Gastric Surgery Research Articles

Preliminary application results of laparoscopic assisted proximal gastrectomy λ-shaped double tract anastomosis

Objective: To share the results of laparoscopic assisted proximal gastrectomy λ- shaped modified double tract reconstruction. Method: This study retrospectively included 3 patients during January 2024 from the Department of Gastric Surgery at the First Affiliated Hospital of Nanjing Medical University using the λ-shaped modified double tract reconstruction. The procedure of the λ-shaped modified double tract reconstruction is as follows. After completing proximal gastrectomy, the jejunum is transected 15 cm from the Treitz ligament. A suture is made 18-20 cm from the distal jejunum to mark the esophagojejunal anastomosis site. A circular stapler anvil is inserted through the distal jejunum, and the remaining end of the jejunum is turned to the right. The circular stapler is pierced through the marked site for an esophagojejunal end-to-end anastomosis, which is reinforced with a barbed suture continuously. A 60mm linear stapler is used to close the remaining end of the jejunum. We then mark the gastric side of the gastrojejunal anastomosis with suture in the middle of the anterior wall of the residual stomach, and mark the jejunal side of the gastrojejunal anastomosis at a distance of about 2 cm and 8 cm from the residual end of the distal jejunum. We make an opening of about 0.5 cm and use a 60 mm linear stapler to perform anastomosis on the jejunal side of the anterior wall of the residual stomach according to the markings, so that the distance between the esophagojejunal anastomosis and the gastrojejunal anastomosis is 10-12 cm. The common opening is closed with barbed wire. About 50 cm below the esophagojejunal anastomosis, the small intestine opening is anastomosed side to side using a circular stapler and the common opening is closed. Return the jejunum into the abdominal cavity to complete the reconstruction of the λ-shaped double tract reconstruction. We analyzed the surgery and postoperative conditions, including surgery time, anastomosis time, intraoperative bleeding, tumor size and pathology, postoperative mobilization, passage of gas and water intake time, discharge time, postoperative complications, and postoperative gastrointestinal imaging to observe the passage of food through the gastric and intestinal loops. Results: Three patients successfully received laparoscopic assisted proximal gastrectomy with λ-shaped modified double tract reconstruction. The surgical time was 155 minutes, 240 minutes, and 160 minutes, respectively; The postoperative time for first ambulation was 20 hours, 18 hours, and 26 hours, respectively. The time for passage of gas was 59 hours, 83 hours, and 75 hours, respectively. The drinking time was 66 hours, 87 hours, and 90 hours, respectively. The postoperative discharge days were all 7 days. No surgical related complications occurred. On the 6th day and 3 months after surgery, gastrointestinal angiography was performed. The contrast agent passed smoothly through the jejunal loop and residual stomach jejunal loop, and both sides were unobstructed. No contrast agent was found to retrograde to the esophagojejunal anastomosis. Conclusion: Laparoscopic assisted proximal gastrectomy with λ-shaped modified double tract reconstruction is safe and feasible, as it improves the diversion of food through the residual stomach while ensuring anti-reflux effects.

Gastrointestinal Microbiota in Gastric Cancer: Potential Mechanisms and Clinical Applications-A Literature Review.

Emerging evidence highlights the crucial role of gastrointestinal microbiota in the pathogenesis of gastric cancer. Helicobacter pylori (H. pylori) infection stands out as a primary pathogenic factor. However, interventions such as anti-H. pylori therapy, gastric surgeries, immunotherapy, and chronic inflammation significantly remodel the gastric microbiome, implicating a broader spectrum of microorganisms in cancer development. These microbial populations can modulate gastric carcinogenesis through various mechanisms, including sustained chronic inflammation, bacterial genotoxins, alterations in short-chain fatty acids, elevated gastrointestinal bile acids, impaired mucus barrier function, and increased concentrations of N-nitrosamines and lactic acid. The dynamic changes in gut microbiota also critically influence the outcomes of anti-cancer therapies by modifying drug bioavailability and metabolism, thus affecting therapeutic efficacy and side effect profiles. Additionally, the effectiveness of radiotherapy can be significantly impacted by gut microbiota alterations. Novel therapeutic strategies targeting the microbiome, such as dietary interventions, probiotic and synbiotic supplementation, and fecal microbiota transplantation, are showing promise in cancer treatment. Understanding the intricate relationship between the gut microbiota and gastric cancer is essential for developing new, evidence-based approaches to the prevention and treatment of this malignancy.

