scholarly journals Effectiveness of a Novel Covered Stent without External Thread Fixation for Anastomotic Leakage after Total or Proximal Gastrectomy for Gastric Cancer

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3720
Author(s):  
Young-Il Kim ◽  
Chan Gyoo Kim ◽  
Jong Yeul Lee ◽  
Il Ju Choi ◽  
Bang Wool Eom ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leakage ◽  
Stent Placement ◽  
Proximal Gastrectomy ◽  
Stent Migration ◽  
Covered Stent ◽  
Double Layers ◽  
Stent Group ◽  
Hospitalization Period ◽  
Gastric Cancer Patients

A thread-fix stent entails long hospitalization and patient discomfort. We aimed to evaluate the efficacy of a novel stent with silicone-covered outer double layers without external fixation (Beta stent) for anastomotic leakage after total or proximal gastrectomy. The outcomes were compared between gastric cancer patients who underwent stent placement using a thread-fix stent between 2014 and 2015 (Thread-Fix Group) and those who received a Beta stent in the succeeding period until October 2018 (Beta Stent Group). The Beta Stent Group (n = 14) had a significantly higher leakage healing rate by the first stent placement (92.9% vs. 53.8%; p = 0.021) and had a shorter hospitalization period (median: 16 days vs. 28 days; p = 0.037) than the Thread-Fix Group (n = 13). Further, 50% of the Beta stent patients received outpatient management until stent removal. Stent maintenance duration was significantly longer in the Beta Stent Group (median, 28 days vs. 18 days; p = 0.006). There was no significant between-group difference in stent-related complications except for stent migration (7.1% (Beta Stent Group) vs. 0% (Thread-Fix Group), p = 0.326). In conclusion, the Niti-S Beta stent is an effective treatment for anastomotic leakage from total or proximal gastrectomy for gastric cancer. Stent maintenance is possible without hospitalization.

scholarly journals Laparoscopic proximal gastrectomy with double-tract reconstruction for upper third gastric cancer

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuo-meng Xiao ◽  
Ping Zhao ◽  
Zhi Ding ◽  
Rui Xu ◽  
Chao Yang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Operation Time ◽  
Nutrition Status ◽  
Proximal Gastric Cancer ◽  
Double Tract Reconstruction ◽  
Significant Difference ◽  
Laparoscopic Proximal Gastrectomy ◽  
Gastric Cancer Patients ◽  
Upper Third

Abstract Background Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. Methods Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case–control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. Results The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. Conclusion LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

scholarly journals Clinical evaluation the success rate and complications of fluoroscopically guided removal of tracheal tube metallic stents

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zong-Ming Li ◽  
De-Chao Jiao ◽  
Xin-Wei Han ◽  
Hui-Bin Lu ◽  
Ke-Wei Ren ◽  
...  
Keyword(s):  
Tracheal Tube ◽  
Granulation Tissue ◽  
Stent Placement ◽  
Covered Stent ◽  
Stent Fracture ◽  
Stent Group ◽  
Airway Stent ◽  
Uncovered Stents ◽  
Uncovered Stent

Abstract Background Long-term placement of airway stents has a high probability of restenosis of the airway due to granulation tissue hyperplasia, and it is difficult to remove the stent. Our aim is to evaluate the success rate and complications of removal of tracheal tube metallic stents under fluoroscopic guidance, and to compare the difference between uncovered stent and covered stent. Methods We retrospectively reviewed 45 cases (31 males and 14 females; age, 12–71 years) of tracheal metallic stent removal performed at our center between January 2014 and December 2019. Covered stents were applied in 36 cases, and uncovered stents were applied in 9 cases. In the covered stent group, 15 patients presented with granulation tissue at both ends; 3 cases, with stent fracture; and 2, with stent intolerance due to severe airway foreign body sensation. In the uncovered stents group, all patients presented with granulation tissue formation; 2 patients, with stent fracture; and 1 patient, with stent intolerance. Results A total of 41 (91.1%) stents were successfully removed (34 [94.4%] in the covered stent group and 7 [77.8%] in the uncovered stent group). The average duration of stent placement was 3.2 ± 0.7 and 2.5 ± 1.2 months in the covered stent group and uncovered stent group, respectively. With regard to the complications, hemoptysis occurred in 4 cases (average blood volume lost, 100 ml), tracheal mucosa tear occurred in 5 cases, tracheal collapse requiring emergency airway stent placement occurred in 1 case, and tracheal rupture requiring emergency surgical suture occurred in 1 case. No procedure-related deaths occurred in either group. Conclusions It is safe to remove the metal stent of the tracheal tube under the guidance of fluoroscopy, with low complications, and can avoid the long-term placement of the airway stent.

