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Guo S, Liu FF, Yuan L, Ma WQ, Er LM, Zhao Q. Subclassification scheme for adenocarcinomas of the esophagogastric junction and prognostic analysis based on clinicopathological features. World J Gastrointest Oncol 2025; 17:103455. [DOI: 10.4251/wjgo.v17.i4.103455] [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: 11/21/2024] [Revised: 01/11/2025] [Accepted: 01/21/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Adenocarcinoma of the esophagogastric junction (AEG) has distinct malignant features compared with other esophageal and gastric cancers. Its management is controversial and largely influenced by tumor location and esophageal involvement. Hence, understanding the clinicopathological characteristics and prognosis of AEG is essential for optimizing treatment strategies.
AIM To evaluate the prognosis and clinicopathological features of patients with AEG, providing insights for management strategies.
METHODS This retrospective study analyzed cases with AEG admitted between January 2016 and December 2017. Patients meeting the inclusion criteria were categorized into three groups: Type E [tumors whose center was located within 5 cm above the esophagogastric junction (EGJ)]; Type Eg (tumors whose center was situated within 2 cm below the EGJ), with a 2-cm esophageal invasion; Type Ge (tumors whose center was situated within 2 cm below the EGJ, with an esophageal invasion of < 2 cm, based on tumor location and esophageal involvement. Then, clinicopathological characteristics and survival outcomes of the groups were compared to evaluate the predictive value of the American Joint Committee on Cancer/International Alliance against Cancer 8th edition gastric cancer and esophageal adenocarcinoma staging systems. Statistical analysis included survival analysis and Cox regression to assess prognostic factors.
RESULTS Totally, 153 patients with AEG were included (median follow up: 41.1 months; 22, 31, and 100 patients from type E, Eg, and Ge, respectively), with significant differences in maximum tumor length, esophageal involvement length, tumor type, pathology, differentiation, depth of invasion, and lymph node metastasis between the groups (P < 0.05). Lymph node metastasis rates at stations 1, 2, 3, and 7 were lower in type E than in Eg and Ge (P < 0.05). Survival rates for type E (45.5%) were significantly lower than those for Eg (48.4%) and Ge (73.0%) (P = 0.001). Type E tumors, vascular infiltration, T3-T4 invasion depth, and lymph node metastasis, were identified as independent prognostic factors (P < 0.05). The gastric cancer staging system outperformed the esophageal adenocarcinoma system for type Ge tumors.
CONCLUSION Clinicopathological characteristics and prognoses varied between the AEG groups, with type E demonstrating distinct features. The gastric cancer staging system more accurately predicted type Ge AEG prognosis, guiding clinical decision-making.
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Affiliation(s)
- Shuo Guo
- Department of Endoscopy, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Fang-Fang Liu
- Department of Nutrition, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li Yuan
- Department of Endoscopy, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Wen-Qian Ma
- Department of Endoscopy, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Li-Mian Er
- Department of Endoscopy, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
| | - Qun Zhao
- Department of Gastrointestinal Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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Zheng H, Zheng H, Du X, Xu B, Hu M, Yu J, Xie R, Wei L, Xue Z, Shen L, Lin J, Xie J, Zheng C, Huang C, Li P. Development of a prognostic oxidative stress-immune-inflammation score and online calculators for predicting survival and recurrence in gastric cancer: a multicenter study. Surg Endosc 2025; 39:2609-2624. [PMID: 40050495 DOI: 10.1007/s00464-025-11596-6] [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: 09/18/2024] [Accepted: 01/29/2025] [Indexed: 03/26/2025]
Abstract
BACKGROUND Oxidative stress, immune response, and inflammation play an important role in the occurrence and progression of gastric cancer (GC). This study is to develop a novel prognostic oxidative stress-immune-inflammation score (POSII score) and to explore the clinical value of the novel nomograms incorporating this factor in survival and recurrence risk. METHODS This study included 3612 GC patients who underwent radical gastrectomy at three tertiary hospitals from 2009 to 2020. One hospital formed the training and internal validation cohorts, while the other two constituted the external validation cohort. Twelve hematological markers were collected and analyzed to develop the POSII score via LASSO regression. Two online calculators were developed and validated. RESULTS The POSII score categorized patients into low and high POSII groups, with the low POSII group showing significantly improved 5-year overall survival (OS) and disease-free survival (DFS) rates, as well as a markedly reduced risk of recurrence (all P < 0.05). Multivariate COX regression showed that the POSII score was an independent prognostic factor. Based on the POSII score, two nomograms (OS: AUC = 0.837; DFS: AUC = 0.834, respectively) for individualized prognostic prediction were constructed. To enhance clinical usability, we further developed two user-friendly online calculators. The high-risk group had an earlier, more persistent peak of recurrence and a high incidence of multiple recurrence patterns. CONCLUSION Two novel online calculators based on the POSII score can be used as reliable tools for predicting survival and recurrence after radical gastrectomy. Our findings provide new insights into the role of cancer-related immune dysregulation, inflammation, and oxidative stress imbalances.
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Affiliation(s)
- Hualong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Honghong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Xiaoqiang Du
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Binbin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
- Department of Digestive Endoscopy, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Minggao Hu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Department of General Surgery, The PLA Navy Anqing Hospital, Anqing, 246000, China
| | - Junhua Yu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Department of General Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, China
| | - Rongzhen Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Department of General Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, 321000, China
| | - Linghua Wei
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Lili Shen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Jia Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Jianwei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Chaohui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Changming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China.
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, FuzhouFujian Province, 350000, China.
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China.
- Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China.
- Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China.
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Ishida H, Sunakawa Y, Kodera Y, Yoshida K, Kochi M, Kakeji Y, Sano T, Takeuchi M, Ichikawa W, Fujii M. Post-recurrence survival in patients with stage III gastric cancer who received adjuvant chemotherapy; post-hoc analysis of the JACCRO GC-07 study. Eur J Cancer 2025; 219:115322. [PMID: 39999670 DOI: 10.1016/j.ejca.2025.115322] [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: 07/22/2024] [Revised: 02/06/2025] [Accepted: 02/16/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND As adjuvant chemotherapy for stage III gastric cancer, the phase III (JACCRO GC-07) trial showed that docetaxel plus S-1 (DS) was superior to S-1 in terms of recurrence-free and overall survival. However, whether adding docetaxel to S-1 in the adjuvant setting affects survival after recurrence remains unclear. The optimal treatment strategy for patients who develop recurrence during or after DS has also been controversial. METHODS We used results from JACCRO GC-07 to investigate post-recurrence survival (PRS) in patients who developed recurrence during or after completing adjuvant chemotherapy. PRS was compared between adjuvant groups and among post-recurrence chemotherapeutic regimens. RESULTS During 5 years of follow-up after surgery, 161 of 441 patients in the DS group and 216 of 452 patients in the S-1 group developed recurrence, with median PRS of 12.6 and 11.4 months, respectively (hazard ratio [HR] 0.98, 95 % confidence interval [CI] 0.79-1.22; p = 0.84). Among patients with recurrence, 115 patients in the DS group and 165 patients in the S-1 group received chemotherapy, and median PRS was 14.5 and 13.7 months, respectively (HR 1.04, 95 %CI 0.81-1.34; p = 0.76). Platinum-based chemotherapy resulted in longer PRS than non-platinum chemotherapy, regardless of the adjuvant chemotherapeutic regimen or time of recurrence. CONCLUSIONS PRS was similar between patients who received adjuvant chemotherapy with DS or with S-1 alone. PRS was also similar between groups of patients who received chemotherapy after recurrence. Platinum-based chemotherapy might be the optimal treatment for patients who develop recurrence after completing adjuvant DS, regardless of the time of recurrence.
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Affiliation(s)
- Hiroo Ishida
- Division of Medical Oncology, Showa University Fujigaoka Hospital, Japan.
| | - Yu Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Mitsugu Kochi
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Japan
| | - Takeshi Sano
- Gastroenterological Surgery, Cancer Institute Hospital, Japan
| | - Masahiro Takeuchi
- The University of Tokyo Graduate School of Mathematical Science, Japan
| | - Wataru Ichikawa
- Division of Medical Oncology, Showa University Fujigaoka Hospital, Japan
| | - Masashi Fujii
- Department of Digestive Surgery, Nihon University School of Medicine, 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 2025:2831460. [PMID: 40072431 PMCID: PMC11904804 DOI: 10.1001/jamasurg.2025.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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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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Van Du N, Anh Tuan N, Ngoc Cuong L. Comparative study of ICG and non-ICG-guided laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis at a single center. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2025; 7:e000313. [PMID: 40051652 PMCID: PMC11883552 DOI: 10.1136/bmjsit-2024-000313] [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: 08/03/2024] [Accepted: 02/03/2025] [Indexed: 03/09/2025] Open
Abstract
ABSTRACT Objectives To investigate the effectiveness of indocyanine green (ICG) lymphography in improving lymph nodes (LNs) harvesting during laparoscopic radical distal gastrectomy for gastric cancer. Design Non-randomized trial, prospective study compared ICG and non-ICG group using 1:1 propensity score matching (PSM) method. Setting Preoperative clinical characteristics, operative outcomes, and follow-up results. Participants 242 patients who underwent laparoscopic distal gastrectomy with D2 lymphadenectomy for gastric cancer between 2019 and 2023. After exclusion and PSM, 160 patients (Pts) were included, paired in two groups: ICG (80 Pts) and non-ICG (80 Pts). Interventions Patients in the ICG group underwent ICG injection submucosal via endoscopy 1 day before surgery. Main outcome measures Comparison of the number of retrieved LNs and complications between the ICG and non-ICG group. Results There were no significant differences in age, sex, height, tumor size, pathological Tumor-stage, histological differentiation, and complications between the two groups. There was a shorter operative time in the ICG group compared with the non-ICG group (median: 118 mins (IQR, 105-135) vs 146 mins (IQR, 120-180), respectively). Regarding the effectiveness of LN dissection: the ICG group had a higher median of retrieved LNs than the non-ICG group (36 LNs (IQR, 29-46) vs 27 LNs (IQR, 21-31); p<0.001). The mean number of metastatic LNs in the ICG group was significantly higher than in the non-ICG group, with 2.6±5.4 LNs compared with 0.9±3.1 LNs, respectively (p=0.018). The proportion of patients with more than 25 and 30 retrieved LNs was higher in the ICG group compared with the non-ICG group, with rates of 86% and 71% versus 64% and 31%, respectively (p<0.001). Conclusions Using ICG fluorescence-guided LNs dissection has increased both the number of total LNs and metastatic LNs dissection without increasing complications in laparoscopic distal gastrectomy for gastric cancer.
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Affiliation(s)
- Nguyen Van Du
- Department of Gastrointestinal Tract Surgery, Military Central Hospital, Ha Noi, Viet Nam
| | - Nguyen Anh Tuan
- Department of Gastrointestinal Tract Surgery, Military Central Hospital, Ha Noi, Viet Nam
| | - Luong Ngoc Cuong
- Department of Gastrointestinal and Hepatobiliary Surgery, Thai Nguyen National Hospital, Thai Nguyen, Viet Nam
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Zhong Q, Shang-Guan ZX, Liu ZY, Wu D, Huang ZN, Wang HG, Chen JY, Wu JX, Li P, Xie JW, Zheng CH, Chen QY, Huang CM. Comparison of a submucosal and subserosal approach in ICG-guided laparoscopic lymphadenectomy in gastric cancer patients: long-term outcomes of a phase 3 randomized clinical trial. Int J Surg 2025; 111:2558-2569. [PMID: 39903562 DOI: 10.1097/js9.0000000000002271] [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: 12/17/2024] [Indexed: 02/06/2025]
Abstract
BACKGROUND Previous studies have demonstrated similar short-term efficacy between subserosal (SSA) and submucosal (SMA) approaches for ICG injection in gastric cancer (GC). This study aims to compare the long-term oncological outcomes of these two injection methods for lymph node (LN) tracing in ICG-guided laparoscopic gastrectomy. MATERIALS AND METHODS This study was a phase 3, open-label, randomized clinical trial (FUGES-019). A total of 266 patients with resectable gastric adenocarcinoma (cT1-4a, N0/ +, M0) were enrolled. We report predefined long-term secondary outcomes, including three-year actual overall survival (OS), three-year actual disease-free survival (DFS), and recurrence patterns. RESULTS Of the 266 participants, 259 patients were included in the per-protocol analysis: 129 in the SSA group and 130 in the SMA group. The actual OS in the SSA group (87.6%) was comparable to that in the SMA group (90.8%, P = 0.41), as were the 3-year actual DFS rates (SSA: 82.9% vs. SMA: 88.5%, log-rank P = 0.19). Per-protocol analysis confirmed the equivalence of the SSA compared with the SMA. The most common type of recurrence was multiple site metastasis (11 of 259[4.24%]), with no differences in recurrence types across cancer stages. Further stratified analysis based on pT, pN staging, tumor size, and BMI showed no significant differences between the two groups. CONCLUSION The 3-year outcomes of the FUGES-019 trial confirm the equivalence of SSA and SMA in ICG-guided laparoscopic lymphadenectomy for GC, supporting the previous short-term findings. The subserosal approach can be recommended for ICG administration based on clinical considerations.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Zhi-Xin Shang-Guan
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Zhi-Yu Liu
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Dong Wu
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Ze-Ning Huang
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Hua-Gen Wang
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Jun-Yun Chen
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Jin-Xun Wu
- Department of Pathology, Lian-jiang Country General Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fuzhou, China
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Sędłak K, Kubiak M, Pelc Z, Mlak R, Kobiałka S, Leśniewska M, Mielniczek K, Chawrylak K, Gumbs A, Grasso SV, Pawlik TM, Polkowski WP, Rawicz-Pruszyński K. Prime suspect or collective responsibility: Impact of specific lymph node station dissection on short- and long-term outcomes among locally advanced gastric cancer patients after neoadjuvant chemotherapy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109545. [PMID: 39675307 DOI: 10.1016/j.ejso.2024.109545] [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: 10/02/2024] [Revised: 11/21/2024] [Accepted: 12/11/2024] [Indexed: 12/17/2024]
Abstract
BACKGROUND Lymphatic route is the main pathway for gastric cancer (GC) spread, and lymph node (LN) involvement is a major prognostic factor after curative resection. The aim of this study was to assess the outcomes of specific LN station dissection. METHODS Patients with locally advanced (cT2-4N0-3M0) GC who underwent multimodal treatment between 2013 and 2023 were included in the study. Patients who had not undergone gastrectomy, had early (cT1) or metastatic GC, who had undergone multiorgan resections, palliative care, had died before the end of curative-intent planned treatment, or had incomplete clinical or pathological information were excluded. The primary endpoint was the development of serious complications, and the secondary outcome was OS. RESULTS Mulivariable analysis revealed, that among patients who received neoadjuvant chemotherapy (NAC), it was observed that station 10 lymphadenectomy was associated with a higher risk of serious postoperative complications. (27.6 % vs 8.7 %; OR = 3.28) Among the no-NAC group, it was observed that station 13 lymphadenectomy was associated with a higher risk of serious postoperative complications. (57.1 % vs 13.2 %; OR = 6.96). Among the NAC group, a lower risk of death was observed in patients with station 8 (HR = 0.53) or 11 lymphadenectomy (HR = 0.53). CONCLUSION While D2 lymphadenectomy remains crucial, particularly in in high-volume, experienced GC centers, the necessity of a more extensive D2+ lymphadenectomy is not supported by our findings. Moreover, we aimed to highlight the importance of tailored surgical approaches and emphasize the significance of LN station dissection in influencing both short-term complications and long-term survival outcomes.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland.
