Laparoscopic Gastric Cancer Research Articles

Real-world data analysis of 3012 patients undergoing laparoscopic radical gastrectomy in a single center over the past 12 years

Real-world data analysis of 3012 patients undergoing laparoscopic radical gastrectomy in a single center over the past 12 years

Small steps to thousands of miles: a tribute to Chinese laparoscopic gastric cancer surgery

Laparoscopic surgery for gastric cancer has been developed in China for more than 20 years. It has gone through the initial stage of exploration in the 1990s, the stage of learning and accumulation in the early 21st century, the stage of development and expansion in the 2010s, and the current stage of standardization, and innovation. Laparoscopic gastric cancer surgery in China has developed from less to more, from more to popular. Surgical techniques have gradually become mature, innovated, and standardized, medical evidence has accumulated, and academic exchanges have become increasingly active and valued by the world. In the future, it is expected to make new progress and breakthrough in tumor specific laparoscopic navigation surgery system, intelligent robotic gastric cancer surgery platform, functional preservation surgery for early gastric cancer under the integration of gastroenterologists and surgeons, and laparoscopic comprehensive treatment for peritoneal metastasis. By reviewing the development of laparoscopic gastric cancer surgery in China, the authors draw inspiration from the depths of history, inherit and innovate, look forward to the future, and pay tribute to the predecessors.

Effects of Laparoscopic versus Open Surgery for Advanced Gastric Cancer after Neoadjuvant Chemotherapy: A Meta-Analysis.

To evaluate the efficacy of laparoscopy and laparotomy after neoadjuvant chemotherapy in the treatment of advanced gastric cancer by meta-analysis. Cochrane Library, Embase, and PubMed were searched by computer until December 1, 2021. Literature was screened according to inclusion and exclusion criteria, and relevant data were extracted for meta-analysis using RevMan 5.3. A total of 1027 patients from 11 literature studies were included in this study, including 413 patients in the laparoscopic group and 614 patients in the open group. Meta-analysis showed that the laparoscopic group had less intraoperative bleeding (SMD = -1.11; 95% CI: -1.75-0.47; P=0.0006), early postoperative exhaust (SMD = -0.45; 95% CI: -0.70-0.20; P=0.0004), and shorter postoperative hospital stay (SMD = 0.97; 95% CI: 1.69∼0.26; P=0.008), but had longer the operation time (SMD = 0.65; 95% CI: 0.52∼0.79; P < 0.00001). There was no significant difference in the number of lymph nodes dissected during operation (SMD = -0.45; 95% CI: -0.42-0.19; P=0.45), the incidence of surgical complications 30 days after operation (OR = 0.78; 95% CI: 0.53∼1.13; P=0.19), time of first defecation (MD = 0.00; 95% CI: -0.10∼0.10; P=0.98), and time of first postoperative feeding (MD = -0.05; 95% CI: -0.22∼0.12; P=0.54) between the two groups. For long-term prognosis, there was no significant difference in the 3-year overall survival rate after operation between the two groups (RR = 0.84; 95% CI: 0.63-1.12; P=0.23). Compared with the open stomach cancer surgery, laparoscopic gastric cancer surgery has less intraoperative blood loss, shorter hospitalization time, and advantages such as early rehabilitation, postoperative complications rate, and long-term survival, which confirmed the validity and security of the laparoscopic surgery.

Laparoscopic gastric cancer surgery for 65 age and elderly patients: A single center experience

