Risk factor analysis and establishment of a predictive model for complications of elderly advanced gastric cancer with Clavien-Dindo classification ≥ II grade.

BACKGROUND: The occurrence of complications following radical gastrectomy for gastric cancer significantly impacts patients' quality of life. Elderly patients are susceptible to postoperative complications. This study seeks to investigate the risk factors associated with Clavien-Dindo ≥IIgrade complications following radical gastrectomy for advanced gastric cancer in elderly patients, develop a nomogram risk prediction model, and validate its accuracy. METHODS: Retrospective collection of clinical and pathological data was conducted on 442 elderly patients with advanced gastric cancer who underwent radical gastrectomy at Shaanxi Provincial People's Hospital from January 2015 to December 2020. They were randomly divided into a training set (n = 310) and a validation set (n = 132) in a 7:3 ratio. The severity of postoperative complications was graded using the Clavien-Dindo classification system, resulting in two complication groups: Clavien-Dindo

Impact of Patient- and Surgeon-Related Factors on Weight Loss after Laparoscopic Sleeve Gastrectomy-A Single-Center Study.

Background and Objectives: Surgical treatment for obesity is becoming increasingly popular. Surgeons have been trying to find a simple way to predict the type of surgical intervention that is best for a specific patient. This study aimed to determine the patient- and surgeon-related factors that affect weight loss after laparoscopic sleeve gastrectomy (LSG). Materials and Methods: A total of 129 patients underwent LSG in one surgical department. The following factors were analyzed: gender; age; highest preoperative and 6-month postoperative weight; the occurrence of obesity-related diseases, such as type 2 diabetes and hypertension; the number of surgeons involved in the surgery; and who performed the surgery, a resident or specialist. The outcomes also included length of hospital stay, operative time and complications. Statistical significance was defined as p ≤ 0.05. Results: A total of 129 patients (94 female) with a median age of 43 years and BMI of 43.1 kg/m2 underwent LSG, while a total of 109 (84.5%) patients achieved ≥50% of excess BMI loss (%EBMIL). Preoperative weight loss had no impact on %EBMIL (p = 0.95), operative time (p = 0.31) and length of hospital stay (p = 0.2). Two versus three surgeons in the operating team had no impact on surgery time (p = 0.1), length of stay (p = 0.98) and %EBMIL (p = 0.14). The operative time and length of hospital stay were similar for specialists and surgeons in training. %EBMIL was higher in the residents' surgery without statistical significance (p = 0.19). Complications occurred in 3.9% without mortality or leaks. Conclusions: Preoperative comorbidities, surgeons' experience and the number of surgeons in the operating team do not impact the complication rate, length of hospital stay, operative time and postoperative weight loss after LSG.

A comparison of efficacy of erector spinae plane block versus serratus anterior plane block plus subcostal transversus abdominus plane block for bariatric laparoscopic sleeve gastrectomy surgery: study protocol for a randomised clinical trial.

BACKGROUND: Obesity is a rapidly growing global health concern. Limited long-term success of diet, behavioural modification and medical therapy have led to the increased performance of bariatric surgery. Laparoscopic sleeve gastrectomy, which permanently reduces the size of the stomach, has been shown to cause considerable weight loss, as well as improving or even eliminating obesity related medical comorbidities such as diabetes, obstructive sleep apnoea and hypertension. Unfortunately, this surgery can also result in significant postoperative pain which, when combined with the dangers of perioperative opioid administration for bariatric patients, can lead to a significantly reduced quality of recovery. Opioid-sparing analgesia has been widely recommended for perioperative bariatric patients, but research into the optimum regional analgesia approach for this surgery is lacking, with no trials to date comparing different regional analgesic techniques. This study protocol describes a randomised clinical trial aimed at answering this question, comparing the quality of recovery after laparoscopic sleeve gastrectomy for patients who receive erector spinae plane block, versus those who receive serratus anterior plane block plus subcostal TAP block. METHODS: We propose a prospective, randomised, blinded (investigator) clinical trial in a tertiary hospital in Ireland. Seventy patients presenting for laparoscopic sleeve gastrectomy will be randomised to two study groups-group A will receive bilateral erector spinae blockade; group B will receive left sided serratus anterior plane block plus subcostal TAP blocks. Both groups will receive the same dose of the same local anaesthetic and the different regional technique performed will be the only difference in their care. The primary outcome will be QoR-15 scores at 24 h postoperatively, a validated international tool for assessing a patient's overall postoperative recovery. DISCUSSION: Regional analgesia should be a mainstay of perioperative opioid-sparing analgesia where possible. This is especially important in the bariatric cohort who are particularly susceptible to the complications of perioperative opioid administration. To the best of our knowledge, this trial will be the first to compare efficacy of two different regional analgesia techniques for bariatric patients undergoing laparoscopic sleeve gastrectomy surgery. TRIAL REGISTRATION: This trial was pre-registered on clinicaltrials.gov, registration number NCT05839704, on March 5, 2023. All items from the World Health Organisation Trial Registration Data Set have been included.

