Subtotal versus total gastrectomy for distal diffuse-type gastric cancer.

INTRODUCTION: Diffuse-type gastric carcinoma in an aggressive form of gastric cancer. Surgery is the only potentially curative treatment. It is controversial whether patients with diffuse-type gastric carcinoma should undergo total or subtotal gastrectomy when feasible. The aim of this study is to analyze the oncologic outcomes and overall survival of patients diagnosed with distal diffuse-type gastric cancer undergoing subtotal versus total gastrectomy with curative intent. METHODS: This retrospective study included all patients with histologically confirmed diffuse-type distal gastric carcinoma and clinical staging cT1-4M0, who underwent surgery with curative intent between 2011 and 2020 in a Tertiary Referral Hospital in Chile. Clinical and pathological staging was conducted using the 8th Edition of the American Joint Committee on Cancer Classification. STG group was comprised by patients who underwent subtotal gastrectomy and TG group by patients who underwent total gastrectomy. Both groups were compared in relation to sociodemographic variables, pathology reports and perioperative data which were obtained from electronic medical records. Data analysis was obtained with Stata 16.1 Statistical Software. RESULTS: One hundred and thirty patients underwent curative intent surgery. Subtotal gastrectomy with D2-lymphadenectomy was completed in 68 patients (52%). An R0 resection was achieved in all patients. Median number of resected lymph nodes, tumor size, proximal margin and depth of invasion were similar in both groups. Pathologic staging was similar between both groups, the most frequent being Stage 3(54%). After a median follow-up of 47 months [0.3-157], no difference was observed in overall survival between both groups (5-year-OS 63% in STG group versus 51% in TG group, p = 0.097). CONCLUSIONS: Oncologic and survival outcomes were similar in patients submitted to subtotal and total gastrectomy, suggesting that a subtotal gastrectomy with D2-lymphadenectomy for distal diffuse-type gastric carcinoma is not associated with a decrease in median overall survival and is an adequate surgical approach when technically feasible.

Risk of venous thromboembolism in patients undergoing gastric cancer surgery: a systematic review and meta-analysis.

BACKGROUND: Venous thromboembolism (VTE) is a common postoperative complication in patients undergoing surgery for gastric cancer (GC). Although VTE incidence may vary among cancers, guidelines rarely stratify preventive methods for postoperative VTE by cancer type. The risk of VTE in patients undergoing surgery for GC remains unclear. METHODS: A systematic review and meta-analysis was undertaken to determine the risk of VTE after GC surgery and discuss the clinical value of pharmacological thromboprophylaxis in these cases. Medline, Embase, Web of Science, and Cochrane Library databases were searched for articles published from their inception to September 2022. RESULTS: Overall, 13 studies (111,936 patients) were included. The overall 1-month incidence of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE) after GC surgery was 1.8% (95% CI, 0.8-3.1%; I²=98.5%), 1.2% (95% CI, 0.5-2.1%; I²=96.1%), and 0.4% (95% CI, 0.1-1.1%; I²=96.3%), respectively. The prevalence of postoperative VTE was comparable between Asian and Western populations (1.8% vs. 1.8%; P > 0.05). Compared with mechanical prophylaxis alone, mechanical plus pharmacological prophylaxis was associated with a significantly lower 1-month rate of postoperative VTE and DVT (0.6% vs. 2.9% and 0.6% vs. 2.8%, respectively; all P < 0.05), but not PE (P > 0.05). The 1-month postoperative incidence of VTE was not significantly different between laparoscopic and open surgery (1.8% vs. 4.3%, P > 0.05). CONCLUSION: Patients undergoing GC surgery do not have a high risk of VTE. The incidence of VTE after GC surgery is not significantly different between Eastern and Western patients. Mechanical plus pharmacological prophylaxis is more effective than mechanical prophylaxis alone in postoperative VTE prevention. The VTE risk is comparable between open and laparoscopic surgery for GC.

Advances, breakthroughs, and challenges in gastric cancer surgery.

