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Zhao S, Li R, Zhou J, Sun L, Sun Q, Wang W, Wang D. Comparison of robotic versus laparoscopic surgery for visceral obesity in mid-low rectal cancer: a propensity-matched analysis. J Robot Surg 2024; 18:178. [PMID: 38642232 DOI: 10.1007/s11701-024-01945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/06/2024] [Indexed: 04/22/2024]
Abstract
Obesity is becoming more and more common, and measuring visceral fat area (VFA) is a useful diagnostic technique for visceral obesity (VO). The purpose of this research is to compare the surgical results of robotic versus laparoscopic rectal surgery, with a focus on assessing the benefits of the latter method for treating both VO and mid-low rectal cancer. Patients receiving laparoscopic or robotic anterior rectal excision at Northern Jiangsu People's Hospital's general surgery department were included in the retrospective analysis. 242 people in all took part in the study; 121 cases were assigned to the robotic surgery (RS) group and another 121 cases to the laparoscopic surgery (LS) group. In comparison to LS, our results show that RS led to a shorter period for the recovery of bowel function (p = 0.03), a shorter hospital stay (p < 0.001), a smaller intraoperative blood loss (p < 0.001), and a shorter time until the commencement of oral intake (p = 0.041). However, there were no statistically significant differences between the two groups in terms of the indices of histopathologic specimens, the proportion of temporary loop ileostomy, and the incidence of early postoperative problems (p > 0.05). When patients with VO undergo surgery for rectal cancer, RS has the added benefit of accelerating patient recovery while producing results that are similar to LS in the near run.
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Affiliation(s)
- Shuai Zhao
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China
| | - Ruiqi Li
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China
| | - Jiajie Zhou
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Department of General Surgery, Taizhou Fourth People's Hospital, Taizhou, China
| | - Qiannan Sun
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Daorong Wang
- Clinical Teaching Hospital of Medical School, Northern Jiangsu People's Hospital, Nanjing University, Yangzhou, China.
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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Ji H, Liu B, Jin P, Li Y, Cui L, Jin S, Wu J, Shan Y, Zhang Z, Ming J, Zhang L, Du C. Creatinine-to-cystatin C ratio and body composition predict response to PD-1 inhibitors-based combination treatment in metastatic gastric cancer. Front Immunol 2024; 15:1364728. [PMID: 38665913 PMCID: PMC11043572 DOI: 10.3389/fimmu.2024.1364728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Background Creatinine-to-cystatin C ratio (CCR) and body composition (BC) parameters have emerged as significant prognostic factors in cancer patients. However, the potential effects of CCR in gastric cancer (GC) remains to be elucidated. This multi-center retrospective study explored the predictive and prognostic value of CCR and BC-parameters in patients with metastatic GC receiving PD-1 inhibitors-based combination therapy. Methods One hundred and thirteen GC patients undergoing PD-1 inhibitors-based combination therapy were enrolled at three academic medical centers from January 2021 to July 2023. A deep-learning platform based on U-Net was developed to automatically segment skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI). Patients were divided into two groups based on the median of CCR or the upper tertile of BC-parameters. Logistic and Cox regression analysis were used to determine the effect of CCR and BC-parameters in predicting response rates and survival rates. Results The CCR was positively correlated with SMI (r=0.43; P<0.001), but not with SATI or VATI (P>0.05). Multivariable logistic analysis identified that both low CCR (OR=0.423, P=0.066 for ORR; OR=0.026, P=0.005 for DCR) and low SATI (OR=0.270, P=0.020 for ORR; OR=0.149, P=0.056 for DCR) were independently associated with worse objective response rate (ORR) and disease control rate (DCR). Patients with low CCR or low SATI had significantly lower 8-month progression-free survival (PFS) rate and 16-month overall survival (OS) rate than those with high CCR (PFS rate, 37.6% vs. 55.1%, P=0.011; OS rate, 19.4% vs. 44.9%, P=0.002) or those with high SATI (PFS rate, 37.2% vs. 53.8%, P=0.035; OS rate, 8.0% vs. 36.0%, P<0.001). Multivariate Cox analysis showed that low CCR (HR=2.395, 95% CI: 1.234-4.648, P=0.010 for PFS rate; HR=2.528, 95% CI: 1.317-4.854, P=0.005 for OS rate) and low SATI (HR=2.188, 95% CI: 1.050-4.560, P=0.037 for PFS rate; HR=2.818, 95% CI: 1.381-5.752, P=0.004 for OS rate) were both independent prognostic factors of poor 8-month PFS rate and 16-month OS rate. A nomogram based on CCR and BC-parameters showed a good performance in predicting the 12- and 16-month OS, with a concordance index of 0.756 (95% CI, 0.722-0.789). Conclusions Low pre-treatment CCR and SATI were independently associated with lower response rates and worse survival in patients with metastatic GC receiving PD-1 inhibitors-based combination therapy.
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Affiliation(s)
- Hongjuan Ji
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
| | - Bona Liu
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
| | - Peng Jin
- Department of Oncology, The Second Affiliated Hospital of Shandong First Medical University, Taian, China
| | - Yingchun Li
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China
| | - Lili Cui
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
| | - Shanxiu Jin
- Department of Oncology, General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, China
| | - Jingran Wu
- Department of Oncology, General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, China
| | - Yongqi Shan
- Department of General Surgery, General Hospital of Northern Theater Command, Shenyang, China
| | - Zhenyong Zhang
- Department Oncology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jian Ming
- Department of Pathology, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang Zhang
- Department of Gastrointestinal Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, Xuzhou, China
| | - Cheng Du
- Department of Oncology, General Hospital of Northern Theater Command, Shenyang, China
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Nie X, Zhang L, Meng H, Zhong Y, Jiang Y, Chen T, Cheng W. Visceral obesity determined by CT as a predictor of short-term postoperative complications in patients with ovarian cancer. Arch Gynecol Obstet 2024; 309:1491-1498. [PMID: 37698603 DOI: 10.1007/s00404-023-07206-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To explore the association between visceral obesity and short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery. METHODS The medical records of patients with advanced epithelial ovarian cancer were reviewed. The visceral fat area, subcutaneous fat area and total fat area at the L3/4 level were measured on a preoperative single-slice CT scan. The receiver operating characteristic (ROC) curve was used to calculate the optimal cutoff value for the visceral fat area. The relationship between the visceral fat area and the characteristics of ovarian cancer patients were analyzed. Univariable and multivariable logistic regression analyses were performed to investigate relationship between perioperative characteristics and short-term complications. RESULTS According to the ROC curve, the best cutoff value of the VFA was 93 cm2. Of the 130 patients, 53.8% (70/130) had visceral obesity. Patients with visceral obesity were older than those with nonvisceral obesity (58.4 years old vs. 52.1 years old, p < 0.001). The proportion of patients with hypertension was higher (35.7 vs. 13.3%, p = 0.003). The total fat area and subcutaneous fat area were larger in patients with visceral obesity (294.3 ± 75.5 vs. 176.2 ± 68.7, p < 0.001; 158.9 ± 54.7 vs. 121.7 ± 52.6, p < 0.001). Compared with patients in the nonvisceral obese group, patients in the visceral obese group were more likely to have postoperative fever (21/70 30.0% vs. 8/60 1.25%, p = 0.023), leading to a longer length of hospital stay (21 days vs. 17 days, p = 0.009). The time from surgery to adjuvant chemotherapy for patients with visceral obesity was shorter (24 days vs. 19 days, p = 0.037). Multivariate analysis showed that visceral obesity (OR = 6.451, p < 0.001) and operation time (OR = 1.006, p < 0.001) were independent predictors of postoperative complications. CONCLUSION Visceral obesity is an important risk factor for short-term postoperative complications in patients with advanced ovarian cancer undergoing cytoreductive surgery.
