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3.
BMC Gastroenterol ; 24(1): 170, 2024 May 17.
Article in English | MEDLINE | ID: mdl-38760726

ABSTRACT

BACKGROUND: Low grade intraepithelial neoplasia (LGIN) and high grade intraepithelial neoplasia (HGIN) are potential precancerous lesion of gastric neoplasms. Endoscopic submucosal dissection (ESD) is the first option for the treatment of precancerous lesion and early gastric cancer (EGC). Traction is an effective method to improve efficiency, and reduce complications during ESD. In this study, we shared a useful traction method using the clip-and-snare method with a pre-looping technique (CSM-PLT) for precancerous lesion and EGC. METHODS: We retrospectively analyzed patients received ESD combined with CSM-PLT or conventional ESD from June 2018 to December 2021 in Shenzhen People's hospital. The primary outcome was resection speed. RESULTS: Forty-two patients were enrolled in ESD combined with CSM-PLT group and sixty-five patients in conventional ESD group respectively. Baseline characteristics were comparable among two groups (P>0.05). There were no significant differences in terms of R0 resection rate, en bloc resection rate (97.6% vs. 98.5%, P = 1.000 and 97.6% vs. 96.9%, P = 1.000, respectively), operation costs (933.7 (644.1-1102.4) dollars vs. 814.7 (614.6-988.3) dollars, P = 0.107), and hospital stays (8.0 ± 3.1 days vs. 7.3 ± 3.2 days, P = 0.236). In addition, no significant difference was observed with respect to complications (P>0.05). However, the resection speed of ESD combined with CSM-PLT was faster than that of conventional ESD (11.3 (9.4-14.9) mm2/min vs. 8.0 (5.8-10.9) mm2/min, P < 0.001), particularly lesions located in anterior wall and lesser curvature. In addition, the association between ESD combined with CSM-PLT and resection speed was still supported after propensity matching scores (PMS). CONCLUSIONS: CSM-PLT can help to improve ESD efficiency without reducing the en bloc resection rate or increasing the incidence of complications.


Subject(s)
Endoscopic Mucosal Resection , Precancerous Conditions , Stomach Neoplasms , Humans , Male , Retrospective Studies , Female , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Middle Aged , Endoscopic Mucosal Resection/methods , Endoscopic Mucosal Resection/adverse effects , Precancerous Conditions/surgery , Precancerous Conditions/pathology , Aged , Treatment Outcome , Operative Time , Carcinoma in Situ/surgery , Carcinoma in Situ/pathology
4.
Clin Nutr ESPEN ; 61: 63-70, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38777474

ABSTRACT

BACKGROUND & AIMS: Preoperative sarcopenia in gastric cancer is associated with increased postoperative complications and reduced long-term survival. However, the association between postoperative sarcopenia and long-term outcomes remains unclear. Therefore, this study aims to clarify the association between sarcopenia after gastrectomy for gastric cancer and survival outcomes. METHODS: This retrospective study included 1512 patients aged ≥65 who underwent curative gastric resection for clinical stage I-III primary gastric cancer during 2008-2018. Sarcopenia was assessed preoperatively by measuring arm muscle area and grip strength, which was repeated 1 month after surgery. We compared the clinical characteristics, surgical treatments, and long-term outcomes between the postoperative normal and sarcopenia groups. RESULTS: Sarcopenia was observed in 173 and 305 patients pre- and postoperatively, respectively. Factors increasing the risk of postoperative sarcopenia included age of ≥75, lower preoperative body mass index, diabetes, and clinical stage II/III gastric cancer. Patients with postoperative sarcopenia after surgery had a significantly lower overall survival rate (hazard ratio [HR] 2.596, p < 0.001). Furthermore, postoperative sarcopenia was linked to decreased overall survival in patients with (HR 2.813, p = 0.002) and without (HR 1.925, p < 0.001) preoperative sarcopenia. Cumulative incidence showed significantly higher rates of deaths due to gastric cancer (HR 1.928, p < 0.001) and other causes (HR 2.736, p < 0.001) in the postoperative sarcopenia group. CONCLUSIONS: Postoperative sarcopenia in gastric cancer is linked to an increased risk of death due to cancer and other causes, underscoring the importance of perioperative sarcopenia management strategies.


