Association of Cholinesterase With Postoperative Pneumonia After Gastrectomy for Gastric Cancer.

INTRODUCTION: Cholinesterase is a classical marker that reflects nutritional and inflammatory status. The aim of the present study was to evaluate the association between serum cholinesterase levels and postoperative infectious complications in patients undergoing gastrectomy for gastric cancer. MATERIALS AND METHODS: This retrospective study comprised 108 patients who underwent gastrectomy for gastric cancer. We comprehensively investigated the association between clinicopathological variables and postoperative infectious complications after gastrectomy. Then patients were divided into the cholinesterase-high and -low groups to analyze their clinicopathological variables. Finally, we analyzed the types of infectious complications that were most associated with preoperative serum cholinesterase levels. RESULTS: Twenty-six patients (24%) developed postoperative infectious complications. Multivariate analysis revealed that serum cholinesterase levels (P = 0.026) and N stage (P = 0.009) were independent risk factors for postoperative infectious complications. In particular, the incidence of pneumonia (P = 0.001) was significantly higher in the cholinesterase-low group. Age (P = 0.023), cerebrovascular comorbidities (P = 0.006), serum cholinesterase levels (P = 0.013), and total gastrectomy (P = 0.017) were identified as independent risk factors for postoperative pneumonia. CONCLUSIONS: Preoperative serum cholinesterase levels were associated with postoperative pneumonia after gastrectomy for gastric cancer, suggesting the importance of preoperative nutritional assessment in gastric cancer surgery.

Cholinesterase as a predictor of skeletal muscle loss after gastrectomy for gastric cancer.

BACKGROUND: Cholinesterase is a classical nutritional and inflammatory marker. The aim of the present study was to evaluate the value of cholinesterase as a predictive marker for postoperative skeletal muscle loss after gastrectomy for gastric cancer. METHODS: The study comprised 68 patients who had undergone gastrectomy for gastric cancer. Skeletal muscle mass was evaluated using skeletal mass index, and major skeletal muscle loss was defined as less than or equal to the median change rate (1-year postoperative/preoperative) of skeletal mass index in all patients. We explored the relationship between postoperative major skeletal muscle loss and disease-free survival and overall survival. Then we investigated the relationship between change rate of skeletal muscle index and serum cholinesterase levels after gastrectomy. RESULTS: The median value of change rate of skeletal mass index was 0.93. Postoperative major skeletal muscle loss was significantly associated with disease-free survival after gastrectomy (P = 0.003). Although major skeletal muscle loss had worse overall survival, it was not significant (P = 0.058). The change rate of skeletal mass index and cholinesterase had a stronger positive correlation compared with other nutritional indices according to Spearman's rank correlation coefficient (r = 0.438, P ≤ 0.001). CONCLUSION: Evaluation of serum cholinesterase levels may be valuable for predicting postoperative skeletal muscle loss after gastrectomy, suggesting the importance of cholinesterase in postoperative nutritional management of patients with gastric cancer.

The role of geriatric nutritional risk index as a predictor for postoperative outcomes in gastrointestinal emergencies.

BACKGROUND: The geriatric nutritional risk index (GNRI) is a simple nutritional and inflammatory marker for older adults. The aim of the present study was to investigate the usefulness of the GNRI in older adults who underwent emergency gastrointestinal surgery. METHODS: This study included 206 older adults who had undergone emergency gastrointestinal surgery. We retrospectively investigated the relationship between the GNRI and postoperative complications. Univariate and multivariate analyses were performed to evaluate risk factors for postoperative complications. We then evaluated the association between GNRI and clinical variables among older adults undergoing emergency gastrointestinal surgery. RESULTS: Postoperatively, all complications occurred in 89 (43%) older adults, infectious in 53 (26%), and non-infectious in 36 (17%). In the multivariate analysis, age (p = 0.016), GNRI (p = 0.012), operative severity (p = 0.003), and operation time (p = 0.003) were independent risk factors for all postoperative complications. While the GNRI (p = 0.049) was an independent risk factor for infectious complications, age (p = 0.035) and bleeding volume (p = 0.035) were independent risk factors for postoperative non-infectious complications. In the low GNRI group, age (p = 0.029), serum C-reactive protein levels (p < 0.001), and proportion of sarcopenia (p < 0.001) were significantly higher, and the length of hospital stay (p < 0.001) was significantly longer than that in the high GNRI group. In Spearman's rank correlation coefficient, the skeletal mass index and the GNRI had a positive correlation (r = 0.415 and p < 0.001). CONCLUSION: The GNRI may be a predictor of postoperative infectious complications in older adults after emergency gastrointestinal surgery, suggesting the usefulness of the GNRI as a nutritional marker and sarcopenia-related parameter. TRIAL REGISTRATION NUMBER: No. 22-16.