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Affiliation(s)
- Xianglin Nie
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lin Zhang
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Huangyang Meng
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yi Zhong
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
- Department of gynaecology and obstetrics, Chongqing Maternal and Child Health Care Hospital, Chongqing, China
| | - Yi Jiang
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Ting Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wenjun Cheng
- Department of Gynecology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Zhao S, Ma Y, Li R, Zhou J, Sun L, Sun Q, Wang W, Wang D. Impact of visceral fat area on short-term outcomes in robotic surgery for mid and low rectal cancer. J Robot Surg 2024; 18:59. [PMID: 38289448 DOI: 10.1007/s11701-023-01814-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/25/2023] [Indexed: 02/01/2024]
Abstract
Rectal cancer is one of the most prevalent cancers that arise in the digestive tract. The purpose of this retrospective study was to investigate the impact of visceral fat area (VFA) on postoperative outcomes in mid and low rectal cancer patients undergoing robotic surgery (RS). Data were collected on patients who underwent robotic anterior rectal resection in a single center from December 2019 to October 2023. Clinical pathology information was analyzed. Statistical analysis was done on the computed tomography (CT) imaging data. A total of 277 patients were included in the study, including 121 cases with visceral obesity (VO) and 156 cases without VO. There was no statistically significant disparity in the lymph node dissection count, blood loss, duration of hospitalization, time to first liquid diet, early postoperative complications, histopathologic specimen indices (quality of TME and CRM involvement rate), and or the rate of conversion to open surgery between VO and non-VO group (P > 0.05). Nevertheless, the group of individuals with VO experienced a lengthier duration of surgery (P < 0.001) and a delayed time until the first passage of flatus (P < 0.001) in comparison to the group without VO. The study suggests that VO does not significantly impact early complications or the quality of surgical outcomes in mid and low rectal cancer patients undergoing robotic surgery. The findings support the continued use of RS as an optimal strategy for technically demanding patients.
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Affiliation(s)
- Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Yue Ma
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Ruiqi Li
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Jiajie Zhou
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China
| | - Longhe Sun
- Department of General Surgery, Taizhou Fourth People's Hospital, Taizhou, China
| | - Qiannan Sun
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China.
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China.
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Hang Y, Zou L, Jiang L, Zhang X, Huang X, Liu Y, Zhou Z, Pan H, Ma H, Rong S. Association between visceral fat area and serum uric acid in Chinese adults: A cross-sectional study. Nutr Metab Cardiovasc Dis 2023; 33:2464-2470. [PMID: 37798231 DOI: 10.1016/j.numecd.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 07/16/2023] [Accepted: 07/28/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Hyperuricemia has become a vital public health problem affecting the health of residents. The visceral fat area (VFA) is closely related to many chronic diseases. However, the association between VFA and hyperuricemia within the Chinese adult population remains nebulous. The aim of the research is to assess the relationship between VFA and serum uric acid levels. METHODS AND RESULTS From June 2020 to June 2021, a total of 340 Chinese adults (240 in the control group and 100 in the hyperuricemia group) were recruited from the physical examination center of Hongqi Hospital Affiliated to Mudanjiang Medical University. General demographic characteristics were collected by questionnaire. VFA was measured by a body composition analyzer, and serum biochemical indices were detected by clinical laboratory. VFA in the hyperuricemia group was higher than in the control group (P<0.05). Further, VFA demonstrated a positive correlation with serum uric acid level (rs = 0.370, P<0.001). To further explore this relationship, we divided the VFA into quartiles (<P25, P25-P50, P50-P75, ≥P75). Upon comparison with the <P25 group, we found the VFA in the P25-P50, P50-P75, and ≥P75 groups to be associated with a substantially escalated risk of hyperuricemia, even after adjusting for age, gender, body weight, fasting plasma glucose, calcium, alanine transaminase, urea, alkaline phosphatase, and γ-glutamyltransferase. The OR and 95% CI were 2.547 (1.023, 6.341), 3.788 (1.409, 10.187) and 3.723 (1.308, 10.595), respectively (P<0.05). CONCLUSION VFA has a positive correlation with serum uric acid levels and may serve as a crucial predictive marker for hyperuricemia.
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Affiliation(s)
- Yongzheng Hang
- Public Health School, Mudanjiang Medical University, Mudanjiang, China
| | - Lina Zou
- The Affiliated Hongqi Hospital, Mudanjiang Medical University, Mudanjiang, China
| | - Lan Jiang
- Public Health School, Mudanjiang Medical University, Mudanjiang, China
| | - Xueqing Zhang
- Public Health School, Mudanjiang Medical University, Mudanjiang, China
| | - Xiaojing Huang
- Public Health School, Mudanjiang Medical University, Mudanjiang, China
| | - Yanan Liu
- Public Health School, Mudanjiang Medical University, Mudanjiang, China
| | - Zhiren Zhou
- Public Health School, Mudanjiang Medical University, Mudanjiang, China
| | - Hongzhi Pan
- Collaborative Research Center, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hongkun Ma
- Public Health School, Mudanjiang Medical University, Mudanjiang, China.
| | - Shengzhong Rong
- Public Health School, Mudanjiang Medical University, Mudanjiang, China.
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Kim CY, Hyun JH, Ryoo E. Functional Gastrointestinal Disorders and Abdominal Visceral Fat in Children and Adolescents. Pediatr Gastroenterol Hepatol Nutr 2023; 26:338-345. [PMID: 38025491 PMCID: PMC10651365 DOI: 10.5223/pghn.2023.26.6.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 12/01/2023] Open
Abstract
Purpose Few reports have investigated the correlation between functional gastrointestinal disorders (FGIDs) and the degree of obesity in children and adolescents. Thus, this study aimed to examine the relationship between FGIDs and the degree of obesity in children and adolescents. Methods Children and adolescents (<19 years old) who had undergone abdominopelvic computed tomography and had been diagnosed with FGIDs from 2015 to 2016 were included in this retrospective case-control study in a ratio of 1:2. Abdominal visceral fat was measured using an image analysis software. Results The mean age of all 54 FGID patients was 12.9±3.4 years, and the male: female ratio was 1:1.2. We observed no difference in body mass index (BMI) between the FGID and control groups (19.5±4.6 vs. 20.6±4.3 kg/m2, p=0.150). However, the FGID group had less abdominal visceral fat than that of the control group (26.2±20.0 vs. 34.4±26.9 cm2, p=0.048). Boys in the FGID group had lower BMI (18.5±3.5 vs. 20.9±4.3 kg/m2, p=0.019) and less abdominal visceral fat (22.8±15.9 vs. 35.9±31.8 cm2, p=0.020) than those of boys in the control group. However, we found no difference in BMI (20.5±5.3 vs. 20.4±4.2 kg/m2, p=0.960) and abdominal visceral fat (29.0±22.9 vs. 33.1±22.1 cm2, p=0.420) between girls in both groups. Conclusion Our study revealed a difference in the relationship between FGID and the degree of obesity according to sex, which suggests that sex hormones influence the pathogenesis of FGIDs. Multicenter studies with larger cohorts are required to clarify the correlation between FGID subtypes and the degree of obesity.
