المؤلفون: Zi jian Wang, Zi yao Xu, Zi jie Huang, Li Li, Da Guan, Yun he Gao, Xin xin Wang

المصدر: BMC Surgery, Vol 24, Iss 1, Pp 1-9 (2024)

مصطلحات موضوعية: Gastric cancer, Proximal gastrectomy, Double tract reconstruction, Surgery, RD1-811

الوصف: Abstract Purpose The aim of this study is to investigate the effect of double-tract reconstruction on short-term clinical outcome, quality of life and nutritional status of patients after proximal gastrectomy by comparing with esophagogastrostomy and total gastrectomy with Roux-en-Y reconstruction. Methods The clinical data of patients who underwent double tract reconstruction (DTR), esophagogastrostomy (EG), total gastrectomy with Roux-en-Y reconstruction (TG-RY) were retrospectively collected from May 2020 to May 2022. The clinical characteristics, short-term surgical outcomes, postoperative quality of life and nutritional status were compared among the three groups. Results Compared with the DTR group, the operation time in the TG group was significantly shorter (200(180,240) minutes vs. 230(210,255) minutes, p

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2482Test

الوصول الحر: https://doaj.org/article/cf2624b9dc8b4cf28804d762c61162c6Test

المؤلفون: Shinji Kuroda, Michihiro Ishida, Yasuhiro Choda, Atsushi Muraoka, Shinji Hato, Tetsuya Kagawa, Norimitsu Tanaka, Toshiharu Mitsuhashi, Yoshihiko Kakiuchi, Satoru Kikuchi, Masahiko Nishizaki, Shunsuke Kagawa, Toshiyoshi Fujiwara

المصدر: Annals of Gastroenterological Surgery, Vol 8, Iss 3, Pp 374-382 (2024)

مصطلحات موضوعية: anti‐reflux surgery, double‐flap technique, gastric cancer, Kamikawa procedure, proximal gastrectomy, Surgery, RD1-811, Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Abstract Background Double‐flap technique (DFT) is a reconstruction procedure after proximal gastrectomy (PG). We previously reported a multi‐center, retrospective study in which the incidence of reflux esophagitis (RE) (Los Angeles Classification ≥Grade B [LA‐B]) 1 year after surgery was 6.0%. There have been many reports, but all of them were retrospective. Thus, a multi‐center, prospective study was conducted. Methods Laparoscopic PG + DFT was performed for cT1N0 upper gastric cancer patients. The primary endpoint was the incidence of RE (≥LA‐B) 1 year after surgery. The planned sample size was 40, based on an estimated incidence of 6.0% and an upper threshold of 20%. Results Forty patients were recruited, and 39, excluding one with conversion to total gastrectomy, received protocol treatment. Anastomotic leakage (Clavien–Dindo ≥Grade III) was observed in one patient (2.6%). In 38 patients, excluding one case of postoperative mortality, RE (≥LA‐B) was observed in two patients (5.3%) 1 year after surgery, and the upper limit of the 95% confidence interval was 17.3%, lower than the 20% threshold. Anastomotic stricture requiring dilatation was observed in two patients (5.3%). One year after surgery, body weight change was 88.9 ± 7.0%, and PNI

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2475-0328Test

الوصول الحر: https://doaj.org/article/5a1df29e2eb14c049f8c7d95545f0212Test

المؤلفون: Yoshiro Imai, Ryo Tanaka, Kentaro Matsuo, Mitsuhiro Asakuma, Sang-Woong Lee

المصدر: Surgery Open Science, Vol 18, Iss , Pp 23-27 (2024)

مصطلحات موضوعية: Advanced gastric cancer, Upper third of the stomach, Proximal gastrectomy, Therapeutic value, Surgery, RD1-811

