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Lei C, Sun W, Wang K, Weng R, Kan X, Li R. Artificial intelligence-assisted diagnosis of early gastric cancer: present practice and future prospects. Ann Med 2025; 57:2461679. [PMID: 39928093 PMCID: PMC11812113 DOI: 10.1080/07853890.2025.2461679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 12/09/2024] [Accepted: 01/23/2025] [Indexed: 02/11/2025] Open
Abstract
Gastric cancer (GC) occupies the first few places in the world among tumors in terms of incidence and mortality, causing serious harm to human health, and at the same time, its treatment greatly consumes the health care resources of all countries in the world. The diagnosis of GC is usually based on histopathologic examination, and it is very important to be able to detect and identify cancerous lesions at an early stage, but some endoscopists' lack of diagnostic experience and fatigue at work lead to a certain rate of under diagnosis. The rapid and striking development of Artificial intelligence (AI) has helped to enhance the ability to extract abnormal information from endoscopic images to some extent, and more and more researchers are applying AI technology to the diagnosis of GC. This initiative has not only improved the detection rate of early gastric cancer (EGC), but also significantly improved the survival rate of patients after treatment. This article reviews the results of various AI-assisted diagnoses of EGC in recent years, including the identification of EGC, the determination of differentiation type and invasion depth, and the identification of borders. Although AI has a better application prospect in the early diagnosis of ECG, there are still major challenges, and the prospects and limitations of AI application need to be further discussed.
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Affiliation(s)
- Changda Lei
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Medical College, Soochow University, Suzhou, China
| | - Wenqiang Sun
- Suzhou Medical College, Soochow University, Suzhou, China
- Department of Neonatology, Children’s Hospital of Soochow University, Suzhou, China
| | - Kun Wang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Medical College, Soochow University, Suzhou, China
| | - Ruixia Weng
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Medical College, Soochow University, Suzhou, China
| | - Xiuji Kan
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Medical College, Soochow University, Suzhou, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Zheng HL, Zhang LK, Zheng HH, Lv CB, Xu BB, Lin GT, Chen QY, Lin JX, Zheng CH, Huang CM, Xie JW. Timing of postoperative chemotherapy and prognosis in neoadjuvant-treated gastric cancer patients: a multicenter real-world cohort study. Ann Med 2025; 57:2500690. [PMID: 40329795 PMCID: PMC12064125 DOI: 10.1080/07853890.2025.2500690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 03/27/2025] [Accepted: 04/14/2025] [Indexed: 05/08/2025] Open
Abstract
BACKGROUND The optimal time to chemotherapy (TTC) in locally advanced gastric cancer (LAGC) patients treated with neoadjuvant chemotherapy (NLAGC) remains unclear. METHODS Consecutive 524 patients with NLAGC between Jan. 2010 and Dec. 2022 were identified. Patients were categorized into three groups: TTC < 6w, 6w ≤ TTC ≤ 8w, and TTC > 8w. Survival analysis was conducted using the Cox proportional hazards model to assess the impact of TTC on gastric cancer-specific mortality (GCSM) and all-cause mortality (ACM). Cumulative competing risk curves were employed to evaluate the incidence of competing events. RESULTS Overall, 451 patients were included.Cumulative competing risk curves showed that the 3-year ACM and GCSM were significantly lower in the 6w ≤ TTC ≤ 8w group (ACM: 19.7% vs. 37.2% vs. 39.7%, GCSM: 19.7% vs. 35.2% vs. 38.8%) compared to the TTC < 6w and TTC > 8w groups. Compared to patients with 6w ≤ TTC ≤ 8w, those with TTC < 6w or >8w had an increased risk of GCSM (HR: 2.792 and HR: 2.343, respectively) and ACM (HR: 3.102 and HR: 2.719, respectively) after adjusting for confounders. Furthermore, 6w ≤ TTC ≤ 8w had later peak recurrence compared to TTC < 6w and TTC > 8w (Peak months: 9.7 vs. 4.3 vs. 3.1). CONCLUSION A postoperative chemotherapy timing of 6-8 weeks was associated with better survival and delayed recurrence in NLAGC patients. These findings suggest that the 6-8 week time-window should be a key timeframe for personalized postoperative adjuvant chemotherapy decisions.
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Affiliation(s)
- Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Ling-Kang Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Hong-Hong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chen-Bin Lv
- Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Bin-Bin Xu
- Department of Digestive Endoscopy, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, Fujian, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
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Wu D, Zhong Q, Zhang ZQ, Liu SQ, Qiu TY, Chen JY, Jiang YM, Lin GT, Liu ZY, Shang-Guan ZX, Sun YQ, Zheng CH, Li P, Xie JW, Lin JX, Chen QY, Huang CM. Comprehensive comparison of technical performance, surgical outcomes, and oncologic prognosis between remnant gastric cancer and primary upper-third gastric cancer in the era of minimally invasive surgery: A pooled analysis of 3 prospective trials. Surgery 2025; 183:109395. [PMID: 40344992 DOI: 10.1016/j.surg.2025.109395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 03/16/2025] [Accepted: 03/31/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND AND OBJECTIVE To compare the technical performances and short- and long-term outcomes of laparoscopic total gastrectomy for remnant gastric cancer and primary upper gastric cancer. METHODS This prospective study (FUGES-004 study) enrolled 50 remnant gastric cancer patients who underwent laparoscopic total gastrectomy at Fujian Medical University Union Hospital between June 2016 and June 2020 (ClinicalTrials.gov identifier: NCT02792881). Propensity score matching (1:2) was used to select upper gastric cancer patients who underwent laparoscopic total gastrectomy in the FUGES-001 and FUGES-002 studies. Technical performance was assessed using the General Error Reporting Tool, Objective Structured Assessment of Technical Skills (OSATS), and Intraoperative Complication Classification. RESULTS After matching, 46 remnant gastric cancer and 92 upper gastric cancer patients were included in the final analysis. Abdominal adhesions in the epigastrium, central abdomen, and bowel-to-bowel regions were more severe in the remnant gastric cancer group (P < .001). The remnant gastric cancer group had more technical errors and intraoperative adverse events (especially grade I bleeding) during surgery (P < .05). However, the Objective Structured Assessment of Technical Skills scores were comparable between the remnant gastric cancer and upper gastric cancer groups (30.8 vs 31.0, P = .799). Although the severe postoperative complication rates were similar between the 2 groups (P = .333), the postoperative complication rate was significantly higher in the remnant gastric cancer group (28.3% vs 7.6%, P = .001). Additionally, the long-term oncologic outcomes (including 3-year disease-free survival, overall survival, and recurrence pattern) were comparable between the remnant gastric cancer and upper gastric cancer groups (log-rank P > .05). CONCLUSIONS Although the long-term oncologic outcomes were comparable between the groups, the remnant gastric cancer group had more intraoperative errors and adverse events and higher postoperative complication rates than the upper gastric cancer group. For complex remnant gastric cancer cases, laparoscopic total gastrectomy may serve as an effective therapeutic option. However, experienced surgeons at high-volume centers should exercise caution when performing laparoscopic total gastrectomy and implement more rigorous perioperative management strategies.
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Affiliation(s)
- Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhi-Quan Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Shu-Qin Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Tao-Yuan Qiu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jun-Yu Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Yi-Ming Jiang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Guang-Tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Zhi-Xin Shang-Guan
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Yu-Qin Sun
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Department of General Surgery Unit 4, ZhangZhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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Kim SH, Signorini FJ, Park K, Kim C, Kim J, Cho YS, Kong SH, Park DJ, Lee HJ, Yang HK. Long-term natural course of patients with lymph node station 6 metastasis after pylorus-preserving gastrectomy. Gastric Cancer 2025; 28:673-683. [PMID: 40249528 DOI: 10.1007/s10120-025-01600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 02/11/2025] [Indexed: 04/19/2025]
Abstract
BACKGROUND Meticulous lymph node 6 station (LN#6) dissection is mandatory in pylorus-preserving gastrectomy (PPG), but can increase the risk of complications, such as postoperative delayed gastric emptying. With analyzing lymphatic spread patterns based on cross-sectional tumor location, we planned to predict the surgical burden of LN#6 dissection, balancing oncological safety and risk of postoperative complications. METHODS We included consecutive PPG cases at Seoul National University Hospital (2007-2017) to assess the incidence, 5-year survival rate (5YSR), and 3-year recurrence-free survival (3RFS) of LN#6 metastasis. Cox regression analyzed the impact of LN#6 metastasis itself on 5YSR and 3RFS. The effect of tumor location among gastric middle-third tumors on LN#6 metastasis was evaluated. The therapeutic indices (TI) of LN#6 based on tumor location were calculated. RESULTS Among 1070 PPG patients, 5YSR and 3RFS were 97.0% and 98.9%. LN#6 metastasis was found in 11 patients (1.03%), with 3 recurrences observed among them (3/11, 0.28%). LN#6 metastasis itself did not significantly affect 5YSR (p = 0.266) or 3RFS (p = 0.075). Tumor location showed a significant association for LN#6 metastasis (p = 0.015), with low body greater curvature (LB-GC) showing the highest prevalence (5/11, 45.45%). TI of LN#6 for LB-GC tumors was 3.76, while TI for low body lesser curvature (LB-LC) and midbody lesser curvature (MB-LC) tumors was 0.0. CONCLUSIONS LN#6 metastasis is infrequent and does not affect 5YSR or 3RFS in PPG patients. Tumors in LB-GC demonstrated a higher tendency for lymphatic spread to LN#6, while those in lesser curvature demonstrated a lower spread, suggesting a reduced surgical burden for lesser curvature tumors. This study evaluated LN#6 metastasis in 1070 PPG patients, demonstrating low incidence and favorable oncological outcomes, supporting tailored LN#6 dissection for lesser curvature tumors to minimize complications without compromising safety.
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Affiliation(s)
- Sa-Hong Kim
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | | | - Kyoyoung Park
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chungyoon Kim
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jeesun Kim
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yo-Seok Cho
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do-Joong Park
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Jia Z, Cao S, Wang D, Tang C, Tan X, Liu S, Liu X, Li Z, Tian Y, Niu Z, Tang B, Zhou Y. Identification and Categorization of Technical Errors and Hazard Zones of Robotic Versus Laparoscopic Total Gastrectomy for Gastric Cancer: A Single-center Prospective Randomized Controlled Study. Ann Surg 2025; 282:37-45. [PMID: 39513271 PMCID: PMC12140557 DOI: 10.1097/sla.0000000000006585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
OBJECTIVE The current research aimed to conduct a detailed analysis of intraoperative surgical performance, short-term outcomes, identify and categorize technical errors, and hazard zones enacted during total gastrectomy performed robotically and laparoscopically by surgeons. Prospective research is needed to determine whether the technical advantages of robotic surgery translate to patient outcomes. BACKGROUND At present, a growing number of clinical studies have demonstrated that the quality of intraoperative surgical performance has a direct impact on the clinical outcomes of the patient. The current research aimed to conduct a detailed analysis of intraoperative surgical performance and short-term outcomes, and identify and categorize technical errors, and hazard zones enacted during total gastrectomy performed robotically and laparoscopically by surgeons. METHODS Eighty-two patients were recruited and participated in this study, with 40 cases undergoing RTG and 42 cases for LTG. Patients undergoing RTG and LTG were recruited and randomized into the study. Six consultant/attending surgeons participated in this study and all surgical procedures were recorded. The unedited surgical video recordings were handed over to third-party experts for granular analysis of the procedures using objective clinical human reliability analysis for the quality of intraoperative performance, technical errors, and intraoperative complications. RESULTS The technical errors enacted and identified in the RTG and the LTG were 46.11 ± 5.63 versus 58.79 ± 8.45 ( P < 0.001), respectively. The highest number of technical errors was identified during the dissection of the supra-pancreatic lymph nodes (task zone 3), including No. 5, 7, 8a, 9, 11p, and 12a to complete the nodal clearance around the celiac artery and its trifurcation (7.29 ± 1.88 vs 9.43 ± 2.24, P < 0.001) in both RTG and LTG. The number of lymph nodes harvested with RTG was higher than LTG (35.36 ± 7.51 vs 30.54 ± 6.95, P = 0.016), especially in the upper margin of the pancreas (13.32 ± 4.17 vs 9.36 ± 3.81, P < 0.001). The total cost of hospitalization in the RTG group is 3% more than the LTG group ($15953.41±3533.91 vs $12198.26±2761.27, P < 0.001). CONCLUSIONS This study offers compelling objective clinical human reliability analysis evidence demonstrating that RTG facilitates significantly superior technical performance compared with LTG. Whether examining short-term clinical outcomes or intraoperative operations, the robotic surgery system consistently outperforms laparoscopic surgery. Lymph node dissection in the supra-pancreatic region emerged as a major hazard zone in both procedures.
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Affiliation(s)
- Zhuoyu Jia
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | - Daosheng Wang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | | | - Xiaojie Tan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | - Shanglong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | - Yulong Tian
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | - Zhaojian Niu
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
| | - Benjie Tang
- Dundee Institute for Healthcare Simulation, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao and Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, China
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Chen X, Yang Z, Huang H, Xu C, Li G, Hu Y, Lin T, Yu J. Joint Nasogastric Tube Versus Traditional Decompression Nasogastric Tube to Guided OGT-Overlap Esophagojejunostomy in Laparoscopic Total Gastrectomy: A Randomized Controlled Trial. Ann Surg Oncol 2025; 32:5173-5182. [PMID: 40301205 DOI: 10.1245/s10434-025-17302-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Accepted: 03/24/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Our team pioneered the use of a joint nasogastric tube (JNT) for pairing overlap-esophagojejunostomy guiding tube (OGT) in an OGT-overlap esophagojejunostomy, demonstrating its safety and efficacy. OBJECTIVE We aimed to compare the safety and efficacy of a novel technique, the JNT, with traditional nasogastric tubing (TNT) in guiding OGT-overlap esophagojejunostomy. METHODS From January 2023 to January 2024, a total of 108 gastric/gastroesophageal junction (G/GEJ) cancer patients undergoing laparoscopic total gastrectomy (LTG) were eligible for inclusion in this study; however, 2 patients were excluded as they underwent hyperthermic intraperitoneal chemotherapy (HIPEC) after surgery. Patients were randomized into two groups: the JNT-OGT-overlap esophagojejunostomy group (JNT group; n = 53) or the TNT-OGT-overlap esophagojejunostomy group (TNT group; n = 53). RESULTS The JNT group had a significantly higher success rate for nasogastric tube (NT) insertion into the esophageal stump on the first attempt (90.6% vs. 58.5%; p < 0.001). Additionally, the insertion times were reduced by 6/7 of their original duration (15 [21] vs. 100 [120] sec; p < 0.001)], and connection times for OGT and NT were shortened to 2/5 of their original duration (90 [63] vs. 220 [130] sec; p < 0.001). Esophagojejunostomy time was also shorter in the JNT group (17.4 vs. 21.7 min; p < 0.001). Two cases were converted from TNT to JNT due to the failure of TNT to guide the esophageal stump entry hole for more than 5 min, which was resolved promptly by the JNT. Postoperative complications (18.9% vs. 20.8%; p = 0.807), particularly esophagojejunal anastomotic leakage (EJAL; 5.7% vs. 3.8%; p =1.000), and complication severity classification (p = 0.315) were comparable between the two groups. CONCLUSIONS The JNT technique significantly and safely improved the efficiency of OGT-overlap esophagojejunostomy compared with TNT, suggesting a well-tolerated and efficient new strategy for esophagojejunostomy.
