Improving the outcomes in gastric cancer surgery

Table 1 MEDLINE search terms used per section

Section	MEDLINE search terms	Limits
Introduction	"Cancer", "Mortality", "Global Burden of Disease", "Cancer statistics", "Gastric cancer", "Disability adjusted life years"	Language: English
		Time period: 2005-2014
Advances in preoperative care
Risk assessment	"Risk assessment", "ASA classification", "peri operative risk", "Charlson Comorbidity Index", "Gastric cancer", "obesity", "complications", "previous abdominal surgery"	Language: English
		Time period: 2005-2014
Nutritional status	"Malnutrition", "screening tool", "Surgery", "Gastric cancer"	Language: English
		Time period: 2005-2014
Sarcopenia	"Gastric cancer", "Sarcopenia", "Surgery"	Language: English
		Time period: 2005-2014
Frailty	"Fraily surgery", "Complications", "Gastric cancer"	Language: English
		Time period: 2005-2014
Prehabilitation	"Prehabilitation", "Cancer"	Language: English
		Time period: 2005-2014
Staging laparoscopy and was cytology	"Gastric cancer", "Staging laparoscopy", "peritoneal cytology", "Hyperthermic Intreperitoneal Chemotherapy"	Language: English
		Time period: 2005-2014
Advances in intra-operative care
Laparoscopic surgery (introduction)	"Gastrectomy", "Gastric cancer", "Laparoscopy"	Language: English
		Time period: 1990-2000
Laparoscopic surgery	"Gastrectomy", "Gastric cancer", "Laparoscopy"	Language: English
		Time period: 2005-2014
		Article type: Review
Lymph node dissection	"D2 resection", "Gastric cancer", "Nodal dissection", "Bursectomy"	Language: English
		Time period: 1995-2014
		Article type: Clinical Trial
Reconstruction technique	"Distal gastrectomy", "Gastric cancer", "Reconstruction", "Billroth", "Reconstruction"	Language: English
		Time period: 2005-2014
Intra-operative feeding jejunostomy placement	"Gastric cancer", "feeding jejunostomy", "morbidity"	Language: English
		Time period: 2005-2014
Advances in postoperative care
Detection and treatment of anastomotic leakage	"Gastrectomy", "anastomotic leak", "risk factors", "gastric cancer", "covered stent"	Language: English
		Time period: 2005-2014
ERAS and Fast-track programs	"Gastric cancer", "ERAS", "Fast track", "Oral feeding", "Gastrectomy"	Language: English
		Time period: 2005-2014
Advances in organization of care: centralization and audits	"Case load" or "hospital volume", "gastric cancer", "gastrectomy"	Language: English
		Time period: 2005-2014

ASA: American Society of Anesthesiologist; ERAS: Enhanced recovery after surgery.

Table 2 Malnutrition universal screening tool and short nutritional assessment questionnaire, screening tools for detecting malnutrition

	Points
MUST
Step 1 Body mass index
> 20	0
18.5-20	1
< 18.5	2
Step 2 Unintentional weight loss past 3-6 mo
< 5%	0
5%-10%	1
> 10%	2
Step 3 Acute disease effect
If patient is acutely ill and there has been or is likely to be no nutritional intake for > 5 d	2
SNAQ
Did you lose weight unintentionally?
More than 6 kg in past 6 mo	3
More than 3 kg in past 3 mo	2
No	0
Did you experience a decreased appetite over the last month?
Yes	1
No	0
Did you use supplemental drinks or tube feeding over the last month?
Yes	1
No	0

Risk of malnutrition: MUST: 0 = Low risk, 1 = Medium risk, 2 or more = High risk. SNAQ: 0-1 = Low risk, 2 = Medium risk, 3 or more = High risk. MUST: Malnutrition universal screening tool; SNAQ: Short nutritional assessment questionnaire.

Table 3 Summary of recently published meta-analysis examining laparoscopic distal gastrectomy vs open distal gastrectomy for gastric cancer

Ref.	Trials included (n)	Laparoscopic/open procedures (n)	TumOR = characteristics	Operative time (min) (WMD)	Blood loss (mL) (WMD)	Harvested lymph nodes (WMD)	Length-of-stay (WMD)	Complication rates	Mortality
Memon et al[62], 2008	4 RCT’s	82/80	EGC, GC	+83 (P < 0.001)	-104 (P = 0.02)	-4.3 (P < 0.001)	-3.3 d (P = 0.14)	OR = 0.66 (P = 0.14)	OR = 0.94 (P = 0.94)
Chen et al[60], 2009	6 RCT’s	323/306	EGC	+87 (P < 0.001)	-108 (P = 0.001)	-4.9 (P < 0.001)	-2.0 d (P = 0.14)	RR = 0.61 (P = 0.01)	Risk difference 0.01 (P = 0.32)
Kodera et al[61], 2010	6 RCT’s	343/323	EGC, GC	+82 (P < 0.001)	-118 (P < 0.001)	-4.8 (P < 0.001)	NA	OR = 0.46 (P = 0.003)	OR = 0.17 (P = 0.86)
Ohtani et al[63], 2011	5 RCT’s	164/162	EGC, GC	+82 (P < 0.001)	-122 (P < 0.001)	-4.8 (P < 0.001)	-2.5 d (P = 0.04)	OR = 0.38 (P = 0.01)	OR = 0.47 (P = 0.54)
Viñuela et al[59], 2012	6 RCT’s	1658/1397	ECG, GC	+48.3 (P < 0.001)	-118 (P < 0.001)	-3.9 (P < 0.001)	-3.6 (P < 0.001)	OR = 0.59 (P < 0.001)	OR = 0.64 (P = 0.39)
	19 NRCT’s

RCT: Randomized controlled trial; NRCT: Non-randomized controlled trial; EGC: Early gastric cancer; GC: Gastric cancer (all stages); WMD: Weighted mean difference; NA: Not available.