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1.
PeerJ ; 12: e17431, 2024.
Article in English | MEDLINE | ID: mdl-38827293

ABSTRACT

Purpose: To compare the impact of erector spinae plane block (ESPB) and paravertebral block (PVB) on the quality of postoperative recovery (QoR) of patients following laparoscopic sleeve gastrectomy (LSG). Methods: A total of 110 patients who underwent elective LSG under general anesthesia were randomly assigned to receive either ultrasound-guided bilateral ESPB or PVB at T8 levels. Before anesthesia induction, 40 mL of 0.33% ropivacaine was administered. The primary outcome was the QoR-15 score at 24 hours postoperatively. Results: At 24 hours postoperatively, the QoR-15 score was comparable between the ESPB and PVB groups (131 (112-140) vs. 124 (111-142.5), P = 0.525). Consistently, there was no significant difference in QoR-15 scores at 48 hours postoperatively, numerical rating scale (NRS) pain scores at any postoperative time points, time to first ambulation, time to first anal exhaust, postoperative cumulative oxycodone consumption, and incidence of postoperative nausea and vomiting (PONV) between the two groups (all P > 0.05). No nerve block-related complications were observed in either group. Conclusion: In patients undergoing LSG, preoperative bilateral ultrasound-guided ESPB yields comparable postoperative recovery to preoperative bilateral ultrasound-guided PVB.


Subject(s)
Gastrectomy , Laparoscopy , Nerve Block , Pain, Postoperative , Humans , Female , Nerve Block/methods , Male , Gastrectomy/adverse effects , Gastrectomy/methods , Laparoscopy/adverse effects , Adult , Pain, Postoperative/prevention & control , Middle Aged , Anesthetics, Local/administration & dosage , Anesthetics, Local/therapeutic use , Ropivacaine/administration & dosage , Ropivacaine/therapeutic use , Ultrasonography, Interventional/methods , Pain Measurement , Paraspinal Muscles/innervation , Paraspinal Muscles/diagnostic imaging , Treatment Outcome , Obesity, Morbid/surgery , Postoperative Nausea and Vomiting/epidemiology , Anesthesia, General/adverse effects
2.
Article in English | MEDLINE | ID: mdl-38839368

ABSTRACT

Esophagogastric junction cancer (EGJC) is a rare malignant disease that occurs in the gastroesophageal transition zone. In recent years, its incidence has been rapidly increasing not only in Western countries but also in East Asia, and it has been attracting the attention of both clinicians and researchers. EGJC has a worse prognosis than gastric cancer (GC) and is characterized by complex lymphatic drainage pathways in the mediastinal and abdominal regions. EGJC was previously treated in the same way as GC or esophageal cancer, but, in recent years, it has been treated as an independent malignant disease, and treatment focusing only on EGJC has been developed. A recent multicenter prospective study revealed the frequency of lymph node metastasis by station and established the optimal extent of lymph node dissection. In perioperative treatment, the combination of multi-drug chemotherapy, radiation therapy, molecular targeted therapy, and immunotherapy is expected to improve the prognosis. In this review, we summarize previous clinical trials and their important evidence on surgical and perioperative treatments for EGJC.


Subject(s)
Esophageal Neoplasms , Esophagectomy , Esophagogastric Junction , Humans , Esophagogastric Junction/surgery , Esophagogastric Junction/pathology , Esophageal Neoplasms/pathology , Esophageal Neoplasms/surgery , Esophageal Neoplasms/mortality , Esophageal Neoplasms/therapy , Treatment Outcome , Esophagectomy/adverse effects , Esophagectomy/mortality , Gastrectomy/mortality , Gastrectomy/adverse effects , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Stomach Neoplasms/mortality , Stomach Neoplasms/therapy , Lymph Node Excision , Chemotherapy, Adjuvant , Lymphatic Metastasis , Risk Factors , Neoadjuvant Therapy/adverse effects , Neoadjuvant Therapy/mortality
3.
Trials ; 25(1): 367, 2024 Jun 07.
Article in English | MEDLINE | ID: mdl-38849875

ABSTRACT

BACKGROUND: Obese patients undergoing laparoscopic sleeve gastrectomy (LSG) are particularly at risk of opioid-related side effects. To reduce patient exposure to opioids, multimodal analgesia, which involves the use of drugs of different classes, may be utilized. One of the drugs under consideration is pregabalin. Despite an opioid-sparing potential, few studies assess the role of pregabalin as an element of multimodal analgesia in LSG. Considering the limited number and inconsistent results of available studies, we decided to conduct a randomized, prospective study on the effect of preemptive pregabalin administration in obese patients on opioid consumption, pain scores, the incidence of opioid side effects, and hemodynamical stability. METHODS: The study is designed as a prospective randomized controlled trial with double-blinding. Randomization will be performed in a block with a parallel 1:1 allocation. The intervention will involve receiving a pregabalin 150 mg capsule 1-2 h before the surgery, whereas the control group will receive an identically looking placebo. The primary outcome measure will be total oxycodone consumption in the first 24 h following surgery. Secondary outcome measures will be pain severity assessed using the Numerical Rating Scale (NRS) 1, 6, 12, and 24 h after surgery, postoperative sedation on the Ramsay scale, PONV impact scale, the incidence of desaturation episodes < 94%, and episodes of blurred vision at 1, 6, 12, and 24 h after surgery, intraoperative hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), total fluid volume, and total ephedrine dose. Patient comfort will be additionally assessed using the QoR-40 questionnaire at discharge. DISCUSSION: The study will explore the efficacy and safety of preemptive pregabalin in a dose of 150 mg as a co-analgesic used in multimodal analgesia for LSG. As studies on opioid-sparing regimes concern the safety of obese patients, we aim to contribute objective data with a relatively large study sample size. The result of the present clinical trial may support the reassessment of recommendations to use pregabalin in the studied population. TRIAL REGISTRATION: ClinicalTrials.gov NCT05804591. Registered on 07.04.2023.


