The Incidence and Risk Factors for Metachronous Gastric Cancer in the Remnant Stomach after Gastric Cancer Surgery

120 Background: Our previous study clarified that morbidity was a negative prognostic factor and sarcopenia defined by of the handgrip strength was a risk factor for the morbidity in gastric cancer surgery. Sarcopenia was reportedly a negative prognostic factor in colorectal cancer, hepatocellular carcinoma and malignant melanoma. This study aimed to evaluate impact of preoperative sarcopenia on recurrence-free survival (RFS) in gastric cancer surgery. Methods: Between May 2011 and June 2013, 256 consecutive primary gastric cancer patients who underwent curative surgery were retrospectively examined. Patients who received neoadjuvant chemotherapy or were diagnosed with pathological stage IV were excluded. Preoperative skeletal muscle mass was evaluated by bioelectrical impedance analysis and was expressed as skeletal muscle index or SMI (muscle mass/height2) by adjusting absolute muscle mass with height. Preoperative muscle function was measured by hand grip strength (HGS). Each cutoff value was determined as the gender-specific lowest 20% of the distribution of each measurement. Univariate and multivariate analyses were preformed to identify risk factors for RFS using a Cox proportional hazards model. Results: Median age (range) was 66 years (37-85 years). Male to female ratio was 168:88. Median follow-up period was 33.4 months. Pathological stage was I in 160, II in 48 and III in 48 patients. Univariate analysis showed that age, adjuvant chemotherapy, pT, pN, histological type, tumor size, total gastrectomy, low SMI and low HGS were significant risk factors for RFS. Multi-variate Cox’s proportional hazard analyses demonstrated that pT (HR 2.76, p = 0.0001), pN (HR 1.375, p = 0.037), histological type (HR 3.46, p = 0.014), low SMI (HR2.17, p = 0.036) were the significant risk factors for RFS. The three-year RFS was 89.1% in the patients with high SMI and 73.2% in those with low SMI (p = 0.007). Conclusions: Low SMI was an independent risk factor for RFS in Stage I-III gastric cancer. Low HGS, a risk factor for morbidity shown in our previous study, was not a risk independent factor for RFS. Preoperative sarcopenia as the short- and long-term outcomes has a value to be tested in the future prospective studies in gastric cancer surgery.

Download Full-text

37. Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2014.08.034 ◽

2014 ◽

Vol 40 (11) ◽

pp. S23-S24

Author(s):

D. Park ◽

H. Yu ◽

D. Jung ◽

Y. Park ◽

S. Son ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Cancer Surgery ◽

Gastric Cancer Surgery

Download Full-text

Development and validation of a nomogram to predict perioperative blood transfusion for gastric cancer surgery

10.21203/rs.3.rs-30326/v1 ◽

2020 ◽

Author(s):

Haoquan Huang ◽

Zhixiao Han ◽

Xia Liang ◽

Zhongqi Liu ◽

Shi Cheng ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Blood Transfusion ◽

Goodness Of Fit ◽

Validation Cohort ◽

Cancer Surgery ◽

Goodness Of Fit Test ◽

Gastric Cancer Surgery ◽

Independent Risk Factors ◽

Perioperative Blood Transfusion

Abstract Background This study aimed to construct and validate a nomogram composed of preoperative variables to predict perioperative blood transfusion for gastric cancer surgery. Methods 600 gastric cancer patients undergoing gastrectomy between January 2010 and December 2015 were selected as primary cohort. 399 patients from January 2016 to June 2019 were collected as validation cohort. In the primary cohort, univariate and multivariate analyses were performed to identify independent risk factors for blood transfusion. Using Akaike information criterion, selected variables were incorporated to construct a nomogram. Validations of the nomogram were performed in the primary and validation cohort. Discrimination of the nomogram was assessed by the concordance index (C-index) and calibration of the nomogram was assessed by calibration curve and Hosmer–Lemeshow goodness-of-fit test. Results The following independent risk factors for transfusion were identified: Charlson comorbidity index score over 3 (odds ratio (OR) 2.15), tumor location (diffuse vs upper: OR 1.50), pTNM stage (III vs I: OR 3.17), type of gastrectomy (subtotal vs total gastrectomy: OR 0.58), extragastric organ resection (OR 2.03) and preoperative hemoglobin less than 80 g/l (vs over 120 g/l: OR 66.03). C-index was 0.863 and 0.901 in the primary and validation cohort, respectively, indicating good discrimination of the nomogram. Both calibration curves and Hosmer–Lemeshow goodness-of-fit tests (P-value 0.716 and 0.935) demonstrated high agreement between prediction and actual outcome. Conclusion A nomogram composed of preoperative variables to predict blood transfusion for gastric cancer surgery was developed and validated. This nomogram could be used to improve utilization of packed red blood cells.

Download Full-text

Risk factors for persistent elevation of perioperative lactate levels in gastric cancer surgery

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i5.29743 ◽

2020 ◽

Vol 11 (5) ◽

pp. 24-28

Author(s):

Selcuk Gulmez ◽

Orhan Uzun ◽

Aziz Serkan Senger ◽

Zehra Zeynep Keklikkiran ◽

Hilmi Bozkurt ◽

...

Keyword(s):

Risk Factors ◽

Gastric Cancer ◽

Operative Time ◽

Multivariate Logistic Regression Analysis ◽

Perioperative Period ◽

Cancer Surgery ◽

Gastric Cancer Surgery ◽

Icu Stay ◽

Lactate Levels ◽

The Impact

Background: The impact of high-risk surgery on tissue perfusion can be indirectly assessed by measuring lactate levels during surgery and intensive care unit (ICU) stay. While consistently high values are associated with poor prognosis, transient elevations do not mean poor clinical outcomes. Therefore, intraoperative and early postoperative blood lactate monitoring is essential for cancer patients. Aims and Objective: This study aimed to determine the risk factors of persistently elevated lactate levels in the intraoperative and postoperative period in patients with elective gastric cancer surgery. Materials and Methods: We retrospectively enrolled 293 patients who underwent curative resection for gastric cancer. Lactate values of all patients were examined during surgery and ICU-stay at 3rd, 6th, 12th, and 18th hours. All lactate values above 2 mmol/L were considered elevated. The patients were divided into two groups as those with perioperative persistently increased lactate levels and those without. Results: Of the 293 patients, 60 (20.5%) had higher lactate levels in the perioperative period. According to multivariate logistic regression analysis, the operative time had the highest significance rate (p = 0.020) out of two significant variables, followed by the BMI ≥ 30 kg/m2 (p = 0.048). Besides, patients with perioperative hyperlactatemia had prolonged hospital stays (p = 0.034). Conclusions: Operative time and obesity (BMI ≥ 30 kg/m2) were independent risk factors for persistent lactate elevation in the perioperative period. Also, perioperative hyperlactatemia extended the length of hospital stay.

Download Full-text