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Purpose: Retraction of the hepatic left lateral segment (HLLS) is a crucial maneuver for surgical field exposure during laparoscopic gastrectomy with systematic lymphadenectomy. Though various methods of retraction are available, there is no perfect solution. Here, we report the results of our initial 42 cases with HLLS inversion method and discuss the feasibility, safety, effectiveness and technical aspects of this method. Methods: The intraoperative and postoperative short-term outcomes of 42 patients who underwent HLLS inversion during laparoscopic total gastrectomy and proximal gastrectomy in our department September, 2023 to January, 2024 were reviewed. HLLS inversion was performed by mobilizing the HLLS and inverting it to the right supra-hepatic space through an incision at the falciform ligament. Results: 42 patients underwent HLLS inversion successfully with an average time of 13.9 min. 7 patients needed re-inversion due to slipping back of the HLLS during operation. Optimal exposure of the surgical field was achieved in all patients. No intra-operative complications occurred, except for 1 patient presented with mild intraoperative hepatic hemorrhage requiring electrocoagulation for hemostasis. Alanine aminotransferase and glutamine aminotransferase elevated in some patients on postoperative day 1(POD1), but declined to preoperative levels on the 7th postoperative day. There were no Clavien-Dindo II grade or higher digestive complications after surgery. In 5 patients with preservation the hepatic branch of the vagus nerve, the contractile function of the gall bladder was intact or slightly impaired 2 weeks after operation. Conclusion: For laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG), HLLS inversion is a feasible method for optimizing visualization of the surgical field with preservation of the function of the hepatic branch of the vagus nerve. It is safe and acceptable as to the manipulation time. Re-inversion is easy and effective even in case of failure of inversion. HLLS inversion seems to be a promising technique for retraction of the liver during laparoscopic gastrectomy. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the complications and long-term survival outcomes in patients who underwent radical gastrectomy for gastric cancer, as well as to identify the risk factors associated with postoperative complications. After conducting a comprehensive search within the medical records system, a total of 2508 patients who underwent radical gastrectomy and met the inclusion criteria were enrolled. Of the 2508 patients, 301 were diagnosed with postoperative complications. The pathological data, postoperative recovery, and survival outcome were compared between complication and control group. Subsequently, univariate and multivariate logistic regression analyses were conducted to identified the risk factors. According to the Clavien-Dindo grading criteria for postoperative complications, the proportions of grade I, II, III, IV, and V complications following radical gastrectomy were observed to be 28.2%, 42.9%, 19.6%, 8.0%, and 1.3%, respectively. The presence of postoperative complications significantly prolonged the duration of gastrointestinal decompression (P < 0.001), catheter retention (P < 0.001), fasting (P < 0.001), and hospitalization (P < 0.001). Additionally, it had a detrimental impact on survival outcomes. Age > 65years [odds ratio (OR) = 1.378, P = 0.020], presence of diabetes (OR = 2.042, P < 0.001), operative duration > 215 min (OR = 1.450, P = 0.006), intraoperative blood loss > 275 ml (OR = 1.474, P = 0.004), and Roux-en-Y anastomosis for both whole stomach (OR = 1.567, P = 0.021) and distal gastric cancer (OR = 2.083, P = 0.003) were identified as independent risk factors for postoperative complications. This study analyzed the complications and survival outcomes following radical gastrectomy, and investigated the predictors for postoperative complications, thereby providing valuable guidance on the prevention and management of surgical complications in gastric cancer. [ABSTRACT FROM AUTHOR]

To discuss the postoperative survival of the gastric cancer patients with different expression levels of myeloid ecotropic viral integration site 1 (MEIS1), and to analyze the predictive value of MEIS1 expression in the prognosis evaluation of gastric cancer. Methods: In a gastric cancer survival cohort, 215 patients who underwent radical gastrectomy were selected. Immunohistochemical staining was used to detect the expression levels of MEIS1 in both gastric cancer and adjacent normal tissues. The relationship between expression level of MEIS1 and the clinicopathological characteristics of the patients were analyzed by χ² test or Fisher's exact probability method; survival curves were plotted by Kaplan-Meier method; the differences in survival of the patients between MEIS1 high expression group and MEIS1 low expression group were compared by Log-rank test; multivariate Cox proportional hazards regression model was used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) to assess the relationship between MEIS1 expression level and the survival of the gastric cancer patients. Results: The immunohistochemical staining result showed that the expression level of MEIS1 in gastric cancer tissue was decreased. The univariate analysis results showed that the patients with high MEIS1 expression had a longer overall survival than those with low expression (P=0. 049), and had a better prognosis. The multivariate Cox proprotional hazards regression analysis results showed that the low MEIS1 expression and high TNM stage were the independent risk factors for poor prognosis of the patients with gastric cancer (HR=1. 577, 95%CI: 1. 011-2. 460, P=0. 045; HR=2. 709, 95%CI: 1. 708-4. 297, P< 0. 001). Conclusion: The gastric cancer patients with low expression of MEIS1 have a shorter postoperative overall survival; MEIS1 is a promising biomarker for prognosis assessment of the patients after radical gastrectomy. [ABSTRACT FROM AUTHOR]

Abstract Purpose Retraction of the hepatic left lateral segment (HLLS) is a crucial maneuver for surgical field exposure during laparoscopic gastrectomy with systematic lymphadenectomy. Though various methods of retraction are available, there is no perfect solution. Here, we report the results of our initial 42 cases with HLLS inversion method and discuss the feasibility, safety, effectiveness and technical aspects of this method. Methods The intraoperative and postoperative short-term outcomes of 42 patients who underwent HLLS inversion during laparoscopic total gastrectomy and proximal gastrectomy in our department September, 2023 to January, 2024 were reviewed. HLLS inversion was performed by mobilizing the HLLS and inverting it to the right supra-hepatic space through an incision at the falciform ligament. Results 42 patients underwent HLLS inversion successfully with an average time of 13.9 min. 7 patients needed re-inversion due to slipping back of the HLLS during operation. Optimal exposure of the surgical field was achieved in all patients. No intra-operative complications occurred, except for 1 patient presented with mild intraoperative hepatic hemorrhage requiring electrocoagulation for hemostasis. Alanine aminotransferase and glutamine aminotransferase elevated in some patients on postoperative day 1(POD1), but declined to preoperative levels on the 7th postoperative day. There were no Clavien-Dindo II grade or higher digestive complications after surgery. In 5 patients with preservation the hepatic branch of the vagus nerve, the contractile function of the gall bladder was intact or slightly impaired 2 weeks after operation. Conclusion For laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG), HLLS inversion is a feasible method for optimizing visualization of the surgical field with preservation of the function of the hepatic branch of the vagus nerve. It is safe and acceptable as to the manipulation time. Re-inversion is easy and effective even in case of failure of inversion. HLLS inversion seems to be a promising technique for retraction of the liver during laparoscopic gastrectomy.

Abstract This study aimed to analyze the complications and long-term survival outcomes in patients who underwent radical gastrectomy for gastric cancer, as well as to identify the risk factors associated with postoperative complications. After conducting a comprehensive search within the medical records system, a total of 2508 patients who underwent radical gastrectomy and met the inclusion criteria were enrolled. Of the 2508 patients, 301 were diagnosed with postoperative complications. The pathological data, postoperative recovery, and survival outcome were compared between complication and control group. Subsequently, univariate and multivariate logistic regression analyses were conducted to identified the risk factors. According to the Clavien-Dindo grading criteria for postoperative complications, the proportions of grade I, II, III, IV, and V complications following radical gastrectomy were observed to be 28.2%, 42.9%, 19.6%, 8.0%, and 1.3%, respectively. The presence of postoperative complications significantly prolonged the duration of gastrointestinal decompression (P 65years [odds ratio (OR) = 1.378, P = 0.020], presence of diabetes (OR = 2.042, P 215 min (OR = 1.450, P = 0.006), intraoperative blood loss > 275 ml (OR = 1.474, P = 0.004), and Roux-en-Y anastomosis for both whole stomach (OR = 1.567, P = 0.021) and distal gastric cancer (OR = 2.083, P = 0.003) were identified as independent risk factors for postoperative complications. This study analyzed the complications and survival outcomes following radical gastrectomy, and investigated the predictors for postoperative complications, thereby providing valuable guidance on the prevention and management of surgical complications in gastric cancer.

