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المؤلفون: Koki Nakanishi, Mitsuro Kanda, Yasuhiro Kodera
المصدر: World Journal of Gastroenterology
مصطلحات موضوعية: medicine.medical_specialty, Blood transfusion, medicine.medical_treatment, Blood Loss, Surgical, Adverse effect, Perioperative Care, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Gastrectomy, Stomach Neoplasms, Tumor Microenvironment, Medicine, Humans, Transplantation, Homologous, Blood Transfusion, Mortality, business.industry, Radical Lymph Node Dissection, Transfusion, Gastroenterology, Cancer, Blood loss, Transfusion Reaction, Immunosuppression, Minireviews, General Medicine, Perioperative, medicine.disease, Prognosis, Surgery, 030220 oncology & carcinogenesis, Lymph Node Excision, 030211 gastroenterology & hepatology, Tumor Escape, Neoplasm Recurrence, Local, business, Complication, Gastric cancer
الوصف: Gastrectomy with radical lymph node dissection is the most promising treatment avenue for patients with gastric cancer. However, this procedure sometimes induces excessive intraoperative blood loss and requires perioperative allogeneic blood transfusion. There are lasting discussions and controversies about whether intraoperative blood loss or perioperative blood transfusion has adverse effects on the prognosis in patients with gastric cancer. We reviewed laboratory and clinical evidence of these associations in patients with gastric cancer. A large amount of clinical evidence supports the correlation between excessive intraoperative blood loss and adverse effects on the prognosis. The laboratory evidence revealed three possible causes of such adverse effects: anti-tumor immunosuppression, unfavorable postoperative conditions, and peritoneal recurrence by spillage of cancer cells into the pelvis. Several systematic reviews and meta-analyses have suggested the adverse effects of perioperative blood transfusions on prognostic parameters such as all-cause mortality, recurrence, and postoperative complications. There are two possible causes of adverse effects of blood transfusions on the prognosis: Anti-tumor immunosuppression and patient-related confounding factors (e.g., preoperative anemia). These factors are associated with a worse prognosis and higher requirement for perioperative blood transfusions. Surgeons should make efforts to minimize intraoperative blood loss and transfusions during gastric cancer surgery to improve patients' prognosis.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e84738123e8e295414e7f98fa02f47f9
http://europepmc.org/articles/PMC6580348 -
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المؤلفون: Hiroki Yamaue, Toshiyasu Ojima, Masaki Nakamura
المصدر: Updates in surgery. 72(4)
مصطلحات موضوعية: medicine.medical_specialty, medicine.medical_treatment, Anastomosis, 03 medical and health sciences, 0302 clinical medicine, Robotic Surgical Procedures, Gastrectomy, Stomach Neoplasms, Laparotomy, medicine, Humans, Robotic surgery, Reconstruction procedure, business.industry, Radical Lymph Node Dissection, Stomach, Cancer, Anastomosis, Roux-en-Y, Plastic Surgery Procedures, medicine.disease, Roux-en-Y anastomosis, Surgery, Treatment Outcome, 030220 oncology & carcinogenesis, Lymph Node Excision, 030211 gastroenterology & hepatology, business
الوصف: A robotic approach with radical lymph node dissection for gastric cancers is a safe and effective surgical procedure. However, there are still only a few studies in the reconstruction procedure after gastrectomy and many aspects of the use of the robotic surgical system remain controversial. In Roux-en-Y reconstruction, most institutions are adapted for reconstruction using small laparotomy due to the complicated procedure. We, therefore, developed a new and easy procedure for full robotic Roux-en-Y reconstruction after robotic gastrectomy. We named this procedure "loop reconstruction technique". This article including video shows our loop reconstruction technique with an intracorporeal robot-sewn anastomosis after robotic gastrectomy.
