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Background: Laparoscopic distal gastrectomy (LDG) for gastric cancer has gradually gained popularity. However, laparoscopic total gastrectomy (LTG) has been reported rarely when compared with LDG. This study was designed to evaluate the surgical outcomes as well as the morbidity and mortality of LTG compared with LDG to confirm the feasibility and safety of LTG., Material and Methods: We reviewed the data of patients at our institution undergoing LTG (n = 448) or LDG (n = 956) for gastric cancer between January 2008 and July 2016. Then the clinical characteristics and perioperative clinical outcomes of the two groups were compared., Results: Except for tumor size and stage, there were no statistically significant differences in the clinicopathological parameters between the groups. LTG was associated with significantly longer operation time, late time to postoperative diet, and longer hospital stay compared with the LDG group. Overall complications developed in 60 patients (13.4%) and surgical complications in 48 patients (10.7%) after LTG. Postoperative complications were less frequent in the LDG group than in the LTG group (8.4% versus 13.4%, p < .01), and fewer surgical complications were observed with LDG than with LTG (7.5% versus 10.7%, p = .05)., Conclusions: The results of LTG were favorable even though are not inferior to those of LDG. LTG for gastric cancer is technically feasible and safe. However, because of the limits of this study, other high-quality studies are needed for further evaluation.

Background: Laparoscopic gastrectomy (LG) has been widely applied in patients with gastric cancer (GC). However, the safety and application value of LG in elderly patients with GC was still unclear. In this study, we aimed to evaluate the feasibility and safety of LG for elderly patients with GC using the meta-analysis., Methods: Studies comparing elderly patients and nonelderly patients who underwent LG for GC were reviewed and collected from the PubMed, EBSCO, Cochrane Library, and EMBASE. Outcomes such as operative results, postoperative recovery, and morbidity were compared and analyzed. The Review Manager 5.3 was used to portray the weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI)., Results: Eleven observational studies with a total of 3275 patients were included. Compared with nonelderly patients, elderly patients had shorter operation time (WMD -10.46; 95% CI -17.06 to -3.86; P = .002), less retrieved lymph nodes (WMD -2.34; 95% CI -3.77 to -0.92; P = .001), delayed time to first flatus (WMD 0.31; 95% CI 0.10-0.51; P = .003), longer postoperative hospital stays (WMD 1.06; 95% CI 0.07-2.05; P = .04), higher risk for overall postoperative complication (OR 1.34; 95% CI 1.08-1.67; P = .009), nonsurgical postoperative complication (OR 1.98; 95% CI 1.24-3.15; P = .004), and postoperative pulmonary complication (OR: 3.09; 95% CI 1.68-5.68; P < .001). There was no significance between nonelderly patients and elderly patients regarding the estimated blood loss, incidences of surgical postoperative complication, surgical site infection, and ileus (P > .05)., Conclusion: Outcomes of LG for elderly patients were comparable to those in nonelderly patients. Age alone should not preclude LG in elderly patients.

Objective: Few studies have compared the surgical outcomes of laparoscopic (LG) and open (OG) gastrectomy in obese patients (BMI≥30 kg/m) with gastric cancer. The current study aimed to investigate the short-term outcomes of LG in this group of patients., Methods: A total of 33 LG cases and 23 OG cases (BMI≥30 kg/m) were identified from our gastric cancer database. Clinicopathologic features, operative details, laboratory examination, and postoperative outcomes were compared between both groups. Regression analysis was used to determine the effects of BMI on intraoperative outcomes., Results: The 2 groups had comparable clinicopathologic characteristics. LG was associated with significantly lesser blood loss, whereas both also groups had a similar operative time, and number of harvested lymph nodes. However, regression analysis indicated that increased BMI affected the operative time and blood loss in patients that underwent OG but had little effect on patients who received LG. The elevation of inflammatory factors (WBC, CRP) was lower in LG than in OG, postoperatively. Postoperative hepatic (alanine aminotransferase, total bilirubin, albumin) and renal (creatinine, blood urea nitrogen) functions in the LG group were not worse than in the OG group. The time to first flatus, initiation of diet, hospitalization, and postoperative complications seemed superior in LG than in OG, but these differences were not statistically significant., Conclusion: LG can be safely performed in obese gastric cancer patients. Compared with conventional OG, LG is less invasive and is characterized by less blood loss and milder surgical trauma. LG is also less adversely affected by increased BMI.

Although surgical outcomes of totally laparoscopic total gastrectomy (TLTG) have been reported from several centers, the effectiveness of this technique has not been conclusively established. The aim of this study was to investigate the feasibility, safety, and efficacy of TLTG for gastric cancer.A prospectively collected and retrospectively analyzed data were used by comparing the short-term surgical outcomes of 124 patients who underwent TLTG with those of 124 patients who underwent open total gastrectomy (OTG) between March 2007 and March 2016.The 2 groups were well matched with respect to age, sex, body mass index, ASA score, and tumor stage. There was no significant difference with regard to the operation time but TLTG showed significantly less intraoperative blood loss (115.5 ± 70.2 vs 210.5 ± 146.7 mL, P < .01). Total numbers of retrieved lymph nodes were similar in the 2 groups. Postoperatively, no significant differences were found for morbidity or mortality. The time to first flatus, initiate oral intake, and postoperative hospital stay were significantly shorter in the TLTG group than in the OTG group (3.2 ± 1.0 vs 4.1 ± 1.2 days; 4.4 ± 1.2 vs 5.6 ± 2.0 days; and 8.9 ± 3.1 vs 11.3 ± 4.5 days, respectively; P < .01).TLTG for gastric cancer is technically safe, feasible, and minimally invasive compared with OTG. A prospective randomized trial is needed to establish the value of TLTG.

