Gastric Surgery Research Articles

Current clinical trials on gastric cancer surgery in China

Current clinical trials on gastric cancer surgery in China

Guidelines and consensus: Jejunoileostomy for diabetes mellitus-surgical norms and expert consensus (2023 version)

Diabetes mellitus (DM) is a group of diseases characterized by high blood glucose caused by insufficient absolute or relative secretion of insulin. Once diagnosed, patients need long-term treatment with hypoglycemic drugs. Currently, the existing first-line hypoglycemic drugs do not provide effective treatment for DM and its complications. In the past, the first generation and the second generation of weight loss surgery, such as gastric bypass and sleeve gastric surgery, had strict body mass index requirements. Moreover, post-surgery, patients are prone to fluctuating hypoglycemia, gastroesophageal reflux, and dumping syndrome. Hence, the curative effect of this type of surgery was compromised to a certain extent. Jejunoileostomy is a third-generation surgery for patients with DM, which has been shown to improve glucose and lipid metabolism, without changing the original gas-trointestinal tract structure. Different from previous weight loss surgeries, jejunoileostomy has been clinically observed to delay the development of DM-related complications. Additionally, the postoperative complications are mild and do not affect the patient’s quality of life. Based on our clinical observations from multi-center large samples, our team developed a consensus on the operative period and perioperative management of jejunoi-leostomy as a reference for clinical researchers.

OGC O01 - Stomach Cancer Elective Surgery Morbidity and Mortality at 90-Days (HOLD Study): A Prospective, International Collaborative Cohort Study

Abstract Background Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors. Method We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome. Results 380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45). Pre-operative higher CCI or ASA score, pre-operative weight loss >10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value<0.05) were identified as predictors of postoperative severe complications and mortality. Conclusion Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes.

BS SO19 - Left Paraduodenal Hernia - Laparoscopic reduction and repair

Abstract Background We present a case of a 39 year old female patient, with a BMI of 37.5 and a background of hypertension scheduled for a bariatric gastric sleeve surgery. During the surgery, incidentally, a left paraduodenal hernia was identified. The incidence of a left paraduodenal hernia is 0.03% of all hernias, which makes it a rare case to present. Method The hernia with all it contents was reduced. The defect was visualised and repaired. Haemostasis achieved. Results The postoperative period was uneventful. The patient was followed up regularly in the bariatric clinic with no further complaints. Conclusion In conclusion, this case highlights the incidental discovery and successful management of a rare left paraduodenal hernia in a 39-year-old female patient undergoing bariatric gastric sleeve surgery. Despite the rarity of this type of hernia, with an incidence of 0.03% of all hernias, prompt intervention led to a favorable outcome. The postoperative course was uneventful, and the patient reported no further complaints during regular follow-ups in the bariatric clinic. This case underscores the importance of vigilance for unexpected findings during surgery and demonstrates the successful resolution of such rare occurrences through careful surgical management.

MS O07 - OGC ‘Textbook Outcome’ for Gastrectomy: Redefining a Valid Composite Measure Assessment Tool for Surgical Performance in a Specialist Unit within the United Kingdom

Abstract Background A ten-item composite measure defining ‘textbook outcome’ (TBO) following oesophagogastric cancer surgery was proposed to benchmark surgical quality. While subsequent studies have demonstrated an association between TBO and improved survival, the reported proportion of patients who meet all the required criteria remained consistently low. Postoperative complications of Clavien-Dindo grade ≥2 (CD≥2) commonly preclude TBO, despite evidence that minor complications are unlikely to influence long-term outcomes. This study aimed to assess whether modification of TBO parameters to Clavien-Dindo grade ≥3 (CD≥3) is associated with improved overall survival in patients undergoing gastric cancer surgery within an UK specialist unit. Method Consecutive patients who underwent a surgical resection for gastric cancer, at a single tertiary centre between January 2016 and December 2019, were identified from a prospectively maintained regional database. Patients were included irrespective of (neo)adjuvant treatments. Data collected included clinicopathological characteristics, treatment modalities and postoperative outcomes. Comparisons were drawn between patients who met all the parameters defining TBO and those who did not, using both CD≥2 and CD≥3 classifications for ‘major’ complications. The primary outcome of interest was overall survival. Results Sixty-seven patients (median 70 years, 61.2% male) underwent resection for gastric cancer during this study. Of these, 27 patients (40.3%) achieved TBO based on a CD≥2 complication grading and 38 patients (56.7%) when CD≥3 was used. Clinicopathological characteristics were all comparable between TBO groups based on both cut-offs. Improved overall survival was evident with a CD≥3 TBO (p=0.026), however not with CD≥2 TBO (p=0.430). Following adjustment for confounding variables, CD≥3 TBO remained associated with improved overall survival (HR: 0.30 (95% CI: 0.10-0.93), p=0.037) while CD≥2 TBO was not (HR: 0.64 (95% CI: 0.21-1.93), p=0.428). Conclusion Textbook outcome is a multi-parameter metric for benchmarking quality in gastric cancer surgery. Modification of the complications parameter required for TBO to CD≥3 in our patient population resulted in a stronger association with overall survival amongst patients undergoing surgical resection for gastric cancer.