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المؤلفون: Hiromitsu Kanzaki, Satoru Kikuchi, Masahiko Nishizaki, Shinji Kuroda, Takehiro Tanaka, Hiroyuki Okada, Shunsuke Kagawa, Tetsuya Kagawa, Yoshiro Kawahara, Toshiyoshi Fujiwara
المصدر: BMC Surgery, Vol 17, Iss 1, Pp 1-6 (2017)
BMC Surgeryمصطلحات موضوعية: Male, medicine.medical_specialty, Lymphovascular invasion, medicine.medical_treatment, lcsh:Surgery, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Gastrectomy, Stomach Neoplasms, medicine, Humans, Lymph node, Early Detection of Cancer, Aged, Retrospective Studies, Early gastric cancer, Lymph node metastasis, business.industry, Standard treatment, Radical Lymph Node Dissection, Retrospective cohort study, Endoscopy, General Medicine, lcsh:RD1-811, Surgery, Early Gastric Cancer, Dissection, medicine.anatomical_structure, Endoscopic resection, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Lymph Node Excision, 030211 gastroenterology & hepatology, Female, business, Research Article
الوصف: Background Endoscopic resection (ER) has been widely accepted as the standard treatment for early gastric cancer (EGC). However, in patients considered to have undergone non-curative ER due to their potential risk of lymph node metastasis (LNM), additional gastrectomy is recommended. The aim of the present study was to identify EGC patients after non-curative ER at high risk of LNM. Methods A total of 150 patients who had undergone ER for EGC were diagnosed as non-curative ER due to their potential risk of LNM. Clinicopathological data and clinical outcomes were examined retrospectively. Results Additional gastrectomy with lymph node dissection was performed in 73 patients, and the remaining 77 patients were followed-up without additional gastrectomy. In patients who underwent additional gastrectomy, 8 patients had local residual tumor, and 8 patients had LNM, which were limited in the peritumoral nodes. Only lymphatic invasion (p = 0.012) was a statistically significant factor for LNM. The 5-year overall survival and recurrence-free survival were not significantly different between patients with and without additional gastrectomy. Conclusion Additional gastrectomy with lymph node dissection is recommended for patients who were diagnosed as non-curative ER with lymphatic invasion, and minimizing the extent of lymph node dissection may be allowed for these patients.
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المؤلفون: Francisco Schlottmann, Marco G. Patti, Marco Di Corpo
المصدر: JAMA surgery. 154(2)
مصطلحات موضوعية: medicine.medical_specialty, business.industry, Radical Lymph Node Dissection, Lymphography, Adjunct, Robotic Surgical Procedures, Gastrectomy, medicine, Lymph Node Excision, Surgery, Radiology, business, Cancer surgery, Original Investigation
الوصف: IMPORTANCE: Fluorescent imaging with indocyanine green can be used to visualize lymphatics. Peritumoral injection of indocyanine green may allow for visualization of every draining lymph node from a primary lesion on near-infrared imaging. OBJECTIVES: To evaluate the role of fluorescent lymphography using near-infrared imaging as an intraoperative tool for achieving complete lymph node dissection and compare the number of lymph nodes retrieved with the use of near-infrared imaging and the number of lymph nodes retrieved without the use of near-infrared imaging. DESIGN, SETTING, AND PARTICIPANTS: This prospective single-arm study was conducted among 40 patients who underwent robotic gastrectomy between August 30, 2013, and July 21, 2014, at a single-center, tertiary referral teaching hospital. After propensity score matching, the results of these 40 patients were compared with the results of 40 historical control patients who underwent robotic gastrectomy without indocyanine green injection between January 1, 2012, and August 31, 2013. Statistical analysis was performed from January 1, 2015, to July 31, 2016. INTERVENTIONS: Robotic gastrectomy with systemic lymphadenectomy and retrieval of lymph nodes under near-infrared imaging after peritumoral injection of indocyanine green to the submucosal layer 1 day before surgery. MAIN OUTCOMES AND MEASURES: The primary