Subject(s)
Analgesics, Opioid , Gastrectomy , Hemodynamics , Laparoscopy , Pain, Postoperative , Pregabalin , Randomized Controlled Trials as Topic , Humans , Pregabalin/administration & dosage , Pregabalin/therapeutic use , Pregabalin/adverse effects , Double-Blind Method , Prospective Studies , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Gastrectomy/adverse effects , Gastrectomy/methods , Pain, Postoperative/prevention & control , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Laparoscopy/adverse effects , Hemodynamics/drug effects , Adult , Treatment Outcome , Pain Measurement , Administration, Oral , Analgesics/administration & dosage , Analgesics/therapeutic use , Analgesics/adverse effects , Middle Aged , Male , Time Factors , Female , Young Adult , Recovery of Function , Oxycodone/administration & dosage , Oxycodone/adverse effects , Oxycodone/therapeutic use
4.
Arch Iran Med ; 27(6): 341-345, 2024 Jun 01.
Article in English | MEDLINE | ID: mdl-38855804

ABSTRACT

Macroscopic tumor implants in the hernia sac are a very rare condition. They occur as a result of the implantation of malignant cells in the malignant ascites from the inguinal canal to the hernia sac. In this case report, we share the clinical and radiological findings of the macroscopic tumoral implants in the hernia sac at the level of the inguinal canal and scrotum in a male patient aged 65 years with a history of total gastrectomy for gastric adenocarcinoma and developing malignant ascites six months after the surgery.


Subject(s)
Adenocarcinoma , Hernia, Inguinal , Stomach Neoplasms , Humans , Male , Stomach Neoplasms/pathology , Stomach Neoplasms/diagnostic imaging , Hernia, Inguinal/diagnostic imaging , Hernia, Inguinal/pathology , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/pathology , Adenocarcinoma/secondary , Aged , Gastrectomy , Tomography, X-Ray Computed , Ascites/etiology , Ascites/diagnostic imaging
5.
Gen Hosp Psychiatry ; 89: 84-92, 2024.
Article in English | MEDLINE | ID: mdl-38838608

ABSTRACT

OBJECTIVE: This study aimed to investigate the effects of opioid-free anesthesia (OFA) in laparoscopic gastrectomy and identify the psychological factors that could influence the efficacy of OFA. METHOD: 120 patients undergoing laparoscopic gastrectomy were allocated to either the opioid-based anesthesia group (OA) (n = 60) or the OFA (n = 60) group. Remifentanil was administered to the OA group intraoperatively, whereas dexmedetomidine and lidocaine were administered to the OFA group. The interaction effect of the psychological factors on OFA was analyzed using the aligned rank transform for nonparametric factorial analyses. RESULTS: The opioid requirement for 24 h after surgery was lower in the OFA group than in the OA group (fentanyl equivalent dose 727 vs. 650 µg, p = 0.036). The effect of OFA was influenced by the pain catastrophizing scale (p = 0.041), temporal pain summation (p = 0.046), and pressure pain tolerance (p = 0.034). This indicates that patients with pain catastrophizing or high pain sensitivity significantly benefited from OFA, whereas patients without these characteristics did not. CONCLUSIONS: This study demonstrated that OFA with dexmedetomidine and lidocaine effectively reduced the postoperative 24-h opioid requirements following laparoscopic gastrectomy, which was modified by baseline pain catastrophizing and pain sensitivity. CLINICAL TRIAL REGISTRY: The study protocol was approved by the Institutional Review Board of Yonsei University Health System Gangnam Severance Hospital (#3-2021-0295) and registered at ClinicalTrials.gov (NCT05076903).


Subject(s)
Analgesics, Opioid , Dexmedetomidine , Gastrectomy , Lidocaine , Pain, Postoperative , Remifentanil , Humans , Male , Middle Aged , Female , Analgesics, Opioid/administration & dosage , Aged , Dexmedetomidine/administration & dosage , Dexmedetomidine/pharmacology , Lidocaine/administration & dosage , Lidocaine/pharmacology , Pain, Postoperative/drug therapy , Remifentanil/administration & dosage , Remifentanil/pharmacology , Laparoscopy , Catastrophization , Adult , Pain Threshold/drug effects , Anesthetics, Local/administration & dosage , Anesthetics, Local/pharmacology
6.
J Robot Surg ; 18(1): 238, 2024 Jun 04.
Article in English | MEDLINE | ID: mdl-38833096

