Radical Gastrectomy Research Articles

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

Clinical effects of intravenous patient-controlled analgesia with dexmedetomidine plus inhalation-intravenous combined anesthesia in patients with gastric cancer undergoing laparoscopic radical gastrectomy

Outcomes for Gastrectomy During Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Non-Gastric Primaries: A 30-Year Experience.

Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) can improve survival for patients with peritoneal surface malignancy. Completeness of cytoreduction correlates with prognosis. The role of gastrectomy in these patients is not well described. 1868 patients who underwent CRS+HIPEC for non-gastric primary between 1991-2024 were analyzed from a prospective database. Patients were stratified by gastrectomy extent and their outcomes compared with no-gastrectomy patients. Continuous variables are presented as mean (SD), categorical variables as N (%) and values considered statistically significant at < 0.05. There were no differences in baseline demographics between the gastrectomy and no-gastrectomy groups. There were 23 major, 45 distal, and 77 wedge gastrectomies (n=145, 7.76%). Appendiceal was the most common neoplasm in the gastrectomy groups (major: 96%, distal: 91%, wedge: 68%, no gastrectomy: 53%). Gastrectomy patients had higher median PCI [major: 27(7.0), distal: 24(7.0), wedge: 19(10.3), no-gastrectomy: 14(9.5); p<0.001], R2 resection (major: 96%, distal: 89%, wedge: 60%, no-gastrectomy: 45%; p<0.001), severe complications (major: 30%, distal: 27%, wedge: 19%, no-gastrectomy: 12%; p<0.001), LOS [major: 24(15.2) , distal: 23(25.7), wedge: 18(22.2), no-gastrectomy: 12 (12.5) days; p<0.001], and 30-day mortality (major: 17%, distal: 11%, wedge: 10%, no-gastrectomy: 5%; p<0.001). There was no difference in 30-day readmission or recurrence. On multivariate analysis, gastrectomy was not independently associated with overall survival (OS) (p=0.18). 8% of patients who underwent CRS+HIPEC for non-gastric primaries underwent gastrectomy. Gastrectomy patients were more likely to have higher PCI and incomplete resections with increased complications and mortality. PCI, resection status, LN's, tumor grade, and primary site, but not gastrectomy type, are significantly associated with OS.

PD-1/PD-L1 Inhibitors Increase Pathological Complete Response in Locally Advanced Gastric Cancer: A Meta-analysis and Trial Sequential Analysis.

Gastric cancer (GC) remains a leading cause of morbidity and mortality worldwide. The current standard of care involves neoadjuvant chemotherapy (NACT) followed by radical gastrectomy. This study aims to evaluate the efficacy of neoadjuvant therapy with PD-1/PD-L1 inhibitors in comparison to chemotherapy alone for patients with locally advanced gastric cancer (LAGC). We conducted a systematic search of PubMed, Web of Science, and Embase to identify studies examining the addition of PD-1/PD-L1 inhibitors to neoadjuvant therapy for LAGC. Odds ratios (OR) were calculated for binary outcomes, such as pathological complete response (pCR), with corresponding 95% confidence intervals (CI). Seven studies were included, encompassing a total of 1772 patients. Baseline median age ranged from 31 to 75years. Most patients had an ECOG performance status score of 0 (942 patients), while 294 had an ECOG score of 1. The estimated pCR (OR 5.94, 95% CI 3.98-8.87; p < 0.000001) significantly favored the PD-1/PD-L1 inhibitors combined with chemotherapy over chemotherapy alone. Additionally, the incidence of certain adverse events increased significantly in the intervention group, including any-grade hypothyroidism (OR 4.55, 95% CI 2.27-9.10; p = 0.000019) and rash (OR 1.74, 95% CI 1.10-2.76; p = 0.017). Conversely, the control group showed a statistically significant lower incidence of grade ≥ 3 fatigue (OR 2.80, 95% CI 1.15-6.85; p = 0.024) compared to the intervention group. This systematic review and meta-analysis indicate that the addition of PD-1/PD-L1 inhibitors to neoadjuvant chemotherapy is associated with a higher pathological complete response rate compared to chemotherapy alone in patients with locally advanced gastric cancer.

