BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gas...BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.展开更多
Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shor...Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shortand long-term outcomes of RG and laparoscopic gastrectomy(LG)in the treatment of stage cT4a gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of patients with stage cT4a gastric cancer diagnosed and treated at eight high-volume tertiary teaching hospitals in China from 2016 to 2019.Propensity score matching(PSM)analysis and inverse probability of treatment weighting(IPTW)analysis was used to adjust for the imbalance in baseline characteristics.The primary research endpoint was the 3-year overall survival(OS)and disease-free survival(DFS).The secondary research endpoint was intraoperative outcomes and postoperative complications.Results:After IPTW and PSM adjustments,baseline characteristics between the RG and LG groups were comparable[standardized mean difference(SMD)<0.10].Post-PSM analysis revealed that the RG group exhibited longer operative time(P<0.001),lower postoperative complication rates(P<0.001),shorter postoperative hospital stays(P=0.037),and earlier initiation of adjuvant chemotherapy(P=0.041)compared with the LG group.Survival analysis demonstrated comparable 3-year OS(P=0.110)and DFS(P=0.088)in the PSM cohort,whereas the IPTW cohort showed superior OS(P=0.030)and DFS(P=0.046)for RG.No significant differences were observed in overall recurrence rates or recurrence sites between groups.Conclusions:For patients with stage cT4a gastric cancer,compared with the LG group,the RG group had shorter postoperative hospital stay,lower incidence of postoperative complications,earlier postoperative adjuvant chemotherapy,and no worse long-term efficacy.展开更多
BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anast...BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures.A comparison of these two surgical procedures,tubular gastroesophageal anastomosis and double-channel anastomosis,has rarely been reported.Therefore,this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.AIM To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.METHODS Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study.The patients were divided into an experimental group(double-channel anastomosis,33 cases)and a control group(tubular gastric anastomosis,30 cases).Baseline characteristics,surgical data,postoperative morbidities,and postoperative nutrition were recorded.RESULTS The differences in baseline data,surgical data,and postoperative complications(20.0%vs 21.2%)were not statistically significant between the two groups.There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively.In addition,the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group(P<0.05).At 12 months postoperatively,the difference in anastomotic reflux esophagitis between the two groups was statistically significant(P<0.05)with the experimental group showing less reflux esophagitis.CONCLUSION Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible.Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.展开更多
BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gast...BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.展开更多
BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous a...BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on intraoperative stability,postoperative complications,and long-term oncologic outcomes in patients with gastric cancer undergoing radical gastrectomy remain unclear.AIM To compare the effects of sevoflurane inhalation anesthesia and propofol total in-travenous anesthesia on clinical outcomes,including intraoperative indicators,postoperative complications,adverse effects,pain scores,and survival.METHODS This single-center retrospective cohort study included 204 patients who underw-ent radical gastrectomy for gastric cancer from February 2019 to December 2022.Patients were assigned to either the sevoflurane group(n=103)or the propofol group(n=101)based on intraoperative anesthetic regimen.Standardized protoc-ols for anesthesia management,intraoperative monitoring,and postoperative analgesia were applied.Baseline characteristics;intraoperative metrics;adverse events;complications;Visual Analog Scale(VAS)scores at 2,4,6,24,and 48 hours;and survival outcomes were retrospectively collected.Group comparisons were performed usingχ2 for categorical variables,t test for continuous variables,RESULTS Baseline demographic and clinical characteristics were similar between groups.No significant differences were observed in intraoperative indicators or most 30-day postoperative outcomes,including length of stay,emergency department visits,and readmission rates.The propofol group showed elevated mean VAS pain score at 24 hours postoperatively,but no differences were found at other time points.The propofol group also had significantly higher postoperative nausea incidence and transiently higher systolic/diastolic blood pressure and heart rate at the time of incision than the sevoflurane group.No significant differences were seen in overall rates or severity of postoperative complications,intraoperative adverse events,or in overall survival and progression-free survival.CONCLUSION In patients undergoing radical gastrectomy for gastric cancer,sevoflurane and propofol anesthesia demonstrated similar profiles regarding intraoperative safety,postoperative complications,adverse events,postoperative pain,and long-term survival.The selection of anesthesia can be personalized without significantly affecting periop-erative or oncologic outcomes.展开更多
In recent years,the detection rate of early gastric cancer in China has significantly increased.Early gastric cancer is associated with a favourable prognosis;thus,enhancing the postoperative quality of life for patie...In recent years,the detection rate of early gastric cancer in China has significantly increased.Early gastric cancer is associated with a favourable prognosis;thus,enhancing the postoperative quality of life for patients has become an increasingly pressing issue in treating gastric cancer.Consequently,function-preserving gastrectomy has emerged as a viable option.This surgical approach aims to mi-nimize the extent of resection while preserving some gastric function,all within the framework of radical tumour excision.Pylorus-preserving gastrectomy(PPG)serves as a representative example of a function-preserving technique and is par-ticularly suitable for early-stage gastric cancer of the middle segment of the sto-mach.Compared with distal gastrectomy,laparoscopic PPG offers several ad-vantages:(1)Results in less surgical trauma;and(2)Reduces the incidence of postoperative complications such as dumping syndrome,bile reflux gastritis,and gallstones while also improving nutritional status postsurgery.However,the implementation of PPG remains contentious within the medical community.In light of new Japanese guidelines for gastric cancer treatment and informed by current research trends along with relevant evidence-based medicine principles,this review examines various aspects related to laparoscopic PPG,including its definition and indications,safety profile,benefits,technical considerations,me-thods for digestive tract reconstruction and postoperative complications.展开更多
BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postopera...BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postoperative weight loss remains controversial.AIM To evaluate the effect of RGV on weight loss and body mass index(BMI)changes in patients undergoing sleeve gastrectomy.METHODS This retrospective study included 49 patients.Preoperative and postoperative body weight and BMI(at 6 months and 12 months after surgery)were recorded.RGV was calculated using the ellipsoid formula based on the specimen’s length,width,and thickness measurements.Statistical analyses included parametric tests,repeated-measures one-way analysis of variance,Bonferroni post-hoc tests,and Pearson correlation analysis.RESULTS Both body weight and BMI significantly decreased over time(weight:F=951.34,P<0.01,η^(2)=0.95;BMI:F=345.97,P<0.01,η^(2)=0.88).A positive and statistically significant correlation was found between preoperative body weight and RGV(r=0.285,P<0.05).However,no significant associations were identified between RGV and weight or BMI at 6 months and 12 months.CONCLUSION RGV correlated with preoperative weight but not with postoperative outcomes,indicating that weight loss after sleeve gastrectomy is a multifactorial process and influenced by hormonal,metabolic,and lifestyle factors.展开更多
Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to c...Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.Methods:We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey.The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%,and defined as high robotic proportion cohort and low robotic proportion cohort.We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching(PSM).To account for potential clustering effects within hospitals,we employed Generalized Estimating Equations with hospital as the clustering variable.Results:This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer.In low robotic proportion cohort,RG had a longer operation time(P<0.001)but similar blood loss(P=0.792)compared to LG.In the high robotic proportion cohort,RG showed longer operation time(P<0.001),less blood loss(P<0.001),and shorter hospital stays(P<0.001)compared to LG.Additionally,RG in the high robotic proportion cohort had shorter operative time(P<0.001)and less blood loss(P=0.024)compared with that in the low robotic proportion cohort.Conclusions:RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis.However,RG offers limited benefits over LG at institutions with lower frequencies of RG use.展开更多
BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report ...BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.展开更多
BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migr...BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migration near the esophagojejunal anastomosis(EJA),resulting in persistent drainage and mimicking EJAL after total gastrectomy.CASE SUMMARY A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma,with two silicone drains placed near the EJA.On postoperative day(POD)4,the patient developed signs of peritonitis and sepsis,necessitating surgical re-exploration abscess drainage,peritoneal lavage,and drain repositioning.A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection.Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59,which revealed approximately 5 cm of the drain within the esophagus,with the perforation site located 2 cm distal to the intact EJA.The drain was repositioned under endoscopic guidance.A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain.The patient was subsequently discharged without further incident.CONCLUSION Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.展开更多
BACKGROUND For patients with advanced gastric cancer,surgical resection remains the main treatment option.Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can signif...BACKGROUND For patients with advanced gastric cancer,surgical resection remains the main treatment option.Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can significantly prolong the survival of patients.Digestive tract reconstruction after total gastrectomy is essential to maintain gastrointestinal function and optimize postoperative recovery.Therefore,it is very important to choose a suitable reconstruction method to improve the quality of life of total gastrectomy patients.AIM To evaluate the effects of different digestive tract reconstruction methods in gastric cancer patients undergoing total gastrectomy.METHODS This retrospective study included 172 patients who underwent total gastrectomy for gastric cancer at The First Hospital of Hebei Medical University for analysis.The patients were categorized into two groups:Group A,consisting of 90 patients who underwent modified Roux-en-Y gastrojejunostomy,and group B,consisting of 82 patients who underwent uncut Roux-en-Y gastrojejunostomy.The general patient characteristics,perioperative indicators,postoperative gastrointestinal mucosal barrier function,nutritional status,immunological markers,and occurrence of complications were compared between the two groups.RESULTS Group A showed shorter digestive tract reconstruction time than group B(P<0.05).On the first postoperative day,group A showed lower serum levels of D-lactate,diamine oxidase,and endotoxin than group B(P<0.05).One month postoperatively,group A showed higher prognostic nutritional index,serum albumin,total protein,and body weight than group B(P<0.05).One month postoperatively,the levels of cluster of differentiation(CD)3+,CD4+,and CD8+cells were not significantly different between two groups(P>0.05).The complication rates were 10.00%in group A and 24.39%in group B;group A had a significantly lower complication rate than group B(P<0.05).CONCLUSION Using modified Roux-en-Y gastrojejunostomy during total gastrectomy shortens the time required for gastrointestinal anastomosis,reduces surgery-induced gastrointestinal mucosal damage,and mitigates postoperative declines in nutritional status.展开更多
BACKGROUND Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure.Few studies focused on intraoperative anastomotic complications in eso...BACKGROUND Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure.Few studies focused on intraoperative anastomotic complications in esophagojejunostomy with circular stapler.AIM To explore whether endoscopic examination could reduce the occurrence of early postoperative anastomotic complications.METHODS Clinical data from 160 patients with gastric cancer who underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler at Nanchong Central Hospital from January 2020 to December 2023 were retrospectively analyzed.Based on whether intraoperative endoscopic examination(IEE)was performed,patients were divided into the IEE group and the non-IEE(NIEE)group.RESULTS All patients successfully underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler.In the IEE group,7(8.8%)patients were found to have anastomotic defects:3(3.8%)air leaks,2(2.5%)bleeding,1(1.3%)stricture and 1(1.3%)full-thickness tearing.Three patients with anastomotic discontinuities were subsequently treated with additional suturing.One anastomotic bleeding was managed with laparoscopic suturing,and another was treated with endoscopic clips.One patient had anastomotic stricture,which was corrected intraoperatively.One patient experienced full-thickness tearing caused by the circular stapler,necessitating a redo anastomosis.These anastomotic defects were repaired intraoperatively,and no postoperative anastomotic complications occurred.6(7.5%)patients with postoperative anastomotic complications were observed in the NIEE group.The NIEE group had a significantly higher incidence of postoperative anastomosis-related complications compared to the IEE group(7.5%vs 0%;P=0.029).CONCLUSION Routine IEE significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects in esophagojejunostomy with circular stapler.展开更多
Traditionally,liver retraction for laparoscopic gastrectomy is done via manual methods,such as the placement of retractors through the accessory ports and using a Nathanson retractor.However,these techniques often pos...Traditionally,liver retraction for laparoscopic gastrectomy is done via manual methods,such as the placement of retractors through the accessory ports and using a Nathanson retractor.However,these techniques often posed issues including extra abdominal incisions,risk of liver injury or ischaemia,and the potential for compromised visualization.Over the years,the development of innovative liver retraction techniques has significantly improved the safety and efficacy of laparoscopic gastrectomy and similar other hiatal procedures.This editorial will comment on the article by Lin et al,and compare this to the other liver retractor techniques available for surgeons and highlight the pros and cons of each technique of liver retraction.展开更多
BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the p...BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the postoperative life of the patient.Currently,the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC.However,more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure,with more reconstruction steps and longer reconstruction time,and the incidence of postoperative complications such as adhesive intestinal obstruction,internal abdominal hernia and volvulus is high.Moreover,the incidence of Roux stasis syndrome is 10%-30%after traditional Roux-en-Y reconstruction.Thus,we modified the traditional Roux-en-Y alimentary tract reconstruction,and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.AIM To evaluate the clinical advantages,feasibility,and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy(total gastrectomy)for GC were divided into two groups:fifty-four in the conventional Roux-en-Y reconstruction group(Orr group)and forty-three in the modified Roux-en-Y reconstruction group(the modified group).Perioperative and short-term outcomes were analyzed,including complications,postoperative weight loss,hemoglobin levels,and nutritional status.RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics.Compared with the Orr group,the modified group had shorter digestive tract reconstruction and operation times,less intraoperative bleeding,and shorter postoperative hospital stays compared to the Orr group.Although both groups had similar amounts of intraoperative blood loss,postoperative recovery times,and hospital expenses,the Orr group experienced longer operation times and digestive tract reconstruction times.Furthermore,the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications,with a reduced incidence of reflux esophagitis and improved nutritional status.CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety,simplicity,and a reduction in bile reflux.This method shortens operation times and minimizes postoperative complications,aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival.This method warrants further clinical application and promotion.展开更多
Metabolic dysfunction-associated steatohepatitis(MASH)has become a leading indication for liver transplantation.Bariatric surgery is a proven intervention for weight loss and metabolic improvement in MASH but concerns...Metabolic dysfunction-associated steatohepatitis(MASH)has become a leading indication for liver transplantation.Bariatric surgery is a proven intervention for weight loss and metabolic improvement in MASH but concerns over surgical risk in patients with advanced liver disease has expanded interest in endoscopic sleeve gastroplasty(ESG)as a less invasive alternative.This review examine the efficacy,safety,and metabolic impact of ESG vs traditional bariatric surgery(Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy)in patients with MASH,with and without cirrhosis.We analyze current evidence on weight loss outcomes,histologic and biochemical improvements in MASH,resolution of metabolic syndrome,and perioperative risks associated with these procedures.Special attention is given to the feasibility of ESG in compensated cirrhosis(Child-Pugh A/B)and the potential role of bariatric interventions in delaying or avoiding liver transplantation.As the prevalence of MASH-related cirrhosis rises,refining bariatric strategies for this high-risk population is imperative.ESG may offer a lower procedural risk profile,but current data are largely limited to small,observational studies with short-term follow-up.A tailored,multidisciplinary approach is essential to optimize weight management and liver health in MASH patients,with future studies needed to clarify the long-term efficacy and safety of ESG in MASH.展开更多
BACKGROUND Gastric cancer remains a significant global health concern.Radical gastrectomy is the primary curative treatment.Diabetes mellitus is a common comorbidity in patients undergoing surgery for gastric cancer,i...BACKGROUND Gastric cancer remains a significant global health concern.Radical gastrectomy is the primary curative treatment.Diabetes mellitus is a common comorbidity in patients undergoing surgery for gastric cancer,including radical gastrectomy.Previous studies have suggested that diabetes can negatively affect postoperative outcomes,such as wound healing,infection rates,and overall recovery.However,the specific impact of diabetes on recovery after radical gastrectomy for gastric cancer remains poorly understood.evaluate the influence of diabetes on postope-rative recovery,including hospital stay duration,complications,and readmission rates,in patients undergoing gastrectomy for gastric cancer.Understanding these effects could help optimize perioperative management and improve patient out-comes.gastric cancer and associated postoperative outcomes.METHODS This retrospective cohort study was performed at the Endocrinology Department of Xuanwu Hospital,Capital Medical University,Beijing,China.We examined patients who underwent radical gastrectomy for cancer between January 2010 and December 2020.The patients were divided into the diabetes and non-diabetes groups.The main outcomes included length of hospital stay,postoperative com-plications,and 30-day readmission rate.Secondary outcomes included quality of life indicators.Propensity score matching was used to adjust for potential con-founding factors.RESULTS A total of 1210 patients were included in the study,with 302 diabetic patients and 908 non-diabetic patients.After propensity score matching,280 patients were included in each group.Diabetic patients demonstrated significantly longer hospital stays(mean difference 2.3 days,95%CI:1.7-2.9,P<0.001)and higher rates of postoperative complications(OR 1.68,95%CI:1.32-2.14,P<0.001).The 30-day readmission rate was also higher in the diabetic group as compared to the non-diabetic group(12.5%vs 7.8%,P=0.02).CONCLUSION Patients with diabetes mellitus undergoing radical gastrectomy for gastric cancer experience prolonged hospital stay,increased postoperative complications,and higher readmission rates,thus requiring optimized perioperative management strategies.展开更多
Radical gastrectomy for gastric cancer demands meticulous pre-operative staging and real-time intra-operative guidance to optimise oncologic margins and mini-mize complications.Recent advances in artificial-intelligen...Radical gastrectomy for gastric cancer demands meticulous pre-operative staging and real-time intra-operative guidance to optimise oncologic margins and mini-mize complications.Recent advances in artificial-intelligence algorithms reliably integrate multimodal clinical,imaging and pathological data,producing highly reproducible tumour-staging and risk-stratification models that inform persona-lised operative strategies.Concurrently,navigation platforms that fuse computed-tomography,magnetic-resonance,ultrasound and fluorescence datasets generate patient-specific three-dimensional reconstructions with sub-millimeter registra-tion accuracy,enabling dynamic margin delineation and reducing inadvertent tissue injury.Predictive analytics that assimilate intra-operative metrics with early postoperative information can forecast survival and complication profiles,thereby supporting tailored follow-up protocols.Remaining barriers include safeguarding data privacy,accelerating image-registration and inference speeds,meeting high computational-resource demands and offsetting the substantial capital and main-tenance costs of these systems.Nevertheless,the convergent evolution of artificial intelligence and real-time imaging navigation is poised to transform radical gast-rectomy by elevating surgical precision,enhancing patient safety and improving long-term outcomes;realizing this promise will require algorithmic refinement,multicenter validation,robust ethical frameworks and cost-effective implemen-tation models.展开更多
