• Humans
• Stomach Neoplasms/surgery
• Stomach Neoplasms/mortality
• Male
• Female
• Gastrectomy/adverse effects
• Aged
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/mortality
• Middle Aged
• Retrospective Studies
• Japan/epidemiology
• Aged, 80 and over
• Kaplan-Meier Estimate
• Disease-Free Survival
• Proportional Hazards Models
• Delirium/etiology
• Delirium/epidemiology
• Adult

• Cardiovascular surgery
• Effects of red blood cell transfusion
• Immune cell kinetics

• Humans
• Erythrocyte Transfusion
• Male
• Female
• Middle Aged
• Aged
• Length of Stay
• Blood Transfusion, Autologous
• Cardiovascular Surgical Procedures
• Lymphocyte Subsets/immunology
• Blood Loss, Surgical
• Killer Cells, Natural/immunology
• Lymphocyte Count
• Kinetics

• autotransfusion
• femoral shaft fracture (FSF)
• hemodilution
• predeposit
• salvage

• Humans
• Granulocyte-Macrophage Colony-Stimulating Factor
• Blood Transfusion, Autologous/methods
• Hemodilution/methods
• Hemoglobins/analysis
• Biological Assay

• PWZxq2022-5 Key Disciplines Group Construction Project of Pudong Health Bureau of Shanghai

• age
• clinicopathological characteristics
• gastric cancer
• prognosis
• young

• disease-free survival
• disease-special survival
• gastric cancer
• overall survival
• perioperative blood transfusions
• postoperative complications

• blood transfusion
• perioperative transfusion trigger score
• restrictive blood transfusion

Peritoneal dissemination (PD) is the most common mode of metastasis for advanced gastric cancer (GC) with poor prognosis. It is of great significance to accurately predict preoperative PD and develop optimal treatment strategies for GC patients. Our study assessed the diagnostic potential of serum tumor markers and clinicopathologic features, to improve the accuracy of predicting the presence of PD in GC patients.

In our study, 1264 patients with GC at Fudan University Shanghai Cancer Center and Wenzhou people’s hospital from 2018 to 2020 were retrospectively analyzed, including 316 cases of PD and 948 cases without PD. All patients underwent enhanced CT scan or magnetic resonance imaging (MRI) before surgery and treatment. Clinicopathological features, including tumor diameter and tumor stage (depth of tumor invasion, nearby lymph node metastasis and distant metastasis), were obtained by imaging examination. The independent risk factors for PD were screened through univariate and multivariate logistic regression analyses, and the results were expressed with 95% confidence intervals (CIs). A model of PD diagnosis and prediction was established by using Cox proportional hazards regression model of training set. Furthermore, the accuracy of the prediction model was verified by ROC curve and calibration plots.

Univariate analysis showed that PD in GC was significantly related to tumor diameter (odds ratio (OR)=12.06, p<0.0006), depth of invasion (OR=14.55, p<0.0001), lymph node metastases (OR=5.89, p<0.0001), carcinoembryonic antigen (CEA) (OR=2.50, p<0.0001), CA125 (OR=11.46, p<0.0001), CA72-4 (OR=4.09, p<0.0001), CA19-9 (OR=2.74, p<0.0001), CA50 (OR=5.20, p<0.0001) and CA242 (OR=3.83, p<0.0001). Multivariate analysis revealed that clinical invasion depth and serum marker of CA125 and CA72-4 were independent risk factors for PD. The prediction model was established based on the risk factors using the R program. The area under the curve (AUC) of the receiver operating characteristics (ROC) was 0.931 (95% CI: 0.900–0.960), with the accuracy, sensitivity and specificity values of 90.5%, 86.2% and 82.2%, respectively.

The nomogram model constructed using CA125, CA72-4 and depth of invasion increases the accuracy and sensitivity in predicting the incidence of PD in GC patients and can be used as an important tool for preoperative diagnosis.

