Is Total Omentectomy Mandatory in T3 and T4a Gastric Cancer for Laparoscopic Distal Gastrectomy?

BACKGROUND: Despite the lack of strong evidence, total omentectomy (TO) remains the recommended procedure for gastric cancer (GC) for T3 or deeper tumors. Partial omentectomy (PO) has recently become a preferred procedure owing to its simplicity during laparoscopic distal gastrectomy (LDG); however, the oncological role of PO needs to be elucidated. METHODS: Overall, 341 patients with T3 or T4a GC who had undergone LDG between 2009 and 2016 were divided into TO (n = 167) and PO (n = 174) groups. Propensity matching was performed with respect to covariance age, sex, T and N stage, tumor size, and degree of tumor differentiation. Clinicopathological characteristics and long-term follow-up data were analyzed for both groups. RESULTS: After successful propensity matching, both groups included 107 patients. In a matched cohort, no significant difference in clinicopathologic features and short-term surgical outcomes was observed between the two groups. Furthermore, no significant difference in relapse-free survival (RFS; p = 0.201) and peritoneal seeding-free survival (PSFS; p = 0.094) was observed. However, tumor recurrence as peritoneal metastasis occurred in 5 (4.7%) patients in the PO group and 13 (12.1%) patients in the TO group. In Cox proportional hazards analysis, omentectomy was not identified as a significant factor for RFS, PSFS, and overall survival; however, advanced N and T4a stage were considered significant factors for RFS and PSFS, respectively. CONCLUSIONS: PO may be adopted during the LDG of T3 or T4a GC without definite gross serosal exposure. More large-scale evidence or prospective study is recommended.

Is single incision laparoscopic surgery (SILS) for gastric gastrointestinal stromal tumor (GIST) dependent on the location of the tumor?

BACKGROUND: We compared the surgical outcomes of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) for gastric gastrointestinal stromal tumor (GIST). METHODS: We performed single-incision gastric wedge resection on prospectively-enrolled 15 consecutive patients with gastric GIST between November 2020 and April 2022 in a single tertiary center. The early perioperative outcomes of these patients were compared to those of patients who underwent CLS. The indications did not differ from those for conventional laparoscopic procedures for gastric GIST. RESULTS: In total, 30 patients were assigned to the SILS (n = 15) and CLS (n = 15) groups. There were no significant differences in the estimated blood loss and intraoperative blood transfusion between the SILS and CLS groups. There were no intraoperative complications or conversions to multiple-port or open surgery in the SILS group. Proximally located tumors were more commonly treated with CLS than with SILS (P = 0.045). GISTs located in the greater curvature were more commonly treated with SILS than with CLS, although the difference was not statistically significant (P = 0.08). The mean incision length in the SILS group was 4.1 cm shorter than that in the CLS group (3.2 ± 0.7 and 7.3 ± 5.2 cm, respectively, P = 0.01). The postoperative analgesic dose was significantly lower in the SILS than in the CLS group (0.4 ± 1.4 and 2.1 ± 2.3, respectively P = 0.01). Also, the duration of postoperative use of analgesic was shorter in SILS than in CLS (0.4 ± 0.7 and 2.0 ± 1.8, respectively, P = 0.01). There were no significant differences in the early postoperative complications between the groups. CONCLUSIONS: SILS is as safe, feasible, and effective for the treatment of gastric GIST as CLS with comparable postoperative complications, pain, and cosmesis. Moreover, SILS can be considered without being affected by the type or location of the tumor.

Genetic polymorphisms of vascular endothelial growth factor (VEGF) associated with gastric cancer recurrence after curative resection with adjuvant chemotherapy.

