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Manara M, Aiolfi A, Bonitta G, Schlanger D, Popa C, Lombardo F, Manfredini L, Biondi A, Bonavina L, Bona D. Short-Term Outcomes Analysis Comparing Open, Lap-Assisted, Totally Laparoscopic, and Robotic Total Gastrectomy for Gastric Cancer: A Network Meta-Analysis. Cancers (Basel) 2024; 16:3404. [PMID: 39410024 PMCID: PMC11475391 DOI: 10.3390/cancers16193404] [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] [Received: 08/28/2024] [Revised: 09/26/2024] [Accepted: 10/03/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND/OBJECTIVES Total gastrectomy (TG) is the cornerstone treatment for gastric cancer (GC). While open TG (OTG) with D2 lymphadenectomy remains the gold standard, alternative techniques such as lap-assisted TG (LATG), totally laparoscopic TG (TLTG), and robotic TG (RTG) have been reported with promising outcomes. The present analysis aimed to compare the short-term outcomes of different techniques for TG comprehensively in the setting of GC. METHODS A systematic review and network meta-analysis were performed. The primary outcomes were overall complications (OC), severe postoperative complications (SPCs), and anastomotic leak (AL). Pooled effect-size measures included risk ratio (RR), weighted mean difference (WMD), and 95% credible intervals (CrIs). RESULTS Sixty-eight studies (44,689 patients) were included. Overall, 52.4% underwent OTG, 6.5% LATG, 39.2% TLTG, and 1.9% RTG. Both TLTG (RR 0.82; 95% CrI 0.73-0.92) and RTG (RR 0.75; 95% CrI 0.59-0.95) showed a reduced rate of postoperative OC compared to OTG. SPCs and AL RR were comparable across all techniques. Despite the longer operative time, LATG, TLTG, and RTG showed reduced intraoperative blood loss, time to first flatus, ambulation, liquid diet resumption, and hospital stay compared to OTG. CONCLUSIONS Minimally invasive approaches seem to be associated with improved OC and functional outcomes compared to OTG.
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Affiliation(s)
- Michele Manara
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (G.B.); (F.L.); (L.M.); (D.B.)
| | - Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (G.B.); (F.L.); (L.M.); (D.B.)
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (G.B.); (F.L.); (L.M.); (D.B.)
| | - Diana Schlanger
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, “Iuliu Hațieganul” University of Medicine and Pharmacy, 400394 Cluj-Napoca, Romania; (D.S.); (C.P.)
| | - Calin Popa
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, “Iuliu Hațieganul” University of Medicine and Pharmacy, 400394 Cluj-Napoca, Romania; (D.S.); (C.P.)
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (G.B.); (F.L.); (L.M.); (D.B.)
| | - Livia Manfredini
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (G.B.); (F.L.); (L.M.); (D.B.)
| | - Antonio Biondi
- G. Rodolico Hospital, Surgical Division, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95131 Catania, Italy;
| | - Luigi Bonavina
- IRCCS Policlinico San Donato, Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, 20097 Milan, Italy;
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (M.M.); (G.B.); (F.L.); (L.M.); (D.B.)
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Vallance PC, Mack L, Bouchard-Fortier A, Jost E. Quality of Life Following the Surgical Management of Gastric Cancer Using Patient-Reported Outcomes: A Systematic Review. Curr Oncol 2024; 31:872-884. [PMID: 38392059 PMCID: PMC10888285 DOI: 10.3390/curroncol31020065] [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: 11/13/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction: Surgical management of gastric adenocarcinoma can have a drastic impact on a patient's quality of life (QoL). There is high variability among surgeons' preferences for the type of resection and reconstructive method. Peri-operative and cancer-specific outcomes remain equivalent between the different approaches. Therefore, postoperative quality of life can be viewed as a deciding factor for the surgical approach. The goal of this study was to interrogate patient QoL using patient-reported outcomes (PROs) following gastrectomy for gastric cancer. Methods: This systematic review was registered at Prospero and followed PRISMA guidelines. Medline, Embase, and Scopus were used to perform a literature search on 18 January 2020. A set of selection criteria and the data extraction sheet were predefined. Covidence (Melbourne, Australia) software was used; two reviewers (P.C.V. and E.J.) independently reviewed the articles, and a third resolved conflicts (A.B.F.). Results: The search yielded 1446 studies; 308 articles underwent full-text review. Ultimately, 28 studies were included for qualitative analysis, including 4630 patients. Significant heterogeneity existed between the studies. Geography was predominately East Asian (22/28 articles). While all aspects of quality of life were found to be affected by a gastrectomy, most functional or symptom-specific measures reached baseline by 6-12 months. The most significant ongoing symptoms were reflux, diarrhoea, and nausea/vomiting. Discussion: Generally, patients who undergo a gastrectomy return to baseline QoL by one year, regardless of the type of surgery or reconstruction. A subtotal distal gastrectomy is preferred when proper oncologic margins can be obtained. Additionally, no one form of reconstruction following gastrectomy is statistically preferred over another. However, for subtotal distal gastrectomy, there was a trend toward Roux-en-Y reconstruction as superior to abating reflux.