BACKGROUND Radical gastrectomy(RGE)for gastric carcinoma(GC)has exerted definite therapeutic efficacy in treating patients with GC.However,a notable risk of postoperative complications(POCs)persists among middle-aged ...BACKGROUND Radical gastrectomy(RGE)for gastric carcinoma(GC)has exerted definite therapeutic efficacy in treating patients with GC.However,a notable risk of postoperative complications(POCs)persists among middle-aged and elderly patients with compromised physiological functions.Hence,developing and implementing reliable nursing interventions to optimize the comprehensive management of these patients is deemed imperative.AIM To analyze the association of multi-channel continuous nursing intervention with POCs,negative emotions(NEs),and quality of life(QoL)of patients undergoing RGE for GC.METHODS This retrospective study selected 99 patients who underwent RGE for GC in our hospital from May 2020 to May 2023.Participants were categorized into the control(n=49 cases)and research groups(n=50 cases)receiving routine and multi-channel continuous nursing care,respectively.Comparative analysis involved data on postoperative rehabilitation(time to first anal exhaust,oral feeding and ambulation,and hospital stay),complications(nausea and vomiting,delayed gastric emptying,and abdominal distension),NEs[Self-rating Anxiety(SAS)/Depression Scale(SDS)],treatment compliance,self-efficacy,and QoL[World Health Organization QoL Brief Version(WHOQOL-BREF)].RESULTS Compared to the control group,the research group demonstrated earlier first postoperative anal exhaust,oral feeding,and ambulation,shorter hospital stay,lower POC rate,and more reduced SAS and SDS scores postintervention,which was significantly lower than the baseline.The treatment compliance scores were significantly higher in the research group than in the control group in terms of medication adherence,daily exercise,reasonable diet,and regular review.Further,the research group demonstrated increased self-efficacy scores in terms of positive attitude,self-stress relief,and self-decision-making,as well as the overall score postintervention,which were higher than the control group.Moreover,the research group reported notably higher WHOQOL-BREF scores in domains such as physiology,psychology,social relations,and environment.CONCLUSION Multi-channel continuous nursing intervention prevents POCs in patients undergoing RGE for GC as well as significantly alleviates patients’NEs and boosts their QoL.展开更多
BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic flu...BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.展开更多
BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclea...BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclear.AIM To clarify the impact of relevant factors,particularly perirenal fat,on postoperative hypertension resolution.METHODS In this retrospective single-center study,a total of 138 patients with obesity and hypertension were included,all of whom underwent LSG in the hospital and were followed up for one year.Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution.Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution,and their predictive values were compared using fivefold cross-validation.RESULTS After LSG,107 patients(77.5%)experienced hypertension resolution,while 31 patients(22.5%)did not achieve resolution.Both the preoperative perirenal fat area(PrFA)and perirenal fat thickness were independent risk factors for postoperative hypertension resolution(P<0.001 vs P=0.002).These factors are curvilinearly correlated with the hypertension resolution rate,but PrFA has a better predictive value than perirenal fat thickness dose(area under the curve=0.846 vs 0.809).Compared with those with PrFA≥18 cm2,patients with PrFA<18 cm2 had a higher hypertension resolution rate[87%vs 68.1%;odds ratio(95%confidence interval)=3.513(1.367-9.902),P=0.012].CONCLUSION PrFA is a preoperative predictor of postoperative hypertension resolution.It is curvilinearly associated with the resolution rate,and patients with PrFA<18 cm²have better hypertension resolution outcomes after LSG.展开更多
基金Supported by Special Fund for the Beijing Hope Marathon of the China Cancer Foundation,No.LC2019 L05and the Capital Health Development Research Special Fund Project,No.2024-2-4026.
文摘BACKGROUND Gastric cancer(GC)is a major global health challenge,and the treatment of proximal GC in particular presents unique clinical and surgical complexities.Currently,there is no consensus on whether proximal gastrectomy(PG)or total gastrectomy(TG)should be used for advanced proximal GC,and the choice of postoperative gastrointestinal reconstruction method remains controversial.AIM To compare the short-term efficacy,long-term survival,and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y re-construction in patients with proximal GC following neoadjuvant chemotherapy(NACT)in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.METHODS A multicenter retrospective cohort study was conducted at two Chinese medical centers between December,2012 and December,2022.Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included.Propensity score matching(PSM)was performed to balance baseline characteristics,and the primary endpoint was 5-year overall survival(OS).Se-condary endpoints included recurrence-free survival(RFS),postoperative complications,and reflux severity.RESULTS After PSM,244 patients(122 PG,122 TG)were finally included and all baseline characteristics were comparable between groups.The PG group had a significantly shorter operation time compared to the TG group(189.50 vs 215.00 minutes,P<0.001),with no differences in intraoperative blood loss or postoperative complications(19.68%vs 14.75%,P=0.792).The 5-year OS rates were 52.7%vs 45.5%(P=0.330),and 5-year RFS rates were 54.3%vs 47.6%(P=0.356)for the PG and TG groups,respectively.Reflux symptoms(18.0%vs 31.1%,P=0.017)and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores≥8(7.4%vs 21.3%,P<0.001)were significantly less frequent in the PG group.Multivariate analysis identified histological differentiation(HR=2.98,95%CI:2.03-4.36,P<0.001)and tumor size(HR=0.26,95%CI:0.17-0.41 for tumors≤4 cm,P<0.001)as independent prognostic factors.CONCLUSION PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT.Additionally,PG has the advantages of shorter operation time and lower rates of postoperative reflux,suggesting potential benefits for patient quality of life.Notably,the analysis of postoperative prognostic factors,including histological differentiation and tumor size,further informs clinical decision-making and highlights the importance of individualized treatment strategies.
基金supported by Fujian Provincial Medical“Building High-level Hospitals,High-level Clinical Medical Centers and Key Clinical Specialty Projects”([2021]No.76)Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare(No.[2022]954)。
文摘Objective:Robotic gastrectomy(RG)is increasingly used in the treatment of gastric cancer.However,studies on patients with clinical serosa-invasive(cT4a)gastric cancer remain scarce.This study aimed to compare the shortand long-term outcomes of RG and laparoscopic gastrectomy(LG)in the treatment of stage cT4a gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of patients with stage cT4a gastric cancer diagnosed and treated at eight high-volume tertiary teaching hospitals in China from 2016 to 2019.Propensity score matching(PSM)analysis and inverse probability of treatment weighting(IPTW)analysis was used to adjust for the imbalance in baseline characteristics.The primary research endpoint was the 3-year overall survival(OS)and disease-free survival(DFS).The secondary research endpoint was intraoperative outcomes and postoperative complications.Results:After IPTW and PSM adjustments,baseline characteristics between the RG and LG groups were comparable[standardized mean difference(SMD)<0.10].Post-PSM analysis revealed that the RG group exhibited longer operative time(P<0.001),lower postoperative complication rates(P<0.001),shorter postoperative hospital stays(P=0.037),and earlier initiation of adjuvant chemotherapy(P=0.041)compared with the LG group.Survival analysis demonstrated comparable 3-year OS(P=0.110)and DFS(P=0.088)in the PSM cohort,whereas the IPTW cohort showed superior OS(P=0.030)and DFS(P=0.046)for RG.No significant differences were observed in overall recurrence rates or recurrence sites between groups.Conclusions:For patients with stage cT4a gastric cancer,compared with the LG group,the RG group had shorter postoperative hospital stay,lower incidence of postoperative complications,earlier postoperative adjuvant chemotherapy,and no worse long-term efficacy.
