Gastrectomy In Cancer Patients Research Articles

Successful open radical gastrectomy for locally advanced or metastatic gastric cancer patients who suffered from coronavirus disease 2019 during preoperative chemotherapy: a report of three cases

BackgroundAccording to previous reports, in patients with preoperative coronavirus disease 2019 (COVID-19) infection, mortality is increased if they undergo surgery within 6 weeks of diagnosis. However, the optimal timing and preoperative examination for gastrectomy with a previous COVID-19 infection are still controversial. We experienced three cases in which patients successfully underwent open radical gastrectomy following preoperative chemotherapy even though they developed COVID-19 infection during the chemotherapy.Case presentationCase 1: A 58-year-old man with locally advanced gastric cancer caught COVID-19 during preoperative chemotherapy comprising 5-fluorouracil, calcium folate, oxaliplatin, and docetaxel. Although the patient had specific lung shadows indicating COVID-19 infection and deep venous thrombosis in the lower extremities, he underwent distal gastrectomy 10 weeks after the COVID-19 diagnosis. He had a good postoperative course. Case 2: A 56-year-old man with gastric cancer and lymph node and peritoneal metastasis caught COVID-19 during palliative chemotherapy comprising S-1, oxaliplatin, and trastuzumab. He underwent total gastrectomy as conversion surgery 8 weeks after COVID-19 infection. His postoperative course was uneventful. Case 3: A 55-year-old man with gastric cancer and paraaortic lymph node and liver metastases caught COVID-19 during S-1 and oxaliplatin treatment as neoadjuvant chemotherapy. He underwent distal gastrectomy, paraaortic lymph node sampling, and partial hepatectomy 8 weeks after COVID-19 infection although he had residual lung shadows and deep venous thrombosis in the lower extremities. He had an uneventful postoperative course.ConclusionsComputed tomography for preoperative evaluation was performed for all three patients and revealed that lung shadows remained post-COVID-19 infection. Despite this finding, the patients had good operative courses and were discharged as planned. Surgery after 7 weeks from the diagnosis of COVID-19 infection can be performed safely even when patients are post-chemotherapy and have residual lung findings and deep venous thrombosis. This report may contribute to the development of a consensus on performing safe gastrectomy for advanced gastric cancer in patients previously infected with COVID-19.

Extremely High Mortality Rate after a Successful Gastrectomy for Cancer in Older Adults.

PurposePoor physiological reserve for withstanding major cancer surgery in older adults is an important concern in the selection of patients for oncologic gastrectomy. The present study aimed to analyze mortality patterns among patients who underwent gastrectomy for cancer according to age groups. The primary outcomes of this study were early- and middle-term results: 30-day and 3-, 6-, 12-, and 36-month mortality rates.Materials and MethodsA retrospective review of 288 patients who underwent surgical resection for gastric cancer in two centers was carried out. Patients were stratified into four groups according to age: 29–50 years (group I, n=27), 51–65 years (group II, n=117), 66–75 years (group III, n=81), and 76–92 years (group IV, n=58). Statistical calculations focused on the differences in the survival rates between groups I and II as well as between groups II and IV.ResultsThe middle-aged patients (group II) had significantly better 3-year survival than either the youngest (group I) or the oldest patients (group IV). The 6-month mortality rates were 16.9% in group III and 29.3% in group IV. Two-thirds of the patients from groups III and IV who died between 2 and 6 months after surgery had an uneventful postoperative course.ConclusionsAge is an important prognostic factor of middle-term survival after gastrectomy for cancer. Geriatric assessment and better patient selection for major surgery for cancer are required to improve the outcome of gastrectomy for cancer in patients aged over 75 years.

Use of Barbed Sutures in Laparoscopic Gastrointestinal Single-Layer Sutures.