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Affiliation(s)
- Xinhua Chen
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Zhijing Yang
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Huilin Huang
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Chuanjin Xu
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China.
- Southern Medical University Nanfang Hospital, Guangzhou, China.
| | - Tian Lin
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China.
- Southern Medical University Nanfang Hospital, Guangzhou, China.
| | - Jiang Yu
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangzhou, China.
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Yabuuchi Y, Masui Y, Kumagai K, Iwagami H, Murai K, Setoyama T, Tochio T, Utsumi T, Yoshikawa T, Araki O, Murakami S, Kitami M, Matsuura K, Kanda N, Hishitani E, Tanaka J, Marui S, Ikuta K, Yoshida H, Nishikawa Y, Nakanishi Y, Seno H, KONOE Project. External validation of the eCura system and comparison with the W-eCura score for predicting lymph node metastasis after non-curative endoscopic submucosal dissection for early gastric cancer: a multicenter retrospective cohort study. J Gastroenterol 2025; 60:829-837. [PMID: 40350513 DOI: 10.1007/s00535-025-02261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2025] [Accepted: 04/28/2025] [Indexed: 05/14/2025]
Abstract
BACKGROUND The eCura system is a widely used risk-scoring model for predicting lymph node metastasis (LNM) after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), but its external validation is limited. Recently, the W-eCura score, a modified version, was proposed. We aimed to validate the eCura system and compare its discriminatory performance with the W-eCura score. METHODS A multicenter retrospective study was conducted using data from 19 Japanese institutions. The patients who underwent ESD for EGC followed by gastrectomy with lymph node dissection were included. The predictive performance of the eCura system, including calibration and discrimination, was evaluated and its discrimination was compared with the W-eCura score. RESULTS Among 901 eligible patients, 65 cases (7.2%) showed LNM. The eCura system demonstrated good calibration, with a calibration-in-the-large of -0.008 (95% confidence interval [CI] -0.024-0.010), an observed-to-expected ratio of 0.905 (95% CI 0.707-1.121), and a calibration slope of 0.975 (95% CI 0.692-1.257). Discrimination was also good, with a C-statistic of 0.741 (95% CI 0.676-0.806). In patients evaluable for both systems, the C-statistics for the eCura system and W-eCura score were 0.745 (95% CI 0.675-0.816) and 0.750 (95% CI 0.684-0.817), respectively, showing no significant difference (P = 0.547). CONCLUSIONS The eCura system was validated as a reliable tool for predicting LNM following ESD in real-world clinical settings.
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Affiliation(s)
- Yohei Yabuuchi
- Department of Gastroenterology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Yuichi Masui
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Ken Kumagai
- Department of Gastroenterology and Hepatology, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Katsuyuki Murai
- Department of Gastroenterology, Kyoto Medical Center, Kyoto, Japan
| | - Takeshi Setoyama
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | | | - Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takaaki Yoshikawa
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Osamu Araki
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan
| | | | - Motoya Kitami
- Department of Gastroenterology, Otsu Red Cross Hospital, Shiga, Japan
| | - Kenshi Matsuura
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Kagawa, Japan
| | - Naoki Kanda
- Department of Gastroenterology and Hepatology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Eriko Hishitani
- Department of Gastroenterology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Junya Tanaka
- Department of Gastroenterology and Hepatology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Saiko Marui
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Shiga, Japan
| | - Kozo Ikuta
- Division of Gastroenterology, Shinko Hospital, Hyogo, Japan
| | - Hiroyuki Yoshida
- Department of Gastroenterology and Hepatology, Kansai Electric Power Hospital, Osaka, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Yuki Nakanishi
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Sędłak K, Bobrzyński Ł, Mlak R, Kołodziejczyk P, Pelc Z, Kobiałka S, Pawlik TM, Szczepanik A, Richter P, Sierżęga M, Polkowski WP, Rawicz-Pruszyński K. Proximal gastrectomy as an alternative to total gastrectomy in patients with advanced proximal gastric cancer: propensity score matching analysis of the 2-center study in European population. J Gastrointest Surg 2025; 29:102091. [PMID: 40381832 DOI: 10.1016/j.gassur.2025.102091] [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: 11/19/2024] [Revised: 04/15/2025] [Accepted: 05/10/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Proximal gastric cancer (PGC) is more common in the West than in the East. Improvements related to the minimally invasive approach in GC surgery and benefits to quality of life may be reasons for adopting proximal gastrectomy (PG). This study aimed to compare short- and long-term oncologic and surgical outcomes among patients with PGC with advanced PGC undergoing total gastrectomy (TG) vs PG in 2 expert centers in a European population. METHODS Patients with locally advanced PGC treated between 2010 and 2020 were included in the study. Patients who had not undergone gastrectomy, had early or metastatic GC, underwent palliative care, or had incomplete clinical or pathologic information were excluded. Propensity score matching (PSM) analysis was used to balance known covariates. RESULTS After PSM, patients who underwent TG had a higher incidence of positive margins (19.1% vs 8.6%; P =.0064), a higher median number of harvested lymph nodes (LNs) (26 vs 18 LNs; P <.0001), and a higher incidence of serious postoperative complications (35.2% vs 20.4%; P =.0030) than individuals who underwent PG. Older age (≥65 years) was related to a higher risk of serious postoperative complications (odds ratio [OR], 1.91). The use of neoadjuvant chemotherapy was related to a lower risk of serious postoperative complications (OR, 0.36). TG was independently associated with a higher risk of serious postoperative complications (OR, 2.02). Median overall survival for PG and TG groups was 44 and 23 months, respectively (hazard ratio, 1.22; 95% CI, 0.94-1.60; P =.1340). CONCLUSION PG may be considered as an alternative approach to TG in well-selected patients with locally advanced PGC. This surgical approach was associated with fewer serious postoperative complications.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland.
| | - Łukasz Bobrzyński
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Piotr Kołodziejczyk
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Sebastian Kobiałka
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Medical Center, Columbus, OH, United States
| | - Antoni Szczepanik
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Richter
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Marek Sierżęga
- First Department of Surgery, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Hu Y, Wen T, Tuo B. The role of ICG NIRL fluorescence imaging in the surgical treatment of digestive system tumors (Review). Mol Med Rep 2025; 32:181. [PMID: 40280113 PMCID: PMC12059463 DOI: 10.3892/mmr.2025.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 03/24/2025] [Indexed: 04/29/2025] Open
Abstract
Indocyanine green (ICG) is a relatively non‑toxic fluorescent dye with a history of safe use, which has fueled the development of new applications for ICG. Research on the use of ICG near‑infrared light (NIRL) fluorescence imaging during oncologic surgery has increased, revealing its role in tumor identification and localization, lymph node navigational resection and blood perfusion assessment. The purpose of the present review was to provide a comprehensive overview of advances in the clinical application of ICG NIRL fluorescence imaging during gastrointestinal tumor surgery. The present review discusses the techniques, outcomes, limitations and key considerations necessary for clinical practice, aiming to provide a valuable resource for professionals in the field.
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Affiliation(s)
- Yanxia Hu
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Tingyuan Wen
- Department of Obstetrics and Gynecology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Biguang Tuo
- Department of Gastroenterology, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
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Yu J, Li M, Qin XZ, Gong L, Qin L, Lv ZB, Guo W, Huang B, Tian YH. Application of modified Roux-en-Y digestive tract reconstruction in total gastrectomy for patients with gastric cancer. World J Gastrointest Surg 2025; 17:106009. [DOI: 10.4240/wjgs.v17.i6.106009] [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: 02/20/2025] [Revised: 04/01/2025] [Accepted: 04/25/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND At present, the concept of surgical treatment of gastric cancer (GC) has changed from “radical treatment” to “care for patients” to a certain extent. The reconstruction method is the most likely to affect the postoperative life of the patient. Currently, the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC. However, more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure, with more reconstruction steps and longer reconstruction time, and the incidence of postoperative complications such as adhesive intestinal obstruction, internal abdominal hernia and volvulus is high. Moreover, the incidence of Roux stasis syndrome is 10%-30% after traditional Roux-en-Y reconstruction. Thus, we modified the traditional Roux-en-Y alimentary tract reconstruction, and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.
AIM To evaluate the clinical advantages, feasibility, and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.
METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy (total gastrectomy) for GC were divided into two groups: fifty-four in the conventional Roux-en-Y reconstruction group (Orr group) and forty-three in the modified Roux-en-Y reconstruction group (the modified group). Perioperative and short-term outcomes were analyzed, including complications, postoperative weight loss, hemoglobin levels, and nutritional status.
RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics. Compared with the Orr group, the modified group had shorter digestive tract reconstruction and operation times, less intraoperative bleeding, and shorter postoperative hospital stays compared to the Orr group. Although both groups had similar amounts of intraoperative blood loss, postoperative recovery times, and hospital expenses, the Orr group experienced longer operation times and digestive tract reconstruction times. Furthermore, the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications, with a reduced incidence of reflux esophagitis and improved nutritional status.
CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety, simplicity, and a reduction in bile reflux. This method shortens operation times and minimizes postoperative complications, aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival. This method warrants further clinical application and promotion.
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Affiliation(s)
- Jing Yu
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Min Li
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Xiang-Zhi Qin
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Lei Gong
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Long Qin
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Zhen-Bing Lv
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Wei Guo
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Bin Huang
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
| | - Yun-Hong Tian
- Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
- Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China
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Xie RZ, Huang ZN, Zhang XQ, Sun YQ, Huang JB, Chen QY, Xie JW, Zheng CH, Huang CM, Lin JX, Li P. Long-term survival analysis after radical gastrectomy for Epstein-Barr virus-associated gastric cancer: A multicenter study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109737. [PMID: 40043593 DOI: 10.1016/j.ejso.2025.109737] [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: 11/19/2024] [Revised: 01/29/2025] [Accepted: 03/01/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND The prognosis of Epstein-Barr virus-associated gastric cancer (EBVaGC)needs to be validated by high-quality studies. This study aimed to assess the long-term survival of EBVaGC patients after radical gastrectomy using multicenter data to explore the potential value of EBV infection status as a prognostic predictor. METHODS We analyzed the clinical data of patients with EBVaGC and Epstein-Barr virus-negative gastric cancer (EBVnGC) who underwent radical gastrectomy from January 2013 to July 2020. The Kaplan-Meier method and Cox regression analysis were used to evaluate overall survival (OS) and disease-free survival (DFS). A Random Survival Forest (RSF) model was constructed to predict the prognosis. RESULTS After propensity score matching, 205 and 410 patients were included in the EBVaGC and EBVnGC groups, respectively. The 3-year OS and DFS rates in the EBVaGC group were significantly higher than those in the EBVnGC group. Multivariate analysis indicated that EBER(Epstein-Barr virus-encoded small RNA) positivity was an independent protective factor for OS and DFS. Among stage II and III EBVaGC patients, those receiving ≥4 cycles of chemotherapy had a 3-year OS significantly better than those receiving <4 cycles. The RSF model based on EBER status outperformed the Cox model and TNM staging system in predicting the 3-year OS and DFS. CONCLUSION The prognostic prediction model established based on the EBER status has good clinical application value and can provide a new reference for clinical follow-up management. It is recommended that patients with stage II and III EBVaGC receive at least four cycles of chemotherapy postoperatively to improve survival.
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Affiliation(s)
- Rong-Zhen Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of Gastrointestinal Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, 350108 Fuzhou, Fujian Province, China
| | - Xing-Qi Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, 350108 Fuzhou, Fujian Province, China
| | - Yu-Qin Sun
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, China
| | - Jiao-Bao Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, 350108 Fuzhou, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, 350108 Fuzhou, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, 350108 Fuzhou, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, 350108 Fuzhou, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, 350108 Fuzhou, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, 350108 Fuzhou, Fujian Province, China.
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Song SK, Zhu J, Feng HM, Ma AS, Yang CG. A retrospective analysis of Gastric Cancer Lymph Nodes Based on Groups, Regions, and Stages. SURGERY IN PRACTICE AND SCIENCE 2025; 21:100287. [PMID: 40530073 PMCID: PMC12171807 DOI: 10.1016/j.sipas.2025.100287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2025] [Revised: 05/09/2025] [Accepted: 05/28/2025] [Indexed: 06/20/2025] Open
Abstract
Objective The consistency between clinical and pathological staging of lymph nodes (LNs) in gastric cancer (GC) remains suboptimal, and there is currently no standardized imaging criterion for diagnosing lymph node metastasis (LNM). This study aimed to elucidate the differences in LNs among various groups, regions, and stages, utilizing imaging and histopathology as the foundational basis. Methods We retrospectively analyzed the clinical data of 100 GC patients who underwent surgical treatment at Zhongnan Hospital of Wuhan University between January 2022 and May 2023. Patient characteristics, along with pathological and radiological data of LNs, were collected and compared across different groups, regions, and stages. Results Pathologically, 3566 LNs were collected, with a median of 35 (range: 17-72). Radiologically, 2233 LNs were collected, with a median of 22 (range: 3-47). Significant differences were observed in the long-axis diameter (LAD), short-axis diameter (SAD), ratios of long to short axis (RLSA), and product of long and short axis (PLSA) between negative and positive LNs. However, only within group 3 did the RLSA show statistical significance upon grouping analysis. The areas under the curve (AUC) for LAD, SAD, PLSA, and their combination index (CI) in diagnosing LNM were 0.817, 0.817, 0.828, and 0.827, respectively. Diverse groups, regions, and stages exerted a more pronounced influence on LN groups 1-6, while having a comparatively lesser impact on LN groups 7-16. Conclusion LAD, SAD, and PLSA exhibited significant diagnostic value for LNM and could serve as diagnostic criteria; however, RLSA demonstrated limited diagnostic utility. The formulation of diagnostic criteria should consider the impact of groups, regions, and stages to enhance sensitivity and specificity.
