Surgical Treatment Of Gastric Cancer Research Articles

Updated systematic review and meta‑analysis for risk predictors of 30‑day unplanned readmission following gastric cancer surgery.

Readmission to hospital is a common occurrence due to adverse post-operative events. The primary objective of the present study was to examine the possible risk predictors for 30-day unplanned readmissions after the surgical treatment of gastric cancer. The secondary aim was to determine the clinical characteristics that are associated with readmission. Studies that reported the risk factors and clinical characteristics of patients with gastric cancer who had an unplanned 30-day post-operative readmission were identified systematically from PubMed, Cochrane Central Register of Controlled Trials, Web of Science and Embase databases, with a final search date of March 30, 2024. A systematic review and meta-analysis were then performed to estimate the risk predictors and relevant clinical characteristics for readmission. A total of 16,154 patients from 12 studies were included in the present study, with 1,736 patients who were readmitted and 14,418 patients who were not readmitted. A higher proportion of patients with an age ≥70 years, cardiovascular comorbidity, Nutritional Risk Screening (NRS) 2002 score ≥3, respiratory diseases, male sex, American Society of Anesthesiologists score ≥3, combined multi-organ resection, greater depth of invasion (T3-4/T1-2), discharge to home with provision of care services, neoadjuvant therapy, post-operative complications or a blood transfusion were found in the readmission group compared with that in the non-readmission group. A meta-analysis was also performed to calculate risk predictors using the results of multivariate regression analyses from the original literature. This identified cardiovascular comorbidity, NRS 2002 score ≥3, pancreatectomy and post-operative complications as risk predictors for 30-day unplanned readmission following surgery for gastric cancer. Therefore, it is recommended that extra attention and support should be given to patients with these high-risk predictors during the perioperative period.

Clinical Application Analysis of Laparoscopic-Assisted Total Gastrectomy in the Surgical Treatment of Gastric Cancer

Objective: To investigate the clinical application effect of laparoscopic-assisted total gastrectomy in the surgical treatment of gastric cancer. Methods: The clinical data of 86 COPD patients included in the study were collected and divided into 43 cases each in Groups A and B using the randomization method, with open total gastrectomy in Group A and laparoscopic-assisted total gastrectomy in Group B. The clinical indexes, pain levels, and complications of patients in the two groups were observed in combination with the indexes. Results: The baseline data of the two groups of patients were not statistically significant (all P > 0.05); the operation time, incision length, first flatulence time, and hospitalization time of patients in Group B were shorter than those in Group A (all P = 0.000); the NRS scores of patients in Group B on the 1st postoperative day and the 2nd postoperative day were significantly lower than those in Group A (t = 23.443, t = 28.784, all P = 0.000); the total complication rate of patients in Group B (1; 2.33%) was significantly lower than that of Group A (9; 20.94%) (χ2 = 7.242, P = 0.007). Conclusion: In the surgical treatment of gastric cancer, laparoscopic-assisted total gastrectomy can promote patients’ recovery, reduce patients’ pain, and lower the probability of complications.

Development and validation of a prognostic immunoinflammatory index for patients with gastric cancer

BACKGROUND Studies have demonstrated the influence of immunity and inflammation on the development of tumors. Although single biomarkers of immunity and inflammation have been shown to be clinically predictive, the use of biomarkers integrating both to predict prognosis in patients with gastric cancer remains to be investigated. AIM To investigate the prognostic and clinical significance of inflammatory biomarkers and lymphocytes in patients undergoing surgical treatment for gastric cancer. METHODS Univariate COX regression analysis was performed to identify potential prognostic factors for patients with gastric cancer undergoing surgical treatment. Least absolute shrinkage and selection operator-COX (LASSO-COX) regression analysis was performed to integrate these factors and formulate a new prognostic immunoinflammatory index (PII). The correlation between PII and clinical characteristics was statistically analyzed. Nomograms incorporating the PII score were devised and validated based on the time-dependent area under the curve and decision curve analysis. RESULTS Patients exhibiting elevated neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune inflammatory index displayed inferior progression-free survival (PFS) and overall survival (OS). Conversely, low levels of CD3(+), CD3(+) CD8(+), CD4(+)CD8(+), and CD3(+)CD16(+)CD56(+) T lymphocytes were associated with improved PFS and OS, while high CD19(+) T lymphocyte levels were linked to worse PFS and OS. The PII score demonstrated associations with tumor characteristics (primary tumor site and tumor size), establishing itself as an independent prognostic factor for both PFS and OS. Time-dependent area under the curve and decision curve analysis affirmed the effectiveness of the PII-based nomogram as a robust prognostic predictive model. CONCLUSION PII may be a reliable predictor of prognosis in patients with gastric cancer undergoing surgical treatment, and it offers insights into cancer-related immune-inflammatory responses, with potential significance in clinical practice.

