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Lin Z, Yan M, Lin Z, Xu Y, Zheng H, Peng Y, Li Y, Yang C. Short-term outcomes of distal gastrectomy versus total gastrectomy for gastric cancer under enhanced recovery after surgery: a propensity score-matched analysis. Sci Rep 2024; 14:17594. [PMID: 39080478 PMCID: PMC11289314 DOI: 10.1038/s41598-024-68787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/29/2024] [Indexed: 08/02/2024] Open
Abstract
Enhanced recovery after surgery (ERAS) has been used safely and effectively in patients with gastric cancer. Our aim was to evaluate the short-term outcomes of total gastrectomy (TG) versus distal gastrectomy (DG) for gastric cancer under ERAS. A prospectively collected database of 1349 patients with gastric cancer who underwent TG or DG between January 2016 and September 2022 was retrospectively analyzed. Propensity score matching analysis was used at a ratio of 1:1 to reduce confounding effects, and perioperative clinical outcomes were compared between the two groups. The primary outcome was overall postoperative complications (POCs). Secondary outcomes comprised time to bowel function recovery, postoperative hospital stay, mortality, and 30-day readmission rate. Of 1349 identified patients, 296 (21.9%) experienced overall POCs. Before matching, multivariable analysis revealed that age, body mass index, diabetes, operation time, and extent of gastrectomy were independent risk factors for overall POCs. After matching, each group comprised 495 patients, and no significant differences were observed between the groups for all parameters except tumor location. Compared with TG, DG was associated with significantly earlier days to first flatus and to eating a soft diet, and shorter postoperative hospital stay (P < 0.05). The incidence of overall- and severe POCs (Clavien-Dindo grade ≥ IIIa) in the TG group was significantly higher vs. the DG group (P < 0.05). There was no significant difference in the number of days to eating a liquid diet, or mortality and 30-day readmission rates between the groups (P > 0.05). In the subgroup analysis for middle-third gastric cancer, the TG group experienced higher rates of overall- and severe POCs, with a longer postoperative hospital stay. Compared with DG, patients who underwent TG had higher POC rates, slower recovery of bowel function, and longer duration of hospitalization under ERAS. Therefore, caution is needed when initiating early feeding for patients who undergo TG.
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Affiliation(s)
- Zhenmeng Lin
- Department of Anesthesiology Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Mingfang Yan
- Department of Anesthesiology Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Zhaoyan Lin
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - Yiping Xu
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Huizhe Zheng
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yunzhen Peng
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yangming Li
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China.
| | - Chunkang Yang
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China.
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Aoyama T, Maezawa Y, Hashimoto I, Yamamoto S, Esashi R, Hara K, Tamagawa A, Cho H, Tanabe M, Morita J, Kazama K, Numata M, Kawahara S, Oshima T, Saito A, Yukawa N. The Systemic Immune-inflammation Index Is an Independent Prognostic Factor for Gastric Cancer Patients Who Receive Curative Treatment. In Vivo 2024; 38:2001-2008. [PMID: 38936948 PMCID: PMC11215563 DOI: 10.21873/invivo.13657] [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: 04/18/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND/AIM Systemic immune-inflammation index (SII) was developed and evaluated for various malignancies. This study evaluated the clinical impact of the SII in patients with gastric cancer (GC) who received curative treatment. PATIENTS AND METHODS Patients who underwent curative resection for GC at Yokohama City University between 2005 and 2020 were chosen consecutively based on their medical records. SII was calculated as follows: platelet (cell/mm3 ×103)× neutrophil (cell/mm3)/lymphocyte (cell/mm3). Three measurements were obtained preoperatively. RESULTS In total, 258 patients were enrolled in this study. Based on the 3- and 5-year survival rates and previous studies, we set the cutoff value of the SII to 550. The 258 patients were classified into the SII-low (n=152) and SII-high (n=106) groups, respectively. The 3- and 5-year overall survival (OS) rates were 82.6% and 78.7%, respectively, in the SII-low group and 74.5% and 61.9%, respectively, in the SII-high group. There were significant differences between the two groups (p<0.001). In the multivariate analysis of factors associated with OS, the SII was identified as an independent prognostic factor (hazard ratio=1.816; 95% confidence interval=1.075-3.069, p=0.026). Similar results were observed for recurrence-free survival. In addition, the incidence of postoperative surgical complications was 30.9% in the SII-low group and 45.2% in the SII-high group (p=0.019). CONCLUSION The SII was an independent prognostic factor for GC. Thus, the SII may be a promising biomarker for the treatment and management of GC.
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Affiliation(s)
- Toru Aoyama
- Department of Surgery, Yokohama City University, Yokohama, Japan;
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yukio Maezawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Itaru Hashimoto
- Department of Surgery, Yokohama City University, Yokohama, Japan;
| | - Sosuke Yamamoto
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Ryuki Esashi
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kentaro Hara
- Department of Surgery, Yokohama City University, Yokohama, Japan
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Ayako Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Haruhiko Cho
- Department of Surgery, Yokohama City University, Yokohama, Japan
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Mie Tanabe
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Junya Morita
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Keisuke Kazama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | | | - Takashi Oshima
- Department of Surgery, Yokohama City University, Yokohama, Japan
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Aya Saito
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Bai Z, Solomon M, Shahab R, Koh C, Steffens D. The good, the bad, and the frail - the role of prehabilitation in frail patients undergoing cancer surgery. ANZ J Surg 2024; 94:993-995. [PMID: 38716489 DOI: 10.1111/ans.19027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 06/19/2024]
Affiliation(s)
- Zirong Bai
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rihan Shahab
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- RPA Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Wang L, Wang H, Fang S, Yao M. Effectiveness of homogenized nursing care intervention in postoperative bladder irrigation of urological system in primary hospitals-Taking the incidence of postoperative complications as an example: A retrospective study. Medicine (Baltimore) 2024; 103:e38270. [PMID: 39259112 PMCID: PMC11142826 DOI: 10.1097/md.0000000000038270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 09/12/2024] Open
Abstract
To explore the effect of homogenized nursing interventions for bladder irrigation after urological surgery in primary hospitals, and to further analyze the incidence of postoperative complications according to the different nursing methods. The experiment selected 110 patients with urological disorders who underwent bladder irrigation, and the subjects were admitted to the hospital from January 2020 to October 2023. The subjects were chronologically divided into a control group and an experimental group, with the admission time of the control group being between between January 2020 and October 2022. The experimental group was admitted between October 2022 and October 2023. Conventional nursing care and homogenized nursing care were used respectively, and the intervention effect of homogenized nursing care was assessed by comparing the patients' psychological state indexes, vital characteristic indexes, and the incidence of various postoperative complications under the 2 interventions. None of the indicators were statistically significant before the nursing intervention. In the comparison of nursing satisfaction and clinical comfort, the experimental group's nursing satisfaction was 94.5% and clinical comfort was 90.9%, which was significantly higher than that of the control group. In the comparison of the incidence of postoperative complications, the incidence of urinary retention in the experimental group was 1.82%, which was significantly lower than that of the control group. In addition, the total incidence of complications in the experimental group was 1.82%, which proved that the homogenized nursing intervention was effective in reducing the complications after urinary bladder irrigation. In multifactorial logistic regression analysis, after homogenized nursing intervention. The relative risks of the 4 complications were 1.836, 1.445, 1.993, and 2.138, respectively, which were significantly lower than those of conventional nursing intervention. In the ROC analysis, the AUC values of the 4 complications were 0.832, 0.731, 0.746, and 0.723, respectively. proving the superiority of homogenized care in preventing postoperative complications. Homogenized nursing intervention can effectively reduce the incidence of postoperative complications in patients with urological postoperative bladder irrigation, improve patients' symptoms and prognosis, and improve the quality of care and patients' quality of life.
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Affiliation(s)
- Lingying Wang
- Department of Ultrasound, Huangshan Shoukang Hospital, Huangshan, Anhui, China
| | - Hong Wang
- Department of Ultrasound, Huangshan Shoukang Hospital, Huangshan, Anhui, China
| | - Shayu Fang
- Department of Ultrasound, Huangshan Shoukang Hospital, Huangshan, Anhui, China
| | - Minye Yao
- Department of Ultrasound, Huangshan Shoukang Hospital, Huangshan, Anhui, China
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Min X, Ma Y, Leng Y, Li X, Zhang J, Xu S, Wang X, Lv R, Guo J, Xing H. Effects of perioperative low-dose naloxone on the immune system in patients undergoing laparoscopic-assisted total gastrectomy: a randomized controlled trial. BMC Anesthesiol 2024; 24:172. [PMID: 38720250 PMCID: PMC11077871 DOI: 10.1186/s12871-024-02524-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Low immune function after laparoscopic total gastrectomy puts patients at risk of infection-related complications. Low-dose naloxone (LDN) can improve the prognosis of patients suffering from chronic inflammatory diseases or autoimmune diseases. The use of LDN during perioperative procedures may reduce perioperative complications. The purpose of this study was to examine the effects of LDN on endogenous immune function in gastric cancer patients and its specific mechanisms through a randomized controlled trial. METHODS Fifty-five patients who underwent laparoscopic-assisted total gastrectomy were randomly assigned to either a naloxone group (n = 23) or a nonnaloxone group (n = 22). Patients in the naloxone group received 0.05 µg/kg-1.h- 1naloxone from 3 days before surgery to 5 days after surgery via a patient-controlled intravenous injection (PCIA) pump, and patients in the nonnaloxone group did not receive special treatment. The primary outcomes were the rates of postoperative complications and immune function assessed by NK cell, CD3+ T cell, CD4+ T cell, CD8+ T cell, WBC count, neutrophil percentage, and IL-6 and calcitonin levels. The secondary outcomes were the expression levels of TLR4 (Toll-like receptor), IL-6 and TNF-α in gastric cancer tissue. RESULTS Compared with the nonnaloxone group, the naloxone group exhibited a lower incidence of infection (in the incision, abdomen, and lungs) (P < 0.05). The numbers of NK cells and CD8+ T cells in the naloxone group were significantly greater than those in the nonnaloxone group at 24 h after surgery (P < 0.05) and at 96 h after surgery (P < 0.05). Compared with those in the nonnaloxone group, the CD3 + T-cell (P < 0.05) and CD4 + T-cell (P < 0.01) counts were significantly lower in the naloxone group 24 h after surgery. At 24 h and 96 h after surgery, the WBC count (P < 0.05) and neutrophil percentage (P < 0.05) were significantly greater in the nonnaloxone group. The levels of IL-6 (P < 0.05) and calcitonin in the nonnaloxone group were significantly greater at 24 h after surgery. At 24 h following surgery, the nonnaloxone group had significantly greater levels of IL-6 (P < 0.05) and calcitonin than did the naloxone group. Compared with those in the naloxone group, the expression levels of TLR4 (P < 0.05) in gastric cancer tissue in the naloxone group were greater; however, the expression levels of IL-6 (P < 0.01) and TNF-α (P < 0.01) in the naloxone group were greater than those in the nonnaloxone group. CONCLUSION Laparoscopic total gastrectomy patients can benefit from 0.05 ug/kg- 1. h- 1 naloxone by reducing their risk of infection. It is possible that LDN alters the number of cells in lymphocyte subpopulations, such as NK cells, CD3 + T cells, and CD4 + T cells, and the CD4+/CD8 + T-cell ratio or alters TLR4 receptor expression in immune cells, thereby altering immune cell activity. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry on 24/11/2023 (ChiCTR2300077948).
