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 At present,the enhanced recovery after surgery(ERAS)protocol is widely implemented in the field of gastric surgery.However,the effect of the ERAS protocol on the long-term prognosis of gastric cancer has no...BACKGROUND At present,the enhanced recovery after surgery(ERAS)protocol is widely implemented in the field of gastric surgery.However,the effect of the ERAS protocol on the long-term prognosis of gastric cancer has not been reported.AIM To compare the effects of ERAS and conventional protocols on short-term outcomes and long-term prognosis after laparoscopic gastrectomy.METHODS We retrospectively analyzed the data of 1026 consecutive patients who underwent laparoscopic gastrectomy between 2012 and 2015.The patients were divided into either an ERAS group or a conventional group.The groups were matched in a 1:1 ratio using propensity scores based on covariates that affect cancer survival.The primary outcomes were the 5-year overall and cancer-specific survival rates.The secondary outcomes were the postoperative short-term outcomes and inflammatory indexes.RESULTS The patient demographics and baseline characteristics were similar between the two groups after matching.Compared to the conventional group,the ERAS group had a significantly shorter postoperative hospital day(7.09 d vs 8.67 d,P<0.001),shorter time to first flatus,liquid intake,and ambulation(2.50 d vs 3.40 d,P<0.001;1.02 d vs 3.64 d,P<0.001;1.47 d vs 2.99 d,P<0.001,respectively),and lower medical costs($7621.75 vs$7814.16,P=0.009).There was a significantly higher rate of postoperative complications among patients in the conventional group than among those in the ERAS group(18.1 vs 12.3,P=0.030).Regarding inflammatory indexes,the C-reactive protein and procalcitonin levels on postoperative day 3/4 were significantly different between the two groups(P<0.001 and P=0.025,respectively).The ERAS protocol was associated with significantly improved 5-year overall survival and cancer-specific survival rates compared with conventional protocol(P=0.013 and 0.032,respectively).When stratified by tumour stage,only the survival of patients with stage III disease was significantly different between the two groups(P=0.044).CONCLUSION Adherence to the ERAS protocol improves both the short-term outcomes and the 5-year overall survival and cancer-specific survival of patients after laparoscopic gastrectomy.展开更多
In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of...In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer(GC).Presently,no consensus exists regarding the optimal reconstructive procedure.In this review,the current state of digestive tract reconstruction after LG is reviewed.According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction,we divide these reconstruction procedures into three categories consistent with the resection procedures.We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes(length of surgery and blood loss)and postoperative complications(anastomotic leakage and stricture)to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.展开更多
BACKGROUND Totally laparoscopic gastrectomy(TLG)entails both gastrectomy and gastrointestinal reconstruction under laparoscopy.Compared with laparoscopic assisted gastrectomy(LAG),TLG has been demonstrated in many stu...BACKGROUND Totally laparoscopic gastrectomy(TLG)entails both gastrectomy and gastrointestinal reconstruction under laparoscopy.Compared with laparoscopic assisted gastrectomy(LAG),TLG has been demonstrated in many studies to require a smaller surgical incision,result in a faster postoperative recovery and less pain and have comparable long-term efficacy,which has been a research hotspot in recent years.Whether TLG is equally safe and feasible for elderly patients remains unclear.AIM To compare the short-term efficacy of and quality of life(QOL)associated with TLG and LAG in elderly gastric cancer(GC)patients.METHODS The clinicopathological data of 462 elderly patients aged≥70 years who underwent LAG or TLG(including distal gastrectomy and total gastrectomy)between January 2017 and January 2022 at the Department of General Surgery,First Medical Center,Chinese PLA General Hospital were retrospectively collected.A total of 232 patients were in the LAG group,and 230 patients were in the TLG group.Basic patient information,clinicopathological characteristics,operation information and QOL data were collected to compare efficacy.Compared with those in the LAG group,intraoperative blood loss in the TLG group was significantly lower(P<0.001),and the time to first flatus and postoperative hospitalization time were significantly shorter(both P<0.001).The overall incidence of postoperative complications in the TLG group was significantly lower than that in the LAG group(P=0.01).Binary logistic regression results indicated that LAG and an operation time>220 min were independent risk factors for postoperative complications in elderly patients with GC(P<0.05).In terms of QOL,no statistically significant differences in various preoperative indicators were found between the LAG group and the LTG group(P>0.05).Compared with the laparoscopic-assisted total gastrectomy group,patients who received totally laparoscopic total gastrectomy had lower nausea and vomiting scores and higher satisfaction with their body image(P<0.05).Patients who underwent laparoscopic-assisted distal gastrectomy were more satisfied with their body image than patients in the totally laparoscopic distal gastrectomy group(P<0.05).CONCLUSION TLG is safe and feasible for elderly patients with GC and has outstanding advantages such as reducing intracorporeal blood loss,promoting postoperative recovery and improving QOL.展开更多
BACKGROUND Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery.In the last decades,minimally invasive gastric cancer surgery has been performed world...BACKGROUND Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery.In the last decades,minimally invasive gastric cancer surgery has been performed worldwide.However,reports on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy are few.AIM To evaluate the feasibility performing totally laparoscopic distal gastrectomy without prophylactic drains in selected patients.METHODS Data of patients with distal gastric cancer who underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed.The outcomes between patients with and without prophylactic drainage were compared.RESULTS A total of 457 patients who underwent surgery for gastric cancer were identified.Of these,125 patients who underwent totally laparoscopic distal gastrectomy were included.After propensity score matching,data of 42 pairs were extracted.The incidence of concurrent illness was higher in the drain group(42.9%vs 31.0%,P=0.258).The overall postoperative complication rates were 19.5%and 10.6%in the drain(n=76)and no-drain groups(n=49),respectively;there were no significant differences between the two groups(P>0.05).The difference between the two groups based on the need for percutaneous catheter drainage was also not significant(9.8%vs 6.4%,P=0.700).However,patients with a larger body mass index(≥29 kg/m2)were prone to postoperative complications(P=0.042).In addition,the number of days from surgery until the first flatus(4.33±1.24 d vs 3.57±1.85 d,P=0.029)was greater in the drain group.CONCLUSION Omitting prophylactic drainage may reduce surgery time and result in faster recovery.Routine prophylactic drains are not necessary in selected patients.A prophylactic drain may be useful in high-risk patients.展开更多