scholarly journals nPTD Classification: An Updated Classification of Gastric Cancer Location for Function Preserving Gastrectomy Based on Physiological Lymphatic Flow

2021 ◽  
Author(s):  
Shinichi Kinami ◽  
Naohiko Nakamura ◽  
Tomoharu Miyashita ◽  
Hidekazu Kitakata ◽  
Sachio Fushida ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Flow Distribution ◽  
Muscle Layer ◽  
Tumor Location ◽  
Lymphatic Flow ◽  
Greater Curvature ◽  
Gastric Cancer Patients ◽  
The Right ◽  
Lesser Curvature

Abstract Background: The correlation between tumor location and lymphatic flow distribution in gastric cancer has been previously reported, and PTD (Proximal – Transitional – Distal) classification, proposed. We updated and developed the nPTD classification.Method: We retrospectively studied gastric cancer patients who underwent the dye method sentinel node biopsy from 1993 to 2020. The inclusion criteria were a single lesion type 0 cancer of ≤5 cm in the long axis, clinically node-negative, and invasion within the proper muscle layer pathologically. In this study, the distribution of dyed lymphatic flow was evaluated for each occupied area of the tumor.Results: We selected 416. The tumors located watershed of the right and left gastroepiploic artery near greater curvature had extensive lymphatic flow; therefore, a newly circular region with a diameter of 5 cm is set on the watershed on greater curvature between P and T zone as the ‘n’ zone. In addition, for cancers located in the lesser P curvature, lymphatic flow to the greater curvature was not observed. Therefore, the P zone is divided into two: the lesser curvature side (PL) and the greater curvature side (PG).Conclusions: The advantage of the nPTD classification is that it provides not only proper nodal dissection, but also adequate function-preserving gastrectomy. If the tumor is localized within the PL, the proximal gastrectomy resection area can be further reduced. In contrast, for cancers located in the ‘n’ zone, near-total gastrectomy is required because of the extensive lymphatic flow.

scholarly journals Retrospective Evaluation of Factors Affecting Lymph Node Retrieval Following Gastrectomies with Oncologic Intent

2021 ◽  
Vol 12 (2) ◽  
pp. e0012
Author(s):  
Steven Fuchs ◽  
◽  
Itamar Ashkenazi ◽  
◽  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Medical Center ◽  
Proximal Gastrectomy ◽  
Univariate Analysis ◽  
Related Factors ◽  
Factors Affecting ◽  
Lymph Node Retrieval ◽  
Gastric Cancer Patients

Background: Adequate lymphadenectomy is an important factor affecting survival in gastric cancer patients. Retrieval and examination of at least 15 lymph nodes is recommended in order to properly stage gastric malignancies. The objectives of this study were to evaluate the proportion of patients undergoing inadequate lymphadenectomies and possible risk factors for inadequate surgery. Methods: This was a retrospective study that included patients, 18 years and older, who underwent gastrectomies with oncologic intent in the Hillel Yaffe Medical Center. We analyzed the association of demographic, clinical, and pathological variables with adequate number of lymph nodes. Results: The retrieval of less than 15 lymph nodes was reported in 51% (53/104) patients undergoing gastrectomies with oncologic intent. The extent of surgery was the only variable associated with inadequate lymphadenectomy on univariate analysis: subtotal/proximal versus total gastrectomy (P=0.047). Differ¬ences observed for previous surgery (P=0.193), T stage (P=0.053), N stage (P=0.051), and lymphovascular invasion (P=0.14) did not reach significance. Subtotal/proximal gastrectomy resulted in inadequate resec¬tion of lymph nodes in 56% of the patients, while this occurred in only 30% of the patients undergoing total gastrectomy (relative risk 1.865; 95% CI 0.93, 3.741). Logistic regression confirmed that only subtotal/prox¬imal versus total gastrectomy was associated with inadequate number of lymph nodes resected (P=0.043). Discussion and Conclusion: In this study we analyzed the association of patient, tumor, and surgery-related factors on adequate lymphadenectomy in patients undergoing gastrectomies for possible gastric cancer. Larger extent of the surgery (total, rather than subtotal/proximal gastrectomy) was revealed to be the only indicator positively associated with adequate lymphadenectomy.

scholarly journals Neutrophil/Lymphocyte Ratio as Predictor of Anastomotic Leak after Gastric Cancer Surgery

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 799
Author(s):  
Dumitru Radulescu ◽  
Vlad Dumitru Baleanu ◽  
Vlad Padureanu ◽  
Patricia Mihaela Radulescu ◽  
Silviu Bordu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leakage ◽  
Anastomotic Leak ◽  
Peripheral Blood ◽  
Gastric Resection ◽  
Cutoff Value ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Gastric Cancer Patients

