Gastric Resection Research Articles

Dumping syndrome

The term "dumping-stomach" to denote the pathological condition in patients after gastroenterostomy for gastric ulcer was proposed by Mix and Andrews in 1920. In 1935, in the monograph of Easterman and Balfour, the appearance of rapid evacuation was described for the first time not only after gastroenterostomy, but also after gastric resection; the authors called this complication "dumping stomach". Gilbert and Dunlop (1947) applied the term "dumping syndrome". For the first time, the secondary dyspeptic syndrome after gastroenterostomy was described by Denesho (1907). Hertz (1911, 1913) pointed out that the emptying of the stomach was too fast after gastroenteroanastomosis, imposed due to gastric ulcer. There are about 60-70 names of the syndrome in the literature: hyperglycemic [10, 17], hypoglycemic [33, 62], hormonal, postgastroresection [27], alimentary-enterogenic vegetative [34], enterogenic asthenia [5], etc. More often, especially abroad, they use the name "dumping syndrome". In the Russian literature, the term "agastric asthenia" is used, proposed by A. A. Busalov to designate a number of pathological conditions after gastric resection, including dumping syndrome. I. D. Tonasienko reasonably believes that agastric asthenia and dumping syndrome should be separated. Agastric asthenia is a chronic condition caused by a violation of a number of functions after gastric resection; dumping syndrome depends on the nature of the food taken, has a paroxysmal character and has little effect on the general condition of patients. Therefore, it is necessary to differentiate more carefully the various conditions after gastric resection, without using the generalized term "agastric asthenia".

Resectable Gastric Adenocarcinoma Cancer and the Role of Early Feeding on Clinical Outcome


 Background: Gastric adenocarsinoma is one of the most common gastrointestinal tract cancer, it could be found either in elderly or young patients. Surgical resection is still the main therapeutic option and the gold standard for the resectable cases. Enhanced recovery protocols has been announced to improved the clinical outcome in of gastrointestinal cancer surgery. Especially in upper GI cancer, which still challenging in starting the oral feeding after surgical resection. We will reported the clincal outcome of early feeding on resectable gastric adenocarsinoma patients.
 
 
 
 
 
 Methods: This was a retrospective study, taken from January 2018 - December 2020. All resectable gastric adenocarsinoma patients were included. Tumor locations, type of resection and reconstruction were evaluated. All patients had early oral feeding from the first post operative day, continued with liquid and semi solid food. The short term outcome were recorded including the anastomose leakage and surgical site infection. 
 
 
 
 
 
 Results: We reported eight gastric cancer patients during this study, 1 patient was young gastric cancer patiens and the rest were > 50 years old patients. Gastric anthrum was the most common tumor site with partial gatrectomy and Billroth II have been done. 3 patients were corpus site and 1 case of fundus cancer, total gastrectomy and roux en y esófago-jejunostomy reconstruction was done. 
 
 
 We found no anastomosis leakage. No SSI and no readmission associated with post operative morbidity. 
 
 
 
 
 
 Conclusion: Early feeding on resectable gastric adenocarsinoma patients was feasibel, has good clinical outcomes and could tolerated well, no matter what type of gastric resection we did.
 
 
 
 
 
 
 
 
 

Histopathologic findings on removed stomach after sleeve gastrectomy. Do they influence the outcome?

Little is known about the role of chronic gastritis on weight loss after laparoscopic sleeve gastrectomy (LSG). This study aims to investigate the relationship between histopathologic findings of gastric specimens, excess weight loss (% EWL), and excess BMI loss (% EBL) at 6 and 12 months follow up after LSG. We retrospectively reviewed the clinical records of 95 patients who had undergone LSG between January 2017 and December 2019. Based on the histopathological findings of gastric resection specimens, patients were divided into those with chronic gastritis (CG) and those without chronic gastritis (NoCG) and compared for their % EWL and % EBL at 6 and 12 months. The mean BMI was 44.74 kg/m2 in the CG group and 44.14 kg/m2 in the NoCG group. At 6 months follow up, the CG group had a mean % EWL of 45.7 and % EBL of 40.5, while NoCG had a mean % EWL of 51.1 and % EBL of 46.7. After 1-year follow-up, the CG group had a mean % EWL of 53.1 and a % EBL of 44.8, while the NoCG group had a % EWL of 54.1 and % EBL of 44. This observational study does not support the hypothesis that the occurrence of chronic gastritis can affect postoperative % EWL and % EBL.

