Treatment Of Early Gastric Cancer Research Articles

The Role of Artificial Intelligence in Gastric Cancer: Surgical and Therapeutic Perspectives: A Comprehensive Review.

Stomach cancer has a high annual mortality rate worldwide necessitating early detection and accurate treatment. Even experienced specialists can make erroneous judgments based on several factors. Artificial intelligence (AI) technologies are being developed rapidly to assist in this field. Here, we aimed to determine how AI technology is used in gastric cancer diagnosis and analyze how it helps patients and surgeons. Early detection and correct treatment of early gastric cancer (EGC) can greatly increase survival rates. To determine this, it is important to accurately determine the diagnosis and depth of the lesion and the presence or absence of metastasis to the lymph nodes, and suggest an appropriate treatment method. The deep learning algorithm, which has learned gastric lesion endoscopyimages, morphological characteristics, and patient clinical information, detects gastric lesions with high accuracy, sensitivity, and specificity, and predicts morphological characteristics. Through this, AI assists the judgment of specialists to help select the correct treatment method among endoscopic procedures and radical resections and helps to predict the resection margins of lesions. Additionally, AI technology has increased the diagnostic rate of both relatively inexperienced and skilled endoscopic diagnosticians. However, there were limitations in the data used for learning, such as the amount of quantitatively insufficient data, retrospective study design, single-center design, and cases of non-various lesions. Nevertheless, this assisted endoscopic diagnosis technology that incorporates deep learning technology is sufficiently practical and future-oriented and can play an important role in suggesting accurate treatment plans to surgeons for resection of lesions in the treatment of EGC.

Short-term outcomes of endoscopic submucosal dissection for the treatment of superficial gastric neoplasms in non-Asian countries: a systematic review and meta-analysis.

Endoscopic submucosal dissection (ESD) is now considered the standard treatment for early gastric cancer (EGC). However, the widespread adoption of ESD in western countries has been slow. We performed a systematic review to evaluate short-term outcomes of ESD for EGC in non-Asian countries. We searched 3 electronic databases from inception until October 26, 2022. Primary outcomes were en bloc, R0 and curative resections rate by region. Secondary outcomes were overall complications, bleeding, and perforation rate by region. The proportion of each outcome, with the 95% confidence interval (CI), was pooled using a random-effects model with the Freeman-Tukey double arcsine transformation. Twenty-seven studies from Europe (n=14), South America (n=11) and North America (n=2) were included, involving 1875 gastric lesions. Overall, en bloc, R0, and curative resection rates were achieved in 96% (95%CI 94-98%), 85% (95%CI 81-89%), and 77% (95%CI 73-81%) of cases, respectively. Considering only information from lesions with adenocarcinoma, the overall curative resection was 75% (95CI 70-80%). Bleeding and perforation were observed in 5% (95%CI 4-7%) and 2% (95%CI 1-4%) of cases, respectively. Our results suggest that short-term outcomes of ESD for the treatment of EGC are acceptable in non-Asian countries.

Totally Laparoscopic Pylorus-Preserving Gastrectomy (TLPPG) is Safe and Effective for Early Gastric Cancer Treatment

Totally Laparoscopic Pylorus-Preserving Gastrectomy (TLPPG) is Safe and Effective for Early Gastric Cancer Treatment

Potentials of Minimally Invasive Technologies in Treatment for Early Gastric Cancer

INTRODUCTION: Gastric cancer remains one of the leading causes of oncological morbidity and mortality.
 AIM: To determine the effectiveness and safety of wedge resections of stomach in patients with early gastric cancer (EGC) in comparison with endoscopic intraluminal treatment methods.
 MATERIALS AND METHODS: Assessment of the immediate and long-term (5 years) prognosis of 164 patients with EGC who underwent wedge resection of stomach and endoscopic intraluminal interventions was performed. One hundred twenty eight patients were operated on in the volume of endoscopic intraluminal mucosal resection or submucosal dissection (the mean age 68.5 9.2 years; men 53.7%). In 36 patients (the mean age 65.3 7.8 years; men 66.7%), according to gastroscopy in combination with chromogastroscopy, narrow-band magnification endoscopy, the tumor dimensions exceeded those recommended for endoscopic methods. Due to contraindications for classic resection interventions in such patients, wedge resections of the stomach were performed.
 RESULTS: In the comparison groups there was no postoperative mortality, however, in the group with use of endoscopic methods, complications were noted (perforations of the stomach and bleeding). All the complications were eliminated endoscopically. In the group of wedge resections, there were no postoperative complications, but in the long-term result, the five-year survival rate was lower than in the group of endoscopic treatment (75.0% versus 92.2%; 2 = 8.10, p = 0.004) due to a more severe comorbid pathology in the patients of wedge resection group.
 CONCLUSION: Safety and equal effectiveness of wedge gastric resections was established in the long-term oncological result in patients with EGC in comparison with intraluminal endoscopic methods.

