein levels after LPPG were significantly higher than those after LDGB1 for 4 postoperative years. Both %BW and %SMI after LPPG were significantly maintained compared with those after LDGB1 during the first year after surgery. For the subsequent years, %BW after LPPG became similar to that after LDGB1, while %SMI after LPPG was significantly larger than LDGB1 continuously. CONCLUSIONS LPPG has a great advantage in maintaining the postoperative skeletal muscle mass as well as the nutritional parameters of older patients. LPPG is expected to be an alternative to LDG in older patients.
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Affiliation(s)
- Masayoshi Terayama
- 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.
| | - 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
| | - 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
| | - 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
| | - Takeshi Sano
- 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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14
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Park JH, Yoon H, Kwak YJ, Wang C, Alzahrani KM, Wang S, Alzahrani FDH, Kim HM, Koo E, Yoo JE, Choi JH, Park SH, Kong SH, Park DJ, Lee HJ, Yang HK. Feasibility and safety of inserting transient biodegradable stents in the pylorus during pylorus-preserving gastrectomy for gastric cancer: a preliminary study in a porcine for proof of concept. Gastric Cancer 2023; 26:155-166. [PMID: 36417001 DOI: 10.1007/s10120-022-01350-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND To evaluate whether insertion of self-biodegradable stent into the pylorus to prevent delayed-gastric emptying after pylorus-preserving gastrectomy is feasible and safe through porcine experiment. METHODS Self-biodegradable dumbbell-shaped pyloric stents were designed from absorbable suture materials: poly(glycolide-co-caprolactone) (PGCL) or poly-p-dioxanone (PPDO). After gastrotomy on ten pigs, each stent was inserted: two shams, four PGCL stents, and four PPDO stents. Body weight (Bwt), body temperature (BT), complete blood cell (CBC) count, and plain X-ray were evaluated. On postoperative day (POD) 13, euthanasia was performed for histologic evaluation. RESULTS Operation was successfully performed in all ten pigs. Without tagging suture, both stents migrated before POD 3. The migration was delayed up to POD 13, when the tagging sutures (-t) were applied between stent and stomach wall. Self-degradation of PGCL started from POD 3, and stents were completely excreted from the abdomen by POD 8. Although PPDO were also weakened as self-degradation progressed, its shape was maintained in gastrointestinal tract for 13 days. Unexpected sudden death occurred in the pig with PPDO-t2 on POD 10, which is more likely due to acute volvulus rather than stent-related complication. There was no significant difference between three groups in terms of Bwt, BT, CBC, and histology (sham vs. PGCL vs. PPDO, all p > 0.05). CONCLUSION The concept of biodegradable stents made of absorbent suture material seems feasible in porcine experiment. Among them, PGCL which has shown rapid absorption, appears to be a more suitable material for transient pyloric absorbable stent when considering safety aspect.
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Affiliation(s)
- Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyesung Yoon
- Samyang Biopharmaceuticals Corp., R&D Center, Seongnam-si, Korea
| | - Yoon Jin Kwak
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Chaojie Wang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Gastrointestinal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Khalid Mohammed Alzahrani
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Taif University, College of Medicine, Taif, Saudi Arabia
| | - Sen Wang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fadhel Dhaifallah H Alzahrani
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Al-Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Hyun Myong Kim
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Eunhee Koo
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Ja Eun Yoo
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Jong-Ho Choi
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Eulji University, Seoul, Korea
| | - Shin-Hoo Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Division of Foregut Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Zhang C, Wei MH, Cao L, Liu YF, Liang P, Hu X. Performing robot-assisted pylorus and vagus nerve-preserving gastrectomy for early gastric cancer: A case series of initial experience. World J Gastrointest Surg 2022; 14:1107-1119. [PMID: 36386400 PMCID: PMC9640333 DOI: 10.4240/wjgs.v14.i10.1107] [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: 02/21/2022] [Revised: 05/15/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pylorus and vagus nerve-preserving gastrectomy (PPG) is a function-preserving surgery for early gastric cancer (GC) that has gained considerable interest in the recent years. The operative technique performed using the Da Vinci Xi robot system is considered ideal for open and laparoscopic surgery.
