Intelligent Algorithm-Based Magnetic Resonance Imaging in Radical Gastrectomy under Laparoscope

The study focused on the influence of intelligent algorithm-based magnetic resonance imaging (MRI) on short-term curative effects of laparoscopic radical gastrectomy for gastric cancer. A convolutional neural network- (CNN-) based algorithm was used to segment MRI images of patients with gastric cancer, and 158 subjects admitted at hospital were selected as research subjects and randomly divided into the 3D laparoscopy group and 2D laparoscopy group, with 79 cases in each group. The two groups were compared for operation time, intraoperative blood loss, number of dissected lymph nodes, exhaust time, time to get out of bed, postoperative hospital stay, and postoperative complications. The results showed that the CNN-based algorithm had high accuracy with clear contours. The similarity coefficient (DSC) was 0.89, the sensitivity was 0.93, and the average time to process an image was 1.1 min. The 3D laparoscopic group had shorter operation time (86.3 ± 21.0 min vs. 98 ± 23.3 min) and less intraoperative blood loss (200 ± 27.6 mL vs. 209 ± 29.8 mL) than the 2D laparoscopic group, and the difference was statistically significant ( P < 0.05 ). The number of dissected lymph nodes was 38.4 ± 8.5 in the 3D group and 36.1 ± 6.0 in the 2D group, showing no statistically significant difference ( P > 0.05 ). At the same time, no statistically significant difference was noted in postoperative exhaust time, time to get out of bed, postoperative hospital stay, and the incidence of complications ( P > 0.05 ). It was concluded that the algorithm in this study can accurately segment the target area, providing a basis for the preoperative examination of gastric cancer, and that 3D laparoscopic surgery can shorten the operation time and reduce intraoperative bleeding, while achieving similar short-term curative effects to 2D laparoscopy.

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Comparison of Perioperative Outcomes in Open and Laparoscopic Radical Cystectomy with Modified Ureterosigmoidostomy (MainzII): A Retrospective Analysis

10.21203/rs.3.rs-805660/v1 ◽

2021 ◽

Author(s):

Bin Zhang ◽

Yang He ◽

Duo Zheng ◽

Junyao Liu ◽

Peng Qi ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Radical Cystectomy ◽

Urinary Diversion ◽

Open Surgery ◽

Operation Time ◽

Laparoscopic Group ◽

Postoperative Hospital Stay ◽

Intraoperative Blood Loss

Abstract Background: To analyze perioperative conditions and long-term efficacy of open modified ureterosigmoidostomy urinary diversion (OMUUD) in patients with bladder cancer who underwent open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC).Methods: In this retrospective study, the clinical data of patients who underwent open and laparoscopic radical cystectomy plus open modified ureterosigmoidostomy urinary diversion in our hospital were collected from January 2011 to December 2019. In addition, perioperative data of 56 patients who underwent ORC and OMUUD were compared with those of 118 patients who underwent laparoscopic radical cystectomy (LRC) plus OMUUD. A long-term follow-up was performed to compare the overall survival (OS) and progression-free survival (PFS) rate between the two groups.Results: Results showed that there was no significant difference between ORC+OMUUD group and LRC+OMUUD group in terms of gender, age, body index, pre-operative ASA grade, history of transurethral resection of bladder tumor (TURBT) before surgery, tumor T stage, lymph node dissection range, pathological grade, and positive postoperative surgical margin. The mean operation time in the open group was shorter than that in the laparoscopic group （P<0.001）. Moreover, the estimated intraoperative blood loss（P<0.001）and postoperative hospital stay（P=0.023）were better in the laparoscopic group than in the open group. The incidence of complications between 30 days (P=0.665) and 90 days (P=0.211) time-points after surgery was not significantly different. Similarly, the OS (P=0.237) and PFS (P=0.307) between the two groups were comparable.Conclusion: This study shows that the LRC group has long operation time, but less estimated intraoperative blood loss, short postoperative hospital stay, small trauma, and fast postoperative recovery compared to open surgery. Moreover, the incidence of complications at 30 - and 90-days postoperation, as well as the OS and PFS is not different between laparoscopy and open surgery.