Short- and Long-term Outcome After Gastric Cancer Resection in Patients Aged 80 Years and Older.

We aimed to assess the risk factors for postoperative complications and long-term outcome of patients aged ≥80 years after curative resection for gastric cancer (GC). Patients aged ≥80 years who underwent curative gastrectomy for stage I-III GC between 2013 and 2020 were included. Clinical factors were retrospectively analyzed. Of all 109 patients, 29 (26.6%) had 33 postoperative complications (Clavien-Dindo grade ≥2). The rate of postoperative complications was higher in those with greater blood loss (≥170 ml, p<0.001). In multivariate analysis, greater blood loss was confirmed as an independent predictor of postoperative complications (p<0.001). The 30-day, 180-day, 1-year, and 3-year cumulative overall survival rates were 100%, 97.0%, 91.6%, and 74.7%, respectively. Multivariate analysis showed postoperative complications (p=0.014) and low prognostic nutritional index (PNI, p=0.044) were independent prognostic factors for poor overall survival. Performing operations with less bleeding is important to reduce postoperative complications. According to the analysis of long-term survival, patients who experience postoperative complications and patients with a low preoperative PNI require special attention in the follow-up period. Nutritional support should be considered in patients with malnutrition.

Perioperative Safety of Gastrectomy for Patients Receiving Antithrombotic Treatment.

The safety of gastrectomy for patients receiving antithrombotic agents remains unclear. This retrospective cohort study sought to compare outcomes between patients who did and did not receive antithrombotic agents. This single-center retrospective cohort study included 548 patients who underwent gastrectomy for primary gastric adenocarcinoma from January 2011 to December 2019. The surgical outcomes were compared between two groups according to whether they received antithrombotic therapy (n=121) or not (n=427). Among the entire cohort, the patients in the antithrombotic therapy group were significantly older than those who did not receive this therapy and had significantly higher postoperative complication rates than those who did not (33.1% vs. 23.9%; p=0.046). However, after propensity score matching, no significant difference in the postoperative complication rate was observed between the two groups. Despite having a high risk for postoperative complications, patients receiving antithrombotic therapy can safely undergo gastric resection.

Quality performance indicators for the surgical treatment of gastric adenocarcinoma: a systematic review.

BackgroundA systematic review was undertaken to identify existing quality performance indicators (QPI) for the surgical treatment of gastric adenocarcinoma (GA) with the aim of defining a set of QPIs that can be used to assist in the accreditation of institutions for training, allow cross jurisdiction comparison of treatment and outcomes, as well as provide a basis to develop quality improvement programs. These QPI's capture key components of patient care that are fundamental to overall outcome.MethodsA systematic literature review was conducted searching MEDLINE, PubMed, EMBASE, and SCOPUS with all literature available until the date of 1 August 2021 included. Search terms utilized were ‘Quality of health care OR Quality improvement or Quality control OR Quality indicators’, AND ‘Gastrectomy’ OR ‘Stomach neoplasm’ OR ‘Adenocarcinoma’ OR ‘Gastric resection’ OR ‘Gastric cancer’.ResultsTwelve articles were included in the final analysis. The selected studies included editorials (n = 2), retrospective review of institutional experience (n = 5), cohort studies (n = 2), survey methodology (n = 1), expert guidelines (n = 1) and consensus statement (n = 1). For GC QPIs, process measures included patient discussion at multi‐disciplinary meetings, access to perioperative multimodal diagnostic pathways, and specific surgical metrics (margin negative resections and adequate lymphadenectomy). Outcome measures included the RO resection rate, reoperation, readmission rate, and length of hospital stay.ConclusionsThere is a relative paucity of internationally agreed QPI for the surgical management of gastric adenocarcinoma. The data from this review will form the basis of a project to develop internationally agreed and feasible QPI for gastric cancer resections.