The impact of sarcobesity on incisional hernia after laparoscopic colorectal cancer surgery.

PURPOSE: Incisional hernia is a common complication after abdominal surgery, especially in obese patients. The aim of the present study was to evaluate the relationship between sarcobesity and incisional hernia development after laparoscopic colorectal cancer surgery. METHODS: In total, 262 patients who underwent laparoscopic colorectal cancer surgery were included in the present study. Univariate and multivariate analyses were performed to evaluate the independent risk factors for the development of incisional hernia. We then performed subgroup analyses to assess the impact of visceral obesity according to clinical variables on the development of incisional hernia in laparoscopic surgery for colorectal cancer surgery. RESULTS: Forty-four patients (16.8%) developed incisional hernias after laparoscopic colorectal cancer surgery. In the univariate analysis, the development of incisional hernia was significantly associated with female sex (P = 0.046), subcutaneous obesity (P = 0.002), visceral obesity (P = 0.002), sarcobesity (P < 0.001), and wound infection (P < 0.001). In the multivariate analysis, sarcobesity (P < 0.001) and wound infection (P < 0.001) were independent predictors of incisional hernia. In subgroup analysis, the odds ratio of visceral obesity was the highest (13.1; 95% confidence interval [CI], 4.51-37.8, P < 0.001) in the subgroup of sarcopenia. CONCLUSION: Sarcobesity may be a strong predictor of the development of incisional hernia after laparoscopic surgery for colorectal cancer, suggesting the importance of body composition in the development of incisional hernia.

Short-term outcomes of colorectal cancer surgery in patients with dialysis: a systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to evaluate the effect of dialysis-dependent chronic kidney disease (CKD) on postoperative complications in colorectal cancer surgery. METHODS: In April 2023, we systematically searched PubMed, the Cochrane library, and Ovid for relevant studies on short-term outcomes of colorectal cancer surgery in patients with dialysis and analyzed the findings from these studies for meta-analysis. RESULTS: Our systematic and meta-analysis review identified seven studies involving 50713 patients. We showed that the dialysis group had higher rates of mortality (OR = 4.12, 95%CI: 2.75-6.20, P < 0.001), cardiac complications (OR = 2.45, 95%CI: 1.88-3.21, P < 0.001), and pneumonia (OR = 2.68, 95%CI: 1.83-3.93, P < 0.001). On the other hand, there were no differences in superficial/deep surgical site infection (SSI) (odds ratio [OR] = 1.17, 95%CI: 0.90-1.53, P = 0.230) and organ/space SSI (OR = 1.35, 95%CI: 1.00-1.82, P = 0.053) between the dialysis group and non-dialysis group. CONCLUSION: Our meta-analysis showed that dialysis-dependent CKD was associated with higher rates of mortality, cardiac complications, and pneumonia after colorectal cancer surgery. However, the limitations of this meta-analysis should be taken into consideration when interpreting the results.

Association of a newly developed Cancer Cachexia Score with survival in Stage I-III colorectal cancer.