Background: The aim of this study is to describe technical considerations and short-term outcomes of the first officially published robot-assisted remote radical distal gastrectomy for gastric cancer with 5G technology. Methods: A 51-year-old gastric cancer patient with clinical stage T2N0M0 underwent 5G-enabled robot-assisted remote radical distal gastrectomy on September 11, 2023 ​at the Third Department of Surgery, the Fourth Hospital of Hebei Medical University. Results: The surgery procedure was successfully performed with an average total intraoperative delay of 225 ​ms, average round-trip delay of 30 ​ms and no packet loss rate. The operative time was 140 ​min and intraoperative blood loss was 20 ​ml. The patient was discharged on postoperative day 6 without any postoperative complications. Conclusion: This case has preliminarily verified the feasibility and safety of 5G-enabled robot-assisted remote radical distal gastrectomy for patients with gastric cancer. The initial study fills in the gaps in related fields and lays a solid foundation for subsequent research. To verify its superior operative outcomes, further clinical trials are needed.

Duodenal stump fistula (DSF) is a serious complication of radical gastrectomy for gastric cancer. Herein, we illustrated an innovative choice for treating duodenal stump fistulas by placing a modified sump drainage through trocar puncture into the DSF-related abscess (DSF-abscess) cavity. We retrospectively analyzed 974 consecutive patients who underwent gastrectomy for gastric cancer between 2011 and 2021. Of these patients, 34 who developed postoperative duodenal stump fistulas postoperatively were enrolled into our study, and their clinical data were retrospectively assessed. From January 2011 to December 2017, 15 patients received conventional treatments (percutaneous catheter drainage, PCD group) known as the traditional percutaneous method, and 19 patients from January 2018 to December 2021 received new treatments (Troca's SD group) consisting of conventional therapies and placement of a modified sump drainage through trocar puncture into DSF-abscess cavity. The demographics, clinical characteristics and treatment outcomes were compared between two groups. Compared with the PCD group, the rates of postoperative complications, duodenostomy creation, subsequent surgery, fistula healing rates of the DSF, and length of postoperative hospital stay were significantly decreased in the Troca SD group. However, there was no significant difference in the abscess recurrence rate and mortality rates. Trocar puncture with a modified sump drainage is an safe, effective, and technically feasible treatment for duodenal stump fistula after radical gastrectomy for gastric cancer. This novel technique should be further investigated using large-scale RCT research.

Abstract Background Hypokalemia is common in patients of various operations, especially gastrointestinal surgery, which seriously affects the safety and enhanced recovery after surgery. Our study aims to explore the risk factors of preoperative hypokalemia of radical gastrectomy for gastric cancer and analyze its impact on postoperative recovery. Methods A total of 122 patients scheduled for radical gastrectomy from September, 2022 to December, 2022 were retrospectively analyzed. According to the serum potassium level before skin incision, patients were divided into hypokalemia group (n = 64) and normokalemia group (n = 58). Factors including age, gender, BMI, ASA classification, glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), creatinine, blood urea nitrogen (BUN), albumin, hypertension history, whether taking calcium channel blockers, β-receptor blockers, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor antagonist (ARB), thiazide diuretics and other drugs, anemia history, diabetes mellitus history, inability to eat or intestinal obstruction, vomiting, diarrhea, hypokalemia on admission and whether under cooperation with clinical nurse specialist were compared between groups. Univariate logistic regression analysis was used to determine risk factors for hypokalemia with p

Abstract Background Management of postoperative pulmonary complications (PPCs) can be challenging in gastric cancer patients undergoing radical gastrectomy and is always associated with poor prognosis. Even though oncology nurse navigator (ONN) provide effective and critical individualized care to patients, little is known about their impact on the occurrence of PPCs in gastric cancer patients. This study aimed to determine whether ONN decreases the incidence of PPCs in gastric cancer patients. Methods This was a retrospective review in which data for gastric cancer patients at one centre was evaluated before and after an ONN hired. An ONN was introduced to patients at their initial visit to manage pulmonary complications throughout treatment. The research was conducted from 1 August 2020 to 31 January 2022. The study participants were divided into the non-ONN group (from 1 August 2020 to 31 January 2021) and the ONN group (from 1 August 2021 to 31 January 2022). The incidence and severity of PPCs between the groups were then compared. Results ONN significantly decreased the incidence of PPCs (15.0% vs. 9.8%) (OR = 2.532(95% CI: 1.087–3.378, P = 0.045)), but there was no significant difference in the components of PPCs including pleural effusion, atelectasis, respiratory infection, and pneumothorax. The severity of PPCs was also significantly higher in the non-ONN group (p = 0.020). No significant statistical difference was observed for the major pulmonary complications (grade ≥ 3) between the two groups (p = 0.286). Conclusions Role of ONN significantly decrease the incidence of PPCs in gastric cancer patients undergoing radical gastrectomy.

Objective To explore the clinical efficacy of preoperative paclitaxel weekly therapy as neoadjuvant chemotherapy combined with radical surgery for gastric cancer. Methods Using a randomized controlled study method, 120 gastric cancer patients admitted to Nanyang Nanshi Hospital from June 2022 to June 2023 were randomly divided into control group and study group, with 60 cases in each group. The patients in control group were treated with gastric cancer radical surgery, while the study group patients received neoadjuvant chemotherapy 2 weeks before surgery, using a paclitaxel weekly therapy mode with a dose of 175 mg/m2 for 2 consecutive weeks, followed by gastric cancer radical surgery. The Barthel index, self-rating anxiety scale (SAS), self-rating depression scale (SDS), visual analog scale (VAS), carcinoembryonic antigen, carbohydrate antigen199 and total adverse reaction rate were compared between two groups. Results After treatment, the Barthel index was higher, while the SAS and SDS scores were lower of patients in the study group than those before treatment and control group (P＜0.05). VAS score, carcinoembryonic antigen, and carbohydrate antigen 199 in the study group were lower than those before treatment and the control group (P＜0.05). There was no significant difference in the incidence of adverse reactions between the study group and the control group (8.33% vs 6.67%, P>0.05). Conclusion Preoperative paclitaxel weekly therapy as neoadjuvant chemotherapy combined with radical surgery for gastric cancer can improve the anxiety and depression status of patients and increase the overall effective rate.

Objective: To investigate the relationship between serum carcinoembryonic antigen (CEA), gastrin 17 (G-17), midkine (MK) and progastrin releasing peptide (ProGRP) and postoperative recurrence risk in patients with radical gastrectomy (RG). 156 patients with gastric cancer who were admitted to the Department of General Surgery of the First Affiliated Hospital of Xinjiang Medical University from January 2018 to August 2020 were selected as the gastric cancer group, and they were divided into the recurrence group and the non-recurrence group according to whether the patients had recurrence after RG, and 52 healthy examination volunteers in our hospital during the same period were selected as the control group. Clinical data of patients with gastric cancer were collected, and serum CEA, G-17, MK and ProGRP levels were determined by enzymed-linked immunosorbent assay. Univariate and multivariate Logistic regression were used to analyze the influencing factors of postoperative recurrence in patients with RG. The predictive value of serum CEA, G-17, MK and ProGRP levels in patients with RG was analyzed by receiver operating characteristic (ROC) curve. Results: Compared with the control group, the serum CEA, G-17, MK and ProGRP levels in the gastric cancer group were increased (P＜0.05). After 2 years of follow-up, 2 cases were lost to follow-up, and the recurrence rate of 154 patients with RG was 28.57% (44/154). Multivariate Logistic regression analysis showed that elevated CEA, G-17, MK and ProGRP, TNM stage Ⅲ, low differentiation, lymph node metastasis were independent risk factors for postoperative recurrence in patients with RG (P＜0.05). ROC curve analysis showed that the area under curve (AUC) of the combined prediction of CEA, G-17, MK and ProGRP in patients with RG was greater than that of CEA, G-17, MK and ProGRP alone. Conclusion: The elevated levels of serum CEA, G-17, MK and ProGRP are closely related to postoperative recurrence in patients with RG, which may be an auxiliary predictor of postoperative recurrence in patients with RG, and the combined prediction of serum CEA, G-17, MK and ProGRP is of high value [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical efficacy and safety of hand-assisted laparoscopic surgery (HALS) in D2 radical gastrectomy. Methods Sixty patients with gastric cancer who underwent radical surgery at Ma'anshan Shiqiye Hospital from April 2017 to December 2020 were selected as the study subjects. They were randomly divided into a HALS group of 30 patients and a traditional open surgery (OS) group of 30 patients by a lottery method. The intra- and post-operative indicators of the two groups were compared, and the survival status was followed up on December 10, 2022. Results In HALS group, the operation time was longer, the intraoperative blood loss and the incision length were smaller, time to exhaust, time to intaking total fluid diet and time to getting out of bed after operation were earlier, and the numerical pain rating (NRS) scores at 6-, 12-, 24- and 48-h after operation were lower, compared with those in OS group (P＜0.05＝. There was no statistical difference in the removal time of abdominal drainage tubes, postoperative hospital stay, number of lymph nodes cleaned, disease-free survival and overall survival between two groups (P＞0.05). The overall incidence of postoperative complications in HALS group was significantly lower than that in OS group (16.67%vs 40.00%, χ=4.02, P＜0.05). Conclusion HALS has lesser trauma and fewer postoperative complications, with safe and feasible in D2 radical surgery for gastric cancer patients. HALS combines the minimally invasive characteristics of laparoscopic surgery with the touch of the surgeon's hand, which reduces the difficulty of operation and is more convenient for complicated abdominal surgery, and can become one of the surgical treatment methods for gastric cancer.