الوصف: Background: The oncological relevance of proximal gastrectomy in advanced gastric cancer remains unclear. We aimed to examine the frequency of lymph node metastasis in advanced gastric cancer to determine the oncological validity of proximal gastrectomy selection. Materials and methods: This study included consecutive 71 patients with locally advanced gastric cancer in the upper third of the stomach who underwent total gastrectomy at our institution between 2001 and 2017. Lymph node metastasis and its therapeutic value index were examined to identify candidates for proximal gastrectomy. Metastatic and 3-year overall survival rates of numbers 3a and 3b lymph nodes were examined from 2010 to 2019. Results: The metastatic rate and therapeutic value index of numbers 4d, 5, 6, and 12a lymph nodes were zero or low. The number 3 lymph node had a metastatic rate and therapeutic value index of 36.6 % and 31.1, respectively. The metastatic and 3-year overall survival rates of the number 3a lymph node were 32.7 % and 89 %, respectively, whereas those of the number 3b lymph node were 3.8 % and 100 %, respectively. All patients with positive metastasis to the number 3b lymph node received adjuvant chemotherapy. Histopathological findings of positive metastasis to the number 3b lymph node were located in the lesser curvature, and the tumor diameter exceeded 40 mm. Conclusion: For advanced gastric cancer of the upper third of the stomach, the indications of localization to the lesser curvature and a tumor diameter of >40 mm should be considered cautiously.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2589845024000046Test; https://doaj.org/toc/2589-8450Test

الوصول الحر: https://doaj.org/article/657de0160eef496a97a401f242e4e51dTest

المؤلفون: DAI Dezhu, SHI Jin, SONG Xudong, DING Fan, TAO Guoquan

المصدر: Zhongguo linchuang yanjiu, Vol 37, Iss 2, Pp 201-205 (2024)

مصطلحات موضوعية: adenocarcinoma of esophagogastric junction, gastric tumor, proximal gastrectomy, total gastrectomy, reflux esophagitis, lymph node dissection, Medicine

الوصف: Objective To compare the advantages and disadvantages of two different resection margins by observing the clinical efficacy of laparoscopic total gastrectomy (TG) and proximal gastrectomy(PG) for radical resection of adenocarcinoma of esophagogastric junction (AEJ). Methods A total of 90 patients with AEJ who were treated by Huai ‘an No.1 People ‘s Hospital from January 2020 to December 2021 were retrospectively reviewed. Patients were divided into PG group ( n=43) and TG group ( n=47) according to the surgical resection range. The general data, surgery related statistical indicators of the two groups were compared. Results The TG group had a longer operation time than the PG group, with significantly more intraoperative blood loss and a greater number of intraoperatively cleared lymph nodes than the PG group (P＜0.05). There was no significant difference in terms of drainage volume of the abdominal drainage tubes in the 3day postoperative period, postoperative period to the drainage removal, the length of hospitalization, and postoperative complications between two groups (P>0.05). Postoperative levels of hemoglobin, albumin, and prealbumin were significant lower in TG group compared with those in PG group (P

وصف الملف: electronic resource

العلاقة: http://zglcyj.ijournals.cn/zglcyj/ch/reader/create_pdf.aspx?file_no=20240208Test; https://doaj.org/toc/1674-8182Test

الوصول الحر: https://doaj.org/article/54d0ad78b8e94ef6886f04b7751d17e7Test

المؤلفون: Yonghe Chen, Xiaojiang Chen, Yi Lin, Shenyan Zhang, Zhiwei Zhou, Junsheng Peng

المصدر: BMC Cancer, Vol 24, Iss 1, Pp 1-9 (2024)

مصطلحات موضوعية: Proximal gastric cancer, Proximal gastrectomy, Neoadjuvant chemotherapy, Tumor regression grade, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282