Association between different patterns of obesity and the short-term outcomes of gastric cancer surgery.

Previous studies have shown that general and central obesity are each linked to adverse outcomes in gastrointestinal cancers. However, their combined effect on gastrointestinal cancers surgery outcomes were less understood. This study aims to integrate both general and central obesity to examine the outcomes of gastric cancer surgery in different obesity patterns. We retrospectively analyzed 248 patients who underwent gastric cancer surgery between 2021 and 2023 in a single institute. The Inbody720 body composition analyzer measured body composition. We evaluated the relationship between obesity patterns - combining BMI with central obesity measures (waist circumference, waist-to-hip ratio, visceral fat area) - and postoperative complications and 30-day readmission. Central-only obesity were more likely to induce fistula (P = 0.025), while non-obesity was more likely to develop postoperative abdominal effusion (P = 0.049) and bleeding (P = 0.042). Central-only obesity was significantly associated with severe postoperative complications after adjustment for hypertension, diabetes, abdominal surgery history, preoperative albumin levels, age, sex, and surgical types. This remains significant even after adjusting for muscle mass. However, we did not find the same results for significant complications. Regarding 30-day readmission, there are no differences between different patterns of obesity. Central-only obesity is an independent risk factor for severe postoperative complications in gastric cancer, while a high BMI appears to be associated with a lower risk compared to non-obese patients, but not significant postoperative complications. The likelihood of readmission within 30 days post-surgery may not be related to the patient's pattern of obesity.

The Metabolic Effects and Effectiveness of the Different Reconstruction Methods used in Gastric Cancer Surgery: A Systematic Review and Meta-Analysis.

Gastric Cancer (GC) is the fifth most common cancer worldwide. Early stages of GC began being detected, giving rise to a new concern, Quality of Life. This study aimed to systematically assess the effects of different GC reconstruction techniques on postoperative type 2 diabetes mellitus (T2DM), hypertension (HBP), and body mass index (BMI) reduction rate and to provide an overview of recent research on oncometabolic surgery (OS). We performed a systematic review and meta-analysis by searching three databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a meta-analysis of risk ratios and mean differences to estimate the impact of duodenal bypass, Roux-en-Y reconstruction, and residual stomach on T2DM, HBP, and BMI reduction rate. Heterogeneity was assessed using the I2 statistics. At the end of the follow-up, the duodenal bypass group compared to Billroth I had a significantly higher postoperative remission of T2DM and HBP, with a relative risk (RR) of 1.43 (95% confidence interval (95% CI) [1.27; 1.62]) and 1.3 (95% CI [1.00; 1.69]), respectively. Compared with the Billroth II group, Roux-en-Y reconstruction had significantly greater T2DM remission after gastrectomy (RR = 1.19; 95% CI [1.08; 1.31]), while HBP showed no significant differences. Regarding the improvement of HBP, total gastrectomy was significantly superior to subtotal gastrectomy (95% CI [1.01; 2.64]). A trend towards Roux-en-Y Esophagojejunostomy as the best option for T2DM remission was observed (95% CI [0.98; 2.77]; p = 0.06). Gastrectomy with Roux-en-Y reconstruction appears to be the most effective treatment for T2DM remission. Further research is needed to assess the impact of OS on metabolic diseases.

Proficiency in bariatric surgery may shorten the learning curve for minimally-invasive D2 gastrectomy.