A retrospective analysis based on multiple machine learning models to predict lymph node metastasis in early gastric cancer.

Endoscopic submucosal dissection has become the primary option of treatment for early gastric cancer. However, lymph node metastasis may lead to poor prognosis. We analyzed factors related to lymph node metastasis in EGC patients, and we developed a construction prediction model with machine learning using data from a retrospective series. Two independent cohorts' series were evaluated including 305 patients with EGC from China as cohort I and 35 patients from Spain as cohort II. Five classifiers obtained from machine learning were selected to establish a robust prediction model for lymph node metastasis in EGC. The clinical variables such as invasion depth, histologic type, ulceration, tumor location, tumor size, Lauren classification, and age were selected to establish the five prediction models: linear support vector classifier (Linear SVC), logistic regression model, extreme gradient boosting model (XGBoost), light gradient boosting machine model (LightGBM), and Gaussian process classification model. Interestingly, all prediction models of cohort I showed accuracy between 70 and 81%. Furthermore, the prediction models of the cohort II exhibited accuracy between 48 and 82%. The areas under curve (AUC) of the five models between cohort I and cohort II were between 0.736 and 0.830. Our results support that the machine learning method could be used to predict lymph node metastasis in early gastric cancer and perhaps provide another evaluation method to choose the suited treatment for patients.

Gastric Emptying is Accelerated in Patients With Gastric Tube Reconstruction Following Laparoscopic Proximal Gastrectomy.

Laparoscopic proximal gastrectomy (LPG) is an attractive option for the treatment of early gastric cancer in the upper third of the stomach. No optimal method of reconstruction after LPG has been established because of problems associated with postoperative reflux. Gastric tube reconstruction, a type of esophagogastrostomy, is a simple procedure, but it is associated with a high frequency of reflux esophagitis (RE). We investigated the relationship between RE and gastric emptying, along with nutritional parameters. We compared gastric emptying in patients who had undergone curative LPG with gastric tube reconstruction for gastric cancer with that of patients after total gastrectomy (TG), distal gastrectomy (DG) and of healthy volunteers and patients after DG. The LPG group was divided into an RE LPG-RE (+) group and a non-reflux esophagitis (non-RE) an LPG-RE (-) group, and we compared gastric emptying and indices of nutrition, such as body weight and laboratory findings, between those among LPG-RE (+), LPG-RE (-), and TG groups. The time lag between ingestion and peak 13 CO 2 expiration (T lag) in the healthy volunteer group was significantly shorter in the LPG group longer than those in the healthy volunteer LPG group and TG group. The T lag was significantly shorter in the RE LPG-RE (+) group than in the non-RE LPG-RE (-) group. The percentage change in body weight percentage in the non-RE LPG-RE (-) group was significantly larger than that in the RE LPG-RE (+) group at 12 months after surgery. Both the serum albumin and hemoglobin levels in the non-RE LPG-RE (-) tended to be preserved compared with those in the RE LPG-RE (+) group and TG group. Gastric emptying was accelerated after LPG, and was associated with RE. Our data suggest that RE could be associated with body weight loss after LPG.

Loss of GNE Predicts Lymph Node Metastasis in Early Gastric Cancer.

Endoscopic surgery is increasingly utilized for the treatment of early gastric cancer (EGC) worldwide, whereas lymph node metastasis (LNM) remains a critical risk factor for the relapse of EGC after endoscopic surgery. Therefore, identifying potential predictive factors and understanding the molecular mechanisms are urgently needed for improving the outcome of EGC patients with LNM. UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase (GNE) is the key enzyme in the process of biosynthesis of CMP-Neu5Ac from UDP-N-acetylglucosamine (UDP-GlcNAc), which acts as a substrate for several reactions in glycan metabolism. In this study, we found that GNE was down-regulated in EGC patients with LNM. GNE expression as well as localization, tumor size, intravascular tumor thrombi and Lauren's classification were further identified as independent predictive factors for LNM. Combining GNE expression with traditional risk factors, including tumor size and differentiation degrees, could generate a better model for predicting LNM in EGC patients. Overall, our study implies that low GNE expression is a potential predictor of LNM in EGC.