AIM To introduce Da Vinci Xi robot-assisted PPG (RAPPG)-based operative procedure and technical points as well as report the initial experience based on the clinical pathology data of eight cases of early GC.
METHODS Da Vinci Xi robot-assisted pylorus and vagus nerve-preserving gastrectomy (RAPPG) was performed for 11 consecutive patients with middle GC from December 2020 to July 2021. Outcome measures were postoperative morbidity, operative time, blood loss, number of lymph nodes harvested, postoperative hospital stay, time to first flatus, time to diet, and resection margins.
RESULTS Eight of the 11 patients who were pathologically diagnosed with early GC were enrolled in a retrospective study to assess the feasibility and safety of RAPPG. The mean operative time, mean blood loss, mean number of lymph nodes harvested, length of preserved pylorus canal, distal margin, and proximal margin were 330.63 ± 47.24 min, 57.50 ± 37.70 mL, 18.63 ± 10.57, 3.63 ± 0.88 cm, 3.50 ± 1.31 cm, and 3.63 ± 1.19 cm, respectively. None of the cases required conversion to laparotomy. Postoperative complications occurred in two (25.0%) patients. Postoperative complications were hyperamylasemia and gastric stasis in one case and incision infection in the other. Time to first flatus was 3.75 ± 2.49 d after the operation, and postoperative hospital stay was 10.13 ± 4.55 d.
CONCLUSION The core technique in the Da Vinci Xi RAPPG is lymph node dissection and the anatomic method of the nerve. Robotic surgical procedures are feasible and safe. With the progress of surgical technology, optimization of medical insurance structure, and emergence of evidence-based medicine, automated surgery systems will have a broad application in clinical treatment.
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Affiliation(s)
- Chi Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Mao-Hua Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Liang Cao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Yan-Feng Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Pin Liang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Xiang Hu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Intracorporeal hand-sewn anastomosis following pylorus-preserving gastrectomy: surgical technique and short-term surgical outcome. Langenbecks Arch Surg 2022; 407:1711-1720. [PMID: 35670857 DOI: 10.1007/s00423-022-02575-9] [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: 09/06/2021] [Accepted: 05/29/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although several procedures for mechanical anastomosis have recently been reported, intracorporeal manually hand-sewn anastomosis for totally laparoscopic pylorus-preserving gastrectomy (TLPPG) is considered technically difficult. Here, we report a new technique for laparoscopic reconstruction using hand-sewn sutures. METHODS Together with a proper lymphadenectomy, the stomach was detached and resected using separate two-layer incisions, similar to the original laparotomy method. An approximately 5-cm antral cuff was left in place. The essential concept of this new method was to align the anastomotic site by rotating each clamped gastric stump. This allowed us to perform a secure, hand-sewn, two-layer anastomosis successfully. The short-term surgical outcome after TLPPG was retrospectively compared with that for patients who underwent a conventional laparoscopy-assisted procedure (LAPPG). RESULTS Of the 20 consecutive patients who underwent pylorus-preserving gastrectomy in our department between 2014 and 2021, the first 8 patients and the subsequent 12 patients underwent LAPPG and TLPPG, respectively. The operation time was significantly longer in the TLPPG group (median, 302 vs. 269 min). The morbidity was comparable (8.3% in TLPPG vs. 12.5% in LAPPG). Postoperative delayed gastric emptying was only observed in one patient in the LAPPG group. TLPPG reduced the cost of the operation by reducing the number of linear stapler cartridges required. CONCLUSION A purely hand-sewn gastrogastrostomy is safe, feasible, and cost-effective, and it omits the need for a mini-laparotomy in the upper abdomen.