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Affiliation(s)
- Chang Yun Kim
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Hyuk Hyun
- Gachon University College of Medicine, Incheon, Korea
| | - Eell Ryoo
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea
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Xie M, Liu G, Dong Y, Yu L, Song R, Zhang W, Zhang Y, Huang S, He J, Xiao Y, Long L. Effect of visceral fat area on the accuracy of preoperative CT-N staging of colorectal cancer. Eur J Radiol 2023; 168:111131. [PMID: 37804651 DOI: 10.1016/j.ejrad.2023.111131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To investigate the effect of visceral fat area (VFA) on the accuracy of preoperative CT-N staging of colorectal cancer. METHODS We retrospectively reviewed the clinical and imaging data of 385 CRC patients who underwent surgical resection for colorectal cancer between January 2018 and July 2021. Preoperative CT-N staging and imaging features were determined independently by two radiologists. Using postoperative pathology as the gold standard, patients were divided into accurately and incorrectly staged groups, and clinical and imaging characteristics were compared between the two groups. VFA and subcutaneous fat area (SFA) at the L3 vertebral level, sex, age, BMI, tumor location, size, and tumor circumference ratio (TCR) were included. Logistic regression analysis was used to evaluate the independent factors influencing the accuracy of preoperative N staging of colorectal cancer. RESULTS Of the 385 patients enrolled, 259 (67.27%) were in the preoperative N-stage accurate staging group, and 126 (32.73%) were in the incorrectly staged group. Univariate analysis showed that there were significant differences in BMI, tumor location, VFA, SFA, size and TCR between the two groups (P<0.05). Logistic regression analysis showed that VFA (95% CI: 1.277, 3.813; P=0.005) and TCR (95% CI: 1.649, 17.545; P=0.005) were independent factors affecting the accuracy of N staging. The optimal cutoff points for VFA and TCR in predicting incorrect staging were 110 cm2 and 0.675, respectively. CONCLUSIONS Colorectal cancer patients with lower VFA and higher TCR and preoperative CT-N staging had an increased risk for diagnostic errors.
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Affiliation(s)
- Meizhen Xie
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China; Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Gangyi Liu
- Department of Laboratory, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Yan Dong
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Lan Yu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Rui Song
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Wei Zhang
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Ying Zhang
- Department of Pathology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Shafei Huang
- Department of Scientific Research, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Jiaqian He
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China
| | - Yunping Xiao
- Department of Radiology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545006, China; Liuzhou Key Laboratory of Molecular Imaging, Liuzhou, Guangxi 545006, China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, China.
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Thormann M, Hinnerichs M, Barajas Ordonez F, Saalfeld S, Perrakis A, Croner R, Omari J, Pech M, Zamsheva M, Meyer HJ, Wienke A, Surov A. Sarcopenia is an Independent Prognostic Factor in Patients With Pancreatic Cancer - a Meta-analysis. Acad Radiol 2023; 30:1552-1561. [PMID: 36564257 DOI: 10.1016/j.acra.2022.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/08/2022] [Accepted: 10/26/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES Sarcopenia is defined as skeletal muscle loss and can be assessed by cross-sectional imaging. Our aim was to establish the effect of sarcopenia on relevant outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) in curative and palliative settings based on a large patient sample. MATERIALS AND METHODS MEDLINE library, EMBASE and SCOPUS databases were screened for the associations between sarcopenia and mortality in patients with PDAC up to March 2022. The primary endpoint of the systematic review was the hazard ratio of Sarcopenia on survival. 22 studies were included into the present analysis. RESULTS The included 22 studies comprised 3958 patients. The prevalence of sarcopenia was 38.7%. Sarcopenia was associated with a higher prevalence in the palliative setting (OR 53.23, CI 39.00-67.45, p<0.001) compared to the curative setting (OR 36.73, CI 27.81-45.65, p<0.001). Sarcopenia was associated with worse OS in the univariable (HR 1.79, CI 1.41-2.28, p<0.001) and multivariable analysis (HR 1.62, CI 1.27-2.07, p<0.001) in the curative setting. For the palliative setting the pooled hazards ratio showed that sarcopenia was associated with overall survival (HR 1.56, CI 1.21-2.02, p<0.001) as well as in multivariable analysis (HR 1.77, CI 1.39-2.26, p<0.001). Sarcopenia was not associated with a higher rate of post-operative complications in univariable analysis (OR 1.10, CI 0.70-1.72, p = 0.69). CONCLUSION Sarcopenia occurs in 38.7% of patients with pancreatic cancer, significantly more in the palliative setting. Sarcopenia is associated with overall survival in both settings. The assessment of sarcopenia is therefore relevant for personalized oncology. Sarcopenia is not associated with postoperative complications.
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Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120.