Effect of epidural analgesia on cancer outcomes after gastric cancer resection: a single-centre cohort study in Taiwan

ObjectiveTo investigate the influence of epidural anaesthesia and analgesia (EA) on cancer recurrence and overall survival after surgery for gastric cancer.Study design and settingA retrospective study which involved patients with...

Anatomy and assessment of a modified technique during totally robotic distal gastrectomy: A retrospective cohort study

BackgroundRobotic surgery has potential benefits in the management of gastric cancer patients. This study compares the outcomes between totally robotic distal gastrectomy (TRDG) with modified port placement and arm positioning technique and conventional totally laparoscopic distal gastrectomy (CTLDG). Materials and methodsFifty-two patients were enrolled into the study following a retrospective review of an in-patient database between January 2019 and June 2021. Patients who underwent gastric resection with the modified robotic technique were recruited into the study. Patients who did not receive treatment using the modified technique were excluded from the study. Data on demographic, clinical data and surgical outcomes were collected, analyzed, and presented. All statistical analyses were done using IBM SPSS statistical software. ResultsNineteen patients were in the TRDG group, and their mean age was 60.42 ± 11.53 years. There were no differences in demographic characteristics (all p > 0.05); nonetheless, laparoscopic patients had a significantly higher preoperative albumin level (p = 0.000). The operative time was longer in the TRDG group (223min), but the difference was insignificant. The reconstruction time was significantly shorter for the laparoscopic group (p = 0.000). Except for a significantly higher value of postoperative albumin level (p-value = 0.005) in the robotic group, there were no significant differences in all other surgical outcomes between the two groups. One (5.3%) patient had a severe complication in the robotic group compared to four (12.1%) in the laparoscopic group. Nevertheless, the differences in complications were statistically insignificant. ConclusionThe modified approach is a safe and feasible in totally robotic distal gastrectomy for the treatment of gastric cancer patients.

Hemodynamic, Surgical and Oncological Outcomes of 40 Distal Pancreatectomies with Celiac and Left Gastric Arteries Resection (DP CAR) without Arterial Reconstructions and Preoperative Embolization.

Simple SummaryDistal pancreatectomy with the celiac artery resection (DPCAR) is an oncologically justified procedure for locally advanced pancreatic ductal adenocarcinoma (PDAC). The results of its use in our selective group of 40 consecutive patients demonstrated a high rate of R0-resections, acceptable morbidity, and survival better than that for resectable PDAC. The unsolved problems of this procedure are the liver and stomach ischemic complications, which can be lethal or lead to prolonged hospital stay and deterioration in survival. The existing clinical data do not explain the mechanisms of these specific complications in sufficient detail and can’t be used for their prognosis and prevention. We have studied the correlation of clinical data and hemodynamic changes of the collateral arteries in a series of technically homogeneous procedures. The geometrical changes of the pancreatoduodenal arcade elements after DPCAR could explain the causes of ischemic complications after surgery and determine the directions for their prevention.DPCAR’s short- and long-term outcomes are highly diverse, while the causes and prevention of ischemic complications are unclear. To assess oncological, surgical, and hemodynamic outcomes of 40 consecutive DPCARs for pancreatic (n37) and gastric tumors (n3) (2009–2021), retrospective analyses of mortality, morbidity, survival, and hemodynamic consequences after DPCAR were undertaken using case history data, IOUS, and pre- and postoperative CT measurements. In postoperative complications (42.5%), the pancreatic fistula was the most frequent event (27%), 90-day mortality was 7.5. With 27 months median follow-up, median overall (OS) and progression-free survival (PFS) for PDAC were 29 and 18 months, respectively; with 1-, 3-, and 5-years, the OS were 90, 60, and 28%, with an R0-resection rate of 92.5%. Liver and gastric ischemia developed in 0 and 5 (12.5%) cases. Comparison of clinical and vascular geometry data revealed fast adaptation of collateral circulation, insignificant changes in proper hepatic artery diameter, and high risk of ischemic gastropathy if the preoperative diameter of pancreaticoduodenal artery was <2 mm. DP CAR can be performed with acceptable morbidity and survival. OS and RFS in this super-selective cohort were compared to those for resectable cancer. The changes in the postoperative arterial geometry could explain the causes of ischemic complications and determine directions for their prevention.