Vagus Nerve Preservation for Early Distal Gastric Cancer With Monitoring and Indocyanine Green Labeling: A Randomized Clinical Trial.

Radical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects. To assess the feasibility and effects of vagus nerve preservation using neurophysiologic monitoring and ICG labeling during laparoscopic distal gastrectomy in patients with early distal gastric cancer. This open-label, prospective randomized clinical trial initially enrolled 285 patients with clinical stage cT1N0M0 distal gastric cancer from May 2022 to May 2023. This trial was conducted at Qilu Hospital of Shandong University in Jinan, China, and enrolled patients aged 18 to 80 years with histologically proven gastric adenocarcinoma scheduled for distal gastrectomy. The final follow-up examination was performed May 1, 2024. Eligible participants were randomly assigned 1:1 to vagus nerve preservation distal gastrectomy (VPG) or vagus nerve resection distal gastrectomy (VRG). The primary outcome was the incidence of postsurgical gastroparesis. Secondary outcomes included postoperative gallstone formation, quality of life, morbidity, mortality, overall survival, and disease-free survival up to 12 months postoperatively. All analyses were based on both intention-to-treat and per-protocol analyses. Of 264 patients included in the intention-to-treat analysis, the median (IQR) patient age was 58.0 (52.0-67.0) years, and 67 patients (25.4%) were female. Both the VPG and VRG groups included 132 patients. Postoperative gastroparesis occurred in 1 patient (0.8%) in the VPG group and in 10 patients (7.6%) in the VRG group. Gallstones developed in 0 patients in the VPG group and in 9 patients (6.8%) in the VRG group. As assessed by mean (SD) score on the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the VRG group experienced more nausea and vomiting at 6 months postsurgery (19.38 [7.62]) than the VPG group (17.15 [9.21]) (P = .03) and had significantly higher rates of persistent appetite loss, reflux symptoms, and eating difficulties at both 6 months and 12 months than the VPG group. Differences in postoperative complications and metastasis were not significant. Neurophysiologic monitoring and ICG labeling during distal laparoscopic gastrectomy for vagus nerve preservation in patients with early distal gastric cancer are safe and feasible. Preserving the perigastric vagus nerve may retain the function of the remnant stomach and improve quality of life. Chictr.org.cn Identifier: ChiCTR2200059489.

OGC SO44 - Robotic gastric resection is feasible and safe - the first 25 cases at a tertiary UK Oesophago-gastric unit