| | - Mattes Hinnerichs
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Felix Barajas Ordonez
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Sylvia Saalfeld
- Research Campus STIMULATE, Otto-von-Guericke University Magdeburg, Magdeburg, Germany; Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Aristoteles Perrakis
- Department of General - Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Roland Croner
- Department of General - Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
| | - Marina Zamsheva
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Germany
| | - Hans-Jonas Meyer
- Department for Radiology, University Clinic Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, University Hospital Magdeburg, Leipziger Str. 44,Magdeburg, Germany, 39120
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Matsui R, Inaki N, Tsuji T, Fukunaga T. Impact of Sex-Specific Preoperative Fat Mass Assessment on Long-Term Prognosis after Gastrectomy for Gastric Cancer. Cancers (Basel) 2023; 15:cancers15072100. [PMID: 37046761 PMCID: PMC10093354 DOI: 10.3390/cancers15072100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/25/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
We investigated the impact of the difference in fat distribution between men and women on long-term prognosis after gastrectomy in patients with advanced gastric cancer. Patients with advanced gastric cancer deeper than p-T2 who underwent gastrectomy between April 2008 and June 2018 were included. Visceral fat mass index (VFI) and subcutaneous fat mass index (SFI) were calculated by dividing the cross-sectional area at the umbilical level by the height squared. The medians of VFI and SFI by sex were defined as cut-off values, below which values were defined as low VFI and low SFI. Of the 485 patients, 323 (66.6%) were men and 162 (33.4%) were women. Men with a low VFI had a significantly worse overall survival (OS) (p = 0.004) and women with a low SFI had a significantly worse OS (p = 0.007). Patients with a low VFI and low SFI had the worst prognosis. Multivariate analysis showed that a low VFI was an independent poor prognostic factor in men, while a low SFI was an independent poor prognostic factor in women. In conclusion, a low visceral fat mass in men and a low subcutaneous fat mass in women were independent poor prognostic factors after radical gastrectomy for advanced gastric cancer.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Japan
- Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Correspondence:
| | - Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Japan
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Toshikatsu Tsuji
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Japan
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8641, Japan
| | - Tetsu Fukunaga
- Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan
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Ma L, Pan H, Chen K. Impact of visceral obesity on the short-term outcomes after laparoscopic appendectomy. Scand J Gastroenterol 2023:1-7. [PMID: 36728716 DOI: 10.1080/00365521.2023.2173022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the effect of visceral obesity on short-term outcomes after laparoscopic appendectomy (LA). METHODS a retrospective study on 441 patients who underwent a LA between July 2019 and July 2020. According to the cutoff visceral fat area (VFA) for visceral obesity, the patients were divided into two groups: visceral obesity group (n = 123) and non-visceral obesity group (n = 318). The general information, comorbidities, perioperative monitoring indicators, and postoperative complications of the patients were collected. RESULTS Compared with the non-visceral obesity group, the proportion of overweight patients (56.10%), preoperative white blood cell count (12.92 (9.99, 15.58)*109mg/dl), postoperative white blood cell count (9.71 ± 3.91*109mg/dl), and hospitalization costs (16,220.93 ± 7038.76¥) in the visceral obesity group were significantly different (all p < 0.05). Additionally, multivariate logistic regression analysis revealed that visceral obesity (2.679, 95%CI: 1.155-5.849, p = 0.027), indwelling drainage tube (7.832, 95%CI: 2.151-27.428, p < 0.001), and perforated appendicitis (3.181, 95%CI: 1.195-7.136, p = 0.025) were identified to be independent risk factors for incision infection after LA. The area under receiver operating characteristic (ROC) curve value for VFA predicting incisional infection after LA was 0.770. CONCLUSIONS Visceral obesity is one of the independent risk factors for incisional infection after LA, and can be used as one of the reference indicators for prognostic assessment of short-term outcomes after LA.
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Affiliation(s)
- Liangliang Ma
- Department of Vascular Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Pan
- Department of Vascular Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kui Chen
- Department of Vascular Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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11
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Inaguma G, Shibasaki S, Nakauchi M, Serizawa A, Nakamura K, Akimoto S, Tsuyoshi T, Inaba K, Uyama I, Suda K. Muscle mass ratio in male gastric cancer patients as an independent predictor of postoperative complications after minimally invasive distal gastrectomy. Surg Endosc 2023; 37:989-998. [PMID: 36085383 DOI: 10.1007/s00464-022-09595-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The current study aimed to investigate the relationship between muscle mass proportion and the incidence of total complications in male gastric cancer (GC) patients after minimally invasive distal gastrectomy (MIDG). METHODS Between March 2017 and March 2020, 152 male GC patients with clinical stage III or lower GC who underwent MIDG were enrolled in this study. The muscle mass ratio (MMR) was calculated by dividing the total muscle weight obtained from bioelectrical impedance analysis by the whole-body weight. Thereafter, the association between MMR and surgical outcomes was determined. RESULTS Based on the optimal MMR cutoff value of 0.712 obtained using the receiver operating characteristic (ROC) curve, patients were divided into two groups (69 and 83 patients in the MMR-L and MMR-H groups). The MMR-L group had a significantly higher total complication rate compared to the MMR-H group (MMR-L, 24.6% vs. MMR-H, 7.2%; P = 0.005). Multivariate analysis also identified MMR-L as a significant independent risk factor for total complications and intra-abdominal infectious complications after MIDG. CONCLUSIONS The MMR calculated using bioelectrical impedance analysis can be a useful predictor for postoperative complications after MIDG in male GC patients.
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Affiliation(s)
- Gaku Inaguma
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Masaya Nakauchi
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Akiko Serizawa
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Shingo Akimoto
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tanaka Tsuyoshi
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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12
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Matsui R, Watanabe J, Banno M, Inaki N, Fukunaga T. Association of visceral adipose tissue with postoperative outcome in upper gastrointestinal cancer: a systematic review and meta-analysis. Am J Clin Nutr 2022; 116:1540-1552. [PMID: 36166841 DOI: 10.1093/ajcn/nqac273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/22/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is no consensus on the relation between visceral fat mass and long-term postoperative prognosis in patients with upper gastrointestinal (GI) cancer. OBJECTIVES The purpose of this study was to investigate the association of preoperative visceral fat mass with postoperative complications and overall survival (OS) in patients with upper GI cancer. METHODS We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE (Dialog), the WHO International Clinical Trials Platform Search Portal, and ClinicalTrials.gov and identified observational studies published from inception through 20 July 2022. We conducted a systematic review and random-effects meta-analysis of studies including patients who were surgically treated for upper GI cancer and whose visceral fat mass was assessed on the basis of body composition. We independently assessed the risk of bias and quality of evidence using the Quality In Prognosis Studies and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. The primary outcome was OS. HRs and 95% CIs for OS were pooled. RESULTS Ninety-one studies (n = 20,583) were included. All studies used computed tomography (CT) to assess the body composition of patients. Twenty-four studies reported the relation between high visceral fat and postoperative outcomes, and their results were synthesized. Compared with low visceral adipose tissue, high visceral adipose tissue assessed by CT may improve OS (HR: 0.69; 95% CI: 0.55, 0.87; I2 = 65%; n = 3407). The risk of bias for OS in each study was moderate or high. The certainty of evidence for OS was very low because of inconsistency in the forest plot, the moderate or high risk of bias, and publication bias. CONCLUSIONS High visceral fat may be associated with improved OS after radical resection in patients with upper GI cancer. Further studies are needed to confirm these findings and mitigate the risk.