Therapeutic modalities for elderly gastric cancer (GC) patients have enlarged with extended life expectancy. The aim of this study was to investigate the outcomes of surgical therapies for GC patients of age 65 and older with a single center experience. Eighty-eight patients who underwent laparoscopic surgery for GC were included in the study. The relationships between surgical methods and clinicopathological or prognostic features were analyzed. The median age of the patients was 72 (65-91) years. Sixty patients (75%) were male. The median BMI was 25 kg/m2 (17.5-42). The most common ASA score was 2 (n=58, 72.5%) and tumors were mostly localized in the distal 1/3 of the stomach (n=39, 48.7%). The median CEA and CA19-9 levels were 1.94 ng/ml(0.07-93.8)and 10IU/ml (0.05-449.3), respectively. Eleven patients (13.8%) hadprevious abdominal surgery history. The most common operation type was subtotal gastrectomy (n=33, 41.3%). The median operation time was 300 min (45-720) and the median intraoperative blood loss was 100 ml (0-800). There were eleven conversion (13.8%). The median first time to oral intake was 2 days (1-10) and length of hospital stay was 7 days (1-48). Postoperative serious complications occurred in fourteen (17.5%) patients. The mean of retrieved lymph node was 30.27 ± 17.08. The most common pathological T stage was T4 (53.75%). The mediantime to chemotherapy was 41 days (6-220). Laparoscopic gastric surgery is a safe and feasible method that can be performed in elderly patients with appropriate oncological principles. The risk of surgery is substantially higher in elderly patients. Therefore, maximal attention should be paid to perioperative care for the prevention and treatment of perioperative complications.

Previous open gastric surgery is not a contraindication for laparoscopic gastric cancer surgery

Previous open gastric surgery is not a contraindication for laparoscopic gastric cancer surgery

The association between psoas muscle area index and morbidity/mortality in laparoscopic gastric cancer surgery

As advanced gastric cancer often leads to obstruction or cancer-related cachexia, gastric cancer seems to have a closer association with sarcopenia than other types of cancer. Our study aim was to investigate the relationship between the psoas muscle area (PSMA) and morbidity and mortality in patients undergoing gastric cancer surgery. The data of patients who underwent laparoscopic gastric resection between November 2014 and April 2020 were analyzed retrospectively. The intervertebral disc space was verified at L3-4 in the sagittal plane. The PSMA on the right and left sides were measured separately and then added to obtain the total PSMA. This value was then divided by the patient's height (m2) to calculate the psoas muscle area index (PSMAI) (mm2/m2). The mean PSMAI of men (741.1 mm2/m2) was significantly higher than that of women (502.1 mm2/m2) (p&lt;0.001). While there was a positive correlation between the PSMAI and BMI (r:0.352, p:0.019 in women; r:0.447, p&lt;0.001 in men), the correlation between PSMAI and age was negative (r: -0.369, p:0.014 in women; r:-0.349, p&lt;0.001 in men). PSMAI was statistically lower in patients with attendant morbidity (p:0.035). There was no significant relationship between PSMAI and the first 30-day mortality rate (p:0.096); however, the association between PSMAI and both the 90-day mortality rate (p:0.023) and the total mortality rate (p:0.046) were significant. In our opinion, assessing gastric cancer patients for sarcopenia and supporting them with the necessary nutrition and exercise program prior to surgery can help predict and lower postoperative morbidity and mortality rates.

Is Prognostic Nutritional Index an Indicator for Postoperative 90-Day Mortality in Laparoscopic Gastric Cancer Surgery?

Gastic cancer is a life-threatening malignancy in the world. The aim of this study was to investigate the clinical significance of the prognostic nutritional index (PNI) as a guiding marker for gastric cancer patients with laparoscopic gastrectomy. We retrospectively examined the medical records of 138 gastric cancer patients who had adenocarcinoma pathological diagnosis and operated laparoscopically. Patients were divided into two groups (survived and death) and these groups were compared with clinical and laboratory parameters results. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Logistic regression analyses were performed to identify the risk factors of 90-day mortality. The median age of the study cohort was 62.5 (19–91) years, 98 (71%) were males, and 9 (6.5%) patients died during the 90-day after laparoscopic gastrectomy. The PNI levels were significantly lower in death group compared with survived group 37.5 (25–47.1) to 46.9 (22.8–64.9). The PNI (Odds Ratio = 0.81, 95% Confidence Interval 0.70–0.92, p = 0.003) was found as an independent factor for 90-day mortality in multivariate analysis. Receiver operating characteristic (ROC) curve analysis showed that 45.15 is the best-cutoff value for 90-day mortality after laparoscopic gastrectomy. 90-day mortality rate of PNI > 45.15 was 2.2% and PNI ≤ 45.15 was 13.6% found. Lower PNI is associated with increased 90-day mortality in laparoscopic gastrectomy for gastric cancer. The PNI may be a useful marker for predicting the 90-day mortality of gastric cancer patients after laparoscopic gastrectomy.