Abstract Background Robotic approaches to upper GI surgery are being increasingly used due to purported benefits including improved vision and dexterity over conventional laparoscopy, and reduction in surgical trauma and wound-related morbidity over open surgery. Introduction of new technology and its implementation into practice comes with an inevitable learning curve and it is paramount that this does not occur at the expense of patient outcomes. This study looked at the surgical and oncological outcomes from the implementation of a robotic gastric resectional service at a tertiary centre in the UK. Method A prospectively maintained database was used to identify all patients undergoing robotic subtotal and total gastrectomy irrespective of indication. Patients having sleeve gastrectomy or gastric wedge resection were not included. Demographic, operative, pathological and complications data were included. Complications were graded using the Clavien-Dindo classification. Textbook outcomes for gastric cancer surgery were defined as complete resection, pathological R0, >15 lymph nodes resected, no intraoperative complications, no reintervention, no ICU readmission, no prolonged hospital stay (defined as > 21 days), no mortality or readmission at 30 days, and no severe complications (Clavien Dindo ≥ II). Results Twenty-five patients were identified, 13 (52%) were women and the median age was 73 (range: 40 – 88). Twenty-two (92%) had a subtotal gastrectomy and adenocarcinoma was the diagnosis in 15 (62.5%). Median blood loss was 50ml (50 – 310 ml) and operative time 320 minutes (225 – 480 minutes). There were no conversions to open. Complications occurred in 6 (24%) with one leak, 2 theatre returns, one death and no readmissions. Median stay was 6 days (4-14 days). Of the 16 having cancer surgery, median nodal yield was 29.5 (16 – 66), R0 rate 100% and a textbook outcome achieved in 14 (87.5%). Conclusion Robotically-assisted gastric resection can be implemented with a low rate of complication. In those patients having surgery for cancer, pathological outcomes were good and 14/16 patients achieved a textbook outcome which is significantly higher than most published studies.

Prognostic impact of a 3-week multimodal prehabilitation program on frail elderly patients undergoing elective gastric cancer surgery: a randomized trial.

Research indicates that prehabilitation is effective in optimizing physical status before surgery, although this method may be considered "aggressive" for frail elderly patients. This study aimed to evaluate whether multimodal prehabilitation decreases postoperative complications and improves functional recovery in frail elderly patients undergoing gastric cancer surgery, in comparison to usual clinical care. This study was a single-center, single-blind, randomized controlled trial. Patients over 65 years old with a Fried Frailty Index of 2 or higher, scheduled for gastric cancer surgery, were considered for inclusion. Eligible participants were randomized in a 1:1 ratio to either the intervention or control group. The intervention group underwent a 3-week multimodal prehabilitation program prior to surgery, in addition to perioperative care guided by ERAS protocols. The control group received only the latter. The primary outcome was the comprehensive complications index (CCI) measured at 30 days after surgery. Secondary outcomes included 30-day overall complications, functional walking capacity as assessed by 6-minute walking distance (6MWD) at 4 weeks postoperatively, and 3-month postoperative quality of life. This study was registered at ClinicalTrials.gov (No. NCT06510088). Among the 112 eligible patients, the median age was 74 years, with 58 (52.7%) being female.No between-group difference was found in the primary outcome measure, 30-day CCI. The Median (Q1-Q3) CCI for the intervention and control groups was 0 (0-12.2) and 0 (0-22.6) (P = 0.082), while the mean (SD) CCI was 6.1 (15.8) and 9.8 (12.7), respectively (P = 0.291). Notably, the incidence of severe complications (CCI > 20) was significantly lower in the intervention group compared to the control group (11.1% vs. 25.9%, P = 0.046), particularly in terms of medical complications (12.3% vs. 29.3%, P = 0.025). Preoperatively, 27 patients (47.4%) in the intervention group exhibited an increase in the 6MWD of at least 20m, compared to 16 patients (27.6%) in the control group (P = 0.028). At 4 weeks postoperatively, more patients in the intervention group returned to their baseline 6MWD levels (63.2% vs. 43.1%, P = 0.031). Secondary parameters of functional capacity in the postoperative period generally favored the multimodal prehabilitation approach. In frail elderly patients undergoing elective gastric cancer surgery, a prehabilitation program did not affect the 30-day postoperative complication rate or CCI but reduced severe complications and improved perioperative functional capacity. [ClinicalTrials.gov], [NCT06510088], [07/15/2024], [Retrospectively registered].

Three-year follow-up outcomes of postoperative quality of life from a randomized controlled trial comparing multi-port versus single-port laparoscopic distal gastrectomy.