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Affiliation(s)
- Si-kai Song
- Department of Abdominal Surgery, The Third People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang, PR China
| | - Jiang Zhu
- Department of Abdominal Surgery, The Third People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang, PR China
| | - Hai-min Feng
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, PR China
| | - An-she Ma
- General surgery department, The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang, PR China
| | - Chao-gang Yang
- Department of Gastrointestinal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, PR China
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Huang ZN, Qiu WW, Li TY, Zhang L, She JJ, Jia BQ, Qin XG, Ren SY, Yao HL, Liu DN, Liang H, Shi FY, Li P, Li BP, Zhang XS, Liu KJ, Zheng CH, Huang CM, Lin JX, Li P. Comparison of short- and long-term outcomes for robotic versus laparoscopic gastrectomy in elderly patients with gastric cancer: a multicenter cohort study. Surg Endosc 2025; 39:3860-3872. [PMID: 40346431 DOI: 10.1007/s00464-025-11756-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 04/20/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND There is limited evidence from large-scale multicenter studies regarding the short- and long-term efficacy of robotic gastrectomy (RG) in elderly patients diagnosed with gastric cancer (GC). As such, this retrospective investigation compared short-term outcomes and long-term oncological prognoses of RG versus (vs.) laparoscopic gastrectomy (LG) in a representative sample of this population. METHODS Data from 1393 patients ≥ 65 years of age diagnosed with GC, who underwent radical gastrectomy at 8 large tertiary hospitals in China between August 2016 and June 2019, were analyzed. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to reduce confounding bias. RESULTS After IPTW and PSM adjustments, baseline characteristics between the RG and LG groups were comparable (standardized mean difference < 0.10). After IPTW adjustment, mean blood loss in the RG group was significantly less than that in the LG group (89.36 vs. 103.39 mL; p = 0.046) as was mean length of hospital stay (9.62 vs. 10.47 days; p = 0.017). There were no statistical differences in postoperative complications between the RG and LG groups (p > 0.05), nor in 3y-DFS (IPTW-adjusted: 74.5% vs. 74.6%, p = 0.957; PSM-adjusted: 76.8% vs. 79.3%, p = 0.323) or 3y-OS (IPTW-adjusted: 75.9% vs. 77.0%, p = 0.640; PSM-adjusted: 77.9% vs. 80.9%, p = 0.235). Similarly, there were no significant differences in postoperative recurrence rates between the RG and LG groups (IPTW-adjusted: 21.1% vs. 20.5%, p = 0.640; PSM-adjusted: 77.9% vs. 80.9%, p = 0.235). CONCLUSION RG yielded superior short-term outcomes compared with LG in elderly patients diagnosed with GC, while achieving comparable long-term outcomes and demonstrating safety and effectiveness.
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Affiliation(s)
- Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Wen-Wu Qiu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Tai-Yuan Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zhang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Jun-Jun She
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bao-Qing Jia
- Department of General Surgery, The First Medical Centre, PLA General Hospital, Beijing, China
| | - Xin-Gan Qin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shuang-Yi Ren
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hong-Liang Yao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Dong-Ning Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Han Liang
- Department of Gastric Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Fei-Yu Shi
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Peng Li
- Department of General Surgery, The First Medical Centre, PLA General Hospital, Beijing, China
| | - Bo-Pei Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin-Sheng Zhang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Kui-Jie Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, Fujian Province, China.
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
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14
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Xiao Y, Ren BC, Zhang T, Peng D, Min J. Factors influencing postoperative complications in patients with gastric cancer: A retrospective study. World J Gastrointest Surg 2025; 17:101047. [DOI: 10.4240/wjgs.v17.i5.101047] [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: 01/10/2025] [Revised: 02/22/2025] [Accepted: 03/19/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Gastric cancer is a malignancy with high morbidity and mortality rates. Surgical intervention, particularly gastrectomy, is essential for curative treatment but carries a substantial risk of complications. Identifying key risk factors and understanding complication profiles are crucial for improving outcomes and guiding perioperative management.
AIM To analyze the incidence of postoperative complications in patients with gastric cancer and identify potential risk factors.
METHODS We conducted a retrospective analysis of 500 patients who underwent gastrectomy between January 2018 and December 2022. Postoperative complications were classified using the Clavien-Dindo system.
RESULTS The overall complication rate was 28.4% (142/500), with 15.2% (76/500) experiencing major complications (Clavien-Dindo grade ≥ III). Pulmonary complications were the most frequent (10.8%), followed by surgical site infections (8.6%), and anastomotic leakage (4.2%). Age 70 years or more, body mass index of 25 kg/m² or more, advanced tumor stage, total gastrectomy, and operative time 240 min or more emerged as independent risk factors.
CONCLUSION Focused preoperative risk assessment, targeted interventions, and reduced operative time for older or obese patients requiring total gastrectomy or presenting with advanced disease are important to improve surgical outcomes.
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Affiliation(s)
- Ying Xiao
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bang-Chun Ren
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Tao Zhang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jiang Min
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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15
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Yoo M, Kong Y, Min GH, Hwang DY, Kang SH, Park YS, Ahn SH, Park DJ, Kim HH, Suh YS. Laparoscopic gastrectomy reduced peritoneal recurrence in Borrmann type IV gastric cancer: a retrospective cohort study with propensity score matching. Surg Endosc 2025:10.1007/s00464-025-11791-5. [PMID: 40425862 DOI: 10.1007/s00464-025-11791-5] [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: 01/19/2025] [Accepted: 05/03/2025] [Indexed: 05/29/2025]
Abstract
BACKGROUND Current evidence on the surgical and oncological safety of laparoscopic surgery in patients with Borrmann type IV (B-IV) advanced gastric cancer (AGC) remains insufficient. This study aimed to compare the surgical and prognostic outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) in patients with B-IV AGC. METHODS Patients with primary B-IV gastric cancer who underwent LG or OG between 2003 and 2019 were retrospectively analyzed. We conducted 1:1 propensity score matching using covariates including sex, age, body mass index, operation type, clinical T and N stages, pathological TNM stage, tumor size, and tumor location. Surgical outcomes, postoperative complications, 5-year survival and recurrence outcomes, and risk factors for peritoneal recurrence were compared between the two groups. RESULTS Of 401 patients enrolled, 106 from each of the LG and OG groups were matched, with all standardized differences < 0.1. The LG had significantly fewer wound infections (P = 0.029), intra-abdominal abscesses (P = 0.035) and a lower peritoneal recurrence rate (5-year cumulative incidence: 48.8% vs. 62.8%, P = 0.032; hazard ratio, 0.66; 95% confidence interval, 0.45-0.96) compared to the OG group, along with a trend toward improved 5-year overall survival (LG vs. OG: 37.0% vs. 26.2%, P = 0.174; hazard ratio, 0.78; 95% confidence interval, 0.55-1.11). Multivariate analyses revealed a 32.6% decrease in the hazard ratio for peritoneal recurrence in the LG group (P = 0.048). CONCLUSIONS LG significantly reduced peritoneal recurrence with fewer wound and intra-abdominal infectious complications in patients with B-IV AGC.
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Affiliation(s)
- Mira Yoo
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yoon Kong
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Guan Hong Min
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Du-Yeong Hwang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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16
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Nakayama I. Therapeutic strategy for scirrhous type gastric cancer. Jpn J Clin Oncol 2025:hyaf081. [PMID: 40403741 DOI: 10.1093/jjco/hyaf081] [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: 02/26/2025] [Accepted: 05/09/2025] [Indexed: 05/24/2025] Open
Abstract
Scirrhous-type gastric cancer (SGC) is a rare but well-recognized subset of resectable gastric cancer (GC), accounting for ⁓10% of cases. Despite its long history of clinical recognition dating back to the pre-1900s, SGC remains one of the most challenging GC subtypes to treat. Traditionally, SGC has been clinically defined as Borrmann type 4 GC, with histological classifications such as signet ring cell carcinoma or diffuse-type histology serving as alternative diagnostic criteria. Therapeutic advancements for SGC have largely focused on locally advanced or oligometastatic disease, yet no SGC-specific treatment has been established. The phase III JCOG0501 trial failed to demonstrate a survival benefit of neoadjuvant S-1 plus cisplatin for Borrmann type 4 and large type 3 GC. Recent developments in biomarker-driven therapies may redefine SGC by molecular subtypes, with CLDN18.2-targeted therapy emerging as a potential option for some SGC cases. However, as the landscape of medical oncology evolves, SGC may not remain a distinct therapeutic entity. The focus should shift toward understanding the intrinsic biology of SGC. Treatment development for SGC is expected to continue advancing, becoming increasingly stratified based on molecular abnormalities while maintaining a commitment to addressing unmet needs, such as early-onset GC and GC with symptomatic peritoneal dissemination.
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Affiliation(s)
- Izuma Nakayama
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwanoha 6-5-1, Kashiwa, 277-8577, Japan
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17
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Zhang C, Wang K, Zhang Z, Zhao X, Yao B, Zhang W. Safety and short‑term outcomes of a modified tubular esophagogastrostomy versus double tract reconstruction after proximal gastrectomy: a propensity score matching analysis. BMC Cancer 2025; 25:908. [PMID: 40399830 PMCID: PMC12096559 DOI: 10.1186/s12885-025-14284-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Accepted: 05/07/2025] [Indexed: 05/23/2025] Open
Abstract
OBJECTIVE To comparatively evaluate the short-term clinical efficacy and quality of life (QoL) between modified tubular esophagogastrostomy (mTEG) and double tract reconstruction (DTR) following proximal gastrectomy (PG), aiming to establish evidence-based recommendations for reconstruction method selection. METHODS The mTEG technique involved three essential steps: 1) tubular reconstruction of gastric remnant, 2) 3-cm artificial gastric fornix creation, and 3) His angle sharpening with posterior mediastinal fixation. This retrospective study included 288 PG patients (2021-2024). Propensity score matching (1:1, caliper = 0.03) balanced baseline characteristics, and thirty-three matched pairs were analyzed. Outcomes encompassed operative metrics, postoperative complications (Clavien-Dindo ≥ II), nutritional status (prealbumin, albumin, hemoglobin, BMI at 1/3/6 months), and QoL (EORTC QLQ-STO22 at 6 months). RESULTS The mTEG group demonstrated shorter median operative time (163.7 vs 247.9 min, p < 0.001) and postoperative hospitalization (8.3 vs 9.9 days, p = 0.001). Intraoperative outcomes including blood loss and lymph node yield were comparable. Early complications (≤ 30 days) occurred exclusively in the DTR group (4 cases: 2 anastomotic leakage, 1chylous leakage and 1 pulmonary related). complication rates showed no statistical difference (p > 0.05). Endoscopic findings demonstrated comparable incidence of reflux esophagitis in Los Angeles Grade B or higher (11.1% vs 4.5%, p = 0.457). Nutritional parameters and QoL scores remained equivalent between groups at all timepoints (p > 0.05). CONCLUSION mTEG represents a technically optimized reconstruction method that achieves equivalent nutritional preservation and reflux prevention compared to DTR, while offering distinct advantages in surgical efficiency and postoperative recovery. These findings support mTEG as a viable reconstruction option for PG patients.
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Affiliation(s)
- Chaoyang Zhang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Kaixing Wang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Zhidong Zhang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China.
| | - Xuefeng Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Bin Yao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
| | - Weishuai Zhang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Rd. Changan District, Shijiazhuang, 050011, China
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18
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Zheng CH, Chen YB, Yu WB, Cai LS, Wang Q, Sun YH, Yan S, He XL, Xu ZK, Li GX, Tian YT, Li C, Wang BG, Ji JF, Xu YC, Zhong Q, Liu ZY, Chen QY, Li P, Xie JW, Liang Y, Liu ZM, Qiu HB, Wei M, Yan ZB, Lv CB, Chen QX, Li S, Zeng LX, Huo BW, Li ZY, Su XQ, Huang CM. Safety and efficacy of indocyanine green-guided laparoscopic lymphadenectomy for locally advanced gastric cancer: The CLASS-11 clinical trials. Cell Rep Med 2025; 6:102136. [PMID: 40398388 DOI: 10.1016/j.xcrm.2025.102136] [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: 09/19/2024] [Revised: 12/31/2024] [Accepted: 04/22/2025] [Indexed: 05/23/2025]
Abstract
We report the short-term results of indocyanine green (ICG)-guided laparoscopic lymphadenectomy for gastric cancer (GC). The primary outcome is 3-year disease-free survival. In this analysis, we present short-term secondary outcomes focused on the number of lymph nodes (LNs) retrieved and the diagnostic value of fluorescent status for metastatic LNs, excluding long-term outcomes. A total of 1,006 patients are included in the per-protocol analysis. The mean number of LNs retrieved in the ICG group is significantly higher than that in the non-ICG group. The negative predictive value is 93.9% for nonfluorescent stations, and the sensitivity of ICG for detecting all metastatic LN stations is 91.6%. ICG technology is safe and feasible for laparoscopic lymphadenectomy in GC and can noticeably increase the number of LNs retrieved. Further follow-up is necessary to warrant whether ICG can improve long-term survival of GC. The Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS)-11 trial has been registered at ClinicalTrials.gov as NCT04593615.
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Affiliation(s)
- Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying-Bo Chen
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Wen-Bin Yu
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China
| | - Li-Sheng Cai
- Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Quan Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Jilin, China
| | - Yi-Hong Sun
- Gastric Cancer Center/Department of Gastrointestinal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Su Yan
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qinghai University, Qinghai, China
| | - Xian-Li He
- Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ze-Kuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guo-Xin Li
- Department of General Surgery, Southern Medical University Nanfang Hospital, Guangdong, China
| | - 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, Beijing, China
| | - Chen Li
- Department of Surgery, Shanghai Key Laboratory of Gastric Neoplasms, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bao-Gui Wang
- Department of Gastric Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Control, Tianjin Clinical Research Center for Cancer, Tianjin, China
| | - Jia-Fu Ji
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yan-Chang Xu
- Gastrointestinal Surgery Unit 1, Teaching Hospital of Putian First Hospital of Fujian Medical University, Fujian, China
| | - Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yao Liang
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Zhi-Min Liu
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hai-Bo Qiu
- Department of Gastric Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Meng Wei
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China
| | - Zhi-Bo Yan
- Department of General Surgery, Qilu Hospital of Shandong University, Shandong, China
| | - Chen-Bin Lv
- Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Qiu-Xian Chen
- Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Shuang Li
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Jilin, China
| | - Ling-Xiao Zeng
- Gastric Cancer Center/Department of Gastrointestinal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bo-Wen Huo
- Department of Gastrointestinal Surgery, Affiliated Hospital of Qinghai University, Qinghai, China
| | - Zi-Yu Li
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang-Qian Su
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Liu S, Song P, Hu Q, Sun F, Lu X, Wang M, Zhao H, Guan W. Efficacy and safety of subserosal versus submucosal carbon nanoparticle-guided laparoscopic radical gastrectomy (DANCE-04): A randomized clinical trial. Surgery 2025:109398. [PMID: 40393912 DOI: 10.1016/j.surg.2025.109398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 03/25/2025] [Accepted: 03/30/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND To compare the efficacy in lymph node dissection, perioperative safety, and cost of subserosal and submucosal administration of carbon nanoparticles in laparoscopic radical gastrectomy for gastric cancer. METHODS This was a randomized clinical trial. Patients with potentially resectable gastric cancer (cT1-4a, cNany, cM0) were randomized into subserosal or submucosal groups. Laparoscopic D2 lymphadenectomy was performed for each patient. RESULTS Between September 2023 and August 2024, 49 patients were enrolled in the subserosal group and 50 patients were enrolled in the submucosal group. The number of retrieved lymph nodes in the subserosal group was significantly greater than that in the submucosal group (36.6 ± 1.4 vs 32.2 ± 1.4, P = .02). The number of retrieved metastatic lymph nodes in the subserosal group was also significantly greater than that in the submucosal group (3.1 ± 0.6 vs 1.5 ± 0.5, P = .04). The duration of surgery in the subserosal group was shorter than that in the submucosal group (150.9 ± 3.0 minutes vs 194.7 ± 6.2 minutes, P < .001). The tracing-related cost in the subserosal group was lower than that in the submucosal group (1,824.8 ± 110.9 vs 2,395.5 ± 112.5 [in Chinese currency], P < .001), whereas the tracing-excluded cost was similar between groups. Diagnostic values, including sensitivity, specificity, positive predictive value, and negative predictive value for metastatic stations or lymph nodes, of the subserosal approach were superior to those of the submucosal approach. CONCLUSION Subserosal is superior to submucosal administration of carbon nanoparticles in lymph node dissection with comparable perioperative safety and decreased tracing-related cost in laparoscopic radical gastrectomy for gastric cancer. TRIAL REGISTRATION ISRCTN11247387 (https://doi.org/10.1186/ISRCTN11247387).