The Contribution of the Hunger Hormone Leptin in the Aetiology of Postoperative Anorexia after Laparoscopic and Open Gastrectomy in Gastric Cancer Patients.

Background: Laparoscopic surgery produces lesser postoperative inflammation with a smaller cytokine and leptin response, and might thus reduce postoperative anorexia compared with open surgery. The aim of the present study was to determine the role of serum leptin in postoperative anorexia after laparoscopic gastric cancer surgery. Methods: Fifty-four consecutive patients with adenocarcinoma of the stomach were operated on either with open or laparoscopic surgery. Correlations were determined between the serum levels of leptin, clinico-pathological characteristics, serum haemoglobin, and albumin. Results: Serum leptin levels on day seven were correlated significantly to gender (p = 0.004), body mass index (BMI) (p = 0.002), and tumour grade (p = 0.033). In the patients with C-reactive protein (CRP) < 100 mg/L (n = 46) the leptin levels on day seven were significantly lower after the laparoscopic operation (p = 0.042) and in patients with lower BMI (p = 0.001). The linear regression model determined a significant correlation between the relative concentration of leptin on day seven and laparoscopic surgery (Beta−0.688; p < 0.0001), gender, BMI, location of the tumour, T stage, N stage, perioperative therapy, tumour grade, perineural invasion, Lauren histological type, and ulceration. In patients with CRP levels below 100 mg/mL, the serum level of albumin on day seven after surgery was significantly higher in patients after laparoscopic surgery. Conclusion: Laparoscopic surgery produced significantly lower relative leptin concentrations on day seven, and higher serum albumin levels in the subgroup with CRP levels below 100 mg/L at discharge. These results suggested that laparoscopic gastric cancer surgery might reduce postoperative leptin response, leading to a better nutritional status at discharge compared with open surgery.

The effect and clinical significance of using nathanson liver retractor on liver function tests in laparoscopic gastric cancer surgery.

There are very few studies in the literature investigating the changes caused by the Nathanson retractors in liver function tests (LFT) after LG and its clinical significance. The present study investigated the changes made by the Nathanson retractor used during LG on LFT and its clinical significance. The data of 236 patients, who underwent radical gastrectomy for primary gastric cancer at Surgical Oncology Unit in the period between January 2015 and January 2020 were retrospective studied. The patients were divided into two groups: laparoscopic gastrectomy (LG; 136 cases) and open gastrectomy (OG; 106 cases). Patients who have undergone cholecystectomy, with primary or secondary liver tumors, with chronic hepatic disease, who have preoperative high ALT, AST and bilirubin values were excluded from the study. LFT were measured preoperatively and postoperative day 1 (LFT1), LFT3, LFT5 and LFT7. LFT: ALT, AST and Total bilirubin (BIL). ALT1, ALT3, ALT5, ALT7 ALT values and AST1, AST3, AST5 AST values of the patients in the LG group were found to be significantly higher (P &lt;0.001). Mean total bilirubin values of the groups were similar (P &gt;0.05). In order to evaluate how the increase in LFT due to the use of the Nathanson retractors reflected on the patients&apos; clinic, we divided the patients who underwent LG into two groups based on ALT increase in ALT1: Normal and Elevated. The in-hospital mortality rates (P = 0.080) and oral nutrition time (P = 0.913) of the groups were similar. No liver infarction developed in any of the groups. The duration of stay in the ICU was significantly longer in individuals with elevated LFT (P = 0.019). Although the use of the Nathanson retractor during LG causes an increase in liver function tests, this does not cause major clinical problems in patients. Key Words: Gastrectomy; gastric cancer; laparoscopy; liver enzymes; liver dysfunciton.

East meets West: the initial results of laparoscopic gastric cancer resections with Eastern principles in a single Western centre - a propensity score-matched study.