Objective:To explore the impact of visceral fat area(VFA)on the short-and long-term efficacy of indocyanine green(ICG)-guided D2 lymphadenectomy for gastric cancer(GC).Methods:A post hoc analysis was performed in pati...Objective:To explore the impact of visceral fat area(VFA)on the short-and long-term efficacy of indocyanine green(ICG)-guided D2 lymphadenectomy for gastric cancer(GC).Methods:A post hoc analysis was performed in patients who participated in a phase 3 randomized clinical trial of ICG-guided laparoscopic radical gastrectomy vs.conventional laparoscopic radical gastrectomy from November 2018 to July 2019.The VFA was calculated based on preoperative computed tomography images.Short-term efficacy included the quality of lymph node(LN)dissection and surgical outcomes,while long-term efficacy included overall survival(OS)and recurrence-free survival(RFS).Results:This study included 126 patients each in the ICG(high-VFA,n=43)and non-ICG groups(high-VFA,n=38).Compared with the non-ICG group,the ICG group had significantly more retrieved LNs(low-VFA:50.1 vs.43.9,P=0.001;high-VFA:49.6 vs.37.5,P<0.001)and a significantly lower LN noncompliance rate(low-VFA:32.5%vs.50.0%,P=0.020;high-VFA:32.6%vs.73.7%,P<0.001),regardless of the VFA.The ICG group had a shorter postoperative hospital stay and fewer intra-abdominal infections than the ICG group in the high-VFA patients(P=0.025 and P=0.020,respectively)but not in the low-VFA patients.Regardless of the VFA,the 3-year OS(RFS)was better in the ICG group than in the non-ICG group[low-VFA:83.1%(76.9%)vs.73.9%(67.0%);high-VFA:90.7%(90.7%)vs.73.7%(73.5%);P for interaction=0.474(0.547)].Conclusions:The short-and long-term efficacies of ICG tracing were not influenced by visceral obesity.展开更多
Laparoscopic gastrectomy has evolved differently in Eastern and Western countries.Feasibility,safety and oncological outcomes of laparoscopic gastrectomy were addressed step-by-step by several randomized controlled tr...Laparoscopic gastrectomy has evolved differently in Eastern and Western countries.Feasibility,safety and oncological outcomes of laparoscopic gastrectomy were addressed step-by-step by several randomized controlled trials from the East.Few phase III studies were published from the West that largely did not show a difference between the laparoscopic and open approach.Despite this,laparoscopic gastrectomy is seen as the standard for the surgical treatment of early and advanced gastric cancer in many European countries.Here,we review and comment on some important studies on laparoscopic gastrectomy for gastric cancer from Eastern and Western countries and also comment on current and future challenges.展开更多
BACKGROUND The development of laparoscopic technology has provided a new choice for surgery of gastric cancer(GC),but the advantages and disadvantages of laparoscopic total gastrectomy(LTG)and laparoscopic-assisted to...BACKGROUND The development of laparoscopic technology has provided a new choice for surgery of gastric cancer(GC),but the advantages and disadvantages of laparoscopic total gastrectomy(LTG)and laparoscopic-assisted total gastrectomy(LATG)in treatment effect and safety are still controversial.The purpose of this study is to compare the efficacy and safety of the two methods in the treatment of GC,and to provide a basis for clinical decision-making.AIM To compare the efficacy of totally LTG(TLTG)and LATG in the context of radical gastrectomy for GC.Additionally,we investigated the safety and feasibility of the total laparoscopic esophagojejunostomy technique.METHODS Literature on comparative studies of the above two surgical methods for GC(TLTG group and LATG group)published before September 2022 were searched in the PubMed,Web of Science,Wanfang Database,CNKI,and other Chinese and English databases.In addition,the following search keywords were used:Gastric cancer,total gastrectomy,total laparoscopy,laparoscopy-assisted,esophagojejunal anastomosis,gastric/stomach cancer,total gastrectomy,totally/completely laparoscopic,laparoscopic assisted/laparoscopy assisted/laparoscopically assisted,and esophagojejunostomy/esophagojejunal anastomosis.Review Manager 5.3 software was used for the meta-analysis after two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies.RESULTS After layer-by-layer screening,258 pieces of literature were recovered,and 11 of those pieces were eventually included.This resulted in a sample size of 2421 instances,with 1115 cases falling into the TLTG group and 1306 cases into the LATG group.Age or sex differences between the two groups were not statistically significant,according to the meta-analysis,however the average body mass index of the TLTG group was considerably higher than that of the LATG group(P=0.01).Compared with those in the LATG group,the incision length in the TLTG group was significantly shorter(P<0.001),the amount of intraoperative blood loss was significantly lower(P=0.003),the number of lymph nodes removed was significantly greater(P=0.04),and the time of first postoperative feeding and postoperative hospitalization were also significantly shorter(P=0.03 and 0.02,respectively).There were no significant differences in tumor size,length of proximal incisal margin,total operation time,anastomotic time,postoperative pain score,postoperative anal exhaust time,postoperative anastomosis-related complications(including anastomotic fistula,anastomotic stenosis,and anastomotic hemorrhage),or overall postoperative complication rate(P>0.05).CONCLUSION TLTG and esophagojejunostomy are safe and feasible.Compared with LATG,TLTG has the advantages of less trauma,less bleeding,easier access to lymph nodes,and faster postoperative recovery,and TLTG is also suitable for obese patients.展开更多
