Total Gastrectomy For Gastric Carcinoma Research Articles

Krukenberg Tumour with Skin Metastasis: A Rare Calamitous Disease

Krukenberg tumour with cutaneous metastasis is a rare entity signifying a disseminated disease with poor prognosis. The prevalence of Krukenberg tumour differs among populations. In regions with a high prevalence of gastric carcinoma, such as Japan, these tumours comprise up to 17.8% of all ovarian carcinomas. We report a case of 42-year-old female patient who presented with lower abdomen pain and nodular lesions over the skin after undergoing total gastrectomy for gastric carcinoma eighteen months back. Through a review of relevant literature and case studies, this paper elucidates the clinical significance of cutaneous metastasis in Krukenberg tumors and highlights the importance of multidisciplinary approaches in managing this condition effectively. Keywords: poor prognosis, signet ring adenocarcinoma, gastric adenocarcinoma, skin metastasis, krukenberg tumour

Postoperative Mortality Rates following Total Gastrectomy for Gastric Cancer: Experience of a Single Surgical Team

Objective: Total gastrectomy is a complex surgical procedure that is characterized by significant postoperative morbidity and mortality rates and the patients may continue to experience adverse events beyond the standard 30-day follow-up period after surgery. The aim of this study is to investigate postoperative complication and 30-day/90-day mortality rates following total gastrectomy in a cohort of patients and highlight the possible ways that can improve the short-term outcome of this surgical procedure.
 Material and Methods: 401 patients underwent total gastrectomy for gastric carcinoma by a single surgical team from January 2001 till December 2021. The patients stratified in 3 groups based on the time period when surgery was performed, hospital- and treatment-related objective factors: group I (61 patients); group II (163 patients) and group III (177 patients).
 Results: Esophagojejunal anastomotic leakage rate varied with periods and ranged from 1.1% to 3.3%, 1.7% in total. Differences were insignificant in complication and death rates between the patients aged ≤70 years and > 70 years (p>0.05). Postoperative death rate within 90 days was higher by 42% compared to that in standard 30-day follow-up period. Neaodjuvant chemotherapy was not found to be associated with an increased rate of 30-day postoperative mortality (p>0.05).
 Conclusion(s): Total gastrectomy for gastric cancer may be associated with minimal rates of esophagojejunal anastomotic leakage and mortality when performed by specialized and experienced high-volume surgeons. 90-day mortality rate after total gastrectomy is 42% higher compared to 30-day mortality that warrants more intense monitoring of the relevant patients within 3 months after surgery.

Reduced anastomotic complications with intracorporeal esophagojejunostomy using endoscopic linear staplers (overlap method) in laparoscopic total gastrectomy for gastric carcinoma.

With advances in surgical technique and instrumentation, intracorporeal anastomosis is increasingly being performed for laparoscopic total gastrectomy (LTG). However, the benefits of intracorporeal anastomosis in reducing postoperative complications have not been demonstrated, although its technical feasibility has been proven in many studies. In this study, we investigated the impact of intracorporeal anastomosis in reducing postoperative complications after LTG. We analyzed 410 consecutive gastric cancer patients who underwent LTG between 2008 and 2018. Of these, 118 underwent intracorporeal anastomosis using linear staplers (overlap method), while 292 underwent extracorporeal anastomosis using a circular stapler. Short-term surgical outcomes including postoperative complications were compared between the two groups. The two groups showed no significant differences in age, sex, comorbidity, and abdominal surgery history. D2 lymph node dissection was more frequently performed in the intracorporeal group because of the presence of more advanced cancer stages. The overall morbidity in the intracorporeal and extracorporeal group was 23.7% and 27.7%, respectively (p = 0.405). However, the intracorporeal group showed a significantly lower incidence of late complications (0.8% vs. 7.5%, p = 0.008). Concerning complications, the incidence of anastomotic bleeding (0% vs. 5.5%, p = 0.008) and anastomotic stenosis (0% vs. 4.5%, p = 0.024) was significantly lower in the intracorporeal group. In univariate and multivariate analyses, American Society of Anesthesiologists score and operative bleeding were independent predictive factors for postoperative complications in patients who underwent intracorporeal anastomosis. Intracorporeal anastomosis using linear staplers reduced anastomotic bleeding and stenosis compared to extracorporeal anastomosis after LTG. Future research will be required to determine the ideal method for intracorporeal anastomosis in LTG.

