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Background: The purpose of this prospective study was to investigate changes in lipid indices associated with whole body composition during 1 year of follow-up after laparoscopic gastrectomy., Methods: Thirty-seven patients with benign and malignant gastric neoplasm who underwent laparoscopic gastrectomy were prospectively enrolled. None of the patients were treated with adjuvant chemotherapy. Lipid indices and body composition were measured preoperatively and at six and 12 months after laparoscopic gastrectomy. Lipid indices included total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). Body weight, fat and lean body mass (LBM) were measured by dual-energy X-ray absorptiometry and the change in fat and LBM in the trunk, arms and legs was compared., Results: Body weight significantly decreased from 63.0 ± 11.1 kg preoperatively to 56.8 ± 10.6 kg 12 months after laparoscopic gastrectomy, with a mean of 7.1% (4.6 kg) weight loss. Fat and LBM loss contributed 68.4% (3.1 kg) and 30.1% (1.4 kg) of the total weight loss, respectively. In both the non-obese and obese groups, body weight, fat and LBM did not change significantly between 6 months and 12 months after gastrectomy. TC and LDL-C levels significantly decreased during the first six-month period and HDL-C significantly increased until 12 months after gastrectomy in the non-obese group. In the obese group, the degree of reduction in fat mass was significantly higher and the LBM/weight ratio significantly increased compared with the non-obese group. However, there was no significant change in lipid indices in the obese group. The TG level was significantly correlated with fat, especially with trunk fat., Conclusion: Gastrectomy resulted in improved lipid indices and a reduction in body weight, fat and LBM. The HDL-C significantly increased in the non-obese group for 1 year after gastrectomy and the reduction of TG level was positively correlated with fat, especially with trunk fat (IRB No. 2015-04-026. Registered 4 May 2015).