BACKGROUND: The relationship between polymorphisms in vascular endothelial growth factor (VEGF) and gastric cancer is still inconclusive. We investigated whether there is an association between VEGF genetic polymorphisms and risk of gastric cancer, and evaluated the recurrence of advanced gastric cancer after curative resection with adjuvant chemotherapy according to VEGF genetic polymorphisms. METHODS: The association of functional single nucleotide polymorphisms (SNPs) of the VEGF gene (+936C > T, - 634G > C, - 2578C > A, + 1612G > A) were evaluated. Genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. A total of 151 patients with gastric cancer were enrolled, and the control group consisted of 413 individuals with esophago-gastroduodenoscopy who were randomly selected through health screening. All of the enrolled patients had curative resections with completion of adjuvant capecitabine and oxaliplatin combination chemotherapy and the initial metastatic cases were excluded. During the regular follow-up protocol, the episodes of the recurrence were documented and the specific genotype and allelic frequencies were evaluated. RESULTS: As for the cancer risk, there were no significant differences in specific genotypes and allelic frequencies. The mean follow-up period was 28.82 ± 30.92 (12 ~ 72) months and the recurrence rate was 28.3%. In the patients carrying the 936-C allele, the recurrence rate of gastric cancer was high (P = 0.02). Disease-free interval was significantly different between the patients carrying the 936-CC and 936-CT/TT genotype (P = 0.02). CONCLUSIONS: VEGF 936-C allele is associated with poor prognosis, but not risk of gastric cancer. In the patients carrying the 936-C allele, more potent adjuvant treatment would be considered.

The predictive factors of gastric cancer recurrence after the completion of adjuvant chemotherapy in advanced gastric cancer.

OBJECTIVE: the administration of adjuvant chemotherapy after a curative resection is accepted as the standard treatment to improve the prognosis of advanced gastric cancer. Nevertheless, the prognosis of recurrence-related gastric cancer is still not clinically satisfactory. We aimed to assess the therapeutic yield of a radical gastrectomy with D2 lymphadenectomy (R0 resection) and the completion of adjuvant chemotherapy. The predictive risk factors for recurrence were also assessed. METHODS: a retrospective cohort study was designed with patients diagnosed with advanced gastric cancer. Patients with an R0 resection who had completed adjuvant chemotherapy were included in the study. RESULTS: data from 130 patients who had undergone an R0 resection and had completed six cycles of adjuvant chemotherapy were analyzed. The chemotherapy compliance rate was 63.11% and the overall recurrence rate was 36.9%. The lymph node ratio (LNR), which was defined as the number of metastatic lymph nodes divided by the retrieved lymph nodes, was a significant risk factor in the lymph node-positive group (p < 0.01). This parameter had a relatively high sensitivity to predict recurrence compared with the 7th and 8th edition of the AJCC staging system, with an area under the curve of 0.735 (95% confidence interval: 0.639-0.832). Baseline CA19-9 level was a risk factor in the lymph node-negative group (p = 0.01). CONCLUSIONS: LNR and baseline CA19-9 levels, as simple markers, had strong predictive values for the recurrence of advanced gastric cancer. With regard to recurrence, more potent adjuvant therapy should be considered in high-risk patients.

Radical Gastrectomy After Chemotherapy May Prolong Survival in Stage IV Gastric Cancer: A Korean Multi-institutional Analysis.

ABASTRACT: BACKGROUND: Despite the development of newer treatments, the prognosis for patients with stage IV gastric cancer remains grave. This study evaluated the efficacy of gastrectomy following response to chemotherapy in patients with stage IV gastric cancer. METHODS: A total of 419 patients who were diagnosed with stage IV gastric cancer were identified from the multi-institutional Catholic Gastric Cancer Study Group database. The patients were divided into four groups: 212 were in the chemotherapy only (CTx) group, 124 were in the chemotherapy after palliative gastrectomy (G-CTx) group, 23 were in the radical gastrectomy after chemotherapy (CTx-G) group, and 60 were in the best supportive care group. To compensate for the effects of chemotherapy, cases of chemotherapy responsive were analyzed separately. To identify factors affecting survival rates, cure rates for surgery in the surgery group were analyzed. RESULTS: The 3-year survival rate of the CTx-G group was significantly higher than that of the CTx group (42.8 vs. 12.0%, p = 0.001). Moreover, the CTx-G group's 3-year survival rate was greater than that of the G-CTx group (42.8 vs. 37.1%, p = 0.207). Chemotherapy-responsive patients in the CTx-G group had a better 3-year survival rate than those in the G-CTx group (46.1 vs. 18.4%, respectively, p = 0.011). In the surgery group, R0 resection led to a significantly better 3-year survival rate than palliative gastrectomy (61.1 vs. 16.2%, p = 0.003). CONCLUSIONS: Adjuvant surgery might improve the survival rate of patients with stage IV gastric cancer, particularly in R0 resection cases.