Evidence from Asian studies suggests that minimally-invasive gastrectomy achieves equivalent oncological but improved perioperative outcomes compared to open surgery. Oncological gastric resections are less frequent in European countries. Index procedures may play a role for the learning curve of minimally-invasive gastrectomy. The aim of our study was to evaluate if skills acquired in bariatric surgery allow a safe and oncologically adequate implementation of minimally-invasive gastrectomy in a cohort of european patients. In this single-center retrospective study, all patients who received primary bariatric surgery between January 2015 and December 2018 and minimally-invasive surgery for gastric cancer treated from June 2019 to January 2023 were evaluated. Primary endpoints were operation time, lymph node yield and lymph node fractions. Secondary endpoints included postoperative complications and oncological outcomes. Learning curves for two surgeons with 350 bariatric procedures and 44 minimally-invasive gastrectomies were analyzed. For bariatric surgery, the mean operation time decreased from initially 82 ± 27 to 45 ± 21min and 118 ± 28 to 81 ± 36min for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), while the complication rate remained within the international benchmark. For laparoscopic gastrectomy (n = 30), operation times decreased but then remained stable over time. Operation times for the robotic platform were longer (302 ± 60 vs. 390 ± 48min; p < 0.001) with the learning curve remaining incomplete after 14 procedures. R0 status was achieved in 95.5% of patients; the mean number of lymph nodes retrieved was 37 ± 14 with no differences between the groups. Complete mesogastric excision was more frequently achieved during the later laparoscopic cases whereas it occurred earlier for the robotic group (p = 0.004). Perioperative morbidity was comparable to the European benchmark. Textbook outcome was achieved in 54.4% of the cases. In summary, we could demonstrate a successful skill transfer from bariatric surgery to minimally-invasive laparoscopic oncological gastric surgery enabling safe and oncologically adequate minimally-invasive D2 gastrectomy in a central European patient collective.

Assessing the Risk of Postoperative Delirium Through Comprehensive Geriatric Assessment and Eastern Cooperative Oncology Group Performance Status of Elderly Patients With Gastric Cancer.

Postoperative delirium is especially common and often problematic among elderly patients undergoing surgery. This study aimed to explore factors that can predict postoperative delirium in elderly patients undergoing gastric cancer surgery. This cohort study included 255 patients age 75 years or older who underwent gastric cancer surgery between July 2010 and December 2020. All the patients underwent preoperative comprehensive geriatric assessment (CGA) evaluation by a geriatrician. In addition to the CGA items, this study investigated the association between postoperative delirium and clinicopathologic factors, including Eastern Cooperative Oncology Group performance status (ECOG-PS). The most common postoperative complication was delirium, present in 31 patients (12.2%). The group with delirium was significantly more likely to have ECOG-PS≥2, diabetes mellitus, cardiovascular disease, or cerebral infarction. The CGA showed frailty in the Instrumental Activities of Daily Living scale (IADL), the Mini-Mental State Examination (MMSE), the Vitality Index (VI), and the Geriatric Depression Scale 15 (GDS-15). In the multivariate analysis, the independent risk factors for delirium were ECOG-PS ≥2 (P=0.002) and MMSE-frailty (P<0.001). Using an MMSE score of ≤23 and an ECOG-PS score of ≥2 as cutoffs, postoperative delirium was predicted with a sensitivity of 80.7% and a specificity of 74.1%. Postoperative delirium might be more easily predicted based on the combination of MMSE and ECOG-PS for elderly patients with gastric cancer undergoing gastrectomy.

8262 Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) after gastric sleeve surgery

