A Gastrectomy for early-stage gastric cancer patients with or without preserving celiac branches of vagus nerves: A meta-analysis

Risk assessment of lymph node metastasis in early gastric cancer patients with vagus nerve-preserving gastrectomy: A multiple centers potential analysis in China

BACKGROUND

Vagus nerve-preserving gastrectomy is gaining popularity for early gastric cancer treatment. This study assesses vagus nerve-preserving gastrectomy's perioperative safety and impact on postoperative quality of life, and explores vagus nerve-associated lymph node metastasis to create a risk model for enhanced therapy.

METHODS

Clinicopathologic data from 1,210 early gastric cancer patients across 11 Chinese centers were analyzed, and the data of 800 patients with follow-up information and 48 patients who underwent vagus nerve-preserving gastrectomy for validation were collected. Propensity score matching was applied to the analysis of perioperative safety and quality of life in vagus nerve-preserving gastrectomy patients. A 6-point risk assessment model was devised and validated to evaluate the risk of vagus nerve-associated lymph node metastasis after vagus nerve-preserving gastrectomy in early gastric cancer patients.

RESULTS

Vagus nerve-preserving gastrectomy patients had shorter postoperative stays, quicker drainage cessation, and fewer incidences of diarrhea, acid reflux, and postoperative gallstones. Additionally, key independent risk factors for vagus nerve-associated lymph node metastasis included tumor size, differentiation type, invasion depth, and lymphatic vessel invasion. Using these factors, a 6-point risk assessment model was established. The values of the area under the receiver operating characteristic curve for the model were 0.796, 0.806, 0.808, and 0.829 in the training cohort, internal validation cohort, external validation cohort, and vagus nerve-preserving gastrectomy cohort, respectively. The model effectively differentiated between high- and low-risk groups in terms of postoperative survival.

CONCLUSIONS

Vagus nerve-preserving gastrectomy can improve the patients' postoperative quality of life and ensure safety in the perioperative period. The vagus nerve-associated lymph node metastasis risk assessment model is a crucial tool in guiding the selection of optimal surgical procedures and treatment strategies for early gastric cancer patients.

Electroacupuncture Reduces Duration of Postoperative Ileus After Laparoscopic Gastrectomy for Gastric Cancer: A Multicenter Randomized Trial

BACKGROUND & AIMS

Electroacupuncture (EA) may reduce the duration of postoperative ileus (POI) after laparoscopic gastrectomy for gastric cancer, although evidence is limited. We investigated the efficacy of EA in reducing POI duration and enhancing gastrointestinal (GI) recovery in patients undergoing laparoscopic surgery for gastric cancer.

METHODS

This multicenter randomized trial was conducted at 7 hospitals in China, enrolling 585 participants who underwent laparoscopic resection for gastric cancer from October 27, 2021, to December 21, 2023. Participants received perioperative standard care and were randomized to 4 sessions of EA, 4 sessions of sham EA (SA), or standard care only. The primary outcome was the time to first flatus. Secondary outcomes included time to first defecation, dietary recovery, quality of life, postoperative mobilization, and duration of hospital stay.

RESULTS

A total of 578 participants were in the full analysis set. EA exhibited a shorter time to first flatus compared with both SA and standard care, with differences of -12.96 hours (95% confidence interval (CI), -19.17 to -6.75; P < .001) and -24.46 hours (95% CI, -30.61 to -18.30; P < .001), respectively. Similarly, EA significantly reduced the time to first defecation: -15.41 hours (95% CI, -27.73 to -3.09; P = .007) vs SA; -24.66 hours (95% CI, -36.76 to -12.55; P < .001) vs standard care. Incidence of prolonged POI was significantly lower in the EA group than in the SA and standard care groups, with group differences of -0.41 (95% CI, -0.66 to -0.16; P < .001) and -0.56 (95% CI, -0.82 to -0.31; P < .001), respectively. No severe adverse events were reported.

CONCLUSIONS

EA was superior to SA and standard care only for reducing POI duration and the risk of prolonged POI in patients undergoing laparoscopic gastrectomy for gastric cancer (Chinese Clinical Trials Register identifier: ChiCTR2100050660).

Auricular Acupressure in Relieving PONV and Promoting Gastrointestinal Function Recovery in Females After Laparoscopic Sleeve Gastrectomy: A Prospective Randomized Controlled Trial

BACKGROUND

The role of current pharmacological treatment after laparoscopic sleeve gastrectomy (LSG) is limited. The incidence of postoperative nausea and vomiting (PONV) after LSG remains high. Auricular acupressure (AA) is believed to relieve PONV after laparoscopic surgeries, but its role in patients with obesity after LSG has yet to be confirmed.

