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Background and objectives: To detect the risk factors associated with esophagojejunal anastomotic leakage (EJAL) after total gastrectomy for gastric and Siewert type II/III esophagogastric cancer. Methods: The data for 609 patients underwent Roux-en-Y esophagojejunostomy after total gastrectomy between March 2015 and March 2021 were reviewed. Univariate and multivariate analyses were performed to evaluate the risk factors. Results: EJAL was observed in 48 (7.9%) of 609 patients. Univariate analysis revealed that gender, the number of comorbidities (hypertension, diabetes mellitus, coronary heart disease and chronic obstructive pulmonary disease), postoperative serum albumin, tumor location, duration of operation were risk factors associated with EJAL. Patients who had the following factors including male, the number of comorbidities ≥2, postoperative serum albumin <35 g/L, tumor location was esophagogastric junction, duration of operation ≥260 min were more likely to develop EJAL than those who had not. Multivariate analysis revealed that the number of comorbidities (OR 3.464, 95% CI 1.178 – 10.189, p = 0.024) and duration of operation (OR 2.657, 95% CI 1.242 – 5.685, p = 0.012) were independent risk factors associated with EJAL. Conclusions: More morbidities and prolonged operative duration were independently associated with EJAL after total gastrectomy for gastric and Siewert type II/III esophagogastric cancer. This study indicated the necessity for careful management of these high-risk patients. [ABSTRACT FROM AUTHOR]

Gastric cancer (GC) treatment is increasingly undergoing laparoscopic total gastrectomy (LTG) procedures. However, we conducted this research to evaluate postoperative outcomes, particularly surgical complications associated with intracorporeal and extracorporeal esophagojejunostomies using linear or circular stapling techniques following LTG for GC treatment. We aimed to compare short-term postoperative outcomes, such as surgical complications and anastomotic outcomes, between the two groups. Method From January 2020 to August 2022, we conducted a retrospective analysis of data from 160 consecutive patients diagnosed with GC who received either IEJ (n = 35) or EEJ (n = 125) during LTG. We utilized the Mann–Whitney U test to ascertain the statistical significance between the two groups. For comparing categorical variables, including numbers and percentages, we employed either the Pearson chi-square test, continuity correction, or Fisher's exact test as appropriate. Results The operative time was similar (IEJ: 184.57 ± 36.489 vs. EEJ: 189.22 ± 43.584; P = 0.565), however, the number of positive lymph nodes was performed more in the IEJ group (IEJ: 4.71 ± 6.114 vs. EEJ: 6.39 ± 9.067 (P = 0.305). The blood loss in the IEJ group was lower than that of the EEJ (IEJ: 73.1429.182 vs. EEJ: 100.6461.693 mL, P = 0.012). There were three anastomosis leakages in the EEJ and one in the IEJ group (EEJ, 3.2% vs. IEJ, 2.8%; P > 0.999). Anastomosis bleeding only occurred in the EEJ (EEJ 1%; P = 0.003). Although the EEJ linear stapling technique had two deaths (EEJ, 1.6%). Conclusion Although EEJ is frequently utilized in the linear stapling technique, research indicates that the use of IEJ minimizes the incidence of complications in LTG. [ABSTRACT FROM AUTHOR]

Objective: The safety of proximal gastrectomy (PG) for the treatment of advanced Siewert II adenocarcinoma of the esophagogastric junction (AEG) remains debatable. In this study, we aim to evaluate the oncological safety of PG and the metastasis rate of key distal lymph node dissection, which is typically excluded in PG. Method: This study retrospective collected advanced Siewert II AEG patients who underwent gastrectomy at the First Medical Center of the General Hospital of the People's Liberation Army (PLA) from January 2014 to December 2019. A total of 421 patients were enrolled, including 237 PG and 184 total gastrectomy (TG). Propensity score matching (PSM) in a 1:1 ratio was performed to reduce the influence of confounding variables. Results: After PSM, 153 cases were matched in each group. The TG group had longer operation time, more lymph node detection and longer postoperative hospitalization time than the PG group (Both P < 0.05). The postoperative complications of the two groups were not statistically significant (P > 0.05). For long-term complications, the incidence of reflux esophagitis and anastomotic stenosis were significantly higher in the PG group than in the TG group (Both P < 0.05), but dumpling syndrome and anemia were significantly lower in the PG group compared to the TG group (Both P < 0.05). The 3-year overall survival (OS) and disease-free survival (DFS) between the two groups were no statistically significant difference (OS: 77.4% and 80.9%, P = 0.223; DFS: 69.7% and 76.1%, P = 0.063). Distal lymph node metastasis rates for No.4d, 5, and 6 were all less than 5%, and the therapeutic value index were also relatively low, with values of 1.09%, 3.26%, and 1.45%, respectively. In addition, the distal No.4d, 5, or No.6 lymph node metastasis rates were significantly higher in patients with tumor size ≥ 4 cm and T4 stage (14.29% and 23.40%) than in patients with tumor size < 4 cm and T2-3 (2.78% and 5.11%) (Both P < 0.05). The results of subgroup survival analysis showed that for patients with tumor size ≥ 4 cm or T4 stage, the TG group had better DFS compared with the PG group (HR 0.618, 0.387–0.987, P = 0.044), while no significant survival benefits were observed in other subgroups. Conclusion: In summary, for Siewert II AEG with tumor size < 4 cm and T2-3 stage, PG may be a reasonable choice with comparable oncological efficacy to TG. But for higher survival benefits, TG remains gold standard particularly for patients with tumor size ≥ 4 cm or T4 stage. [ABSTRACT FROM AUTHOR]

Background: Little information is available from prospective clinical trials on the influences of surgical approaches on postoperative quality of life (QOL). We aimed to prospectively compare chronological changes in postoperative body weight and QOL between laparoscopic and open total gastrectomy for stage I gastric cancer (GC). Methods: We conducted a multi‐institutional prospective study (CCOG1504) of patients who undergo laparoscopic or open total gastrectomy. Body weight was measured at the baseline and at the 1st, 2nd, and 3rd postoperative years (POY). QOL using the European Organization for Research and Treatment of Cancer quality of life questionnaire‐C30 (EORTC QLQ‐C30) and the Post‐Gastrectomy Syndrome Assessment Scale‐37 (PGSAS‐37) questionnaires were measured at the baseline and at the 1st, 3rd, 6th, 12th, and 36th postoperative months (POM). Results: We enrolled 84 patients from 15 institutions, and finally 43 patients for the laparoscopic group and 16 for the open group were eligible for data analysis. There were no significant differences in body weight change between the two groups. The role functioning score among the EORTC QLQ‐C30 tended to be higher (i.e., better QOL) in the laparoscopic group at POM 1 and 12 after surgery compared to the open group. The dissatisfaction at working score among the PGSAS‐37 at 1 month after surgery was lower (i.e. better QOL) in the laparoscopic group compared to the open group. Conclusions: The results of CCOG1504 indicated that laparoscopic approach for total gastrectomy was associated with a more favorable dissatisfaction at working score (PGSAS‐37). [ABSTRACT FROM AUTHOR]