Introduction: Bariatric surgery effectively induces long-term weight loss in Western populations. However, its effectiveness in Asians remains to be confirmed objectively. The Korean Society for Metabolic and Bariatric Surgery proposes the first prospective cohort study on Koreans undergoing bariatric surgery., Methods and Analysis: The Korean OBEsity Surgical treatment Study (KOBESS) is a prospective, multicentre, single-arm, observational, cohort study on morbidly obese patients who undergo primary sleeve gastrectomy or Roux-en-Y gastric bypass in Korea. In total, 100 consecutive obese Asian patients who will undergo bariatric surgery will be recruited in 2016-2017; follow-up will be for 1 year. Primary outcomes are change in body weight and waist circumference at 1 year. All patients will undergo anthropometry, laboratory tests, bioelectrical impedance analysis, gastrofibroscopy, polysomnography and fat-measuring CT before and after surgery. Patients with diabetes will also undergo perioperative oral glucose tolerance and endocrinological hormone tests. Hypertensive patients will also undergo perioperative echocardiography and carotid Doppler ultrasonography. Female patients suspected of having polycystic ovarian syndrome will also undergo perioperative hormone tests and abdominal ultrasonography. Visceral and subcutaneous fat will be harvested during surgery. Blood, stool and urine samples will be taken at various perioperative time points. Although the cohort is small and the follow-up duration is relatively short, this study will determine whether bariatric surgery induces satisfactory weight loss in obese Koreans. Significantly, the tissue samples will also facilitate many studies examining the effects of bariatric surgery and their mechanisms., Ethics and Dissemination: Ethics approval was obtained from the institutional review board of each participating hospital. All findings arising from this cohort study will be published in open-access peer-reviewed journals and will be presented at national and international meetings. All KOBESS investigators will be able to propose research studies and potential publications based on KOBESS data and tissue samples., Trial Registration Number: NCT03100292; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Aims: Robotic gastrectomy for gastric cancer has been proven to be a feasible and safe minimally invasive procedure. However, our previous multicenter prospective study indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. This study aimed to identify which subgroups of patients would benefit from robotic gastrectomy rather than from conventional laparoscopic gastrectomy., Methods: A prospective multicenter comparative study comparing laparoscopic and robotic gastrectomy was previously conducted. We divided the patients into subgroups according to obesity, type of gastrectomy performed, and extent of lymph node dissection. Surgical outcomes were compared between the robotic and laparoscopic groups in each subgroup., Results: A total of 434 patients were enrolled into the robotic (n = 223) and laparoscopic (n = 211) surgery groups. According to obesity and gastrectomy type, there was no difference in the estimated blood loss (EBL), number of retrieved lymph nodes, complication rate, open conversion rate, and the length of hospital stay between the robotic and laparoscopic groups. According to the extent of lymph node dissection, the robotic group showed a significantly lower EBL than did the laparoscopic group after D2 dissection (P = 0.021), while there was no difference in EBL in patients that did not undergo D2 dissection (P = 0.365)., Conclusion: Patients with gastric cancer undergoing D2 lymph node dissection can benefit from less blood loss when a robotic surgery system is used., (Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Due to the high 5-year overall survival rate (>95 %) for early gastric cancer (EGC), patients now face risks of developing comorbidities. Cardiovascular disease (CVD) is one of the most common causes of death not only in the general population and but also in cancer patients. Thus, we determined the effect of gastrectomy on cardiovascular risk factors by analyzing changes in lipid profiles of patients who underwent curative gastrectomy for EGC., Methods: Seventy-three patients who received curative gastrectomy for EGC were included and divided into gastroduodenostomy (GD) and duodenal bypass (DB) groups according to the anastomosis. Changes in visceral fat area (VFA), subcutaneous fat area (SFA), and lipid profiles [total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C)] were evaluated in both groups 1 year after gastrectomy., Results: Body weight, VFA, SFA, TG, LDL-C, and TC decreased significantly while HDL-C increased (p < 0.001) after the surgery. We observed a weak negative correlation between percent change of VFA and HDL-C (r = -0.245, p = 0.036). When compared with the GD group, the DB group lost more SFA (p < 0.001), body weight (p = 0.008), and TC (p = 0.031). We also found that the degree of BMI change (∆BMI) was greater in the obese patients than in the non-obese patients (p < 0.001)., Conclusions: Curative gastrectomy reduces VFA, SFA, and body weight and improves lipid profiles in patients with EGC, all of which indicates reduced cardiovascular risk. Therefore, prospective studies are required to verify whether gastrectomy in EGC patients has favorable effects on future CVD mortality.

Background: Endoscopically diagnosed early gastric cancers (EGCs) are sometimes revealed to be advanced gastric cancers (AGCs) on pathologic examination of the resected specimen, and also endoscopically diagnosed AGCs are often determined to be EGCs. This study was designed to determine the impact on prognosis of the discordant finding between preoperative endoscopy and postoperative pathology in gastric cancer patients., Methods: Patients with gastric cancer stages pT1a-T4a who underwent curative gastrectomy between 2004 and 2010 were included in the study. The preoperative endoscopic findings and clinicopathologic features were analyzed. The prognostic impact on recurrence-free survival of discordance between endoscopic and pathologic examinations was analyzed using multivariate analysis., Results: Among 367 patients diagnosed with EGC on preoperative endoscopy, 40 (11 %) had AGC on final pathologic examination; this was more common in female patients, upper one-third location of the cancer, poorly differentiated tumor, combined gross type (elevated and depressed), lymphovascular invasion and lymph node metastasis. Among 350 patients diagnosed with AGC on preoperative endoscopy, 66 (19 %) had EGC pathologically; this was more frequent in patients with tumor in the lower and/or middle third of the stomach, differentiated tumor, Borrmann type 1 and absence of lymph node metastasis. The endoscopic appearance of AGC was identified as a poor prognostic factor related to recurrence-free survival in patients with EGC, whereas discordance did not influence recurrence-free survival in patients with AGC., Conclusions: Discordant preoperative endoscopic appearance may be an indicator of biologic aggressiveness and a reliable prognostic factor in EGC, but not in AGC.