METHODS

Ninety-five female patients who underwent LSG were randomized into two groups: AA combined with conventional anti-nausea medication (AA group, 47 patients) or conventional anti-nausea medication group (control group, 48 patients). Index of nausea and vomiting and retching (INVR) scores, postoperative anti-vomiting medication use, time of first anus exhausting, time of first fluid intake, and time of first to get out of bed were collected within 48 h after surgery.

RESULTS

Demographic data of patients in both groups were balanced and comparable. INVR score (F = 7.505, P = 0.007), vomiting score (F = 11.903, P = 0.001), and retching score (F = 12.098, P = 0.001) were significantly lower in the AA group than that in the control group within 48 h postoperatively. Use of metoclopramide was significantly less in the AA group than in the control group (4.7 [5.5]) vs. 8.8 [7.6], P = 0.004); time to first anus exhausting was significantly less in the AA group than in the control group (17.50 [6.00] vs. 20.42 [8.62], P = 0.020).

CONCLUSIONS

AA combined with conventional anti-vomiting agents can alleviate PONV in female patients after LSG, and AA can promote gastrointestinal exhaustion.

TRIAL REGISTRATION

The trial has been registered in the Chinese Clinical Trial Registry (ChiCTR) with the registration no. ChiCTR2100047381 on June 13, 2021.

Vagus nerve signal has an inhibitory influence on the development of peritoneal metastasis in murine gastric cancer

The vagus nerve is the only pathway for transmitting parasympathetic signals between the brain and thoracoabdominal organs, thereby exhibiting anti-inflammatory functions through the cholinergic anti-inflammatory pathway. Despite often being resected during lymph node dissection in upper gastrointestinal cancer surgery, the impact of vagotomy on postoperative outcomes in gastric cancer patients remains unclear. Sub-diaphragmatic vagotomy was performed on C57BL/6 mice. Three weeks later, syngeneic murine gastric cancer cell line YTN16P was injected into the peritoneal cavity, and the number of peritoneal metastases (PM) on the mesentery and omentum compared with control mice. The phenotypes of immune cells in peritoneal lavage and omental milky spots one day after tumor inoculation were analyzed using flow cytometry and immunohistochemistry. Intraperitoneal transfer of 3 × 105 YTN16P significantly increased the number of metastatic nodules on the mesentery in the vagotomy group compared to the control group. The omental metastasis grade was also significantly higher in the vagotomy group. Phenotypic analysis of immune cells in peritoneal lavage did not reveal significant differences after vagotomy. However, vagotomized mice exhibited a notable increase in milky spot area, with a higher presence of cytokeratin(+) tumor cells, F4/80(+) macrophages, and CD3(+) T cells. Vagus nerve signaling appears to regulate the immune response dynamics within milky spots against disseminated tumor cells and inhibits the development of PM. Preserving the vagus nerve may offer advantages in advanced gastric cancer surgery to reduce peritoneal recurrence.

Risk factors for severe low anterior resection syndrome in patients with rectal cancer undergoing sphincter‑preserving resection: A systematic review and meta‑analysis

The present study aimed to evaluate the incidence and risk factors of severe low anterior resection syndrome (LARS) in patients with rectal cancer undergoing sphincter-preserving resection, and to provide the clinical basis and reference for the treatment of rectal cancer and the prevention of LARS. Studies on the incidence and risk factors for severe LARS in patients with rectal cancer undergoing sphincter-preserving resection were searched using PubMed, Embase, Cochrane Library, Scopus and Web of Science, according to the inclusion and exclusion criteria. After evaluating the study quality and extracting relevant data, RevMan 5.2 and STATA software were used to conduct a meta-analysis. A total of 12 articles were considered eligible for the present meta-analysis. Within these articles, there were 3,877 cases of sphincter-preserving resection for rectal cancer and 1,589 cases of severe LARS; the incidence of severe LARS was 40.99%. The results of the meta-analysis revealed that sex [female; odds ratio (OR), 6.54; 95% CI, 3.63-11.76; Z, 6.27; P<0.00001], radiotherapy and chemotherapy (OR, 3.45; 95% CI, 2.29-5.21; Z, 5.91; P<0.00001), total mesorectal excision (TME; OR, 4.39; 95% CI, 3.32-5.79; Z, 10.41; P<0.00001), and distance between tumor and anal margin (OR, 2.74; 95% CI, 0.86-8.72; Z, 1.70; P<0.00001) may be the risk factors for severe LARS.