Subject(s)
Gastrectomy , Postoperative Complications , Sarcopenia , Stomach Neoplasms , Humans , Sarcopenia/complications , Stomach Neoplasms/surgery , Stomach Neoplasms/mortality , Stomach Neoplasms/complications , Male , Female , Aged , Retrospective Studies , Postoperative Complications/mortality , Aged, 80 and over , Risk Factors , Hand Strength
5.
BMC Cancer ; 24(1): 583, 2024 May 13.
Article in English | MEDLINE | ID: mdl-38741082

ABSTRACT

BACKGROUND: Insufficient evidence existed about the prognostic role of the advanced lung cancer inflammation index (ALI) for gastric cancer patients who underwent curative resection. The aim of this study was to identify the predictive ability of ALI for survival after curative gastrectomy. METHODS: We retrospectively analyzed 328 gastric cancer patients who received curative gastrectomy from the database of Chongqing University Cancer Hospital, and investigated the prognostic role of the preoperative ALI compared with clinicopathological variables and other serum biomarkers, such as preoperative neutrophil-to-lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and Lymphocyte-monocyte ratio (LMR). To minimize intergroup differences, propensity score matching (PSM) analysis was employed. Additionally, we performed a meta-analysis of four cohort studies published up to October 2023 following the PRISMA guidelines. RESULTS: In the overall cohort, patients in the low ALI group had a significantly worse overall survival compared to those in the high ALI group (P < 0.0001). Subgroup analysis identified that ALI maintained its prognostic significance across different subgroups. In addition, ROC analysis showed that ALI had a higher AUC value for 3-year overall survival compared to NLR, PLR, and LMR (0.576 vs. 0.573 vs. 0.557 vs. 0.557). Multivariate analysis indicated that ALI, other than other serum biomarkers, was an independent risk factor for decreased overall survival in GC patients following curative surgery (HR = 1.449; 95%CI: 1.028-2.045; P = 0.034). Consistently, PSM analysis supported all of these findings. The meta-analysis including 4 studies evaluating 2542 patients, confirmed the association between the low ALI and poor survival outcomes. CONCLUSION: The preoperative ALI was an independent prognostic factor for survival in gastric cancer patients who underwent curative gastrectomy.


Subject(s)
Gastrectomy , Propensity Score , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/mortality , Stomach Neoplasms/blood , Stomach Neoplasms/pathology , Prognosis , Male , Female , Middle Aged , Retrospective Studies , Inflammation/blood , Aged , Neutrophils , Lymphocytes
6.
Sci Rep ; 14(1): 10060, 2024 05 02.
Article in English | MEDLINE | ID: mdl-38698246

ABSTRACT

This study aimed to evaluate the safety and efficiency of hybrid endoscopic submucosal dissection (H-ESD) using a newly developed ALL IN ONE (AIO) snare. This was a matched control study in a porcine model. Five paired simulated stomach lesions 2-2.5 cm in size were removed by H-ESD using an AIO snare or conventional ESD (C-ESD) using an endoscopic knife. The outcomes of the two procedures were compared, including en-bloc resection rates, procedure times, intraprocedural bleeding volumes, muscular injuries, perforations, thicknesses of the submucosal layer in resected specimens, and stomach defects. All simulated lesions were resected en-bloc. Specimens resected by H-ESD and C-ESD were similar in size (7.68 ± 2.92 vs. 8.42 ± 2.42 cm2; P = 0.676). H-ESD required a significantly shorter procedure time (13.39 ± 3.78 vs. 25.99 ± 4.52 min; P = 0.031) and submucosal dissection time (3.99 ± 1.73 vs. 13.1 ± 4.58 min; P = 0.003) versus C-ESD; H-ESD also yielded a faster dissection speed (241.37 ± 156.84 vs. 68.56 ± 28.53 mm2/min; P = 0.042) and caused fewer intraprocedural bleeding events (0.40 ± 0.55 vs. 3.40 ± 1.95 times/per lesion; P = 0.016) than C-ESD. The thicknesses of the submucosal layer of the resected specimen (1190.98 ± 134.07 vs. 1055.90 ± 151.76 µm; P = 0.174) and the residual submucosal layer of the stomach defect (1607.94 ± 1026.74 vs. 985.98 ± 445.58 µm; P = 0.249) were similar with both procedures. The AIO snare is a safe and effective device for H-ESD and improves the treatment outcomes of gastric lesions by shortening the procedure time.