Laparoscopic surgery for gastric cancer has become widely used; minimally invasive surgery has become the mainstream of treatment. This randomized controlled trial (RCT) aimed to compare long-term quality of life (QoL) and weight loss rates in patients who underwent single-port laparoscopic gastrectomy (SLG) or multi-port laparoscopic gastrectomy (MLG) for gastric cancer. This single-center RCT compared MLG and SLG in patients with clinical stage I gastric cancer, all of which underwent distal gastrectomy between April 2016 and September 2018. A total of 101 patients were evaluated for eligibility; all were randomized into either the SLG group (n = 50) or MLG group (n = 51). Blood tests, weight measurements, and postoperative questionnaires (DAUGS20, EORTC QLQ-C30, PGSAS-45) were performed at 3, 6, 12, and 36months after surgery to compare the QoL. At six months postoperatively, there was a higher trend toward lower weight loss in the SLG group compared with the MLG group. At 1, 3, 6, and 36months postoperatively, the neutrophil-to-lymphocyte ratio was significantly lower in the SLG group than that in the MLG group. The QoL, as measured using the postoperative questionnaires, was generally comparable. However, some favorable results, such as fewer diarrheas, were achieved. SLG was partially superior to MLG in terms of long-term QoL, in addition to assurance of esthetics and reduced pain. In addition, systemic inflammatory markers and weight loss rates were lower, suggesting a potential long-term benefit. SLG may be an option for stage I gastric cancer surgery. Further follow-up and multicenter studies should be considered.

Screening high-risk individuals for primary gastric adenocarcinoma: evaluating progression-free survival probability score in the presence and absence of Rictor expression after gastrectomy

ObjectiveDeveloping nomogram-based risk stratification model to determine 3-year and 5-year progression-free survival (PFS) and to identify high-risk patients with gastric adenocarcinoma based on different Rictor statuses.Methods1366 individuals who underwent radical gastric surgery to treat gastric adenocarcinoma at Shanxi Cancer Hospital from May 2002 to December 2020 were analyzed. Cox regression analysis was employed to create the nomograms. The nomograms’ performance was assessed using C-index, time receiver operating characteristic (t-ROC) curves, calibration curves, and decision curve analysis (DCA) curves in training and validation cohorts. Subsequently, patients were categorized into high-risk and low-risk groups based on the nomogram’s risk scores.ResultsThe Rictor (-) nomogram for predicting PFS included variables such as age, number of positive lymph nodes, vascular invasion, maximum diameter of the tumor, omentum metastasis, and expression of MSH2. In the internal validation, the C-index of the Rictor (-) nomogram was 0.760 (95%CI: 0.720-0.799), which was superior to the C-index of the American Joint Committee on Cancer (AJCC) 8th edition TNM staging (0.683, 95%CI: 0.646-0.721). Similarly, the Rictor (+) nomogram for predicting PFS included variables such as gender, age, pT stage, number of positive lymph nodes, neural invasion, maximum diameter of the tumor, omentum metastasis, Clavien-Dindo classification for complications, and CGA expression. The C-index of the Rictor (+) nomogram was 0.795 (95%CI: 0.764-0.825), which outperformed the C-index of the AJCC 8th edition TNM staging (0.693, 95%CI: 0.662-0.723). The calibration curves, t-ROC curves, and decision curve analysis for both nomogram models demonstrated their excellent prediction ability.ConclusionThis study presents the first risk stratification for Rictor status in gastric adenocarcinoma. Our model identifies low-risk patients who may not require additional postoperative treatment, while high-risk patients should consider targeted therapies that specifically target Rictor-positive indicators.

The effects of laparoscopic sleeve gastrectomy on serum levels of growth hormone and insulin-like growth factor 1

Background. It is unclear exactly how bariatric surgery affects the body’s metabolic and physiological functions. The purpose of the study was to assess the activity of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels in obese individuals before and six months after laparoscopic sleeve gastrectomy. Materials and methods. This study included 52 patients with a body mass index (BMI) ranging from 35 to 56 kg/m2 who qualified for laparoscopic sleeve gastrectomy and had completed data at the 6-month postoperative follow-up. All patients were clinically examined by a team of surgeons and a physician before operation. The serum levels of GH and IGF-1 were assessed pre- and post-operatively. Results. The study included 52 patients with obesity who were undergoing laparoscopic gastric sleeve surgery. Their mean age was 32.04 ± 6.90 years. More than half of the patients, 27 (51.9 %), were aged 19 to 32 years, 32 (61.5 %) patients were females, and 38 (73.1 %) had a BMI of 35–49.9 kg/m2. There was a significant increase in the serum GH after the sleeve gastrectomy compared to the pre-operative level (0.95 ± 0.30 vs 0.62 ± 0.40 ng/ml, p = 0.0001). IGF-1 also significantly increased after the surgery: 117.13 ± 32.40 vs 102.63 ± 33.90 ng/ml (p = 0.0001). Concerning BMI, there was no significant difference in the GH mean for patients with a BMI of 35–49.9 and 50–56 kg/m2 pre- and post-operatively: 0.6 vs 0.8 (p = 0.07) and 0.9 vs 1 (p = 0.5), respectively. On the other hand, IGF-1 exhibited a significant difference before and after surgery: 107.7 vs 88.9 ng/ml (p = 0.02) and 123.2 vs 100.7 (p = 0.03). Conclusions. This study concludes that sleeve gastrectomy significantly increases the serum level of both GH and IGF-1 and, consequently, their effects on disturbed lipid and protein metabolism in morbidly obese patients.