The Diagnosis of Early Gastric Cancer Based on Medical Imaging Technology and Mathematical Modeling.

The key to reducing the mortality of gastric cancer is early detection, early diagnosis, and early treatment of gastric cancer. Early diagnosis of gastric cancer is the key to early detection and diagnosis of gastric cancer. Early diagnosis and treatment of gastric cancer is of great significance for improving the curative effect and reducing mortality of gastric cancer. The purpose of this paper is to study the diagnosis of early gastric cancer based on medical imaging techniques and mathematical modeling. The effect of W-DeepLab network-assisted diagnosis of images under white light was analyzed, and the value of Narrow Band Imaging and Blue Laser Imaging in the diagnosis of early gastric cancer was compared. Because Blue Laser Imaging endoscopy can clearly observe the demarcation line and microvascular morphology; but when using Narrow Band Imaging observation, part of the demarcation line and microvascular morphology is not observed. The results show that Blue Laser Imaging is brighter than Narrow Band Imaging's endoscopic images, and it is easier to observe the microstructure of lesions under endoscopy, so as to accurately determine the nature of lesions.

S1615 Clinical Outcome of Endoscopic Submucosal Dissection for Early Gastric Cancer: A Retrospective Single Center Study

Introduction: Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer without the risk of lymph node metastasis. However, the outcomes in the United States are not well studied because of the low prevalence of gastric cancer. We aimed to assess the efficacy and safety of ESD for early gastric cancer in the United States. Methods: We performed a single-center retrospective analysis of patients who underwent gastric ESD between June 2018 and December 2021. The main outcome measures were en-bloc resection rate, R0 (complete) resection rate, procedure time, tumor size, hospital length of stay (LOS), histology, and complication rate. Results: In total, 46 patients were included (Table). The median age was 71 years (range, 68.9-76.8 years). En-bloc and R0 resection rates were 94.5% and 81.8%, respectively. The median procedure time was 87.5 min (range, 69.3-118.8 min). The median tumor size was 26mm (range, 20-35 mm). The mean hospital length of stay was 1.87±1.38 days. The most common histologic type was pT1a (45.7%), followed by pT1b (26.1%), adenoma with low-grade dysplasia (13.0%), adenoma with high-grade dysplasia (10.9%), and neuroendocrine tumor (4.3%). There were 3 adverse events all of which were delayed bleeding and no perforations were reported. Conclusion: Our study showed that gastric ESD is a safe and effective method for superficial gastric neoplasia. ESD should be considered for patients with suitable lesions in the U.S. Table 1. - Baseline Characteristics and Outcomes of Gastric Endoscopic Submucosal Dissection ESD, endoscopic submucosal dissection; EMR, endoscopic mucosal dissection; LGD, low-grade dysplasia; HGD, high-grade dysplasia Baseline characteristics Age, y, median (IQR) 71 (68.9-76.8) Sex, men/women, n 30/16 ASA class, n (%) Ⅰ 0 0 II 0 0 Ⅲ 5 10.9 Ⅳ 41 89.1 Lesion site, n (%) Antrum 10 21.7 Body 13 28.3 Greater curvature 1 2.2 Lesser curvature 5 10.9 Cardia 12 26.1 Incisura angularis 5 10.9 Type of injection, n (%) Eleview 11 23.9 Orise 35 76.1 Type of primary knife for ESD, n (%) Dual knife 29 63.0 ProKnife 17 37.0 Anesthesia, n (%) Propofol 7 15.2 General anesthesia 39 84.8 Interventions before ESD, n (%) Tattoo underneath lesion 6 13.0 Scar underneath lesion 10 21.7 Radiofrequency ablation 1 2.2 ESD 4 8.7 EMR 4 8.7 Outcomes En bloc resection, n (%) 43 93.5 R0 resection, n (%) 36 78.3 Procedure time, min, median (IQR) 87.5 (69.3 - 118.8) Tumor size, mm, median (IQR) 26 (20 - 35) Length of hospital stay, d, mean ± SD 1.8 ± 1.4 Histology, n (%) Adenoma with LGD 6 13.0 Adenoma with HGD 5 10.9 pT1a 21 45.7 pT1b 12 26.1 Neuroendocrine tumor 2 4.3 Adverse event, n (%) Delayed bleeding 3 6.5 Perforation 3 6.5 Infection 0 0

Efficacy and safety of pocket-creation method for early gastric cancers.

