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Moriyama T, Ohuchida K, Ohtsuka T, Shindo K, Ikenaga N, Nakata K, Nakamura M. Higher incidence of cholelithiasis with Roux-en-Y reconstruction compared with Billroth-I after laparoscopic distal gastrectomy for gastric cancer: a retrospective cohort study. Langenbecks Arch Surg 2024; 409:75. [PMID: 38409456 DOI: 10.1007/s00423-024-03267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Cholelithiasis occurs often after gastrectomy. However, no consensus has been established regarding the difference in the incidence of postgastrectomy cholelithiasis with different reconstruction methods. In this study, we examined the frequency of cholelithiasis after two major reconstruction methods, namely Billroth-I (B-I) and Roux-en-Y (R-Y) following laparoscopic distal gastrectomy (LDG) for gastric cancer. METHODS Among 696 gastric cancer patients who underwent LDG between April 2000 and March 2017, after applying the exclusion criteria, 284 patients who underwent B-I and 310 who underwent R-Y were examined retrospectively. The estimated incidence of cholelithiasis was compared between the methods, and factors associated with the development of cholelithiasis in the gallbladder and/or common bile duct were investigated. RESULTS During the median follow-up of 61.2 months, 52 patients (8.8%) developed cholelithiasis postgastrectomy; 12 patients (4.2%) after B-I and 40 (12.9%) after R-Y (p = 0.0002). Among them, choledocholithiasis was more frequent in patients who underwent R-Y (n = 11, 27.5%) vs. B-I (n = 1, 8.3%) (p = 0.0056). Univariate and multivariate analyses revealed that male sex, body mass index > 22.5 kg/m2, and R-Y reconstruction were significant predictors of the development of postLDG cholelithiasis. CONCLUSION Regarding cholelithiasis development, B-I reconstruction should be preferred whenever possible during distal gastrectomy.
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Affiliation(s)
- Taiki Moriyama
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
- Seiryo Iwasato Hospital, Hita, Oita, Japan
| | - Kenoki Ohuchida
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan.
| | - Takao Ohtsuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan
| | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Naoki Ikenaga
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Kyushu University Medical Sciences, 3-1-1, Maidashi, Fukuoka, 812-8582, Japan
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Abouzid A, Setit A, Abdallah A, Abd Elghaffar M, Shetiwy M, Elzahaby IA. Laparoscopic gastrectomy for gastric cancer: A single cancer center experience. Turk J Surg 2023; 39:354-364. [PMID: 38694526 PMCID: PMC11057925 DOI: 10.47717/turkjsurg.2023.6158] [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: 06/22/2023] [Accepted: 12/20/2023] [Indexed: 05/04/2024]
Abstract
Objectives Laparoscopic gastrectomy (LG) was challenging to most surgeons due to the two-dimensional view, difficult manipulations of the instruments, ergonomic discomfort, and the associated muscular spasm and effort. Technological advances with improved surgical experience, have made LG a more feasible and favorable approach for gastric cancer (GC) patients. Material and Methods LG was performed in 44 patients with GC between July 2015 to June 2022, in the Department of Surgical Oncology, Oncology Center, Mansoura University, Egypt, and we assessed the surgical outcomes of this approach as an initial experience of a single cancer center. Results Twenty-seven patients underwent laparoscopic distal gastrectomy, and seventeen underwent laparoscopic total gastrectomy. Two cases had combined resection. Operative time was 339.2 ± 76.73 min, while blood loss was 153.86 ± 57.51 mL. The patients were ambulant on postoperative day 0, oral intake was started within three days (range 1-5 days) and the hospital stay was six days (range 3-9 days). Conclusion LG for GC is a feasible approach for both early and advanced GC patients as it allows for adequate diagnosis of the peritoneal disease, meticulous dissection, and identification of the lymph nodes with minimal blood loss and decrease surgery-related problems and encourage the early patients' discharge from hospital and return to daily life activities.
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Affiliation(s)
- Amr Abouzid
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Setit
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Abdallah
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Abd Elghaffar
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Mosab Shetiwy
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
| | - Islam A. Elzahaby
- Department of Surgical Oncology, Oncology Center, Mansoura University, Mansoura, Egypt
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Di Carlo S, Siragusa L, Fassari A, Fiori E, La Rovere F, Izzo P, Usai V, Cavallaro G, Franceschilli M, Dhimolea S, Sibio S. Laparoscopic versus Open Total Gastrectomy for Locally Advanced Gastric Cancer: Short and Long-Term Results. Curr Oncol 2022; 29:8442-8455. [PMID: 36354725 PMCID: PMC9689079 DOI: 10.3390/curroncol29110665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy for early gastric cancer is widely accepted and routinely performed. However, it is still debated whether the laparoscopic approach is a valid alternative to open gastrectomy in advanced gastric cancer (AGC). The aim of this study is to compare short-and long-term outcomes of laparoscopic (LG) and open (OG) total gastrectomy with D2 lymphadenectomy in patients with AGC. METHODS A retrospective comparative study was conducted on patients who underwent LG and OG for ACG between January 2015 and December 2021. Primary endpoints were the following: recurrence rate, 3-year disease-free survival, 3-year and 5-year overall survival. Univariate and multivariate analysis was conducted to compare variables influencing outcomes and survival. RESULTS Ninety-two patients included: fifty-three OG and thirty-nine LG. No difference in morbidity and mortality. LG was associated with lower recurrence rates (OG 22.6% versus LG 12.8%, p = 0.048). No differences in 3-year and 5-year overall survival; 3-year disease-free survival was improved in the LG group on the univariate analysis but not after the multivariate one. LG was associated with longer operative time, lower blood loss and shorter hospital stay. Lymph node yield was higher in LG. CONCLUSION LG for AGC seems to provide satisfactory clinical and oncological outcomes in medium volume centers, improved postoperative results and possibly lower recurrence rates.