BACKGROUND Previously,some studies have proposed that total laparoscopic gastrectomy(TLG)is superior to laparoscopic-assisted gastrectomy(LAG)in terms of safety and feasibility based on the related intraoperative oper...BACKGROUND Previously,some studies have proposed that total laparoscopic gastrectomy(TLG)is superior to laparoscopic-assisted gastrectomy(LAG)in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications.However,there are still few studies on the changes in postoperative liver function in patients undergoing LG.The present study compared the postoperative liver function of patients with TLG and LAG,aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.AIM To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.METHODS The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center(including the Department of Gastrointestinal Surgery and the Department of General Surgery)of Zhongshan Hospital affiliated with Xiamen University,including 40 patients who underwent TLG and 40 patients who underwent LAG.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyltransferase(GGLT),total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL),and other liver function-related test indices were compared between the 2 groups before surgery and on the 1^(st),3^(rd),and 5^(th) d after surgery.RESULTS The levels of ALT and AST in the 2 groups were significantly increased on the 1st to 2nd postoperative days compared with those before the operation.The levels of ALT and AST in the TLG group were within the normal range,while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group(P<0.05).The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range(P<0.05).The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2,the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4,and the TBIL,DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7(P<0.05).No significant difference was observed at other time points(P>0.05).CONCLUSION Both TLG and LAG can affect liver function,but the effect of LAG is more serious.The influence of both surgical approaches on liver function is transient and reversible.Although TLG is more difficult to perform,it may be a better choice for patients with gastric cancer combined with liver insufficiency.展开更多
BACKGROUND Lymphadenectomy of the infrapyloric region remains technically demanding in laparoscopic radical gastrectomy.Traditional vessel-guided approaches often result in incomplete dissection and higher complicatio...BACKGROUND Lymphadenectomy of the infrapyloric region remains technically demanding in laparoscopic radical gastrectomy.Traditional vessel-guided approaches often result in incomplete dissection and higher complication rates,especially at station No.6.AIM To propose a mesentery-based strategy for infrapyloric lymphadenectomy and evaluate its safety,feasibility,and efficacy.METHODS By identifying key anatomical landmarks and defining the inferior mesenteric boundary of the pyloric region(right gastro-omental mesentery),this approach enables full exposure and en bloc resection of anterior and posterior mesenteric planes,with proximal ligation at the root of feeding vessels.A retrospective cohort study was conducted on 330 gastric cancer patients who underwent D2 lymphadenectomy(D2)from January 2020 to December 2021.Outcomes were compared between 165 patients treated with D2 plus complete mesogastric excision(D2+CME)and 165 matched controls receiving conventional D2.RESULTS The D2+CME group demonstrated significantly improved surgical outcomes,including shorter total operative time(279.19±45.50 minutes vs 301.25±52.30 minutes,P<0.001),reduced infrapyloric dissection time(22.24±3.80 minutes vs 27.58±4.20 minutes,P<0.001),and lower blood loss(4.71±1.12 mL vs 24.83±6.35 mL,P<0.001).More lymph nodes were retrieved overall(43.80±10.05 vs 37.25±8.80,P<0.001),particularly at station No.6(5.26±0.87 vs 4.14±0.41,P<0.001).Postoperative recovery indicators and hospital stay were comparable between groups,while the complication rate was significantly lower in the D2+CME group(20%vs 30.3%,P=0.042).CONCLUSION The mesentery-based approach enables safe pyloric lymphadenectomy.Systematic mesogastric excision improves operative efficiency and lymph node yield,especially at station No.6,offering potential oncological benefits in gastric cancer surgery.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
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 Gastric cancer is among the most prevalent malignancies worldwide.Despite significant advancements in chemoradiotherapy,targeted therapy,and neoadjuvant therapy,conventional surgical intervention remains th...BACKGROUND Gastric cancer is among the most prevalent malignancies worldwide.Despite significant advancements in chemoradiotherapy,targeted therapy,and neoadjuvant therapy,conventional surgical intervention remains the cornerstone of gastric cancer management.Improvements in surgical techniques,coupled with the use of staplers and other advanced instruments,have substantially reduced the incidence of complications and mortality following gastric cancer surgery.However,dysphagia remains a common postoperative complication.AIM To retrospectively investigate the potential factors contributing to dysphagia in patients who have undergone laparoscopic radical gastrectomy for gastric cancer and to explore effective strategies for its postoperative management.METHODS In this retrospective study,we analyzed data from patients who underwent elective laparoscopic total gastrectomy at Lihuili Hospital,Ningbo University,between January 2018 and May 2022.A total of 115 eligible postoperative patients were included.Postoperatively,patients completed questionnaires and were categorized into two groups based on their responses:The dysphagia group(Eating Assessment Tool-10 score≥3)and the non-dysphagia group(Eating Assessment Tool-10 score<3).Risk factors associated with dysphagia following total gastrectomy were assessed usingχ2 tests,Fisher’s exact tests,t-tests,Pearson correlation coefficients,and univariate and multivariate regression analyses.RESULTS Multivariate analysis further identified anastomotic style,prolonged intubation time,advanced age,and low albumin(ALB)levels as independent risk factors for postoperative dysphagia.Implementing targeted preventive measures for high-risk groups may significantly enhance postoperative quality of life.CONCLUSION Univariate analysis revealed that anastomotic style,low serum ALB levels,advanced age,and prolonged intubation time were significantly associated with postoperative dysphagia in gastric cancer patients.Multivariate analysis further identified anastomotic style,prolonged intubation time,advanced age,and low ALB levels as independent risk factors for postoperative dysphagia.Implementing targeted preventive measures for high-risk groups may significantly enhance postoperative quality of life.展开更多