ABSTRACT

The objective of this meta-analysis was to assess the comparative efficacy of robot-assisted and laparoscopic surgery in treating gastric cancer among patients characterized by a high visceral fat area (VFA). In April 2024, we conducted a comprehensive literature review using major international databases, such as PubMed, Embase, and Google Scholar. We restricted our selection to articles written in English, excluding reviews, protocols without published data, conference abstracts, and irrelevant content. Our analysis focused on continuous data using 95% confidence intervals (CIs) and standard mean differences (SMDs), while dichotomous data were assessed with odds ratios (ORs) and 95% CIs. We set the threshold for statistical significance at P < 0.05. Data extraction included baseline characteristics, primary outcomes (such as operative time, major complications, lymph node yield, and anastomotic leakage), and secondary outcomes. The meta-analysis included three cohort studies totaling 970 patients. The robotic-assisted group demonstrated a significantly longer operative time compared to the laparoscopic group, with a weighted mean difference (WMD) of - 55.76 min (95% CI - 74.03 to - 37.50; P < 0.00001). This group also showed a reduction in major complications, with an odds ratio (OR) of 2.48 (95% CI 1.09-5.66; P = 0.03) and fewer occurrences of abdominal infections (OR 3.17, 95% CI 1.41-7.14; P = 0.005), abdominal abscesses (OR 3.83, 95% CI 1.53-9.57; P = 0.004), anastomotic leaks (OR 4.09, 95% CI 1.73-9.65; P = 0.001), and pancreatic leaks (OR 8.93, 95% CI 2.33-34.13; P = 0.001). However, no significant differences were observed between the groups regarding length of hospital stay, overall complications, estimated blood loss, or lymph node yield. Based on our findings, robot-assisted gastric cancer surgery in obese patients with visceral fat appears to be correlated with fewer major complications compared to laparoscopic surgery, while maintaining similar outcomes in other surgical aspects. However, it is important to note that robot-assisted procedures do tend to have longer operative times.


Subject(s)
Laparoscopy , Obesity, Abdominal , Operative Time , Robotic Surgical Procedures , Stomach Neoplasms , Humans , Laparoscopy/methods , Robotic Surgical Procedures/methods , Robotic Surgical Procedures/adverse effects , Stomach Neoplasms/surgery , Treatment Outcome , Obesity, Abdominal/complications , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Gastrectomy/methods , Anastomotic Leak/etiology , Anastomotic Leak/epidemiology
7.
BMC Neurol ; 24(1): 188, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38840065

ABSTRACT

BACKGROUND: Myasthenia gravis (MG) is a long-term autoimmune disorder that affects the neuromuscular junction, causing muscle weakness and fatigue as its primary clinical features. Vitamin D is crucial for both the autoimmune response and skeletal muscle function. CASE PRESENTATION: Here, we presented a case report documenting the substantial improvement in symptoms experienced by a patient who underwent subtotal gastrectomy for gastric cancer following high-dose Vitamin D supplementation. The patient developed generalized MG two months after the surgery and did not respond adequately to pyridostigmine therapy, experiencing a progressive deterioration of the condition. A significant reduction in vitamin D concentration was observed following subtotal gastrectomy. In response, high-dose vitamin D supplementation was administered to the patient. Within one week of treatment, swallowing symptoms improved, enabling the consumption of a small amount of liquid food. By the second week, substantial swallowing and neck function improvements were evident. After one month, the patient regained the ability to straighten the neck while walking and consumed a regular diet despite persistent difficulties chewing hard food. CONCLUSIONS: This case underscores the therapeutic potential of vitamin D in alleviating MG symptoms, particularly in individuals with compromised vitamin D levels following gastrectomy. The observed improvements present a new perspective on the possible involvement of vitamin D supplementation in the management of postoperative MG cases.


Subject(s)
Gastrectomy , Myasthenia Gravis , Vitamin D , Humans , Gastrectomy/adverse effects , Myasthenia Gravis/surgery , Myasthenia Gravis/drug therapy , Vitamin D/therapeutic use , Vitamin D/administration & dosage , Stomach Neoplasms/surgery , Male , Female , Aged , Middle Aged , Dietary Supplements
8.
BMC Surg ; 24(1): 176, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38840104

ABSTRACT

BACKGROUND: Laparoscopic sleeve gastrectomy combined with fundoplication (LSGFD) can significantly control body weight and achieve effective anti-reflux effects. The aim of this study is to investigate the correlation between the alteration in Ghrelin levels and weight loss following SGFD, and to compare Ghrelin levels, weight loss and metabolic improvements between SG and SGFD, with the objective of contributing to the existing body of knowledge on SGFD technique in the management of patients with obesity and gastroesophageal reflux disease (GERD). METHODS: A retrospective analysis was conducted on the clinical data of 115 obese patients who underwent bariatric surgery between March 2023 and June 2023 at the Department of Minimally Invasivew Surgery, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region. The subjects were divided into two groups based on surgical methods: sleeve gastrectomy group (SG group, 93 cases) and sleeve gastrectomy combined with fundoplication group (SGFD group, 22 cases). Clinical data, such as ghrelin levels before and after the operation, were compared between the two groups, and the correlation between changes in ghrelin levels and weight loss effectiveness after the operation was analyzed. RESULTS: Three months after the operation, there was no significant difference in body mass, BMI, EWL%, fasting blood glucose, triglyceride, cholesterol, and uric acid levels between the SG and SGFD groups (P > 0.05). However, the SGFD group exhibited a significant decrease in body weight, BMI, and uric acid levels compared to preoperative levels (P < 0.05), while the decrease in ghrelin levels was not statistically significant (P > 0.05). Logistic regression analysis indicated that ghrelin levels three months after the operation were influential in postoperative weight loss. CONCLUSION: The reduction of plasma Ghrelin level in patients after SGFD is not as obvious as that in patients after SG, but it can make obese patients get the same good weight loss and metabolic improvement as patients after SG. Ghrelin level at the third month after operation is the influencing factor of postoperative weight loss.