Abstract Disclosure: R.E. Thomas: None. A. Charales: None. B. Bangash: None. S. Haider: None. S. Ouais: None. Introduction: Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a rare condition characterized by endogenous hyperinsulinemic hypoglycemia after meals. This article explores NIPHS, emphasizing its occurrence post-gastric sleeve surgery. We delve into clinical features, diagnosis, treatment, and challenges, using a case presentation to illustrate complexities.Clinical Features and Classification:NIPHS entails endogenous hyperinsulinemic hypoglycemia without islet cell neoplasms, featuring islet cell hypertrophy. Formerly "Nesidioblastosis," post-RYGB cases constitute a distinct diagnosis. Common features include postprandial hyperinsulinemic hypoglycemia, negative radiologic localization, and a positive calcium stimulation test.Patients present postprandial hypoglycemia 2-4 hours after meals, with symptoms like tachycardia, tremors, confusion, and occasional seizures. Lab findings include elevated insulin, C peptide, and pro-insulin, low beta-hydroxybutyrate, and negative sulfonylurea/meglitinide screen.Diagnostic Workup:Evaluate glucose, insulin, pro-insulin, C peptide, beta-hydroxybutyrate, and sulfonylurea/meglitinide. Ultrasound differentiates insulinoma from diffuse processes. If negative, conduct SACST for localization.Case Presentation:A 37-year-old female post-gastric sleeve surgery presented with severe hypoglycemia. Symptoms included confusion, nausea, and palpitations, occurring postprandially, relieved by food or juice. Glucagon was administered, and consultations sought. Diazoxide stabilized blood glucose.Treatment Modalities:Dietary modifications reduce free carbohydrate intake, spaced meals minimize hyperinsulinemic episodes. Medical management (octreotide, verapamil, diazoxide, acarbose) proves effective, especially post-gastric bypass. Sub-total pancreatectomy is considered in severe refractory cases.Multidisciplinary Approach:Management involves endocrinologists, surgeons, radiologists, and dietitians. Regular monitoring assesses efficacy, adjusts medications, and addresses complications. Challenges and Future Perspectives: NIPHS complexities include variable presentation and diagnostic challenges. Research should refine criteria, explore interventions, and understand pathophysiology. Conclusion: Non-insulinoma pancreatogenous hypoglycemia syndrome, especially post-gastric sleeve surgery, presents complexities. This exploration highlights clinical aspects, diagnostics, and management challenges, emphasizing the need for a multidisciplinary approach. Continued research aims to enhance diagnostic precision and improve outcomes for those affected by this intriguing syndrome. Presentation: 6/3/2024

6666 Asymptomatic Fasting Hypoglycemia After Sleeve Gastrectomy

Abstract Disclosure: K. Mitrollari: None. H.K. Deveaux: None. A. Gundeti: None. A.P. Calimag: None. T. Yasmeen: None. Introduction: Post-bariatric surgery hypoglycemia (PBSH), though previously considered rare, is increasingly recognized, occurring not only after Roux-en-Y gastric bypass (RYGB,) but also following various bariatric procedures. PBSH can manifest as postprandial or fasting hypoglycemia, requiring thorough investigation and prevention due to potential asymptomatic presentations that may lead to severe consequences, including coma and death. Case Report A 45-year-old female with a history of type 2 DM, ESRD on HD, gastric sleeve surgery, bilateral trans-metatarsal amputations, coronary artery disease, and congestive heart failure presented with bilateral lower extremity wounds. On admission her venous blood glucose was 71 mg/dL. Glycohemoglobin was 3.9% and fructosamine was 225 (205-285 umol/L). Her glycohemoglobin levels consistently remained below 6.4% status post sleeve gastrectomy off diabetes medications. Throughout admission, she experienced almost daily episodes of fasting asymptomatic hypoglycemia correlated with venous sample with lowest blood glucose reading 38 mg/dL. Initially, these episodes were attributed to NPO status for procedures or decreased PO intake. Her diet consisted of fast food brought by her family, which she reported was similar to her diet at home. Workup during a hypoglycemic episode (glucose 51 mg/dL,) revealed insulin 4 mUnits/L, proinsulin 7.1 pmol/L (&amp;lt;=7.2 pmol/L), C-peptide 25.7 ng/mL (0.8-3.9 ng/mL), and beta-hydroxybutyrate 0.5 mmol/L (0.0-0.3 mmol/L). Negative insulin antibodies and sulfonylurea panel, normal cortisol, and ACTH levels were noted. The patient was placed on a 10% dextrose infusion to avoid further episodes of hypoglycemia. However, she continued to experience hypoglycemia and was started on oral diazoxide. A CT pancreas with and without contrast was unremarkable, and endoscopic ultrasonography only revealed a 10 mm accessory spleen. The patient was discharged with counseling on glucose monitoring, dietary changes, and follow-up with endocrinology. Conclusion: PBSH should be considered as a differential diagnosis in patients with unexplained hypoglycemia and a history of bariatric surgery. PBSH mimics insulinoma or non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) with elevated insulin, proinsulin, C-peptide, and low beta-hydroxybutyrate during hypoglycemia, however NIPHS is exclusive to non-bariatric patients. Imaging is crucial to rule out insulinoma, and invasive tests such as endoscopic ultrasound aid diagnosis. PBSH is a diagnosis of exclusion; therefore, workup involves ruling out other causes of hypoglycemia. First-line treatment involves diet modification, with medications like diazoxide or acarbose considered if dietary changes prove insufficient. This case underscores the complexity of hypoglycemia, implicating bariatric surgery as a contributing factor. Presentation: 6/3/2024