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Affiliation(s)
- Xiangzhen Min
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Yan Ma
- Department of Anesthesiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinanm, Shandong Province, China
| | - Yufang Leng
- Department of Anesthesiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
| | - Xiaoxi Li
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Jianmin Zhang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Shoucai Xu
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Xiuqin Wang
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Renjun Lv
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, Gansu, China
| | - Jie Guo
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Huaixin Xing
- Department of Anesthesiology, Shandong Cancer Hospital and Institute Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, Shandong, China.
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Ren LF, Xu YH, Long JG. Prognostic Value of Postoperative Complication for Gastric Cancer. J Laparoendosc Adv Surg Tech A 2024; 34:339-353. [PMID: 38573161 DOI: 10.1089/lap.2023.0456] [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: 04/05/2024] Open
Abstract
Background: The incidence of complications in gastric cancer (GC) patients after surgery was increasing, and it was not clear whether postoperative complications would have an impact on prognosis. The current study attempted to investigate the role of postoperative complication for prognosis on GC patients undergoing radical resection. Materials and Methods: Eligible studies were searched in three databases, including PubMed, Embase, and the Cochrane Library, in accordance with the searching strategy on September 4th, 2022. The survival values were most concerned; then, hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled up. All prognostic values, including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and recurrence-free survival (RFS), were allowed. Subgroup analysis based on complication types was used for further in-depth research. Results: A total of 29 studies involving 33,858 patients were included in this study. Intra-abdominal abscess (19.4%) was the most common complications in the included studies, followed by anastomotic leakage (17.0%) and pneumonia (16.4%). There were 23, 4, 6, and 10 studies that reported OS, DFS, DSS, and RFS, respectively. After analysis, postoperative complication was found to be an independent prognostic factor for OS (HR = 1.52, I2 = 1.14%, 95% CI = 1.42-1.61, P = .00), DFS (HR = 1.71, I2 = 0.00%,95% CI = 1.44-1.98, P < .05), DSS (HR = 1.60, I2 = 54.58%, 95% CI = 1.26-1.93, P < .1), and RFS (HR = 1.26, I2 = 0.00%, 95% CI = 1.11-1.41, P < .05). Subgroup analysis found that noninfectious complication was not significantly associated with OS (HR = 1.39, I2 = 0.00%, 95% CI = 0.96-1.82, P > .05). Conclusion: Surgeons needed to pay more attention to GC patients who developed postoperative complications, especially infectious complications, and take proactive management to improve the prognosis.
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Affiliation(s)
- Lin-Fei Ren
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Yong-Hong Xu
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Jie-Gen Long
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
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Ren JY, Wang D, Zhu LH, Liu S, Yu M, Cai H. Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer. World J Gastrointest Oncol 2024; 16:732-749. [PMID: 38577468 PMCID: PMC10989372 DOI: 10.4251/wjgo.v16.i3.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/09/2023] [Accepted: 01/09/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Gastric cancer has a high incidence and fatality rate, and surgery is the preferred course of treatment. Nonetheless, patient survival rates are still low, and the incidence of major postoperative complications cannot be disregarded. The systemic inflammatory response, nutritional level, and coagulation status are key factors affecting the postoperative recovery and prognosis of gastric cancer patients. The systemic inflammatory response index (SIRI) and the albumin fibrinogen ratio (AFR) are two valuable comprehensive indicators of the severity and prognosis of systemic inflammation in various medical conditions. AIM To assess the clinical importance and prognostic significance of the SIRI scores and the AFR on early postoperative outcomes in patients undergoing radical gastric cancer surgery. METHODS We conducted a retrospective analysis of the clinicopathological characteristics and relevant laboratory indices of 568 gastric cancer patients from January 2018 to December 2019. We calculated and compared two indicators of inflammation and then examined the diagnostic ability of combined SIRI and AFR values for serious early postoperative complications. We scored the patients and categorized them into three groups based on their SIRI and AFR levels. COX analysis was used to compare the three groups of patients the prognostic value of various preoperative SIRI-AFR scores for 5-year overall survival (OS) and disease-free survival (DFS). RESULTS SIRI-AFR scores were an independent risk factor for prognosis [OS: P = 0.004; hazards ratio (HR) = 3.134; DFS: P < 0.001; HR = 3.543] and had the highest diagnostic power (area under the curve: 0.779; 95% confidence interval: 0.737-0.820) for early serious complications in patients with gastric cancer. The tumor-node-metastasis stage (P = 0.001), perioperative transfusion (P = 0.044), positive carcinoembryonic antigen (P = 0.014) findings, and major postoperative complications (P = 0.011) were factors associated with prognosis. CONCLUSION Preoperative SIRI and AFR values were significantly associated with early postoperative survival and the occurrence of severe complications in gastric cancer patients.
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Affiliation(s)
- Jing-Yao Ren
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Da Wang
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Medical College of Jiangsu University, Jiangsu University, Zhenjiang 212013, Jiangsu Province, China
| | - Li-Hui Zhu
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Shuo Liu
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Miao Yu
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Hui Cai
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750000, Ningxia Hui Autonomous Region, China
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- NHC Key Laboratory of Diagnosis and Therapy of Gastrointestinal Tumor, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
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Jiang Z, Lin H, Huang J, Sharma R, Lu Y, Zheng J, Chen X, Yang X, Niu M. Lack of clinical benefit from preoperative short-term parenteral nutrition on the clinical prognosis of patients treated with radical gastrectomy for gastric cancer: a two-center retrospective study based on propensity score matching analysis. J Gastrointest Oncol 2024; 15:96-111. [PMID: 38482215 PMCID: PMC10932686 DOI: 10.21037/jgo-23-1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/15/2024] [Indexed: 07/12/2024] Open
Abstract
Background Preoperative nutritional support studies for patients undergoing gastrointestinal (GI) surgery mostly focused on enteral nutrition (EN) or long-term (≥7 days) parenteral nutrition (PN). Some studies also found that preoperative short-term PN could improve the postoperative short-term nutritional status of tumor patients. But whether short-term PN support (1-6 days) before surgery can improve the prognosis of patients undergoing surgery for gastric cancer (GC) remains unclear. Therefore, we focused on assessing the effect of preoperative short-term PN on the outcomes of patients undergoing radical surgery for GC. Methods A retrospective analysis of 1,155 patients who underwent radical gastrectomy for GC between July 2014 and February 2019 was conducted. According to whether patients received short-term (1-6 days) PN support before surgery, patients were divided into non-PN group and PN group. After 1:1 propensity score matching (PSM), two groups of patients with similar baseline clinical characteristics were obtained. The incidence of various complications and overall survival (OS) rate were compared between the two groups, and logistic regression analysis for complications, Cox regression analysis for OS, and subgroup analysis were performed. Results Each group had 478 patients after PSM, and the clinical characteristics were balanced. There were no significant differences in overall postoperative complications (pre-PSM: P=0.495; post-PSM: P>0.99), postoperative length of stay (LOS; pre-PSM: P=0.092; post-PSM: P=0.460), or readmission rate within 30 days (pre-PSM: P=0.496; post-PSM: P=0.793) between the two groups before and after PSM. The OS of PN group before matching was lower than that of non-PN group (P=0.023), but this difference was not significant after matching (P=0.950), but the PN group's hospitalization expenses were substantially greater than those of the control group (post-PSM: P<0.001). Preoperative short-term PN support was not an independent factor in the incidence of postoperative complications (P>0.99) and OS (P=0.949). Subgroup analyses failed to identify those patients who might benefit from preoperative short-term PN support. Conclusions Preoperative short-term PN support may have no significant benefit on short-term postoperative complications or the long-term OS of patients with GC but increase hospitalization costs. It thus should not be the first choice of treatment for these patients.
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Affiliation(s)
- Zhixuan Jiang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hang Lin
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- First College of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jianqiang Huang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Rohit Sharma
- Department of Surgery, Marshfield Clinic Health System, Marshfield, WI, USA
| | - Yangbin Lu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jingwei Zheng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xinxin Yang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- Department of Gastrointestinal Surgery, the Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Mengyuan Niu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- School of Basic Medicine, Wenzhou Medical University, Wenzhou, China
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Zuo J, Zhou D, Zhang L, Zhou X, Gao X, Zhang J, Ding X, Hou W, Wang C, Jiang P, Wang X. Phase angle - A screening tool for malnutrition, sarcopenia, and complications in gastric cancer. Clin Nutr ESPEN 2024; 59:334-342. [PMID: 38220395 DOI: 10.1016/j.clnesp.2023.12.004] [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] [Received: 07/23/2023] [Revised: 11/25/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Patients with gastric cancer (GC) are more likely to experience malnutrition and muscle wasting. This study aims to investigate the potential of phase angle (PhA) as a screening tool for identifying malnutrition and sarcopenia in GC patients, as well as its association with short-term outcomes after radical gastrectomy. METHODS This cross-sectional study enrolled patients diagnosed with GC at The Affiliated People's Hospital of Jiangsu University from October 2021 to September 2022. PhA was measured using bioelectrical impedance analysis. Computed tomography scan images were analyzed for body composition at the level of the third lumbar vertebra. Malnutrition was diagnosed using Global Leadership Initiative on Malnutrition (GLIM) criteria. Sarcopenia diagnosis was based on the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. RESULTS A total of 248 patients with GC were analyzed, including 188 patients who underwent radical gastrectomy. Of these, 71.4 % (n = 177) were male and 28.6 % (n = 71) were female and the median overall age was 68 years (IQR: 61-72 years). According to GLIM criteria, 49.2 % (n = 122) of patients were malnourished and 19.8 % (n = 49) had sarcopenia based on AWGS criteria. A one-degree decrease in PhA was significantly associated with GLIM malnutrition (Odds Ratio [OR] = 8.108, 95 % CI:3.181-20.665) and sarcopenia (OR = 2.903, 95 % CI:1.170-7.206). PhA exhibited fair to good diagnostic accuracy in identifying GLIM malnutrition (male: AUC = 0.797; female: AUC = 0.816) and sarcopenia (male: AUC = 0.814; female: AUC = 0.710). Low PhA (OR = 3.632, 95 % CI: 1.686-7.824) and operation time (OR = 2.434, 95 % CI:1.120-5.293) were independently associated with the risk of postoperative complications. CONCLUSIONS PhA can serve as a reliable screening tool for identifying patients at risk of malnutrition, sarcopenia, and postoperative complications in GC.