Abdominal Drainage in the Prevention and Management of Major Intra-Abdominal Complications after Total Gastrectomy for Gastric Carcinoma.

PurposeThe role of prophylactic abdominal drainage in total gastrectomy is not well-established. This study aimed to evaluate the efficacy of abdominal drainage in the prevention and management of major intra-abdominal complications after total gastrectomy for gastric carcinoma.Materials and MethodsWe retrospectively reviewed the data of 499 patients who underwent total gastrectomy for gastric carcinoma in a high-volume institution. The patients were divided into drainage and non-drainage groups and compared for the development and management of major intra-abdominal complications, including anastomotic leak, abdominal bleeding, abdominal infection, and pancreatic fistulas.ResultsThe drainage group included 388 patients and the non-drainage group included 111 patients. The 2 groups showed no significant differences in clinicopathological characteristics or operative procedures, except for more frequent D2 lymphadenectomies in the drainage group. After surgery, the overall morbidity (drainage group vs. non-drainage group: 24.7% vs. 28.8%, P=0.385) and incidence of major intra-abdominal complications (6.4% vs. 6.3%, P=0.959) did not significantly differ between the two groups. The non-drainage group showed no significant increase in the incidence rate of major intra-abdominal complications in the subgroups divided by age, sex, comorbidity, operative approach, body mass index, extent of lymphadenectomy, and pathological stage. Abdominal drainage had no significant impact on early diagnosis, secondary intervention or reoperation, or recovery from major intra-abdominal complications.ConclusionsProphylactic abdominal drainage showed little demonstrable benefit in the prevention and management of major intra-abdominal complications of total gastrectomy for gastric carcinoma.

Outcomes of early postoperative diet on the first postoperative day in patients undergoing total gastrectomy for gastric carcinoma

Outcomes of early postoperative diet on the first postoperative day in patients undergoing total gastrectomy for gastric carcinoma

Status and progress about total gastrectomy for gastric carcinoma

Gastric cancer is a common gastrointestinal cancer. With the incidence of cancer in the middle and proximal stomach is increasing year by year, radical total gastrectomy as a major operative method, is widely used in the treatment of gastric cancer. However, various surgical complications often occur after total gastrectomy, which affect patients’ postoperative recovery and the quality of life. This article discussed the influential factors of surgical complications after total gastrectomy, and discussed the feasibility of applying Clavien-Dindo classification system to evaluate the severity of complications after total gastrectomy. Key words: Stomach neoplasms; Postoperative complications; Review; Total gastrectomy; Clavien-Dindo Classification

Technical and Survival Risks Associated With Esophagojejunostomy by Laparoscopic Total Gastrectomy for Gastric Carcinoma

We performed esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) using functional end-to-end anastomosis (FEEA) as the first choice and laparoscopic-assisted total gastrectomy (LATG) using a circular stapler with a transorally inserted anvil as the second choice. We examined 109 patients with gastric cancer who underwent TLTG and LATG. Among these, 100 patients underwent TLTG and the rest underwent LATG. The length of resected esophageal segment in LATG patients was significantly longer than that in TLTG patients (P<0.001). The length of the resected esophagus segment was inversely correlated with body mass index in cases of esophagojejunostomy by FEEA (P<0.05). Multivariate analysis revealed that T factor, N factor, and severe complications were the independent factors for survival. Esophagojejunostomy using FEEA or a circular stapler with a transorally inserted anvil should be selected according to the length of the resected esophageal segment and/or body mass index.

Impaired gallbladder function in patients after total gastrectomy

Background and aims: The incidence of gallstones and gallbladder sludge is higher in patients after total gastrectomy than in general population. Formation of gallstones after gastrectomy is multifactorial. Here, we investigate the changes in gallbladder and biliary tract functions by cholescintygraphy and monitored changes in cholecystokinin (CCK) release in long-term survivors after total gastrectomy for gastric carcinoma.Material and methods: Patients had undergone total gastrectomy for gastric carcinoma at least five years ago. The final study population consisted of 25 patients.Results: Eight patients had undergone cholecystectomy before or at the time of gastrectomy. Gallstone formation was observed in seven of the remaining 17 patients during follow-up (41%). Maximum uptake of radioactivity and gallbladder maximum uptake was significantly delayed in the gastrectomy group than in the control group. There was no significant difference in CCK levels after the overnight fasting and at 60 minutes after stimulation among patients with or without stones in situ compared with healthy volunteers, but 30 minutes after the energy-rich drink patients had higher CCK levels than the control group.Conclusions: In gastrectomy patients, technetium isotope visualisation of the gallbladder and time for maximum activity was significantly delayed. This may indicate impaired gallbladder function. On the contrary, CCK release was not impaired.