Comparison of the Efficacy of D2 Gastrectomy Plus Liver Radiofrequency Combined With Chemotherapy Versus Chemotherapy Alone in the Treatment of Advanced Gastric Cancer With Unresectable Synchronous Liver Metastases: A Multicenter Randomized Controlled Trial Protocol.

BackgroundWhether patients with advanced gastric cancer with unresectable synchronous liver metastases require surgical treatment remains a controversial topic among surgeons. Recently, an open-label multicenter, international RCT study show that compared with chemotherapy alone, gastric resection combined with chemotherapy had no survival advantage for advanced gastric cancer with unresectable synchronous liver metastases. A limitation of this study was that gastrectomy for gastric cancers was restricted to D1 lymphadenectomy and no metastatic lesions were removed. Whether D2 gastrectomy plus liver radiofrequency plus postoperative chemotherapy could provide benefits to these patients is worthy of further confirmation by high-level evidence-based medicine.Methods/DesignThis study will investigate the efficacy of D2 gastrectomy plus liver radiofrequency plus postoperative chemotherapy compared to chemotherapy alone in a prospective, multicenter, randomized controlled trial that will enroll 200 patients who have advanced gastric cancer with unresectable synchronous liver metastases. The patients will be randomly divided into two groups: the test group (D2 gastrectomy plus liver radiofrequency plus postoperative chemotherapy, n=100) and the control group (chemotherapy alone, n=100). The patients’ general information, past medical history, laboratory tests, imaging results, surgery details, and chemotherapy details will be recorded and analysed. The overall survival (OS) will be recorded as primary endpoints. Progression-free survival (PFS) and the total incidence of complications will be recorded as secondary endpoints.DiscussionThis study is to establish a multicentre randomized controlled trial to compare the efficacy of D2 gastrectomy plus liver radiofrequency combined with postoperative chemotherapy versus chemotherapy alone.Trial RegistrationChinese Clinical Trial Registry, Approved No. of ethics committee:ChiECRCT20200331. Registered on 15 November 2020. Registration number:ChiCTR2000039964. The study has received full ethical and institutional approval.Advantages and Limitations of this StudyThis is the first clinical trial that will provide evidence on the efficacy of D2 gastrectomy plus liver radiofrequency combined with chemotherapy versus chemotherapy alone for the treatment of advanced gastric cancer with unresectable synchronous liver metastases. A prospective RCT with 200 patients who have advanced gastric cancer with unresectable synchronous liver metastases.Clinical Trial Registration[https://www.chictr.org.cn/], identifier ChiCTR2000039964.

A254 PREVALENCE OF HELICOBACTER PYLORI INFECTION IN BARIATRIC SURGERY PATIENTS

Abstract Background Helicobacter Pylori (HP) infection is the most common chronic infection in humans. Known risk factors include poor socioeconomic status and living conditions, especially at a young age. In Canada, the prevalence is estimated between 23% and 38%. The relationship between BMI and HP infection is controversial. Some data suggests that HP infection occurs less frequently in individuals who are overweight. Other authors endorse that obesity is a risk factor for HP infection, possibly explained by altered innate and adaptive immunity in these patients. Aims The objectives were to determine the prevalence of HP infection in patients undergoing bariatric surgery and assess the correlation between HP infection and various patient characteristics. Methods All patients who underwent bariatric surgery with a gastric resection in a single hospital between 01/2004 and 01/2019 were analyzed. When gastritis was present, HP immunohistochemical testing was performed. Characteristics of HP-positive (HP+) and HP-negative (HP-) patients were compared using Student’s t-test and χ 2 test. Results A total of 6388 specimens were reviewed (4365 women &amp; 2023 men) with a mean age of 44.9±11.2 years and a mean BMI of 49.3±8.2 kg/m2. Histology-proven HP infection rate was 6.3% (n=405). There was no significant difference in sex, BMI and body weight between HP+ and HP- patients. HP+ patients were significantly older than HP– patients (47.4±9.8 vs 44.7±11.3 years, respectively, p&amp;lt;0.0001). Logistic regressions identified age as a risk factor for HP infection in this population (OR 1.26, p&amp;lt;0.0001, CI95% 1.14–1.40 for every 10-year increase). Conclusions The rate of histology-proven HP infection is low in patients with severe obesity who present for bariatric surgery and is directly associated with age. The benefits of routine preoperative testing in non-gastric-bypass surgery candidates should be questioned. Characteristics of study participants Funding Agencies This study was performed with support from the Research Chair in Bariatric and Metabolic Surgery at Laval University (L. Biertho and A. Tchernof). MC is the recipient of a studentship from Diabète Québec.

