Surgery For Gastric Cancer Research Articles

Amputation neuroma with a difficult differential diagnosis from perihilar cholangiocarcinoma:a case report

Biliary amputation neuroma is a rare benign tumor that develops due to the peribiliary dissection of nerve fibers during cholecystectomy, a common bile duct surgery, or lymph node dissection performed in gastric cancer surgery. We report a case of amputation neuroma that presented a challenging differential diagnosis from perihilar cholangiocarcinoma. A 64-year-old man, who had undergone open cholecystectomy 30 years ago, was incidentally found to have a bile duct tumor during computed tomography (CT) following surgery for renal cell carcinoma. He had no specific symptoms, and blood test results showed only a slight elevation in alkaline phosphatase levels. Contrast-enhanced CT revealed a 10-mm solid tumor with contrast effect in the common bile duct. On cholangiography, the tumor appeared as a protruding lesion with a smooth surface unilaterally. Given the atypical findings suggestive of cholangiocarcinoma, three bile duct biopsies were performed. Pathological examination did not rule out adenocarcinoma. The patient opted for surgery;however, an intraoperative rapid histological examination confirmed a benign disease, thereby avoiding extensive surgery. Consequently, a minimally invasive bile duct resection was performed. Postoperative histopathological examination revealed the tumor to be an amputation neuroma. Biliary amputation neuromas are characterized as unilateral protruding lesions with contrast effect or benign strictures. If such findings are observed in a patient with a history of surgery around the bile duct, the possibility of an amputation neuroma should be considered. However, completely ruling out malignancy preoperatively, even when suspecting amputation neuroma, can be challenging;therefore, considering surgery to achieve a definitive diagnosis is reasonable. During surgery, a rapid intraoperative histological examination is useful to avoid extensive procedures. In conclusion, diagnosing an amputation neuroma before surgery can be difficult, as it can mimic malignant tumors such as bile duct cancers. In this case, although a preoperative diagnosis of amputation neuroma was not feasible, performing a rapid intraoperative pathological examination helped avoid extensive surgery.

Medical disputes and compensation costs associated with gastric cancer surgery at a large-volume center in Korea

Medical disputes and compensation costs associated with gastric cancer surgery at a large-volume center in Korea

A Case of Multiple Bone Metastases following Gastric Cancer Surgery who Survived for 3 Years an 10 Months after Diagnosis

A Case of Multiple Bone Metastases following Gastric Cancer Surgery who Survived for 3 Years an 10 Months after Diagnosis

Clinical value of prognostic nutritional index combined with C-reactive protein and albumin in early prediction of anastomotic leakage after radical gastric cancer surgery.

To evaluate the predictive value of the Prognostic Nutritional Index (PNI) combined with C-reactive protein (CRP) and albumin (ALB) for anastomotic leakage following radical gastric cancer surgery. A retrospective case-control study was conducted with 275 gastric cancer patients at the Second People's Hospital of Lanzhou City from September 2019 to October 2022. Patients were categorized into an anastomotic leakage group (n=31) or a non-leakage group. Clinical, surgical, and pathological data were analyzed using logistic regression to develop two risk models: a combined clinical-laboratory index (RISK1) and a separate laboratory index (RISK2). Model effectiveness was compared using Receiver Operating Characteristic (ROC) curves. Anastomotic leakage occurred in 11.27% of patients, predominantly in those with advanced TNM stages (P=0.006). Notably, higher operative times (P=0.049) and increased intraoperative bleeding (P=0.027) were associated with the leakage group. Significant differences in ALB, PNI, and CRP levels were observed between the groups. Both RISK1 and RISK2 identified ALB, CRP, PNI, operative time, and intraoperative bleeding as independent predictors of leakage, demonstrating high predictive accuracy (RISK1 AUC=0.937, RISK2 AUC=0.911), with no significant difference in performance between the models (P=0.245). The combination of ALB, CRP, and PNI effectively predicts the risk of anastomotic leakage in patients undergoing gastric cancer surgery. These biomarkers can significantly enhance postoperative management and improve patient outcomes.