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Affiliation(s)
- Sara Di Carlo
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Alessia Fassari
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Enrico Fiori
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca La Rovere
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Valeria Usai
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
| | - Marzia Franceschilli
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Sirvjo Dhimolea
- Department of Surgical Sciences, University of Rome “Tor Vergata”, Viale Oxford 81, 00133 Rome, Italy
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Sapienza University of Rome, “Umberto I” University Hospital, Viale del Policlinico 155, 00161 Rome, Italy
- Correspondence:
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Caruso S, Giudicissi R, Mariatti M, Cantafio S, Paroli GM, Scatizzi M. Laparoscopic vs. Open Gastrectomy for Locally Advanced Gastric Cancer: A Propensity Score-Matched Retrospective Case-Control Study. Curr Oncol 2022; 29:1840-1865. [PMID: 35323351 PMCID: PMC8947505 DOI: 10.3390/curroncol29030151] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Minimally invasive surgery has been increasingly used in the treatment of gastric cancer. While laparoscopic gastrectomy has become standard therapy for early-stage gastric cancer, especially in Asian countries, the use of minimally invasive techniques has not attained the same widespread acceptance for the treatment of more advanced tumours, principally due to existing concerns about its feasibility and oncological adequacy. We aimed to examine the safety and oncological effectiveness of laparoscopic technique with radical intent for the treatment of patients with locally advanced gastric cancer by comparing short-term surgical and oncologic outcomes of laparoscopic versus open gastrectomy with D2 lymphadenectomy at two Western regional institutions. Methods: The trial was designed as a retrospective comparative matched case-control study for postoperative pathological diagnoses of locally advanced gastric carcinoma. Between January 2015 and September 2021, 120 consecutive patients who underwent curative-intent laparoscopic gastrectomy with D2 lymph node dissection were retrospectively recruited and compared with 120 patients who received open gastrectomy. In order to obtain a comparison that was as homogeneous as possible, the equal control group of pairing (1:1) patients submitted to open gastrectomy who matched those of the laparoscopic group was statistically generated by using a propensity matched score method. The following potential confounder factors were aligned: age, gender, Body Mass Index (BMI), comorbidity, ASA, adjuvant therapy, tumour location, type of gastrectomy, and pT stage. Patient demographics, operative findings, pathologic characteristics, and short-term outcomes were analyzed. Results: In the case-control study, the two groups were clearly comparable with respect to matched variables, as was expected given the intentional primary selective criteria. No statistically significant differences were revealed in overall complications (16.7% vs. 20.8%, p = 0.489), rate of reoperation (3.3% vs. 2.5%, p = 0.714), and mortality (4.2% vs. 3.3%, p = 0.987) within 30 days. Pulmonary infection and wound complications were observed more frequently in the OG group (0.8% vs. 4.2%, p < 0.01, for each of these two categories). Anastomotic and duodenal stump leakage occurred in 5.8% of the patients after laparoscopic gastrectomy and in 3.3% after open procedure (p = 0.072). The laparoscopic approach was associated with a significantly longer operative time (212 vs. 192 min, p < 0.05) but shorter postoperative length of stay (9.1 vs. 11.6 days, p < 0.001). The mean number of resected lymph nodes after D2 dissection (31.4 vs. 33.3, p = 0.134) and clearance of surgical margins (97.5% vs. 95.8%, p = 0.432) were equivalent between the groups. Conclusion: Laparoscopic gastrectomy with D2 nodal dissection appears to be safe and feasible in terms of perioperative morbidity for locally advanced gastric cancer, with comparable oncological equivalency with respect to traditional open surgery.