Objective To observe the effect of Qichang Xuexheng decoction retention enema combined with heat-sensitive moxibustion after radical gastrectomy. Methods Eighty-three cases of gastric cancer admitted to our hospital from January 2019 to January 2022 were divided into two groups by envelope random method. The control group was given normal saline enema after operation for gastric cancer, and the observation group was given Qichang Xuexheng Decoction retention enema combined with heat-sensitive moxibustion after operation for gastric cancer. Results The indexes of gastrointestinal function recovery in observation group were better than those in control group (P < 0.05 ). There was no significant difference between the observation group and the control group (P > 0.05), and the other intestinal flora in the observation group was better than that in the control group (P < 0.05) at 3 and 7 days after surgery. Shannon index, Chaol index, gastrin (GAS) and motilin (MTL) in observation group were higher than those in control group at 3 and 7 days after operation, vasoactive peptide (VIP) and TCM syndrome score were lower than those in control group (P < 0.05). There was no significant difference in CD8+ between the observation group and the control group at 7 days after surgery (P > 0.05), and the immune function indexes of the observation group were better than those of the control group at 3 and 7 days after surgery (P < 0.05). Conclusion Qi Chang Xue Xing Tang retention enema combined with heat sensitive moxibustion is beneficial to the recovery of gastrointestinal function and immune function in patients after radical gastrectomy, which may be related to the regulation of intestinal flora diversity. [ABSTRACT FROM AUTHOR]

Background: Hypokalemia is common in patients of various operations, especially gastrointestinal surgery, which seriously affects the safety and enhanced recovery after surgery. Our study aims to explore the risk factors of preoperative hypokalemia of radical gastrectomy for gastric cancer and analyze its impact on postoperative recovery. Methods: A total of 122 patients scheduled for radical gastrectomy from September, 2022 to December, 2022 were retrospectively analyzed. According to the serum potassium level before skin incision, patients were divided into hypokalemia group (n = 64) and normokalemia group (n = 58). Factors including age, gender, BMI, ASA classification, glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), creatinine, blood urea nitrogen (BUN), albumin, hypertension history, whether taking calcium channel blockers, β-receptor blockers, angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor antagonist (ARB), thiazide diuretics and other drugs, anemia history, diabetes mellitus history, inability to eat or intestinal obstruction, vomiting, diarrhea, hypokalemia on admission and whether under cooperation with clinical nurse specialist were compared between groups. Univariate logistic regression analysis was used to determine risk factors for hypokalemia with p < 0.2 included as a cutoff. Multivariate logistic regression was used to analyze the influencing factors of preoperative hypokalemia for the indicators with differences. A receiver operating characteristic (ROC) curve was used to evaluate the efficacy of the regression model. Primary exhaust time and defecation time after surgery were compared between the two groups. Results: The use of ACEI or ARB [OR 0.08, 95% CI (0.01 to 0.58), p = 0.012] and thiazide diuretics [OR 8.31, 95% CI (1.31 to 52.68), p = 0.025], inability to eat for more than 3 days or intestinal obstruction [OR 17.96, 95% CI (2.16 to 149.43), p = 0.008], diarrhea for more than 48 h [OR 6.21, 95% CI (1.18 to 32.61), p = 0.031] and hypokalemia on admission [OR 8.97, 95% CI (1.05 to 77.04), p = 0.046] were independent influencing factors of hypokalemia before skin incision. Primary postoperative exhaust time and defecation time was significantly longer in the hypokalemia group than in the normokalemia group, no matter after laparoscopic radical gastrectomy (p = 0.044, p = 0.045, respectively) or open radical gastrectomy (p = 0.033, p = 0.019, respectively). Conclusion: Early attention and management of serum potassium in patients undergoing radical gastrectomy can better reduce perioperative adverse reactions and promote recovery of gastrointestinal function. [ABSTRACT FROM AUTHOR]

Purpose: Radical gastrectomy with D2 lymphadenectomy can trigger a high incidence of postoperative pancreatic fistula (POPF), which produces a poor clinical prognosis. We sought to evaluate the effect of somatostatin analogs (SSA) on POPF and clinical prognosis after radical gastrectomy. Methods: A total of 123 patients with a high risk of POPF after radical gastrectomy (drainage fluid amylase concentration on a postoperative day [POD] 1 > 3 times the upper limit of normal serum amylase value) were randomly divided into the SSA group (n = 61) and the control group (n = 62). The former received continuous intravenous SSA (0.3 mg/8 h) for 3 days from POD1, and the latter normal saline. The primary outcome was the incidence of POPF. Results: The incidence of POPFs in the SSA group was significantly lower than that in the control group (3.3% vs. 14.5%, P = 0.029). The incidence of short-term postoperative complications was significantly lower in the SSA group than in the control group (9.8% vs. 24.2%, P = 0.034). The median white blood cell counts, neutrophil counts, and the percentage of neutrophils on POD4 were significantly lower in the SSA group than in the control group (all P < 0.05). The SSA group had a shorter mean time to the first liquid diet (87.33 ± 17.92 h vs. 93.97 ± 17.29 h, P = 0.039). And the SSA group had less median daily drainage volume (96.33 mL vs. 119.67 mL, P = 0.025) and shorter drainage duration (7.0 days vs. 10.0 days, P = 0.013). Conclusion: Postoperative treatment with a somatostatin analog reduced the incidence of POPF and short-term complications after radical gastrectomy. (TRN: ChiCTR2200056201, Reg. Date: 2022/2/1). [ABSTRACT FROM AUTHOR]

Background: This study was designed to investigate incidences of surgeons' mental distress following severe complications after radical gastrectomy. Methods: A cross-sectional survey was conducted between 1 June 2021 and 30 September 2021 among Chinese general and/or gastrointestinal surgeons who experienced severe complications after radical gastrectomy. The clinical features collected in the questionnaire included: (i) feeling burnout, anxiety, or depression; (ii) avoiding radical gastrectomy or feeling stress, slowing down the process during radical gastrectomy operations; (iii) having physical reactions, including heart pounding, trouble breathing, or sweating while recalling; (iv) having urges to quit being a surgeon; (v) taking psychiatric medications; and (vi) seeking psychological counselling. Analyses were performed to identify risk factors of severe mental distress, which was defined as meeting three or more of the above-mentioned clinical features. Results: A total of 1062 valid questionnaires were received. The survey showed that most of the participating surgeons (69.02%) had at least one clinical feature of mental distress following severe complications after radical gastrectomy, and more than 25% of the surgeons suffered from severe mental distress. Surgeons from non-university affiliated hospitals, the junior surgeons, and existing violent doctor--patient conflicts were recognized as independent risk factors for surgeons' severe mental distress related to the severe complications after radical gastrectomy. Conclusions: About 70% of surgeons had mental health problems following severe complications after radical gastrectomy, and more than 25% of the surgeons suffered from severe mental distress. More strategies and policies are needed to improve the mental well-being of these surgeons after such incidences. [ABSTRACT FROM AUTHOR]