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Affiliation(s)
| | - Lloyd Mack
- Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada (A.B.-F.)
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Antoine Bouchard-Fortier
- Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada (A.B.-F.)
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Evan Jost
- Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada (A.B.-F.)
- Department of Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada
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Takeoka T, Yamamoto K, Kurokawa Y, Miyazaki Y, Kawabata R, Omori T, Imamura H, Fujita J, Eguchi H, Doki Y. Comparison of the effects of open and laparoscopic approach on body composition in gastrectomy for gastric cancer: A propensity score-matched study. Ann Gastroenterol Surg 2024; 8:40-50. [PMID: 38250677 PMCID: PMC10797822 DOI: 10.1002/ags3.12723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 01/23/2024] Open
Abstract
Aim To compare the effects of open (OG) and laparoscopic gastrectomy (LG) on body composition and muscle strength. Methods This study performed a propensity score matching analysis using cases from a large-scale, multicenter, phase III randomized controlled trial concerning oral nutritional supplements after gastrectomy and analyzed both the whole and matched cohorts. Measurements of body composition and hand grip strength (HGS) were performed at baseline (preoperatively) and at 1, 2, 3, 6, and 12 months after gastrectomy. Results Of 835 patients, 275 and 560 underwent OG and LG, respectively. Skeletal muscle mass (SMM) and HGS loss were significantly lesser in the LG group than in the OG group. The propensity score-matched analysis, including 120 pairs of patients, confirmed that the % SMM loss values at 1, 2, 3, 6, and 12 POM were -4.5%, -4.0%, -4.7%, -4.6%, and -5.8% in the OG group and -3.0%, -1.9%, -2.4%, -2.2%, and -2.7% in the LG group, respectively. The % SMM loss was significantly lesser in the LG group than in the OG group (repeated measures ANOVA p < 0.001). The HGS loss was non-significantly smaller in the LG group than in the OG group. Conclusion Skeletal muscle mass loss was significantly lesser in the LG group than in the OG group in both cohorts, indicating that LG may be more effective than OG for maintaining muscle mass.