PURPOSE: Cancer cachexia, a complex multifactorial syndrome associated with sarcopenia, negatively affects the quality of life and survival in patients with several cancers. We aimed to develop a new score for cachexia assessment and evaluate its effectiveness in the classification of patients undergoing radical resection for colorectal cancer. METHODS: This study included 396 patients who underwent radical resection for Stage I-III colorectal cancer. To develop the Cancer Cachexia Score (CCS), we analyzed predictive factors of cachexia status related to the development of sarcopenia and incorporated significant factors into the score. We then evaluated the relationship between CCS and survival after radical resection for colorectal cancer. RESULTS: As body mass index (P < 0.001), prognostic nutritional index (P = 0.005), and tumor volume (P < 0.001) were significantly associated with the development of sarcopenia, these factors were included in CCS. Using CCS, 221 (56%), 98 (25%), and 77 (19%) patients were diagnosed with mild, moderate, and severe cancer cachexia, respectively. In multivariate analysis, severe CCS (P < 0.001), N stage 1-2 (P < 0.001), and occurrence of postoperative complications (P = 0.007) were independent predictors of disease-free survival. Age ≥ 65 years (P = 0.009), severe CCS (P < 0.001), and N stage 1-2 (P < 0.001) were independent predictors of overall survival. CONCLUSIONS: CCS may be a useful prognostic factor for predicting poor survival after radical resection in patients with Stage I-III colorectal cancer.

The influence of serum cholinesterase levels and sarcopenia on postoperative infectious complications in colorectal cancer surgery.

PURPOSE: Cholinesterase is a nutritional marker associated with sarcopenia. The present study evaluated the relationship between cholinesterase and postoperative infectious complications in patients undergoing colorectal resection for colorectal cancer. METHODS: The study involved 231 patients who had undergone colorectal resection for colorectal cancer. We retrospectively investigated the relationship between preoperative serum cholinesterase levels and postoperative infectious complications. Univariate and multivariate analyses were performed to identify independent risk factors for postoperative infectious complications. We then performed stratified analyses to assess the interaction between cholinesterase and clinical variables to predict postoperative infectious complications. RESULTS: In the multivariate analysis, the body mass index (P = 0.010), serum cholinesterase levels (P = 0.005), sarcopenia (P = 0.003) and blood loss (P < 0.001) were independent risk factors for postoperative infectious complications. In stratified analyses, the association between serum cholinesterase levels and postoperative infectious complications differed by the sarcopenia status (Pinteraction = 0.006). CONCLUSION: Preoperative serum cholinesterase levels may be useful for predicting postoperative infectious complications in colorectal cancer surgery. The association differs by the sarcopenia status, suggesting a potential interaction between nutritional markers and sarcopenia.

The impact of low serum cholinesterase levels on survival in patients with colorectal cancer.

PURPOSE: Nutritional and inflammatory status have been associated with postoperative recurrence and poor survival in patients with colorectal cancer. The aim of the present study is to investigate the relationship between serum cholinesterase levels and postoperative outcomes among patients who underwent curative resection for colorectal cancer. METHODS: The study comprised 174 patients who had undergone curative resection for colorectal cancer. We explored the relationship between preoperative serum cholinesterase levels and disease-free survival and overall survival after curative resection. Then patients were divided into the high-cholinesterase group (n = 102) and the low-cholinesterase group (n = 72) to analyze their clinicopathological variables including other nutritional markers and systemic inflammatory responses. RESULTS: In multivariate analysis, lymph node metastasis (P = 0.011) and serum cholinesterase levels (P < 0.01) were independent predictors of disease-free survival, while lymph node metastasis (P = 0.013), serum cholinesterase levels (P < 0.01), and carbohydrate antigen19-9 (P = 0.022) were independent predictors of overall survival. In the low-cholinesterase group, neutrophil to lymphocyte ratio, (P = 0.021), C-reactive protein to albumin ratio (P < 0.01), and distant metastasis (P < 0.01) were higher, and prognostic nutritional index (P < 0.01) was lower compared with the high-cholinesterase group. CONCLUSION: Preoperative low serum cholinesterase levels can be a prognostic factor for postoperative recurrence and poor prognosis in patients after curative resection for colorectal cancer, suggesting an important role of cholinesterase in the assessment of nutritional and inflammatory status in cancer patients.

