scholarly journals Influence of Visceral Fat on Early Postoperative Outcomes After Distal and Total Gastrectomy for Gastric Cancer

2017 ◽  
Vol 102 (1-2) ◽  
pp. 95-99
Author(s):  
Chikashi Shibata ◽  
Hitoshi Ogawa ◽  
Kaori Koyama ◽  
Kazuaki Mukouda ◽  
Hajime Iwasashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Total Gastrectomy ◽  
Visceral Fat ◽  
Distal Gastrectomy ◽  
Operation Time ◽  
Patient Characteristics ◽  
Postoperative Outcomes ◽  
Visceral Fat Area ◽  
Clinical Records

We studied the influence of visceral fat area (VFA) on early postoperative outcomes separately after distal and total gastrectomy. The influence of obesity on outcomes might differ between distal and total gastrectomy, but few studies have directly compared the effects of VFA on early postoperative results between these 2 procedures. We reviewed clinical records of 124 patients with gastric cancer undergoing curative distal or total gastrectomy. Patients were classified into 2 groups: low (<100 cm2) or high (≥100 cm2) VFA. Patient characteristics and early postoperative outcomes were compared between 2 groups separately in distal or total gastrectomy. There were 77 and 47 patients who underwent distal and total gastrectomy, respectively. After distal gastrectomy, operation time (268 ± 44 versus 239 ± 39 minutes, P < 0.05) as well as blood loss (351 ± 231 versus 239 ± 147 mL, P < 0.05) was increased in the high VFA group (N = 32) compared to the low VFA group (N = 45), but morbidity rates did not differ between the 2 groups (50% versus 36%). After total gastrectomy; operation time (285 ± 42 versus 260 ± 53 minutes, P < 0.05); blood loss (427 ± 326 versus 280 ± 179 mL, P < 0.05); rate of morbidity (56% versus 24%, P < 0.05); and intra-abdominal infection (17% versus 0%, P < 0.05) were increased in the high VFA group (N = 18) compared to the low VFA group (N = 29). These results suggest that postoperative morbidity increases after total gastrectomy but not after distal gastrectomy in patients with excessive visceral fat.

Impact of an Ultrasonically Activated Device in Robot-Assisted Distal Gastrectomy

2017 ◽  
Vol 12 (6) ◽  
pp. 453-458
Author(s):  
Makoto Hikage ◽  
Masanori Tokunaga ◽  
Rie Makuuchi ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Surgical Outcomes ◽  
Distal Gastrectomy ◽  
Operation Time ◽  
Patient Characteristics ◽  
Clinicopathological Characteristics ◽  
Robot Assisted ◽  
Estimated Blood Loss ◽  
Device Use

Objective Robot-assisted gastrectomy is increasingly used for the treatment of gastric cancer, although it remains a time-consuming procedure. An ultrasonically activated device might be useful to shorten operation times. This study therefore assessed the effect of ultrasonically activated device use on procedural times and on other early surgical outcomes. Methods Consecutive patients (N = 42) who underwent robot-assisted distal gastrectomy for gastric cancer were included. Clinicopathological characteristics and early surgical outcomes were compared between robotic-assisted gastrectomy procedures using an ultrasonically activated device (U group, n = 21) and those without it (NU group, n = 21). Results There were no significant differences in patient characteristics between the groups; however, the median operation time was significantly less in the U group than in the NU group (291 vs 351 minutes, P = 0.006). In detail, the median duration of console time until dividing the duodenum was less in the U group (70 vs 102 minutes, P < 0.001). Estimated blood loss, incidence of postoperative morbidity, and duration of postoperative hospital stay were not different between the groups. Conclusions An ultrasonically activated device reduced the operation time of robot-assisted gastrectomy without increasing blood loss and morbidity.

Risk factors for severe weight loss after gastrectomy for gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 38-38
Author(s):  
Kenki Segami ◽  
Toru Aoyama ◽  
Taiichi Kawabe ◽  
Shigeya Hayashi ◽  
Yousuke Makuuchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Weight Loss ◽  
Body Weight ◽  
Blood Loss ◽  
Total Gastrectomy ◽  
Significant Risk ◽  
Operation Time ◽  
Time Range ◽  
Eras Protocol