Deep learning model for predicting postoperative survival of patients with gastric cancer.

Prognostic prediction for surgical treatment of gastric cancer remains valuable in clinical practice. This study aimed to develop survival models for postoperative gastric cancer patients. Eleven thousand seventy-five patients from the Surveillance, Epidemiology, and End Results (SEER) database were included, and 122 patients from the Chinese database were used for external validation. The training cohort was created to create three separate models, including Cox regression, RSF, and DeepSurv, using data from the SEER database split into training and test cohorts with a 7:3 ratio. Test cohort was used to evaluate model performance using c-index, Brier scores, calibration, and the area under the curve (AUC). The new risk stratification based on the best model will be compared with the AJCC stage on the test and Chinese cohorts using decision curve analysis (DCA), the net reclassification index (NRI), and integrated discrimination improvement (IDI). It was discovered that the DeepSurv model predicted postoperative gastric cancer patients' overall survival (OS) with a c-index of 0.787; the area under the curve reached 0.781, 0.798, 0.868 at 1-, 3- and 5- years, respectively; the Brier score was below 0.25 at different time points; showing an advantage over the Cox and RSF models. The results are also validated in the China cohort. The calibration plots demonstrated good agreement between the DeepSurv model's forecast and actual results. The NRI values (test cohort: 0.399, 0.288, 0.267 for 1-, 3- and 5-year OS prediction; China cohort:0.399, 0.288 for 1- and 3-year OS prediction) and IDI (test cohort: 0.188, 0.169, 0.157 for 1-, 3- and 5-year OS prediction; China cohort: 0.189, 0.169 for 1- and 3-year OS prediction) indicated that the risk score stratification performed significantly better than the AJCC staging alone (P < 0.05). DCA showed that the risk score stratification was clinically useful and had better discriminative ability than the AJCC staging. Finally, an interactive native web-based prediction tool was constructed for the survival prediction of patients with postoperative gastric cancer. In this study, a high-performance prediction model for the postoperative prognosis of gastric cancer was developed using DeepSurv, which offers essential benefits for risk stratification and prognosis prediction for each patient.

Bridge to cancer therapy in patients with chronic heart failure: implantation of a left ventricular assist device before surgical treatment of gastric cancer

The co-occurrence of chronic heart failure (CHF) and cancer is becoming more and more common as people live longer. The lack of a structured approach to the treatment of cancer patients with severe cardiovascular conditions is an essential issue. Up to 25% of cancer patients cannot be operated on for their main disease profile due to the presence of cardiovascular disease. This article describes a clinical case of successful treatment of a patient with two competing (prognosis-determining) diseases: end-stage heart failure and stomach cancer within the framework of a bridge-to-cancer strategy.

Quality control of gastric resection range in laparoscopic locally advanced gastric cancer

After nearly 30 years of exploration and practice, minimally invasive surgical techniques represented by laparoscopic technology have become an important means for the surgical treatment of gastric cancer. In China, laparoscopic radical resection for locally advanced gastric cancer has been extensively carried out. However, there are still controversies regarding the gastric resection range and methods for advanced gastric cancer. By reviewing relevant domestic and foreign guideline documents and combining team practice experience, this article elaborates on the key points of quality control of laparoscopic gastric resection range for locally advanced gastric cancer from aspects such as tumor localization and gastric resection range for upper, middle and lower gastric tumors. It aims to provide reference for carrying out and promoting laparoscopic radical gastrectomy more safely.

Real-world Nationwide Outcomes of Minimally Invasive Surgery for Advanced Gastric Cancer Based on Korean Gastric Cancer Association-Led Survey.