Gastric cancer (GC) remains a substantial health burden worldwide, ranking fifth in incidence and third in mortality among all cancer types. Surgeons have persistently attempted to address this growing burden through surgical management of GC encompassing various aspects of surgery, including advances in surgical techniques and tools for minimally invasive surgery, novel technology for real-time image-guided surgery, and function-preserving and oncometabolic surgeries, aimed at improving patients' quality of life. The current perspective discusses the five most critical dimensions of the recent technical improvements and conceptual changes in GC surgery. We recommend further exploration of long-term benefits of these advancements, identification of breakthrough solutions to address current challenges, and delivery of the best quality of care.

Important risk factors for gallstones after laparoscopic gastrectomy: a retrospective study.

BACKGROUND: The frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population. While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after laparoscopic gastrectomy (LG). Therefore, this study aimed to evaluate the incidence of gallstones after LG. METHODS: We retrospectively reviewed the records of 184 patients who underwent LG between January 2011 and May 2016 at Saiseikai Utsunomiya Hospital. After gastrectomy, abdominal ultrasonography was generally performed every 6 months for 5 years. Patients who underwent cholecystectomy before LG, underwent simultaneous cholecystectomy, and did not undergo abdominal ultrasonography, with an observation period of < 24 months, were excluded from the study. Finally, 90 patients were analyzed. Laparoscopic cholecystectomy was performed whenever biliary complications occurred. Patient characteristics were compared using the two-tailed Fisher's exact test or Chi-square test. In addition, the risk factors for postoperative gallstones were analyzed using logistic regression analysis. RESULTS: Among the 90 patients included in this study, 60 were men (78%), and the mean age was 65.5 years. Laparoscopic total gastrectomy was performed for 15 patients and laparoscopic distal gastrectomy for 75 patients. D2 lymph node dissection was performed for 8 patients (9%), whereas 68 patients underwent LG with Roux-en-Y reconstruction (76%). Gallstones were detected after LG in 27 of the 90 (30%) patients. Multivariate analysis identified Roux-en-Y reconstruction and male sex as significant risk factors of gallstones after gastrectomy. The incidence of gallstones was significantly higher (53%) in male patients who underwent Roux-en-Y reconstruction. Symptomatic gallstones after laparoscopic cholecystectomy were found in 6 cases (6/27, 22%), and all patients underwent laparoscopic cholecystectomy. CONCLUSION: Roux-en-Y reconstruction and male sex were identified as significant risk factors for gallstones after LG.

Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial.

BACKGROUND: Preoperative randomization for postoperative treatment might affect quality of surgery. In the CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach), patients were randomized before treatment to receive chemotherapy prior to a D1 + gastrectomy (removal of lymph node station (LNS) 1-9 + 11), followed by either chemotherapy (CT) or chemoradiotherapy (CRT). In this analysis, the influence of upfront randomization on the quality of surgery was evaluated. METHODS: Quality of surgery was analyzed in both study arms using surgicopathological compliance (removal of ≥ 15 lymph nodes), surgical compliance (removal of the indicated LNS), and surgical contamination (removal of LNS that should be left in situ). Furthermore, the 'Maruyama Index of Unresected disease' (MI) was evaluated in both study arms, and validated with overall survival. RESULTS: Between 2007 and 2015, 788 patients with gastric cancer were included in the CRITICS study of which 636 patients were operated with curative intent. No difference was observed between the CT and CRT group regarding surgicopathological compliance (74.8% vs 70.9%, P = 0.324), surgical compliance (43.2% vs 39.2%, P = 0.381), and surgical contamination (59.4% vs 59.9%, P = 0.567). Median MI was 1 in both groups (range CT 0-88 and CRT 0-136, P = 0.700). A MI below 5 was associated with better overall survival (CT: P = 0.009 and CRT: P = 0.013). CONCLUSION: Surgical quality parameters were similar in both study arms in the CRITICS gastric cancer trial, indicating that upfront randomization for postoperative treatment had no impact on the quality of surgery. A Maruyama Index below five was associated with better overall survival.

[Role of a computer program in gastric cancer surgery - beyond the evidence]. / A számítógépes program szerepe a gyomortumor-sebészetben ­ Túl az evidencián.

