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 Prognosis of Patients With Gastric Cancer Who Underwent Proximal Gastrectomy

2012 ◽  
Vol 97 (3) ◽  
pp. 275-279 ◽  
Author(s):  
Masahide Ikeguchi ◽  
Abdul Kader ◽  
Seigo Takaya ◽  
Youji Fukumoto ◽  
Tomohiro Osaki ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Proximal Gastrectomy ◽  
Survival Rates ◽  
Daily Lives ◽  
Multiple Cancers ◽  
Upper Third ◽  
Disease Specific

Abstract Proximal gastrectomy (PG) has been introduced for patients who are preoperatively diagnosed with early gastric cancer located in the upper third of the stomach. In the present study, we compared the prognosis of patients who underwent PG with that of patients who underwent total gastrectomy (TG). Between 1997 and 2006, 51 patients were diagnosed with early gastric cancer located in the upper third of the stomach and underwent PG. In the same period, 35 patients were diagnosed with early gastric cancer and underwent TG. Of these, in 24 patients, the cancer was localized in the middle to upper part of the stomach, and 11 patients had multiple cancers. We compared the clinicopathologic differences and prognoses between the two groups. Significantly fewer lymph nodes were dissected in the PG group (mean, 18.2) than in the TG group (mean, 36.6;P < 0.001). Complications were detected in 17.6% of patients in the PG group and in 14.3% of patients in the TG group, which was not significant (P = 0.678). The overall and disease-specific 5-year survival rates in the 51 patients who underwent PG (88.7% and 97.1%, respectively) were not different from those in the 35 patients who underwent TG (87.6% and 93.4%; P = 0.971 and P = 0.553; respectively). These findings indicate that PG can be performed safely and may have various advantages compared with TG in terms of patients' daily lives.

scholarly journals Clinicopathological Characteristics and Prognosis of Upper Gastric Cancer Patients in China: A 32-Year Single-Center Retrospective Clinical Study

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Yingbo Gong ◽  
Pengliang Wang ◽  
Zhi Zhu ◽  
Junyan Zhang ◽  
Jinyu Huang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Radical Surgery ◽  
Proximal Gastrectomy ◽  
Clinicopathological Characteristics ◽  
Tumor Diameter ◽  
Gastric Cancers ◽  
Macroscopic Type ◽  
Retrospective Clinical Study ◽  
Gastric Cancer Patients

Purpose. Upper or proximal gastric cancer occurs in the upper third of the stomach between the cardia and a line connecting the greater and lesser curvatures. As it differs from other gastric cancers in pathology and prognosis, we evaluated patient and disease characteristics that might guide improved treatment and survival of upper gastric cancer. Methods. We conducted a retrospective analysis of 649 patients with upper gastric cancer and 1551 patients with lower gastric cancer and R0 radical surgery at our institution between January 1980 and December 2012. Results. Survival after radical surgery for upper gastric cancer was 77.8% at 1 year, 49.6% at 3 years, and 41.1% at 5 years. The corresponding rates for lower gastric cancer were 85.9%, 60.0%, and 57.2% (p<0.001). Upper gastric cancer had a poor prognosis. Sex (p=0.036), tumor diameter (p=0.001), macroscopic type (p<0.001), pTM stage (p<0.001), tissue differentiation type (p=0.003), and serosal invasion (p=0.034) were independently associated with lymph node metastasis. The macroscopic type (p=0.045), lymphovascular tumor emboli (p=0.021), and pTNM stage were independently associated with recurrence and metastasis. Survival of 333 patients with D2 total gastrectomy was 81.3% at 1 year, 54.4% at 3 years, and 45.2% at 5 years. The corresponding rates for 316 proximal gastrectomy patients were 75.4%, 44.9%, and 36.7%. Radical total gastrectomy had better survival than radical proximal resection. Conclusions. Upper gastric cancers were more aggressive, had a worse prognosis, and were more prone to recurrence and metastasis compared with lower gastric cancers. Survival was better after total gastrectomy than after proximal resection.

scholarly journals Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta−Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Peirong Tian ◽  
Yang Liu ◽  
Shibo Bian ◽  
Mengyi Li ◽  
Meng Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Reflux Esophagitis ◽  
Proximal Gastrectomy ◽  
Laparoscopic Total Gastrectomy ◽  
Anastomotic Stenosis ◽  
Proximal Gastric Cancer ◽  
Laparoscopic Proximal Gastrectomy

BackgroundTo compare laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) with regard to outcomes, including efficacy and safety, in patients with proximal gastric cancer.MethodsOriginal English-language articles comparing LPG and LTG for proximal gastric cancer up to November 2019 were systematically searched in the Embase, PubMed, Cochrane Library, Web of Knowledge, and ClinicalTrials.gov databases by two independent reviewers. Our main endpoints were surgery-related features (operation time, blood loss, harvested lymph nodes, and postoperative hospital stay), postoperative complications (anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis), and oncologic outcomes (5-year overall survival and recurrent cancer).ResultsFourteen studies including a total of 1,282 cases (510 LPG and 772 LTG) were enrolled. Fewer lymph nodes were harvested (WMD = −13.33, 95% CI: −15.66 to −11.00, P &lt; 0.00001) and more postoperative anastomotic stenosis (OR = 2.03, 95% CI: 1.21 to 3.39, P = 0.007) observed in LPG than LTG. There were no significant differences in other explored parameters between the two methods. However, based on a subgroup analysis of digestive tract reconstruction, LPG with esophagogastrostomy (LPG-EG) had shorter operative time (WMD = −42.51, 95% CI: −58.99 to −26.03, P &lt; 0.00001), less intraoperative blood loss (WMD = −79.52, 95% CI: −116.63 to −42.41, P &lt; 0.0001), and more reflux esophagitis (OR = 3.92, 95% CI: 1.56 to 9.83, P = 0.004) than was observed for LTG. There was no difference between LPG performed with the double tract anastomosis/double-flap technique (DT/DFT) and LTG.ConclusionLPG can be performed as an alternative to LTG for proximal gastric cancer, especially LPG-DT/DFT, with comparable safety and efficacy.