Investigating the mechanism and the effect of aquaporin 5 (AQP5) on the self-renewal capacity of gastric cancer stem cells.

Aquaporin 5 (AQP5) has been shown to have a pro-carcinogenic effect in numerous types of malignancies. This research intends to investigate the role and the molecular mechanism of AQP5 on enriched gastric cancer stem cells (GCSCs). Methods: Immunohistochemistry, western blot (WB), and RT-qPCR techniques were employed to identify the presence of AQP5 in gastric cancer (GC) and the neighboring paracancerous tissues. Additionally, a statistical analysis was conducted to determine the correlation between AQP5 expression and the pathological and histological parameters. Furthermore, the study aimed to assess the predictive value of AQP5 expression in long-term survival after GC surgery. GCSCs were enriched using the serum-free culture method. The expression of AQP5 in enriched GCSCs was explored using RT-qPCR and WB. Plate cloning, transwell, WB, RT-qPCR, and the sphere-forming assay were utilized to monitor the proliferation, migration, and self-renewal capability of GCSCs after AQP5 knockdown. WB and Immunofluorescence for Detecting the Effect of AQP5 on Autophagy. WB, RT-qPCR, and other experiments were used for in-depth investigation of the potential molecular regulatory mechanism of AQP5 in GC. Results: AQP5 was highly expressed in GC tissues and GC cells, and overexpression of AQP5 was associated with lymph node metastasis, increased tumor size, and low 5-year postoperative survival in GC patients; other studies have shown that the AQP5 was highly expressed in GCSCs. Knockdown of AQP5 suppressed tumorigenesis in vivo and inhibited the proliferative, migratory, and self-renewal capability of GCSCs. It was also found that AQP5 could activate the autophagy phenomenon of GCSCs, and mechanistically, we found that AQP5 could regulate TRPV4 to affect the self-renewal ability of GCSCs. Conclusion: AQP5 can be further explored for GC therapy, as it has shown a significant impact on the self-renewal capability of GCSCs, which prevents GC progression.

The association between objectively measured preoperative light-intensity physical activity and postoperative ambulation in patients with gastrointestinal cancer.

[Purpose] To clarify the association between preoperative physical activity and postoperative ambulation based on physical activity intensity, and independent of functional capacity and depression, in patients with gastrointestinal cancer. [Participants and Methods] Seventy patients who underwent surgery for primary colorectal or gastric cancer were enrolled. Preoperative moderate-to-vigorous-intensity physical activity, light-intensity physical activity, and sedentary behavior were assessed using an accelerometer. The primary outcome was the days to postoperative first ambulation (capable of independently and continuously walking 150 m). Functional capacity and depression, as confounders, were evaluated by measuring the 6-minute walk distance and using the Hospital Anxiety and Depression Scale. [Results] Of the 70 patients, 28 had insufficient accelerometer data, and 42 were included in the analysis. Preoperative light-intensity physical activity, but not moderate-to-vigorous-intensity physical activity and sedentary behavior, was negatively associated with the days to postoperative first ambulation, after adjusting for age, preoperative functional capacity, and preoperative depression. [Conclusion] Preoperative light-intensity physical activity was associated with the days to postoperative ambulation independently of age, functional capacity, and depression. Hence, predicting delayed ambulation by preoperative light-intensity physical activity in patients with gastrointestinal cancer may be useful.

Real-world Nationwide Outcomes of Minimally Invasive Surgery for Advanced Gastric Cancer Based on Korean Gastric Cancer Association-Led Survey.