BACKGROUND Although surgery remains the primary treatment for proximal gastric cancer(PGC),ongoing refinements in surgical strategies are essential to improving clinical outcomes.AIM To investigate the effect of doubl...BACKGROUND Although surgery remains the primary treatment for proximal gastric cancer(PGC),ongoing refinements in surgical strategies are essential to improving clinical outcomes.AIM To investigate the effect of double-tract reconstruction(DTR)on immune function and stress response in patients undergoing laparoscopic proximal gastrectomy(LPG).METHODS In total,78 patients with PGC admitted between August 2020 and August 2024 were enrolled.The research group consisted of 39 patients who underwent DTR+LPG,whereas the control group comprised 39 patients who underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy.Perioperative indices(intraoperative blood loss,digestive tract anastomosis time,and time to first postoperative flatus),postoperative complications(intestinal obstruction,anastomotic ulcer,diarrhea,dumping syndrome,and gastroesophageal reflux),nutritional parameters(serum albumin,hemoglobin,and body mass index),immune function immunoglobulin(IgG,IgA,and IgM),and stress response indicators(C-reactive protein,interleukin-6,and tumor necrosis factor-α)were collected and analyzed for both groups.RESULTS The intraoperative blood loss was lower(P<0.05),and the time to first postoperative flatus time was shorter(P<0.001)in the research group than in the control group.The two groups had comparable digestive tract anastomosis time(P>0.05).The overall complication rate was significantly lower in the research group than in the control group(P=0.042).Compared with the control group,the research group exhibited notably higher albumin,hemoglobin,and body mass index levels at 2 and 3 months postoperatively,as well as considerably high immunoglobulin(Ig)G,IgA,and IgM levels on postoperative day 1(P<0.05).The postoperative levels of C-reactive protein,interleukin-6,and tumor necrosis factor-αwere also lower in the research group than in the control group(P<0.001).CONCLUSION The combination of DTR and LPG in the treatment of patients with PGC is more effective in enhancing immune function and suppressing stress responses,showing more advantages over laparoscopic total gastrectomy.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
Laparoscopic sleeve gastrectomy(LSG),as an effective treatment for morbid obesity and its metabolic complications,exerts its therapeutic effects by significantly reducing body weight and improving metabolic disorders....Laparoscopic sleeve gastrectomy(LSG),as an effective treatment for morbid obesity and its metabolic complications,exerts its therapeutic effects by significantly reducing body weight and improving metabolic disorders.Its core mechanisms involve multi-level regulation of free fatty acid(FFA)metabolism and chronic low-grade inflammatory states(represented by tumor necrosis factor-alpha,TNF-α).This paper systematically reviews the direct impact of LSG on FFA dynamics including lipolysis,tissue uptake,and oxidation,as well as the molecular pathways through which it indirectly regulates TNF-αby reducing adipose tissue inflammation,improving intestinal barrier function,and modulating epigenetic modifications such as SCD gene methylation.Postoperatively,FFA and TNF-αform a bidirectional promoting feedback loop.LSG effectively breaks this vicious cycle of mutual promotion between the two under obese conditions by reducing FFA levels and inhibiting TNF-αexpression.Lower FFA levels alleviate inflammatory signal activation,while reduced TNF-αinhibits lipolysis,collectively promoting the restoration of insulin sensitivity.A thorough understanding of these mechanisms provides a theoretical basis for optimizing surgical strategies and developing targeted therapies.展开更多
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 Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity an...BACKGROUND Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity and effectiveness in achieving weight loss.However,the long-term effects of LSG on gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)remain areas of active investigation.AIM To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.METHODS A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia.Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included.Data on demographics,comorbidities,GERD symptoms,and endoscopic findings were extracted.GERD was defined clinically,esophagitis was graded per the Los Angeles classification,and BE was defined histologically.Multivariate logistic regression was used to identify predictors of GERD,endoscopic esophagitis(EE),and BE.RESULTS The study included 114 patients(mean age:44 years;61%female).GERD prevalence increased from 16%preoperatively to 64%5 years post-LSG,with 54%of cases representing de novo GERD.EE prevalence rose to 30%,with 23%of cases being de novo.BE was detected in 2.6%of patients,all presenting with short-segment BE without intestinal metaplasia.On univariate analysis,the pre-LSG body mass index was significantly associated with EE(P=0.038),and age was significantly associated with BE(P=0.037).However,on multivariate analysis,only hypertension was independently associated with GERD development(odds ratio=5.09;P=0.01).No factors were significantly associated with EE or BE on multivariate analysis.CONCLUSION This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG,with a relatively low but notable incidence of BE.The findings underscore the need for long-term endoscopic surveillance,particularly for older patients,even in populations with lower baseline.展开更多
Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provi...Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.展开更多
Background:The benefits of laparoscopic gastrectomy(LG)in elderly gastric-cancer patients still remain unclear.The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patie...Background:The benefits of laparoscopic gastrectomy(LG)in elderly gastric-cancer patients still remain unclear.The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patients.Methods:We retrospectively evaluated patients who underwent LG or open gastrectomy(OG)between June 2009 and July 2015 in a single high-volume center.We compared surgical,short-term,and long-termsurvival outcomes among an elderly(-70 years old)LG(ELG)group(n=114),a non-elderly(<70 years old)LG(NLG)group(n=740),and an elderly OG(EOG)group(n=383).Results:Except for extended time to first flatus,the surgical and short-term outcomes of the ELG group were similar to those of the NLG group.The ELG group revealed comparable disease-specific survival(DSS)rates to the NLG group(64.9%vs 66.2%,P=0.476),although the overall survival(OS)rate was lower(57.0%vs 65.5%,P<0.001)in the ELG group than in the NLG group.The ELG group showed longer operation time than the EOG group(236.4677.3 vs 179652.2 min,P<0.001).The ELG group had less estimated blood loss(174.0688.4 vs 209.36133.8,P=0.008)and shorter post-operative hospital stay(8.362.5 vs 9.264.5,P=0.048)than the EOG group.The severity of complications was similar between the ELG and NLG groups.Multivariate analysis confirmed that LG was not a risk factor for post-operative complications.Conclusions:LG is a feasible and safe procedure for elderly patients with acceptable short-and long-term survival outcomes.展开更多
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.