Endoscopic submucosal dissection (ESD) is the standard endoscopic treatment for early gastric cancers (EGCs). However, obscured view and difficulty in submucosal lifting during ESD have been demonstrated. Additionally, ESD is time-consuming and poses a high risk of perforation and bleeding when performed in challenging locations. The pocket-creation method (PCM) is a newly developed strategy for colorectal tumors, while the outcomes of application in the treatment of EGCs are rarely reported. In the present study, we aimed to compare the technical efficacy and safety of PCM-ESD and the conventional ESD (c-ESD) technique for the treatment of EGCs. This was a single-center retrospective study consisting of 162 patients with EGCs who underwent ESD between February 2019 and February 2021. One-to-one propensity score matching (PSM) was performed. In addition, clinicopathological characteristics and treatment outcomes were also compared. PCM-ESD was more likely to be used in patients with larger lesions than c-ESD with/without traction. In addition, the resection speed for lesions of the PCM-ESD was faster compared with c-ESD without traction (median dissection speed: 19.6mm2/min vs. 15mm2/min; p < 0.001) and c-ESD with traction (median dissection speed after PSM: 19.9mm2/min vs. 15mm2/min; p = 0.001). In multiple linear regression analysis, significant factors related to a higher dissection speed were the treatment method of PCM-ESD (p = 0.034), the long diameter of the resected lesion (p = 0.001), and lesion location (p = 0.046). Collectively, PCM-ESD appeared to be a safer and more effective treatment for EGCs than c-ESD. In addition, PCM-ESD could significantly improve the speed of tumor resection.

Pathological and oncological outcomes of pylorus-preserving versus conventional distal gastrectomy in early gastric cancer: a systematic review and meta-analysis

BackgroundPylorus-preserving gastrectomy (PPG) is a function-preserving surgery for the treatment of early gastric cancer (EGC) in the middle third of the stomach. According to the literature reports, PPG decreases the incidence of dumping syndrome, bile reflux, gallstone formation, and nutritional deficit compared with conventional distal gastrectomy (CDG). However, the debates about PPG have been dominated by the incomplete lymphadenectomy and oncological safety. We carried out a systematic review and meta-analysis to evaluate the pathological and oncological outcomes of PPG.MethodsThe protocol was registered in PROSPERO under number CRD42022304677. Databases including PubMed, Embase, Web of Science, and the Cochrane Register of Controlled Trials were searched before February 21, 2022. The outcomes included the pooled odds ratios (ORs) for dichotomous variables and weighted mean differences (WMDs) for continuous variables. For all outcomes, 95% confidence intervals (CIs) were calculated. Meta-analysis was performed using STATA software (Stata 14, Stata Corporation, Texas) and Review Manager 5.4.ResultsA total of 4500 patients from 16 studies were included. Compared with the CDG group, the PPG group had fewer lymph nodes harvested (WMD= −3.09; 95% CI −4.75 to −1.43; P < 0.001). Differences in the number of resected lymph nodes were observed at stations No. 5, No. 6, No. 9, and No. 11p. There were no differences in lymph node metastasis at each station. Shorter proximal resection margins (WMD = −0.554; 95% CI −0.999 to −0.108; P = 0.015) and distal resection margins (WMD = −1.569; 95% CI −3.132 to −0.007; P = 0.049) were observed in the PPG group. There were no significant differences in pathological T1a stage (OR = 0.99; 95% CI 0.80 to 1.23; P = 0.88), T1b stage (OR = 1.01; 95% CI 0.81 to 1.26; P = 0.88), N0 stage (OR = 0.97; 95% CI 0.63 to 1.48; P = 0.88), tumor size (WMD = −0.10; 95% CI −0.25 to 0.05; P = 0.187), differentiated carcinoma (OR = 1.04; 95% CI 0.74 to 1.47; P = 0.812) or signet ring cell carcinoma (OR = 1.22; 95% CI 0.90 to 1.64; P = 0.198). No significant differences were observed between the groups in terms of overall survival (HR = 0.63; 95% CI 0.24 to 1.67; P = 0.852) or recurrence-free survival (HR = 0.29; 95% CI 0.03 to 2.67; P = 0.900).ConclusionsThe meta-analysis of existing evidence demonstrated that the survival outcomes of PPG may be comparable to those of CDG. However, fewer lymph nodes at stations in No. 5, No. 6, No. 9, and No. 11p were harvested with PPG. We also found shorter proximal resection margins and distal resection margins for PPG, meaning more remnant stomachs would be preserved in PPG.