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: secondary analysis of a prospective randomized trial

Background & aimsNutritional support after hospital discharge was found to enhance the nutritional condition of patients after cancer surgery. However, the effect of nutritional support after hospital discharge in patients after cancer surgery on long-term clinical outcomes is controversial. We aimed to investigate the effect of nutritional support after hospital discharge on long-term clinical outcomes in patients after gastric cancer surgery. MethodsThis study conducted a secondary analysis on individuals at nutritional risk who underwent gastric cancer surgery included in a randomized controlled trial. The intervention group received oral nutritional supplements combined with dietary advice, and the control group received dietary advice alone. The long-term mortality (primary outcome) and other clinical outcomes were compared between groups. ResultsIn total, 321 patients were included in this analysis, with a median follow-up duration of 60.5 months. According to the Nutritional Risk Screening 2002 (NRS 2002), the presence of nutritional risk was found to be a significant predictor of death. This association remained independent even after adjusting for age, sex, comorbidity, and American Joint Committee on Cancer stage (AJCC). The adjusted hazard ratio (HR) for mortality increased by 1.30 [95% confidence interval (CI) 1.05-1.60, P= 0.016] for each additional point rise in NRS. During the follow-up, a total of 64 individuals (39.5%) in the intervention group and 81 patients (50.9%) in the control group died. Consequently, the adjusted HR for mortality between two groups was 0.69 (95% CI 0.50-0.96, P=0.026). The results of interaction tests did not yield statistically significant variations in fatality rates through the age, sex, comorbidity, NRS, and AJCC stage subgroups. Nutritional support after hospital discharge significantly improved handgrip strength (adjusted coefficient 5.05, 95% CI 3.01-7.08, P=0.000) among other functional outcomes. ConclusionsNutritional support after hospital discharge reduced long-term mortality and improved handgrip strength among patients at nutritional risk after gastric cancer surgery. The current investigation provides the guarantee of nutritional support after hospital discharge for patients after surgery in cancer management guidelines.

S5113 An Unexpected Diagnosis was Found From Recurrent Gastric Perforation and Gastric Surgeries

S5113 An Unexpected Diagnosis was Found From Recurrent Gastric Perforation and Gastric Surgeries

Helicobacter Pylori Infection as the Predominant High-Risk Factor for Gastric Cancer Recurrence Post-Gastrectomy: An 8-Year Multicenter Retrospective Study.