文摘BACKGROUND At present,the enhanced recovery after surgery(ERAS)protocol is widely implemented in the field of gastric surgery.However,the effect of the ERAS protocol on the long-term prognosis of gastric cancer has not been reported.AIM To compare the effects of ERAS and conventional protocols on short-term outcomes and long-term prognosis after laparoscopic gastrectomy.METHODS We retrospectively analyzed the data of 1026 consecutive patients who underwent laparoscopic gastrectomy between 2012 and 2015.The patients were divided into either an ERAS group or a conventional group.The groups were matched in a 1:1 ratio using propensity scores based on covariates that affect cancer survival.The primary outcomes were the 5-year overall and cancer-specific survival rates.The secondary outcomes were the postoperative short-term outcomes and inflammatory indexes.RESULTS The patient demographics and baseline characteristics were similar between the two groups after matching.Compared to the conventional group,the ERAS group had a significantly shorter postoperative hospital day(7.09 d vs 8.67 d,P<0.001),shorter time to first flatus,liquid intake,and ambulation(2.50 d vs 3.40 d,P<0.001;1.02 d vs 3.64 d,P<0.001;1.47 d vs 2.99 d,P<0.001,respectively),and lower medical costs($7621.75 vs$7814.16,P=0.009).There was a significantly higher rate of postoperative complications among patients in the conventional group than among those in the ERAS group(18.1 vs 12.3,P=0.030).Regarding inflammatory indexes,the C-reactive protein and procalcitonin levels on postoperative day 3/4 were significantly different between the two groups(P<0.001 and P=0.025,respectively).The ERAS protocol was associated with significantly improved 5-year overall survival and cancer-specific survival rates compared with conventional protocol(P=0.013 and 0.032,respectively).When stratified by tumour stage,only the survival of patients with stage III disease was significantly different between the two groups(P=0.044).CONCLUSION Adherence to the ERAS protocol improves both the short-term outcomes and the 5-year overall survival and cancer-specific survival of patients after laparoscopic gastrectomy.
文摘In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer(GC).Presently,no consensus exists regarding the optimal reconstructive procedure.In this review,the current state of digestive tract reconstruction after LG is reviewed.According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction,we divide these reconstruction procedures into three categories consistent with the resection procedures.We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes(length of surgery and blood loss)and postoperative complications(anastomotic leakage and stricture)to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.
基金Supported by National Basic Research Program of China,No.2019YFB1311505National Natural Science Foundation of China,No.81773135 and No.82073192+2 种基金Natural Science Foundation of China for Youth,No.82103593Natural Science Foundation of Beijing for Youth,No.7214252Program of Military Medicine for Youth,No.QNF19055.
文摘BACKGROUND Totally laparoscopic gastrectomy(TLG)entails both gastrectomy and gastrointestinal reconstruction under laparoscopy.Compared with laparoscopic assisted gastrectomy(LAG),TLG has been demonstrated in many studies to require a smaller surgical incision,result in a faster postoperative recovery and less pain and have comparable long-term efficacy,which has been a research hotspot in recent years.Whether TLG is equally safe and feasible for elderly patients remains unclear.AIM To compare the short-term efficacy of and quality of life(QOL)associated with TLG and LAG in elderly gastric cancer(GC)patients.METHODS The clinicopathological data of 462 elderly patients aged≥70 years who underwent LAG or TLG(including distal gastrectomy and total gastrectomy)between January 2017 and January 2022 at the Department of General Surgery,First Medical Center,Chinese PLA General Hospital were retrospectively collected.A total of 232 patients were in the LAG group,and 230 patients were in the TLG group.Basic patient information,clinicopathological characteristics,operation information and QOL data were collected to compare efficacy.Compared with those in the LAG group,intraoperative blood loss in the TLG group was significantly lower(P<0.001),and the time to first flatus and postoperative hospitalization time were significantly shorter(both P<0.001).The overall incidence of postoperative complications in the TLG group was significantly lower than that in the LAG group(P=0.01).Binary logistic regression results indicated that LAG and an operation time>220 min were independent risk factors for postoperative complications in elderly patients with GC(P<0.05).In terms of QOL,no statistically significant differences in various preoperative indicators were found between the LAG group and the LTG group(P>0.05).Compared with the laparoscopic-assisted total gastrectomy group,patients who received totally laparoscopic total gastrectomy had lower nausea and vomiting scores and higher satisfaction with their body image(P<0.05).Patients who underwent laparoscopic-assisted distal gastrectomy were more satisfied with their body image than patients in the totally laparoscopic distal gastrectomy group(P<0.05).CONCLUSION TLG is safe and feasible for elderly patients with GC and has outstanding advantages such as reducing intracorporeal blood loss,promoting postoperative recovery and improving QOL.
基金Supported by National Natural Science Foundation of China,No.81772642Capital’s Funds for Health Improvement and Research,No.CFH 2018-2-4022.
文摘BACKGROUND Prophylactic drains have been used to remove intraperitoneal collections and detect complications early in open surgery.In the last decades,minimally invasive gastric cancer surgery has been performed worldwide.However,reports on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy are few.AIM To evaluate the feasibility performing totally laparoscopic distal gastrectomy without prophylactic drains in selected patients.METHODS Data of patients with distal gastric cancer who underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed.The outcomes between patients with and without prophylactic drainage were compared.RESULTS A total of 457 patients who underwent surgery for gastric cancer were identified.Of these,125 patients who underwent totally laparoscopic distal gastrectomy were included.After propensity score matching,data of 42 pairs were extracted.The incidence of concurrent illness was higher in the drain group(42.9%vs 31.0%,P=0.258).The overall postoperative complication rates were 19.5%and 10.6%in the drain(n=76)and no-drain groups(n=49),respectively;there were no significant differences between the two groups(P>0.05).The difference between the two groups based on the need for percutaneous catheter drainage was also not significant(9.8%vs 6.4%,P=0.700).However,patients with a larger body mass index(≥29 kg/m2)were prone to postoperative complications(P=0.042).In addition,the number of days from surgery until the first flatus(4.33±1.24 d vs 3.57±1.85 d,P=0.029)was greater in the drain group.CONCLUSION Omitting prophylactic drainage may reduce surgery time and result in faster recovery.Routine prophylactic drains are not necessary in selected patients.A prophylactic drain may be useful in high-risk patients.