The study aimed to investigate real-world surgical outcomes of minimally invasive surgery (MIS) for advanced gastric cancer using Korean Gastric Cancer Association (KGCA)-led nationwide data. A nationwide survey of patients who underwent surgical treatment for gastric cancer in 2019 was conducted by the KGCA. A total of 14,076 patients from 68 institutions underwent surgery, and 4,953 patients diagnosed with pathological stages IB-III gastric cancer were included. Among them, 1,689 patients who underwent MIS (MIS group) and 1,689 who underwent the open approach (open group) were matched using propensity score in a 1:1 ratio. Surgical outcomes were compared, and multivariate analysis was performed to identify the independent factors for overall morbidity. The MIS group had a lower proportion of D2 lymphadenectomy, total omentectomy, and combined resection. However, the number of harvested lymph nodes was higher in the MIS group. Better surgical outcomes, including less blood loss and shorter hospital stay, were observed in the MIS group, and the overall morbidity rate was significantly lower in the MIS group (17.5% vs. 21.9%, P=0.001). The mortality rates did not differ significantly between the 2 groups. In the multivariate analysis, the minimally invasive approach was a significant protective factor against overall morbidity (odds ratio, 0.799; P=0.006). Based on the Korean nationwide data, MIS for stage IB-III gastric cancer had better short-term outcomes than the open approach, including lower rates of wound complications, intra-abdominal abscesses, and cardiac problems.

Role of Recurrence Pattern Multiplicity in Predicting Post-recurrence Survival in Patients Who Underwent Curative Gastrectomy for Gastric Cancer.

This study aimed to investigate the recurrence patterns in patients who underwent curative surgery for gastric cancer (GC) and analyze their prognostic value for post-recurrence survival (PRS). We retrospectively reviewed the medical records of 204 patients who experienced GC recurrence following curative gastrectomy for GC at a single institution between January 2012 and December 2017. Specific recurrence patterns (lymph node, peritoneal, and hematogenous) and their multiplicity were analyzed as prognostic factors of PRS. The median PRS of the 204 patients was 8.3 months (interquartile range [IQR]: 3.2-17.4). For patients with a single recurrence pattern (n=164), the difference in each recurrence pattern did not show a significant prognostic value for PRS (lymph node vs. peritoneal, P=0.343; peritoneal vs. hematogenous, P=0.660; lymph node vs. hematogenous, P=0.822). However, the patients with a single recurrence pattern had significantly longer PRS than those with multiple recurrence patterns (median PRS: 10.2 months [IQR: 3.7-18.7] vs. 3.9 months [IQR: 1.8-10.4]; P=0.037). In the multivariate analysis, multiple recurrence patterns emerged as independent prognostic factors for poor PRS (hazard ratio, 1.553; 95% confidence interval, 1.092-2.208; P=0.014) along with serosal invasion, recurrence within 1 year after gastrectomy, and the absence of post-recurrence chemotherapy. Regardless of the specific recurrence pattern, multiple recurrence patterns emerged as independent prognostic factors for poor PRS compared with a single recurrence pattern.

Clinical Impact of Polyglycolic Acid Mesh to Reduce Pancreas-Related Complications After Minimally Invasive Surgery for Gastric Cancer: A Propensity Score Matching Analysis.

Prevention of pancreas-related complications after gastric cancer surgery is critical. Polyglycolic acid (PGA) mesh reduces postoperative pancreatic fistula formation following pancreatic resection. However, the clinical efficacy of PGA mesh in gastric cancer surgery has not been adequately investigated. This retrospective study compared the short-term outcomes between two groups: patients who underwent minimally invasive R0 gastrectomy for gastric cancer with the use of a PGA mesh (PGA group) and those without the use of a PGA mesh (non-PGA group) at the Cancer Institute Hospital, Tokyo, between January 2019 and May 2023. Propensity score matching (PSM) was performed to adjust for the possible confounding factors. A total of 834 patients were initially included, of whom 614 (307 in each group) remained after PSM. The amylase levels in the drained abdominal fluid on postoperative days 1 and 3 were similar between the PGA and non-PGA groups. The PGA group had a significantly lower incidence of pancreas-related complications of Clavien-Dindo grade ≥2 than that in the non-PGA group (6.8% vs. 2.9%, P=0.025). In subgroup analyses, the odds ratio for pancreas-related complications appeared to be better in the PGA group than in the non-PGA group in patients with American Society of Anesthesiologists Physical Status Classification score of 2 or 3, those operated via a laparoscopic approach, and those undergoing procedures other than proximal gastrectomy. The use of PGA mesh significantly reduced pancreas-related complications after minimally invasive surgery for gastric cancer and might thus benefit patients at risk of such complications.