The study aimed to investigate real-world surgical outcomes of minimally invasive surgery (MIS) for advanced gastric cancer using Korean Gastric Cancer Association (KGCA)-led nationwide data. A nationwide survey of patients who underwent surgical treatment for gastric cancer in 2019 was conducted by the KGCA. A total of 14,076 patients from 68 institutions underwent surgery, and 4,953 patients diagnosed with pathological stages IB-III gastric cancer were included. Among them, 1,689 patients who underwent MIS (MIS group) and 1,689 who underwent the open approach (open group) were matched using propensity score in a 1:1 ratio. Surgical outcomes were compared, and multivariate analysis was performed to identify the independent factors for overall morbidity. The MIS group had a lower proportion of D2 lymphadenectomy, total omentectomy, and combined resection. However, the number of harvested lymph nodes was higher in the MIS group. Better surgical outcomes, including less blood loss and shorter hospital stay, were observed in the MIS group, and the overall morbidity rate was significantly lower in the MIS group (17.5% vs. 21.9%, P=0.001). The mortality rates did not differ significantly between the 2 groups. In the multivariate analysis, the minimally invasive approach was a significant protective factor against overall morbidity (odds ratio, 0.799; P=0.006). Based on the Korean nationwide data, MIS for stage IB-III gastric cancer had better short-term outcomes than the open approach, including lower rates of wound complications, intra-abdominal abscesses, and cardiac problems.

Comparison of Totally Laparoscopic Total Gastrectomy and Laparoscopy-Assisted Total Gastrectomy on Short-Term Outcomes, Inflammatory Response Markers, and Glucose and Lipid Metabolism in Gastric Cancer Patients.

To investigate the therapeutic efficacy of totally laparoscopic total gastrectomy (TLTG) versus laparoscopy-assisted total gastrectomy (LATG) in gastric cancer (GC) treatment, as well as their effects on postoperative inflammation and glucose and lipid metabolic status. Clinical data of 68 individuals with GC who underwent LATG (n=31) and TLTG (n=37) from January 2020 to December 2022 were procured. This included intraoperative blood loss, operative time, incision length, number of lymph nodes dissected, postoperative complication rates, and recovery indicators, such as inflammation, glucose metabolism, and lipid metabolism. The TLTG cohort demonstrated significant advantages in intraoperative blood loss, operative time, and incision length compared to the LATG cohort. Furthermore, TLTG was superior in reducing the incidence of complications. Nevertheless, no substantial variation was observed in the quantity of lymph nodes dissected. Additionally, TLTG showed benefits in postoperative recovery, including better control of the inflammatory response, reduction of complication risks, shorter hospital stay, and alleviation of postoperative pain. TLTG also exhibited a reduced impact on inflammation and demonstrated greater effectiveness in improving postoperative glucose and lipid levels. TLTG surgery is associated with superior clinical outcomes in the treatment of GC compared to LATG, particularly in reducing surgical trauma and accelerating postoperative recovery. Furthermore, TLTG facilitates the resolution of postoperative inflammatory responses and the amelioration of metabolic disorders. The findings from this investigation advocate for the broader adoption of TLTG in the surgical treatment of GC.

Remote pre-habilitation in patients with cachexia and resectable gastric cancer: a case series

Background. The high rate of functional impairment and nutritional deficiency in patients with localized and locally advanced gastric tumors led to the concept of "pre-habilitation". Multimodal pre-habilitation refers to a combination of physical therapy, nutritional support, and psychological counseling during the preparation of patients for antitumor treatment.&#x0D; Aim. To present the outcomes of patients with cachexia after the program of remote multimodal pre-habilitation before surgical treatment of gastric cancer.&#x0D; Materials and methods. The outcomes of 10 patients with resectable gastric cancer and cancer cachexia were analyzed. Patients underwent comprehensive preoperative preparation, including nutritional support, physical therapy, and remote psychological counseling.&#x0D; Results. There was an improvement in functional parameters: an increase in walking speed in 8 patients, an increase in hand grip strength measured by dynamometry in 7 patients, and an increase in exercise tolerance in 2 patients. No early or late postoperative complications were reported.&#x0D; Conclusion. Multimodal remote pre-habilitation is a promising option for preparing patients with cachexia for surgical treatment of gastric cancer.

