Abstract Background Body weight loss (BWL) after gastrectomy impact on the short- and long-term outcomes. Oral nutritional supplement (ONS) has potential to prevent BWL in patients after gastrectomy. ...However, there is no consistent evidence supporting the beneficial effects of ONS on BWL, muscle strength and health-related quality of life (HRQoL). This study aimed to evaluate the effects of ONS formulated primarily with carbohydrate and protein on BWL, muscle strength, and HRQoL. Methods This will be a multicenter, open-label, parallel, randomized controlled trial in patients with gastric cancer who will undergo gastrectomy. A total of 120 patients who will undergo gastrectomy will be randomly assigned to the ONS group or usual care (control) group in a 1:1 ratio. The stratification factors will be the clinical stage (I or ≥ II) and surgical procedures (total gastrectomy or other procedure). In the ONS group, the patients will receive 400 kcal (400 ml)/day of ONS from postoperative day 5 to 7, and the intervention will continue postoperatively for 8 weeks. The control group patients will be given a regular diet. The primary outcome will be the percentage of BWL (%BWL) from baseline to 8 weeks postoperatively. The secondary outcomes will be muscle strength (handgrip strength), HRQoL (EORTC QLQ-C30, QLQ-OG25, EQ-5D-5L), nutritional status (hemoglobin, lymphocyte count, albumin), and dietary intake. All analyses will be performed on an intention-to-treat basis. Discussion This study will provide evidence showing whether or not ONS with simple nutritional ingredients can improve patient adherence and HRQoL by reducing BWL after gastrectomy. If supported by the study results, nutritional support with simple nutrients will be recommended to patients after gastrectomy for gastric cancer. Trial registration jRCTs051230012; Japan Registry of Clinical Trails. Registered on Apr. 13, 2023.
Pulmonary complications (PCs) after esophagectomy for patients with esophageal cancer have been correlated with prolonged hospital stays and in-hospital mortality. Previous studies have shown that ...minimally-invasive esophagectomy (MIE) is associated with a lower rate of PCs compared to conventional open surgery. Although PCs were reportedly associated with many factors, including surgical approaches, patients' demographics, and perioperative variables, the predictive factors for PCs including MIE, have not been fully evaluated.
A total of 209 patients with resectable esophageal cancer who underwent three types of esophagectomy were included in the present study; (i) 93 cases who underwent the combined thoracoscopic MIE and laparoscopic MIE; (ii) 42 cases who underwent the combined open thoracotomy and laparoscopic MIE; (iii) 74 cases who underwent the combined open thoracotomy and open laparotomy, which were defined as the total MIE group, hybrid MIE group, and total open group, respectively. We compared clinical outcomes of the three groups and identified postoperative predictive factors of PCs using multivariate analysis.
The incidence of PCs was significantly reduced (p=0.015) in the total-MIE group (8/93: 8.5%) compared with the total-open group (16/74: 21.6%), but it was not significantly reduced in the hybrid MIE group (5/42: 11.9%) compared with the total open group (p=0.19). The multivariate analysis showed that the presence of cardiac comorbidity odds ratio (OR)=5.90; p=0.013, lung comorbidity (OR=3.95; p=0.031), and anastomotic leakage (OR=6.00; p<0.01) were independent risk factors for PCs after esophagectomy. In contrast, total MIE reduced the risk of PCs (OR=0.328; p=0.036).
The combination of thoracoscopic and laparoscopic MIE presents as an excellent surgical procedure for the reduction of PCs after esophagectomy.
The prognosis of patients with locally advanced esophageal squamous cell carcinoma (LAESC) is extremely poor. The impact of adverse effects of chemoradiotherapy (CRT), particularly myelosuppression, ...on postoperative long-term results has remained unclear.
A total of 44 patients with LAESC who underwent CRT followed by esophagectomy were enrolled. We compared long-term survival by various clinical variables, including myelosuppression (Grade 3 and 4 leukopenia) due to CRT, response to CRT, performance status, postoperative complications, and pathological nodal status. Finally, multivariate analysis of prognostic factors was assessed by the Cox proportional hazards model.
