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简介：AIM:ToevaluatetheimpactofadvancedageonoutcomeMETHODS:Twohundredsandelevenpatientsundergonehepatectomy,gastrectomyandpancreatoduodenectomyfromJanuary1998toSeptember2002wereanalyzedretrospectively.Clinicopathologicfeaturesandoperativeoutcomeof83patientsaged65yearsormorewerecomparedwiththatin128youngerpatientsagedlessthan65years.RESULTS:Thenutritionalstate,suchaspre-operationlevelofserumalbuminandhemoglobinintheolderpatientswaspoorerthanthatintheyoungerpatients.Theolderpatientshadhighercomorbiditiesthantheyoungerpatients(48.2%vs15.6%).Nosignificantdifferencewasobservedinpedoperativemortality,andcomplicationratebetweentheolderandyoungerpatients(2.4%vs1.6%and22.9%vs20.3%,respectively).Multivariateanalysisdemonstratedthatpancreatoduodenectomy,hepatectomywithresectionofmorethan2segmentsandcomorbiditieswereindependentpredictorsofpostoperativecomplication,whereasagewasnot(P=0.3172).CONCLUSION:Itissafeforpatientsaged65yearsormoretoundergohepatic,pancreaticandgastricresectionifgreatcareistakenduringperioperativeperiod.

简介：Sleevegastrectomy(SG)isarestrictivebariatricsurgerytechniquethatwasfirstusedaspartofrestrictivehorizontalgastrectomyintheoriginalScopinarotypebiliopancreaticdiversion.Itsgoodresultsasasingletechniquehaveledtoariseinitsuse,anditiscurrentlythesecondmostperformedtechniqueworldwide.SGachievesclearlybetterresultsthanotherrestrictivetechniquesandiscomparableinsomeaspectstotheRoux-en-Ygastricbypass,thecurrentgoldstandardinbariatricsurgery.Thesebenefitshavebeenassociatedwithdifferentpathophysiologicmechanismsunrelatedtoweightlosssuchasincreasedgastricemptyingandintestinaltransit,andactivationofhormonalmechanismssuchasincreasedGLP-1hormoneanddecreasedghrelin.TheaimofthisreviewwastohighlightthesalientaspectsofSGregardingitshistoricalevolution,pathophysiologicmechanisms,mainresults,clinicalapplicationsandperioperativecomplications.

简介：AIM:Toinvestigatetheefficacyofneoadjuvantchemoradiotherapy(NACRT)forresectabilityoflocallyadvancedgastriccancer(LAGC).METHODS:BetweenNovember2007andJanuary2014,29patientswithLAGC(clinicallyT3withdistalesophagusinvasion/T4orbulkyregionalnodemetastasis)thatweretreatedwithNACRTfollowedbyD2gastrectomywereincludedinthisstudy.ResectabilitywasevaluatedwithradiologicandendoscopicexamsbeforeandafterNACRT.Usingthreedimensionalconformalradiotherapy,patientsreceived45Gy,withadailydoseof1.8Gy.Theentiretumorextentandtheregionalmetastaticlymphnodeswereincludedinthegrosstumorvolume.PatientspresentingwitharesectabletumorafterNACRTreceivedatotalorsubtotalgastrectomywithD2dissection.ThepathologictumorresponsewasevaluatedusingJapaneseGastricCancerAssociationhistologicevaluationcriteria.PostoperativemorbiditywasevaluatedusingtheNationalCancerInstitute-CommonTerminologyCriteriaforAdverseEventsversion4.0.Overallsurvival(OS)andprogression-freesurvival(PFS)rateswereestimatedusingaKaplan-Meieranalysisandcomparedusingthelog-ranktest.RESULTS:Allpatientswereassessedasunresectablecases.Twenty-fourpatients(24/29;82.8%)showedLAGConpositronemissiontomography-computedtomography(CT)andcontrast-enhancedCT,whereasfourpatients(4/29;13.8%)withvagueinvasionorabutmenttoanadjacentorganunderwentdiagnosticlaparoscopy.Onepatient(1/29;3.4%),initiallyassessedasaresectablecase,underwentan'openandclosure'afterthetumorwasfoundtobeunresectable.Abutmenttoanadjacentorgan(34.5%)wasthemostcommonreasonforNACRT.TheclinicalresponserateonemonthafterNACRTwas44.8%.AfterNACRT,69%(20/29)ofpatientshadaresectabletumor.Ofthe20patientswitharesectabletumor,18patients(62.1%)underwentaD2gastrectomy.TheR0resectionratewas94.4%andtwopatients(2/18;11.1%)showedacompleteresponse.Themedianfollow-updurationwas13.5mo.Theone-yearOSandPFS