Background: Management of postoperative pulmonary complications (PPCs) can be challenging in gastric cancer patients undergoing radical gastrectomy and is always associated with poor prognosis. Even though oncology nurse navigator (ONN) provide effective and critical individualized care to patients, little is known about their impact on the occurrence of PPCs in gastric cancer patients. This study aimed to determine whether ONN decreases the incidence of PPCs in gastric cancer patients. Methods: This was a retrospective review in which data for gastric cancer patients at one centre was evaluated before and after an ONN hired. An ONN was introduced to patients at their initial visit to manage pulmonary complications throughout treatment. The research was conducted from 1 August 2020 to 31 January 2022. The study participants were divided into the non-ONN group (from 1 August 2020 to 31 January 2021) and the ONN group (from 1 August 2021 to 31 January 2022). The incidence and severity of PPCs between the groups were then compared. Results: ONN significantly decreased the incidence of PPCs (15.0% vs. 9.8%) (OR = 2.532(95% CI: 1.087–3.378, P = 0.045)), but there was no significant difference in the components of PPCs including pleural effusion, atelectasis, respiratory infection, and pneumothorax. The severity of PPCs was also significantly higher in the non-ONN group (p = 0.020). No significant statistical difference was observed for the major pulmonary complications (grade ≥ 3) between the two groups (p = 0.286). Conclusions: Role of ONN significantly decrease the incidence of PPCs in gastric cancer patients undergoing radical gastrectomy. [ABSTRACT FROM AUTHOR]

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Objective To investigate the effects of preoperative pre-rehabilitation on postoperative gastrointestinal function, nutritional indicators, quality of life and adverse reactions in patients with gastric cancer. Methods A total of 66 patients who underwent radical gastrectomy for gastric cancer in the 901st Hospital of Joint Logistics Support Force of the CPLA from November 2019 to March 2022 were selected as the research subjects. The patients were divided into control group (n=35) and study group (n=31) by random number table method. The control group received routine preoperative preparation, and the study group received preoperative pre-rehabilitation. Postoperative gastrointestinal function recovery (first postoperative exhaust time, defecation time and the time to first oral feeding), serum nutritional indicators ［total protein (TP), albumin (Alb), prealbumin (PA) and hemoglobin (Hb)］, postoperative gastrointestinal adverse reactions during enteral nutrition, and the generic quality of life inventory-74 (GQOL-74) scores were compared between two groups. Results The time to first oral feeding, defecation recovery time and exhaust time in the study group after operation were significantly shorter than those in the control group (P

Digestive tract reconstruction is one of the key operations of gastric cancer surgery. Its quality directly affects the occurrence of postoperative complications and long-term nutritional status and quality of life. Reasonable selection of digestive tract reconstruction in totally laparoscopic radical gastrectomy for gastric cancer can significantly reduce postoperative complications and improve postoperative nutritional status and quality of life. This paper discusses the advantages and disadvantages of digestive tract anastomosis used in total laparoscopic distal gastrectomy and total gastrectomy, explores the best possible anastomosis at present, describes the progress of anastomosis in complete laparoscopic proximal gastrectomy, and introduces the progress of physiology and biomechanical reconstruction theory.

Objective To explore the efficacy and safety of traditional Chinese medicine(TCM) combined with chemotherapy in the prevention and treatment of postoperative recurrence and metastasis of locally advanced gastric cancer (LAGC) by meta-analysis. Moreover, we evaluated the efficacy of TCM on the quality of life, immune indexes, and toxic and side effects during adjuvant chemotherapy. Methods The CNKI, Wanfang, PubMed, and other databases were searched by computer. Randomized controlled trials (RCTs) were searched. After literature screening and data extraction, Review Manager 5.3 software provided by Cochrane was used for meta-analysis. Results A total of 18 RCTs were included. Compared with chemotherapy alone, TCM combined with chemotherapy could improve the KPS score and CD3+ and CD4+/CD8+ index levels. The incidence rates of postoperative leucopenia, hemoglobin reduction, thrombocytopenia, nausea and vomiting, diarrhea, and neurotoxicity were reduced. In terms of postoperative QLQ-C30 score, abnormal liver function, and abnormal renal function, the incidence of TCM combined chemotherapy was similar to that of chemotherapy alone, with no statistical difference. Compared with chemotherapy alone, TCM combined chemotherapy could reduce the 1-, 2-, 3-, and 5-year cumulative recurrence and metastasis rates and prolong the disease-free survival time. Conclusion Compared with chemotherapy alone in adjuvant chemotherapy, TCM combined chemotherapy could improve the immune level and KPS score of LACC patients after surgery, reduce the incidence of adverse reactions, as well as reduce the recurrence and metastasis rate of LAGC after surgery and DFS could be improved.

Background: Reoperation due to elective surgery complications is very mentally, physically, and economically detrimental to patients. This study investigated the potential risk factors associated with early reoperation after radical gastrectomy in gastric cancer patients and included an in-depth analysis of these risk factors. Methods: This retrospective study reviewed 1568 patients with gastric cancer. Grade 3 or greater complications were defined as severe. Any factors related to reoperation after radical gastrectomy were analyzed in patients with severe local complications. Results: Among 1537 patients undergoing radical gastrectomy, 115 (7.5%) patients had severe postoperative complications, 98 (6.38%) of whom experienced severe local complications. The most common local complication was anastomotic leakage (31, 2.02%), followed by intra-abdominal abscess (30, 1.95%), pancreatic leakage (22, 1.43%), duodenal stump leakage (18, 1.17%), intra-abdominal bleeding (12,.78%), intraluminal bleeding (8,.52%), small bowel obstruction (5,.32%), and chyle leakage (3,.19%). Of these patients, 26 (1.69%) underwent reoperation, and 6 (.39%) died. In the univariate analysis of clinical factors related to reoperation, intra-abdominal bleeding and small bowel obstruction were risk factors for reoperation, and intra-abdominal bleeding (odds ratio [OR] = 9.57, confidence interval [CI] = 2.65-40.20, P <.001) and small bowel obstruction (OR = 19.14, CI = 2.60-390.13, P =.011) were independent risk factors associated with reoperation in the multivariate analysis. Conclusion: Intra-abdominal bleeding and small bowel obstruction are independent risk factors for reoperation following radical gastrectomy. Patients with postoperative intra-abdominal bleeding and small bowel obstruction need to be warned about reoperation. [ABSTRACT FROM AUTHOR]

ObjectiveTo study the value of Onodera’s prognostic nutrition index (PNI) in patients with gastric neuroendocrine cancer (G-NEC).MethodsThe clinical data on 148 cases of G-NEC presented between March 2010 and April 2022 were retrospectively analyzed. The relationship between the clinical characteristics of the patients and PNI was analyzed. Optimal PNI cutoff values for G-NEC prognosis prediction were calculated using the X-tile software. The survival curves were created using the Kaplan–Meier method. A Cox proportional hazards model was also established to identify independent prognostic factors that impact the prognosis of patients with G-NEC.ResultsThe median overall survival (OS) rate was 30 months (range 6–127 months), and the OS rates at 1, 3 and 5 years were 89.2, 71.6 and 68.2%, respectively. The mean PNI of the 148 patients before the operation was 49.5 ± 8.0. The mean PNI of patients with anemia (p

Objective To explore the effect of subcutaneous continuous negative pressure drainage on prevention of postoperative infection in patients with gastric cancer, so as to provide guidance for clinical practice. Methods The clinical data of 177 patients who underwent radical gastrectomy from January 2018 to September 2021 in Tumor Hospital Affiliated to Nantong University were analyzed retrospectively. The total operation time, postoperative hospital stay, incision healing grade and incision infection rate of patients in the subcutaneous continuous negative pressure drainage group (drainage group, 95 cases) and the conventional direct suture group(conventional group, 82 cases) were statistically compared. Results Compared with conventional group, drainage group had better incision healing grade（Z=2.372,P=0.018）, lower incision infection rate(5.3% vs15.9%, χ2=5.762, P=0.016), and shorter postoperative hospital stay［（8.9±1.4）d vs（9.8±2.4）d, t=3.096,P=0.002］. Subgroup analysis showed that the wound infection rate in the drainage group was significantly lower than that in the conventional group in patients with diabetes or obesity (P

Abstract Background Gastric cancer is the most prevalent tumor in Chinese men, and surgery is currently the most important treatment. Billroth II and Roux-en-Y are the anastomosis methods used for reconstruction after gastrectomy. Jejunal intussusception is a rare complication after gastric surgery. Main Body Intussusception after gastric surgery occurs mostly at the gastrojejunostomy site for Billroth II reconstruction, and the Y-anastomosis site for Roux-en-Y reconstruction. Many studies have reported that postoperative intussusception appears at the anastomosis after bariatric surgery, while a few have reported intussusception at the anastomosis and its distal end after radical gastrectomy. Conclusion A review was carried out to analyze intussusception after radical gastrectomy with roux-en-y anastomosis during the current situation. And the relevant mechanisms, diagnosis, treatment methods, etc. are described, hoping to provide better guidance for clinicians