The mean age of patients was 62.8 years and the male/female ratio was 32/9. The response rate to CRT was 75% (33/44), which included five cases with complete response and 28 cases with partial response. Grade 3 and 4 leukopenia was 43% (19/44). Mortality and postoperative pneumonia occurred in 3 (7.3%) and 14 cases (31.8%), respectively. Multivariate analysis demonstrated that myelosuppression was a significant negative prognostic factor in overall survival (OS) hazard ratio (HR)=4.758, p=0.005. The 5-year OS rate was significantly poorer in the group with myelosuppression than in the group without (15.4% vs. 69.0%, p=0.003). Discontinuation of the preoperative CRT schedule and dose reduction of chemotherapeutic agents was significantly more frequent in the group with myelosuppression than in the group without (p=0.003), and peripheral lymphocyte counts after surgery was significantly lower, which may explain poor prognosis in the group with myelosuppression.
Pre-operative CRT-induced myelosuppression has a negative impact on the prognosis of patients with LAESC. Our findings indicate that a careful postoperative follow-up is required for patients who develop myelosuppression after neoadjuvant CRT followed by curative resection for locally advanced esophageal cancer.
An 81-year-old woman who had previously been diagnosed with situs inversus totalis was referred to our hospital for a positive fecal occult blood. She was diagnosed with sigmoid colon cancer by total ...colonoscopy. Chest x-ray and chest and abdominal computed tomography (CT) showed situs inversus totalis. We performed laparoscopic sigmoidectomy. No bowel malrotation or vascular malformations were observed.She was discharged from the hospital seven days after the surgery without any perioperative complications. The tumor was histopathologically diagnosed as pT2, N0, M0, stage I. Although attention to intraoperative disorientation is necessary for surgery in situs inversus totalis, laparoscopic surgery can be performed safely with enough recognition of the anatomical position using a left-right mirror image.
Patients with clinical T4 esophageal squamous cell carcinoma (ESCC) have an unfavorable prognosis, mainly indicated by the response to chemoradiotherapy (CRT), crucial to estimating long-term ...survival. Other prognostic measures include systemic inflammatory or immunonutritional indices such as the Glasgow Prognostic Score (GPS) and Prognostic Nutritional Index (PNI) that have not been sufficiently documented.
This study retrospectively evaluated 91 patients with T4 ESCC treated at our Hospital between 2000 and 2013. All patients initially received CRT, including 5-fluorouracil (5FU) and cisplatin or nedaplatin with concurrent 2-Gy/fraction radiation (total dose, 40-60 Gy). Curative tumor resection was undertaken in suitable patients on completing CRT. Patients were classified as GPS0, GPS1, or GPS2 based on C-reactive protein (CRP) ≤ 10 mg/l and albumin ≥ 35 g/l, CRP >10 mg/l or albumin <35 g/l, or CRP >10 mg/l and albumin <35 g/l, respectively. PNI was calculated as 10-times the serum albumin (g/dl)+0.005 × total lymphocyte count (/mm(3)). The impact of the pre-treatment GPS and PNI on the prognosis of patients with T4 ESCC was investigated in univariate and multivariate analyses.
Sixty (67%) patients responded to CRT (9 complete responses and 51 partial responses). Forty-one (45%) patients also underwent surgical resection of the residual tumor. The overall 5-year survival rate and median survival time were 27.0% and 11.8 months, respectively. In the cohort of CRT-plus-surgical resection, the 5-year survival rate was significantly higher than in the groups treated with CRT-alone (51.1% vs. 6.5%; p < 0.01). On multivariate analysis, good response to CRT hazard ratio (HR) =0.449, p<0.01, GPS1/2 (HR=2.151, p=0.015), and surgical resection (HR=0.282, p<0.01) were significant prognostic factors, whereas PNI was not.
The GPS is a useful, simple survival marker for patients with T4 ESCC undergoing multimodal therapy.
A meta-analysis was conducted to evaluate and compare the short- and long-term outcomes of laparoscopic and conventional open surgery for gastric gastrointestinal stromal tumors (GISTs).