Baseline and early changes in CT body composition can predict recurrence-free survival after radical gastrectomy: A sex-specific study.

This study aimed to explore the predictive value of baseline CT body composition and its early changes on recurrence-free survival (RFS) following radical gastrectomy, while also assessing potential sex-related differences. We conducted a retrospective analysis of gastric cancer (GC) patients with confirmed pathology from October 2019 to May 2023. All patients underwent preoperative and postoperative CT scans to assess visceral fat area (VFA), subcutaneous fat area (SFA), skeletal muscle area (SMA), and skeletal muscle density (SMD), along with calculating their respective rates of change. Multivariate Cox regression analyses were used to identify independent predictors of RFS in male and female patients separately, and nomogram models were subsequently developed. The models' predictive performance was assessed using calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). The study included 287 patients, consisting of 185 males and 102 females. At baseline, males had a lower subcutaneous adipose tissue index (SATI) but higher skeletal muscle index (SMI) and SMD compared to females (p＜0.001). Postoperatively, both SATI and visceral adipose tissue index (VATI) were significantly lower in both males and females than their corresponding preoperative values (p＜0.005). In males, SMI (HR=0.442, p=0.002), VATI (HR=1.843, p=0.018), lymphocyte (LYM) (HR=0.486, p=0.040), pathological T stage (HR=3.004, p=0.003), and postoperative complication (POC) (HR=1.893, p=0.014) were found to be independent predictors of RFS. In females, independent predictors of RFS included SMI (HR=0.361, p=0.013), SATI change rate (δSATI) (HR=0.428, p=0.024), albumin (ALB) (HR=0.242, p=0.003), CEA (HR=5.418, p<0.001), and POC (HR=3.425, p<0.001). The male-specific nomogram model demonstrated predictive accuracy for recurrence-free survival (RFS), with areas under the ROC curve (AUC) of 0.621, 0.783, and 0.796 at 1, 2, and 3years, respectively. Similarly, the female-specific nomogram model achieved AUCs of 0.796, 0.836, and 0.783 at the corresponding time points. Calibration curves indicated a strong concordance between predicted and observed outcomes, while DCA validated the clinical utility of both models. Additionally, the models effectively stratified patients into low-risk and high-risk groups. Sex differences were observed in the predictive value of CT body composition for RFS after gastrectomy. By incorporating CT body composition parameters and clinical indicators, sex-specific nomogram models were developed, demonstrating effective prediction of RFS in gastric cancer patients post-surgery.

Nomogram for pre-procedural prediction of lymph node metastasis in patients with submucosal early gastric cancer.

The treatment of early gastric cancer (EGC) is contingent upon the status of lymph node metastasis (LNM). Accurate preoperative prediction of LNM is critical for reducing unnecessary surgeries. This study seeks to evaluate the risk factors for LNM in submucosal EGC and develop a predictive model to optimize therapeutic decision-making. A retrospective analysis was performed on clinical data from 389 patients with T1b-stage EGC who underwent radical gastrectomy. Univariate and multivariate analyses were conducted to identify independent risk factors, followed by the development of a nomogram to predict LNM. The model's efficacy was validated through receiver operating characteristic curves, calibration curves, and decision curve analysis. Of the 389 patients, 77 had LNM. Logistic regression analysis identified gender, CA199 levels, tumor location, degree of differentiation, presence of ulcers, and lymph node enlargement on CT as independent risk factors for LNM. A nomogram was constructed to assess the risk of LNM, demonstrating strong predictive accuracy with an area under the curve of 0.82 in the training set and 0.74 in the validation set, along with good sensitivity and positive predictive value. This study presents a reliable preoperative nomogram to estimate the likelihood of LNM in submucosal EGC, providing valuable guidance for determining the most effective treatment strategies for patients.

Comparison of the effectiveness of nurse-led preoperative counseling and postoperative follow-up care vs standard care for patients with gastric cancer.