Short-term surgical outcomes of laparoscopy-assisted versus totally laparoscopic Billroth-II gastrectomy for gastric cancer: a matched-cohort study.

BACKGROUND: To evaluate feasibility and benefits of intracorporeal anastomosis, we compared short-term surgical outcomes between laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) with Billroth-II (B-II) anastomosis for gastric cancer. METHODS: Sixty patients underwent attempted B-II TLDG from 2011 through 2013. Patients who underwent B-II LADG prior to 2011 were matched to TLDG cases for demographics, comorbidities, tumor characteristics, and TNM stage. Perioperative and short-term surgical outcomes were compared between the two groups. RESULTS: Clinicopathological characteristics of both groups were comparable. The B-II TLDG group had a shorter hospital stay (9.4 vs. 12.0 days, P = 0.038) and average incision size was smaller (3.5 vs. 5.4 cm, P = 0.030) than in the B-II LADG group. Anastomotic leakage was not recorded in either group, and there were no differences in the rates of perioperative complications and in inflammatory parameters between the two groups. CONCLUSIONS: This study suggests that B-II TLDG is feasible, compared to B-II LADG, and that it has several advantages over LADG, including a smaller incision, a shorter hospital stay, and more convenience during surgery. However, prospective randomized controlled studies are still needed to confirm that B-II TLDG can be used as a standard procedure for LDG.

Surgical outcomes and survival after gastrectomy in octogenarians with gastric cancer.

BACKGROUND: The aim of this study was to evaluate the surgical outcomes and survival after gastrectomy in octogenarians and identify the optimal treatment for these patients. METHODS: The medical records of 1262 patients with gastric cancer who underwent gastrectomy from January 2003 to December 2012 were reviewed retrospectively. Patients were divided into two age groups: octogenarians (≥ 80 y, n = 75) and nonoctogenarians (<80 y, n = 1187). The patients' clinicopathologic data, surgical outcomes, and survival were evaluated. RESULTS: Octogenarians exhibited a higher proportion of female patients, poorer performance scale scores, higher comorbidities, and more advanced tumor-node-metastasis (TNM) stages than did nonoctogenarians. There was no difference in the surgical curability between the two groups, although octogenarians were more likely to have higher postoperative morbidity and mortality than those of nonoctogenarians. In an analysis of risk factors affecting survival after gastrectomy for octogenarians, only advanced TNM stage was an independent prognostic factor. Overall survival was significantly lower in octogenarians than in nonoctogenarians, whereas disease-specific survival was comparable between the two groups. There was no difference in the disease-specific survival for each stage of cancer after adjustment for tumor stage. CONCLUSIONS: Octogenarians had higher postoperative morbidity and mortality rates but comparable cancer-specific survival compared with nonoctogenarians. Only an advanced TNM stage influenced the prognosis of octogenarians. Early detection and thorough postoperative care would improve the overall survival for octogenarians with gastric cancer.

Prognostic Value of Preoperative Serum Levels of Five Tumor Markers (Carcinoembryonic Antigen, CA19-9, Alpha-fetoprotein, CA72-4, and CA125) in Gastric Cancer.

BACKGROUND/AIMS: There is no known specific tumor marker for gastric cancer, although several tumor markers have been used. The aim of this study was to investigate the prognostic significance of preoperative carcinoembryonic antigen (CEA), CA 19-9, alpha-fetoprotein (AFP), CA 72-4, and CA 125 levels in patients with gastric cancer. METHODOLOGY: Medical records of 1,253 patients who were diagnosed with gastric adenocarcinoma were retrospectively reviewed. The clinicopathologic characteristics and disease-free survival rate of the patients were compared between positive and negative CEA, CA 19-9, AFP, CA 72-4, and CA 125 groups of patients. Additionally, the prognostic significance of each tumor marker was assessed by multivariate analysis. RESULTS: CEA, CA19-9, and CA72-4 were more frequently positive in patients with lymphatic and venous invasion, serosal involvement, and lymph node metastasis. The 5-year overall survival and disease free survival rates were significantly associated with elevated serum levels of CEA, CA 19-9, and CA 72-4. The depth of invasion and CA 19-9 were independent prognostic factors. Patients with elevated serum levels of CA 19-9 showed a 3.35-fold higher risk of death than patients with low levels of the marker. CONCLUSIONS: CA 19-9 has prognostic significance in gastric cancer, and a high preoperative serum level of CA 19-9 can be useful for estimating worse prognosis and a higher recurrence of gastric cancer.