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Affiliation(s)
- Stefano Caruso
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
- Correspondence: ; Tel.: +39-55-9508373 or +39-349-8312397
| | - Rosina Giudicissi
- Department of General and Oncologic Surgery, Unit of General Surgery, Santo Stefano Hospital, Central Tuscany Local Health Company, 59100 Prato, Italy; (R.G.); (S.C.)
| | - Martina Mariatti
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
| | - Stefano Cantafio
- Department of General and Oncologic Surgery, Unit of General Surgery, Santo Stefano Hospital, Central Tuscany Local Health Company, 59100 Prato, Italy; (R.G.); (S.C.)
| | - Gian Matteo Paroli
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
| | - Marco Scatizzi
- Department of General Surgery and Surgical Specialties, Unit of General Surgery, Santa Maria Annunziata Hospital, Central Tuscany Local Health Company, Via dell’Antella 58, Bagno a Ripoli, 50012 Florence, Italy; (M.M.); (G.M.P.); (M.S.)
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Bjelovic M, Veselinovic M, Gunjic D, Bukumiric Z, Babic T, Vlajic R, Potkonjak D. Laparoscopic Gastrectomy for Cancer: Cut Down Complications to Unveil Positive Results of Minimally Invasive Approach. Front Oncol 2022; 12:854408. [PMID: 35311139 PMCID: PMC8931216 DOI: 10.3389/fonc.2022.854408] [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: 01/13/2022] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Several randomized controlled trials and meta-analyses have confirmed the advantages of laparoscopic surgery in early gastric cancer, and there are indications that this may also apply in advanced distal gastric cancer. The study objective was to evaluate the safety and effectiveness of laparoscopic gastrectomy (LG), in comparison to open gastrectomy (OG), in the management of locally advanced gastric cancer. The single-center, case–control study included 204 patients, in conveyance sampling, who underwent radical gastrectomy for locally advanced gastric cancer. Out of 204 patients, 102 underwent LG, and 102 patients underwent OG. The primary endpoints were safety endpoints, i.e., complication rates, reoperation rates, and 30-day mortality rates. The secondary endpoints were efficacy endpoints, including perioperative characteristics and oncological outcomes. Even though the overall complication rate was higher in the OG group compared to the LG group (30.4% and 19.6%, respectively), the difference between groups did not reach statistical significance (p = 0.075). No significant difference was identified in reoperation rates and 30-day mortality rates. Time spent in the intensive care unit (ICU) and overall hospital stay were shorter in the LG group compared to the OG group (p < 0.001). Although the number of retrieved lymph nodes is oncologically adequate in both groups, the median number is higher in the OG group (35 vs. 29; p = 0.024). Resection margins came out to be negative in 92% of patients in the LG group and 73.1% in the OG group (p < 0.001). The study demonstrated statistically longer survival rates for the patients in the laparoscopic group, which particularly applies to patients in the most prevalent, third stage of the disease. When patients with the Clavien–Dindo grade ≥II were excluded from the survival analysis, further divergence of survival curves was observed. In conclusion, LG can be safely performed in patients with locally advanced gastric cancer and accomplish the oncological standard with short ICU and overall hospital stay. Since postoperative complications could affect overall treatment results and diminish and blur the positive effect of the minimally invasive approach, further clinical investigations should be focused on the patients with no surgical complications and on clinical practice to cut down the prevalence of complications.
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Affiliation(s)
- Milos Bjelovic
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
- *Correspondence: Milos Bjelovic,
| | - Milan Veselinovic
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Gunjic
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Zoran Bukumiric
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Institute for Medical Statistics, Belgrade, Serbia
| | - Tamara Babic
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Radmila Vlajic
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dario Potkonjak
- Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
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Barranquero AG, Priego P, Muñoz P, Bajawi M, Cuadrado M, Blázquez L, Sánchez-Picot S, Galindo J, Fernández-Cebrián JM. Laparoscopic vs. Open Gastrectomy for Advanced Gastric Cancer in a Western Population: a Propensity-Score Matched Analysis of Surgical and Oncological Results. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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7
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Laparoscopic gastrectomy for gastric cancer: has the time come for considered it a standard procedure? Surg Oncol 2022; 40:101699. [PMID: 34995972 DOI: 10.1016/j.suronc.2021.101699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/29/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022]
Abstract
Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer. A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage gastric cancer. At present, laparoscopic gastrectomy is considered a standard procedure for early-stage gastric cancer, especially in Asian countries. On the other hand, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Additional high-quality studies comparing laparoscopic gastrectomy versus open gastrectomy for gastric cancer have been recently published, in particular concerning the latest results obtained by laparoscopic approach to advanced gastric cancer. It seems very useful to update the review of literature in light of these new evidences for this subject and draw some considerations.