We compared the initial experience of totally laparoscopic gastric cancer surgery with Eastern principles with the results of propensity score-matched counterparts operated with open surgery. From 1163 patients stored in our database, 62 PSM patients were selected for this study. The quality control was assured with video documentation and standardisation of the procedures. According to the distribution of age, comorbidities, and general health, patients in the LG and OG were well-balanced. Most of the patients in both groups had advanced gastric cancer (69.3%). In the OG, 67.8% of patients received a total gastrectomy, as well as 54.8% of patients in the LG. There was no significant difference in the postoperative mortality between groups. The recovery of bowel function was significantly faster, and postoperative pain was significantly decreased in the LG. Compared to the OG, the inflammatory response was significantly smaller in the LG. There was no significant difference in the overall survival between LG and OG patients. We have shown that laparoscopic gastrectomy with Eastern principles can be safely introduced in a high-volume Western centre with sufficient laparoscopic training. We have also shown that laparoscopy offers a significant faster bowel function recovery, less postoperative pain, and a smaller inflammatory response.

Value of preoperative gastroscopic carbon nanoparticles labeling in patients undergoing laparoscopic radical gastric cancer surgery

Lymph node metastasis is crucial for gastric cancer. We aim to explore the value of preoperative gastroscopic carbon nanoparticles labeling in patients undergoing laparoscopic radical gastric cancer surgery. 1199 cases undergoing laparoscopic radical gastric cancer surgery were retrospectively analyzed. 214 cases received preoperative gastroscopic carbon nanoparticles labeling. The number of total lymph nodes detected, positive lymph nodes, N staging, and operation time were analyzed. The patients received carbon nanoparticles labeling had more total lymph nodes detected (27.9±6.5 vs 22.2±4.0; P ＜ 0.001) and shorter operation time (185.9±27.8min vs 218.7±69.2min; P ＜ 0.001) compared with the control group. In addition, preoperative endoscopic carbon nanoparticles labeling improved the diagnosis rate of synchronous multiple gastric cancer (2.8% vs 0.4%; P ＜ 0.001). Preoperative endoscopic carbon nanoparticles tracer labeling is of great value in patients undergoing laparoscopic radical gastric cancer surgery. It shortens the operation time, increases the number of total lymph nodes detected for more accurate pathological TNM staging, and finds some cases of synchronous multiple gastric cancer.

Incisional hernia after minimally invasive gastrectomy in gastric cancer patients.

PurposeAlthough there are several studies on the incidence and risk factors for incisional hernia (IH) after open surgery, data about IH after minimally invasive surgery (MIS) for gastric cancer is rare. This study aimed to identify the incidence and risk factors for IH after MIS in gastric cancer patients.MethodsWe analyzed the clinicopathologic data of patients who had laparoscopic or robotic gastric cancer surgeries between January 2006 and July 2019 at National Cancer Center, South Korea. Risk factors for development of IH were investigated with univariate and multivariate analyses.ResultsA total of 2,769 patients underwent laparoscopic-assisted or robot-assisted gastrectomy with extracorporeal gastric resection and reconstruction, while 1,469 underwent totally laparoscopic or totally robotic gastrectomy (TLRG) with intracorporeal gastric resection and reconstruction. IH repair was performed in 23 patients (0.5%) after gastric cancer surgery. In the multivariate analysis, female sex (odds ratio [OR], 5.23; 95% confidence interval [CI], 2.03–13.43; p = 0.001), high body mass index (BMI) of ≥25 kg/m2 (OR, 4.23; 95% CI, 1.73–10.35; p = 0.002), larger tumor size (OR, 21.67; 95% CI, 5.37–87.34; p < 0.001), and intracorporeal procedure (OR, 5.63; 95% CI, 2.15–14.61; p < 0.001) were independent significant risk factors for IH.ConclusionIH after MIS for gastric cancer is not common. Female sex, high BMI, large tumor size, and intracorporeal procedure were significant risk factors for it in this study. Therefore, in patients with risk factors, surgeons should cautiously close the abdominal wall access wound after MIS for gastric cancer, to prevent IH.

Laparoscopic gastrectomy in remnant gastric cancer.