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Affiliation(s)
- Ryota Matsui
- Department of Surgery, Juntendo University Urayasu Hospital, Urayasu City, Japan.,Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General, and Transplant Surgery, Jichi Medical University, Shimotsuke City, Japan.,Center for Community Medicine, Jichi Medical University, Shimotsuke City, Japan.,Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Masahiro Banno
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa City, Japan
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, Japan
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Gao B, Li X, Chen W, Wang S, He J, Liu Y, Ding C, Chen X. The associations between lipid profiles and visceral obesity among gastrointestinal cancer patients: a cross-sectional study. Lipids Health Dis 2022; 21:102. [PMID: 36242019 PMCID: PMC9563782 DOI: 10.1186/s12944-022-01707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Visceral obesity is associated with cancer incidence and prognosis. Altered lipid profiles are frequently seen in visceral obese patients. The blood test of lipid profiles is more convenient and has no radical side effects than computed tomography (CT), which is presently the most accurate way to measure visceral fat area. This article aims to investigate the associations between lipid profiles and visceral obesity in gastrointestinal cancer patients. Methods In total, 399 patients newly diagnosed with gastrointestinal cancer were enrolled in this observational study. Lipid profiles were obtained from blood samples, and visceral fat mass area (VFA) was measured by CT. VFA ≥ 100 cm2 was considered visceral obesity. The area under the receiver operating characteristic curve (AUROC) was utilized to evaluate the prognostic powers of lipid parameters for viscerally obese gastrointestinal cancer patients. Results Patients who had visceral obesity had higher triglyceride (TG) levels (1.20 ± 0.60 vs. 0.87 ± 0.57 mmo/L, P < 0.001), total cholesterol (TC) levels (3.57 ± 0.84 vs. 3.40 ± 0.82, P = 0.044), and low-density lipoprotein (LDL-C) levels (2.08 ± 0.66 vs. 1.94 ± 0.66, P = 0.047) and lower high-density lipoprotein (HDL-C) levels (0.88 ± 0.24 vs. 1.00 ± 0.26, P < 0.001) than those in the normal group. TG was positively correlated with VFA (r = 0.299, P < 0.001), while HDL-C was inversely correlated with VFA (r = -0.237, P < 0.001). TG and HDL-C had predictive capacity for visceral obesity at cutoff levels of 0.92 mmol/L (AUROC 0.700, 95% CI, 0.653–0.745, P < 0.001) and 0.98 mmol/L (AUROC 0.700, 95% CI, 0.585–0.682, P < 0.001), respectively. TG > 0.92 mmol/L with HDL-C < 0.98 mmol/L was linked with an increased risk of visceral obesity (OR = 4.068, 95% CI, 2.338—7.079, P < 0.001). Conclusions Lipid profiles were significantly correlated with VFA. Gastrointestinal cancer patients with TG > 0.92 mmol/L and HDL-C < 0.98 mmol/L were at elevated risk of visceral obesity in the Chinese population. Identifying visceral obesity and taking proper actions in gastrointestinal cancers are helpful for overall tumor prognosis.
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Affiliation(s)
- Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Xiangrui Li
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Wenqing Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Shu'an Wang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Gulou District, 321 Zhongshan Road, Nanjing, China
| | - Yu Liu
- Department of Gynecology and Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 1 Tianfei Road, Qinhuai District, Nanjing, China
| | - Chao Ding
- Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Gulou District, 321 Zhongshan Road, Nanjing, China.
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China.
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14
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Matsui R, Inaki N, Tsuji T, Kokura Y, Momosaki R. Preoperative High Visceral Fat Increases Severe Complications but Improves Long-Term Prognosis after Gastrectomy for Patients with Advanced Gastric Cancer: A Propensity Score Matching Analysis. Nutrients 2022; 14:nu14204236. [PMID: 36296920 PMCID: PMC9607456 DOI: 10.3390/nu14204236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 11/24/2022] Open
Abstract
This study investigated the paradox of high visceral fat mass increasing severe complications but improving long-term prognosis after radical gastrectomy for gastric cancer. This was a retrospective cohort study of consecutive patients with primary stage I–III gastric cancer who underwent gastrectomy between April 2008 and June 2018. The visceral adipose tissue index (VAI) was calculated by dividing the visceral fat mass preoperatively measured on computed tomography by the square of the height. Patients with VAIs below the median cut-off value were classified as low-VAI, while those above it were classified as high-VAI. We compared the postoperative complication rate and overall survival (OS) in the low- and high-VAI groups after adjusting patient characteristics using propensity score matching (PSM). There were 155 patients in both groups after PSM. After matching, there was no significant difference in factors other than BMI and VAI that were not adjusted. The high-VAI group had more severe postoperative complications (p = 0.018), but the OS was significantly better in the high-VAI group (hazard ratio 0.611, 95%CI 0.403–0.928, p = 0.021). Preoperative high visceral fat mass not only increased severe complications, but also improved OS after gastrectomy in patients with advanced gastric cancer.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi, Kanazawa 920-8530, Ishikawa, Japan
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
- Correspondence:
| | - Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi, Kanazawa 920-8530, Ishikawa, Japan
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Toshikatsu Tsuji
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-higashi, Kanazawa 920-8530, Ishikawa, Japan
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Ishikawa, Japan
| | - Yoji Kokura
- Department of Nutritional Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, Hosu 927-0023, Ishikawa, Japan
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Mie, Japan
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Kano T, Kim H, Kawakami M, Nitta M, Hasegawa M, Shoji S, Miyajima A. Preoperative factors affecting the operative outcomes of laparoscopic nephrectomy. Int J Urol 2022; 29:757-763. [PMID: 35393716 DOI: 10.1111/iju.14892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Laparoscopic radical nephrectomy is the standard surgery for localized renal cell carcinoma. Both tumor and patient factors affect the difficulty of laparoscopic radical nephrectomy. Obesity is a major factor influencing technical difficulty in surgical procedures. This study examined preoperative tumor and patient factors affecting the operating time. METHODS The data of 123 patients who underwent laparoscopic radical nephrectomy at our institution between January 2014 and December 2018 were retrospectively analyzed. The operating time was determined based on the median pneumoperitoneum time. Surgical procedures with a pneumoperitoneum time of ≥130 min were defined as having prolonged pneumoperitoneum time. Multiple logistic regression analyses were performed to identify the preoperative factors affecting the prolonged pneumoperitoneum time, and risk stratification was performed based on these factors. RESULTS Multiple logistic regression analyses revealed that a total number of renal pedicle blood vessels ≥3 and a visceral fat volume ≥3000 cm3 were associated with prolonged pneumoperitoneum time of laparoscopic radical nephrectomy. Based on the multivariate analysis results, these factors were considered individually, and the cohort was stratified into three risk groups: low (0 point), intermediate (1 point), and high (2 points) risk groups. The pneumoperitoneum time was significantly prolonged as the number of risk factors increased. CONCLUSIONS We developed a risk stratification model using preoperative factors to predict the prolonged pneumoperitoneum time of laparoscopic radical nephrectomy, which can help select suitable cases that are appropriate for each surgeon's skill level.
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Affiliation(s)
- Tatsuo Kano
- Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hakushi Kim
- Department of Urology, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Masayoshi Kawakami
- Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masahiro Nitta
- Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Masanori Hasegawa
- Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Akira Miyajima
- Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Lei J, Luo Y, Xie Y, Wang X. Visceral Adiposity Index Is a Measure of the Likelihood of Developing Depression Among Adults in the United States. Front Psychol 2022; 13:772556. [PMID: 35401344 PMCID: PMC8991090 DOI: 10.3389/fpsyg.2022.772556] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background Depression is a serious mental disorder often accompanied by emotional and physiological disorders. Visceral fat index (VAI) is the current standard method in the evaluation of visceral fat deposition. In this study, we explored the association between VAI and depression in the American population using NHANES data. Methods A total of 2,577 patients were enrolled for this study. Data were collected through structured questionnaires. Subgroup analysis for the relationship between VAI and depression was evaluated using multivariate regression analysis after adjustment for potential confounding factors. Results For every 1 unit increase in VAI, the clinical depression increased by 14% (OR = 1.14, 95% CI: 1.04–1.25). High VAI scores (T3) increased the highest risk of developing depression (OR = 2.32, 95% CI: 1.2–4.47). Subgroup analysis demonstrated a strong and stable association between VAI and the development of depression. Conclusion Our study showed that depressive symptoms are associated with a high ratio of visceral adiposity index after controlling confounding factors.
