Resection For Proximal Gastric Cancer Research Articles

Complete laparoscopic and Da Vinci robot esophagogastric anastomosis double muscle flap plasty for radical resection of proximal gastric cancer.

To investigate the application value of complete laparoscopy and Da Vinci robot esophagogastric anastomosis double muscle flap plasty in radical resection of proximal gastric cancer. A retrospective descriptive study was used. The clinicopathological data of 35 patients undergoing radical operation for proximal gastric cancer admitted to Liaoning Cancer Hospital from January 2020 to December 2023 were collected. Variables evaluated: 1. Transoperative,2. Postoperative, 3. Follow-up. In relation to follow-up, esophageal disease status reflux, anastomosis, nutritional status score, serum hemoglobin, tumor recurrence, and metastasis were investigated. The trans and postoperative variables were obtained from the clinical records and the patients were followed up in outpatient department and by telephone. Among the 35 patients, 17 underwent robotic surgery and 18 underwent laparoscopic surgery. There were 29 males and 6 females. 1) Transoperative: Robotic surgery: The operation time was (305.59 ± 22.07) min, the esophagogastric anastomosis double muscle flap plasty time was (149.76 ± 14.91) min, the average number of lymph nodes cleared was 30, and the average intraoperative blood loss was 30 ml. Laparoscopic surgery: The mean operation time was 305.17 ± 26.92min, the operation time of esophagogastric anastomosis double muscle flap was (194.06 ± 22.52) min, the average number of lymph nodes cleared was 24, and the average intraoperative blood loss was 52.5 ml. 2) Postoperative: Robotic surgery: the average time for patients to have their first postoperative anal emission was 3 days, the average time to first postoperative feeding was 4 days, and the average length of hospitalization after surgery was 8 days. Laparoscopic surgery: the average time for patients to have their first postoperative anal emission was 5 days, the average time to first postoperative feeding was 6 days, the average length of hospitalization after surgery was 10 days. 3) Follow-up: The follow-up time ranged from 1 to 42 months, with a median follow-up time of 24 months. Complete Da Vinci robot and laparoscopic esophagogastric anastomosis double muscle flap plasty for radical resection of proximal gastric cancer can minimize surgical incision, reduce abdominal exposure, accelerate postoperative recovery of patients, and effectively prevent reflux esophagitis and maintain good hemoglobin concentration and nutritional status. The advantages of robotic surgery is less intraoperative bleeding and faster post-surgical recovery, but it is relatively more expensive.

Clinical application of laparoscopic continuous interposition jejunostomy with double-tract anastomosis and esophagogastric anastomosis: a retrospective study.

The aim of this study was to compare the early clinical outcomes of laparoscopic-assisted proximal gastrectomy with continuous interposition of jejunal cis-peristaltic dual-channel anastomosis and esophagogastric anastomosis. A retrospective analysis of 130 patients who underwent laparoscopic-assisted radical resection of proximal gastric cancer in the Department of Gastrointestinal Surgery at the Affiliated Hospital of Chengde Medical College between June 2018 and October 2022 was conducted. Continuous interposition jejunal double-channel anastomosis (double-tract anastomosis) was used in 71 patients and esophagogastric anastomosis (esophagogastrostomy) in 59 patients. The basic clinical data, preoperative and postoperative clinical test indexes, postoperative complications and improvement of symptoms compared to preoperative ones, basic nutritional status and Visick classification of esophageal reflux symptoms at 6 months after surgery were compared between the two groups. Postoperative contrast images of patients in the continuous interposition jejunal double-tract group were collected and analyzed for the ratio of contrast agent remaining in the stomach to that remaining in the small intestinal channel. A total of 130 cases meeting the criteria were included in this study, including 71 cases involving the double-tract (DT) anastomosis method and 59 cases involving the esophagogastrostomy (EG) anastomosis method. There was no significant difference in preoperative information and perioperative safety between the two groups. Visick score of the DT group was significantly better than that of the EG group. Double-tract jejunal anastomosis can effectively improve esophageal reflux symptoms after proximal gastrectomy. At the same time, its anastomotic method also improves the nutritional status in the short term compared to the esophagogastric anastomosis and is a more ideal procedure for reconstructing the digestive tract after proximal gastrectomy.