Simple Summary: Minimally invasive approaches to total gastrectomy (TG) are gaining acceptance worldwide for the treatment of gastric cancer. Previous studies comparing short-term results were limited by pairwise comparisons and the inclusion of both total and distal gastrectomy. The present analysis aimed to compare the short-term outcomes of different techniques for TG comprehensively in the setting of GC. Lap-assisted TG (LATG), totally laparoscopic TG (TLTG), and robotic TG (RTG) seem to be associated with a lower overall complications rate and improved short-term functional outcomes compared to open TG (OTG). Severe postoperative complications and anastomotic leak seem comparable across techniques. Our findings support the adoption of minimally invasive TG techniques in the surgical management of gastric cancer. Background/Objectives: Total gastrectomy (TG) is the cornerstone treatment for gastric cancer (GC). While open TG (OTG) with D2 lymphadenectomy remains the gold standard, alternative techniques such as lap-assisted TG (LATG), totally laparoscopic TG (TLTG), and robotic TG (RTG) have been reported with promising outcomes. The present analysis aimed to compare the short-term outcomes of different techniques for TG comprehensively in the setting of GC. Methods: A systematic review and network meta-analysis were performed. The primary outcomes were overall complications (OC), severe postoperative complications (SPCs), and anastomotic leak (AL). Pooled effect-size measures included risk ratio (RR), weighted mean difference (WMD), and 95% credible intervals (CrIs). Results: Sixty-eight studies (44,689 patients) were included. Overall, 52.4% underwent OTG, 6.5% LATG, 39.2% TLTG, and 1.9% RTG. Both TLTG (RR 0.82; 95% CrI 0.73–0.92) and RTG (RR 0.75; 95% CrI 0.59–0.95) showed a reduced rate of postoperative OC compared to OTG. SPCs and AL RR were comparable across all techniques. Despite the longer operative time, LATG, TLTG, and RTG showed reduced intraoperative blood loss, time to first flatus, ambulation, liquid diet resumption, and hospital stay compared to OTG. Conclusions: Minimally invasive approaches seem to be associated with improved OC and functional outcomes compared to OTG. [ABSTRACT FROM AUTHOR]

Abstract Gastric cancer (GC) treatment is increasingly undergoing laparoscopic total gastrectomy (LTG) procedures. However, we conducted this research to evaluate postoperative outcomes, particularly surgical complications associated with intracorporeal and extracorporeal esophagojejunostomies using linear or circular stapling techniques following LTG for GC treatment. We aimed to compare short-term postoperative outcomes, such as surgical complications and anastomotic outcomes, between the two groups. Method From January 2020 to August 2022, we conducted a retrospective analysis of data from 160 consecutive patients diagnosed with GC who received either IEJ (n = 35) or EEJ (n = 125) during LTG. We utilized the Mann–Whitney U test to ascertain the statistical significance between the two groups. For comparing categorical variables, including numbers and percentages, we employed either the Pearson chi-square test, continuity correction, or Fisher's exact test as appropriate. Results The operative time was similar (IEJ: 184.57 ± 36.489 vs. EEJ: 189.22 ± 43.584; P = 0.565), however, the number of positive lymph nodes was performed more in the IEJ group (IEJ: 4.71 ± 6.114 vs. EEJ: 6.39 ± 9.067 (P = 0.305). The blood loss in the IEJ group was lower than that of the EEJ (IEJ: 73.1429.182 vs. EEJ: 100.6461.693 mL, P = 0.012). There were three anastomosis leakages in the EEJ and one in the IEJ group (EEJ, 3.2% vs. IEJ, 2.8%; P > 0.999). Anastomosis bleeding only occurred in the EEJ (EEJ 1%; P = 0.003). Although the EEJ linear stapling technique had two deaths (EEJ, 1.6%). Conclusion Although EEJ is frequently utilized in the linear stapling technique, research indicates that the use of IEJ minimizes the incidence of complications in LTG.

Abstract Objective The safety of proximal gastrectomy (PG) for the treatment of advanced Siewert II adenocarcinoma of the esophagogastric junction (AEG) remains debatable. In this study, we aim to evaluate the oncological safety of PG and the metastasis rate of key distal lymph node dissection, which is typically excluded in PG. Method This study retrospective collected advanced Siewert II AEG patients who underwent gastrectomy at the First Medical Center of the General Hospital of the People’s Liberation Army (PLA) from January 2014 to December 2019. A total of 421 patients were enrolled, including 237 PG and 184 total gastrectomy (TG). Propensity score matching (PSM) in a 1:1 ratio was performed to reduce the influence of confounding variables. Results After PSM, 153 cases were matched in each group. The TG group had longer operation time, more lymph node detection and longer postoperative hospitalization time than the PG group (Both P 0.05). For long-term complications, the incidence of reflux esophagitis and anastomotic stenosis were significantly higher in the PG group than in the TG group (Both P

Abstract Background Little information is available from prospective clinical trials on the influences of surgical approaches on postoperative quality of life (QOL). We aimed to prospectively compare chronological changes in postoperative body weight and QOL between laparoscopic and open total gastrectomy for stage I gastric cancer (GC). Methods We conducted a multi‐institutional prospective study (CCOG1504) of patients who undergo laparoscopic or open total gastrectomy. Body weight was measured at the baseline and at the 1st, 2nd, and 3rd postoperative years (POY). QOL using the European Organization for Research and Treatment of Cancer quality of life questionnaire‐C30 (EORTC QLQ‐C30) and the Post‐Gastrectomy Syndrome Assessment Scale‐37 (PGSAS‐37) questionnaires were measured at the baseline and at the 1st, 3rd, 6th, 12th, and 36th postoperative months (POM). Results We enrolled 84 patients from 15 institutions, and finally 43 patients for the laparoscopic group and 16 for the open group were eligible for data analysis. There were no significant differences in body weight change between the two groups. The role functioning score among the EORTC QLQ‐C30 tended to be higher (i.e., better QOL) in the laparoscopic group at POM 1 and 12 after surgery compared to the open group. The dissatisfaction at working score among the PGSAS‐37 at 1 month after surgery was lower (i.e. better QOL) in the laparoscopic group compared to the open group. Conclusions The results of CCOG1504 indicated that laparoscopic approach for total gastrectomy was associated with a more favorable dissatisfaction at working score (PGSAS‐37).

Abstract Background This study was conducted to investigate the long-term outcomes of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) in patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NACT). Methods Patients with AGC who received NACT before surgery were enrolled in either the LTG or OTG group. Propensity score matching (PSM) (1:2) was performed between the two groups based on the propensity score using a 0.15 calliper width. Three-year overall survival (OS) and disease-free survival (DFS) were compared between these two groups before and after PSM. OS and DFS rates were calculated by the Kaplan‒Meier method, and any differences in survival were evaluated with a log-rank test. Univariate and multivariate Cox proportional hazards analyses were used to estimate the simultaneous effects of prognostic factors on survival and the hazard ratio (HR) between LTG and OTG patients. Results A total of 144 patients completed the follow-up, with 24 patients in the LTG group and 120 patients in the OTG group. After a mean follow-up of 64.40 months, there were no significant differences in the 3-year OS or DFS rates between the two groups before (P = 0.453 and P = 0.362, respectively) or after PSM (P = 0.972 and P = 0.884, respectively). Multivariate Cox proportional hazards analysis indicated that ypN stage was an independent risk factor for worse OS (P = 0.013). Conclusions This study showed that LTG with D2 lymphadenectomy performed by an experienced surgical team resulted in comparable 3-year OS and DFS compared with OTG in patients with AGC after NACT. Trial registration This study is not registered.