Subject(s)
Endoscopic Mucosal Resection , Gastric Mucosa , Animals , Endoscopic Mucosal Resection/methods , Endoscopic Mucosal Resection/adverse effects , Endoscopic Mucosal Resection/instrumentation , Swine , Gastric Mucosa/surgery , Gastroscopy/methods , Operative Time , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Stomach/surgery , Models, Animal
7.
Sci Rep ; 14(1): 11213, 2024 05 16.
Article in English | MEDLINE | ID: mdl-38755185

ABSTRACT

The preoperative distinguishment of lymph nodes (LN) with metastasis plays a pivotal role in guiding the surgical extension for gastric cancer (GC). We aim to identify the preparative risk factors for LN metastasis in GC patients. We retrospectively reviewed 424 patients who underwent radical GC resection in our medical center between Jan 2011 and Dec 2018. Multivariate logistic regression was employed to identify risk factors for LN metastasis, while multivariate COX regression was utilized to evaluate prognostic factors. The median overall survival of patients with or without LN metastases was 31 and 58 months, respectively. In multivariate analysis, lower albumin (OR = 0.512; P = 0.004) and prealbumin (OR = 0.367, P = 0.001) and higher CEA (OR = 3.178, P < 0.001), CA199 (OR = 2.278, P = 0.002) and platelets (OR = 1.697, P = 0.017) were found to be significantly associated with LN metastasis. In survival analysis, older age (HR = 1.712), larger tumors (HR = 1.082), higher D-dimer (HR = 1.561) and CA199 (HR = 1.553), advanced staging (stage II, HR = 3.446; stage III-IV, HR = 11.089), lower prealbumin levels (lower level for reference, HR = 0.63), and absence of adjuvant chemotherapy (HR = 0.396) was discovered to be associated with poorer overall survival (all P < 0.05). In conclusion, our results demonstrated that preoperative prealbumin-bound tumor markers can effectively predict LN metastasis. Additionally, prealbumin was found to possess prognostic value as well.


Subject(s)
Lymphatic Metastasis , Stomach Neoplasms , Humans , Stomach Neoplasms/pathology , Stomach Neoplasms/mortality , Stomach Neoplasms/surgery , Male , Female , Middle Aged , Prognosis , Aged , Retrospective Studies , Lymph Nodes/pathology , Risk Factors , Neoplasm Staging , Adult , Biomarkers, Tumor/metabolism , Preoperative Period , Aged, 80 and over
8.
Nutrients ; 16(10)2024 May 14.
Article in English | MEDLINE | ID: mdl-38794723

ABSTRACT

Gastric cancer (GC) remains a significant global health concern, ranking as the third leading cause of cancer-related deaths. Malnutrition is common in GC patients and can negatively impact prognosis and quality of life. Understanding nutritional issues and their management is crucial for improving patient outcomes. This cross-sectional study included 51 GC patients who underwent curative surgery, either total or subtotal gastrectomy. Various nutritional assessments were conducted, including anthropometric measurements, laboratory tests, and scoring systems such as Eastern Cooperative Oncology Group/World Health Organization Performance Status (ECOG/WHO PS), Observer-Reported Dysphagia (ORD), Nutritional Risk Screening-2002 (NRS-2002), Patient-Generated Subjective Global Assessment (PG-SGA), and Simplified Nutritional Appetite Questionnaire (SNAQ). Serum carcinoembryonic antigen (CEA) levels were significantly higher in the subtotal gastrectomy group. Nutritional assessments indicated a higher risk of malnutrition in patients who underwent total gastrectomy, as evidenced by higher scores on ORD, NRS-2002, and PG-SGA. While total gastrectomy was associated with a higher risk of malnutrition, no single nutritional parameter emerged as a strong predictor of surgical approach. PG-SGA predominantly identified malnutrition, with its occurrence linked to demographic factors such as female gender and age exceeding 65 years.


Subject(s)
Gastrectomy , Malnutrition , Nutrition Assessment , Nutritional Status , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/complications , Gastrectomy/adverse effects , Female , Cross-Sectional Studies , Male , Middle Aged , Aged , Malnutrition/etiology , Malnutrition/diagnosis , Quality of Life , Adult
9.
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
10.
World J Surg Oncol ; 22(1): 136, 2024 May 23.
Article in English | MEDLINE | ID: mdl-38778314