Subject(s)
Fundoplication , Gastrectomy , Gastroesophageal Reflux , Ghrelin , Weight Loss , Humans , Ghrelin/blood , Weight Loss/physiology , Male , Female , Gastrectomy/methods , Retrospective Studies , Adult , Fundoplication/methods , Gastroesophageal Reflux/surgery , Gastroesophageal Reflux/blood , Gastroesophageal Reflux/etiology , Middle Aged , Obesity, Morbid/surgery , Obesity, Morbid/blood , Laparoscopy/methods , Bariatric Surgery/methods , Treatment Outcome
9.
Crit Rev Immunol ; 44(6): 63-73, 2024.
Article in English | MEDLINE | ID: mdl-38848294

ABSTRACT

Postoperative sleep disturbance is a common issue that affects recovery in patients undergoing general anesthesia. Dexmedetomidine (Dex) has a potential role in improving postoperative sleep quality. We evaluated the effects of different doses of Dex on postoperative sleep disturbance and serum neurotransmitters in patients undergoing radical gastrectomy under general anesthesia. Patients were assigned to the control, NS, and Dex (Dex-L/M/H) groups based on different treatment doses [0.2, 0.4, and 0.6 µg/(kg · h)]. The Athens Insomnia Scale (AIS) and ELISA kits were used to assess sleep disturbance and serum neurotransmitter (GABA, 5-HT, NE) levels before surgery and on postoperative days one, four, and seven. The effects of different doses on postoperative sleep disturbance incidence and serum neurotransmitter levels were analyzed by the Fisher exact test and one-way and repeated-measures ANOVA. Patients had no differences in gender, age, body mass index, operation time, and bleeding volume. Different Dex doses reduced the postoperative AIS score of patients under general anesthesia, improved their sleep, and increased serum levels of 5-HT, NE, and GABA. Furthermore, the effects were dose-dependent within the range of safe clinical use. Specifically, Dex at doses of 0.2, 0.4, and 0.6 µg/(kg · h) reduced postoperative AIS score, elevated serum neurotransmitter levels, and reduced postoperative sleep disturbance incidence. Collectively, Dex has a potential preventive effect on postoperative sleep disturbance in patients undergoing general anesthesia for radical gastrectomy. The optimal dose of Dex is between 0.2 and 0.6 µg/(kg · h), which significantly reduces the incidence of postoperative sleep disturbance and increases serum neurotransmitter levels.


Subject(s)
Anesthesia, General , Dexmedetomidine , Neurotransmitter Agents , Postoperative Complications , Sleep Wake Disorders , Humans , Dexmedetomidine/administration & dosage , Anesthesia, General/adverse effects , Neurotransmitter Agents/blood , Male , Female , Sleep Wake Disorders/etiology , Sleep Wake Disorders/epidemiology , Middle Aged , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Incidence , Aged , Gastrectomy/adverse effects
10.
Cancer Rep (Hoboken) ; 7(6): e2099, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38837676

ABSTRACT

BACKGROUND: An elevated neutrophil-to-lymphocyte ratio (NLR) in peripheral blood is an independent prognostic indicator of various cancers. AIMS: In this study, we aimed to investigate the prognostic relevance of the intratumoral immune cell balance in gastric cancer. METHODS AND RESULTS: The study included 82 patients who underwent curative resection for gastric cancer. The intratumoral cluster of differentiation (CD) 15- and CD8-positive cells were evaluated using immunohistochemical staining. Additionally, clinicopathological factors and prognoses were analyzed. Patients with high intratumoral CD15/CD8 ratios had significantly lower overall survival (OS) and relapse-free survival (RFS) compared to those with low CD15/CD8 ratios (p = .0026 and p < .0001, respectively). Additionally, a high CD15/CD8 ratio was associated with lymph node metastasis (p = .019). Patients with high NLR had a significantly lower RFS than those with low NLR (p = .0050). Multivariate analysis revealed that the intratumoral CD15/CD8 ratio, NLR, and venous invasion were independent prognostic indicators of RFS (CD15/CD8 ratio: p < .001, hazard ratio (HR) = 14.7, 95% confidence interval (CI) = 3.8-56.8; NLR: p = .010, HR = 5.4, 95% CI = 1.5-19.6; venous invasion: p = .005, HR = 7.4, 95% CI = 1.8-29.7). CONCLUSION: In summary, we found that the intratumoral CD15/CD8 ratio is an independent prognostic factor following gastric cancer resection and its increase is associated with lymph node metastasis and microscopic lymph vessel invasion. Immunological evaluation with additional aspects of innate immunity may be useful in predicting cancer prognosis.


