scholarly journals The Contribution of the Hunger Hormone Leptin in the Aetiology of Postoperative Anorexia after Laparoscopic and Open Gastrectomy in Gastric Cancer Patients

Biomolecules ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1601
Author(s):  
Tomaz Jagric

Background: Laparoscopic surgery produces lesser postoperative inflammation with a smaller cytokine and leptin response, and might thus reduce postoperative anorexia compared with open surgery. The aim of the present study was to determine the role of serum leptin in postoperative anorexia after laparoscopic gastric cancer surgery. Methods: Fifty-four consecutive patients with adenocarcinoma of the stomach were operated on either with open or laparoscopic surgery. Correlations were determined between the serum levels of leptin, clinico-pathological characteristics, serum haemoglobin, and albumin. Results: Serum leptin levels on day seven were correlated significantly to gender (p = 0.004), body mass index (BMI) (p = 0.002), and tumour grade (p = 0.033). In the patients with C-reactive protein (CRP) < 100 mg/L (n = 46) the leptin levels on day seven were significantly lower after the laparoscopic operation (p = 0.042) and in patients with lower BMI (p = 0.001). The linear regression model determined a significant correlation between the relative concentration of leptin on day seven and laparoscopic surgery (Beta−0.688; p < 0.0001), gender, BMI, location of the tumour, T stage, N stage, perioperative therapy, tumour grade, perineural invasion, Lauren histological type, and ulceration. In patients with CRP levels below 100 mg/mL, the serum level of albumin on day seven after surgery was significantly higher in patients after laparoscopic surgery. Conclusion: Laparoscopic surgery produced significantly lower relative leptin concentrations on day seven, and higher serum albumin levels in the subgroup with CRP levels below 100 mg/L at discharge. These results suggested that laparoscopic gastric cancer surgery might reduce postoperative leptin response, leading to a better nutritional status at discharge compared with open surgery.

Author(s):  
Tomaz Jagric

Background: Laparoscopic surgery produces lesser postoperative inflammation with a smaller cytokine and leptin response, and might thus reduce postoperative anorexia compared to open surgery. The aim of the present study was to determine the role of serum leptin in postoperative anorexia after laparoscopic gastric cancer surgery. Methods: Fifty-four consecutive patients with adenocarcinoma of the stomach were operated on either with open or laparoscopic surgery. Correlations were determined between the serum levels of leptin, clinico-pathological characteristics, serum haemoglobin and albumin. Results: Serum leptin levels on day seven were correlated significantly to gender (p=0.004), BMI (p=0.002) and tumour grade (p=0.033). In the patients with CRP &lt; 100 mg/l the leptin levels on day seven were significantly lower after the laparoscopic operation (p=0.042) and in patients with lower BMI (p=0.001). The linear regression model determined a significant correlation between the relative concentration of leptin on day seven and laparoscopic surgery (Beta -0.688; p &lt; 0.0001), gender, BMI, location of the tumour, T stage, N stage, perioperative therapy, tumour grade, perineural invasion, Lauren histological type and ulceration. In patients with CRP levels below 100 mg/ml the serum level of albumin on day seven after surgery was significantly higher in patients after laparoscopic surgery. Conclusion: Laparoscopic surgery produced significantly lower relative leptin concentrations on day seven, and higher serum albumin levels in the subgroup with CRP levels below 100 mg/l at discharge. These results suggested that laparoscopic gastric cancer surgery might reduce postoperative leptin response, leading to a better nutritional status at discharge compared to open surgery.


2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 10-10
Author(s):  
Yosuke Atsumi ◽  
Yasushi Rino ◽  
Hiroo Wada ◽  
Yuichi Kitani ◽  
Yukihiro Ozawa ◽  
...  