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Impact of retrieved lymph nodes count on short-term complications in patients with gastric cancer: a retrospective study

10.21203/rs.3.rs-17793/v1 ◽

2020 ◽

Author(s):

Feng Sun ◽

Song Liu ◽

Peng Song ◽

Chen Zhang ◽

Zhijian Liu ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Postoperative Complications ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Operation Time ◽

Short Term ◽

Node Metastasis ◽

Significant Difference ◽

Univariate Analyses

Abstract Background: It is well established that retrieved lymph nodes (RLNs) count were positively correlated with better overall survival in gastric cancer (GC). But little is known about the relationship between RLNs count and short-term complications after radical surgery. Methods: A total of 1487 consecutive GC patients between January 2016 and December 2018 at Nanjing Drum Tower Hospital were retrospectively analyzed. Univariate analyses were performed to elucidate the association between RLNs count and postoperative complications. We further identified clinical factors that might affect the RLNs count.Results: Among all of the patients, postoperative complications occurred in 435 (29.3%) patients. The mean RLNs count was 25.1 and 864 (58.1%) patients were diagnosed with lymph node metastasis. Univariate analyses showed no significant difference between RLNs count and postoperative complications (both overall and stratified by CDC grade). We further explored that preoperative serum albumin, type of resection, operation time, tumor invasion, lymph node metastasis, and pTNM stage were associated with RLNs count. Conclusions: The current study demonstrated that RLNs count was not associated with postoperative short-term complications following gastrectomy of GC, which provided a rationale for the determination of a proper RLNs count of curative gastrectomy.

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Impact of Retrieved Lymph Nodes Count on Short-Term Complications in Patients with Gastric Cancer

10.21203/rs.3.rs-34560/v1 ◽

2020 ◽

Author(s):

Feng Sun ◽

Song Liu ◽

Peng Song ◽

Chen Zhang ◽

Zhijian Liu ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Postoperative Complications ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Operation Time ◽

Short Term ◽

Node Metastasis ◽

Significant Difference ◽

Univariate Analyses

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Laparoscopic vs open gastrectomy- An updated metaanalysis of randomised control trials for short term outcomes

10.1101/2020.04.12.20062562 ◽

2020 ◽

Author(s):

Bhavin Vasavada ◽

Hardik Patel

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Operative Time ◽

Laparoscopic Group ◽

Open Gastrectomy ◽

Systemic Review ◽

Wound Complications ◽

Short Term ◽

Significant Difference ◽

Randomised Control Trials

AbstractIntroductionAim of this metaanalysis was to compare short term outcomes of laparoscopic and open gastrectomy for gastric cancer.Material and methodsEMBASE, MEDLINE, PubMed and the Cochrane Database were searched for randomised control trials comparing outcomes in patients undergoing laparoscopic gastrectomies with those patients undergoing open gastrectomies. The primary outcome was 30 day morbidity and mortality. Secondary outcomes studied included length of stay, blood loss, d2gastrectomies, lymphnode retrieval, operative time, distal gastrectomy, wound complications and intraabdominal complications Systemic review and Metaanalysis were done according to MOOSE and PRISMA guidelines.ResultsMorbidity was significantly low in laparoscopic group(P=0.004).There was no significant difference between mortality between the two groups. (P=0.989). There less wound complications in laparoscpic group, no difference intra-abdominal complications in both the groups. Operative time was significantly higher in laparoscopic group. (P< 0.001) wmd 56.904. Hospital stay was similar in laparoscopic group. (P=0.305) wmd –0.533 days. Blood loss was significantly lesser in laparoscopic group.(p <0.001). Laparoscopic group patients had less number of lymph node retrieval compared to laparoscopic group.(p< 0.001). Laparoscopic group also contained similar advanced staged gastric cancer than open gastrectomies.ConclusionsLaparoscopic gastrectomies were associated with better short term outcomes.