Remnant Gastric Cancer (RGC) describes cancers occurring in the remaining stomach and/or anastomosis in the follow-up after gastric cancer or benign gastric surgery. RGC is diagnosed in esophago-gastroscopy follow-ups of patients who underwent this surgery in the past. Again, the increase in the success of gastric cancer surgery and following medical treatments has increased the incidence of RGC in long-term follow-up after gastric cancer surgery. Laparoscopic surgery has been also reported in few cases. In the present study, the purpose was to present the results of the first five patients that underwent laparoscopic total gastrectomy due to RGC in our clinic. The patients who underwent laparoscopic gastric cancer surgery between November 2014 and December 2018 were evaluated retrospectively. Mean age of the patients was 62.4 years (ranging between 49 and 74 years). Two of these patients had a surgical history due to gastric cancer and 3 due to peptic ulcer. Surgery was completed laparoscopically in all patients. In the early period, one patient had to undergo re-surgery due to stenosis in Jejuno-Jejunostomy, and the patient died. One patient underwent laparotomy due to colonic stenosis in the second month after the surgery. Recurrence was detected on the 140th and 180th days of follow-up in the other two patients. Laparoscopic surgery is a technically applicable method in RGC; however, it is also a risk factor for past surgical postoperative complications. Early recurrence in this group of patients requires a comparison of open and laparoscopic surgery.

Ultrasound-guided bilateral subcostal transversus abdominis plane block in gastric cancer patients undergoing laparoscopic gastrectomy: a randomised-controlled double-blinded study.

The effectiveness of subcostal transversus abdominis plane block (TAPB) in laparoscopic gastric cancer surgery is unknown. We aimed to investigate its opioid-sparing and pain-relief effects in laparoscopic gastrectomy for gastric cancer. One hundred and twelve patients undergoing elective laparoscopic gastrectomy were randomised to the TAPB or control group. The TAPB group received ultrasound-guided bilateral subcostal TAPB at the end of surgery, while the control group did not. We investigated fentanyl consumption administered via intravenous patient-controlled analgesia and as a rescue analgesic, the numeric rating scale (NRS) pain scores at rest and during coughing, and the opioid-related side effects at 6, 12, 24, and 48h postoperatively. The primary outcome was cumulative fentanyl consumption at 24h postoperatively. The study included 53 patients in each group. The cumulative fentanyl consumption 24h postoperatively was significantly lower in the TAPB group than in the control group (median difference -170 mcg, P = 0.03, 95% CI -360 to -15 mcg). Subcostal TAPB also significantly reduced the resting NRS score at 48h postoperatively (median difference -1, 95% CI -1 to 0, P = 0.01) and coughing NRS score at all time points (all median difference -1, 95% CI -2 to 0, P < 0.01, P =0.02, 0.01, and 0.01, respectively). However, it did not reduce the occurrence of opioid-related side effects, except the use of antiemetics during the first 6h postoperatively (TAPB, 1.9% vs. Control, 15.1%, P = 0.03). Ultrasound-guided bilateral subcostal TAPB provides efficient postoperative analgesia with an opioid-sparing effect after laparoscopic gastrectomy.

Diagnosis of advanced gastric cancer using image enhancement and autofluorescence imaging systems.

The indication of laparoscopic gastrectomy for advanced cases such as serosal invasion or peritoneal dissemination is still controversial. We report the clinical experiences of laparoscopic diagnosis with image enhancement and autofluorescence (AF) systems for laparoscopic gastric cancer surgery. The image enhancement system was introduced to 164 patients who underwent laparoscopic gastric cancer surgery as the AF group. The control group was defined as 165 cases who underwent bright light observation without the image enhancement system. The operative findings were recorded during surgery. All image findings were retrospectively compared with the pathological findings. Furthermore, the relationship between the image and pathological findings for peritoneal dissemination and subserosal invasion was evaluated. This study included 329 patients, divided into the control group of 165 patients (50.2%) and the AF group of 164 patients (49.8%). There was no statistically significant difference in patient background between the two groups. In seven cases of peritoneal dissemination, AF was positive, and macroscopic abnormal vascularization was detected. The sensitivity, specificity, and positive and negative predictive values were 100%, 99.4%, 87.5%, and 100%, respectively. In 29 cases of serosal invasion, AF was positive, and macroscopic abnormal vascularization was detected. In the detection accuracy of subserosal invasion, the sensitivity, specificity, and positive and negative predictive values were 75.7%, 97.6%, 90.3%, and 93.2%, respectively. The image enhancement with the AF system is useful for the laparoscopic intraoperative diagnosis of serosal invasion and peritoneal dissemination for advanced gastric cancer.