Yongsheng Meng, Pengfei Zhao, Rong Yong Department of Anesthesiology, Taizhou People’s Hospital, Taizhou, Jiangsu, People’s Republic of ChinaCorrespondence: Rong YongDepartment of Anesthesiology, Taizhou People’s Hospital, No.366, Taihu Road, Taizhou Pharmaceutical High-Tech Zone, Taizhou, 225300, Jiangsu Province, People’s Republic of ChinaEmail tz_134233591@126.comBackground: Pulmonary infection is one of the most common postoperative complications after radical gastrectomy for gastric cancer (GC) and is associated with a poorer prognosis. This study aimed to investigate potential predictive factors for pulmonary infection in elderly GC patients.Methods: This study retrospectively enrolled 346 elderly GC patients undergoing elective radical gastrectomy between January 2017 and December 2020. Pulmonary infection within postoperative 30 days was set as the primary observational endpoint. The baseline demographic, clinicopathological, and laboratory data were compared between patients with or without pulmonary infection. ROC curves were plotted to evaluate the cut-off and predictive values of factors. Binary univariate and multivariate logistic regression analyses were employed to determine risk factors for postoperative pulmonary infection.Results: Of the enrolled 346 patients, pulmonary infection was observed in 51 patients within postoperative 30 days, with an incidence of 14.7%. mFI was a significant predictor for pulmonary infection by ROC curve analysis (AUC: 0.770, P < 0.001). Moreover, preoperative mFI was the only independent risk factor for pulmonary infection (OR: 2.72, 95% CI: 2.02– 3.31, P = 0.011) by univariate and multivariate logistic regression analyses.Conclusion: Our study indicates that mFI independently predicts pulmonary infection in elderly GC patients.Keywords: gastric cancer, elderly, radical gastrectomy, postoperative pulmonary infection, modified frailty index

Summary: Background: Different methods for digestive tract reconstruction have a complex impact on the nutritional status of gastric cancer (GC) patients after radical gastrectomy. Previous studies reported that Roux-en-Y (R-Y) reconstruction resulted in obvious weight reduction and improvement in type 2 diabetes in obese patients. We investigated the relationship between R-Y reconstruction, gut microbiota, and the NLRP3 inflammasome in GC patients with poor basic nutrition. Methods: Changes in the gut microbiota after radical gastrectomy accomplished by different methods of digestive tract reconstruction were investigated via fecal microbiota transplantation. The underlying mechanisms were also explored by analyzing the role of the microbiota, butyrate, and the NLRP3 inflammasome in the colon tissues of colitis model mice and GC patients after radical gastrectomy. Findings: R-Y reconstruction effectively relieved intestinal inflammation and facilitated nutrient absorption. 16S rRNA analysis revealed that gavage transplantation with the fecal microbiota of R-Y reconstruction patients could reverse dysbacteriosis triggered by radical gastrectomy and elevate the relative abundance of some short-chain fatty acid (SCFA)-producing bacteria. Subsequently, butyrate negatively regulated the NLRP3-mediated inflammatory signaling pathway to inhibit the activation of macrophages and the secretion of pro-inflammatory mediators such as caspase-1 and interleukin (IL)-1β, decreasing the level of intestinal inflammation and promoting nutrient absorption. Interpretation: R-Y reconstruction induced colonization with SCFA-producing bacteria to alleviate radical gastrectomy-induced colitis by down-regulating the NLRP3 signaling pathway. This can be a new strategy and theoretical basis for the management of the postoperative nutritional status of GC patients. Funding: This work was supported by the National Nature Science Foundation of China (81974375), the BoXi cultivation program (BXQN202130), and the Project of Youth Foundation in Science and Education of the Department of Public Health of Suzhou (KJXW2018001).

OBJECTIVES: This study focuses on the evaluation of the effectiveness of radical gastrectomy with D2 node dissection after neoadjuvant therapy in the patients with gastric cancer. Gastric cancer is a widespread type of cancer, and it is the third leading cause of death in the cancer patients. Metastases most often occur in the lymph nodes and therefore, in addition to gastrectomy, lymph node dissection is often performed in the patients. We are distinguishing between D1, 2 and 3 dissections. As with other cancers, the effectiveness of neoadjuvant therapy is being considered, which aims to improve the patient's prognosis and thus the 5-year survival rate. METHODS: Within the study, we evaluated a group of the patients diagnosed with gastric cancer (n=41). The average age of the patients was 62.3 years (20-72 years). 68.3 % (n=28) patients underwent neoadjuvant therapy before surgery, the remaining 31.7 % (n=13) underwent only radical gastrectomy with D2 lymphadenectomy. In all the cases, an open operational approach was implemented. CONCLUSION: Lymphadenopathy was found in 85.4 % of the patients. Complications occurred in both groups, but in the group with neoadjuvant therapy their share was lower (14.3 % vs 23.1 %), while in the group without neoadjuvant treatment the proportion of duodenal leaks was higher, as well as the number of reoperations. In total, an average of 30 ± 8 lymph nodes were harvested. A lower number of T3-4 cases was found in the neoadjuvant group (17.9 % vs 61.6 %), confirming that the tumour size was significantly smaller in the neoadjuvant group than in the group, who did not undergo it and underwent only surgical treatment. Relapse was found in 29.3 % of the patients after neoadjuvant treatment and in 38.5 % of the patients without neoadjuvant treatment. Also, mortality due to relapse was higher in the group without neoadjuvant treatment (30.8 % vs 21.7 %). The average survival was 25 months (Tab. 3, Fig. 3, Ref. 60). [ABSTRACT FROM AUTHOR]

We report a case of 40-year-old healthy patient presented with aborted sudden cardiac death. Echocardiography and coronarography were normal. ECG showed minimal non-specific changes in right precordial leads. A concealed Brugada syndrome was considered. We performed a provocative ajmaline test with Brugada-specific lead placement in 2nd, 3rd and 4th intercostal spaces at both parasternal sides. The test has confirmed the supposed diagnose. Detailed history taking revealed that the patient underwent a calf tattoo procedure on the same day. In this case report, we describe a new mechanism in Brugada patients, possibly leading to sudden cardiac death. The skin tattoo procedure is in more than 7 % of cases accompanied with a "tattoo flu syndrome", manifesting with fever, headache and fatigue. The fever is well described as a provoking factor for malignant arrhythmias in Brugada patients. Thus, a simple and safe procedure like skin tattoo can potentially lead to death in concealed Brugada syndrome population (Fig. 7, Ref. 9). [ABSTRACT FROM AUTHOR]

Objective To compare the treatment effects and complications of three reconstruction procedures in patients after radical gastrectomy. Methods A total of 194 patients with radical gastrectomy were selected and divided into the U-RY group (Uncut Roux-en-Y anastomosis, 69 cases), the B Ⅰ group (Billroth-Ⅰ modified delta-shaped anastomosis, 65 cases) and the B Ⅱ +Braun group (Billroth- Ⅱ +Braun anastomosis, 60 cases) according to the gastrointestinal reconstruction methods. The basic data of the three groups were matched by propensity score matching. The surgical status, postoperative recovery status, intestinal barrier function [diamine oxidase (DAO), D-lactic acid, endotoxin (ETX)], inflammatory stress indicators [interleukin-6 (IL-6), interleukin-10 (IL-10), 8-iso-prostaglandin F2α (8-iso-PGF2α), heme oxygenase-1 (HO-1)] and complications were compared between the three groups. Results Before propensity score matching, gender and age were not evenly distributed in the three groups (P＜0.05). After matching, 147 cases of 194 patients were successfully matched, with 49 cases in each group. There were no significant differences in general data between the three groups (P＞0.05). The surgical time increased successively in the B Ⅰ group, the B Ⅱ+Braun group and the U-RY group (P＜0.05). The intraoperative blood loss, postoperative bowel sound recovery time, first exhaust time, extubation time, eating time, first defecation time and hospital stay were less or shorter in the B Ⅰ group than those in the B Ⅱ+Braun group and the U-RY group (P＜0.05), but there were no significant differences in the above indicators between the B Ⅱ+Braun group and the U-RY group (P＞0.05). At 3 d after surgery, the levels of DAO, D-lactic acid and ETX were significantly lower in the B Ⅰ group than those of the U-RY group and the B Ⅱ+Braun group, while the levels of IL-6, IL10, 8-iso-PGF2α and HO-1 were higher compared with those in the U-RY group and the B Ⅱ+Braun group (P＜0.05). There were no significant differences in the above indicators between the U-RY group and the B Ⅱ+Braun group (P＞0.05). There were no significant differences in incidence rates of complications between the three groups (P＞0.05). Conclusion Billroth- Ⅰ modified delta-shaped anastomosis has the advantages of shorter surgical duration, less blood loss, faster recovery and smaller effect on the intestinal barrier compared to Billroth- Ⅱ+Braun anastomosis and Uncut Roux-en-Y anastomosis, but the latter two are more suitable for more indications and have milder inflammatory stimulation, and Uncut Roux-en-Y anastomosis can reduce postoperative reflux. [ABSTRACT FROM AUTHOR]