INTRODUCTION: Forty percent of patients with gastric cancer have an unnecessarily extended lymph node dissection with a higher rate of morbidity and mortality. While the Maruyama computer program (MCP) can estimate the lymph node involvement before the surgery, the Maruyama Index (MI) could be a good predictor of overall and disease free survival. METHODS: To measure the probability calculations by MCP, we had to define different "cut-off" levels, with using the calculation of the receiver-operating characteristics analysis. The long term oncological results, as the overall survival (OS) and disease free survival (DFS) were calculated in correlation with the extension of lymphadenectomy (D1 versus D2) and Maruyama Index (MI < 5 versus MI ≥ 5). RESULTS: 74 patients were investigated by the Maruyama computer program preoperatively for the short-term results, and the data of 101 patients were eligible for evaluation of the long-term oncological outcomes. The MCP had a 90.2% of sensitivity, 63.3% of specificity and 78.4% of accuracy. The positive predictive value was 75.5% and the negative predictive value was 84%. In D1 group the DFS was 93.6 months and 68.7 months in D2 group (p = 0.41; HR = 1.34), and the OS was 74.6 and 72.2 months respectively (p = 0.66; HR = 0.87). In patients with MI < 5 the DFS was 92 months and 62.5 months in patients with MI ≥ 5 (p = 0.31; HR = 1.4), while the OS was 86 months and 60.4 months (p = 0.17; HR = 1.52). CONCLUSIONS: Our results proved, that the computerized prediction of LN metastases is efficient and the long term results suggest, that the MI < 5 has a better impact on survival, than the D-level guided surgery.

Preoperative smoking cessation can reduce postoperative complications in gastric cancer surgery.

BACKGROUND: Despite the close link between cigarette smoking and the development of gastric cancer, little is known about the effects of cigarette smoking on surgical outcomes after gastric cancer surgery. The aim of this study was to investigate whether preoperative smoking status and the duration of smoking cessation were associated with short-term surgical consequences in gastric cancer surgery. METHODS: Among 1,489 consecutive patients, 1,335 patients who underwent curative radical gastrectomy at the Samsung Medical Center between January and December 2009 were included in the present study. The smoking status was determined using questionnaires before surgery. Smokers were divided into four groups according to the duration of smoking cessation preoperatively (<2, 2-4, 4-8, and >8 weeks). The primary endpoint was postoperative complications (wound, lung, leakage, and bleeding); secondary endpoints were 3-year recurrence-free survival (RFS) and overall survival (OS). RESULTS: Five hundred twenty-two patients (39.1 %) were smokers. Smokers had a significantly higher overall incidence of postoperative complications than nonsmokers (12.3 vs. 5.2 %, P < 0.001, respectively), especially in impaired wound healing, pulmonary problems, and leakage. Smokers also had more severe complications than nonsmokers. After adjusting for other risk factors, the odds ratio (95 % CI) for the development of postoperative complications in the subgroups who stopped smoking <2 weeks, 2-4, 4-8, and >8 weeks preoperatively were 3.35 (1.92-5.83), 0.99 (0.22-4.38), 2.18 (1.00-4.76), and 1.32 (0.70-2.48), respectively, compared with the nonsmokers. There were no significant differences in 3-year RFS (P = 0.884) and OS (P = 0.258) between smokers and nonsmokers. CONCLUSIONS: Preoperative smoking cessation for at least 2 weeks will help to reduce the incidence of postoperative complications in gastric cancer surgery.

Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia.

BACKGROUND: Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity. AIM: To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer (GC) surgery to provide a reference basis for the formulation of anesthesia protocols for radical GC surgery. METHODS: This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024. There was no restriction on sex. The patient grouping method used was a digital random table method, and the number of cases in each group was 56. The control group was administered total intravenous anesthesia, and the observation group compounded the stellate ganglion block according to the total intravenous anesthesia protocol. Postoperative hemodynamics, pain levels, and immune indices were compared between the groups. RESULTS: The heart rate and mean arterial pressure in the observation group after intubation were lower than those in the control group (P < 0.05). Pain levels were compared between the two groups at 2 hours, 12 hours, 24 hours, and 48 hours after surgery (P > 0.05). The number of CD3+, CD4+, and CD4+/CD8+ cells at the end of surgery was higher in the observation group than in the control group, and the number of CD8+ cells was lower in the observation group than in the control group (P < 0.05). There were no significant differences between the two groups in terms of propofol dosage, awakening time, extubation time, or postoperative adverse reactions (P > 0.05). CONCLUSION: The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery. However, it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.