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Mori M, Shuto K, Hirano A, Narushima K, Kosugi C, Yamazaki M, Koda K, Yoshida M. Preoperative Neutrophil-to-Lymphocyte Ratio may Predict Postoperative Pneumonia in Stage I-III Gastric Cancer Patients After Curative Gastrectomy: A Retrospective Study. World J Surg 2021; 45:3359-3369. [PMID: 34333681 DOI: 10.1007/s00268-021-06264-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several studies have demonstrated that diverse systemic inflammatory-based prognostic parameters predict a poor prognosis in patients with gastric cancer. However, few studies have focused on the relationships between postoperative complications and systemic inflammatory-based prognostic parameters after curative gastrectomy. We investigated the relationships between postoperative complications and these parameters and assessed the clinical utility of the parameters as predictors of postoperative complications in patients with stage I-III gastric cancer. METHODS We retrospectively reviewed 300 patients who underwent curative gastrectomy for stage I-III gastric cancer. All postoperative complications were classified as infectious or noninfectious. We evaluated the relationships between postoperative complications and clinical factors, including systemic inflammatory-based prognostic parameters. RESULTS In total, 101 patients (33.7%) had postoperative Clavien-Dindo grade II-IV complications, and 54 (18.0%) patients developed infectious complications including pancreatic fistula, pneumonia, anastomotic leak, intra-abdominal abscess, and cholecystitis. The relationships between postoperative complications and systemic inflammatory-based prognostic parameters were evaluated by the areas under the receiver operating characteristic curves. Postoperative pneumonia was identified as the most sensitive complication to the systemic inflammatory-based prognostic parameters. Multivariate analysis revealed that preoperative neutrophil-to-lymphocyte ratio (odds ratio, 14.621; 95% confidence interval, 1.160-184.348; p = 0.038) was an independent predictor of pneumonia. CONCLUSIONS Preoperative neutrophil-to-lymphocyte ratio may be a useful predictor of postoperative pneumonia in patients with stage I-III gastric cancer after curative gastrectomy.
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Affiliation(s)
- Mikito Mori
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan.
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Atsushi Hirano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan
| | - Kazuo Narushima
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan
| | - Chihiro Kosugi
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Masato Yamazaki
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare Ichikawa Hospital, 6-1-14 Kounodai, Ichikawa, Chiba, 272-0827, Japan
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Park DJ, Kim YW, Yang HK, Ryu KW, Han SU, Kim HH, Hyung WJ, Park JH, Suh YS, Kwon OK, Yoon HM, Kim W, Park YK, Kong SH, Ahn SH, Lee HJ. Short-term outcomes of a multicentre randomized clinical trial comparing laparoscopic pylorus-preserving gastrectomy with laparoscopic distal gastrectomy for gastric cancer (the KLASS-04 trial). Br J Surg 2021; 108:1043-1049. [PMID: 34487147 DOI: 10.1093/bjs/znab295] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/20/2021] [Accepted: 07/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND There remain concerns about the safety and functional benefit of laparoscopic pylorus-preserving gastrectomy (LPPG) compared with laparoscopic distal gastrectomy (LDG). This study evaluated short-term outcomes of a randomized clinical trial (RCT) comparing LPPG with LDG for gastric cancer. METHODS The Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial was an investigator-initiated, open-label, parallel-assigned, superiority, multicentre RCT in Korea. Patients with cT1N0M0 cancer located in the middle third of the stomach at least 5 cm from the pylorus were randomized to undergo LPPG or LDG. Participants, care givers and those assessing the outcomes were not blinded to group assignment. Outcomes were 30-day postoperative morbidity rate and death at 90 days. RESULTS Some 256 patients from nine institutions were randomized (LPPG 129 patients, LDG 127 patients) between July 2015 and July 2017 and outcomes for 253 patients were analysed. Postoperative complications within 30 days were seen in 19.3 and 15.5 per cent in the LPPG and LDG groups respectively (P = 0·419). Postoperative pyloric stenosis was observed in nine (7.2 per cent) and two (1·5 per cent) patients in the LPPG and LDG groups (P = 0·026) respectively. In multivariable analysis higher BMI was a risk factor for postoperative complications (odds ratio 1·17, 95 per cent c.i. 1·04 to 1·32; P = 0·011). Death at 90 days was zero in both groups. CONCLUSION Postoperative complications and mortality was comparable in patients undergoing LPPG and LDG. Registration number: NCT02595086 (http://www.clinicaltrials.gov).