Purpose: Radical gastrectomy is considered the first choice of curative treatment for older patients with gastric cancer (GC). However, there is limited data on the survival benefits of gastrectomy for older patients with GC. Methods: This was a retrospective observational study where medical records of patients aged ≥ 75 years with clinically resectable primary GC, comprising 115 patients who underwent radical surgery (S group) and 33 patients who received conservative therapy (non-S group) (total cohort) and 44 propensity-matched patients (matched cohort), were reviewed. Survival and independent risk factors, including comorbidities and systemic nutritional and inflammatory statuses, were evaluated. Results: In the total cohort, the 5-year overall survival (OS) in the S group was significantly higher than that in the non-S group (53.7% vs 19.7%, P < 0.0001). In the matched cohort, the 3-year OS in the S group was significantly higher than that in the non-S group (59.4% vs 15.9%, P < 0.01). Multivariate analysis of the total cohort showed that no surgery was an independent prognostic factor for poor OS (hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.91–7.20, P = 0.0001). In the S group in the total cohort, the multivariate analysis showed that renal disease (HR 2.51, 95% CI 1.23–5.12, P < 0.05) was an independent prognostic factor for poor OS. Conclusions: Gastrectomy for older patients improved the prognosis; however, careful patient selection is essential, especially among those with renal disease. [ABSTRACT FROM AUTHOR]

Objective To explore the efficacy and safety of traditional Chinese medicine(TCM) combined with chemotherapy in the prevention and treatment of postoperative recurrence and metastasis of locally advanced gastric cancer (LAGC) by meta-analysis. Moreover, we evaluated the efficacy of TCM on the quality of life, immune indexes, and toxic and side effects during adjuvant chemotherapy. Methods The CNKI, Wanfang, PubMed, and other databases were searched by computer. Randomized controlled trials (RCTs) were searched. After literature screening and data extraction, Review Manager 5.3 software provided by Cochrane was used for meta-analysis. Results A total of 18 RCTs were included. Compared with chemotherapy alone, TCM combined with chemotherapy could improve the KPS score and CD3+ and CD4+/CD8+ index levels. The incidence rates of postoperative leucopenia, hemoglobin reduction, thrombocytopenia, nausea and vomiting, diarrhea, and neurotoxicity were reduced. In terms of postoperative QLQ-C30 score, abnormal liver function, and abnormal renal function, the incidence of TCM combined chemotherapy was similar to that of chemotherapy alone, with no statistical difference. Compared with chemotherapy alone, TCM combined chemotherapy could reduce the 1-, 2-, 3-, and 5-year cumulative recurrence and metastasis rates and prolong the disease-free survival time. Conclusion Compared with chemotherapy alone in adjuvant chemotherapy, TCM combined chemotherapy could improve the immune level and KPS score of LACC patients after surgery, reduce the incidence of adverse reactions, as well as reduce the recurrence and metastasis rate of LAGC after surgery and DFS could be improved. [ABSTRACT FROM AUTHOR]

Digestive tract reconstruction is one of the key operations of gastric cancer surgery. Its quality directly affects the occurrence of postoperative complications and long-term nutritional status and quality of life. Reasonable selection of digestive tract reconstruction in totally laparoscopic radical gastrectomy for gastric cancer can significantly reduce postoperative complications and improve postoperative nutritional status and quality of life. This paper discusses the advantages and disadvantages of digestive tract anastomosis used in total laparoscopic distal gastrectomy and total gastrectomy, explores the best possible anastomosis at present, describes the progress of anastomosis in complete laparoscopic proximal gastrectomy, and introduces the progress of physiology and biomechanical reconstruction theory. [ABSTRACT FROM AUTHOR]

Deliang Yu,1,&ast; Xiaoyong Wu,1,&ast; Xuzhao Li,1,&ast; Xiaonan Liu,1 Kun Jiang,2 Qingchuan Zhao,1 Huang Nie3 1Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China; 2Information Center, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, Shaanxi, People’s Republic of China; 3Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, 710032, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qingchuan Zhao Tel +86-29-84771503Email zhaoqcxjh@163.comHuang Nie +86-29-84775343Email niehuang@163.comAim: Enhanced recovery after surgery (ERAS) gradually shortens the length of stay but increases the rate of unplanned readmission after discharge. Currently, objective discharge criteria for patients after radical gastrectomy is lacking. This study aimed to construct and validate a nomogram for estimation of the possibility of safe discharge on the fifth-day post radical gastrectomy.Methods: We enrolled 496 consecutive patients undergoing radical gastrectomy as the development cohort. After the fifth day of surgery, patients were assigned to the postoperative complication group and no postoperative complication group. Multivariate logistic regression analyses were performed for both groups. Then, we constructed the risk prediction model of postoperative severe complications (PSCs) and applied it to evaluate whether the patient could be discharged safely. The external validation cohort comprised 245 patients, whom we used to evaluate the capability of our model to predict the risk of PSCs. The primary measure was the negative predictive rate (NPR) and the area under the curve (AUC).Results: Through multivariate analysis, gender, maximum body temperature on the 4th postoperative day (POD4), oral intake and ambulatory duration on POD4, the proportion of neutrophils (≥ 75% or < 75%) and pain score (≥ 4 or < 4) on POD5, and defecation with 5 days after the procedure (yes or no) were identified as independent predictors for PSCs. Upon incorporation of these variables, the nomogram demonstrated a good NPR of 0.957 and 0.916 and AUC of 0.918 and 0.719 in the two cohorts, respectively. With a nomogram score of 110, patients were stratified into low and high risk of PSCs.Conclusion: The nomogram demonstrated good predictive potential for low-risk patients. It could serve as an objective safe discharge approach for patients after the fifth day of radical gastrectomy.Keywords: gastric cancer, radical gastrectomy, postoperative complications, safe discharge, perioperative management

Xiaonan Zhang,1,&ast; Huimin Fang,1,&ast; Zhigang Zeng,1 Kaijun Zhang,1 Zhanyi Lin,1,2 Gang Deng,1 Weiping Deng,1 Lichang Guan,1 Xuebiao Wei,1 Xinyi Li,2 Lei Jiang,1– 3 Lishu Xu1– 3 1Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, People’s Republic of China; 2School of Medicine, South China University of Technology, Guangzhou, 510641, People’s Republic of China; 3The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lei Jiang; Lishu Xu Tel +86-20-83827812; +86-20-13660032429Email jianglei@smu.edu.cn; xulishu70@163.comPurpose: Gastric cancer is a common tumor type associated with nutritional and immune status. The aim of the current study was to investigate the prognostic value of a preoperative prognostic nutritional index (PNI), composed of nutritional factors and immune factors in elderly patients undergoing gastric cancer surgery.Patients and Methods: A total of 454 patients undergoing gastric cancer surgery were divided into two groups based on preoperative PNI scores: ≤ 45.1 (n = 307) and > 45.1 (n = 147). Survival analysis was performed using the Kaplan–Meier method and Log rank tests. Univariate and multivariate analyses were conducted to identify independent prognostic factors using a Cox proportional hazards model.Results: According to the X-tile program, the optimal cutoff value for predicting overall survival (OS) with the PNI was 45.1. The receiver operating characteristic analysis revealed that PNI exhibited 70.6% sensitivity and 56.5% speci&filig;city for predicting death during long-term follow-up. The cumulative incidence of postoperative 4-year mortality indicated that the risk of death increased significantly for PNI ≤ 45.1. In multivariate analysis, preoperative PNI was a significant independent predictor of mortality. In the age-stratified subgroup analysis, preoperative PNI was more sensitive for the old elderly subgroup than for the young elderly subgroup.Conclusion: Preoperative PNI is a sensitive and specific prognostic predictor among elderly patients undergoing gastric cancer surgery.Keywords: elderly patients, gastric cancer, prognostic nutritional index, radical gastrectomy

