Treatment Of Proximal Gastric Cancer Research Articles

Novel reconstruction method using long and narrow gastric tube in laparoscopic proximal gastrectomy for cancer: a retrospective case series study.

To clarify the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with our novel reconstruction methods. Novel method is a reconstruction with a long and narrow gastric tube with widening of the proximal side created by linear stapler, and esophagogastrostomy is performed by linear stapler. In conventional method, esophagogastrostomy is performed by a circular stapler. Short- and long-term outcomes of a novel method were compared with those of conventional method. A total of 44 patients whom LPG was performed were enrolled in this retrospective study. No cases of anastomotic leakage and stenosis were observed in both groups. The cases of postoperative reflux esophagitis (Grade B or higher) at 1 year after operation in the Novel group were less than those in the Conventional group (17% vs. 44%). LPG with novel reconstruction method can be easily performed, and may be feasible for the treatment of proximal gastric cancer.

Immediate and Long-Term Results of the Spleen-Preserved Operations in the Surgical Treatment of Gastric Cancer

ntroduction. Currently, total gastrectomy with D2 lymphadenectomy is the standard surgical treatment for proximal gastric cancer at the resectable stages (I-III). The issue of advisability of splenectomy as a component of lymphadenectomy remains a controversial one, especially when the tumor is localized in the region of the body or cardiac region of the stomach.The aim of the study was to compare immediate and long-term outcomes, including the quality of life, between spleen preserving and spleen removing surgeries.Methods. The study included 363 patients with gastric cancer II-III stages, localized in the upper and/or the middle third of the stomach, who underwent surgery at the Voronezh Regional Clinical Oncology Hospital and the Voronezh Clinical Hospital of the Russian Railway-Medicine in 2015-2017. All patients were conditionally divided into 2 groups for comparative retrospective analysis. All patients of the first (experimental or spleen-preserved) group (144 patients) were performed R0 total gastrectomy with D2 lymphadenectomy, including splenic hilar nodes (№ 10,11) removal without splenectomy. Patients of the second (control or splenectomy) group (219 patients) were performed R0 total gastrectomy with D2 lymphadenectomy and prophylactic splenectomy (for splenic hilar nodes removal).Results. The average duration of the operation and the volume of blood loss did not differ in both groups. The incidence of early postoperative surgical complications was lower in the spleen-preserved group. Splenectomy was associated with more severe complications of class 4 and 5 according to the Clavien-Dindo classification. Conclusion. Parameters of the 1- and 3-year overall survival rate did not differ in both groups. The results of the GSRS questionnaire were similar in both groups, excluding reflux-esophageal symptoms scale. The reflux scale demonstrated a statistically and clinically significant advantage of spleen preservation.

Three-dimensional computed tomography simulation for laparoscopic lymph node dissection in the treatment of proximal gastric cancer.

Application of laparoscopic surgery (LS) has expanded worldwide in the various fields due to the potential advantage of being less invasive than open surgery; however difficulty in recognizing positional relationship of the organs is one of the disadvantages of this kind of surgery. In order to compensate this drawback, preoperative three-dimensional computed tomography (3D-CT) simulation is regarded as promising. In gastric cancer surgery, 3D-CT simulation seems particularly effective in the splenic hilar dissection, because this region is associated with remarkable anatomical variation with complexity. As effects from the use of 3D-CT simulation, reduction of blood loss or complication rate, shortening of operation time and enhancement of surgical quality are expected. In this article, we introduce our methodological protocol of 3D-CT simulation in gastric cancer surgery with clinical case examples, and also additionally review previous publications reporting this imaging technology.

Hospital volume effects in surgical treatment of gastric cancer : Results of aprospective multicenter observational study