• gastric cancer
• peritoneal dissemination
• prediction nomogram
• risk factors
• serum tumor markers

The purpose of the current meta-analysis was to analyze whether intraoperative blood loss (IBL) influenced the complications and prognosis of gastric cancer patients after gastrectomy.

We systematically searched the PubMed, Embase and Cochrane library databases on November 29, 2021. The Newcastle-Ottawa scale was used to evaluate the quality of included studies. This meta-analysis uses RevMan 5.3 for data analysis.

A total of nine retrospective studies were included in this meta-analysis, involving 4653 patients. In terms of short-term outcomes, the Larger IBL group has a higher complication rate (OR = 1.94, 95% CI, 1.44 to 2.61, P < 0.0001) and a longer operation time (OR = 77.60, 95% CI, 41.95 to 113.25, P < 0.0001) compared with the smaller IBL group, but the Larger IBL group had higher total retrieved lymph nodes (OR = 3.68, 95% CI, 1.13 to 6.24, P = 0.005). After pooling up all the HRs, the Larger IBL group has worse overall survival (OS) (HR = 1.80, 95% CI, 1.27 to 2.56, P = 0.001) and disease-free survival (DFS) (HR = 1.48, 95% CI, 1.28 to 1.72, P < 0.00001).

Larger IBL increased operation time and postoperative complications, and decreased OS and DFS of gastric cancer patients. Therefore, surgeons should be cautious about IBL during operation.

Background and objectives: Adenocarcinoma of the esophagogastric junction (AEG) has a complicated surgical anatomy, due to which it sometimes induces excessive intraoperative blood loss that necessitates intraoperative blood transfusion (BTF). However, few reports have focused on the impact of BTF on the survival outcomes of patients with AEG. We aimed to evaluate the impact of BTF on AEG prognosis. Materials andMethods: We included 63 patients who underwent surgical resection for AEG at our hospital between January 2010 and September 2020. Clinicopathological characteristics and survival outcomes were compared between patients with (n = 12) and without (n = 51) BTF. Multivariate analysis was performed to identify the independent prognostic factors for overall survival. Results: None of the patients who underwent minimally invasive surgery received BTF. Patients who received BTF had a significantly worse 5-year survival rate than those who did not (67.8% vs. 28.3%, p = 0.001). BTF was an independent risk factor for overall survival (hazard ratio: 3.90, 95% confidence interval 1.30–11.7), even after patients who underwent minimally invasive surgery were excluded. Conclusions: BTF adversely affected the survival outcomes of patients with AEG who underwent curative surgery. To avoid BTF, surgeons should strive to minimize intraoperative bleeding.

• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Blood Transfusion
• Esophagogastric Junction/pathology
• Esophagogastric Junction/surgery
• Humans
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/pathology

• Blood loss
• Gastrectomy
• Gastric cancer
• Prognosis
• Surgical

• gastric cancer
• peritoneal recurrence
• preventive treatment
• radical resection
• risk assessment

Stomach cancer is a common malignancy and one of the leading causes of cancer death in Taiwan. Although tumor characteristics are the main determinants of oncological outcomes, modulation of the immune system may also play some role in cancer progression. Despite the hypothesis that perioperative blood transfusion may suppress the immune reactivity and promote tumor recurrence, the role of perioperative transfusion in the prognosis of stomach cancer remains controversial. To fill this gap, we designed this retrospective study using sound analytical approaches to investigate the impact of perioperative transfusion on oncologic outcomes after curative resection for stomach cancer. We demonstrated that perioperative transfusion was associated with inferior disease-free and overall survival after stomach cancer surgery and a dose-response relationship was also noted between the amount of transfusion and risk of cancer recurrence or mortality.