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Affiliation(s)
- Song Liu
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China; MOE Key Laboratory of Model Animal for Disease Study, Nanjing, China
| | - Peng Song
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiongyuan Hu
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Feng Sun
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaofeng Lu
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Meng Wang
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Haijian Zhao
- Division of Gastrointestinal Surgery, Department of General Surgery, the Affiliated Huai'an Hospital of Xuzhou Medical University, Nanjing, China
| | - Wenxian Guan
- Division of Gastric Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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20
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He C, Zhou H, He G, Zhang W, Chen H. Application of accommodated jejunal interposition double tract reconstruction after total gastrectomy for gastric cancer: a retrospective study. Discov Oncol 2025; 16:729. [PMID: 40354014 PMCID: PMC12069787 DOI: 10.1007/s12672-025-02536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 04/29/2025] [Indexed: 05/14/2025] Open
Abstract
BACKGROUND The aim of this study was to compare the effects of accommodated jejunal interposition double tract reconstruction (aji-DTR) and Roux-en-Y reconstruction after laparoscopic-assisted total gastrectomy on intraoperative and postoperative indicators in advanced gastric cancer (AGC) patients. METHODS A retrospective analysis was performed on 80 AGC patients, including 43 with aji-ATR and 37 with Roux-en-Y reconstruction. Propensity score matching was performed between the two groups. The primary outcome measures included operative time, intraoperative blood loss, postoperative complications, postoperative hospital stay, total hospitalization costs, and survival rate. The secondary outcome measures were postoperative nutritional status, recovery of digestive function, and postoperative gastrointestinal·symptoms. RESULTS There were 24 pairs of patients after matching. There were no significant differences in the operative time, intraoperative blood loss, time of first flatus, time of first defecation, time of liquid diet, time of semi-liquid diet, postoperative complications, postoperative hospital stays, and total hospitalization costs (all P > 0.05). Interestingly, Roux stasis syndrome was significantly more frequent in Roux-en-Y group than aji-DTR group [6 (25.0%) vs 1 (4.2%), P = 0.045]. While no significant difference was observed in survival rates, reflux esophagitis, dumping syndrome and nutritional parameter including hemoglobin, albumin, and prognostic nutritional index (all P > 0.05). CONCLUSIONS Compared with Roux-en-Y reconstruction, aji-DTR had similar surgical parameters, postoperative digestive function recovery, nutritional parameters, and survival rate, but showed an advantage in reducing Roux stasis syndrome. Therefore, aji-DTR after laparoscopic assisted total gastrectomy may be a safe and feasible alternative for AGC patients.
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Affiliation(s)
- Cankun He
- Department of General Surgery, Hui'an County Hospital, 582 Huixing Street, Hui'an, 362100, China
| | - Huangming Zhou
- Department of General Surgery, Hui'an County Hospital, 582 Huixing Street, Hui'an, 362100, China
| | - Guobao He
- Department of General Surgery, Hui'an County Hospital, 582 Huixing Street, Hui'an, 362100, China
| | - Weixin Zhang
- Department of General Surgery, Hui'an County Hospital, 582 Huixing Street, Hui'an, 362100, China
| | - Huizhong Chen
- Department of General Surgery, Hui'an County Hospital, 582 Huixing Street, Hui'an, 362100, China.
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21
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He Y, Xie X, Yang B, Jin X, Feng Z. Combining biomarkers to construct a novel predictive model for predicting preoperative lymph node metastasis in early gastric cancer. Front Oncol 2025; 15:1533889. [PMID: 40406257 PMCID: PMC12094995 DOI: 10.3389/fonc.2025.1533889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Accepted: 04/14/2025] [Indexed: 05/26/2025] Open
Abstract
Background Accurately identifying the status of lymph node metastasis (LNM) is crucial for determining the appropriate treatment strategy for early gastric cancer (EGC) patients. Methods Univariate and multivariate logistic regression analyses were used to explore the association between clinicopathological factors and LNM in EGC patients, leading to the development of a nomogram. Differential expression analysis was conducted to identify biomarkers associated with LNM, and their expression was evaluated through immunohistochemistry. The biomarker was integrated into the conventional model to create a new model, which was then assessed for reclassification and discrimination abilities. Results Multivariate logistic regression analysis revealed that tumor size, histological type, and the presence of ulcers are independent risk factors for LNM in EGC patients. The nomogram demonstrated good clinical performance. Incorporating HAVCR1 immunohistochemical expression into the new model further improved its performance, reclassification, and discrimination abilities. Conclusion The novel nomogram predictive model, based on preoperative clinicopathological factors such as tumor size, histological type, presence of ulcers, and HAVCR1 expression, provides valuable guidance for selecting treatment strategies for EGC patients.
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Affiliation(s)
| | | | | | | | - Zhijie Feng
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Hebei Key Laboratory of Gastroenterology, Hebei Institute of Gastroenterology, Hebei Clinical Research Center for Digestive Diseases, Shijiazhuang, Hebei, China
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22
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Zhang X, Han X. Synchronous occurrence of primary gastric and liver cancer: A case report. Oncol Lett 2025; 29:222. [PMID: 40103599 PMCID: PMC11916645 DOI: 10.3892/ol.2025.14968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 10/02/2024] [Indexed: 03/20/2025] Open
Abstract
Primary gastric and liver cancers rank among the most prevalent malignant tumors of the digestive tract. Despite their serious implications for health, the global age-standardized incidence remains relatively low, at ~11.1 per 100,000 for primary gastric cancer and ~8.657 per 100,000 for primary liver cancer. Although the occurrence of multiple primary malignancies is not uncommon in clinical practice, reports of synchronous primary gastric and liver cancer are exceedingly rare. The present study describes a case involving a 60-year-old man diagnosed with synchronous primary gastric and liver cancer. The patient underwent endoscopic submucosal dissection for lesions located at the gastric angle, followed by laparoscopic resection of a small liver tumor. Pathological examinations revealed moderately differentiated intramucosal adenocarcinoma at the gastric angle and well-differentiated hepatocellular carcinoma in the liver. Following a 3-year follow-up, the patient remained in good health, with no evidence of disease recurrence. In conclusion, clinicians should exercise caution in patients presenting with distinct lesions to ensure that subtle malignancies are not overlooked, particularly in those with confirmed cancer. For patients with multiple cancers, it is crucial to ascertain whether the malignancies are primary, as this determination influences treatment strategies.
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Affiliation(s)
- Xiaomin Zhang
- Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
| | - Xiaoying Han
- Department of Gastroenterology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei 441021, P.R. China
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Liu Q, Meng C, Cao S, Liu X, Tian Y, Li Z, Zhong H, Sun Y, Yu J, Zhou Y. Comparison of short- and long-term outcomes of robotic versus laparoscopic gastrectomy for locally advanced gastric cancer after neoadjuvant therapy: a high-volume center retrospective study with propensity score matching. Surg Endosc 2025; 39:2814-2827. [PMID: 40064692 DOI: 10.1007/s00464-025-11626-3] [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: 10/28/2024] [Accepted: 02/18/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Although neoadjuvant therapy (NAT) for advanced gastric cancer (AGC) can benefit patient survival, few studies have compared the short- and long-term outcomes of robotic and laparoscopic gastrectomy for AGC after NAT. METHODS The clinical data of 321 AGC patients who received NATs and who underwent robotic gastrectomy (RG, n = 109) or laparoscopic gastrectomy (LG, n = 212) between May 2017 and September 2022 were collected and analyzed retrospectively at our center. After propensity score matching (PSM) for 1:1 matching to eliminate bias, both groups had 106 cases. Short-term clinical outcomes and long-term survival-related indicators were compared between the two groups of patients. RESULTS A total of 212 patients were included in the groups after matching. There were fewer overall complications (13.2% vs. 28.3%, P = 0.007) and surgical complications (8.5% vs. 17.9%, P = 0.043) in the RG group than in the LG group. Compared with the LG group, the RG group had more harvested overall lymph nodes (35.25 ± 4.99 vs. 31.45 ± 6.31, P < 0.001) and more suprapancreatic lymph nodes (13.12 ± 4.38 vs. 10.05 ± 4.13, P < 0.001). Patients in the RG group had significantly shorter surgery times (217.62 ± 47.49 vs. 267.25 ± 70.68, P < 0.001) and less blood loss (46.51 ± 27.02 vs. 70.75 ± 37.25, P < 0.001) than patients in the LG group. The RG group had significantly faster bowel function recovery, earlier liquid diet, and shorter hospital stay. Compared with LG, RG had a better 3-year RFS (75.5% vs. 62.3%, P = 0.017). CONCLUSION Compared with laparoscopic surgery, robotic surgery significantly increased the number of lymph node dissected, reduced intraoperative blood loss, and postoperative surgical complications rate. Although RG did not statistically improve 3-year overall survival, there was a significant improvement in RFS and could be an alternative surgical method for GC patients after NAC.
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Affiliation(s)
- Qi Liu
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Cheng Meng
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Shougen Cao
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Xiaodong Liu
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Yulong Tian
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Zequn Li
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Hao Zhong
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Yuqi Sun
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Junjian Yu
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China
| | - Yanbing Zhou
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, 266000, Shandong Province, People's Republic of China.
- Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong Province, China.
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Ushimaru Y, Omori T, Yamamoto K, Yanagimoto Y, Masuike Y, Matsuura N, Sugase T, Kanemura T, Mori R, Kitakaze M, Amisaki M, Kubo M, Mukai Y, Komatsu H, Sueda T, Kagawa Y, Wada H, Gotoh K, Yasui M, Miyata H. Robotic and laparoscopic gastrectomy for gastric cancer: comparative insights into perioperative performance and three-year survival outcomes. Gastric Cancer 2025; 28:514-526. [PMID: 40009253 DOI: 10.1007/s10120-025-01601-1] [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: 11/08/2024] [Accepted: 02/16/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND The primary treatment for gastric cancer (GC) is surgical resection, particularly for locally advanced cases. While laparoscopic gastrectomy (LG) has shown short- and long-term benefits, robotic gastrectomy (RG) offers enhanced precision and may lead to better outcomes, especially in advanced-stage disease. METHODS This retrospective study analyzed data from 1538 patients with pathological Stage I-III GC who underwent RG or LG between 2014 and 2021. Propensity score matching created 466 matched pairs. Perioperative outcomes, 3 year overall survival (OS), 3 year recurrence-free survival (RFS), and recurrence patterns were compared between RG and LG. RESULTS RG demonstrated significantly shorter operative time (235.5 vs. 242.5 min, p = 0.001), less blood loss (19.1 vs. 33.4 ml, p < 0.001), and shorter hospital stay (7.9 vs. 9.7 days, p < 0.001). Overall complications did not differ significantly (p = 0.183), but RG had lower rates of anastomotic leakage (p = 0.045) and pancreatic fistula (p = 0.024). No significant differences in OS were observed in the overall cohort or by stage. Similarly, RFS showed no significant differences in the overall cohort (3 year RFS: RG 86.81% vs. LG 83.04%, p = 0.1347). By stage, no differences were found in stage I or II, but in stage III, RG showed better 3 year RFS (67.52% vs. 52.97%, p = 0.0424). RG also had lower recurrence rates (9.0% vs. 14.8%, p = 0.0061), with fewer liver (p = 0.0069) and lymph node metastases (p = 0.0223). CONCLUSION RG demonstrated superior short-term outcomes and comparable three-year OS to laparoscopic gastrectomy, with improved three-year RFS and reduced recurrence in Stage III, likely facilitated by earlier adjuvant chemotherapy initiation.
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Affiliation(s)
- Yuki Ushimaru
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan.
| | - Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Yasunori Masuike
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Norihiro Matsuura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Takahito Sugase
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Takashi Kanemura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Ryota Mori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Masatoshi Kitakaze
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Masataka Amisaki
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Masahiko Kubo
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Yousuke Mukai
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Hisateru Komatsu
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Toshinori Sueda
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka City, Osaka, Japan
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Tang YH, Huang ZN, Sun YQ, Zhao YQ, Qiu WW, He JX, Li P, Xie JW, Wang JB, Chen QY, Cao LL, Zheng CH, Lin JX, Yan S, Huang CM. Prognostic Impact of Fluorescent Lymphography on Gastric Cancer After Neoadjuvant Chemotherapy. JAMA Surg 2025; 160:554-563. [PMID: 40072431 PMCID: PMC11904804 DOI: 10.1001/jamasurg.2025.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 12/30/2024] [Indexed: 03/15/2025]
Abstract
Importance Indocyanine green (ICG)-guided lymphadenectomy has been increasingly used to treat gastric cancer. However, its oncologic impact remains unclear. Objective To investigate the effect of ICG tracing on long-term outcomes in patients diagnosed with locally advanced gastric cancer undergoing neoadjuvant chemotherapy (NAC) followed by laparoscopic radical gastrectomy. Design, Settings, and Participants This retrospective cohort study included patients diagnosed with cT2-4N0/+M0 gastric adenocarcinoma who underwent NAC and laparoscopic radical gastrectomy at 3 teaching hospitals in China between January 2015 and June 2021, with follow-up data examined until June 2024. Overlap weighting (OW) was used to compare outcomes between the ICG and non-ICG groups. Results were tested for robustness using propensity score matching (PSM) and instrumental variable analysis. Exposure ICG-guided lymphadenectomy during laparoscopic gastrectomy. Main Outcomes and Measures The primary end points were 3-year survival outcomes, including overall survival (OS) and recurrence-free survival (RFS). Results Data from 459 patients (338 men [73.6%] and 121 women [26.4%]; mean [SD] age, 60.8 [9.9] years), of whom 119 underwent ICG-guided lymphadenectomy, were included. After OW adjustment, the ICG group exhibited a higher number of lymph nodes harvested (47.4 vs 38.3; P < .001) and better 3-year OS (78.6% vs 66.6%; P = .04) and RFS (74.0% vs 57.0%; P = .03) compared with the non-ICG group. Multivariable Cox regression analysis revealed that ICG tracing was an independent prognostic factor for both OS (hazard ratio, 0.59; 95% CI, 0.39-0.90; P = .02) and RFS (hazard ratio, 0.59; 95% CI, 0.40-0.87; P = .01), with the results remaining significant in both doubly robust and instrumental variable-adjusted models. Furthermore, in the OW-adjusted population, the OS benefit of ICG tracing was more pronounced in subgroups with ypN2/3 gastric adenocarcinoma (70.3% vs 36.2%; P = .01) and those achieving major pathological response (97.7% vs 77.6%; P = .04) (both P for interaction = .04). Similar results were obtained after adjusting for PSM. Conclusion and Relevance In this study, ICG tracing was associated with enhanced lymphadenectomy and improved survival outcomes in patients with locally advanced gastric cancer after NAC. A prospective randomized clinical trial is needed to verify these findings.