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Affiliation(s)
- Jun Lei
- School of Nursing Hunan University of Chinese Medicine, Changsha, China
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yaoyue Luo
- School of Nursing Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Yaoyue Luo,
| | - Yude Xie
- School of Nursing Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoju Wang
- College of Integrated Traditional Chinese and Western Medicine, Changsha, China
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Hikage M, Fujiya K, Waki Y, Kamiya S, Tanizawa Y, Bando E, Notsu A, Terashima M. Advantages of a robotic approach compared with laparoscopy gastrectomy for patients with high visceral fat area. Surg Endosc 2022; 36:6181-6193. [PMID: 35294634 DOI: 10.1007/s00464-022-09178-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric cancer surgery for obese patients is regarded as a technically challenging procedure. The morbidity after gastrectomy has been reported to be significantly higher in patients with high visceral fat area (VFA). Robotic gastrectomy (RG) is expected to be advantageous for complicated operations. However, whether RG is superior to conventional laparoscopic gastrectomy (LG) for patients with visceral fat obesity remains unclear. The present study aimed to clarify the impact of RG on the short- and long-term outcomes of patients with high VFAs. METHODS This study included 1306 patients with clinical stage I/II gastric cancer who underwent minimally invasive gastrectomy between January 2012 and December 2020. The patients were subclassified according to VFA. The short- and long-term outcomes of RG were compared with those of LG in two VFA categories. RESULTS This study included 394 (high-VFA, 151; low-VFA, 243) and 882 patients (high-VFA, 366; low-VFA, 516) in the RG and LG groups, respectively. RG was associated with a significantly longer operative time than LG (high-VFA, P < 0.001; low-VFA, P < 0.001). The incidence rates of overall and intra-abdominal infectious complications in the high-VFA patients were lower in the RG group than in the LG group (P = 0.019 and P = 0.048, respectively) but not significantly different from those in the low-VFA patients. In the multivariate analysis, LG was identified as the only independent risk factor of overall (odds ratio [OR] 3.281; P = 0.012) and intra-abdominal infectious complications (OR 3.462; P = 0.021) in the high-VFA patients. The overall survival of high-VFA patients was significantly better in the RG group than in the LG group (P = 0.045). CONCLUSIONS For patients with visceral fat obesity, RG appears to be advantageous to LG in terms of reducing the risk of complications and better long-term survival.
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Affiliation(s)
- Makoto Hikage
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Keiichi Fujiya
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yuhei Waki
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Satoshi Kamiya
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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Griffin SB, Palmer MA, Strodl E, Lai R, Burstow MJ, Ross LJ. Elective Surgery in Adult Patients with Excess Weight: Can Preoperative Dietary Interventions Improve Surgical Outcomes? A Systematic Review. Nutrients 2021; 13:3775. [PMID: 34836028 PMCID: PMC8623302 DOI: 10.3390/nu13113775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/12/2022] Open
Abstract
This systematic review summarises the literature regarding the impact of preoperative dietary interventions on non-bariatric surgery outcomes for patients with excess weight/obesity, a known risk factor for poor surgical outcomes. Four electronic databases were searched for non-bariatric surgery studies that evaluated the surgical outcomes of a preoperative diet that focused on weight/fat loss or improvement of liver steatosis. Meta-analysis was unfeasible due to the extreme heterogeneity of variables. Fourteen studies, including five randomised controlled trials, were selected. Laparoscopic cholecystectomy, hernia repair, and liver resection were most studied. Diet-induced weight loss ranged from 1.4 kg to 25 kg. Preoperative very low calorie diet (≤800 kcal) or low calorie diet (≤900 kcal) for one to three weeks resulted in: reduction in blood loss for two liver resection and one gastrectomy study (-27 to -411 mL, p < 0.05), and for laparoscopic cholecystectomy, reduction of six minutes in operating time (p < 0.05) and reduced difficulty of aspects of procedure (p < 0.05). There was no difference in length of stay (n = 7 studies). Preoperative ≤ 900 kcal diets for one to three weeks could improve surgical outcomes for laparoscopic cholecystectomy, liver resection, and gastrectomy. Multiple randomised controlled trials with common surgical outcomes are required to establish impact on other surgeries.
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Affiliation(s)
- Sally B. Griffin
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD 4131, Australia; (M.A.P.); (R.L.)
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia;
| | - Michelle A. Palmer
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD 4131, Australia; (M.A.P.); (R.L.)
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4215, Australia
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD 4059, Australia;
| | - Rainbow Lai
- Department of Nutrition & Dietetics, Logan Hospital, Meadowbrook, QLD 4131, Australia; (M.A.P.); (R.L.)
| | - Matthew J. Burstow
- Division of Surgery, Logan Hospital, Meadowbrook, QLD 4131, Australia;
- School of Medicine, Griffith University, Gold Coast, QLD 4215, Australia
| | - Lynda J. Ross
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia;
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19
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van Kooten RT, Bahadoer RR, Peeters KCMJ, Hoeksema JHL, Steyerberg EW, Hartgrink HH, van de Velde CJH, Wouters MWJM, Tollenaar RAEM. Preoperative risk factors for major postoperative complications after complex gastrointestinal cancer surgery: A systematic review. Eur J Surg Oncol 2021; 47:3049-3058. [PMID: 34340874 DOI: 10.1016/j.ejso.2021.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/16/2021] [Accepted: 07/24/2021] [Indexed: 12/20/2022] Open
Abstract
Patients undergoing complex gastrointestinal surgery are at high risk of major postoperative complications (e.g., anastomotic leakage, sepsis), classified as Clavien-Dindo (CD) ≥ IIIa. Identification of preoperative risk factors can lead to the identification of high-risk patients. These risk factors can also be used to design personalized perioperative care. This systematic review focuses on the identification of these factors. The Medline and Embase databases were searched for prospective, retrospective cohort studies and randomized controlled trials investigating the effect of risk factors on the occurrence of major postoperative complications and/or mortality after complex gastrointestinal cancer surgery. Risk of bias was assessed using the Quality in Prognostic Studies tool. The level of evidence was graded based on the number of studies reporting a significant association between risk factors and major complications. A total of 207 eligible studies were retrieved, identifying 33 risk factors for major postoperative complications and 13 preoperative laboratory results associated with postoperative complications. The present systematic review provides a comprehensive overview of preoperative risk factors associated with major postoperative complications. A wide range of risk factors are amenable to actions in perioperative care and prehabilitation programs, which may lead to improved outcomes for high-risk patients. Additionally, the knowledge of this study is important for benchmarking surgical outcomes.
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Affiliation(s)
- Robert T van Kooten
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - Renu R Bahadoer
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jetty H L Hoeksema
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Michel W J M Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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20
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Saravana-Bawan B, Goplen M, Alghamdi M, Khadaroo RG. The Relationship Between Visceral Obesity and Post-operative Complications: A Meta-analysis. J Surg Res 2021; 267:71-81. [PMID: 34130241 DOI: 10.1016/j.jss.2021.04.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/19/2021] [Accepted: 04/10/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Body composition can have important influence on surgical outcome. There is substantial literature examining sarcopenia, however much less in known about the impact of fat. Visceral fat area (VFA) is a reliable measures of fat distribution that can be quantified with CT scan. The aim of this study is to determine the impact of VFA to predict complications and mortality after emergent or elective surgery. MATERIALS AND METHODS A systematic review and meta-analysis was performed in accordance with the Preferred.
