ObjectiveTo analyze the factors influencing the total number of harvested lymph nodes in laparoscopic radical gastrectomy for advanced gastric cancer.MethodsThe clinicopathologic data of patients who underwent laparoscopic D2 radical resection of gastric cancer in this hospital for advanced gastric cancer from January 2018 to July 2020 were retrospectively analyzed. The statistical analysis was conducted to analyze the influence factors (age, gender, tumor size, tumor site, body mass index, infiltration depth, lymph node metastasis, HER-2 gene amplification status, presence or absence of vascular tumor thrombus, presence or absence of nerve infiltration, differentiation type, pTNM, Borrmann type, and type of gastrectomy) on the number of harvested lymph nodes.ResultsA total of 536 patients met the inclusion and exclusion criteria were included. The results of univariate analysis showed that the total number of harvested lymph nodes during laparoscopic radical gastrectomy for advanced gastric cancer was correlated with age, tumor size, tumor infiltration depth, lymph node metastasis, pTNM stage, Borrmann type, and type of gastrectomy. That was, the younger the patient was (≤ 54 years old), the larger the tumor was (long diameter >3.5 cm), the later the Borrmann classification was (type Ⅲ, Ⅳ), the deeper the tumor invasion was, the more the number of lymph node metastasis was, the later the pTNM stage was, and the more the number of lymph nodes was detected in patients undergoing total gastrectomy (all P<0.05). The multiple linear regression analysis showed that the age, lymph node metastasis, and PTNM stage had significant effects on the number of harvested lymph nodes. The multiple linear regression model was statistically significant (F=6.754, P<0.001). 11.2% of the variation in the number of harvested lymph nodes could be explained by the age, lymph node metastasis, and pTNM stage (adjusted R2=11.2%). ConclusionsNumber of harvested lymph nodes in laparoscopic radical gastrectomy for advanced gastric cancer is greatly affected by the age of patients, lymph node metastasis, and pTNM stage. So patients should be evaluated objectively and individually according to their age so as to harvest sufficient number of lymph nodes, which is conducive to accurately judge pTNM stage, formulate accurate adjuvant treatment scheme, and improve prognosis of patients.
ObjectiveTo study the clinical significance of prognostic nutritional index (PNI) combined with neutrophil to lymphocyte ratio (NLR) in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.MethodsTo retrospectively analyze and collect the clinical data of 517 patients with gastric cancer who were diagnosed at the Third People’s Hospital of Shangqiu City from January 2016 to May 2020, all of the patients received radical gastrectomy. We explored the risk factors that affect the occurrence of postoperative anastomotic leakage, and explored the clinical significance of PNI combined with NLR on the third day after operation in predicting the occurrence of anastomotic leakage.ResultsAmong 517 patients undergoing radical gastrectomy, 61 had anastomotic leakage, and the incidence of anastomotic leakage was 11.8%. The results of multivariate logistic regression analysis showed that patients with preoperative diabetes and intraoperative blood loss ≥400 mL had a higher incidence of anastomotic leakage, and with the increase of NLR value on the 3rd and 5th day after operation, and the decrease of PNI value on the 3rd and 5th day after operation, the incidence of anastomotic leakage increased (P<0.05). The area under the curve of NLR, PNI, and NLR combined with PNI on the 3rd day after operation in predicting the occurrence of anastomotic leakage were 0.849, 0.581, and 0.949, respectively, and the differences were statistically significant (P<0.05), the sensitivity and specificity of NLR combined with PNI were higher than the individual indicator.ConclusionPNI combined with NLR on the 3rd day after operation has important clinical significance in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.