| | - Marcin Kubiak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Radosław Mlak
- Department of Laboratory Diagnostics, Medical University of Lublin, Chodźki 1 St., 20-093, Lublin, Poland
| | - Sebastian Kobiałka
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Magdalena Leśniewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Katarzyna Mielniczek
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Katarzyna Chawrylak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Andrew Gumbs
- Department of General-, Visceral-, Vascular- and Transplantation Surgery, University of Magdeburg, Magdeburg, Germany; Department of Advanced & Minimally Invasive Surgery, American Hospital of Tbilisi, Tbilisi, Georgia
| | - S Vincent Grasso
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Wojciech P Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
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Yu J, Zheng H, Xue Z, Sun Y, Xu B, Shen L, Ma Y, Zhang L, Zheng H, Wang Y, Zheng C, Wu S, Huang C, Lin J, Zheng C. Effect of Adjuvant Chemotherapy Cycles on Patients with Node-Negative Gastric Cancer Following Neoadjuvant Chemotherapy: Multicenter Cohort Study. Ann Surg Oncol 2025; 32:2150-2160. [PMID: 39674863 DOI: 10.1245/s10434-024-16585-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: 07/10/2024] [Accepted: 11/12/2024] [Indexed: 12/16/2024]
Abstract
BACKGROUND Research investigating the potential impact of postoperative adjuvant chemotherapy cycles on patients with lymph node-negative gastric cancer following neoadjuvant chemotherapy is currently sparse. This study aims to explore the effect of adjuvant chemotherapy cycles on the prognosis of this specific patient group. PATIENTS AND METHODS We analyzed clinicopathological data from patients at four institutions between 2010 and 2020. Independent risk factors associated with 3-year overall survival (OS) were identified using a Cox proportional hazards regression model. RESULTS We enrolled a total of 219 patients in this study. Patients with lymph node-negative gastric cancer who received neoadjuvant chemotherapy and underwent at least five cycles of adjuvant chemotherapy (AC ≥ 5) after surgery had a significantly higher 3-year overall survival rate of 86.8% compared with those who received fewer than five cycles (AC < 5) with a survival rate of 68.1% (P = 0.016). Multivariate analysis identified several factors, including AC ≥ 5 (HR 0.367, 95% CI 0.166-0.815, P = 0.014), ypT stage ≥ 2 (HR 2.779, 95% CI 1.199-6.438, P = 0.017), and poorly differentiated tumors (HR 2.501, 95% CI 1.385-4.517, P = 0.002), as independently associated with 3-year OS in this patient group. Stratified analysis further revealed that AC ≥ 5 significantly enhanced long-term outcomes in patients with ypT stage ≥2 (3-year OS, 82.5% vs. 62.6%, P = 0.025) and in those with poorly differentiated tumors (3-year OS, 82.6% vs. 53.3%, P = 0.021). CONCLUSION Patients who have lymph node-negative gastric cancer following neoadjuvant chemotherapy, with either ypT stage ≥ 2 or poorly differentiated gastric cancers, may experience benefits from undergoing at least five cycles of adjuvant chemotherapy.
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Affiliation(s)
- Junhua Yu
- 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, Fuzhou, Fujian Province, China
- Department of Gastrointestinal Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Hualong 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, Fuzhou, Fujian Province, China
| | - Zhen Xue
- 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, Fuzhou, Fujian Province, China
| | - Yuqin Sun
- 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, Fuzhou, Fujian Province, China
- Department of Gastrointestinal Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian Province, China
| | - Binbin Xu
- 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, Fuzhou, Fujian Province, China
| | - Lili Shen
- 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, Fuzhou, Fujian Province, China
| | - Yubin Ma
- Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital, Xining, China
| | - Lingkang 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, Fuzhou, Fujian Province, China
| | - Honghong 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, Fuzhou, Fujian Province, China
| | - Yonghong Wang
- 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, Fuzhou, Fujian Province, China
- Department of Gastrointestinal Surgery, The People's Hospital of Leshan, Leshan, Sichuan Province, China
| | - Changyue 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, Fuzhou, Fujian Province, China
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Putian University, Putian,, Fujian Province, China
| | - Shichao Wu
- 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, Fuzhou, Fujian Province, China
- Gastrointestinal Surgery Unit 2, Teaching Hospital of Putian First Hospital of Fujian Medical University, Putian, Fujian Province, China
| | - Changming 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, Fuzhou, Fujian Province, China
| | - Jianxian 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, Fuzhou, Fujian Province, China
| | - Chaohui 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, Fuzhou, Fujian Province, China.
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10
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Qiao Y, Kang B, Zhang Y, Song J, Liu S, Wang Q, Guo Y, Li Y, Zhu J, Li J. Short- and long-term outcomes of robotic- versus laparoscopic-assisted early-onset gastric cancer: a propensity score-matched retrospective cohort study. BMC Cancer 2025; 25:361. [PMID: 40016662 PMCID: PMC11866809 DOI: 10.1186/s12885-025-13767-z] [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: 01/19/2025] [Accepted: 02/18/2025] [Indexed: 03/01/2025] Open
Abstract
BACKGROUND Early-onset gastric cancer (EOGC) is a distinct subtype of gastric cancer with increasing incidence, characterized by unique clinical and pathological features. This propensity score-matched retrospective cohort study aims to compare the perioperative safety and outcomes of EOGC patients who underwent laparoscopic versus robotic radical gastrectomy, providing a scientific basis for surgical treatment of EOGC. MATERIALS AND METHODS We included 252 patients diagnosed with EOGC at or before the age of 45, who underwent robotic or laparoscopic radical gastrectomy between January 2015 and April 2021. After propensity score matching, 47 patients in the robotic surgery group and 94 in the laparoscopic surgery group were compared. The study evaluated intraoperative and postoperative outcomes, pathological results, and long-term survival. RESULTS The robotic surgery group showed less intraoperative bleeding (50 ml vs. 100 ml, p = 0.042) and shorter postoperative hospital stays (6 days vs. 7 days, p = 0.008) compared to the laparoscopic group. The number of positive lymph nodes was higher in the robotic group (median 2 vs. 1, p = 0.016), but the number of lymph nodes harvested did not significantly differ. No significant differences were found in overall survival (3-year OS: 65.9% vs. 62.5%, p = 0.596) and disease-free survival (3-year DFS: 61.4% vs. 61.7%, p = 0.765) between the two groups. CONCLUSIONS Robotic resection for EOGC is non-inferior to laparoscopic surgery in terms of perioperative outcomes and long-term prognosis. This study suggests that robotic surgery may be a viable option for the treatment of EOGC.
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Affiliation(s)
- Yihuan Qiao
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Boyu Kang
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yichao Zhang
- Department of General Surgery, Peking University People's Hospital, Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Jiawei Song
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Shuai Liu
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Qi Wang
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yajie Guo
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Yunlong Li
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China.
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China.
| | - Jun Zhu
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China.
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China.
- Department of General Surgery, The Southern Theater Air Force Hospital, Guangzhou, China.
| | - Jipeng Li
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China.
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The First Affiliated Hospital of Air Force Medical University, Xi'an, China.
- Department of Experiment Surgery, The First Affiliated Hospital of Air Force Medical University, Xi'an, China.
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Lai M, Li Y, Lan N, Yuan W. Cost-effectiveness of open vs. laparoscopic gastrectomy for locally advanced gastric cancer in China. Sci Rep 2025; 15:6714. [PMID: 40000698 PMCID: PMC11861295 DOI: 10.1038/s41598-025-91003-1] [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: 11/26/2024] [Accepted: 02/17/2025] [Indexed: 02/27/2025] Open
Abstract
Locally advanced gastric cancer (LAGC) poses a significant surgical challenge. While laparoscopic gastrectomy (LG) offers potential advantages, its cost-effectiveness relative to open gastrectomy (OG) in China remains uncertain. To compare the cost-effectiveness of LG and OG for LAGC in China. A Markov model compared the cost-effectiveness of LG and OG for LAGC. Probabilities and utilities were derived from published literature. Direct medical costs were obtained from the First Hospital of Lanzhou University. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as the cost per quality-adjusted life-year (QALY) gained, using a willingness-to-pay threshold of ¥268,074/QALY. Sensitivity analyses assessed model robustness. Across 1-, 3-, and 5-year time horizons, OG had lower total costs and greater effectiveness than LG for LAGC. At 5 years, OG had a total cost of ¥128,259 and 7.20 QALYs versus LG's ¥136,668 and 7.18 QALYs; the ICER for OG was -¥474,758/QALY. OG dominated at the ¥268,074 willingness-to-pay threshold. Sensitivity analysis indicated that variations in LG and OG costs minimally influenced the cost-effectiveness. Probabilistic sensitivity analysis, performed across 10,000 iterations, consistently identified OG as the optimal strategy (100% of iterations). From a Chinese health economics perspective-a framework essential for informing national healthcare resource allocation-OG consistently demonstrated a superior cost-effectiveness compared with LG for LAGC across 1, 3, and 5 years. This longitudinal observation of sustained cost-effectiveness persisted despite the statistically insignificant differences in overall costs and effectiveness between the two procedures.
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Affiliation(s)
- Min Lai
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - YanTing Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Ning Lan
- Department of Radiation Oncology, First Affiliated Hospital of Xi 'an Jiaotong University, Xian, China
| | - Wenzhen Yuan
- Department of Surgical Oncology, The First Hospital of Lanzhou University, Lanzhou, China.
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12
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Wang SY, Wang JH, Chen RK, Yuan Z, Cui H, Wei B, Cui JX. Mapping the landscape of gastric signet ring cell carcinoma: Overcoming hurdles and charting new paths for advancement. World J Clin Oncol 2025; 16:98983. [PMID: 39995554 PMCID: PMC11686557 DOI: 10.5306/wjco.v16.i2.98983] [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: 07/10/2024] [Revised: 09/26/2024] [Accepted: 11/13/2024] [Indexed: 12/11/2024] Open
Abstract
BACKGROUND In recent years, the global prevalence of gastric cancer (GC) has witnessed a progressive decrease, accompanied by a step-growth in the incidence of gastric signet ring cell carcinoma (GSRCC). As precision medicine concepts progress, GSRCC, a distinct sub-type of GC, has drawn considerable attention from researchers. However, there still persist some controversies regarding the associated research findings. AIM To summarize the current obstacles and potential future directions for research on GSRCC. METHODS To begin with, all literature related to GSRCC published from January 1, 2004 to December 31, 2023 was subjected to bibliometric analysis in this article. Additionally, this paper analyzed the research data using CiteSpace, GraphPad Prism v8.0.2, and VOSviewer, which was obtained from the Web of Science Core Collection database. The analysis results were visually represented. RESULTS This study provided a comprehensive overview of the statistical characteristics of the 995 English articles related to GSRCC, including cited references, authors, journals, countries, institutions, and keywords. The popular keywords and clusters contain "prognosis", "survival", "expression", "histology", and "chemotherapy". CONCLUSION The prognosis, precise definition and classification, as well as chemoresistance of GSRCC, continue to be crucial areas of ongoing research, whose directions are closely tied to advancements in molecular biology research on GSRCC.