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Affiliation(s)
- Tomohira Takeoka
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
- Sakai City Medical CenterSakaiJapan
| | | | | | | | - Ryohei Kawabata
- Sakai City Medical CenterSakaiJapan
- Osaka Rosai HospitalOsakaJapan
| | - Takeshi Omori
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
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Wang L, Chen X, Miao W, Ma Y, Ma X, Wang C, Cao X, Xu H, Wei J, Yan S. Total laparoscopic versus laparoscopic-assisted transabdominal posterior mediastinal digestive tract reconstruction in the treatment of Siewert II adenocarcinoma of the esophagogastric junction: A retrospective study. Front Surg 2022; 9:874857. [PMID: 36061040 PMCID: PMC9437538 DOI: 10.3389/fsurg.2022.874857] [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: 02/13/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background The method of operation and the range of resection for Siewert II adenocarcinoma of the esophagogastric junction (AEG) remain controversial. This study aims to evaluate the safety, feasibility, and short-term postoperative effect of total laparoscopic versus laparoscopic-assisted transabdominal posterior mediastinal digestive tract reconstruction in the treatment of Siewert II AEG. Methods Total laparoscopic or laparoscopic-assisted gastrointestinal reconstruction through abdominal posterior mediastinum was performed in 108 patients with Siewert II AEG from October 2017 to February 2019. This study evaluated the loss of intraoperative blood, the number of lymph nodes, the marginal of the tumor, short-term postoperative complications (within 30 days), the rate of survival at follow-up, and the economic cost, feasibility, and effect of short-term postoperative recovery for patients who received these two operations. Result There were no significant differences in general data between the total laparoscopic group and the laparoscopic-assisted group (P > 0.05). However, the total laparoscopic group cost more time on the surgical procedure and digestive tract reconstruction, lost less intraoperative blood, and had more mediastinal lymph nodes compared with the laparoscopic-assisted group (P < 0.05). The total laparoscopic group was significantly better than the laparoscopic-assisted group compared with the short-term postoperative recovery indexes, such as the first exhaust time, the first defecation time, the first fluid time, the first semi-fluid diet time, the postoperative hospital stay, and other postoperative recovery indexes (P < 0.05). In addition, there were no significant differences in postoperative complications, postoperative pathological indexes, the recurrence rate, and mortality between the total laparoscopic group and laparoscopic-assisted group (P > 0.05). Conclusions The safety, feasibility, and short-term effect of total laparoscopic transabdominal posterior mediastinal digestive tract reconstruction in the treatment of Siewert II AEG were better than those for the laparoscopic-assisted group.
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Nakada K, Kawashima Y, Kinami S, Fukushima R, Yabusaki H, Seshimo A, Hiki N, Koeda K, Kano M, Uenosono Y, Oshio A, Kodera Y. Comparison of effects of six main gastrectomy procedures on patients’ quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45. World J Gastrointest Surg 2021; 13:461-475. [PMID: 34122736 PMCID: PMC8167845 DOI: 10.4240/wjgs.v13.i5.461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The effects of various gastrectomy procedures on the patient’s quality of life (QOL) are not well understood. Thus, this nationwide multi-institutional cross-sectional study using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome, was conducted.
AIM To compare the effects of six main gastrectomy procedures on the postoperative QOL.
METHODS Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures [total gastrectomy with Roux-en-Y reconstruction (TGRY; n = 393), proximal gastrectomy (PG; n = 193), distal gastrectomy with Roux-en-Y reconstruction (DGRY; n = 475), distal gastrectomy with Billroth-I reconstruction (DGBI; n = 909), pylorus-preserving gastrectomy (PPG; n = 313), and local resection of the stomach (LR; n = 85)] were analyzed. Among the 19 main outcome measures of PGSAS-45, the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means.
RESULTS TGRY and PG significantly impaired the QOL of postoperative patients. Postoperative QOL was excellent in LR (cardia and pylorus were preserved with minimal resection). In procedures removing the distal stomach, diarrhea subscale (SS) and dumping SS were less frequent in PPG than in DGBI and DGRY. However, there was no difference in the postoperative QOL between DGBI and DGRY. The most noticeable adverse effects caused by gastrectomy were meal-related distress SS, dissatisfaction at the meal, and weight loss, with significant differences among the surgical procedures.
CONCLUSION Postoperative QOL greatly differed among six gastrectomy procedures. The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures, overcome surgical shortcomings, and enhance postoperative care.