ObjectiveTo explore the clinical effect of keeping the pancreatic capsule in radical gastrectomy for early stage of gastric cancer. MethodsTwo hundreds and seven patients with early stage of gastric cancer who were treated in our hospital from Jan 2011 to December 2011 were enrolled prospectively, and were divided into experimental group (n=95) and control group (n=112). Patients in experimental group kept the pancreatic capsule in radical gastrec-tomy, but patients in control group didn't keep the pancreatic capsule. Comparison of the clinical effect between the 2 groups was performed. ResultsThe blood loss[(134.1±5.3) mL vs. (150.3±3.7) mL] and operation time[(76.4±5.7) min vs. (87.5±9.1) min]of experimental group were all lower or shorter than those of control group (P<0.05), but there were no significant difference between the 2 groups in incidence of total complication[7.37% (7/95) vs. 10.71% (12/112)], stomal leak[3.16% (3/95) vs. 4.46% (5/112)], and anastomotic stenosis[4.21% (4/95) vs. 6.25% (7/112)], P>0.05. All of the 207 patients were followed-up for 1-36 months, with the median time of 17.5 months. During the follow-up period, in experimental group, there were 30 patients suffered from recurrence, 23 patients suffered from metastasis, and 44 patients died, and the 1-and 3-year survival rates was 84.21% (80/95) and 53.68% (51/95) respectively, 1- and 3-year disease free survival rates was 80.00% (76/95) and 48.42% (46/95) respectively; in control group, there were 37 patients suffered from recurrence, 23 patients suffered from metastasis, and 49 patients died, and the 1-and 3-year survival rates was 85.71% (96/112) and 56.25% (63/112) respectively, 1-and 3-year disease free survival rates was 81.25% (91/112) and 49.11% (55/112) respectively. There were no significant difference in the 1-and 3-year survival rate, 1-and 3-year disease free survival rate (P>0.05). In addition, there were no significant difference in the survival and disease free survival situation (P>0.05). ConclusionsSurvival and disease free survival situation of keeping the pancreatic capsule in radical gastrectomy is similar with traditionally radical gastrectomy, but surgery of keeping the pancreatic capsule in radical gastrectomy has the advantages of less bleeding and shorter operation time, which is worthy of further study.
ObjectiveTo systematically review the methods, characteristics, and indications of technique for retraction of liver and evaluate their application effects during the laparoscopic radical gastrectomy for gastric cancer, so as to provide reference for clinicians to choose the most suitable liver retraction method. MethodThe relevant research literature on the application of liver retraction method both domestically and internationally during the laparoscopic radical gastrectomy was reviewed and compared. ResultsThe main liver retraction methods that were used both domestically and internationally included V-shaped retraction, W-shaped retraction, medical adhesive retraction, and liver dilator retraction. Among them, the V-shaped, W-shaped, and liver dilator retraction techniques had been improved according to the situation, but these retraction techniques had their own advantages and disadvantages and could not be completely replaced by each other. ConclusionsCurrently, there is no absolutely ideal retraction method that is simple, safe, and effective. The specific choice of liver retraction technology needs to be selected based on the patient’s specific physical conditions, considering the safety, effectiveness, and rationality of this method.
ObjectiveTo investigate the research progress of assisted techniques for lymph node dissection in gastric cancer. Method The literatures on the applications of assisted techniques of lymph node dissection in the gastric cancer radical gastrectomy in recent years were reviewed. ResultsAt present, the assisted techniques used for lymph node dissection in the radical gastrectomy mainly included the lymphatic tracing technology and laparoscopic and robotic surgeries. The lymphatic tracing technology mainly included the use of dye tracers, indocyanine green, gamma probe, intraoperative radiation technology, etc. Among which gamma probe and intraoperative radiation technology were expensive and not suitable for clinical application, and intraoperative radiation technology had a radiation risk, so it was rarely used currently. At present, the dye tracers and indocyanine green were mainly used in the clinical lymph node tracing, both of which could improve the detection rate and increase the number of lymph node dissection, and improve the prognosis of patients. The laparoscopic radical gastrectomy was not inferior to traditional radical gastrectomy in terms of lymph node dissection, and had been more widely used in the clinical practice due to its advantages of visualization, minimally invasive, quickly postoperative recovery, and good short-term efficacy. Compared with the conventional laparoscopic system, the robotic surgical system was more precise, dexterous, stable, and had a better feedback feeling, which was more conducive to the lymph node dissection of special location. ConclusionUse of lymphatic tracers, laparoscopy and robotics could increase lymph node detection rate and improve prognosis of patients.