Background: Late recurrence of gastric cancer is rare and there are few data on recurrence in patients who are disease free for >5 years after gastrectomy. The aim of this study was to evaluate the predictors and status of tumor recurrence among these patients., Methods: Clinicopathologic characteristics, patterns of recurrence, and postrecurrence survival were analyzed in patients who were diagnosed as disease free at 5 years postoperatively and thereafter experienced recurrence. Independent factors associated with the late recurrence were analyzed., Results: Among 1,573 patients who underwent curative surgery from June 1992 to December 2006, 348 patients had recurrence. Of them, 7.6% (n = 25) suffered from late recurrence after 5 years after gastrectomy. Among patients who were diagnosed as disease free at 5 years after surgery, it accounted for 2.8% (25/902). Cases with late recurrence were characterized by more aggressive clinicopathologic features than those without recurrence. The median time to recurrence was 88.8 months (range, 64.8-238.0); of the 25 patients, 18 (72.0%) had recurrence within 8 years after surgery. The most common pattern was peritoneal recurrence (n = 19; 76.0%). The estimated median survival after recurrence was 9.4 months. On multivariate analysis, pT4 classification was the only independent risk factor for late recurrence. There were 185 patients with pT4 tumor who had no recurrence at 5 years after surgery; 19 (10.3%) had late recurrence., Conclusion: pT4 tumor was the only important predictor of late recurrence. Whether extended follow-up for T4 tumors affects survival needs to be demonstrated in more large-scale studies., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy., Background: Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assumed technical superiority over conventional laparoscopy., Methods: A prospective, multicenter comparative study was conducted. Patients were matched according to the surgeon, extent of gastric resection, and sex. The primary endpoint was morbidity and mortality. Outcomes were analyzed on an intention-to-treat and per-protocol basis., Results: A total of 434 patients were enrolled for treatment with either robotic (n = 223) or laparoscopic (n = 211) gastrectomy for intention-to-treat analysis, and a total of 370 patients (n = 185 per treatment) were compared in per-protocol analysis. Results were similar between both analyses. In per-protocol analysis, both groups showed similar overall complication rates (robotic = 11.9% vs laparoscopic = 10.3%) and major complication rates (robotic = 1.1% vs laparoscopic = 1.1%) with no operative mortality in either group. Patients treated with robotic surgery showed significantly longer operative time (robotic = 221 minutes vs laparoscopic = 178 minutes; P < 0.001) and significantly higher total costs (robotic = US$13,432 vs laparoscopic = US$8090; P < 0.001), compared with those who underwent laparoscopic gastrectomy. No significant differences between groups were noted in estimated blood loss, rates of open conversion, diet build-up, or length of hospital stay., Conclusions: The use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery. However, our analysis of perioperative surgical outcomes indicated that robotic gastrectomy is not superior to laparoscopic gastrectomy. Clinical trials identification: NCT01309256.

Background: We evaluated metabolic changes after vertical sleeve gastrectomy (VSG) surgery in a rat model using proteomics and metabolomic profiling in liver and serum., Methods: Rats were randomly divided into two groups: sham (n = 10) and VSG (n = 12). Food intake, body weight, blood glucose, insulin, and thyroid hormone levels were measured. Two-dimensional electrophoresis, nuclear resonance spectroscopy, mass spectroscopy, immunofluorescence, and immunoblot analyses were used to determine and validate changes in metabolites and proteins in liver tissue and serum samples., Results: Food intake and body weight decreased after VSG group (p < 0.05 and p < 0.05, respectively). Random blood glucose (sham, 183.3 ± 5.6 mg/dL; VSG, 138.5 ± 3.7 mg/dL) decreased while random insulin (sham, 0.45 ± 0.16 μg/L; VSG, 1.05 ± 0.18 μg/L) increased after VSG (p < 0.05 and p < 0.01, respectively). We found that expressions of gluconeogenic enzymes (phosphoenolpyruvate carboxykinase-1 and glucose-6-phosphatase) and concentrations of pyruvate and malate decreased while lactate, NADH, NADPH, glucose, and AMP/ATP ratio increased after VSG. Thyroid hormones, triiodothyronine (T3) and free thyroxine (fT4), decreased after VSG., Conclusion: This study proves that VSG suppresses hepatic glucose production.

