Gastrectomy For Gastric Cancer Research Articles

One-year Survival after Gastrectomy for Gastric Cancer: An Analysis of Prognostic Influencing Factors and Therapeutic Implications

One-year Survival after Gastrectomy for Gastric Cancer: An Analysis of Prognostic Influencing Factors and Therapeutic Implications

Endoscopic Stent for Anastomotic Leakage Treatment Post Proximal Gastrectomy in Gastric Cancer: A Case Report

Endoscopic Stent for Anastomotic Leakage Treatment Post Proximal Gastrectomy in Gastric Cancer: A Case Report

Analysis of surgical volume and short‐term outcomes for upper gastrointestinal cancer post‐COVID‐19: Evidence from a nationwide Japanese database

AbstractAimPrevious studies indicated that short‐term outcomes for gastroenterological surgeries did not worsen during the COVID‐19 pandemic. However, it remains unclear whether surgical volumes and medical resource use have recovered postpandemic. This study examines pre‐ and postpandemic trends in upper gastrointestinal surgeries, including esophagectomy and gastrectomy, and their short‐term outcomes.MethodsData from the Japan's National Clinical Database (NCD) were analyzed for patients who underwent esophagectomy for esophageal cancer and gastrectomy for gastric cancer between January 2018 and December 2023. We evaluated changes in surgical volume, intensive care unit (ICU) use, morbidity, mortality rates, and the standardized morbidity and mortality ratio (SMR)—a comparison of observed versus expected outcomes using an NCD‐established risk calculator. Key metrics included 30d mortality, surgical mortality, and four major morbidities like pneumonia and anastomotic leakage.ResultsEsophagectomy volumes remained stable from 2018 to 2023, while gastrectomy volumes decreased notably over the past 6 y. The proportion of patients over 70 increased significantly in both surgery types. Morbidity and mortality rates showed no significant deterioration postpandemic, as indicated by SMR values.ConclusionsThis study analyzed changes in surgical volume and short‐term outcomes for upper gastrointestinal cancer in the post‐COVID‐19 era using a Japanese nationwide database. It found that surgical treatments for gastrectomy and esophagectomy remained safe even after the pandemic.

A Predictive Model for Gastric Cancer-Specific Death after Gastrectomy: A Competing-Risk Nomogram.

We aimed to assess the likelihood of cause-specific death and other causes of death after gastrectomy for gastric cancer (GC). Additionally, a competing-risk nomogram was developed for patient counseling and decision-making. Eligible GC patients who had gastrectomy between 2007 and 2015 were included in the study from the Surveillance, Epidemiology, and End Results (SEER) database. Death from gastric cancer and death from other causes were considered as separate competing events. Cumulative incidence functions (CIF) were calculated for each event, and a competing-risk nomogram was developed. Overall, 8,808 patients who underwent gastrectomy were analyzed. Among them, 4,659 (52.90%) died from gastric cancer and 1,284 (14.58%) died from other causes. The five-year cumulative incidence of cause-specific death for gastric cancer was 50.4%, and 10.2% for deaths from other causes. Several independent factors, such as age at diagnosis, tumor site, grade, size, lymph node examination results, pathological T status, pathological N status, metastatic status, Lauren classification, radiation, and chemotherapy, were found to be associated with gastric cancer-specific death. The nomogram, based on results from the competing risk regression model, demonstrated good performance. We have developed a nomogram aimed at predicting gastric cancer-specific mortality in patients following gastrectomy. The model has undergone internal validation, demonstrating good accuracy and reliability. It serves as useful tool that can assist physicians and patients in making more informed clinical decisions.