Preoperative serum cholinesterase levels as a risk factor of postoperative complications for the elderly undergoing emergency surgery.

PURPOSES: An accurate assessment of preoperative malnutrition in the elderly is critically important to predicting postoperative complications. The aim of this study is to evaluate the predictive value of the preoperative serum cholinesterase levels as a risk factor for postoperative complications in the elderly who have undergone emergency surgery. METHODS: The study comprised 60 elderly patients who had undergone emergency major gastroenterological surgery. We retrospectively investigated the relationship between the preoperative serum cholinesterase levels and postoperative complications (Clavien-Dindo classification ≥ II). Univariate and multivariate analyses were performed to evaluate the risk factors for postoperative complications. RESULTS: Thirty-three patients (55%) developed postoperative complications. According to the univariate analysis, hemoglobin (P = 0.018), albumin (P = 0.0036), cholinesterase (P < 0.001), C-reactive protein (P = 0.043), prognostic nutritional index (P = 0.0050), the Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (P < 0.001) and operation time (P = 0.042) were identified to be risk factors for postoperative complications. According to the multivariate analysis, low preoperative serum cholinesterase levels were found to be an independent risk factor for postoperative complications (P = 0.029). In the extremely elderly (80-95 years), the cholinesterase-low group had a higher complication rate compared to the cholinesterase-high group (77.8 vs 43.8%, P = 0.028). CONCLUSION: The preoperative serum cholinesterase levels may be a risk factor for postoperative complications in elderly patients after emergency surgery, thus suggesting the significance of cholinesterase in evaluating the nutritional status.

Quantitative Assessment of Blood Flow in the Gastric Conduit With Thermal Imaging for Esophageal Reconstruction.

OBJECTIVE: The study's primary aim was to evaluate the effectiveness of thermal imaging (TI) and its secondary aim was to compare TI and indocyanine green (ICG) fluorescence angiography, with respect to the evaluation of the viability of the gastric conduit. SUMMARY BACKGROUND DATA: The optimal method for evaluating perfusion in the gastric conduit for esophageal reconstruction has not been established. METHODS: We reviewed the prospectively collected data of 263 patients who had undergone esophagectomy with gastric conduit reconstruction. TI was used in all patients. ICG fluorescence was concomitantly used in 24 patients to aid comparison with TI. A cut-off value of the anastomotic viability index (AVI) was calculated using the receiver operating characteristic curve in TI. RESULTS: Anastomotic leak was significantly less common in patients with AVI > 0.61 compared with those with AVI ≤ 0.61 (2% vs 28%, P< 0.001). Microvascular augmentation was performed in 20 patients with a low AVI score and/or preoperative chemoradiotherapy. Overall ability was comparable between TI and ICG fluorescence regarding the qualitative evaluation of the gastric conduit. However, TI was superior in the quantitative assessment of viability. CONCLUSIONS: TI could delineate the area of good perfusion in the gastric conduit for esophageal reconstruction, which can help identify patients at high risk of anastomotic leak.

Comparison of the cost and outcomes following totally laparoscopic and laparoscopy-assisted distal gastrectomies for gastric cancer: a single-institution comparison.