Does Epstein-Barr virus-positive gastric cancer establish a significant relationship with the multiple genes related to gastric carcinogenesis?

Gastric cancer has been categorized into molecular subtypes including Epstein-Barr virus (EBV)-positive tumors, which provide clinicopathological and prognostic information. In this study, we investigated the EBV infection status of patients with gastric cancer and its correlation with the clinicopathological characteristics and multiple genes related to gastric carcinogenesis. The data of 460 gastric cancer patients who underwent curative gastrectomy with D2 lymph node dissection between January 2017 and February 2022 were analyzed. The clinicopathological features and prognosis of the patients with EBV-positive gastric cancers were compared with those of EBV-negative gastric cancers. Immunohistochemistry for epidermal growth factor receptor (EGFR), C-erb B2, Ki-67, and p53 was performed. Additionally, in situ hybridization was conducted to detect EBV, and microsatellite instability (MSI) analysis was used to assess the deficiency in mismatch repair (MMR) genes. EBV-positivity and MSI were identified in 10.4% and 37.3% of gastric cancer patients, respectively. EBV positivity was associated with male gender (P = 0.001), proximal location (P = 0.004), poorly differentiated histological type (P = 0.048), moderate to severe lymphoid stroma (P = 0.006), high Ki-67 expression (P = 0.02), and a shorter resection margin. EGFR was more often expressed in EBV-negative gastric cancers (P < 0.001). MSI tumors were associated with older age (P = 0.01), the presence of lymphatic invasion (P = 0.02), less perineural invasion (P = 0.05), and the presence of H. pylori infection (P = 0.05). EBV positive gastric cancer is associated with increased Ki-67 and decreased EGFR expression and a shorter resection margin due to the prominent lymphoid stroma. However, MMR deficiency is not associated with EBV status even though MSI gastric cancer is related to H. pylori status.

Clinicopathological features and management strategy for superficial nonampullary duodenal tumors: a multi-center retrospective study.

Purpose: We investigated the clinicopathological features and management for superficial nonampullary duodenal tumors (SNADTs). The safety and feasibility of laparoscopic management, especially laparoscopic endoscopic cooperative surgery (LECS), were evaluated. Methods: A total of 59 patients with SNADTs who underwent operations from January 2009 to December 2018 at all 8 institutions of the Catholic Medical Center were identified in our comprehensive multi-institutional database. Clinicopathological and surgical data on the 4 anatomical regions of the duodenum were collected and compared. Characteristics of conventional laparoscopic procedure (laparoscopy-only) and LECS procedures were also compared. Results: There were significantly more asymptomatic patients with tumors in the first and second vs. third and fourth duodenal regions. Gastrointestinal stromal tumors (GISTs), carcinoids, and ectopic pancreatic tumors were identified in 32, 12, and 5 cases, respectively. Forty-two patients (71.2%) underwent laparoscopy. Of patients undergoing laparoscopy, the LECS group exhibited significantly more endophytic features and smaller tumor sizes (P < 0.001 and P < 0.001, respectively). Although no significant difference in the wedge resection or postoperative complication rate was seen between the 2 groups (P = 0.096 and P = 0.227, respectively), the wedge resection rate was higher, and the complication rate lower, in the LECS group than the conventional laparoscopic surgery group. Conclusion: Most of the SNADTs located in proximal duodenum were detected incidentally. GISTs were the most common diagnoses of SNADTs in all locations. In treating these tumors, laparoscopic resection is safe and feasible. Especially, LECS may be ideal for treating small endophytic tumors, minimizing over-resection and postoperative complications.

The expression of claudin-1, claudin-2, claudin-3, and claudin-4 in gastric cancer tissue.