Robotic radical gastrectomy - own experience and review of literature

IntroductionGastric cancer is the fifth most common cancer worldwide. Surgery or endoscopic treatment is essential in all disease stages. The most common procedure is total gastrectomy with D2 lymphadenectomy. Removal of stomach and lymph nodes can be performed using minimally invasive techniques. These include laparoscopic gastrectomy, present in gastric cancer surgery since 1994 and robotic gastrectomy, which appeared for the first time in 2003. Last-mentioned method is the youngest and the most technically advanced form of surgical treatment of gastric cancer. First laparoscopic robot-assisted total gastrectomy in Poland was reported by Marek Zawadzki. In this paper we present technique of totally robotic total gastrectomy.AimPresentation of our experience in robotic radical gastrectomy. Description of first in Poland totally robotic gastrectomy. Review of literature assessing novel minimally invasive technique in gastric cancer treatment - robotic gastrectomy.Material and methodsPresentation of our own experience in robotic surgery. Review of literature.ResultsRobotic gastrectomy as an alternative to the laparoscopic technique is associated with earlier return of bowel motility after surgery and earlier introduction of a liquid diet. In terms of perioperative and postoperative complications, morbidity, and mortality, as well as a need to convert to open surgery, the laparoscopic and robotic techniques do not differ from each other. In our Department for the first time in Poland totally robotic radical gastrectomy using da Vinci Xi ® Surgical System (Intuitive Surgical) was performed. No postoperative complications were observed.ConclusionsTotally robotic radical gastrectomy is a safe alternative to classic and laparoscopic surgery which can have additional benefits both for the surgeon (less exhaustion, ergonomy, lack of hand tremor on instruments) as for the patient (earlier tolerance of oral diet, earlier hospital discharge). Further study is needed to assess relevance of potential benefits and cost-effectiveness of this novel technique.

Comorbidity in predicting surgical outcomes for gastric cancer

Objective: The present study aimed to analyze the treatment outcomes and develop a predictive model of surgical treatment for gastric cancer, taking into account the comorbidity of patients. Material and Methods. The treatment outcomes were studied in 477 (100 %) gastric cancer patients. Patients were stratifed into two groups according to the Age-Adjusted Charlson Comorbidity Index (ACCI) (0–4 points – 311 (65,2 %), more than 4 points – 166 (34,8 %) patients). Two hundred and seventy six patients (57.9 %) underwent distal or total gastrectomy, 178 (37.3 %) total gastrectomy, 19 (4 %) minimally invasive gastrectomy, and 4 (0.8 %) patients underwent extirpation of the gastric stump. The construction of models for the prognosis of surgical treatment was carried out using binary logistic regression, the comparison of models – by analyzing error curves (ROC-analysis). Results. The incidence rate of postoperative complications (grade III-V) according to the Clavien-Dindo classifcation was signifcantly higher in group 2 (9.9 %, 47/477) compared to group 1 (2.1 %, 10/477) (χ2 =64.79, p&lt;0.001; OR 11.9 [5.82–24.3]). Postoperative mortality rate was 0.2 % (1/477) in group 1 and 1.9 % (9/477) in group 2 (χ2 =13.7, p&lt;0.001; OR 17.8 [2.23–142]). In a comparative analysis, the prognostic model, taking into account the ACCI of the patient, allowed prediction of the development of postoperative grade III–V complications according to the Clavien-Dindo with the greatest accuracy. The area under the curve (AUC) was 0.921 ± 0.01 (95 % CI: 0,96–0,998), sensitivity – 71.9 %, specifcity – 99.8 %, diagnostic accuracy – 96.4 %. Conclusion. The inclusion of comorbidity in gastric cancer patients in the predictive concept makes it possible to improve the accuracy of prediction of postoperative complications of III–V grade according to Clavien-Dindo.

Current standards of lymphadenectomy in gastric cancer.

Gastric cancer remains the 5th most common cancer and the 3rd most common cause of cancer mortality. Most patients diagnosed with gastric cancer still have a poor prognosis due to its advanced presentation at diagnosis, even in countries with developed screening programs. Surgery is the cornerstone of the treatment for gastric cancer, often combined with perioperative chemotherapy. Lymph node dissection is a crucial component of the surgical treatment of gastric cancer. D1 lymphadenectomy is currently recommended for early stage tumors. The extent of lymphadenectomy in advanced gastric cancer, however, is still a matter of debate between Eastern and Western surgeons. Although a D2 dissection is the current standard recommended by most guidelines, there might be a place for more limited dissections such as D1 + in selected cases. This evidence-based review will help defining the optimal lymphadenectomy for patients with gastric cancer.

