Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2020; 26(43): 6837-6852
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6837
Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer
Hao Liu, Peng Jin, Fu-Hai Ma, Shuai Ma, Yi-Bin Xie, Yang Li, Wei-Kun Li, Wen-Zhe Kang, Yan-Tao Tian
Hao Liu, Peng Jin, Fu-Hai Ma, Shuai Ma, Yi-Bin Xie, Yang Li, Wen-Zhe Kang, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Hao Liu, Department of Gastrointestinal Surgery, The Second Hospital, Jilin University, Changchun 130041, Jilin Province, China
Wei-Kun Li, Department of Pancreatic Stomach Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Xie YB designed the research; Liu H, Jin P, and Ma FH analyzed the data and wrote the main manuscript text; Li Y, Kang WZ, Ma S, and Li WK collected the patients’ clinical data; Tian YT was involved in study conception and design, data interpretation, manuscript revision, and discussion.
Supported by National Natural Science Foundation of China, No. 81772642; Beijing Municipal Science and Technology Commission, No. Z161100000116045; and Capital’s Funds for Health Improvement and Research, No. CFH 2018-2-4022.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Cancer Center Hospital.
Informed consent statement: Written informed consent was obtained from all patients before the procedure. The data were anonymously analyzed.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: Some or all data, code generated or used during the study are available from the corresponding author by request.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, MD, PhD, Professor, Surgeon, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Received: June 29, 2020
Peer-review started: June 29, 2020
First decision: August 8, 2020
Revised: August 21, 2020
Accepted: September 18, 2020
Article in press: September 18, 2020
Published online: November 21, 2020
Processing time: 143 Days and 18.7 Hours
ARTICLE HIGHLIGHTS
Research background

Consensus on the optimal surgical treatment strategy for advanced gastric cancer located in the middle of the stomach is yet to be established. Most patients ultimately undergo total gastrectomy (TG).

Research motivation

TG is associated with reduced nutritional status, and higher rates of postoperative complications. We modified the laparoscopic subtotal gastrectomy procedure to treat advanced middle-third gastric cancer.

Research objectives

This study aimed to evaluate short-term postoperative patient outcomes, nutritional status, and long-term oncological outcomes to assess the safety and efficacy of laparoscopic-assisted tailored subtotal gastrectomy (LaTSG) compared to those of laparoscopic-assisted total gastrectomy (LaTG).

Research methods

This study retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third gastric cancer who underwent LaTSG (47 cases) or LaTG (45 cases) at Department of Pancreatic Stomach Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College between 2013 and 2017.

Research results

The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group (4.2% vs 17.8%, P < 0.05). At postoperative 12 mo, albumin, prealbumin, total protein, hemoglobin levels, and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group (P < 0.05). Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group (0% vs 11.1%, P < 0.05). Kaplan–Meier analysis showed a significant improvement in the overall survival (OS) and disease free survival (DFS) in the LaTSG group.

Research conclusions

LaTSG is a safer procedure than LaTG in terms of both short and long-term outcomes. The long-term survival of patients who undergo LaTSG is better than that of patients who undergo LaTG.

Research perspectives

Further randomized control trials and more enrolled patients are needed to help validate our findings.