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Impact of Retrieved Lymph Nodes Count on Short-term Complications in Patients With Gastric Cancer: A Retrospective Study

10.21203/rs.3.rs-27768/v1 ◽

2020 ◽

Author(s):

Feng Sun ◽

Song Liu ◽

Peng Song ◽

Chen Zhang ◽

Zhijian Liu ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Postoperative Complications ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Operation Time ◽

Short Term ◽

Node Metastasis ◽

Significant Difference ◽

Univariate Analyses

Abstract Background:It is well established thatretrieved lymph nodes (RLNs) count were positively correlated with better overall survival in gastric cancer (GC). But little is known about the relationship between RLNs count and short-term complications after radical surgery.Methods: A total of 1487 consecutive GC patients between January 2016 and December 2018 at Nanjing Drum Tower Hospital were retrospectively analyzed. Univariate analyses were performed to elucidate the association between RLNs count and postoperative complications. We further identified clinical factors that might affect the RLNs count.Results: Among all of the patients, postoperative complications occurred in 435 (29.3%) patients. The mean RLNs count was 25.1 and 864 (58.1%) patients were diagnosed with lymph node metastasis. Univariate analyses showed no significant difference between RLNscount and postoperative complications (both overall and stratified by CDC grade). We further explored that preoperative serum albumin, type of resection, operation time, tumor invasion, lymph node metastasis, and pTNM stage were associated with RLNs count.Conclusions: The current study demonstrated that RLNs count was not associated with postoperative short-term complications following gastrectomy of GC, which provided a rationale for the determination of a proper RLNs count of curative gastrectomy.

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Ligation-free single scrotal incision orchiectomy with ultrasonic scalpel: Xinhua Zhang Procedure

10.31083/jomh.2021.010 ◽

2021 ◽

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Postoperative Complication ◽

Operation Time ◽

Postoperative Hospital Stay ◽

Complication Rates ◽

Intraoperative Blood Loss ◽

Ultrasonic Scalpel ◽

Surgery Group ◽

Significant Difference

Background: To explore the eﬃcacy and safety of a new type of testicular excision with ultrasonic dissector. Methods: A retrospective analysis was performed on 69 patients with advanced prostate cancer undergoing orchiectomy in our hospital between June 2017 and June 2019. All patients were divided into a traditional surgery group (n = 27) and an ultrasonic scalpel surgery group (n = 42). The operation time, intraoperative blood loss, postoperative hospital stay and postoperative complication rates were compared. Results: The ultrasonic scalpel surgery group had signiﬁcantly shorter operation times and less intraoperative blood loss than the traditional surgery group (each P < 0.01). Moreover, the incidence of postoperative complication differed signiﬁcantly between the traditional surgery group (18.52%) and the ultrasonic scalpel surgery group (0%) (P < 0.01). However, there was no signiﬁcant difference in postoperative hospital stay between the two groups (P > 0.05). Conclusions: The surgery time for testicular excision using the ultrasonic knife is short, the operation is simple and the complications are few and thus it may become a form of replacement for traditional testicular excision.

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The Safety and Efficacy of Total Laparoscopic Distal Gastrectomy With Delta-Shaped Anastomosis Compared With Laparoscopic-Assisted Distal Gastrectomy

International Surgery ◽

10.9738/intsurg-d-19-00014.1 ◽

2020 ◽

Vol 104 (3-4) ◽

pp. 131-137

Author(s):

Y. B. Gao ◽

W. D. Jin ◽

J. Cao ◽

Z. Y. Zhang ◽

X. Cai ◽

...

Keyword(s):

