Gastric Surgery Research Articles

Surgical treatment results for oligo-recurrence of gastric cancer.

462 Background: Despite advancements in diverse treatments, approximately 40-50% of advance gastric cancer patients experience recurrence even after curative resection surgery. The condition where there is a limited recurrence after the control of the primary tumor site is referred to as oligo-recurrence. However, there is scarce reporting on oligo-recurrence after gastric cancer surgery. This study compiled cases of patients who underwent surgery for recurrent gastric cancer after R0 surgery. Since there are no specific treatment guidelines for recurrence after gastric cancer surgery, this research could be beneficial in providing insights and assistance. Methods: This retrospective study includes data from 25 patients who underwent surgery for suspected oligo-recurrence of gastric cancer among those who had undergone surgery from June 2008 to May 2018. If a solitary mass suspected of recurrence is identified during surveillance, a PET-CT is performed. Patients with suspicion of peritoneal dissemination, carefully excluded through a multidisciplinary approach, are selectively omitted. All patients undergo excision surgery for both treatment and tissue examination purposes. Results: Out of 25 cases, there were 6 cases of paraaortic lymph node enlargement, 9 cases liver nodules, 8 case lung nodules, and 1 case tumor bed mass. In the postoperative tissue analysis, 4 cases of paraaortic lymph node enlargement, 5 cases of the liver nodules, and 1case tumor bed mass were confirmed to be recurrences of gastric cancer. All of lung nodule were diagnosed with lung cancer. All 10 cases underwent chemotherapy after metastatectomy. Among them, 3 cases experienced recurrence and died an average of 12.3 months after surgery. Seven cases did not experience recurrence and have survived with an average survival time of 102 months to date. Conclusions: The metastatectomy is safe and effective for patients with oligo-recurrence from GC and can improve their prognosis. For an accurate diagnosis, oligometastectomy is essential. However, our results need to be confirmed by more randomized controlled clinical studies. Treatment result after metastatectomy. Case Diagnosis Chemotherapy aftermetastatectomy Recurence after metastatectomy DFS after metastatectomy OS after metastatectomy OS after gastrectomy Status 1 LN metastasis 1/1 15cycles FOLFOX 147 147 156.4 ALIVE 2 LN metastasis 1/1 37cycles TAS-118 liver metastasis 22 40.6 74.9 DEATH 3 LN metastasis 1/3 12cycles FOLFOX 98.1 98.1 125.5 ALIVE 4 LN metastasis 1/1 35cycles FOLFOX 50.9 50.9 71.3 ALIVE 5 Liver metastasis ONO tiral Liver, bone mets. 3.73 27.9 64.6 DEATH 6 Liver metastasis 12cycles FOLFOX 68.3 68.3 122.2 ALIVE 7 Liver metastasis 12cycles FOLFOX 96 96 105.8 ALIVE 8 Liver metastasis 82cycles FOLFOX 55 55 77.4 ALIVE 9 Liver metastasis 12cycles FOLFOX 94.4 94.4 103.9 ALIVE 10 Tumor bed 12cycles FOLFOX 9 25.5 24.4 DEATH

The impact of different gastrointestinal reconstruction techniques on gut microbiota after gastric cancer surgery