BACKGROUND: The claudins (CLDNs) are a family of functional tight junction proteins, and are involved with the epithelial-to-mesenchymal transition (EMT). The claudin proteins have a significant influence on the biological behavior of tumor progression in several types of cancers. In this study, we aimed to evaluate the expression pattern of claudin-1, claudin-2, claudin-3, and claudin-4 in gastric cancer tissue. MATERIALS AND METHODS: Tissue was obtained from surgically resected specimens of 72 patients who were diagnosed with gastric adenocarcinoma at a single institution. The expressions of claudin-1, claudin-2, claudin-3, and claudin-4 were determined by immunohistochemical staining with the ABC method. RESULTS: Claudin-2 demonstrated the highest expression rate (73.6%) and claudin-4 demonstrated the lowest expression rate (44.4%). The expression of claudin-1 was significantly lower in cases of intestinal type adenocarcinoma based on the Lauren classification. The expressions of claudin-3 and claudin-4 were significantly lower in cases with positive lymphatic invasion. The expression of claudin-3 was significantly lower in cases with an advanced T-stage (T3 and T4). The expression of claudin-3 showed significantly positive correlations with the expression of the other claudin proteins. In survival analysis, the expression of claudin-4 was related to good overall survival rate with significance (P = 0.046). CONCLUSION: We suggest that claudin-3 and claudin-4 represent useful molecular markers for gastric cancer. Claudin-3 and claudin-4 would be the most important proteins related to the lymphatic invasion process, and claudin-4 would be useful with prognostic marker based on our results. Further investigations with a greater number of subjects are required to identify the action mechanism of claudin in gastric cancer.

Body mass index and skeletal muscle index are useful prognostic factors for overall survival after gastrectomy for gastric cancer: Retrospective cohort study.

Among patients undergoing gastrectomy for gastric cancer, the impact of anthropometric indices on surgical outcomes is not well-established. The aim of this study was to evaluate the prognostic significance of the skeletal muscle index (SMI) and body mass index (BMI) on overall survival (OS) in patients with gastric cancer.A total of 305 patients who underwent curative gastrectomy for gastric adenocarcinoma between January 2005 and March 2008 were enrolled. Patients were classified into groups based on the SMI and BMI. The SMI was measured by preoperative abdominal computed tomography (CT). The SMI groups were classified based on gender-specific cut-off values obtained by means of optimum stratification. BMI groups were divided according to the World Health Organization definition of obesity for Asians.The mean SMI was 58.2 cm/m and the mean BMI was 23.2 kg/m. One hundred fifteen (37.7%) patients had sarcopenia based on the diagnostic cut-off values (56.2 cm/m for men and 53.6 cm/m for women). Apart from gender, there were no significant differences in patient characteristics or surgical outcomes between the SMI groups. In the underweight group, tumor (T) stage, tumor-node-metastasis (TNM) stage, number of retrieved lymph nodes, D2 dissection, and hospital stay were significantly increased compared with the overweight/obese group. High and low BMI, and low SMI, were independent prognostic factors for OS (hazard ratio [HR] = 2.355, 1.736, and 1.607, respectively; P = .009, .023, and .033, respectively).SMI and BMI did not impact perioperative morbidity in patients undergoing gastrectomy for gastric cancer. Both SMI and BMI are useful prognostic factors for OS in gastric cancer patients after gastrectomy.

Does tumor size have an impact on gastric cancer? A single institute experience.

PURPOSE: The present study investigated the prognostic significance of tumor size in gastric carcinoma patients. METHODS: Nine hundred seventy-three gastric carcinoma patients who underwent curative gastrectomy were included and hospital records were reviewed to determine the relationship between tumor size and survival. RESULTS: First, the patients were divided based on the mean value of the tumor size in respective stages to control selection bias. Only in stages I and III was tumor size a significant independent prognostic factor. Second, we analyzed the appropriate cutoff value for the large tumor. The minimum criterion for a large tumor, which was determined by the receiver-operating characteristic curve for cancer-related death, was 3.5 cm. There were significant differences between patients with large and small tumors with respect to depth of invasion, number of lymph node metastasis, and stage of disease. CONCLUSIONS: Tumor size serves as an indicator of prognosis in gastric cancer patients and a tumor size of 3.5 cm can be used as a significant lower limit of standard size criterion.

Is totally laparoscopic gastrectomy less invasive than laparoscopy-assisted gastrectomy?: prospective, multicenter study.