Prevention and management of complications related to laparoscopic spleen-preserving hilar lymph node dissection for gastric cancer

Hilar splenic lymph node metastasis is one of the risk factors for poor prognosis in patients with proximal gastric cancer. Laparoscopic spleen-preserving splenic hilar lymph node dissection (LSPSHLD) can effectively improve the survival benefits of patients at high risk of splenic hilar lymph node metastasis. However, LSPSHLD is still a challenging surgical difficulty in radical resection of proximal gastric cancer. Moreover, improper operation can easily lead to splenic vascular injury, spleen injury and pancreatic injury and other related complications, due to the deep anatomical location of the splenic hilar region and the intricate blood vessels.Therefore, in the prevention and treatment of LSPSHLD-related complications, we should first focus on prevention, clarify the indication of surgery, and select the benefit group of LSPSHLD individually, so as to avoid the risk caused by over-dissection. Meanwhile, during the perioperative period of LSPSHLD, it is necessary to improve the cognition of related risk factors, conduct standardized and accurate operations in good surgical field exposure and correct anatomical level to avoid surrounding tissues and organs injury, and master the surgical skills and effective measures to deal with related complications, so as to improve the surgical safety of LSPSHLD.

Impact of proximal resection margin involvement on survival outcome in patients with proximal gastric cancer

AimThe aim of this study was to evaluate the risk factors for proximal resection margin involvement and its impact on survival outcome in patients with proximal gastric cancer.MethodsA total of...

Clinicopathology and Survival in Patients with Gastroesophageal Reflux After Radical Surgery of Proximal Gastric Cancer.

Gastroesophageal reflux (GR) after radical resection of proximal gastric cancer (PGC) may influence survival; however, few studies have investigated survival in PGC patients who develop GR following radical resection. This study aimed to correlate the occurrence of GR after proximal gastrectomy (PG) and total gastrectomy (TG) with clinicopathological factors and long-term survival. The PGC patient cohort was retrospectively grouped as follows: postoperative patients with and without GR (NGR). Clinicopathological characteristics and survival data were compared between the two groups. A total of 88 patients who underwent PG (53%) experienced postoperative GR; however, only 30 patients who underwent TG (14%) experienced GR (P=0.000). The incidence of GR was significantly associated with surgical procedure (P<0.01), tumor size (P<0.01), infiltration depth (P<0.01), lymph node metastasis (P=0.018), postoperative distant metastasis (P<0.01) and recurrence (P=0.001). The 5-year overall survival of the GR group was significantly worse than that of the NGR group (39.3 vs. 46.5%, respectively; P=0.046). The PG and TG groups had significantly different 5-year overall survival (45.2 vs. 50.9%, respectively; P=0.047), and multivariate analysis revealed GR as an independent risk factor associated with poor overall survival. Patients who experienced GR after radical resection for PGC were more likely to develop recurrence and metastasis, leading to shorter survival. TG for PGC was associated with a more favorable 5-year overall survival than was PG. Thus, TG should be performed for PGC patients with tumors larger than 5cm, T3/T4 disease or lymph node metastasis to improve their long-term survival.

TREATMENT OUTCOMES OF PROXIMAL GASTRIC CANCER DEPENDING ON THE EXTENT OF SURGICAL RESECTION

Surgical resection for proximal gastric cancer remains an important problem of oncology. Personalized surgical management represents one of the main challenges in treating gastric cancer. The aim of the study was to analyze surgical outcomes of proximal gastric cancer depending on the tumor spread, extent of surgery and the presence of intraperitoneal free cancer cells. Material and Methods. The study included 68 patients with morphologically verified locally advanced proximal gastric cancer. The patients were divided into 2 groups. Group I consisted 37 patients, who underwent total gastrectomy of 31 patients; Group II comprised who underwent proximal subtotal gastrectomy. Results. The overall three-year survival was 48.7 ± 16.9 % in Group I and 66.4 ± 13.2 % in Group II patients. The 3-year progressive-free survival rate was 51.5 ± 18.5 % after proximal subtotal gastrectomy and 34.8 ± 25.6 % after total gastrectomy. The presence of tumor cells in the abdominal cavity was proven to lead to early carcinomatosis. Thus, the 2-year overall survival rate was 26.7 ± 42.8 % in patients in whom free cancer cells were found in peritoneal washings and 69.8 ± 9.0 % in patients with negative cytology findings from washings. Conclusion. Proximal subtotal gastrectomy provides better survival rates compared to total gastrectomy in patients with locally advanced proximal gastric cancer. Local spread of the tumor, which is known to significantly increase the risk of lymph node metastasis and contamination of the peritoneal cavity with cancer cells, is one of the main unfavorable prognostic factors.

