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Background: Although laparoscopy is widely used in oncologic digestive surgery, many centers are still reluctant to replace open surgery for gastric cancer treatment, especially in advanced disease. The aim of this study was to assess long-term survival and recurrence in patients after laparoscopic (LG) versus open (OG) oncological gastrectomy, in a tertiary reference center., Methods: All consecutive patients with gastric adenocarcinoma undergoing curative gastrectomy between December 2007 and December 2021 were retrospectively analyzed. Clinico-pathological characteristics, survival and recurrence were compared among LG, OG or converted (CoG) patients. The ×2 test was used for categorical variables and the Mann-Whitney U test for continuous ones. Survival was assessed with the Kaplan-Meier method and log-rank test, as well as a multivariable Cox regression analysis., Results: Among 156 included patients, 49 (31.4 ​%) were in the LG group, 93 (59.6 ​%) in the OG group, and 14 (9 ​%) in the CoG group. Baseline demographics were similar among the groups. R0 resection rates were 75.5 ​% in LG, 80.6 ​% in OG, and 64.3 ​% in CoG (p ​= ​0.489). Open surgery was associated with a higher mean lymph node yield (28.4 ​± ​11.6) compared to LG (22.8 ​± ​9.7) and CoG (26.5 ​± ​12.3, p ​= ​0.036). Severe postoperative complications were higher in the CoG group (64.3 ​% CoG versus 29 ​% OG, 32.7 ​% LG, p ​= ​0.035). The CoG group had a significantly inferior disease-free survival (p ​= ​0.012 vs OG, p ​= ​0.003 vs LG; 53.3 ​% OG, 62.7 ​% LG and 28.1 ​% CoG) although overall survival was similar (57.1 ​% OG, 62.7 ​% LG and 32.7 ​% CoG, all p ​> ​0.005)., Conclusions: Laparoscopic gastrectomy, while associated with a lower lymph node yield, provides similar overall survival rates compared to open surgery. Conversion to open surgery was associated with higher major postoperative morbidity and inferior disease-free survival., Competing Interests: Declaration of interest statement The authors listed below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership; employment; consultancies; stock ownership; or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: According to current international guidelines, stage cT2N0M0 gastric adenocarcinoma warrants preoperative chemotherapy followed by surgery. However, upfront surgery is often preferred in clinical practice, depending on patient clinical status and local treatment preferences., Objective: The aim of the present study was to assess the impact of neoadjuvant chemotherapy in overall survival (OS) and disease-free survival (DFS) of cT2N0M0 patients., Methods: A retrospective analysis was performed among 32 centers, including gastric adenocarcinoma patients operated between January 2007 and December 2017. Patients with cT2N0M0 stage were divided into upfront surgery (S) and neoadjuvant chemotherapy followed by surgery (CS) groups. Inverse probability of treatment weighting (IPTW) was used to compensate for baseline differences between the groups., Results: Among the 202 patients diagnosed with cT2N0M0 stage, 68 (33.7%) were in the CS group and 134 (66.3%) were in the S group. CS patients were younger (mean age 62.7 ± 12.8 vs. 69.8 ± 12.1 years for S patients; p < 0.001) and had a better health status (World Health Organization performance status = 0 in 60.3% of CS patients vs. 34.5% of S patients; p = 0.006). During follow-up, recurrence occurred in 27.2% and 19.6% of CS and S patients, respectively, after IPTW (p = 0.32). Five-year OS was similar between CS and S patients (78.9% vs. 68.3%; p = 0.42), as was 5-year DFS (70.4% vs. 68.5%; p = 0.96). Neoadjuvant chemotherapy was associated with neither OS nor DFS in multivariable analysis after IPTW., Conclusions: Patients with cT2N0M0 gastric adenocarcinoma did not present a survival or recurrence benefit if treated with perioperative chemotherapy followed by surgery as opposed to surgery alone., (© 2024. The Author(s).)

Purpose: Perioperative chemotherapy combined with surgical resection represent the gold standard in the treatment of locally advanced gastric cancer. The Mandard tumor regression score (TRG) is widely used to evaluate pathological response to neoadjuvant treatment. The aim of this study was to assess the prognostic value of TRG in terms of overall survival (OS) and disease-free (DFS)., Methods: Retrospective analysis of all consecutive patients who underwent oncological gastrectomy after neoadjuvant chemotherapy from January 2007 to December 2019 for gastric adenocarcinoma was performed. Based on their TRG status they were categorized into two groups: good responders (TRG 1-2) and poor responders (TRG 3-5). Subsequent multivariable analyses were conducted., Results: Seventy-four patients were included, whereby 15 (20.3%) were TRG 1-2. Neoadjuvant regimens for TRG 1-2 vs. TRG 3-5 were similar: MAGIC (53% vs. 39%), FLOT (40% vs. 36%), FOLFOX (7% vs. 15%, p = 0.462). Histologic types according to Lauren classification for TRG 1-2 vs. TRG 3-5 were: 13% vs. 29% intestinal, 53% vs. 44% diffuse and 34% vs. 27% indeterminate (p = 0.326). TRG 1-2 group exhibited significantly less advanced ypT (46% vs. 10%, p = 0.001) and ypN stages (66% vs. 37%, p = 0.008), alongside a diminished recurrence rate (20% vs. 42%, p = 0.111). The 3-year DFS was significantly better in this group (81% vs. 47%, p = 0.041) whereas the disparity in three-year OS (92% vs. 55%, p = 0.054) did not attain statistical significance., Conclusions: TRG 1-2 was associated with less advanced ypT and ypN stage and better DFS compared to TRG 3-5 patients, without a significant impact on OS., (© 2024. The Author(s).)

Although protein malnutrition (PM) is often reported after highly malabsorptive procedures, its exact incidence and mechanisms after Roux-en-Y gastric bypass (RYGB) are poorly understood. The aim of this study was to present a challenging clinical case of PM after RYGB and conduct a scoping review of the literature. Among the 18 studies with 3015 RYGB patients included in the review, the median incidence of PM was 1.7% (range, 0%-8.9%), and it was diagnosed 12 to 120 months after RYGB. The most common cause is insufficient oral intake of protein; however, in cases of persistent hypoalbuminemia, a thorough diagnostic workup needs to be performed. Risk factors for PM after RYGB include specific triggering events such as intractable vomiting and dysphagia, and a total alimentary limb length less than 250 to 300 cm., (Copyright © 2022 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Gastric adenocarcinoma remains associated with a poor long-term survival, despite recent therapeutical advances. In most parts of the world where systematic screening programs do not exist, diagnosis is often made at advanced stages, affecting long-term prognosis. In recent years, there is increasing evidence that a large bundle of factors, ranging from the tumor microenvironment to patient ethnicity and variations in therapeutic strategy, play an important role in patient outcome. A more thorough understanding of these multi-faceted parameters is needed in order to provide a better assessment of long-term prognosis in these patients, which probably also require the refinement of current staging systems. This study aims to review existing knowledge on the clinical, biomolecular and treatment-related parameters that have some prognostic value in patients with gastric adenocarcinoma.