Background and Objectives:Laparoscopic anastomotic methods are not commonly used because of the cumbersome laparoscopic intracorporeal sutures and tying involved. The barbed suture is one of the various devices developed to simplify the placement of intracorporeal sutures. However, barbed sutures are not commonly used during reconstruction after radical gastrectomy in cancer patients or for single-layer entire-thickness running suturing for intestinal anastomoses. We describe the procedure for using barbed sutures and report on the short-term surgical outcomes.Methods:Between August 2012 and March 2014, 15-cm-long barbed sutures (V-Loc 180; Covidien, Mansfield, MA, USA) were used for laparoscopic intestinal anastomoses, including intestinal hole closure for esophagojejunal and gastrojejunal anastomoses after mechanical anastomoses and gastric wall closure after partial resection.Results:In total, 38 patients underwent 40 laparoscopic anastomoses (esophagojejunostomies, 26; gastrojejunostomies, 7; and simple closure of gastric defect, 7); no cases required conversion to open surgery. Two cases exhibited positive air leak test results during surgery (1 case of esophagojejunostomy and 1 case of simple closure of gastric defect). Two cases of intestinal obstruction were noted; of those, one patient with postoperative intestinal paresis (grade II) was managed conservatively, and the other underwent repeat laparoscopic surgery (grade IIIb) for internal herniation unrelated to V-Loc use. No postoperative complications at the anastomosis site and no surgery-related deaths were noted.Conclusion:Single-layer entire-thickness running suturing with the V-Loc 180 barbed suture after stapled side-to-side intestinal anastomosis was found to be safe and feasible in the reported cases.

Sa1099 Clinical Studies of Gastrectomy for Gastric Cancer in Patients Over 80 Years Old

G A A b st ra ct s indirect effect (2%) mediated by increasing a patient's CSBM rate (Figure 1). Spontaneous bowel movements (SBMs) that were not associated with a sense of completeness and BMs associated with rescue medication use did not qualitatively increase the amount of mediated LIN pain effect. The results of the 2-way CSBM stratification analysis (Table 1) indicated that improvement in abdominal pain was influenced by the time since last CSBM and the number of recent CSBMs. However, consistent with the predominant direct effect of LIN on abdominal pain shown in the mediation analysis, in each cell of Table 1, the LIN-treated patients had greater abdominal pain relief than PBO-treated patients when controlling for these CSBM factors. Conclusions: The results of these analyses are consistent with the hypothesis that the LIN effect on abdominal pain (over PBO) was predominantly a direct effect and, to a lesser extent, a mediated effect of increasing CSBM frequency. Table 1. Percent Improvement in Abdominal Pain Stratified by Number of Recent CSBMs and Time Since Last CSBM by Treatment Group (LIN/PBO [LIN-PBO difference])

157 POSTER Analysis of outcome predictors after gastrectomy for cancer in patients over 75 years of age

157 POSTER Analysis of outcome predictors after gastrectomy for cancer in patients over 75 years of age

Symptom control may improve food intake, body composition, and aspects of quality of life after gastrectomy in cancer patients.

That severe malnutrition affects body function and psychological well-being is well documented. We addressed the question of whether quality of life relates to changes in variables such as food intake, body composition, and gastrointestinal symptomatology after gastrectomy for gastric cancer. Thirty-two patients undergoing gastric resection had their dietary intake, body composition, and specific and general aspects of quality of life determined preoperatively, at 12 months and, in the 15 surviving patients, several years after the operation. The patients lost 10% of their preoperative weight (mainly body fat) during the first year. Food intake did not correlate to changes in body composition or quality of life. Gastrointestinal symptoms adversely related to changes in lean body mass, meal size, and general aspects of quality of life for a long time after the operation. Gastrointestinal symptom control seems important to minimize impairment in quality of life, body composition, and eating after gastrectomy.

Effects of distal gastrectomy on gastroesophageal motility in cancer patients

The purpose of this prospective study was to determine whether a distal gastrectomy in cancer patients with no endoscopic evidence of hiatal hernia could affect motor functions of the gastroesophageal junction. Preoperative measurements were completed in 45 patients with tumor confined to the antrum and about to undergo a planned radical subtotal gastrectomy; however, a total of 36 patients (30 men and 6 women; age range, 34 to 76 years) completed the study according to the protocol. These 36 patients underwent a preoperative esophageal manometry to measure motor functions, including lower esophageal sphincter pressure and length and swallow-induced relaxation response. This measurement procedure was repeated at least 6 months after a successful tumor resection. We used a nonparametric analysis to compare the preoperative and postoperative motor functions. Our results indicated that neither the resting lower esophageal sphincter pressure, the length of this sphincter, nor the dry or wet swallow-induced relaxation ability was changed statistically significantly after the tumor resection. Based on the results of this small study, we syggest that radical subtotal gastrectomy in gastric cancer patients with no preoperative diagnosis of hiatal hernia does not alter their gastroesophageal motor functions.