7276 Hypothyroid Patients With Gastric Diseases In Treatment With Liquid L-T4: An Observational Study

Abstract Disclosure: P. Fallahi: None. F. Ragusa: None. A. Patrizio: None. V. Mazzi: None. C. Botrini: None. G. Elia: None. E. Balestri: None. E. Barozzi: None. L. Rugani: None. E. Palmisano: None. M. Cosenza: None. G. Varricchi: None. S. Ulisse: None. S. Benvenga: None. S. Ferrari: None. A. Antonelli: None. We have conducted an observational and retrospective study, by enrolling patients with hypothyroidism and gastric diseases in treatment with liquid L-T4 (L-LT4) or tablet L-T4 (T-LT4). The aim of the study was to compare the stability of TSH in these patients. Eighty-four patients were in treatment with L-LT4, and 120 patients with T-LT4; all of them assumed L-T4 30 minutes before breakfast. The patients were affected by different types of gastric disease: a) in T-LT4 group: 74 chronic gastritis (CG); 4 gastrectomy for gastric cancer (GTx); 42 gastro-plastics (GP); b) in L-LT4 group: 60 CG; 3 GTx; 21 GP (p>0.05). In the T-LT4 group 66% of the patients were chronically treated with PPI, against 51% in the L-LT4 group (p>0.05). The frequency of Helicobacter Pylori infection was 17% in both T-LT4 and L-LT4 groups. The gender distribution, mean age and body weight were similar in the two groups (p>0.05). The mean L-T4 dosage in the T-LT4 group at the basal evaluation was 1.22+/-0.27 μg/kg/die, in the L-LT4 group was 1.36+/-0.22 μg/kg/die (p>0.05). At the basal evaluation the prevalence of patients with a TSH > 3.5 μIU/mL in the T-LT4 group was 36%, whereas in the L-LT4 group was of 46% (p<0.05). After adjustment of the dosage of the LT-4 therapy, the patients were re-evaluated with an interval range of 5-9 months, for 4 times, during an overall period ranging from 23 to 31 months. At the first re-evaluation, the prevalence of patients with a TSH>3.5 μIU/mL was 13% in both groups. At the second re-evaluation, the prevalence of patients with a TSH > 3.5 μIU/mL in the T-LT4 group was 26%, and of 13% in the L-LT4 group (p<0.05). At the third re-evaluation, the prevalence of patients with TSH>3.5 μIU/mL in the T-LT4 group was 19%, and of 9% in the L-LT4 group (p=0.05). At the fourth and last re-evaluation, the prevalence of patients with a TSH > 3.5 μIU/mL in the T-LT4 group was 18%, and of 5% in the L-LT4 group (p<0.05). Mean FT4 and FT3 circulating levels were not significantly different in the two group at each visit. These data highlight a more stable control of TSH levels in hypothyroid patients with gastric disorders in the long-term follow-up, by using a liquid L-T4 formulation therapy with respect to a tablet L-T4. Presentation: 6/3/2024

Impact of splenectomy on long-term outcomes after gastrectomy for gastric cancer: a population-based study

BackgroundNo national studies comparing long-term survival after total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation exist. This study aimed to examine the 5-year overall survival (OS) of patients with gastric adenocarcinoma who underwent total or partial gastrectomy with splenectomy due to injury or oncologic reasons or spleen preservation in a population-based nationwide setting. MethodsThis study included all patients undergoing total or partial gastrectomy with splenectomy or spleen preservation for gastric adenocarcinoma in Finland from 2005 to 2016, with follow-up until December 31, 2019. A total of 2196 patients with gastric cancer diagnosis and total or partial gastrectomy were identified in the registries. Of these patients, 2118 were applicable for this study. Cox proportional hazard models provided hazard ratios (HRs) with 95% CIs of 5-year OS. The results were adjusted for age, sex, year of operation, comorbidities, tumor location, pathologic stage, and neoadjuvant therapy. ResultsThe observed 5-year OS rates were 38.7% in patients with no or minor spleen injury, 39.7% in patients with splenectomy due to injury, and 30.8% in patients with splenectomy due to oncologic reasons (P = .032). Patients who underwent R0 gastrectomy with splenectomy due to oncologic reasons had higher 5-year mortality (the adjusted model HR, 1.26; 95% CI, 1.01–1.56) than patients who underwent spleen preservation. ConclusionThe OS was worst in patients who underwent gastrectomy with splenectomy due to oncologic reasons, highlighting the poor prognosis in patients with advanced gastric cancer. Splenectomy due to injury does not compromise the prognosis.