outcome was the number of retrieved lymph nodes in each nodal station. RESULTS: Among the 40 patients in the study (19 women and 21 men; mean [SD] age, 52.2 [11.7] years), no complications related to indocyanine green injection or near-infrared imaging were observed. On completion of the lymphadenectomy, the absence of fluorescent lymph nodes in the dissected area was confirmed. A mean (SD) total of 23.9 (9.0) fluorescent lymph nodes were recorded among a mean (SD) total of 48.9 (14.6) overall lymph nodes retrieved. The mean number of overall lymph nodes retrieved was larger in the near-infrared group than in the historical controls (48.9 vs 35.2; P
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::585c2e67654fa0cc965a55e21582a56b
https://pubmed.ncbi.nlm.nih.gov/30427990 -
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المؤلفون: Sang Hoon Ahn, Do Joong Park, Hyung Ho Kim
المصدر: Korean Journal of Clinical Oncology. 11:37-42
مصطلحات موضوعية: medicine.medical_specialty, business.industry, medicine.medical_treatment, General surgery, Radical Lymph Node Dissection, Sentinel lymph node, Cancer, Sentinel node, medicine.disease, Early Gastric Cancer, Surgery, medicine.anatomical_structure, medicine, Gastrectomy, Lymphadenectomy, business, Lymph node
الوصف: Gastric cancer surgery with curative intent comprises subtotal or total gastrectomy with radical lymph node dissection. Recently, as the incidence of early gastric cancer (EGC) is increasing, minimally invasive surgery can be applied to gastric cancer treatment. Minimally invasive gastric surgery has four aspects such as minimally invasive access, modified function-preserving gastrectomy, limited lymphadenectomy, and no reconstruction. Laparoscopic gastrectomy became popular for EGC and its indication is being expanded to advanced gastric cancer. Reduced or single port gastrectomy can be performed for selective EGC. For middle or upper EGC, laparoscopic pylorus-preserving gastrectomy or proximal gastrectomy is applicable as function-preserving gastrectomy. D1+ node dissection is enough for EGC without lymph node metastasis and sentinel node biopsy will be helpful for avoiding unnecessary lymph node dissection in EGC patients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::aed7bc0e7059a0e25fafdcc82bccb580
https://doi.org/10.14216/kjco.15008 -
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المؤلفون: Takeru Matsuda, Yoshiko Matsuda, Yoshihiro Kakeji, Yasuo Sumi, Kimihiro Yamashita, Satoshi Suzuki, Tetsu Nakamura, Shingo Kanaji, Masashi Yamamoto, Taro Oshikiri
المصدر: Annals of surgical oncology. 24(9)
مصطلحات موضوعية: medicine.medical_specialty, Dissection (medical), Splenic artery, 03 medical and health sciences, 0302 clinical medicine, Celiac artery, Celiac Artery, Gastrectomy, Stomach Neoplasms, medicine.artery, medicine, Humans, Laparoscopy, Lymph node, Common hepatic artery, medicine.diagnostic_test, business.industry, Radical Lymph Node Dissection, Cancer, medicine.disease, Surgery, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Lymph Node Excision, 030211 gastroenterology & hepatology, Radiology, Lymph Nodes, business, Splenic Artery
الوصف: Recent technical improvements allow safe laparoscopic lymph node dissection (LND) in gastric cancer.1After LND around the CHA and right side of the CA from the patient's right side, the surgeon then moves to the patient's left side. The anterior pancreatic fascia is cut at the middle point of the SA to discern the dorsal layer of the LN along the SA, such as the splenic vein. LND is performed by preserving the posterior pancreatic fascia around the SA in a left-to-right direction. Finally, the LNs around the left side of the CA are deeply dissected.We performed this procedure on ten patients between April 2016 and January 2017; no operative complications were reported in grade II or higher cancer patients.3 After exposing the dorsal landmark, LNs around the proximal SA and left side of the CA were removed in all patients.This procedure enables early identification of the dorsal layer and deep LND around the left side of the CA, keeping this layer. The left lateral approach is useful for radical LND along the proximal SA.