Xueli Lv,1,* Xiaoxiao Li,1,* Kedi Guo,1,* Tong Li,1 Yuping Yang,1 Wensi Lu,1 Shuting Wang,1 Su Liu1,2 1Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Su LiuDepartment of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of ChinaTel +86 18118309692Fax +0516-8346-9496Email 150040009@qq.comObjective: This study aimed to explore the effects of lidocaine on postoperative quality of recovery (QoR) and immune function in patients undergoing laparoscopic radical gastrectomy.Methods: In total, 135 patients were enrolled and were equally randomized to receive low-dose lidocaine (Group LL: 1.5 mg/kg bolus followed by an infusion at 1.0 mg/kg/hour) or high-dose lidocaine (Group HL: 1.5 mg/kg bolus followed by an infusion at 2.0 mg/kg/hour) or Controls (Group C: received a volume-matched normal saline at the same rate). The primary outcome was a QoR-40 score on postoperative day (POD) 1. Secondary outcomes were a QoR-40 score on POD 3, levels of inflammatory factors (IL-6, IL-10, TNF-α) and CD4+T cells, CD8+T cells proportions, and CD4+/CD8+ cell ratios and postoperative recovery of bowel function.Results: There were no statistically significant differences in patient characteristics at baseline. The total QoR-40 scores on POD 1 in Group HL (171.4± 3.89) were higher than those in Group LL (166.20± 4.05) and in Group C (163.40± 4.38) (adjusted P< 0.001). Differences in the dimension scores of QoR-40 for pain, physical comfort, and emotional state were significant across the three groups. Lidocaine administration significantly reduced the release of IL-6, IL-10, TNF-α, and attenuated immune changes induced by trauma. Kaplan–Meier curves showed that the median time to the first exhaust and defecation were shorter in the Group HL than in Groups LL and C (1.55 days vs 2.4 days vs 2.6 days, log rank P< 0.0001; and 2.86 days vs 3.22 days vs 3.46 days, log rank P=0.002, respectively). Additionally, patients in lidocaine groups required less remifentanil consumption and experienced lower pain intensity, compared with the control group.Conclusion: Systemic lidocaine improved postoperative recovery, alleviated inflammation and immunosuppression, and accelerated the return of bowel function, and is thus, worthy of clinical application.Clinical Trials Registration: ChiCTR2000028934.Keywords: lidocaine, QoR-40, postoperative quality of life, radical gastrectomy

Objective To investigate the predictive value of visceral fat area (VFA) in patients with gastric cancer after radical gastrectomy. Methods A retrospective analysis was performed on 195 patients who underwent radical gastrectomy in the Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University from January 2014 to December 2017. CT image data and clinicopathological data within 1 week before surgery were collected. VFA was calculated by software， and the patients were divided into VFA-H group (n=96）and VFA-L group (n=99）. The relationship between VFA in different groups and long-term prognosis was compared. Results CT examination results showed that VFA value was（111±62）cm2 ，and BMI was positively correlated with VFA value (r=0. 640，P<0. 001）. ROC curve showed that VFA was more valuable in predicting the prognosis of gastric cancer (AUC=0. 703，P<0. 001） and better than BMI. Cox regression analysis of prognostic factors in gastric cancer patients: Univariate analysis showed that age， tumor length， TNM stage and VFA were the influencing factors for prognosis， while multivariate analysis showed that TNM stage III and VFA-L were independent risk factors for prognosis of gastric cancer patients. Conclusion VFA has a good predictive ability and can be used to evaluate the prognosis of gastric cancer patients after operation. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is the most prevalent tumor in Chinese men, and surgery is currently the most important treatment. Billroth II and Roux-en-Y are the anastomosis methods used for reconstruction after gastrectomy. Jejunal intussusception is a rare complication after gastric surgery. Main Body: Intussusception after gastric surgery occurs mostly at the gastrojejunostomy site for Billroth II reconstruction, and the Y-anastomosis site for Roux-en-Y reconstruction. Many studies have reported that postoperative intussusception appears at the anastomosis after bariatric surgery, while a few have reported intussusception at the anastomosis and its distal end after radical gastrectomy. Conclusion: A review was carried out to analyze intussusception after radical gastrectomy with roux-en-y anastomosis during the current situation. And the relevant mechanisms, diagnosis, treatment methods, etc. are described, hoping to provide better guidance for clinicians [ABSTRACT FROM AUTHOR]

Gastric cancer is the fifth most common cancer in the world and the third leading cause of cancer-related deaths. Signet-ring cell type is the most malicious subtype. We report a case of advanced stage gastric adenocarcinoma case post-radical gastrectomy who presented with nausea, vomiting, and diarrhea. Though there were no signs of bowel obstruction on abdominal CT and PET imagine studies, and the cytology of body fluid was initially negative, the patient had unilateral malignant pleural effusion, a moderate amount of ascites and bilateral hydronephrosis. After laparoscopic surgery, the patient was diagnosed with local cancer relapse causing jejunojejunal anastomosis obstruction and peritoneal carcinomatosis causing hydronephrosis. We urge broadening the indication of EGD in the evaluation of advanced stage gastric carcinoma to include mechanic bowel obstruction.

This systematic review examines the feasibility and safety of early oral feeding (EOF) after radical gastrectomy in patients with gastric cancer. A comprehensive literature search identified eight eligible studies, including both clinical trials and cohort studies, conducted between 2011 and 2020. The review analyzed outcomes such as postoperative complications, length of hospital stay, time to first flatus/bowel movement, and changes in nutritional markers. The findings suggest that EOF is generally feasible and well-tolerated, with high adherence rates reported across studies. Most patients successfully initiated oral intake within 72 hours post-surgery without significant protocol deviations. Regarding safety, the studies reported comparable or lower rates of postoperative complications in EOF groups compared to traditional feeding protocols, though some noted non-significant increases in complications with EOF. Several studies observed potential benefits of EOF, including shorter hospital stays, earlier return of gastrointestinal function, and improved nutritional status. However, the results were mixed, with some studies finding no significant differences in these outcomes. While the review suggests EOF is a viable option for postoperative management after radical gastrectomy, it emphasizes the importance of patient-specific factors and close monitoring during implementation. The heterogeneity in study designs, EOF protocols, and outcome measures limits direct comparisons. Future large-scale randomized controlled trials are warranted to establish standardized EOF protocols and provide more robust evidence for this patient population., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ali et al.)

Background: The population of elderly patients with gastric cancer is increasing, which is a major public health issue in China. Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer., Aim: To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy., Methods: A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020., Results: The overall rate of malnutrition was 31.8%. The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group ( P < 0.001). Nutritional characteristics in the malnourished group, including body mass index, prognostic nutritional index (PNI), albumin, prealbumin, and hemoglobin, were all significantly lower than those in the well-nourished group. The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the well-nourished group (22.1% vs 33.5%, P = 0.001). Age ≥ 70 years (HR = 1.216, 95%CI: 1.048-1.411), PNI < 44.5 (HR = 1.792, 95%CI: 1.058-3.032), operation time ≥ 160 minutes (HR = 1.431, 95%CI: 1.237-1.656), and postoperative complications grade III or higher (HR = 2.191, 95%CI: 1.604-2.991) were all recognized as independent risk factors associated with delayed discharge., Conclusion: Malnutrition is relatively common in elderly patients undergoing gastrectomy. Low PNI is an independent risk factor associated with delay discharge. More strategies are needed to improve the clinical outcome of these patients., Competing Interests: Conflict-of-interest statement: The authors claim no conflict of interests., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

To investigate the occurrence of postoperative complications in and factors influencing the prognosis of patients undergoing radical gastrectomy after neoadjuvant chemotherapy. A total of 238 patients with gastric cancer were enrolled in this study. There were 194 patients who underwent neoadjuvant chemotherapy before surgery and 44 patients who underwent concurrent radiochemotherapy before surgery. The clinical data of patients and the incidence of postoperative complications were collected. Postoperative complications were graded based on the Clavien-Dindo classification. The impact of postoperative complications on the prognosis of patients was analysed. (1) The overall incidence of postoperative complications was 17.2% (41/238) among all patients. A total of 49 patients experienced postoperative complications, including 12 cases of grade I, 15 cases of grade II, seven cases of grade IIIa, three cases of grade IIIb, seven cases of grade IV, and four cases of grade V complications. A total of 21 patients experienced severe complications. Multivariate analysis indicated that age, body mass index (BMI), and scope of gastrectomy were independent risk factors for postoperative complications (p <.05). (2) The five-year survival rate for the entire group of patients was 58.4%. The five-year survival rate for the complication group and non-complication group were 31.7% and 51.7%, respectively, with a significant difference between the two groups (χ2=15.41p =.000). Based on the severity of complications, the subgroup analysis indicated that the five-year survival rate for patients with severe postoperative complications was 21.1% and that for patients with non-severe complications was 40.9%; the difference was significant (χ2=21.70, p =.000). (3) Multivariate analysis indicated that age, pathological tumour, node, and metastasis (ypTNM) stages II-III, operation time >3.5 h, total gastrectomy, and postoperative complications were independent risk factors affecting the prognosis of patients undergoing radical gastrectomy after neoadjuvant chemotherapy. Postoperative adjuvant therapy was an independent protective factor for patient prognosis (p <.05). The incidence of complications in patients undergoing radical gastrectomy after neoadjuvant chemotherapy is closely correlated with patient age and the scope of surgical resection, and the occurrence of severe complications has a significant adverse effect on patient prognosis. [ABSTRACT FROM AUTHOR]