Explore the Link between the Improvement of Metabolic Indicators in Diabetic Rats with Sleeve Gastrectomy and Changes in the Composition of Intestinal Flora.

Diabetes mellitus (DM) has become a major medical and health problem in my country and even the world. Doctors and patients have gradually realized that a new type of metabolic surgery is a way to treat diabetes. The operation is relatively simple, and the effect of the operation is no less than that of the gastric shunt. The initial hypothesis could not fully explain the blood pressure and blood sugar reduction mechanism in waist and abdominal surgery. According to requirements, they were divided into the sleeve gastrectomy group (SG group, n = 10) and sham operation group (SS group, n = 10), and corresponding measures were taken. Observe their weight changes; perform an oral glucose tolerance test (GB) before surgery and at 2, 8, and 16 weeks after surgery to evaluate the effect of surgery on improving the glucose metabolism. The postoperative GLP-1 specificity curve was detected in the two groups of patients; the immunohistochemical method was used to detect the postoperative changes of the digestive tract l cells in the two groups; RT-PCR was used to detect the mRNA transcription level of the digestive tract GLP-1 receptor. The bodyweight was significantly different 4 weeks after the operation. Food intake and bodyweight were not significantly different between the SG and SS groups. FBG: one week after operation, the SG group was significantly smaller than the SS group. The SS group was significantly lower than the SG group at 12 weeks after operation, and the SS group was significantly lower than the SG group at 14 weeks after operation. The transcription levels of c-kit mRNA and SCF mRNA in jejunum and ileum tissues are significantly different: the transcription levels of c-kit mRNA and SCF mRNA in the SG group are higher than those in the SS group, jejunum and ileum in the SG group. The number of cell 1 was significantly greater than that of the SS group. Sleeve gastrectomy can improve the regulation of the glucose metabolism in diabetic rats. The increase in small bowel motility may be related to the increase in ICC cells, intestinal cells, and GLP after gastric sleeve resection. The increase is in -1R and faster insoluble CHM in bowel motility. It has better contact with cell 1 and GLP-1R and stimulates cell 1 to secrete GLP-1.

Adjuvant Chemotherapy Might Be Recommended to Patients With Positive Margin After Gastrectomy: A 20-Year Retrospective Analysis in a Single Center.

BackgroundMargin positivity after gastric cancer resection is associated with poorer outcomes. However, the prognostic factors and the choice of postoperative adjuvant treatment of patients with positive margin (PM) after gastrectomy are still being debated.MethodsA single-center, retrospective analysis was conducted for patients with PM after gastrectomy from the China National Cancer Center Gastric Cancer Database (NCCGCDB) from 1998 to 2018. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors of overall survival (OS) and recurrence-free survival (RFS).ResultsA total of 449 patients were included in the study, including 192 (42.8%) in the proximal PM group (PPM), 205 (45.7%) in the distal PM group (DPM), and 52 (11.6%) in the bilateral PM group (BPM). The 3- and 5-year OS rates for the PM patients investigated were 47.5% and 39.3%, respectively, and the 3- and 5-year RFS rates were 60.0% and 53.6%, respectively. Multivariate Cox regression analysis proved total gastrectomy (hazard ratio (HR): 1.783, 95%CI: 1.133–2.805, p = 0.012), pT4 (HR: 5.264, 95%CI: 1.493–18.565, p = 0.01), pN2 (HR: 2.263, 95%CI: 1.164–4.397, p = 0.016), pN3 (HR: 2.327, 95%CI: 1.233–4.393, p = 0.009), and combined resection (HR: 1.952, 95%CI: 1.256–3.034, p = 0.003) to be independent risk factors of OS, and pT3 (HR: 9.257, 95%CI: 1.152–74.386, p = 0.036) and pT4 (HR: 11.361, 95%CI: 1.469–87.847, p = 0.020) to be independent risk factors for RFS. Adjuvant chemotherapy prolonged OS in the PPM group (p = 0.032) and prolonged RFS in the PPM group (p < 0.001) and the DPM group (p = 0.035) compared with surgery alone.ConclusionsAdvanced pathologic stage was associated with poor prognosis, and postoperative adjuvant chemotherapy might be recommended in PM patients after gastrectomy. Still, further prospective trials are warranted to verify and support our conclusions.