Function-preserving gastrectomy in gastric cancer

Background: This study aimed to provide an overview of minimally invasive and function-preserving surgeries for gastric cancer, focusing on the latest developments in proximal gastrectomy.Current Concepts: Laparoscopic and robotic surgeries have increasingly been adopted as minimally invasive techniques, and pylorus-preserving gastrectomy (PPG) and proximal gastrectomy (PG) have increasingly been performed as function-preserving surgeries. PPG reduces the incidence of dumping syndrome, bile reflux, and gallstones. After PG, there is a high possibility that vitamin B12 injections are not needed. In addition, compared with total gastrectomy, it has the advantages of less anemia, better nutritional status, and secretion of various gastrointestinal hormones. Double-tract reconstruction (DTR) is often performed in PG to prevent reflux esophagitis. In the Korean Laparoendoscopic Gastrointestinal Surgery Study 05 trial, patients who underwent laparoscopic PG with DTR required less vitamin B12 supplementation than those who underwent total gastrectomy, and there was no difference in complication and survival rates. In addition, quality of life, such as physical and social functions, was better.Discussion and Conclusion: PG with DTR can be recognized as function-preserving gastric cancer surgery for patients with upper early gastric cancer. Minimally invasive surgeries such as laparoscopic and robotic procedures have become more common. Function-preserving surgeries now include PPG and PG. Among these, the DTR technique is frequently performed after PG, offering the advantages of preserving vitamin B12 levels and improving the quality of life.

Cholinesterase as a predictor of skeletal muscle loss after gastrectomy for gastric cancer.

Cholinesterase is a classical nutritional and inflammatory marker. The aim of the present study was to evaluate the value of cholinesterase as a predictive marker for postoperative skeletal muscle loss after gastrectomy for gastric cancer. The study comprised 68 patients who had undergone gastrectomy for gastric cancer. Skeletal muscle mass was evaluated using skeletal mass index, and major skeletal muscle loss was defined as less than or equal to the median change rate (1-year postoperative/preoperative) of skeletal mass index in all patients. We explored the relationship between postoperative major skeletal muscle loss and disease-free survival and overall survival. Then we investigated the relationship between change rate of skeletal muscle index and serum cholinesterase levels after gastrectomy. The median value of change rate of skeletal mass index was 0.93. Postoperative major skeletal muscle loss was significantly associated with disease-free survival after gastrectomy (P=0.003). Although major skeletal muscle loss had worse overall survival, it was not significant (P=0.058). The change rate of skeletal mass index and cholinesterase had a stronger positive correlation compared with other nutritional indices according to Spearman's rank correlation coefficient (r=0.438, P≤0.001). Evaluation of serum cholinesterase levels may be valuable for predicting postoperative skeletal muscle loss after gastrectomy, suggesting the importance of cholinesterase in postoperative nutritional management of patients with gastric cancer.

Omentum preservation versus complete omentectomy in gastrectomy for gastric cancer (OMEGA trial): study protocol for a randomized controlled trial