We searched ...MEDLINE, EMBASE, Science Citation Index, and the Cochrane Controlled Trial Register for relevant articles published between 2000 and July 2013 by using the search terms "laparoscopic", "laparoscopy-assisted", "surgery", "gastrointestinal tumor", "GIST" and "gastric".
We identified 12 articles reporting results that compared laparoscopic surgery with open surgery for gastric GISTs. Our meta-analysis included 644 patients with GISTs; 312 had undergone laparoscopic surgery, and 332 had undergone open surgery. In the short-term period, 14 outcome variables were examined. In the long-term period, six oncological variables were analyzed. Laparoscopic surgery for gastric GIST was associated with a reduction in intraoperative blood loss, shorter period to flatus, earlier resumption of oral intake, and shorter duration of hospital stay over the short-term, and with a significantly lower rate of overall recurrence, metastatic recurrence and local recurrence in the long-term compared to open surgery.
Laparoscopic surgery may be an acceptable surgical treatment option compared to open surgery for gastric GIST.
Background
Patients with overweight reportedly have more comorbidities, including diabetes mellitus and cardiovascular disease, and longer operating times as well as more blood loss during surgery ...compared with those with normal weight. However, the impact of overweight on the short-term outcome after transthoracic esophagectomy for patients with esophageal squamous cell carcinoma (ESCC) remains unclear. We hypothesized that overweight has a negative impact on short-term surgical outcomes after esophagectomy for patients with ESCC.
Methods
A total of 304 patients who underwent transthoracic esophagectomy for ESCC were included in this study. Body mass index (BMI) was classified into three categories, <18.49, 18.50–24.99, and >25.00 (kg/m
2
), defined as low, normal, and high BMI, respectively, according to the World Health Organization criteria. We investigated the association of BMI status with patient demographics and surgical outcomes after esophagectomy for patients with ESCC. In addition, overall survival and relapse-free survival stratified by BMI were compared.
Results
Fifty-nine (19.4 %) and 41 (13.4 %) patients were classified to low BMI and high BMI, respectively. The high-BMI group had significantly higher comorbidity rates of diabetes mellitus (
p
< 0.01) and anastomotic leakage (
p
= 0.011) than the normal-BMI group. There were no significant association between high BMI and another various complications except for an anastomotic leakage, severe complications defined by Clavien–Dindo classification and in-hospital mortality. In multivariate analysis, high BMI was a significant risk factor for anastomotic leakage (
p
= 0.030, hazard ratio; 3.423, 95%CI; 1.128–10.38). On the other hand, no significant association was observed between low BMI and short surgical outcomes. There were no significant differences in overall and relapse-free survival among the three BMI groups in univariate and multivariate analysis (
p
= 0.128 and
p
= 0.584, respectively).
Conclusion
The surgical treatment should not be denied for patients with ESCC due to overweight and underweight. However, intraoperative prevention and postoperative careful monitoring for anastomotic leakage might be required after esophagectomy for overweight patients with ESCC.
Cushing's syndrome caused by adrenocorticotropic hormone (ACTH)-independent macronodular adrenal hyperplasia (AIMAH) is an extremely rare disease, which shows bilateral macronodular adrenal ...hypertrophy and autonomous cortisol production. We herein report a case of AIMAH treated successfully by minimally invasive simultaneous bilateral laparoscopic adrenalectomy. A 73-year-old woman with hypertension, diabetes mellitus, and osteoporosis was referred to our hospital because of an incidentally found huge bilateral adrenal mass. An abdominal computed tomography scan showed large bilateral adrenal glands with multiple nodules. A diagnosis of AIMAH was made and a simultaneous bilateral laparoscopic adrenalectomy was thus performed. The total operation time was 310 min and blood loss was 70 g. Both glands were hypertrophic (right 5 x 3 cm, 48.5 g and left 4 x 2 cm, 39.2 g) and consisted of multiple golden yellow macronodules. The postoperative course was uneventful. A simultaneous bilateral adrenalectomy for AIMAH performed by an experienced surgical team is therefore considered to be a safe and minimally invasive procedure.
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