[Preliminary report on the use of total lumpectomyconical remnant gastric - esophagus side overlap anastomosis in radical resection of Siewert type II proximal gastric cancer].

Objective: There is no standard method for esophageal remnant gastric reconstruction for proximal gastrectomy. Reflux esophagitis caused by esophagogastrostomy remains a difficult surgical problem. To report the preliminary surgical results of novel esophagus-conical remnant gastric side overlap anastomosis (CGEO) , with particular emphasis on postoperative esophageal reflux. Methods: In June 2022, we developed a novel CGEO for laparoscopic proximal gastrectomy on two patients with Siewert type II esophagogastric junction adenocarcinoma. Surgical procedures for CGEO: (1) Laparoscopic proximal gastrectomy and preparation of conically shaped gastric remnant; (2) Determining anastomotic site of residual stomach and esophagus; (3) Side-to-side anastomosis of right esophageal wall to anterior of conical gastric remnant; (4) Valvuloplasty of esophageal stump. Results: Case 1 was a 71-year-old man with an operation time of 305 minutes and was successfully discharged from the hospital on the 9th day after surgery, and the postoperative pathology was T3N0M0. Case 2 was an 82-year-old man with an operation time of 325 minutes. He was discharged on the 10th day after surgery. In both cases, only mild esophageal mucosal changes were seen in gastroscopy, there were no obvious symptoms of esophageal reflux. There was also no significant weight change at half a year after operation. Conclusion: CGEO is moderately safe in radical surgery for proximal gastric cancer, and may have a preventive effect on the occurrence of postoperative esophageal reflux, but long-term results need to be confirmed by further studies with follow-up.

The comparative safety of biological treatment in patients with axial spondylarthritis: a meta-analysis of randomized controlled trials with placebo.

OBJECTIVE: To evaluate the comparative safety of biological treatment in patients with axial spondyloarthritis (axSpA) enrolled in randomized controlled trials (RCTs) with placebo. MATERIALS AND METHODS: Studies were systematically retrieved from the Web of Science, PubMed, Cochrane Library, and Embase databases. The last search was performed on 8 June 2020. The primary outcome measures were adverse events (AEs), serious AEs, infection, serious infection, and discontinuation due to AEs. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of twenty-two trials, including 2599 participants treated with biologics and 1547 participants treated with placebo, met the inclusion criteria. There was a significantly higher risk of infection, AEs, and discontinuation due to AEs in the biologics groups compared to the placebo groups [risk ratio (RR) = 1.38, 95% confidence interval (95% CI) = 1.22-1.57, p < 0.01; RR = 1.17, 95% CI = 1.10-1.25, p < 0.01; and RR = 1.72, 95% CI = 1.03-2.87, p = 0.04, respectively], and low heterogeneity was found among the included studies (I2 = 0%, p = 0. 49; I2 = 29%, p = 0.10; and I2 = 0%, p = 0.79, respectively). The risk of serious infection and serious AEs was not significantly different between axSpA patients treated with biologics and those treated with placebo [RR = 1.62, 95% CI = 0.54-4.90, p = 0.39 and RR = 1.17, 95% CI = 0.79-1.73, p = 0.44]. Low heterogeneity was found among the included studies (I2 = 0%, p = 0.94 and I2 = 0%, p = 0.69). The subgroup analyses based on tumour necrosis factor inhibitors and interleukin antagonists did not yield significant differences. CONCLUSIONS: This meta-analysis is the first comprehensive assessment of the safety of various biological agents in axSpA patients. The use of biological agents in axSpA is generally safe and tolerable.