BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is increasingly recognized for its role in the pathogenesis of various cancers.However,its impact on gastric cancer(GC)outcomes,particularly in patients undergoing la...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is increasingly recognized for its role in the pathogenesis of various cancers.However,its impact on gastric cancer(GC)outcomes,particularly in patients undergoing laparoscopic distal gastrectomy(LDG),remains unclear.AIM To investigate the clinical and prognostic impacts of NAFLD on GC patients undergoing LDG.METHODS In this retrospective cohort study,we collected clinical data from 1122 GC patients who underwent LDG at the Gastric Cancer Center of the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2022.Propensity score-matching(PSM)was used to mitigate the bias to compare the oncological and surgical outcomes between the two groups.Survival analysis was also performed to evaluate NAFLD as a prognostic factor.RESULTS PSM yielded a balanced cohort of 260 patients(52 with NAFLD and 208 controls)from the original cohort.No differences in clinicopathological characteristics,including surgery time,complications,T stage,N stage,p-tumornode-metastasis stage,neural invasion,vascular invasion,total number of retrieved lymph nodes,positive retrieved lymph nodes and positive lymph nodes rate,were observed between the two groups.Overall survival was comparable between two groups(Log-rank P=0.49),whereas progression-free survival(PFS)in the NAFLD group was inferior to that in the control group(Log-rank P=0.016).Univariable Cox regression analysis further confirmed that NAFLD was an unfavorable prognostic factor for PFS.CONCLUSION GC patients with NAFLD exhibited inferior PFS,suggesting that addressing NAFLD-related metabolic alterations may enhance clinical outcomes.Future investigations should explore the mechanistic links between NAFLD and GC progression and consider integrated therapeutic strategies.展开更多
BACKGROUND For total laparoscopic distal gastrectomies for gastric cancer,the reconstruction method is critical to the clinical outcome of the procedure.However,which reconstruction technique is optimal remains contro...BACKGROUND For total laparoscopic distal gastrectomies for gastric cancer,the reconstruction method is critical to the clinical outcome of the procedure.However,which reconstruction technique is optimal remains controversial.We originally reported the augmented rectangle technique(ART)as a reconstruction option for total laparoscopic Billroth I reconstructions.Still,little is known about its effect on long-term outcomes,specifically the incidence of postgastrectomy syndrome and its impact on quality of life.AIM To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37(PGSAS-37)questionnaire.METHODS At Juntendo University,a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire.Multidimensional analysis was performed,comparing those 94 ART cases from our institution(ART group)to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database(PGSAS group).RESULTS Patients in the ART group had significantly better total symptom scores in all the symptom subscales(i.e.,esophageal reflux,abdominal pain,meal-related distress,indigestion,diarrhea,constipation,and dumping).The loss of body weight was marginally greater for those in the ART group than in the PGSAS group(-9.3%vs-7.9%,P=0.054).The ART group scored significantly lower in their dissatisfaction of ongoing symptoms,during meals,and with daily life.CONCLUSION ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.展开更多
Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays ...Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.展开更多
Background Laparoscopy-assisted radical gastrectomy is gaining acceptance for treating early gastric cancer. However, few reports concerning the effectiveness of laparoscopy-assisted D2 radical distal gastrectomy （L...Background Laparoscopy-assisted radical gastrectomy is gaining acceptance for treating early gastric cancer. However, few reports concerning the effectiveness of laparoscopy-assisted D2 radical distal gastrectomy （LADG） for advanced gastric cancer or data comparing the results obtained after open distal gastrectomy （ODG） are yet available. The aim of this study was to evaluate the method, feasibility and clinical result of LADG for advanced gastric cancer. Methods A retrospective study was performed comparing LADG and ODG for advanced gastric cancer. Seventy-eight patients who underwent LADG were compared with 90 patients who underwent ODG in terms of pathologic findings, operative outcome, and complications. Results There was no conversion to open surgery in the LADG group and no postoperative mortality of any patients. There were no significant differences between LADG and ODG in operative time （（245±35） vs （220±620） minutes）, complication rate （7.7% vs 10.0%）, and number of lymph nodes （23.5±6.0 vs 21.0±7.5）, while the blood loss was less after LADG （（110±25） vs （196±30） ml, P 〈0.05）. The time to postoperative flatus and postoperative hospital stay were shorter after LADG （（73.0±8.5） vs （102.0±10.5） hours, and （8.6±1.2） vs （12.1 ±2.5） days, P 〈0.05, respectively）. Conclusion LADG for advanced gastric cancer is feasible, safe, and minimally invasive.展开更多