Introduction. Neutrophil/lymphocyte ratio (NLR) is known as a prognostic for the outcome of the patients with gastric cancer. As no definite risk marker for anastomotic leakage after gastric resection was identified, we investigated the possible role of NLR. Methods. Peripheral blood count for neutrophils and lymphocytes was done at the patient’s admission. We retrospectively evaluated 204 gastric cancer patients, who underwent gastric resection, comparing the values of NLR between the group of patients with anastomotic leakage and those without complications. Results. Using the ROC curve, we found the cutoff value of NLR, which permitted the comparison of the group with low NLR, presenting increased NLR. The cutoff value for NLR was 3.54. Between the two groups, we could observe statistically significant differences in developing fistula (p < 0.01) and complications leading to death (p < 0.025). The odds ratio for patients with NLR greater than 3.54 to develop anastomotic leak was 17.62, compared to those with lower NLR. Conclusion. Peripheral blood NLR proved to be a predictor for anastomotic leakage.

scholarly journals Methods for early detection of anastomotic leakage after radical gastrectomy

2020 ◽  
Author(s):  
Birendra Kumar Sah ◽  
Yang Zhang ◽  
Jian Li ◽  
Chen Li ◽  
Huan Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Detection ◽  
Anastomotic Leakage ◽  
Multivariate Analyses ◽  
Curative Gastrectomy ◽  
Ct Examination ◽  
Predictive Variables ◽  
Anastomosis Site ◽  
Life Threatening ◽  
Gastric Cancer Patients

AbstractBackgroundAnastomotic leakage is a life-threatening postoperative complication after gastric cancer surgery. Previous studies have not produced effective methods for the early detection of anastomotic leakage. We investigated whether the use of postoperative computed tomography (CT) facilitates the early diagnosis of anastomotic leakage.MethodsGastric cancer patients who underwent curative gastrectomy and had a CT examination after surgery were included in this study. Propensity score (PS) matching generated 70 cases (35 cases of anastomotic leakage and 35 cases of no anastomotic leak) among 210 eligible cases. Univariate and multivariate analyses were used to identify the predictive variables.ResultsLogistic regression analysis revealed that the neutrophilia (NE ≥ 85.8%) during postoperative day 1 to day 3 (POD 1-3), fever (body temperature (T) ≥ 38.5°C) during postoperative day 4 to day 7 (POD 4-7), and extraluminal gas at the anastomosis site (on CT examination), were the independent predictive factors for an anastomotic leakage (p<0.05).ConclusionsOn CT examination, extraluminal gas at the anastomosis site is highly suggestive of anastomotic leakage. Postoperative CT examination is beneficial for the early detection of anastomotic leakage especially in patients with neutrophilia and fever.

scholarly journals nPTD classification: an updated classification of gastric cancer location for function preserving gastrectomy based on physiological lymphatic flow

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shinichi Kinami ◽  
Naohiko Nakamura ◽  
Tomoharu Miyashita ◽  
Hidekazu Kitakata ◽  
Sachio Fushida ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Flow Distribution ◽  
Muscle Layer ◽  
Tumor Location ◽  
Lymphatic Flow ◽  
Greater Curvature ◽  
Gastric Cancer Patients ◽  
The Right ◽  
Lesser Curvature

Abstract Background The correlation between tumor location and lymphatic flow distribution in gastric cancer has been previously reported, and PTD (Proximal – Transitional – Distal) classification was proposed. Our group updated and developed the nPTD classification. Method We retrospectively studied gastric cancer patients who underwent the dye method sentinel node biopsy from 1993 to 2020. The inclusion criteria were a single lesion type 0 cancer of ≤5 cm in the long axis, clinically node-negative, and invasion within the proper muscle layer pathologically. In this study, the distribution of dyed lymphatic flow was evaluated for each occupied area of the tumor. Results We included 416 patients in this study. The tumors located in the watershed of the right and left gastroepiploic arteries near greater curvature had extensive lymphatic flow; therefore, a newly circular region with a diameter of 5 cm is set on the watershed of the greater curvature between P and T zone as the ‘n’ zone. In addition, for cancers located in the lesser P curvature, lymphatic flow to the greater curvature was not observed. Therefore, the P zone was divided into two: the lesser curvature side (PL) and the greater curvature side (PG). Conclusions The advantage of the nPTD classification is that it provides not only proper nodal dissection but also adequate function-preserving gastrectomy. If the tumor is localized within the PL, the proximal gastrectomy resection area can be further reduced. In contrast, for cancers located in the ‘n’ zone, near-total gastrectomy is required because of the extensive lymphatic flow.

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