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Affiliation(s)
- Koji Nakada
- Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Yoshiyuki Kawashima
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama 362-0806, Japan
| | - Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Hiroshi Yabusaki
- Department of Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Akiyoshi Seshimo
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Keisuke Koeda
- Department of Medical Safety Science, Iwate Medical University, Iwate 028-3695, Japan
| | - Mikihiro Kano
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima 731-0293, Japan
| | - Yoshikazu Uenosono
- Department of Digestive Surgery, Imamura General Hospital, Kagoshima 890-0064, Japan
| | - Atsushi Oshio
- Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 162-8644, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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Wang Y, Lei X, Liu Z, Shan F, Ying X, Li Z, Ji J. Short-term outcomes of laparoscopic versus open total gastrectomy after neoadjuvant chemotherapy: a cohort study using the propensity score matching method. J Gastrointest Oncol 2021; 12:237-248. [PMID: 34012622 DOI: 10.21037/jgo-20-374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Until now, little is known about the benefit of laparoscopic total gastrectomy (LTG) after neoadjuvant chemotherapy (NACT). This study was designed to compare the safety and efficacy of the LTG versus the open total gastrectomy (OTG) approach after NACT treatment in patients with advanced gastric cancer (AGC). Methods This study involved a cohort of 145 patients with AGC who underwent total gastrectomy after NACT at our centre between April 2013 and August 2018 including 24 cases of LTG and 121 OTG. The baseline characteristics were matched based on 1:2 balanced propensity score-matching method. Results Sixty-nine marched cases were finally analysed (23 LTG vs. 46 OTG). All patients underwent R0 resection. Compared to the OTG group, the LTG group had a longer surgery duration (P<0.001), but a shorter incision length (P<0.001) and less intravenous patient-controlled analgesia (IV-PCA) time after surgery (P=0.027). No statistical differences were observed in terms of blood loss, retrieved lymph nodes (LNs), resection margin, length of stay, postoperative pain intensity, and complications (P>0.05). Conclusions LTG had comparable safety and histological findings to OTG after NACT in the perioperative period; however, LTG is less invasive and patients can benefit from less IV-PCA use. Further research is needed to investigate long-term effects. Keywords Gastric cancer (GC); neoadjuvant chemotherapy (NACT); safety; laparoscopic technique.
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Affiliation(s)
- Yinkui Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaokang Lei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zining Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangji Ying
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
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Chen XD, He FQ, Liao MS, Chen M. Laparoscopic versus open transhiatal approach for adenocarcinoma of the esophagogastric junction: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 47:778-788. [PMID: 33268214 DOI: 10.1016/j.ejso.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/04/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Laparoscopic transhiatal approach (LTH) has gained growing popularity in the treatment of AEG. However, its safety and efficacy need to be evaluated. METHODS Original studies comparing LTH with open transhiatal approach (OTH) were searched. Meta-analysis was performed using RevMan 5.3. RESULTS Nine studies involving 2149 patients were eligible. Compared with OTH, LTH was associated with longer operation time (mean difference [MD] = 31min, 95%CI [20,41], P < 0.001) while less blood loss (MD = -103ml [-135, -72], P < 0.001), and harvested similar number of lymph nodes (MD = 0.1 [-1.2, 1.4], P = 0.89). There were no differences in time to ambulation (MD = -0.79 days [-1.77, 0.20], P = 0.12) or time to first flatus (MD = -0.82 days [-1.76, 0.11], P = 0.08); however, LTH was associated with shorter postoperative hospital stay (MD = -1.70 days [-2.34, -1.05], P < 0.001). The mortality after surgery was comparable for LTH and OTH (risk difference [RD] = -0.00 [-0.01, 0.01], P = 0.55). The incidence of total major complications was similar in LTH (6.1%) and OTH (8.4%) (RD = -0.02 [-0.05, 0.01], P = 0.12); there were no significant differences in the incidence of each complication. Furthermore, LTH achieved similar 2-year overall survival (OS) rate (risk ratio [RR] = 1.17 [0.86, 1.60], P = 0.31) while higher 5-year OS rate (RR = 1.43 [1.18, 1.73], P = 0.0003) and significant improvement of OS (univariable hazard ratio = 0.65 [0.50, 0.84], P = 0.0009; multivariable hazard ratio = 0.59 [0.44, 0.80], P = 0.0006). CONCLUSIONS LTH is feasible and safe for AEG, and may provide more favorable short-term outcomes and potential long-term survival benefit, which needs to be confirmed by randomized trials.
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Affiliation(s)
- Xiao-Dong Chen
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, China.
| | - Fu-Qian He
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, China.