Laparoscopic Total Gastrectomy in Elderly Patients (≥70 Years) with Gastric Carcinoma: A Retrospective Study.

PurposeTo compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients.Materials and MethodsBetween 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (≥70 years, n=71) vs. non-elderly (<70 years, n=172). Postoperative outcomes, including length of hospital stay, morbidity, and mortality were compared between the groups.ResultsThe elderly group showed a significantly higher rate of comorbidities and American Society of Anesthesiologists scores than those in the non-elderly group. No significant differences were found with respect to lymphadenectomy or combined organ resection between the groups. After surgery, the elderly group showed a significantly higher incidence of grade III and above complications than the non-elderly group (15.5% vs. 4.1%, P=0.003). Among the complications, anastomosis leakage was significantly more common in the elderly group (9.9% vs. 2.9%, P=0.044). Univariate and multivariate analyses showed that old age (≥70 years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above.ConclusionsElderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy.

Risk Factors and Learning Curve Associated with Postoperative Morbidity of Laparoscopic Total Gastrectomy for Gastric Carcinoma

Laparoscopic total gastrectomy (LTG) is a challenging surgical procedure that has substantial technical difficulties and complications. In this study, we investigated risk factors for morbidity and mortality after LTG, and the learning curve associated with postoperative morbidity. Prospectively constructed data of 203 patients undergoing LTG between 2004 and 2013 were retrospectively reviewed. The multivariate logistic regression model was used to analyze risk factors for postoperative morbidity. The Cumulative Sum (CUSUM) technique was used to assess the learning curve. Postoperative morbidity and mortality after LTG was 18.7 and 1.5 %, respectively. Of 38 patients with postoperative morbidity, 7 (3.4 %) were managed with reoperation, 8 (4.0 %) with radiologic or endoscopic intervention, and 23 (11.3 %) with a conservative treatment. Of local complications, gastrointestinal bleeding was the most common (12 patients), followed by anastomosis leakage (9 patients) and intra-abdominal abscess (9 patients). Respiratory complication was the most common of the systemic complications. There were 17 cases (8.4 %) of complications exceeding grade III severity, of which anastomosis leakage was the most common. CUSUM analysis showed that postoperative morbidity reached a plateau after around 45 cases. Univariate and multivariate analyses revealed that old age (over 65 years of age) and surgical experience (<45 cases) were independent factors for postoperative morbidity after LTG. LTG is a feasible technique with acceptable morbidity and mortality. However, substantial surgical experience is of most importance to reduce postoperative morbidity and mortality.

Laparoscopy: A Procedure no less than Laparotomy for Lymph Node Dissection in Total Gastrectomy for Gastric Carcinoma

Aim: To show that laparoscopic lymph node dissection and harvesting is equal to laparotomic lymph node dissection in patients undergoing total gastrectomy for gastric carcinoma. Materials and methods: Retrospective data was collected from 36 patients who underwent total gastrectomy for carcinoma stomach. Fifteen patients underwent open total gastrectomy (OG) and other 21 laparoscopic assisted total gastrectomy (LAG) over a period of 4 years from March 2009 to June 2012. In the laparoscopic group, dissection of lymph nodes and division of ligaments and omentum was done laparoscopically using harmonic scalpel. Both groups were compared for operative blood loss, operative time, blood transfusion, morbidity, mortality, the number of harvested lymph nodes (HLNs) with emphasis on harvested lymph nodes. Results: There were no significant differences in morbidity or mortality in both groups. Tumor free margins were obtained in all cases. Compared with OG group, the LAG group had significantly less blood loss, but a longer operation time. The mean harvested lymph nodes (HLN’s) is 24.7 in LAG group as compared 23.3 in OG group. Conclusion: Laparoscopic dissection and harvested lymph nodes is equivalent to OG with no other significant differences except for decreased blood loss and increased operative time. Thus, this procedure can achieve the same result as OG.