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Affiliation(s)
- Shu-Yuan Wang
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Jing-Hang Wang
- School of Medicine, Nankai University, Tianjin 300071, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Run-Kai Chen
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhen Yuan
- School of Medicine, Nankai University, Tianjin 300071, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Hao Cui
- School of Medicine, Nankai University, Tianjin 300071, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Bo Wei
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jian-Xin Cui
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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13
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Zhu S, Chen Y, Wang H, Teng L. Effect of thoracic size on postoperative outcomes in transabdominal gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction. World J Surg Oncol 2025; 23:54. [PMID: 39955562 PMCID: PMC11830219 DOI: 10.1186/s12957-025-03691-8] [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] [Received: 10/06/2024] [Accepted: 01/28/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND The surgery of adenocarcinoma of the esophagogastric junction (AEG) is a complex procedure that increases postoperative morbidity compared to distal gastric cancer. In this study, we included thoracic anatomical parameters of patients for the first time to investigate their impact on the postoperative outcomes of transabdominal gastrectomy for Siewert type II/III AEG. METHODS All patients with Siewert type II or III AEG of our institution who underwent transabdominal proximal or total gastrectomy from January 2015 to December 2022 were included in this study. We measured thoracic anatomical parameters on the level of the lower edge of the sternum using preoperative computer tomography. The anteroposterior diameter of the thorax was measured as the distance from the posterior edge of the sternum to the anterior edge of the spine, while the transverse diameter was the maximum distance between the ribs on both sides. Patients' data and postoperative details were retrospectively collected. Correlation between thoracic anatomical parameters with postoperative complications were analyzed. RESULTS Overall, 647 patients were eligible for this study. The incidence of postoperative complications was 28.1%, with postoperative pulmonary complications occurring in 24.7%. In multivariate analysis, anteroposterior thoracic diameter > 10.2 cm was an independent risk factor for postoperative complications (OR = 1.891, 95% CI: 1.137-3.146, p = 0.014), transverse thoracic diameter > 23.3 cm was an independent risk factor for postoperative pulmonary complications (OR = 2.243, 95% CI: 1.234-4.079, p = 0.004). In open group, transverse thoracic diameter over 23.3 cm correlated independently with postoperative complications (OR = 2.451, 95% CI: 1.219-4.927, p = 0.012) and postoperative pulmonary complications (OR = 2.988, 95% CI: 1.407-6.347, p = 0.004). However, this correction was not significant in laparoscopy-assisted group. CONCLUSIONS Thoracic size is an independent risk factor affecting the postoperative outcomes of transabdominal gastrectomy for Siewert type II and III AEG. Patients with larger thoracic cage are at a higher risk of postoperative complications, particularly pulmonary complications. For those patients, laparoscopic surgery may be a viable option.
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Affiliation(s)
- Songting Zhu
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Yanyan Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
| | - Haiyong Wang
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Lisong Teng
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
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Li Z, Li Z, Sun C, Zhang X, Fei H, Xing C, Zhao D. Association between adjuvant radiotherapy in adults with gastric cancer and risk of second primary malignancy: a retrospective cohort study using the Surveillance, Epidemiology and End Results database. BMJ Open 2025; 15:e086349. [PMID: 39938963 PMCID: PMC11822440 DOI: 10.1136/bmjopen-2024-086349] [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: 03/12/2024] [Accepted: 01/27/2025] [Indexed: 02/14/2025] Open
Abstract
OBJECTIVES This study aims to assess the association between adjuvant radiotherapy and the development of second primary malignancies (SPMs) and identify its determinants in patients who have undergone surgical treatment for gastric cancer. DESIGN Retrospective cohort study using the Surveillance, Epidemiology and End Results (SEER) database. SETTING Cohorts (18 registries, 2000-2018, from SEER) were screened for any malignancy that developed after sufficient latency from diagnosis of surgically treated non-metastatic gastric cancer. PARTICIPANTS 24 777 surgically treated gastric cancer cases were included in the cohort. Among them, 6128 patients underwent adjuvant radiotherapy. OUTCOME MEASURES The cumulative incidence of SPMs was estimated using Fine and Gray's competing risk model and the radiotherapy-correlated risks were calculated using Poisson regression analysis. RESULTS Among patients with sufficient latency, there was no significant association between radiotherapy and the risk of developing second primary solid malignancies (relative risk=1.05, 95% CI 0.83 to 1.33) or haematological malignancies (relative risk=1.17, 95% CI 0.62 to 2.11). Interestingly, radiotherapy was associated with a reduced cumulative incidence of second lung and bronchus cancer compared with no radiotherapy, with a 15-year incidence of 1.4%-3.17% (p<0.05). Radiotherapy was not associated with a significant increase in standardised incidence ratios of SPMs. CONCLUSIONS Adjuvant radiotherapy was not associated with an increased risk of developing SPMs in surgically treated patients with gastric cancer. Clinical trials are warranted to further verify the findings.
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Affiliation(s)
- Zheng Li
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/ National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zefeng Li
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/ National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chongyuan Sun
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/ National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojie Zhang
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/ National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - He Fei
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/ National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Xing
- Department of General Surgery, Beijing Hospital, Beijing, China
| | - Dongbing Zhao
- Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/ National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Bae JY, Ryu CB, Lee MS, Dimitriadis S. Endoscopic and Surgical Treatment in Early Gastric Cancer: The Gray Zone in Treatment Decision-Making from the Perspectives of Endoscopists. Cancers (Basel) 2025; 17:602. [PMID: 40002197 PMCID: PMC11853301 DOI: 10.3390/cancers17040602] [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: 01/17/2025] [Revised: 02/06/2025] [Accepted: 02/08/2025] [Indexed: 02/27/2025] Open
Abstract
To treat early gastric cancer, one must choose between endoscopic treatment and surgical treatment. Endoscopic treatment has been developing significantly since the late 1990s and has made great progress up to the present. However, many patients with early gastric cancer still undergo unnecessary surgery or endoscopic procedures. This is due to the existence of a "gray zone" of ambiguities between endoscopic and surgical treatment. These ambiguities arise because the important factors in determining the treatment for early gastric cancer can only be fully understood after endoscopic or surgical resection or because of discrepancies between the factors identifiable before treatment and those identifiable after treatment. This article aims to explore these ambiguous factors and discuss methods and efforts to reduce them.
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Affiliation(s)
- Jun Yong Bae
- Digestive Disease Center, Department of Internal Medicine, Seoul Medical Center, Seoul 02053, Republic of Korea;
| | - Chang Beom Ryu
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon 14584, Republic of Korea;
| | - Moon Sung Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon 14584, Republic of Korea;
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Hayano K, Kurata Y, Matsumoto Y, Otsuka R, Sekino N, Toyozumi T, Nakano A, Shiraishi T, Uesato M, Ohira G, Matsubara H. Improvement of Oral Intake after Treatment Using Enteral Feeding Tube for Large Advanced Gastric Cancer Invading Proximal Stomach: A Case Series of 20 Patients. Surg Case Rep 2025; 11:24-0143. [PMID: 39991496 PMCID: PMC11842876 DOI: 10.70352/scrj.cr.24-0143] [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: 12/16/2024] [Accepted: 01/08/2025] [Indexed: 02/25/2025] Open
Abstract
INTRODUCTION Patients with large Stage IV gastric cancer (GC) invading the proximal stomach find it difficult to receive not only bypass surgery but also S-1-based chemotherapy. This study aimed to show our treatment results for those GC patients using elementary diet (ED) tubes, which enabled S-1-based chemotherapy and nutrition support. CASE PRESENTATION We evaluated 20 patients (13 men and 7 women; median age 70 years) with large Stage IV GCs (8.7-21.9 cm) invading the proximal stomach, who were admitted due to inability to eat, treated with S-1-based chemotherapy using an ED tube. The duration from the initiation of the chemotherapy to the improvement of oral intake, changes in nutritional status, and disease-specific survival (DSS) were retrospectively investigated. Two of the 20 patients failed to complete even one cycle of chemotherapy due to severe nausea or diarrhea. The other 18 patients improved oral liquid intake after 47.5 ± 18.8 days, and 17 patients improved oral solid food intake after 54.5 ± 19.6 days from the start of chemotherapy. In addition, three patients (16.7%) could receive conversion surgery after improvement of oral intake. The median DSS of those 18 patients was 13.1 months. Serum albumin level and prognostic nutritional index (PNI) were significantly improved after about 1 month of the treatment (both P <0.0001). Improvement of serum albumin level and PNI during the first 1 month of the treatment significantly correlated with better DSS (P = 0.006, 0.01, respectively). CONCLUSIONS Given a high oral intake success rate, S-1-based chemotherapy using an ED tube can be a promising treatment option for large Stage IV GC with poor oral intake.
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Affiliation(s)
- Koichi Hayano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Yoshihiro Kurata
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Ryota Otsuka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Nobufumi Sekino
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Akira Nakano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Tadashi Shiraishi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
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17
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Tian Z, Cheng Y, Wang Y, Ren J, Wang S, Wang D. A 3-Arm case-matched analysis of anti-reflux reconstruction methods after laparoscopic proximal gastrectomy - Single tract jejunal interposition vs double tract reconstruction vs tube-like stomach reconstruction. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109482. [PMID: 39580964 DOI: 10.1016/j.ejso.2024.109482] [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: 07/25/2024] [Revised: 11/03/2024] [Accepted: 11/18/2024] [Indexed: 11/26/2024]
Abstract
BACKGROUND Owing to reportedly superior prognosis, proximal gastrectomy (PG) is expected to be an alternative to total gastrectomy for upper gastric cancer. However, limited data are available regarding the optimal anti-reflux reconstruction method after PG. This study aimed to evaluate the effect of laparoscopic PG with single-tract jejunal interposition (LPG-STJI), double-tract reconstruction (LPG-DTR), and tube-like stomach reconstruction (LPG-TLR) on surgical outcomes in patients with upper-third gastric cancer. METHODS Using propensity score-matching (PSM) to adjust for baseline characteristics, a well-balanced cohort was established by matching each patient who underwent LPG-STJI as the study group with one who underwent LPG-DTR or LPG-TLR as the control group at a 1:1 ratio. This study was registered at ClinicalTrials.gov (No. NCT06347757). RESULTS PSM yielded 62 matched pairs, with comparable demographic and tumor characteristics. The incidence of reflux esophagitis at one year postoperatively was significantly lower in the LPG-STJI and LPG-DTR groups than in the LPG-TLR group (11.3 % vs 9.7 % vs 24.2 %, P = 0.046), and fewer patients required proton-pump inhibitor administration (62.9 % vs 56.5 % vs 79.0 %, P = 0.024). In terms of nutritional status, the LPG-STJI group showed minimal changes in postoperative body weight and nutrition-related biochemical indices, approaching preoperative levels by the 12-month mark. In addition, the LPG-STJI group demonstrated a more favorable quality of life than the LPG-DTR and LPG-TLR groups, as assessed using the EORTC QLQ-C30 and QLQ-STO22 questionnaires. CONCLUSION LPG-STJI may be the preferred option for anti-reflux reconstruction, since it appears to reduce the occurrence of endoscopic reflux esophagitis and improve quality of life without raising surgical complications or compromising nutritional status. Further well-designed prospective studies are warranted to re-evaluate these findings.
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Affiliation(s)
- Zhen Tian
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Yifan Cheng
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Yong Wang
- Scientific Research Department, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jun Ren
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Sen Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Daorong Wang
- Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China; Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China; General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China.
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18
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Inoue T, Agatsuma N, Utsumi T, Tanaka Y, Nishikawa Y, Horimatsu T, Shimizu T, Nikaido M, Nakanishi Y, Hoshino N, Takahashi Y, Nakayama T, Seno H. Development and validation of a claims-based algorithm to identify incidents and determine the progression phases of gastric cancer cases in Japan. J Gastroenterol 2025; 60:141-151. [PMID: 39589534 PMCID: PMC11794417 DOI: 10.1007/s00535-024-02167-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 10/30/2024] [Indexed: 11/27/2024]
Abstract
BACKGROUND Although health insurance claims data can address questions that clinical trials cannot answer, the uncertainty of disease names and the absence of stage information hinder their use in gastric cancer (GC) research. This study aimed to develop and validate a claims-based algorithm to identify and determine the progression phases of incident GC cases in Japan. METHODS The gold standard for validation in this retrospective observational study was medical records of patients with incident GC who underwent specific treatments, defined by the claim codes associated with GC treatment. The algorithm was developed and refined using a cohort from two large tertiary care medical centers (April-September 2017 and April-September 2019) and subsequently validated using two independent cohorts: one from different periods (October 2017-March 2019 and October 2019-March 2021) and the other from a different institution (a community hospital). The algorithm identified incident cases based on a combination of the International Classification of Diseases, 10th Revision diagnosis codes for GC (C160-169), and claim codes for specific treatments, classifying them into endoscopic, surgical, and palliative groups. Positive predictive value (PPV), sensitivity of incident case identification, and diagnostic accuracy of progression phase determination were evaluated. RESULTS The developed algorithm achieved PPVs of 90.0% (1119/1244) and 95.9% (94/98), sensitivities of 98.0% (1119/1142) and 98.9% (94/95) for incident case identification, with diagnostic accuracies of 94.1% (1053/1119) and 93.6% (88/94) for progression phase determination in the two validation cohorts, respectively. CONCLUSIONS This validated claims-based algorithm could advance real-world GC research and assist in decision-making regarding GC treatment.
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Affiliation(s)
- Takahiro Inoue
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobukazu Agatsuma
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
- Department of Internal Medicine, Hino Memorial Hospital, Shiga, Japan
| | - Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Yukari Tanaka
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Horimatsu
- Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto, Japan
| | - Takahiro Shimizu
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Mitsuhiro Nikaido
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yuki Nakanishi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
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19
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Wu J, Huang ZN, Zhang XQ, Hou SS, Wang JB, Chen QY, Li P, Xie JW, Huang CM, Lin JX, Zheng CH. Development of a modified nutritional index model based on nutritional status and sarcopenia to predict long-term survival and chemotherapy benefits in elderly patients with advanced gastric cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109503. [PMID: 39642588 DOI: 10.1016/j.ejso.2024.109503] [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: 07/13/2024] [Revised: 11/04/2024] [Accepted: 11/24/2024] [Indexed: 12/09/2024]
Abstract
BACKGROUND Elderly patients with advanced gastric cancer have poor prognoses. This study aims to develop a prediction model for long-term survival after radical surgery and to identify patients who may benefit from chemotherapy. METHODS Data from 555 elderly patients with advanced gastric cancer admitted to two medical centers from 2009 to 2018 were retrospectively analyzed. Sarcopenia was combined with the Controlling Nutritional Status (CONUT) score to create a modified nutritional index (mCONUT). Cox regression analyses were used to develop a novel nomogram prediction model (mCNS) that combined mCONUT, pN, and tumor size, and its performance was further verified both internally and externally. RESULTS Multivariate Cox analysis revealed that tumor size, pN, and mCONUT were independent prognostic risk factors for overall survival (OS). The mCNS model showed good fit and high predictive value (AUC: training set 0.711; validation set 0.707), outperforming the pTNM model (p < 0.05). To further investigate the association between the model and adjuvant chemotherapy, we categorized the model into two risk groups: a high-risk group and a low-risk group. Further analysis revealed that, in the low-risk group, the OS and recurrence-free survival(RFS) for patients receiving adjuvant chemotherapy was significantly better than that of those who did not receive chemotherapy (p = 0.047,p = 0.019). In the high-risk group, this result was not observed (p = 0.120, p = 0.053). CONCLUSION The mCNS model has high predictive value in predicting long-term survival of elderly patients with advanced gastric cancer. Patients with mCNS-L were able to benefit from chemotherapy after laparoscopic radical gastrectomy.