Radical gastrectomy is generally prefered for gastric cancer but has postoperative complications. The objectives of the study are to evaluate the effectiveness of three different models of preoperative counseling and postoperative follow-up care in patients who underwent radical gastrectomy for gastric cancer. In retrospective medical record analyses, patients received nurse-led preoperative counseling and postoperative follow-up care (NC cohort, n = 105) or surgeon-led preoperative counseling and surgeon-led follow-up (SC cohort, n = 140), or did not receive counseling and aftercare (RC cohort, n = 160). Patients had a postoperative intensive care unit (PICU) stay of 24 (26-22) h/patient and postoperative pain of 6 (6-5)/ patient. The frequencies of nausea, vomiting, medical intensive care unit admission(s), dizziness, length of PICU stay, and intensity of postoperative pain were lower among patients in the NC cohort, followed by those in the SC and RC cohorts. A higher number of patients in the RC cohort died when compared to the NC (25 [16%) vs 2 [2%], p = 0.0458) and the SC (25 [16%] vs 11 [8%], p = 0.0001) cohorts in follow-up. Patients who undergo radical gastrectomy for gastric cancer require healthcare professional-led preoperative counseling and postoperative aftercare. Nurse-led preoperative counseling and postoperative aftercare, could improve outcome measures in patients who underwent radical gastrectomy for gastric cancer.

Developing a predictive model for delayed healing of esophagojejunal anastomotic fistula following total gastrectomy based on imaging and clinical inflammatory-nutritional status.

Esophagojejunal anastomotic fistula (EJF) following radical total gastrectomy is a severe perioperative complication in patients with gastric cancer, particularly as delayed fistula healing increases hospitalization costs and leads to poor prognosis. Numerous factors influence the occurrence and progression of EJF, with inflammation and nutritional status being significant contributors to perioperative complications. Therefore, this study aims to investigate the prediction of delayed EJF healing based on postoperative clinical and imaging-related inflammation-nutrition status. We retrospectively collected data on 315 cases of EJF following radical total gastrectomy for gastric cancer from two centers between 2015 and 2023 (training group: center one with 194 cases, validation group: center two with 121 cases). EJF was diagnosed based on clinical presentation, gastrointestinal imaging, or endoscopic findings. The healing time for EJF was defined as the period from diagnosis to the removal of the abdominal drainage tube, and patients were categorized into early healing and delayed healing groups based on the median healing time. Postoperative abdominal computed tomography(CT) scans and clinical characteristics at the time of EJF diagnosis were collected. Univariate and multivariable logistic regression analyses were performed on the training group data to construct a predictive model (nomogram). The model's performance in both the training and validation groups was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration curves, and decision curve analysis (DCA). The mean healing time for EJF was 16 ± 7 days (median time: 12 days, range: 4-43 days). Postoperative systemic immune-inflammation index (SII) > 521×10ˆ9/L, controlling nutritional status score (CONUT) > 4, nutritional support method, visceral fat index (VFI) < 74.42 cm2/m2, and skeletal muscle index (SMI) < 41.25 cm2/m2 were associated with delayed EJF healing times. A comprehensive model was developed, in the validation group, the model demonstrated an AUC of 0.838 (95% confidence interval (95% CI): 0.763-0.912). The DCA and calibration curves indicated a strong predictive consistency and clinical utility of the model.

Serum Cystatin S (CST4): A Novel Prognostic Marker for Gastric Cancer.

Serum Cystatin S (CST4), a secretory protein that inhibits cellular matrix degradation, significantly influences the tumor microenvironment and tumor progression. However, the prognostic value of serum CST4 in gastric cancer (GC) remains unclear. This study aims to explore serum CST4's utility in GC prognostic assessment. A cohort of 334 patients with GC who underwent radical gastrectomy was assessed. Preoperative serum CST4 levels were measured alongside traditional tumor markers, correlating with clinical data and patient outcomes. The cohort was divided into training and test sets at a ratio of 3:1 for Cox regression analyses, which identified CST4 as an independent risk factor for overall survival (OS) and disease-free survival (DFS). A prognostic model was developed, validated with calibration curves, and its predictive value was evaluated using receiver operating characteristic (ROC) curves. In addition, CST4 expression was correlated with immune cell infiltration using data from The Cancer Genome Atlas (TCGA). Patients were stratified by median CST4 levels, and Kaplan-Meier curves for OS and DFS were plotted. Cystatin S was confirmed as an independent risk factor for OS and DFS. Integrating CST4 with traditional markers and TNM pathological staging significantly enhanced the predictive value for prognosis. Cystatin S's impact on tumor progression is likely mediated through modulation of the immune microenvironment, including immune suppression and evasion. Cystatin S is an effective biomarker for GC prognostic assessment, assisting in the evaluation of prognosis and the selection of treatment strategies for patients with GC.