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المؤلفون: Takeshi Kubota, Naoki Hiki, Xiaohua Jiang, Souya Nunobe
المصدر: Annals of Surgical Oncology. 20:2683-2692
مصطلحات موضوعية: medicine.medical_specialty, medicine.medical_treatment, Gastric Bypass, Stomach surgery, Esophagus, Gastrectomy, Stomach Neoplasms, Gastroscopy, medicine, Humans, Reflux esophagitis, Laparoscopy, Pylorus, medicine.diagnostic_test, business.industry, Radical Lymph Node Dissection, Stomach, digestive, oral, and skin physiology, Surgery, Endoscopy, Early Gastric Cancer, Jejunum, medicine.anatomical_structure, Oncology, business, Organ Sparing Treatments
الوصف: The number of early gastric cancer (EGC) cases has been increasing because of improved diagnostic procedures. Applications of function-preserving gastric cancer surgery may therefore also be increasing because of its low incidence of lymph node metastasis, excellent survival rates, and the possibility of less-invasive procedures such as laparoscopic gastrectomy being used in combination. Pylorus-preserving gastrectomy (PPG) with radical lymph node dissection is one such function-preserving procedure that has been applied for EGC, with the indications, limitations, and survival benefits of PPG already reported in several retrospective studies. Laparoscopy-assisted proximal gastrectomy has also been applied for EGC of the upper third of the stomach, although this procedure can be associated with the 2 major problems of reflux esophagitis and carcinoma arising in the gastric stump. In the patient with EGC in the upper third of the stomach, laparoscopy-assisted subtotal gastrectomy with a preserved very small stomach may provide a better quality of life for the patients and fewer postoperative complications. Finally, the laparoscopy endoscopy cooperative surgery procedure combines endoscopic submucosal dissection with laparoscopic gastric wall resection, which prevents excessive resection and deformation of the stomach after surgery and was recently applied for EGC cases without possibility of lymph node metastasis. Function-preserving laparoscopic gastrectomy is recommended for the treatment of EGC if the indication followed by accurate diagnosis is strictly confirmed. Preservation of remnant stomach sometimes causes severe postoperative dysfunctions such as delayed gastric retention in PPG, esophageal reflux in PG, and gastric stump carcinoma in the remnant stomach. Moreover, these techniques present technical difficulties to the surgeon. Although many retrospective studies showed the functional benefit or oncological safety of function-preserving gastrectomy, further prospective studies using large case series are necessary.
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المؤلفون: Hisashi Ikoma, Yasutoshi Murayama, Kazuma Okamoto, Toshiyuki Kosuga, Eigo Otsuji, Hirotaka Konishi, Masayoshi Nakanishi, Ryo Morimura, Daisuke Ichikawa, Shuhei Komatsu, Yoshiaki Kuriu, Atsushi Shiozaki, Katsutoshi Shoda, Hitoshi Fujiwara, Tomohiro Arita
المصدر: Annals of surgical oncology. 23(Suppl 5)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Endoscopic Mucosal Resection, medicine.medical_treatment, Endoscopic mucosal resection, Risk Assessment, Disease-Free Survival, 03 medical and health sciences, 0302 clinical medicine, Gastrectomy, Risk Factors, Stomach Neoplasms, medicine, Humans, Neoplasm Invasiveness, Risk factor, Survival rate, Lymph node, Aged, Lymphatic Vessels, Retrospective Studies, Aged, 80 and over, business.industry, Radical Lymph Node Dissection, Patient Selection, Margins of Excision, Retrospective cohort study, Middle Aged, Surgery, Early Gastric Cancer, Tumor Burden, Survival Rate, medicine.anatomical_structure, Oncology, 030220 oncology & carcinogenesis, Lymphatic Metastasis, Blood Vessels, Lymph Node Excision, 030211 gastroenterology & hepatology, Female, Radiology, Neoplasm Grading, business