IntroductionGastric cancer is one of the common malignant tumors in the digestive tract, characterized by high incidence and mortality rates. This is particularly significant in China, where a large proportion of global new cases of gastric cancer and related deaths occur. In recent years, with the continuous development of molecular biology technology, people have gained a deeper understanding of the gastrointestinal microbiome, and studies have shown that it is closely related to the occurrence, development, and therapeutic response of gastric cancer. Although surgical intervention is crucial in significantly extending the survival of gastric cancer patients, the disruption of the balance of the intestinal microbiota caused by surgery itself should not be overlooked, as it may affect postoperative recovery.MethodsThis study was approved by the Biomedical Ethics Committee of Sichuan Mianyang 404 Hospital. A random sampling method was used to select patients who underwent gastric cancer surgery at the hospital from January 2023 to December 2023. All patients signed written informed consent forms. Standardized perioperative management was conducted for the patients in the study, including preoperative preparation, intraoperative handling, and postoperative treatment. Fecal samples were collected from patients before surgery (before bowel preparation) and around one week after surgery for 16S rRNA sequencing analysis, through which differential biomarkers and related functional genes were sought.ResultsThe study results indicated that there was no significant difference in the diversity of the gut microbiota between the two groups. Compared with the R-Y group, the DTR surgical method significantly altered the structure of the gut microbiota, affecting the types, quantities, and proportions of intestinal bacteria. Furthermore, the DTR group exhibited poorer postoperative nutritional absorption capacity compared to the R-Y group, as indicated by a lower F/B ratio. The R-Y group showed a richer abundance of Bacteroidetes and a lower abundance of Proteobacteria, as well as a higher F/B ratio after surgery. These findings provide new insights into the changes in the gut microbiota following gastric cancer surgery, which may be of significant importance for postoperative recovery and long-term health management.DiscussionThis study reveals the impact of different gastrointestinal reconstruction techniques on the postoperative gut microbiota of gastric cancer patients, providing new insights into the physiological changes during the postoperative recovery period. Although there was no significant difference in microbial diversity between the DTR group and the R-Y group, the DTR group showed more pronounced changes in microbial structure postoperatively, which may be associated with an increased risk of postoperative infection. These findings emphasize the importance of considering the impact on the gut microbiota when selecting gastric cancer surgery methods. However, the study had a limited sample size and did not delve into changes in metabolites. Future studies should expand the sample size and conduct metabolomic analyses to further validate these preliminary findings.

Changes in gut microbiota after gastric cancer surgery: a prospective longitudinal study

BackgroundThis study was designed to characterize gut microbiota changes of the patients with gastric cancer before and after the gastrectomy during their hospital staying periods.Methods16S ribosomal RNA (rRNA) gene sequencing was used to evaluate differences in gut microbiota among patients with gastric cancer before and after the gastrectomy by comparing gut microbiota α diversity, β diversity, and structure composition at different taxonomic levels.ResultsA total of 120 fecal specimens were collected from 60 patients. There was no significant difference in Chao1 index, Shannon index, and Simpson index before and after gastrectomy (all P > 0.05). At the phylum level, the gut microbiota in the gastrectomy group showed less abundance of Bacteroidota, Synergistota, and Verrucomicrobiota but with higher abundance of Campylobacter, Actinobacteria, and Bacillota. At the genus level, the gut microbiota in the gastrectomy group showed less abundance of flora Bacteroides, Faecalibacterium, Blautia, and Lachnospiraceae nk4a136 group but with higher abundance of Campylobacter, Porphyromona, Finegordia, Dialist, Anaerococcus, and Corynebacterium.ConclusionsThere was no significant change in the diversity of intestinal flora before and after surgery. However, significant changes in the structure of intestinal flora before and after surgery were occurred.

Multimorbid patients in visceral surgery-Upper gastrointestinal tract

The treatment of multimorbid patients in oncological surgery of the upper gastrointestinal tract requires adifferentiated consideration of every single risk factor in order to provide a holistic assessment. This article focuses on pre-existing diseases that are particularly relevant for elective esophageal and gastric surgery and have practical clinical consequences. In this way a differtiation is made between metabolic, vascular, cardiopulmonary and organ-specific risks. The aim of this work is to provide practical guidelines for complex and multimorbid cases. Given the multifactorial interrelationships, the importance of athorough preoperative evaluation and interdisciplinary management cannot be overemphasized.

Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline).

Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area. Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version. Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.

Peroral Endoscopic Myotomy in a Patient With Gastric Bypass, a Therapeutic Challenge in the Management of Postoperative Achalasia

ABSTRACT Achalasia is a rare esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter and ineffective contraction of the esophageal body. This condition is not often associated with obesity; however, in recent years, cases of achalasia after bariatric surgery have been described. We describe the case of a 30-year-old female patient with a history of gastric sleeve surgery in 2018, which, 4 years after the intervention, presented with dysphagia, regurgitation, and weight loss. A diagnosis of achalasia was made, and peroral endoscopic myotomy was performed.

Endoscopy and Anesthesia Outcomes Associated with Glucagon-Like Peptide-1 Receptor Agonist use in Patients Undergoing Outpatient Upper Endoscopy.