Conversion surgery for gastric cancer with limited peritoneal carcinomatosis

Conversion surgery for gastric cancer with limited peritoneal carcinomatosis

Fluorescence navigation and angiography with indocyanine green in stomach cancer surgery

To evaluate the effectiveness of intraoperative angiography and fluorescence navigation with indocyanine green in reducing the risks of intra- and postoperative complications, as well as resection quality in patients with gastric cancer. The main group consisted of patients who underwent intraoperative angiography and fluorescence navigation with indocyanine green (n=43). The control group included patients without these procedures (n=154). Both groups did not differ in gender (p=0.937) and age (p=0.437). The lower third of the stomach was the most common tumor location in the main group (62.7% of cases), the middle and lower thirds of the stomach - in the control group (37% and 38.9% of patients, respectively). There was no between-group difference in «cT» grading (p>0.05). However, there were more «cN+» patients in the main group (14 (32.6%) versus 28 (18.4%) ones of «N0» category, p=0.042). Therefore, 41.9% and 13.6% of patients underwent neoadjuvant chemotherapy in both groups, respectively (<0.001). Intraoperative angiography and fluorescence navigation with indocyanine green does not increase mortality (p=0.631), incidence of major (CD 3-5) (p=0.436) and minor (CD 1-2) postoperative complications (p=0.177), surgery time (p=0.288), mean intraoperative blood loss (p=0.144) and length of hospital-stay (p=0.631). Fluorescence navigation with indocyanine green does not affect the number of detected «positive» resection margins (R1) (p=0.883) but significantly increases the number of excised lymph nodes (p<0.001). Intraoperative angiography and fluorescence navigation with indocyanine green are safe for intraoperative visualization of tumor and lymph nodes, as well as assessment of arterial blood supply. This technique is effective in traditional and minimally invasive surgeries for gastric cancer. Fluorescence navigation with indocyanine green significantly increases the number of excised lymph nodes.

Comparison of enteral immunonutrition and enteral nutrition in patients undergoing gastric cancer surgery: a systematic review and meta-analysis of randomized, controlled trials.

Enteral immunonutrition is a nutritional intervention that has been studied in postoperative patients with gastric cancer, but its effectiveness is controversial. This study aimed to investigate the effects of enteral immunonutrition and enteral nutrition on immune function in patients who undergo gastric cancer surgery. We performed a systematic review and meta-analysis. A comprehensive search was conducted in PubMed, Embase, Cochrane, Web of Knowledge, and ClinicalTrials.gov from the inception of the review until 10 March 2023. Twelve studies were included for qualitative and quantitative analyses. We studied 1124 patients, including 565 patients in the enteral immunonutrition group and 559 in the enteral nutrition (controls) group. All included randomized, controlled trials were high quality. CD4+ levels, lymphocytes, transferrin concentrations, and systemic inflammatory response syndrome were not significantly different between the enteral immunonutrition and enteral nutrition groups. However, CD8+, immunoglobulins G and M, and proalbumin concentrations, CD4+/CD8+, and infectious complications were significantly higher in the enteral immunonutrition group than in the enteral nutrition group. A sensitivity analysis showed consistent results after excluding each study. Begg's test showed no publication bias. Enteral immunonutrition is an effective nutritional intervention that improves immune function in patients who have undergone gastric cancer surgery.

위암 수술 후 간호에 대한 Debriefing for Meaningful 적용 시뮬레이션 교육의 효과

Purpose : Debriefing is essential for the simulation practice, but the educational varies depending on the debriefing guide. The purpose of this study is to present the effects of attempting debriefing for meaningful learning (DML) for the simulation practice on the critical thinking disposition, problem-solving processes, learning self-efficacy and debriefing experience scale. Methods : This study is based on the single group pre-post test experimental design study, with 58 fourth graders of nursing students were targeted. The application of DML for the simulation practice was conducted for 7 weeks on the subject of nursing care after gastric cancer surgery was completed from May 8 to June 16, 2023. The collected data were analyzed using SPSS 27.0 through the frequency, percentage, mean, standard deviation and paired t-test. Results : After DML, the results present that there were significant differences in the problem-solving processes(t＝-2.79, p＝.007) and learning self-efficacy(t ＝-3.90, p＜.001), while the critical thinking disposition(t＝-1.61, p＝.111) demonstrated no significant differences. Conclusion : In the simulation-based education, debriefing with DML can be used as an effective strategy, and the comparative and repetitive studies using other debriefing will be needed in the future.