Abstract This study compared the surgical outcomes and long-term prognosis of intracorporeal and extracorporeal esophagojejunostomy after laparoscopic total gastrectomy (LTG) for gastric cancer patients. In total 228 clinical stage I gastric cancer patients undergoing LTG were enrolled from January 2012 and December 2022. Each case in the totally laparoscopic total gastrectomy (TLTG) group was 1:1 propensity score-matched to control cases in the laparoscopy-assisted total gastrectomy (LATG) group. In total, 95 and 93 LATG and TLTG patients were included after propensity score matching (PSM). Clinicopathological features, surgical outcomes, and survival variables were compared, and risk factors for postoperative complications were analyzed. Patient characteristics were well balanced between the LATG and TLTG groups after PSM. The TLTG group showed less blood loss, decreased frequency of analgesic use, and shorter duration of analgesic use. The TLTG group had significantly lower rates of intestinal obstruction and surgical site infection. Larger tumor size and advanced pTNM stage were independent risk factors for postoperative complications. There was no significant difference in overall survival (OS). Compared with LATG, TLTG was associated with better surgical outcomes and fewer postoperative surgical complications in gastric cancer patients although there was no significant difference in OS.

Esophagojejunal varices occurring after total gastrectomy are rare but potentially fatal in cases of variceal bleeding. Owing to their rarity, treatment strategies for this condition are not well established. Here, we describe the case of a 48-year-old woman who presented with hematemesis and melena. Four years prior, she underwent a total gastrectomy for gastric cancer. Esophagojejunal variceal bleeding supplied by a dilated jejunal vein, along with liver cirrhosis, was diagnosed as per endoscopy and computed tomography findings. Initial attempts at endoscopic therapy were unsuccessful. Subsequently, transjugular intrahepatic portosystemic shunt placement was performed to reduce the portal pressure gradient, resulting in the cessation of bleeding. At the 1-month follow-up endoscopy, the varices had resolved, and no rebleeding occurred during 6 months of follow-up. Transjugular intrahepatic portosystemic shunt placement may be considered as an effective treatment option for esophagojejunal variceal bleeding.

Abstract Background The usefulness of high-resolution impedance manometry (HRIM) in patients who underwent total gastrectomy with Roux-en-Y (R-Y) anastomosis has never been well validated. This study aimed to investigate whether intraesophageal pressure affects quality of life in patients who underwent total gastrectomy with R-Y anastomosis. Methods The participants comprised 12 patients who underwent total gastrectomy for gastric cancer between October 2014 and July 2022 and underwent a postsurgical HRIM examination. The association between the HRIM data and Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaires was analyzed. Results Esophageal body motility was normal in almost all patients. The anastomosis shape (circular stapler and overlap method with linear stapler) did not influence intraesophageal pressure. The integrated relaxation pressure and lower esophageal sphincter (LES) residual pressure during swallowing-induced relaxation were involved in “diarrhea subscale” scores (p = 0.0244 and p = 0.0244, respectively). The average maximum intrabolus pressure was not involved in postgastrectomy symptom. The contractile front velocity correlated with the “indigestion subscale,” “diarrhea subscale,” and “constipation subscale” (p = 0.0408, p = 0.0143, and p = 0.0060, respectively). The distal latency, i.e., the time from upper esophageal sphincter relaxation to contractile deceleration, was also associated with the “abdominal pain subscale” (p = 0.0399). LES pressure and esophageal body motility affected patients’ quality of life after total gastrectomy. Conclusions HRIM for the evaluation of intraesophageal pressure is useful for the functional assessment of esophagojejunostomy with the R-Y reconstruction after total gastrectomy.

Background: This study was conducted to investigate the long-term outcomes of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) in patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NACT). Methods: Patients with AGC who received NACT before surgery were enrolled in either the LTG or OTG group. Propensity score matching (PSM) (1:2) was performed between the two groups based on the propensity score using a 0.15 calliper width. Three-year overall survival (OS) and disease-free survival (DFS) were compared between these two groups before and after PSM. OS and DFS rates were calculated by the Kaplan‒Meier method, and any differences in survival were evaluated with a log-rank test. Univariate and multivariate Cox proportional hazards analyses were used to estimate the simultaneous effects of prognostic factors on survival and the hazard ratio (HR) between LTG and OTG patients. Results: A total of 144 patients completed the follow-up, with 24 patients in the LTG group and 120 patients in the OTG group. After a mean follow-up of 64.40 months, there were no significant differences in the 3-year OS or DFS rates between the two groups before (P = 0.453 and P = 0.362, respectively) or after PSM (P = 0.972 and P = 0.884, respectively). Multivariate Cox proportional hazards analysis indicated that ypN stage was an independent risk factor for worse OS (P = 0.013). Conclusions: This study showed that LTG with D2 lymphadenectomy performed by an experienced surgical team resulted in comparable 3-year OS and DFS compared with OTG in patients with AGC after NACT. Trial registration: This study is not registered. [ABSTRACT FROM AUTHOR]

Background: The usefulness of high-resolution impedance manometry (HRIM) in patients who underwent total gastrectomy with Roux-en-Y (R-Y) anastomosis has never been well validated. This study aimed to investigate whether intraesophageal pressure affects quality of life in patients who underwent total gastrectomy with R-Y anastomosis. Methods: The participants comprised 12 patients who underwent total gastrectomy for gastric cancer between October 2014 and July 2022 and underwent a postsurgical HRIM examination. The association between the HRIM data and Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaires was analyzed. Results: Esophageal body motility was normal in almost all patients. The anastomosis shape (circular stapler and overlap method with linear stapler) did not influence intraesophageal pressure. The integrated relaxation pressure and lower esophageal sphincter (LES) residual pressure during swallowing-induced relaxation were involved in "diarrhea subscale" scores (p = 0.0244 and p = 0.0244, respectively). The average maximum intrabolus pressure was not involved in postgastrectomy symptom. The contractile front velocity correlated with the "indigestion subscale," "diarrhea subscale," and "constipation subscale" (p = 0.0408, p = 0.0143, and p = 0.0060, respectively). The distal latency, i.e., the time from upper esophageal sphincter relaxation to contractile deceleration, was also associated with the "abdominal pain subscale" (p = 0.0399). LES pressure and esophageal body motility affected patients' quality of life after total gastrectomy. Conclusions: HRIM for the evaluation of intraesophageal pressure is useful for the functional assessment of esophagojejunostomy with the R-Y reconstruction after total gastrectomy. [ABSTRACT FROM AUTHOR]