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Affiliation(s)
- Ju Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, 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
| | - Xing-Qi Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Shuang-Shuang Hou
- Department of General Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, China; Department of Surgery, FuYang Normal University Second Affiliated Hospital, Fuyang, 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
| | - 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
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, 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
| | - 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.
| | - 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.
| | - 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.
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20
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Fonseca GM, Braghiroli MIFM, Pirola Kruger JA, Coelho FF, Herman P. Is There a Role for Locoregional Therapies for Non-colorectal Gastrointestinal Malignancies? Hematol Oncol Clin North Am 2025; 39:125-141. [PMID: 39510669 DOI: 10.1016/j.hoc.2024.08.004] [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] [Indexed: 11/15/2024]
Abstract
The liver is the most common site of metastases from solid gastrointestinal tract tumors. Over the past few decades, the role of locoregional therapies, resection and thermal ablation, for neuroendocrine and colorectal liver metastases has been widely studied. However, for liver metastases originating from other gastrointestinal organs, the role of locoregional treatment remains unclear. This review summarizes and discusses the available evidence regarding benefits, risks, and indications for locoregional therapies for non-colorectal and non-neuroendocrine gastrointestinal liver metastases, highlighting the importance of multidisciplinary approach and patient selection.
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Affiliation(s)
- Gilton Marques Fonseca
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Maria Ignez Freitas Melro Braghiroli
- Instituto do Cancer do Estado de Sao Paulo (ICESP), University of Sao Paulo, and Rede D'Or Sao Paulo, Av. Dr. Arnaldo, 251 - São Paulo, SP, Brazil. CEP: 01246-000, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil
| | - Paulo Herman
- Digestive Surgery Division, Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo Medical School, Avenida Doutor Enéas de Carvalho Aguiar, 255, Instituto Central, 9° andar, Sala 9074, Cerqueira Cesar, São Paulo, São Paulo CEP: 05403-900, Brazil.
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21
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Kanaya N, Kuroda S, Kakiutchi Y, Kashima H, Kikuchi S, Nishizaki M, Kagawa S, Fujiwara T. Short-Term and Long-Term Outcomes of Robotic Gastrectomy for Gastric Cancer: A Single-Center, Single-Arm Prospective Study. Cureus 2025; 17:e79063. [PMID: 40104481 PMCID: PMC11913632 DOI: 10.7759/cureus.79063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2025] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND Robotic gastrectomy (RG) has emerged as a promising approach for gastric cancer (GC) treatment, offering advantages such as enhanced dexterity, improved visualization, and increased precision. However, its widespread adoption remains limited due to technical complexity, high costs, limited applications, and insufficient evidence. METHODS We conducted a single-center, prospective study to evaluate the safety and feasibility of RG, including robotic total gastrectomy (RTG), robotic proximal gastrectomy (RPG), and robotic distal gastrectomy (RDG) with D1+ or D2 lymphadenectomy, in clinical stage I/II GC. The primary endpoint was the incidence of intraoperative and postoperative complications, while the secondary endpoints included surgical outcomes and long-term prognosis. RESULTS Seven patients were enrolled. No intraoperative complications or conversions to open surgery occurred. The primary endpoint was met, with no major postoperative complications. RTG had a longer operative time and more lymph nodes dissected than RDG and RPG. The median postoperative hospital stay was 10 days. Recurrence was observed in two cases, one of which achieved long-term survival without chemotherapy. CONCLUSION Our findings demonstrate the safety and feasibility of RG for early and advanced GC. Further multicenter studies with larger cohorts are needed to establish its oncological benefits and cost-effectiveness, facilitating broader clinical adoption.
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Affiliation(s)
- Nobuhiko Kanaya
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Shinji Kuroda
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Yoshihiko Kakiutchi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Hajime Kashima
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Satoru Kikuchi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Masahiko Nishizaki
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
- Department of Surgery, Tsuyama Chuo Hospital, Tsuyama, JPN
| | - Shunsuke Kagawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, JPN
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22
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Yu J, Zheng T, Yuan A, Wang W, Li Z, Cao S. The Role of Patient-Controlled Epidural Analgesia in the Short-Term Outcomes of Laparoscopic-Assisted Gastrectomy in Elderly Gastric Cancer Patients. J Surg Res 2025; 306:257-265. [PMID: 39809036 DOI: 10.1016/j.jss.2024.11.008] [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: 02/14/2024] [Revised: 09/24/2024] [Accepted: 11/15/2024] [Indexed: 01/16/2025]
Abstract
INTRODUCTION Patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) constitute two major advances in pain management after major abdominal surgery. However, the role of PCIA or PCEA has not been particularly studied in elderly patients with gastric cancer. The aim of this study is to make a comparison between PCIA and PCEA in terms of their performance on short-term outcomes in elderly patients undergoing laparoscopic-assisted gastrectomy. METHODS This single-center, retrospective study included 254 elderly patients (≥70 y) who underwent laparoscopic radical gastrectomy for gastric cancer. Patients received either general anesthesia combined with epidural anesthesia followed by PCEA (PCEA group, n = 123) or general anesthesia alone followed by PCIA (PCIA group, n = 131). The primary endpoint was pain intensity-tested using a 100-mm visual analog scale on postoperative days 1, 2, and 3. Demographics, comorbidities, perioperative data, postoperative short-term outcomes, and analgesia-related side effects were also assessed. RESULTS The visual analog scale scores at rest were lower in the PCEA group compared to the PCIA group on postoperative day 1, 2, and 3 (27.8 ± 13.9 versus 33.1 ± 15.0, P = 0.004; 25.2 ± 11.3 versus 30.1 ± 14.3, P = 0.002; 16.9 ± 7.1 versus 20.9 ± 9.5, P < 0.001, respectively). The postoperative hospital stay was shorter in the PCEA group than in the PCIA group (11 versus 12 d, P = 0.018). The times to postoperative first flatus, semifluid diet, independent ambulation, and tracheal extubation after surgery in the PCEA group were significantly shorter than in the PCIA group. Overall morbidity, mortality, hospital readmission rate, and reoperation rate were not significantly different between the two groups. Regarding side-effects related to analgesia, there were no significant differences in terms of the rates of postoperative nausea and vomiting, urinary retention, or oxygen saturation <90% between the two groups. However, PCEA was associated with a higher incidence of postoperative hypotension compared to PCIA (10.6% versus 3.8%, P = 0.036). CONCLUSIONS In elderly patients undergoing laparoscopic radical gastrectomy, epidural anesthesia and analgesia may convey superior pain relief, faster restoration of gastrointestinal motility, and shorter hospitalization.
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Affiliation(s)
- Junjian Yu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Taohua Zheng
- Liver Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Antai Yuan
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wei Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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Matsui R, Nunobe S, Ri M, Makuuchi R, Irino T, Hayami M, Ohashi M, Sano T. Preoperative low prealbumin independently predicts non-gastric cancer death after gastrectomy in elderly and young patients: a retrospective cohort study. Surg Today 2025:10.1007/s00595-025-02996-1. [PMID: 39870988 DOI: 10.1007/s00595-025-02996-1] [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: 10/12/2024] [Accepted: 12/18/2024] [Indexed: 01/29/2025]
Abstract
PURPOSE To investigate the effect of preoperative prealbumin levels on long-term survival outcomes after gastrectomy in patients with gastric cancer (GC) dichotomized based on age. METHODS This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary stage I-III GC between May 2006 and March 2017. Patients were allocated to groups based on age (≥ 70 or < 70 years) and subgroups based on prealbumin levels (high, ≥ 22 mg/dL; moderate, 15-22 mg/dL; or low, < 15 mg/dL), and multivariate Cox regression was used for survival analyses. RESULTS Of 4732 patients, 3172 (67.0%) were aged < 70 years and 1560 (33.0%) were ≥ 70 years of age. The median follow-up period was 66 months. A low prealbumin level was an independent prognostic factor for poor overall survival in older patients only [hazard ratio, 2.057; 95% confidence interval, 1.528-2.770; P < 0.001]. A low prealbumin level was an independent prognostic factor for poor other-cause survival in the older (hazard ratio: 2.719, 95% confidence interval: 1.887-3.918, P < 0.001) and younger (HR: 4.611, 95% CI 2.424-8.772, P < 0.001) groups. CONCLUSION Low preoperative prealbumin levels were associated with poor overall survival in older patients with GC after gastrectomy and with earlier non-GC death in older and younger patients.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
| | - Motonari Ri
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Tomoyuki Irino
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
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24
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Yu C, Jiang H, Wang L, Jiang Z, Jin C. Baseline (derived) neutrophil-lymphocyte ratio associated with survival in gastroesophageal junction or gastric cancer treated with ICIs. Front Oncol 2025; 15:1404695. [PMID: 39926278 PMCID: PMC11802431 DOI: 10.3389/fonc.2025.1404695] [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: 03/21/2024] [Accepted: 01/06/2025] [Indexed: 02/11/2025] Open
Abstract
Objective We carried out the meta-analysis to determine the predictive value of baseline neutrophil to lymphocyte ratio (NLR) and derived neutrophil to lymphocyte ratio (dNLR) levels in patients with gastroesophageal junction or gastric cancer (GJGC) who underwent immune checkpoint inhibitor (ICI) treatment. Methods Eligible articles were obtained through PubMed, the Cochrane Library, EMBASE, and Google Scholar, until April 15, 2023. The clinical outcomes evaluated in this study encompassed overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Results A total of 24 articles with 2221 patients were included in this meta-analysis. The pooled results demonstrated that patients with high NLR levels had significantly poorer OS (HR: 1.860, 95% CI: 1.564-2.213, p < 0.001) and PFS (HR: 1.678, 95% CI: 1.354-2.079, p < 0.001), and lower ORR (OR: 0.754, 95% CI: 0.621-0.915, p = 0.004) and DCR (OR: 0.391, 95% CI: 0.262-0.582, p < 0.001). Besides, we also found that high dNLR levels were significantly associated with shorter OS (HR: 2.117, 95% CI: 1.590-2.820, p < 0.001) and PFS (HR: 1.803, 95% CI: 1.415-2.297, p < 0.001). Conclusion Low baseline (Derived) NLR has the potential to predict the good efficacy of ICIs and survival outcomes in patients with GJGC. (Derived) NLR could be useful in determining the optimal treatment strategies for these patients.
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Affiliation(s)
| | | | | | | | - Chong Jin
- Department of General Surgery, Taizhou Central Hospital, Taizhou University, Taizhou, Zhejiang, China
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25
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Bobadilla CR, Dussan GF, Vargas J, Suarez L, Jimenez G, Gonzalez C, Córdoba AC, Martín W, Olivera D, Guevara R. Exploring the boundaries of anastomotic leak: experience in a high-volume center. World J Surg Oncol 2025; 23:15. [PMID: 39819666 PMCID: PMC11737246 DOI: 10.1186/s12957-024-03622-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: 08/04/2024] [Accepted: 12/15/2024] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND Gastric cancer remains a major global health challenge, ranking fourth in cancer-related deaths. Total gastrectomy with lymphadenectomy is the standard treatment, with advancements in surgery shifting towards minimally invasive techniques to reduce surgical trauma and metabolic response. Esophagojejunal anastomotic leak is a frequent complication of gastrectomy, significantly increasing morbidity and mortality rates by up to 64%. MATERIALS AND METHODS A retrospective cohort study reviewed adults undergoing total gastrectomy for gastric cancer who developed esophagojejunal anastomotic leaks. The study described patient characteristics, diagnostic methods, and management at Clinica Universitaria Colombia from 2013 to 2023. RESULTS Among 500 patients who had total gastrectomy, 54 developed esophagojejunal leaks. The cohort was 64.8% male, average age 55.2 years (± 14.87), and average BMI 24.5 kg/m². Notably, 18.5% smoked, 11.1% had lung disease, and 9.3% had heart disease or diabetes. Chest tomography was used in 60% of cases, followed by endoscopy in 35.2%. Endoscopic management with fully covered stents was the main strategy, used in 84% of cases. Average hospitalization was 18 days, with 33% needing intensive care, and overall hospital stay was 23.31 ± 16.33 days. Patients undergoing neoadjuvant and elective laparoscopic surgeries had a significant 30-day mortality risk. CONCLUSIONS Despite advances in surgical techniques and perioperative management, esophagojejunal anastomotic leaks continue to represent a serious complication, increasing morbidity and mortality. Therefore, early postoperative detection, based on the patient's clinical signs that allow confirmatory studies to be performed, is crucial. This facilitates the implementation of timely treatments, whether conservative, through the use of endoscopic or percutaneous strategies, or surgical procedures. The next step for the scientific community will be to conduct studies with long-term follow-ups to ensure consistency of the high-quality results reported so far.