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Affiliation(s)
- Junbo Zuo
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Da Zhou
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Li Zhang
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaodong Zhou
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Xuejin Gao
- Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - JingXin Zhang
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Xin Ding
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Wenji Hou
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Wang
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Pengcheng Jiang
- Department of General Surgery, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China.
| | - Xinying Wang
- Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, Nanjing, China; Department of General Surgery, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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10
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Li AH, Bu S, Wang L, Liang AM, Luo HY. Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection. World J Gastrointest Oncol 2024; 16:79-89. [PMID: 38292851 PMCID: PMC10824106 DOI: 10.4251/wjgo.v16.i1.79] [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: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/29/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer. However, there is a debate concerning their differential effects on cognitive function, anxiety, and depression in patients undergoing this procedure. AIM To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function, anxiety, depression, and organ function in patients undergoing radical resection of gastric cancer. METHODS A total of 80 patients were involved in this research. The subjects were divided into two groups: Propofol group and sevoflurane group. The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment (LOTCA), and anxiety and depression were assessed with the aid of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Hemodynamic indicators, oxidative stress levels, and pulmonary function were also measured. RESULTS The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group. Additionally, the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group. The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group. Moreover, the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group. CONCLUSION Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer. Propofol anesthesia has a minimal effect on patients' pulmonary function, consequently enhancing their postoperative recovery. Sevoflurane anesthesia causes less impairment on patients' cognitive function and mitigates negative emotions, leading to an improved postoperative mental state. Therefore, the selection of anesthetic agents should be based on the individual patient's specific circumstances.
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Affiliation(s)
- Ao-Han Li
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China
| | - Su Bu
- Department of Cardiothoracic Surgery, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China
| | - Ling Wang
- Department of Rehabilitation, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China
| | - Ai-Min Liang
- Department of Internal Medicine-Cardiovascular, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China
| | - Hui-Yu Luo
- Department of Anesthesiology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei Province, China
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11
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Osminin SV, Vetshev FP, Bilyalov IR, Alekseev KI, Eventyeva EV, Astaeva MO, Keramidi SS. [Fluorescence navigation and angiography with indocyanine green in stomach cancer surgery]. Khirurgiia (Mosk) 2024:34-41. [PMID: 38380462 DOI: 10.17116/hirurgia202402234] [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: 02/22/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of intraoperative angiography and fluorescence navigation with indocyanine green in reducing the risks of intra- and postoperative complications, as well as resection quality in patients with gastric cancer. MATERIAL AND METHODS The main group consisted of patients who underwent intraoperative angiography and fluorescence navigation with indocyanine green (n=43). The control group included patients without these procedures (n=154). Both groups did not differ in gender (p=0.937) and age (p=0.437). The lower third of the stomach was the most common tumor location in the main group (62.7% of cases), the middle and lower thirds of the stomach - in the control group (37% and 38.9% of patients, respectively). There was no between-group difference in «cT» grading (p>0.05). However, there were more «cN+» patients in the main group (14 (32.6%) versus 28 (18.4%) ones of «N0» category, p=0.042). Therefore, 41.9% and 13.6% of patients underwent neoadjuvant chemotherapy in both groups, respectively (<0.001). RESULTS Intraoperative angiography and fluorescence navigation with indocyanine green does not increase mortality (p=0.631), incidence of major (CD 3-5) (p=0.436) and minor (CD 1-2) postoperative complications (p=0.177), surgery time (p=0.288), mean intraoperative blood loss (p=0.144) and length of hospital-stay (p=0.631). Fluorescence navigation with indocyanine green does not affect the number of detected «positive» resection margins (R1) (p=0.883) but significantly increases the number of excised lymph nodes (p<0.001). CONCLUSION Intraoperative angiography and fluorescence navigation with indocyanine green are safe for intraoperative visualization of tumor and lymph nodes, as well as assessment of arterial blood supply. This technique is effective in traditional and minimally invasive surgeries for gastric cancer. Fluorescence navigation with indocyanine green significantly increases the number of excised lymph nodes.
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Affiliation(s)
- S V Osminin
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - F P Vetshev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - I R Bilyalov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - K I Alekseev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - E V Eventyeva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - M O Astaeva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S S Keramidi
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Chen J, Wang W, Zhang Y, Wang C, Wang W, Zheng A. OIP5-AS1/CD147/TRPM7 axis promotes gastric cancer metastasis by regulating apoptosis related PI3K-Akt signaling. Front Oncol 2023; 13:1221445. [PMID: 38156103 PMCID: PMC10753821 DOI: 10.3389/fonc.2023.1221445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/15/2023] [Indexed: 12/30/2023] Open
Abstract
Background To explore the mechanism of OIP5-AS1/CD147/TRPM7 axis to gastric cancer (GC) metastasis. Methods Bioinformatic analysis was performed to pick up the candidate genes associated with regulation GC metastasis. Using GC cell lines, AGS and MKN-45 as research objects, identify the effect of candidate genes on GC metastasis, judge cell proliferation status by MTT assay and cell clone number, and detect cell migration by Transwell and Wound-healing assay. The molecular mechanism of CD147/OIP5/TRPM7 axis regulating GC metastasis was further explored by RNA sequencing. The key signaling pathways were subsequently verified by flow cytometry and WB. Results Bioinformatic analysis suggested OIP5-AS1/CD147/TRPM7 axis may be involving in GC metastasis. The RNA interference experiment proved that after gene interference, the proliferation ability of GC cells decreased significantly (P<0.05), which was manifested in the reduction of the number of cell clones. In addition, the migration ability of GC cells was also affected, which was based on the results of Wound Healing (P<0.05). CD147, OIP5-AS1 and TRPM7 all have harmful effects on GC cells. The relationship between OIP5-AS1 and CD147/TRPM7 was detected by RNA immunoprecipitation. Moreover, the RNA sequencing data indicated that CD147/OIP5-AS1/TRPM7 may coordinately regulate the PI3K-AKT pathway related to GC cell apoptosis, thereby affecting the proliferation and migration of GC cells. After RNA interference, the level of apoptosis increased both in AGS and MKN-45 cells. Meanwhile, the expression of pro-apoptotic proteins Caspase9 and BAX were up-regulated (P<0.05). In addition, the expression of PI3K and AKT proteins was reduced (P<0.05). The mouse tumorigenesis experiment corroborated the results of the in vitro study. Conclusion OIP5-AS1/CD147/TRPM7 axis reduces GC cell proliferation by regulating apoptosis associated with PI3K-AKT signaling, further affecting cancer metastasis.
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Affiliation(s)
- Jianpeng Chen
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wei Wang
- Department of Oncology, Dongying Hospital of Traditional Chinese Medicine, Dongying, China
| | - Yujie Zhang
- Department of Outpatient, Guangzhou University, Guangzhou, China
| | - Caixia Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Weibo Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Aiming Zheng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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13
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Suenaga H, Schifter M, Chen N, Ali F, Byth K, Peck C. Impact of oral/dental disease burden on postoperative infective complications: a prospective cohort study. Clin Oral Investig 2023; 27:6461-6470. [PMID: 37730892 PMCID: PMC10630249 DOI: 10.1007/s00784-023-05251-4] [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: 06/15/2022] [Accepted: 09/09/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVES This prospective cohort study aimed to assess the association between dental disease burden and postoperative infective complications (POICs) in patients undergoing major surgical procedures under general anaesthesia. METHODS Pre-surgical dental assessment was undertaken on patients planned for major surgery. Demographic and surgical variables including putative risk factors for POICs and POIC status were documented. The univariable association between POIC status and each factor was examined. Those variables associated at P value ≤ 0.2 were candidates for inclusion in multiple logistic regression models. Backward stepwise variable selection was used to identify the independent predictors for POIC in the best fitting logistic regression model. The area under the receiver operating curve (AUC) was used to quantify the model's global classification performance. RESULTS Among the 285 patients, 49 patients (17.2%) had POICs. The independent predictors for POIC were expected length of hospital stay (4-6 days; odds ratio [OR] = 4.80, 95% confidence internal [CI]: 1.30-17.70, P = 0.018, 7-9 days; OR = 5.42, 95% CI: 1.51-19.41, P = 0.009, ≥ 10 days; OR = 28.80, 95% CI: 4.12-201.18, P < 0.001), four or more decayed teeth (OR = 6.03, 95% CI: 2.28-15.94, P < 0.001) and visible tongue plaque (OR = 3.21, 95% CI: 1.54-6.70, P = 0.002). The AUC was 0.78 (95% CI: 0.71-0.85) indicating good discrimination. A simple screening tool for POIC was developed. CONCLUSIONS/CLINICAL RELEVANCE In addition to systemic/surgical factors, this study identified clinically detected decayed teeth and visible tongue plaque as independent predictors for POICs. Preoperative dental assessment/care might be beneficial to assess risk for POICs and improve postoperative outcomes.
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Affiliation(s)
- Hanako Suenaga
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Level 2-3 Westmead Centre for Oral Health, Westmead, NSW, 2145, Australia.
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8575, Japan.
| | - Mark Schifter
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Level 2-3 Westmead Centre for Oral Health, Westmead, NSW, 2145, Australia
- Department of Oral Medicine, Oral Pathology and Special Needs Dentistry, Westmead Centre for Oral Health, Level 3, Westmead, NSW, 2145, Australia
| | - Nancy Chen
- Department of Oral Medicine, Oral Pathology and Special Needs Dentistry, Westmead Centre for Oral Health, Level 3, Westmead, NSW, 2145, Australia
| | - Farheen Ali
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Cnr Darcy & Hawkesbury Roads, Westmead, NSW, 2145, Australia
| | - Karen Byth
- Research and Education Network, Western Sydney Local Health District, Westmead Hospital, Westmead, NSW, 2145, Australia
| | - Chris Peck
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Level 2-3 Westmead Centre for Oral Health, Westmead, NSW, 2145, Australia
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Lin J, Liang H, Zheng H, Li S, Liu H, Ge X. CONUT can be a predictor of postoperative complications after laparoscopic-assisted radical gastrectomy for elderly gastric cancer patients. Medicine (Baltimore) 2023; 102:e35424. [PMID: 37800831 PMCID: PMC10553070 DOI: 10.1097/md.0000000000035424] [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: 07/01/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
Compared with young patients, elderly patients with gastric cancer usually have lower muscle mass, poorer nutritional status, lower immunity, and worse cardiopulmonary function. Therefore, how to improve the prognosis of elderly gastric cancer patients after laparoscopic-assisted radical gastrectomy is the focus and difficulty of clinician. The aim of our study was to investigate the risk factors for postoperative complications of these patients. The data of gastric cancer patients aged ≥ 60 years who underwent laparoscopic-assisted radical gastrectomy were analyzed. Univariate was used to determine the potential risk factors and then multivariate analyses was used to determine the independent risk factors for postoperative complications. Univariate analysis showed that age, preoperative red blood cell (RBC), preoperative albumin (ALB), preoperative C-reactive protein (CRP), preoperative hemoglobin (Hb), preoperative blood transfusion, preoperative lymphocytes, total cholesterol, CRP-to-ALB ratio, controlling nutritional status (CONUT) score, TNM stage were all the potential risk factors for postoperative complications. Binary logistic regression showed that CONUT, age and preoperative RBC were correlated with postoperative complications. For elderly gastric cancer patients after laparoscopic-assisted radical gastrectomy, CONUT, age and preoperative RBC were all the independent risk factors for overall postoperative complications and could be used as reliable indicators for judging the short-term prognosis.