Correlation of surgical volume and outcomes with gastrectomy.

272 Background: Gastric cancer(GC) is associated with significant mortality worldwide. Radical gastrectomy with lymphadenectomy is considered the only curative option for GC. Traditionally, these operations are associated with significant morbidity. However, a significant proportion of gastric resections are performed at low volume centers. We sought to compare oncologic outcomes of gastrectomy by surgical volume. Methods: Utilizing the National Cancer Database we identified patients with gastric cancer who underwent gastrectomy. We then stratified based upon volume of institution. Low volume(LV) &lt; 10 gastric resections per year, and high volume(HV) &gt; 10 gastric resections per year. Mann-Whitney U and Kruskal were used to compare continuous variables and Pearson’s Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method. Multivariate analysis (MVA) was performed to identify predictors of survival. All statistical tests were two-sided and p &lt; 0.05 was considered significant. Results: We identified 29,216 patients who underwent gastrectomy with a median age of 66.5 (18-90) years. There were 21,166 (72%) gastric resections performed at LV centers and 8,050 at HV centers, p &lt; 0.001. Neoadjuvant therapy was most often utilized in the HV centers at 41.7% vs 24.1% in the LV centers, p &lt; 0.001. The median number of lymph nodes removed were 19 (13-28) in the HV and 14 (8-21) in the LV groups respectively, p &lt; 0.001. The R0 resection rates were 91.1% in high volume centers and 84.6% in the low volume centers p &lt; 0.001. The length of hospitalization did not differ between groups (median 8 (6-12) days), p = 0.33. The 30-day readmission rates however, were higher in the low volume centers at 6.5% compared to 5.8% in the high volume centers. The 30 and 90-day mortality was 1.7% and 4.1% in the HV and 4.9% and 9.2% in the LV groups, p &lt; 0.001 and p &lt; 0.001 respectively. The median and overall 5-year survival was 83.8mo and 56% in the HV and 49.4mo and 46% in the LV cohorts, p = 0.001. Multivariate analysis revealed that age, sex, Charlson/Deyo score, tumor location, histology, grade, stage, facility volume, and neoadjuvant therapy were all predictors of survival. Conclusions: While the majority of gastric resections are performed at LV centers, oncologic outcomes, survival and mortality rates are worse compared to patients who undergo gastric resection at high volume centers. Gastric resections should be regionalized to high volume centers to ensure the best surgical and oncologic outcomes.

Intraoperative Tumor Identification During Laparoscopic Distal Gastrectomy: a Novel Fluorescent Clip Marking Versus Metal Clip Marking and Intraoperative Gastroscope