简介：Objective:Patientsundergoingtotalgastrectomyforcancerareatriskofmalnourishment.Theaimofthisselfcontrolledstudywastoexaminetheeffectofjejunostomytubefeeding(JTF)andotherfactorsonpostoperativeweightandtheincidenceofjejunostomy-relatedcomplicationsinpatientsundergoingtotalgastrectomyforcancer.Methods:Allconsecutivepatientswhounderwenttotalgastrectomyforgastriccancerwithjejunostomyplacementwereincludedfromaprospectivesingle-centerdatabase(2003–2014).Jejunostomy-relatedcomplicationsandpostoperativeweightchangeswereevaluatedupto12monthsaftersurgery.Multivariablelinearregressionanalysiswasperformedtoidentifyfactorsassociatedwithweightloss12monthsaftergastrectomy.Results:Of113patientsoperatedinthestudyperiod,65receivedJTFaftertotalgastrectomyforamediandurationof18d[interquartilerange(IQR),10–55d].Jejunostomy-relatedcomplicationsoccurredin11(17%)patients,includingskinleakage(n=3)andperitonealleakage(n=2),luxation(n=3),occlusion(n=2),infection(n=1)andtorsion(n=1).In2(3%)patients,areoperationwasneededduetojejunostomy-relatedcomplications.Themeanpreoperativeweightofpatientswas71.8kg(100%),andremainedstableduringJTF(73.9kg,103%,P=0.331).AfterJTFwasstopped,themeanweightofpatientsdecreasedto64.9kg(90%)at12monthsaftersurgery(P<0.001).Ahighpreoperativebodymassindex(BMI)(≥25kg/m~2)wasassociatedwithhighpostoperativeweightlosscomparedtopatientswithalowBMI(<25kg/m~2)(16.3%vs.8.6%,P=0.016).Conclusions:JTFcanpreventweightlossintheearlypostoperativephase.However,thisisattheprizeofpossiblecomplications.Asweightlossinthelongtermisnotprevented,routineJTFshouldbere-evaluatedandbalancedagainsttheselecteduseinpreoperativelymalnourishedpatients.SpecialattentionshouldbepaidtopatientswithahighpreoperativeBMI,whoareatriskofmorepostoperativeweightloss.

简介：AbstractBackground:About 10% of patients get a surgical-site infection (SSI) after radical gastrectomy for gastric cancer, but SSI remains controversial among surgeons. The aim of this study was to explore the risk factors for SSIs after radical gastrectomy in patients with gastric cancer to guide clinical therapies and reduce the incidence of SSI.Methods:The study was a retrospective cohort study in patients who underwent radical gastrectomy for gastric cancer. SSI was defined in accordance with the National Nosocomial Infection Surveillance System. We evaluated patient-related and peri-operative variables that could be risk factors for SSIs. The Chi-squared test and logistic regression analysis were used to assess the association between these risk factors and SSI.Results:Among the 590 patients, 386 were men and 204 were women. The mean age was 56.6 (28-82) years and 14.2% (84/590) of these patients had an SSI. Among them, incisional SSI was observed in 23 patients (3.9%) and organ/space SSI in 61 patients (10.3%). Multivariate logistic regression analysis identified sex (odds ratios [ORs] = 2.548, and 95% confidence interval [CI]: 1.268-5.122, P = 0.009), total gastrectomy (OR = 2.327, 95% CI: 1.352-4.004, P = 0.002), albumin level (day 3 after surgery) <30 g/L (OR= 1.868, 95% CI: 1.066-3.274, P = 0.029), and post-operative total parenteral nutrition (OR = 2.318, 95% CI: 1.026-5.237, P = 0.043) as independent risk factors for SSI.Conclusions:SSI was common among patients after radical gastrectomy for gastric cancer. The method supporting post-operative nutrition and the duration of prophylactic antibiotics may be important modifiable influencing factors for SSI.