38 Background: Body weight loss (BWL) is frequently observed in gastric cancer patients who underwent gastrectomy for gastric cancer. Recently, we reported that severe BWL after gastrectomy was a significant risk factor for continuation of S-1 adjuvant chemotherapy. However, risk factors of BWL after surgery remain unclear. Methods: The present study retrospectively examined the patients who electively underwent curative gastrectomy for gastric cancer between January of 2012 and June of 2014. All patients received peri-operative care of ERAS protocol. %BWL was calculated by percentile of body weight at one month after surgery to preoperative body weight. Severe BWL was defined as %BWL over 10%. Risk factors for severe BWL were determined by both univariate and multivariate logistic regression analyses. Results: Two-hundred seventy eight patients were examined. Median age (range) was 68 years (27-86). Median body mass index (range) was 22 (13.4-33.5). Thirty patients had received neoadjuvant chemotherapy. Operative procedure was total gastrectomy (TG) in 97 patients (Open in 61 and laparoscopic in 36) and distal gastrectomy (DG) in 181 patients (Open in 94 and laparoscopic in 87). Median operation time (range) was 268.5 minutes (95-554). Median blood loss (range) was 115 mL (0-1600). Morbidity of grade 2 or more defined by Clavien-Dindo classification was observed in 37 patients including pancreatic fistula in 8, anastomotic leakage in 5, and abdominal abscess in 3. No mortality was found. Completion of ERAS protocol without any variance was 95.3%. Median %BWL was 6% (-4.3% to 19.5%). Both univariate and multivariate logistic analyses demonstrated that morbidity (odds rate 3.56, p=0.001), blood loss over 300ml (odds rate 2.04, p=0.0356), and total gastrectomy (odds rate 2.1, p=0.0258) were significant risk factors for severe BWL. Conclusions: Nutritional intervention trial to inhibit BWL after gastrectomy should be focused on the patients who developed morbidity, showed blood loss over 300ml, or received total gastrectomy.

scholarly journals The effectiveness of laparoscopic gastrectomy with totally intracorporeal reconstruction of gastrointestinal tract using unprecut method in management for gastric cancer

2019 ◽  
Vol 9 (3) ◽  
Author(s):  
Duy Long Võ ◽  
Keyword(s):  
Gastric Cancer ◽  
Gastrointestinal Tract ◽  
Total Gastrectomy ◽  
Laparoscopic Gastrectomy ◽  
Distal Gastrectomy ◽  
Gastrointestinal Surgery ◽  
Operation Time ◽  
Operative Complications ◽  
The Mean ◽  
Post Operative Complications

Tóm tắt Đặt vấn đề: Phẫu thuật nội soi cắt dạ dày và nạo hạch mang lại nhiều lợi ích cho người bệnh. Phục hồi lưu thông ruột theo Roux - en -Y hoàn toàn bằng phẫu thuật nội soi (PTNS) theo phương pháp cắt dạ dày và ruột non trước tốn nhiều stapler, làm tăng chi phí điều trị. Mục tiêu của nghiên cứu này nhằm đưa ra kỹ thuật phục hồi lưu thông ruột hoàn toàn bằng PTNS mà không cắt ruột trước trong điều trị ung thư dạ dày. Phương pháp nghiên cứu: Đây là nghiên cứu tiền cứu, can thiệp lâm sàng. Từ tháng 6 năm 2015 đến tháng 8 năm 2016, tại khoa Ngoại Tiêu hóa, Bệnh viện Đại học Y Dược TP. HCM có 70 trường hợp ung thư dạ dày được phẫu thuật nội soi cắt dạ dày kèm nạo hạch D2 và phục hồi lưu thông ruột hoàn toàn trong ổ bụng theo Roux en Y bằng kỹ thuật không cắt ruột trước. Trong số này, có 40 trường hợp được cắt bán phần dưới dạ dày và 30 trường hợp cắt toàn bộ dạ dày. Các dữ kiện để đánh giá kết quả gồm: số lượng stapler dùng, thời gian mổ, biến chứng sau mổ và thời gian sống còn sau mổ. Kết quả: Tuổi trung bình 51,1. Thời gian mổ trung bình là 178 ± 28 phút. Số lượng stapler dùng cho 1 trường hợp cắt bán phần dưới hoặc toàn bộ dạ dày là 3, tối đa dùng 4 stapler. Tất cả trường hợp đều không còn tế bào ác tính ở bờ mặt cắt. Có 1 trường hợp (1,4%) nối lộn quai. Không có biến chứng xì, rò hay chảy máu miệng nối sau mổ. Thời gian sống còn chung sau mổ 1 và 3 năm lần lượt là 92% và 81%. Kết luận: Phục hồi lưu thông ruột theo phương pháp Roux - en -Y hoàn toàn qua PTNS cắt dạ dày và nạo hạch D2 mà không cắt ruột trước làm giảm số lượng stapler dùng và không tăng thêm biến chứng sau mổ. Thời gian sống còn sau mổ khả quan. Abstract Introduction: Gastrectomy associated with lymphadenectomy for patients with gastric cancer has great benefits. Totally intracorporeal Roux-en-Y anastomosis uses lot of staplers, and costs to patients. The aim of this study is to investigate on the effectiveness laparoscopic gastrectomy with totally intracorporeal reconstruction of gastrointestinal tract using unprecut method for gastric cancer. Material and Methods: This was a prospective interventional clinical research. From June 2015 to August 2016 at Gastrointestinal Surgery Department of UMC, 70 patients of gastric cancer were performed D2-gastrectomy with totally intracorporeal Roux-en-Y anastomosis using unprecut method. Among them, there were 40 cases of distal gastrectomy and 30 cases of total gastrectomy. The data collected were : number of staplers, operation time, post-operative complications, survival time. Results: The mean age was 51.1 years. The mean operation time was 178 +/- 28 minutes. The number of staplers per case for distal gastrectomy or total gastrectomy was 3 staplers, with maximum of 4 staplers. All cases had R0 margins. There was one case (1.4%) of misconstruction. There were no post-operative complications such as leakage or anastomotic fistular even bleeding. Overall 1-year and 3-year survival rates were 92% and 81%, respectively. Conclusion: Laparoscopic gastrectomy with totally intracorporeal reconstruction of gastrointestional tract using unprecut method for gastric cancer saved the number of staplers and not increased post-operative complications. The survival rate was satisfied. Keyword: Laparoscopic gastric