ObjectiveTo compare the effect and safety between laparoscopic versus laparotomy D2 radical gastrectomy for advanced gastric cancer. MethodsTwo hundred and seventeen patients with advanced gastric cancer who were treated in our hospital from March 2011 to March 2014 were selected as research objects. According to surgical method, they were divided into laparoscopy group (103 patients received laparoscopic D2 radical gastrectomy) and laparotomy group (114 patients received laparotomy D2 radical gastrectomy). Comparison of the surgical effect-related indicators between 2 groups was performed. ResultsIn the aspect of intra-operative indicators:the operation time, proximal margin length, distal margin length, and the number of removal lymph node between the 2 groups did not significantly differed with each other (P>0.05); while the bleeding volume and the length of incision in laparoscopy group were significantly less (shorter) than those of laparotomy group (P<0.05). In the aspect of post-operative indicators:the time to first flatus, time to resumed oral intake, time to ambulation, post-operative hospital stay, time of analgesics given, and the total incidence of postoperative complication in laparoscopy group were significantly shorter (less or lower) than those of laparotomy group (P<0.05), the operating cost in laparoscopy group was significantly higher than that of the laparotomy group (P<0.05), but there was no significant difference in total treatment cost, mortality of gastric cancer, and recurrence or metastasis rate between the 2 groups (P>0.05). ConclusionsBoth laparoscopic and laparotomy D2 radical gastrectomy in treatment of advanced gastric cancer can obtain good clinical effect. But compared with laparotomy D2 radical gastrectomy, laparoscopic D2 radical gastrectomy can reduce operative wound, reduce incidence of complications, improve postoperative recovery, and has higher safety.
ObjectiveTo investigate the risk factors affecting the occurrence of infectious complications after radical gastrectomy for gastric cancer, and to establish a risk prediction Nomogram model. MethodsThe clinicopathologic data of 429 primary gastric cancer patients who underwent radical resection for gastric cancer at the Second Department of General Surgery of Shaanxi Provincial People’s Hospital between January 2018 and December 2020 were retrospectively collected to explore the influencing factors of infectious complications using multivariate logistic regression analyses, and to construct a prediction model based on the results of the multivariate analysis, and then to further validate the differentiation, consistency, and clinical utility of the model. ResultsOf the 429 patients, infectious complications occurred in 86 cases (20.05%), including 53 cases (12.35%) of pulmonary infections, 16 cases (3.73%) of abdominal infections, 7 cases (1.63%) of incision infections, and 10 cases (2.33%) of urinary tract infections. The results of multivariate logistic analysis showed that low prognostic nutritional index [OR=0.951, 95%CI (0.905, 0.999), P=0.044], long surgery time [OR=1.274, 95%CI (1.069, 1.518), P=0.007], American Society of Anesthesiologists physical status classification (ASA) grade Ⅲ–Ⅳ [OR=9.607, 95%CI (4.484, 20.584), P＜0.001] and alcohol use [OR=3.116, 95%CI (1.696, 5.726), P＜0.001] were independent risk factors for the occurrence of infectious complications, and a Nomogram model was established based on these factors, with an area under the ROC of 0.802 [95%CI (0.746, 0.858)]; the calibration curves showed that the probability of occurrence of infectious complications after radical gastrectomy predicted by the Nomogram was in good agreement with the actual results; the decision curve analysis showed that the Nomogram model could obtain clinical benefits in a wide range of thresholds and had good practicality.ConclusionsClinicians need to pay attention to the perioperative management of gastric cancer patients, fully assess the patients’ own conditions through the prediction model established by prognostic nutritional index, surgery time, ASA grade and alcohol use, and take targeted interventions for the patients with higher risks, in order to reduce the risk of postoperative infectious complications.
