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Objective To analyze the relationship between No.12a lymph node metastasis and clinicopathological features of upper gastric cancer and to discuss the indications and prognostic significance of lymph node dissection in this group. Methods A retrospective analysis was performed on the medical records of 377 patients with upper gastric cancer, to compare the relationship between No.12a lymph node metastasis and clinicopathological characteristics of patients with upper gastric cancer. Kaplan-Meier method was used to analyze the prognosis of patients with or without No.12a lymph node metastasis, and Cox regression analysis was performed to analyze the influencing factors of prognosis and survival of patients with upper gastric cancer. Results Tumor location (lesser curvature side), tumor diameter (≥5.5 cm), degree of differentiation, and T/N/TNM stage were significantly correlated with No.12a lymph node metastasis (P < 0.05). After excluding N staging, Cox regression results showed that the degree of differentiation (HR: 0.668, 95%CI: 0.48-0.931, P=0.017) and pTNM stage (HR: 6.319, 95%CI: 4.063-9.828, P < 0.001) were the independent risk factors, but No.12a lymph node metastasis (HR: 1.477, 95%CI: 0.71-3.075, P=0.297) was not an independent risk factor for survival of upper gastric cancer patients. Conclusion No.12a lymph node metastasis does not seem to be an independent risk factor for the prognosis of upper gastric cancer patients. However, the prognosis of patients with No.12a lymph node metastasis is worse than that of patients without No.12a lymph node metastasis. The No.12a lymph nodes should be actively dissected when the tumor is in the following situations: the tumor is located in the lesser curvature, the degree of differentiation is poorly differentiated, and the tumor stage is late (T4, N3, or Ⅱ-Ⅲ stage).
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Objective:To investigate the clinical efficacy of radical proximal gastrectomy with esophagogastrostomy and double-tract anastomosis for upper gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 172 patients who underwent radical proximal gastrectomy for upper gastric cancer in Tianjin Medical University Cancer Institute and Hospital from January 2018 to December 2020 were collected. There were 147 males and 25 females, aged from 25 to 81 years, with a median age of 62 years. All the 172 patients underwent digestive reconstruction. Of the 172 patients, 83 cases undergoing esophagogastrostomy were allocated into esophagogastrostomy group, 89 cases undergoing double-tract anastomosis were allocated into double-tract anastomosis group. Patients were performed radical proximal gastrectomy combined with D 1+ lymph node dissection by attending surgeons from department of gastric cancer. The operator decided to adopt esophagogastrostomy or double-tract anastomosis for digestive reconstruction. Observation indicators: (1) surgical situations; (2) follow-up. Follow-up using outpatient examination, telephone interview, and online APP was conducted at postoperative 1 month, once three months within postoperative 2 years, and once six months within postoperative 2-5 years. The questionnaires of reflux esophagitis, gastroscopy and upper gastrointestinal angio-graphy were conducted to evaluate gastroesophageal reflux and anastomotic stenosis up to February 1, 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed using the Mann-Whitney U test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. Results:(1) Surgical situations: cases with open, laparoscopic or Da Vinci robotic surgery (surgical method), the number of metastatic lymph node, duration of postoperative hospital stay were 74, 9, 0, 2(range, 0-15), (12±4)days for the esophagogastrostomy group, versus 65, 15, 9, 3(range, 0-28), (11±3)days for the double-tract anastomosis group, respectively, showing significant differences in the above indicators between the two groups ( χ2=10.887, Z=-1.058, t=3.284, P<0.05). (2) Follow-up: 172 patients were followed up for 2-38 months, with a median follow-up time of 13 months. Cases with gastroesophageal reflux and anastomotic stenosis were 58 and 10 for the esophagogastrostomy group, versus 14 and 1 for the double-tract anastomosis group, respectively, showing significant differences in the above indicators between the two groups ( χ2=51.743, 7.219, P<0.05). Conclusions:For upper gastric cancer patients undergoing proximal radical gastrectomy, double-tract anastomosis is more suitable for Siewert type Ⅱ adenocarcinoma of esophagogastric junction in large curvature or lower located tumor. Compared with esophago-gastrostomy, double-tract anastomosis has lower incidence of postoperative gastroesophageal reflux and anastomotic stenosis, without increasing complications.