Subject(s)
CD8-Positive T-Lymphocytes , Neoplasm Recurrence, Local , Neutrophils , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/immunology , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Male , Female , Neutrophils/immunology , Neutrophils/pathology , CD8-Positive T-Lymphocytes/immunology , Middle Aged , Aged , Neoplasm Recurrence, Local/immunology , Neoplasm Recurrence, Local/pathology , Prognosis , Lewis X Antigen/analysis , Lewis X Antigen/metabolism , Adult , Aged, 80 and over , Gastrectomy , Lymphatic Metastasis/pathology , Lymphocytes, Tumor-Infiltrating/immunology , Retrospective Studies , Disease-Free Survival
11.
Gastroenterol Nurs ; 47(3): 203-212, 2024.
Article in English | MEDLINE | ID: mdl-38847430

ABSTRACT

The aim of this study was to determine the nutritional experiences of patients who underwent total gastrectomy surgery. This qualitative study was conducted using the phenomenological research design. The sample consisted of 18 individuals who underwent total gastrectomy surgery. The research data were collected using the semistructured in-depth interview method. Interviews were conducted and recorded using audio/visual tools during the COVID-19 pandemic. Data analysis was carried out by two researchers according to the hermeneutic phenomenological approach. The nutritional experiences of the informants were organized under three themes, namely, First Feeding Experiences may remain, Gastrointestinal Problems, and Coping Methods. It was determined that individuals face various problems after total gastrectomy, both physical and psychological. They have developed coping methods to deal with the nutritional problems they experience. Development of a patient-specific nutrition program is recommended to support adaptation to new eating habits after total gastrectomy.


Subject(s)
Adaptation, Psychological , Gastrectomy , Qualitative Research , Humans , Gastrectomy/psychology , Female , Male , Middle Aged , Aged , COVID-19/prevention & control , COVID-19/epidemiology , Adult , Nutritional Status , Stomach Neoplasms/surgery , SARS-CoV-2
12.
Cancer Med ; 13(11): e7326, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38826114

ABSTRACT

BACKGROUND: Optimal adjuvant chemotherapy after laparoscopic surgery in gastric cancer (GC) patients is still undefined. We aimed to evaluate the efficacy of S-1 plus oxaliplatin (SOX) and capecitabine plus oxaliplatin (CAPOX) in patients with GC after laparoscopic gastrectomy. METHODS: A non-inferiority randomized controlled clinical trial was performed in China. Patients with advanced GC who underwent laparoscopic D2 gastrectomy were randomly assigned to receive SOX and CAPOX regimens. RESULTS: In total, 191 patients were screened between May 2018 and June 2019, and 140 (73.3%) were included in the modified intent-to-treat analysis (mITT), of whom 69 and 71 were assigned to the SOX and CAPOX groups, respectively. The SOX group had similar 3-year overall survival (OS) and disease-free survival to the CAPOX group. Subgroup analysis revealed significantly better OS in the SOX group for male patients ([HR] = 0.395; 95% [CI], 0.153-1.019; p = 0.045), age >60 (HR = 0.219; 95% [CI], 0.064-0.753; p = 0.016), tumors in the gastric antrum (HR = 0.273; 95% [CI], 0.076-0.981; p = 0.047), and moderately differentiated tumors (HR = 0.338; 95% [CI], 0.110-1.041; p = 0.041). There were no significant differences observed in terms of adverse events and recurrence patterns between the two groups. CONCLUSION: Adjuvant SOX was non-inferior to CAPOX treatments for patients with GC who underwent curative laparoscopic D2 gastrectomy. For male patients, aged >60 years, tumors in the gastric antrum, and moderately differentiated tumors, adjuvant SOX may achieve an improvement compared with CAPOX.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols , Capecitabine , Drug Combinations , Gastrectomy , Laparoscopy , Oxaliplatin , Oxonic Acid , Stomach Neoplasms , Tegafur , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/drug therapy , Stomach Neoplasms/pathology , Stomach Neoplasms/mortality , Male , Gastrectomy/methods , Female , Middle Aged , Laparoscopy/methods , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Oxaliplatin/therapeutic use , Oxaliplatin/administration & dosage , Tegafur/therapeutic use , Tegafur/administration & dosage , Oxonic Acid/therapeutic use , Oxonic Acid/administration & dosage , Chemotherapy, Adjuvant/methods , Capecitabine/administration & dosage , Capecitabine/therapeutic use , Aged , Adult
13.
Cancer Rep (Hoboken) ; 7(6): e2101, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38831124

ABSTRACT

BACKGROUND: Hepatoid adenocarcinoma of the stomach (HAS) is a rare and aggressive subtype of gastric cancer (GC), accounting for less than 1% of all cases. It is characterized by frequent liver metastasis recurrence and a poorer prognosis than conventional GC. However, established treatment guidelines for HAS are currently not available.In this report, we present the results of a clinicopathological study of 19 patients diagnosed with HAS, including seven patients with liver metastasis, conducted by the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO) between 2016 and 2018. AIMS: The aim of the study was to retrospectively observe the outcomes of HAS with gastrectomy and hepatectomy for liver metastasis and determine relevant prognostic factor. We also examined the criteria and outcomes of hepatectomy for liver metastasis and aimed to suggest the optimal treatment for HAS, including chemotherapy. METHODS AND RESULTS: A total of 2147 patients underwent gastrectomy for GC at HiSCO-affiliated institutions during the study period; 19 patients, all male with a mean age of 70.9 years, were diagnosed with HAS by hematoxylin-eosin and immunohistochemical staining. Patients underwent gastrectomy at varying pathological stages: six at Stage I, three at Stage II, seven at Stage III, and three at Stage IV. Ten patients received postoperative chemotherapy and the 5-year survival rate was 67.7% after gastrectomy. Among the seven patients with pre or postoperative liver metastasis, five patients underwent hepatectomy. Although one patient had recurrence, the 3-year survival rate was 100% after hepatectomy. CONCLUSION: Contrary to previous reports suggesting a 3-year survival rate of approximmately 30% for HAS, our findings indicate that the prognosis for HAS may not be as poor as reported previously. This study contributes valuable insights into the management and potential treatment strategies for HAS.