ObjectiveTo explore the predictive value of metastatic lymph node ratio (MLNR) on prognosis of patients with gastric cancer after radical gastrectomy, and to evaluate whether MLNR can be used as a reference tool to guide the formulation of postoperative adjuvant treatment strategies and prognosis prediction of gastric cancer.MethodsThe clinicopathologic features of patients who underwent D2 radical gastrectomy from January 2014 to December 2017 were retrospectively analyzed. The factors influencing the disease specific survival of gastric cancer were analyzed by Cox proportional hazards model, then the variables with statistical significance in multivariate analysis were included in the construction of nomograms model for prognosis of patients with gastric cancer.ResultsA total of 262 patients with gastric cancer were included. There was no correlation between MLNR and total number of lymph nodes (rs=0.037, P=0.547), there was a positive correlation between MLNR and pN stage (rs=0.909, P<0.001). Multivariate Cox regression analysis showed that pT stage, pN stage, MLNR, and postoperative chemotherapy were the independent predictors of prognosis of gastric cancer after radical gastrectomy. Four variables including pT stage, pN stage, postoperative chemotherapy, and MLNR were included in the construction of nomogram model, the C index of MLNR and pN stage model was 0.707 and 0.692 respectively. Survival analysis showed that the higher the MLNR, the worse the prognosis.ConclusionsThe ability of MLNR to predict prognosis of gastric cancer might be better than pN stage. Therefore, it is considered that MLNR could be used as an important evaluation tool to guide adjuvant treatment and prognosis prediction after radical gastrectomy.
ObjectiveTo recognize the recent research progress in the prevention of duodenal stump leakage (DSL) after laparoscopic radical gastrectomy (LRG) for gastric cancer, so as to find a new breakthrough for reducing the occurrence of DSL. MethodA review was conducted by searching recent domestic and international literature on the prevention and management of DSL after LRG for gastric cancer. ResultsAt present, the risk factors of DSL after LRG were generally recognized in the literature, including relevant patients’ factors and surgery factors. The relevant factors of the patients themselves mainly were old age, malnutrition, and basic diseases; The factors relevant surgery mainly included surgical instruments, doctors’ operation level, etc. According to the literature, the measures taken for relevant patients’ factors mainly included preoperative improvement of nutritional status and control of the basic diseases; The preventive measures adopted for the relevant operation factors mainly included carefully intraoperative operation, improving of the anastomosis skills, and tacit cooperation of the team, which could reduce the occurrence of DSL. There was still controversy about the effect and method of routine duodenal stump reinforcement during operation. ConclusionsThe focus of reducing the occurrence of DSL is prevention. In clinical practice, patients with high-risk factors should receive special attention, with efforts to improve their condition, implement individualized decision-making, and perform meticulous intraoperative techniques to minimize complications, promote rapidly postoperative recovery, and maximize patients benefits.
Objective To explore method of jejunum nutrition tube implantation in total laparoscopic radical gastrectomy for distal gastric cancer (GC). Methods The clinical data of 30 patients with distal GC underwent the total laparoscopic radical gastrectomy from October 2017 to March 2018 in the Departmeng of Tumor Surgery, Lanzhou University Second Hospital were retrospectively analyzed, the total laparoscopic radical distal gastrectomy were performed in all the patients and the jejunum nutrition tube were implanted during the operation. Results Thirty patients with distal GC were successfully treated with the total laparoscopic radical gastrectomy and the jejunum nutrition tubes were implanted into under the total laparoscopy through the intraoperative guidance by the gastric tube, firstly fastening the nutrition tube to the gastric tube in vitro, and then separating them in vivo, finally the nutrition tube was smoothly implanted into the jejunum under the direct vision. The implantation time was 10 to 15 min with an average of 13.5 min. The jejunal nutrition tube retention time was 5 to 7 d with an average of 6 d. There were no complications such as the bleeding, anastomotic leakage, anastomotic obstruction, stenosis, intestinal leakage, intestinal obstruction, and other complications after the operation in the 30 patients. Conclusions Method of jejunum nutrition tube implantation in total laparoscopic radical gastrectomy for distal GC is easy to be performed. Intraoperative and postoperative complications are few. It provides a favorable guarantee for improving postoperative nutritional status of patient with distal GC.