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Objective To explore the short-term effect of totally laparoscopic radical total gastrectomy with D2 lymph node dissection for treatment of local advanced upper gastric cancer. Methods Clinical data of 112 patients with local advanced upper gastric cancer who underwent totally laparoscopic or open radical total gastrectomy with D2 lymph node dissection in Affiliated Cancer Hospital of Shanxi Medical University from June 2016 to June 2018 were analyzed. The patients were divided into totally laparoscopic radical total gastrectomy with D2 lymph node dissection group (totally laparoscopic gastrectomy group, 54 cases) and open surgery radical total gastrectomy with D2 lymph node dissection group (opening gastrectomy group, 58 cases). The perioperative conditions and postoperative pathological conditions between the two groups were compared. Results All the 112 operations were technically successful. Compared with the opening gastrectomy group, the operating time of the totally laparoscopic gastrectomy group was longer [(240 ±47) min vs. (203 ±30) min], and the estimated blood loss was reduced [(103±21) ml vs. (260±34) ml], and the length of operative incision on body surface was shorter [(4.3±0.8) cm vs. (17.0±1.3) cm], and the differences between the two groups were statistically significant (all P< 0.05). There were no significant differences in the distance between the upper incision edge and tumor and the number of excised lymph node between the two groups (both P> 0.05). Compared with the opening gastrectomy group, the pain degree in 3-5 d after operation was slighter in the totally laparoscopic gastrectomy group, and the ratio of postoperative complications was lower, and the time of intestinal recovery and postoperative hospital stay was shorter, and the differences between the two groups were statistically significant (all P<0.05). Conclusion Totally laparoscopic radical total gastrectomy with D2 lymph node dissection for local advanced upper gastric cancer has advantages in operation safety, the time of postoperative recovery and the number of postoperative complications, and the effect of lymph node dissection can reach the level of open surgery.
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Objective?To investigate the effects of laparoscope assisted total gastrectomy (LATG) and open total gastrectomy (OTG) combined with D2 dissection in the treatment of upper gastric cancer and the impact on stress response.?Methods?145 patients with upper gastric cancer who underwent total gastrectomy from June 2014 to June 2017 were selected as research subjects, and they were divided into study group (treated by LATG, n = 70) and control group (treated by OTG + D2 dissection, n = 75) according to different surgical methods. The general condition of surgery, stress indexes cortisol (Cor), C reactive protein (CRP), postoperative recovery and the incidence of complications were compared between the two groups.?Results?The surgical time of the study group was longer than that of the control group, while the length of incision, intraoperative blood loss and length of hospital stay were shorter/less than those of the control group (P < 0.05). There was no significant difference in the number of dissected lymph nodes between the two groups (P > 0.05). Serum Cor and CRP levels in the study group were lower than those the control group during surgery and at 3 d after surgery (P < 0.05). The initial exhaust time and recovery time of liquid diet in the study group was shorter than that in the control group (P < 0.05), but there was no significant difference between the two groups in the rate of second surgery and readmission rate within 30 days (P > 0.05). The incidence of complications in the study group at 6 months after surgery was lower than that in the control group (P < 0.05).?Conclusion?Compared with OTG and D2 dissection, LATG has advantages of less trauma, earlier exhaust and feeding and fewer stress reactions, with quick recovery and few complications.
