Invasive Treatment Of Gastric Cancer Research Articles

Robot-assisted laparoscopic subtotal gastrectomy for early-stage gastric cancer: Case series of initial experience

BackgroundIn the last decade's robotic gastrectomy (RG) has increasingly widespread as a valid minimally invasive option for treatment of gastric cancer. In literature, evidence of its routine use is not yet well established. The aims of this study are to report our initial experience and to present possible advantages of our hybrid operative technique for subtotal gastrectomy. Materials and methodsRetrospectively, we analyzed data from 41 patients (22 male and 19 female) who underwent robot-assisted laparoscopic subtotal gastrectomy (RALG) with D2 lymphadenectomy using the da Vinci XI robotic system. Inclusion criteria were gastric cancer in the middle or lower portion of the stomach amenable of radical subtotal gastrectomy without preoperative suspicion of positive lymph-nodes or other organs involving and distant metastasis. All the procedures were performed by attending surgeons. ResultsThe mean operative time was 270 min with one case of conversion to open surgery. The mean age was 71.4 (IQR 68.2–76.8) with 43.9% of patients classified as ASA (American Society of Anesthesiologists) score ≥3. The median of lymph-nodes retrieved was 25 (IQR 19–35). No intra-operative complications occurred. Time to resume a soft diet was 5 days. Patients were hospitalized a median of 7 days. According to pathological AJCC-TNM, 21 patients were classified as advanced gastric cancer. Post-operative morbidity was recorded in 9 patients (21.9%) with major complications requiring surgical operation in 4 patients (9.8%). Elevated ASA score, fewer lymph-nodes retrieved and ICU recovery requirements were significant increased in patients with major complications. ConclusionThe preliminary results demonstrated that robot-assisted laparoscopic subtotal gastrectomy is safe and feasible. In particular, we found that the da Vinci platform improves surgeon abilities to perform an adequate lymphadenectomy and digestive reconstruction. Further studies are necessary to better clarify the role of this high-cost technology in minimally invasive treatment of gastric cancer.

Experience and technique of simultaneous robotic resection for synchronous advanced gastric and rectal cancers: a case report

BackgroundRecently, robotic surgery has become more common as a minimally invasive treatment for gastric cancer (GC) and rectal cancer (RC). Herein, we report successful simultaneous robotic gastrectomy and low anterior resection in a patient with advanced GC and RC.Case presentationA 76-year-old woman who presented with bloody stool was found to have advanced GC with lymph node metastases and advanced RC. Simultaneous robotic distal gastrectomy with D2 lymph node dissection and Billroth I reconstruction and low anterior resection with D3 lymph node dissection were performed. Preoperatively, multidisciplinary medical staff discussed the case in detail and conducted a simulation with the robot, operating room, and patient. The total operative time was 648 min (console time, 520 min), and the estimated blood loss was small. The patient was discharged on postoperative day 10 without any adverse events. In this case, careful simulation of the patient cart setting and planning of the best port layout resulted in a successful surgical outcome despite this being our first simultaneous total robotic surgery for advanced GC and RC.ConclusionsSimultaneous robotic surgery for advanced GC and RC may be technically feasible and could provide an option for future minimally invasive treatment.

Feasibility and efficacy of laparoscopic treatment for advanced gastric cancer from LOC-A study

With the progression of surgical techniques, laparoscopic equipment and treatment concepts, laparoscopic radical gastrectomy has been widely used in clinical practice. However, whether laparoscopic surgery can be used for the treatment of locally advanced gastric cancer is still controversial. Recent results from the Korean KLASS-02 study, the Japanese JCOG-0901 study, and the Chinese CLASS-01 study suggest that there is no significant difference in the short-term efficacy between laparoscopic surgery and open surgery in the treatment of locally advanced gastric cancer. The long-term results have not been published. The LOC-A study was a multicenter, large sample size retrospective analysis that enrolled 1948 laparoscopic and open surgery cases with stage II to III locally advanced gastric cancer in 8 Japanese hospitals between 2008 and 2014. As a result, after removal of confounding factors by propensity score matching (PSM), the analysis showed no significant difference in long-term efficacy between laparoscopic surgery and open surgery for locally advanced gastric cancer. However, some bias still remain after the bias-control. Therefore, due to insufficiency of the high-level evidence-based medical evidence, we believe that the all-round promotion of laparoscopic surgery of locally advanced gastric cancer is too early, nevertheless, we should also recognize that the minimally invasive treatment of gastric cancer is the current development trend, and we should be confident in laparoscopic treatment of locally advanced gastric cancer.