BACKGROUND: Laparoscopic surgery has been adopted for the treatment of gastric cancer, and many reports have confirmed its favorable outcomes. Most surgeons prefer to laparoscopy-assisted gastrectomy using minilaparotomy rather than totally laparoscopic procedures because of technical difficulties of intracorporeal anastomosis. We conducted this study to compare laparoscopy-assisted distal gastrectomy with totally laparoscopic distal gastrectomy. In addition, laparoscopic procedures were compared with open distal gastrectomy. MATERIAL AND METHODS: This prospective, nonrandomized, multicenter study enrolled 60 patients with early gastric cancer at three branch hospitals of our institutes. Twenty-five- to 30-cm-long mid-line incision, 5-cm midline or transverse incision, and 3-cm U-shaped incision were used in open distal gastrectomy, laparoscopy-assisted distal gastrectomy, and totally laparoscopic distal gastrectomy, respectively. Postoperative outcomes, immunologic changes, and operation-related costs were compared between the three groups. RESULTS: There was no difference in gender, mean age, body mass index, and tumor characteristics between the three groups. No operation-related death occurred. Estimated blood loss, number of additional analgesics use, first flatus, and soft meal diet time were significantly different between the three groups (P < 0.05). In totally laparoscopic distal gastrectomy, the time to first flatus was significantly shorter than laparoscopy-assisted distal gastrectomy (3.7 vs. 2.8 days, in laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy, respectively, P < 0.05). White blood cell count and C-reactive protein level at postoperative day 1 were significantly higher in open distal gastrectomy than the other groups; however, there was no difference between laparoscopy-assisted distal gastrectomy and totally laparoscopic distal gastrectomy. The operation-related costs were significantly greater in totally laparoscopic distal gastrectomy (P < 0.05). CONCLUSION: Although totally laparoscopic distal gastrectomy needs more cost, totally laparoscopic distal gastrectomy provides shorter bowel recovery time than laparoscopy-assisted distal gastrectomy.

Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience.

BACKGROUND: We analyzed our preliminary clinical data for totally laparoscopic gastrectomy (TLG) in order to evaluate its effectiveness in terms of minimal invasiveness, technical feasibility, and safety. METHODS: Forty-five consecutive patients who underwent TLG in our institution between June 2004 and February 2006 were enrolled in this study. There were 26 men and 19 women, with a mean age of 58.8 years and a mean body mass index (BMI) of 23.2. In all cases, only laparoscopic linear staplers were used for intracorporeal anastomosis. RESULTS: The reasons that gastrectomy was performed were adenocarcinoma in 41 cases, benign disease in three cases and gastrointestinal stromal tumor in one case, and the types of surgery were distal gastrectomy (40), total gastrectomy (four) and pylorus-preserving gastrectomy (one). Among the distal gastrectomies, Billroth I (25) was the most frequent procedure, followed by uncut Roux-en-Y gastrojejunostomy (14) and Billroth II (one), respectively. The mean operation time was 314 minutes, the mean anastomotic time was 41 minutes, the mean number of staples used was eight, and the mean estimated blood loss was 150 ml. There was no case of conversion to an open procedure. The first flatus was observed at 2.9 days, and liquid diet was started at 3.7 days. The mean number of postoperative analgesic use, except for patient-controlled analgesia (PCA), was 1.4 times, and the mean postoperative hospital stay was 11 days. Postoperative complication occurred in six patients (13.3 %), but no postoperative mortality occurred. There were two cases of delayed gastric empting and one case of anastomotic leakage, anastomotic stenosis, intraabdominal bleeding, and ventral hernia each. All of the patients recovered well with conservative or surgical management. CONCLUSIONS: TLG with intracorporeal anastomosis using laparoscopic linear staplers was safe and feasible, and we were able to obtain acceptable surgical outcomes in terms of minimal invasiveness.

The prevalence and clinical significance of postgastrectomy anemia in patients with early-stage gastric cancer: A retrospective cohort study.