Laparoscopic spleen-preserving hilar lymph node dissection through pre-pancreatic and retro-pancreatic approach in patients with gastric cancer.

BackgroundThe conventional radical resection of proximal gastric cancer is even more risky when performed laparoscopically, though this technique is widely used in gastrointestinal surgery and is accepted as the superior method. This paper explores the feasibility of laparoscopic spleen-preserving hilar lymph node dissection using a retro-pancreatic approach for the treatment of proximal gastric cancer.MethodsTwo cadavers were dissected for examination of and the pre-pancreatic and retro-pancreatic spaces. Following the dissection of the cadavers, ten live patients with proximal gastric cancer from May 2008 to May 2013 at Nanfang Hospital, Guangzhou, China, were given total gastrectomy and adjuvant splenic hilar lymph node clearance through pre-pancreatic and retro-pancreatic approach on the precondition of preserving the pancreas and spleen. The clinicopathologic characteristics, as well as the intraoperative and postoperative variables affecting the procedure, were observed and analyzed.ResultsAnatomy of the space anterior and posterior to the pancreas in the two cadavers demonstrated the feasibility of pre-pancreatic and retro-pancreatic approach. The surgeries were all successfully performed laparoscopically; conversion to laparotomy was not necessary for any of the ten patients. The overall mean operative time was 243.6 ± 45 min. The mean estimated blood loss was 232 ± 80 ml. At the time of follow-up (median 12 months post-surgery), there had been neither local recurrence nor mortality in any of the patients.ConclusionLaparoscopic spleen- and pancreas-preserving splenic hilar lymph node dissection during total gastrectomy, using both pre-pancreatic and retro-pancreatic approaches, is indicated as a safe and feasible method for the treatment of proximal gastric cancer.

Laparoscopy-assisted resection of proximal gastric cancer: is less than all more or less complete, or is all more, nonetheless?

The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2012 In this issue of Gastric Cancer, Ahn et al. [1] present a series of 131 patients with early-stage proximal gastric cancer who underwent laparoscopic resection, either in the form of laparoscopy-assisted total gastrectomy (LATG) or that of laparoscopy-assisted proximal gastrectomy (LAPG). The comparison of these two minimally invasive techniques with assessment of multiple early and late measures of outcomes is intriguing, and although not being based on a randomized trial deserves careful recognition and analysis. Fifty LAPG patients had lower intraoperative blood loss and operative times than 81 patients after LATG, but no obvious differences of early postoperative recovery or longer-term survival outcomes were found, with the main group differences consisting of delayed complications and functional parameters. The results generally appear to be excellent, with good postoperative outcomes indicative of proper patient selection and appropriate conduct of the operative procedures. With respect to a comparison of proximal versus total gastrectomy in a laparoscopy-assisted approach, these findings seem to resemble those results found after an open approach to total and proximal gastrectomy that showed no differences between the techniques regarding early postoperative and late oncological outcomes, but indicated possible functional differences between these groups [2]. Are the authors just wrapping the old debate on total versus proximal gastrectomy for proximal gastric cancer into a minimally invasive package here, or is their experience telling us more? We think that this series highlights several relevant aspects and poses some questions that deserve further comment.

Prognostic factors for patients after curative resection for proximal gastric cancer

The factors influencing the long-term survival of patients with proximal gastric cancer (PGC) after curative resection were investigated. Data from 171 patients who underwent curative resection for PGC were retrospectively analyzed. The patients were grouped according to the clinicopathological factors and operative procedures. The tumor depth (T stage) and lymph node metastasis (pN stage) were graded according to the fifth edition of TNM Staging System published by UICC in 1997. The metastatic lymph node ratio (MLR) was divided into four levels: 0%, <10%, 10%-30% and >30%. The data of survival rate were analyzed by Kaplan-Meier method (log-rank test) and Cox regression model. The 5-year overall survival rate of 171 patients was 37.32%. The univariate analysis demonstrated that the survival time of the postoperative patients with PGC was related to tumor size (chi2=4.57, P=0.0325), gross type (chi2=21.38, P<0.001), T stage (chi2=27.91, P<0.001), pN stage (chi2=44.72, P<0.001), MLR (chi2=61.12, P<0.001), TNM stage (chi2=44.91, P<0.001), and range of gastrectomy (chi2=4.36, P=0.0368). Multivariate analysis showed that MLR (chi2=10.972, P=0.001), pN stage (chi2=6.640, P=0.010), TNM stage (chi2=7.081, P=0.007), T stage (chi2=7.687, P=0.006) and gross type (chi2=6.252, P=0.012) were the independent prognostic factors. In addition, the prognosis of patients who underwent total gastrectomy (TG) was superior to that of patients who underwent proximal gastrectomy (PG) for the cases of tumor>or=5 cm (chi2=6.31, P=0.0120), Borrmann III/IV (chi2=7.96, P=0.0050), T4 (chi2=4.57, P=0.0325), pN2 (chi2=5.52, P=0.0188), MLR 10%-30% (chi2=4.46, P=0.0347), MLR>30% (chi2=13.34, P=0.0003), TNM III (chi2=14.05, P=0.0002) or TNM IV stage (chi2=4.37, P=0.0366); and combining splenectomy was beneficial to the cases of T3 (chi2=5.68, P=0.0171) or MLR>30% (chi2=6.11, P=0.0134). It was concluded that MLR, pN stage, TNM stage, T stage, and gross type had advantages in providing a precise prognostic evaluation for patients undergoing curative resection for PGC, in which MLR was the most valuable index. TG and combining splenectomy were useful to improve the prognosis to patients with PGC of TNM III/IV stage, serosa invasion, or extensive regional lymph node metastasis.