Background: Whether perioperative packed red blood cell (pRBC) transfusion is associated with inferior long-term outcomes after stomach cancer surgery remains controversial. Methods: This research used a retrospective cohort study. Patients with stage I~III stomach cancer undergoing tumor resection were collected at a tertiary medical center. Patient characteristics, surgical features and pathologic findings were gathered from an electronic medical chart review. The associations of perioperative pRBC transfusion with postoperative disease-free and overall survivals were evaluated using Cox regression analysis with an inverse probability of treatment weighting (IPTW). Restricted cubic spline functions were employed to characterize dose-response relationships between the amount of transfusion and cancer outcomes after surgery. Results: Among the 569 patients, 160 (28.1%) received perioperative pRBC transfusion. Perioperative transfusion was associated with worse disease-free survival (IPTW adjusted HR: 1.42, 95% CI: 1.18–1.71, p < 0.001) and overall survival (IPTW adjusted HR: 1.27, 95% CI: 1.05–1.55, p = 0.014). A non-linear dose-response relationship was noted between the amount of transfusions and worse disease-free or overall survival. Conclusions: Perioperative pRBC transfusion was associated with worse disease-free and overall survival after stomach cancer surgery, and strategies aiming to minimize perioperative transfusion exposure should be further considered to reduce the potential risk.

• blood transfusion
• disease-free survival
• dose-response
• stomach neoplasms
• survival analysis

Limb-sparing surgery with negative margins is possible in most soft tissue sarcoma (STS) resections and focuses on maximising function and minimising morbidity. Various risk factors for surgical site infections (SSIs) have been reported in the literature specific to sarcoma surgery. The aim of this study is to determine whether systemic inflammatory response prognostic scoring systems can predict post-operative SSI in patients undergoing potentially curative resection of STS.

Patients who had a planned curative resection of a primary STS at a single centre between January 2010 and December 2019 with a minimum follow-up of 6 months were included. Data were extracted on patient and tumour characteristics, and pre-operative blood results were used to calculate inflammatory prognostic scores based on published thresholds and correlated with risk of developing SSI or debridement procedures.

A total of 187 cases were included. There were 60 SSIs. On univariate analysis, there was a statistically significant increased risk of SSI in patients who are diabetic, increasing specimen diameter, American Society of Anaesthesiology (ASA) grade 3, use of endoprosthetic replacement, blood loss greater than 1 L, and junctional tumour location. Modified Glasgow prognostic score, C-reactive protein/albumin ratio and neutrophil–platelet score (NPS) were statistically associated with the risk of SSI. On multivariate analysis, ASA grade 3, junctional tumour location and NPS were independently associated with the risk of developing a SSI.

This study supports the routine use of simple inflammation-based prognostic scores in identifying patients at increased risk of developing infectious complications in patients undergoing potentially curative resection of STS.

• Infection
• Inflammatory prognostic score
• Modified Glasgow prognostic score
• Soft tissue sarcoma

• Gastric cancer
• Glasgow prognostic score
• Postoperative complications

• exosome
• gastric cancer
• metastasis
• pre-metastatic niche
• tumor microenvironment

• Blood Transfusion
• Chemotherapy, Adjuvant
• Gastrectomy/adverse effects
• Humans
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/surgery

• kq1907125 the Science and Technology Foundation of Changsha
• 2020JJ5339 Hunan Provincial Natural Science Foundation of China
• 20200608 the Research Project of Health Commission of Hunan Province

• Cancer
• Meta-analysis
• Overall survival
• Surgery
• Transfusions

• Clavien–Dindo
• Complication
• Gastrectomy
• Gastric cancer
• Survival outcomes

• Robotic gastrectomy
• gastric cancer
• oncological outcomes
• perioperative outcomes

• Colorectal cancer
• Organ/space surgical site infection
• Postoperative recurrence
• Stage I

• Colorectal Neoplasms/surgery
• Humans
• Neoplasm Recurrence, Local/diagnosis
• Prognosis
• Retrospective Studies
• Risk Factors
• Surgical Wound Infection/diagnosis
• Surgical Wound Infection/etiology