Subject(s)
Adenocarcinoma , Gastrectomy , Hepatectomy , Liver Neoplasms , Stomach Neoplasms , Humans , Male , Stomach Neoplasms/pathology , Stomach Neoplasms/mortality , Stomach Neoplasms/therapy , Stomach Neoplasms/surgery , Retrospective Studies , Aged , Middle Aged , Adenocarcinoma/pathology , Adenocarcinoma/mortality , Adenocarcinoma/therapy , Adenocarcinoma/surgery , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Liver Neoplasms/mortality , Liver Neoplasms/therapy , Prognosis , Survival Rate , Aged, 80 and over , Neoplasm Staging , Neoplasm Recurrence, Local/pathology , Female
14.
Cell Mol Biol (Noisy-le-grand) ; 70(6): 92-96, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38836675

ABSTRACT

The currest study aimed to measure the effects of laparoscopic radical gastrectomy on inflammatory response along with immune function in gastric cancer (GC) patients. Seventy patients with GC in our hospital were retrospectively chosen to be the study objects and separated into control group (CG, 35 cases) and observation group (OG, 35 cases). Patients in the OG received radical laparotomy. Patients in the OG received laparoscopic radical gastrectomy. The surgical indicators, postoperative recovery indicators, inflammatory factors, immune function, incidence of adverse reactions along with quality of life of patients in both groups were compared. In contrast to the CG, the operation time of the OG presented as shorter (P<0.05), and the amount of intraoperative blood loss together with postoperative VAS score in the OG presented lower (P<0.05), but the number of lymph nodes dissection presented not statistically significant between 2 groups (P>0.05). The postoperative exhaust time, feeding time as well as hospital stay in the OG presented shorter relative to the CG (P<0.05). The serum levels of CRP, and IL-6 together with TNF-α presented elevated in both groups after surgery, and those in the OG presented lower when compared with the CG (P<0.05). The serum levels of IgA, and IgG together with IgM presented declined in both groups after surgery, and those in the OG presented higher when compared with the CG (P<0.05). The incidence of postoperative complications in the OG presented reduction relative to the CG (P<0.05). The GLQI scores of the OG presented significantly higher relative to the CG at discharge (P<0.05). Compared with radical gastrectomy, laparoscopic radical gastrectomy is more suitable for the treatment of GC, which can reduce the inflammatory response and promote the immune function of GC patients.


Subject(s)
Gastrectomy , Inflammation , Laparoscopy , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/immunology , Gastrectomy/methods , Gastrectomy/adverse effects , Laparoscopy/adverse effects , Laparoscopy/methods , Male , Female , Middle Aged , Inflammation/immunology , Aged , Quality of Life , Retrospective Studies , C-Reactive Protein/metabolism , Postoperative Complications/immunology , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Tumor Necrosis Factor-alpha/blood , Interleukin-6/blood
15.
Langenbecks Arch Surg ; 409(1): 174, 2024 Jun 05.
Article in English | MEDLINE | ID: mdl-38837064

ABSTRACT

BACKGROUND: Despite being oncologically acceptable for esophagogastric junction adenocarcinoma with an esophageal invasion length of 3-4 cm, the transhiatal approach has not yet become a standard method given the difficulty of reconstruction in a narrow space and the risk of severe anastomotic leakage. This study aimed to clarify the safety and feasibility of the open left diaphragm method during the transhiatal approach for esophagogastric junction adenocarcinoma. METHODS: This retrospective study compared the clinical outcomes of patients who underwent proximal or total gastrectomy with lower esophagectomy for Siewert type II/III adenocarcinomas with esophageal invasion via the laparoscopic transhiatal approach with or without the open left diaphragm method from April 2013 to December 2021. RESULTS: Overall, 42 and 13 patients did and did not undergo surgery with the open left diaphragm method, respectively. The median operative time was only slightly shorter in the open left diaphragm group than in the non-open left diaphragm group (369 vs. 482 min; P = 0.07). Grade ≥ II postoperative respiratory complications were significantly less common in the open left diaphragm group than in the non-open left diaphragm group (17% vs. 46%, P = 0.03). Neither group had grade ≥ IV anastomotic leakage, and two cases of anastomotic leakage requiring reoperation were drained using the left diaphragmatic release technique. CONCLUSIONS: Transhiatal lower esophagectomy with gastrectomy using the open left diaphragm method is safe, highlighting its advantages for Siewert type II/III esophagogastric junction adenocarcinoma with an esophageal invasion length of ≤ 4 cm.