简介：AbstractObjective:Chinese rhubarb is a promising Chinese medicine for the promotion of gastrointestinal function. This study was conducted to investigate the safety and efficacy of Chinese rhubarb administered via ultrasound delivery in promoting the early recovery of gastrointestinal function after gastrectomy.Methods:In this prospective randomized controlled study, 100 patients who were scheduled to undergo total or subtotal gastrectomy in Changzhi People’s Hospital or Subei People’s Hospital from August 2017 to January 2018 were recruited. These patients were randomly assigned into two equal groups before surgery: 50 in the experimental (Chinese rhubarb) group, and 50 in the control (routine nursing) group. After surgery, time to flatus, bowel movement, clear liquid diet, and removal of nasogastric tube were recorded and analyzed. In addition, postoperative pain, postoperative bowel movement-related complications, and postoperative hospital stay duration were also recorded and analyzed. The study was approved by The protocol was approved by the Institutional Review Board of Changzhi People’s Hospital and Subei People’s Hospital on July 1, 2017 and registered with the Chinese Clinical Trial Registry on December 17, 2018 (registration number: ChiCTR1800020143).Results:Time to flatus (control group 85.68±22.00 hours vs experimental group 73.06±23.42 hours; P=0.007), bowel movement (5.52±1.56 vs 4.40±1.21 days; P<0.001), clear liquid diet (6.72±1.16 vs 6.22±1.28 days; P=0.044), and removal of nasogastric tube (6.30±1.52 vs 5.65±1.58 days; P=0.044) were significantly shorter in the experimental group compared with the control group, as was the postoperative hospital stay duration (14.30±3.46 vs 12.86±1.36 days; P=0.006). In addition, better pain relief (P=0.003) and a lower incidence of postoperative bowel movement-related complications (6 vs 21; P=0.001) were noted in the experimental group.Conclusion:Ultrasound delivery of Chinese rhubarb is useful to promote the early recovery of gastrointestinal function after gastrectomy.

简介：AbstractBackground:The complete mesogastrium excision (CME) based on D2 radical gastrectomy is believed to significantly reduce the local-regional recurrence compared with D2 radical gastrectomy in advanced gastric cancer, and it is widely used in China. This study aimed to explore whether D2 + CME is superior to D2 on surgical outcomes during gastrectomy from Chinese data.Methods:Feasible studies comparing the D2 + CME (D2 + CME group) and D2 (D2 group) published up to March 2020 are searched from electronic databases. The data showing surgical and complication outcomes are extracted to be pooled and analyzed.Results:Fourteen records including 1352 patients were included. The D2 + CME group had a shorter mean operative time (weighted mean difference [WMD] = -16.72 min, 95% confidence interval [CI]: -26.56 to - 6.87 min, P < 0.001), lower mean blood loss (WMD = -39.08 mL, 95% CI: -49.94 to -28.21 mL, P < 0.001), higher mean number of retrieved lymph nodes (WMD = 2.13, 95% CI: 0.58-3.67, P = 0.007), shorter time to first flatus (WMD =-0.31 d, 95% CI: -0.53 to - 0.10 d, P = 0.005), and postoperative hospital days (WMD =-1.09, 95% CI: -1.92 to -0.25, P = 0.010) than the D2 group. Subgroup analysis suggested that the advantages from the D2 + CME group were obvious in traditional open radical gastrectomy, proximal gastrectomy, and distal gastrectomy compared with D2 group. The evaluations of post-operative complications showed that the patients who underwent D2 + CME had a lower incidence of post-operative complications than the patients who underwent D2 surgery alone (relative risk [RR] = 0.65, 95% CI: 0.45-0.87, P = 0.003). The D2 radical gastrectomy plus CME improved 3-year overall survival (OS) (RR = 1.16, 95% CI: 1.02-1.32, P = 0.020) and lowered the local recurrence rate (RR = 0.51, 95% CI: 0.28-0.94, P = 0.030). The patients undergoing laparoscopic surgery or total gastrectomy had more significant advantages compared between D2 + CME and D2 groups in 3-year OS.Conclusion:The data from China show that D2 radical gastrectomy plus CME are reliable procedures and safety compared to D2 radical gastrectomy with faster recovery, lower risk, and better prognosis.

简介：AbstractObjective:To identify risk factors for anastomotic leakage after gastrectomy in patients with Siewert type II/III adenocarcinoma (AEG) of the esophagogastric junction.Methods:This was a retrospective case-control study of 903 patients with Siewert type II/III AEG treated from January 2012 to January 2015 at the Shanxi Cancer Hospital in China. All patients underwent gastrectomy, and their clinical characteristics were analyzed to identify associations with anastomotic leakage. Independent risk factors were identified by binary logistic regression. The 2-year disease-free survival was calculated and compared between patients with anastomotic leakage and control patients. The study was approved by the Institutional Review Board of Shanxi Medical University (approval No. 2014-09-39) on September 19, 2014.Results:Out of the 903 patients were included in the study, 80 (8.86%, 80/903) experienced anastomotic leakage. The mortality rate attributed to anastomotic leakage was 8.75% (7/80). Logistic regression analysis revealed that preoperative hypoalbuminemia (odds ratio (OR)=3.249, 95% confidence interval (CI): 1.569-6.725, P=0.002), type of reconstruction (OR=1.795, 95% CI: 1.026-3.142, P=0.040), and combined organ resection (OR=1.807, 95% CI: 1.069-3.055, P=0.027) were independent risk factors for anastomotic leakage.Conclusion:Preoperative hypoalbuminemia, type of reconstruction, and combined organ resection were identified as risk factors for anastomotic leakage in patients undergoing gastrectomy for Siewert type II/III AEG.