Mutant Pattern of p53 as a Feasible Predictor of Distant Metastasis Following Curative Gastrectomy for Advanced-stage Gastric Cancer.

Objective: The TP53 mutation is a poor prognostic factor for malignant tumors in a number of organs. The present study primarily aimed to clarify the impact of the mutant pattern of p53 on the prognosis and recurrence of gastric cancer. Methods: For this purpose, 519 patients who underwent radical gastrectomy for cancer were enrolled in the present study. Immunohistochemistry (IHC) was used to examine p53 expression in tissues and a three-stage classification system was used to divide the patient tissues into three groups according to the expression of p53: Heterogeneous (wild-type), absent and overexpression (mutant). Results: After 5 years of follow-up, recurrence and metastasis occurred in 38.7% of patients with stomach cancer, with a p53 mutant pattern in 48.4% of these patients. Patients with a p53 mutant pattern had lower recurrence-free and overall survival rates at 5 years compared with those who were p53 wild-type (P<0.001). It was found that the p53 pattern differed significantly (P<0.001) between the wild-type and mutant patterns, including the pN0 and pN+ gastric cancer subgroups (P<0.001 and P=0.014, respectively). The p53 mutant pattern was also significant in the determination of the recurrence-free survival of patients with progressive stomach cancer (P<0.0001). The 5-year overall survival rates were 71.7 and 36.2%, and the recurrence-free survival rates were 71.2 and 35.2% in the pN0 and pN+ groups, respectively (P<0.001). The mutant pattern of p53 was a significant prognostic factor for both distant metastasis [relative risk (RR)=2.881, P<0.001] and overall survival (RR=2.809, P<0.001) in the univariate Cox regression analysis. In the multivariate analysis, distant metastasis (RR=2.767, P<0.001) remained significant in the mutant pattern of p53 staining. After propensity score matching, 189 patients with a p53 wild-type and 189 patients with a p53 mutant pattern were extracted for analysis. The 5-year overall survival rate in patients with the p53 mutant pattern (n = 189) was worse than that in the patients with p53 wild-type (n = 189) and with significant differences (log-rank P<0.01). The study was statistically significant after Cox univariate and multivariate regression analysis, which revealed that the mutant pattern of p53 is an independent prognostic factor impacting distant metastases following curative gastrectomy for advanced-stage gastric cancer (p = 0.48).

Perioperative risk factors for osteoporosis after radical gastrectomy for gastric cancer

BackgroundOsteoporosis, a frequent complication of gastrectomy, increases with age, and the average age of gastric cancer patients continues to rise. This study aims to analyze perioperative factors of osteoporosis after radical gastrectomy.Materials and methodsThis retrospective cohort study included patients who underwent dual-energy-X-ray absorptiometry after gastrectomy due to gastric cancer between 2016 and 2019 at Seoul Boramae Medical Center. Data were analyzed from before surgery to 12 months after surgery. Statistical analyses identified osteoporosis risk factors among perioperative factors.ResultsAmong 189 patients, osteoporosis was diagnosed in 72 patients and peaked at 36 months postoperatively (46.3%; 24 out of 54) with the lowest mean T score of -3.34 although Ca and vitamin D supplements were prescribed to 157 patients (83.1%) on average 32.4 months postoperatively. In multivariate analysis, age (P = 0.002; Adjusted OR: 1.059, 95% CI: 1.020–1.098), body weight (P = 0.009; Adjusted OR: 0.950, 95% CI: 0.914–0.987), sex (P = 0.021; Adjusted OR: 2.322, 95% CI: 1.138–4.739), and serum ALP (P = 0.009; Adjusted OR: 1.023, 95% CI: 1.006–1.040) were significant preoperatively. Additionally, age (P = 0.005; Adjusted OR: 1.067, 95% CI: 1.020–1.116), serum Ca (P = 0.046; Adjusted OR: 0.357, 95% CI: 0.130–0.980), Cr (P = 0.003; Adjusted OR: 0.021, 95% CI: 0.002–0.268), and ALP (P = 0.014; Adjusted OR: 1.017, 95% CI: 1.003–1.030) were observed significantly at 12 months postoperatively.Conclusions38.1% of patients were diagnosed with osteoporosis after radical gastrectomy, despite Ca and vitamin D supplements. Age, body weight, sex, serum Ca, Cr, and ALP correlated with osteoporosis perioperatively.