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Affiliation(s)
- D J Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Y-W Kim
- Department of Surgery, National Cancer Centre, Goyang, Korea
| | - H-K Yang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - K W Ryu
- Department of Surgery, National Cancer Centre, Goyang, Korea
| | - S-U Han
- Department of Surgery, Ajou University Hospital, Suwon, Korea
| | - H-H Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - W-J Hyung
- Department of Surgery, Yonsei University Severance Hospital, Seoul, Korea
| | - J H Park
- Department of Surgery, Gyeongsang National University Hospital, Daegu, Korea
| | - Y-S Suh
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - O K Kwon
- Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - H M Yoon
- Department of Surgery, National Cancer Centre, Goyang, Korea
| | - W Kim
- Department of Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Y-K Park
- Department of Surgery, Chonnam National University Medical School, Hwasun, Korea
| | - S-H Kong
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - S H Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - H-J Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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19
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Kosuga T, Tsujiura M, Nakashima S, Masuyama M, Otsuji E. Current status of function-preserving gastrectomy for gastric cancer. Ann Gastroenterol Surg 2021; 5:278-286. [PMID: 34095717 PMCID: PMC8164463 DOI: 10.1002/ags3.12430] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/15/2020] [Accepted: 12/27/2020] [Indexed: 12/17/2022] Open
Abstract
Early gastric cancer (EGC) has excellent postoperative survival outcomes; thus, one of the recent keywords in the treatment of EGC is "function-preserving gastrectomy (FPG)." FPG reduces the extent of lymphadenectomy and gastric resection without compromising the long-term prognosis. Proximal gastrectomy (PG) is an alternative to total gastrectomy (TG) for EGC in the upper-third of the stomach, in which the gastric reservoir, gastric acid secretion, and intrinsic factors are maintained. Distal gastrectomy (DG) with a small remnant stomach, namely subtotal gastrectomy (STG), is another option for upper EGC, where the function of the cardia and fundus is preserved. Pylorus-preserving gastrectomy (PPG) is a good alternative to DG for EGC in the middle-third of the stomach, where pyloric function is preserved. Following elucidation of the markedly low incidences of possible metastasis to lymph node stations where dissection is omitted, the oncological safety of these FPG procedures was clarified. Nutritional advantages of PG or STG over TG have been reported; however, the standardized reconstruction methods after PG are yet to be established, and it is important to devise methods to prevent postoperative gastroesophageal reflux and anastomotic complications regardless of the reconstruction method. Nutritional benefits of PPG compared with DG have also been clarified, in which reducing postoperative gastric stasis is important. For the further spread of these FPG procedures, several issues, such as precise evaluation of preserved function, confirmation of oncological safety, and standardization of the technique, should be addressed in future prospective randomized controlled trials.
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Affiliation(s)
- Toshiyuki Kosuga
- Department of SurgerySaiseikai Shiga HospitalRittoJapan
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
| | | | | | | | - Eigo Otsuji
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
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20
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Zhou J, Du R, Zhang Q, Wang D. Laparoscopy-assisted pylorus-preserving gastrectomy versus laparoscopy-assisted distal gastrectomy for early gastric cancer in perioperative outcomes: A meta-analysis. Asian J Surg 2020; 43:862-863. [PMID: 32527581 DOI: 10.1016/j.asjsur.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jiajie Zhou
- Dalian Medical University, Dalian, 116044, China.
| | - Rui Du
- Dalian Medical University, Dalian, 116044, China
| | - Qi Zhang
- Yangzhou University, Yangzhou, 225001, China
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu Province Hospital, Clinical Medical College, Yangzhou University, Institute of General Surgery - Yangzhou University, Yangzhou, China.
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