BACKGROUND: This study explored the cumulative incidence of anemia after gastrectomy in patients with early-stage gastric cancer and evaluated the relationship between postgastrectomy anemia and nutritional factors during long-term follow-up. METHODS: The medical records of patients with stage I gastric cancer who underwent curative gastrectomy between January 2006 and December 2013 were reviewed retrospectively. Hematologic parameters like hemoglobin, iron, ferritin, and vitamin B12 level were obtained prior to and after surgery with other nutritional parameters such as total protein, albumin, total cholesterol, triglyceride, calcium, and phosphate. Postoperative follow-up was conducted at 6 months after surgery and then annually for 5 years. RESULTS: Among 566 patients who did not have anemia preoperatively, 240 (42.4%) experienced anemia at least once during the 5 years after gastrectomy. These 240 patients (the anemia group) showed lower preoperative levels of hemoglobin, iron, ferritin, and triglyceride than those of the patients who did not experience anemia (the normal group). Total gastrectomy, advanced T stage, and lymph node metastasis were significantly more common in the anemia group compared with the normal group. During long-term follow-up, the anemia group showed significantly lower serum levels of nutritional markers, especially triglycerides, compared with the normal group. The overall survival rate was significantly lower in the anemia group than in the normal group. CONCLUSIONS: Anemia was common among gastric cancer patients after gastrectomy. Total gastrectomy and advanced T stage were identified as independent risk factors for postgastrectomy anemia. In addition, anemia might be associated with nutritional problems and a poor prognosis. Thus, regular monitoring and appropriate management of postgastrectomy anemia are important for early-stage gastric cancer patients with a long life expectancy.

Safety of Laparoscopic Radical Gastrectomy in Gastric Cancer Patients with End-Stage Renal Disease.

PURPOSE: The surgical outcomes of end-stage renal disease (ESRD) patients undergoing radical gastrectomy for gastric cancer were inferior compared with those of non-ESRD patients. This study aimed to evaluate the short- and long-term surgical outcomes of ESRD patients undergoing laparoscopic gastrectomy (LG) and open gastrectomy (OG) for gastric cancer. MATERIALS AND METHODS: Between 2004 and 2014, 38 patients (OG: 21 patients, LG: 17 patients) with ESRD underwent gastrectomy for gastric cancer. Comparisons were made based on the clinicopathological characteristics, surgical outcomes, and long-term survival rates. RESULTS: No significant differences were noted in the clinicopathological characteristics of either group. LG patients had lower estimated blood loss volumes than OG patients (LG vs. OG: 94 vs. 275 mL, P=0.005). The operation time and postoperative hospital stay were similar in both the groups. The postoperative morbidity for LG and OG patients was 41.1% and 33.3%, respectively (P=0.873). No significant difference was observed in the long-term overall survival rates between the 2 groups (5-year overall survival, LG vs. OG: 82.4% vs. 64.7%, P=0.947). CONCLUSIONS: In ESRD patients, LG yielded non-inferior short- and long-term surgical outcomes compared to OG. Laparoscopic procedures might be safely adopted for ESRD patients who can benefit from the advantages of minimally invasive surgery.

Long-Term Trends in Hematological and Nutritional Status After Gastrectomy for Gastric Cancer.

BACKGROUND: This study investigated long-term trends in hematological and nutritional parameters after gastrectomy for gastric cancer and evaluated the influence of the reconstruction type on these trends. METHODS: The medical records of 558 patients who underwent curative gastrectomy with standard lymph node dissection for stage I gastric cancer between January 2006 and December 2013 were reviewed. The hematological and nutritional parameters evaluated included hemoglobin, ferritin, vitamin B12, total protein, albumin, total cholesterol, triglyceride, and calcium. The patients were followed up for 6 months postoperatively and then annually until death, cancer recurrence, or follow-up loss. RESULTS: In the long term, ferritin and triglyceride gradually decreased after gastrectomy, while the other parameters decreased slightly or were stable. In the comparisons according to reconstruction type, the Roux-en-Y group had the lowest levels of hemoglobin, ferritin, vitamin B12, total protein, albumin, and total cholesterol beginning 6 months postoperatively compared with the Billroth I and II groups. However, only ferritin and vitamin B12 had significant differences in the 5-year cumulative incidences of deficiency/reduction according to the reconstruction type, whereas albumin, triglyceride, total cholesterol, and calcium did not. CONCLUSIONS: Although malabsorption and malnutrition are common in patients after a gastrectomy, most nutritional parameters were stable or decreased slightly in the long-term and were not markedly influenced by the reconstruction type or extent of gastrectomy. Therefore, for more accurate nutritional assessment after gastrectomy, multidirectional monitoring should be considered rather than simply measuring biochemical parameters.