• Gastrectomy
• Gastric cancer
• Postoperative complications
• Survival

• Female
• Follow-Up Studies
• Gastrectomy
• Humans
• Male
• Postoperative Complications/epidemiology
• Postoperative Complications/mortality
• Postoperative Complications/prevention & control
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery
• Survival Rate
• Time Factors
• Treatment Outcome

• Ginsenoside Rg3
• human gastric cancer cell
• hypoxia-induced factor-1α
• vascular endothelial growth factor

• blood loss
• intraoperative
• pancreatic cancer
• survival rates
• transfusion

• Complicaciones postoperatorias
• Cumplimiento de protocolo
• Estancia hospitalaria
• Gastrectomy
• Gastrectomía
• Length of stay
• Postoperative complications
• Protocol compliance
• Recovery of function
• Recuperación de la función

• Adenocarcinoma/blood
• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Biomarkers, Tumor/blood
• C-Reactive Protein/analysis
• Carcinoma, Signet Ring Cell/blood
• Carcinoma, Signet Ring Cell/pathology
• Carcinoma, Signet Ring Cell/surgery
• Female
• Fibrinogen/analysis
• Follow-Up Studies
• Gastrectomy
• Humans
• Lymph Node Excision
• Male
• Middle Aged
• Neoplasm Recurrence, Local/blood
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/surgery
• Neoplasm Staging
• Preoperative Care
• ROC Curve
• Retrospective Studies
• Serum Albumin/analysis
• Stomach Neoplasms/blood
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate

• Aged
• Aged, 80 and over
• Drug Combinations
• Female
• Gastrectomy
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Oxonic Acid/therapeutic use
• Prognosis
• Retrospective Studies
• Stomach Neoplasms/drug therapy
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Tegafur/therapeutic use

Risk management is becoming an increasingly important healthcare issue. Gastrectomy with lymphadenectomy is still the mainstay of treatment for localized gastric cancer, but it is sometimes associated with postoperative complications that compromise the patient’s quality of life, tolerability of adjuvant treatment, and prognosis. Parameters based exclusively on preoperative factors can identify patients most at risk of postoperative complications, whereby surgeons can provide the patient with precise informed consent information and optimal perioperative management. Ultimately, these predictive tools can also help minimize medical costs. In this context, many studies have identified factors that predict postoperative complications, including indicators based on body constitution, nutrition, inflammation, organ function and hypercoagulation. This review presents our current understanding and discusses some future perspectives of preoperatively identified factors predictive of complications after resection for gastric cancer.

• Gastrectomy
• Gastric cancer
• Postoperative complication
• Predictor

• Body Constitution
• Cost Savings
• Forecasting
• Gastrectomy
• Humans
• Inflammation
• Informed Consent
• Kidney/physiopathology
• Lung/physiopathology
• Lymph Node Excision
• Nutritional Status
• Postoperative Complications/etiology
• Risk
• Stomach Neoplasms/physiopathology
• Stomach Neoplasms/surgery
• Thrombophilia

Gastrectomy with radical lymph node dissection is the most promising treatment avenue for patients with gastric cancer. However, this procedure sometimes induces excessive intraoperative blood loss and requires perioperative allogeneic blood transfusion. There are lasting discussions and controversies about whether intraoperative blood loss or perioperative blood transfusion has adverse effects on the prognosis in patients with gastric cancer. We reviewed laboratory and clinical evidence of these associations in patients with gastric cancer. A large amount of clinical evidence supports the correlation between excessive intraoperative blood loss and adverse effects on the prognosis. The laboratory evidence revealed three possible causes of such adverse effects: anti-tumor immunosuppression, unfavorable postoperative conditions, and peritoneal recurrence by spillage of cancer cells into the pelvis. Several systematic reviews and meta-analyses have suggested the adverse effects of perioperative blood transfusions on prognostic parameters such as all-cause mortality, recurrence, and postoperative complications. There are two possible causes of adverse effects of blood transfusions on the prognosis: Anti-tumor immunosuppression and patient-related confounding factors (e.g., preoperative anemia). These factors are associated with a worse prognosis and higher requirement for perioperative blood transfusions. Surgeons should make efforts to minimize intraoperative blood loss and transfusions during gastric cancer surgery to improve patients’ prognosis.