Safety and efficacy of robotic-assisted versus laparoscopic distal gastrectomy after neoadjuvant chemotherapy for advanced gastric cancer.

Robot-assisted distal gastrectomy (RADG) has been used in the minimally invasive surgical treatment of gastric cancer, but the research on advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NAC) has not been reported. This study aimed to analyze the outcomes of RADG versus laparoscopic distal gastrectomy (LDG) after NAC for AGC. This was a retrospective propensity score-matched analysis from February 2020 and March 2022. Patients who underwent RADG or LDG for AGC (cT3-4a/N +) following NAC were enrolled and a propensity score-matched analysis was performed in a 1:1 manner. The patients were divided into RADG group and LDG group. The clinicopathological characteristics and short-term outcomes were observed. After propensity score matching, 67 patients each in the RADG and LDG groups. RADG was associated with a lower intraoperative blood loss (35.6 vs. 118.8ml, P = 0.014) and more retrieved lymph nodes (LNs) (50.7 vs. 39.5, P < 0.001), more extraperigastric (18.3 vs. 10.4, P < 0.001), and suprapancreatic LNs (16.33 vs. 13.70, P = 0.042). The RADG group showed lower VAS scores at postoperative 24h (2.2 vs 3.3, P = 0.034), earlier ambulation (1.3 vs. 2.6, P = 0.011), aerofluxus time (2.2 vs. 3.6, P = 0.025), and shorter postoperative hospital stay (8.3 vs. 9.8, P = 0.004). There were no significant differences in the operative time (216.7 vs.194.7min, P = 0.204) and postoperative complications between the two groups. RADG may be a potential therapeutic option for patients with AGC after NAC considering its advantages in perioperative period compared with LDG.

Surgical treatment of gastric cancer and Barrett’s carcinoma

Die Resektion des Primarius, zumeist im multimodalen Setting, stellt einen wichtigen Bestandteil der kurativen Therapie des Magen- und Barrett-Karzinoms dar. Die Operation kann in spezialisierten Zentren in der Regel vollständig minimal-invasiv angeboten werden, entweder konventionell laparoskopisch/thorakoskopisch oder robotisch assistiert. Tumoren des ösophagogastralen Übergangs stellen besondere chirurgische Herausforderungen dar, wenn bisweilen sowohl ein abdominaler Zugang mit transhiataler Erweiterung als auch eine abdominothorakale Resektion technisch möglich erscheinen und die Wahl der Methode von krankheits- und patientenspezifischen Faktoren abhängt. Bei Magenkarzinomen ist häufig eine partiell organerhaltene Resektion in Kombination mit radikaler Lymphadenektomie möglich, wenn auf interdisziplinäre intraoperative Hilfsmittel, wie Schnellschnittuntersuchung und Endoskopie, zurückgegriffen wird. Die Ösophagektomie ist beim Barrett-Karzinom die Resektion der Wahl und die zunehmende Durchführung in minimal-invasiver Technik hat das Trauma für die Patienten deutlich reduziert und die postoperativen Ergebnisse verbessert. Eine gute Zentrumsstruktur bietet neben intraoperativen interdisziplinären Hilfestellungen und minimal-invasiven Techniken auch eine interventionelle Endoskopie, die für die Vorbereitung der chirurgischen Resektion und eine etwaige Komplikationsbehandlung eine wichtige Rolle spielt. In dieser Übersicht soll die moderne Ösophagus- und Magenchirurgie am Beispiel der Therapie des Magen- und Barrett-Karzinoms und unter Berücksichtigung der aktuellen Studienlage dargestellt werden.

Scientific and rigorous data registration of patients with gastric cancer is the cornerstone of high-quality surgical research on gastric cancer: lessons learned from the Dutch upper gastrointestinal cancer audit (DUCA)

The postoperative 30-day mortality and morbidity of gastric cancer surgery has markedly improved over the past years due to minimally invasive techniques, perioperative rehabilitation programs and centralization of care. However, there is still need for improvement as postoperative complications may have a serious negative impact on the efficacy of surgical treatment of gastric cancer. High-quality clinical research is a very important tool to analyze treatment outcomes and evaluate new treatment strategies. The meticulous registration of gastric cancer patient data is the basis of high-quality surgical research. In the past 11 years, the Dutch upper gastrointestinal cancer audit (DUCA) database has vast experience in data registration and maintenance of patients with upper gastrointestinal cancer. The effective measures it has taken in data registration, data quality control, data application and use, and data security have maintained quality at a high level. These data has been used for medical care quality monitoring and scientific research leading to a positive impact on the postoperative short-term outcomes of patients with upper gastrointestinal cancer. The work of DUCA may be a good incentive for the setup of population-based databases and clinical research in other countries.