Laparoscopy: A Procedure no less than Laparotomy for Lymph Node Dissection in Total Gastrectomy for Gastric Carcinoma

Laparoscopy: A Procedure no less than Laparotomy for Lymph Node Dissection in Total Gastrectomy for Gastric Carcinoma

Isolated splenic metastases from gastric carcinoma: A case report and literature review

Isolated metastases to the spleen from gastric carcinoma is very rare. Only a few cases have been reported in the literature. We herein present a case of isolated splenic metastases in a 62-year-old man, occurring 12 mo after total gastrectomy for gastric carcinoma. The patient underwent a laparoscopic exploration, during which two lesions were found at the upper pole of the spleen, without involvement of other organs. A laparoscopic splenectomy was performed. Histological examination confirmed that the splenic tumor was a poorly differentiated adenocarcinoma similar to the primary gastric lesion. The postoperative course was uneventful and the patient has been well for 9 mo, with no tumor recurrence. The clinical data of 18 cases of isolated splenic metastases from gastric carcinoma treated by splenectomy were summarized after a literature review. To our knowledge, this is the first reported case of isolated splenic metastases undergoing laparoscopic splenectomy.

Comparison of Short-Term Surgical Outcomes Between Laparoscopic and Open Total Gastrectomy for Gastric Carcinoma: Case-Control Study Using Propensity Score Matching Method

To evaluate the technical feasibility and safety of laparoscopic total gastrectomy (LTG) for gastric carcinoma, this study compared short-term surgical outcomes between LTG and open total gastrectomy (OTG) using the propensity score matching method. After generating propensity scores given the covariates of age, sex, body mass index, comorbidity, American Society of Anesthesiologists (ASA) score, operators, and tumor stage, 122 patients with LTG were matched to 122 OTG patients using the nearest available score matching. Operative outcomes and hospital courses were compared in the matched groups and in the subgroups by the extent of lymph node dissection (LND). The 2 study groups were well balanced with respect to the baseline characteristics of the propensity score derivation model. In the analysis of overall patients, the LTG group showed significantly longer operating time (289 vs 203 min, p < 0.001), but postoperative outcomes, including hospital stay, morbidity, and mortality, were similar in the 2 groups. In the subgroup with D1 + ß LND (perigastric nodes + Nos. 7, 8a, 9, 11p), the LTG group showed no significant differences in hospital stay, morbidity, and mortality from the OTG group. However, in the subgroup with D2 LND (perigastric nodes + Nos. 7, 8a, 9, 10, 11p, 11d, 12a), the LTG group showed significantly increased morbidity (52.6% vs 21.0%, p = 0.007) and tendency toward increased length of hospital stay and mortality as compared with the OTG group. Laparoscopic total gastrectomy is a safe and feasible technique for treatment of upper gastric carcinoma. However, LTG with D2 LND for upper gastric cancer may increase the operative risk and requires considerable experience in laparoscopic surgery.

Successful Treatment of Reactive Hypoglycemia Secondary to Late Dumping Syndrome Using Miglitol

We herein describe a 59-year-old woman who had undergone a total gastrectomy for gastric carcinoma and suffered from postprandial hypoglycemia characterized by a loss of consciousness and spasms. She was diagnosed with reactive hypoglycemia and treated with nutrition therapy, but the frequency and severity of the hypoglycemic episodes did not decrease. She was subsequently treated successfully with miglitol, an alpha-glucosidase inhibitor (α-GI) taken twice a day; other α-GIs (acarbose and voglibose) were not effective. In conclusion, the administration of miglitol was effective for preventing reactive hypoglycemia secondary to late dumping syndrome.

Analysis of splenic hilar lymph node metastasis in advanced gastric cancer and dissection techniques