scholarly journals Prediction of the Risk of Laparoscopy-Assisted Gastrectomy by Comparing Visceral Fat Area and Body Mass Index

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yongke Liu ◽  
Dong Guo ◽  
Zhaojian Niu ◽  
Yuliang Wang ◽  
Guanghua Fu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Blood Loss ◽  
Body Mass ◽  
Visceral Fat ◽  
Operation Time ◽  
Intraoperative Blood Loss ◽  
Imaging Data ◽  
Visceral Fat Area ◽  
Conversion To Open Surgery ◽  
Laparoscopic Assisted

Propose. The purpose of this study was to compare the accuracy of visceral fat area (VFA) and body mass index (BMI) in predicting the risk of laparoscopic-assisted gastrectomy. Methods. Clinicopathological and imaging data of 133 patients who underwent laparoscopy-assisted gastrectomy were recorded, including 17 cases of conversion to open surgery. The remaining 116 patients were retrospectively analyzed after we excluded 17 patients who had been transferred to laparotomy. The patients were divided into two groups according to BMI (≤25 kg/m2: BMI-L group; >25 kg/m2: BMI-H group) and VFA (≤100 cm2: VFA-L group; >100 cm2: VFA-H group). Clinical outcomes were compared between the BMI and VFA subgroups. Results. There were no differences in intraoperative blood loss and the number of harvested lymph nodes between low and high patients defined by BMI and VFA (p>0.050). However, in the comparison of patients who underwent laparoscopic resection only, it was found that the operation time and intraoperative blood loss of the VFA-H group were more than those of the VFA-L group (p<0.050). Compared to the VFA-L group, the VFA-H group had later first exhaust time (p=0.018), more complications (p<0.001), and longer hospital stays (p=0.049). However, no similar conclusion was obtained in the BMI group (p>0.050). Conclusion. This study demonstrates that VFA better evaluates the difficulty of laparoscopy-assisted gastrectomy and the risk of postoperative complications than BMI.

Phẫu thuật nội soi 3D cắt bán phần xa dạ dày trong điều trị ung thư dạ dày

2021 ◽  
Author(s):  
Hai Thanh Phan
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Operative Time ◽  
Distal Gastrectomy ◽  
Three Dimensional ◽  
Oncologic Outcome ◽  
Intraoperative Blood Loss ◽  
3D Laparoscopy ◽  
Distal Gastric Cancer ◽  
The Mean