Advantages of adjuvant chemotherapy using S-1 following minimally invasive gastrectomy for gastric cancer versus open surgery: a propensity score-matched analysis.

It is essential to ensure optimal adherence to adjuvant chemotherapy regimens following gastric cancer surgery. However, treatment intensity for S-1 as adjuvant chemotherapy has not as yet been compared between minimally invasive (MI) and open (Open) surgery. We retrospectively compared dose modification of adjuvant S-1 between MI and Open surgery in patients undergoing R0 gastrectomy for gastric or esophago-gastric junction cancer at the Cancer Institute Hospital Tokyo, Japan, during the period from 2012 to 2022, and receiving S-1 for pStage II or S-1 plus docetaxel for pStage III as adjuvant chemotherapy. Propensity score matching (PSM) was conducted to adjust for possible confounders. In total, 323 patients were initially included. After PSM, 158 patients remained, 79 in each group. The adjuvant chemotherapy completion rates were similar in the two groups. However, the proportion of patients who required S-1 dose reduction was significantly lower in the MI than in the Open group (43.0% vs. 65.8%, p = 0.004). In addition, the MI group had significantly fewer patients requiring suspension of S-1 than the Open group (46.8% vs. 64.6%, p = 0.025). Moreover, the frequency of adverse events of grade ≥ 3 was significantly lower in the MI than in the Open group (17.7% vs. 31.7%, p = 0.042). In adjuvant chemotherapy for gastric cancer, minimally invasive surgery may offer better treatment intensity for oral S-1 administration than open surgery.

Development and validation of a prognostic model for cachexia in postoperative gastric cancer patients with low nutritional risk: a dual-center retrospective cohort study.

Gastric cancer can lead to excessive catabolism in patients. After undergoing gastric surgery, patients may experience additional unintended weight loss, resulting in severe malnutrition and potentially cachexia. We selected and incorporated patients from two centers. Cohort 1 (n = 1393) served as the development cohort, while cohort 2 (n = 501) was designated as an external validation cohort. Within cohort 1, 70% of the patients were utilized for model training, with the remaining 30% reserved for internal validation. The training set initially underwent univariate logistic regression, followed by multivariate logistic regression. The factors ultimately incorporated were used to construct the model and create nomograms. The discriminative ability was assessed using ROC curves in all three datasets, calibration curves were used to evaluate consistency, and decision curves analysis was performed to assess the clinical application value. The model incorporated 12 factors, specifically: age (OR = 1.07), preoperative BMI (OR = 0.89), surgery type (Total Gastrectomy (TG), OR = 1.83), chemotherapy (yes, OR = 1.52), stage (III, OR = 1.40), anastomotic obstruction (yes, OR = 6.85), Postsurgical Gastroparesis Syndrome (PGS) (yes, OR = 2.27), albumin (OR = 0.95), hemoglobin (OR = 0.98), triglycerides (OR = 0.36), CRP (OR = 1.07), and Neutrophil to Lymphocyte Ratio (NLR) (OR = 1.05). The model demonstrated robust performance in ROC with AUC values of 0.805 in the training set, 0.767 in the validation set, and 0.795 in Cohort 2. Calibration curves in all three datasets exhibited a high degree of concordance between actual and predicted probabilities. Decision curve analysis (DCA) indicated that the model holds substantial clinical utility across all three datasets. We have developed a predictive model for cachexia in patients undergoing gastric cancer surgery. This model enables healthcare professionals to accurately estimate the risk of cachexia in postoperative patients with nutritional deficits, allowing for timely nutritional interventions to enhance patient quality of life and prognosis.