• Gastric cancer
• Blood loss
• Prognosis
• Transfusion
• Adverse effect
• Immunosuppression
• Mortality
• Recurrence
• Complication

• Blood Loss, Surgical
• Blood Transfusion/statistics & numerical data
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Humans
• Lymph Node Excision/adverse effects
• Lymph Node Excision/methods
• Neoplasm Recurrence, Local/diagnosis
• Neoplasm Recurrence, Local/immunology
• Perioperative Care/statistics & numerical data
• Prognosis
• Stomach Neoplasms/immunology
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery
• Transfusion Reaction/immunology
• Transplantation, Homologous/adverse effects
• Tumor Escape/immunology
• Tumor Microenvironment/immunology

• Blood transfusion
• Gastric cancer
• Perioperative transfusion
• Post-operative infection

To evaluate the prognostic significance of perioperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels in stage II/III gastric cancer.

From a multi-institutional retrospective database compiled by integrating clinical data from nine institutions, data of 998 patients who underwent curative resection for stage II/III gastric cancer between 2010 and 2014 were retrieved and analyzed. The prognostic impact of the preoperative and postoperative levels and chronological changes in CEA, CA19-9 and their combination were evaluated. To test whether postoperative adjuvant chemotherapy alters the prognostic impact of perioperative CEA and CA19-9 levels, the hazard ratios for mortality were compared between patients who underwent surgery alone and patients who underwent surgery followed by adjuvant chemotherapy.

The prognostic impact of postoperative CEA and CA19-9 was superior to that of the preoperative levels. Multivariable analysis identified high postoperative CEA and CA19-9 levels as independent prognostic factors for overall survival. Disease-free survival rates clearly decreased in a stepwise manner in association with postoperative CEA and CA19-9 levels, and patients with high levels of both markers showed significantly poorer prognosis than other patient groups. When we analyzed perioperative changes in serum CEA and CA19-9 levels, patients with high levels before and after surgery had the worst disease-free survival rates among all patient groups. Patients with normalized CEA levels after surgery had a significantly lower disease-free survival rate than those with normal perioperative levels, whereas patients with normalized CA19-9 levels after surgery had equivalent survival to those with normal perioperative levels. The prognostic impact of high CEA levels was observably smaller in patients who underwent adjuvant chemotherapy than in patients who underwent surgery alone, whereas that of high CA19-9 was greater in patients who underwent adjuvant chemotherapy. High postoperative CEA levels were significantly associated with an increased prevalence of liver, lung and bone recurrences, and high postoperative CA19-9 levels were significantly associated with increased frequencies of lymph node and liver recurrences.

The evaluation of serum CEA and CA 19-9 levels both before and after surgery provides useful information for precise risk stratification after curative gastrectomy.

• Gastric cancer
• Carcinoembryonic antigen
• Carbohydrate antigen 19-9
• Perioperative levels
• Prognosis