BackgroundIn complete laparoscopic distal gastrectomy, the gastric resection line is difficult to determine due to a lack of tactile sensation. The use of intraoperative gastroscopy and intraoperative radiography has been reported, but the burden on personnel and technical complexity present impediments. In our department, based on lesion extent determined with preoperative gastroscopy, a fluorescent clip is used to mark the oral side of the lesion, which is resected after confirmation with a fluorescent laparoscopic system. In this study, we investigated the efficacy of fluorescent clip marking (FCM) in achieving an accurate resection line and reducing the operative time. MethodsFifty-six patients with gastric cancer who underwent complete laparoscopic distal gastrectomy from January 2018 to March 2021 were divided into two groups: the FCM group (n = 32) and the conventional metal clip marking and intraoperative gastroscopy (MCMG) group (n = 24). Short-term outcomes, including the resection margins, gastric resection time, and operative time, were compared and examined. ResultsThe fluorescent clips were visible in all cases, and all stumps were negative according to permanent preparations. The operative times for FCM and MCMG were 350 (216–533) vs. 373.5 (258–651) min, respectively, with no significant difference (p = 0.316), while the gastric resection times were 636.5 (321–2572) vs. 1457.5 (843–4973) s, respectively, and were significantly shorter in the FCM group (p < 0.0001). ConclusionsFCM shortened the gastric resection time and could possibly shorten the operative time. FCM is feasible and safe and can potentially be used as a tumor-marking agent to determine accurate surgical resection lines. Clinical Trial RegistrationExamination of Gastric Cancer, Research Ethics Committee of the Kawaguchi Municipal Medical Centre (Saitama, Japan), approval number: 2019-33. https://kawaguchi-mmc.org/wp-content/uploads/clinicalresearch-r02.pdf

The Analysis of Surgical Outcomes in Operable Gastric Cancer Patients Presenting With or Without Sarcopenia.

We aimed to identify the patients with increased risk of post-operative complications using pre-operative sarcopenia as an indicator of adverse outcome in gastric cancer patients undergoing resection. This study was a prospective observational cohort study including patients with adenocarcinoma of stomach, undergoing gastric resection with curative intent. All the patient underwent pre-operative evaluation of sarcopenia including skeletal muscle index (SMI) measurements and hand grip strength (HGS) analysis. The post-operative parameters assessed were the time to initiate enteral feeding, the time to pass first flatus, post-operative complications, post-operative hospital stay, and histopathological staging of the resected specimen. All these parameters were compared between the sarcopenia and non-sarcopenia arms to obtain the final results. The total number of patients enrolled was 72 (46 male, 26 female). The mean SMI of the study cohort was 47.1 cm2/m2 and the mean HGS was 29.35kg. Thirty-six patients (24 male, 12 female) were sarcopenic pre-operatively. Sixty-two patients underwent subtotal gastrectomy with D2 lymphadenectomy, and 10 patients underwent total gastrectomy with D2 lymphadenectomy. The median time to pass flatus was 4days, the median time to initiation of enteral feeding was 4days, and the median post-operative hospital stay was 12days. Majority of the study patients had a pT3N1-2 disease. Sarcopenia was significantly associated with worsening ECOG performance status (p = 0.001), delay in passage of first flatus post-operatively (p = 0.017), higher post-operative complications (p = 0.012), higher T stage (p = 0.040), and higher N stage (p = 0.001). But there was no significant association between sarcopenia and time to initiation of enteral feeding and post-operative hospital stay. Sarcopenia is an independent prognostic factor for adverse short-term post-operative outcomes in patients undergoing curative intent resection of gastric cancer.

Multisite study of Titan SGS stapler in longitudinal gastric resection

BackgroundStandardization of the laparoscopic sleeve gastrectomy procedure is needed to improve patient outcomes. A single-fire 23 cm stapler was developed to streamline the operation. Comparative testing conducted on excised human tissue has demonstrated the superiority of the novel Titan SGS stapler to two commonly utilized commercial devices in both staple line integrity and burst pressure. We hypothesized that the stapler would be safe and effective in creating longitudinal gastric resections in human patients.Methods61 patients were enrolled to undergo gastric resection with the Titan SGS stapler. Perioperative interventions and post-operative adverse events were recorded. Upper GI study was completed on post-operative day 1, and patients were followed for 6 weeks post-operatively to determine any subacute device-related adverse events.ResultsSurgeon feedback for intraoperative device utilization and post-operative gastric pouch shape were positive. Adverse events were found to be mild, limited, and generally well-known effects of bariatric surgery. One episode of post-operative hemorrhage required surgical takeback, with no criminal bleeding vessel identified.ConclusionThe Titan SGS stapler is both safe and effective in sleeve gastrectomy pouch creation.