ABSTRACT

BACKGROUND: As the prevalence of gastric cancer rises in aging populations, managing surgical risks and comorbidities in elderly patients presents a unique challenge. The Comprehensive Preoperative Assessment and Support (CPAS) program, through comprehensive preoperative assessments, aims to mitigate surgical stress and improve outcomes by enhancing patient awareness and preparation. This study investigates the efficacy of a CPAS program, incorporating frailty and sarcopenia evaluations, to improve short-term outcomes in elderly gastric cancer patients. METHODS: A retrospective analysis was conducted on 127 patients aged 75 or older who underwent surgery with CPAS between 2018 and August 2023, compared to 170 historical controls from 2012 to 2017. Propensity score matching balanced both groups based on age-adjusted Charlson Comorbidity Index and surgical details. The primary focus was on the impact of CPAS elements such as rehabilitation, nutrition, psychological support, oral frailty, and social support on short-term surgical outcomes. RESULTS: Among 83 matched pairs, the CPAS group, despite 40.4% of patients in the CPAS group and 21.2% in the control group had an ASA-PS score of 3 or higher (P < 0.001), demonstrated significantly reduced blood loss (100 ml vs. 190 ml, P = 0.026) and lower incidence of serious complications (19.3% vs. 33.7%, P = 0.034), especially in infections and respiratory issues. Sarcopenia was identified in 38.6% of CPAS patients who received tailored support. Additionally, the median postoperative hospital stay was notably shorter in the CPAS group (10 days vs. 15 days, P < 0.001), with no in-hospital deaths. These results suggest that personalized preoperative care effectively mitigates operative stress and postoperative complications. CONCLUSION: Implementing CPAS significantly enhances surgical safety and reduces complication rates in elderly gastric cancer patients, emphasizing the critical role of personalized preoperative care in surgical oncology for this demographic.


Subject(s)
Gastrectomy , Postoperative Complications , Preoperative Care , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Female , Male , Retrospective Studies , Aged , Postoperative Complications/epidemiology , Preoperative Care/methods , Aged, 80 and over , Gastrectomy/methods , Gastrectomy/adverse effects , Prognosis , Geriatric Assessment/methods , Follow-Up Studies , Sarcopenia/epidemiology , Sarcopenia/complications , Case-Control Studies , Frailty/complications , Frailty/epidemiology
11.
Medicine (Baltimore) ; 103(21): e38251, 2024 May 24.
Article in English | MEDLINE | ID: mdl-38788023

ABSTRACT

Predicting postgastrectomy relapse and mortality in patients with gastric cancer (GC) remains challenging, with limitations to traditional staging systems such as the tumor-node-metastasis (TNM) system. This study aimed to investigate the impact of preoperative Hounsfield unit (HU) values, which serve as a surrogate marker for bone mineral density (BMD), in predicting survival outcomes in patients with GC. A retrospective analysis was conducted on data from patients with GC who underwent curative-intent gastrectomy. Opportunistic abdominopelvic computed tomography images were used to assess HU values at the 3rd lumbar vertebra (L3). These values were then categorized using a cutoff value of 110 HU, which has been established in previous studies as a determinant for abnormal versus normal BMD. Cox regression analysis established predictor models for overall survival (OS). Among 501 initial patients, 478 met the inclusion criteria. Multivariate analyses revealed HU values (hazard ratio, 1.51), along with other factors (the 5-factor modified frailty index, type of gastrectomy, TNM stage, anemia, and serum albumin level), as significant predictors of OS. The full model (FM) incorporating these variables demonstrated superior discrimination ability compared to the baseline model (BM), which is based solely on the TNM stage (concordance index: 0.807 vs 0.709; P < .001). Furthermore, the FM outperformed the BM in predicting OS risks at 36- and 60-months post-surgery. In conclusion, among patients undergoing gastrectomy for GC, those with HU values ≤ 110 (indicating abnormal BMD) at the L3 level, as determined through opportunistic CT scans, exhibited a poorer prognosis than those with HU values > 110 (indicating normal BMD). Integrating HU with other clinicopathological parameters enhances predictive accuracy, facilitating individualized risk stratification and treatment decision-making, which could potentially lead to improved survival outcomes.


