Background
The effects of obesity on prognosis in gastric cancer are controversial.
Aims
To evaluate the association between body mass index (BMI) and mortality in patients with gastric cancer.
...Methods
A single-institution cohort of 7765 patients with gastric cancer undergoing curative gastrectomy between October 2000 and June 2016 was categorized into six groups based on BMI: underweight (< 18.5 kg/m
2
), normal (18.5 to < 23 kg/m
2
), overweight (23 to < 25 kg/m
2
), mildly obese (25 to < 28 kg/m
2
), moderately obese (28 to < 30 kg/m
2
), and severely obese (≥ 30 kg/m
2
). Hazard ratios (HRs) for overall survival (OS) and disease-specific survival (DSS) were calculated using Cox proportional hazard models.
Results
We identified 1279 (16.5%) all-cause and 763 (9.8%) disease-specific deaths among 7765 patients over 83.05 months (range 1.02–186.97) median follow-up. In multivariable analyses adjusted for statistically significant clinicopathological characteristics, preoperative BMI was associated with OS in a non-linear pattern. Compared with normal-weight patients, underweight patients had worse OS HR 1.42; 95% confidence interval (CI) 1.15–1.77, whereas overweight (HR 0.84; 95% CI 0.73–0.97), mildly obese (HR 0.77; 95% CI 0.66–0.90), and moderately obese (HR 0.77; 95% CI 0.59–1.01) patients had better OS. DSS exhibited a similar pattern, with lowest mortality in moderately obese patients (HR 0.58; 95% CI 0.39–0.85). Spline analysis showed the lowest all-cause mortality risk at a BMI of 26.67 kg/m
2
.
Conclusion
In patients undergoing curative gastric cancer surgery, those who were overweight or mildly-to-moderately obese (BMI 23 to < 30 kg/m
2
) preoperatively had better OS and DSS than normal-weight patients.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Circulating tumor DNA (ctDNA) has emerged as a candidate biomarker for cancer screening. However, studies on the usefulness of ctDNA for postoperative recurrence monitoring are limited. The present ...study monitored ctDNA in postoperative blood by employing cancer-specific rearrangements. Personalized cancer-specific rearrangements in 25 gastric cancers were analyzed by whole-genome sequencing (WGS) and were employed for ctDNA monitoring with blood up to 12 months after surgery. Personalized cancer-specific rearrangements were identified in 19 samples. The median lead time, which is the median duration between a positive ctDNA detection and recurrence, was 4.05 months. The presence of postoperative ctDNA prior to clinical recurrence was significantly correlated with cancer recurrence within 12 months of surgery (P = 0.029); in contrast, no correlation was found between cancer recurrence and the presence of preoperative ctDNA, suggesting the clinical usefulness of postoperative ctDNA monitoring for cancer recurrence in gastric cancer patients. However, the clinical application of ctDNA can be limited by the presence of ctDNA non-shedders (42.1%, 8/19) and by inconsistent postoperative ctDNA positivity.
Background
The standard surgery for proximal advanced gastric cancer (PAGC) is total gastrectomy with D2 lymph node dissection (LND). Although prophylactic splenectomy for splenic hilar LND (No. 10) ...is not recommended due to any survival advantage, prophylactic LND (No. 10) without splenectomy remains controversial. Thus, we aimed to evaluate whether No. 10 LND is essential for patients’ survival benefit in PAGC.
Methods
We conducted a retrospective study of 1038 patients with PAGC who underwent total gastrectomy without splenectomy. After adjusting for confounders and propensity score matching (PSM), patients were grouped into Group 1 (D2 LND without splenic hilar LN;
n
= 288) or Group 2 (D2 LND with splenic hilar LN;
n
= 288). Variables between the two groups (5-year overall survival OS and disease-free survival DFS) were compared, as well as in patients with tumors located in the greater curvature and those with Borrmann type IV disease.
Results
The 5-year OS and DFS rates after PSM were not significantly different between Groups 1 and 2 (57.3% vs. 62.1%,
p
= 0.300; 52.8% vs. 59.7%,
p
= 0.100, respectively). Furthermore, the 5-year OS and DFS rates in patients with greater curvature involvement (54.4% vs. 61.9%,
p
= 0.500; 50.0% vs. 57.6%,
p
= 0.400, respectively) and Borrmann type IV disease (23.8% vs. 38.6%,
p
= 0.400; 16.7% vs. 33.9%,
p
= 0.200, respectively) after PSM were also not significantly different between the two groups.
Conclusions
Prophylactic splenic hilar LND without splenectomy does not improve long-term survival in PAGC. Therefore, this procedure might not be essential for patients with PAGC as well greater curvature involvement and Borrmann type IV disease.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Although the internal hernia is rare after gastric cancer surgery, it is a serious complication, and prompt surgical treatment is essential. However, internal hernia has not been studied ...because of low incidence and difficulty of diagnosis. This study investigated the clinical characteristics and proper management of internal hernia after gastrectomy.