Laparoscopic gastric sleeve resection for metabolic syndrome (MS) with obstructive sleep apnea-hypopnea syndrome (OSAHS): Report of two cases

To evaluate the therapeutic efficacy of Laparoscopic Gastric Sleeve Resection (LGSR) for patients with metabolic syndrome and Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Two patients with metabolic syndrome and OSAHS received LGSR in our hospital in 2015 and were postoperatively followed up for 3 months to observe relief of the symptoms of Acanthosis Nigricans (AN) and snoring, and changes in metabolism-associated parameters, endocrine hormones and inflammatory factors. The results of 3-month postoperative follow-up observations showed that body weight was reduced and the associated symptoms of AN and snoring were relieved significantly in both patients. Body Mass Index (BMI) and neck and abdominal circumferences were also decreased significantly. Metabolism-related biochemical parameters, inflammatory factors and endocrine hormones including Apnea-Hypopnea Index (AHI), Red Blood Cell Distribution Width (RDW), Fast Blood Glucose (FBG), blood insulin, CReactive Protein (CRP), mean blood pressure and sex hormones all underwent favorable changes in both patients. The clinical outcome of the two patients in our series demonstrates that LGSR is a viable option for the treatment of patients with metabolic syndrome and OSAHS in that it can relieve the snoring symptoms of sleep apnea, improve lipid and glucose metabolisms and endocrine hormone levels in obese patients, and attenuate their chronic inflammation. Keywords: laparoscopic gastric sleeve resection; obstructive sleep apnea-hypopnea syndrome (OSAHS); inflammation; sex hormone.

Diagnosis and treatment of sliding hiatal hernia and false gastric diverticulum in a British shorthair cat

AbstractA 7‐year 9‐month‐old, neutered, male British shorthair cat was referred for chronic regurgitation and vomiting. Previous symptomatic medical management did not improve these clinical signs. Survey radiographs and abdominal ultrasound revealed no significant abnormalities of the gastrointestinal tract. Exploratory laparotomy was performed to obtain gastrointestinal biopsies. Sliding hiatal hernia and an abnormal gastric outpouching at the fundus, measuring 15 × 15 × 15 mm, were identified. Surgical treatment of the hiatal hernia included phrenoplasty, oesophagopexy and left‐sided gastropexy. Additionally, the gastric outpouching was resected. Histopathologic examination of the excised fundic tissue revealed findings consistent with those indicative of a false gastric diverticulum. Postoperative examinations on Days 5 and 10 and telephone follow‐up on Days 30 and 120 revealed a marked reduction in clinical signs. The combination of surgical techniques—phrenoplasty, left‐sided gastropexy, oesophagopexy and gastric diverticulum resection—was found to effectively improve the cat's clinical signs.

Spontaneous hemoperitoneum as a rare presentation of gastric lesions: Two case reports

IntroductionSpontaneous hemoperitoneum is a rare but life-threatening condition. Clinical presentation is usually nonspecific. The aim of this report is to document a rare clinical presentation of two different intramural stomach tumors.Clinical casesA 40-year-old patient with 24 h epigastric pain was admitted to the emergency, pale, with signs of peritoneal irritation. Computed tomography showed an hemoperitoneum with active bleeding in the posterior wall of the stomach. A wedge resection was performed. Histological report revealed a plexiform fibromyxoma (PF). The second case presents a 79-year-old patient with 24 h abdominal pain, fullness and dizziness, pale and with signs of peritoneal irritation. A voluminous exophytic lesion on gastric wall with active bleeding was diagnosed. Wedge resection was performed and histological report demonstrated a gastrointestinal stromal tumor (GIST).DiscussionImaging plays a role in the diagnosis of spontaneous hemoperitoneum, in elucidating a cause and detecting active hemorrhage. Tumor hemorrhage may be the first presentation of an underlying mass. The presence of a bleeding gastric mass of uncertain nature may result in a challenging situation for the surgeon, who is forced to perform a gastric resection without knowing the exact nature of the tumor and hence the extent of gastric resection required. To our knowledge, our case is the first of PF presenting as hemoperitoneum. Hemoperitoneum is rare as first presentation of GIST, with few cases reported in literature.ConclusionWe report two extremely rare cases of spontaneous hemoperitoneum as first presentation of gastric tumor. For the diagnosis a high level of suspicion is required.