Impact of drinking Chinese green tea on postoperative short outcomes for gastric cancer: a randomized controlled trial

Background Early intake after surgery can decrease postoperative ileus. Several studies show coffee can stimulate bowel activity and be safe in patients after elective colectomy, mainly due to caffeine. It was postulated that drinking Chinese green tea as rich caffeine beverage after subtotal distal gastrectomy accelerates postoperative recovery in patients. Method This was a single-centre parallel open-label randomized trial. Patients with gastric cancer undergoing robotic or laparoscopic subtotal gastrectomy were randomly allocated to receive drinking Chinese green tea (GT group) or potable water (PW group) after surgery. The primary endpoint was the time to gastrointestinal function recovery and tolerance of solid food, and the secondary endpoints included the incidence of postoperative complications, symptoms of postoperative adverse reaction, length of stay, pain as assessed by analgesic consumption and a visual analogue scale, and fatigue as assessed by a fatigue score model. Results A total of 80 patients were recruited, 40 to each group. Patient characteristics were similar in both groups. The GT group showed significantly shorter time to gastrointestinal function recovery compared with PW group to first flatus (47.23 ± 13.46 vs. 76.96 ± 20.35, P < 0.001), first bowel motion (78.70 ± 25.77 vs. 125.76 ± 36.25, P < 0.001) and tolerance of solid food (62.20 ± 16.15 vs. 98.66 ± 20.15, P < 0.001). Conclusion Drinking Chinese green tea after robotic or laparoscopic subtotal gastrectomy is safe and promotes postoperative recovery of gastrointestinal function, also was an add method with strengthening analgesia and anti-inflammatory effect in the presence of the Enhance Recovery After Surgery (ERAS) program. Registration number: ChiCTR1800018294 (http://www.chictr.org.cn).

Lymph node mapping in gastric cancer: A pilot study in Western patients.

192 Background: Adequate surgical lymphadenectomy is integral to the staging and treatment of gastric cancer. A number of Asian studies have explored the utility of lymph node (LN) mapping in gastric cancer but this in not commonly performed in Western countries. We sought to evaluate the utility and safety of LN mapping in Western patients. Methods: We conducted a pilot study of 13 patients with histologically proven non-metastatic gastric adenocarcinoma that received endoscopic peri-tumoral indocyanine green fluorescence (ICG) injections immediately prior to surgical resection to facilitate LN mapping. Illumination with ICG around the primary tumor, in lymphatic basins, tracts, and lymph nodes were confirmed by the PINPOINT system on recorded videos. Descriptive statistical analysis was performed. Results: Among the 13 patients enrolled, median age was 75 years and 7 were men. On pathologic review, 15% were T1, 54% were T2, and 69% had were node negative. Tumours were located in the proximal third in 1 patient, middle third in 2 patients and distal third in 10 patients. All patients had a laparoscopic subtotal gastrectomy and 10 patients had a D2 lymphadenectomy. 5 patients received preoperative and 7 received postoperative chemotherapy. The median number of LNs harvested was 26 [IQR 24-34]. Video confirmation of ICG mapping of the primary tumor, lymphatic basins, tracts, and LNs were obtained in all patients. All LNs identified with ICG uptake were removed with surgical lymphadenectomy. ICG mapped LNs fell outside the D1 distribution in 100% and outside the D1-plus distribution in 54% of cases. ICG mapped LNs were within the D2 distribution in all cases. No ICG related allergic reactions or procedural complications were observed. Postoperative complications included 2 grade A pancreatic fistulas, 1 gastrointestinal bleed, and 1 NSTEMI. Peri-operative morality was zero. Conclusions: We demonstrate ICG lymph node mapping as a safe and useful technique for identifying regional draining lymph nodes and for primary tumor localization in Western patients. The majority of cases found LNs draining outside the D1 and D1+ distributions, highlighting the importance of appropriate lymphadenectomies in gastric cancer.