Background: Laparoscopic resections for submucosal tumors (SMTs) of the stomach have been developed rapidly over the past decade. Several types of laparoscopic methods for gastric SMTs have been created. We assessed the short-term outcomes of two commonly used types of laparoscopic local resection (LLR) for gastric SMTs and reported our findings., Methods: We retrospectively analyzed the clinicopathological results of 266 patients with gastric SMTs whom underwent LLR between January 2006 and September 2016. 228 of these underwent laparoscopic exogastric wedge resection (LEWR), the remaining 38 patients with the tumors near the esophagogastric junction (EGJ) or antrum underwent laparoscopic transgastric resection (LTR)., Results: All the patients underwent laparoscopic resections successfully. The mean operation times of LEWR and LTR were 90.2 ± 37.2 min and 101.7 ± 38.5 min respectively. The postoperative length of hospital stays for LEWR and LTR were 5.1 ± 2.1 days and 5.3 ± 1.7 days respectively. There was a low complication rate (4.4%) and zero mortality in our series., Conclusion: ELWR is technically feasible therapy of gastric SMTs. LTR is secure and effective for gastric intraluminal SMTs located near the EGJ or antrum.

Objective: This study was designed to investigate the expression patterns of CEACAM1 and its relationship with angiogenesis in nonneoplastic and neoplastic gastric lesions., Methods: CEACAM1 and TGF-β expression was detected by immunohistochemical staining and dual-labeling immunohistochemical staining in neoplastic and nonneoplastic lesions. MVD-CD31 and MVD-CD105 were counted in CEACAM1-positive areas by dual-labeling immunohistochemistry., Results: There was no expression of CEACAM1 in normal gastric mucosa. In IM and GIN, CEACAM1 was mainly expressed with membranous pattern. CEACAM1 was expressed with membranous pattern in well-differentiated adenocarcinoma, with cytoplasmic pattern in poorly differentiated adenocarcinoma, and with cytoplasmic and membranous pattern mixed together in intermediately adenocarcinoma. The expression patterns of CEACAM1 showed a significant difference (P < 0.05) in nonneoplastic and neoplastic lesions. Coexpression of CEACAM1 and TGF-β was elevated and significantly different from nonneoplastic to neoplastic lesions (P < 0.05). Moreover, CEACAM1 and TGF-β coexpression were related to carcinoma progression (r = 0.35; P < 0.05). MVD-CD31 and MVD-CD105 showed significant differences from nonneoplastic to neoplastic lesions (P < 0.05)., Conclusions: CEACAM1 has different expression patterns in nonneoplastic and neoplastic lesions. The coexpression of CEACAM1 and TGF-β increased from nonneoplastic to neoplastic lesions and may be related with tumor progression via promoting tumorous angiogenesis.

The aim of this study was to investigate the expression of Nrf2 and IGF-1 in benign, premalignant, and malignant gastric lesions, and to explore the role of Nrf2 and IGF-1 in gastric carcinoma carcinogenesis. Nrf2 and IGF-1 expression was detected in normal gastric mucosa, hyperplastic polyp, intraepithelial neoplasia, and adenocarcinoma by immunohistochemistry. There was no expression of Nrf2 and IGF-1 in normal gastric mucous membrane. With the elevation of Nrf2, IGF-1 expression, their co-expressions were highly elevated from benign proliferative lesions to malignant lesions. There were significant differences between hyperplastic polyps, intraepithelial neoplasias, and adenocarcinoma (hyperplastic polys vs. intraepithelial neoplasia: P=0.012; hyperplastic polyps vs. adenocarcinoma: P=0.023; and intraepithelial neoplasia vs. adenocarcinoma: P=0.027; hyperplastic polyps vs. adenocarcinoma: P=0.0000, respectively). Nrf2 expression and IGF-1 expression were correlated positively (r=0.337, P=0.037). The increased expression of Nrf2 and IGF-1 may be related to gastric carcinogenesis. Elevated Nrf2 and IGF-1 may play important roles in promoting tumor progression., (Copyright © 2011. Published by Elsevier GmbH.)

The purpose of this study was to investigate the expression of carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) and its effects on promoting angiogenesis in gastric adenocarcinomas. Paraffin wax sections of 222 patients with gastric adenocarcinomas having undergone surgery between 2001 and 2006 were classified into three histotypes: intestinal, diffuse, and mixed carcinomas following the Laurén classification. Immunohistochemistry (IHC) was used to study the distribution of CEACAM1, and double-labeling immunohistochemistry was used to observe the relationship between CEACAM1 expression and neovascularization in carcinoma areas. No CEACAM1 expression was found in normal non-metaplastic mucosa adjacent to the tumors; but in metaplastic mucosa, CEACAM1 was expressed on the apical surface. However, all of the collected gastric carcinomas expressed CEACAM1 with cytoplasmic or membranous staining. CEACAM1 was expressed mainly with a membranous pattern in the intestinal carcinomas, and with a cytoplasmic pattern in the diffuse carcinomas. There was a significant difference between the expression patterns and the histotypes (P<0.0001). CEACAM1 expression was classified as high (> or =66% positive cells) and low (<66% positive cells), and high CEACAM1 expression was associated with lymph nodes metastasis (P<0.05). High microvessel density (MVD) was observed more frequently in the tumors with membranous expression, and low MVD in the tumors with cytoplasmic staining (P<0.0001). The transformation of CEACAM1 distribution from membrane to cytoplasm is an important incident for the reverse effects on the tumorous angiogenesis, and high expression of CEACAM1 facilitates the metastasis of carcinoma cells to lymph nodes. Moreover, the different distribution of CEACAM1 in the intestinal and diffuse carcinomas indicates a different tumorigenic pathway.