基金Supported by the“521 Project”Funding Project Day of Lianyungang。
文摘BACKGROUND According to statistics,the incidence of proximal gastric cancer has gradually increased in recent years,posing a serious threat to human health.Tubular gastroesophageal anastomosis and double-channel anastomosis are two relatively mature anti-reflux procedures.A comparison of these two surgical procedures,tubular gastroesophageal anastomosis and double-channel anastomosis,has rarely been reported.Therefore,this study aimed to investigate the effects of these two reconstruction methods on the quality of life of patients with proximal gastric cancer after proximal gastrectomy.AIM To compare short-term clinical results of laparoscopic proximal gastrectomy with double-channel anastomosis vs tubular gastric anastomosis.METHODS Patients who underwent proximal gastrectomy at our hospital between January 2020 and January 2023 were enrolled in this retrospective cohort study.The patients were divided into an experimental group(double-channel anastomosis,33 cases)and a control group(tubular gastric anastomosis,30 cases).Baseline characteristics,surgical data,postoperative morbidities,and postoperative nutrition were recorded.RESULTS The differences in baseline data,surgical data,and postoperative complications(20.0%vs 21.2%)were not statistically significant between the two groups.There were no statistically significant differences in the levels of postoperative nutrition indicators between the two groups of patients during the preoperative period and at 3 months postoperatively.In addition,the levels of postoperative nutrition indicators in patients in the experimental group declined significantly less at 6 months and 12 months postoperatively compared with those of the control group(P<0.05).At 12 months postoperatively,the difference in anastomotic reflux esophagitis between the two groups was statistically significant(P<0.05)with the experimental group showing less reflux esophagitis.CONCLUSION Both double-channel anastomosis and tubular gastric anastomosis after proximal gastrectomy are safe and feasible.Double-channel anastomosis has a better anti-reflux effect and is more beneficial in improving the postoperative nutritional status.
文摘BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.
文摘BACKGROUND Gastric cancer is a major global health issue,and the perioperative period critic-ally influences patient outcomes.The different effects of sevoflurane inhalation anesthesia and propofol total intravenous anesthesia on intraoperative stability,postoperative complications,and long-term oncologic outcomes in patients with gastric cancer undergoing radical gastrectomy remain unclear.AIM To compare the effects of sevoflurane inhalation anesthesia and propofol total in-travenous anesthesia on clinical outcomes,including intraoperative indicators,postoperative complications,adverse effects,pain scores,and survival.METHODS This single-center retrospective cohort study included 204 patients who underw-ent radical gastrectomy for gastric cancer from February 2019 to December 2022.Patients were assigned to either the sevoflurane group(n=103)or the propofol group(n=101)based on intraoperative anesthetic regimen.Standardized protoc-ols for anesthesia management,intraoperative monitoring,and postoperative analgesia were applied.Baseline characteristics;intraoperative metrics;adverse events;complications;Visual Analog Scale(VAS)scores at 2,4,6,24,and 48 hours;and survival outcomes were retrospectively collected.Group comparisons were performed usingχ2 for categorical variables,t test for continuous variables,RESULTS Baseline demographic and clinical characteristics were similar between groups.No significant differences were observed in intraoperative indicators or most 30-day postoperative outcomes,including length of stay,emergency department visits,and readmission rates.The propofol group showed elevated mean VAS pain score at 24 hours postoperatively,but no differences were found at other time points.The propofol group also had significantly higher postoperative nausea incidence and transiently higher systolic/diastolic blood pressure and heart rate at the time of incision than the sevoflurane group.No significant differences were seen in overall rates or severity of postoperative complications,intraoperative adverse events,or in overall survival and progression-free survival.CONCLUSION In patients undergoing radical gastrectomy for gastric cancer,sevoflurane and propofol anesthesia demonstrated similar profiles regarding intraoperative safety,postoperative complications,adverse events,postoperative pain,and long-term survival.The selection of anesthesia can be personalized without significantly affecting periop-erative or oncologic outcomes.
文摘In recent years,the detection rate of early gastric cancer in China has significantly increased.Early gastric cancer is associated with a favourable prognosis;thus,enhancing the postoperative quality of life for patients has become an increasingly pressing issue in treating gastric cancer.Consequently,function-preserving gastrectomy has emerged as a viable option.This surgical approach aims to mi-nimize the extent of resection while preserving some gastric function,all within the framework of radical tumour excision.Pylorus-preserving gastrectomy(PPG)serves as a representative example of a function-preserving technique and is par-ticularly suitable for early-stage gastric cancer of the middle segment of the sto-mach.Compared with distal gastrectomy,laparoscopic PPG offers several ad-vantages:(1)Results in less surgical trauma;and(2)Reduces the incidence of postoperative complications such as dumping syndrome,bile reflux gastritis,and gallstones while also improving nutritional status postsurgery.However,the implementation of PPG remains contentious within the medical community.In light of new Japanese guidelines for gastric cancer treatment and informed by current research trends along with relevant evidence-based medicine principles,this review examines various aspects related to laparoscopic PPG,including its definition and indications,safety profile,benefits,technical considerations,me-thods for digestive tract reconstruction and postoperative complications.