Metabolic and Bariatric Surgery for Adolescents.

Obesity is a chronic, complex, and multifactorial disease. Currently, approximately 6% have severe obesity with higher rates seen among racial/ethnic minority subgroups and in rural communities. Severe obesity is associated with cardiometabolic, psychologic, and musculoskeletal comorbidities. Metabolic and bariatric surgery is an effective treatment option for adolescents endorsed by major pediatric organizations. The most common procedure is the vertical sleeve gastrectomy. Pre-operative evaluation includes an in-depth medical, nutrition, physical activity and psychosocial assessment, with a care plan developed by a multidicplinary team with the adolescent and caregiver. The post-operative plan should include monitoring for surgical complications, weight regain, micronutrient deficiencies, psychologic challenges, and transition to adult care.

The short-term efficacy of neoadjuvant SOX versus SOX plus immune checkpoint inhibitor following laparoscopic gastrectomy for locally advanced gastric cancer: a multicenter retrospective cohort study in China.

BACKGROUND: This study aims to evaluate the short-term efficacy for locally advanced gastric cancer (LAGC) who accepted laparoscopic gastrectomy (LG) after neoadjuvant SOX versus SOX plus immune checkpoint inhibitors (ICIs). METHODS: LAGC patients who accepted LG after neoadjuvant SOX (SOX-LG, n = 169) and SOX plus ICIs (SOX + ICIs-LG, n = 140) in three medical centers between Jan 2020 and Mar 2024 were analyzed. We compared the tumor regression, treatment-related adverse events (TRAEs), perioperative safety between two groups, and explored the risk factors of postoperative complications (POCs) for LG after neoadjuvant therapy. RESULTS: The baseline characteristics were comparable between two groups (P > 0.05). SOX + ICIs-LG group acquired a higher proportion of objective response (63.6% vs. 46.7%, P = 0.003), major pathological response (43.6% vs. 31.4%, P = 0.001), and pathological complete response (17.9% vs. 9.5%, P = 0.030). There were no significant differences in the TRAEs rates, operation time, R0 resection, retrieved lymph nodes, postoperative first flatus, and hospitalized days, overall and severe POCs between two groups (P > 0.05). Patients in the SOX-ICIs-LG group had lower estimated blood loss (EBL) compared with SOX-LG (P = 0.001). Multivariate analysis showed that more EBL (P = 0.003) and prognostic nutritional index (PNI) < 40 (P = 0.005) were independent risk factors of POCs for LG after neoadjuvant therapy. CONCLUSION: Neoadjuvant SOX plus ICIs brings better tumor regression and similar TRAEs compared with SOX alone for LAGC. SOX + ICIs-LG is safe and feasible to conduct with less EBL. Surgeons should focus on the perioperative management to control POCs for patients with PNI < 40 and more EBL.

Safety, effectiveness and the optimal duration of preoperative imatinib in locally advanced gastric gastrointestinal stromal tumors: A retrospective cohort study.