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Affiliation(s)
- Yi-Hui Tang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
| | - Yu-Qin Sun
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Ya-Qi Zhao
- Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, China
| | - Wen-Wu Qiu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ji-Xun He
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
| | - Su Yan
- Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, China
- Laboratory of Gastrointestinal Cancer, Fujian Medical University, Ministry of Education, Fuzhou, China
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Ri M, Hayami M, Ohashi M, Makuuchi R, Irino T, Sano T, Nunobe S. Possibly more favorable short-term outcomes with minimally invasive surgery than with open surgery in total gastrectomy for locally advanced gastric cancer: A single high-volume center study. Ann Gastroenterol Surg 2025; 9:439-447. [PMID: 40385332 PMCID: PMC12080201 DOI: 10.1002/ags3.12881] [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: 07/29/2024] [Revised: 09/11/2024] [Accepted: 10/19/2024] [Indexed: 05/20/2025] Open
Abstract
Background Minimally invasive total gastrectomy (MTG) requires advanced surgical skills and is still associated with a higher rate of postoperative complications than other types of gastrectomy. Additionally, the short-term outcomes of MTG compared to open total gastrectomy (OTG) for locally advanced gastric cancer have yet to be demonstrated. Methods We retrospectively compared short-term outcomes between MTG and OTG for locally advanced gastric and esophago-gastric junctional cancer, performed at the Cancer Institute Hospital, Tokyo, during the period from January 2017 to March 2024. Propensity score matching (PSM) was conducted to adjust for potential confounders. Results In total, 359 patients were included, with 190 remaining after PSM, resulting in 95 in each group. The MTG group experienced a significantly lower incidence of postoperative complications of Clavien-Dindo classification (C-D) ≥3 than the OTG group (3.2% vs. 11.6%, p = 0.026). Moreover, the rate of postoperative intra-abdominal infectious complications (IAIC) was significantly lower in the MTG than in the OTG group (C-D ≥ 2; 7.4% vs. 17.9%, p = 0.029 and C-D ≥ 3; 2.1% vs. 9.5%, p = 0.030, respectively). Subgroup analyses showed the odds ratios for IAIC with C-D ≥ 2 to be more favorable for the MTG than the OTG group in male patients, those ≥70 years of age, patients without esophageal invasion, those without neoadjuvant chemotherapy, those diagnosed with cT≥3, and patients not undergoing combined resection of other organs except for the gallbladder or spleen. Conclusions MTG for locally advanced gastric cancer may provide improved short-term outcomes compared to OTG, when performed or supervised by surgeons with high proficiency in laparoscopic techniques.
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Affiliation(s)
- Motonari Ri
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Tomoyuki Irino
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
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Fujimoto D, Taniguchi K, Takashima J, Kobayashi H. Possibility of preventing intra-abdominal infection by lymph node mapping with indocyanine green in robotic gastrectomy. Surgery 2025; 181:109212. [PMID: 39954317 DOI: 10.1016/j.surg.2025.109212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 01/05/2025] [Accepted: 01/17/2025] [Indexed: 02/17/2025]
Abstract
BACKGROUND Intra-abdominal infection can be an onerous and fatal complication of radical gastrectomy for gastric cancer. High drain amylase levels are closely related to pancreatic damage and intra-abdominal infection. We aimed to investigate whether robotic radical gastrectomy with lymph node mapping by indocyanine green tracer reduces drain amylase levels. METHODS Between March 2019 and July 2024, patients at our institution with clinical tumor stage cT1-T4a, N0/+, M0, and possibly treatable gastric cancer were enrolled in this study and divided into the indocyanine green group or the non-indocyanine green group based on the use of indocyanine green. One day before surgery, the patients in the indocyanine green group underwent endoscopic peritumoral injection of indocyanine green into the submucosa. Drain amylase levels on postoperative days 1 and 3, postoperative intra-abdominal infection, and perioperative outcomes were compared between the 2 groups. RESULTS There were no significant differences in patient background and pathologic factors between the 2 groups. Drain amylase levels on postoperative days 1 and 3 were significantly lower in the indocyanine green group than in the non-indocyanine green group, and postoperative hospital stay was shorter. The incidence of intra-abdominal infection was also significantly lower in the indocyanine green group than in the non-indocyanine green group. However, multivariate analysis of intra-abdominal infection showed a drain amylase level of 200 IU/L or higher on postoperative day 3 to be an independent risk factor for postoperative intra-abdominal infection, whereas indocyanine green use was not. CONCLUSION This study showed the clinical usefulness of robotic radical gastrectomy with lymph node mapping by indocyanine green. This procedure can reduce drain amylase levels and consequently may reduce the incidence of intra-abdominal infection.
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Affiliation(s)
- Daisuke Fujimoto
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan.
| | - Keizo Taniguchi
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Junpei Takashima
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
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Bahcecioglu IB, Guler S, Morkavuk SB, Turan M, Akgul GG, Erzincan MB, Ozluk KK, Bardakci O, Gulcelik MA. A Novel and Feasible Intracorporeal Esophagojejunostomy Anastomosis in Totally Laparoscopic Total Gastrectomy Surgery: Sutureless L-Shape with Endoscopic Assistance (SLEJ). MEDICINA (KAUNAS, LITHUANIA) 2025; 61:795. [PMID: 40428753 PMCID: PMC12113305 DOI: 10.3390/medicina61050795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2025] [Revised: 04/19/2025] [Accepted: 04/23/2025] [Indexed: 05/29/2025]
Abstract
Background and Objectives: In contrast to the standardization of laparoscopic gastrectomy techniques, the complexity of intracorporeal anastomosis techniques in totally laparoscopic total gastrectomy, the lack of standardization, the positional challenges posed by working in a confined space, and varying complication rates have prevented a consensus on the optimal intracorporeal digestive tract reconstruction method. Selecting an appropriate reconstruction method for esophagojejunostomy is crucial for a successful surgical outcome. This study aims to define a modified anastomotic technique for TLTG and share our experience with this technique. Materials and Methods: A total of 21 patients who underwent TLTG with D2 LND between July 2024 and December 2024 using the sutureless L-shape esophagojejunostomy (SLEJ) technique at the Surgical Oncology Clinic of Gulhane Training and Research Hospital due to gastric cancer were included in the study. In our technique, gastrectomy, lymph node dissection, anastomosis preparation, esophagojejunostomy anastomosis, and enteroenterostomy anastomosis were all performed laparoscopically and intracorporeally. Results: The mean operative time was 180.48 min, with a mean EJ anastomosis duration of 40.24 min. In the standard technique, two Endo GIA™ staplers were used for pyloric and small bowel transection, two for EJ anastomosis, and one for intracorporeal jejunojejunostomy. In only one patient, three staplers were used for anastomosis. Therefore, the average number of staplers was 5.05, with a mean of 2.05 staplers used for anastomosis. The mean hospital stay was 8.19 days, and there were no mortalities. The number of patients with an anastomotic leakage was 1. Since the patient's general condition remained stable, percutaneous drainage or laparotomy was not planned. The patients' esophagojejunostomy anastomotic leak was classified as Class 1 and Grade 3a according to the Clavien-Dindo classification. The average size of our widest incision was 3.28 cm, and surgical site infections were developed in two patients. Conclusions: Sutureless L-Shape With Endoscopic Assistance (SLEJ) is an easily applicable, technically simpler, shorter-in-duration, easier-to-learn, and safer intracorporeal EJ anastomosis technique with a low rate of postoperative complications.
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Affiliation(s)
- Ibrahim Burak Bahcecioglu
- Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey; (I.B.B.); (S.G.); (M.B.E.); (K.K.O.); (O.B.)
| | - Sumeyra Guler
- Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey; (I.B.B.); (S.G.); (M.B.E.); (K.K.O.); (O.B.)
| | - Sevket Baris Morkavuk
- Department of Surgical Oncology, Gulhane Faculty of Medicine, Health Sciences University, Ankara Gulhane Research and Training Hospital, Ankara 06010, Turkey; (G.G.A.); (M.A.G.)
| | - Mujdat Turan
- Department of General Surgery, Gulhane Faculty of Medicine, Health Sciences University, Ankara Gulhane Research and Training Hospital, Ankara 06010, Turkey;
| | - Gokhan Giray Akgul
- Department of Surgical Oncology, Gulhane Faculty of Medicine, Health Sciences University, Ankara Gulhane Research and Training Hospital, Ankara 06010, Turkey; (G.G.A.); (M.A.G.)
| | - Mirac Baris Erzincan
- Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey; (I.B.B.); (S.G.); (M.B.E.); (K.K.O.); (O.B.)
| | - Kubilay Kenan Ozluk
- Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey; (I.B.B.); (S.G.); (M.B.E.); (K.K.O.); (O.B.)
| | - Osman Bardakci
- Department of Surgical Oncology, Gulhane Research and Training Hospital, Ankara 06010, Turkey; (I.B.B.); (S.G.); (M.B.E.); (K.K.O.); (O.B.)
| | - Mehmet Ali Gulcelik
- Department of Surgical Oncology, Gulhane Faculty of Medicine, Health Sciences University, Ankara Gulhane Research and Training Hospital, Ankara 06010, Turkey; (G.G.A.); (M.A.G.)
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Miyatani K, Takahashi T, Shimizu S, Shishido Y, Hanaki T, Kihara K, Matsunaga T, Yamamoto M, Tokuyasu N, Takano S, Sakamoto T, Hasegawa T, Saito H, Fujiwara Y. A higher preoperative cachexia index can result in the sufficient administration of S-1 adjuvant chemotherapy and lead to a good prognosis for elderly patients with stage II/III gastric cancer. Surg Today 2025:10.1007/s00595-025-03038-6. [PMID: 40240667 DOI: 10.1007/s00595-025-03038-6] [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: 12/16/2024] [Accepted: 03/12/2025] [Indexed: 04/18/2025]
Abstract
PURPOSE This study aimed to clarify the significance of the relative dose intensity (RDI) of S-1 adjuvant chemotherapy (ACT) after gastrectomy in elderly patients with stage II/III gastric cancer (GC) and to determine whether the cachexia index (CXI) correlates with RDI. METHODS We enrolled 76 patients with stage II/III GC, aged > 70 years. The overall survival (OS) and disease-specific survival (DSS) of participants in the surgery alone, S-1 ACT completion (RDI ≥ 58%), and S-1 ACT non-completion (RDI < 58%) groups were compared. In addition, the clinicopathological determinants of RDI were examined. RESULTS The S-1 ACT completion group had better OS and DSS, while the prognoses of patients in the surgery alone and S-1 ACT non-completion groups did not differ significantly. S-1 ACT non-completion or surgery alone was identified as an independent poor prognostic factor for OS and DSS. Furthermore, a multivariate analysis revealed that a high preoperative CXI (≥ 75.5 for males and ≥ 79.4 for females) was an independent predictor of success in achieving an RDI ≥ 58%. CONCLUSIONS A higher preoperative CXI can result in a higher RDI and improve the prognosis of elderly patients with stage II/III GC who underwent S-1 ACT.
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Affiliation(s)
- Kozo Miyatani
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan.
| | - Tomohiro Takahashi
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Shota Shimizu
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Yuji Shishido
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Takehiko Hanaki
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Kyoichi Kihara
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Tomoyuki Matsunaga
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Manabu Yamamoto
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Naruo Tokuyasu
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Shuichi Takano
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Teruhisa Sakamoto
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Toshimichi Hasegawa
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
| | - Hiroaki Saito
- Department of Surgery, Japanese Red Cross Tottori Hospital, Tottori, 680‑8517, Japan
| | - Yoshiyuki Fujiwara
- Faculty of Medicine, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University, 36-1 Nishi-Cho, Yonago, 683-8504, Japan
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Du XY, Xia RJ, Shen LW, Ma JG, Yao WQ, Xu W, Lin ZP, Ma LB, Niu GQ, Fan RF, Xu SM, Yan L. Quadruple therapy with immunotherapy and chemotherapy as first-line conversion treatment for unresectable advanced gastric adenocarcinoma: A case report. World J Gastrointest Oncol 2025; 17:102258. [PMID: 40235902 PMCID: PMC11995329 DOI: 10.4251/wjgo.v17.i4.102258] [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: 10/13/2024] [Revised: 01/20/2025] [Accepted: 02/24/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND The treatment of gastric cancer remains highly challenging, particularly in cases of unresectable locally advanced or metastatic disease. Although chemotherapy and immunotherapy have shown some efficacy in such patients, significant limitations persist in extending survival and enhancing safety. To address these challenges, we designed an innovative first-line quadruple conversion therapy regimen that integrates a programmed cell death protein 1 (PD-1) inhibitor with chemotherapy, and we successfully implemented this therapy regimen in the treatment of a patient with unresectable locally advanced gastric adenocarcinoma. CASE SUMMARY We report the case of a 55-year-old male who was diagnosed with unresectable locally advanced gastric adenocarcinoma and presented with intermittent epigastric pain and multiple lymph node metastases in the abdominal cavity, with the metastasis being notably large in size. The tumor tissue was negative for human epidermal growth factor receptor 2 by immunohistochemistry. Considering the patient's status, the multidisciplinary team decided to administer sintilimab in combination with albumin-bound paclitaxel (nab-paclitaxel), S-1, and oxaliplatin as a quadruple drug conversion therapy. After 4 cycles of conversion therapy, the patient's epigastric pain was significantly alleviated, his stool color normalized, the volume of the primary tumor and lymph node metastases was markedly reduced, and the tumor marker levels decreased to within the normal range. The patient subsequently underwent laparoscopic total gastrectomy with abdominal lymph node dissection, and postoperative pathological biopsy revealed a pathological complete response and R0 resection, after which the patient recovered to an excellent physical status. CONCLUSION To the best of our knowledge, this is the first reported case of unresectable locally advanced gastric adenocarcinoma successfully treated with quadruple therapy with a PD-1 inhibitor and chemotherapy as a first-line conversion regimen. This first-line conversion therapy with the quadruple regimen may be effective and safe for unresectable locally advanced gastric adenocarcinoma.