文摘BACKGROUND Obesity is a major global health concern associated with increased morbidity and mortality.Sleeve gastrectomy is an effective bariatric surgery;however,the impact of resected gastric volume(RGV)on postoperative weight loss remains controversial.AIM To evaluate the effect of RGV on weight loss and body mass index(BMI)changes in patients undergoing sleeve gastrectomy.METHODS This retrospective study included 49 patients.Preoperative and postoperative body weight and BMI(at 6 months and 12 months after surgery)were recorded.RGV was calculated using the ellipsoid formula based on the specimen’s length,width,and thickness measurements.Statistical analyses included parametric tests,repeated-measures one-way analysis of variance,Bonferroni post-hoc tests,and Pearson correlation analysis.RESULTS Both body weight and BMI significantly decreased over time(weight:F=951.34,P<0.01,η^(2)=0.95;BMI:F=345.97,P<0.01,η^(2)=0.88).A positive and statistically significant correlation was found between preoperative body weight and RGV(r=0.285,P<0.05).However,no significant associations were identified between RGV and weight or BMI at 6 months and 12 months.CONCLUSION RGV correlated with preoperative weight but not with postoperative outcomes,indicating that weight loss after sleeve gastrectomy is a multifactorial process and influenced by hormonal,metabolic,and lifestyle factors.
基金supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI),funded by the Ministry of Health&Welfare,Republic of Korea(No.RS-2023-KH140183)the new faculty research fund of Ajou University School of Medicine(No.M-2024C0460-00064)。
文摘Objective:The Safety of robotic gastrectomy(RG)compared to laparoscopic gastrectomy(LG)for gastric cancer remains uncertain on a national scale,with limited comparative studies across institutions.This study aims to compare the morbidity rates between RG and LG using data from a nationwide survey.Methods:We utilized data from the Korean Gastric Cancer Association's 2019 nationwide survey.The proportion of robotic surgeries in minimally invasive surgery at each institution was classified using a cut-off value of 10%,and defined as high robotic proportion cohort and low robotic proportion cohort.We analyzed surgical outcomes between robotic and laparoscopic gastrectomy in each cohort using propensity score matching(PSM).To account for potential clustering effects within hospitals,we employed Generalized Estimating Equations with hospital as the clustering variable.Results:This study included 776 patients who underwent RG and 7,804 patients who underwent LG for gastric cancer.In low robotic proportion cohort,RG had a longer operation time(P<0.001)but similar blood loss(P=0.792)compared to LG.In the high robotic proportion cohort,RG showed longer operation time(P<0.001),less blood loss(P<0.001),and shorter hospital stays(P<0.001)compared to LG.Additionally,RG in the high robotic proportion cohort had shorter operative time(P<0.001)and less blood loss(P=0.024)compared with that in the low robotic proportion cohort.Conclusions:RG demonstrated comparable perioperative outcomes to LG in a nationwide PSM analysis.However,RG offers limited benefits over LG at institutions with lower frequencies of RG use.
文摘BACKGROUND Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery,especially in patients with a history of complex abdominal procedures.CASE SUMMARY This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplan-tation.The patient presented with a body mass index of 40.7 kg/m2 and a giant incisional hernia,compounded by extensive intraabdominal adhesions from mul-tiple previous surgeries.A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan.Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions,and the procedure was completed successfully using standard stapling techniques.Postoperative recovery was smooth,with significant weight loss achieved within the first month.CONCLUSION This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.
文摘BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a severe complication following gastrectomy for gastric cancer,typically treated with drainage and nutritional support.We report a case of intraluminal drain migration near the esophagojejunal anastomosis(EJA),resulting in persistent drainage and mimicking EJAL after total gastrectomy.CASE SUMMARY A 64-year-old male underwent open total gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma,with two silicone drains placed near the EJA.On postoperative day(POD)4,the patient developed signs of peritonitis and sepsis,necessitating surgical re-exploration abscess drainage,peritoneal lavage,and drain repositioning.A contrast swallow study on POD 18 revealed rapid filling of the abdominal drain without extraluminal contrast collection.Persistent drainage prompted an upper gastrointestinal endoscopy on POD 59,which revealed approximately 5 cm of the drain within the esophagus,with the perforation site located 2 cm distal to the intact EJA.The drain was repositioned under endoscopic guidance.A repeat contrast radiograph on POD 67 demonstrated no evidence of extraluminal contrast extravasation or filling of the abdominal drain.The patient was subsequently discharged without further incident.CONCLUSION Intraluminal drain migration is a rare complication following gastric surgery but should be considered when persistent drainage occurs.
文摘BACKGROUND For patients with advanced gastric cancer,surgical resection remains the main treatment option.Total gastrectomy combined with radical resection of gastric cancer lesions and sentinel lymph nodes can significantly prolong the survival of patients.Digestive tract reconstruction after total gastrectomy is essential to maintain gastrointestinal function and optimize postoperative recovery.Therefore,it is very important to choose a suitable reconstruction method to improve the quality of life of total gastrectomy patients.AIM To evaluate the effects of different digestive tract reconstruction methods in gastric cancer patients undergoing total gastrectomy.METHODS This retrospective study included 172 patients who underwent total gastrectomy for gastric cancer at The First Hospital of Hebei Medical University for analysis.The patients were categorized into two groups:Group A,consisting of 90 patients who underwent modified Roux-en-Y gastrojejunostomy,and group B,consisting of 82 patients who underwent uncut Roux-en-Y gastrojejunostomy.The general patient characteristics,perioperative indicators,postoperative gastrointestinal mucosal barrier function,nutritional status,immunological markers,and occurrence of complications were compared between the two groups.RESULTS Group A showed shorter digestive tract reconstruction time than group B(P<0.05).On the first postoperative day,group A showed lower serum levels of D-lactate,diamine oxidase,and endotoxin than group B(P<0.05).One month postoperatively,group A showed higher prognostic nutritional index,serum albumin,total protein,and body weight than group B(P<0.05).One month postoperatively,the levels of cluster of differentiation(CD)3+,CD4+,and CD8+cells were not significantly different between two groups(P>0.05).The complication rates were 10.00%in group A and 24.39%in group B;group A had a significantly lower complication rate than group B(P<0.05).CONCLUSION Using modified Roux-en-Y gastrojejunostomy during total gastrectomy shortens the time required for gastrointestinal anastomosis,reduces surgery-induced gastrointestinal mucosal damage,and mitigates postoperative declines in nutritional status.