Early intravenous branched-chain amino acid-enriched nutrition supplementation in older patients undergoing gastric surgery: a randomized clinical trial

BackgroundThe initiation time and formula for supplemental parenteral nutrition after surgery require optimization, especially in older patients undergoing major gastrointestinal surgery. This study aimed to assess the effect of early supplementation with a branched-chain amino acid (BCAA)-enriched formula (BAF) on short-term postoperative outcomes in older patients undergoing gastric surgery.MethodsThis single-center, prospective, double-blinded, randomized clinical trial was conducted from March 10, 2020, to September 15, 2022. Patients aged 65–80 years with gastric cancer scheduled for curative resection were assessed for eligibility and randomly allocated to a high-proportion BCAA (HBCAA) (early supplementation with the BAF) or control (routine nutrition) group. The primary outcome was the standardized length of hospital stay (LOS).ResultsA total of 150 patients were randomized. Thirteen patients were excluded due to the resection of other organs, presence of metastasis, or withdrawal of consent. Finally, we included 70 and 67 patients in the HBCAA and control groups, respectively (mean age: 70.5 ± 4.2 years; 96 men [70.1%]). The standardized LOS was significantly shorter in the treatment group than in the control group (median [interquartile range]: 8.0 [7.8, 8.0] vs. 8.5 [8.0, 9.0] days; mean difference, 0.38; 95% confidence interval [CI], 0.02–0.74 days; P < .001). Patients in the HBCAA group showed better gastrointestinal function with faster defecation (4.0 [3.6, 5.0] vs. 5.0 [4.0, 5.5] days; mean difference, 0.6 days; 95% CI, 0.26–0.94 days; P < .001) and semi-liquid diet initiation (8.0 [7.5, 8.0] vs. 8.0 [8.0, 8.8] days; mean difference, 0.36 days; 95% CI, 0.03–0.7 days; P < .001) and had lesser weight loss at postoperative day 5 than those in the control group did (3.5 [2.7, 6.5] vs. 4.9 [3.3, 7.6]%; mean difference, 1.23%; 95% CI, 0.27–2.19%; P = .011).ConclusionsIn this randomized clinical trial, compared with routine nutrition, early supplementation with a BAF was associated with a shorter standardized LOS in older patients undergoing gastric surgery, suggesting that it may be a favorable strategy for patients with a poor tolerance to external nutrition who are undergoing major surgery.Trial registrationClinicalTrials.gov; Identifier: ChiCTR2000029635.

Centralization of gastric cancer surgery- impact on treatment strategies and survival - a national population-based cohort study

BackgroundCentralized surgery care improves results of curative resection in rare malignancies. Less is known of secondary effects of such centralization on all patients, including patients receiving palliative or no tumor treatment. This population-based cohort study aimed to evaluate effects of centralization on survival and treatment decision in all gastric cancer patients in Sweden between 2006-2016. MethodsAll patients diagnosed with gastric cancer, including cardia cancer Siewert III, were identified using National Registry for Esophageal and Gastric Cancer (NREV) in Sweden. Patients diagnosed at a local hospital performing low-volume curative gastric cancer surgery before centralization were compared to patients in the same communities after curative cases were referred elsewhere. Survival differences were investigated with multivariate cox-regression models and probability of curative care with multivariate logistical regression. Results4547 patients diagnosed at 49 hospitals were included, whereof 28 stopped performing curative gastric cancer surgery during the study period. After centralization, 8 hospitals performed curative gastric cancer surgery, and the median overall survival increased from 7.9 to 9.1 months. Resection rates fell from 36% to 30%. Treatment recommendations made at multidisciplinary cancer conference increased from 23% to 80%, where any active tumor treatment (curative and palliative) recommendation increased from 68% to 73%. No significant difference in treatment strategy or time to surgery was found between the groups. No difference in overall survival was found between the groups. ConclusionDuring the centralization of gastric cancer surgery, survival, multidisciplinary treatment decisions and active treatment increased, with no detrimental effects on populations outside the major centers’ primary uptake areas.