BackgroundPotentially curative therapy for locally advanced gastric cancer consists of gastrectomy, usually in combination with perioperative chemotherapy. An oncological resection includes a radical (R0) gastrectomy and modified D2 lymphadenectomy; generally, a total omentectomy is also performed, to ensure the removal of possible microscopic disease. However, the omentum functions as a regulator of regional immune responses to prevent infections and prevents adhesions which could lead to bowel obstructions. Evidence supporting a survival benefit of routine complete omentectomy during gastrectomy is lacking.MethodsOMEGA is a randomized controlled, open, parallel, non-inferiority, multicenter trial. Eligible patients are operable (ASA < 4) and have resectable (≦ cT4aN3bM0) primary gastric cancer. Patients will be 1:1 randomized between (sub)total gastrectomy with omentum preservation distal of the gastroepiploic vessels versus complete omentectomy. For a power of 80%, the target sample size is 654 patients. The primary objective is to investigate whether omentum preservation in gastrectomy for cancer is non-inferior to complete omentectomy in terms of 3-year overall survival. Secondary endpoints include intra- and postoperative outcomes, such as blood loss, operative time, hospital stay, readmission rate, quality of life, disease-free survival, and cost-effectiveness.DiscussionThe OMEGA trial investigates if omentum preservation during gastrectomy for gastric cancer is non-inferior to complete omentectomy in terms of 3-year overall survival, with non-inferiority being determined based on results from both the intention-to-treat and the per-protocol analyses. The OMEGA trial will elucidate whether routine complete omentectomy could be omitted, potentially reducing overtreatment.Trial registrationClinicalTrials.gov NCT05180864. Registered on 6th January 2022.

Reduced cardiovascular disease risk after gastrectomy for gastric cancer: Unexpected treatment benefits.

51 Background: The relationship between gastrectomy for gastric cancer and subsequent cardiovascular risk modifications has been noted, yet the direct consequences of such surgeries on cardiovascular incidences are not fully established. This study evaluated cardiovascular event rates among patients who received gastrectomy versus a matched general cohort. Methods: In a nationwide retrospective cohort analysis, we examined individuals diagnosed with gastric cancer who underwent gastrectomy (n=18,698), and a control group matched for demographics (n=81,787) from 2004 to 2008. Criteria for inclusion were patients devoid of any previous cancer diagnosis (except gastric cancer), myocardial infarction, or ischemic stroke. The primary outcome was the incidence of major adverse cardiovascular events (MACE) such as acute myocardial infarction (MI) or acute ischemic stroke, in patients with gastric cancer. Results: Within a seven-year observational window, 2.7% of the gastrectomy group (or 4.29 events per 1000 person-years) experienced new MAC). The gastrectomy group showed a significantly lower incidence rate of MACE compared to the matched control subjects (hazard ratio [HR] 0.65; 95% confidence interval [CI] 0.63–0.71; P&lt;0.001), MI (HR, 0.68; 95% CI, 0.60–0.78; P &lt; 0.001), and stroke (HR, 0.73; 95% CI, 0.66–0.79; P&lt;0.001). In the subgroup analyses, no significant interactions were identified between the study groups and baseline variables. Conclusions: The study indicates a decreased risk of developing cardiovascular diseases post-gastrectomy for gastric cancer, as opposed to the general population. Beyond their significance for public health strategies aimed at cardiovascular risk management in gastric cancer patients, these findings empower both patients and healthcare providers with enhanced knowledge for making decisions about gastric cancer surgical options. Furthermore, this study lays the groundwork for future investigations into the metabolic effects of gastric cancer surgeries, notably their potential in lowering cardiovascular risk.

Pancreas-left gastric artery angle predicts difficulty of suprapancreatic lymph node dissection in gastrectomy for gastric cancer: a cross-sectional study.

Suprapancreatic lymph node dissection is one of the most challenging procedures performed in the treatment of gastric cancer. This study aimed to investigate whether the pancreas-left gastric artery angle (PLA) can be used to predict the difficulty of the procedure. This was a single-center cross-sectional study. Before gastrectomy, the patients were classified according to the size of the PLA into the small PLA (s-PLA; < 30°) and large PLA (l-PLA; ≥ 30°) groups in a surgeon-blinded manner. After gastrectomy, a surgeon evaluated suprapancreatic lymph node dissection as hard, normal, or easy to perform. Seventy-three patients were enrolled in the study. Surgeons evaluated lymph node dissection as hard in 43.8 and 8.7% of patients in the s-PLA and l-PLA groups, respectively (p = 0.002). The time taken for suprapancreatic lymph node dissection was also significantly longer in the s-PLA group than in the l-PLA group (p = 0.040). In patients who underwent laparoscopic gastrectomy, the time for node dissection in the s-PLA group was also significantly longer than that in the s-PLA group (p = 0.021), while there was no difference in those who underwent robotic surgery (p = 0.815). PLA is useful for predicting the degree of difficulty of suprapancreatic lymph node dissection during gastrectomy for gastric cancer.