BACKGROUND: The optimal duration of preoperative imatinib (IM) remains controversial. This study aimed to evaluate the safety, therapeutic effectiveness, and optimal duration of preoperative IM in patients with locally advanced gastric gastrointestinal stromal tumors (GIST). METHODS: The clinicopathologic data of 41 patients with locally advanced gastric GIST who received preoperative IM and underwent surgical resection from January 2014 and December 2021 were retrospectively analyzed. RESULTS: After a median of 7.0 (IQR: 4.5-10) months of preoperative IM treatment, 30 patients experienced adverse events (AEs), 80% of which were grade 1/2 AEs. The mean tumor size decreased from 12.71 ± 5.34 cm to 8.26 ± 4.00 cm, with a reduction rate of 35%. Setting 8 months as the cut-off value according to the results of ROC analysis. The proportion of laparoscopic surgery was higher in patients with short-term (≤8 months) versus long-term (>8 months) preoperative IM. Compared with the subtotal/total gastrectomy group, patients in the local gastrectomy group exhibited less intraoperative blood loss, shorter length of postoperative hospital stay, and fewer postoperative complications. The 3-year recurrence-free survival (RFS) and overall survival (OS) rates were 82.9% and 97.6%, and the expected 5-year RFS and OS rates were 75.6% and 90.2% respectively. RFS was better in the short-term than in the long-term preoperative IM treatment group, and it was also better in pre- plus postoperative IM treatment group than that in the preoperative IM alone group. Both univariate and multivariate COX analysis showed that a higher mitotic index and long-term preoperative IM treatment were associated with worse RFS, while postoperative IM treatment could significantly improve RFS. CONCLUSIONS: The study suggests that in patients with locally advanced gastric GIST, preoperative short-term (≤8 months) use of IM is associated with higher RFS than long-term use.

Bariatric Surgery: Current Trends and Newer Surgeries.

Bariatric surgery has evolved and gained in popularity as it has been recognized as the most sustainable and effective treatment for obesity and related diseases. These related diseases are significant causes of obesity related morbidity and mortality. Most bariatric procedures incorporate some component of gastric restriction with or without intestinal bypass, but the full mechanism of these procedures has yet to be elucidated. The most popular surgical procedure remains the sleeve gastrectomy over the last 10 years, while gastric bypass is also still commonly performed. We have also seen growth in revisional bariatric surgery and novel surgical procedures.

Association of metabolic syndrome and frailty with postoperative complications in older gastric cancer patients: A body composition perspective.

OBJECTIVES: To compare the characteristics of body compositions between metabolic syndrome (MetS) and frailty, and determine the independent and overlapping of MetS and frailty with postoperative complications among older patients with gastric cancer. DESIGN: A prospectively observational study. SETTING AND PARTICIPANTS: Two hundred and eighty six older patients from 60 to 80 years undergoing radical gastrectomy for the first time. MEASUREMENTS: MetS was diagnosed by the criteria from the 2020 edition of Chinese guideline for the prevention and treatment of type 2 diabetes mellitus, and frailty was defined by frailty phenotype. An InBody770 impedance analyzer was used to measure body compositions and with 10 fat- and muscle-related indicators being included in this study. Based on the presence of frailty and MetS, patients were divided into the frailty group, MetS group, frailty+MetS group, and normal group, and the body compositions indicators of these groups were compared. Clavien-Dindo classification was used to grade the severity of postoperative complications. Univariate and multivariate regression models were performed to explore the independent and joint association of MetS and frailty with postoperative complications. RESULTS: The incidence rate of MetS, frailty, and frailty+MetS being 20.3%, 15.7%, and 4.2% respectively. Compared with the normal group, both fat and muscle compositions were decreased significantly in the frailty group (p < 0.05), while the statistically significant difference of fat-to-muscle mass ratio (FMR) and skeletal muscle mass to visceral fat area ratio (SVR) were not observed (p > 0.05). In contrast, except SVR, the other indicators of the MetS group were higher than the normal group (p < 0.05). As to the frailty+MetS group, there was a significant increase in fat compositions and FMR, as well as a significant decline in SVR (p < 0.05), while the difference of muscle compositions was not statistically significant (p > 0.05). There was an association of frailty with postoperative total (OR = 3.068, 95% CI: 1.402-6.713) and severe (OR = 9.423, 95% CI: 2.725-32.589) complications, but no association was found of MetS alone. MetS coexisting with frailty was associated with the highest risk of both total (OR = 3.852, 95% CI: 1.020-14.539) and severe (OR = 12.096, 95% CI: 2.183-67.024) complications. CONCLUSIONS: Both frailty and MetS coexisting with frailty had adverse effects on postoperative complications, which appeared greatly different characteristics in body compositions and therefore reinforced the importance of targeted nutritional or metabolic intervention. Although MetS alone were not significantly associated with postoperative complications, it is essential to focus on the causal relationship and development trend between MetS and frailty to prevent MetS from shifting into frailty, considering the highest risk in their coexistence state.

