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Background: The MAGIC and ACCORD 07 trials have established the role of perioperative chemotherapy in locally advanced gastric adenocarcinoma. A more recent study has demonstrated the superiority of the FLOT perioperative regimen. The best strategy to improve outcomes has yet to be determined. Aims of the study were to evaluate perioperative chemotherapy in terms of morbidity and tolerance of FLOT regimen with modification and histopathological responseMethods: This prospective study was started after ethical committee approval in February 2019 at a tertiary cancer center in South India for a period of 1 year up till February 2020. Patients fulfilling inclusion criteria were enrolled. Perioperative chemotherapy was given as scheduled regimen and adverse effects and response to preoperative chemotherapy were recorded. Radical D2 gastrectomy and histopathology assessed analysed by using IBM SPSS statistics ver. 21 and descriptive statistics used.Results: From February 2019 till February 2020, a total of 24 patients of newly diagnosed adenocarcinoma of the stomach of which 18 patients were nonmetastatic on workup. Moderately different (38.8%), well-differentiated in 11.2%, poorly differentiated in 50%. Total 66.7% were diagnosed as metastatic on staging laparoscopy, peritoneal wash cytology in 50% was negative. The cardiopulmonary resuscitation was seen in two patients.Conclusions: Even though it is an interim analysis with less number of patients enrolled, so far it can be concluded that all patients where surgery is planned should undergo peritoneal lavage cytology and FLOT regimen can be practised with acceptable morbidity. Long term results after completion of study will definitely throw more light.
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Minimally invasive surgery is widely adopted and recognized. In recent years new technologies of minimally invasive surgery emerge in endlessly. Application of 4K laparoscopy promotes the development, stangardization and training of minimally invasive surgery for gastrointestinal and colorectal diseases. Clear understanding of the anatomical structure of left gastroepiploic vessels is helpful for No.4 lymph node dissection. The surgeon′s accurate anatomy, good patience, and the high degree of coordination between surgeons and nurses help to reduce and prevent complications. The authors elaborates on lymph node dissection along the left gastroepiploic vessels region in 4K laparoscopic radical gastrectomy with the surgeon on right position
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OBJECTIVE: To clarify the value of unconventional prophylactic drain placement in laparoscopy assisted D2 gastrectomy for gastric cancer.METHODS: The clinical data of 193 patients with gastric cancer who underwent laparoscopy-assisted D2 Gastrectomy in Department of General Surgery,Chinese PLA General Hospital between February 2017 and February 2018 were analyzed retrospectively.The patients were divided into two groups according to whether the abdominal drain was placed.The drain group comprised 150 patients with routine prophylactic intraabdominal drain placement and the no drain group comprised 43 patients without intra-abdominal drain placement after laparoscopy-assisted D2 gastrectomy.The general information,post-operative recovery and the incidence of postoperative complications were compared in the two groups.RESULTS: There was no significant difference in the general information and postoperative complications in the two groups.The no drain group had shorter hospital stay[(7.17±0.14)d vs.(10.88±0.88) d,(P<0.05)],and shorter exhaust time[(3.39±0.21)d vs.(4.30±0.16)d,P<0.01],less pain [VAS(3.23±0.61) vs.(5.39±0.42),(P<0.05)] and less times of wound dressing change after operation [(3.53±0.52)vs.(7.81±1.05),(P<0.05)] compared with the drain group.CONCLUSION: The unconventional prophylactic drain placement in laparoscopy assisted D2 gastrectomy is safe and feasible.Unnecessary drain placement should be avoided.