OBJECTIVE: This study aimed to compare the short-term surgical outcomes and cost-benefits following totally laparoscopic distal gastrectomy (TLDG) and laparoscopy-assisted distal gastrectomy (LADG) for the treatment of gastric cancer. METHODS: Between April 2007 and December 2013, a total of 100 patients with gastric cancer underwent laparoscopic distal gastrectomy. The patients were classified into two groups according to whether intracorporeal anastomosis or extracorporeal anastomosis had been performed. The comparison between the groups was based on clinicopathological characteristics and surgical and economic outcomes. RESULTS: There were 57 and 43 patients who underwent TLDG and LADG, respectively. The patients' demographics and tumor characteristics did not show any statistically significant differences with the exception for tumor location. In the LADG group, tumors were localized to relatively higher positions (p = 0.024) and received Roux-en-Y reconstruction more frequently (p < 0.001). There were no differences in the incidence of morbidity. Anastomotic leakage was not recorded in either group, although anastomotic stenosis occurred in one patient (1.8 %) after TLDG and in two patients (4.7 %) after LADG. Compared with the LADG group, the TLDG group was associated with significantly less operative blood loss (p < 0.001), a shorter time to oral intake (p = 0.012), and hospital stay (p = 0.018). The median operation costs were greater in the TLDG group than in the LADG group (¥982,000 in TLDG vs. ¥879,830 in LADG; p < 0.001), whereas the median total hospital costs were similar between the two groups (¥1302,665 in LADG vs. ¥1383,322 in TLDG: p = 0.119). CONCLUSION: This study suggests that TLDG is as technically feasible, safe, and effective as LADG for treating patients with gastric cancer. Furthermore, TLDG is associated with equivalent total hospital costs compared with LADG. The increased operation cost is offset by the decreased costs associated with longer periods of hospitalization.

Laparoscopic gastrectomy for gastric cancer in the elderly patients.

BACKGROUND: This study aimed to investigate the short-term surgical outcomes of laparoscopic gastrectomy for gastric cancer in elderly patients in order to determine the safety, feasibility, and risk factors for postoperative complications associated with this procedure. METHODS: We retrospectively investigated 208 patients who underwent laparoscopic gastrectomy for gastric cancer between January 2007 and September 2014. After excluding 15 patients with unusual medical histories or surgical treatments, 193 were selected for this cohort study. We divided the patients into two cohorts: elderly patients (≥75 years old) and non-elderly patients (<74 years old). We compared these cohorts with respect to clinicopathological characteristics and intraoperative and postoperative parameters. RESULTS: The overall complication rates were 11.4% (8 of 70 patients) in the elderly cohort and 8.1% (10 of 123 patients) in the non-elderly cohort (P = 0.449). In a univariate analysis, Charlson comorbidity index (CCI) of ≥3, American Society of Anesthesiologists (ASA) score of 3, operative time of ≥330 min, and intraoperative blood loss of ≥50 ml were found to correlate significantly with postoperative complications. In a multivariate analysis, CCI of ≥3 (P = 0.034), ASA score of 3 (P = 0.019), and intraoperative blood loss of ≥50 ml (P = 0.016) were found to be independent risk factors of postoperative complications. In contrast, age was not found to significantly affect the risk of postoperative complications. CONCLUSIONS: Laparoscopic gastrectomy for gastric cancer can be successfully performed in elderly patients with an acceptable complication rate. This study suggested that high CCI, ASA score, and intraoperative blood loss volume were identified as independent predictors of postoperative complications after laparoscopic gastrectomy for gastric cancer.

[The usefulness of prokinetics in the treatment of acid-related disease].

The main drugs for the acid-related disease are acid suppression agents, however, such treatment sometimes fail to obtain a satisfactory relief of symptoms. In primary care settings, it is usually difficult to discern the underlying pathophysiology of the putative acid-related symptoms whether excessive acid secretion or impaired gastrointestinal motility is involved. Prokinetic agents have the usefull effects such as the reduction in the gastroesophageal reflux episodes by increasing lower esophageal sphincter pressure, the improvement of esophageal clearance by strengthening esophageal peristalsis, the prevention of rise in intragastric pressure by ameliorating delayed gastric emptying and impaired accommodation, and the attenuation of visceral hypersensitivity by heightening the threshold to gastric distension, therefore, it is conceivable that prokinetic agents relief the acid-related symptoms via a different mechanism other than acid suppression agents. Prokinetic agents seem potent as an alternative or an additional drug in the treatment of acid-related symptoms when the acid suppression agents are ineffective.