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Objective:To investigate the efficacy, safety, and overall survival of advanced upper gastric cancer patients who received preoperative chemoradiation therapy. Methods:A total of 62 patients who received preoperative chemotherapy or chemoradiation therapy in the Department of Gastrointestinal Surgery of Beijing Cancer Hospital&Institute were retrospectively observed to determine the efficacy and safety and to perform survival analysis of preoperative chemoradiation therapy. Results:Results of the postoperative pathology showed that the number of patients with T4 and N3 stages was significantly lower in the preoperative chemoradiation therapy group than in the preoperative chemotherapy group (P<0.05). In addition, the differences between the two groups in terms of safety and toxicity were not significant (P≥0.05). Analysis also showed that the differences between the two groups in terms of survival were not significant (P≥0.05). Conclusion:Patients with advanced upper gastric cancer can gain a potential survival advantage from preoperative chemoradiation therapy. Compared with preoperative chemotherapy, preoperative chemoradiation therapy was performed without increased risk of toxicity and insecurity. Preoperative chemoradiation therapy can also improve the local control ratio, especial y the control ratio of lymphatic metastasis. However, the final results of survival analysis depend on long-term follow-up of patients.
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PURPOSE: The aim of this study was to compare the short-term operative outcomes of laparoscopy-assisted total gastrectomy (LATG) with those of open total gastrectomy (OTG) for patients suffering with advanced upper gastric cancer. MATERIALS AND METHODS: Of the 47 patients who underwent LATG with D1+beta or D2 lymphadenectomy from July 2004 to March 2008, 29 patients with pathologically proven advanced gastric cancer were compared with 35 patients who underwent conventional OTG during the same time period. The comparison was based on the clinicopathological characteristics, the surgical outcome, the follow-up survival and tumor recurrence. RESULTS: The patients' age, gender and body mass index were similar between the two groups. However, there were statistically differences in tumor size (9.2+/-3.9 vs 6.1+/-3.6 cm, P=0.002) and the proximal resected margin (2.1+/-2.0 vs 3.6+/-2.1 cm P=0.004). There was no significant difference in most of the peri- and post-operative courses such as the time to first flatus, the time to starting a solid diet and the length of the hospital stay, except for a longer operating time (289.0 vs. 361.3 minutes, P<0.001) in the LATG group. The complication rate was higher in the LATG group (13.8%) than that in the OTG group (5.7%). The mean overall survival and disease free survival times were 32 and 31 months, and 24 and 28 months, respectively, with an average 18.8 months follow-up duration. The main recurrent sites were peritoneum and lymph node in both groups. CONCLUSION: The early results of the current study suggest that LATG for AGC is technically feasible and it does not show any inferiorities of the postoperative outcomes as compared to those of conventional open total gastrectomy.
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Humans , Body Mass Index , Diet , Disease-Free Survival , Flatulence , Follow-Up Studies , Gastrectomy , Length of Stay , Lymph Node Excision , Lymph Nodes , Peritoneum , Stomach Neoplasms , Stress, PsychologicalABSTRACT
PURPOSE: A total gastrectomy is generally performed for the treatment of upper third gastric cancer. However, the optimal extent of resection for early-stage upper third gastric cancer is still controversial. In this research, we compared the nutritional status and the quality of life in patients who underwent a total gastrectomy with uncut Roux en Y esophagojejunostomy with those in patients who underwent a proximal gastrectomy with esophagogastrostomy for treatment of upper third gastric cancer. MATERIALS AND METHODS: We reviewed 50 patients with no evidence of recurrent disease following curative surgery for upper third gastric cancer. Among this group, 25 patients underwent a total gastrectomy (TG) and 25 patients a proximal gastrectomy (PG). 8 TG and 4 PG patients were excluded from this study because of death, refusal to interview, etc. The nutritional status was assessed by measuring body weight, serum albumin, serum hemoglobin, and serum total protein. The gastrointestinal function and the quality of life were assessed by Cuschieri grading and modified Visick grading. RESULTS: In analysis of covariance of age and preoperative serum albumin, PG patients demonstrated lower weight loss (P=0.038), elevated serum albumin (P=0.049), and better outcome based on modified Visick grading (P=0.016) than TG, but there were no significant differences in the serum hemoglobin change (P=0.165), serum total protein change (P=0.435), and Cuschieri grading (P=0.064) between the preoperative and the postoperative data. CONCLUSION: In this study, a proximal gastrectomy led to a better nutritional status and quality of life than a total gastrectomy, as judged from the low weight loss, elevated serum albumin and better modified Visick grade.