Long-Term Effects of Oral Nutritional Supplements After Gastrectomy for Gastric Cancer: A Survival Analysis from a Multicenter, Open-Label, Randomized Controlled Trial.

Weight loss (WL) after gastrectomy for gastric cancer is associated with both decreased compliance with adjuvant chemotherapy and impaired survival. This study examined the effects of administering oral nutritional supplements (ONS) for 3months after gastrectomy in terms of compliance with adjuvant chemotherapy and survival outcomes. This large-scale, multicenter, open-label, randomized controlled trial enrolled 1,003 gastric cancer patients undergoing curative gastrectomy. Patients were assigned to the control group (n = 503) or ONS group (n = 500). In the ONS group, 400kcal/day of ONS was recommended in addition to a regular diet for 3months after gastrectomy. Compliance with adjuvant chemotherapy and survival outcomes were compared between the two groups. Compared with the control group, the ONS group showed significantly decreased WL at 3months after gastrectomy (8.6 ± 6.1 vs. 7.2 ± 5.7%, respectively, P = 0.0004). The control and ONS groups did not differ regarding the induction rate of adjuvant chemotherapy (84.9 vs. 82.8%, respectively, P = 0.614) or the continuation rate at 3months postoperatively (75.3 vs. 76.6%, respectively, P = 0.809). Oral nutritional supplements for 3months showed no survival benefit; the 3- and 5-year overall survival (OS) rates were 91.3% and 87.6% in the control group and 89.6% and 86.4% in the ONS group, respectively, indicating no significant difference (P = 0.548). Subgroup analysis could not detect a population in which ONS administration increased OS. Administration of ONS for 3months after gastrectomy was not associated with increased compliance with adjuvant chemotherapy or with improved prognosis.

Comparison of Postoperative Complications After Gastrectomy for Gastric Cancer with Antecolic Versus Retrocolic Reconstruction: A Population-Based Study

BackgroundThe purpose of this study was to examine the rates of 90-day anastomotic complications and other postoperative complications after total or partial gastrectomy with antecolic versus retrocolic reconstruction in a population-based setting.MethodsThis population-based nationwide retrospective cohort study included all patients undergoing total or partial gastrectomy for gastric adenocarcinoma in Finland in 2005–2016, with follow-up until 31 December 2019. Logistic regression provided odds ratios (ORs) with 95% confidence intervals (CIs) of 90-day mortality. Results were adjusted for age, sex, year of the surgery, comorbidities, tumor locations, pathological stage, and neoadjuvant therapy.ResultsA total of 2063 patients having gastrectomy with antecolic (n = 814) or retrocolic (n = 1249) reconstruction were identified from the registries. The anastomotic complication rate was 3.8% with antecolic reconstruction and 5.0% with retrocolic reconstruction. Antecolic reconstruction was not associated with a higher risk of anastomotic complications compared with retrocolic reconstruction in the adjusted analysis (OR 0.69, 95% CI 0.44–1.09) of the whole cohort or in the predefined subgroups. The reoperation rate was 8.2% with antecolic reconstruction and 7.7% with retrocolic reconstruction, without statistical significance. In subgroup analysis of total gastrectomy patients, the risk of major complications was lower with antecolic reconstruction compared with retrocolic reconstruction (OR 0.62, 95% CI 0.45–0.86).ConclusionsThe rate of anastomotic complications did not differ after antecolic versus retrocolic reconstruction after total or partial gastrectomy. In total gastrectomies, the risk of major complications was lower after antecolic compared with retrocolic reconstruction.