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Affiliation(s)
- Xiao-Yu Du
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
- Department of Medicine, Northwest Minzu University, Lanzhou 730050, Gansu Province, China
| | - Ren-Jie Xia
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
- Department of Medicine, Northwest Minzu University, Lanzhou 730050, Gansu Province, China
| | - Li-Wen Shen
- Department of Medical Support Center, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Jian-Guo Ma
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
- First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730030, Gansu Province, China
| | - Wei-Qing Yao
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
- Department of Medicine, Northwest Minzu University, Lanzhou 730050, Gansu Province, China
| | - Wei Xu
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Zhi-Peng Lin
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Liang-Bin Ma
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Guo-Qiang Niu
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Rui-Fang Fan
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Shu-Mei Xu
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Long Yan
- Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
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Guo C, Li Z, Guo X, Liu Y, Qu D, Xing Z, Ren H, Sun C, Fei H, Zhang X, Ge L, Gao Y, Li E, Yin C, Zhang J, Wang G, Zhao D. The transhiatal tunnel valvuloplasty technique following laparoscopic proximal gastrectomy: the single-center experience in a retrospective cohort. World J Surg Oncol 2025; 23:127. [PMID: 40200202 PMCID: PMC11978188 DOI: 10.1186/s12957-025-03744-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Accepted: 03/07/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND The debate over the optimal reconstruction technique following proximal gastrectomy continues. Transhiatal tunnel valvuloplasty (ThTV) is a novel esophagogastrostomy method. This study aimed to evaluate the feasibility and safety of ThTV. METHODS A cohort with upper early gastric cancer or Siewert type II tumors who underwent laparoscopic proximal gastrectomy was retrospectively reviewed in a single center. The ThTV esophagogastrostomy procedure involved placing a lengthy gastric tube into the lower mediastinum and firmly binding it to the esophagus. Demographic and surgical morbidity data were extracted from the medical records. RESULTS Between March 2023 and November 2023, 15 patients underwent laparoscopic proximal gastrectomy using ThTV. The cohort consisted of 13 males and 2 females, with a median age of 68 years (range 49-77). The median operative time was 213 minutes (range 171-370). The median times for tunnel construction and anastomosis were 7 minutes (range 4-30) and 17 minutes (range 10-29), respectively. The median tumor size was 2.0 cm (range 1.0-5.0), and the median number of lymph nodes dissected was 29 (range 13-49). TNM staging revealed 9 cases of stage I, 5 cases of stage II, and 1 case of stage III. As of January 1, 2025, the median follow-up duration was 16.8 months (range 13.8-22.2). No tumor recurrence was observed. No patients reported severe reflux symptoms (Visick score ≥III). Gastroscopy confirmed reflux esophagitis (Los Angeles classification Grade A) in one patient, and an anastomotic stricture requiring endoscopic balloon dilation was observed in another patient. CONCLUSIONS Transhiatal tunnel valvuloplasty is a simple and reliable anti-reflux method following laparoscopic proximal gastric surgery. The further verification of the esophageal function is warranted.
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Affiliation(s)
- Chunguang Guo
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China
| | - Zefeng Li
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China
| | - Xin Guo
- Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin, 150001, China
| | - Yong Liu
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dong Qu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhaodong Xing
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China
| | - Hu Ren
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China
| | - Chongyuan Sun
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China
| | - He Fei
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China
| | - Xiaojie Zhang
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China
| | - Lei Ge
- Department of Gastrointestinal Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, 524001, China
| | - Yanwei Gao
- Surgical Oncology, Inner Mongolia People's Hospital, Huhehaote, 010017, China
| | - Enjun Li
- General Surgery Department 6 (Gastrointestinal Surgery), Handan Central Hospital, Handan, 056001, China
| | - Chaodong Yin
- Surgery Department 4, Datong No.2 People's Hospital & Cancer hospital, Datong, 037000, China
| | - Jing Zhang
- General Surgery Department, Cancer Hospital of Huanxing Chaoyang District, Beijing, Beijing, 100021, China
| | - Guiqi Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dongbing Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 PanjiayuanNanli, Chaoyang District, Beijing, 100021, China.
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Zhu H, Jiang W, Zhang Q, Yu C. The role of UPK1B in gastric cancer: multi-omics analysis and experimental validation. Discov Oncol 2025; 16:476. [PMID: 40189715 PMCID: PMC11973043 DOI: 10.1007/s12672-025-02263-2] [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: 10/16/2024] [Accepted: 03/28/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND UPK1B has been implicated in various cancers; however, its mechanism of action in gastric cancer remains elusive. METHODS We utilized transcriptional data and clinical information, and mutation profiles from The Cancer Genome Atlas (TCGA) database to analyze UPK1B's expression and clinical relevance. Biological enrichment, immune microenvironment characterization, and drug sensitivity analyses were conducted. Functional assays, including proliferation, migration, invasion, and in vivo metastasis models, were used to validate UPK1B's role in gastric cancer. RESULTS UPK1B was significantly upregulated in gastric cancer and correlated with worse clinical outcomes, including advanced stages and reduced survival rates. Biological enrichment analysis revealed its involvement in cancer-related pathways such as DNA replication and immune regulation. UPK1B was negatively correlated with NK cells and M1 macrophages, indicating its role in immune evasion. Functional experiments demonstrated that knockdown of UPK1B significantly suppressed gastric cancer cell proliferation, invasion, and migration in vitro and reduced pulmonary metastases in vivo. Drug sensitivity analysis suggested that high UPK1B expression was associated with increased sensitivity to lapatinib and resistance to cisplatin. CONCLUSIONS UPK1B promotes tumor progression and modulates the immune microenvironment in gastric cancer, making it a potential therapeutic target for future research and clinical applications.
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Affiliation(s)
- Haixing Zhu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Wen Jiang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Qian Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China
| | - Changjun Yu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui Province, People's Republic of China.
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Eom SS, Park SH, Rhee YS, Kim SH, Lee HJ, Kim YW, Yang HK, Park DJ, Han SU, Kim HH, Hyung WJ, Park JH, Suh YS, Kwon OK, Kim W, Park YK, Yoon HM, Ahn SH, Kong SH, Ryu KW. The Impact of Vascular Anatomic Variations in the Infra-Pyloric Area on the Surgical Outcomes of Laparoscopic Pylorus-Preserving Gastrectomy in Early Gastric Cancer: A Post Hoc Analysis of a Multicenter Prospective Trial (KLASS-04). J Clin Med 2025; 14:2508. [PMID: 40217957 PMCID: PMC11989293 DOI: 10.3390/jcm14072508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2025] [Revised: 03/28/2025] [Accepted: 04/02/2025] [Indexed: 04/14/2025] Open
Abstract
Background/Objectives: During laparoscopic pylorus-preserving gastrectomy (LPPG), the preservation of the infra-pyloric artery (IPA) and dissection of the infra-pyloric lymph node (LN) station 6 are essential, underscoring the importance of understanding the anatomical structure of the IPA. This study aimed to investigate anatomical variations in the IPA and surgical outcomes based on data from a multicenter prospective trial. Methods: A post hoc analysis was conducted based on the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-04 trial, in which patients randomly underwent LPPG or laparoscopic distal gastrectomy (LDG). The IPA variations were categorized into three groups: distal, caudal, and proximal. Clinicopathological characteristics and surgical outcomes were analyzed according to the IPA type. Results: Among the 192 patients, the distribution of IPA types was as follows: 45 (23.44%) distal, 74 (38.54%) caudal, and 73 (38.02%) proximal. There were no significant differences in the clinicopathological characteristics between the IPA types. Of the 119 patients who underwent LPPG, a significant difference in operative time was observed based on the IPA type, with a longer duration observed with the distal type compared to that of the proximal type (distal type vs. proximal type: 202.5 (150-275) vs. 170 (105-265) min, p = 0.0300). No significant differences were observed in other surgical outcomes. Conclusions: The distribution of IPA types was more diverse than that reported in previous studies. There was a statistically significant difference in the operating time based on the IPA type. Identifying IPA variations during LPPG may be beneficial for gastric cancer surgeons.
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Affiliation(s)
- Sang Soo Eom
- Department of Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang 10380, Republic of Korea
| | - Sin Hye Park
- Department of Gastrointestinal Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young Shick Rhee
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsanseo-gu, Goyang 10408, Republic of Korea
| | - Sa-Hong Kim
- Department of Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsanseo-gu, Goyang 10408, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Sang Uk Han
- Department of Surgery, Ajou University Hospital, Suwon 16499, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University Severance Hospital, Seoul 03722, Republic of Korea
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Daegu 52727, Republic of Korea
| | - Yun-Suhk Suh
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Oh-Kyung Kwon
- Department of Surgery, Kyungpook National University Hospital, Daegu 41566, Republic of Korea
| | - Wook Kim
- Department of Surgery, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul 14662, Republic of Korea
| | - Young-Kyu Park
- Department of Surgery, Chonnam National University Medical School, Hwasun 58128, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsanseo-gu, Goyang 10408, Republic of Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Seong-Ho Kong
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsanseo-gu, Goyang 10408, Republic of Korea
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Zhang H, Sun N, Li F, Wang Q, Sun Z, Zhang Y, Wang L, Zhao C, Fu Y. Construction of a modified TNM staging system and prediction model based on examined lymph node counts for gastric cancer patients at pathological stage N3. Front Oncol 2025; 15:1569736. [PMID: 40248208 PMCID: PMC12003143 DOI: 10.3389/fonc.2025.1569736] [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: 02/01/2025] [Accepted: 03/13/2025] [Indexed: 04/19/2025] Open
Abstract
Background Examined lymph node (ELN) count is a critical factor affecting the number of metastatic lymph nodes (MLNs). The impact of the ELN number on survival and staging remains unclear. Methods This study included 4,291 stage N3 GC patients from the SEER database (training cohort) and 567 stage N3 GC patients from the FAHZZU database (validation cohort). The optimal ELN count and stage migration were investigated, and a modified TNM (mTNM) staging system including the ELN count was proposed. LASSO regression and random forest analyses were used to screen and evaluate the variables associated with survival, and an mTNM-based nomogram was constructed. The performance of the mTNM staging system and mTNM-based nomogram were compared with that of the 8th edition of the TNM staging system. Results The optimal threshold of the ELN count was identified as 21. An insufficient number of ELNs (≤ 21) was associated with poorer survival outcomes and led to stage migration in all N3 patients. A new mTNM staging system was proposed, integrating the ELN count into the TNM staging system (8th edition). LASSO regression analysis revealed that age, tumor size, adjuvant chemotherapy, adjuvant radiotherapy, and the mTNM system were associated with overall survival (OS) outcomes, and random forest analysis revealed that the mTNM system was the most important variable for predicting survival. An mTNM-based nomogram was constructed to predict 1-, 3-, and 5-year OS rates. Compared with the TNM staging system (8th edition), the mTNM staging system and mTNM-based nomogram showed superior prognosis discriminative ability, better predictive accuracy, and greater net improvement in survival outcomes. Conclusions The optimal ELN count for N3 GC patients was 21. The mTNM staging system and mTNM-based nomogram showed superior discriminative ability, predictive accuracy, and greater net benefit for OS outcomes.
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Affiliation(s)
- Hongyu Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nan Sun
- Department of Plastic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Feng Li
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiyang Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhao Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yawei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Wang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunlin Zhao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Fu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Niikawa M, Akimoto T, Kirita K, Yoshida Y, Okubo T, Hayama K, Hatori T, Goto O, Fujimori S, Iwakiri K. Liver metastatic recurrence after curative endoscopic submucosal dissection for slightly submucosal invasive gastric cancer: A case report and literature review. DEN OPEN 2025; 5:e70041. [PMID: 39925769 PMCID: PMC11805676 DOI: 10.1002/deo2.70041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 11/09/2024] [Accepted: 11/18/2024] [Indexed: 02/11/2025]
Abstract
In Japan, differentiated-type early gastric cancer with submucosal invasion <500 µm, tumor diameter <3 cm, no lymphovascular invasion, and negative resection margin are included in pathological curative criteria after endoscopic resection (ER). However, there are a few reports presenting local or metastatic recurrence after ER for the lesions described above. A 72-year-old man was diagnosed with early gastric cancer and underwent endoscopic submucosal dissection (ESD). Pathological diagnosis was well-differentiated tubular adenocarcinoma, 8 × 6 mm, T1b1(SM1; 428 µm below the muscularis mucosae), negative lymphovascular invasion, and negative resection margin, which was included in curative criteria. Eighteen months after ESD, the laboratory studies indicated an increase in carcinoembryonic antigen of 17.6 ng/mL (normal range <5 ng/mL). While endoscopy showed no local recurrence finding, contrast-enhanced computed tomography (CT) showed a metastatic liver tumor in S4. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography/CT revealed metastatic liver tumors in S4, S5, and S8. The liver biopsy specimen showed tubular adenocarcinoma and the findings of immunochemical staining were similar to that of the specimen of prior ESD. Thus, he was diagnosed with multiple liver metastatic recurrences after curative ER. Currently, it has been 3 years and 5 months since ESD and 1 year and 11 months since liver metastatic recurrence, and the patient has survived receiving 5th-line systemic chemotherapy. Here, we report a rare case of liver metastatic recurrence 18 months after curative ESD for early gastric cancer.
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Affiliation(s)
- Masahiro Niikawa
- Department of GastroenterologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Teppei Akimoto
- Department of GastroenterologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Kumiko Kirita
- Department of GastroenterologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Yuji Yoshida
- Department of GastroenterologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Tomomi Okubo
- Department of GastroenterologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Korenobu Hayama
- Department of GastroenterologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Tsutomu Hatori
- Department of PathologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Osamu Goto
- Department of GastroenterologyNippon Medical School HospitalTokyoJapan
| | - Shunji Fujimori
- Department of GastroenterologyNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Katsuhiko Iwakiri
- Department of GastroenterologyNippon Medical School HospitalTokyoJapan
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Yano G, Miyake H, Nagai H, Yoshioka Y, Shibata K, Takamizawa J, Yuasa N. Prognostic factors for relapse-free 5-year survivors after gastrectomy for gastric cancer. J Gastrointest Surg 2025; 29:101958. [PMID: 39793957 DOI: 10.1016/j.gassur.2025.101958] [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: 09/22/2024] [Revised: 12/22/2024] [Accepted: 01/05/2025] [Indexed: 01/13/2025]
Abstract
BACKGROUND Few studies have examined the prognosis of long-term survivors with gastric cancer (GC) after gastrectomy. This study aimed to identify the prognostic factors for 5-year recurrence-free survivors after gastrectomy for GC. METHODS A total of 721 patients with pathologic stage Ⅰ to Ⅲ GC who underwent gastrectomy between 2005 and 2018 and survived for 5 years without recurrence were enrolled. Conditional overall survival (cOS), conditional disease-specific survival (cDSS), and conditional non-disease-specific survival (cNDSS) of 5-year recurrence-free survivors were calculated. The association between cOS, cDSS, and cNDSS and clinicopathologic factors was evaluated using univariate and multivariate analyses. RESULTS The mean age of the patients was 70.5 ± 10.1 years, 68.5% of the patients were male, and 491, 128, and 102 had stage Ⅰ, Ⅱ, and Ⅲ GC, respectively. Of note, 17 patients relapsed, and 65 patients died (disease-specific, non-disease-specific, and unknown: 12, 45, and 6, respectively) during a median follow-up of 36 months. The 5-year cOS, cDSS, and cNDSS rates were 90.3%, 97.3%, and 93.3%, respectively. Multivariate analysis showed that age of ≥80 years and neutrophil-to-lymphocyte ratio (NLR) of ≥2.7 were significantly associated with poorer cOS. Stage Ⅲ GC was associated with decreased cDSS, and age of ≥80 years, NLR of ≥2.7, and mean corpuscular volume (MCV) of ≥93.4 fL were associated with lower cNDSS. CONCLUSION Age of ≥80 years, stage Ⅲ GC, NLR of ≥2.7, and MCV of ≥93.4 fL were unfavorable prognostic factors for 5-year recurrence-free survivors after gastrectomy for GC. Long-term surveillance after gastrectomy could be tailored based on these factors.