Vessel invasion is a risk factor for gastric cancer: a retrospective analysis study

ObjectiveTo explore the relationship between vessel invasion (VI) and clinicopathological features and prognosis in patients with gastric cancer (GC).MethodsA total of 3600 cases of patients with GC who underwent radical gastrectomy in gastrointestinal surgery department of the First Affiliated Hospital of Naval Medical University from June 2014 to June 2019 were retrospectively analyzed, and filtering them based on specific inclusion and exclusion criteria. To reduce the possibility of selection bias about the impact of VI, patients were divided into two groups according to the presence or absence of it, and performed a one-to-one propensity score matching (PSM), resulting in 724 patients in each group. In the analysis of data from 3,205 GC patients was employed to examine inter-group variations in VI positivity across diverse clinicopathological factors. Both univariate and multivariate Cox regression models were applied to investigate the correlation between clinicopathological factors and prognosis. The findings were further illustrated through the plotting of Kaplan-Meier survival curves.Results3205 patients were included in this study, of which 989 (30.9%) were VI-positive and 2216 (69.1%) were VI-negative. VI-positive group was found to be significantly associated with age, body mass index (BMI), pTNM stage, tumor location, perineural invasion (PI), Lauren classfication and tumor deposit (TD) (P < .05), but not with gender or basic disease. VI-positive patients had a worse survival than VI-negative patients before (P < .001) and after (P = .007) PSM matching. The Kaplan-Meier survival curve after PSM illustrated that patients with VI had a 5-year survival rate of 58.03%, whereas patients without VI had a higher rate at 66.25%. Further, multivariate analysis after matching demonstrated that VI was an independent risk factor for prognosis (P = .030).ConclusionVI is associated with multiple pathological factors and serves as an independent risk factor affecting the prognosis of GC.

Comparative analysis of conventional laparoscopic surgery and single-incision laparoscopic surgery in gastric cancer treatment: Outcomes and prognosis.

Gastric cancer surgery has advanced with minimally invasive techniques. This study compares outcomes between single-incision laparoscopic surgery plus one port (SILS + 1) and conventional laparoscopic surgery (CLS) in treating gastric cancer. To explore the curative effect of SILS + 1 and CLS on gastric cancer and their influences on prognosis. A total of 93 patients with gastric cancer undergoing radical gastrectomy in the hospital were retrospectively analyzed between September 2019 and September 2022. According to different surgical methods, they were divided into SILS + 1 group (n = 56) and CLS group (n = 37). The perioperative indexes, pain degree [visual analogue scale (VAS)] and stress response [C-reactive protein (CRP), white blood cell count (WBC)] in the two groups were compared. The postoperative complications, recurrence rate and mortality at 1 year after surgery were recorded. Intraoperative blood loss was significantly lower in the SILS + 1 group (76.53 ± 8.12 mL) compared to the CLS group (108.67 ± 12.34 mL, P < 0.001), and the total incision length was also significantly shorter in the SILS + 1 group (5.29 ± 1.01 cm vs 9.45 ± 2.34 cm, P < 0.001). SILS + 1 patients experienced faster recovery, with shorter times to first flatus (1.94 ± 0.43 days vs 3.23 ± 0.88 days, P < 0.001) and ambulation (2.76 ± 0.58 days vs 4.10 ± 0.97 days, P < 0.001). Postoperative pain, as measured by VAS scores, was significantly lower in the SILS + 1 group on postoperative days 1, 2, and 3 (P < 0.001). Additionally, stress markers (CRP and WBC) were significantly lower in the SILS + 1 group on the first postoperative day (CRP: 6.41 ± 1.63 mg/L vs 7.82 ± 1.88 mg/L, P < 0.001; WBC: 6.34 ± 1.50 × 109/L vs 7.09 ± 1.61 × 109/L, P = 0.024). The complication rate in the SILS + 1 group was also significantly lower than in the CLS group (8.93% vs 27.03%, P = 0.020). However, there was no significant difference in recurrence rates between the two groups after one year (3.57% vs 8.11%, P > 0.05). SILS + 1 and CLS have the comparable lymph node clearance effect in patients with gastric cancer. However, SILS + 1 is more beneficial to reduce intraoperative blood loss, relieve pain, alleviate stress response, reduce the incidence of complications and promote rapid postoperative recovery.