Clinical value of prognostic nutritional index combined with C-reactive protein and albumin in early prediction of anastomotic leakage after radical gastric cancer surgery.

OBJECTIVE: To evaluate the predictive value of the Prognostic Nutritional Index (PNI) combined with C-reactive protein (CRP) and albumin (ALB) for anastomotic leakage following radical gastric cancer surgery. METHODS: A retrospective case-control study was conducted with 275 gastric cancer patients at the Second People's Hospital of Lanzhou City from September 2019 to October 2022. Patients were categorized into an anastomotic leakage group (n=31) or a non-leakage group. Clinical, surgical, and pathological data were analyzed using logistic regression to develop two risk models: a combined clinical-laboratory index (RISK1) and a separate laboratory index (RISK2). Model effectiveness was compared using Receiver Operating Characteristic (ROC) curves. RESULTS: Anastomotic leakage occurred in 11.27% of patients, predominantly in those with advanced TNM stages (P=0.006). Notably, higher operative times (P=0.049) and increased intraoperative bleeding (P=0.027) were associated with the leakage group. Significant differences in ALB, PNI, and CRP levels were observed between the groups. Both RISK1 and RISK2 identified ALB, CRP, PNI, operative time, and intraoperative bleeding as independent predictors of leakage, demonstrating high predictive accuracy (RISK1 AUC=0.937, RISK2 AUC=0.911), with no significant difference in performance between the models (P=0.245). CONCLUSION: The combination of ALB, CRP, and PNI effectively predicts the risk of anastomotic leakage in patients undergoing gastric cancer surgery. These biomarkers can significantly enhance postoperative management and improve patient outcomes.

Robotic-Assisted Total Gastrectomy for Gastric Cancer After Coronary Artery Bypass Grafting Using the Right Gastroepiploic Artery: A Case Report.

The right gastroepiploic artery (RGEA) is frequently used in coronary artery bypass grafting (CABG) for right coronary artery bypass requiring long-term patency. We experienced a case of upper-third advanced gastric cancer after CABG using RGEA. The absence of enlarged lymph nodes (LNs) or distant metastasis was confirmed through computed tomography (CT), and the RGEA graft remained patent according to coronary CT angiography. Based on these findings, the patient underwent robotic total gastrectomy while preserving the RGEA graft without infra-pyloric LN dissection. We suggested that caution should be exercised to avoid injury to the graft during gastrectomy, and robotic surgery could contribute to safely preserving the RGEA. We should consider the decision to dissect the infra-pyloric LN for the patient's safety and curability.

Self-reported exhaustion and a 4-item physical frailty index to predict the incidence of major complications after onco-geriatric surgery.

BACKGROUND: The aim of this study was to analyze four pre-operative physical frailty indicators from a geriatric assessment (GA) independently and combined in a physical frailty index, in their ability to predict postoperative 30 d-complications. MATERIALS AND METHODS: In this secondary analysis of data from the published PERATECS study (ClinicalTrials.gov: NCT01278537), the predictive value of four physical frailty indicators from a defined GA battery was examined with univariable and multivariate logistic regression models in a sample of 493 onco-geriatric surgical patients. The primary endpoint was incidence of major (Clavien-Dindo ≥ grade 2 [CD ≥ 2]) complications within 30 postoperative days. Predictors of the first model included self-reported exhaustion (SRE), body mass index (BMI), Timed Up-and-Go (TUG) and handgrip strength (HGS) independently, and a second model combined these four items as a Physical Frailty Index (4i-PFI). Both regression models were adjusted for age, gender, American Society of Anesthesiologists (ASA) status, tumor sites, duration of surgery time and Mini Nutritional Assessment (MNA) score. RESULTS: A total of 233 patients (47 %) developed CD ≥ 2 complications. In addition to ASA score, length of surgery, and gynecological and upper gastrointestinal tumor sites, the first model showed that SRE (OR 1.866) predicted CD ≥ 2 complications, but not TUG, BMI and HGS. In the second model, the 4i-PFI predicted CD ≥ 2 complications (OR pre-frail = 1.808, frail = 3.787). CONCLUSIONS: Physical frailty indicators as SRE revealed a better ability to predict CD ≥ 2 complications than BMI, TUG and HGS. However, prediction of CD ≥ 2 complications was enhanced when these parameters were combined in a novel 4i-PFI.