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Affiliation(s)
- Jian Lin
- Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine Longyou Campus, Longyou, China
| | - Huiping Liang
- Department of Medicine, GuangXi Medical College, Nanning, China
| | - Huanhuan Zheng
- Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine Longyou Campus, Longyou, China
| | - Shengqi Li
- Department of Medicine, GuangXi Medical College, Nanning, China
| | - Huaying Liu
- Department of Medicine, GuangXi Medical College, Nanning, China
| | - Xiaolong Ge
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Nagarajan G, Doshi P, Bardeskar NS, Kulkarni A, Punamiya A, Tongaonkar H. Association between sarcopenia and postoperative complications in patients undergoing surgery for gastrointestinal or hepato-pancreatico-biliary cancer. J Surg Oncol 2023; 128:682-691. [PMID: 37183521 DOI: 10.1002/jso.27315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite surgical advances, postoperative complications persist, affecting oncologic outcomes and increasing treatment costs. It is important to identify a marker that can predict postoperative complications, which can help prehabilitate patients before surgery. This study evaluated sarcopenia as a predictive marker of postoperative complications in patients undergoing surgery for gastrointestinal (GI) or hepato-pancreatico-biliary (HPB) cancer. METHODS Sarcopenia was assessed using the skeletal muscle index at the third lumbar vertebra on abdominal computed tomography. The predictive ability of sarcopenia was evaluated by adjusting for other clinicopathological factors. RESULTS Of the 210 patients, 81 (38.57%) were sarcopenic. The overall morbidity and mortality were 33.81% and 2.86%, respectively. Major complications (Clavien-Dindo Grade ≥ III) were observed in 10.95% patients and sarcopenic patients were significantly more likely to develop major complications (p = 1.42 × 10-10 ). Sarcopenia (p = 6.13 × 10-6 ; odds ratio = 12.29) independently predicted postoperative complications and prolonged hospital stay (p = 0.01). CONCLUSION Sarcopenia objectively predicted the development of postoperative complications and prolonged hospital stay in patients undergoing surgery for GI or HPB cancer. This may facilitate the prehabilitation of patients planned for surgery to reduce the risk of complications.
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Affiliation(s)
- Ganesh Nagarajan
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Pratik Doshi
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Nikhil S Bardeskar
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Aniruddha Kulkarni
- Department of Interventional Radiology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Aditya Punamiya
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Hemant Tongaonkar
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
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Yamagishi S, Okamura Y, Kang W, Shindate M, Kochi M, Mitsuka Y, Watabe M, Yoshida N, Ikarashi M, Yamazaki S, Aramaki O, Nakayama H, Moriguchi M, Higaki T, Yamashita H. Impact of Sarcopenic Obesity on Severe Postoperative Complications in Patients with Gastric Cancer Undergoing Gastrectomy. Dig Surg 2023; 40:143-152. [PMID: 37527628 DOI: 10.1159/000531797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Several studies have indicated that sarcopenia affects the short- and long-term outcomes of cancer patients, including those with gastric cancer. In recent years, sarcopenic obesity and its effects have been reported in cancer patients. This study aimed to evaluate the impact of sarcopenic obesity on postoperative complications in patients with gastric cancer undergoing gastrectomy. METHODS This single-center, retrospective study included 155 patients who underwent curative gastrectomy for gastric cancer from January 2015 to July 2021. Sarcopenia was defined by the psoas muscle index (<6.36 cm2/m2 in men and <3.92 cm2/m2 in women), which measures the iliopsoas muscle area at the lumbar L3 level using computed tomography. Obesity was defined by body mass index (≥25). Patients with both sarcopenia and obesity were defined as the sarcopenic obesity group and others as the non-sarcopenic obesity group. Severe postoperative complications were defined as Clavien-Dindo classification grade IIIa or higher. RESULTS Of the 155 patients, 26 (16.8%) had sarcopenic obesity. The incidence of severe postoperative complications was significantly higher in the sarcopenic obesity group (30.8% vs. 10.9%; p = 0.014). Multivariate analysis indicated that sarcopenic obesity was an independent risk factor for severe postoperative complications (odds ratio, 3.950; 95% confidence interval, 1.390-11.200; p = 0.010). CONCLUSION Sarcopenic obesity is an independent risk factor for severe postoperative complications.
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Affiliation(s)
- Shunsuke Yamagishi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan,
| | - Yukiyasu Okamura
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Woodae Kang
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan
| | - Masataka Shindate
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Mitsugu Kochi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mitsuka
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Megumu Watabe
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Nao Yoshida
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masahito Ikarashi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shintaro Yamazaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Aramaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hisashi Nakayama
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Masamichi Moriguchi
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tokio Higaki
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroharu Yamashita
- Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan
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Oh SK, Ko CS, Jeong SA, Yook JH, Yoo MW, Kim BS, Lee IS, Gong CS, Min SH, Kim NY. Comparison of Laparoscopic and Open Gastrectomy for Patients With Gastric Cancer Treated With Neoadjuvant Chemotherapy: A Multicenter Retrospective Study Based on the Korean Gastric Cancer Association Nationwide Survey. J Gastric Cancer 2023; 23:499-508. [PMID: 37553135 PMCID: PMC10412975 DOI: 10.5230/jgc.2023.23.e28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE Despite scientific evidence regarding laparoscopic gastrectomy (LG) for advanced gastric cancer treatment, its application in patients receiving neoadjuvant chemotherapy remains uncertain. MATERIALS AND METHODS We used the 2019 Korean Gastric Cancer Association nationwide survey database to extract data from 489 patients with primary gastric cancer who received neoadjuvant chemotherapy. After propensity score matching analysis, we compared the surgical outcomes of 97 patients who underwent LG and 97 patients who underwent open gastrectomy (OG). We investigated the risk factors for postoperative complications using multivariate analysis. RESULTS The operative time was significantly shorter in the OG group. Patients in the LG group had significantly less blood loss than those in the OG group. Hospital stay and overall postoperative complications were similar between the two groups. The incidence of Clavien-Dindo grade ≥3 complications in the LG group was comparable with that in the OG group (1.03% vs. 4.12%, P=0.215). No statistically significant difference was observed in the number of harvested lymph nodes between the two groups (38.60 vs. 35.79, P=0.182). Multivariate analysis identified body mass index (odds ratio [OR], 1.824; 95% confidence interval [CI], 1.029-3.234; P=0.040) and extent of resection (OR, 3.154; 95% CI, 1.084-9.174; P=0.035) as independent risk factors for overall postoperative complications. CONCLUSIONS Using a large nationwide multicenter survey database, we demonstrated that LG and OG had comparable short-term outcomes in patients with gastric cancer who received neoadjuvant chemotherapy.
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Affiliation(s)
- Seul Ki Oh
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Seok Ko
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Seong-A Jeong
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hwan Yook
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Moon-Won Yoo
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Beom Su Kim
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - In-Seob Lee
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chung Sik Gong
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sa-Hong Min
- Department of Stomach Surgery, Asan Medical Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Na Young Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Jeong SH, Yoo MW, Park M, Seo KW, Min JS. Complication After Gastrectomy for Gastric Cancer According to Hospital Volume: Based on Korean Gastric Cancer Association-Led Nationwide Survey Data. J Gastric Cancer 2023; 23:462-475. [PMID: 37553132 PMCID: PMC10412979 DOI: 10.5230/jgc.2023.23.e24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE This study aimed to analyze the incidence and risk factors of complications following gastric cancer surgery in Korea and to compare the correlation between hospital complications based on the annual number of gastrectomies performed. MATERIALS AND METHODS A retrospective analysis was conducted using data from 12,244 patients from 64 Korean institutions. Complications were classified using the Clavien-Dindo classification (CDC). Univariate and multivariate analyses were performed to identify the risk factors for severe complications. RESULTS Postoperative complications occurred in 14% of the patients, severe complications (CDC IIIa or higher) in 4.9%, and postoperative death in 0.2%. The study found that age, stage, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) score, hospital stay, approach methods, and extent of gastric resection showed statistically significant differences depending on hospital volumes (P<0.05). In the univariate analysis, patient age, comorbidity, ASA score, ECOG score, approach methods, extent of gastric resection, tumor-node-metastasis (TNM) stage, and hospital volume were significant risk factors for severe complications. However, only age, sex, ASA score, ECOG score, extent of gastric resection, and TNM stage were statistically significant in the multivariate analysis (P<0.05). Hospital volume was not a significant risk factor in the multivariate analysis (P=0.152). CONCLUSIONS Hospital volume was not a significant risk factor for complications after gastric cancer surgery. The differences in the frequencies of complications based on hospital volumes may be attributed to larger hospitals treating patients with younger age, lower ASA scores, better general conditions, and earlier TNM stages.
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Affiliation(s)
- Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Moon-Won Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Miyeong Park
- Department of Anesthesiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea.
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19
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Miao X, Ding L, Hu J, Zhu H, Zhao K, Lu J, Jiang X, Xu Q, Zhu S. A web-based calculator combining Geriatric Nutritional Risk Index (GNRI) and Tilburg Frailty Indicator (TFI) predicts postoperative complications among young elderly patients with gastric cancer. Geriatr Gerontol Int 2023; 23:205-212. [PMID: 36746414 DOI: 10.1111/ggi.14544] [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: 08/10/2022] [Revised: 12/26/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023]
Abstract
AIM Nutritional status and frailty are significant indicators reflecting physiological reserve. We sought to establish and validate a web-based calculator containing the Geriatric Nutritional Risk Index (GNRI) and the Tilburg Frailty Indicator (TFI) together with general clinical information to predict total complications among elderly patients with gastric cancer. METHODS This was a prospective cohort study of 582 elderly patients with gastric cancer in a tertiary hospital in China. Nutritional status and frailty were assessed by the GNRI and the TFI, respectively. The nomogram was built and further converted into a web-based calculator. The receiver operating characteristic analysis was performed to evaluate the discrimination of the nomogram. Calibration was assessed using the calibration curve and Hosmer-Lemeshow test via the bootstrap resampling procedure. The decision curve analyses (DCAs) were employed to quantify the net benefits of a certain threshold probability for assessing the clinical values. RESULTS The GNRI (odds ratio [OR], 0.921; 95% confidence interval [CI], 0.895-0.949; P < 0.001), the TFI (OR, 1.243; 95% CI, 1.113-1.386; P < 0.001), surgical approach (OR, 1.913; 95% CI, 1.073-3.408; P = 0.028) and comorbidity (OR = 1.599, 95%CI = 1.028-2.486, P = 0.037) were independently associated with total complications. The nomogram demonstrated good discrimination (area under the receiver operating characteristic curve: training cohort, 0.735; validation cohort, 0.777) and calibration (P = 0.135). The DCA curves of the nomogram also showed good positive net benefits. CONCLUSIONS The web-based calculator incorporating the GNRI, the TFI, surgical approach, and comorbidity could successfully predict total complications among elderly patients with gastric cancer with good accuracy in a convenient manner. Geriatr Gerontol Int 2023; 23: 205-212.