Subject(s)
Adenocarcinoma , Diaphragm , Esophageal Neoplasms , Esophagectomy , Esophagogastric Junction , Gastrectomy , Laparoscopy , Stomach Neoplasms , Humans , Esophagogastric Junction/surgery , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Female , Male , Retrospective Studies , Middle Aged , Laparoscopy/methods , Esophageal Neoplasms/surgery , Esophageal Neoplasms/pathology , Aged , Gastrectomy/methods , Esophagectomy/methods , Diaphragm/surgery , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Plastic Surgery Procedures/methods
16.
BMC Anesthesiol ; 24(1): 207, 2024 Jun 13.
Article in English | MEDLINE | ID: mdl-38872117

ABSTRACT

BACKGROUND: Intra-operative anaesthesia management should be optimised to reduce the occurrence of postoperative nausea and vomiting in high-risk patients; however, a single intervention may not effectively reduce postoperative nausea and vomiting in such patients. This study assessed the effect of an optimised anaesthetic protocol versus a conventional one on postoperative nausea and vomiting in patients who underwent laparoscopic sleeve gastrectomy. METHODS: A single-centre randomised trial was conducted at Peking University Shenzhen Hospital from June 2021 to December 2022. Among 168 patients who underwent laparoscopic sleeve gastrectomy, 116 qualified, and 103 completed the study with available data. Patients were categorized into the conventional group (received sevoflurane and standard fluids) and the optimised group (underwent propofol-based anaesthesia and was administered goal-directed fluids). The primary endpoints were postoperative nausea and vomiting incidence and severity within 24 h. RESULTS: Postoperative nausea and vomiting assessment at 0-3 h post-surgery revealed no significant differences between groups. However, at 3-24 h, the optimised anaesthetic protocol group showed lower postoperative nausea and vomiting incidence and severity than those of the conventional group (P = 0.005). In the conventional group, 20 (37.04%) patients experienced moderate-to-severe postoperative nausea and vomiting, compared to six (12.25%) patients in the optimised group (odds ratio = 0.237; 95% CI = 0.086, 0.656; P = 0.006). No significant differences were noted in antiemetic treatment, moderate-to-severe pain incidence, anaesthesia recovery, post-anaesthetic care unit stay, or postoperative duration between the groups. While the total intra-operative infusion volumes were comparable, the optimised group had a significantly higher colloidal infusion volume (500 mL vs. 0 mL, P = 0.014) than that of the conventional group. CONCLUSIONS: The incidence and severity of postoperative nausea and vomiting 3-24 h postoperatively in patients who underwent laparoscopic sleeve gastrectomy were significantly lower with propofol-based total intravenous anaesthesia and goal-directed fluid therapy than with sevoflurane anaesthesia and traditional fluid management. Total intravenous anaesthesia is an effective multimodal antiemetic strategy for bariatric surgery. TRIAL REGISTRATION: This trial was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC- 2,100,046,534, registration date: 21 May 2021).


Subject(s)
Gastrectomy , Laparoscopy , Postoperative Nausea and Vomiting , Propofol , Sevoflurane , Humans , Postoperative Nausea and Vomiting/prevention & control , Postoperative Nausea and Vomiting/epidemiology , Male , Female , Laparoscopy/methods , Gastrectomy/methods , Gastrectomy/adverse effects , Adult , Propofol/administration & dosage , Sevoflurane/administration & dosage , Middle Aged , Anesthetics, Intravenous/administration & dosage , Anesthetics, Inhalation/administration & dosage , Anesthesia/methods
17.
Surg Oncol Clin N Am ; 33(3): 539-547, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38789196

ABSTRACT

Gastric adenocarcinoma is an aggressive disease and a leading cause of cancer-related deaths worldwide. Surgery entails either a total or a subtotal gastrectomy. These complex operations carry elevated morbidity and mortality with an extended recovery time. As such, research has focused on minimizing these risks and enhancing postoperative care. Robotic surgery is a newer platform that helps overcome some of the limitations of laparoscopy through three-dimensional vision, better mobility, and improved surgeon dexterity. As such, many surgeons have embraced robotics and advocated for their implementation in cancer surgery. This review will discuss the technical considerations of performing a robotic gastrectomy.


Subject(s)
Gastrectomy , Minimally Invasive Surgical Procedures , Robotic Surgical Procedures , Stomach Neoplasms , Humans , Gastrectomy/methods , Stomach Neoplasms/surgery , Robotic Surgical Procedures/methods , Minimally Invasive Surgical Procedures/methods , Laparoscopy/methods , Adenocarcinoma/surgery , Adenocarcinoma/pathology
18.
Curr Oncol ; 31(5): 2662-2669, 2024 05 08.
Article in English | MEDLINE | ID: mdl-38785482

ABSTRACT

While the importance of conversion surgery has increased with the development of systemic chemotherapy for gastric cancer (GC), reports of conversion surgery for patients with GC with distant metastasis and tumor thrombus are extremely scarce, and a definitive surgical strategy has yet to be established. Herein, we report a 67-year-old man with left abdominal pain referred to our hospital following a diagnosis of unresectable GC. Esophagogastroduodenoscopy and contrast-enhanced abdominal computed tomography (CT) revealed advanced GC with splenic metastasis. A splenic vein tumor thrombus (SVTT) and a continuous thrombus to the main trunk of the portal vein were detected. The patient was treated with anticoagulation therapy and systemic chemotherapy comprising S-1 and oxaliplatin. One year following chemotherapy initiation, a CT scan revealed progressive disease (PD); therefore, the chemotherapy regimen was switched to ramucirumab with paclitaxel. After 10 courses of chemotherapy resulting in primary tumor and SVTT shrinkage, the patient underwent laparoscopic total gastrectomy (LTG) and distal pancreaticosplenectomy (DPS). He was discharged without complications and remained alive 6 months postoperatively without recurrence. In summary, the wait-and-see approach was effective in a patient with GC with splenic metastasis and SVTT, ultimately leading to an R0 resection performed via LTG and DPS.