Postoperative Complications After Neoadjuvant Chemotherapy Versus Upfront Surgery in Gastric Adenocarcinoma: A Population-Based Nationwide Study in Finland

BackgroundTo date, no large population-based studies have compared complications and short-term outcomes between neoadjuvant chemotherapy and upfront surgery in gastric cancer. More nationwide studies with standardized reporting on complications are needed to enable international comparison between studies. This study aimed to compare postoperative complications between neoadjuvant therapy and upfront surgery after gastrectomy for gastric adenocarcinoma in a population-based setting.MethodsThis population-based study based on the Finnish National Esophago-Gastric Cancer Cohort included all patients 18 years of age or older undergoing gastrectomy for gastric adenocarcinoma in Finland during 2005–2016. Logistic regression provided odds ratios (ORs) with 95% confidence intervals (CIs), both crude and adjusted for key confounders. Different types of complications were graded based on the Esophagectomy Complications Consensus Group definitions, and major complications were assessed by the Clavien-Dindo scale.ResultsThis study analyzed 769 patients. Neoadjuvant chemotherapy did not increase major postoperative complications after gastrectomy for gastric cancer compared with upfront surgery (OR, 1.12; 95% CI 0.81–1.56). Furthermore, it did not increase pneumonia, anastomotic complications, wound complications, or other complications.ConclusionsNeoadjuvant therapy is not associated with increased postoperative complications, reoperations, or short-term mortality compared with upfront surgery in gastric adenocarcinoma.

The Effect of Fiberoptic Bronchoscopy Combined with Alveolar Lavage in the Treatment of Severe Lung Infection After Gastric Cancer Surgery

Objective: To explore the effect of fiberoptic bronchoscopy combined with alveolar lavage in the treatment of severe lung infection after gastric cancer surgery. Methods: 60 patients with severe lung infection after gastric cancer surgery who were admitted into The First Hospital of Nanping from January 2020 to June 2023 were selected as study subjects. The patients were randomly divided into a control group and an experimental group, with 30 cases in each group. The control group was treated with conventional treatment methods, and the experimental group was treated with fiberoptic bronchoscopy combined with alveolar lavage. The clinical efficacy of the treatment and the blood gas index levels (PaO2, PaCO2, SpO2) and serum inflammatory factor levels (CRP, IL-6, IL-8) of the two groups were evaluated. Results: The treatment received in the experimental group was more effective than that of the control group (P &lt; 0.01). Besides, the PaO2 and SpO2 of the patients in the experimental group were higher than those of the control group after treatment; the PaCO2 of the experimental group was lower than that of the control group; and the differences were statistically significant (P &lt; 0.01). Both groups showed a significant decrease in CRP, IL-6, and IL-8 levels after the treatment (P &lt; 0.01). Conclusion: Fiberoptic bronchoscopy combined with alveolar lavage is effective in treating severe lung infection after gastric cancer surgery, so it should be popularized in clinical practice.

Oncological outcomes of conversion therapy in gastric cancer patients with peritoneal metastasis: a large-scale retrospective cohort study