RATIO OF METASTATIC LYMPH NODES VS. RESECTED LYMPH NODES (N-RATIO) HAS PROGNOSTIC IMPLICATIONS IN GASTRIC CANCER.

BACKGROUND: Lymph node status is vital for gastric cancer (GC) prognosis, but the conventional pN stage may be limited by variations in lymphadenectomy and stage migration. The N-Ratio, which assesses the ratio of metastatic to resected lymph nodes, emerges as a promising prognostic tool. AIMS: To assess N-Ratios prognostic value in GC, particularly in patients with <25 resected lymph nodes. METHODS: Patients who underwent gastrectomy with curative intent for GC were retrospectively evaluated. The N-Ratio categories were determined using the ROC curve method, and the area under the curve (AUC) was used as a measure of performance in predicting recurrence/death. RESULTS: A total of 561 GC patients were included in the study, 57% had pN+ status, and 17.5% had <25 resected lymph nodes. N-Ratio, with a mean of 0.12, predicted survival with 74% accuracy (AUC=0.74; 95%CI 0.70-0.78, p<0.001). N-Ratio categories included: N-Ratio 0 (43%); N-Ratio 1 (12.3%); N-Ratio 2 (31.6%); and N-Ratio 3 (13.2%). Disease-free survival (DFS) varied among all N-Ratio groups, with N-Ratio 3 showing worse survival than pN3 cases (DFS=21.8 vs. 11 months, p=0.022, p<0.05). In cases with <25 resected lymph nodes, DFS was not significantly worse in N-Ratio 0 (68.8 vs. 81.9%, p=0.061, p>0.05) and N-Ratio 1 (66.2 vs. 50%, p=0.504, p>0.05) groups. The DFS of N-Ratio-0 cases with <25 lymph nodes was similar to N-Ratio 1 cases. CONCLUSIONS: N-Ratio influenced survival in GC patients, especially in advanced lymph node disease (N-Ratio 3). Considering that N-Ratio does not impact pN0 cases, individualized prognosis assessment is essential for patients with <25 resected lymph nodes.

Percutaneous endoscopic intragastric surgery for gastric metastases of renal cell carcinoma: A case report.

To our knowledge, this is the first report of percutaneous endoscopic intragastric surgery (PEIGS) for gastric metastases from other organs. A 70-year-old male with a history of renal cell carcinoma (RCC) was referred to our department for the treatment of gastric metastasis of RCC. Partial gastrectomy was performed using single-incision PEIGS. Two years after the surgery, a follow-up esophagogastroduodenoscopy revealed a tumor located on the middle greater curvature of the stomach. The diagnosis was metastatic renal cell carcinoma, prompting a similar surgery. No recurrence was observed after the second surgery. PEIGS is a minimally invasive option for the treatment of metastatic gastric tumors.

Effect of omentum preservation on long-term prognosis of locally advanced gastric cancer: a systematic review and meta-analysis.