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East meets West: the initial results of laparoscopic gastric cancer resections with Eastern principles in a single Western centre - a propensity score-matched study. Langenbecks Arch Surg 2021; 406:2699-2708. [PMID: 34331126 DOI: 10.1007/s00423-021-02283-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND We compared the initial experience of totally laparoscopic gastric cancer surgery with Eastern principles with the results of propensity score-matched counterparts operated with open surgery. METHODS From 1163 patients stored in our database, 62 PSM patients were selected for this study. The quality control was assured with video documentation and standardisation of the procedures. RESULTS According to the distribution of age, comorbidities, and general health, patients in the LG and OG were well-balanced. Most of the patients in both groups had advanced gastric cancer (69.3%). In the OG, 67.8% of patients received a total gastrectomy, as well as 54.8% of patients in the LG. There was no significant difference in the postoperative mortality between groups. The recovery of bowel function was significantly faster, and postoperative pain was significantly decreased in the LG. Compared to the OG, the inflammatory response was significantly smaller in the LG. There was no significant difference in the overall survival between LG and OG patients. CONCLUSION We have shown that laparoscopic gastrectomy with Eastern principles can be safely introduced in a high-volume Western centre with sufficient laparoscopic training. We have also shown that laparoscopy offers a significant faster bowel function recovery, less postoperative pain, and a smaller inflammatory response.
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Khaled I, Priego P, Soliman H, Faisal M, Saad Ahmed I. Oncological outcomes of laparoscopic versus open gastrectomy after neoadjuvant chemotherapy for locally advanced gastric cancer: a retrospective multicenter study. World J Surg Oncol 2021; 19:206. [PMID: 34243773 PMCID: PMC8272390 DOI: 10.1186/s12957-021-02322-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The oncological outcomes of laparoscopic gastrectomy (LG) and open gastrectomy (OG) following neoadjuvant chemotherapy have been investigated in a few studies. Our purpose was to evaluate the oncological outcomes of LG and OG after neoadjuvant chemotherapy in patients with locally advanced gastric cancer (GC) and to determine the advantages, preferences, and ease of use of the two techniques after chemotherapy. METHODS We conducted a retrospective chart review of all patients who underwent either OG (n = 43) or LG (n = 41). The neoadjuvant treatment regimen consisted of capecitabine plus oxaliplatin for three cycles, which was then repeated 6 to 12 weeks after the operation for four cycles. RESULTS The hospital stay time and intraoperative blood loss in the LG group were significantly lower than those in the OG group. The mortality rate and the 3-year survival rate for patients in the LG group were comparable to those of patients in the OG group (4.6% vs. 9.7% and 68.3% vs. 58.1%, respectively). Similar trends were observed regarding the 3-year recurrence rate and metastasis. The mean survival time was 52.9 months (95% confidence interval [CI], 44.2-61.6) in the OG group compared with 43.3 (95% CI, 36.6-49.8) in the LG group. Likewise, the mean disease-free survival was 56.1 months (95% CI, 46.36-65.8) in the LG group compared with 50.9 months (95% CI, 44.6-57.2) in the OG group. CONCLUSION LG is a feasible and safe alternative to OG for patients with locally advanced GC receiving neoadjuvant chemotherapy.
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Affiliation(s)
- Islam Khaled
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Kilo 4.5, Ring Road, Ismailia, Egypt.
| | - Pablo Priego
- Department of Oesophagogastric, Bariatric and Minimally Invasive Surgery, Ramon y Cajal University Hospital, Madrid, Spain
| | - Hany Soliman
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Faisal
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Suez Canal University Hospital, Kilo 4.5, Ring Road, Ismailia, Egypt
| | - Ihab Saad Ahmed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Yüksel C, Erşen O, Mercan Ü, Başçeken Sİ, Bakırarar B, Bayar S, Ünal AE, Demirci S. Long-Term Results and Current Problems in Laparoscopic Gastrectomy: Single-Center Experience. J Laparoendosc Adv Surg Tech A 2020; 30:1204-1214. [PMID: 32348706 PMCID: PMC7699011 DOI: 10.1089/lap.2020.0180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The study aims to evaluate the long-term results of patients who underwent laparoscopic gastrectomy for gastric cancer in Ankara University Medical Faculty, Surgical Oncology Clinic, within 5 years. Materials and Methods: We retrospectively reviewed the data of patients who underwent laparoscopic gastrectomy for gastric cancer at the Surgical Oncology Clinic of Ankara University Medical Faculty between January 2014 and September 2019. One hundred forty-six patients were included in the study. Results: Fifty-one (34.9%) of the patients were female; 95 (65.1%) were male. The mean ± standard deviation and median (minimum-maximum) values of the patients were 60.92 ± 14.13 and 64.00 (22.00-93.00), respectively (Table 1). Eighty-seven (59.6%) cases were located in the antrum, 29 (19.9%) were in the cardia region, and 30 (20.5%) were in the corpus region. Overall, 106 (72.6%) of 146 patients were alive, while 40 (27.4%) were ex. The mean survival was 21.8 months (0-69). Postoperative mortality was seen in 9 patients (6.2%) and our disease-free survival rate was 70.5%. Recurrence occurred in 14 (9.6%) of all patients. [Table: see text] Conclusion: In conclusion, although laparoscopic gastrectomy is a reliable and feasible method for gastric cancer, the standardization of laparoscopic surgery is required in clinics.