Methods
From June 2001 to June 2016, patients who underwent gastrectomy, either open or laparoscopic (robotic) surgery, with potential internal hernia defect were enrolled. The hernia defect was not closed in any of the enrolled patients. The clinicopathological data of internal hernia patients were compared to patients without internal hernia to identify risk factors. Surgical outcomes of internal hernia were compared between patients who underwent early and late intervention group according to time interval from symptom onset to operation.
Results
Of 5777 patients who underwent gastrectomy with possible internal hernia, 24 (0.4%) underwent emergency or scheduled surgery for internal hernia. Internal hernia through the Petersen space was observed in 15 cases, and through the jejunojejunostomy mesenteric defect in 9 cases. Low body mass index (odds ratio OR 4.403,
p
= 0.003) and laparoscopic approach (OR 6.930 p < 0.001) were statistically significant factors in multivariate analysis. Postoperative complication rate (16.7% vs. 50%
p
= 0.083) and mortality rate (8.3% vs. 25.0%
p
= 0.273) were slightly higher in the late intervention group.
Conclusions
Although internal hernia is a rare complication, it is difficult to diagnose and cause serious complications. To prevent internal hernia, the necessity of hernia defect closure should be investigated in the further studies. Early surgical treatment is necessary when it is suspected.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Several studies have reported that intracorporeal anastomosis reduces the requirement for the additional incision for anastomosis, resulting in early recovery compared to extracorporeal ...anastomosis during laparoscopic distal gastrectomy. However, few studies have investigated postoperative outcome after laparoscopic total gastrectomy (LTG). We compared short-term postoperative outcomes between totally laparoscopic total gastrectomy (TLTG) with intracorporeal anastomosis and conventional laparoscopy-assisted total gastrectomy (LATG) with extracorporeal anastomosis for gastric cancer.
Methods
This retrospective case–control study included 202 patients who underwent LTG from January 2012 to June 2019. LATG was performed in the period before July 2015; TLTG was performed in the period after July 2015. Postoperative short-term outcomes and white blood cell (WBC) count, and C-reactive protein (CRP) levels at 1, 3, and 5 days postoperatively were compared between the groups.
Results
One hundred ten patients underwent LATG; 92 underwent TLTG. The pathologic stage was significantly higher in the TLTG group (
p
= 0.010). Intraoperative estimated blood loss was significantly lower in the TLTG group than in the LATG group (median range: 100 50–150 mL versus vs. 50 30–100,
p
< 0.001). Postoperative hospital stay duration was significantly longer in the TLTG group than in the LATG group (median range: 7 7–9 days vs. 8 7–11,
p
< 0.001). WBC count (6.3 10
9
/L ± 1.9 vs. 8.2 ± 2.5,
p
= 0.004) and CRP levels (8.3 mg/L ± 6.1 vs. 13.3 ± 9.4,
p
< 0.001) were lower in the LATG group than in the TLTG group. The overall complication rate was higher in the TLTG group than in the LATG group (16.3% vs. 32.6%,
p
= 0.007). A higher American Society of Anesthesiologist score was the only significant risk factor for postoperative complications.
Conclusion
Both procedures are feasible, although TLTG has more risk for postoperative complications than LATG. TLTG should be improved to reduce postoperative complications and provide better postoperative outcomes.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Countries differ in their treatment expertise and research results regarding gastric cancer; hence, treatment guidelines are diverse based on evidence and medical situations. A comprehensive and ...comparative review of each country's guidelines is imperative to understand the similarities and differences among countries. We reviewed and compared five gastric cancer treatment guidelines in terms of endoscopic, surgical, perioperative, and palliative systemic treatment based on evidence levels and recommendation grades, as well as the postoperative follow-up strategies for each guideline. The Korean, Chinese, and European guidelines provided evidence and grading of the recommendations. The United States guidelines suggested categories for evidence and consensus. The Japanese guidelines suggested evidence and recommendations only for systemic treatment. The Korean and Japanese guidelines described endoscopic treatment, surgery, and lymphadenectomy in detail. The Chinese, United States, and European guidelines more intensively considered perioperative chemotherapy. In particular, the indications for chemotherapy and the regimens recommended by each guideline differed slightly. Considering their medical situations, each guideline had some diversity in terms of adopting evidence, which resulted in heterogeneous recommendations. This review will help medical personnel to comprehensively understand the diversity in gastric cancer treatment guidelines for each country in terms of evidence and recommendations.
Background
The purpose of this study was to evaluate laparoscopy-assisted distal gastrectomy (LADG) compared to open distal gastrectomy (ODG) in the treatment of early gastric cancer with respect to ...survival, surgical outcomes, complications, and quality of life (QOL).
Methods
One hundred sixty-four patients with cT1N0M0 and cT1N1M0 distal gastric cancer were randomly assigned to either the LADG group or the ODG group. The primary end point was the 5-year disease-free survival (DFS) rate. Complications were classified using the accordion severity classification of postoperative complications scheme. QOL was measured using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-STO22 preoperatively and postoperatively during regular follow-up visits. This trial is registered at ClinicalTrials.gov (NCT00546468).