Immune-related adverse events with renal colic as the main manifestation: a case report of sintilimab-induced ureteritis/cystitis treated by ureteral stent and review of the literature

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of systemic cancer therapy. During disinhibiting the antitumor responses of immune system, ICIs may also cause unique immune-related adverse events (irAEs) which could affect any organ. Here, we report a rare case of sintilimab-induced ureteritis/cystitis in a 55-year-old male undergoing neoadjuvant chemo-immunotherapy for gastric cancer. The patient presented with severe renal colic, hematuria, and hydronephrosis. Antibiotic antispasmodic and nonsteroidal anti-inflammatory drug treatment failed to alleviate symptoms. The application of corticosteroid was negated for recent extirpative surgery under plan. Bilateral ureteral stenting effectively resolved the pain and improved renal function. The patient later successfully underwent laparoscopic radical gastrectomy with significant tumor regression in postoperative pathology. This case highlights ureteral stenting as a potential corticosteroid-free treatment option for ICI-induced ureteritis/cystitis.

Prognostic impact of lymphovascular invasion in node-negative gastric cancer: a retrospective cohort study

BackgroundLymphovascular invasion (LVI) has been identified as a prognostic factor in various cancers, but its significance in node-negative gastric cancer remains unclear. Gastric cancer prognosis is notably affected by lymph node metastasis, with LVI potentially indicating metastatic spread.MethodsA retrospective review was conducted on 5,699 patients who underwent curative radical gastrectomy for gastric cancer between 1989 and 2018. The median follow-up duration was 62 months (0–362 months). Overall, disease-specific, and disease-free survival were compared based on LVI status and stratified by T stage. Additionally, patients with stage IIA or T2N0 were further evaluated to clarify the clinical significance of LVI in the T2N0 group.ResultsThe T2N0 LVI-positive group exhibited significantly poor prognosis than those in the T2N0 LVI-negative group, with no significant differences observed on comparing the T2N0 LVI-positive group with the T2N1 LVI-negative or LVI-positive groups. Furthermore, although the T2N0 LVI-negative group demonstrated better prognosis compared to the IIA group, the T2N0 LVI-positive group exhibited worse survival. In addition, LVI positivity was an independent risk factor for overall survival in T2N0 patients.ConclusionsLVI in node-negative gastric cancer has clinical significance as a prognostic indicator, indicating an increased risk of disease recurrence and poor survival especially in T2 cohort. This indicates an increased likelihood of lymph node involvement and may influence treatment decisions and follow-up strategies.

Clinical Value of Nomograms Integrating Circulating Lipid and Inflammation Risk Score in Predicting Long-Term Outcomes After Radical Gastrectomy in Gastric Cancer: A Multicenter Real-World Study.

The clinical value of incorporating lipid and inflammatory factors to predict long-term survival in patients with gastric cancer (GC) is unreported. This study aimed to investigate the clinical value of nomograms integrating the Circulating Lipid and Inflammation Risk Score (CLIRS) for predicting the long-term outcome of patients with GC. A retrospective analysis included patients with GC who underwent radical resection at four tertiary medical centers. Patients were divided into training and validation cohorts, with least absolute shrinkage and selection operator regression selecting optimal lipid and inflammatory indicators related to GC prognosis. The CLIRS was developed from six indicators: lymphocyte, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Overall, 2534 patients were studied, including 1910 in the training cohort and 624 in the validation cohort. The CLIRS was an independent risk factor for overall survival (OS; hazard ratio [HR] 1.529, 95% confidence interval [CI] 1.271-1.839; p<0.001) and disease-free survival (DFS; HR 1.511, 95% CI 1.267-1.801; p<0.001) in GC patients. The OS nomogram (area under the receiver operating characteristic curve 0.823 vs. 0.785; p<0.05) and DFS nomogram (AUC 0.804 vs. 0.770; p<0.05) based on the CLIRS outperformed pTNM stage. High-risk patients had earlier and more sustained recurrence, with higher rates of local, peritoneal, and distant recurrences (p<0.05). The CLIRS, combining circulating lipid and inflammatory factors, is an independent prognostic factor for patients with GC. Nomograms incorporating the CLIRS are superior to pTNM stage in predicting postoperative survival and recurrence in patients with GC.