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Affiliation(s)
- Carolina Riscanevo Bobadilla
- Department of General Surgery, Sanitas University Foundation, Clínica Universitaria Colombia, Calle 23 # 66-46, Bogotá, D.C., Colombia.
| | - Gloria Flórez Dussan
- General Surgeon, Department of General Surgery, Clínica Universitaria Colombia, Bogotá, D.C., Colombia
| | - Jorge Vargas
- General Surgeon, Department of General Surgery, Clínica Universitaria Colombia, Bogotá, D.C., Colombia
| | - Liliana Suarez
- General Surgeon, Department of General Surgery, Clínica Universitaria Colombia, Bogotá, D.C., Colombia
| | - German Jimenez
- General Surgeon, Department of General Surgery, Clínica Universitaria Colombia, Bogotá, D.C., Colombia
| | - Carlos Gonzalez
- Gastroenterologist, Clínica Universitaria Colombia, Bogotá, D.C, Colombia
| | | | - Wilmar Martín
- General Surgeon, Department of General Surgery, Clínica Universitaria Colombia, Bogotá, D.C., Colombia
| | - Diego Olivera
- Department of General Surgery, Sanitas University Foundation, Clínica Universitaria Colombia, Calle 23 # 66-46, Bogotá, D.C., Colombia
| | - Raúl Guevara
- General Surgeon, Department of General Surgery, Clínica Universitaria Colombia, Bogotá, D.C., Colombia
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Xia Y, Sheng N, Wang Z, Zhu Q. The comparison of post-proximal gastrectomy digestive tract reconstruction methods. BMC Surg 2025; 25:1. [PMID: 39754095 PMCID: PMC11697823 DOI: 10.1186/s12893-024-02748-x] [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: 08/08/2024] [Accepted: 12/27/2024] [Indexed: 01/07/2025] Open
Abstract
OBJECTIVE Proximal gastrectomy (PG) is commonly used to remove proximal gastric cancer leading to gastroesophageal reflux and requires digestive tract reconstruction. This study is to compare the performance of esophagogastrostomy (EG), jejunal interposition (JI), and double tract reconstruction (DTR) on post-PG reconstruction effectiveness. METHODS A retrospective study was conducted using the clinical data of 94 PG patients who underwent digestive tract reconstruction by EG (37 patients), JI (29 patients) or DTR (28 patients). The safety of the reconstruction procedure and the incidence of surgical complications were evaluated using the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Questionnaire (GERD-Q) scale score, gastroscopy, barium meal examination of digestive tract, and 24-h pH monitoring. RESULTS The DTR group showed significantly lower GERD-Q scores (p < 0.05) and RSI scores (p < 0.05) compared to the EG and JI groups. This indicates that DTR is more effective in preventing reflux esophagitis. The pre- and post-surgical GERD-Q scores assessed by esophageal 24-h pH acidity measurements and Los Angeles Grading were reduced in all patient groups, with the DTR group showing better results than the other two (p < 0.05). The results of the EORTC QLQ-STO22 questionnaire indicated that the DTR group had a higher overall health status score than the other two groups (p < 0.001). CONCLUSION EG had a short surgical duration and less bleeding. JI reduced the prevalence of reflux esophagitis. DTR presented improved prevention of reflux esophagitis and enhanced quality of life.
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Affiliation(s)
- Yang Xia
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Nengquan Sheng
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Zhigang Wang
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qingchao Zhu
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Zhao Z, Dai E, Jin B, Deng P, Salehebieke Z, Han B, Wu R, Yu Z, Ren J. A prognostic nomogram to predict the cancer-specific survival of patients with initially diagnosed metastatic gastric cancer: a validation study in a Chinese cohort. Clin Transl Oncol 2025; 27:135-150. [PMID: 38918302 PMCID: PMC11735592 DOI: 10.1007/s12094-024-03576-4] [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: 05/09/2024] [Accepted: 06/15/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Few studies have been designed to predict the survival of Chinese patients initially diagnosed with metastatic gastric cancer (mGC). Therefore, the objective of this study was to construct and validate a new nomogram model to predict cancer-specific survival (CSS) in Chinese patients. METHODS We collected 328 patients with mGC from Northern Jiangsu People's Hospital as the training cohort and 60 patients from Xinyuan County People's Hospital as the external validation cohort. Multivariate Cox regression was used to identify risk factors, and a nomogram was created to predict CSS. The predictive performance of the nomogram was evaluated using the consistency index (C-index), the calibration curve, and the decision curve analysis (DCA) in the training cohort and the validation cohort. RESULTS Multivariate Cox regression identified differentiation grade (P < 0.001), T-stage (P < 0.05), N-stage (P < 0.001), surgery (P < 0.05), and chemotherapy (P < 0.001) as independent predictors of CSS. Nomogram of chemotherapy regimens and cycles was also designed by us for the prediction of mGC. Thus, these factors are integrated into the nomogram model: the C-index value was 0.72 (95% CI 0.70-0.85) for the nomogram model and 0.82 (95% CI 0.79-0.89) and 0.73 (95% CI 0.70-0.86) for the internal and external validation cohorts, respectively. Calibration curves and DCA also demonstrated adequate fit and ideal net benefit in prediction and clinical applications. CONCLUSIONS We established a practical nomogram to predict CSS in Chinese patients initially diagnosed with mGC. Nomograms can be used to individualize survival predictions and guide clinicians in making therapeutic decisions.
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Affiliation(s)
- Ziming Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, People's Republic of China
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Erxun Dai
- Department of Oncology, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, People's Republic of China
| | - Bao Jin
- Department of General Surgery, Xinyuan County People's Hospital, Ili Kazak Autonomous Prefecture, People's Republic of China
| | - Ping Deng
- Department of General Surgery, Xinyuan County People's Hospital, Ili Kazak Autonomous Prefecture, People's Republic of China
| | - Zulihaer Salehebieke
- Department of General Surgery, Xinyuan County People's Hospital, Ili Kazak Autonomous Prefecture, People's Republic of China
| | - Bin Han
- Department of General Surgery, Xinyuan County People's Hospital, Ili Kazak Autonomous Prefecture, People's Republic of China
| | - Rongfan Wu
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, People's Republic of China
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Zhaowu Yu
- Department of General Surgery, Xinyuan County People's Hospital, Ili Kazak Autonomous Prefecture, People's Republic of China.
| | - Jun Ren
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, Yangzhou, People's Republic of China.
- Department of General Surgery, Xinyuan County People's Hospital, Ili Kazak Autonomous Prefecture, People's Republic of China.
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China.
- Department of General Surgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, People's Republic of China.
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Takabatake K, Sakuramoto S, Kobayashi R, Toriumi T, Ebara G, Li S, Miyawaki Y, Sato H, Yamashita K. Prognostic Impact of Preoperative Left Ventricular Systolic Dysfunction in Older Adult Patients With Gastric Cancer. In Vivo 2025; 39:419-425. [PMID: 39740914 PMCID: PMC11705123 DOI: 10.21873/invivo.13844] [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: 09/22/2024] [Revised: 10/14/2024] [Accepted: 10/30/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND/AIM The effect of left ventricular systolic dysfunction (LVSD), a risk factor for postoperative mortality, in older adult patients with gastric cancer has not been fully elucidated. This study aimed to evaluate the impact of low preoperative left ventricular ejection fraction (EF) on short- and long-term outcomes in older adult patients with gastric cancer. PATIENTS AND METHODS This retrospective study enrolled 237 older adult patients with gastric cancer (≥75 years old) who underwent preoperative echocardiography and curative gastrectomy. LVSD was defined as an EF <50%. Postoperative complications and prognosis were compared between patients with low- and normal-EF using the Fisher's exact or Chi-square test, log-rank test, Kaplan-Meier method, and Cox regression analysis. RESULTS Thirteen patients (5.4%) exhibited LVSD. The incidence of postoperative complications was not significantly different between the two groups (p=0.470), although the incidence of pneumonia was high (p=0.003) and overall survival was significantly worse in the low-EF group compared to the normal-EF group (p=0.016). Multivariate analysis revealed that decreased EF, low preoperative body mass index, and advanced pathological stage were significant prognostic factors in older adult patients with gastric cancer. CONCLUSION LVSD increases the risk of postoperative pneumonia and has a negative prognostic impact on older adult patients with gastric cancer.
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Affiliation(s)
- Kazuya Takabatake
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan;
| | - Shinichi Sakuramoto
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryota Kobayashi
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tetsuro Toriumi
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Gen Ebara
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Seigi Li
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yutaka Miyawaki
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroshi Sato
- Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Sagamihara, Japan
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29
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Ri M, Nishie N, Ohashi M, Fukuoka S, Yamaguchi K, Makuuchi R, Hayami M, Irino T, Sano T, Nunobe S. Advantages of adjuvant chemotherapy using S-1 following minimally invasive gastrectomy for gastric cancer versus open surgery: a propensity score-matched analysis. Gastric Cancer 2025; 28:122-130. [PMID: 39509007 DOI: 10.1007/s10120-024-01565-8] [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: 08/12/2024] [Accepted: 10/26/2024] [Indexed: 11/15/2024]
Abstract
BACKGROUND It is essential to ensure optimal adherence to adjuvant chemotherapy regimens following gastric cancer surgery. However, treatment intensity for S-1 as adjuvant chemotherapy has not as yet been compared between minimally invasive (MI) and open (Open) surgery. METHODS We retrospectively compared dose modification of adjuvant S-1 between MI and Open surgery in patients undergoing R0 gastrectomy for gastric or esophago-gastric junction cancer at the Cancer Institute Hospital Tokyo, Japan, during the period from 2012 to 2022, and receiving S-1 for pStage II or S-1 plus docetaxel for pStage III as adjuvant chemotherapy. Propensity score matching (PSM) was conducted to adjust for possible confounders. RESULTS In total, 323 patients were initially included. After PSM, 158 patients remained, 79 in each group. The adjuvant chemotherapy completion rates were similar in the two groups. However, the proportion of patients who required S-1 dose reduction was significantly lower in the MI than in the Open group (43.0% vs. 65.8%, p = 0.004). In addition, the MI group had significantly fewer patients requiring suspension of S-1 than the Open group (46.8% vs. 64.6%, p = 0.025). Moreover, the frequency of adverse events of grade ≥ 3 was significantly lower in the MI than in the Open group (17.7% vs. 31.7%, p = 0.042). CONCLUSIONS In adjuvant chemotherapy for gastric cancer, minimally invasive surgery may offer better treatment intensity for oral S-1 administration than open surgery.
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Affiliation(s)
- Motonari Ri
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Naoki Nishie
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Shota Fukuoka
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomoyuki Irino
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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30
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Carvalho TCD, Borges AKDM, Silva IFD. [Gastric cancer cases in Brazil and waiting times for diagnosis and treatment]. CIENCIA & SAUDE COLETIVA 2025; 30:e01222023. [PMID: 39879439 DOI: 10.1590/1413-81232025301.01222023] [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: 02/28/2023] [Accepted: 10/03/2023] [Indexed: 01/31/2025] Open
Abstract
The aim is to describe the sociodemographic and clinical-epidemiological profile of hospital cases of gastric cancer and to analyze factors associated with the Time-to-Treatment in Brazil. Exploratory study of sociodemographic and clinical-epidemiological characteristics of cases of gastric cancer. Time-to-Treatment were continuously estimated and then categorized into ≤ 60/> 60 days to estimate prevalence. Factors associated with delay in treatment were considered by simple and multiple logistic regression. Results: the time between diagnosis and initiation of treatment, both for cases that arrived without diagnosis and without treatment, and for those that arrived with diagnosis and without treatment, was shorter for cases whose 1st intervention was surgery and those with staging- III /IV. The main factors associated with delayed treatment were: age, region, marital status, education, city of residence, staging and first intervention received. There was a disparity in the time-to-treatment according to the 1st intervention received, staging and status of arrival at the institution. In addition, there was an association between sociodemographic and clinical factors and a delay in starting treatment.
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Affiliation(s)
- Thayana Calixto de Carvalho
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | - Anne Karin da Mota Borges
- Coordenadoria de Avaliação Econômica em Saúde, Agência Nacional de Saúde Suplementar. Rio de Janeiro RJ Brasil
| | - Ilce Ferreira da Silva
- Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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31
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Oya S, Sakuramoto S, Morimoto Y, Matsui K, Nishibeppu K, Ebara G, Fujita S, Fujihata S, Lee S, Miyawaki Y, Sugita H, Sato H, Yamashita K. Comparisons in Postoperative Endoscopic Findings and Postoperative Weight Change Between Delta-Shaped Anastomosis and Circular-Stapled Anastomosis in Laparoscopy-Assisted Distal Gastrectomy With B-I Reconstruction. Asian J Endosc Surg 2025; 18:e70023. [PMID: 39853701 PMCID: PMC11757014 DOI: 10.1111/ases.70023] [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: 07/08/2024] [Revised: 01/03/2025] [Accepted: 01/08/2025] [Indexed: 01/26/2025]
Abstract
BACKGROUND Laparoscopy-assisted distal gastrectomy (LADG) with Billroth I (B-I) reconstruction is frequently performed for gastric cancer. However, the difference between the circular stapler technique (CS) and delta-shaped anastomosis (DA) remains unclear, especially regarding the postoperative endoscopic physiological findings. METHODS Three hundred and one patients including 150 CS patients and 151 DA patients during LADG with B-I reconstruction between 2013 and 2019 at Saitama Medical University International Medical Center were chosen as study subjects. Postoperative endoscopic findings (1-year post-surgery) in the remnant stomach were evaluated according to the residue, gastritis, and bile-reflux classification, and the first-year postoperative weight changes were also recorded. RESULTS The incidences of Grade 2 or higher remnant gastritis, bile reflux, and postoperative exacerbated reflux esophagitis were significantly higher in the DA group, while the amount of residual food was higher in the CS group. Multivariate analysis also revealed the higher risks of Grade 2 or higher gastritis and the postoperative existence or exacerbation of erosive reflux esophagitis in the DA group (OR [95% CI] was 2.737 [1.566-4.783], 3.533 [1.101-11.34], and 3.749 [1.021-13.76], respectively). However, none of these endoscopic differences but the broader extent of gastritis was the only endoscopic factor associated with severe postoperative weight loss. CONCLUSION There was a trend toward more exacerbation of residual gastritis and reflux esophagitis with the DA technique and more food remnants with the CS technique. Although the difference in the anastomotic technique did not directly result in weight loss, attention should be paid to prevent extensive residual gastritis.