Glucagon-like peptide-1 receptor agonists (GLP1RAs) can cause delayed gastric emptying, raising concern for retained gastric contents (RGCs) during endoscopy and adverse anesthesia events. We aimed to determine associations between GLP1RA and endoscopy and anesthesia outcomes. This single-center retrospective cohort study examined patients prescribed GLP1RA who underwent outpatient endoscopy stratified by exposure at the time of endoscopy. The GLP1RA group had ≥6 weeks of exposure as confirmed by pharmacy dispensation reports. The control group were patients not on GLP1RA at the time of endoscopy (prescription never filled, discontinued ≥6 weeks prior, or started post-endoscopy). The outcomes were the presence of solid RGCs, aborted procedures or any adverse anesthesia events. 598 patients were included in the study with 360 on GLP1RA and 298 controls. Baseline characteristics including age, sex, chronic opiate use, gastroparesis and prior gastric surgery were similar, but diabetes mellitus was more prevalent in the GLP1RA group (68% vs. 57%, p=0.005). The odds of solid RGCs was significantly higher in the GLP1RA group in multivariate analysis (OR 3.80; 95% CI 1.57-9.21; p=0.003), but odds were not increased in patients undergoing concurrent colonoscopy. More patients in the GLP1RA group had procedures aborted (1.3% vs. 0%, p=0.021), but rates of hypoxia were similar (0.2% vs. 0.3%, p=0.341). There were no cases of pulmonary aspiration. Patients on GLP1RAs have increased rates of solid RGCs during upper endoscopy, but not with concurrent colonoscopy, and higher rates of aborted procedures, but similar rates of adverse anesthesia events.

Short-Term Outcomes of a Novel Hybrid Technique, Minimally Invasive Laparoscopic and Robotic Surgery (MILAR) Using the da Vinci SP System for Gastric Cancer.

Robotic surgery may have shown advantages over conventional laparoscopic surgery, but the da Vinci SP system, which utilizes a single incision, has had limited use in gastric cancer surgery. This study aims to evaluate the short-term outcomes of a novel hybrid technique, minimally invasive laparoscopic and robotic surgery (MILAR), with the da Vinci SP system for gastric cancer. This retrospective study reviewed 23 consecutive patients who underwent gastrectomy for gastric cancer using the MILAR technique with the da Vinci SP system between May and October 2024. Operative time, blood loss, and morbidity were analyzed. The median operation time was 192 min (191 min for distal gastrectomy, 174 min for proximal gastrectomy, and 308 min for total gastrectomy). Blood loss was minimal, with a median of 13 mL and no patient exceeding 250 mL. Postoperative complications were also minimal; one patient developed a grade II intra-abdominal fluid infection and another had grade II enteritis. There were no anastomotic leakages or pancreatic fistulas, and no grade III or higher complications were observed. MILAR using the da Vinci SP system is feasible and safe for gastric cancer surgery, with minimal blood loss and acceptable operative times. This is the first report from Japan showing the successful application of this system in gastric cancer, offering new prospects in minimally invasive surgery.

Association between the geriatric nutritional risk index and postoperative delirium in gastric surgery patients: an analysis of the MIMIC-IV database

BackgroundThis study explores the correlation between nutritional status, as determined by the Geriatric Nutritional Risk Index (GNRI), and the incidence of postoperative delirium (POD) in patients undergoing gastric surgery.MethodsData were obtained from the MIMIC-IV 2.2 database for patients aged 18 years or older who underwent gastric surgery. Patients were categorized into the malnourished group (GNRI < 98) and the non-malnourished group (GNRI ≥ 98). Multivariable logistic regression was performed to assess the association between GNRI and POD, and various potential confounders were adjusted to ensure the robustness of the results. Non-linear relationships between GNRI and POD risk were evaluated through restricted cubic spline (RCS) analysis. Subgroup analyses were conducted to examine the effect of GNRI on POD across different patient categories, and interactions were calculated. Propensity score matching (PSM) was employed to reduce confounding bias.ResultsThe study included a total of 4,818 patients, of whom 1,133 (23.5%) developed POD. Patients with a GNRI < 98 had a significantly higher risk of POD compared with those with a GNRI ≥ 98 (odds ratio (OR): 2.21, 95% confidence interval (CI): 1.93–2.53, p < 0.001). Even after adjustment for relevant confounders, GNRI remained significantly associated with POD (OR:1.24, 95% CI: 1.04–1.48, p < 0.001). This association was further supported by the results from PSM (OR:1.23, 95% CI: 1.01–1.51, p = 0.045). RCS analysis demonstrated a non-linear relationship between GNRI and POD risk (p < 0.05). Subgroup analyses revealed significant interactions within the cardiovascular disease, renal replacement therapy, benzodiazepine medication, and vasoactive drug subgroups (p for interaction < 0.05). After the patient population was adjusted to individuals aged 65 and older, this correlation remained significant (p for interaction < 0.05).ConclusionsThis study identifies a significant association between GNRI and the incidence of POD in patients undergoing gastric surgery. Improving nutritional status before surgery may lower the risk of developing POD.