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Affiliation(s)
- Xueyi Miao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Lingyu Ding
- Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jieman Hu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jinling Lu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoman Jiang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
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20
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Nonogaki A, Kanda M, Ito S, Mochizuki Y, Teramoto H, Ishigure K, Murai T, Asada T, Ishiyama A, Matsushita H, Tanaka C, Kobayashi D, Fujiwara M, Murotani K, Kodera Y. Preoperative neutrophil-to-platelet ratio as a potential prognostic factor for gastric cancer with positive peritoneal lavage cytology in the absence of other non-curative factors: a multi-institutional dataset analysis. Surg Today 2023; 53:198-206. [PMID: 35767068 DOI: 10.1007/s00595-022-02539-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/30/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Peritoneal dissemination is the key to the prognosis of gastric cancer (GC) and can be detected early with peritoneal lavage cytology. No studies have examined preoperative prognostic factors in GC patients who have positive cytology but no other non-curative factors. METHODS We conducted a retrospective analysis using a multicenter database of 3575 patients who underwent gastrectomy between 2010 and 2014. Patients with positive peritoneal lavage cytology as a sole non-curative factor were retrieved, and correlations between parameters and the prognosis were compared. RESULTS A total of 66 patients were identified as eligible. In the receiver operating characteristic (ROC) curve analysis, the neutrophil-to-platelet ratio (NPR) had the greatest area under the curve value and was selected. We divided the NPR into two groups based on the optimal cutoff value of the NPR (2.000), as determined by the ROC curve analysis. A high preoperative NPR was the only prognostic factor. The NPR-high group had shorter overall survival than the NPR-low group (hazard ratio 1.85, 95% confidence interval 1.05-3.28, P = 0.032). CONCLUSION Our analysis indicated that the preoperative NPR serves as a prognostic factor in GC patients with positive peritoneal lavage cytology in the absence of other non-curative factors.
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Affiliation(s)
- Akira Nonogaki
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Chuo Hospital, Nagoya, Japan
| | | | - Hitoshi Teramoto
- Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | | | - Toshifumi Murai
- Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Takahiro Asada
- Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | | | | | - Chie Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | | | - Michitaka Fujiwara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kenta Murotani
- Division of Biostatistics, Biostatistics Center, Kurume University, Kurume, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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21
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Alfaro A, Zanabria D, Aguilar A, Jimenez-Solano SA, Zevallos A, Fajardo W. Gastric adenocarcinoma with high‑level microsatellite instability: A case report. Mol Clin Oncol 2023; 18:16. [PMID: 36798468 PMCID: PMC9926044 DOI: 10.3892/mco.2023.2612] [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: 03/16/2022] [Accepted: 11/16/2022] [Indexed: 01/28/2023] Open
Abstract
Gastric cancer (GC) ranks fifth on the list of the most common malignancies worldwide. In Peru, gastric neoplasms are considered the second leading cause of mortality among males. Among the molecular subgroups of GC, microsatellite instability presents a favorable prognosis due to its hypermutated phenotype, which activates immunosurveillance. The present study describes the case of a 75-year-old patient, who was admitted in the hospital with a history of upper gastrointestinal bleeding and recurrent hospital admission, due to severe anemia. The patient presented with pale skin, normal vital functions, slight swelling of the lower extremities, and abdominal distention and bloating upon a physical examination. An endoscopic examination revealed an infiltrating circular ulcerated lesion. The histopathological analysis identified a moderately differentiated intestinal-type adenocarcinoma with pathological stage T3N0M0. Tumor genomic profiling demonstrated alterations in 15 different genes with a tumor mutational burden of 28 mutations/Mb. Finally, the patient underwent a partial gastrectomy without pre-operative chemotherapy. After 4 days, the patient presented with post-operative complications for which he was re-operated on. The patient did not survive. To the best of our knowledge, in the present case, pernicious anemia was an early sign of GC and a gastroscopy had to be performed. Furthermore, MutS homolog 3 alterations probably conditioned the presence of multiple frame-shift mutations.
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Affiliation(s)
- Alejandro Alfaro
- Department of Pathology, Hospital Nacional Dos de Mayo, Lima 15003, Peru
| | | | - Alfredo Aguilar
- Basic and Translational Research Unit, Oncosalud-AUNA, Lima 15036, Peru
| | - Sergio A. Jimenez-Solano
- Faculty of Natural Sciences and Mathematics, Universidad Nacional Federico Villarreal, Lima 15007, Peru
| | - Alejandra Zevallos
- School of Medicine, Universidad Privada San Juan Bautista, Lima 15067, Peru,Correspondence to: Professor Alejandra Zevallos, School of Medicine, Universidad Privada San Juan Bautista, Avenue José Antonio Lavalle N˚ 302-304 (Ex Hacienda Villa), Chorrillos, Lima 15067, Peru
| | - Williams Fajardo
- Department of Pathology, Hospital Nacional Dos de Mayo, Lima 15003, Peru,School of Medicine, Universidad Privada San Juan Bautista, Lima 15067, Peru
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22
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He Y, Liu H, Ma Y, Li J, Zhang J, Ren Y, Dong C, Bai B, Zhang Y, Lin Y, Yue P, Meng W. Preoperative prognostic nutritional index predicts short-term complications after radical resection of distal cholangiocarcinoma. Front Surg 2023; 9:1091534. [PMID: 36704510 PMCID: PMC9872124 DOI: 10.3389/fsurg.2022.1091534] [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: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023] Open
Abstract
Background The occurrence of postoperative complications of distal cholangiocarcinoma (dCCA) is an indicator of poor patient prognosis. This study aimed to determine the immune-nutritional indexes (INIs) that can predict short-term postoperative complications. Methods A retrospective analysis of 148 patients with dCCA who were operated radical pancreaticoduodenectomy at the First Hospital of Lanzhou University from December 2015 to March 2022 was conducted to assess the predictive value of preoperative INIs and preoperative laboratory tests for short-term postoperative complications, and a decision tree model was developed using classification and regression tree (CART) analysis to identify subgroups at risk for overall complications. Results In this study, 83 patients (56.08%) experienced overall complications. Clavien-Dindo grade III-V complications occurred in 20 patients (13.51%), and 2 patients died. The areas under curves (AUCs) of the preoperative prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, and neutrophil-to-lymphocyte ratio (NLR) were compared; the PNI provided the maximum discrimination for complications (AUC = 0.685, 95% CI = 0.600-0.770), with an optimal cutoff value of 46.9, and the PNI ≤ 46.9 group had higher incidences of overall complications (70.67% vs. 40.00%, P < 0.001) and infectious complications (28.77% vs. 13.33%, P = 0.035). Multivariate logistic regression analysis identified PNI (OR = 0.87, 95% CI: 0.80-0.94) and total bilirubin (OR = 1.01, 95% CI: 1.00-1.01) were independent risk factors for overall complications (P < 0.05). According to CART analysis, PNI was the most important parameter, followed by the total bilirubin (TBIL) level. Patients with a PNI lower than the critical value and TBIL higher than the critical value had the highest overall complication rate (90.24%); the risk prediction model had an AUC of 0.714 (95% CI, 0.640-0.789) and could be used to stratify the risk of overall complications and predict grade I-II complications (P < 0.05). Conclusion The preoperative PNI is a good predictor for short-term complications after the radical resection of dCCA. The decision tree model makes PNI and TBIL easier to use in clinical practice.
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Affiliation(s)
- Yulong He
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Haoran Liu
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yuhu Ma
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jianlong Li
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jinduo Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yanxian Ren
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Chunlu Dong
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Bing Bai
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yong Zhang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yanyan Lin
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ping Yue
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China,Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, China,Correspondence: Wenbo Meng Ping Yue
| | - Wenbo Meng
- The First Clinical Medical College, Lanzhou University, Lanzhou, China,Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China,Gansu Province Key Laboratory of Biological Therapy and Regenerative Medicine Transformation, Lanzhou, China,Correspondence: Wenbo Meng Ping Yue
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23
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Maeda K, Kuriyama N, Ito T, Gyoten K, Hayasaki A, Fujii T, Iizawa Y, Murata Y, Tanemura A, Kishiwada M, Mizuno S. Safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients. Langenbecks Arch Surg 2022; 407:2861-2872. [PMID: 35996005 DOI: 10.1007/s00423-022-02654-x] [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: 04/24/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the safety and benefits of major hepatectomy with extrahepatic bile duct resection in older perihilar cholangiocarcinoma patients and to identify possible predictors of surgical mortality. METHODS We retrospectively analyzed the data of 102 consecutive patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar cholangiocarcinoma in our institution between 2004 and 2021. The patients were included and divided into two groups: older patients ≥ 75 years and non-older patients < 75 years. Patient characteristics, preoperative nutritional and operative risk scores, intraoperative details, postoperative outcomes, and long-term prognosis were compared between the groups. Univariate and multivariate analyses were used to identify the predictors of 90-day mortality after major hepatectomy with extrahepatic bile duct resection. RESULTS Significant differences were identified for some preoperative surgical risk scores, but not for nutritional scores. Older patients had a higher morbidity rate of respiratory complications (p = 0.016), but there were no significant differences in overall (p = 0.735) or disease-specific survival (p = 0.858). A high Dasari's score was identified as an independent predictive factor of 90-day mortality. CONCLUSIONS Major hepatectomy with extrahepatic bile duct resection can be performed for optimally selected older and younger patients with perihilar cholangiocarcinoma, resulting in a good prognosis. However, indications for extended surgery should be recognized. Dasari's preoperative risk score may be a good predictor of 90-day mortality.