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Affiliation(s)
- Shuichiro Oya
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
- Department of Gastrointestinal SurgeryThe University of TokyoTokyoJapan
| | - Shinichi Sakuramoto
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Yosuke Morimoto
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Kazuaki Matsui
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Keiji Nishibeppu
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Gen Ebara
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Shohei Fujita
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Shiro Fujihata
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Seigi Lee
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Yutaka Miyawaki
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Hirofumi Sugita
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Hiroshi Sato
- Department of Gastroenterological SurgerySaitama Medical University International Medical CenterSaitamaJapan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical FrontiersKitasato University School of MedicineSagamiharaJapan
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Lim JK, Kim SB, Shin HD. Metachronous Schnitzler's Metastasis of Gastric Adenocarcinoma 13 Years After Curative Resection: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2024; 84:282-287. [PMID: 39716950 DOI: 10.4166/kjg.2024.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 11/01/2024] [Accepted: 11/11/2024] [Indexed: 12/25/2024]
Abstract
A 54-year-old man presented with constipation with a six-month duration and a 5 kg weight loss over 10 months. He had undergone a subtotal gastrectomy and chemotherapy for advanced gastric cancer 13 years earlier. A colonoscopy revealed a firm, circular, in-growing mass in the rectum. A computed tomography (CT) scan showed a 3.0×1.2 cm invasive mass near the prostate, abutting the rectal wall and invading the right ureterovesical junction, causing hydroureteronephrosis. A positron emission tomography-CT scan indicated low fluorodeoxyglucose uptake in the rectal or prostate area. The biopsy results showed poorly differentiated carcinoma. An immunohistochemistry study confirmed CK7 positive, CK20 negative, MUC2 negative, and CDX2 focally positive immune phenotype for cancer cells, suggesting a diagnosis of metastatic adenocarcinoma with a gastric origin rather than a prostate and rectal origin.
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Affiliation(s)
- Jun Kyeong Lim
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Suk Bae Kim
- Division of Gastroenterology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Deok Shin
- Division of Gastroenterology, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
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Matsui R, Ohashi M, Ri M, Makuuchi R, Irino T, Hayami M, Sano T, Nunobe S. Oncological impact of the preoperative combined assessment of skeletal muscle mass for patients undergoing curative gastrectomy for gastric cancer. Surg Today 2024:10.1007/s00595-024-02978-9. [PMID: 39671110 DOI: 10.1007/s00595-024-02978-9] [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: 09/30/2024] [Accepted: 10/27/2024] [Indexed: 12/14/2024]
Abstract
PURPOSE We performed a combined assessment of skeletal muscle mass using the skeletal muscle mass index (SMI) and the psoas muscle index (PMI) to evaluate their association with the overall survival (OS) of gastric cancer patients after curative gastrectomy. METHODS We analyzed, retrospectively, the computed tomography records of skeletal muscle mass of patients who underwent radical gastrectomy for pStage I-III gastric cancer between April, 2010 and April, 2016. We then compared OS as the primary outcome, stratifying patients according to their SMI or PMI, and investigated prognostic factors using multivariate analyses. RESULTS The median follow-up duration was 62 months. Of the 550 patients analyzed, 262 (47.6%), 194 (35.3%), and 94 (17.1%) were classified into normal, single-low, and double-low SMI and PMI groups, respectively. Patients with double-low SMI and PMI had the poorest OS (P = 0.018). Multivariate analysis revealed that double-low indices were an independent prognostic factor for poor OS (hazard ratio, 1.808; 95% confidence interval 1.009-3.238; P = 0.046). CONCLUSIONS This study revealed that evaluation of skeletal muscle mass based on the combined SMI and PMI can predict the survival outcomes of patients after curative gastrectomy for gastric cancer, and that the coexistence of a low-SMI and low-PMI was associated with the poorest survival.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan.
| | - Motonari Ri
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Tomoyuki Irino
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ku, Tokyo, 135-8550, Japan
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34
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Anand U, Anwar S, Parasar K, Singh BN, Kant K. The Outcome and Survival of Locally Advanced Gastric Cancer with Gastric Outlet Obstruction After Upfront Radical Surgery. Indian J Surg Oncol 2024. [DOI: 10.1007/s13193-024-02163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 12/04/2024] [Indexed: 01/04/2025] Open
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Evdokimova SF, Kornietskaya AL, Bolotina LV, Kolobayev IV, Fedenko AA, Kaprin AD. Conversion surgery for stage IV gastric cancer after third-line immunotherapy: a case report. Front Oncol 2024; 14:1494669. [PMID: 39711962 PMCID: PMC11659121 DOI: 10.3389/fonc.2024.1494669] [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: 09/11/2024] [Accepted: 11/11/2024] [Indexed: 12/24/2024] Open
Abstract
The 5-year overall survival rate for stage IV gastric cancer is lower than 10%, despite the development of systemic therapy. Conversion surgery has shown to improve survival outcomes in patients with durable clinical response on chemotherapy. We report a clinical case of a patient, who underwent conversion surgery after pembrolizumab in the third-line setting for stage IV gastric cancer. The patient did not have recurrence for 22 months after conversion surgery.
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Affiliation(s)
- Sevindzh F. Evdokimova
- P. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Anna L. Kornietskaya
- P. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Larisa V. Bolotina
- P. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Iliya V. Kolobayev
- P. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alexander A. Fedenko
- P. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Andrey D. Kaprin
- P. Hertsen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, Moscow, Russia
- Peoples’ Friendship University of Russia, Moscow, Russia
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Peña-Galo EM, Palacios-Navarro G, Pastora-Membreño J, Torres-Herman T, Norwood DA, Montalvan-Sanchez EE, Beasley T, Bravo LE, Morgan DR. High Gastric Cancer Mortality and Years of Life Lost in Nicaragua: A Population-Based Study 1997 to 2012. Cancer Epidemiol Biomarkers Prev 2024; 33:1564-1570. [PMID: 38884563 DOI: 10.1158/1055-9965.epi-23-1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/30/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Gastric adenocarcinoma is the fourth leading cause of cancer-related mortality and leading infection-associated cancer. Gastric adenocarcinoma has striking geographic variability, with high incidence in East Asia and mountainous Latin America. Reliable cancer data and population-based cancer registries are lacking for the majority of low- and middle-income countries, including the Central American Four region (CA-4, Nicaragua, El Salvador, Honduras, and Guatemala). METHODS Mortality data for Nicaragua were obtained from the highly rated Ministry of Health death registry. All the patients were diagnosed with gastric cancer between 1997 and 2012 (ICD-10 codes, C16.0-C16.9) and death due to any cause were included in the study. Data on variables such as sex, age (stratified by 5-year age groups), municipality, urban/rural, altitude, and year of death were analyzed. RESULTS A total of 3,886 stomach cancer deaths were reported in Nicaragua between 1997 and 2012, of which 2,214 (56.9%) were male. The age-standardized mortality rates were 13.1 and 8.7 per 100,000 habitants for males and females, respectively, and without significant change during the study period (annual percentage change = -0.7, P = 0.2). An average of 17.9 years were lost per death, accounting for 67,964 years of life lost (YLL). CONCLUSIONS The burden of gastric cancer mortality is high in Nicaragua with a significantly elevated age-standardized mortality rate, YYL, and average YLL. IMPACT The projected increase in mortality portends the double cancer burden in northern Central America, with persistent infection-associated cancers and growing transition cancers (e.g., breast and colon cancers), which has implications for cancer control in Mesoamerica and US Latino populations. See related commentary by Riquelme and Abnet, p. 1550.
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Affiliation(s)
- Edgar M Peña-Galo
- Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
- Universidad Nacional Autónoma de Nicaragua, Leon (UNAN-Leon), León, Nicaragua
| | | | | | - Tatiana Torres-Herman
- UAB Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Dalton A Norwood
- Division of Preventive Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Timothy Beasley
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Luis E Bravo
- Registro Poblacional de Cáncer de Cali, Departamento de Patología, Facultad de Salud, Universidad del Valle, Cali, Colombia
| | - Douglas R Morgan
- UAB Division of Gastroenterology and Hepatology, The University of Alabama at Birmingham, Birmingham, Alabama
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Nakashima C, Iida M, Nishiyama M, Watanabe Y, Shindo Y, Tokumitsu Y, Tomochika S, Nakagami Y, Takahashi H, Nagano H. Impact of infectious complications after gastrectomy on non‑gastric cancer‑related deaths. Oncol Lett 2024; 28:562. [PMID: 39385950 PMCID: PMC11462511 DOI: 10.3892/ol.2024.14695] [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: 09/06/2024] [Indexed: 10/12/2024] Open
Abstract
Infectious complications (ICs) have been reported as major causes of postoperative mortality in patients with cancer. However, to the best of our knowledge, the impact of ICs after gastrectomy on non-gastric cancer-related deaths (NGCDs) remains unexplored. The present study aimed to identify the impact of ICs after gastrectomy on NGCDs. A retrospective analysis of 712 patients with gastric cancer who underwent curative gastrectomy was conducted. The participants were categorized into IC and non-IC groups based on the incidence of postoperative IC. Clinicopathological factors and non-gastric cancer-related survival (NGCS) rates were compared between groups. Further NGCD and associated risk factor analyses were performed in a background factor-adjusted cohort using multivariate analysis. Among the 712 patients, 112 developed ICs (Clavien-Dindo classification grade ≥II). In the entire cohort, the IC group had a significantly worse 5-year cumulative incidence of NGCD (17.8 vs. 10.6%; Gray's P=0.021) compared with the non-IC group. Although a number of clinicopathological factors differed between the groups, including patient background, operative factors and tumor factors, the risk factors for NGCD identified in the multivariate analysis were older age, low prognostic nutritional index, low skeletal muscle index and Charlson comorbidity index ≥1, excluding IC incidents. The IC group exhibited more background factors contributing to NGCDs, suggesting a potential increase in NGCD regardless of IC incidence.
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Affiliation(s)
- Chiyo Nakashima
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Michihisa Iida
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Mitsuo Nishiyama
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yusaku Watanabe
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shinobu Tomochika
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yuki Nakagami
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
- Department of Data Science, Faculty of Data Science, Shimonoseki City University, Shimonoseki, Yamaguchi 751-8510, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
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Junttila A, Helminen O, Helmiö M, Huhta H, Jalkanen A, Kallio R, Koivukangas V, Kokkola A, Laine S, Lietzen E, Louhimo J, Meriläinen S, Pohjanen VM, Rantanen T, Ristimäki A, Räsänen JV, Saarnio J, Sihvo E, Toikkanen V, Tyrväinen T, Valtola A, Kauppila JH. Impact of splenectomy on long-term outcomes after gastrectomy for gastric cancer: a population-based study. J Gastrointest Surg 2024; 28:2090-2096. [PMID: 39393772 DOI: 10.1016/j.gassur.2024.10.009] [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: 05/14/2024] [Revised: 09/03/2024] [Accepted: 10/05/2024] [Indexed: 10/13/2024]
Abstract
BACKGROUND No national studies comparing long-term survival after total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation exist. This study aimed to examine the 5-year overall survival (OS) of patients with gastric adenocarcinoma who underwent total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation in a population-based nationwide setting. METHODS This study included all patients undergoing total or partial gastrectomy with splenectomy or spleen preservation for gastric adenocarcinoma in Finland from 2005 to 2016, with follow-up until December 31, 2019. A total of 2196 patients with gastric cancer diagnosis and total or partial gastrectomy were identified in the registries. Of these patients, 2118 were applicable for this study. Cox proportional hazard models provided hazard ratios (HRs) with 95% CIs of 5-year OS. The results were adjusted for age, sex, year of operation, comorbidities, tumor location, pathologic stage, and neoadjuvant therapy. RESULTS The observed 5-year OS rates were 38.7% in patients with no or minor spleen injury, 39.7% in patients with splenectomy due to injury, and 30.8% in patients with splenectomy due to oncologic reasons (P = .032). Patients who underwent R0 gastrectomy with splenectomy due to oncologic reasons had higher 5-year mortality (the adjusted model HR, 1.26; 95% CI, 1.01-1.56) than patients who underwent spleen preservation. CONCLUSION The OS was worst in patients who underwent gastrectomy with splenectomy due to oncologic reasons, highlighting the poor prognosis in patients with advanced gastric cancer. Splenectomy due to injury does not compromise the prognosis.