Total gastrectomy is not necessary for proximal gastric cancer

Background: Although there is an increasing incidence of proximal gastric cancers in the United States, the appropriate extent of resection for proximal gastric cancer is not known. This study addresses whether the type of operation (total gastrectomy [TG] vs proximal gastrectomy [PG]) affects outcome for proximal gastric adenocarcinoma. Methods: Review of the prospective gastric database at Memorial Sloan–Kettering Cancer Center from July 1985 to August 1995 identified 391 patients with proximal gastric cancer. Of those patients, 98 underwent curative TG or PG through an exclusively abdominal approach. Patients undergoing esophagogastrectomy (n = 293) were excluded from analysis. Data are expressed as medians and ranges. Results: The length of hospital stay was the same for patients undergoing resection for PG (16.5 days [range 8 to 55]) and for TG (18 days [range 8 to 48]). In addition, hospital mortality rates for PG (6.0%) were similar to those for TG (3.0%). There was no significant difference in tumor differentiation and overall stage between the groups that underwent TG and those that underwent PG. There was no significant difference in time to recurrence between the two operative groups (PG, 15.7 months, versus TG, 18 months). In addition, there was no association between first site of recurrence and type of procedure. The overall 5-year survival rate for proximal gastric cancer was 43% (median survival 46 months), whereas the 5-year survival rate for TG was 41% (median survival 51 months; difference not significant). Conclusions: The extent of resection for proximal gastric cancer does not affect long-term outcome. TG and PG have similar overall survival rates and time and rate of recurrence, and both procedures can be accomplished safely. (Surgery 1998;123:127-30.)

Survival benefit of extended D2 resection for proximal gastric cancer.

The long-term survival of patients with adenocarcinoma of the proximal stomach remains dismal. Despite its increasing frequency and poor prognosis, a general consensus has not been reached on the extent of surgical resection. The significance of extended lymph node dissection (D2 gastrectomy) for the surgical treatment of patients with proximal gastric cancer was evaluated. Sixty-two patients who underwent a potentially curative total or proximal gastric resection were retrospectively divided by extent of lymphadenectomy into two groups: the extended resection group (D2,D2.5) and limited resection group (D1,D1.5). Survival rates were estimated by the method of Kaplan and Meier [J Am Stat Assoc 53:457-486, 1958] and the differences compared by the log rank test. Multivariate analysis of prognostic parameters was performed using the Cox proportional hazard model. The median overall survival time for the extended resection group (D2,D2.5) was 34 months compared to 18 months for patients treated by a more limited resection (D1,D1.5). Patients treated with extended resection had an estimated 5-year overall survival rate of 37% compared to 21% for patients treated with limited resection. This difference was statistically significant with a P value of 0.04. The median disease-free interval for the extended resection group was 31 months compared to 17.6 months for patients in the limited resection group. The 5 year disease-free survival rate for both groups was 37% and 17%, respectively (P = 0.09). Extent of lymphadenectomy and stage of disease were found to be independent predictors of overall and cancer-free survival. Patients treated with an extended lymph node dissection (D2 gastrectomy) were more likely to survive 5 years, had longer disease-free intervals, and prolonged median survival times (particularly patients with T1-3,N0-1,M0 cancers) as compared to those patients treated with a more limited lymph node dissection (D1,D1.5). These differences reached or approached statistical significance.