10 Background: Several reports have showed that bone disorders occur after gastric cancer surgery, however there are few studies that compared pre- and postoperative bone mineral density of the same patient. The purpose of this study was to assess changes in bone metabolism after gastric cancer surgery prospectively. Methods: We prospectively enrolled 39 men undergoing gastrectomy for early gastric cancer. We excluded women to avoid the effect of menopause. Patients with severe kidney disease requiring dialysis treatment, patients with severe liver disease and patients with treatment with bisphosphonates or any other bone-active drugs were also excluded. Dual energy X-ray absorptiometry (DEXA) was performed before and 1 and 2 years after surgery to evaluate bone mineral density (BMD). The serum levels of 1,25-dihydroxy vitamin D (1,25(OH)2VD), 25-hydroxy vitamin D (25(OH)VD), estradiol, and alkaline phosphatase (ALP) were measured before surgery and every three months until two years after surgery. Results: DEXA revealed that BMD was significantly decreased by 0.036±0.033 g/cm2 at 12 months after gastrectomy (P < 0.001). The serum ALP was significantly increased by 38.88±6.42 IU/l at 24 months after surgery (P = 0.013), and there was a marginally significant correlation between the changes in BMD and the changes in the serum ALP at 24 months after surgery; the correlation coefficient was -0.30 (P = 0.090). The serum 25(OH)VD was significantly decreased by 4.88±6.42 ng/ml at 24 months after surgery (P < 0.001), however there was no significant correlation between the changes in BMD and the changes in the serum 25(OH)VD. The serum 1,25(OH)2VD and estradiol were not significantly changed before and after surgery. The factor significantly correlated to the reductions of BMD at 12 months after surgery included preoperative lower body mass index (BMI); the correlation coefficients was 0.37 (P = 0.025). Conclusions: This study showed a significant reduction in the BMD of gastric cancer patients at 12 months after gastrectomy and suggested that low preoperative BMI could be a high risk factor for the bone disorder after gastric cancer surgery.


2018 ◽  
Vol 23 (5) ◽  
pp. 895-903 ◽  
Author(s):  
Wei-Han Zhang ◽  
Kun Yang ◽  
Xin-Zu Chen ◽  
Ying Zhao ◽  
Kai Liu ◽  
...  

2021 ◽  
Vol 37 (1) ◽  
pp. 59-62
Author(s):  
Egemen Çiçek ◽  
Akile Zengin ◽  
Örgün Güneş ◽  
Fatih Sümer ◽  
Cüneyt Kayaalp

Objective: Remnant Gastric Cancer (RGC) describes cancers occurring in the remaining stomach and/or anastomosis in the follow-up after gastric cancer or benign gastric surgery. RGC is diagnosed in esophago-gastroscopy follow-ups of patients who underwent this surgery in the past. Again, the increase in the success of gastric cancer surgery and following medical treatments has increased the incidence of RGC in long-term follow-up after gastric cancer surgery. Laparoscopic surgery has been also reported in few cases. In the present study, the purpose was to present the results of the first five patients that underwent laparoscopic total gastrectomy due to RGC in our clinic. Material and Methods: The patients who underwent laparoscopic gastric cancer surgery between November 2014 and December 2018 were evaluated retrospectively. Results: Mean age of the patients was 62.4 years (ranging between 49 and 74 years). Two of these patients had a surgical history due to gastric cancer and 3 due to peptic ulcer. Surgery was completed laparoscopically in all patients. In the early period, one patient had to undergo re-surgery due to stenosis in Jejuno-Jejunostomy, and the patient died. One patient underwent laparotomy due to colonic stenosis in the second month after the surgery. Recurrence was detected on the 140th and 180th days of follow-up in the other two patients. Conclusion: Laparoscopic surgery is a technically applicable method in RGC; however, it is also a risk factor for past surgical postoperative complications. Early recurrence in this group of patients requires a comparison of open and laparoscopic surgery.