Background/aims: The metabolic effects of gastrectomy and the reduction of visceral adiposity through omentectomy for gastric cancer are unknown., Methodology: We retrospectively reviewed of prospectively collected data of 67 patients over one year who underwent radical gastrectomy with either a complete or partial omentectomy for gastric cancer. The change in Body mass index (BMI), triglyceride, low density lipoprotein, high density lipoprotein, and hematological profile were evaluated., Results: In the group of 67 patients changes were observed after 1 year follow-up for BMI (23.7±3.1 versus 21.3±2.5kg/m2; p<0.001), triglyceride (155.2±136.1 versus 89.7±41.2mg/dL, p=0.011), low density lipoprotein (107.4±45.4 versus 95.8±27.5mg/dL, p=0.020), vitamin B12 (681.4±297.4 versus 558.1±338.6pg/mL, p=0.076). High density lipoprotein (41.4±12.6 versus 52.8±10.5mg/dL) increased after surgery (p<0.001). There were no changes between the complete and partial omentectomy groups for BMI, albumin, triglyceride, lipoprotein, and hemoglobin., Conclusions: Gastrectomy with or without omentectomy induced a decrease of BMI and improvements in metabolic parameters such as triglyceride, low density lipoprotein, high density lipoprotein. Omentectomy had no significant impact on any measured parameter in this group.

Background: The omentum has variable functions in surgical procedures. Nevertheless, there is very little information about the effect of omentum on abdominal complications after gastrectomy. The purpose of the present study was to determine the outcome of omentum-preserving gastrectomy for early gastric cancer., Methods: We evaluated 1,116 patients who had a gastrectomy for early gastric cancer between the years 2004 and 2006; 992 patients underwent conventional gastrectomy (CG), and 124 patients had an omentum-preserving gastrectomy (OPG). These cases were analyzed retrospectively. The early and late abdominal complications were compared between the CG and OPG groups., Results: The results of the study show no significant differences between the early abdominal complications in the CG and OPG groups. However, the late abdominal complication rate in the OPG was significantly lower than the CG (p = 0.026). The most common risk factor associated with early abdominal complications was type of operation. The combination of CG and early abdominal complication represented a statistically significant risk for late abdominal complications (p = 0.026, 0.031 respectively)., Conclusion: The findings of this study demonstrate that the omentum-preserving gastrectomy in the treatment of early gastric cancer showed a lower rate of abdominal complications compared to the conventional gastrectomy.

We sought to elucidate the clinical value of tumor location of the remnant gastric cancer developed after partial gastrectomy for gastric cancer to determine the disease characteristics and surgical outcome. Fifty-two patients underwent a second operation with a curative intent because of remnant gastric cancer after undergoing partial gastrectomy for gastric cancer between 1995 and 2005. The clinicopathological features of their primary and recurrent diseases, surgical results, and survivals according to tumor sites within the remnant stomach were examined. Tumors that developed at the anastomotic site (n = 27) in remnant stomach favored a female gender, younger age, and unfavorable histological characteristics of primary and recurrent diseases and were also associated with lower tumor resectability than those that developed in the non-anastomotic site (n = 25). The overall 5-year survival rates of patients that experienced an anastomotic recurrence and non-anastomotic recurrence were 36.9 and 95.8% (p = 0.001), respectively, and the overall 5-year survival rates of patients with stage I primary gastric cancer were 83.3 and 100% (p = 0.018) for anastomotic and non-anastomotic recurrence. Tumor location of remnant gastric cancer is an important factor for predicting surgical outcome, but it also reflects the characteristics of primary and recurrent diseases. It is hoped that these results will assist surgeons establishing the treatment plan for remnant gastric cancer.