文摘BACKGROUND Early postoperative anastomosis-related complications are frequently associated with technical defects during the anastomotic procedure.Few studies focused on intraoperative anastomotic complications in esophagojejunostomy with circular stapler.AIM To explore whether endoscopic examination could reduce the occurrence of early postoperative anastomotic complications.METHODS Clinical data from 160 patients with gastric cancer who underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler at Nanchong Central Hospital from January 2020 to December 2023 were retrospectively analyzed.Based on whether intraoperative endoscopic examination(IEE)was performed,patients were divided into the IEE group and the non-IEE(NIEE)group.RESULTS All patients successfully underwent laparoscopic total gastrectomy with esophagojejunostomy using a circular stapler.In the IEE group,7(8.8%)patients were found to have anastomotic defects:3(3.8%)air leaks,2(2.5%)bleeding,1(1.3%)stricture and 1(1.3%)full-thickness tearing.Three patients with anastomotic discontinuities were subsequently treated with additional suturing.One anastomotic bleeding was managed with laparoscopic suturing,and another was treated with endoscopic clips.One patient had anastomotic stricture,which was corrected intraoperatively.One patient experienced full-thickness tearing caused by the circular stapler,necessitating a redo anastomosis.These anastomotic defects were repaired intraoperatively,and no postoperative anastomotic complications occurred.6(7.5%)patients with postoperative anastomotic complications were observed in the NIEE group.The NIEE group had a significantly higher incidence of postoperative anastomosis-related complications compared to the IEE group(7.5%vs 0%;P=0.029).CONCLUSION Routine IEE significantly reduces early anastomotic complications by enabling immediate detection and repair of technical defects in esophagojejunostomy with circular stapler.
文摘Traditionally,liver retraction for laparoscopic gastrectomy is done via manual methods,such as the placement of retractors through the accessory ports and using a Nathanson retractor.However,these techniques often posed issues including extra abdominal incisions,risk of liver injury or ischaemia,and the potential for compromised visualization.Over the years,the development of innovative liver retraction techniques has significantly improved the safety and efficacy of laparoscopic gastrectomy and similar other hiatal procedures.This editorial will comment on the article by Lin et al,and compare this to the other liver retractor techniques available for surgeons and highlight the pros and cons of each technique of liver retraction.
文摘BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the postoperative life of the patient.Currently,the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC.However,more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure,with more reconstruction steps and longer reconstruction time,and the incidence of postoperative complications such as adhesive intestinal obstruction,internal abdominal hernia and volvulus is high.Moreover,the incidence of Roux stasis syndrome is 10%-30%after traditional Roux-en-Y reconstruction.Thus,we modified the traditional Roux-en-Y alimentary tract reconstruction,and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.AIM To evaluate the clinical advantages,feasibility,and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy(total gastrectomy)for GC were divided into two groups:fifty-four in the conventional Roux-en-Y reconstruction group(Orr group)and forty-three in the modified Roux-en-Y reconstruction group(the modified group).Perioperative and short-term outcomes were analyzed,including complications,postoperative weight loss,hemoglobin levels,and nutritional status.RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics.Compared with the Orr group,the modified group had shorter digestive tract reconstruction and operation times,less intraoperative bleeding,and shorter postoperative hospital stays compared to the Orr group.Although both groups had similar amounts of intraoperative blood loss,postoperative recovery times,and hospital expenses,the Orr group experienced longer operation times and digestive tract reconstruction times.Furthermore,the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications,with a reduced incidence of reflux esophagitis and improved nutritional status.CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety,simplicity,and a reduction in bile reflux.This method shortens operation times and minimizes postoperative complications,aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival.This method warrants further clinical application and promotion.
文摘Metabolic dysfunction-associated steatohepatitis(MASH)has become a leading indication for liver transplantation.Bariatric surgery is a proven intervention for weight loss and metabolic improvement in MASH but concerns over surgical risk in patients with advanced liver disease has expanded interest in endoscopic sleeve gastroplasty(ESG)as a less invasive alternative.This review examine the efficacy,safety,and metabolic impact of ESG vs traditional bariatric surgery(Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy)in patients with MASH,with and without cirrhosis.We analyze current evidence on weight loss outcomes,histologic and biochemical improvements in MASH,resolution of metabolic syndrome,and perioperative risks associated with these procedures.Special attention is given to the feasibility of ESG in compensated cirrhosis(Child-Pugh A/B)and the potential role of bariatric interventions in delaying or avoiding liver transplantation.As the prevalence of MASH-related cirrhosis rises,refining bariatric strategies for this high-risk population is imperative.ESG may offer a lower procedural risk profile,but current data are largely limited to small,observational studies with short-term follow-up.A tailored,multidisciplinary approach is essential to optimize weight management and liver health in MASH patients,with future studies needed to clarify the long-term efficacy and safety of ESG in MASH.
文摘BACKGROUND Gastric cancer remains a significant global health concern.Radical gastrectomy is the primary curative treatment.Diabetes mellitus is a common comorbidity in patients undergoing surgery for gastric cancer,including radical gastrectomy.Previous studies have suggested that diabetes can negatively affect postoperative outcomes,such as wound healing,infection rates,and overall recovery.However,the specific impact of diabetes on recovery after radical gastrectomy for gastric cancer remains poorly understood.evaluate the influence of diabetes on postope-rative recovery,including hospital stay duration,complications,and readmission rates,in patients undergoing gastrectomy for gastric cancer.Understanding these effects could help optimize perioperative management and improve patient out-comes.gastric cancer and associated postoperative outcomes.METHODS This retrospective cohort study was performed at the Endocrinology Department of Xuanwu Hospital,Capital Medical University,Beijing,China.We examined patients who underwent radical gastrectomy for cancer between January 2010 and December 2020.The patients were divided into the diabetes and non-diabetes groups.The main outcomes included length of hospital stay,postoperative com-plications,and 30-day readmission rate.Secondary outcomes included quality of life indicators.Propensity score matching was used to adjust for potential con-founding factors.RESULTS A total of 1210 patients were included in the study,with 302 diabetic patients and 908 non-diabetic patients.After propensity score matching,280 patients were included in each group.Diabetic patients demonstrated significantly longer hospital stays(mean difference 2.3 days,95%CI:1.7-2.9,P<0.001)and higher rates of postoperative complications(OR 1.68,95%CI:1.32-2.14,P<0.001).The 30-day readmission rate was also higher in the diabetic group as compared to the non-diabetic group(12.5%vs 7.8%,P=0.02).CONCLUSION Patients with diabetes mellitus undergoing radical gastrectomy for gastric cancer experience prolonged hospital stay,increased postoperative complications,and higher readmission rates,thus requiring optimized perioperative management strategies.
