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Background: There are two methods of Roux‐en‐Y (RY) reconstruction after gastrectomy: the antecolic route (ACR) and retrocolic route (RCR). There is no evidence to support that the ACR achieves comparable long‐term survival. Methods: This was a multi‐center historical cohort study. Patients diagnosed with clinical T3/4a and any N stage who underwent open gastrectomy and R0 resection for gastric adenocarcinoma between January 2006 and December 2012 were enrolled. The primary outcome was the hazard ratio of ACR for overall survival, with adjustment for confounding factors by propensity score matching, and a Cox proportional hazards model. Results: A total of 1758 eligible patients were identified from the database. After matching, 410 patients in the ACR and RCR groups were included in the final analysis. The adjusted hazard ratio (95% CI) for ACR was 1.148 (0.870–1.492). The five‐year survival rates in the ACR and RCR groups were 74.3% (69.5–78.4) and 77.3% (72.3–81.2), respectively. The short‐term surgical outcomes of the two groups did not differ to a statistically significant extent. Conclusion: The route used to lift the jejunum in RY reconstruction did not affect the incidence of long‐term survival or postoperative complications. The ACR and RCR are both acceptable options for RY reconstruction during gastric cancer surgery. [ABSTRACT FROM AUTHOR]

Aim: To compare the survival outcomes of laparoscopic total gastrectomy (LTG) with those of open total gastrectomy (OTG) in gastric cancer. Methods: Using an in‐house database, this single‐center study reviewed clinical data for patients who underwent surgery for gastric adenocarcinoma in 2008–2018. The patients were divided into an LTG group and an OTG group. Results: Data for 638 patients were screened. After exclusions, 580 patients (LTG, n = 212; OTG, n = 368) were enrolled. Noting that the OTG group included more advanced tumors, 1:1 propensity score matching was implemented to reduce any selection bias, leaving 326 patients (LTG, n = 163; OTG, n = 163; pStage I/II/III = 147/87/92) for further analysis. The operation time was longer and blood loss was less in the LTG group. The postoperative hospital stay was shorter in the LTG group than in the OTG group (9 d vs 10 d；P =.040). There was no significant difference in the incidence of grade III or worse postoperative complications (8.9% vs 11.0%). Five‐year overall survival was better in the LTG group (84.9% vs 73.5%; P =.0010, log‐rank test), but there was no significant difference in overall survival according to pStage (I, 93.0% vs 89.0%; II, 85.8% vs 77.5%; III, 64.1% vs 52.5%). There was a similar trend in relapse‐free survival. Distribution of recurrence sites was comparable. Conclusion: LTG may provide survival outcomes similar to those of OTG when performed by an experienced surgical team. Further evidence is required for final conclusions, especially regarding its efficacy for stage II/III. [ABSTRACT FROM AUTHOR]

Aim: A hiatal hernia (HH) complicates the diagnosis and surgical treatment of gastroesophageal junction (GEJ) cancer. This study aimed to investigate the effect of HH on the survival outcomes of GEJ cancer patients. Methods: This single‐center study reviewed clinical data of 78 patients with GEJ adenocarcinoma who underwent R0 resection from 2008 to 2017. The patients were divided into two groups according to whether they presented with or without HH: the HH (+) group (n = 46) and the HH (−) group (n = 32). Results: Patients in the HH (+) group were older than those in the HH (−) group (69.0 vs 67.5 years, P =.018). Regarding surgical outcomes, intra‐abdominal infectious complications was more common in the HH (+) group than in the HH (−) group (23.9% vs 9.4%, respectively; P =.089), particularly abscess formation (17.4% vs 3.1%, respectively; P =.036). Neither overall survival (OS) nor relapse‐free survival (RFS) differed between the two groups. However, survival rates were significantly worse in a subset of patients with T3‐4 disease (OS: log‐rank, P =.036) (RFS: log‐rank, P =.040) in the HH (+) group. In a multivariate analysis for OS in this cohort, HH was an independent prognostic factor (hazard ratio 3.60; 95% confidence interval 1.06‐11.9, P =.032). Conclusion: Hiatal hernia may adversely affect surgical and survival outcomes in patients with GEJ cancer. Thus, surgical strategy must be carefully considered in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Total gastrectomy with splenectomy (TGS) is sometimes performed for treatment of locally advanced gastric cancer invading the greater curvature because metastasis to splenic hilar nodes is expected. Despite the widespread use of laparoscopic procedures, the feasibility of laparoscopic TGS (LTGS) has been scarcely reported because of its technical difficulties. Methods: This retrospective single‐institutional study included 93 consecutive patients with proximal advanced gastric cancer who underwent either LTGS or open TGS (OTGS) from 2010 to 2018. The patients who underwent LTGS (n = 12) were compared with a 1:2 ratio propensity score‐matched cohort of patients who underwent OTGS (n = 20). Clinical outcomes were retrospectively reviewed and compared between the two groups. Results: The patients' baseline characteristics were well balanced between the two groups. The operating time was longer (332.5 vs 222.5 minutes, P <.01) but the blood loss volume was smaller (34.5 vs 426 mL, P <.01) in the LTGS than OTGS group. The incidence of postoperative morbidity (≥ Clavien‐Dindo grade III) was much lower (0.0% vs 36.8%, P =.02) and the median postoperative hospital stay was shorter (9 vs 11 days, P <.01) in the LTGS than OTGS group. The median number of harvested No. 10 or 11 days lymph nodes was equivalent between the two groups. Conclusions: Although TGS is not a common procedure, LTGS may be safely performed in selected patients when carried out by an experienced surgical team. The oncological safety remains unclear and needs to be further examined in future trials. [ABSTRACT FROM AUTHOR]