Background and objectivesTo detect the risk factors associated with esophagojejunal anastomotic leakage (EJAL) after total gastrectomy for gastric and Siewert type II/III esophagogastric cancer.MethodsThe data for 609 patients underwent Roux-en-Y esophagojejunostomy after total gastrectomy between March 2015 and March 2021 were reviewed. Univariate and multivariate analyses were performed to evaluate the risk factors.ResultsEJAL was observed in 48 (7.9%) of 609 patients. Univariate analysis revealed that gender, the number of comorbidities (hypertension, diabetes mellitus, coronary heart disease and chronic obstructive pulmonary disease), postoperative serum albumin, tumor location, duration of operation were risk factors associated with EJAL. Patients who had the following factors including male, the number of comorbidities ≥2, postoperative serum albumin

Abstract Objective To investigate the potential of group I pepsinogen (PG I) and group II pepsinogen (PG II) as diagnostic markers for recurrence in gastric cancer (GC) patients post-total gastrectomy. Methods Ninety-six patients who underwent total gastrectomy for GC between June 2022 and June 2023 were included in this study. Clinical data, serum samples, and ascites samples were collected. Patients were categorized based on recurrence status at the time of sample collection and the primary tumor site. PG I and PG II levels were determined using a chemiluminescent immunoassay, and their clinical utility following total gastrectomy for GC was evaluated via receiver operating characteristic (ROC) curve analysis. Results This study included 96 GC patients who underwent total gastrectomy, 55 of whom experienced postoperative recurrence (57.29%). The levels of serum PG I (27.86 (27.04, 30.97) vs. 26.05 (24.16, 27.09) ng/mL; P

Objective: To investigate the potential of group I pepsinogen (PG I) and group II pepsinogen (PG II) as diagnostic markers for recurrence in gastric cancer (GC) patients post-total gastrectomy. Methods: Ninety-six patients who underwent total gastrectomy for GC between June 2022 and June 2023 were included in this study. Clinical data, serum samples, and ascites samples were collected. Patients were categorized based on recurrence status at the time of sample collection and the primary tumor site. PG I and PG II levels were determined using a chemiluminescent immunoassay, and their clinical utility following total gastrectomy for GC was evaluated via receiver operating characteristic (ROC) curve analysis. Results: This study included 96 GC patients who underwent total gastrectomy, 55 of whom experienced postoperative recurrence (57.29%). The levels of serum PG I (27.86 (27.04, 30.97) vs. 26.05 (24.16, 27.09) ng/mL; P < 0.0001) and PG II (1.95 (1.23, 3.05) vs. 0.63 (0.47, 0.90) ng/mL; P < 0.0001) were significantly greater in the recurrent group compared to the non-recurrent group. The secretion of PG I and/or PG II by metastatic cancer cells correlated with the primary lesion site. When the cut-off value for serum PG I was 26.93 ng/mL, the area under the curve (AUC) for PG I was 0.77. When the cut-off value for serum PG II was 0.96 ng/mL, the AUC reached 0.90. The combined AUC was 0.97. Conclusion: These findings suggest that serum PG I and PG II are valuable biomarkers for identifying GC patients with biochemical recurrence post-total gastrectomy. [ABSTRACT FROM AUTHOR]

Multiport robots are now widely used for total gastrectomy for gastric cancer, while there is almost a void of research on whether single‐port (SP) robots can be used for total gastrectomy. Here, we report a case of a 75‐year‐old female patient who was diagnosed with gastric cardia adenocarcinoma by gastroscopy and underwent total gastrectomy assisted by the SHURUI SP robot. We successfully accomplished total gastrectomy and D2 lymph node dissection using the novel SP robotic platform. The patient was discharged from the hospital successfully with no complications during or after the surgery. Pathologic diagnosis showed adenocarcinoma of the gastric mucosa with partial signet‐ring cell carcinoma, and no metastasis was found in the 29 cleared lymph nodes. The use of the SHURUI SP robot for total gastrectomy in treating gastric cancer is both technically feasible and safe. [ABSTRACT FROM AUTHOR]

A meta‐analysis investigation was carried out to measure the wound infections (WIs) and other postoperative problems (PPs) of distal gastrectomy (DG) compared with total gastrectomy (TG) for gastric cancer (GC). A comprehensive literature investigation till February 2023 was used and 1247 interrelated investigations were reviewed. The 12 chosen investigations enclosed 2896 individuals with GC in the chosen investigations' starting point, 1375 of them were TG, and 1521 were DG. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were utilized to compute the value of the WIs and other PPs of DG compared with TG for GC by the dichotomous approaches and a fixed or random model. TG had significantly higher overall PP (OR, 1.58; 95% CI, 1.15–2.18, p = 0.005), WIs (OR, 1.69; 95% CI, 1.07–2.67, p = 0.02), peritoneal abscess (PA) (OR, 2.99; 95% CI, 1.67–5.36, p < 0.001), anastomotic leakage (AL) (OR, 1.90; 95% CI, 1.21–2.97, p = 0.005) and death (OR, 2.26; 95% CI, 1.17–4.37, p = 0.02) compared to those with DG in individuals with GC. TG had significantly higher overall PP, WIs, PA, AL and death compared to those with DG in individuals with GC. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta‐analysis. [ABSTRACT FROM AUTHOR]

ObjectiveCommon gastrectomy methods can significantly affect patients’ postoperative quality of life. This study investigated the safety, feasibility, and short-term efficacy of λ-type esophagojejunostomy in total gastrectomy under total laparoscopy.MethodsWe retrospectively analyzed the clinical and follow-up data of 50 patients with adenocarcinoma of the gastric/gastroesophageal junction who underwent total laparoscopic radical gastrectomy with λ-type esophagojejunostomy at the Beijing Friendship Hospital from January 2021 to July 2022. Data are reported as mean ± standard deviation.ResultsPatients comprised 27 males and 23 females, aged 42 to 76 (60.9 ± 5.6) years. There were 26 cases of gastroesophageal junction adenocarcinoma (16 Siewert type II and 10 Siewert type III) and 24 cases of adenocarcinoma of the proximal gastric body. All patients underwent radical total gastrectomy and D2 lymph node dissection with λ-type esophagojejunostomy for digestive tract reconstruction under total laparoscopy. The total operation time was 235–295 (249.4 ± 48.5) min, digestive tract reconstruction time was (48.2 ± 23.2) min, intraoperative blood loss was (63.4 ± 48.4) mL, recovery time of exhaust was (3.1 ± 2.2) d, first drinking or eating time was (4.1 ± 2.1) d, and hospital stay was (9.3 ± 4.4) d. Three patients had postoperative complications, including one with duodenal remnant leakage combined with abdominal infection. Anastomotic bleeding and postoperative inflammatory intestinal obstruction occurred in one patient each, all of whom were cured by conservative treatment. The Nutritional Risk Index of the whole group was 53.5 ± 8.4 preoperatively, 47.3 ± 5.6 one week postoperatively, 50.3 ± 5.6 six months postoperatively, and 52.4 ± 4.2 at 12 months postoperatively. Roux-en-Y stasis syndrome and bile reflux esophagitis occurred in one patient each (2.0%). There were no occurrences of recanalization of the closed end of the afferent loop of the esophagojejunostomy anastomosis, anastomotic stricture or obstruction, or tumor recurrence.Conclusionλ-type esophagojejunostomy is safe and feasible for digestive tract reconstruction after total laparoscopic radical gastrectomy. This digestive tract reconstruction method not only maintains intestinal continuity but also simplifies surgical procedures, allowing patients to recover quickly with an excellent short-term effect.