BACKGROUND: The effect of omentum preservation (OP) on locally advanced gastric cancer (LAGC) remains controversial. This study aimed to investigate the long-term prognosis of LAGC patients with OP versus omentum resection (OR). METHODS: A comprehensive search of databases including PubMed, Web of Science, Embase, and Cochrane Library was conducted up until February 2024. Statistical analysis was performed using Stata 12.0 software. The primary outcome was to assess the impact of OP on the long-term prognosis of patients with LAGC, including overall survival (OS) and recurrence-free survival (RFS). RESULTS: A total of six case-control studies were included, encompassing a cohort of 1897 patients. The OP group consisted of 844 patients, while the OR group comprised 1053 patients. The study results showed that the OS (HR = 0.72, 95% CI: 0.58-0.90, P = 0.003) and 5-year RFS (HR = 0.79, 95% CI: 0.63-0.99, P = 0.038) in the OP group were superior to those observed in the OR group. Subgroup analysis indicated that 5-year OS (HR = 0.64, P = 0.003) and 5-year RFS (HR = 0.69, P = 0.005) in the OP group were also better than those in the OR group in Korea. However, the subgroup analysis conducted on stage T3-T4 tumors revealed no statistically significant differences in OS (P = 0.083) and 5-year RFS (P = 0.173) between the two groups. CONCLUSION: Compared with OR, OP shows non-inferiority in patients with LAGC and can be considered a potential treatment option for radical gastrectomy.

Short-term safety and effectiveness of conversion from sleeve gastrectomy to Ring augmented Roux-en-Y gastric bypass.

BACKGROUND: Weight recurrence, suboptimal clinical response and functional disorder (such as reflux) after a Sleeve Gastrectomy (SG) are problems that may require conversional surgery. For reflux, conversion to Roux-en-Y Gastric Bypass (RYGB) is considered effective. Regarding treatment for suboptimal clinical response, the technique of choice remains a subject of debate. This study aims to evaluate the safety and effectiveness of conversion from SG to Ring-augmented RYGB ( RaRYGB). METHODS: All laparoscopic SG to RaRYGB conversions performed between January 2016 and January 2022 were included. Primary outcome was percentage total weight loss (%TWL) after 1-year follow-up. Secondary outcomes consisted of cumulative %TWL, complications (with a focus on ring-related complications), and resolution of medical-associated problems. RESULTS: We included 50 patients of whom 44 were female. Mean pre-conversion BMI was 37.6 kg/m2. All patients have reached the 1-year follow-up point, however 10 were lost to follow-up. After 1-year mean TWL was 17.8% while mean cumulative TWL, calculated from primary SG, was 32%. A total of 10 complications occurred in 8 patients within 30 days, 6 of which were ≤ CD3a and 4 ≥ CD3b. One MiniMizer was removed for complaints of severe dysphagia. Of the 35 medical-associated problems present at screening 5 remained unchanged(14.2%), 15 improved(42.9%) and 15 achieved remission(42.9%). CONCLUSION: Our series of 50 patients undergoing conversion from SG to RaRYGB is adequate and successful regarding additional weight loss 1 year after conversion, cumulative weight loss, complication rate and achievement of improvement or remission of medical-associated problems.

[Shanghai consensus on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy(2024 edition)].

Morbid obesity and its accompanying diseases have become one of the most serious public health problems warranting global effort and bariatric and metabolic surgery is still the most effective method for long-term weight control. Among all bariatric and metabolic procedures, sleeve gastrectomy is currently the most widely used, but it is not a perfect procedure. One of the most serious issues that this surgical procedure faces is the possibility of worsening existing or developing de novo gastroesophageal reflux disease after surgery. Moreover, there is currently a lack of high-level clinical trial evidence on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts with rich experience in bariatric and metabolic surgery and diagnosis and treatment of gastroesophageal reflux disease from China, Japan, and South Korea reached a consensus on the diagnosis and treatment of gastroesophageal reflux disease in sleeve gastrectomy patients using the Delphi method. There are a total of 59 consultation questions in this consensus, of which 44 have reached a consensus. We hope that this consensus can not only serve as a reference for clinical diagnosis and treatment, but also provide more possible directions for future high-quality clinical research.

[Comprehensive evaluation of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in obese patients based on efficacy and nutrition].