الوصف: Abstract Purpose This study assesses the metastasis rate of the key distal lymph nodes (KDLN) that are not routinely dissected in proximal gastrectomy, aiming to explore the oncological safety of proximal gastrectomy for upper gastric cancer who underwent neoadjuvant chemotherapy. Methods We analyzed a cohort of 150 patients with proximal locally advanced gastric cancer (cT3/4 before chemotherapy) from two high-volume cancer centers in China who received preoperative neoadjuvant chemotherapy (NAC) and total gastrectomy with lymph node dissection. Metastasis rate of the KDLN (No.5/6/12a) and the risk factors were analyzed. Results Key distal lymph node metastasis was detected in 10% (15/150) of patients, with a metastasis rate of 6% (9/150) in No. 5 lymph nodes, 6.7% (10/150) in No. 6 lymph nodes, and 2.7% (2/75) in No. 12a lymph nodes. The therapeutic value index of KDLN as one entity is 5.8. Tumor length showed no correlation with KDLN metastasis, while tumor regression grade (TRG) emerged as an independent risk factor (OR: 1.47; p-value: 0.04). Of those with TRG3 (no response to NAC), 80% (12/15) was found with KDLN metastasis. Conclusion For cT3/4 proximal locally advanced gastric cancer patients, the risk of KDLN metastasis remains notably high even after NAC. Therefore, proximal gastrectomy is not recommended; instead, total gastrectomy with thorough distal lymphadenectomy is the preferred surgical approach.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2407Test

الوصول الحر: https://doaj.org/article/e2c9908312574b199a479692bcc1da7aTest

المؤلفون: Bailong Li, Yinkui Wang, Baocong Li, Fei Shan, Ziyu Li

المصدر: BMC Cancer, Vol 24, Iss 1, Pp 1-15 (2024)

مصطلحات موضوعية: Gastric cancer, Proximal gastrectomy, Digestive tract reconstruction, Short-term outcome, Quality of life, Meta-analysis, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282

الوصف: Abstract Background The optimal reconstruction method after proximal gastrectomy remains unclear. This systematic review and meta-analysis aimed to compare the short-term outcomes and long-term quality of life of various reconstruction methods. Methods PubMed, Embase, Web of Science and Cochrane Library were searched to identify comparative studies concerning the reconstruction methods after proximal gastrectomy. The reconstruction methods were classified into six groups: double tract reconstruction (DTR), esophagogastrostomy (EG), gastric tube reconstruction (GT), jejunal interposition (JI), jejunal pouch interposition (JPI) and double flap technique (DFT). Esophagogastric anastomosis group (EG group) included EG, GT and DFT, while esophagojejunal anastomosis group (EJ group) included DTR, JI and JPI. Results A total of 27 studies with 2410 patients were included in this meta-analysis. The pooled results indicated that the incidences of reflux esophagitis of DTR, EG, GT, JI, JPI and DFT were 7.6%, 27.3%, 4.5%, 7.1%, 14.0%, and 9.1%, respectively. The EG group had more reflux esophagitis (OR = 3.68, 95%CI 2.44–5.57, P

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2407Test

الوصول الحر: https://doaj.org/article/54c7a5221fe74010b96d5d09ee59dce8Test

المؤلفون: Jianhua Chen, Fei Wang, Shuyang Gao, Yapeng Yang, Ziming Zhao, Jiahao Shi, Liuhua Wang, Jun Ren

المصدر: BMC Surgery, Vol 23, Iss 1, Pp 1-11 (2023)

مصطلحات موضوعية: Gastric cancer, Laparoscopic proximal gastrectomy, Esophagogastrostomy, Double-tract reconstruction, Gastric tube reconstruction, Surgery, RD1-811