Gastric Cancer ◽

Hospital Stay ◽

Distal Gastrectomy ◽

Enhanced Recovery ◽

Operation Time ◽

Laparoscopic Distal Gastrectomy ◽

Short Term ◽

Therapeutic Benefits ◽

Significant Difference ◽

Laparoscopic Assisted

Aim: To evaluate the safety and short-time benefits of enhanced recovery after surgery on hospital stay, recovery of gastrointestinal function and complications after total laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis, comparing with laparoscopic-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was performed in 134 patients with gastric cancer who were treated at Wuhan General Hospital of Guangzhou Military Area Command from November 2013 to August 2015. A total of 70 patients underwent TLDG, and 64 patients underwent LADG. All patients were performed elective standard D2 total gastrectomy by 1 group of experienced surgeons. The short-term therapeutic benefits, including duration of flatus and defecation, postoperative pain, duration of postoperative stay, and complications between the 2 groups were analyzed. Results: Compared with LADG, TLDG had shorter time to the first flatus (74.09 ± 11.08 h versus 84.11 ± 12.18 h, P < 0.001), earlier postoperative liquid diet intake (98.83 ± 10.63 h versus 108.58 ± 13.08 h, P < 0.001), less dosage of pain killers (2.01 ± 0.85 versus 2.41 ± 0.85, P = 0.009), faster recovery with a shorter postoperative hospital stay (8.14 ± 0.3.43 d versus 9.97 ± 4.53 d, P = 0.009), There were no significant difference in operation time, blood loss, the number of lymph nodes retrieved, or the incidence of postoperative complications (anastomotic bleeding or leakage, wound infection, digestive tract dysfunction, thrombosis, or death; P > 0.05). Conclusions: TLDG with delta-shaped anastomosis is a safe and effective fast-tract surgical approach for earlier gastric cancer, which would probably achieve the short-term curative effect. Further studies based on larger volumes and long-term effects are required to confirm these findings.

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Short-term Outcomes of Robotic- versus Laparoscopic-Assisted Total Gastrectomy for Advanced Gastric Cancer: A Propensity Score Matching Study

10.21203/rs.2.16736/v1 ◽

2019 ◽

Author(s):

Changdong Yang ◽

Yan Shi ◽

Shaohui Xie ◽

Jun Chen ◽

Yongliang Zhao ◽

...

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Advanced Gastric Cancer ◽

Propensity Score Matching ◽

Total Gastrectomy ◽

Resection Margin ◽

Operation Time ◽

Clinicopathological Characteristics ◽

Short Term ◽

Significant Difference

Abstract Background Few studies have been designed to evaluate the short-term outcomes for advanced gastric cancer (AGC) between robotic-assisted total gastrectomy (RATG) and laparoscopy-assisted total gastrectomy (LATG) alone. The purpose of this study was to assess short-term outcomes of RATG compared with LATG for AGC.Methods We retrospectively evaluated 116 and 244 patients who underwent RATG or LATG respectively. Besides, we performed a propensity score matching (PSM) analysis between RATG and LATG for clinicopathological characteristics to reduce bias and compared short-term surgical outcomes.Results After PSM, the RTAG group had longer mean operation time (291.09±58.41 vs. 271.99±48.41min, p=0.007), less intraoperative bleeding (151.98±92.83 vs. 172.59±97.01ml, p=0.032) and more N2 tier RLNs (9.33±5.46 vs. 7.50±3.86, p=0.018) than the LATG group. Besides, the total RLNs of RATG was at the brink of significance compared to LATG (35.09±12.93 vs.32.34±12.05, p=0.062). However, no significant differences were found between the two groups in terms of length of incision, proximal resection margin, distal resection margin, postoperative hospital stay. The conversion rate was 4.92% and 8.61% in the RATG and LATG groups, respectively, with no significant difference. The ratio of splenectomy was 1.7% and 0.4% respectively. There was no significant difference in overall complication rate between RATG and LATG groups before PSM (24.1% vs. 28.7%; p=0.341) and after PSM (24.1% vs. 33.6%; p=0.102). The grade II complications accounted for most of all complications in the two cohorts both before and after PSM.Conclusion This study demonstrates that RATG is comparable to LATG in terms of short-term surgical outcomes.

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“Micro Hand S” Surgical Robot vs Laparoscopic Gastrectomy for Gastric Cancer: Comparison of Short-Term Outcomes

10.21203/rs.3.rs-41120/v1 ◽

2020 ◽

Author(s):

Yuan-Bing Yao ◽

Guo-Hui Wang ◽

Yong Liu ◽

Bo Yi ◽

Zheng Li ◽

...