The cytotoxic effects of green synthesized AgCl2 nanoparticles on gastric cancer (AGS) cells

In recent years, with the development of nanotechnology, the use of various metal nanoparticles has become widespread specifically in the treatment of cancer. Furthermore, the application of silver nanoparticles (AgNPs) should not be denied in this respect. AgNPs hold great potential in the field of cancer biology and because of their anti-microbial activities they are vastly used in diverse clinical applications. AgNPs possess some physical and chemical features including heterogeneity in size, shape, and capping material. Moreover, their novel cytotoxic characteristics against mammalian cells makes them more applicable in tumor therapy and acting as anti-cancer agents. AgNPs have great potential in tumor diagnosis as well as treatment (Zhao et al., 2022; Păduraru et al., 2022; Patil et al., 2021). Gastric cancer is the fifth most common cancer with more than 1 million people newly diagnosed worldwide each year. Despite its worldwide decline in incidence and mortality over the past 5 decades, gastric cancer remains the third leading cause of cancer-related death (Sexton et al., 2020; Thrift and El-Serag, 2020) Gastric cancer is diagnosed histologically after endoscopic biopsy and staged using CT, endoscopic ultrasound, PET, and laparoscopy. The main treatment for early gastric cancer is endoscopic resection. Non-early operable gastric cancer is treated with surgery, which should include D2 lymphadenectomy (including lymph node stations in the perigastric mesentery and along the celiac arterial branches). Perioperative or adjuvant chemotherapy improves survival in patients with stage 1B or higher cancers. Advanced gastric cancer is treated with sequential lines of chemotherapy, starting with a platinum and fluoropyrimidine doublet in the first line; median survival is less than 1 year. Metastatic gastric cancer remains a non-curative disease. Palliative chemotherapy has been demonstrated to prolong survival without quality of life compromise. Many single-agents and combinations have been confirmed to be active in the treatment of metastatic disease. In the setting of metastatic or inoperable gastric cancer, the current evidence shows that chemotherapy improves survival in comparison to best supportive care and that combination chemotherapy is superior to monotherapy in terms of survival, response rate and symptom control. Although there are no internationally accepted standard regimens, in Europe, ECF (epirubicin, cisplatin, fluorouracil) has been considered the reference regimen; in the US cisplatin-fluoropyrimidine combinations are mainly used, while in Japan, cisplatin with S1 has become the standard. It has also been suggested that immunochemotherapy may improve survival of patients with curatively resected gastric cancer. Targeted therapies licensed to treat gastric cancer include trastuzumab (HER2-positive patients first line), ramucirumab (anti-angiogenic second line), and nivolumab or pembrolizumab (anti-PD-1 third line). Gastrointestinal symptoms are the most notable side effects of chemotherapeutic drugs (Kim et al., 2013; Janunger et al., 2001; Choi et al., 2018; Sastre et al., 2006; Zhou et al., 2017). Many recent studies have shown that green synthesized silver nanoparticles (AgNPs) can have cytotoxic effects on different cancer cells (Yesilot and Aydin, 2019). The biosynthesized AgNPs using the leaves extracts of Hemichroa pentandra showed considerable antioxidant activity and excellent anti-cancer activity against breast cancer cells (Punathil, 2018). Biosynthesized AgNPs from the leaf extract of Ochradenus arabicus can have suppressive effects against the human breast cancer cells (Al-kawmani et al., 2020). Also, green synthesized silver nanoparticles using Teucrium polium leaf extract exhibited significant anticancer activity against MNK45 human gastric cancer cell line (Hashemi et al., 2020). In this study we investigated the cytotoxic effects of green synthesized AgCl2 nanoparticles on gastric cancer (AGS) cells. Onopordum acanthium extract was used to synthesize AgCl2 nanoparticles. Onopordum acanthium has been applied traditionally as bactericide and antitumor agent (Al-Snafi, 2020). Gastric cancer cells were purchased from Pasteur Institute of Iran and cultured in growth medium until they reached 80-90% confluence. The cells were then treated with different concentrations (1.5625, 3.125, 6.25, 12.5, 25 and 50 μg/ml) of AgCl2 nanoparticle for 24 hours. The cytotoxic effect of AgCl2 nanoparticles was assessed using MTT assay method. The results showed that viability of AGS cells did not significantly change 24 hours after treatment with 1.5625 μg/ml of green synthesized AgCl2 nanoparticles compared to the control group; However, the viability in AGS cells significantly decreased when treated with 3.125, 6.25, 12.5, 25 and 50 μg/ml of green synthesized AgCl2 nanoparticles compared to control group. There cytotoxic effect was more in groups treated with 6.25, 12.5, and 25 than groups treated with 3.125, 6.25, and 12.5 μg/ml of green synthesized AgCl2, respectively. There was not significant difference between cell viability of group treated with 25 and 50 μg/ml of green synthesized AgCl2.Conclusion: Our results show that green synthesized AgCl2 nanoparticles have cytotoxic effects against gastric cancer (AGS) cells in vitro.