Surgical resection remains the gold standard treatment for gastric cancer; however, the rate of post-operative complications remains unsatisfactory. Although the majority of complications are treatable, it remains unknown whether the long-term survival of patients is affected and what type of complications affect prognosis. In the present study, the modified Clavien-Dindo classification system was used to examine the incidence of early complications along with the related risk factors following radical gastrectomy (RG) and to determine the effects of such complications on long-term prognosis. For this purpose, 525 gastric cancer patients with RG were analyzed retrospectively. The results revealed that age [odds ratio (OR), 1.781; P=0.013], pre-operative comorbidity (OR, 1.765; P=0.020), blood loss (OR, 2.153; P=0.001) and the type of surgery (OR, 3.137; P<0.001) were identified as independent risk factors associated with post-surgery complications. Blood loss (OR, 13.053; P=0.013) and the resection type (OR, 7.936; P=0.047) were identified as independent risk factors for severe complications. The 5-year overall survival (OS) rate of patients in the severe complication group was 35%, which was significantly worse than that of patients in the non-severe complication group (61.8%). Severe complications (hazard ratio, 1.595; P=0.107) were not found to be independent risk factors associated with the 5-year OS. On the whole, the present study demonstrates that complications following RG were significantly related to age, pre-operative comorbidity, blood loss and the type of surgery. Severe complications were distinctly affected by blood loss and the resection type. The 5-year OS of patients in the severe complication group was significantly worse than that of patients in the non-severe complication group; however, severe complications were not found to be independent risk factors associated with long-term survival. [ABSTRACT FROM AUTHOR]

The clinical value of indocyanine green (ICG) in laparoscopic radical gastrectomy remains controversial. We performed this meta-analysis to investigate the safety and efficacy of ICG fluorescence imaging-guided radical gastrectomy. All relevant studies published until 30 October 2020 were retrieved from several databases. Fixed- and random-effects models were used to analyze the results based on different heterogeneity levels. Data were expressed as odds ratios or weighted mean differences along with 95% confidence intervals. The Grading of Recommendations, Assessment, Development, and Evaluation system scale was used for quality of evidence evaluation. This meta-analysis included six cohort studies that investigated 622 patients. Compared with conventional radical gastrectomy, ICG fluorescence imaging-guided gastrectomy facilitates complete lymph node dissection, reduces intraoperative blood loss, and shortens the length of postoperative hospitalization. Moreover, we observed no significant intergroup differences in the operative time, first exhaust time, and postoperative complications. ICG fluorescence imaging-guided radical gastrectomy scores over conventional gastrectomy and appears to be a promising approach in patients who require radical gastrectomy. However, further research is warranted to explore the potential long-term survival benefit of ICG fluorescence imaging in patients with gastric cancer. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of duodenal prior disconnection in laparoscopic assisted distal gastrectomy on stress response, inflammatory factors and quality of life in patients with gastric cancer. Methods: 93 cases of patients with gastric cancer undergoing laparoscopic assisted distal gastrectomy in Handan Central Hospital of Hebei Province from March 2018 to December 2020 were selected, and they were divided into control group with 45 cases and study group with 48 cases according to different operation methods. The control group was given laparoscopic assisted distal gastrectomy via left posterior approach, and the study group was given duodenal prior disconnection laparoscopic assisted distal gastrectom. Perioperative indicators, stress response, inflammatory factors, quality of life and postoperative complications in two groups were compared. Results: There was no significant difference in the number of lymph nodes removed between the two groups (P>0.05). The operation time, recovery time of gastrointestinal function and hospitalization time of the study group were shorter than those of the control group and the intraoperative blood loss of the study group was less than that of the control group(P<0.05). The blood glucose, cortisol and epinephrine of the study group were lower than those of the control group at 3 d and 5 d after operation (P<0.05). The levels of interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-α(TNF-α)of the study group were lower than those of the control group at 3 d and 5 d after operation (P<0.05). The scores of subjective symptoms, physiological function, social activity function and psychological emotion state of the study group were higher than those of the control group at 1 month after operation (P<0.05). There was no significant difference in the incidence rate of postoperative complications between the two groups (P>0.05). Conclusion: Compared with laparoscopic assisted distal gastrectomy via left posterior approach, duodenal priority can simplify the operation steps of laparoscopic assisted distal gastrectomy, reduce the stress reaction and inflammatory reaction of patients with gastric cancer, and effectively promote the recovery of patients after operation. [ABSTRACT FROM AUTHOR]

Surgery remains the undisputed mainstay in the management of gastric cancer, and advances in chemotherapy and radiation have improved outcomes in patients with resectable disease. A multidisciplinary approach, with active coordination across specialties dealing with management of gastric cancers provides improved quality of care and outcomes. Radical gastrectomy involves complete removal of tumor with adequate margins and appropriate lymph node dissection. Spleen preserving D2 lymphadenectomy is the present standard of care for all resectable tumors except few early tumors (T1a lesions) where endoscopic or local resections are deemed suitable. Perioperative or adjuvant chemotherapy should be offered to all patients with resectable tumor, having advanced T stage or node-positive disease. In patients with advanced tumors with invasion of adjacent organs, multivisceral resections can be offered selectively in the presence of good performance status and response to chemotherapy, which can lead to improvement in overall survival. The role of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy needs to be evaluated in patients with limited peritoneal disease. [ABSTRACT FROM AUTHOR]

Patients with gastric cancer often suffer from generalized and progressive reduction of skeletal muscle mass and strength, which negatively affects the quality of life (QOL). In this study, we explored the impact of sarcopenia on QOL and overall survival (OS). From December 2015 to June 2017, 135 patients underwent radical gastrectomy at the First Affiliated Hospital of Wenzhou Medical University. Based on the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS), data including handgrip strength, 6-m gait speed and muscle mass were collected and analyzed. EORTC QLQ-C30 and EORTC QLQ-STO22 were used to evaluate the QOL before surgery, 1, 3 and 6 months after surgery. A total of 27 out of the 135 patients (20.00%) were diagnosed with sarcopenia. Compared with non-sarcopenia group, patients in sarcopenia group had a higher incidence of postoperative complications (14.80% vs. 40.70%, p = 0.003), and more hospitalization costs (p = 0.029). The scores of eating restriction (p = 0.026), anxiety (p = 0.045) and body image (p = 0.046) were significantly higher in sarcopenia group at postoperative 6 months. Besides, sarcopenia was an independent risk factor for global health status at 6 months after operation (OR: 2.881, 95% CI: 1.110–7.475, p = 0.030) and OS (HR: 3.140, 95% CI: 1.255–7.855, p = 0.014). Other factors, including tumor stage III and the postoperative complications, had negative influences on OS. Sarcopenia is a predictive factor of poor QOL and prognosis in patients with gastric cancer. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the effects of a high body mass index (BMI) on the outcomes of radical gastrectomy for gastric cancer. Methods: We conducted a retrospective cohort study of 1729 patients with stage I to III gastric cancer who received open radical gastrectomy from February 2003 to August 2011. The patients were divided into 3 groups according to their BMI: a low BMI group (BMI < 18.5 kg/m2), normal BMI group (18.5 ≤ BMI < 25 kg/m2), and high BMI group (BMI ≥ 25 kg/m2). Results: A total of 871 patients were included in the final analysis, of which the median BMI was 22.7 kg/m2 (range 13.6–44.9 kg/m2). A high BMI increased the risk of postoperative intestinal fistula but not the risk of a reduced number of examined lymph nodes or hospital death. Furthermore, a high BMI did not negatively affect the overall survival (OS) of gastric cancer patients. Conclusions: A high BMI increased the operative morbidity after radical gastrectomy for gastric cancer. However, a high BMI did not negatively affect the quality of lymphadenectomy or the OS of gastric cancer patients in experienced high-volume centers. A careful approach during operation and meticulous perioperative management are required for gastric cancer patients with a high BMI. [ABSTRACT FROM AUTHOR]