First successful case of percutaneous transabdominal thoracic duct embolization (PTTDE) for chylous ascites resulting from laparoscopic gastric cancer surgery

A 61-year-old woman underwent laparoscopy-assisted distal gastrectomy (LADG) with extragastric lymph node dissection (D2). Two months later, she was readmitted to hospital to be treated for chylous ascites. Oral intake was discontinued and total parenteral nutrition started, but increasing body weight and decreasing serum albumin concentration was not controllable. Percutaneous transabdominal thoracic duct embolization (PTTDE) was performed on the 8th day after the readmission. Five days after PTTDE, oral intake was resumed. Seventeen days after PTTDE, the patient was discharged without recurrence of ascites. She has remained asymptomatic. We describe here the first patient with chylous ascites two months after LADG with D2 dissection for early gastric cancer who was successfully treated by PTTDE.

Influence of Neoadjuvant Chemotherapy on Anastomotic Complications and Long-Term Prognosis after Laparoscopic Radical Gastric Cancer Surgery

Objective: To analyze the occurrence of neoadjuvant chemotherapy on anastomotic complications after radical gastric cancer surgery and the influence of anastomotic complications on the long-term prognosis.

Conversion in laparoscopic gastric cancer surgery a highlight on the abdominal access

Aim: The aim of this study was to compare the data of patients who underwent gastric cancer surgery as laparoscopically completedand converted to open surgery and draw attention to complications arising from trocar entry.Materials and Methods: This study included 211 patients who underwent laparoscopic gastric cancer surgery. Patients were dividedin to two groups as laparoscopically completed and converted to open surgery. Demographics parameters and perioperative datawere retrospectively analyzed.Results: The median age of the study group was 62 (19-91) years and 68.2% were males. Conversion occured in 16 patients (7.5%).The reasons for conversion were locally advanced tumor (n=6), complications due to trocar insertion (n=4), technical difficultyin performing esophagojejunostomy anastomosis (n=4), leakage in esophagojejunostomy anastomosis (n=1), and persistentbradycardia (n=1). Intraoperative blood loss was higher and time to oral intake was longer in the conversion group. No significantdifference was found in terms of demographic parameters, operative time, length of hospital stays, the rate of postoperativecomplications, reoperation, 30-day mortality.Conclusion: Complications due to trocar entry is an unpredictable and preventable conversion reason in laparoscopic gastric cancersurgery. Thin patients are riskier for complications during abdominal access. Abdominal access should be performed with an opentechnique in thin patients

Comparing the Impact of Laparoscopic Sleeve Gastrectomy and Gastric Cancer Surgery on Resting-State Brain Activity and Functional Connectivity.

Laparoscopic sleeve gastrectomy (LSG) is one of the most performed bariatric surgeries in clinical practice. Growing neuroimaging evidence shows that LSG induces brain functional and structural alterations accompany with sustained weight-loss. Meanwhile, for clinical treatment of gastric cancer, stomach removal surgery is a similar procedure to LSG. It is unclear if the gastric cancer surgery (GCS) would induce the similar alterations in brain functions and structures as LSG, and it would help to clarify the specificity of the LSG. We recruited 24 obese patients who received LSG in the LSG group and 16 normal weight patients with gastric cancer who received GCS as the control group. Functional magnetic resonance imaging was employed to investigate the differences and similarity of surgery’s impact on resting-state brain activity and functional connectivity (RSFC) between LSG and GCS groups. Both LSG and GCS groups showed increased activities in the posterior cingulate cortex (PCC) and supplementary motor area (SMA) as well as the decreased RSFC of PCC- dorsomedial prefrontal cortex and SMA- dorsolateral prefrontal cortex. There were decreased resting-state activity of hippocampus and putamen in LSG group and increases in GCS group. In LSG group, resting-state activities of hippocampus and putamen were correlated with craving for high-caloric food and body mass index after surgery, respectively. These findings suggest LSG induced alterations in resting-state activity and RSFC of hippocampus and putamen specifically regulate the obese state and overeating behaviors in obese patients.

Laparoscopic treatment advanced gastric cancer in frail patients

Laparoscopic treatment advanced gastric cancer in frail patients