The effect of supplementary parenteral nutrition with different energy intakes on clinical outcomes of patients after gastric cancer surgery

BackgroundTo investigate the effect of postoperative supplementary parenteral nutrition (SPN) containing varying energy intake levels during the early postoperative period on the clinical outcomes of patients diagnosed with gastric cancer.MethodsData from 237 patients, who were diagnosed with gastric cancer between January 2016 and June 2022, were retrospectively analyzed. Patients were divided into 2 groups based on mean daily SPN energy intake: low (L-SPN; < 20 kcal/kg/day); and high (H-SPN; ≥ 20 kcal/kg/day). Data regarding gender, age, body mass index, preoperative Nutrition Risk Screening 2002 (NRS 2002) score, American Society of Anesthesiologists Physical Status classification system, age-adjusted Charlson Comorbidity Index, diabetes, hypertension, chronic lung disease, and the Tumor-Node-Metastasis (TNM [Eighth edition]) classification were collected for propensity score matching (PSM). Postoperative indicators were monitored. A power analysis was performed during the design phase of this study to ensure that statistical power exceeded 80% to reliably detect differences between the 2 groups.ResultsAfter PSM, data from 128 patients were analyzed (H-SPN, n = 64; L-SPN, n = 64). The H-SPN group experienced shorter postoperative hospital stay (8.11 ± 6.00 days vs. 10.38 ± 7.73 days; P = 0.045) and a lower number of infectious complications (36 [56.3%] vs. 60 [93.8%]; P < 0.001), particularly pulmonary infections, compared with the L-SPN group. Additionally, no increase in hospitalization costs or non-infectious complications occurred in the H-SPN group. Subgroup analysis revealed that H-SPN significantly reduced the incidence of infectious complications among those < 65 years of age (hazard ratio [HR] [95% confidence interval (CI) 0.240 0.069–0.829]; P = 0.024), NRS 2002 score ≥ 3 (HR 0.417 [95% CI 0.156–0.823]; P = 0.028), age-adjusted Charlson Complexity Index < 2 (HR 0.106 [95% CI 0.013–0.835]; P = 0.033), and TNM stage III (HR 0.504 [95% CI 0.224–0.921]; P = 0.046).ConclusionsH-SPN effectively reduced postoperative infectious complications and the length of hospital stay, suggesting that early postoperative H-SPN may be an advantageous nutritional support strategy for patients diagnosed with gastric cancer.

Intraoperative thermostatic nursing and failure mode and effects analysis enhance gastrectomies' care quality.

Utilizing failure mode and effects analysis (FMEA) in operating room nursing provides valuable insights for the care of patients undergoing radical gastric cancer surgery. To evaluate the impact of FMEA on the risk of adverse events and nursing-care quality in patients undergoing radical surgery. Among 230 patients receiving radical cancer surgery between May 2019 and May 2024, 115 were assigned to a control group that received standard intraoperative thermoregulation, while the observation group benefited from FMEA-modeled operating room care. Clinical indicators, stress responses, postoperative gastrointestinal function recovery, nursing quality, and the incidence of adverse events were compared between the two groups. Significant differences were observed in bed and hospital stay durations between the groups (P < 0.05). There were no significant differences in intraoperative blood loss or postoperative body temperature (P > 0.05). Stress scores improved in both groups post-nursing (P < 0.05), with the observation group showing lower stress scores than the control group (P < 0.05). Gastrointestinal function recovery and nursing quality scores also differed significantly (P < 0.05). Additionally, the incidence of adverse events such as stress injuries and surgical infections varied notably between the groups (P < 0.05). Incorporating FMEA into operating room nursing significantly enhances patient care by improving safety, expediting recovery, and reducing healthcare-associated risks.

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.