Clinical significance of medial approach for suprapancreatic lymph node dissection during laparoscopic gastric cancer surgery.

OBJECTIVE: Suprapancreatic lymph node dissection is critical for gastric cancer surgery. Beginning in 2010, a medial approach was adopted for suprapancreatic lymph node dissection during laparoscopic gastrectomy for distal gastric cancer in our institution. The aim of this study was to compare surgical outcomes of the medial approach and conventional approach in laparoscopic gastric surgery. METHODS: Between January 2007 and December 2012, a total of 100 patients with clinical T1 or T2 tumors underwent laparoscopic distal gastrectomy involving suprapancreatic lymph node dissection by the medial approach (n = 44) and conventional approach (n = 56) with curative intent. The comparison was based on clinicopathological characteristics and surgical outcome. RESULTS: The laparoscopic procedure was not converted to laparotomy in any patient. The patients' demographics and tumor characteristics did not show any statistically significant difference, except for tumor location. In the conventional approach group, the tumors were at a higher position (p = 0.037) and more frequently received Roux-en-Y reconstruction (p < 0.001). Intracorporeal anastomosis was significantly more common in the medial approach group (p < 0.001). Compared with the conventional approach, the medial approach was associated with significantly less operative blood loss (p < 0.001), more retrieved suprapancreatic lymph nodes (p = 0.019), and a shorter hospital stay (p = 0.018). The rates of complications were comparable between the two groups. CONCLUSION: This study suggests that the medial approach to suprapancreatic lymph node dissection seems to be convenient and useful in laparoscopic gastric cancer surgery.

Assessment of motor function of the remnant stomach by ¹³C breath test with special reference to gastric local resection.

BACKGROUND: Indications for gastric local resection (LR) include gastrointestinal stromal tumors, neuroendocrine tumors, and early gastric cancer. LR is expected to preserve physiological function and ameliorate postgastrectomy syndrome. METHODS: Gastric emptying was assessed by the (13)C-acetate breath test in 20 healthy volunteers (HVs) and 60 gastrectomized patients [distal gastrectomy with Billroth I reconstruction (DGBI) in 26 patients, LR in 34 patients]. For the (13)C breath test, 100 mg of (13)C-acetate sodium salt was mixed in a test meal. Breath samples were collected before intake and during the next 3 h. We compared the gastric reservoir capacity using the gastric retention rate at 5 min (RR5) and gastric emptying by the half emptying time (T½). Patients completed a questionnaire survey about their symptoms, dietary intake, body weight, and restriction of activities of daily living [reflecting quality of life (QOL)]. RESULTS: The RR5 values for the HV, LR, and DGBI groups were 93.7, 90.0, and 45.3* %, respectively (*compared to HV and LR, p < 0.0001). The T½ values were 23.3, 20.2, and 5.9* min, respectively. Dietary intake and body weight change were significantly more reduced in the DGBI group than the LR group (p < 0.05). Subgroup analysis indicated that the reservoir capacity in those with LR at the lesser curvature was more disturbed than that in patients with LR at the greater curvature. The questionnaire showed no differences in those patients' QOL. CONCLUSIONS: Because the reservoir capacity, the gastric emptying and QOL were maintained, LR is an option for selected patients with early gastric cancer.

Clinical outcomes after pancreaticoduodenectomy in elderly patients at middle-volume center.

BACKGROUND/AIMS: It has been reported that age and hospital volume are risk factors after pancreaticoduodenectomy (PD), however the mortality rate after PD at middle volume center is decreasing by surgical advances and recently PD in the elderly patients is safely performed. The aim of this study is to evaluate the safety and feasibility of PD in the patients over 80 years of age at middle-volume center. METHODOLOGY: 60 patients who underwent PD between 2004 and 2012 were divided into two groups (≥80 and <80years). The clinical outcomes of the two groups were retrospectively analyzed. RESULTS: There were no statistical differences in terms of preoperative parameters, co-morbidity, perioperative data, morbidity, mortality and postoperative hospital stay. We achieved zero mortality in patients over 80 years of age and 40% of them are alive without recurrence. CONCLUSIONS: Clinical outcomes after PD in the elderly patients at middle-volume center are acceptable. Age and hospital volume are not necessarily risk factors after PD.