基金Supported by Gansu Provincial Natural Science Foundation,No.25JRRA304and National Health Commission,No.NHCDP2022001。
文摘Radical gastrectomy for gastric cancer demands meticulous pre-operative staging and real-time intra-operative guidance to optimise oncologic margins and mini-mize complications.Recent advances in artificial-intelligence algorithms reliably integrate multimodal clinical,imaging and pathological data,producing highly reproducible tumour-staging and risk-stratification models that inform persona-lised operative strategies.Concurrently,navigation platforms that fuse computed-tomography,magnetic-resonance,ultrasound and fluorescence datasets generate patient-specific three-dimensional reconstructions with sub-millimeter registra-tion accuracy,enabling dynamic margin delineation and reducing inadvertent tissue injury.Predictive analytics that assimilate intra-operative metrics with early postoperative information can forecast survival and complication profiles,thereby supporting tailored follow-up protocols.Remaining barriers include safeguarding data privacy,accelerating image-registration and inference speeds,meeting high computational-resource demands and offsetting the substantial capital and main-tenance costs of these systems.Nevertheless,the convergent evolution of artificial intelligence and real-time imaging navigation is poised to transform radical gast-rectomy by elevating surgical precision,enhancing patient safety and improving long-term outcomes;realizing this promise will require algorithmic refinement,multicenter validation,robust ethical frameworks and cost-effective implemen-tation models.
文摘BACKGROUND Radical gastrectomy(RGE)for gastric carcinoma(GC)has exerted definite therapeutic efficacy in treating patients with GC.However,a notable risk of postoperative complications(POCs)persists among middle-aged and elderly patients with compromised physiological functions.Hence,developing and implementing reliable nursing interventions to optimize the comprehensive management of these patients is deemed imperative.AIM To analyze the association of multi-channel continuous nursing intervention with POCs,negative emotions(NEs),and quality of life(QoL)of patients undergoing RGE for GC.METHODS This retrospective study selected 99 patients who underwent RGE for GC in our hospital from May 2020 to May 2023.Participants were categorized into the control(n=49 cases)and research groups(n=50 cases)receiving routine and multi-channel continuous nursing care,respectively.Comparative analysis involved data on postoperative rehabilitation(time to first anal exhaust,oral feeding and ambulation,and hospital stay),complications(nausea and vomiting,delayed gastric emptying,and abdominal distension),NEs[Self-rating Anxiety(SAS)/Depression Scale(SDS)],treatment compliance,self-efficacy,and QoL[World Health Organization QoL Brief Version(WHOQOL-BREF)].RESULTS Compared to the control group,the research group demonstrated earlier first postoperative anal exhaust,oral feeding,and ambulation,shorter hospital stay,lower POC rate,and more reduced SAS and SDS scores postintervention,which was significantly lower than the baseline.The treatment compliance scores were significantly higher in the research group than in the control group in terms of medication adherence,daily exercise,reasonable diet,and regular review.Further,the research group demonstrated increased self-efficacy scores in terms of positive attitude,self-stress relief,and self-decision-making,as well as the overall score postintervention,which were higher than the control group.Moreover,the research group reported notably higher WHOQOL-BREF scores in domains such as physiology,psychology,social relations,and environment.CONCLUSION Multi-channel continuous nursing intervention prevents POCs in patients undergoing RGE for GC as well as significantly alleviates patients’NEs and boosts their QoL.
文摘BACKGROUND Petersen’s hernia occurring through the epiploic foramen of the greater omentum,is an uncommon type of internal hernia.When it presents with complications such as chylous ascites,which is the lymphatic fluid accumulation in the abdominal cavity,it is particularly rare.Following laparoscopic total gastrectomy and Roux-en-Y anastomosis,the incidence of this condition is exceedingly low.CASE SUMMARY A 62-year-old male patient developed Petersen’s hernia following laparoscopic total gastrectomy(LTG)for gastric cancer,after Roux-en-Y anastomosis.Intestinal torsion and obstruction were experienced by the patient,along with a small amount of chylous ascites.Imaging studies and clinical assessment confirmed the diagnosis.Emergency surgery was performed promptly for the patient in the operating room.The twisted small intestine was reduced and the defect in Petersen’s space was repaired.The procedure was successful in the correction of the intestinal torsion and approximation of the hernia without the need for bowel resection.The patient’s condition significantly improved following the surgery.The ascites evolved from a milky white appearance to a pale yellow,with a substantial decrease in the triglyceride levels in the ascitic fluid,implying a favorable recovery trajectory.The patient was monitored closely and received appropriate care postoperatively,including nutritional support and fluid management.CONCLUSION This report illustrates the significance of recognizing Petersen’s hernia as a potential complication following gastrectomy for gastric cancer.It highlights the fundamental role of early surgical intervention in the effective management of such complications.The favorable outcome in this patient illustrates that prompt and appropriate surgical management can deter the necessity for more extensive procedures such as bowel resection.
基金Supported by the National Natural Science Foundation of China,No.82270914 and No.82401043.
文摘BACKGROUND Laparoscopic sleeve gastrectomy(LSG)can lead to complete resolution of hypertension in most patients with obesity within one year.However,the preoperative factors related to this resolution are still unclear.AIM To clarify the impact of relevant factors,particularly perirenal fat,on postoperative hypertension resolution.METHODS In this retrospective single-center study,a total of 138 patients with obesity and hypertension were included,all of whom underwent LSG in the hospital and were followed up for one year.Multivariate logistic regression models were used to identify independent risk factors for postoperative hypertension resolution.Generalized additive models were employed to clarify the nonlinear relationships between these factors and hypertension resolution,and their predictive values were compared using fivefold cross-validation.RESULTS After LSG,107 patients(77.5%)experienced hypertension resolution,while 31 patients(22.5%)did not achieve resolution.Both the preoperative perirenal fat area(PrFA)and perirenal fat thickness were independent risk factors for postoperative hypertension resolution(P<0.001 vs P=0.002).These factors are curvilinearly correlated with the hypertension resolution rate,but PrFA has a better predictive value than perirenal fat thickness dose(area under the curve=0.846 vs 0.809).Compared with those with PrFA≥18 cm2,patients with PrFA<18 cm2 had a higher hypertension resolution rate[87%vs 68.1%;odds ratio(95%confidence interval)=3.513(1.367-9.902),P=0.012].CONCLUSION PrFA is a preoperative predictor of postoperative hypertension resolution.It is curvilinearly associated with the resolution rate,and patients with PrFA<18 cm²have better hypertension resolution outcomes after LSG.