Indications for surgical treatment of gastric cancer - is histological diagnosis a limiting factor? – a series of cases

Indications for surgical treatment of gastric cancer - is histological diagnosis a limiting factor? – a series of cases

Relationship between physical activity and bone mineral density loss after gastrectomy in gastric cancer patients.

The prevention of osteoporosis is a particularly relevant issue for gastric cancer survivors. We investigated the relationship between postoperative physical activity and the change of bone mineral density (BMD) in patients with gastric cancer. Patients who underwent radical gastrectomy for gastric cancer were enrolled in this single-center prospective cohort study. Physical activity was evaluated using the International Physical Activity Questionnaire Short Form at postoperative month (POM) 6 and patients were classified into high, middle, and low physical activity groups accordingly. The primary outcome was the change in BMD from baseline at POM 12, which was expressed as a percentage of the young adult mean (YAM). The YAM of the lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry. One hundred ten patients were enrolled in this study. The physical activity level at POM 6 was classified as high (n = 50; 45%), middle (n = 25; 23%), and low (n = 35; 32%). The mean decrease of YAM% was 5.1% in the lumbar spine and 4.2% in the femoral neck at POM 12. A multivariable-adjusted logistic regression model revealed that low physical activity at POM 6 was a significant risk factor for BMD loss at POM 12 (odds ratio, 3.76; 95% confidence interval, 1.48-9.55; p = 0.005). Low physical activity after gastrectomy is an independent risk factor for decreased BMD at POM 12. The introduction of exercise may prevent osteoporosis after the surgical treatment of gastric cancer.

Rare variation: the absence of both the celiac trunk artery and the common hepatic artery

BackgroundKnowledge of celiac trunk anatomy is important in gastrointestinal surgery, hepatopancreatobiliary surgery, transplantation and interventional radiology. Variations in the celiac trunk are common and should be predicted prior to these interventions.MethodsA 58-year-old woman was admitted to our department for surgical treatment of gastric cancer (GC) confirmed by gastroduodenoscopy and gastric antrum biopsy. In the contrast-enhanced computed tomography (CT), we found an absence of both the celiac trunk artery (CA) and the common hepatic artery (CHA). Therefore, we used computerized three-dimensional (3D) vascular reconstruction technology to reconstruct the abdominal trunk and its branch vessels before operation.ResultsComputerized 3D vascular reconstruction confirmed an extremely rare vascular anomaly: the absence of both CA and CHA. The splenic artery (SA) and gastroduodenal artery (GDA) originated from the abdominal aorta (AA). The left gastric artery (LGA) originated from the AA directly above the junction of SA and the GDA. The left hepatic artery (LHA) originated from the left gastric artery (LGA). The right hepatic artery (RHA) originated from the superior mesenteric artery (SMA). Laparoscopic radical resection of GC was performed. This anomaly was also confirmed intraoperatively. This patient was discharged on the 10th day after surgery without any postoperative complication. There were no signs of tumor recurrence during the 6-month follow-up.ConclusionCorrect identification of abnormal abdominal large blood vessels and their relationship with tumors before surgery is of great significance to avoid intraoperative blood vessel damage, major postoperative complications and the missing of lymph node dissection.

Preliminary analysis of the promotion effect of laparoscopic standardized surgical treatment for gastric cancer in regional medical centers in Shanghai