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

Abstract Background Recent advances in treatment are expected to bring a cure to more patients with gastric cancer (GC). Focusing on the risk of death from other diseases (DOD) has become a crucial issue in patients cured of GC. The aim of this study was to elucidate the risk factors for DOD in patients who underwent curative gastrectomy with lymph node dissection for GC. Methods We enrolled 810 patients who underwent curative gastrectomy with lymph node dissection for GC from January 1990 to December 2014 and had no recurrence or death of GC until December 2019. We investigated the risk factors for DOD defined as death excluding death from a malignant neoplasm, accident, or suicide after gastrectomy, focusing on the perioperative characteristics at gastrectomy. Results Among 315 deaths from any cause, 210 died from diseases other than malignancy, accidents and suicide. The leading cause of DOD was pneumonia in 54 patients (25.7%). The actual survival period in 167 patients (79.5%) with DOD was shorter than their estimated life expectancy at gastrectomy. Multivariate analysis revealed that a high Charlson Comorbidity Index score (score 1–2: hazard ratio [HR] 2.192, 95% confidence interval [CI] 1.713–2.804, P

Abstract Background Juvenile polyposis syndrome (JPS) is an autosomal dominant, inherited disorder characterized by multiple hyperproliferative polyps of the gastrointestinal tract, particularly of the colon, rectum, and stomach. SMAD4 mutations are frequently associated with multiple polyposis of the stomach; the condition causes severe bleeding and hypoproteinemia, which may progress to severe dysplasia and adenocarcinoma formation. We report our experience with the first case of total gastrectomy with pancreaticoduodenectomy following two partial jejunectomies for JPS, who presented with refractory anemia and protein-losing gastroenteropathy due to polyposis of the stomach and duodenum. Case presentation A 33-year-old Japanese man presented with the chief complaint of shortness of breath on exertion. His family history included gastric polyposis (mother, aunt, and cousin) and cerebral infarction (grandmother). Blood testing at the initial visit indicated iron-deficiency anemia, whereas endoscopy revealed multiple polyps in the duodenum and jejunum. Genetic testing revealed a 4 bp deletion (TGAA) in exon 5 of the SMAD4 gene; two partial small bowel resections were performed, but polyps grew in the remaining stomach, duodenum, and small intestine. The patient developed hypoalbuminemia and anemia, and required central venous nutrition and blood transfusion. However, because the hyponutrition and anemia remained poorly controlled, a total gastrectomy with concomitant pancreaticoduodenectomy was performed. Malnutrition and anemia improved, and there was no polyp recurrence in the remaining intestinal tract at 18 months after the surgery. Conclusions We report a case of JPS with refractory anemia and protein-losing gastroenteropathy that was treated with total gastrectomy with concomitant pancreaticoduodenectomy. Although the surgery was highly invasive, the patient’s nutritional status and anemia improved postoperatively, and the treatment was successful. However, to determine the appropriate surgical procedure, a detailed examination of the gastrointestinal lesions and the effects of the surgical invasion on nutritional status must be undertaken.

Background: Proximal gastrectomy (PG) has become an increasingly preferred procedure for treating early cancer in the upper third of the stomach. However, advantages of PG in postoperative quality of life (QOL) over total gastrectomy (TG) has not fully proven. Methods: We conducted a multi‐institutional prospective observational study (CCOG1602) of patients who undergo TG or PG for cStage I gastric cancer. We used the PGSAS‐37 and EORTC‐QLQ‐C30 to evaluate the changes in body weight and QOL over a 3‐year postoperative period. The primary endpoint was the weight loss rate 3 years after surgery. Results: We enrolled 109 patients from 18 institutions and selected 65 and 19 patients for inclusion in the TG and PG groups, respectively. Mean postoperative weight loss rates were 16.0% and 11.7% for the TG and PG groups, respectively (p = 0.056, Cohen's d 0.656) during postoperative year 1% and 15.0% and 10.8% for TG and PG (p = 0.068, Cohen's d 0.543), respectively, during postoperative year 3, indicating that the PG group achieved a better trend with a moderate effect size. According to the PGSAS‐37, the PG group experienced a better trend in the indigestion subscale (p < 0.001, Cohen's d −1.085) and total symptom score (p = 0.050, Cohen's d −0.59) during postoperative year 3 compared with the TG group. In contrast, the EORTC‐QLQ‐C30 detected no difference between the groups at any time point during 3‐year postoperative period. Conclusions: This prospective study demonstrates that PG tended to be more favorable compared with TG with respect to postoperative weight loss and QOL, particularly regarding indigestion. [ABSTRACT FROM AUTHOR]

Background: For gastric cancer with total gastrectomy, the usual laparoscopic surgical approaches are totally laparoscopic total gastrectomy (TLTG) and laparoscopic-assisted total gastrectomy (LATG). Due to its difficult anastomotic technique, the adoption of TLTG is limited. Therefore, surgeons prefer using LATG, which also led to TLTG being somewhat overlooked, so there is no clear conclusion today as to which surgical procedure is more favorable to the patient's recovery. This article aimed to compare the safety and short-term outcomes of the two surgical approaches. Materials and methods: Studies comparing TLTG and LATG, published up to December 2022, were searched in PubMed, Web of Science, and Embase databases. The study outcomes, including operative time, blood loss, anastomosis time, number of retrieved lymph nodes, proximal and distal resection margins, time to first fluid and soft diet, hospitalization duration, time to first flatus, and postsurgical and anastomotic complications, were compared between these two different surgical procedures. Statistics were analyzed with RevMan 5.4 and Stata 13.1. Results: Fifteen publications were included in this study. The total sample included 3023 cases. The meta-analysis revealed no significant difference in overall postoperative complications between the two surgical approaches (P>0.05). Compared with LATG, TLTG led to reduced intraoperative blood loss (P< 0.0001), an increased number of lymphatic node dissections (P<0.0001), and decreased hospitalization duration (P=0.002). However, operative time, anastomosis time, pulmonary infection, resection margins, time to first fluid and soft diet, time to first flatus and anastomosis-related complications were no significant difference between TLTG and LATG groups (P> 0.05). Conclusion: TLTG did not lead to an increase in overall postoperative complications, which is a reliable surgical approach for treatment of gastric cancer. Moreover, it may reduce harm to patients and enable them to obtain better surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: This study aimed to analyze and compare the short-term and long-term outcomes of proximal gastrectomy (PG) and total gastrectomy (TG) in patients with locally advanced proximal gastric cancer (GC) following neoadjuvant chemotherapy (NACT). Method: A multicenter retrospective cohort study and propensity score matching (PSM) were employed. The authors examined 367 patients with proximal GC who received NACT followed by PG (n =164) or TG (n=203) at two Chinese medical institutions between December 2009 and December 2022. Clinical and pathological parameters, postoperative complications, and 5-year overall survival (OS) and recurrence-free survival (RFS) were compared between the two groups. The dissection status and metastasis rate of each lymph node station were assessed. Results: After PSM, 80 patients were enrolled in both TG and PG group, and baseline characteristics were comparable between the groups (all P> 0.05). The TG group had a higher total number of lymph nodes retrieved (P<0.001) and longer operative time (P =0.007) compared to the PG group. The incidence of Clavien-Dindo grade II or higher postoperative complications was similar between the TG group (21.3%, 17/80) and the PG group (17.5%, 14/80) (P =0.689). The 5-year OS rates were 68.4 for the PG group and 66.0% for the TG group (P= 0.881), while the 5-year RFS rates were 64.8 and 61.9%, respectively (P= 0.571), with no statistically significant differences. Metastasis rates at lymph node stations #4d, #5, #6, and #12a were notably low in the TG group, with values of 2.74, 0.67, 1.33, and 1.74%, respectively. Conclusion: For proximal GC patients following NACT, PG maintains comparable curative potential and oncological efficacy to TG, making it a safe option. [ABSTRACT FROM AUTHOR]