Objective: To evaluate the 1-year postoperative efficacy and nutritional indicators of single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in obese patients. Methods: This retrospective observational study included patients with a body mass index (BMI) of ≥40.0 kg/m2 regardless of other related metabolic diseases and patients with severe type 2 diabetes and a BMI between 27.5 and 40.0 kg/m2. The clinical data of 66 obese patients who underwent SADI-S at the Bariatric and Metabolic Surgery Department of China-Japan Union Hospital of Jilin University from November 2018 to May 2022 were collected, including 53 cases of da Vinci robotic surgery and 13 cases of laparoscopic surgery. The patients comprised 38 men and 28 women with a median age of 35 (18-61) years and a mean preoperative BMI of 42.93 ± 6.82 kg/m2. A total of 38 patients had type 2 diabetes, and 46 had hyperuricemia, 45 had hypertension, 35 had hyperlipidemia, 12 had hypercholesterolemia, and 12 had a high low-density lipoprotein (LDL) level. The main observation indicators were (1) intraoperative and postoperative conditions; (2) weight loss outcomes, including body weight, BMI, excess body weight loss (%EWL), and total body weight loss (%TWL) at 3, 6, and 12 months after surgery; (3) effects of treatment on metabolic disease; and (4) changes in nutrient indicators. Results: (1) Intraoperative and postoperative conditions: All patients successfully underwent SADI-S with neither conversion to laparotomy nor death. Four (6.1%) patients developed postoperative complications, and all of them recovered and were discharged after conservative or surgical treatment. (2) Weight loss outcomes: %EWL at 3, 6, and 12 months after surgery was 62.07 ± 26.56, 85.93 ± 27.92, and 106.65 ± 29.65, respectively, and %TWL was 22.67 ± 4.94, 32.10 ± 5.18, and 40.56 ± 7.89, respectively. Body weight and BMI 3 to 12 months after surgery were significantly lower than those before surgery (all P < 0.001). (3) Effect of treatment on metabolic disease: 3 to 12 months after surgery, fasting blood sugar, HbA1c, uric acid, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, LDL, and other indicators were significantly lower than those before surgery (all P < 0.05). Twelve months after surgery, the remission rates of diabetes, hyperuricemia, hypertension, hypertriglyceridemia, hypercholesterolemia, and high LDL were 100% (38/38), 65.2% (30/46), 62.2% (28/45), 94.3% (33/35), 100% (12/12), and 100% (12/12), respectively. (4) Changes in nutrient indicators: Compared with the preoperative nutrient levels, the hemoglobin and hematocrit levels were lower at 3 to 12 months after surgery, the total protein level was lower at 6 to 12 months after surgery, the albumin level was lower at 6 months after surgery, and the ferritin level was lower at 3 months after surgery. The differences were statistically significant (all P < 0.05). The incidence of anemia was 6.1% (4/66), hypoalbuminemia was 4.5% (3/66), and ferritin deficiency was 4.5% (3/66), all of which were improved or normalized through conservative treatment. Twelve months after surgery, 30 (45.5%) patients had vitamin A deficiency, 17 (25.8%) had vitamin E deficiency, 11 (16.7%) had folic acid deficiency, 2 had potassium deficiency (3.0%), 3 (4.5%) had calcium deficiency, 2 (3.0%) had magnesium deficiency, 9 (13.6%) had iron deficiency, and 16 (24.2%) had zinc deficiency. However, no relevant clinical symptoms occurred. Conclusions: SADI-S has a very significant effect on weight loss and alleviation of metabolic diseases. Nutrient deficiencies after SADI-S mainly involve vitamin A, vitamin E, zinc, and folic acid. The long-term efficacy and safety of SADI-S still need further follow-up observation.

Residual gastritis associated with Strongyloides stercoralis infection: A case report.