The reappearance of gastric cancer, a frequent postoperative complication following radical gastric cancer surgery, substantially impacts the near-term and far-reaching medical outlook of patients. The objective of this research was to create a machine learning algorithm that could recognize high-risk factors for gastric cancer recurrence and anticipate the correlation between gastric cancer recurrence and Helicobacter pylori (H. pylori) infection. This investigation comprised 1234 patients diagnosed with gastric cancer, and 37 characteristic variables were obtained. Four machine learning algorithms, namely, extreme gradient boosting (XGBoost), random forest (RF), k-nearest neighbor algorithm (KNN), and multilayer perceptron (MLP), were implemented to develop the models. The k-fold cross-validation technique was utilized to perform internal validation of the four models, while independent datasets were employed for external validation of the models. In contrast to the other machine learning models, the XGBoost algorithm demonstrated superior predictive ability regarding high-risk factors for gastric cancer recurrence. The outcomes of Shapley additive explanation (SHAP) analysis revealed that tumor invasion depth, tumor lymph node metastasis, H. pylori infection, postoperative carcinoembryonic antigen (CEA), tumor size, and tumor number were risk elements for gastric cancer recurrence in patients, with H. pylori infection being the primary high-risk factor. Out of the four machine learning models, the XGBoost algorithm exhibited superior performance in predicting the recurrence of gastric cancer. In addition, machine learning models can help clinicians identify key prognostic factors that are clinically meaningful for the application of personalized patient monitoring and immunotherapy.

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

Nutritional support after hospital discharge reduces long-term mortality in patients after gastric cancer surgery: Secondary analysis of a prospective randomized trial

The Evaluation of Gastric Cancer Lymphovascular Invasion Using CT Volume Perfusion.

The best treatment option for patients with resectable gastric cancer is radical gastric cancer surgery. However, the postoperative overall survival rate is low. Lymphovascular invasion (LVI) is a risk factor for cancer recurrence and a stand-alone predictor of a poor post-operative prognosis for gastric cancer (GC) patients. Current evaluation of tumor LVI performed on histological specimens, which can only be assessed after surgery, is also limited by intra-tumoural heterogeneity via biopsy. This study explored the value of CT volume perfusion in assessing tumors' lymphovascular invasion of gastric cancer. 59 gastric cancer patients confirmed by pathology who underwent both computed tomography (CT) volume perfusion examinations and gastrectomy surgery were prospectively included. Tumour lymphovascular invasion (LVI, positive or negative) was evaluated. The relationship between clinicopathological variables associated with LVI and CT perfusion parameters was analyzed by univariate analysis, followed by multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis. The LVI-positive and LVI-negative groups differed significantly in terms of time to start (TTS), mean transit time (MTT), Tmax, and flow extraction product (FEP). Both FEP (odds ratio (OR), 1.048; 95% confidence interval (CI): 1.005-1.092) and MTT (OR, 0.549; 95% CI: 0.351-0.858) have the potential to be employed as independent predictors of LVI (both p < 0.05). There were different correlations between LVI, lower MTT and greater FEP. The specificity of MTT (87.88%) was higher than that of FEP (72.73%), while the sensitivity of MTT (53.85%) was lower than that of FEP (57.69%). Compared to MTT and FEP alone, the combination demonstrated a comparatively higher area under the curve (AUC) (0.797) and sensitivity (84.62%). CT volume perfusion helps evaluate LVI in gastric cancer before surgery. MTT and FEP are independent predictors for LVI, and the combination variation has better diagnostic performance. Clinical Trial Register: Jiangmen Central Hospital, https://www.chictr.org.cn/showproj.html?proj=24375, ChiCTR1800014455.

The effect of fat supplementation on the occurrence of dumping syndrome related symptoms in patients having undergone gastric surgery

The effect of fat supplementation on the occurrence of dumping syndrome related symptoms in patients having undergone gastric surgery

Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia.

Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity. To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer (GC) surgery to provide a reference basis for the formulation of anesthesia protocols for radical GC surgery. This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024. There was no restriction on sex. The patient grouping method used was a digital random table method, and the number of cases in each group was 56. The control group was administered total intravenous anesthesia, and the observation group compounded the stellate ganglion block according to the total intravenous anesthesia protocol. Postoperative hemodynamics, pain levels, and immune indices were compared between the groups. The heart rate and mean arterial pressure in the observation group after intubation were lower than those in the control group (P < 0.05). Pain levels were compared between the two groups at 2 hours, 12 hours, 24 hours, and 48 hours after surgery (P > 0.05). The number of CD3+, CD4+, and CD4+/CD8+ cells at the end of surgery was higher in the observation group than in the control group, and the number of CD8+ cells was lower in the observation group than in the control group (P < 0.05). There were no significant differences between the two groups in terms of propofol dosage, awakening time, extubation time, or postoperative adverse reactions (P > 0.05). The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery. However, it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.