Subject(s)
Bone Density , Gastrectomy , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/mortality , Stomach Neoplasms/pathology , Gastrectomy/methods , Male , Female , Retrospective Studies , Middle Aged , Prognosis , Aged , Tomography, X-Ray Computed/methods , Neoplasm Staging , Preoperative Period
12.
Langenbecks Arch Surg ; 409(1): 148, 2024 May 02.
Article in English | MEDLINE | ID: mdl-38695994

ABSTRACT

In the past 40 years, the incidence of esophagogastric junction cancer has been gradually increasing worldwide. Currently, surgical resection remains the main radical treatment for early gastric cancer. Due to the rise of functional preservation surgery, proximal gastrectomy has become an alternative to total gastrectomy for surgeons in Japan and South Korea. However, the methods of digestive tract reconstruction after proximal gastrectomy have not been fully unified. At present, the principal methods include esophagogastrostomy, double flap technique, jejunal interposition, and double tract reconstruction. Related studies have shown that double tract reconstruction has a good anti-reflux effect and improves postoperative nutritional prognosis, and it is expected to become a standard digestive tract reconstruction method after proximal gastrectomy. However, the optimal anastomoses mode in current double tract reconstruction is still controversial. This article aims to review the current status of double tract reconstruction and address the aforementioned issues.


Subject(s)
Anastomosis, Surgical , Gastrectomy , Plastic Surgery Procedures , Stomach Neoplasms , Humans , Gastrectomy/methods , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Anastomosis, Surgical/methods , Plastic Surgery Procedures/methods , Esophagogastric Junction/surgery , Surgical Flaps , Jejunum/surgery
13.
Int J Mol Sci ; 25(9)2024 Apr 29.
Article in English | MEDLINE | ID: mdl-38732067

ABSTRACT

Plexiform fibromyxoma (PF), also referred to as plexiform angiomyxoid myofibroblast tumor, is an exceedingly rare mesenchymal neoplasm primarily affecting the stomach. Herein, we present a case of PF diagnosed in a 71-year-old male with a history of lung cancer, initially suspected to have a gastrointestinal stromal tumor (GIST) of the stomach, who subsequently underwent subtotal gastrectomy. The histopathological and molecular features of the tumor, including mutations in ABL1, CCND1, CSF1R, FGFR4, KDR, and MALAT1-GLI1 fusion, are elucidated and discussed in the context of diagnostic, prognostic, and therapeutic considerations.


Subject(s)
Fibroma , Stomach Neoplasms , Humans , Male , Aged , Stomach Neoplasms/genetics , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery , Stomach Neoplasms/metabolism , Fibroma/genetics , Fibroma/pathology , Fibroma/metabolism , Immunohistochemistry , Mutation , Biomarkers, Tumor/genetics , Gastrectomy
14.
Surg Oncol Clin N Am ; 33(3): 487-495, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38789191

ABSTRACT

Early detection of esophageal and gastric cancers offers the possibility of curative treatments with less-invasive interventions than traditional surgical approaches. This review highlights the main endoscopic therapeutic modalities used for early esophageal and gastric malignancies. Endoscopic resection techniques include endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). EMR is beneficial for smaller, well-defined lesions and involves resecting the superficial layer of the mucosa. In contrast, ESD permits en bloc resection of larger lesions, including those involving the superficial submucosa, offering precise histopathological assessments and reduced recurrence rates. As such, multidisciplinary collaboration is essential to achieve optimal outcomes.


Subject(s)
Esophageal Neoplasms , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Esophageal Neoplasms/surgery , Esophageal Neoplasms/pathology , Endoscopic Mucosal Resection/methods , Neoplasm Staging
15.
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
16.
BMC Anesthesiol ; 24(1): 185, 2024 May 24.
Article in English | MEDLINE | ID: mdl-38789968

ABSTRACT

BACKGROUND: Despite the implementation of various postoperative management strategies, the prevalence of postoperative fatigue syndrome (POFS) remains considerable among individuals undergoing laparoscopic radical gastrectomy. While the N-methyl-D-aspartic acid receptor antagonist esketamine has demonstrated efficacy in enhancing sleep quality and alleviating postoperative pain, its impact on POFS remains uncertain. Consequently, the objective of this study is to ascertain whether perioperative administration of esketamine can effectively mitigate the occurrence of POFS in patients undergoing laparoscopic radical gastrectomy. METHODS: A total of 133 patients diagnosed with gastric cancer were randomly assigned to two groups, namely the control group (Group C) (n = 66) and the esketamine group (Group E) (n = 67), using a double-blind method. The Group C received standardized anesthesia, while the Group E received esketamine in addition to the standardized anesthesia. The primary outcome measure assessed was the Christensen fatigue score at 3 days after the surgical procedure, while the secondary outcomes included the disparities in postoperative fatigue, postoperative pain, sleep quality, and adverse reactions between the two groups. RESULTS: In the group receiving esketamine, the fatigue scores of Christensen on the third day after surgery were significantly lower compared to the Group C (estimated difference, -0.70; 95% CI, -1.37 to -0.03; P = 0.040). Additionally, there was a significant decrease in the occurrence of fatigue in the Group E compared to the Group C on the first and third days following surgery (P < 0.05). Also, compared to individuals who had distal gastrectomy, those who had entire gastrectomy demonstrated a higher degree of postoperative tiredness reduction with esketamine. Furthermore, the Group E exhibited reduced postoperative pain and improved sleep in comparison to the Group C. Both groups experienced similar rates of adverse events. CONCLUSIONS: The use of esketamine during the perioperative period can improve POFS after laparoscopic radical gastrectomy, without adverse reactions. TRIAL REGISTRATION: Registered in the Chinese Clinical Trial Registry (ChiCTR2300072167) on 05/06 /2023.