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Affiliation(s)
- Genta Yano
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hideo Miyake
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hidemasa Nagai
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yuichiro Yoshioka
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Koji Shibata
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Junichi Takamizawa
- Department of Laboratory Medicine, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Norihiro Yuasa
- Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan; Department of Laboratory Medicine, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan.
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Sakamoto T, Oda I, Okamura T, Cho H, Toyoshima N, Nonaka S, Suzuki H, Nakamura T, Watanabe D, Matsuo K, Hanano K, Takeyama T, Yoshinaga S, Saito Y. Exploratory investigation of virtual lesions in gastrointestinal endoscopy using a novel phase-shift method for three-dimensional shape measurement. DEN OPEN 2025; 5:e381. [PMID: 38725875 PMCID: PMC11079539 DOI: 10.1002/deo2.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
Accurate measurement of the size of lesions or distances between any two points during endoscopic examination of the gastrointestinal tract is difficult owing to the fisheye lens used in endoscopy. To overcome this issue, we developed a phase-shift method to measure three-dimensional (3D) data on a curved surface, which we present herein. Our system allows the creation of 3D shapes on a curved surface by the phase-shift method using a stripe pattern projected from a small projecting device to an object. For evaluation, 88 measurement points were inserted in porcine stomach tissue, attached to a half-pipe jig, with an inner radius of 21 mm. The accuracy and precision of the measurement data for our shape measurement system were compared with the data obtained using an Olympus STM6 measurement microscope. The accuracy of the path length of a simulated protruded lesion was evaluated using a plaster model of the curved stomach and graph paper. The difference in height measures between the measurement microscope and measurement system data was 0.24 mm for the 88 measurement points on the curved surface of the porcine stomach. The error in the path length measurement for a lesion on an underlying curved surface was <1% for a 10-mm lesion. The software was developed for the automated calculation of the major and minor diameters of each lesion. The accuracy of our measurement system could improve the accuracy of determining the size of lesions, whether protruded or depressed, regardless of the curvature of the underlying surface.
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Affiliation(s)
- Taku Sakamoto
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Ichiro Oda
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Takuma Okamura
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Hourin Cho
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
| | - Naoya Toyoshima
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
- Division of Science and Technology for EndoscopyExploratory Oncology Research and Clinical Trial CenterNational Cancer CenterTokyoJapan
| | - Satoru Nonaka
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
- Division of Science and Technology for EndoscopyExploratory Oncology Research and Clinical Trial CenterNational Cancer CenterTokyoJapan
| | - Haruhisa Suzuki
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
- Division of Science and Technology for EndoscopyExploratory Oncology Research and Clinical Trial CenterNational Cancer CenterTokyoJapan
| | - Tatsuya Nakamura
- Optical EngineeringOlympus Medical Systems CorporationTokyoJapan
| | - Daichi Watanabe
- Optical EngineeringOlympus Medical Systems CorporationTokyoJapan
| | - Keigo Matsuo
- Optical EngineeringOlympus Medical Systems CorporationTokyoJapan
| | - Kazunari Hanano
- Optical EngineeringOlympus Medical Systems CorporationTokyoJapan
| | | | - Shigetaka Yoshinaga
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
- Division of Science and Technology for EndoscopyExploratory Oncology Research and Clinical Trial CenterNational Cancer CenterTokyoJapan
| | - Yutaka Saito
- Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
- Division of Science and Technology for EndoscopyExploratory Oncology Research and Clinical Trial CenterNational Cancer CenterTokyoJapan
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Li D, Morgan DR, Corral JE, Montgomery EA, Riquelme A, Shah SC. Gastric Cancer Screening in the United States: A Review of Current Evidence, Challenges, and Future Perspectives. Am J Gastroenterol 2025; 120:765-777. [PMID: 40072512 DOI: 10.14309/ajg.0000000000003301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 12/18/2024] [Indexed: 03/14/2025]
Abstract
Gastric cancer remains a leading cause of cancer-related mortality worldwide. In the United States, gastric cancer incidence and mortality are substantially higher among non-White racial and ethnic groups and new immigrants from high-incidence countries. This is in large part related to the higher prevalence of Helicobacter pylori -associated gastric premalignant changes in these populations. Apart from primary prevention, early detection of gastric cancer is the principal strategy to reduce gastric cancer mortality and improve survival. Extensive evidence in Asian countries has demonstrated the benefits of endoscopic screening in detecting early-stage gastric cancer and reducing gastric cancer-related mortality. By contrast, direct, high-quality US-based data, such as from large clinical trials or observational studies, on important outcomes of gastric cancer screening are still lacking. In this review, we evaluate and summarize the latest global evidence on the epidemiology and predisposing factors of gastric cancer as well as the efficacy, benefits vs. risks, and cost-effectiveness of gastric cancer screening. We further discuss the critical knowledge gaps and challenges in promoting gastric cancer screening in the United States. Dedicated research is urgently needed to enrich the US-based data on gastric cancer primary and secondary prevention to inform clinical practice and reduce gastric cancer-related morbidity and mortality in a cost and resource efficient manner.
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Affiliation(s)
- Dan Li
- Department of Gastroenterology, Kaiser Permanente Medical Center, Santa Clara, California, USA
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Douglas R Morgan
- Division of Gastroenterology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Juan E Corral
- Division of Gastroenterology, Prisma Health, Greenville, South Carolina, USA
| | - Elizabeth A Montgomery
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Arnoldo Riquelme
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Center for Control and Prevention of Cancer (CECAN), Santiago, Chile
| | - Shailja C Shah
- Division of Gastroenterology, University of California, San Diego, La Jolla, California, USA
- Gastroenterology Section, Jennifer Moreno Department of Veterans Affairs Medical Center, La Jolla, California, USA
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Jingtao Z, Shaoqin C, Tao Z, Li Y, Sheng Y, Qingqi H, Hexin L, Yinan C, Huangdao Y, Yifu C, Xuejun Y, Jun Y. Clinical outcomes of double-flap technique versus gastric tube reconstruction following laparoscopic proximal gastrectomy: a multicenter propensity score-matched cohort study. World J Surg Oncol 2025; 23:110. [PMID: 40158150 PMCID: PMC11954176 DOI: 10.1186/s12957-025-03672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 01/19/2025] [Indexed: 04/01/2025] Open
Abstract
BACKGROUND Various anti-reflux procedures are currently utilized for digestive tract reconstruction following proximal gastrectomy (PG), but the optimal reconstruction method remains debated. This study aims to compare and analyze the clinical outcomes and postoperative quality of life between double-flap technique (DFT) and gastric tube (GT) reconstruction after laparoscopic proximal gastrectomy (LPG), providing a reference for selecting the appropriate digestive tract reconstruction method. METHODS This multicenter, retrospective cohort study employed propensity score matching (PSM) to address baseline imbalances. Clinical, pathological, and follow-up data were collected from 124 patients who underwent either LPG-GT or LPG-DFT between January 2016 and May 2023 at four medical centers in China. The surgical outcomes, incidence of postoperative gastroesophageal reflux and anastomotic stricture, postoperative nutritional status, and quality of life were compared between the two groups. RESULTS After 1:1 PSM, 41 patients were included in each group for analysis. Compared to the LPG-GT group, the LPG-DFT group had a longer operation time (340.0 min vs. 280.0 min, P < 0.001) but less intraoperative blood loss (80.0 ml vs. 100.0 ml, P < 0.001), a shorter time to nasogastric tube removal (3.0 days vs. 5.0 days, P < 0.001), and shorter postoperative hospital stay (9.0 days vs. 12.0 days, P < 0.001). The incidence of gastroesophageal reflux in the LPG-DFT and LPG-GT groups was 7.3% and 24.3% (P = 0.034), respectively, and the incidence of anastomotic stricture requiring dilation was 14.6% and 7.3% (P = 0.480). One year postoperatively, BMI (22.0 kg/m² vs. 20.6 kg/m², P = 0.010) and albumin levels at six months postoperatively (41.6 g/L vs. 39.1 g/L, P = 0.033) were significantly higher in the LPG-DFT group. However, albumin levels one year postoperatively showed no significant difference between the two groups (42.3 g/L vs. 40.7 g/L, P = 0.226). CONCLUSION The surgical outcomes suggest that both LPG-GT and LPG-DFT are safe and feasible methods. However, LPG-DFT provides better anti-reflux effects and may help reduce the risk of postoperative malnutrition.
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Affiliation(s)
- Zhu Jingtao
- Department of Gastrointestinal Oncology Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fujian, China
| | - Chen Shaoqin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhang Tao
- Department of Gastrosurgery, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yang Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - You Sheng
- First Clinical Medical College of Shanxi Medical University, Taiyuan, 030001, PR China
| | - Hong Qingqi
- Department of Gastrointestinal Oncology Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, Fujian, China
| | - Lin Hexin
- Department of Gastrointestinal Oncology Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, Fujian, China
| | - Chen Yinan
- Department of Gastrointestinal Oncology Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, Fujian, China
| | - Yu Huangdao
- Department of Gastrointestinal Oncology Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, Fujian, China
| | - Chen Yifu
- Department of Gastrointestinal Oncology Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, Fujian, China
| | - Yu Xuejun
- Department of Gastrointestinal Oncology Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, Fujian, China
| | - You Jun
- Department of Gastrointestinal Oncology Surgery, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, 361003, Fujian, China.
- The School of Clinical Medicine, Fujian Medical University, Fujian, China.
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40
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Munini M, Fodor M, Corradi A, Frena A. Clinical benefits and controversies of jejunostomy feeding in patients undergoing gastrectomy for gastric cancer. World J Gastrointest Surg 2025; 17:100384. [PMID: 40162383 PMCID: PMC11948112 DOI: 10.4240/wjgs.v17.i3.100384] [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: 08/14/2024] [Revised: 01/20/2025] [Accepted: 02/08/2025] [Indexed: 02/24/2025] Open
Abstract
Globally, gastric cancer ranks as the fifth most common malignancy and the third leading cause of cancer-related mortality. Gastrectomy combined with perioperative chemotherapy is currently the standard of care in locally advanced stages, but the completion rate of multimodal approach is influenced also by patient related factors. Malnutrition is a well-known risk factor associated with poor oncological outcomes. Its perioperative supplementation could lead to an improvement of the nutritional status. This article reviews and comments the retrospective study conducted by Jaquet et al, which evaluates the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer. The authors included 172 patients, 35% of whom received jejunostomy. Patients with optimized biological nutritional parameters (body mass index, albumin, prealbumin) showed reduced major complications (> III), according to the Dindo-Clavien classification, 0 (0%) vs 8 (4.7%) (P = 0.05). In the era of multimodal treatment, optimization of nutritional and performance status is integral part of the therapeutic strategy.
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Affiliation(s)
- Martino Munini
- Department of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano 39100, Trentino-Alto Adige, Italy
| | - Margot Fodor
- Department of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano 39100, Trentino-Alto Adige, Italy
| | - Alessio Corradi
- Department of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano 39100, Trentino-Alto Adige, Italy
| | - Antonio Frena
- Department of General and Pediatric Surgery, Bolzano Central Hospital, Bolzano 39100, Trentino-Alto Adige, Italy
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Shi X, Shi X, Yan Y, Gong A. Modified Charlson comorbidity index of long-term, non-gastric cancer mortality in patients with early gastric cancer: a multicenter retrospective study. World J Surg Oncol 2025; 23:100. [PMID: 40128794 PMCID: PMC11931881 DOI: 10.1186/s12957-025-03741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 03/07/2025] [Indexed: 03/26/2025] Open
Abstract
PURPOSE In patients with early gastric cancer (EGC) who undergo endoscopic submucosal dissection (ESD) with endoscopic curability (eCura) C-2, the risk of non-gastric cancer mortality should be evaluated before receiving further gastrectomy. Charlson comorbidity index (CCI) is often used to estimate prognosis based on patient's background before treatment. We identified the long-term risk of mortality from other causes associated with comorbidities in CCI and applied it to the creation of EGC specific CCI (GCCI). METHODS A total of 1810 patients with EGC from 3 centers were included from January 2015 to February 2023. We used Cox proportional risk models to determine the risk of non-gastric cancer mortality related to comorbidities and used these hazard ratios to reweight the Charlson index to establish GCCI. RESULTS The Cox model suggested that moderate to severe liver disease, metastatic solid tumors, severe to very severe chronic obstructive pulmonary disease (COPD), and leukemia had the highest risk of non-gastric cancer mortality [hazard ratio (HR) > 5)]. Survival analysis showed that the 5-year non-gastric cancer mortality rates in low-risk group (GCCI score 0-1), medium-risk group (GCCI score 2-4), and high-risk group (GCCI score 5-13) were 3%, 10%, and 52%, respectively. CONCLUSIONS GCCI could identify patients with EGC who have higher non-gastric cancer mortality. The GCCI could be used to help patients with EGC make medical decisions.
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Affiliation(s)
- Xiao Shi
- Department of Gastroenterology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Xiaoyi Shi
- Department of Gastroenterology, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yuxing Yan
- Department of Gastroenterology, the Second People's Hospital of Liaocheng, Liaocheng, China
| | - Aixia Gong
- Department of Gastroenterology, First Affiliated Hospital, Dalian Medical University, Dalian, China.