| | - Mao-Shan Liao
- Department of Laboratory Medicine, Santai People's Hospital, China
| | - Mi Chen
- Department of Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, China
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Liao C, Feng Q, Xie S, Chen J, Shi Y. Laparoscopic versus open gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a meta-analysis. Surg Endosc 2020; 35:860-871. [PMID: 32076857 DOI: 10.1007/s00464-020-07458-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 02/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The potential advantages of laparoscopic gastrectomy (LG) compared with open gastrectomy (OG) for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) have not been fully clarified. The aim of this meta-analysis was to evaluate the safety and efficacy of LG for Siewert type II/III AEG, compared with OG. METHODS A comprehensive search was performed in various medical databases up to December 30, 2018. Seven non-randomized controlled trials comparing LG and OG for Siewert type II/III AEG were included. Outcomes evaluated including operation time, estimated blood loss, number of retrieved lymph nodes (LNs), post-operation complications, postoperative hospital stay, time to first flatus, time to ambulation, and overall survival (OS). RESULTS Seven studies of 1915 patients were included for meta-analysis. The estimated blood loss [weighted mean difference (WMD) = - 77.49, 95%CI - 111.84 to - 43.15; P < 0.00001] was significantly less and the postoperative hospital stay (WMD = - 1.98, 95%CI - 2.14 to - 1.83; P < 0.00001) was significantly shorter in the LG group than in the OG group, while the operation time, number of retrieved LNs, time to first flatus, and time to ambulation showed no significant difference between LG and OG groups. The overall postoperative complications [odds ratio (OR) 0.78, 95%CI 0.60-1.02; P = 0.07] in LG group were less than those in OG group, although the difference was not significant between the two groups. CONCLUSION LG can achieve short-term surgical outcomes comparable to OG, with respect to safety and efficiency in treatment of Siewert type II/III AEG.
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Affiliation(s)
- CunXiang Liao
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Qing Feng
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - ShaoHui Xie
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Jun Chen
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China
| | - Yan Shi
- Department of General Surgery, Southwest Hospital, Army Medical University, Gaotanyan Main Street 29, Shapingba District, Chongqing, 400038, People's Republic of China.
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Laparoscopic-assisted versus open total gastrectomy for Siewert type II and III esophagogastric junction carcinoma: a propensity score-matched case-control study. Surg Endosc 2016; 31:3495-3503. [PMID: 27981384 DOI: 10.1007/s00464-016-5375-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 11/25/2016] [Indexed: 01/07/2023]
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Inokuchi M, Otsuki S, Ogawa N, Tanioka T, Okuno K, Gokita K, Kawano T, Kojima K. Postoperative Complications of Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Gastric Cancer in a Meta-Analysis of High-Quality Case-Controlled Studies. Gastroenterol Res Pract 2016; 2016:2617903. [PMID: 28042292 PMCID: PMC5155090 DOI: 10.1155/2016/2617903] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/03/2016] [Indexed: 12/17/2022] Open
Abstract
Background. Some meta-analyses of case-controlled studies (CCSs) have shown that laparoscopic or laparoscopy-assisted total gastrectomy (LTG) had some short-term advantages over open total gastrectomy (OTG). However, postoperative complications differed somewhat among the meta-analyses, and some CCSs included in the meta-analyses had mismatched factors between LTG and OTG. Methods. CCSs comparing postoperative complications between LTG and OTG were identified in PubMed and Embase. Studies matched for patients' status, tumor stage, and the extents of lymph-node dissection were included. Outcomes of interest, such as anastomotic, other intra-abdominal, wound, and pulmonary complications, were evaluated in a meta-analysis performed using Review Manager version 5.3 software. Result. This meta-analysis included a total of 2,560 patients (LTG, 1,073 patients; OTG, 1,487 patients) from 15 CCSs. Wound complications were significantly less frequent in LTG than in OTG (n = 2,430; odds ratio [OR] 0.30, 95% confidence interval [CI] 0.29-0.85, P = 0.01, I2 = 0%, and OR 0.46, 95% CI 0.17-0.52, P < 0.0001, I2 = 0%). However, the incidence of anastomotic complications was slightly but not significantly higher in LTG than in OTG (n = 2,560; OR 1.44, 95% CI 0.96-2.16, P = 0.08, I2 = 0%). Conclusion. LTG was associated with a lower incidence of wound-related postoperative complications than was OTG in this meta-analysis of CCSs; however, some concern remains about anastomotic problems associated with LTG.