Subject(s)
Splenic Neoplasms , Splenic Vein , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/drug therapy , Stomach Neoplasms/complications , Male , Aged , Splenic Vein/surgery , Splenic Neoplasms/secondary , Splenic Neoplasms/surgery , Splenic Neoplasms/drug therapy , Minimally Invasive Surgical Procedures/methods , Venous Thrombosis/surgery , Venous Thrombosis/drug therapy , Gastrectomy/methods
19.
Eur J Surg Oncol ; 50(6): 108367, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38718701

ABSTRACT

BACKGROUND: The effects of the dynamics of serum tumor markers (CA72-4, CEA, CA19-9, CA125 and AFP) before and after neoadjuvant chemotherapy (NACT) on the prognosis of gastric cancer(GC) patients remain unclear. METHODS: The training set contained 334 GC patients from Fujian Medical University Union Hospital (FJMUUH) and 113 GC patients in Qinghai University Affiliated Hospital (QhUAH) were used as an external validation set. Tumor marker regression load (ΔTMRL) indicator, including ΔCA72-4, ΔCEA, ΔCA19-9, ΔCA125, and ΔAFP, is defined as [(postNACT marker- preNACT marker)/preNACT marker]. Tumor marker regression load score (TMRLS) consists of ΔCA72-4, ΔCEA and ΔCA125. The predictive performance of the nomogram-TMRLS was evaluated using the area under the receiver operating characteristic(ROC) curve(AUC), decision curve analysis(DCA), and C-index. RESULTS: Patients from FJMUUH were divided into two groups, TMRLS-low and TMRLS-high, determined by R package maxstat. Survival analysis revealed a higher 3-year overall survival(OS) in the TMRLS-low than in the TMRLS-high group. The TMRLS-high group who received postoperative adjuvant chemotherapy(AC) showed a significantly higher 3-year OS rate than those who did not. Multivariate COX regression analysis indicated that TMRLS was an independent prognostic factor for OS. A nomogram for predicting OS based on TMRLS showed a significantly higher C-index and AUC than the ypTNM stage. The above results were also found in the QhUAH external validation cohort. CONCLUSION: TMRLS is a novel independent prognostic factor for GC who underwent NACT and a radical gastrectomy. Furthermore, the TMRLS-high group, who received postoperative AC, may achieve better survival outcomes. Notably, the predictive performance of the nomogram-TMRLS significantly outperformed that of the ypTNM stage.


Subject(s)
Antigens, Tumor-Associated, Carbohydrate , Biomarkers, Tumor , Gastrectomy , Neoadjuvant Therapy , Nomograms , Stomach Neoplasms , Humans , Stomach Neoplasms/pathology , Stomach Neoplasms/drug therapy , Stomach Neoplasms/surgery , Male , Female , Middle Aged , Prognosis , Biomarkers, Tumor/blood , Antigens, Tumor-Associated, Carbohydrate/blood , CA-125 Antigen/blood , Aged , Carcinoembryonic Antigen/blood , Chemotherapy, Adjuvant , CA-19-9 Antigen/blood , Survival Rate , ROC Curve , Retrospective Studies , Adult , alpha-Fetoproteins
20.
Arq Bras Cir Dig ; 37: e1799, 2024.
Article in English | MEDLINE | ID: mdl-38747883

ABSTRACT

BACKGROUND: Curative treatment for gastric cancer involves tumor resection, followed by transit reconstruction, with Roux-en-Y being the main technique employed. To permit food transit to the duodenum, which is absent in Roux-en-Y, double transit reconstruction has been used, whose theoretical advantages seem to surpass the previous technique. AIMS: To compare the clinical evolution of gastric cancer patients who underwent total gastrectomy with Roux-en-Y and double tract reconstruction. METHODS: A systematic review was carried out on Web of Science, Scopus, EmbasE, SciELO, Virtual Health Library, PubMed, Cochrane, and Google Scholar databases. Data were collected until June 11, 2022. Observational studies or clinical trials evaluating patients submitted to double tract (DT) and Roux-en-Y (RY) reconstructions were included. There was no temporal or language restriction. Review articles, case reports, case series, and incomplete texts were excluded. The risk of bias was calculated using the Cochrane tool designed for randomized clinical trials. RESULTS: Four studies of good methodological quality were included, encompassing 209 participants. In the RY group, there was a greater reduction in food intake. In the DT group, the decrease in body mass index was less pronounced compared to preoperative values. CONCLUSIONS: The double tract reconstruction had better outcomes concerning body mass index and the time until starting a light diet; however, it did not present any advantages in relation to nutritional deficits, quality of life, and post-surgical complications.


Subject(s)
Anastomosis, Roux-en-Y , Gastrectomy , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Gastrectomy/methods , Anastomosis, Roux-en-Y/methods , Gastrointestinal Transit/physiology , Plastic Surgery Procedures/methods
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