Laparoscopy-assisted Distal Gastrectomy for Gastric Cancer in Elderly Patients: Surgical Outcomes and Prognosis.

Elderly patients usually have various comorbidities. Laparoscopic gastrectomy as a minimally-invasive treatment might be feasible for these patients. The aim of this study was to evaluate the safety and efficacy of laparoscopy-assisted distal gastrectomy (LADG) in elderly patients with gastric cancer by comparing the surgical outcomes and prognosis. We analyzed 136 patients who had undergone LADG between January 2013 and December 2014. We compared elderly patients (75 years old or more) with non-elderly patients. The incidence of all postoperative complications did not differ between groups, and there were no significant differences in the time to first oral intake or the duration of postoperative hospital stay. The 3-year overall and recurrence-free survival rates were not significantly different between the groups. LADG is a safe and less invasive treatment for gastric cancer in elderly patients, who have a greater incidence of comorbidity.

Recognition of specialization of minimally invasive treatment for gastric cancer in the era of precision medicine

With the introduction and promotion of "precision medicine" conception, the history of disease occurrence, progression and prognosis has been deeply investigated with more accuracy, and the surgical treatment concept has become more precise and minimally invasive. With the rapid development of minimally invasive technique, laparoscopic gastrectomy has become an important part for treatment of gastric cancer. A number of randomized controlled clinical trials, such as KLASS-01 and CLASS-01, have demonstrated that laparoscopic gastrectomy is safe and feasible for treatment of early and locally advanced gastric cancer, respectively. Endoscopic treatment would also be considered with strict indications. The surgical safety is identical between standard laparoscopy surgery and open surgery for local advanced gastric cancer. Radical cure, organ function preservation and reduced surgical trauma are the basic rules for minimally invasive treatment for gastric cancer. Specialized treatment mode, which consists of precise evaluation of tumor location, gastrectomy and lymph node resection, reduced surgical trauma and control of postsurgical complications, is the premise for implementation of minimally invasive surgery. Accurate preoperative staging, strict indication of operation, accurate quality control and postoperative management are important warrants for the effect of minimally invasive treatment in patients with gastric cancer. With standard diagnosis and treatment procedures, the specialized treatment mode for gastric cancer combined with standard surgical resection is an important force to promote the development of minimally invasive surgery. And what should we do to train and promote gastric cancer treatment in primary medical care centers is an urgent problem. With the development of equipment, minimally invasive treatment will be more professional, more precise, safer and less invasive. In the era of precision medicine, with deeper exploring the pathogenesis of gastric cancer, promoting the development of specialized treatment mode and strengthened surgical team training could meet the demand for minimally invasive treatment of gastric cancer. Therefore, specialized minimally invasive treatment is the trend of minimally invasive treatment for gastric cancer in the new era.

Value of multi-slice spiral CT perigastric angioraphy in minimally invasive treatment of gastric cancer

Value of multi-slice spiral CT perigastric angioraphy in minimally invasive treatment of gastric cancer

Screening and minimally invasive treatment for gastric cancer are important challenges in elderly patients

Screening and minimally invasive treatment for gastric cancer are important challenges in elderly patients

Laparoscopy-Assisted Distal Gastrectomy for Gastric Cancer

ObjectiveThe purpose of this study was to evaluate the safety and value of laparoscopy-assisted distal gastrectomy (LADG) for early stage gastric cancer (stages IA, IB, and II). Materials and MethodsWe retrospectively assessed 101 cases treated by LADG and compared to 49 contemporaneous cases treated by open distal gastrectomy (DG) between 2001 and 2006. Clinical variables, such as tumor diameter, operation time, blood loss, number of lymph nodes dissected, and length of stay were investigated. ResultsTumor size (mm) was significantly smaller in the LADG group (p < 0.0001). Although operation time (min) in the two groups was similar (278 ± 57 vs. 268 ± 55), mean blood loss was significantly higher in the DG group (139 ± 181 vs. 460 ± 301, p < 0.0001). Fewer lymph nodes were harvested in the LADG group (27 ± 14 vs. 34 ± 19, p = 0.012). Hospital stay was longer in the DG group (13.3±8.5 vs. 16.7 ± 10.5, p = 0.034). There was no mortality in either group. Postoperative surgical complications occurred in six (6%) of the LADG and four (8%) of the DG. ConclusionsThe authors conclude that laparoscopy-assisted distal gastrectomy is a safe and useful operation for early-stage gastric cancers. If patients are selected properly, laparoscopy-assisted distal gastrectomy can be a curative and minimally invasive treatment for gastric cancer.