Predictive values of body mass index, prognostic nutritional index and C-reactive protein to prealbumin ratio for prognosis of patients receiving radical gastrectomy.

we aimed to analyze the predictive values of body mass index (BMI), prognostic nutritional index (PNI) and C-reactive protein to prealbumin ratio (CRP/PA) for the prognosis of patients receiving radical gastrectomy. one hundred patients subjected to radical gastrectomy from August 2015 to January 2018 were enrolled. The cut-off values of BMI, PNI and CRP/PA on the receiver operating characteristic (ROC) curves were obtained and applied to establish a low BMI group (n = 46) and a high BMI group (n = 54), a low PNI group (n = 48) and a high PNI group (n = 52), as well as a low CRP/PA group (n = 57) and a high CRP/PA group (n = 43). through comparing the low BMI group with the high BMI group, there were differences in the tumor diameter, invasion depth, clinical stage, and lymph node metastasis status (p < 0.05). Differences were found in the invasion depth, tumor diameter, lymph node metastasis status, clinical stage, and postoperative adjuvant therapy in the low CRP/PA group compared with the high CRP/PA group (p < 0.05). The survival rate of all patients was 45.00 % (45/100) during the 5 years of follow-up. According to the Kaplan-Meier survival analysis, the low BMI group, low PNI group and high CRP/PA group had significantly reduced overall survival rates in comparison to those of the high BMI group, high PNI group and low CRP/PA group, respectively (p < 0.05). BMI, PNI and CRP/PA have important predictive values for the prognosis of patients undergoing radical gastrectomy.

Oncological impact of the preoperative combined assessment of skeletal muscle mass for patients undergoing curative gastrectomy for gastric cancer.

We performed a combined assessment of skeletal muscle mass using the skeletal muscle mass index (SMI) and the psoas muscle index (PMI) to evaluate their association with the overall survival (OS) of gastric cancer patients after curative gastrectomy. We analyzed, retrospectively, the computed tomography records of skeletal muscle mass of patients who underwent radical gastrectomy for pStage I-III gastric cancer between April, 2010 and April, 2016. We then compared OS as the primary outcome, stratifying patients according to their SMI or PMI, and investigated prognostic factors using multivariate analyses. The median follow-up duration was 62months. Of the 550 patients analyzed, 262 (47.6%), 194 (35.3%), and 94 (17.1%) were classified into normal, single-low, and double-low SMI and PMI groups, respectively. Patients with double-low SMI and PMI had the poorest OS (P = 0.018). Multivariate analysis revealed that double-low indices were an independent prognostic factor for poor OS (hazard ratio, 1.808; 95% confidence interval 1.009-3.238; P = 0.046). This study revealed that evaluation of skeletal muscle mass based on the combined SMI and PMI can predict the survival outcomes of patients after curative gastrectomy for gastric cancer, and that the coexistence of a low-SMI and low-PMI was associated with the poorest survival.

Prognostic effect of CEA, AFP, CA19‑9 and CA242 for recurrence/metastasis of gastric cancer following radical gastrectomy.