Background: Gastric poorly cohesive carcinoma (PCC) in advanced stages has a poor prognosis. Total gastrectomy (TG) remains the common treatment for distal gastric PCC, but subtotal gastrectomy (SG) may improve quality of life without compromising outcomes. Currently, no clear recommendation on the best surgical strategy for distal PCC is available. This study aimed to compare overall survival (OS) and disease-free survival (DFS) at 5 years for patients with antropyloric PCC treated by total versus subtotal gastrectomy. Methods: A large retrospective European multicenter cohort study analyzed 2131 patients treated for gastric cancer between 2007 and 2017 by members of the French Association of Surgery (AFC). The study compared a group of patients who underwent TG with a group who underwent SG for antropyloric PCC. The primary outcomes were 5 year OS and DFS. Results: The study enrolled 269 patients: 140 (52.0%) in the TG group and 129 (48.0%) in the SG group. The baseline characteristics and pTNM stage were similar between the two groups. According to Dindo-Claven classification, the patients treated with TG had more postoperative complications than the patients treated with SG (p < 0.001): grades I to IIIa (77.1% vs 59.5%) and grades IIIb to IVb (14.4% vs 9.0%). No difference in 5-year OS was observed between TG (53.8%; 95 % confidence interval [CI], 43.2–63.3%) and SG (53.0%; 95% CI, 41.4–63.3%) (hazard ratio [HR], 0.94; 95% CI, 0.68–1.29). The same was observed for 5-year DFS: TG (46.0%; 95% CI, 35.9–55.5%) versus SG (45.3%; 95% CI, 34.3–55.6%) (HR, 0.97; 95% CI, 0.70–1.34). Conclusions: At 5 years, SG was not associated with worse OS and DFS than TG for distal PCC. Surgical morbidity was higher after TG. Subtotal gastrectomy is a valuable option for distal PCC gastric cancer. [ABSTRACT FROM AUTHOR]

Introduction: Despite the increasing performance of laparoscopic proximal gastrectomy (LPG) for proximal gastric cancer and esophagogastric junction cancer, the benefit of LPG over laparoscopic total gastrectomy (LTG) remains to be established. Therefore, this study was conducted to compare postoperative outcomes between LPG and LTG. Methods: Data from 141 patients who underwent LPG or LTG for gastric neoplasm with curative intent between 2016 and 2022 were retrospectively reviewed. Clinicopathological findings, body weight changes, and serological nutritional markers during the postoperative course were evaluated. Results: LPG and LTG were performed in 78 patients and 63 patients, respectively. Patients' characteristics did not differ; however, tumor stages in patients who underwent LTG were more advanced than those who underwent LPG. The mean (± standard deviation) weight loss rate after 1 year was −13.5 (±6.9)% and −18.7 (±6.6)% for LPG and LTG, respectively (p <.01). LTG (OR: 3.326, p <.01), pT disease (OR: 3.000, p =.01), pN disease (OR: 2.708, p =.02), and postoperative chemotherapy (OR: 2.488, p =.05) were correlated with severe weight loss (16% or more) 1 year after surgery, then multivariate analysis identified LTG as an independent factor (p =.01). The mean (± standard deviation) serum total protein level of LPG was significantly higher than that of LTG at 3 months (6.8 ± 0.5 vs. 6.6 ± 0.4 g/dL, p =.02) and 1 year (6.9 ± 0.4 vs. 6.7 ± 0.5 g/dL, p =.01) postoperatively. No difference was observed in postoperative serum hemoglobin and albumin levels. Conclusion: LPG more improved postoperative weight loss than LTG. [ABSTRACT FROM AUTHOR]

Background: There are reconstructing methods of the alimentary tract after TLG as Roux-en-Y anastomosis and functional Jejunal interposition (FJI), and each of these methods has its advantages and drawbacks. But, no consensus has been reached yet about the best method. We aim to assess the post-operative outcomes of performing FJI or the Roux-en-Y procedure then jejunum transection as reconstruction procedures of the alimentary tract after performing TLG in gastric cancer patients and to compare between both procedures regarding post-operative complications and functional recovery. Patients and methods: We included 100 cases with clinical and radiological evidence of gastric carcinoma stages I-III. Patients were randomly divided for 2 equal groups the first group underwent FJI and the second group underwent Roux-en-Y as reconstructive techniques after performing gastrectomy. We correlate between both groups of patients regarding, operative parameters, post-operative complications. Results: time of the operation in patients who underwent PJI procedure was longer than that in patients who underwent Roux-en-Y procedure (P < 0.001). The postoperative hemoglobin, total protein and albumin in patients who underwent PJI procedure were higher than in patients who underwent Roux-en-Y procedure (P < 0.001). The post-operative loss in bodyweight at 3 and 12 months in the group of patients who underwent FJI groups was less than that in group of patients who underwent Roux-en-Y (P = 0.011). Conclusions: performing jejunal interposition as a reconstructive post-gastrectomy procedure is more effective than performing Roux-en-Y anastomosis regarding lowed incidence of postoperative complications and improving long-term post-operative life quality of patients. [ABSTRACT FROM AUTHOR]

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.

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.