TÓM TẮT Đặt vấn đề: Những nghiên cứu gần đây cho thấy phẫu thuật nội soi với kỹ thuật 3D (three - dimensional) đã mang lại nhiều thuận lợi trong điều trị ung thư dạ dày khi so sánh với màn hình 2D truyền thống. Vì vậy chúng tôi thực hiện nghiên cứu này với mục đích đánh giá tính an toàn, kết quả ngắn hạn và kết quả ung thư học của phẫu thuật nội soi 3D trong điều trị ung thư phần xa dạ dày. Phương pháp nghiên cứu: Thực hiện nghiên cứu tiến cứu trên 37 bệnh nhân cắt phần xa dạ dày kèm nạo vét hạch điều trị ung thư dạ dày bằng phẫu thuật nội soi kỹ thuật 3D tại Khoa Ngoại nhi - cấp cứu bụng, Bệnh viện Trung Ương Huế từ 03/2018 đến 09/2021. Kết quả: Phẫu thuật nội soi 3D được thực hiện ở tất cả 37 bệnh nhân, không có trường hợp nào chuyển mổ mở. Thời gian phẫu thuật trung bình là 69,86 ± 20,46 phút, lượng máu mất trong mổ trung bình là 171,22 ± 15,47 ml, số hạch vét được trung bình là 20,49 ± 4,11 hạch và thời gian nằm viện sau phẫu thuật trung bình là 10 ngày (6 - 26 ngày). Tỷ lệ biến chứng là 8,1 % với 1 trường hợp (2,7%) dò mỏm tá tràng, không có trường hợp nào tử vong sớm sau mổ. Tỉ lệ sống còn sau 1 năm là 87,27% và sau 3 năm là 83,31%. Kết luận: Áp dụng phẫu thuật nội soi 3D trong cắt phần xa dạ dày có thể thực hiện an toàn và khả thi. Giúp giảm đáng kể thời gian mổ, lượng máu mất trong mổ và đảm bảo được nguyên tắc an toàn về ung thư học. ABSTRACT EFFICACY USING THREE - DIMENSIONAL LAPAROSCOPY IN THE TREATMENT OF DISTAL GASTRIC CANCER Background: Recent studies have supported that three - dimensional (3D) laparoscopy has advantages in treating gastric cancer compared with conventional two - dimensional (2D) screens. This study investigated the safety, short - term efficacy, and oncological outcome of three - dimensional (3D) laparoscopic distal gastric cancer surgery. Materials and Methods: We prospectively analyzed the clinical data from 37 patients treated with 3D laparoscopic systemic lymphadenectomy for distal gastric cancer at the Hue Central Hospital from March 2018 to September 2021. The effects on operative time, intraoperative blood loss, the number of lymph nodes removed, postoperative recovery time, complications, and oncologic outcome were analyzed. Results: Three - dimensional (3D) laparoscopic distal gastrectomy was successfully carried out in 37 patients. The mean operative time was 69,86 ± 20,46 minutes, mean intraoperative blood loss was 171,22 ± 15,47 ml, the number of harvested lymph nodes was 20,49 ± 4,11, and the mean postoperative hospital stay was 10 (6 - 26 days). The incidence of postoperative complications was 8,1%, with 1 case of duodenal stump fistula. The one - year overall survival rate was 87,27%, and the three - year overall survival rate was 83,31%. Conclusions: 3D laparoscopy distal gastrectomy could be performed safely and feasibly. They reducethe operative time and intraoperative blood loss in distal gastrectomy with a good oncologic outcome. Keywords: Laparoscopic gastrectomy, D2 lymphadenectomy, 3D laparoscopy

scholarly journals Our experience with laparoscopic total gastrectomy for gastric cancer: A case series

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Manash Ranjan Sahoo ◽  
Satyajit Samal ◽  
Jyotirmay Nayak
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Total Gastrectomy ◽  
Median Time ◽  
Operative Time ◽  
Laparoscopic Total Gastrectomy ◽  
Oral Feeding ◽  
Care Hospital ◽  
Intraoperative Blood Loss

Background: Though laparoscopic distal gastrectomy has become a standard procedure for treatment of gastric cancer, laparoscopic total gastrectomy has not been widely accepted as it requires more dexterity and lack of evidence about its feasibility and safety. Methods: Here retrospectively we review a series of 12 cases of gastric cancer undergone laparoscopic total gastrectomy with D1 or D2 lymphadenectomy over a period of 7 years at a tertiary care hospital. The patient demographic characteristics were reviewed and the outcomes after surgery was analyzed in terms of extent of lymphadenectomy, mean operative time, mean intraoperative blood loss median number of lymph nodes harvested, median time for postoperative ambulation, median time for postoperative oral feeding, median time of postoperative hospital stay, postoperative complications and mortality. Results: All patients had total gastrectomy entirely through laparoscopic method. Mean operative time was 282 minutes, mean intraoperative blood loss was 120 ml, median time for ambulation and oral feeding was 3 days and 6 days respectively. Median time of hospital stay was 16 days and 2 patients had complications as pancreatic fistula and port site abscess. No mortality was observed. Conclusion: With zero mortality and accepted rate of complications, laparoscopic total gastrectomy appears to be technically feasible and safe for management of gastric cancer. But more studies have to be conducted with comparison to other standard gastrectomies and long term follow up to be done to establish its standardized application.

scholarly journals Is There any Role of Visceral Fat Area for Predicting Difficulty of Laparoscopic Gastrectomy for Gastric Cancer?

2015 ◽  
Vol 15 (3) ◽  
pp. 151 ◽  
Author(s):  
Ho-Jung Shin ◽  
Sang-Yong Son ◽  
Long-Hai Cui ◽  
Cheulsu Byun ◽  
Hoon Hur ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Visceral Fat ◽  
Laparoscopic Gastrectomy ◽  
Visceral Fat Area
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