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Affiliation(s)
- Cemil Yüksel
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ogün Erşen
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ümit Mercan
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | | | - Batuhan Bakırarar
- Biostatistic Department, Ankara University Medicine Faculty, Ankara, Turkey
| | - Sancar Bayar
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Ali Ekrem Ünal
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
| | - Salim Demirci
- General Surgery Department, Surgical Oncology Clinic, Ankara University Medicine Faculty, Ankara, Turkey
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11
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YALAV O, TOPAL U, ÜNAL AG, RENCÜZOĞULLARI A, ERAY İC, SARTIAŞ AG. Early results in laparoscopic gastric cancer surgery. CUKUROVA MEDICAL JOURNAL 2019; 44:1347-1356. [DOI: 10.17826/cumj.529972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Amaç: Bu çalışmada bir üniversite kliniğinde gerçekleştirilen laparoskopik gastrektomilerin erken dönem sonuçlarının paylaşılması amaçlanmıştır.Gereç ve Yöntem: Eylül 2015- Eylül 2018 tarihleri arasında yapılan laparoskopik gastrektomiler total ve distal olmak üzere iki gruba ayrılmış, teknik, patolojik sonuç ve erken postoperatif komplikasyonlar açısından incelenmiştir.Bulgular: Çalışmaya 11’i erkek, 7’si kadın olmak üzere 18 hasta dahil edilmiştir. Yaş ortalaması 57,4 olup, ortalama BMI 26,3 idi. 13 hastada cerrahi ilk planda tutulmuş sadece beş hastaya neoadjuvan tedavi protokolü uygulanmıştır. Total gastrektomi 14 hastada, distal gastrektomi 4 hastada tercih edilen ameliyat yöntemidir. Tüm hastalara tümör yerleşimine göre standart D2 lenf disseksiyonu uygulandı ve Total gastrektomi grubunda Ortalama 33,2 distal gastrektomi grubunda 32 lenf nodu disseke edildi. Ortalama oral başlama süresi ve Total gastrektomi grubunda 6,4 gün distal gastrektomi grubunda 2,5 gün idi. Duodenal güdük kaçağı 4 hastada, özefagojejunostomi kaçağı 2 hastada tespit edilirken 1 hastada da dren yerinde kanama görüldü.Sonuç: Laparoskopik gastrektomi ve lenfatik disseksiyonun yeterliliğini gösteren birçok çalışma bulunmaktadır. Ancak öğrenim süreci uzun, teknik zorlukları fazla olan bu ameliyatlarda deneyim ve tecrübe arttıkça ameliyat sürenin kısalacağını ve komplikasyon oranının azalacağını düşünmekteyiz.
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Affiliation(s)
- Orçun YALAV
- ÇUKUROVA ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - Uğur TOPAL
- ÇUKUROVA ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - Ayşe Gizem ÜNAL
- ÇUKUROVA ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - Ahmet RENCÜZOĞULLARI
- ÇUKUROVA ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - İsmail Cem ERAY
- ÇUKUROVA ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
| | - Ahmet Gökhan SARTIAŞ
- ÇUKUROVA ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, GENEL CERRAHİ ANABİLİM DALI
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A New Robot-assisted Billroth-I Reconstruction: Details of the Technique and Early Results. Surg Laparosc Endosc Percutan Tech 2018; 28:e33-e39. [PMID: 29346168 DOI: 10.1097/sle.0000000000000505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic surgery for gastric tumor is considered a demanding procedure because of lymph node dissection and reconstruction. Billroth-I (B-I) reconstruction after laparoscopic distal gastrectomy is commonly performed extracorporeally because of the complexity of an intracorporeal procedure. Robotic surgery overcomes some limitations of laparoscopy, allowing to reproduce the basic maneuvers of open surgery. We describe a new technique to perform robotic B-I anastomosis. METHODS Between January 2012 and February 2015, 5 patients underwent distal gastrectomy with intracorporeal B-I-stapled anastomosis. Patient demographics, tumor characteristics, histopathologic features, and perioperative data were analyzed. RESULTS Median operative time was 170 minutes (145 to 180 min). There were no conversions. Contrast swallow was routinely performed on the third postoperative day. Median postoperative hospitalization was 7 days (range: 6 to 8). No major complications or mortality were observed. CONCLUSIONS Robotic distal gastrectomy with intracorporeal B-I anastomosis is a safe and promising technique in selected cases of gastric tumors.