基金supported by the Construction Funds for“High-level Hospitals and Clinical Specialties”of Fujian Province(No.[2021]76)。
文摘Objective:To explore the impact of visceral fat area(VFA)on the short-and long-term efficacy of indocyanine green(ICG)-guided D2 lymphadenectomy for gastric cancer(GC).Methods:A post hoc analysis was performed in patients who participated in a phase 3 randomized clinical trial of ICG-guided laparoscopic radical gastrectomy vs.conventional laparoscopic radical gastrectomy from November 2018 to July 2019.The VFA was calculated based on preoperative computed tomography images.Short-term efficacy included the quality of lymph node(LN)dissection and surgical outcomes,while long-term efficacy included overall survival(OS)and recurrence-free survival(RFS).Results:This study included 126 patients each in the ICG(high-VFA,n=43)and non-ICG groups(high-VFA,n=38).Compared with the non-ICG group,the ICG group had significantly more retrieved LNs(low-VFA:50.1 vs.43.9,P=0.001;high-VFA:49.6 vs.37.5,P<0.001)and a significantly lower LN noncompliance rate(low-VFA:32.5%vs.50.0%,P=0.020;high-VFA:32.6%vs.73.7%,P<0.001),regardless of the VFA.The ICG group had a shorter postoperative hospital stay and fewer intra-abdominal infections than the ICG group in the high-VFA patients(P=0.025 and P=0.020,respectively)but not in the low-VFA patients.Regardless of the VFA,the 3-year OS(RFS)was better in the ICG group than in the non-ICG group[low-VFA:83.1%(76.9%)vs.73.9%(67.0%);high-VFA:90.7%(90.7%)vs.73.7%(73.5%);P for interaction=0.474(0.547)].Conclusions:The short-and long-term efficacies of ICG tracing were not influenced by visceral obesity.
文摘Laparoscopic gastrectomy has evolved differently in Eastern and Western countries.Feasibility,safety and oncological outcomes of laparoscopic gastrectomy were addressed step-by-step by several randomized controlled trials from the East.Few phase III studies were published from the West that largely did not show a difference between the laparoscopic and open approach.Despite this,laparoscopic gastrectomy is seen as the standard for the surgical treatment of early and advanced gastric cancer in many European countries.Here,we review and comment on some important studies on laparoscopic gastrectomy for gastric cancer from Eastern and Western countries and also comment on current and future challenges.
文摘BACKGROUND The development of laparoscopic technology has provided a new choice for surgery of gastric cancer(GC),but the advantages and disadvantages of laparoscopic total gastrectomy(LTG)and laparoscopic-assisted total gastrectomy(LATG)in treatment effect and safety are still controversial.The purpose of this study is to compare the efficacy and safety of the two methods in the treatment of GC,and to provide a basis for clinical decision-making.AIM To compare the efficacy of totally LTG(TLTG)and LATG in the context of radical gastrectomy for GC.Additionally,we investigated the safety and feasibility of the total laparoscopic esophagojejunostomy technique.METHODS Literature on comparative studies of the above two surgical methods for GC(TLTG group and LATG group)published before September 2022 were searched in the PubMed,Web of Science,Wanfang Database,CNKI,and other Chinese and English databases.In addition,the following search keywords were used:Gastric cancer,total gastrectomy,total laparoscopy,laparoscopy-assisted,esophagojejunal anastomosis,gastric/stomach cancer,total gastrectomy,totally/completely laparoscopic,laparoscopic assisted/laparoscopy assisted/laparoscopically assisted,and esophagojejunostomy/esophagojejunal anastomosis.Review Manager 5.3 software was used for the meta-analysis after two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies.RESULTS After layer-by-layer screening,258 pieces of literature were recovered,and 11 of those pieces were eventually included.This resulted in a sample size of 2421 instances,with 1115 cases falling into the TLTG group and 1306 cases into the LATG group.Age or sex differences between the two groups were not statistically significant,according to the meta-analysis,however the average body mass index of the TLTG group was considerably higher than that of the LATG group(P=0.01).Compared with those in the LATG group,the incision length in the TLTG group was significantly shorter(P<0.001),the amount of intraoperative blood loss was significantly lower(P=0.003),the number of lymph nodes removed was significantly greater(P=0.04),and the time of first postoperative feeding and postoperative hospitalization were also significantly shorter(P=0.03 and 0.02,respectively).There were no significant differences in tumor size,length of proximal incisal margin,total operation time,anastomotic time,postoperative pain score,postoperative anal exhaust time,postoperative anastomosis-related complications(including anastomotic fistula,anastomotic stenosis,and anastomotic hemorrhage),or overall postoperative complication rate(P>0.05).CONCLUSION TLTG and esophagojejunostomy are safe and feasible.Compared with LATG,TLTG has the advantages of less trauma,less bleeding,easier access to lymph nodes,and faster postoperative recovery,and TLTG is also suitable for obese patients.
基金The study was reviewed and approved by the Institutional review board of Zhongshan Hospital Xiamen University(approval No.2022-257).