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Affiliation(s)
- Anna Junttila
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
| | - Olli Helminen
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Mika Helmiö
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Heikki Huhta
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Aapo Jalkanen
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Raija Kallio
- Department of Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Vesa Koivukangas
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Arto Kokkola
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Simo Laine
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Elina Lietzen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Johanna Louhimo
- Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland
| | - Sanna Meriläinen
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Vesa-Matti Pohjanen
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Ari Ristimäki
- Department of Pathology, Helsinki and Uusimaa Hospital District Laboratory, Helsinki and Uusimaa Diagnostic Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Applied Tumor Genomics Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari V Räsänen
- Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juha Saarnio
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Eero Sihvo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Vesa Toikkanen
- Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Tuula Tyrväinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Antti Valtola
- Department of Surgery, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Joonas H Kauppila
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Nagata H, Kinoshita T, Komatsu M, Habu T, Yoshida M, Yura M. Comparison of robotic versus laparoscopic total gastrectomy for gastric cancer: A single-center retrospective cohort study in a Japanese high-volume center. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108706. [PMID: 39357414 DOI: 10.1016/j.ejso.2024.108706] [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: 04/09/2024] [Revised: 08/21/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Robotic-assisted surgery has become increasingly popular worldwide in recent years. This study aimed to compare the surgical outcomes of robotic total gastrectomy (RTG) and laparoscopic total gastrectomy (LTG) to figure out the advantages of RTG. METHODS The eligible cases in this study were patients who underwent RTG or LTG for gastric adenocarcinoma at our hospital from January 2014 to December 2022. Propensity score matching (PSM) was employed to balance the underlying selection bias. Then, surgical outcomes of patients were analyzed to be compared. RESULTS Overall, 255 patients (LTG: 178, RTG: 77) were included in this study. After PSM, 73 patients in each arm were assigned for analysis. Operation time was longer in the RTG than in the LTG (373 vs 336 min, p < 0.01). However, the RTG was associated with shorter postoperative hospital stays (8 vs 9 days, p = 0.04) and lower incidence of grade 3 or higher postoperative complications (1 % vs 11 %, p = 0.03). More lymph nodes were harvested in the RTG (59 vs 47, p < 0.01). CONCLUSIONS Although RTG requires longer operation time, it has the potential to provide advantages to the patient such as quicker recovery, reduction in postoperative complication, or more yield number of lymph nodes. Regarding survival outcomes, further analysis with enough follow-up is needed.
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Affiliation(s)
- Hiromi Nagata
- Division of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan; Course of Advanced Clinical Research on Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo, 113-8421, Japan
| | - Takahiro Kinoshita
- Division of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan.
| | - Masaru Komatsu
- Division of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Takumi Habu
- Division of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Mitsumasa Yoshida
- Division of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
| | - Masahiro Yura
- Division of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, 277-8577, Japan
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40
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Zheng H, Zheng H, Wei L, Xue Z, Xu B, Hu M, Yu J, Xie R, Zhang L, Zheng Z, Xie J, Zheng C, Huang C, Lin J, Li P. Risk stratification models incorporating oxidative stress factors to predict survival and recurrence in patients with gastric cancer after radical gastrectomy: A real-world multicenter study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108658. [PMID: 39244978 DOI: 10.1016/j.ejso.2024.108658] [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: 05/13/2024] [Revised: 08/13/2024] [Accepted: 09/02/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Oxidative stress significantly influences the development and progression of gastric cancer (GC). It remains unreported whether incorporating oxidative stress factors into nomograms can improve the predictive accuracy for survival and recurrence risk in GC patients. METHODS 3498 GC patients who underwent radical gastrectomy between 2009 and 2017 were enrolled and randomly divided into training cohort (TC) and internal validation cohort (IVC). Cox regression analysis model was used to evaluate six preoperative oxidative stress indicators to formulate the Systemic oxidative stress Score (SOSS). Two nomograms based on SOSS was constructed by multivariate Cox regression and validated using 322 patients from another two hospitals. RESULTS A total of 3820 patients were included. The SOSS, composed of three preoperative indicators-fibrinogen, albumin, and cholesterol-was an independent prognostic factor for both overall survival (OS) and disease-free survival (DFS). The two nomograms based on SOSS showed a significantly higher AUC than the pTNM stage (OS: 0.830 vs. 0.778, DFS: 0.824 vs. 0.775, all P < 0.001) and were validated in the IVC and EVC (all P < 0.001). The local recurrence rate, peritoneal recurrence rate, distant recurrence rate and multiple recurrence rate in high-risk group were significantly higher than those in low-risk group (P < 0.05). CONCLUSIONS The two novel nomograms based on SOSS which was a combination score of three preoperative blood indicators, demonstrated outstanding predictive abilities for both survival and recurrence in GC patients with different risk groups, which may potentially improve survival through perioperatively active intervention strategies and individualized postoperatively close surveillance.
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Affiliation(s)
- Honghong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Hualong Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Linghua Wei
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Zhen Xue
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Binbin Xu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Minggao Hu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Department of General Surgery, The PLA Navy Anqing Hospital, Anqing, 246000, China
| | - Junhua Yu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Department of General Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, 324000, China
| | - Rongzhen Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Department of General Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, 321000, China
| | - Lingkang Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Zhiwei Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Jianwei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - Chaohui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China
| | - ChangMing Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China.
| | - Jianxian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China.
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350000, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350000, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, 350000, China; Fujian Province Minimally Invasive Medical Center, Fuzhou, 350000, China.
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Matsui R, Nunobe S, Ri M, Makuuchi R, Irino T, Hayami M, Ohashi M, Sano T. Prealbumin Prognostic Score: A Novel Prognostic Indicator After Radical Gastrectomy in Patients with Gastric Cancer. Cancers (Basel) 2024; 16:3889. [PMID: 39594844 PMCID: PMC11593146 DOI: 10.3390/cancers16223889] [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: 09/18/2024] [Revised: 11/11/2024] [Accepted: 11/19/2024] [Indexed: 11/28/2024] Open
Abstract
Background: This study aimed to determine whether the prealbumin prognostic score (PPS), a novel indicator using prealbumin instead of albumin in the modified Glasgow Prognostic Score (mGPS), is a better predictive marker postoperatively in patients with gastric cancer. Methods: This retrospective study included consecutive patients who underwent radical gastrectomy for primary pStages I-III gastric cancer between 2006 and 2017. The cutoff values for preoperative prealbumin and C-reactive protein (CRP) were 22 mg/dL and 0.5 mg/dL, respectively. According to the prealbumin and CRP levels, a PPS of zero was defined as both being above the cutoff value, of one as either being below the cutoff value, and of two as both being below the cutoff value. Results: Of the 4663 patients, 3421 (73.4%) had a score of zero, 984 (21.1%) had a score of one, and 258 (5.5%) had a score of two. The higher the PPS, the poorer the overall survival [OS] (p < 0.001). When comparing OS by the PPS in patients with an mGPS of zero, a PPS of one indicated poorer OS than a PPS of zero (p < 0.001). In the multivariate analysis, PPSs of one (hazard ratio [HR]: 1.603; 95% confidence interval [CI]: 1.378-1.866; p < 0.001) and two (HR: 1.322; 95% CI: 1.055-1.656; p = 0.015) were independent poor prognostic factors for OS. Conclusions: The PPS, which is based on a combination of prealbumin and CRP levels, can identify a wider range of patients with poor OS than mGPS in patients with gastric cancer after gastrectomy.
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Affiliation(s)
| | - Souya Nunobe
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (R.M.); (M.R.); (R.M.); (T.I.); (M.H.); (M.O.); (T.S.)
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Yang ZY, Yang F. Nutritional status of patients with gastrointestinal cancers and analysis of factors for postoperative infections. BMC Cancer 2024; 24:1389. [PMID: 39533237 PMCID: PMC11555947 DOI: 10.1186/s12885-024-13093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Patients with gastrointestinal cancer have a higher risk of malnutrition and postoperative infection. OBJECTIVE To investigate the nutritional status of patients with gastrointestinal cancers and factors for postoperative infections. METHOD Based on the nutritional risk status, 294 patients with gastrointestinal tumours were divided into a nutritional risk group and a non-nutritional risk group, and the differences between the two groups were compared. RESULTS Among the included patients, 128 were at preoperative nutritional risk (43.54%); there were significant differences between the two groups in terms of age (66.25 ± 11.73 vs. 58.36 ± 10.41 years, P < 0.001), percentage of gastric cancers (39.84% vs. 28.92%, P = 0.049), percentage of stage IV tumours (60.16% vs. 45.18%, P = 0.011), total protein (64.90 ± 6.82 vs. 67.21 ± 7.41 g/L, P = 0.007), albumin (38.32 ± 4.74 vs. 41.61 ± 5.10 g/L, P < 0.001) and haemoglobin (112.72 ± 22.63 vs. 125.11 ± 22.79 g/L, P < 0.001). Multivariate logistic regression analysis showed that risk factors for postoperative infections in patients included age ≥ 60 years (odds ratio [OR] = 2.266 95%CI = 1.357-4.134), Nutrition Risk Screening (NRS)-2002 score ≥ 3 (OR = 2.183, 95%CI = 1.218-4.102), alcohol history (OR = 2.505, 95%CI = 1.370-4.683), comorbid diabetes mellitus (OR = 2.110, 95%CI = 1.381-4.023) and surgical time ≥ 6 h (OR = 2.446, 95%CI = 1.359-4.758). CONCLUSION Patients with gastrointestinal cancers are at high incidence of preoperative nutritional risk, and those with an NRS-2002 score of > 3, history of alcohol consumption and surgical time of > 6 h have a higher risk of postoperative infections.
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Affiliation(s)
- Zhi-Yong Yang
- Department of Oncology and Intervention, General hospital of TISCO, The Sixth Hospital of Shanxi Medical University, No.7 Yingxin Street, Jiancaoping District, Taiyuan City, 030003, Shanxi Province, China.
| | - Fan Yang
- Department of Oncology and Intervention, General hospital of TISCO, The Sixth Hospital of Shanxi Medical University, No.7 Yingxin Street, Jiancaoping District, Taiyuan City, 030003, Shanxi Province, China
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Sugimoto S, Nomura T, Temma T, Sawa E, Omae K, Tsuda N, Okuda A, Okuda H, Kawabata M, Matsushima R, Nakamura H, Hisada H, Hayashi S, Murabayashi T, Oyamada J, Kamei A, Nakagawa H. Closure of gastric mucosal defects using the reopenable-clip over-the-line method to decrease the risk of bleeding after endoscopic submucosal dissection: a multicenter propensity score-matched case-control study (with video). Gastrointest Endosc 2024:S0016-5107(24)03696-4. [PMID: 39542223 DOI: 10.1016/j.gie.2024.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 10/31/2024] [Accepted: 11/05/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer. However, post-ESD bleeding presents significant risks. Closing mucosal defects after ESD may reduce the incidence of post-ESD bleeding. Currently, no optimal closure method exists. Therefore, we invented clip-line closure using the reopenable-clip over-the-line method (ROLM) and evaluated its efficacy in preventing post-ESD bleeding. METHODS We retrospectively reviewed data from patients who underwent gastric ESD between January 2012 and March 2024. Patients were categorized into 2 groups: the nonclosure group (mucosal defect remained unclosed) and the ROLM group (defect was closed using ROLM). Baseline characteristics of patients, distribution of bleeding risk factors, and incidence and timing of post-ESD bleeding were compared between the groups. Propensity score matching was used to minimize potential bias. RESULTS After propensity score matching, 162 ESDs were performed for 168 lesions in the nonclosure group, whereas 160 ESDs were performed for 168 lesions in the ROLM group. The mean long diameter of the mucosal defects, procedure time for ROLM, and number of clips required for ROLM were 45.9 mm, 35.6 minutes, and 33.2, respectively. All mucosal defects resulting from the ESD were fully closed using ROLM. The post-ESD bleeding rate in the ROLM group was significantly lower (1.8%; 3 of 168 lesions) than in the nonclosure group (7.7%; 13 of 168 lesions; P = .02). CONCLUSIONS ROLM is feasible for mucosal defect closure after gastric ESD and effectively prevents post-ESD bleeding in high-risk patients, addressing a significant gap in existing methods.
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Affiliation(s)
- Shinya Sugimoto
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Tatsuma Nomura
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan; Department of Gastroenterology, Suzuka General Hospital, Suzuka, Japan; Department of Gastroenterology, Mie Prefectural Shima Hospital, Shima, Japan.
| | - Taishi Temma
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Emika Sawa
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Keita Omae
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Nobuyuki Tsuda
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Ayako Okuda
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Hirofumi Okuda
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Mayu Kawabata
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | | | - Haruka Nakamura
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Hirohisa Hisada
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Satoshi Hayashi
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Jun Oyamada
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Akira Kamei
- Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology and Hepatology, Mie University Hospital, Tsu, Japan
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Manuel AG, Kinoshita T, Amini N, Akimoto E, Yura M, Yoshida M, Habu T, Nagata H, Komatsu M, Sano J, Terajima D. Oncological long-term outcomes of laparoscopic versus open gastrectomy for cT3-4 gastric cancer at surgical staging: a propensity-score matched cohort study. Surg Endosc 2024; 38:6682-6690. [PMID: 39317910 DOI: 10.1007/s00464-024-11287-8] [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] [Received: 08/03/2024] [Accepted: 09/13/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND The oncological efficacy of laparoscopic surgery for advanced gastric cancer (AGC) has been evaluated by several randomized trials. However, the inclusion of earlier-stage disease was a limitation in previous studies. METHODS Patients with cT3-4 gastric cancer, determined by surgical staging to minimize migration of earlier stages, treated at a tertiary cancer center from 2009 to 2018 were included. Based on the surgical approach, the patients were divided into two groups: the laparoscopic gastrectomy (LG) and the open gastrectomy (OG) and matched for age, sex, macroscopic appearance (type 4 or non-type 4), body mass index, estimated tumor size, clinical stage T3'T4, clinical N stage, pathologic T stage (T3 or T4), and type of surgery (total or distal gastrectomy). RESULTS 588 patients (221 LG, 367 OG) were included in the analysis. After 1:1 propensity-score matching, 386 patients (193 LG, 193 OG) were assigned for analysis. In the LG group, operation time was longer with lower blood loss. The incidence of postoperative complications (≥ grade III) did not differ significantly between the groups (OG: 8.3%, vs. LG: 9.3%). Overall survival (OS) was longer in the LG group (5-year OS: 79.3 vs. 73% HR 0.66, 95% CI 0.44-0.99, P = 0.0497). Relapse-free survival (RFS) did not show a statistical difference (5-year RFS: 69.5 vs. 68.7 HR 0.88, 95% CI 0.62-1.26, P = 0.487). Subgroup analysis for OS also demonstrated equivalent outcomes. CONCLUSION LG demonstrates comparable safety and efficacy to OG for advanced gastric cancer at surgical staging, with similar rates of severe complications and long-term oncological outcomes. Further research is needed to validate these findings, particularly for total gastrectomy and for patients from Western populations.