Analysis of prognostic risk factors for patients with locally advanced gastric cancer in the stage ypT0~2N0M0 after neoadjuvant chemotherapy

Objectives: To analyze the long-term prognosis of patients with locally advanced gastric cancer in the stage of ypT0~2N0M0 after neoadjuvant chemotherapy. Methods: The clinical data of 78 patients with locally advanced gastric cancer who underwent neoadjuvant chemotherapy and radical resection at ypT0~2N0M0 stage from January 2012 to December 2019 in the Department of Abdominal Surgery/Pancreatic and Gastric Surgery of the Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. Kaplan-Meier method was used to calculate the overall survival and disease-free survival, and the survival difference between patients with postoperative ypT0N0M0 and ypT1~2N0M0 was compared. Multivariate Cox proportional hazards regression analysis was performed on clinical, pathologic and treatment measures that may affect survival. Results: Among the 78 patients, there were 18 cases (23.1%) with ypT0N0M0, 14 cases (17.9%) with ypT1aN0M0, 17 cases (21.8%) with ypT1bN0M0, and 29 cases (37.2%) with ypT2N0M0. Median follow-up time was 74.1 (19.8~132.5) months. Fourteen patients (17.9%) had tumor recurrence and metastasis, and 9 patients died from tumor recurrence and metastasis. The 5-year disease-free survival and overall survival rates were 84.4% and 87.8%, respectively. There was no statistically significant difference in 5-year overall survival (86.9% vs 87.8%) or 5-year disease-free survival (88.9% vs 83.2%) between patients with ypT0N0M0 and ypT1~2N0M0. Analysis of factors that may affect prognosis revealed that signet ring cell carcinoma, nerve invasion, and lymph node dissection of fewer than 16 were significantly associated with prognosis (P＜0.05). Multivariate Cox analysis including these three factors showed that only lymph node dissection of fewer than 16 was an independent risk factor affecting prognosis (OS: HR=10.44 ,95% CI: 2.15-50.72, P=0.004; DFS: HR=11.47, 95% CI: 2.85-46.20, P=0.001). Conclusions: The long-term prognosis of patients with locally advanced gastric cancer at ypT0~2N0M0 stage after neoadjuvant chemotherapy is relatively good, and the long-term survival time of patients with ypT1~2N0M0 and ypT0N0M0 is similar. Lymph node dissection of less than 16 nodes may be an independent risk factor affecting prognosis. During surgery, efforts should be made to increase the number of lymph node dissections. For patients with less than 16 nodes dissected, postoperative treatment and follow-up should be strengthened.

The Effect of Early Enteral Nutrition under the ERAS Model on Gastrointestinal and Immune Function Recovery in Patients Undergoing Gastric Tumor Surgery.

Patients with gastric malignant tumors usually undergo surgical treatment when indicated. Surgical intervention causes significant trauma and can lead to considerable stress responses in patients. These patients experience increased malnutrition along with reduced immune function, which ultimately leads to the occurrence of postoperative complications. Therefore, this study explored the effects of early enteral nutrition on gastrointestinal and immune function in patients undergoing gastric cancer surgery under the Enhanced Recovery After Surgery (ERAS) model, aiming to support early postoperative recovery. A retrospective analysis was conducted on the clinical data obtained from gastric tumors patients who underwent surgery in the Affiliated Hospital of Jiangsu University, between January 2019 and December 2022. Based on the gastrointestinal management approaches, the patients were divided into a control group (n = 92) and an observation group (n = 92). The control group received routine gastrointestinal management and parenteral nutrition support, while the observation group underwent early enteral nutrition support under the ERAS model. The initial postoperative flatulence, the first instance of eating, and the initial bowel movement, as well as serum nutritional indicators [albumin (Alb), prealbumin (PA), hemoglobin (Hb)], immune markers [immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA)], inflammatory markers [white blood cell (WBC), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6)] were evaluated at different time points before and after surgery. Furthermore, the incidence of postoperative complications (abdominal distension, diarrhea, and infection) and the length of post-surgery hospitalization were documented for both patient cohorts. The observation group showed shorter time to first postoperative flatus, earlier food consumption, and an advanced first bowel movement than the control group (p < 0.05). On the third day after surgery, the serum concentrations of Alb, PA, Hb, IgG, IgM, and IgA were diminished in both groups compared to their preoperative levels (p < 0.05). Moreover, on the 7th day after surgery, the serum levels of Alb, PA, Hb, IgG, IgM, and IgA increased in both groups compared to the 3rd day (p < 0.05) but remained lower than before surgery levels (p < 0.05). Additionally, the serum Alb, PA, Hb, IgG, IgM, and IgA levels were significantly higher in the observation group than in the control group on the 3rd and 7th postoperative days (p < 0.05). Three days following surgery, WBC, hs-CRP, and IL-6 levels were elevated in both groups compared to their preoperative levels (p < 0.05). On the 7th day after surgery, WBC, hs-CRP, and IL-6 levels decreased in both groups compared to the 3rd day after surgery (p < 0.05) but remained higher than preoperative levels (p < 0.05). Moreover, WBC, hs-CRP, and IL-6 levels were relatively lower in the observation group than in the control group on the 3rd and 7th postoperative days (p < 0.05). Furthermore, the observation group exhibited a decreased overall frequency of postoperative complications compared to the control group (p < 0.05), along with shorter hospitalization following the surgery (p < 0.05). Our findings indicate that early enteral nutrition under the ERAS model can better promote the recovery of gastrointestinal and immune functions in patients undergoing gastric tumor surgery while reducing postoperative complications and facilitating early discharge of patients.