Objective: To explore the promotion effect of laparoscopic standardized surgery for gastric cancer observational in some regional medical centers in Shanghai. Methods: A retrospective cohort study was carried out. Eleven regional medical centers in Shanghai received the promotion program of laparoscopic standardized surgery for gastric cancer, which was led by Ruijin Hospital, Shanghai Jiaotong University School of Medicine (Shanghai Minimally Invasive Surgery Center) from January to December 2020. Clinicopathological data of gastric cancer patients treated at these 11 regional medical centers before and after the promotion program were collected. Inclusion criteria were as follows: patients undergoing laparoscopic distal gastrectomy or total gastrectomy; gastric cancer confirmed by pathology; without distant metastasis or peritoneal metastasis. Patients who did not undergo laparoscopic D2 radical resection, or received neoadjuvant chemotherapy before surgery, or without complete clinical data were excluded. Patients undergoing laparoscopic surgery from January to December 2019 were included in the pre-promotion group (46 cases). Patients undergoing laparoscopic surgery from January to December 2021 were included in the post-promotion group (102 cases). In addition, patients undergoing laparoscopic surgery at Ruijin Hospital from January 2021 to December were included in the control group (138 cases). The baseline data, perioperative measurements postoperative complications, and pathological results of the three groups were analyzed and compared. Results: There were no significant differences in baseline characteristics among the three groups (all P>0.05). Compared with the pre-promotion group, the operation time in post-promotion group was significantly shorter [(207.3±36.0) minutes vs. (254.2±47.1) minutes, t=7.038,P<0.001], and the number of harvested lymph node was significantly more (24.4±12.2 vs. 18.9±5.5, t=2.900, P=0.004). However, there were no significant differences in the extent of resection, time to fluid intake, and postoperative hospital stay between the two groups (all P>0.05). Compared with the control group, the operation time [(207.3±36.0) minutes vs (172.6±26.0) minutes, t=8.281, P<0.001], time to fluid intake [(6.3±3.2) days than (5.5±3.0) days, t=2.029, P=0.044], and the postoperative hospital stay [(14.3±5.6) days vs. (10.1±4.8) days, t=6.036, P<0.001] in the post- promotion group were still longer. Total gastrectomy was less common in the post-promotion group compared with the control group [18 cases (17.6%) vs. 41 cases (29.7%), χ2=7.380, P=0.007]. However, there was no significant difference in the number of harvested lymph node between the two groups (P>0.05). The morbidity of postoperative complication in the post-promotion group (9.8%, 10/102) was significantly lower than that in the pre-promotion group (23.9%, 11/46) (χ2=5.183, P=0.023), while above morbidity was not significantly different between the post-promotion group and the control group [9.8% vs. 6.5% (9/138), χ2=0.867, P=0.352]. Conclusion: After the promotion of laparoscopic standardized surgery for gastric cancer in regional medical centers, the standardization degree of surgery has been improved, and the morbidity of postoperative complication decreases. Laparoscopic standardized surgery for gastric cancer can be promoted to more regional medical centers.

Effects of Sarcopenia on Postoperative Outcomes in Patients Who Underwent Gastrectomy for Gastric Cancer.

The relationship between sarcopenia and postoperative outcomes in patients with gastric cancer remains controversial. This study aimed to investigate the impact of sarcopenia on short-term outcomes after surgery for gastric cancer. Patients who underwent surgical treatment for gastric cancer were evaluated in this prospective observational study. Muscle strength, muscle mass, and physical performance were measured before surgery. Diagnosis of sarcopenia was based on the revised European Working Group on Sarcopenia criteria. Postoperative 30-day outcomes, including complications, reoperation, readmission, and operative mortality, were recorded. Sarcopenia was observed in 31 out of 146 patients (21.2%). The overall complication incidence was 31.5%. The postoperative complication rate was higher in the sarcopenic patients compared to the nonsarcopenic patients (54.8% versus 25.2%, P=0.003). There was no statistically significant difference in terms of surgical complication rates (25.8% versus 14.8%, P=0.239), although the sarcopenic group had a significantly higher systemic complication rate (38.7% versus 13%, P=0.003). No statistically significant difference was observed in terms of major complications (3.2% versus 5.2%, P=1.000). Muscle strength, muscle mass, and physical performance were not identified as independent factors when tested alone at adjusted multivariable analysis. Sarcopenia (Odds ratio: 2.73, 95% CI 1.02-7.52, P=0.047) and severe sarcopenia (Odds ratio: 4.44, 95% CI 1.57-13.34, P=0.006) were identified as independent prognostic factors for postoperative complications. Sarcopenia was associated with postoperative complications after gastrectomy for gastric cancer. Severe sarcopenia may serve as a more robust prognostic indicator. The variation in the complication rates between sarcopenic and nonsarcopenic patients was mainly due to difference in systemic complications rather than surgical complications.