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Affiliation(s)
- Mikito Inokuchi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Sho Otsuki
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Norihito Ogawa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Toshiro Tanioka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Keisuke Okuno
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Kentaro Gokita
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Tatsuyuki Kawano
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Kazuyuki Kojima
- Department of Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo 113-8519, Japan
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Inokuchi M, Otsuki S, Murase H, Kawano T, Kojima K. Feasibility of laparoscopy-assisted gastrectomy for patients with poor physical status: A propensity-score matching study. Int J Surg 2016; 31:47-51. [PMID: 27260314 DOI: 10.1016/j.ijsu.2016.05.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/11/2016] [Accepted: 05/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopically-assisted gastrectomy (LAG) has been established to be a minimally invasive treatment for early gastric cancer. However, few studies have shown the feasibility of LAG in patients with risky comorbidities according to the American Society of Anesthesiologists physical status (ASA-PS) classification. We performed this retrospective cohort study to assess the feasibility of LG in patients with an ASA-PS class of 3 or higher. METHODS We retrospectively identified 214 patients with an ASA-PS class of 3 or 4 among 1192 patients who underwent radical gastrectomy with lymph-node dissection between 1999 and 2014 in our hospital. Finally, 106 patients were generated by propensity-score matching between LAG and open gastrectomy (OG). Postoperative complications were compared between LAG and OG. RESULT The overall incidence of complications was the same in LAG (30%) and OG (30%). Surgical complications were similar in LAG and OG (19% and 17%, p = 0.80). Medical complications also did not differ significantly between LAG and OG (21% and 15%, p = 0.45). CONCLUSION LAG was a feasible procedure for patients with gastric cancer who had an ASA-PS class of 3 or 4 and could undergo general anesthesia. LAG can become an optional treatment for such risky patients.
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Affiliation(s)
- Mikito Inokuchi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan.
| | - Sho Otsuki
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Hideaki Murase
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Tatsuyuki Kawano
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
| | - Kazuyuki Kojima
- Department of Minimally Invasive Surgery, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan
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12
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Mönig SP, Chon SH, Weindelmayer J, de Manzoni G, Hölscher AH. [Spectrum of laparoscopic surgery for gastric tumors]. Chirurg 2015; 85:675-82. [PMID: 25052815 DOI: 10.1007/s00104-014-2753-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Minimally invasive operative procedures are increasingly being used for treating tumors of the upper gastrointestinal tract. While minimally invasive surgery (MIS) has become established as a standard procedure for benign tumors and gastrointestinal stromal tumors (GIST) based on current studies, the significance of MIS in the field of gastric cancer is the topic of heated debate. Until now the majority of studies and meta-analyses on gastric cancer have come from Asia and these indicate the advantages of MIS in terms of intraoperative blood loss, minor surgical complications and swifter convalescence although without any benefits in terms of long-term oncological results and quality of life. Unlike in Germany, gastric cancer in Asia with its unchanged high incidence rate, 50 % frequency of early carcinoma and predominantly distal tumor localization is treated at high-volume centres. Due to the proven marginal advantages of MIS over open resection described in the published studies no general recommendation for laparoscopic surgery of gastric cancer can currently be given.
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Affiliation(s)
- S P Mönig
- Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland,
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Kunisaki C, Makino H, Takagawa R, Kimura J, Ota M, Ichikawa Y, Kosaka T, Akiyama H, Endo I. A systematic review of laparoscopic total gastrectomy for gastric cancer. Gastric Cancer 2015; 18:218-26. [PMID: 25666184 DOI: 10.1007/s10120-015-0474-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic total gastrectomy (LTG) has been performed since 1999. Although surgical outcomes have been reported from Japan, Korea, China, and many Western countries, the effectiveness of this technique has not been conclusively established. This study therefore aimed to review the literature systematically. METHODS Our search of the research literature identified 150 studies, which were mostly retrospective and from single institutions. RESULTS There has recently been a remarkable increase in the number of studies from Korea, and the number of patients included in studies has increased since 2009. In most studies, the surgical procedures were longer, blood loss was reduced, and the number of retrieved lymph nodes was the same in the LTG group as in the open total gastrectomy group. The incidence of postoperative complications and that of inflammation during postoperative recovery were the same in these two groups. CONCLUSIONS During LTG, the method used for esophagojejunostomy is important for surgical reliability and to reduce postoperative complications. There has been rapid development of new techniques from the level of esophagojejunostomy through a small skin incision to the high level of intracorporeal esophagojejunostomy using various techniques. A nationwide prospective phase II study is urgently needed to establish the value of LTG.
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Affiliation(s)
- Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan,
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