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Affiliation(s)
| | - Michael Goplen
- Department of Surgery, University of Alberta, Edmonton, Canada
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21
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Shiomi S, Toriumi T, Yagi K, Asaoka R, Okumura Y, Wakamatsu K, Aikou S, Yamashita H, Nomura S, Seto Y. Trunk fat volume can be a predictor of postoperative complications after gastrectomy: a retrospective cohort study. BMC Surg 2021; 21:207. [PMID: 33892713 PMCID: PMC8067392 DOI: 10.1186/s12893-021-01221-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background Obesity can affect postoperative outcomes of gastrectomy. Visceral fat area is superior to body mass index in predicting postoperative complications. However, visceral fat area measurement is time-consuming and is not optimum for clinical use. Meanwhile, trunk fat volume (TFV) can be easily measured via bioelectrical impedance analysis. Hence, the current study aimed to determine the ability of TFV to predict the occurrence of complications after gastrectomy. Methods We retrospectively reviewed patients who underwent curative gastrectomy for gastric cancer between November 2016 and November 2019. The trunk fat volume-to-the ideal amount (%TFV) ratio was obtained using InBody 770 before surgery. The patients were classified into the obese and nonobese groups according to %TFV (TFV-H group, ≥ 150%; TFV-L group, < 150%) and body mass index (BMI-H group, ≥ 25 kg/m2; BMI-L group, < 25 kg/m2). We compared the short-term postoperative outcomes (e.g., operative time, blood loss volume, number of resected lymph nodes, and duration of hospital stay) between the obese and nonobese patients. Risk factors for complications were assessed using logistic regression analysis. Results In total, 232 patients were included in this study. The TFV-H and BMI-H groups had a significantly longer operative time than the TFV-L (p = 0.022) and BMI-L groups (p = 0.006). Moreover, the TFV-H group had a significantly higher complication rate (p = 0.004) and a lower number of resected lymph nodes (p < 0.001) than the TFV-L group. In the univariate analysis, %TFV ≥ 150, total or proximal gastrectomy, and open gastrectomy were found to be potentially associated with higher complication rates (p < 0.1 for all). Moreover, the multivariate analysis revealed that %TFV ≥ 150 (OR: 2.73; 95% CI: 1.37–5.46; p = 0.005) and total or proximal gastrectomy (OR: 3.57; 95% CI: 1.79–7.12; p < 0.001) were independently correlated with postoperative morbidity. Conclusions %TFV independently affected postoperative complications. Hence, it may be a useful parameter for the evaluation of obesity and a predictor of complications after gastrectomy.
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Affiliation(s)
- Shinichiro Shiomi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tetsuro Toriumi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Raito Asaoka
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kotaro Wakamatsu
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sachiyo Nomura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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22
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Takeda K, Mizutani K, Minami I, Kido D, Mikami R, Konuma K, Saito N, Kominato H, Takemura S, Nakagawa K, Izumi Y, Ogawa Y, Iwata T. Association of periodontal pocket area with type 2 diabetes and obesity: a cross-sectional study. BMJ Open Diabetes Res Care 2021; 9:e002139. [PMID: 33879517 PMCID: PMC8061845 DOI: 10.1136/bmjdrc-2021-002139] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The aim was to investigate the relationship of full-mouth inflammatory parameters of periodontal disease with diabetes and obesity. RESEARCH DESIGN AND METHODS This cross-sectional study conducted diabetes-related examinations and calculated periodontal inflamed and epithelial surface area (PISA and PESA) of 71 Japanese patients with type 2 diabetes. Multiple linear regression analyses were performed to evaluate associations between PISA or PESA and diabetes and obesity parameters. RESULTS Median value of body mass index (BMI), hemoglobin A1c (HbA1c) level, fasting plasma glucose (FPG) level, and visceral fat area (VFA) were 25.7 kg/m2, 9.1%, 151 mg/L, and 93.3 cm2, respectively. PISA and PESA were significantly associated with HbA1c after adjusting for age, sex, BMI, smoking status, and full-mouth plaque control level (PISA: coefficient=38.1, 95% CI 8.85 to 67.29, p=0.001; PESA: coefficient=66.89, 95% CI 21.44 to 112.34, p=0.005). PISA was also significantly associated with the highest FPG tertile (>175 mg/dL) after adjusting for confounders (coefficient=167.0, 95% CI 48.60 to 285.4, p=0.006). PISA and PESA were not significantly associated with BMI or VFA. CONCLUSION PISA was associated with FPG and HbA1c, but not with obesity parameters, independent from confounders such as full-mouth plaque control level in patients with type 2 diabetes.
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Affiliation(s)
- Kohei Takeda
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Mizutani
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Isao Minami
- Department of Molecular Endocrinology and Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Endocrinology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Daisuke Kido
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Risako Mikami
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kuniha Konuma
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Natsumi Saito
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiromi Kominato
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shu Takemura
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keita Nakagawa
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Izumi
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Oral Care Perio Center, Southern Tohoku Research Institute for Neuroscience Southern Tohoku General Hospital, Fukushima, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Iwata
- Department of Periodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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23
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Mao C, Chen X, Sun X, Wang X, Zhu C, Chen W, Xue X, Shen X. Laparoscopic gastrectomy reduces adverse postoperative outcomes and decreases morbidity for gastric cancer patients with visceral obesity: a propensity score-matched analysis. J Cancer 2021; 12:2113-2121. [PMID: 33754010 PMCID: PMC7974537 DOI: 10.7150/jca.47552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Laparoscopic gastrectomy for gastric cancer shortens the recovery period without decreasing long-term survival. However, clinical evidence on whether laparoscopic radical gastrectomy reduces the surgical stress and improves the short- and long-term outcomes of obese patients with gastric cancer is lacking. We compared the short- and long-term outcomes of gastric cancer patients with visceral obesity (VO) who underwent laparoscopic gastrectomy (LG) or open gastrectomy (OG). Methods: We prospectively collected data from 578 patients who underwent radical gastrectomy in two centers between January 2014 and December 2016. The visceral fat area (VFA) was measured on the umbilicus level, and VFA ≥100 cm2 was defined as VO. The section bias was reduced by conducting a propensity score matching analysis. The short- and long-term outcomes were further compared between patients who underwent OG and those who underwent LG. Results: Overall, 245 patients (42.61%) were classified as having VO, of whom 102 were included for further analysis after matching. There were no significant differences in clinical characteristics between the two groups in the matched cohort. The LG group had significantly fewer overall complications (P<0.001) and shorter postoperative hospital stays (P<0.001). Subgroup analysis of postoperative complications also showed that the incidence of surgical complications was lower in the LG group (P=0.002). Further survival analysis showed the LG group had significantly better long-term overall survival (P=0.017). Conclusions: Compared with open radical gastrectomy, laparoscopy would reduce the rate of postoperative complications in patients with VO, as well as prolong their overall survival.