To study the status of splenic hilar lymph nodes(No.4sa, No.10 or No.11d lymph nodes) metastasis and to investigate the proper dissection technique in patients with advanced gastric cancer. A retrospective study was performed to investigate 590 patients who underwent D2 curative proximal or total gastrectomy for gastric carcinoma from January 2006 to December 2009. Clinicopathological factors such as sex, age, location of the primary tumor, tumor sizes, gross type, depth of invasion, microscopic classification, neoadjuvant chemotherapy and the metastasis of adjacent lymph node were analyzed with univariate and multivariate analysis. Influence of combined splenectomy or pancreatectomy on lymph node dissection was also investigated. The overall ratio of metastatic lymph node(positive lymph nodes/lymph nodes harvested) in the splenic hilum was 17.5%(99/565). The positive rates of No.4sa, No.10, No.11d lymph nodes were 17.8% (41/230), 13.9%(29/209), and 22.8%(29/127), respectively. A total of 7.1%(42/590) of the patients had lymph node metastasis in the splenic hilum. Multivariable logistic regression analysis showed that age, tumor size, depth of tumor invasion, positive metastasis of No.4sb lymph node were independent risk factors for lymph node metastasis in the splenic hilum region. When comparing patients undergoing combined splenectomy or pancreatectomy(n=23) and those who did not undergo combined organ resection (n=553), the ratios of metastatic lymph node in the splenic hilum were 14.8%(4/27) and 17.2%(91/527), respectively, and the difference was not statistically significant(P>0.05). The postoperative complication rates were 26.1%(6/23) and 5.4%(30/553), respectively, and the difference was statistically significant(P<0.05). The operative mortality rates were 4.3% and 0.9%, respectively, and the difference was not statistically significant(P>0.05). Metastasis to lymph nodes in the splenic hilum region in patients with gastric cancer possesses a certain pattern, and it is associated with tumor location, size, depth of invasion, and metastasis in No.4sb. Combined resection of the spleen or pancreas does not result in increased number of harvested lymph nodes or positive lymph nodes, yet is associated with higher complication rate. Therefore, combined organ resection should be meticulous.

Lebensqualität nach totaler Gastrektomie wegen Magenkarzinoms*: Ösophagojejunoplicatio mit Pouch versus Ösophagojejunostomie ohne Pouch

A group of 178 patients with total gastrectomy for gastric carcinoma were divided into two groups matched for sex, age, tumour stage and follow-up interval (29 pairs, 46 men and 12 women; mean age 63.4 [39-74] years) according to the type of reconstruction performed, oesophagojejunal plication with pouch or simple oesophagojejunostomy without pouch. Those with left-extended gastrectomy, follow-up period of 9 months or less, and local recurrence or metastasis were excluded. Quality of life was evaluated by means of three standardized questionnaires sent to all the patients: (1) general physical complaints; (2) satisfaction with life; and (3) psychosocial burden. Patients with pouch reconstruction declared more favourable results in 90 of the 94 questions contained in the questionnaire (96%) than the patients without pouch. Patients in the former group also had significantly fewer general physical complaints (P less than or equal to 0.05) and were significantly more satisfied with life (P less than or equal to 0.05) than those without pouch. Correlation analysis for the entire group (n = 58) indicated significant relationships especially between quality of life and postoperative nutrition and body weight. Technical surgical problems of total gastrectomy having largely been solved, the question of quality of life must increasingly determine the choice of treatment.

Quality of life in the long‐term survivors after total gastrectomy for gastric carcinoma

Several studies report the health-related quality of life (HRQoL) after total gastrectomy in short term but long-term results have been less published. One hundred and seventy two patients underwent total gastrectomy between years 1987-1999 for gastric carcinoma. In 2005, 30% of them were still alive. The final study population consisted of 25 patients less than 80 years of age, for whom validated control population data were available. The SF-36 and 15D questionnaires were used as QoL instruments. The median follow-up time from surgery was 9. The study group did not differ significantly in any of the SF-36 sub scores from the normal population controls. There was no significant difference in the total score in 15D but the patients did statistically significantly worse than the normal population controls in sleeping, elimination and distress. There was significant weight loss during the follow up, but this was not associated with any of HRQoL changes. This study shows that patients who survived for long-term after total gastrectomy for gastric carcinoma do generally as well as the normal population controls, but depending on the QoL instrument used, may have lower QoL in some sub dimensions.

On quality of life in the long‐term survivors after total gastrectomy for gastric carcinoma

On quality of life in the long‐term survivors after total gastrectomy for gastric carcinoma

Total gastrectomy for gastric carcinoma: a retrospective study of different procedures and assessment of a new technique of gastric reconstruction.

A retrospective study of the value of reconstructive surgery after total gastrectomy of gastric carcinoma in 118 patients who underwent different types of reconstructive procedures is presented. Dissatisfaction with established methods of reconstruction led to the development of a new technique. The new method was associated with less regurgitation, less dumping and functioned as a reservoir without undue delay in emptying time. It was associated with an improved quality of life in the postoperative period, with minimal dumping symptoms, maintenance of weight and the ability to return to work. The mortality and morbidity of the new method are acceptable and it thus offers not only an improved reconstructive procedure for total gastrectomy after resection for gastric cancer, but offers potential for reconstructive surgery after total gastrectomy carried out for other reasons.