الوصف: Abstract Background There is no consensus on the optimal reconstruction technique after proximal gastrectomy. The purpose of this study was to retrospectively compare the surgical outcomes among esophagogastrostomy (EG) anastomosis, gastric tube (GT) reconstruction and double-tract (DT) reconstruction in patients who underwent laparoscopic proximal gastrectomy (LPG) to clarify the superior reconstruction method. Methods This study enrolled 164 patients who underwent LPG at the Northern Jiangsu People's Hospital in Jiangsu between January 2017 to January 2022 (EG: 51 patients; GT: 77 patients; DT: 36 patients). We compared the clinical and pathological characteristics, surgical features, postoperative complications, nutritional status, and quality of life (QOL) among the above three groups. Results Mean operative time was longer with the DT group than the remaining two groups (p = 0.001). With regard to postoperative complications, considerable differences in the postoperative reflux symptoms (p = 0.042) and reflux esophagitis (p = 0.040) among the three groups were found. For the nutritional status, total protein, hemoglobin and albumin reduction rates in the GT group were significantly higher than the other two groups at 12 months postoperatively. In the PGSAS-45, three assessment items were better in the DT group significantly compared with the esophageal reflux subscale (p = 0.047, Cohen’s d = 0.44), dissatisfaction at the meal (p = 0.009, Cohen’s d = 0.58), and dissatisfaction for daily life subscale (p = 0.012, Cohen’s d = 0.56). Conclusions DT after LPG is a valuable reconstruction technique with satisfactory surgical outcomes, especially regarding reduced reflux symptoms, improving the postoperative nutritional status and QOL.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2482Test

الوصول الحر: https://doaj.org/article/7b8ed844ad5e4834866bec6313956293Test

المؤلفون: Hiroharu Yamashita, Kazuhiro Toyota, Chikara Kunisaki, Akiyoshi Seshimo, Tsuyoshi Etoh, Ryo Ogawa, Hideo Baba, Koichi Demura, Sachiko Kaida, Atsushi Oshio, Koji Nakada

المصدر: Asian Journal of Surgery, Vol 46, Iss 10, Pp 4344-4351 (2023)

مصطلحات موضوعية: Proximal gastric cancer, Total gastrectomy, Proximal gastrectomy, Esophagogastrostomy, Reconstruction method, Surgery, RD1-811

الوصف: Background: Surgical procedures for proximal gastric cancer remain a highly debated topic. Total gastrectomy (TG) is widely accepted as a standard radical surgery. However, subtotal esophagectomy, proximal gastrectomy (PG) or even subtotal gastrectomy, when a small upper portion of the stomach can technically be preserved, are alternatives in current clinical practice. Methods: Using a cohort of the PGSAS NEXT trial, consisting of 1909 patients responding to a questionnaire sent to 70 institutions between July 2018 and December 2019, gastrectomy type, reconstruction method, and furthermore the remnant stomach size and the anti-reflux procedures for PG were evaluated. Results: TG was the procedure most commonly performed (63.0%), followed by PG (33.4%). Roux-en-Y was preferentially employed following TG irrespective of esophageal tumor invasion, while jejunal pouch was adopted in 8.5% of cases with an abdominal esophageal stump. Esophagogastrostomy was most commonly selected after PG, followed by the double-tract method. The former was preferentially employed for larger remnant stomachs (≧3/4), while being used slightly less often for tumors with as compared to those without esophageal invasion in cases with a remnant stomach 2/3 the size of the original stomach. Application of the double-tract method gradually increased as the remnant stomach size decreased. Anti-reflux procedures following esophagogastrostomy varied markedly. Conclusions: TG is the mainstream and PG remains an alternative in current Japanese clinical practice for proximal gastric cancer. Remnant stomach size and esophageal stump location appear to influence the choice of reconstruction method following PG.

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S101595842201627XTest; https://doaj.org/toc/1015-9584Test

الوصول الحر: https://doaj.org/article/d4dfe131a53b4cd5889716e0174a32b3Test

المؤلفون: JiaQing Gong, Xia Liu, GuangLan Wang, Wei Li, GuoDe Luo, Yan Lin, Bin Zhang, ChuanDong Chen

المصدر: Asian Journal of Surgery, Vol 46, Iss 10, Pp 4196-4201 (2023)

مصطلحات موضوعية: Proximal gastrectomy, Digestive tract reconstruction, Uncut jejunal interposition, Jejunal pouch, Adenocarcinoma of the esophagogastric junction, Surgery, RD1-811