Perioperative body composition changes and their clinical implications in patients with gastric cancer undergoing radical gastric cancer surgery: a prospective cohort study

BackgroundThis study aimed to investigate perioperative body composition changes and their clinical implications in patients undergoing radical gastric cancer surgery. MethodsPatient data are prospectively collected. Computed tomography scans were conducted within 30 days preoperatively and on the seventh postoperative day to assess skeletal muscle mass index (SMI), skeletal muscle density (SMD), and subcutaneous adipose tissue (SAT). Changes in these parameters between the 2 scans were quantified. Logistic regression analysis was used to determine factors influencing body composition loss and clinical outcomes. ResultsA total of 335 patients were included, showing varying degrees of decline in SMI, SMD, and SAT during the perioperative period. Multivariate analysis identified age ≥65 and low handgrip strength as independent risk factors for excessive SMI loss, whereas laparoscopic surgery served as a protective factor. For excessive SMD loss, independent risk factors included preoperative low SMD, Nutritional Risk Screening 2002 score ≥3, and hypoalbuminemia. Moreover, age ≥65 was identified as an independent risk factor for excessive SAT loss, whereas laparoscopic surgery remained protective. Excessive SMI and SMD loss are correlated with increased postoperative complications, prolonged hospital stays, and higher costs. Both excessive losses in SMI and SMD are independently associated with the incidence of postoperative complications. Further analysis revealed that excessive SMD loss (odds ratio, 3.164; 95% CI, 1.214–8.243) independently contributed to readmission risk. ConclusionExcessive SMI and SMD loss are associated with adverse clinical outcomes. It is essential to address and improve preoperative modifiable risk factors to reduce perioperative muscle loss and enhance prognosis.

Effect of Remimazolam- Vs Propofol-Based Intravenous Anesthesia on Surgical Stress Response and Post-Operative Immune Function in Patients with Gastric Radical Surgery

Effect of Remimazolam- Vs Propofol-Based Intravenous Anesthesia on Surgical Stress Response and Post-Operative Immune Function in Patients with Gastric Radical Surgery

Efficacy of traditional Chinese medicine in the conservative management of complete small intestinal obstruction post-gastric cancer surgery: A case report

In this case report, we describe the successful treatment of a patient with complete small bowel obstruction following gastric cancer surgery, employing an integrated approach of traditional Chinese medicine and Western medicine. Initial treatment consisted of conventional biomedical interventions, including intestinal obstruction catheterization, but after 16 days without improvement, surgical intervention was recommended. The patient, however, refused surgery and opted for treatments based on traditional Chinese medicine. Comprehensive traditional Chinese medicine therapies such as acupuncture, moxibustion, flash cupping, oral administration of compound herbal formulas, and enemas using Chinese herbal medicine were implemented alongside modern medical care. The obstruction resolved, and the patient was discharged without requiring surgery. Follow-up revealed no recurrence of the condition. This case highlights the potential of integrating traditional Chinese medicine with Western medical practices in the conservative management of complete small bowel obstruction, offering a reference for clinical application.

The emergence of additional causes of thiamine deficiency in the modern world: The impact of gastric surgery

We present a case of shoshin beriberi with non-specific hyperamylasemia but on a different background of thiamine deficiency. Due to the fulminant of the clinical presentation and the lack of rapid diagnostic tests, shoshin beriberi remains under-diagnosed, particularly among non-alcoholic patients. The present report of presumed shoshin beriberi aims to highlight the emergence of additional causes of thiamine deficiency in the modern world, especially those resulting from esophagogastric surgery, which carries a substantial risk of malnutrition in the medium to long term. The timely administration of thiamine is generally safe and can result in rapid improvement, making it both a valuable therapeutic and diagnostic tool.

A Case of Tracheogastric Puncture Using Transnasal Esophagoscopy After Total Laryngopharyngoesophagectomy and Gastric Pull-Up Reconstruction

Voice rehabilitation after total laryngopharyngoesophagectomy is a significant challenge, especially when accompanied by gastric pull-up reconstruction. In 2021, a study revealed that tracheoesophageal puncture is also safe and feasible option for voice rehabilitation in patients who underwent gastric pull-up surgery. Here, we report for the first time in South Korea a case that represents an instance of voice prosthesis insertion after gastric pull-up surgery. The case demonstrates the feasibility and safety of voice prosthesis insertion in patients who undergo total laryngopharyngoesophagectomy and gastric pull-up surgery, providing evidence that voice prosthesis insertion is achievable and can be performed in the outpatient setting using transnasal esophagoscopy.