Prognostic significance of the preoperative C-reactive protein-albumin-lymphocyte (CALLY) index on outcomes after gastrectomy for gastric cancer.

Systemic inflammatory response markers are reported to be prognostic for patients with cancer. The C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index has been established as an immuno-nutritional scoring system. The aim of this study was to clarify the impact of the preoperative CALLY index on the outcome of patients undergoing gastrectomy for gastric cancer. We analyzed the data of 826 patients who underwent gastrectomy for stage I, II, or III gastric cancer between 2010 and 2017. The CALLY index was defined as (albumin × lymphocyte)/(CRP × 104). The cut-off of the CALLY index was 2. The 147 patients with a preoperative CALLY index < 2 had significantly worse overall survival (OS) and relapse-free survival (RFS) than those with a CALLY index ≥ 2 (P < 0.01, P < 0.01, respectively). Multivariate analysis identified that a CALLY index < 2 (P = 0.02), intraoperative blood loss (P < 0.01), and stage II or III disease (P < 0.01) were independent and significant predictors of worse RFS. A CALLY index < 2 (P = 0.01), intraoperative blood loss (P < 0.01), postoperative complications (P = 0.02), and stage II or III disease (P < 0.01) were independent and significant predictors of worse OS. The preoperative CALLY index was independently associated with a poor prognosis for patients after gastrectomy for gastric cancer.

Postoperative sarcopenia increases both gastric cancer and other-cause mortality in older adults undergoing radical gastrectomy for cancer

Preoperative sarcopenia in gastric cancer is associated with increased postoperative complications and reduced long-term survival. However, the association between postoperative sarcopenia and long-term outcomes remains unclear. Therefore, this study aims to clarify the association between sarcopenia after gastrectomy for gastric cancer and survival outcomes. This retrospective study included 1512 patients aged ≥65 who underwent curative gastric resection for clinical stage I-III primary gastric cancer during 2008-2018. Sarcopenia was assessed preoperatively by measuring arm muscle area and grip strength, which was repeated 1 month after surgery. We compared the clinical characteristics, surgical treatments, and long-term outcomes between the postoperative normal and sarcopenia groups. Sarcopenia was observed in 173 and 305 patients pre- and postoperatively, respectively. Factors increasing the risk of postoperative sarcopenia included age of ≥75, lower preoperative body mass index, diabetes, and clinical stage II/III gastric cancer. Patients with postoperative sarcopenia after surgery had a significantly lower overall survival rate (hazard ratio [HR] 2.596, p<0.001). Furthermore, postoperative sarcopenia was linked to decreased overall survival in patients with (HR 2.813, p=0.002) and without (HR 1.925, p<0.001) preoperative sarcopenia. Cumulative incidence showed significantly higher rates of deaths due to gastric cancer (HR 1.928, p<0.001) and other causes (HR 2.736, p<0.001) in the postoperative sarcopenia group. Postoperative sarcopenia in gastric cancer is linked to an increased risk of death due to cancer and other causes, underscoring the importance of perioperative sarcopenia management strategies.

Impact of the COVID-19 pandemic on gastric surgery in Japan: A nationwide study using interrupted time-series analyses.