Preoperative evaluation of endoscopic submucosal dissection for early gastric cancer.

Objective:To retrospectively analyze the preoperative endoscopic evaluation of the size, nature, and depth of lesions in endoscopic submucosal dissection (ESD) for early gastric cancer and precancerous lesions, determine whether the lesions can be completely resected, and reduce the risk of additional surgery after ESD.Methods:A total of 114 patients with high-grade intraepithelial neoplasia(HGIN) and early gastric cancer treated with ESD in Hebei General Hospital from January 2016 to April 2021 were enrolled in this study. The lesions were evaluated preoperatively according to the endoscopic findings of white light, magnifying endoscopy, endoscopic features of narrow band imaging, and preoperative pathology. Lesion size, positive resection margin, lesion depth, and vascular invasion of postoperative pathology were used as criteria.Results:There were 121lesions in 114 patients. The coincidence rates of preoperative and postoperative pathology were 87.21% (75/86) for HGIN and 92.1% (35/38) for adenocarcinoma. There was no significant difference in the coincidence rate between preoperative pathological evaluation and postoperative pathology among the 3 lesions (χ2 = 10.614, P = .005). The type and malignancy of the lesion were not related to its location or size. Magnifying endoscopy combined with narrow-band imaging showed that HGIN and early gastric cancer had clear borders, irregular microvessels, and irregular surface microarchitecture on endoscopic features. Lesions > 3 cm, surface ulcers and spontaneous bleeding may be risk factors for deeper lesions.Conclusion:ESD is not only a method for the treatment of early gastric cancer and precancerous lesions, but is also an important method for definite pathological diagnosis. Accurate preoperative assessment of lesion type, lesion extent and depth of invasion is helpful to improve the complete resection rate of ESD and reduce the risk of additional surgery.

Construction and analysis of an ulcer risk prediction model after endoscopic submucosal dissection for early gastric cancer.

BACKGROUNDEndoscopic submucosal dissection (ESD) has been widely used in the treatment of early gastric cancer (EGC). A personalized and effective prediction method for ESD with EGC is urgently needed.AIMTo construct a risk prediction model for ulcers after ESD for EGC based on LASSO regression.METHODSA total of 196 patients with EGC who received ESD treatment were prospectively selected as the research subjects and followed up for one month. They were divided into an ulcer group and a non-ulcer group according to whether ulcers occurred. The general data, pathology, and endoscopic characteristics of the groups were compared, and the best risk predictor subsets were screened by LASSO regression and tenfold cross-validation. Multivariate logistic regression was applied to analyze the risk factors for ulcers after ESD in patients with EGC. A receiver operating characteristic (ROC) curve was used to estimate the predictive model performance.RESULTSOne month after the operation, no patient was lost to follow-up. The incidence of ulcers was 20.41% (40/196) (ulcer group), and the incidence of no ulcers was 79.59% (156/196) (non-ulcer group). There were statistically significant differences in the course of disease, Helicobacter pylori infection history, smoking history, tumor number, clopidogrel medication history, lesion diameter, infiltration depth, convergent folds, and mucosal discoloration between the groups. Gray's medication history, lesion diameter, convergent folds, and mucosal discoloration, which were the 4 nonzero regression coefficients, were screened by LASSO regression analysis. Further multivariate logistic analysis showed that lesion diameter [Odds ratios (OR) = 30.490, 95%CI: 8.584-108.294], convergent folds (OR = 3.860, 95%CI: 1.060-14.055), mucosal discoloration (OR = 3.191, 95%CI: 1.016-10.021), and history of clopidogrel (OR = 3.554, 95%CI: 1.009-12.515) were independent risk factors for ulcers after ESD in patients with EGC (P < 0.05). The ROC curve showed that the area under the curve of the risk prediction model for ulcers after ESD in patients with EGC was 0.944 (95%CI: 0.902-0.972).CONCLUSIONClopidogrel medication history, lesion diameter, convergent folds, and mucosal discoloration can predict the occurrence of ulcers after ESD in patients with EGC.