文摘BACKGROUND Previously,some studies have proposed that total laparoscopic gastrectomy(TLG)is superior to laparoscopic-assisted gastrectomy(LAG)in terms of safety and feasibility based on the related intraoperative operative parameters and incidence of postoperative complications.However,there are still few studies on the changes in postoperative liver function in patients undergoing LG.The present study compared the postoperative liver function of patients with TLG and LAG,aiming to explore whether there is a difference in the influence of TLG and LAG on the liver function of patients.AIM To investigate whether there is a difference in the influence of TLG and LAG on the liver function of patients.METHODS The present study collected 80 patients who underwent LG from 2020 to 2021 at the Digestive Center(including the Department of Gastrointestinal Surgery and the Department of General Surgery)of Zhongshan Hospital affiliated with Xiamen University,including 40 patients who underwent TLG and 40 patients who underwent LAG.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),γ-glutamyltransferase(GGLT),total bilirubin(TBIL),direct bilirubin(DBIL)and indirect bilirubin(IBIL),and other liver function-related test indices were compared between the 2 groups before surgery and on the 1^(st),3^(rd),and 5^(th) d after surgery.RESULTS The levels of ALT and AST in the 2 groups were significantly increased on the 1st to 2nd postoperative days compared with those before the operation.The levels of ALT and AST in the TLG group were within the normal range,while the levels of ALT and AST in the LAG group were twice as high as those in the TLG group(P<0.05).The levels of ALT and AST in the 2 groups showed a downward trend at 3-4 d and 5-7 d after the operation and gradually decreased to the normal range(P<0.05).The GGLT level in the LAG group was higher than that in the TLG group on postoperative days 1-2,the ALP level in the TLG group was higher than that in the LAG group on postoperative days 3-4,and the TBIL,DBIL and IBIL levels in the TLG group were higher than those in the LAG group on postoperative days 5-7(P<0.05).No significant difference was observed at other time points(P>0.05).CONCLUSION Both TLG and LAG can affect liver function,but the effect of LAG is more serious.The influence of both surgical approaches on liver function is transient and reversible.Although TLG is more difficult to perform,it may be a better choice for patients with gastric cancer combined with liver insufficiency.
基金Supported by the Natural Science Foundation Program in Fujian Province of China,No.2023J011726.
文摘BACKGROUND Lymphadenectomy of the infrapyloric region remains technically demanding in laparoscopic radical gastrectomy.Traditional vessel-guided approaches often result in incomplete dissection and higher complication rates,especially at station No.6.AIM To propose a mesentery-based strategy for infrapyloric lymphadenectomy and evaluate its safety,feasibility,and efficacy.METHODS By identifying key anatomical landmarks and defining the inferior mesenteric boundary of the pyloric region(right gastro-omental mesentery),this approach enables full exposure and en bloc resection of anterior and posterior mesenteric planes,with proximal ligation at the root of feeding vessels.A retrospective cohort study was conducted on 330 gastric cancer patients who underwent D2 lymphadenectomy(D2)from January 2020 to December 2021.Outcomes were compared between 165 patients treated with D2 plus complete mesogastric excision(D2+CME)and 165 matched controls receiving conventional D2.RESULTS The D2+CME group demonstrated significantly improved surgical outcomes,including shorter total operative time(279.19±45.50 minutes vs 301.25±52.30 minutes,P<0.001),reduced infrapyloric dissection time(22.24±3.80 minutes vs 27.58±4.20 minutes,P<0.001),and lower blood loss(4.71±1.12 mL vs 24.83±6.35 mL,P<0.001).More lymph nodes were retrieved overall(43.80±10.05 vs 37.25±8.80,P<0.001),particularly at station No.6(5.26±0.87 vs 4.14±0.41,P<0.001).Postoperative recovery indicators and hospital stay were comparable between groups,while the complication rate was significantly lower in the D2+CME group(20%vs 30.3%,P=0.042).CONCLUSION The mesentery-based approach enables safe pyloric lymphadenectomy.Systematic mesogastric excision improves operative efficiency and lymph node yield,especially at station No.6,offering potential oncological benefits in gastric cancer surgery.
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.
文摘BACKGROUND Gastric cancer is among the most prevalent malignancies worldwide.Despite significant advancements in chemoradiotherapy,targeted therapy,and neoadjuvant therapy,conventional surgical intervention remains the cornerstone of gastric cancer management.Improvements in surgical techniques,coupled with the use of staplers and other advanced instruments,have substantially reduced the incidence of complications and mortality following gastric cancer surgery.However,dysphagia remains a common postoperative complication.AIM To retrospectively investigate the potential factors contributing to dysphagia in patients who have undergone laparoscopic radical gastrectomy for gastric cancer and to explore effective strategies for its postoperative management.METHODS In this retrospective study,we analyzed data from patients who underwent elective laparoscopic total gastrectomy at Lihuili Hospital,Ningbo University,between January 2018 and May 2022.A total of 115 eligible postoperative patients were included.Postoperatively,patients completed questionnaires and were categorized into two groups based on their responses:The dysphagia group(Eating Assessment Tool-10 score≥3)and the non-dysphagia group(Eating Assessment Tool-10 score<3).Risk factors associated with dysphagia following total gastrectomy were assessed usingχ2 tests,Fisher’s exact tests,t-tests,Pearson correlation coefficients,and univariate and multivariate regression analyses.RESULTS Multivariate analysis further identified anastomotic style,prolonged intubation time,advanced age,and low albumin(ALB)levels as independent risk factors for postoperative dysphagia.Implementing targeted preventive measures for high-risk groups may significantly enhance postoperative quality of life.CONCLUSION Univariate analysis revealed that anastomotic style,low serum ALB levels,advanced age,and prolonged intubation time were significantly associated with postoperative dysphagia in gastric cancer patients.Multivariate analysis further identified anastomotic style,prolonged intubation time,advanced age,and low ALB levels as independent risk factors for postoperative dysphagia.Implementing targeted preventive measures for high-risk groups may significantly enhance postoperative quality of life.