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Dong X, Liu Y. Expression and significance of miR-24 and miR-101 in patients with advanced gastric cancer. Oncol Lett 2018; 16:5769-5774. [PMID: 30405753 PMCID: PMC6202543 DOI: 10.3892/ol.2018.9324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/07/2018] [Indexed: 12/18/2022] Open
Abstract
Clinical significance of micro ribonucleic acid (miR)-24 and miR-101 were investigated by evaluating the expression of miR-24 and miR-101 in the tissues of patients with advanced gastric cancer. A total of 247 gastric cancer tissue specimens and 150 cancer-adjacent normal tissues (>5 cm away from the tumor) from patients with advanced gastric cancer who underwent surgical resection in the Surgical Oncology Department of Tianjin Union Medical Centre (Tianjin, China) from April 2013 to May 2016 were collected. The expression of miR-24 and miR-101 in gastric cancer and cancer-adjacent normal tissues were detected via reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and the correlation of the levels of miR-24 and miR-101 in gastric cancer tissues with their clinical and pathological features were explored. The expression level of miR-24 in gastric cancer tissues was significantly higher than that in cancer-adjacent normal tissues (t=10.26, p<0.01), while the expression level of miR-101 was significantly lower (t=13.940, p<0.01). The expression of miR-24 and miR-101 in gastric cancer was correlated with the pathological differentiation degree of the tumor, lymph node metastasis and depth of infiltration (p<0.05). The multivariate Cox regression analysis revealed that miR-24 and miR-101 were independent prognostic factors affecting the overall survival of patients (p<0.01). The results indicated that the expression of miR-24 is upregulated and that of miR-101 is downregulated in gastric cancer tissues. miR-24 and miR-101 may promote the occurrence, development, infiltration and metastasis of gastric cancer, and can be indicators for the prognosis of patients with gastric cancer.
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Affiliation(s)
- Xuetao Dong
- Department of Gastroenterology, Tianjin Union Medical Centre, Tianjin 300120, P.R. China
| | - Yandi Liu
- Department of Gastroenterology, Tianjin Union Medical Centre, Tianjin 300120, P.R. China
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14
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Rod X, Fuks D, Macovei R, Levard H, Ferraz JM, Denet C, Tubbax C, Gayet B, Perniceni T. Comparison between open and laparoscopic gastrectomy for gastric cancer: A monocentric retrospective study from a western country. J Visc Surg 2018; 155:91-97. [DOI: 10.1016/j.jviscsurg.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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15
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Lianos GD, Hasemaki N, Glantzounis GK, Mitsis M, Rausei S. Assessing safety and feasibility of 'pure' laparoscopic total gastrectomy for advanced gastric cancer in the West. Review article. Int J Surg 2018; 53:275-278. [PMID: 29602017 DOI: 10.1016/j.ijsu.2018.03.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 03/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastric cancer is reported to be the fourth most common cancer and the second leading cause of cancer-related death worldwide. Minimally invasive surgical treatment for gastric cancer is a very challenging approach which offers undoubtedly important advantages. MATERIALS AND METHODS There is intense debate concerning the minimally invasive surgical approach for advanced gastric cancer especially in the Western population. A careful literature search was conducted in order to clarify the feasibility and safety of pure laparoscopic total gastrectomy in the West. RESULTS Herewith we aim to summarize the current scientific evidence assessing the feasibility and short-term outcomes of laparoscopic gastrectomy for advanced gastric cancer in the West. A lack of data from Western institutions regarding minimally invasive surgical approach for gastric cancer is yet a reality. Nevertheless, the laparoscopic procedure appears to provide satisfactory short-term oncologic outcomes and improved postoperative outcomes. CONCLUSION It is obvious that future well-conducted trials on long-term results are necessary for Western patients in order safe conclusions to be reached regarding a potential definitive 'place' for laparoscopy in the curative gastric cancer treatment.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece; Department of Surgery, General Hospital of Preveza, Preveza, Greece.
| | - Natasha Hasemaki
- Department of Surgery, General Hospital of Preveza, Preveza, Greece
| | - Georgios K Glantzounis
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece
| | - Michail Mitsis
- Department of Surgery, University Hospital of Ioannina and University of Ioannina, Ioannina, 45110, Greece
| | - Stefano Rausei
- Department of Surgery, University of Insubria, Varese, Italy
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16
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Liu J, Zhou H, Qin H, Ru H, Huang J, Liang S, Mo X, Tang W. Comparative study of clinical efficacy using three-dimensional and two-dimensional laparoscopies in the treatment of distal gastric cancer. Onco Targets Ther 2018; 11:301-306. [PMID: 29391806 PMCID: PMC5769587 DOI: 10.2147/ott.s153520] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Three-dimensional (3D) laparoscopy has the advantages and characteristics of more radical procedures in the treatment of gastric cancer. The objective of this research was to investigate the short-term efficacy and safety of 3D laparoscopic procedures in the treatment of advanced distal gastric cancer. Methods We retrospectively analyzed the clinical data of 124 patients treated with 3D and two-dimensional (2D) laparoscopic D2 lymphadenectomy for distal gastric cancer at the China Academy of Medical Sciences Cancer Hospital and the Affiliated Cancer Hospital of Guangxi Medical University from January 2014 to January 2015. The effects on operative time, bleeding, hospitalization time, complications, and the number of lymph nodes removed were analyzed. Results The difference between the general data of the two groups was not statistically significant (P>0.05). In analysis of the subgroups, the number of lymph nodes removed in the 3D laparoscopic group was significantly higher than in the 2D laparoscopic group ([2.52±1.88] vs [2.22±1.80], P=0.001; [2.22±1.80] vs [1.47±1.99], P=0.019). However, the differences among the total number of lymph nodes removed, operative time, intraoperative blood loss, intraoperative complications, postoperative complications, postoperative recovery time, and postoperative hospital stay were not statistically significant. Conclusion 3D laparoscopic-assisted radical gastrectomy for distal advanced gastric cancer is safe and feasible.