Advances in Gastric Cancer Surgical Management.

The goal of a gastric cancer operation is a microscopically negative resection margin and D2 lymphadenectomy. Minimally invasive techniques (laparoscopic and robotic) have been proven to be equivalent for oncologic care, yet with faster recovery. Endoscopic mucosal resection can be used for T1a N0 tumor resection. Better understanding of hereditary gastric cancer and molecular subtypes has led to specialized recommendations for MSI-high tumors and patients with pathogenic CDH1 mutations. In the future, surgical management will support minimally invasive approaches and personalized cancer care based on subtype.

Incidence of Postoperative Diabetes Mellitus After Roux-en-Y Reconstruction for Gastric Cancer: Retrospective Single-Center Cohort Study.

Background: Sleeve gastrectomy is an effective surgical option for morbid obesity, and it improves glucose homeostasis. In patients with gastric cancer and type 2 diabetes mellitus (DM), gastrectomy, including total gastrectomy, is beneficial for glycemic control. Objective: This study aims to clarify the effects of gastrectomy and different reconstructive techniques on the incidence of postoperative DM in patients with gastric cancer. Methods: This retrospective, single-center, cohort study included 715 patients without DM who underwent total gastrectomy at the Tokyo Metropolitan Bokutoh Hospital between August 2005 and March 2019. Patients underwent reconstruction by Roux-en-Y (RY) gastric bypass or other surgical techniques (OT), with DM onset determined by hemoglobin A1c levels or medical records. Analyses included 2-sample, 2-tailed t tests; χ2 tests; and the Kaplan-Meier method with log-rank tests to compare the onset curves between the RY and OT groups, along with additional curves stratified by sex. A Swimmer plot for censoring and new-onset DM was implemented. Results: Stratified data analysis compared the RY and OT reconstruction methods. The hazard ratio was 1.52 (95% CI 1.06-2.18; P=.02), which indicated a statistically significant difference in the incidence of new-onset diabetes between the RY and OT groups in patients with gastric cancer. The hazard ratio after propensity score matching was 1.42 (95% CI 1.09-1.86; P=.009). Conclusions: This first-of-its-kind study provides insight into how different methods of gastric reconstruction affect postoperative diabetes. The results suggest significant differences in new-onset DM after surgery based on the reconstruction method. This research highlights the need for careful surgical planning to consider potential postoperative DM, particularly in patients with a family history of DM. Future studies should investigate the role of gut microbiota and other reconstructive techniques, such as laparoscopic jejunal interposition, in developing postoperative DM.

Clinical significance of peripheral blood immune cells in patients with gastric cancer after surgery.

BACKGROUND: Gastric cancer is one of the most common malignant tumors worldwide, and surgical resection is one of the main ways to treat gastric cancer. However, the immune status of postoperative patients is crucial for prognosis and survival, and immune cells play an important role in this process. Therefore, it is helpful to understand the immune status of postoperative patients by evaluating the levels of peripheral blood immune cells, especially total T cells (CD3+), helper T cells (CD3+CD4+), and suppressor T cells (CD3+CD8+), and its relationship to survival. AIM: To analyzed the immune cells in peripheral blood of patients with gastric cancer after surgery, detect the levels of total T cells, helper T cells and suppressor T cells. METHODS: A total of 58 patients with gastric cancer who received surgical treatment were included in the retrospective study. Flow cytometry was used to detect the level of peripheral blood immune cells and analyze the correlation between total T cells, helper T cells and inhibitory T cells. To explore the relationship between these immune markers and patient survival. RESULTS: The results showed that the levels of total T cells, helper T cells, and suppressor T cells changed in patients after gastric cancer surgery. There was a significant positive correlation between total T cells, helper T cells and suppressor T cells (r = 0.35, P < 0.01; r = 0.56, P < 0.01). However, there was a negative correlation between helper T cells and suppressor T cells (r = -0.63, P < 0.01). Follow-up showed that the survival rate of patients in the high-level total T cell group was significantly higher than that in the low-level group (28.87 ± 24.98 months vs 18.42 ± 16.21 months). The survival curve shows that the curve of patients in the high-level group is shifted to the upper right, and that of the low-level group is shifted downward. There was no significant difference between the levels of helper T cells and suppressor T cells and patient survival time. CONCLUSION: By detecting peripheral blood immune cells with flow cytometry, we can initially evaluate the immune status of patients after gastric cancer surgery and initially explore its relationship with patient survival.