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Affiliation(s)
- Arrieta G Manuel
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
- Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Neda Amini
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Surgical Oncology, Northwell Health, North Shore/Long Island Jewish, New Hyde Park, NY, USA
| | - Eigo Akimoto
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masahiro Yura
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Mitsumasa Yoshida
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takumi Habu
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hiromi Nagata
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masaru Komatsu
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Junichi Sano
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Daiki Terajima
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Kim SH, Chae Y, Kang BT, Lee S. Use of 18-Fluorodeoxyglucose Positron Emission Tomography and Near-Infrared Fluorescence-Guided Imaging Surgery in the Treatment of a Gastric Tumor in a Dog. Animals (Basel) 2024; 14:2917. [PMID: 39457847 PMCID: PMC11503833 DOI: 10.3390/ani14202917] [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: 08/27/2024] [Revised: 10/04/2024] [Accepted: 10/09/2024] [Indexed: 10/28/2024] Open
Abstract
A 13-year-old Maltese dog with an abdominal mass underwent 18F-FDG PET/computed tomography (CT) for tumor localization and metastatic evaluation. PET/CT scans revealed a gastric mass near the esophagogastric junction and demonstrated mean and maximum standardized uptake values (SUVs) of 4.596 and 6.234, respectively, for the abdominal mass. Subsequent surgery incorporated ICG for NIR fluorescence-guided imaging, aiding in precise tumor localization and margin assessment. The excised mass was identified as a low-grade leiomyosarcoma on histopathology. The dog underwent PET/CT imaging six months postoperatively following the excision of the mass, which confirmed the absence of recurrence or residual lesions during follow-up. NIR fluorescence imaging using ICG demonstrated efficacy in real-time tumor visualization and margin assessment, a technique not previously reported in veterinary literature. The PET/CT findings complemented the diagnosis and provided valuable insights into metastasis. The absence of recurrence or complications in postoperative follow-up underscores the potential of these imaging modalities in enhancing surgical precision and improving prognosis in canine gastric tumors.
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Affiliation(s)
- Su-Hyeon Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea;
- Department of Veterinary Surgery, Heamaru Referral Hospital, Seongnam 13590, Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea; (Y.C.); (B.-T.K.)
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea; (Y.C.); (B.-T.K.)
| | - Sungin Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea;
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Chen F, Xian J, Huo J. Prognostic significance of a pathological response in metastatic lymph nodes of patients with gastric cancer who underwent neoadjuvant chemotherapy followed by surgery. Surg Today 2024; 54:1255-1264. [PMID: 38587668 DOI: 10.1007/s00595-024-02829-7] [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: 11/24/2023] [Accepted: 03/13/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To grade the pathological response of lymph nodes (LNs) to neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC) and investigate its prognostic significance. METHODS This retrospective study included 196 patients who underwent NAC, followed by radical gastrectomy for LAGC between January 2010 and October 2019. Pathological responses were evaluated based on the proportion of residual tumor cells within the tumor area in the primary tumor (PT) and LNs and included the following categories: 1a (0%), 1b (< 10%), 2 (10-50%), and 3 (> 50%). RESULTS Among 166 patients with clinically node-positive disease, 38/27/39/62 were classified as having LN regression grade (LRG) 1a/1b/2/3, respectively. Compared to LN non-responders (LRG 2 or 3), LN responders (LRG 1a or 1b) had significantly higher 5-year overall survival (72.5% vs. 19.0%, P < 0.001) and recurrence-free survival rates (67.8% vs. 22.2%, P < 0.001), irrespective of PT response. Furthermore, a multivariate analysis revealed that the LN response was an independent risk factor for the overall survival (hazard ratio [HR] 0.417, 95% confidence interval [CI] 0.181-0.962, P = 0.040) and recurrence-free survival (HR 0.490, 95% CI 0.242-0.991, P = 0.047), but not the PT response (P > 0.05). CONCLUSIONS The pathological LN response may be a reliable prognostic prediction tool in patients with LAGC who received NAC.
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Affiliation(s)
- Fengju Chen
- Department of Radiotherapy and Chemotherapy, The Second Affiliated Hospital of Xingtai Medical College, No. 618 Gangtie North Road, Xingtai, 054000, Hebei Province, China
| | - Jia Xian
- Department of Radiotherapy and Chemotherapy, The Second Affiliated Hospital of Xingtai Medical College, No. 618 Gangtie North Road, Xingtai, 054000, Hebei Province, China
| | - Junjie Huo
- Department of Radiotherapy and Chemotherapy, The Second Affiliated Hospital of Xingtai Medical College, No. 618 Gangtie North Road, Xingtai, 054000, Hebei Province, China.
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Omori T, Yamamoto K, Kurokawa Y, Miyazaki Y, Fujitani K, Kawabata R, Imamura H, Takeno A, Yanagimoto Y, Takahashi T, Saito T, Eguchi H, Doki Y. Long-Term Effects of Oral Nutritional Supplements After Gastrectomy for Gastric Cancer: A Survival Analysis from a Multicenter, Open-Label, Randomized Controlled Trial. Ann Surg Oncol 2024; 31:6909-6917. [PMID: 38985228 DOI: 10.1245/s10434-024-15667-1] [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: 04/25/2024] [Accepted: 06/10/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Weight loss (WL) after gastrectomy for gastric cancer is associated with both decreased compliance with adjuvant chemotherapy and impaired survival. This study examined the effects of administering oral nutritional supplements (ONS) for 3 months after gastrectomy in terms of compliance with adjuvant chemotherapy and survival outcomes. METHODS This large-scale, multicenter, open-label, randomized controlled trial enrolled 1,003 gastric cancer patients undergoing curative gastrectomy. Patients were assigned to the control group (n = 503) or ONS group (n = 500). In the ONS group, 400 kcal/day of ONS was recommended in addition to a regular diet for 3 months after gastrectomy. Compliance with adjuvant chemotherapy and survival outcomes were compared between the two groups. RESULTS Compared with the control group, the ONS group showed significantly decreased WL at 3 months after gastrectomy (8.6 ± 6.1 vs. 7.2 ± 5.7%, respectively, P = 0.0004). The control and ONS groups did not differ regarding the induction rate of adjuvant chemotherapy (84.9 vs. 82.8%, respectively, P = 0.614) or the continuation rate at 3 months postoperatively (75.3 vs. 76.6%, respectively, P = 0.809). Oral nutritional supplements for 3 months showed no survival benefit; the 3- and 5-year overall survival (OS) rates were 91.3% and 87.6% in the control group and 89.6% and 86.4% in the ONS group, respectively, indicating no significant difference (P = 0.548). Subgroup analysis could not detect a population in which ONS administration increased OS. CONCLUSIONS Administration of ONS for 3 months after gastrectomy was not associated with increased compliance with adjuvant chemotherapy or with improved prognosis.
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Affiliation(s)
- Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | - Ryohei Kawabata
- Department of Gastroenterological Surgery, Sakai City Medical Center, Sakai, Japan
| | - Hiroshi Imamura
- Department of Surgery Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Atsushi Takeno
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Ebihara Y, Kurashima Y, Shichinohe T, Hirano S. Robotic spleen‑preserving suprapancreatic and splenic hilar lymph node dissection using the preemptive retropancreatic approach in total gastrectomy for gastric cancer. Updates Surg 2024; 76:2483-2487. [PMID: 38758469 DOI: 10.1007/s13304-024-01880-w] [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: 05/17/2022] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
Advanced gastric cancer that has not invaded the greater curvature is a good indication for total gastrectomy (TG) with spleen-preserving suprapancreatic and splenic hilar lymph node dissection (LND). However, the suprapancreatic and splenic hilar LND increases the area of dissection of the pancreas, and prolonged pressure drainage of the pancreas is required to maintain a clear operative view. This can lead to an increased risk of postoperative pancreatic complications. To report the efficacy of our novel preemptive retropancreatic approach (PRA) for the suprapancreatic and splenic hilar LND in robotic TG (RTG). We report our experience with nine patients with gastric cancer who underwent spleen-preserving splenic hilar LND using PRA during RTG at Hokkaido University from October 2018 to November 2021. The PRA involves initial dissection of the left side of the retropancreatic space, followed by the release of the adherence between the retroperitoneum surface and the pancreas (fusion fascia), which provides a good operative field and prevents contact with the pancreas during the suprapancreatic and splenic hilar LND in RTG. The median operating time was 488 min (254-564 min). The median intraoperative bleeding was 55 mL (0-115 mL). One patient had postoperative complications (above grade II of the Clavien-Dindo classification), but there were no postoperative pancreatic complications. The spleen-preserving suprapancreatic and splenic hilar LND using PRA could help to reduce the postoperative pancreatic complications associated with RTG.Trial registration number and date of registration The Hokkaido University Hospital institutional review board approved the data collection and analysis. The trial registration number and date of registration are No. 021-0022 and July 26, retrospectively registered.
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Affiliation(s)
- Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan.
- Division of Minimally Invasive Surgery, Hokkaido University Hospital, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan.
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, North 15 West 7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan
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Teng F, Zhu Q, Zhou XL, Shi YB, Sun H. Preoperative predictive model for the probability of lymph node metastasis in gastric cancer: a retrospective study. Front Oncol 2024; 14:1473423. [PMID: 39399177 PMCID: PMC11466724 DOI: 10.3389/fonc.2024.1473423] [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: 07/31/2024] [Accepted: 09/11/2024] [Indexed: 10/15/2024] Open
Abstract
Background Effectively diagnosing lymph node (LN) metastasis (LNM) is crucial in determining the condition of patients with gastric cancer (GC). The present study was devised to develop and validate a preoperative predictive model (PPM) capable of assessing the LNM status of individuals with GC. Methods A retrospective analysis of consecutive GC patients from two centers was conducted over the period from January 2021 to December 2023. These patients were utilized to construct a 289-patient training cohort for identifying LNM-related risk factors and developing a PPM, as well as a 90-patient testing cohort used for PPM validation. Results Of the GC patients included in the training cohort, 67 (23.2%) and 222 (76.8%) were respectively LNM negative and positive. Risk factors independently related to LNM status included cT3 invasion (P = 0.001), CT-reported LN (+) (P = 0.044), and CA199 value (P = 0.030). LNM risk scores were established with the following formula: score = -2.382 + 0.694×CT-reported LN status (+: 1; -: 0)+2.497×invasion depth (cT1: 0; cT2: 1; cT3: 2)+0.032×CA199 value. The area under the curve (AUC) values for PPM and CT-reported LN status were 0.753 and 0.609, respectively, with a significant difference between them (P < 0.001). When clinical data from the testing cohort was included in the PPM, the AUC values for the PPM and CT-reported LN status were 0.756 and 0.568 (P < 0.001). Conclusions The established PPM may be an effective technique for predicting the LNM status of patients preoperatively. This model can better diagnose LNM than CT-reported LN status alone, this model is better able to diagnose LNM.
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Affiliation(s)
- Fei Teng
- Department of Interventional Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Qian Zhu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Xi-Lang Zhou
- Department of Gastroenterology, Xuzhou Central Hospital, Xuzhou, China
| | - Yi-Bing Shi
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Han Sun
- Department of Gastroenterology, Xuzhou Central Hospital, Xuzhou, China
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Kim TS, An JY, Choi MG, Lee JH, Sohn TS, Bae JM, Min YW, Lee H, Lee JH, Rhee PL, Kim JJ, Kim KM, Min BH. Clinicopathological Characteristics and Lymph Node Metastasis Rates in Early Gastric Lymphoepithelioma-Like Carcinoma: Implications for Endoscopic Resection. Gut Liver 2024; 18:807-813. [PMID: 39054912 PMCID: PMC11391134 DOI: 10.5009/gnl240006] [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: 01/04/2024] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 07/27/2024] Open
Abstract
Background/Aims Lymphoepithelioma-like carcinoma (LELC) is a rare subtype of gastric cancer. We aimed to identify the clinicopathological features and rate of lymph node metastasis (LNM) to investigate the feasibility of endoscopic submucosal dissection for early gastric LELC confined to the mucosa or submucosa. Methods We compared the clinicopathological characteristics of 116 early gastric LELC patients and 5,753 early gastric well- or moderately differentiated (WD or MD) tubular adenocarcinoma patients treated by gastrectomy. Results Compared to WD or MD early gastric cancer (EGC) patients, early LELC patients were younger and had a higher prevalence of proximally located tumors. Despite more frequent deep submucosal invasion (86.2% vs 29.8%), lymphatic invasion was less frequent (6.0% vs 16.2%) in early LELC patients than in WD or MD EGC patients. Among tumors with deep submucosal invasion, the tumor size was smaller, lymphatic invasion was less frequent (6.0% vs 40.2%) and the rate of LNM was lower (10.0% vs 19.4%) in patients with LELC than in those with WD or MD EGC. The overall rate of LNM in early LELC patients was 8.6% (10/116). The risk of LNM in patients with mucosal, shallow submucosal invasive, or deep submucosal invasive LELC was 0% (0/6), 0% (0/10), and 10% (10/100), respectively. Conclusions Early LELC is a distinct subtype of EGC with more frequent deep submucosal invasion but less lymphatic invasion and LNM than WD or MD EGCs. Endoscopic submucosal dissection may be considered curative for patients with early LELC confined to the mucosa or shallow submucosa, given its negligible rate of LNM.
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Affiliation(s)
- Tae-Se Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung-Mee Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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