Machine Learning Improves the Prediction Rate of Non-Curative Resection of Endoscopic Submucosal Dissection in Patients with Early Gastric Cancer

Simple SummaryEndoscopic submucosal dissection (ESD) is accepted as a standard treatment for early gastric cancer (EGC). Non-curative resection (NCR) of EGC after ESD can increase the burden of additional treatment and medical expenses. Thus, we aimed to develop a machine-learning (ML)-based NCR prediction model for EGC prior to ESD. We obtained data from 4927 patients with EGC who underwent ESD between January 2006 and February 2020. Seven ML-based NCR prediction models were developed using ten clinicopathological characteristics. The performance of NCR prediction was highest in the XGBoost model (AUROC, 0.851; 95% confidence interval, 0.837–0.864). Our ML model improved the ability to predict NCR of ESD in patients with EGC. This ML model can provide useful information for decision-making regarding the appropriate treatment of EGC before ESD.Non-curative resection (NCR) of early gastric cancer (EGC) after endoscopic submucosal dissection (ESD) can increase the burden of additional treatment and medical expenses. We aimed to develop a machine-learning (ML)-based NCR prediction model for EGC prior to ESD. We obtained data from 4927 patients with EGC who underwent ESD between January 2006 and February 2020. Ten clinicopathological characteristics were selected using extreme gradient boosting (XGBoost) and were used to develop a ML-based model. Dataset was divided into the training and internal validation sets and verified using an external validation set. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were evaluated. The performance of each model was compared by using the Delong test. A total of 1100 (22.1%) patients were identified as being treated non-curatively with ESD. Seven ML-based NCR prediction models were developed. The performance of NCR prediction was highest in the XGBoost model (AUROC, 0.851; 95% confidence interval, 0.837–0.864). When we compared the prediction performance by the Delong test, XGBoost (p = 0.02) and support vector machine (p = 0.02) models showed a significantly higher performance among the NCR prediction models. We developed an ML model capable of accurately predicting the NCR of EGC before ESD. This ML model can provide useful information for decision-making regarding the appropriate treatment of EGC before ESD.

Relaparoscopy in the management of post-operative complications after minimally invasive gastrectomy for gastric cancer

Laparoscopy has already been validated for treatment of early gastric cancer. Despite that, no data have been published about the possibility of a minimally invasive approach to surgical complications after primary laparoscopic surgery. In this multicentre study, we describe our experience in the management of complications following laparoscopic gastrectomy for gastric cancer. A chart review has been performed over data from 781 patients who underwent elective gastrectomy for gastric cancer between January 1996 and July 2020 in two high referral department of gastric surgery. A fully descriptive analysis was performed, considering all the demographic characteristics of patients, the type of primary procedure and the type of complication which required reoperation. Moreover, a logistic regression was designed to investigate if either the patients or the primary surgery characteristics could affect conversion rate during relaparoscopy. Fifty-one patients underwent reintervention after elective laparoscopic gastric surgery. Among patients who received a laparoscopic reintervention, 11 patients (34.3%) required a conversion to open surgery. Recovery outcomes were significantly better in patients who completed the reoperation through laparoscopy. Relaparoscopy is safe and effective for management of complications following laparoscopic gastric surgery and represent a useful tool both for re-exploration and treatment, in expert and skilled hands.

Comparison between Endoscopic Submucosal Dissection and Surgery in Patients with Early Gastric Cancer.

Simple SummaryConventional gastrectomy combined with regional lymph node dissection has been the standard treatment for early gastric cancer (EGC). This retrospective case–control study aimed to compare the clinical outcomes of endoscopic submucosal dissection (ESD) and surgical resection for EGC in China. After propensity score-matching, there were no significant differences between the two groups for OS, RFS, and DSS. Additionally, with similar R0 resection and recurrence rates, the ESD group showed less blood loss, fewer adverse events, lower hospital cost, and a shorter operative time and hospital duration than the surgery group. Therefore, ESD can be a first-line treatment of EGC in addition to surgery.Background: Endoscopic submucosal dissection (ESD) has become a preferred treatment option for early gastric cancer (EGC). This study aimed to compare the clinical outcomes of ESD and surgical resection for EGC. Methods: This was a retrospective case–control study. Patients with a diagnosis of EGC who underwent ESD or surgery in our hospital from 2011 to 2020 were enrolled. We compared the clinical characteristics and treatment outcomes of these two groups according to propensity score-matching. The primary outcome comparison was overall survival (OS). Secondary outcomes were disease-specific survival (DSS), recurrence-free survival (RFS), and treatment-related events. Results: In the matched cohort, the ESD group showed comparable OS, RFS, and DSS with the surgery group. Statistical differences were shown in blood loss and adverse events. Furthermore, the ESD group showed lower hospital cost, as well as a shorter operative time and hospital duration than the surgery group. The R0 resection and recurrence rates were similar between the two groups. In Cox regression analysis, age, tumor size, poor differentiation, and lymphovascular invasion were regarded as independent factors of OS. Conclusions: With sufficient safety and advantages, ESD can be a first-line treatment of EGC. Preoperative evaluation is vital to the appropriate treatment and prognosis.