Abstract Objective This study aimed to establish novel nomograms that could be used to predict the prognosis of gastric carcinoma patients who underwent D2 + total gastrectomy on overall survival (OS) and progression-free survival (PFS). Methods Lasso regression was employed to construct the nomograms. The internal validation process included bootstrapping, which was used to test the accuracy of the predictions. The calibration curve was then used to demonstrate the accuracy and consistency of the predictions. In addition, the Harrell’s Concordance index (C-index) and time-dependent receiver operating characteristic (t-ROC) curves were used to evaluate the discriminative abilities of the new nomograms and to compare its performance with the 8th edition of AJCC-TNM staging. Furthermore, decision curve analysis (DCA) was performed to assess the clinical application of our model. Finally, the prognostic risk stratification of gastric cancer was conducted with X-tile software, and the nomograms were converted into a risk-stratifying prognosis model. Results LASSO regression analysis identified pT stage, the number of positive lymph nodes, vascular invasion, neural invasion, the maximum diameter of tumor, the Clavien–Dindo classification for complication, and Ki67 as independent risk factors for OS and pT stage, the number of positive lymph nodes, neural invasion, and the maximum diameter of tumor for PFS. The C-index of OS nomogram was 0.719 (95% CI: 0.690–0.748), which was superior to the 8th edition of AJCC-TNM staging (0.704, 95%CI: 0.623–0.783). The C-index of PFS nomogram was 0.694 (95% CI: 0.654–0.713), which was also better than that of the 8th edition of AJCC-TNM staging (0.685, 95% CI: 0.635–0.751). The calibration curves, t-ROC curves, and DCA of the two nomogram models showed that the prediction ability of the two nomogram models was outstanding. The statistical difference in the prognosis between the low- and high-risk groups further suggested that our model had an excellent risk stratification performance. Conclusion We reported the first risk stratification and nomogram for gastric carcinoma patients with total gastrectomy in Chinese population. Our model could potentially be used to guide treatment selections for the low- and high-risk patients to avoid delayed treatment or unnecessary overtreatment.

Background: There have been few studies regarding the feasibility and safety of pure single-incision laparoscopic total gastrectomy (SITG) or proximal gastrectomy (SIPG) for early gastric cancer (EGC). The purpose of this study was to analyze the surgical outcome of all consecutive SITG or SIPG cases compared with multiport laparoscopic total gastrectomy (MLTG) or proximal gastrectomy (MLPG) for EGC. Methods: We analyzed all consecutive SITG or SIPG cases with double-tract reconstruction for ECG, including the initial case, between March 2013 and December 2021. SITG/SIPG was performed on patients without significant systemic comorbidities through a 3–4 cm vertical transumbilical incision. SITG/SIPG was matched to multiport laparoscopic total or proximal gastrectomy (MLTG/MLPG) cases performed in the same period using a 1:3 propensity score matching, including sex, body mass index (BMI), age and type of resection, year of operation, and institution as covariates. We compared perioperative clinicopathological characteristics and early postoperative morbidity within 1 month after surgery between the SITG/SIPG and MLTG/MLPG groups. Results: In total, 21 patients with SITG and 15 patients with SIPG were compared with those with MLTG (n = 264) and MLPG (n = 220). No conversion to an open or multiport approach occurred in the SITG/SIPG group. After matching, operation time was similar between SITG/SIPG and MLTG/MLPG (223.9 ± 63.5 min vs 234.8 ± 68.7 min, P = 0.402). Length of stay was not significantly different between SITG/SIPG and MLTG/MLPG (11.9 ± 15.4 days vs 8.4 ± 5.0 days, P = 0.210). The average number of retrieved lymph nodes was not significantly different between SITG and MLTG (53.1 ± 16.3 vs 63.2 ± 27.5, P = 0.115), but it was significantly higher in SIPG than MLPG (59.6 ± 27.2 vs 46.0 ± 19.7, P = 0.040). The overall complication rate (30.6% vs 25.9%, P = 0.666) and Clavien–Dindo grade III or higher complication rates (13.9% vs 6.5%, P = 0.175) were not significantly different between the SITG/SIPG and MLTG/MLPG groups. Conclusion: Cautious adoption of SITG/SIPG procedures for EGC is feasible and safe. [ABSTRACT FROM AUTHOR]

Background: Surgical resection remains the cornerstone of treatment for locally advanced gastric cancer (LAGC) and is accompanied by potential deterioration in patients' health-related quality of life (HRQOL). As an important indicator of the psychosocial burden, HRQOL has become an essential endpoint to evaluate the efficacy and impact of cancer treatment. We examined longitudinal changes in HRQOL among patients with LAGC receiving total gastrectomy (TG) or distal gastrectomy (DG) over time. Materials and methods: The patients in this study were from a prospective observational study (NCT04408859) conducted during 2018-2022. We used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and the stomach module questionnaire to evaluate HRQOL at baseline and at postoperative months 1, 3, 6, and 12. We used linear mixed models to analyze longitudinal changes in HRQOL between groups and correlations with follow-up time. Results: A total of 219 patients were included. After propensity score matching, 186 patients were ultimately analyzed. Compared with the DG group, patients in the TG group reported significantly poorer global health status, physical functioning, and role functioning and more severe fatigue, insomnia, appetite loss, pain, and financial problems. Gastric-specific symptoms, dysphagia, chest and abdominal pain, reflux, restricted eating, and anxiety were more common and severe in the TG group. Most scales showed deterioration at months 1 and 3 after surgery, with gradual recovery thereafter, except the scales for global health status, pain, chest and abdominal pain, and reflux, which improved continually compared with baseline. TG was associated with worsening in at least six HRQOL domains for each measure after baseline, compared with DG. Conclusions: In contrast with DG, TG had an adverse impact on postoperative HRQOL scales in patients with LAGC. Different HRQOL scales had various recovery trajectories after surgery. Effects of the gastrectomy scope on patients' HRQOL should be considered together with sound oncology principles. [ABSTRACT FROM AUTHOR]