文摘BACKGROUND Although surgery remains the primary treatment for proximal gastric cancer(PGC),ongoing refinements in surgical strategies are essential to improving clinical outcomes.AIM To investigate the effect of double-tract reconstruction(DTR)on immune function and stress response in patients undergoing laparoscopic proximal gastrectomy(LPG).METHODS In total,78 patients with PGC admitted between August 2020 and August 2024 were enrolled.The research group consisted of 39 patients who underwent DTR+LPG,whereas the control group comprised 39 patients who underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy.Perioperative indices(intraoperative blood loss,digestive tract anastomosis time,and time to first postoperative flatus),postoperative complications(intestinal obstruction,anastomotic ulcer,diarrhea,dumping syndrome,and gastroesophageal reflux),nutritional parameters(serum albumin,hemoglobin,and body mass index),immune function immunoglobulin(IgG,IgA,and IgM),and stress response indicators(C-reactive protein,interleukin-6,and tumor necrosis factor-α)were collected and analyzed for both groups.RESULTS The intraoperative blood loss was lower(P<0.05),and the time to first postoperative flatus time was shorter(P<0.001)in the research group than in the control group.The two groups had comparable digestive tract anastomosis time(P>0.05).The overall complication rate was significantly lower in the research group than in the control group(P=0.042).Compared with the control group,the research group exhibited notably higher albumin,hemoglobin,and body mass index levels at 2 and 3 months postoperatively,as well as considerably high immunoglobulin(Ig)G,IgA,and IgM levels on postoperative day 1(P<0.05).The postoperative levels of C-reactive protein,interleukin-6,and tumor necrosis factor-αwere also lower in the research group than in the control group(P<0.001).CONCLUSION The combination of DTR and LPG in the treatment of patients with PGC is more effective in enhancing immune function and suppressing stress responses,showing more advantages over laparoscopic total gastrectomy.
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.
基金Medical Science and Technology Disciplinary Reserve Talent Program under the Kunming Municipal Health Science and Technology Talent Cultivation Project(Project No.:2024-SW(Reserve)-45)Health Research Project of the Kunming Municipal Health Commission(Project No.:2023-03-06-012)。
文摘Laparoscopic sleeve gastrectomy(LSG),as an effective treatment for morbid obesity and its metabolic complications,exerts its therapeutic effects by significantly reducing body weight and improving metabolic disorders.Its core mechanisms involve multi-level regulation of free fatty acid(FFA)metabolism and chronic low-grade inflammatory states(represented by tumor necrosis factor-alpha,TNF-α).This paper systematically reviews the direct impact of LSG on FFA dynamics including lipolysis,tissue uptake,and oxidation,as well as the molecular pathways through which it indirectly regulates TNF-αby reducing adipose tissue inflammation,improving intestinal barrier function,and modulating epigenetic modifications such as SCD gene methylation.Postoperatively,FFA and TNF-αform a bidirectional promoting feedback loop.LSG effectively breaks this vicious cycle of mutual promotion between the two under obese conditions by reducing FFA levels and inhibiting TNF-αexpression.Lower FFA levels alleviate inflammatory signal activation,while reduced TNF-αinhibits lipolysis,collectively promoting the restoration of insulin sensitivity.A thorough understanding of these mechanisms provides a theoretical basis for optimizing surgical strategies and developing targeted therapies.
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 Obesity is a significant global health concern,with laparoscopic sleeve gastrectomy(LSG)being the most commonly performed bariatric surgery in the Middle East,including Saudi Arabia,due to its simplicity and effectiveness in achieving weight loss.However,the long-term effects of LSG on gastroesophageal reflux disease(GERD)and Barrett’s esophagus(BE)remain areas of active investigation.AIM To determine the prevalence of GERD and BE 5 years post-LSG in a Saudi Arabian population.METHODS A retrospective cohort study was conducted at a tertiary bariatric referral center in Saudi Arabia.Patients who underwent LSG 5 years prior and completed postoperative gastroscopy were included.Data on demographics,comorbidities,GERD symptoms,and endoscopic findings were extracted.GERD was defined clinically,esophagitis was graded per the Los Angeles classification,and BE was defined histologically.Multivariate logistic regression was used to identify predictors of GERD,endoscopic esophagitis(EE),and BE.RESULTS The study included 114 patients(mean age:44 years;61%female).GERD prevalence increased from 16%preoperatively to 64%5 years post-LSG,with 54%of cases representing de novo GERD.EE prevalence rose to 30%,with 23%of cases being de novo.BE was detected in 2.6%of patients,all presenting with short-segment BE without intestinal metaplasia.On univariate analysis,the pre-LSG body mass index was significantly associated with EE(P=0.038),and age was significantly associated with BE(P=0.037).However,on multivariate analysis,only hypertension was independently associated with GERD development(odds ratio=5.09;P=0.01).No factors were significantly associated with EE or BE on multivariate analysis.CONCLUSION This study highlights the significant increase in GERD and EE prevalence 5 years post-LSG,with a relatively low but notable incidence of BE.The findings underscore the need for long-term endoscopic surveillance,particularly for older patients,even in populations with lower baseline.
文摘Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.
基金supported by the National Key Research and Development Program of China [2017YFC1311004]The Key Research and Development Program of Shanxi province [2017-ZDXM-SF-053].
文摘Background:The benefits of laparoscopic gastrectomy(LG)in elderly gastric-cancer patients still remain unclear.The purpose of this study was to evaluate the feasibility and safety of LG in elderly gastric-cancer patients.Methods:We retrospectively evaluated patients who underwent LG or open gastrectomy(OG)between June 2009 and July 2015 in a single high-volume center.We compared surgical,short-term,and long-termsurvival outcomes among an elderly(-70 years old)LG(ELG)group(n=114),a non-elderly(<70 years old)LG(NLG)group(n=740),and an elderly OG(EOG)group(n=383).Results:Except for extended time to first flatus,the surgical and short-term outcomes of the ELG group were similar to those of the NLG group.The ELG group revealed comparable disease-specific survival(DSS)rates to the NLG group(64.9%vs 66.2%,P=0.476),although the overall survival(OS)rate was lower(57.0%vs 65.5%,P<0.001)in the ELG group than in the NLG group.The ELG group showed longer operation time than the EOG group(236.4677.3 vs 179652.2 min,P<0.001).The ELG group had less estimated blood loss(174.0688.4 vs 209.36133.8,P=0.008)and shorter post-operative hospital stay(8.362.5 vs 9.264.5,P=0.048)than the EOG group.The severity of complications was similar between the ELG and NLG groups.Multivariate analysis confirmed that LG was not a risk factor for post-operative complications.Conclusions:LG is a feasible and safe procedure for elderly patients with acceptable short-and long-term survival outcomes.