The impact of hospital and surgeon volume on the treatment outcome based on data obtained from cohort and register studies has been controversially discussed in the international literature. The results of large-scale prospective observational studies within the framework of clinical healthcare research may lead to relevant recommendations in this ongoing discussion. Within the framework of the prospective multicenter German Gastric Cancer Study 2 (QCGC2), from 1 January 2007 to 31 December 2009 a total of 2897 patients with the histological diagnosis of gastric cancer from 140 surgical departments were registered and analyzed. The departments were subdivided according to the number of cases into 4 volume groups: I) <5, II) 5-10, III) 11-20 and IV) >20 patients with surgical interventions per year. Overall 1163 patients (65.6 %) underwent surgical interventions in the departments of groups III and IV. Of the patients 521 (18 %) were scheduled for neoadjuvant treatment but with no significant differences among the various volume groups. In the departments of volume groups I and II subtotal gastric resection was performed significantly more often. Transthoracic extended surgical interventions in cases of a proximal tumor site were significantly more frequent in departments from volume group IV (p<0.001). The proportion of intraoperative fresh frozen sections correlated with the case volume: group I 23.2 % vs. group IV 61.2 %. Overall hospital mortality was 6.1 % and slightly higher in volume group I with 7.8 %. The median survival time and the 5‑year survival rate showed no significant differences between the various volume groups independent of tumor stages. There was a tendency towards a longer median survival time in volume group IV only for proximal tumor sites, i.e. adenocarcinoma of the esophagogastric junction (AEG). Using Cox regression analysis hospital volume did not have an independent impact on long-term survival. Hospital volume effects could only be detected for the treatment of AEG. To improve oncological long-term outcome, centralization of treatment of proximal gastric cancer appears to be recommendable.

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

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

A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

The purpose of this study is to depict a novel delta-shaped intracorporeal double-tract reconstruction (DT) for totally laparoscopic (TL) proximal gastrectomy (PG), and to evaluate its safety and feasibility by analyzing its surgical and postoperative outcomes. We retrospectively reviewed the cases of 21 patients who underwent TLPG and TLDT (TLPG-DT) from January to December 2014 in our hospital. The data of clinicopathologic characteristics, surgical and postoperative outcomes, and follow-up findings were collected and analyzed. The mean duration of the operation was 173.8±21.8min, including 27.8±5.3min of reconstruction. The blood loss was 109.2±96.3mL. The mean number of LNs dissected was 25.7±4.7. The mean time of the first flatus was at postoperative day 2.3±1.0, and the mean postoperative hospital stay was 6.8±2.5days. The early complications rate was 9.5%, including one intraperitoneal hemorrhage and one pulmonary infection (both were managed through conservative methods and no re-operation occurred). The rate of complications in late stage was also 9.5%, including one diarrhea and one reflux symptom claim. Among the total 21 cases, 17 patients were followed up more than 6months, showing no signs of reflux esophagitis or anastomotic stenosis. The mean weight loss in 3 and 6months after the operation was 4.3 and 5.7%, respectively. Totally laparoscopic delta-shaped intracorporeal double-tract reconstruction is a safe, feasible and minimally invasive reconstruction method with excellent postoperative outcomes in terms of preventing reflux esophagitis and anastomotic stenosis. TLPG-DT might serve as a promising treatment for proximal gastric cancer of early stage.

Comparison of the effect of different surgical treatment for proximal gastric cancer

Objective To compare the clinical effect of proximal gastric malignant tumor treated by the total gastrectomy and the proximal gastrectomy.Methods 278 patients with gastric cancer were randomly divided into two groups by double blind method(1 ∶ 1).Patients in the two groups received total gastrectomy (TG)and proximal gastrectomy(PG) treatment,respectively.The surgery effect,postoperative complications,survival rate and tumor recurrence rate were compared between the two groups.Results In PG group,the average blood loss was (151.6 ± 26.4)mL,operation time was (124.5 ±36.2) min,hospital stay was(8.9 ± 3.1) days,which were significantly lower than those in TG group (231.5 ± 15.3) mL,(162.4 ± 24.8) min and (12.6 ± 6.2) days (t =45.352,36.521,11.243,all P ＜0.05).The lymph node excision rate of PG group was (13.2 ± 3.1)％,which was significantly lower than (16.4 ±4.6) ％ in TG group(t =9.654,P ＜ 0.05).The incidence rate of postoperative complications between the two groups had statistically significant difference(x2 =25.321,20.254,all P ＜ 0.05).The survival rates of 3 years,5 years in TG group were 62.16％,42.32％,those in PG group were 60.39％,34.23％.The 3 years survival rate had no significant difference between the two groups (x2 =6.321,P =0.079),5 years survival rate had statistically significant difference between the two groups (x2 =31.265,P =0.000).The recurrence rate in group TG was 22.30％,which was significantly lower than 34.53 ％ in PG group (x2 =29.365,P =0.000).Conclusion Average blood loss,operation time,hospitalization time and postoperative complications of PG group are less,,but the lymph node resection rate is low,tumor recurrence rate is high,the 5-year survival rate is lower than the TG after surgery.TG can be recommended for the proximal gastric malignancy. Key words: Gastrectomy; Stomach neoplasms

Current Controversy in the Treatment of Proximal Gastric Cancer

Current Controversy in the Treatment of Proximal Gastric Cancer