BackgroundData on the long-term oncological outcomes of patients who undergo conversion surgery (CS) in gastric cancer (GC) patients with peritoneal metastasis (PM) are limited.MethodsGC patients with PM who received intraperitoneal (ip) and systemic chemotherapy between April 2015 and January 2021 were enrolled. Multivariate analysis was performed to identify risk factors associated with survival. Clinicopathological and survival outcomes were compared between those with CS and those without CS (NCS). The paclitaxel (PTX) plus tegafur–gimeracil–oteracil potassium capsules (S-1) (PS) + ip PTX and oxaliplatin plus S-1 (SOX) + ip PTX groups were matched in a 1:1 ratio using propensity score matching. Oncological and survival data were collected and analyzed.ResultsA total of 540 patients who received ip chemotherapy via subcutaneous port and systemic chemotherapy were analyzed and 268 patients were enrolled, including 113 who underwent CS and 155 who did not. Overall survival (OS) were 27.0 months and 11.8 months in the CS and NCS groups (P < 0.0001), respectively. R0 resection was an independent prognostic factor for patients who underwent CS. The OS of patients with or without ovariectomy was 21.3 or 12.0 months (P < 0.0001). No difference of clinicopathological and survival outcomes was found between the PS + ip PTX and SOX + ip PTX groups.ConclusionConversion therapy is safe and adverse events were manageable. CS improves the survival of GC patients with PM after ip and systemic chemotherapy. R0 is an important prognostic factor. Furthermore, outcomes are comparable between the PS + ip PTX and SOX + ip PTX groups.

Gastric residual volume, safety, and effectiveness of drinking 250 mL of glucose solution 2-3 hours before surgery in gastric cancer patients: a multicenter, single-blind, randomized-controlled trial.

Carbohydrate drinking 2-3 hours before surgery has been widely adopted in colorectal operations. However, there is little direct evidence regarding its application in gastric cancer surgery. We aimed to evaluate the gastric residual volume, safety, and effectiveness of drinking 250 mL of 5% glucose solution 2-3 hours before elective gastric cancer surgery. We conducted an investigator-initiated, multicenter, randomized-controlled, parallel group, and equivalence trial. Eighty-eight patients with gastric adenocarcinoma were randomized into study or control group. Patients in the control group followed the traditional routine of 6-8 hours preoperative fasting, while those in the study group drank 250 mL of 5% glucose solution 2-3 hours before surgery. Immediately following tracheal intubation, gastric contents were aspirated through gastroscopy. The primary outcome was preoperative gastric residual volume. Eighty-three patients were eventually analysed in the study (42 in the study group and 41 in the control group). Two groups were comparable at baseline characteristics. There were no statistical differences in residual gastric fluid volumes (35.86 ± 27.13 vs 27.70 ± 20.37 mL, P = 0.135) and pH values (2.81 ± 1.99 vs 2.66 ± 1.68, P = 0.708) between the two groups. Preoperative discomfort was significantly more decreased in the study group than in the control group (thirst score: 1.49 ± 1.23 vs 4.14 ± 2.07, P < 0.001; hunger score: 1.66 ± 1.18 vs 3.00 ± 2.32, P = 0.007). There was no statistical difference in the incidence of postoperative complications (19.05% vs 17.07%, P = 0.815). Drinking 250 mL of 5% glucose solution 2-3 hours before surgery in elective gastric cancer patients shows benefits in lowering thirst and hunger scores without increasing gastric residual volume and perioperative complications.

Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for gastric cancer with intraoperative detection of limited peritoneal metastasis: a Phase II study of CLASS-05 trial.

Systemic chemotherapy for gastric cancer with peritoneal metastasis has limited clinical benefit; for those with intraoperative detection of occult peritoneal metastasis, cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is an alternative treatment. However, the feasibility and effects of this modality and criteria for selecting suitable groups remain unclear. This study aimed to explore the safety and efficacy of laparoscopic cytoreductive surgery (L-CRS) followed by HIPEC in gastric cancer with limited peritoneal metastasis, and this study also aimed to determine the optimized cut-off of the peritoneal cancer index. Between March 2017 and November 2019, patients diagnosed with gastric cancer peritoneal metastases by using laparoscopy and the Sugarbaker peritoneal cancer index of ≤12 were eligible for inclusion. All patients received L-CRS (including gastrectomy with D2 lymph node dissection) and resection of visible peritoneal metastasis, followed by post-operative HIPEC, and systemic chemotherapy. The primary end points were median progression-free survival and median survival time, and the secondary outcomes were morbidity and mortality within 30 days after surgery. Thirty patients were eligible for analysis, of whom 19 (63.3%) were female, and the overall mean age was 53.0 years. The post-operative morbidity was 20% and the severe complication rate was 10%. The median survival time was 27.0 months with a 2-year overall survival rate of 52.3% and median progression-free survival was 14.0 months with a 2-year progression-free survival of 30.4%. L-CRS followed by HIPEC can be safely performed for gastric cancer with limited peritoneal metastasis and potential survival benefits.