The present study aimed to determine the potential of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen (CA)19-9 and CA242 in predicting recurrence/metastasis of gastric cancer in patients following radical gastrectomy. The clinical data of 368 patients with stage I-III gastric cancer who underwent radical gastrectomy were analyzed, and CEA, AFP, CA19-9 and CA242 levels were detected prior to surgery and 6-12 months following surgery. Univariate and multivariate analyses were used to evaluate the potential risk factors for post-operative recurrence/metastasis of gastric cancer, and the predictive value of CEA, AFP, CA19-9 and CA242 levels was evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC). Cumulative survival rates were calculated using Kaplan-Meier analysis, and statistical significance was evaluated using a log-rank test. Results of the univariate analysis demonstrated that open surgery, age ≥70, total gastrectomy, disease stage III, and pre-operative CA19-9 and CA242 positivity were risk factors for recurrence/metastasis. ROC curve analysis revealed that the AUC values of postoperative CA19-9 were higher than other values. According to the Kaplan-Meier survival analysis, patients with negative CEA, AFP, CA19-9 and CA242 levels prior to surgery exhibited a higher five-year survival rate than those who exhibited positive levels of these tumor markers. In addition, patients with positive CEA, AFP, CA19-9 and CA242 levels prior to surgery exhibited a significantly worse prognosis. Collectively, the results of the present study indicated that CEA, AFP, CA19-9 and CA242 exhibited potential as predictive biomarkers for recurrence/metastasis following radical gastrectomy in patients with gastric cancer. Notably, CA19-9 and CA242 may exhibit the highest potential in predicting recurrence/metastasis.

Potential Probes for Targeted Intraoperative Fluorescence Imaging in Gastric Cancer.

Gastric cancer (GC) is a malignant tumor of the gastrointestinal tract associated with high mortality rates and accounting for approximately 1 million new cases diagnosed annually. Surgery, particularly radical gastrectomy, remains the primary treatment; however, there are currently no specific approaches to better distinguish malignant from healthy tissue or to differentiate between metastatic and non-metastatic lymph nodes. As a result, surgeons have to remove all lymph nodes indiscriminately, increasing intraoperative risks for patients and prolonging hospital stay. Near-infrared fluorescence imaging with indocyanine green (ICG) can provide real-time visualization of the surgical field using both conventional laparoscopy and robotic mini-invasive precision surgery platforms. However, its application shows some limits, as ICG is a non-targeted contrast agent. Several studies are now investigating the potential efficacy of fluorescent targeted agents that could selectively bind to the tumor tissue, offering a valuable tool for metastatic mapping during robotic gastrectomy. This review aims to summarize the key fluorescent agents that have been developed to recognize GC markers, as well as those targeting the tumor microenvironment (TME) and metabolic features. These agents hold great potential as valuable tools for enhancing precision surgery in robotic gastrectomy procedures improving the clinical recovery of GC patients.

Gut Microbiome Changes After Neoadjuvant Chemotherapy and Surgery in Patients with Gastric Cancer.

Neoadjuvant chemotherapy (NAC) followed by radical gastrectomy is the current standard approach for locally advanced gastric cancer (GC) in the West. Both NAC and gastrectomy can significantly influence the gut microbiome, potentially leading to clinically significant changes. However, no longitudinal studies to date support this hypothesis. This study investigates gut microbiome changes throughout GC treatment, including NAC and gastrectomy. This longitudinal observational study included GC patients undergoing NAC followed by gastrectomy. Fecal microbiome composition, intestinal inflammation (fecal calprotectin), and gut permeability (LBP, sCD14) markers were investigated at baseline, after NAC, and after gastrectomy. A total of 38 patients were included in the study. The results showed that NAC did not affect the gut microbiome composition at the phylum level. In contrast, radical gastrectomy led to an increased abundance of Bacteroidetes and Proteobacteria and a decreased abundance of Firmicutes and Actinobacteria. Furthermore, NAC alone did not impact alpha or beta diversity, while a combination of NAC and gastrectomy significantly influenced both. After gastrectomy, the gut microbiome composition analysis also revealed enrichment of oralization-associated bacterial species such as Escherichia-Shigella, Streptococcus equinus, uncultured Streptococcus species, and species from the Enterobacteriaceae family. Intestinal inflammation and gut permeability markers did not significantly change throughout the treatment. The radical treatment of advanced GC with NAC and radical surgery has long-term effects on the gut microbiome, characterized by gut microbiome oralization. These sustained alterations primarily stem from the radical gastrectomy rather than the NAC. Since previous studies have linked oralization-associated dysbiosis to various gastrointestinal symptoms, this study highlights the gut microbiome as a potential therapeutic target to enhance the quality of life in long-term survivors following gastrectomy.