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Affiliation(s)
- Jungang Liu
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region
| | - Haitao Zhou
- Department of Colorectal Surgery, Tumor Hospital of Chinese Academy of Medical Sciences, Beijing, China
| | - Haiquan Qin
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region
| | - Haiming Ru
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region
| | - Jiahao Huang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region
| | - Siyuan Liang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region
| | - Xianwei Mo
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region
| | - Weizhong Tang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region
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17
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Veziant J, Antomarchi O, Pezet D, Daniel G, Le Roy B. Laparoscopic distal gastrectomy with type D2 lymphadenectomy for adenocarcinoma (hybrid procedure) (with video). J Visc Surg 2017; 154:135-136. [PMID: 28395957 DOI: 10.1016/j.jviscsurg.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Veziant
- Department of Digestive Surgery, Estaing hospital, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - O Antomarchi
- Department of Digestive Surgery, Estaing hospital, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - D Pezet
- Department of Digestive Surgery, Estaing hospital, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - G Daniel
- Department of Digestive Surgery, Estaing hospital, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - B Le Roy
- Department of Digestive Surgery, Estaing hospital, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France.
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18
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Brenkman HJF, Roelen SVS, Steenhagen E, Ruurda JP, van Hillegersberg R. Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas. Chin J Cancer Res 2017; 29:333-340. [PMID: 28947865 PMCID: PMC5592821 DOI: 10.21147/j.issn.1000-9604.2017.04.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self-controlled study was to examine the effect of jejunostomy tube feeding (JTF) and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer. METHODS All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy placement were included from a prospective single-center database (2003-2014). Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastrectomy. RESULTS Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range (IQR), 10-55 d]. Jejunostomy-related complications occurred in 11 (17%) patients, including skin leakage (n=3) and peritoneal leakage (n=2), luxation (n=3), occlusion (n=2), infection (n=1) and torsion (n=1). In 2 (3%) patients, a reoperation was needed due to jejunostomy-related complications. The mean preoperative weight of patients was 71.8 kg (100%), and remained stable during JTF (73.9 kg, 103%, P=0.331). After JTF was stopped, the mean weight of patients decreased to 64.9 kg (90%) at 12 months after surgery (P<0.001). A high preoperative body mass index (BMI) (≥25 kg/m2) was associated with high postoperative weight loss compared to patients with a low BMI (<25 kg/m2) (16.3% vs. 8.6%, P=0.016). CONCLUSIONS JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.
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Affiliation(s)
- Hylke J F Brenkman
- Cancer Center, Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Stéphanie V S Roelen
- Cancer Center, Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Elles Steenhagen
- Cancer Center, Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Jelle P Ruurda
- Cancer Center, Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Richard van Hillegersberg
- Cancer Center, Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, the Netherlands
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Treitl D, Hochwald SN, Bao PQ, Unger JM, Ben-David K. Laparoscopic Total Gastrectomy with D2 Lymphadenectomy and Side-to-Side Stapled Esophagojejunostomy. J Gastrointest Surg 2016; 20:1523-9. [PMID: 27184675 DOI: 10.1007/s11605-016-3162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/02/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An optimal method has yet to be established for laparoscopic total gastrectomy with intracorporeal anastomosis. METHODS We aim to describe a simple technique for intracorporeal anastomoses. Technique of laparoscopic total gastrectomy with side-to-side stapled intracorporeal esophagojejunostomy anastomosis and Roux-en-Y jejunojejunostomy is performed on patients with gastric malignancy in an academic community tertiary care center. RESULTS The anastomotic technique of laparoscopic total gastrectomy with side-to-side stapled esophagojejunostomy is described. CONCLUSION Laparoscopic total gastrectomy with D2 lymphadenectomy and side-to-side esophagojejunostomy is safe to perform and has the advantage of a wide lumen with low chance for stricture. A laparoscopic total gastrectomy with stapled side-to-side esophagojejunostomy is feasible and safe in advanced gastric cancer.
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Affiliation(s)
- Daniela Treitl
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA
| | - Steven N Hochwald
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA
| | - Philip Q Bao
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA
| | - Joshua M Unger
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA
| | - Kfir Ben-David
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA.