الوصف: Aim: An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double anastomosis(Uncut-D), was established in recent years. In order to fully clarify the superiority of the procedure, this study has conducted a systematic analysis and thorough discussion. Methods: 118 patients with adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy were enrolled in this study. According to the methods of digestive tract reconstruction, these patients were divided into three groups: Uncut-D(n = 43), esophagogastrostomy (EG, n = 36), jejunal interposition (JI, n = 39).The preoperative indicators, surgical complications and related indicators of postoperative quality of life were analyzed. Results: There were no significant differences in preoperative data among all groups (P > 0.05); The digestive tract reconstruction time in Uncut-D group was more than that in EG group, and less than that in JI group (P

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S1015958422016281Test; https://doaj.org/toc/1015-9584Test

الوصول الحر: https://doaj.org/article/d1b2fa67e01a4287a1186bdfcba5f8bbTest

المؤلفون: Naruhiko Ikoma, Travis Grotz, Hirofumi Kawakubo, Hyoung-Il Kim, Satoru Matsuda, Yuki Hirata, Atsushi Nakao, Loretta A. Williams, Xin Shelley Wang, Tito Mendoza, Xuemei Wang, Brian D. Badgwell, Paul F. Mansfield, Woo-Jin Hyung, Vivian E. Strong, Yuko Kitagawa

المصدر: BMC Surgery, Vol 23, Iss 1, Pp 1-9 (2023)

مصطلحات موضوعية: Robotic gastrectomy, Proximal gastrectomy, Total gastrectomy, Patient-reported outcomes, Quality of life, Surgery, RD1-811

الوصف: Abstract Background The current standard operation for proximal gastric and gastroesophageal junction (P/GEJ) cancers with limited esophageal extension is total gastrectomy (TG). TG is associated with impaired appetite and weight loss due to the loss of gastric functions such as production of ghrelin and with anemia due to intrinsic factor loss and vitamin B12 malabsorption. Theoretically, proximal gastrectomy (PG) can mitigate these problems by preserving gastric function. However, PG with direct esophagogastric reconstruction is associated with severe postoperative reflux, delayed gastric emptying, and poor quality of life (QoL). Minimally invasive PG (MIPG) with antireflux techniques has been increasingly performed by experts but is technically demanding owing to its complexity. Moreover, the actual advantages of MIPG over minimally invasive TG (MITG) with regards to postoperative QoL are unknown. Our overall objective of this study is to determine the short-term QoL benefits of MIPG. Our central hypotheses are that MIPG is safe and that patients have improved appetite after MIPG with effective antireflux techniques, which leads to an overall QoL improvement when compared with MITG. Methods Enrollment of a total of 60 patients in this prospective survey-collection study is expected. Procedures (MITG versus MIPG, antireflux techniques for MIPG [double-tract reconstruction versus the double-flap technique]) will be chosen based on surgeon and/or patient preference. Randomization is not considered feasible because patients often have strong preferences regarding MITG and MIPG. The primary outcome is appetite level (reported on a 0-10 scale) at 3 months after surgery. With an expected 30 patients per cohort (MITG versus MIPG), this study will have 80% power to detect a one-point difference in appetite level. Patient-reported outcomes will be longitudinally collected (including questions about appetite and reflux), and specific QoL items, body weight, body mass index and ghrelin, albumin, and hemoglobin levels will be compared. Discussion Surgeons from the US, Japan, and South Korea formed this collaboration with the agreement that the surgical approach to P/GEJ cancers is an internationally important but controversial topic that requires immediate action. At the completion of the proposed research, our expected outcome is the establishment of the benefit and safety of MIPG. Trial registration This trial was registered with Clinical Trials Reporting Program Registration under the registration number NCI-2022–00267 on January 11, 2022, as well as with ClinicalTrials.gov under the registration number NCT05205343 on January 11, 2022.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2482Test

الوصول الحر: https://doaj.org/article/6116cf959f86401d9ba5cb1e898af491Test