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Erol CI, Leblebici M, Kilic F, Aydemir MA, Ekinci O, Alimoglu O. Effect of Tumor Localization on Metastatic Lymph Node Distribution and Prognosis in Gastric Cancers. Indian J Surg 2025. [DOI: 10.1007/s12262-025-04342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 03/13/2025] [Indexed: 05/10/2025] Open
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Minamide T, Ono H, Kawata N, Maeda Y, Yoshida M, Yamamoto Y, Takada K, Kishida Y, Ito S, Imai K, Hotta K, Sato J, Ishiwatari H, Matsubayashi H, Notsu A, Bando E. Evaluating the Need for Additional Surgery After Non-Curative Endoscopic Resection in Patients with Remnant Gastric Cancer. J Gastrointest Cancer 2025; 56:80. [PMID: 40090990 DOI: 10.1007/s12029-025-01199-8] [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] [Accepted: 03/02/2025] [Indexed: 03/19/2025]
Abstract
PURPOSE Completion total gastrectomy is considered an additional treatment after non-curative endoscopic resection for remnant gastric cancer. However, its high invasiveness remains a concern. This study aimed to assess the necessity of additional surgery after non-curative endoscopic submucosal dissection in patients with remnant gastric cancer. METHODS This study included patients who underwent non-curative endoscopic submucosal dissection for remnant gastric cancer between September 2002 and January 2018. The eCura system was used to stratify the risk of lymph node metastasis into low, intermediate, or high. The overall survival, disease-specific survival, and long-term clinical course were analyzed. RESULTS Among the 46 patients analyzed, 15 underwent additional completion total gastrectomy, whereas 31 were only followed up. Within a median follow-up period of 62.5 months, the additional surgery and follow-up groups showed 5-year overall survival rates of 79.4% and 76.8% (P = 0.93) and disease-specific survival rates of 92.9% and 92.7% (P = 0.98). A total of 19 low-, 8 intermediate-, and 4 high-risk patients in the follow-up group achieved 5-year disease-specific survival rates of 100%, 100%, and 33.3%. Significant differences were observed in the disease-specific survival between the low- and high-risk patients (P < 0.001) and between the intermediate- and high-risk patients (P = 0.02). CONCLUSION Risk stratification using the eCura system allows for individualized treatment decisions, with follow-up being a viable option for low- and intermediate-risk patients and additional surgery recommended for high-risk patients after non-curative endoscopic submucosal dissection for remnant gastric cancer.
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Affiliation(s)
- Tatsunori Minamide
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan.
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Yuki Maeda
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Yoichi Yamamoto
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Yoshihiro Kishida
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Hirotoshi Ishiwatari
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, Nagaizumi-cho, Shizuoka, 411-8777, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi-Cho, Shizuoka, 411-8777, Japan
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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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Chung JH, Lim D, Lee SH, Hwang SH. Evaluating the impact of a navigation system on the initial cases of robotic gastrectomy for gastric cancer. J Robot Surg 2025; 19:115. [PMID: 40080316 DOI: 10.1007/s11701-025-02262-z] [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: 01/19/2025] [Accepted: 02/23/2025] [Indexed: 03/15/2025]
Abstract
Robotic gastrectomy for gastric cancer presents challenges for novice surgeons owing to the lack of tactile feedback, particularly during complex procedures, such as lymph node dissection. To address these issues, a vascular navigation system was developed to enhance procedural safety and efficiency by providing three-dimensional vascular and anatomical guidance. We retrospectively analyzed 49 patients who underwent robotic distal gastrectomy at Pusan National University Yangsan Hospital. Patients were divided into two groups: those without navigation support (noRUS) and those with a vascular navigation system (RUS). We compared the dissection time, number of lymph nodes (LNs) retrieved, C-reactive protein level on postoperative day 3 (CRPD3), and postoperative recovery status. Univariate and multivariate linear regression analyses were performed. The RUS group demonstrated significantly shorter dissection times (179.85 ± 6.88 vs. 204.87 ± 9.60 min, p = 0.0478) and higher LN retrieval (41.81 ± 2.77 vs. 30.96 ± 2.31, p = 0.0048). The CRPD3, a marker of surgical trauma, was significantly lower in the RUS group (8.27 ± 0.85 vs. 11.68 ± 1.13 mg/dL, p = 0.0184). Moreover, no significant differences were observed in the complication rates or postoperative recovery. The vascular navigation system significantly improved surgical efficiency and LN retrieval and reduced surgical trauma during robotic gastrectomy. This study is the first to evaluate the impact of the navigation system on novice surgeons, highlighting its potential to overcome the learning curve earlier and improve patient outcomes.
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Affiliation(s)
- Jae Hun Chung
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Kyungsangnam-do, 50612, Korea
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- School of Medicine, Pusan National University, Yangsan, Korea
| | - Dongwon Lim
- School of Medicine, Pusan National University, Yangsan, Korea
| | - Si-Hak Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Kyungsangnam-do, 50612, Korea
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- School of Medicine, Pusan National University, Yangsan, Korea
| | - Sun-Hwi Hwang
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, Kyungsangnam-do, 50612, Korea.
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Hospital, Yangsan, Korea.
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
- School of Medicine, Pusan National University, Yangsan, Korea.
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He QC, Huang ZN, Lv CB, Wu YH, Qiu WW, Ma YB, Wu J, Zheng CY, Lin GS, Li P, Wang JB, Lin JX, Lin M, Tu RH, Zheng CH, Huang CM, Cao LL, Xie JW. Effect of Helicobacter pylori infection on survival outcomes of patients undergoing radical gastrectomy after neoadjuvant chemotherapy: a multicenter study in China. BMC Cancer 2025; 25:460. [PMID: 40082850 PMCID: PMC11907980 DOI: 10.1186/s12885-025-13840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 02/28/2025] [Indexed: 03/16/2025] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) has been confirmed to improve the prognosis of patients with advanced gastric cancer (AGC). However, no study has investigated whether Helicobacter pylori (HP) infection affects the postoperative survival of patients who receive NAC. METHODS This retrospective cohort study included 307 patients with AGC who underwent laparoscopic radical gastrectomy after NAC at three hospitals in China between January 1, 2016, and April 31, 2020. Cox regression was used to assess prognostic factors for survival. Kaplan-Meier was used for survival analysis. RESULTS The HP + and the HP- group included 141 and 166 cases. The 3-year overall survival (OS) and disease-free survival (DFS) of the HP + group were significantly better than the HP- group (3-year OS: 75.9% vs. 60.2%, 3-year DFS: 70.2% vs. 52.3%; All P < 0.001). For the HP + group, ypTNM Stage III (HR, 4.00; 95% CI, 1.11-14.39; P = 0.034), NAC ≥ 4 cycles (HR, 0.43; 95% CI, 0.20-0.90; P = 0.026), and adjuvant chemotherapy (AC) ≥ 4 cycles (HR, 0.20; 95% CI, 0.09-0.48; P < 0.001) are independent prognostic factors for OS. In the cohort of HP + patients who received ≥ 4 cycles of NAC, the prognosis of patients who received ≥ 4 cycles of AC after surgery was better than that of patients who received < 4 cycles of AC (3-year OS: 92.5% vs 71.4%; P = 0.042). CONCLUSIONS Following NAC, HP + patients with AGC exhibit better prognosis than that of HP- counterparts. For potentially resectable HP + AGC patients, radical surgery following ≥ 4 cycles of NAC with ≥ 4 cycles of sequential AC might be recommended to improve survival.
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Affiliation(s)
- Qi-Chen He
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Chen-Bin Lv
- Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Yong-He Wu
- Department of Pathology, Zhangzhou Affiliated Hospital of Fujian Medical University, ZhangZhou, China
| | - Wen-Wu Qiu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Yu-Bin Ma
- Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, China
| | - Ju Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Chang-Yue Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Guo-Sheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Rd, Fuzhou, 350001, Fujian Province, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China.
- Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China.
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Matsui R, Ohashi M, Ri M, Makuuchi R, Irino T, Hayami M, Sano T, Nunobe S. Worse oncological impact of preoperative anemia in patients with locally advanced gastric cancer after curative gastrectomy: A retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109762. [PMID: 40101679 DOI: 10.1016/j.ejso.2025.109762] [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: 10/01/2024] [Revised: 02/23/2025] [Accepted: 03/09/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND The impact of preoperative anemia on long-term survival outcomes after gastrectomy remains unclear. This study determined the effect of preoperative anemia on long-term survival outcomes in patients undergoing gastrectomy for gastric cancer. METHODS This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStages I-III gastric cancer between May 2006 and March 2017. According to the World Health Organization hemoglobin classification, ≥13.0 g/dL for men and ≥12.0 g/dL for women are considered normal, 11.0-12.9 g/dL for men and 11.0-11.9 g/dL for women as mild anemia, 8.0-10.9 g/dL moderate anemia, and <8.0 g/dL as severe anemia. The primary outcome was overall survival (OS). Comparisons were made using the log-rank test, and prognostic factors were identified using Cox proportional hazards regression analysis. RESULTS The median follow-up duration was 60 months. Of 4730 patients, 3066 (64.8 %) were classified as normal, 1093 (23.1 %) as mild, 540 (11.4 %) as moderate, and 31 (0.7 %) as severe anemia. Patients with anemia had poorer survival outcomes than those without anemia (P < 0.001). No differences were found among survival outcomes in OS based on severity. When stratified by pStage, patients with anemia had a poorer survival outcome than those without anemia in each pStage. Multivariate analysis showed that preoperative anemia was an independent poor prognostic factor for OS regardless of blood transfusion (hazard ratios: 1.650, 95 % confidence interval: 1.432-1.902, P < 0.001). CONCLUSIONS Preoperative anemia, independent of perioperative blood transfusions, may worsen OS in patients with gastric cancer after curative gastrectomy.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Motonari Ri
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoyuki Irino
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Wang FY, Huang XM, Cao YQ, Cao J, Song M, Fang ZJ, Huang XE. Comparison of PSOX (paclitaxel, oxaliplatin, S-1) and SOX (oxaliplatin, S-1) as postoperative adjuvant chemotherapy for stage II-III gastric cancer. World J Surg Oncol 2025; 23:75. [PMID: 40055779 PMCID: PMC11887138 DOI: 10.1186/s12957-025-03723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 02/16/2025] [Indexed: 05/13/2025] Open
Abstract
BACKGROUND Adjuvant chemotherapy is the conventional treatment for stage II and III gastric cancer(GC). Postoperative doublet chemotherapy has consistently shown improved survival outcomes in advanced-stage GC patients compared to single-agent regimens. Triplet regimens have shown significant survival benefits in the perioperative settings. This retrospective study evaluated the efficacy and safety of paclitaxel/S-1/oxaliplatin (PSOX) compared to S-1/oxaliplatin (SOX) as postoperative adjuvant chemotherapy in stage II-III GC patients following D2 gastrectomy. METHODS A retrospective review was conducted on patients with histologically confirmed stage II-III gastric cancer who underwent D2 gastrectomy at Jiangsu Cancer Hospital, categorizing them into two groups. A total of 75 patients were included in PSOX group and 81 patients in the SOX group between April 2018 and August 2021. Patients in PSOX group received paclitaxel (120 mg/m2), oxaliplatin (100 mg/m2) and S-1 (80 - 60 mg/d) per cycle, while those patients in SOX group were administrated oxaliplatin (130 mg/m2) and S-1 (80-120 mg/d) per cycle. Patients from both groups were matched in a 1:1 ratio using propensity scores to assess differences in disease-free survival (DFS) and safety. RESULTS The 3-year DFS rate was 78.2% for the PSOX group and 74.0% for the SOX group (P = 0.355), with a hazard ratio for peritoneal relapse of 0.287 (95% CI, 0.090-0.915; P = 0.035). Subgroup analysis indicated that stage IIIC GC patients in the PSOX group had a higher DFS rate than those in the SOX group(P = 0.032). Grade 3 or 4 adverse events, as per the National Cancer Institute Common Toxicity Criteria, such as leucopenia (10.6% vs. 4.5%), neutropenia (10.6% vs. 9.1%), nausea/vomiting (4.5% vs. 3.0%), and diarrhea (4.5% vs. 3.0%) were relatively common in the PSOX group compared to the SOX group, with no statistically significant differences between the two groups. CONCLUSION Our findings suggested that adjuvant PSOX chemotherapy offers superior survival benefits compared to the SOX regimen in patients with staged IIIC GC after D2 gastrectomy. The incidence of adverse events with PSOX chemotherapy was comparable to that of SOX chemotherapy.
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Affiliation(s)
- Fei-Yu Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China
| | - Xiang-Ming Huang
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
| | - Yu-Qing Cao
- Department of Medical Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China
| | - Jie Cao
- Department of Medical Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China
| | - Meng Song
- Department of Medical Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China
| | - Zhi-Jun Fang
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China.
| | - Xin-En Huang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China.
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Ou H, Zhuang J, Jian M, Zheng X, Wu T, Cheng H, Qian R. Perioperative versus adjuvant chemotherapy for resectable gastric cancer: a meta-analysis of randomized controlled trials. Front Oncol 2025; 15:1432596. [PMID: 40115020 PMCID: PMC11922704 DOI: 10.3389/fonc.2025.1432596] [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: 05/14/2024] [Accepted: 02/17/2025] [Indexed: 03/22/2025] Open
Abstract
Objectives To report the latest systematic review and meta-analysis of randomized controlled trials (RCT) to compare perioperative versus adjuvant chemotherapy for resectable gastric cancer. Methods We conducted a systematic literature retrieval via PubMed, Embase, Web of Science, and Cochrane until April, 2024 for RCT which compared perioperative versus adjuvant chemotherapy for resectable gastric cancer. Outcomes measured were overall survival (OS) and progression-free survival (PFS). Results 5 RCTs including 2,735 patients were included for meta-analysis. Meta-analysis revealed a significant longer PFS in the neoadjuvant chemotherapy (NAC) group (HR: 0.77; 95% CI: 0.69, 0.85; P<0.00001) compared with adjuvant chemotherapy (AC) group. Subgroup analysis found that there was still a significant superiority of NAC in female (HR: 0.53; 95% CI: 0.40, 0.70; P<0.0001) and cN+ (HR: 0.77; 95% CI: 0.67, 0.89; P=0.0005) patients, while the superiority disappeared in male (HR: 0.87; 95% CI: 0.74, 1.01; P=0.07) and cN- patients (HR: 0.91; 95% CI: 0.46, 1.78; P=0.77). In addition, meta-analysis observed a trend towards improved OS with NAC (HR: 0.86; 95% CI: 0.70, 1.07; P = 0.17), and sensitivity analysis demonstrated instability in OS. Conclusions NAC can significantly prolong PFS in patients with resectable gastric cancer compared to AC, and the benefit is more significant in women and cN+ patients. Besides, our analysis indicated that NAC has a potential to improve OS compared with AC. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024546165.
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Affiliation(s)
- Haiya Ou
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jiamei Zhuang
- Department of Nephrology, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Mingwei Jian
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xinyi Zheng
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Tingping Wu
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Honghui Cheng
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Rui Qian
- Department of Gastroenterology, Shenzhen Bao'an Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
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50
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Morini A, Zizzo M, Zanelli M, Sanguedolce F, Palicelli A, Nardecchia M, Formisano D, Fabozzi M. Evaluation of YouTube Laparoscopic Total Gastrectomy Videos for Benign and Malignant Diseases as Educational Materials, Using the LAP-VEGaS Video Assessment Tool. Indian J Surg 2025. [DOI: 10.1007/s12262-025-04334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 02/26/2025] [Indexed: 04/29/2025] Open
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