Changes in the number of surgeries for gastric cancer during the coronavirus disease 2019 (COVID-19) pandemic have been reported, but data are insufficient to understand the impact at the national level. This study aimed to determine the impact of the COVID-19 pandemic on gastric surgery in Japan. Insurance claims data registered from January 2015 to January 2021 were used. Changes in the number of endoscopic resections and gastrectomies for gastric cancer were estimated using an interrupted time-series analysis. The number of endoscopic resections significantly decreased in July 2020 (-1565; 95% confidence interval [CI]: -2022, -1108) and January 2021 (-539; 95% CI: -970, -109), and the number of laparoscopic surgeries significantly decreased in July 2020 (-795; 95% CI: -1097, -492), October 2020 (-313; 95% CI: -606, -19), and January 2021 (-507; 95% CI: -935, -78). Meanwhile, the number of open gastrectomies remained unchanged, and the number of robot-assisted gastrectomies steadily increased since their coverage by public health insurance in April 2018. The decreased number of endoscopic resections and laparoscopic surgeries in Japan suggests a decline in early-stage gastric cancer diagnosis, likely due to the suspension of gastric cancer screening and diagnostic testing during the pandemic. Meanwhile, the number of open and robot-assisted gastrectomies remained unchanged and increased, respectively, indicating that these applications were not affected by the pandemic-related medical crisis. These findings highlight that procedures for cancer diagnosis, including screening, should still be provided during pandemics.

Predictive Postoperative Inflammatory Response Indicators of Infectious Complications Following Gastrectomy for Gastric Cancer.

Perioperative factors are useful for predicting postoperative infectious complications (PIC) in gastric cancer. Specifically, postoperative inflammatory response indicators (PIRI), [C-reactive protein (CRP) level, body temperature (BT), and white blood cell (WBC) count], are widely used in clinical practice. We investigated predictive factors for PIC, including PIRI, to establish a simple and practical indicator of postoperative complications after gastrectomy. We retrospectively collected clinical data from 200 patients with fStage I-III gastric cancer. Univariate/multivariate analysis was performed to evaluate the relationship of predictive factors [host factors, clinicopathological factors, and PIRI (BT, WBC count, and CRP level on postoperative day (POD) 1 and 3) ]. Cut-off values of the predictive factors were analyzed using receiver operating characteristic (ROC) curve modulated by the presence/absence of PIC Grade II, III (Clavien-Dindo classification). Age [Odds ratio (OR): 5.67], smoking history (OR: 3.51), and CRP level (OR: 5.65), WBC count (OR: 8.96), and BT (OR: 3.37) on POD3 were selected as independent factors from multivariate analysis. Cut-off values were 77 years, 14.8 mg/dL, 116.0×102/μL, and 37.4°C, respectively. Predictive factors relative to PIC in gastric cancer were CRP level ≥ 14.8 mg/dL, WBC count ≥ 116.0×102/μL, and BT ≥ 37.4°C all on POD3. Age ≥ 77 years, and history of smoking were relative to PIC, suggesting a simple and practical indicator applicable in clinical practice.

Comparison of the survival outcomes between retrocolic and antecolic Roux-en-Y reconstruction after gastrectomy for gastric cancer.

There are two methods of Roux-en-Y (RY) reconstruction after gastrectomy: the antecolic route (ACR) and retrocolic route (RCR). There is no evidence to support that the ACR achieves comparable long-term survival. This was a multi-center historical cohort study. Patients diagnosed with clinical T3/4a and any N stage who underwent open gastrectomy and R0 resection for gastric adenocarcinoma between January 2006 and December 2012 were enrolled. The primary outcome was the hazard ratio of ACR for overall survival, with adjustment for confounding factors by propensity score matching, and a Cox proportional hazards model. A total of 1758 eligible patients were identified from the database. After matching, 410 patients in the ACR and RCR groups were included in the final analysis. The adjusted hazard ratio (95% CI) for ACR was 1.148 (0.870-1.492). The five-year survival rates in the ACR and RCR groups were 74.3% (69.5-78.4) and 77.3% (72.3-81.2), respectively. The short-term surgical outcomes of the two groups did not differ to a statistically significant extent. The route used to lift the jejunum in RY reconstruction did not affect the incidence of long-term survival or postoperative complications. The ACR and RCR are both acceptable options for RY reconstruction during gastric cancer surgery.