2020 ◽  
Vol 4 (4) ◽  
pp. 360-368 ◽  
Author(s):  
Takeshi Kubota ◽  
Katsutoshi Shoda ◽  
Hirotaka Konishi ◽  
Kazuma Okamoto ◽  
Eigo Otsuji

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033267
Author(s):  
Dengfeng Wang ◽  
Yang Yu ◽  
Pengxian Tao ◽  
Dan Wang ◽  
Yajing Chen ◽  
...  

IntroductionVenous thromboembolism (VTE) is a serious life-threatening complication in patients with gastric cancer. Abnormal coagulation function and tumour-related treatment may contribute to the occurrence of VTE. Many guidelines considered that surgical treatment would put patients with cancer at high risk of VTE, so positive prevention is needed. However, there are no studies that have systematically reviewed the postoperative risk and distribution of VTE in patients with gastric cancer. We thus conduct this systematic review to determine the risk of VTE in patients with gastric cancer undergoing surgery and provide some evidence for clinical decision-making.Methods and analysisStudies reporting the incidence of VTE after gastric cancer surgery will be included. Primary studies of randomised controlled trials, cohort studies, population-based surveys and cross-sectional studies are eligible for this review and only studies published in Chinese and English will be included. We will search the Medline, Embase, Web of Science, CBM, CNKI and Wanfang data from their inception to November 2019. Two reviewers will independently select studies and extract data. The quality of each included study will be assessed with tools corresponding to their study design. Meta-analysis will be used to pool the incidence data from included studies. Heterogeneity of the estimates across studies will be assessed, if necessary, a subgroup analysis will be performed to explore the source of heterogeneity. The Grades of Recommendation, Assessment, Development and Evaluation method is applied to assess the level of evidence obtained from this systematic review.Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, and thus ethical approval is not required. The results of this review will be sought for publication.PROSPERO registration numberCRD42019144562


2021 ◽  
pp. 1-8
Author(s):  
Johannes Asplund ◽  
Eivind Gottlieb-Vedi ◽  
Wilhelm Leijonmarck ◽  
Fredrik Mattsson ◽  
Jesper Lagergren

2021 ◽  
pp. 1-10
Author(s):  
Sachiko Kaida ◽  
Toru Miyake ◽  
Satoshi Murata ◽  
Tsuyoshi Yamaguchi ◽  
Takeshi Tatsuta ◽  
...  

Introduction: This study aimed to clarify the frequency and risk factors of intercurrent venous thromboembolism (VTE) in patients undergoing major curative gastric cancer surgery. Methods: This prospective, multicenter, observational study included patients with gastric cancer who underwent radical gastrectomy at 5 hospitals between June 2016 and May 2018. Patients who were preoperatively administered anticoagulants were excluded. Results: A total of 126 patients were eligible to participate. VTE occurred within 9 days postoperatively in 5 cases (4.0%; 2 symptomatic and 3 asymptomatic). Postoperative day (POD) 1 plasma D-dimer and soluble fibrin (SF) levels were significantly higher in the VTE group than in the non-VTE group. Receiver-operating characteristic curve (ROC) analysis indicated a statistically significant ability of POD 1 D-dimer and SF levels to predict postoperative VTE development after gastrectomy; this finding was reflected by an area under the curve (AUC) of 0.97 (95% CI 0.92–1.0) and 0.87 (95% CI 0.74–1.0), respectively. Cutoff values of D-dimer (24.6 µg/mL) and SF (64.1 µg/mL) were determined. Intraoperative blood transfusion (odds ratio [OR] 7.86), POD 1 D-dimer ≥24.6 µg/mL (OR 17.35), and POD 1 SF ≥64.1 µg/mL (OR 19.5) were independent predictive factors for postoperative VTE (p < 0.05). Conclusion: VTE occurred in 4.0% patients (1.6% symptomatic and 2.4% asymptomatic) after gastric cancer surgery; however, with an early diagnosis and anticoagulant therapy, no patients experienced progression. Careful observation of patients with a high risk for VTE, including intraoperative blood transfusion and high POD 1 D-dimer or SF levels, would contribute to the early detection of VTE.


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