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Affiliation(s)
- Koki Maeda
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
- Regional Medical Support Center, Mie University Hospital, Tsu city, Mie, Japan
| | - Naohisa Kuriyama
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan.
| | - Takahiro Ito
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Kazuyuki Gyoten
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Aoi Hayasaki
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Takehiro Fujii
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Yusuke Iizawa
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Yasuhiro Murata
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Akihiro Tanemura
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Masashi Kishiwada
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, Japan
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Winter AS, Haverkamp C, Gratzke C, Huber R, Lederer AK. Valerian and postoperative sleep: a retrospective cohort analysis of gynecological, urologic, and general surgical patients. Sleep 2022; 45:6594703. [DOI: 10.1093/sleep/zsac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/21/2022] [Indexed: 10/18/2022] Open
Abstract
Abstract
Study Objectives
Postoperative sleep disturbances appear to be a common complication after surgery being treated with sleep-promoting medication such as valerian, but robust data and evidence of medicinal approaches are lacking.
Methods
We performed a retrospective cohort analysis of all 21 168 urological, gynecological, and general surgical patients of the University Medical Center Freiburg, Germany, who underwent surgery between 2015 and 2020. Target parameters were the usage of sleep-promoting medication to estimate the occurrence of postoperative sleep disturbances as well as the kind of sleep medication with a special focus on herbal medication such as valerian.
Results
Drug-treated sleep disturbances occurred in 15% (n = 3083) of the patients. Valerian was the second most applied drug (n = 814, 26.4%) after classic benzodiazepines (n = 1 138, 36.9%). The majority of patients got valerian as monotherapy. Age, length of stay, and comorbidities were associated with demand for sleep medication in general (p < .001). Valerian monotherapy was more common in women (OR 1.53, 95% CI: 1.33–1.77, p < .001), elderly patients (OR 1.50, 95% CI: 1.29–1.75, p < .001), and patients with prolonged hospital stay (OR 2.23, 95% CI: 1.91–2.61, p < .001).
Conclusions
Valerian plays an important role in the treatment of postoperative sleep disturbances clinically, and it appears to be a promising therapeutic approach especially in women, older and sicker patients, and those with prolonged hospital stay. Further research has to clarify the efficacy of valerian postoperatively.
Clinical trial registration
DRKS00027903, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00027903
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Affiliation(s)
- Anne-Sophie Winter
- Department of Medicine II, Center for Complementary Medicine, University Medical Center , Freiburg , Germany
| | - Christian Haverkamp
- Institute of Digitalization in Medicine, University Medical Center , Freiburg , Germany
| | - Christian Gratzke
- Department of Urology, University Medical Center , Freiburg , Germany
| | - Roman Huber
- Department of Medicine II, Center for Complementary Medicine, University Medical Center , Freiburg , Germany
| | - Ann-Kathrin Lederer
- Department of Medicine II, Center for Complementary Medicine, University Medical Center , Freiburg , Germany
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University , Mainz, Germany
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25
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Penning Y, El Asmar A, Moreau M, Raspé J, Dal Lago L, Pepersack T, Donckier V, Liberale G. Evaluation of the Comprehensive Geriatric Assessment (CGA) tool as a predictor of postoperative complications following major oncological abdominal surgery in geriatric patients. PLoS One 2022; 17:e0264790. [PMID: 35239731 PMCID: PMC8893608 DOI: 10.1371/journal.pone.0264790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/16/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction The concept of frailty extends beyond chronological age. Identifying frailty using a two-step approach, starting with the use of a screening tool (G8) followed by comprehensive geriatric assessment (CGA), may be useful in guiding treatment decisions and follow-up. This study evaluated the association between G8 and CGA, and the risk of 90-day postoperative complications risk, in oncogeriatric patients. Methods Data on geriatric patients with major oncological abdominal surgery was retrospectively collected from our hospital records between 2016 and 2019. Patients with an impaired G8 screening score, who subsequently underwent CGA geriatric screening, were included. Postoperative complications were classified using the Clavien-Dindo classification (CD), and the Comprehensive Complication Index (CCI). The association between the individual components of the geriatric assessment tools and the 90-day postoperative complications risk was analyzed. Results One hundred and twelve patients, aged ≥ 70 years, operated for an intra-abdominal tumor with curative intent, were included. Seventy-six patients (67.9%) presented with an impaired G8, out of whom sixty-six (58.9%) had a CGA performed. On univariate analysis, altered nutritional status assessed by the Mini-Nutritional Assessment-Short Form was the only variable associated with higher postoperative total complication rate (p = 0.01). Patients with an impaired G8 had significantly more postoperative complications and higher 1-year mortality rates than patients with normal G8. Fifteen patients (13.4%) had grade III-IVb complications. A CCI > 50 was recorded in 16 patients (14.3%). All-cause 90-day postoperative mortality was 10.7%. Conclusion Identifying an altered preoperative nutritional status, as part of the CGA, in patients screening positive for frailty, is a potentially modifiable risk factor that can enhance preoperative management and optimize treatment decision making. G8 may be a predictive factor for postoperative complications in oncogeriatric patients.
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Affiliation(s)
- Yoon Penning
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Antoine El Asmar
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
- * E-mail:
| | - Michel Moreau
- Data Centre and Statistics Department, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Julie Raspé
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lissandra Dal Lago
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Thierry Pepersack
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Vincent Donckier
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Role of Platelet to Lymphocyte Ratio and Red Cell Distribution Width in Predicting Postoperative Complications in Patients with Acute Mesenteric Ischemia. Ann Vasc Surg 2022; 84:298-304. [PMID: 35247535 DOI: 10.1016/j.avsg.2022.01.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 12/20/2021] [Accepted: 01/26/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The predictive values of the platelet to lymphocyte ratio (PLR) and red cell distribution width (RDW) have been demonstrated in different types of abdominal surgery. The aim of this study was to investigate the interest of the preoperative PLR and RDW as predictors of 30-day postoperative complications in patients with acute mesenteric ischemia (AMI). METHODS Clinical data of 105 AMI patients were retrospectively reviewed. Postoperative complications were evaluated by the Clavien-Dindo classification. The cutoff values for neutrophil to lymphocyte ratio (NLR), PLR, and RDW were determined by receiver operating characteristic curves. Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed. RESULTS In the univariate analyses, advanced age, female, anemia, high white blood cell (WBC), high PLR, high NLR, high RDW, Charlson comorbidity index (CCI) score ≥2, and bowel resection were associated with the postoperative complications. A multivariable analysis revealed that advanced age, high PLR, high RDW, and bowel resection were independent predictors of postoperative complications. CONCLUSIONS The PLR and RDW might play important roles in evaluation of the risk of postoperative complications in AMI patients. The preoperative PLR and RDW are simple and useful predictors of postoperative complications in AMI patients.
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Inflection-Point Nutrition Support Determined by Oral Mucosal Apoptosis Rate Is a Novel Assessment Strategy for Personalized Nutrition: A Prospective Cohort Study. J Pers Med 2022; 12:jpm12030358. [PMID: 35330358 PMCID: PMC8948995 DOI: 10.3390/jpm12030358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Energy intake and nutritional status influences a patient’s recovery from major abdominal surgery. The aim of this study is to explore and validate the clinical feasibility of an inflection-point nutrition strategy for personalized nutrition in gastric cancer patients after surgery. Methods: We conducted a prospective cohort study from a single tertiary referral hospital. Patients diagnosed with gastric cancer who met the inclusion criteria were included in this study. We collected the demographic and clinic pathological characteristics of included patients. Patients were divided into a formular nutrition (FN) and inflection-point nutrition (IPN) group. We monitored the perioperative dynamics of the oral mucosal epithelia cell apoptosis rate. Predictive factors for inflection phenomenon were investigated in univariate and multivariate analysis. Results: A total of 53 gastric cancer patients were included. A total of 30 (56.6%) patients showed the inflection phenomenon, with 9 (34.6%) patients in the FN group and 21 (77.8%) patients in the IPN group, respectively. We found that patients with the inflection phenomenon had a shorter duration of hospital stay compared to patients without the inflection phenomenon (p = 0.04). In multivariate analysis, independent predictive factors for inflection phenomenon were age (p = 0.015), operation time ≤ 300 min (p = 0.012), and average energy intake ≥ 25 Kcal/kg/day (p = 0.038). Conclusions: Our findings for the first time revealed that the oral epithelial cell apoptosis rate can promptly reflect the patients’ perioperative nutrition needs. Meanwhile, we developing a novel and feasible nutrition therapy guided by the oral epithelial cell apoptosis rate is novel in gastric cancer patients that have undergone laparoscopic gastrectomy.
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Lidoriki I, Mylonas KS, Syllaios A, Vergadis C, Stratigopoulou P, Marinos G, Mastoraki A, Karavokyros I, Schizas D. The Impact of Nutritional and Functional Status on Postoperative Outcomes following Esophageal Cancer Surgery. Nutr Cancer 2022; 74:2846-2858. [DOI: 10.1080/01635581.2022.2036769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Konstantinos S. Mylonas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Athanasios Syllaios
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | | | | | - Georgios Marinos
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Karavokyros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
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Liu X, Lei S, Wei Q, Wang Y, Liang H, Chen L. Machine Learning-based Correlation Study between Perioperative Immunonutritional Index and Postoperative Anastomotic Leakage in Patients with Gastric Cancer. Int J Med Sci 2022; 19:1173-1183. [PMID: 35919820 PMCID: PMC9339417 DOI: 10.7150/ijms.72195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022] Open
Abstract
Backgrounds: The immunonutritional index showed great potential for predicting postoperative complications in various malignant diseases, while risk assessment based on machine learning (ML) methods is becoming popular in clinical practice. Early detection and prevention for postoperative anastomotic leakage (AL) play an important role in prognosis improvement among patients with gastric cancer (GC). Methods: This retrospective study included 297 patients with gastric cancer receiving gastrectomy between 2018 and 2021 in general surgery department of Xinhua Hospital. Perioperative clinical variables were collected to evaluate the predictive value for postoperative AL with 5 ML models. Then, AUROC was applied to identify the optimal perioperative clinical index and ML model for predicting postoperative AL. Results: The incidence of postoperative AL was 6.1% (n=18). After the training of 5 ML classification models, we found that immunonutritional index had significantly better classification ability than inflammatory or nutritional index alone separately (AUROC=0.87 vs. 0.83, P=0.01; AUROC=0.87 vs. 0.68, P<0.01). Next, we found that support vector machine (SVM), one of the ML methods, with selected immunonutritional index showed significantly greater classification ability than optimal univariant parameter [CRP on postoperative day 4 (AUROC=0.89 vs.0.86, P=0.02)]. Also, statistical analysis revealed multiple variables with significant relevance to postoperative AL, including serum CRP and albumin on postoperative day 4, NLR and SII etc. Conclusion: This study showed that perioperative immunonutritional index could act as an indicator for postoperative AL. Also, ML methods could significantly enhance the classification ability, and therefore, could be applied as a powerful tool for postoperative risk assessment for patients with GC.