Construction and validation of a risk-prediction model for anastomotic leakage after radical gastrectomy: A cohort study in China

ObjectivesAnastomotic leakage (AL) stands out as a prevalent and severe complication following gastric cancer surgery. It frequently precipitates additional serious complications, significantly influencing the overall survival time of patients. This study aims to enhance the risk-assessment strategy for AL following gastrectomy for gastric cancer. MethodsThis study included a derivation cohort and validation cohort. The derivation cohort included patients who underwent radical gastrectomy at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 1, 2015 to December 31, 2020. An evidence-based predictor questionnaire was crafted through extensive literature review and panel discussions. Based on the questionnaire, inpatient data were collected to form a model-derivation cohort. This cohort underwent both univariate and multivariate analyses to identify factors associated with AL events, and a logistic regression model with stepwise regression was developed. A 5-fold cross-validation ensured model reliability. The validation cohort included patients from August 1, 2021 to December 31, 2021 at the same hospital. Using the same imputation method, we organized the validation-queue data. We then employed the risk-prediction model constructed in the earlier phase of the study to predict the risk of AL in the subjects included in the validation queue. We compared the predictions with the actual occurrence, and evaluated the external validation performance of the model using model-evaluation indicators such as the area under the receiver operating characteristic curve (AUROC), Brier score, and calibration curve. ResultsThe derivation cohort included 1377 patients, and the validation cohort included 131 patients. The independent predictors of AL after radical gastrectomy included age ≥65 y, preoperative albumin <35 g/L, resection extent, operative time ≥240 min, and intraoperative blood loss ≥90 mL. The predictive model exhibited a solid AUROC of 0.750 (95% CI: 0.694–0.806; p < 0.001) with a Brier score of 0.049. The 5-fold cross-validation confirmed these findings with a calibrated C-index of 0.749 and an average Brier score of 0.052. External validation showed an AUROC of 0.723 (95% CI: 0.564–0.882; p = 0.006) and a Brier score of 0.055, confirming reliability in different clinical settings. ConclusionsWe successfully developed a risk-prediction model for AL following radical gastrectomy. This tool will aid healthcare professionals in anticipating AL, potentially reducing unnecessary interventions.

High incidence of gallstones after Roux-en-Y reconstruction gastrectomy in gastric cancer: a multicenter, long-term cohort study.

Roux-en-Y reconstruction is a common anastomosis technique during gastrectomy in gastric cancer. There is a lack of studies on gallstones after Roux-en-Y reconstruction gastrectomy. This study investigated the incidence and potential risk factors associated with gallstones after Roux-en-Y reconstructive gastrectomy in gastric cancer. The study analyzed data from gastric cancer who underwent radical gastrectomy and Roux-en-Y reconstruction at two hospitals between January 2014 and December 2020. The patients fall into distal and total gastrectomy groups based on the extent of gastrectomy. The cumulative event probability curve was plotted using the Kaplan-Meier, and differences in gallstone between groups were evaluated using the Log-Rank. Propensity score matching was applied to construct a balanced total versus distal gastrectomies cohort. A Cox regression was employed to analyze the risk factors for gallstones after Roux-en-Y reconstructive gastrectomy in gastric cancer. Further subgroup analysis was performed. Five hundred thirty-one patients were included in this study, 201 in the distal gastrectomy group and 330 in the total gastrectomy. During the follow-up, gallstones occurred in 170 cases after gastrectomy, of which 145 cases accounted for 85.29% of all stones in the first two years after surgery. Then, to reduce the impact of bias, a 1:1 propensity score matching analysis was performed on the two groups of patients. A total of 344 patients were evaluated, with each subgroup comprising 172 patients. In the matched population, the Cox regression analysis revealed that females, BMI ≥23kg/m 2 , total gastrectomy, No.12 lymph node dissection, and adjuvant chemotherapy were risk factors for gallstones after Roux-en-Y reconstructive gastrectomy. Subgroup analysis showed that open surgery further increased the risk of gallstones after total gastrectomy. The incidence of gallstones increased significantly within 2years after Roux-en-Y reconstructive gastrectomy for gastric cancer. Patients with these risk factors should be followed closely after gastrectomy to avoid symptomatic gallstones.