Theory and practice on mesentery margin in vessel-oriented complete mesentery resection of gastric cancer

The concept of mesenteric anatomy has been evolving in cognition. With the continuous development of endoscopic techniques, the submicroscopic structures of many mesenteries have been gradually understood, ultimately confirming the ubiquitous presence of mesenteries in the digestive organs. Based on various domestic and foreign mesenteric anatomical theories and combined with years of clinical practice, we have summarized and proposed a new concept and theory-vascular-guided complete mesenteric resection for gastric cancer. The theoretical basis is that, from the perspective of the embryonic development of the digestive tract, the rotation of the digestive tract and its associated mesentery is always centered on blood vessels. Therefore, the supply vessels and digestive tracts and their associated mesentery are naturally connected. The mesentery is a complex structure that encompasses blood vessels, nerves, and lymphatic tissues. The blood vessels serve as the boundary of the mesentery, ensuring that the lymphatic network that drains the tumor is maximally resected. This article focuses on the complete mesenteric resection margins in gastric cancer surgery, that is, the lateral boundary of the mesentery as the vascular-supplied guided resection boundary and its mesentery, and the base boundary as the mesenteric bed. Using precise vascular guidance to define the extent of mesenteric resection will help accurately define the mesenteric margin during radical resection for different stages of gastric cancer.

Duodenal Bezoar: A Rare Cause of Acute Pancreatitis

Gastrointestinal bezoars often occur as a complication of previous gastric surgery or in patients with altered gastrointestinal motility. Complications associated with gastrointestinal bezoars include perforation, peritonitis, protein-losing enteropathy, and acute appendicitis. Acute pancreatitis secondary to a duodenal bezoar is rare, and few studies have reported this complication. We report a case of acute pancreatitis and subsequent duodenal obstruction caused by a large duodenal phytobezoar.

The Naples Score: Can it Outperform Existing Scores in Predicting Gastric Cancer Mortality?

Objective: Gastric surgery, including curative and palliative procedures, is crucial in managing gastric cancer. Despite advancements, postoperative mortality remains a significant concern, influenced by factors such as patient nutritional status. Accurate assessment of nutritional status is essential for risk stratification and improving patient outcomes.This study aims to investigate the correlation between four nutritional scores: Naples Prognostic Score , Controlling Nutritional Status score, Prognostic Nutritional Index, and Systemic Inflammation Score and the mortality rate following gastric surgery, to identify the most reliable predictors of postoperative mortality. Materials and methods: This retrospective study evaluated 50 patients diagnosed with gastric adenocarcinoma and operated on at Erol Olçok Training and Research Hospital between April 2021 and September 2023. Data collected included age, gender, operation type, laparoscopy usage, albumin, cholesterol, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, mortality rates, and TNM stages. Nutritional scores were calculated, and their predictive accuracy for mortality was assessed using time-dependent Receiver Operating Characteristic curve analysis. Results: The study included 50 patients. Significant differences in albumin levels, neutrophil-to-lymphocyte rate, lymphocyte-to-monocyte ratio, and nutritional scores were found between deceased and surviving patients. Prognostic Nutritional Index had the highest predictive accuracy with an Area under the curve of 0.792, sensitivity of 76%, and specificity of 86.2%, outperforming others. Conclusion: The Prognostic Nutritional Index is the most effective predictor of postoperative mortality among the evaluated scores.

Effect of prehabilitation for patients undergoing gastric cancer surgery: a protocol of a systematic review and meta-analysis

IntroductionGastric cancer is a high-risk cancer with surgical treatments often leading to significant postoperative complications and mortality. Prehabilitation, involving exercise, nutrition and psychological support before surgery, aims to boost patients’...

Function-preserving gastrectomy in gastric cancer

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