Background Replacement of the reservoir function of the stomach after total gastrectomy is of particular importance. And several types of gastric substitutes have been suggested. The most widely accepted is the Hunt-Lawrence-Rodino or Jejunal pouch. Aim and objectives To compare the nutritional, functional outcomes and quality life of a Jejunal pouch reconstruction to the simple Roux -en-Y esophago jejunostomy in patients who had total gastrectomy due to cancer. Subjects and methods 40 patients underwent total gastrectomy and reconstruction at the upper GIT surgery unit of the Department of Surgery of the University Medical School of Ain shams between august 2020 and October 2022. Patients divided into two groups, group (A) 20 patients reconstructed by simple roux -en - y esophagojejunostomy. Group (B) 20 patients reconstructed by roux - en - y esophagojejunostomy with oral type jejunal pouch. Both groups were compared regarding anthropometeric, nutritional and laboratory values at preoperative, 3 and 6 months p o, also early postoperative complications, post gastrectomy and reflux symptoms and patient's QOLI using Eypasch questionnaire at 6 month p o. Results No significant difference regarding morbidity or mortality associated with pouch reconstruction (P-value >0.05). also no significance regarding body weight, BMI at 3 and 6 months p o. the pouch group was associated with a lower incidence of dumping, diarrhea and reflux symptoms (P-value <0.05)., also a better food intake, and better quality of life parameters at 6 months post -operative (P-value <0.05). Conclusion In a 6-month follow-up after total gastrectomy, pouch reconstruction was superior to Roux-en-Y esophagojejunostomy in terms of p o food intake, incidence of dumping, diarrhoea, and reflux symptoms, as well as quality of life. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Summary: Background: Total gastrectomy has been performed for adenocarcinoma of the esophagogastric junction (AEG) because of severe gastro-esophageal reflux (GER) after classic esophago-gastrostomy. Thus, we applied a novel esophago-gastrostomy with anti-reflux triangle-valve (EGAT) in Siewert type II/III AEG patients to prevent postoperative GER. Methods: This was a three-year retrospective cohort study. We followed 144 Siewert type II/III AEG patients who underwent EGAT (n = 73) and total gastrectomy (TG, n = 71) at our hospital. We analyzed the incidence of postoperative nutritional (hemoglobin, protein levels, and weight) and reflux esophagitis in the two groups. Finally, we conducted a survival analysis was performed. Results: The average operation time was significantly lower in the EGAT group than in the TG group. However, no significant differences were detected for postoperative complications between the two groups. Postoperative nutritional indexes, including albumin and prealbumin, were significantly higher in the EGAT group than in the TG group six months after surgery. Moreover, we evaluated the hemoglobin one year after surgery, and total protein and body weight after two years of surgery were significantly higher in the EGAT group compared to the TG group. Further, the reflux esophagitis follow-up did not differ (p > 0.05). Finally, no significant difference was detected in the 3‑year overall survival rate between the two groups of patients (p = 0.519). Conclusion: EGAT is simple and can prevent GER in Siewert type II/III AEG patients. [ABSTRACT FROM AUTHOR]

Abstract Background In some earlier studies, self-pulling and later transection (SPLT) esophagojejunostomy (E-J) was incorporated into total laparoscopic total gastrectomy (TLTG) procedures. Its effectiveness and safety, however, remain unknown. This study compared (SPLT)-E-J in TLTG with conventional E-J in laparoscopic-assisted total gastrectomy (LATG) in order to assess the short-term safety and efficacy of (SPLT)-E-J in TLTG. Methods This research analyzed patients with gastric cancer who received SPLT-TLTG or LATG between January 2019 and December 2021 in the First Affiliated Hospital of Chongqing Medical University. Baseline data and postoperative short-term surgical outcomes were obtained retrospectively and compared between the two groups. Results A total of 83 patients who underwent SPLT-TLTG (n = 40, 48.2%) or LATG (n = 43, 51.8%) were included in this study. There were no differences between the two groups in terms of patient demographics or tumor characteristics. No statistically significant differences were observed between the two groups in terms of operation time, intraoperative blood loss, harvested lymph nodes, postoperative complications, postoperative decrease in hemoglobin and albumin levels, or postoperative hospital stay. Five and seven patients experienced short-term postoperative complications in the SPLT-TLTG and LATG groups, respectively. Conclusions SPLT-TLTG is a dependable and safe surgical method for the treatment of gastric cancer. Its short-term outcomes were similar to those of conventional E-J in LATG and had advantages regarding surgical incision and simplification of reconstruction.

Abstract Background This study aimed to investigate the feasibility and safety of our enhanced recovery after surgery protocol including early oral intake and omitting nasogastric tube (NGT) placement after total gastrectomy. Methods We analyzed 182 consecutive patients who underwent total gastrectomy. The clinical pathway was changed in 2015, and patients were divided into 2 groups (conventional group and modified group). Postoperative complications, bowel movement, and postoperative hospital stays were compared in the two groups in all cases and propensity score matching (PSM). Results Flatus and defecation were significantly earlier in the modified group compared with those in the conventional group (flatus: 2 (1–5) days vs 3 (2–12) days, p = 0.03; defecation: 4 (1–14) days vs 6 (2–12) days p = 0.04). The postoperative hospital stay was 18 (6–90) days in the conventional group and 14 (7–74) days in the modified group (p = 0.009). Days until discharge criteria were met were earlier in the modified group compared with that in the conventional group (10 (7–69) days vs 14 (6–84) days p = 0.01). Overall and severe complications occurred in nine patients (12.6%) and three patients (4.2%) in the conventional group and twelve patients (10.8%) and four patients (3.6%) in the modified group, respectively (p = 0.70 and p = 0.83) in all cases. In PSM, there is no significant difference between the two groups concerning the postoperative complications (overall complication 6 (12.5%) vs 8 (16.7%) p = 0.56, severe complications 1 (2%) vs 2 (4.2%) p = 0.83). Conclusions Modified ERAS for total gastrectomy may be feasible and safe.

Abstract Background To compare the clinical efficacy of two alimentary tract reconstruction methods—“P”-shape jejunal interposition (PJI) and Roux-en-Y anastomosis after total gastrectomy. Method The following search phrases were utilized to search PubMed, Cochrane Library, Embase, China Academic Journals Network Full-text Database (CNKI), and Wanfang Database as of April 2022: “gastrectomy,” “Roux-en-Y,” “interposition,” “total gastrectomy,” and “jejunal interposition.” Meta-analysis of the operation time, intraoperative blood loss, complication rate, and postoperative nutritional status of patients was performed using RevMan 5.4 software. Results A total of 24 studies and 1887 patients were included in the study. Among patients who received a total gastrectomy, the operation time in the PJI group was substantially longer than that in the Roux-en-Y group (WMD = 19.77, 95% CI: 5.84–33.70, P = 0.005). The incidence of postoperative reflux esophagitis in the PJI group was considerably reduced than that in the Roux-en-Y group (OR = 0.39, 95% CI: 0.28–0.56, P

Aim: This study aimed to evaluate the utility and complications of ultra-short cecum (USC) in the reconstruction of digestive tract after total gastrectomy (TG) for the alleviation of reflux esophagitis and to determine its effect on long-term nutritional status. Methods: Patients who underwent TG with USC or normal cecum (NC) at a single institution between June 2018 and December 2020 were included in this study. The inclusion and exclusion criteria were defined, and the primary endpoints were reflux esophagitis, anastomotic leakage and postoperative nutritional status. The long-term nutritional status was evaluated by the change trend of laboratory blood tests, including total protein, prealbumin, hemoglobin, and total leukocytes. Results: Totally 240 cases were included in the final analysis out of 496 patients who received TG with USC or NC. Postoperative reflux esophagitis was significantly higher in the NC group than in the USC group (24.7% versus 7.7%, P = 0.001), and the NC group had a higher incidence of severe esophagitis symptoms compared to the USC group (13.6% versus 0.00%, P < 0.001), and the incidence of anastomotic leakage in the USC group was similar to that in the NC group (9.0% versus 6.2%, P = 0.6). There was no significant difference in longterm nutritional status between the USC and NC groups in the two years following the surgery (P > 0.05). Conclusion: Ultra-short cecum after total gastrectomy should be more actively recommended due to its significant reduction in reflux esophagitis and similar incidence of anastomotic leakage and nutritional status compared with normal cecum after total gastrectomy. [ABSTRACT FROM AUTHOR]