The Great Mimicker of Gastric Cancer: A Case Report of Ménétrier's Disease.

This is the case of a 52-year-old Indian lady who presented with hematemesis, severe anemia, and an abdominal lump in cardiac failure. On radiographic evaluation, the lesion appeared to be gross circumferential asymmetric proximal gastric wall thickening, with suspicion of gastric lymphoma or tubercular hypertrophic gastritis. After stabilization with multiple transfusions, she underwent proximal D2 gastrectomy with esophago-gastric anastomosis and a total splenectomy. Grossly, the gastric rugae appeared to be hypertrophied and firm. No growth was identified grossly; however, necrotic areas were identified at the distal end. Microscopic examination of multiple sections studied showed significant foveolar hyperplasia, tortuous glands, and a few cystically dilated foveolar glands, which were limited up to the muscle layer. Mild serosal congestion was seen. No atypia or invasion was seen. An impression to consider is the possibility of Ménétrier's disease (MD). MD is an acquired protein-losing enteropathy with giant gastric rugal folds, decreased acid secretion, and increased gastric mucous production. Radiographically, endoscopically, and grossly, the condition can be confused with malignant lymphoma or carcinoma. It is difficult to diagnose, and histopathological confirmation of the resected specimen is needed for a definitive diagnosis. Our intention in presenting this case is to emphasize that MD can present as massive hematemesis and should be considered in a differential diagnosis. Surgical treatment by total or partial gastrectomy is recommended for cases with persistent, debilitating symptoms or a risk of cancer.

When Stents Go Astray, We Find a Way: A Case Report on Retrieving a Migrated Esophageal Stent.

Benign esophageal strictures are characterized by the narrowing of the esophageal passage due to fibrotic changes. These strictures can arise from various causes, including gastroesophageal reflux disease, which leads to peptic strictures; surgical procedures causing esophageal injury, resulting in anastomotic strictures; radiation therapy, ingestion of corrosive substances, or endoscopic resection. Approximately 10% of benign esophageal strictures do not respond to conventional dilation therapy, prompting the consideration of temporary stent insertion as an alternative treatment approach. However, only about one-third of patients with refractory benign esophageal strictures experience sustained relief from dysphagia following self-expanding stent placement. Challenges such as stent migration and hyperplastic tissue response pose limitations to the effectiveness of this intervention. The utilization of self-expanding metal stents (SEMSs) in benign esophageal diseases is not standard practice due to the associated risks of adverse events such as tissue ingrowth at the uncovered portions, migration, and bleeding. One of the major challenges encountered is the growth of hyperplastic tissue around the stent during retrieval and subsequent serial esophageal bougie dilations. Long-term self-bougie dilations, coupled with the patient's gained self-confidence, played a crucial role in the management. While most migrated esophageal metallic stents are typically left in the stomach, in this particular case, the patient's progressive dysphagia necessitated retrieval. This article discusses a 65-year-old female with a benign esophageal stricture treated with a self-expandable metallic stent. Eight months post-insertion by another doctor, she presented to us with worsening dysphagia. Endoscopy revealed a stent migrated into the antrum of the stomach with a proximal esophageal stricture. Endoscopic dilation and stent retrieval were performed, followed by serial esophageal bougie dilations. Subsequently, her dysphagia settled with self-insertion of a 9 mm esophageal dilator.

The Challenges of Gastric Cancer Surgery during the COVID-19 Pandemic.