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Affiliation(s)
- Chenchen Mao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiangwei Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ce Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenjing Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiangyang Xue
- Department of Medical Microbiology and Immunology, Basic Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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24
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Zhang Y, Li Z, Jiang L, Xue Z, Ma Z, Kang W, Ye X, Liu Y, Jin Z, Yu J. Impact of body composition on clinical outcomes in people with gastric cancer undergoing radical gastrectomy after neoadjuvant treatment. Nutrition 2021; 85:111135. [PMID: 33556785 DOI: 10.1016/j.nut.2020.111135] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The influence of body composition on clinical outcomes in individuals with gastric cancer (GC) undergoing radical gastrectomy after neoadjuvant treatment (NT) remains unclear. The purpose of this retrospective study was to investigate the association between body composition before NT or after NT and clinical outcomes in individuals with GC receiving multimodal treatments. METHODS This retrospective study included individuals with GC who received NT followed by radical gastrectomy between January 2016 and December 2018. Skeletal muscle, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) were measured by cross-sectional areas at the level of third lumbar vertebra based on single-slice computed tomography scan prior to NT and prior to the surgical operation. Sarcopenia, high VAT, and high SAT were defined using cutoff points of skeletal muscle index, visceral fat area, and subcutaneous fat area. Univariate and multivariate analyses were performed to evaluate risk factors of NT-related adverse events, postoperative complications and predictors of long-term survival. RESULTS A total of 110 individuals with GC were enrolled in this study. Sarcopenia was present in 62.7% of them before NT and in 56.4% after NT. Sarcopenia before NT was associated with more NT-related adverse events (odds ratio, 2.901; 95% confidence interval [CI], 1.205-6.983; P = 0.018). High VAT after NT (≥106 cm2) was associated with an increasing incidence of postoperative complications (odds ratio, 4.261; 95% CI, 1.332-13.632; P = 0.015). No body-composition parameter was relevant to tumor pathologic response to NT. As for long-term survival, poor overall survival was associated with both low VAT before NT (<120 cm2; hazard ratio [HR], 2.542; 95% CI, 1.111-5.817; P = 0.027) and low SAT after NT (<99.5 cm2; HR, 2.743; 95% CI, 1.248-6.027; P = 0.012). Similarly, shorter disease-free survival was associated with low VAT before NT (<120 cm2; HR, 2.502; 95% CI, 1.222-5.124; P = 0.012) and low VAT after NT (<106 cm2; HR, 2.505; 95% CI, 1.172-5.358; P = 0.018). CONCLUSIONS Body composition measured by computed tomography could predict NT-related adverse events, postoperative complications, and long-term survival in multimodal treatments for GC. More meaningfully, adipose-tissue status has significant prognostic value for individuals with advanced GC.
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Affiliation(s)
- Yingjing Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zijian Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhigang Xue
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiqiang Ma
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqin Liu
- Cell Culture Centre, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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25
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Huang H, Yang X, Sun J, Zhu C, Wang X, Zeng Y, Xu J, Mao C, Shen X. Value of Visceral Fat Area in the Preoperative Discrimination of Peritoneal Metastasis from Gastric Cancer in Patients with Different Body Mass Index: A Prospective Study. Cancer Manag Res 2020; 12:6523-6532. [PMID: 32801890 PMCID: PMC7395682 DOI: 10.2147/cmar.s257849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/27/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose Although peritoneal metastasis (PM) is associated with poor prognosis in gastric cancer (GC) patients, it is difficult to discriminate preoperatively. Our previous study has demonstrated visceral fat area (VFA) is a better obesity index than body mass index (BMI) in predicting abdominal metastasis. This study aimed to further explore the relationship between obesity and PM. Patients and Methods VFA was retrieved for 859 consecutive patients undergoing radical gastrectomy between January 1, 2009, and December 31, 2013. A receiver operating characteristic curve analysis was used to determine the BMI-specific cutoff values for VFA. Univariate and multivariate analyses evaluating the risk factors for PM at different BMI levels were performed. Results The optimal cutoff values for VFA were 67.28, 88.03, and 175.32 cm2 for low, normal, and high BMI patients, respectively, and 18 (15.52%), 220 (40.15%), and 61 (31.28%) patients were classified as having high VFA in each group. Univariate logistic regression revealed that the association between high VFA and PM was not dependent on BMI (odds ratio [OR]=9.048, P=0.007 for low BMI, OR=3.827, P<0.001 for normal BMI, and OR=2.460, P=0.049 for high BMI). In multivariate logistic regression analysis, high VFA (OR=3.816, P<0.001) and vascular invasion (OR=1.951, P=0.039) were independent risk factors for PM only in the normal BMI group. Conclusion VFA only effectively predicted PM for GC patients with normal BMI, rather than those with low and high BMI. More attentions should be paid to those GC patients with high VFA and normal BMI.
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Affiliation(s)
- He Huang
- Department of General Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xinxin Yang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jing Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ce Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiang Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yunpeng Zeng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Jingxuan Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chenchen Mao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xian Shen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.,Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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26
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Kubota T, Shoda K, Konishi H, Okamoto K, Otsuji E. Nutrition update in gastric cancer surgery. Ann Gastroenterol Surg 2020; 4:360-368. [PMID: 32724879 PMCID: PMC7382435 DOI: 10.1002/ags3.12351] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/24/2022] Open
Abstract
Patients with gastric cancer are often malnourished during tumor progression. Malnutrition is a risk factor for postoperative complications and a poor prognosis. Early evaluation and management of nutrition can improve these outcomes. Various combined indices in which albumin is the primary component are used to evaluate the nutritional status, including the Prognostic Nutritional Index, Glasgow Prognostic Score, and Controlling Nutritional Status score. Both the American Society for Parenteral and Enteral Nutrition and the European Society for Clinical Nutrition and Metabolism guidelines recommend immediate and early oral/enteral nutrition. However, few reports have described the additional effects of preoperative immunonutrition on clinical outcomes of gastric cancer surgery. Gastrectomy types and reconstruction methods that consider the postoperative nutritional status have been used when oncologically acceptable. Total gastrectomy has recently tended to be avoided because of its negative impact on nutritional status. New findings obtained from the emergence of continuous glucose measurement, such as glucose fluctuation and nocturnal hypoglycemia, may affect nutritional management after gastrectomy. Some prospective clinical studies on perioperative nutritional intervention have set postoperative body weight loss as a primary endpoint. It seems important to continue oral nutritional supplement, even in small doses, to reduce body weight loss after gastrectomy. Evidence generated by prospective, well-developed randomized controlled studies must be disseminated so that nutritional therapy is widely recognized as an important multimodal therapy in patients undergoing gastric cancer surgery.
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Affiliation(s)
- Takeshi Kubota
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
| | - Katsutoshi Shoda
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
| | - Hirotaka Konishi
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
| | - Kazuma Okamoto
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
| | - Eigo Otsuji
- Division of Digestive SurgeryDepartment of SurgeryKyoto Prefectural University of MedicineKyotoJapan
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