Laparoscopic Surgery for Gastric Cancer: 5 years' Experience

The purpose of this study was to clarify the safety and value of laparoscopic surgery for gastric cancer. This retrospective study involved 101 patients with gastric cancer treated with laparoscopic surgery at the Nippon Medical School Hospital from February 2001 through July 2005. The following variables were evaluated: age, sex, comorbid conditions, tumor size, location, gross type, histological type, depth of wall invasion, and presence or absence of lymph node metastasis. The surgical variables investigated included operating time, blood loss, postoperative complications, and length of postoperative stay. Mean tumor diameter was 24.1 +/- 18.4 mm, and most tumors were located in the lower third of the stomach. Endoscopic examination revealed that 98 of the tumors were early gastric cancers. The mean operation time was 255 +/- 74 min, and mean blood loss was 128 +/- 162 g. Local gastrectomy without lymphadenectomy was performed in 13 cases, and pylorus-preserving gastrectomy with perigastric lymphadenectomy was performed in 16 cases. Distal gastrectomy with systemic lymphadenectomy was performed in 56 cases. Proximal or total gastrectomy with lymph node dissection for tumors located in the upper half of the stomach was performed in 16 cases. The mean postoperative hospital stay was 13.3 +/- 7.6 days. No patients died during the admission. Postoperative surgical complications occurred in 10 patients (10%) and consisted of anastomotic bleeding in 3 patients, pneumohypoderma in 1 patient, and remote infection in 6 patients. The only medical complication was a stroke in 1 patient. We conclude that laparoscopy-assisted gastrectomy is a safe and useful operation for most early gastric cancers. If patients are selected properly, laparoscopy-assisted gastrectomy can be a curative and minimally invasive treatment for gastric cancer.

Minimally invasive treatment for gastric cancer: Approaches and selection process

Minimally invasive treatment of gastric cancer has emerged as a result of the technical advances, better understanding of gastric physiology, and more knowledge of the biologic behavior of gastric cancer. This treatment results in improved quality of life embodied by smaller incisions, reduced length of hospital stay, and a faster return to productive life. However, minimally invasive treatment for gastric cancer must take into consideration the potential effects of these techniques on tumor dissemination at the time of the treatment procedure, as well as the rates of recurrence and overall survival. Several technical treatment approaches to gastric cancer have now become possible, utilizing endoscopy, laparoscopy, or an open method. Endoscopic mucosal resection (EMR), limited resection, and laparoscopic surgical resection are the currently practiced modalities as the minimally invasive treatment. Lymph node dissection with the minimally invasive techniques is a barrier to its wide application. Although it is not commonly performed in Western countries, the use of minimally invasive treatment for gastric cancer is growing, especially in Korea and Japan. Minimally invasive treatment for early gastric cancer (EGC) has already been shown to be safe and effective in many retrospective series though no prospective randomized studies comparing it to open resection have been performed. Therefore, routine implementation of these procedures must await confirmatory outcomes generated by well-done randomized prospective clinical trials.

Combined evaluation of mucin antigen and E-cadherin expression may help select patients with gastric cancer suitable for minimally invasive therapy.

MUC1 mucin is known to be highly expressed in carcinomas that show invasive growth and poor prognosis. Impairment of adhesion molecule E-cadherin expression has been widely accepted as a critical event for cancer invasion and metastasis. The present study evaluated the combination of mucin and E-cadherin status as a possible predictor of patients suitable for minimally invasive therapy for gastric cancer. Two hundred and nine paraffin-embedded specimens of gastric carcinoma (141 early, 68 advanced) were examined by immunohistochemical staining using monoclonal antibodies against MUC1 mucin (MUC-1-CORE, DF3), MUC2 mucin (Ccp58) and E-cadherin (anti-E-cad). Gastric carcinoma with MUC1-positive expression demonstrated malignant characteristics. Normal E-cadherin expression showed an inverse correlation with MUC1 expression. Patients with early gastric carcinoma who had a combination of normal E-cadherin and MUC1-negative expression had no recurrence and a favourable prognosis. Moreover, cancers with normal E-cadherin/MUC1-negative expression were not found at an advanced stage in differentiated-type carcinoma. A normal E-cadherin/MUC1-negative expression pattern in gastric cancer is a favourable marker. Preoperative estimation of the E-cadherin and MUC1 status of an endoscopic biopsy specimen may help select appropriate patients for minimally invasive treatment of gastric cancer.