RATIONALE: Strongyloides stercoralis, a rare human intestinal parasite, poses a significant health risk, capable of causing lifelong infection and even mortality due to its atypical manifestation of symptoms. In this case report, we reported a case of a patient diagnosed with S. stercoralis infection of the residual stomach and meticulously detail its treatment process, offering valuable insights and a reference point for clinicians. PATIENT CONCERNS: we report a case of infection caused by S. stercoralis after subtotal gastrectomy (Billroth type II) in a 47-year-old middle-aged man. It presents with recurrent nausea and vomiting, accompanied by intermittent food residue vomiting and constipation. DIAGNOSES: Upon endoscopic examination, we observed mucosal swelling and erosion in the anastomosis and output ring of stomach, while pathological analysis confirmed the presence of Strongyloides stercoralis eggs. Subsequently, the administration of albendazole for anti-infection treatment proved to be effective, thereby reinforcing the diagnosis of S. stercoralis infection. INTERVENSIONS: The patient underwent aggressive management including fasting, fluid replacement, anti-infection therapy, albumin supplementation, and albendazole treatment at a dose of 300 mg/kg/day for 3 days to eliminate the parasite. OUTCOMES: After treatment, the patient's symptoms of nausea, vomiting, and constipation were alleviated and returned to normal upon discharge. Over the subsequent 3 years, the patient reported no instances of vomiting and experienced a recovery of digestive function compared to their discharge status. LESSONS: S. stercoralis infection is relatively rare in the remnant stomach, endoscopic and pathological examination may be one of the important methods to diagnose S. stercoralis infection, and it is effective to treat albendazole according to the course of treatment.

A modified GLIM criteria-based nomogram for the survival prediction of gastric cancer patients undergoing surgical resection.

BACKGROUND: This study aimed to develop a comprehensive model based on five GLIM variables to predict the individual survival and provide more appropriate patient counseling. METHODS: This retrospective cohort study included 301 gastric cancer (GC) patients undergoing radical resection. C-reactive protein (CRP) as an inflammatory marker was included in GLIM criteria and a nomogram for predicting 5-year overall survival (OS) in GC patients was established. The Bootstrap repeated sampling for 1000 times was used for internal validation. RESULTS: Of the total 301 patients, 20 (6.64%) died within 5 years. CRP improved the sensitivity and accuracy of the survival prediction model (AUC = 0.782, 0.694 to 0.869 for the model without CRP; AUC = 0.880, 0.809 to 0.950 for the model adding CRP). Besides, a GLIM-based nomogram was established with an AUC of 0.889. The C-index for predicting OS was 0.878 (95% CI: 0.823 to 0.934), and the calibration curve fitted well. Decision curve analysis (DCA) showed the clinical utility of the nomogram based on GLIM. CONCLUSION: The addition of CRP improved the sensitivity and accuracy of the survival prediction model. The 5-year survival probability of GC patients undergoing radical resection can be reliably predicted by the nomogram presented in this study.

Efficacy of neoadjuvant chemotherapy combined with prophylactic intraperitoneal hyperthermic chemotherapy for patients diagnosed with clinical T4 gastric cancer who underwent laparoscopic radical gastrectomy: a retrospective cohort study based on propensity score matching.

BACKGROUND: Clinical T4 (cT4) stage gastric cancer presents with frequent postoperative recurrence and poor prognosis. This study is to evaluate the oncological efficacy of laparoscopic radical total gastrectomy combined with postoperative prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with cT4N + M0 gastric cancer who received neoadjuvant chemotherapy. METHODS: We reviewed the clinicopathological data of 174 patients with clinical T4 gastric cancer who underwent neoadjuvant chemotherapy followed by laparoscopic radical total gastrectomy between June 2017 and December 2021. Among them, 142 were included in the non-HIPEC group, and 32 in the HIPEC group. Patients in both groups were paired based on propensity score in a 2:1 ratio to assess disparities in tumor recurrence and long-term survival. RESULTS: After matching, there were no significant differences in the clinicopathological data between the two groups. The peritoneum (16.1%) and distant organs (10.9%) were the most frequent locations for recurrence. Prior to matching, the recurrence rates were similar at all sites for both groups. Compared with those in the non-HIPEC cohort, the recurrence rates at all sites, the lung, and the peritoneum were notably lower in the HIPEC cohort. Prior to matching, the 3-year overall survival and disease-free survival rates were similar between the two groups; following matching, the HIPEC group exhibited notably greater survival rates than did the non-HIPEC group. The disparities in survival rates between the groups became even more pronounced after conducting a stratified analysis among patients with stage III disease. CONCLUSIONS: Neoadjuvant chemotherapy combined with prophylactic HIPEC after laparoscopic radical gastrectomy can effectively reduce the rate of peritoneal metastasis in patients with cT4N + M0 advanced gastric cancer and significantly improve the prognosis of such patients, which is of great clinical value.