The aim of this study was to quantify the impact of the COVID-19 pandemic on the surgical treatment of patients with gastric cancer. Data from patients undergoing surgery for gastric cancer during the pandemic were analyzed and the results obtained were compared with the corresponding periods of 2016-2017 and 2018-2019. Various parameters were taken into consideration and their dynamics highlight significant changes in the pandemic year compared with the two pre-pandemic periods. Statistical analysis revealed a marked decrease in the number of surgeries performed during the pandemic (p < 0.001). Severe prognostic factors for gastric cancer, including weight loss and upper gastrointestinal hemorrhage, were associated with an increased number of postoperative fistulas, while emesis was statistically correlated with a more advanced cancer stage (p < 0.011). There was also a reduction in the total duration of hospitalization (p = 0.044) and postoperative hospitalization (p = 0.047); moreover, the mean duration of surgical intervention was higher during the pandemic (p = 0.044). These findings provide evidence for the significant changes in clinical and therapeutic strategies applied to patients undergoing surgery for gastric cancer during the study period. The ongoing pandemic has exerted a substantial and complex impact, the full extent of which remains yet to be fully comprehended.

Cost analysis of a patient blood management program for patients undergoing gastric cancer surgery.

Patient Blood Management (PBM) programs have probed to reduce blood transfusions and postoperative complications following gastric cancer resection, but evidence on their economic benefit is scarce. A recent prospective interventional study of our group described a reduction in transfusions, infectious complications and length of stay after implementation of a multicenter PBM program in patients undergoing elective gastric cancer resection with curative intent. The aim of the present study was to analyze the economic impact associated with these clinical benefits. The mean [and 95% CI] of total healthcare cost per patient was lower (-1955 [-3764, -119] €) after the PBM program implementation. The main drivers of this reduction were the hospital stay (-1847 [-3161, -553] €), blood transfusions (-100 [-145, -56] €), and post-operative complications (-162 [-718, 411] €). Total societal cost was reduced by -2243 [-4244, -210] € per patient. These findings highlight the potential economic benefit of PBM strategies.

Jejunogastric Intussusception: A Rare Case Report Study.

Jejunogastric intussusception (JGI) is a rare, potentially fatal complication of gastrojejunostomy following any gastric resection or gastric bypass surgery. Very less no of cases have been reported to date in the literature, with a very low incidence of <0.1%. Early recognition of JGI followed by prompt intervention is necessary to avoid any serious complications of gut gangrene or even possible death. It carries a mortality rate of approx. 10% of patients subjected to early intervention within 24 hours as compared to 50% in cases where surgery was delayed for more than 48 hours. The usual presenting complaints include a triad of palpable epigastric mass, hematemesis, and epigastric pain with only 50% of patients having this classical presentation. We here, report a middle-aged male with JGI which was diagnosed and managed at our center with emergency surgical intervention. How to cite this article: Haq MFU, Wagay BA, Malik AA, et al. Jejunogastric Intussusception: A Rare Case Report Study. Euroasian J Hepato-Gastroenterol 2023;13(2):163-165.

The Evolving Surgical Landscape: A Comprehensive Review of Robotic Versus Laparoscopic Gastrectomy for the Treatment of Gastric Cancer.

Robotic gastrectomy has been gaining ground in the past 20 years. This study aims to (a) provide an updated and all-encompassing comprehensive review including post-operative outcomes, rate of complications, surgical efficiency and costs, pathology, overall survival, mortality and recurrence, and disease-free survival of robotic versus laparoscopic gastrectomy, (b) report research gaps, and (c) identify ongoing or forthcoming clinical trials that could potentially shed light on underreported findings within the existing literature. Regarding the methodology, PubMed and Google Scholar were searched for randomized controlled trials, systematic reviews, and meta-analyses published between January 2012 and October 2023. ClinicalTrials.gov was searched for related clinical trials currently underway or recruiting. Robotic gastrectomy, when compared to laparoscopic gastrectomy, for the treatment of gastric cancer, performs equally well or shows superiority in terms of the length of hospitalization, overall complications rates, rate of conversion to open surgery, surgical complications, anastomotic leakage, pancreatic complications, blood loss, mortality rates, time to first flatus, time to oral intake, distal and proximal resection margins, recurrence rate, reoperation rates, and overall survival. However, it is associated with higher costs and longer operative time. Parameters such as duodenal stump leakage, anastomosis stenosis, intestinal obstruction, ileus, delayed gastric emptying, wound complications, acute pancreatitis, pancreatic fistula, direct costs, time to initiation of adjuvant chemotherapy, postoperative morbidity, recurrence, and disease-free survival are currently underreported in the literature and necessitate for further research. Lastly, four clinical trials are currently underway or recruiting that could possibly bridge the research gap.