Early results of laparoscopic subtotal gastrectomy for gastric cancer

Tóm tắt Đặt vấn đề: PTNS cắt bán phần dưới dạ dày điều trị ung thư biểu mô dạ dày đã dần được chấp nhận và áp dụng rộng rãi. Tuy nhiên, ngay cả với những phẫu thuật viên nhiều kinh nghiệm, PTNS cắt gần toàn bộ dạ dày điều trị ung thư biểu mô dạ dày, với phần dạ dày còn lại sau cắt rất nhỏ (10 – 20%), vẫn còn nhiều thử thách và nhiều tranh cãi, đặc biệt là khả năng nạo hạch hệ thống cũng như tái lập lưu thông sau cắt gần toàn bộ dạ dày. Tại Việt Nam, chưa có bất cứ nghiên cứu nào về phẫu thuật nội soi hoàn toàn cắt gần toàn bộ dạ dày nạo hạch tiêu chuẩn D2 điều trị ung thư biểu mô dạ dày, đặc biệt là cho nhóm ung thư biểu mô dạ dày vị trí 1/3 giữa. Phương pháp nghiên cứu: nghiên cứu tiến cứu, tại bệnh viện Đại học Y Dược TP HCM có 40 người bệnh (NB) ung thư biểu mô dạ dày được PTNS cắt gần toàn bộ dạ dày và nạo hạch tiêu chuẩn D2 trong khoảng thời gian từ tháng 1 năm 2018 đến tháng 5 năm 2019. Các dữ liệu lâm sàng và kết quả phẫu thuật được lượng giá. Kết quả: Thời gian phẫu thuật trung bình là 224,5 phút (từ 150 phút đến 360 phút), lượng máu mất trung bình là 25,6 ml (từ 10ml đến 200ml). Thời gian tái lập lưu thông trung bình là 32 phút (từ 15 phút đến 50 phút). Không có biến chứng trong mổ. Không có tử vong sau mổ. Biến chứng sau mổ gặp 2 trường hợp (5%): 1 tràn dịch màng phổi trái, và 1 nhiễm trùng vết mổ. Thời gian nằm viện trung bình là 7,8 ngày (từ 5 đến 14 ngày). Không có trường hợp nào xì miệng nối dạ dày hỗng tràng hoặc mỏm tá tràng. Kết luận: PTNS cắt gần toàn bộ dạ dày điều trị ung thư dạ dày nạo hạch tiêu chuẩn là an toàn, khả thi. Hơn nữa kỹ thuật này có thể thực hiện đối với ung thư dạ dày 1/3 giữa, thậm chí 1/3 trên, và có thể áp dụng thường qui. Abstract Background: Laparoscopic distal gastrectomy for adenocarcinoma has been accepted and worldwide applied. However, even experienced surgeons, laparoscopic subtotal gastrectomy for adenocarcinoma, remaining small part of stomach (10 – 20%) are still challenges and discussable issue among surgeons around the world, especially in lymph node dissection and reconstruction of intestinal tract. Nowadays in Viet Nam, no research about laparoscopic subtotal gastrectomy with standard D2 lymph node dissection for adenocarcinoma is available, especially the lesion is located in one third part of stomach. Materials and Method: This is a prospective study, conducted at the Pharmacy and Medicine University in Ho Chi Minh city. 40 patients underwent the laparoscopic subtotal gastrectomy associated with the standard lymph node dissection from Jan 2018 to May 2019 enrolled. The clinical database and surgical outcomes were assessed and quantified. Results: The average operation time was 224,5 minutes ( from 150 to 360 minutes), average blood loss is 25,6 ml (range, 10 to 90ml), average anastomosis time is 32 minutes (range, 15 to 50 minutes). No complications were observed during surgery. There were no deaths, and post-operative morbidity were two cases, accounted for 5%: one pleural effusion, and one surgical site infection. The average hospital length stay was 7,8 days ( from 5 to 14 days). No leakage of gastrojejunostomy or duodenal stump fistula. Conclusions: Laparoscopic subtotal gastrectomy with standard D2 lymph node dissection for gastric cancer is safe, feasible. Additionally, it is also reliable gastric cancers located in middle third, and even upper third of stomach, and could be routinely applied. Key words: Gastric cancer, laparoscopic surgery, subtotal gastrectomy.

Outcomes of laparoscopic subtotal gastrectomy for gastric adenocarcinoma in Nghe An Friendship General Hospital

Tóm tắt Đặt vấn đề: Đánh giá tính an toàn và hiệu quả của phẫu thuật nội soi cắt đoạn dạ dày nạo vét hạch trong điều trị ung thư biểu mô dạ dày. Phương pháp nghiên cứu: Nghiên cứu hồi cứu mô tả, tất cả người bệnh ung thư biểu mô dạ dày được phẫu thuật nội soi cắt đoạn dạ dày từ 2012 đến 2019. Kết quả: 278 người bệnh ung thư dạ dày được phẫu thuật nội soi cắt đoạn dạ dày, tuổi trung bình 60,2 (33 -78), tỷ lệ nam/nữ 3,3. Ung thư ở giai đoạn IA, IB, IIA, IIB, IIIA và IIIB lần lượt là 2,2%, 9,7%, 22,3%, 30,9%, 27,3% và 7,5%. Số hạch vét được trung bình 12,2 hạch, số hạch di căn trung bình 3,1 hạch. Tỷ lệ tai biến, biến chứng chung là 2,5%. Không có tử vong trong và sau mổ. Thời gian mổ trung bình là 185 phút, nằm viện sau mổ 8,1 ngày. Thời gian sống sau mổ 1 năm, 2 năm, 3 năm và 5 năm là 95,7%, 80,2%, 71,1% và 53,4%. Kết luận: Phẫu thuật nội soi cắt đoạn dạ dày nạo vét hạch là khả thi, an toàn và hiệu quả trong điều trị ung thư biểu mô dạ dày, thời gian hồi phục và nằm viện ngắn. Abstract Introduction: To assess the initial outcomes including the effectiveness, safety of laparoscopic subtotal gastrectomy with lymph nodes dissection for gastric adenocarcinoma. Material and Methods: Prospective study conducted from 2012 to 2019 in Nghe An Friendship General Hospital. All the patients underwent the laparoscopic subtotal gastrectomy with lymph nodes dissection for gastric adenocarcinoma enrolled. Results: 278 patients underwent laparoscopic subtotal gastrectomy with lymph nodes dissection, mean age was 60.2 (33 - 78). Male and female ratio was 3.3. Stages of the tumor were 2.2% IA, 9.7% IB, 22.3% IIA, 30.9% IIB, 27.3% IIIA and 7.5% IIIB. The mean of lymph nodes removed were 12.2 and mean lymph nodes metastasis were 3.1. The overall complication and incident rates were 2.5%. No per-operative and post-operative mortality was observed. The mean operative time was 185 min. The mean postoperative length stays were 8.1 days. Overall survival rates for one year, two years, three year and five years were 95.7%, 80.2%, 71,1% and 53.4% respectively. Conclusion: Laparoscopic subtotal gastrectomy with lymph node resection for gastric adenocarcinoma is safe and effective, shorten recovery time and hospitalization. Keyword: Laparoscopic subtotal gastrectomy.