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Affiliation(s)
- Xuanyu Liu
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Su Lei
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Qi Wei
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Yizhou Wang
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Haibin Liang
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Lei Chen
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
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Bhattacharyya A, Ramamoorthy L, Pottakkat B. Effect of Pre-operative Nutritional Protocol Implementation on Postoperative Outcomes Following Gastrointestinal Surgeries: A Randomized Clinical Trial. J Caring Sci 2021; 10:177-183. [PMID: 34849362 PMCID: PMC8609123 DOI: 10.34172/jcs.2021.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/02/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction: A significant proportion of patients undergoing major gastrointestinal operations suffer from malnutrition. Although the benefit of postoperative nutritional support is well established, the effects of energy intake during pre-operative period is less reported. The present study was designed to test the effect of structured pre-operative nutritional therapy on the postoperative recovery of patients undergoing major gastrointestinal operations.
Methods: A randomized clinical trial was conducted among 80 patients of the surgical gastroenterology department of a tertiary care center in south India. A simple random sampling method was used. The nutritional status of all participants was assessed by subjective global assessment (SGA). While control group received standard energy intake nutrition, the experimental group received calculated nutrition with an extra 50 g of soy protein for seven days pre operatively. Data were analysed using SPSS version 20.
Results: The median day of removal of abdominal drainage tube was 3 (0-5) compared to 5 (2.5-7.5) in the control group. In the intervention group, the median time for the appearance of bowel sounds and starting of enteral feeding was 1.1 (0.5) days and 2 (1-2) days, while in the control group, it was 1.6 (0.9) days, 3 (1-4) days, respectively which was significant at P < 0.05. Similarly, the mean (SD) postoperative serum albumin on third day was 3.6 (0.4) g/dL vs 3.4 (0.4) g/dL experimental and in the control group.
Conclusion: Preoperative nutrition protocol improved the patients’ clinical outcomes in terms of post-operative serum albumin, the timing of bowel sounds, and early initiation of enteral feeds.
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Affiliation(s)
- Ananya Bhattacharyya
- Department of Medical Surgical Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Lakshmi Ramamoorthy
- Department of Medical Surgical Nursing, College of Nursing, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Biju Pottakkat
- Department of Surgical Gastro Enterology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Cheng YX, Tao W, Liu XY, Yuan C, Zhang B, Zhang W, Peng D. The outcome of young vs. old gastric cancer patients following gastrectomy: a propensity score matching analysis. BMC Surg 2021; 21:399. [PMID: 34798854 PMCID: PMC8603584 DOI: 10.1186/s12893-021-01401-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose The purpose of the current study was to compare the postoperative complications, overall survival and disease-free survival in young and old gastric cancer patients after gastrectomy using propensity score matching (PSM). Methods Adult patients (aged ≥ 18 years) who underwent gastrectomy for gastric cancer in a single clinical center from January 2013 to December 2017 were enrolled continuously for retrospective analysis. To minimize the selection bias between the young and old groups, the PSM was conducted in this study. Results A total of 558 patients were included in this study, with 51 patients in the young group (aged ≤ 45 years) and 507 patients in the old group (aged > 45 years). After 1:1 matching according to PSM, 51 patients in the young group were matched to 51 patients in the old group. After PSM, there was no difference in the baseline information. In terms of short-term outcomes, no difference was found in operation time (P = 0.190), intraoperative blood loss (P = 0.336), retrieved lymph nodes (P = 0.948), blood transfusion (P = 0.339), postoperative hospital stay (P = 0.194), or postoperative complications (P = 0.477) between the two groups. For overall survival, no statistically significant difference was found in all stages (P = 0.383), stage I (P = 0.431), stage II (P = 0.875) or stage III (P = 0.446) gastric cancer. Furthermore, regarding disease-free survival, no differences were found between the two groups in all stages (P = 0.378), stage I (P = 0.431), stage II (P = 0.879) or stage III (P = 0.510) gastric cancer. Conclusion Age might not be an independent prognostic factor for short-term outcomes, OS, or DFS in gastric cancer patients who underwent gastrectomy. The pTNM stage of GC might be an independent prognostic factor for OS and DFS.
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Affiliation(s)
- Yu-Xi Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Tao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chao Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bin Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Dan Zeng CD, Tong YX, Xiao AT, Gao C, Zhang S. Peripheral Lymphocyte Subsets Absolute Counts as Feasible Clinical Markers for Predicting Surgical Outcome in Gastric Cancer Patients After Laparoscopic D2 Gastrectomy: A Prospective Cohort Study. J Inflamm Res 2021; 14:5633-5646. [PMID: 34744447 PMCID: PMC8565983 DOI: 10.2147/jir.s335847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Immune function influenced patients’ recovery from major abdominal surgery. The aim of this study is to explore the clinical feasibility of peripheral lymphocyte absolute counts for predicting short-term surgical outcomes in gastric cancer patients after laparoscopic D2 gastrectomy. Methods This is a prospective cohort study from a single tertiary referral hospital. Patients diagnosed with gastric cancer who met the inclusion criteria were included in this study. We collected the demographic and clinicopathological characteristics of included patients. We monitored perioperative dynamics of absolute counts of peripheral lymphocyte subsets. Predictive factors for length of postoperative hospital stay and complications were investigated in univariate and multivariate analyses. Results A total of 137 gastric cancer patients were included. Decreased preoperative absolute counts of peripheral lymphocyte subsets were correlated with advanced clinical stage. In multivariate analysis, independent predictive factors for prolonged hospital stay were age (p=0.04), decreased preoperative B cell counts (p=0.05), decreased preoperative NK cell counts (p=0.05) and complications (p<0.01). For postoperative complication, independent predictive factors were age (p=0.02), operation time (p=0.05), lymphocyte to C-reactive protein ratio (p=0.01) and decreased preoperative B cell counts (p=0.01). Conclusion Our findings for the first time revealed that absolute counts of peripheral lymphocyte subsets are independent predictive factors for surgical outcomes in gastric cancer patients after D2 gastrectomy. We suggested that patients with impaired immune state should receive both preoperative immune modulator and nutritional support.
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Affiliation(s)
- Ci Dian Dan Zeng
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yi Xin Tong
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ai Tang Xiao
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chun Gao
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Cheng YX, Tao W, Liu XY, Zhang H, Yuan C, Zhang B, Zhang W, Peng D. Does Chronic Kidney Disease Affect the Surgical Outcome and Prognosis of Patients with Gastric Cancer? A Meta-Analysis. Nutr Cancer 2021; 74:2059-2066. [PMID: 34693829 DOI: 10.1080/01635581.2021.1993277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this meta-analysis was to evaluate the impact of chronic kidney disease on short-term complications and long-term survival in patients with gastric cancer. The PubMed, Embase, and Cochrane Library databases were searched from inception to May 18, 2021. The search strategy focused on two keywords: chronic kidney disease and gastric cancer. Pooled odds ratios, mean differences, and hazard ratios were analyzed. RevMan 5.3 was used for data analysis in this meta-analysis. A total of seven studies including 3,346 patients were included in this meta-analysis. The chronic kidney disease group had a higher proportion of males and older patients, lower albumin levels, higher comorbidity rates, and higher N staging. The chronic kidney disease group had higher rates of overall postoperative complications (OR = 2.05, 95% CI = 1.38 to 3.05, P = 0.0004), more severe postoperative complications (OR = 2.06, 95% CI = 1.59 to 2.66, P < 0.00001), and higher rates of cardiovascular-related complications, anastomotic leakage, pneumonia, wound infections, pancreatic-related diseases and short-term death. Furthermore, the chronic kidney disease group had poorer overall survival than the nonchronic kidney disease group (HR = 2.89, 95% CI = 2.20 to 3.80, P < 0.00001). Preexisting chronic kidney disease was associated with higher complications and poorer overall survival following gastrectomy in patients with gastric cancer.
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Affiliation(s)
- Yu-Xi Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Tao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hua Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bin Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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E-PASS scoring system serves as a predictor of short- and long-term outcomes in gastric cancer surgery. Surg Today 2021; 52:914-922. [PMID: 34694494 DOI: 10.1007/s00595-021-02394-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSES This study aimed to evaluate the estimation of the physiological ability and surgical stress (E-PASS) scoring system for predicting the short- and long-term outcomes in gastric cancer (GC) surgery. METHODS We analyzed a multi-institutional dataset to study patients who underwent gastrectomy with a curative intent between 2010 and 2014. This study evaluated the associations between the optimal E-PASS score cutoff value and the following outcomes: (1) the incidence of postoperative complications in stage I-III GC patients and (2) the prognosis in stage II-III GC patients. RESULTS A total of 2495 GC patients were included. A cutoff value of 0.419 was determined using the ROC curve analysis. Postoperative complications were observed more frequently in the E-PASS-high group than that in the E-PASS-low group (30% vs. 17%, p < 0.0001). Among pStage II-III GC patients (n = 1009), the overall survival time of the E-PASS-high group was significantly shorter than that of the E-PASS-low group (hazard ratio 2.08; 95% confidence interval 1.64-2.65; p < 0.0001). A forest plot revealed that E-PASS-high was associated with a greater prognostic factor for overall survival in most subgroups. CONCLUSIONS The E-PASS scoring system may therefore be a useful predictor of the short- and long-term outcomes in patients with GC who have undergone radical gastrectomy.
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Nakamura N, Kaida D, Tomita Y, Miyata T, Miyashita T, Fujita H, Kinami S, Ueda N, Takamura H. Risk Factors for Overall Complications and Remote Infection After Gastrectomy in Elderly Gastric Cancer Patients. In Vivo 2021; 35:2917-2921. [PMID: 34410987 DOI: 10.21873/invivo.12582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/20/2021] [Accepted: 06/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM A significant predictive factor for the occurrence of complications after gastrectomy in elderly gastric cancer patients is yet to be determined. We aimed to evaluate the clinical factors associated with overall complications including remote infection after gastrectomy in elderly gastric cancer patients. PATIENTS AND METHODS We retrospectively analyzed data of 101 patients aged over 80 years, who underwent curative gastrectomy. We analyzed the clinicopathological factors that were independently associated with the occurrence of overall complications or remote infection by a logistic regression model. RESULTS The overall complication rate was 24.8%. We identified pneumonia as a remote infection, and the occurrence rate of remote infections was 5.9%. On multivariate analysis, hemoglobin (<11 g/dl) and operation time (>240 min) were significantly correlated with the occurrence of overall complications. Regarding the occurrence of remote infection, performing total gastrectomy and a hemoglobin level <11 g/dl were identified as significant risk factors. CONCLUSION Preoperative anemia and intraoperative factors, including the surgical procedure, could affect the occurrence of postoperative complications in elderly patients.