China guideline for the screening, early detection and early treatment of gastric cancer (2022, Beijing)

Gastric cancer (GC) is a major digestive tract malignancy in China, which seriously threatens the health of Chinese population. A large number of researches have demons-trated that screening, early detection and early treatment are effective in reducing the incidence and mortality of GC. The development of the guideline for GC screening, early detection and early treatment in line with epidemic characteristics of GC in China will greatly promote the homogeneity and standardization, and improve the effect of GC screening. This guideline was commissioned by the Bureau of Disease Control and Prevention of the National Health Commission. The National Cancer Center of China initiated and convened a working group comprising multidisciplinary experts. Following the World Health Organization Handbook for Guideline Development, this guideline combined the most up-to-date evidence of GC screening, China's national conditions, and practical experience in cancer screening. This guideline provided evidence-based recommendations with respect to the screening population, technology and procedure management, aiming to improve the effect of GC screening and provide scientific evidence for the GC prevention and control in China.

Autoimmune Pancreatitis with Gastric Cancer: Some IgG4-related Diseases May Be Paraneoplastic Syndrome

A 70-year-old man was referred to our department for the treatment of early gastric cancer. Contrast-enhanced computed tomography (CT) incidentally showed diffuse enlargement of the pancreas with a capsule-like rim, and blood tests showed elevated serum IgG4 levels, leading to a diagnosis of autoimmune pancreatitis (AIP). Endoscopic treatment for gastric cancer was performed, and pathological findings showed adenocarcinoma with abundant IgG4-positive plasma cell infiltration. Thereafter, the serum IgG4 levels normalized, and the findings of AIP disappeared on CT without steroid treatment. These findings suggest that the gastric cancer activated an IgG4-related immune response, resulting in the development of AIP.

The Safety and Clinical Validity of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients Aged More Than 85 Years.

Simple SummaryIn this study, we elucidated whether endoscopic submucosal dissection for early gastric cancer is safe and feasible in very old patients. We compared the characteristics and outcomes of patients aged ≥85 years with those of other patients. We found no significant differences in the incidence of adverse events between patients ≥85 years of age and other patients. However, the overall survival of patients aged ≥85 years was significantly lower than that of other patients. We found that poor nutritional status was correlated with poor prognosis in patients aged ≥85 years. Therefore, we conclude that endoscopic submucosal dissection for early gastric cancer is safe and valid for patients aged ≥85 years. However, the indications should be carefully decided because it is difficult to estimate the survival benefits of endoscopic submucosal dissection for early gastric cancer in patients aged ≥85 years, especially those with poor nutritional status.Endoscopic submucosal dissection (ESD) is a safe and minimally invasive method for the treatment of early gastric cancer (EGC). However, whether ESD for EGC is also safe and feasible in patients aged ≥85 years is unclear. The patients enrolled in this study were divided into three groups: age ≥85 years (44 patients, 49 lesions), age 65–84 years (624 patients, 687 lesions), and age ≤64 years (162 patients, 174 lesions). We evaluated the incidence of adverse events (AEs) and overall survival (OS) and disease-specific survival (DSS). We analyzed the factors that had a significant impact on the prognosis of patients aged ≥85 years. No significant differences were found in the incidence of AEs among the three groups (p = 0.612). The OS was significantly lower in patients aged ≥85 years (p < 0.001). Conversely, DSS was not significantly worse in patients aged ≥85 years (p = 0.100). The poor Geriatric Nutritional Risk Index correlated with poor prognosis in patients aged ≥85 years (p < 0.001). ESD is a safe and valid treatment for EGC in patients aged ≥85 years. However, the indications should be carefully decided because it is difficult to estimate the survival contribution of ESD for EGC in patients aged ≥85 years, especially in those with poor nutritional status.