Keyword(s):

Gastric Cancer ◽

Laparoscopic Gastrectomy ◽

Operation Time ◽

Surgical Robot ◽

R0 Resection ◽

Robotic Gastrectomy ◽

Short Term ◽

Significant Difference ◽

Grade Ii ◽

Comprehensive Complications Index

Abstract Background Expensive cost of surgery has limited the use of surgical robot in China. The emergence of “Micro Hand S” surgical robot provides more choices for surgical treatment. Our study was to evaluate the safety and feasibility of “Micro Hand S” surgical robotic gastrectomy for gastric cancer. Methods Perioperative data of 75 patients who underwent “Micro Hand S” surgical robotic gastrectomy (RG) or laparoscopic gastrectomy (LG) at the Department of General Surgery, Third Xiangya Hospital, Central South University from June 2017 to January 2019 were collected to compare the short-term outcomes between the two groups. Results No statistically significant difference was found in baseline characteristics between the two groups (P > 0.05). RG group had longer operation time (P < 0.01). The harvested lymph nodes were comparable between the two groups (P = 0.084). There were five positive margins in the LG group, and the R0 resection rate was comparable between the two groups (P = 0.247). 16 complications occurred in the RG group according to the Clavien-Dindo classification system, 6 in grade I, and 10 in grade II. 68 complications happened in the LG group, 22 in grade I, 44 in grade II, 1 in grade IIIa and 1 in grade IVa. The comprehensive complications index (CCI) was similar between the two groups (P = 0.895). Intraoperative blood loss, surgical resection, reconstruction of the digestive tract intraoperative blood transfusion, Chemoradiotherapy, pathological type, degree of differentiation, proximal resection margin, time of first flatus, time of liquid diet, time of abdominal drainage tube extraction, and hospital stay for RG and LG were similar too (P > 0.05). Conclusion “Micro Hand S” surgical robotic gastrectomy is safe and feasible. Keywords Surgical robot; Gastric cancer; Gastrectomy; Safety; Feasibility

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The Safety and Efficacy of Total Laparoscopic Distal Gastrectomy With Delta-Shaped Anastomosis Compared With Laparoscopic-Assisted Distal Gastrectomy

International Surgery ◽

10.9738/intsurg-d-18-00006.1 ◽

2020 ◽

Vol 104 (3-4) ◽

pp. 116-122

Author(s):

You-Bing Gao ◽

Jin Wei-Dong ◽

Cao Jun ◽

Zhang Zhi-Yong ◽

Cai Xun ◽

...

Keyword(s):

Gastric Cancer ◽

Hospital Stay ◽

Distal Gastrectomy ◽

Enhanced Recovery ◽

Operation Time ◽

Laparoscopic Distal Gastrectomy ◽

Short Term ◽

Therapeutic Benefits ◽

Significant Difference ◽

Laparoscopic Assisted

Aim: To evaluate the safety and short-time benefits of enhanced recovery after surgery on hospital stay, recovery of gastrointestinal function and complications after total laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis, comparing with laparoscopic-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was performed in 134 patients with gastric cancer who were treated at Wuhan General Hospital of Guangzhou Military Area Command from November 2013 to August 2015. A total of 70 patients underwent TLDG, and 64 patients underwent LADG. All patients were performed elective standard D2 total gastrectomy by 1 group of experienced surgeons. The short-term therapeutic benefits, including duration of flatus and defecation, postoperative pain, duration of postoperative stay, and complications between the 2 groups were analyzed. Results: Compared with LADG, TLDG had shorter time to the first flatus (74.09 ± 11.08 hours versus 84.11 ± 12.18 hours, P < 0.001), earlier postoperative liquid diet intake (98.83 ± 10.63 hours versus 108.58 ± 13.08 hours, P < 0.001), less dosage of pain killers (2.01 ± 0.85 versus 2.41 ± 0.85, P = 0.009), faster recovery with a shorter postoperative hospital stay (8.14 ± 0.3.43 days versus 9.97 ± 4.53 days, P = 0.009), There were no significant difference in operation time, blood loss, the number of lymph nodes retrieved, or the incidence of postoperative complications (anastomotic bleeding or leakage, wound infection, digestive tract dysfunction, thrombosis, or death; P > 0.05). Conclusions: TLDG with delta-shaped anastomosis is a safe and effective fast-tract surgical approach for earlier gastric cancer, which would probably achieve the short-term curative effect. Further studies based on larger volumes and long-term effects are required to confirm these findings.

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