Subject(s)
Gastrectomy , Ketamine , Laparoscopy , Pain, Postoperative , Postoperative Complications , Stomach Neoplasms , Humans , Ketamine/administration & dosage , Ketamine/therapeutic use , Stomach Neoplasms/surgery , Male , Female , Double-Blind Method , Laparoscopy/methods , Middle Aged , Gastrectomy/methods , Postoperative Complications/prevention & control , Pain, Postoperative/drug therapy , Pain, Postoperative/prevention & control , Fatigue/prevention & control , Aged
17.
Rev Gastroenterol Peru ; 44(1): 79-82, 2024.
Article in Spanish | MEDLINE | ID: mdl-38734917

ABSTRACT

Menetrier's disease represents a low prevalence clinical entity, characterized by complexity in its diagnosis, particularly due to the need to exclude its potential association with gastric cancer. In this context, we present the clinical case of a 54-year-old male with nonspecific gastrointestinal symptoms and hypoalbuminemia. During the upper endoscopy procedure, a noticeable thickening of gastric folds was observed, associated with multiple polypoid lesions in the stomach, predominantly in the fundus and body. Since the patient did not show improvement in symptoms and given the inability to rule out gastric cancer, total gastrectomy was chosen as the treatment. Surgical specimen and histology confirmed the presence of Menetrier's disease.


Subject(s)
Gastritis, Hypertrophic , Polyps , Humans , Male , Middle Aged , Gastritis, Hypertrophic/complications , Gastritis, Hypertrophic/diagnosis , Polyps/diagnosis , Polyps/complications , Polyps/surgery , Polyps/pathology , Stomach Diseases/diagnosis , Stomach Diseases/complications , Hyperplasia , Gastrectomy , Stomach Neoplasms/diagnosis , Stomach Neoplasms/pathology , Stomach Neoplasms/complications , Stomach Neoplasms/surgery , Adenomatous Polyps
19.
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
20.
Support Care Cancer ; 32(6): 387, 2024 May 27.
Article in English | MEDLINE | ID: mdl-38801426

ABSTRACT

AIM AND OBJECTIVES: The purpose of this study was to describe the number, type and trajectory of symptom clusters during the perioperative period in patients with gastric cancer at four different time points. The study also aimed to identify the changes and consistency of these symptom clusters over time. DESIGN: This was a longitudinal study. METHODS: This study was conducted in a tertiary cancer hospital with 205 patients with gastric cancer. The M.D. Anderson Symptom Inventory Gastrointestinal Cancer Module was used to assess the incidence and severity of symptom clusters. Exploratory factor analysis was used to extract symptom clusters. RESULTS: The study identified four symptom clusters in patients with gastric cancer during the perioperative period: gastrointestinal symptom cluster, physical symptom cluster, psychological symptom cluster, and sleep disturbance symptom cluster. These clusters were observed across two to four time points. CONCLUSION: The findings of this study provide scientific evidence for medical staff and researchers to better understand the symptoms of patients with gastrointestinal cancer during the perioperative period. These findings can help develop individualized interventions for managing symptoms. RELEVANCE TO CLINICAL PRACTICE: Gastric cancer patients suffered from various symptom clusters, which lasted from one day before surgery to one month after surgery. They should be given careful consideration by clinical staff.


Subject(s)
Perioperative Period , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Longitudinal Studies , Male , Female , Middle Aged , Aged , Sleep Wake Disorders/etiology , Sleep Wake Disorders/epidemiology , Adult , Factor Analysis, Statistical , Severity of Illness Index , Aged, 80 and over
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