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Caruso S, Patriti A, Roviello F, De Franco L, Franceschini F, Coratti A, Ceccarelli G. Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations. World J Gastroenterol 2016; 22:5694-5717. [PMID: 27433084 PMCID: PMC4932206 DOI: 10.3748/wjg.v22.i25.5694] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 05/20/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.
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21
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Li HZ, Chen JX, Zheng Y, Zhu XN. Laparoscopic-assisted versus open radical gastrectomy for resectable gastric cancer: Systematic review, meta-analysis, and trial sequential analysis of randomized controlled trials. J Surg Oncol 2016; 113:756-67. [PMID: 27076039 DOI: 10.1002/jso.24243] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/21/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Previous studies comparing laparoscopic-assisted to open gastrectomy (OG) for resectable gastric cancer were inexhaustive, so an updated meta-analysis was performed to clarify quality of life, patient satisfaction, safety and effectiveness associated with laparoscopic-assisted gastrectomy (LAG). METHODS Pubmed, Embase, and The Cochrane Library were searched from inception to December 2015 for randomized controlled trials (RCTs) comparing LAG with OG for resectable gastric cancer. Relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were pooled with random-effects model. Furthermore, trial sequential analysis (TSA) was employed to indicate the credibility of pooled estimate. RESULTS Fourteen RCTs totaling 2,307 gastric cancer patients (1,163 in laparoscopic and 1,144 in open) were included. Compared with OG, LAG showed higher patient satisfaction and quality of life, less blood loss, hospital stay and overall postoperative morbidity, and longer operating time, which were confirmed by TSA. LAG also accelerated time to first flatus, first walking and first intake and reduced frequency of analgesic administration and days of fever. There were no significant difference between the two groups in number of retrieved lymph nodes, mortality, recurrence, long-term overall survival and disease-free survival. CONCLUSION For patients with resectable gastric cancer, LAG decreased blood loss, length of hospital stay and overall postoperative morbidity and improved postsurgical recovery. J. Surg. Oncol. 2016;113:756-767. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hui-Zi Li
- Department of General Surgery, The Fourth Affiliated Hospital of Nan Chang University, Nanchang, Jiangxi, China
| | - Jia-Xi Chen
- Department of General Surgery, The Fourth Affiliated Hospital of Nan Chang University, Nanchang, Jiangxi, China
| | - Yang Zheng
- Department of General Surgery, The Fourth Affiliated Hospital of Nan Chang University, Nanchang, Jiangxi, China
| | - Xiang-Nan Zhu
- Department of General Surgery, The Fourth Affiliated Hospital of Nan Chang University, Nanchang, Jiangxi, China
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22
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Brenkman HJF, Correa-Cote J, Ruurda JP, van Hillegersberg R. A Step-Wise Approach to Total Laparoscopic Gastrectomy with Jejunal Pouch Reconstruction: How and Why We Do It. J Gastrointest Surg 2016; 20:1908-1915. [PMID: 27561635 PMCID: PMC5078159 DOI: 10.1007/s11605-016-3235-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/02/2016] [Indexed: 02/06/2023]
Abstract
Laparoscopic gastrectomy (LG) is a safe alternative compared to open gastrectomy for cancer. To increase the uptake of minimally invasive approaches and facilitate their analysis and improvement a stepwise approach is warranted. This study describes our technique and experiences total laparoscopic gastrectomy (TLG) with jejunal pouch reconstruction for gastric cancer. Technical modifications throughout the years were described. In patients with anastomotic leakage, the CT-scan and reoperation report were reviewed to identify the location and cause of the leak. A total of 47 patients who underwent laparoscopic total gastrectomy with extracorporeal jejunal pouch reconstruction and stapled circular esophagojejunostomy from May 2007 to August 2015 were prospectively analyzed. A stepwise approach of 10 steps was designed based on video and case analysis. Median operation time was 301 (148-454) minutes and median blood loss was 300 (30-900) milliliters. Anastomotic leakage occurred in six (12.8 %) patients; additionally, one (2.12 %) jejunal-pouch staple line leak was identified. An important modification in our technique was a purse-string suture around the anvil of the circular stapler to prevent esophageal mucosa to slip away. After this modification, the leakage rate was reduced to 7 % in the last 15 procedures. In conclusion, TLG with jejunal pouch reconstruction is a feasible procedure in a selected group of patients. Our stepwise approach and technique may help surgeons to introduce jejunal pouch reconstruction during laparoscopic gastrectomy in their center.
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Affiliation(s)
- Hylke J. F. Brenkman
- Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands
| | - Juan Correa-Cote
- Department of Surgical Oncology, Hospital Pablo Tobón Uribe, Calle 78 B #, 69 - 240 Medellín, Colombia ,Department of Surgical Oncology, University of Toronto, Room 3-130, 610 University Avenue, Toronto, ON M5G 2M9 Canada
| | - Jelle P. Ruurda
- Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, PO BOX 85500, 3508 GA Utrecht, The Netherlands
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