Plasmatic variability of direct oral anticoagulants in people with atrial fibrillation and previous gastric surgery: a pilot case series.

Data on cardioembolic prevention with direct oral anticoagulants (DOAC) in atrial fibrillation (AF) patients with previous gastric surgery are lacking. We report inter- and intra-individual differences in DOAC concentration in people with gastric surgery, to identify potential treatment options. Patients with previous gastric surgery receiving DOAC for AF as stroke secondary prevention, and undergoing peak-trough DOAC plasmatic testing were selected from the regional EDDIE-AF registry. DOAC levels were tested at least 75-102h after DOAC initiation with Siemens Innovance® assays. Eight patients with previous gastric surgery were included (mean age 75years, 50% women). Overall, only 20/36 tests were within range (55.5%; apixaban 75.0%; dabigatran 0%; edoxaban 64.3%; rivaroxaban 33.3%). Rivaroxaban and dabigatran failed to reach therapeutic peak-trough concentrations. Apixaban and edoxaban reached therapeutic levels in 4/6 and 3/7 cases respectively, with marginal out-of-target concentrations in all remaining cases. Our data support a consistent variability in DOAC absorption after gastric surgery, suggesting that implementation of DOAC plasmatic testing may help in ensuring therapeutic levels are met whenever DOACs are preferred over warfarin.

Effect of restrictive versus liberal fluid therapy for laparoscopic gastric surgery on postoperative complications: a randomized controlled trial.

Currently, laparoscopic surgery is a standard technique in the field of abdominal surgery. However, the most adequate fluid regimen during laparoscopic surgery remains unclear. The aim of this trial is to compare a restricted fluid therapy with a liberal fluid therapy for laparoscopic abdominal surgery. Our hypothesis was that restrictive fluid therapy would reduce postoperative complications better than liberal fluid therapy. In this randomized controlled trial, patients scheduled for laparoscopic gastric surgery were randomized to either the liberal group (receiving 7-10ml/kg/h of crystalloid) or the restrictive group (receiving 1-2ml/kg/h of crystalloid) for each stratum of surgical procedure from April 2017 to March 2019. For both groups, blood loss was replaced by an equal volume of hydroxyethyl starch. The primary endpoint was postoperative complications up to 30days after surgery, according to the Clavien-Dindo classification. We enrolled 148 patients, and 140 of these were randomized to either the liberal or the restrictive group after exclusion. As a result, 69 cases were included in the liberal group for analysis, and 67 patients composed the restrictive group. Median fluid administration for the liberal and restrictive groups was 2950ml and 800ml, respectively. As well, overall complications in the liberal and restrictive groups were 27.5% and 19.4%, respectively (risk ratio 0.71, 95% confidence interval 0.38-1.31, p value = 0.264). Restricted fluid therapy and liberal fluid therapy did not show any statistical differences in postoperative complications after laparoscopic gastric surgery.

Evaluation of the safety and effectiveness of easyEndo™ universal stapler compared with easyEndo™ E-lite in patients submitted to gastric surgery: a retrospective/prospective study including a large number of patients