A comprehensive radiopathological nomogram for the prediction of pathological staging in gastric cancer using CT-derived and WSI-based features

ObjectiveThis study aims to develop and validate an innovative radiopathomics model that combines radiomics and pathomics features to effectively differentiate between stages I-II and stage III gastric cancer (pathological staging). MethodsOur study included 200 patients with well-defined stages of gastric cancer divided into a training cohort (n = 140) and a test cohort (n = 60). Radiomics features were extracted from contrast-enhanced CT images using PyRadiomics, while pathomics features were obtained from whole slide images of pathological specimens through a fine-tuned deep learning model (ResNet-18). After rigorous feature dimensionality reduction and selection, we constructed radiomics models (SVM_rad, LR_rad, and MLP_rad) and pathomics models (SVM_path, LR_path, and MLP_path) utilizing support vector machine (SVM), logistic regression (LR), and multilayer perceptron (MLP) algorithms. The optimal radiomics and pathomics models were chosen based on comprehensive evaluation criteria such as ROC curves, Hosmer‒Lemeshow tests, and calibration curve tests. Feature patterns extracted from the best-performing radiomics model (MLP_rad) and pathomics model (SVM_rad) were integrated to create a powerful radiopathomics nomogram. ResultsFrom a pool of 1834 radiomics features extracted from CT images, 14 were selected to construct radiomics models. Among these, the MLP_rad model exhibited the most robust predictive performance (AUC, training cohort: 0.843; test cohort: 0.797). Likewise, 10 pathomics features were chosen from 512 extracted from whole slide images to build pathomics models, with the SVM_path model demonstrating the highest predictive efficiency (AUC, training cohort: 0.937; test cohort: 0.792). The combined radiopathomics nomogram model exhibited optimal discriminative ability (AUC, training cohort: 0.951; test cohort: 0.837), as confirmed by decision curve analysis (DCA), which indicated superior clinical effectiveness. ConclusionThis study presents a cutting-edge radiopathomics nomogram model designed to predict pathological staging in gastric cancer, distinguishing between stages I-II and stage III. Our research leverages preoperative CT images and histopathological slides to forecast gastric cancer staging accurately, potentially facilitating the estimation of staging before radical gastric cancer surgery in the future.

Appropriate concentration setting for the intraoperative administration of indocyanine green for fluorescence imaging to identify the sentinel lymph node in early gastric cancer: a clinical pilot study.

Some prospective trials have demonstrated the feasibility of sentinel node (SN) biopsy in gastric cancer (GC) surgery. This study aimed to identify the appropriate concentration settings for the intraoperative injection of indocyanine green (ICG) for SN biopsy. Before the clinical studies, porcine model experiments explored the optimal concentration of ICG injected intraoperatively. Next, nine GC patients were enrolled in the clinical research. ICG (0.5ml) was injected intraoperatively into four quadrants of the submucosa around the tumor at various concentrations (0.5, 0.25, and 0.1mg/ml). The lymphatic basin dissection method was applied to the ICG-positive lymphatic areas. The number and location of the lymphatic basins and positive nodes were recorded intraoperatively. In the porcine model, the visibility gradually became clear at an ICG concentration higher than 0.1mg/ml. In the clinical study, the average number of detected lymphatic basins was 3.3, 1.7, and 1.7, respectively. The mean number of detected SNs was 14.7, 6.7, and 4.0, respectively. To improve the reproducibility of SN biopsy, it is essential to prepare the correct concentration setting of ICG. Under current conditions in which ICG is injected intraoperatively, a 0.1mg/ml concentration setting of ICG may be necessary and sufficient for SN identification.