Anastomotic leakage is a major cause of prolonged hospitalization after gastrectomy and sometimes leads to fatal complications, such as abdominal abscess and sepsis. Arginine, glutamine, and β-hydroxy-β-methylbutyrate (HMB) are indispensable for biosynthesis of collagen, which plays an important role in the process of wound healing. However, treatment effects of amino acid supplements containing HMB on the healing process of anastomotic leakage after gastrectomy remain unclear. We designed an open-label, multicenter, phase II clinical trial to evaluate the therapeutic efficacy of an enteral amino acid supplement consisting of arginine, glutamine, and HMB (Abound, Abbott Japan Co., Ltd., Tokyo, Japan) in patients with anastomotic leakage after gastrectomy. Patients who are diagnosed with anastomotic leakage within 14 days after gastrectomy are eligible for this trial and the target sample size is 20. A pack of Abound is administered twice a day for 2 weeks. The primary objective of this clinical trial is to determine the length of time between diagnosis and cure of anastomotic leakage. The secondary endpoints include the safety of Abound, duration of drainage placement and fasting, postoperative hospital stay, surgical procedure, and blood test data. Variables are compared between enrolled patients and a historical control consisting of 20 patients who underwent gastrectomy between 2004 and 2016 at Nagoya University Hospital. We herein describe the study design and the concept in this protocol paper.

• Nutrition for anastomotic leakage

• AKT
• Chemoresistance
• Gastric cancer
• Invasion
• Proliferation
• TCF21

Hepatic recurrence of gastric cancer (GC) is uncontrollable. Discovery of causative oncogenes and the development of sensitive biomarkers to predict hepatic recurrence are required to improve patients’ outcomes. In this study, recurrence pattern‐specific transcriptome analysis of 57 749 genes was conducted to identify mRNAs specifically associated with hepatic metastasis of patients with stage III GC who underwent curative resection. GC cell lines were subjected to mRNA expression analysis, PCR array analysis, and siRNA‐mediated knockdown. The expression levels of primary cancer tissues from 154 patients with resectable GC were determined and correlated with clinicopathological variables. Among 21 genes significantly overexpressed specifically in patients with hepatic recurrence, Sushi domain containing 2 (SUSD2) was selected as a promising target. PCR array analysis revealed that SUSD2 mRNA levels positively correlated with those of FZD7, CDH2, TGFB1, SPARC, ITGA5, and ZEB1. Functional analysis revealed that knockdown of SUSD2 significantly reduced the proliferation, migration, and invasiveness GC cell lines. Patients with high SUSD2 expression were more likely to experience shorter disease‐free and overall survival. Analysis of the relation between disease recurrence pattern and SUSD2 levels revealed that significantly more patients with hepatic metastases expressed higher levels of SUSD2 mRNA. The cumulative incidence of hepatic recurrence was greater in patients with high SUSD2 expression. In conclusion, SUSD2 likely contributes to the malignant potential of GC and may serve as a novel biomarker that predicts hepatic recurrence after curative resection.

• SUSD2
• expression
• gastric cancer
• hepatic recurrence
• prognosis

• Gastric cancer
• Perioperative blood transfusion
• Prognosis

• Adenocarcinoma/mortality
• Adenocarcinoma/surgery
• Adult
• Aged
• Databases, Factual
• Erythrocyte Transfusion/adverse effects
• Female
• Gastrectomy
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Perioperative Care/adverse effects
• Perioperative Care/methods
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery

• 81502027 National Natural Science Foundation of China
• 17411963200 Shanghai Committee of Science and Technology Funds

• Aged
• Animals
• Biomarkers, Tumor/antagonists & inhibitors
• Biomarkers, Tumor/metabolism
• Cell Line, Tumor
• Computational Biology
• Female
• Follow-Up Studies
• Humans
• Male
• Mice
• Mice, Inbred BALB C
• Middle Aged
• Neoplasm Transplantation
• Peritoneal Neoplasms/metabolism
• Peritoneal Neoplasms/prevention & control
• Peritoneal Neoplasms/secondary
• RNA Interference
• RNA, Small Interfering/therapeutic use
• RNAi Therapeutics
• Stomach Neoplasms/metabolism
• Stomach Neoplasms/pathology
• Stomach Neoplasms/therapy
• Synaptotagmins/antagonists & inhibitors
• Synaptotagmins/metabolism
• Transcriptome

• Fe
• Iron status
• Prognosis
• TIBC