Results
The median (range) follow-up period was 74.3 (24.8–90.8) months. The LADG and ODG groups showed similar survival 5-year DFS rate: 98.8 % vs. 97.6 %, respectively (
P
= 0.514), 5-year overall survival (OS) rate: 97.6 vs. 96.3 %, respectively (
P
= 0.721) or overall complication rate (29.3 vs. 42.7 %, respectively;
P
= 0.073). Mild complications were significantly less frequent in the LADG group than in the ODG group (23.2 vs. 41.5 %;
P
= 0.012). The rates of moderate, severe, and long-term complications (i.e., 31 days to 5 years after surgery) did not differ significantly between groups. No clinically meaningful differences were detected between the two groups in long-term QOL.
Conclusion
LADG showed similar DFS and OS compared to ODG in treating early gastric cancer. Marginal benefits in mild complications were observed with LADG. LADG did not show advantages over ODG regarding other complications and long-term QOL.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
IMPORTANCE: Acute isovolemic anemia occurs when blood loss is replaced with fluid. It is often observed after surgery and negatively influences short-term and long-term outcomes. OBJECTIVE: To ...evaluate the efficacy and safety of ferric carboxymaltose to treat acute isovolemic anemia following gastrectomy. DESIGN, SETTING, AND PARTICIPANTS: The FAIRY trial was a patient-blinded, randomized, phase 3, placebo-controlled, 12-week study conducted between February 4, 2013, and December 15, 2015, in 7 centers across the Republic of Korea. Patients with a serum hemoglobin level of 7 g/dL to less than 10 g/dL at 5 to 7 days following radical gastrectomy were included. INTERVENTIONS: Patients were randomized to receive a 1-time or 2-time injection of 500 mg or 1000 mg of ferric carboxymaltose according to body weight (ferric carboxymaltose group, 228 patients) or normal saline (placebo group, 226 patients). MAIN OUTCOMES AND MEASURES: The primary end point was the number of hemoglobin responders, defined as a hemoglobin increase of 2 g/dL or more from baseline, a hemoglobin level of 11 g/dL or more, or both at week 12. Secondary end points included changes in hemoglobin, ferritin, and transferrin saturation levels over time, percentage of patients requiring alternative anemia management (oral iron, transfusion, or both), and quality of life at weeks 3 and 12. RESULTS: Among 454 patients who were randomized (mean age, 61.1 years; women, 54.8%; mean baseline hemoglobin level, 9.1 g/dL), 96.3% completed the trial. At week 12, the number of hemoglobin responders was significantly greater for ferric carboxymaltose vs placebo (92.2% 200 patients for the ferric carboxymaltose group vs 54.0% 115 patients for the placebo group; absolute difference, 38.2% 95% CI, 33.6%-42.8%; P = .001). Compared with the placebo group, patients in the ferric carboxymaltose group experienced significantly greater improvements in serum ferritin level (week 12: 233.3 ng/mL for the ferric carboxymaltose group vs 53.4 ng/mL for the placebo group; absolute difference, 179.9 ng/mL 95% CI, 150.2-209.5; P = .001) and transferrin saturation level (week 12: 35.0% for the ferric carboxymaltose group vs 19.3% for the placebo group; absolute difference, 15.7% 95% CI, 13.1%-18.3%; P = .001); but there were no significant differences in quality of life. Patients in the ferric carboxymaltose group required less alternative anemia management than patients in the placebo group (1.4% for the ferric carboxymaltose group vs 6.9% for the placebo group; absolute difference, 5.5% 95% CI, 3.3%-7.6%; P = .006). The total rate of adverse events was higher in the ferric carboxymaltose group (15 patients 6.8%, including injection site reactions 5 patients and urticaria 5 patients) than the placebo group (1 patient 0.4%), but no severe adverse events were reported in either group. CONCLUSION AND RELEVANCE: Among adults with isovolemic anemia following radical gastrectomy, the use of ferric carboxymaltose compared with placebo was more likely to result in improved hemoglobin response at 12 weeks. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01725789
Background After gastrectomy, patients may experience the postgastrectomy syndrome and face difficulties adapting to everyday diet. Recently, human health coaching via a mobile application (app) has ...been used for obese patients or patients with chronic diseases, with significant improvements in clinical outcomes. The aim of this study is to evaluate and compare the effects of human health coaching via a mobile app and conventional face-to-face counseling in patients who underwent gastrectomy for gastric cancers. Methods This study is a single-institution, prospective randomized controlled trial comparing the mobile health and face-to-face counselling groups. After randomization, participants assigned to the mobile health coaching group will receive health coaching via a mobile app for 3 months after discharge, and the assigned coaches will provide personalized advice based on the self-recorded health data. Participants in the face-to-face group will have 1- and 3-months postoperative dietary consultations with a clinical dietitian. The primary endpoint is the food restriction score on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-STO22, and secondary endpoints included all other quality of life scale scores and nutritional parameters. The calculated sample size is 180, and the outcomes will be measured until 1-year post-surgery. Significance This study will show the efficacy of human health coaching via a mobile app on dietary adaptation in patients who underwent gastrectomy. A relational approach based on personal data and timely intervention using a mobile platform could reduce patients’ trial and error and improve quality of life. Trial registration ClinicalTrials.gov, NCT04394585, Registered 19 May, 2020 –Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT040394585.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