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 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.

Evaluation of the Safety and Feasibility of Laparoscopic Total Gastrectomy in Clinical Stage I Gastric Cancer Patients

2015 ◽  
Vol 39 (7) ◽  
pp. 1782-1788 ◽  
Author(s):  
Daisuke Ichikawa ◽  
Shuhei Komatsu ◽  
Takeshi Kubota ◽  
Kazuma Okamoto ◽  
Hirotaka Konishi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Total Gastrectomy ◽  
Clinical Stage ◽  
Laparoscopic Total Gastrectomy ◽  
Stage I ◽  
Gastric Cancer Patients

The prognostic significance of isolated tumor cells in the lymph nodes of gastric cancer patients

2010 ◽  
Vol 13 (3) ◽  
pp. 191-196 ◽  
Author(s):  
Takeo Fukagawa ◽  
Mitsuru Sasako ◽  
Seiji Ito ◽  
Hayao Nakanishi ◽  
Hisae Iinuma ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Tumor Cells ◽  
Prognostic Significance ◽  
Isolated Tumor Cells ◽  
Gastric Cancer Patients

Kinh nghiệm qua 126 bệnh nhân phẫu thuật nội soi cắt toàn bộ dạ dày điều trị ung thư dạ dày

2021 ◽  
Author(s):  
Van Huong Nguyen
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Operative Time ◽  
Laparoscopic Total Gastrectomy ◽  
Oral Feeding ◽  
Linear Stapler ◽  
The Mean ◽  
End To End ◽  
Mean Time

TÓM TẮT Đặt vấn đề: Báo cáo kinh nghiệm về kỹ thuật phẫu thuật nội soi cắt toàn bộ dạ dày qua 126 bệnh nhân điều trị ung thư dạ dày tại Bệnh viện Hữu nghị Đa khoa Nghệ An. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả hồi cứu, các bệnh nhân được phẫu thuật nội soi cắt toàn bộ dạ từ 2014 đến 05/2021. Kết quả: Có 126 bệnh nhân, tuổi trung bình 60,6 ± 11,1 tuổi. 15,9% ung thư 1/3 trên dạ dày và 81,7% là 1/3 giữa. Ung thư ở giai đoạn I, II, III là 19,0%, 49,2%, 31,7%. 71,4% PTNS hoàn toàn cắt TBDD và nối lưu thông tiêu hóa bằng máy cắt nối thẳng. 3,2% trường hợp có tai biến trong mổ và 2,4% có biến chứng sau mổ, không có trường hợp nào tử vong. Số hạch nạo vét được trung bình 22,06 ± 7,6 hạch, lượng máu mất trung bình là 32,14 ± 10,4 ml, thời gian phẫu thuật trung bình là 210,4 ± 34,3 phút, thời gian nằm viện trung bình là 8,3 ± 2,5 ngày và thời gian sống thêm toàn bộ sau mổ trung bình là 36,9 ± 2,25 tháng. Kết luận: PTNS cắt TBDD là kỹ thuật an toàn và hiệu quả trong điều trị UTDD, nối thực quản hỗng tràng bằng máy cắt nối thẳng không cắt thực quản và hỗng tràng trước là kỹ thuật an toàn, tiết kiệm. Từ khóa: Kỹ thuật phẫu thuật nội soi dạ dày, ung thư dạ dày. ABSTRACT EXPERIENCE IN 126 PATIENTS OF LAPAROSCOPIC TOTAL GASTRECTOMY FOR THE TREATMENT OF GASTRIC CANCER Background: The goal of this study was to report on the experience of laparoscopic total gastrectomy (LTG) in 126 patients with gastric cancer Materials and Methods: Retrospective descriptive study of 126 patients who underwent LTG for gastric cancer between 2014 and May 2021. Results: Mean age 60,6 ± 11,1; gastric cancer at stage I, II, III was 19,0%, 49,2%, 31,7% respectively. 71,4% patients underwent totally LTG and functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum. 3.2% of cases had complications during surgery and 2,4% of cases had complications after surgery. There was no postoperative deaths. The average number of dredged lymph nodes was 22.06 ± 7.6 lymph nodes. The mean blood loss was 32.14 ± 10.4 ml. The mean operative time was 210.4 ± 34.3 minutes. The mean time for beginning oral feeding was 4.4 ± 1.9 days. The mean hospital stay was 8.3 ± 2.5 days. The mean overall survival was 36.9 ± 2,25 months. Conclusions: LTG is a safe and effective technique for the treatment of gastric cancer. The technique functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum was safe and saving. Keywords: Technique of laparoscopic gastrectomy, gastric cancer

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