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Affiliation(s)
- Naohiko Nakamura
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Daisuke Kaida
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Yasuto Tomita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Takashi Miyata
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Tomoharu Miyashita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Hideto Fujita
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Nobuhiko Ueda
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
| | - Hiroyuki Takamura
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Ishikawa, Japan
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Liu R, Lai X, Wang J, Zhang X, Zhu X, Lai PBS, Guo CR. A non-linear ensemble model-based surgical risk calculator for mixed data from multiple surgical fields. BMC Med Inform Decis Mak 2021; 21:88. [PMID: 34330254 PMCID: PMC8323237 DOI: 10.1186/s12911-021-01450-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The misestimation of surgical risk is a serious threat to the lives of patients when implementing surgical risk calculator. Improving the accuracy of postoperative risk prediction has received much attention and many methods have been proposed to cope with this problem in the past decades. However, those linear approaches are inable to capture the non-linear interactions between risk factors, which have been proved to play an important role in the complex physiology of the human body, and thus may attenuate the performance of surgical risk calculators. METHODS In this paper, we presented a new surgical risk calculator based on a non-linear ensemble algorithm named Gradient Boosting Decision Tree (GBDT) model, and explored the corresponding pipeline to support it. In order to improve the practicability of our approach, we designed three different modes to deal with different data situations. Meanwhile, considering that one of the obstacles to clinical acceptance of surgical risk calculators was that the model was too complex to be used in practice, we reduced the number of input risk factors according to the importance of them in GBDT. In addition, we also built some baseline models and similar models to compare with our approach. RESULTS The data we used was three-year clinical data from Surgical Outcome Monitoring and Improvement Program (SOMIP) launched by the Hospital Authority of Hong Kong. In all experiments our approach shows excellent performance, among which the best result of area under curve (AUC), Hosmer-Lemeshow test ([Formula: see text]) and brier score (BS) can reach 0.902, 7.398 and 0.047 respectively. After feature reduction, the best result of AUC, [Formula: see text] and BS of our approach can still be maintained at 0.894, 7.638 and 0.060, respectively. In addition, we also performed multiple groups of comparative experiments. The results show that our approach has a stable advantage in each evaluation indicator. CONCLUSIONS The experimental results demonstrate that NL-SRC can not only improve the accuracy of predicting the surgical risk of patients, but also effectively capture important risk factors and their interactions. Meanwhile, it also has excellent performance on the mixed data from multiple surgical fields.
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Affiliation(s)
- Ruoyu Liu
- School of Computer Science and Technology, Xi’an Jiaotong University, Xi’an, 710049 China
| | - Xin Lai
- School of Computer Science and Technology, Xi’an Jiaotong University, Xi’an, 710049 China
- Department of Tumor Gynecology, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, 350014 China
| | - Jiayin Wang
- School of Computer Science and Technology, Xi’an Jiaotong University, Xi’an, 710049 China
| | - Xuanping Zhang
- School of Computer Science and Technology, Xi’an Jiaotong University, Xi’an, 710049 China
| | - Xiaoyan Zhu
- School of Computer Science and Technology, Xi’an Jiaotong University, Xi’an, 710049 China
| | - Paul B. S. Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Ci-ren Guo
- Department of Tumor Gynecology, Fujian Medical University Cancer Hospital and Fujian Cancer Hospital, Fuzhou, 350014 China
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Alemdar A, Eğin S, Yılmaz I, Kamalı S, Duman MG. Can intraoperative endoscopy prevent esophagojejunal anastomotic leakage after total gastrectomy? Hippokratia 2021; 25:108-112. [PMID: 36683901 PMCID: PMC9851135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Esophagojejunostomy (EJ) is frequently performed after total gastrectomy for proximal gastric tumors. Despite evolving surgical techniques and improving perioperative care, the EJ leak is one of the most severe life-threatening complications. This study investigated the preventability of postoperative anastomotic complications by performing intraoperative endoscopy. METHODS We included 86 patients who underwent total gastrectomy and Roux-en-Y esophagojejunostomy anastomosis in the study. Patients were divided into two groups and analyzed retrospectively. Group 1 consisted of 43 patients who did not undergo intraoperative endoscopy between 2017 and 2019, and Group 2 included 43 patients who underwent intraoperative endoscopy between 2019 and 2020. RESULTS Esophagojejunostomy anastomotic leak (EAL) was observed in 2.3 % of patients in Group 1 but not in Group 2. Anastomosis-related abnormal findings (anastomotic defect, bleeding, air leak, mucosal separation) were recorded in seven patients of Group 2 during endoscopy. When such findings were observed, additional full-thickness sutures were placed on the anastomosis line and strengthened. Complication related to anastomosis was not observed in the postoperative period in Group 2. DISCUSSION After a total gastrectomy, the most severe complication affecting mortality, morbidity, and consequently the cost of the disease is esophagojejunal anastomotic leakage. Most of these complications are induced by technical errors not noticed during surgery. The crucial advantage of performing intraoperative endoscopy is the technically detailed evaluation of anastomosis. CONCLUSION Intraoperative endoscopy is a safe method to evaluate the strength of anastomosis. This procedure provides detailed information regarding anastomotic integrity. HIPPOKRATIA 2021, 25 (3):108-112.
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Affiliation(s)
- A Alemdar
- Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, İstanbul, Turkey
| | - S Eğin
- Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, İstanbul, Turkey
| | - I Yılmaz
- Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, İstanbul, Turkey
| | - S Kamalı
- Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, İstanbul, Turkey
| | - M G Duman
- Department of General Surgery, Prof. Dr. Cemil Taşçıoğlu Şehir Hastanesi, İstanbul, Turkey
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Aoyama T, Nakazono M, Nagasawa S, Segami K. Clinical Impact of a Perioperative Exercise Program for Sarcopenia and Overweight/Obesity Gastric Cancer. In Vivo 2021; 35:707-712. [PMID: 33622863 DOI: 10.21873/invivo.12311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
Gastrectomy with D2 lymph node dissection and perioperative adjuvant treatment is the standard treatment for locally advanced gastric cancer. However, the morality rate is reported to be 20%-40% after gastrectomy for gastric cancer. Perioperative sarcopenia and obesity are strongly related to postoperative surgical complications after gastrectomy. Furthermore, recent studies have shown that postoperative surgical complications are related to long-term oncological outcomes. If we can prevent or improve perioperative sarcopenia or obesity in gastric cancer patients, the rate of postoperative surgical complications in these patients might be reduced, thereby improving the long-term oncological outcomes. Given this hypothesis, recent studies have focused on enacting perioperative exercise programs for gastric cancer patients with sarcopenia and overweight/obesity. Such exercise programs have proven promising and demonstrated some clinical benefits for gastric cancer patients with sarcopenia and overweight/obesity. However, whether or not perioperative exercise programs have clinical benefits with regard to long-term oncological outcomes in gastric cancer patients is unclear. To optimize these perioperative exercise programs for gastric cancer patients, it is necessary to clarify the benefits with regard to the long-term oncological outcomes in these patients and establish an optimal perioperative exercise program.
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Affiliation(s)
- Toru Aoyama
- Department of Surgery, Yokohama City University, Yokohama, Japan; .,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Masato Nakazono
- Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Shinsuke Nagasawa
- Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kenki Segami
- Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
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Zhang Y, Wang X, Yang H. Effect of traditional Chinese medicine nursing on postoperative patients with gastric cancer and its impact on quality of life. Am J Transl Res 2021; 13:5589-5595. [PMID: 34150162 PMCID: PMC8205706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the effect of traditional Chinese medicine (TCM) nursing on postoperative patients with gastric cancer and its impact on quality of life. METHODS According to the random number table method, 103 patients with gastric cancer were divided into observation group (n=52, TCM nursing) and control group (n=51, routine nursing). The postoperative recovery of gastrointestinal function, the scores of mental states, inflammatory index, self-esteem scale (SES) and quality of life score (generic quality of life inventory-74 scale, GQOLI-74 scale) before and after intervention were compared between the two groups, and the adverse reactions were recorded. RESULTS Compared with the control group, the first postoperative exhaust time, the regression time of epigastric distension symptoms, the first defecation time and the time of returning to normal eating in the observation group were shorter than those in the control group (all P<0.05). After intervention, the scores of Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and the levels of serum TNF-α, CRP and IL-1β in the two groups were lower than those before intervention, and those in the observation group were lower than those in the control group (all P<0.05). After intervention, the scores of SES and GQOLI-74 in both groups were higher than those before intervention, and those in the observation group were higher than those in the control group (all P<0.05). During hospitalization, the total incidence of adverse reactions in the observation group was lower than that in the control group (P<0.05). CONCLUSION Perioperative TCM nursing for patients with gastric cancer can more obviously improve postoperative gastrointestinal dysfunction, alleviate acute inflammation, improve postoperative unhealthy mental state, reduce the occurrence of postoperative complications, and finally improve the quality of life of postoperative patients, which is worthy of clinical application.
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Affiliation(s)
- Yi Zhang
- Department of Oncology, The Central Hospital of WuhanWuhan, Hubei Province, China
| | - Xueyan Wang
- Department of Hospital Infection Management, Liaocheng People’s HospitalLiaocheng, Shandong Province, China
| | - Haixia Yang
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’an, Shaanxi Province, China
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Garcia D, Siegel JB, Mahvi DA, Zhang B, Mahvi DM, Camp ER, Graybill W, Savage SJ, Giordano A, Giordano S, Carneiro-Pla D, Javid M, Lesher AP, Abbott A, DeMore NK. What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer. ACTA ACUST UNITED AC 2020; 3:1-11. [PMID: 34142081 PMCID: PMC8208646 DOI: 10.31487/j.cor.2020.06.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The impact of the COVID-19 pandemic has spread beyond those infected with SARS-CoV-2. Its widespread consequences have affected cancer patients whose surgeries may be delayed in order to minimize exposure and conserve resources. Methods Experts in each surgical oncology subspecialty were selected to perform a review of the relevant literature. Articles were obtained through PubMed searches in each cancer subtype using the following terms: delay to surgery, time to surgery, outcomes, and survival. Results Delays in surgery > 4 weeks in breast cancer, ductal carcinoma in situ, T1 pancreatic cancer, ovarian cancer, and pediatric osteosarcoma, negatively impacted survival. Studies on hepatocellular cancer, colon cancer, and melanoma (Stage I) demonstrated reduced survival with delays > 3 months. Conclusion Studies have shown that short-term surgical delays can result in negative impacts on patient outcomes in multiple cancer types as well as in situ carcinoma. Conversely, other cancers such as gastric cancer, advanced melanoma and pancreatic cancer, well-differentiated thyroid cancer, and several genitourinary cancers demonstrated no significant outcome differences with surgical delays.
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Affiliation(s)
- Denise Garcia
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Julie B Siegel
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David A Mahvi
- Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA
| | - Biqi Zhang
- Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA
| | - David M Mahvi
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - E Ramsay Camp
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Whitney Graybill
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephen J Savage
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Antonio Giordano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sara Giordano
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Denise Carneiro-Pla
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA.,Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mahsa Javid
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Aaron P Lesher
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrea Abbott
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nancy Klauber DeMore
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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