Background: Staple line complications represent the most dangerous complication after gastric surgery. Better-formed staples could potentially reduce complications postoperatively. The newer motorized generation stapling system would lead to fewer intraoperative staple line complications compared to traditional stapling systems. Purpose was to evaluate the safety and efficacy of these two types of stapler models by determining its intraoperative performance and peri-operative complications. Methods: It was an observational cohort study including a total of 3613 patients submitted to gastric surgery for benign or malignant disease. The study was conducted within two periods: stage A using easyEndoTM universal (n=2359 patients, from January 2017 to December 2022) and stage B (n=1254 patients, from January 2023 to June 2024) using easyEndoTM E-lite motorized stapler including obese patients (n=3239), benign diseases with indication of surgical treatment (n=268) and patients with gastric cancer (n=106). Results: Although higher rate of leaks and postoperative complications were observed in patients submitted to sleeve gastrectomy or gastric bypass during stage A compared with stage B (p=0.0025), both type of staplers are safe and effective for performing gastric surgery. In patients submitted to gastric resections, no significates differences were demonstrated in terms of postoperative complications comparing the two groups (p=0.1). Conclusions: Patients operated on using motorized stapler presented less suture line interventions but no differences regarding postoperative complication. The results confirmed data published in previous reports and meta-analysis, but now including a big number of patients and complex procedures.

Implications of compressive loading of the stomach wall: Interplay between mechanical deformation and microstructure.

During gastric surgery, the stomach wall is compressed with clamps and sutures or staple lines. These short- and long-term deformations can severely compromise the integrity of the tissue and make it difficult for the stomach wall to respond and remodel to the new loading conditions. Consequently, serious intra- and postoperative complications such as the formation of leaks during bariatric surgeries, can be associated with these immense tissue deformations. Hence, the study aimed to investigate the effects of compressive loading of the stomach wall in the radial direction. This was done by macroscopic mechanical loading of the stomach wall in each region of the stomach and evaluating the microstructural changes inflicted in the tissue. For this purpose, several imaging techniques were used, i.e., a histological analysis, second-harmonic generation microscopy, and X-ray micro-computed tomography. The combination of these three methods allowed us to investigate the gradual compression of the different stomach layers as well as the local reorientation and deformation of the main microstructural components, e.g., collagen fibers and muscle bundles. Importantly, this study found that the collagen bundles in the stomach wall straighten and reorient toward the circumferential-longitudinal plane and partially fan out with increased radial compressive deformation. The 3D scans of the stomach wall indicated a deterioration of the blood vessels and buckling of the mucosal glands due to compression. Statement of significance Unfortunately, little is known about the load transfer in the stomach wall during gastric surgery and the associated deformations on the macro- and microscale. The present study investigates the structural changes of the stomach wall, its layers and the inherent biological building blocks using histology, multi-photon microscopy, and micro-computed tomography. For the first time, the layer-specific response to stepwise radial compression of the stomach wall was studied, the related collagen fiber parameters were estimated, and a 3D sample structure was visualized. This clinically-oriented study links the structural changes within the wall to the postoperative remodel- ing process and the irreversibly altered gastric motility, thereby underscoring its relevance to the field of biomedical engineering, e.g., the development and improvement of surgical instruments.

A nomogram for predicting nutritional risk before gastric cancer surgery.

Gastric cancer (GC) is the fourth leading cause of cancer death worldwide. Patients with GC have higher nutritional risk. This study aimed to construct a nomogram model for predicting preoperative nutritional risk in patients with GC in order to assess preoperative nutritional risk in patients more precisely. Patients diagnosed with GC and undergoing surgical treatment were included in this study. Data was collected through clinical information, laboratory testing, and radiomics-derived characteristics. Least absolute shrinkage selection operator (LASSO) regression analysis and multi-variable logistic regression were employed to construct a clinical prediction model, which takes the form of a logistic nomogram. The effectiveness of the nomogram model was evaluated using receiver operat-ing characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). A total of three predictors, namely body mass index (BMI), hemoglobin (Hb) and radiomics characteristic score (Radscore) were identified by LASSO regression analysis from a total of 21 variables studied. The model constructed using these three predictors displayed medium prediction ability. The area under the ROC curve was 0.895 (95% CI 0.844-0.945) in the training set, with a cutoff value of 0.651, precision of 0.957, and sensitivity of 0.718. In the validation set, it was 0.880 (95% CI 0.806-0.954), with a cutoff value of 0.655, precision of 0.930, and sensitivity of 0.698. DCA also confirmed the clinical benefit of the combined model. This simple and dependable nomogram model for clinical prediction can assist physicians in assessing preoperative nutritional risk in GC patients in a time-efficient and accurate manner to facilitate early identification and diagnosis.

Using three-dimensional stomach models to identify anatomical landmarks and estimate the resection site in gastric cancer surgery

Using three-dimensional stomach models to identify anatomical landmarks and estimate the resection site in gastric cancer surgery