基金Supported by China Postdoctoral Science Foundation,No.2021TQ0132The Youth Fund Program for National Natural Science Foundation of China from the First Affiliated Hospital of Nanjing Medical University,No.PY2021032。
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is increasingly recognized for its role in the pathogenesis of various cancers.However,its impact on gastric cancer(GC)outcomes,particularly in patients undergoing laparoscopic distal gastrectomy(LDG),remains unclear.AIM To investigate the clinical and prognostic impacts of NAFLD on GC patients undergoing LDG.METHODS In this retrospective cohort study,we collected clinical data from 1122 GC patients who underwent LDG at the Gastric Cancer Center of the First Affiliated Hospital of Nanjing Medical University between January 2020 and December 2022.Propensity score-matching(PSM)was used to mitigate the bias to compare the oncological and surgical outcomes between the two groups.Survival analysis was also performed to evaluate NAFLD as a prognostic factor.RESULTS PSM yielded a balanced cohort of 260 patients(52 with NAFLD and 208 controls)from the original cohort.No differences in clinicopathological characteristics,including surgery time,complications,T stage,N stage,p-tumornode-metastasis stage,neural invasion,vascular invasion,total number of retrieved lymph nodes,positive retrieved lymph nodes and positive lymph nodes rate,were observed between the two groups.Overall survival was comparable between two groups(Log-rank P=0.49),whereas progression-free survival(PFS)in the NAFLD group was inferior to that in the control group(Log-rank P=0.016).Univariable Cox regression analysis further confirmed that NAFLD was an unfavorable prognostic factor for PFS.CONCLUSION GC patients with NAFLD exhibited inferior PFS,suggesting that addressing NAFLD-related metabolic alterations may enhance clinical outcomes.Future investigations should explore the mechanistic links between NAFLD and GC progression and consider integrated therapeutic strategies.
文摘BACKGROUND For total laparoscopic distal gastrectomies for gastric cancer,the reconstruction method is critical to the clinical outcome of the procedure.However,which reconstruction technique is optimal remains controversial.We originally reported the augmented rectangle technique(ART)as a reconstruction option for total laparoscopic Billroth I reconstructions.Still,little is known about its effect on long-term outcomes,specifically the incidence of postgastrectomy syndrome and its impact on quality of life.AIM To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37(PGSAS-37)questionnaire.METHODS At Juntendo University,a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 questionnaire.Multidimensional analysis was performed,comparing those 94 ART cases from our institution(ART group)to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database(PGSAS group).RESULTS Patients in the ART group had significantly better total symptom scores in all the symptom subscales(i.e.,esophageal reflux,abdominal pain,meal-related distress,indigestion,diarrhea,constipation,and dumping).The loss of body weight was marginally greater for those in the ART group than in the PGSAS group(-9.3%vs-7.9%,P=0.054).The ART group scored significantly lower in their dissatisfaction of ongoing symptoms,during meals,and with daily life.CONCLUSION ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.
文摘Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.
文摘Background Laparoscopy-assisted radical gastrectomy is gaining acceptance for treating early gastric cancer. However, few reports concerning the effectiveness of laparoscopy-assisted D2 radical distal gastrectomy （LADG） for advanced gastric cancer or data comparing the results obtained after open distal gastrectomy （ODG） are yet available. The aim of this study was to evaluate the method, feasibility and clinical result of LADG for advanced gastric cancer. Methods A retrospective study was performed comparing LADG and ODG for advanced gastric cancer. Seventy-eight patients who underwent LADG were compared with 90 patients who underwent ODG in terms of pathologic findings, operative outcome, and complications. Results There was no conversion to open surgery in the LADG group and no postoperative mortality of any patients. There were no significant differences between LADG and ODG in operative time （（245±35） vs （220±620） minutes）, complication rate （7.7% vs 10.0%）, and number of lymph nodes （23.5±6.0 vs 21.0±7.5）, while the blood loss was less after LADG （（110±25） vs （196±30） ml, P 〈0.05）. The time to postoperative flatus and postoperative hospital stay were shorter after LADG （（73.0±8.5） vs （102.0±10.5） hours, and （8.6±1.2） vs （12.1 ±2.5） days, P 〈0.05, respectively）. Conclusion LADG for advanced gastric cancer is feasible, safe, and minimally invasive.