Cachexia Index in Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis.

PURPOSE: The cachexia index is a novel biomarker of cancer cachexia. This systematic review and meta-analysis aimed to evaluate the prognostic impact of cachexia index on prognosis after surgery for gastrointestinal cancer. METHODS: In August 2023, we systematically searched PubMed, the Cochrane Library, and Ovid for relevant studies on the oncological outcome after gastrointestinal cancer surgery and analyzed the findings from these studies for meta-analysis. RESULTS: Our systematic and meta-analysis review identified eight studies involving 1876 patients. The number of patients with low cachexia index accounted for 813 patients (43.3%). We found that low cachexia index was associated with worse overall survival (pooled HR, 2.30; 95% CI, 1.85-2.87; z = 7.49; P < 0.001) and disease/relapse/progression-free survival (pooled HR, 1.77; 95% CI, 1.45-2.18; z = 5.50; P < 0.001). CONCLUSION: Our meta-analysis showed that cachexia index was associated with oncological outcome after gastrointestinal cancer surgery. However, the limitations of this meta-analysis should be taken into consideration when interpreting the results.

Prognostic Value of Systemic Inflammatory Response in Lymph Node-Negative Colorectal Cancer.

BACKGROUND: The aim of this study was to investigate the prognostic value of systematic inflammatory response in patients with lymph node-negative colorectal cancer. METHODS: We retrospectively investigated 245 patients with lymph node-negative colorectal cancer who underwent curative resection and evaluated the prognostic impact of systematic inflammatory response, which was represented by neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and C-reactive protein-to-albumin ratio (CAR). Then, the prognostic significance of the systematic inflammatory response on survival was analyzed using the Kaplan-Meier method in patients selected by propensity score matching (PSM) analysis. RESULTS: In the multivariate analysis, CAR ≥ .081 (P = .004) was independent predictors of disease-free survival, while American Society of Anesthesiologists physical status ≥3 (P = .049) and CAR ≥ .081 (P < .001) were independent predictors of overall survival. By PSM analysis, PSM-high-CAR was significantly associated with worse disease-free survival (P = .043) and overall survival (P = .041) in patients with lymph node-negative colorectal cancer. CONCLUSIONS: C-reactive protein-to-albumin ratio may be a significant indicator of poor long-term outcomes in patients with lymph node-negative colorectal cancer.

Totally laparoscopic complete resection of the remnant stomach for gastric cancer.

BACKGROUND: In patients having carcinoma in the remnant stomach, total resection of the remnant stomach with lymph node dissection is a prerequisite. MATERIALS AND METHODS: We present the first series of successful totally laparoscopic complete gastrectomy (TLCG) for gastric remnant cancer. RESULTS: TLCG was successfully performed without adverse events during surgery in five patients with gastric remnant cancer. The median age of the patients was 72 years (range, 56-84 years), and there were three men and two women. Three of them had a Billroth I reconstruction and two had a Billroth II reconstruction, and in four cases following partial gastrectomy for gastric cancer and one for gastroduodenal ulcer. The median operative time was 360 min; blood loss was 20 ml. The median number of retrieved lymph nodes was 19. No complications occurred postoperatively, and all of the patients were discharged within the ninth postoperative day. CONCLUSIONS: Although TLCG for gastric remnant cancer is a technically difficult and challenging operation that requires careful lysis of adhesion and dissection along the major vessels, as well as intracorporeal anastomosis, this procedure is technically feasible. Long-term follow-up is mandatory to validate oncological outcome.