الوصف: Extended indications for endoscopic resection for early gastric cancer (EGC) have been widely accepted. However, according to current guidelines, additional gastrectomy with lymph node dissection (LND) is recommended for patients proven to have potential risks of lymph node metastasis (LNM) on histopathological findings. The aim of this study was to elucidate the risk stratification of outcome and LNM according to the number of factors that meet the inclusion criteria for radical LND for possible LNM (LNM risk factors) in patients with negative endoscopic resection margin. We enrolled 511 EGC patients whose tumors did not meet the absolute or extended indications for endoscopic resection, and investigated the risk stratification of prognosis and LNM according to the total number of LNM risk factors. Recurrence-free and overall survival rates were significantly higher in patients with fewer LNM risk factors for surgical indication (p = 0.0274 and 0.0002, respectively; log-rank test), and the total number of LNM risk factors and frequency of LNM were significantly correlated (p
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المؤلفون: Atsushi Itami, Hiroshi Okabe, Kazutaka Obama, Yoshiharu Sakai, Hisahiro Hosogi, Eiji Tanaka
المصدر: Surgery. 149:15-21
مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.medical_treatment, Splenectomy, Postoperative Hemorrhage, Risk Assessment, Disease-Free Survival, Hospitals, University, Pancreatic Fistula, Japan, Gastrectomy, Stomach Neoplasms, Gastroscopy, medicine, Humans, Pancreas, Aged, Neoplasm Staging, Retrospective Studies, Postoperative Care, Pain, Postoperative, business.industry, Radical Lymph Node Dissection, Mortality rate, Anastomosis, Surgical, Cancer, Length of Stay, Middle Aged, medicine.disease, Survival Analysis, Surgery, Pancreatic Function Tests, Treatment Outcome, medicine.anatomical_structure, Pancreatic fistula, Case-Control Studies, Feasibility Studies, Lymph Node Excision, Female, Lymphadenectomy, Lymph Nodes, business, Follow-Up Studies
الوصف: Background There is little evidence for the technical feasibility of laparoscopic gastrectomy (LG) with peripancreatic lymphadenectomy in terms of postoperative complications. To evaluate the technical feasibility of LG with radical lymphadenectomy, we focused on pancreas-related complications in LG and open gastrectomy (OG), and then investigated whether such complications increased in LG. Methods We reviewed the surgical outcomes of 138 consecutive patients with gastric cancer who underwent LG with peripancreatic lymphadenectomy in our hospital between July 2005 and February 2009. As a control group, we used 95 consecutive OG cases with peripancreatic lymphadenectomy without splenectomy or para-aortic lymphadenectomy. LG and OG were compared for clinicopathologic characteristics, operative outcomes, postoperative morbidities and mortalities, and amylase concentration of drainage fluid (d-AMY). Results The overall operative morbidity rates were 15% in the LG and 20% in the OG group. Rates of postoperative pancreatic fistula (POPF), Grade B and C in the International Study Group on Pancreatic Fistula definition, were 7% in the LG group and 2% in the OG group, indicating no statistical difference (P = .149). There were no in-hospital deaths. The median value of d-AMY in LG was 934.5 IU/L, while that in OG was 349 IU/L; d-AMY after LG was significantly higher than that after OG (P Conclusion Considering low morbidity and mortality rates, LG with peripancreatic lymphadenectomy is technically feasible. Although POPF after LG was infrequent, d-AMY level was higher than after OG. We should pay attention to the potential risk of pancreatic leakage when carrying out LG with peripancreatic lymphadenectomy.
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المؤلفون: Shinji Ishikawa, Hideo Baba, Kouei Ikeda, Nobutomo Miyanari, Yoshifumi Baba, Shinobu Honda, Ken Ichi Iyama
المصدر: Gastric Cancer. 10:135-139
مصطلحات موضوعية: Cancer Research, Pathology, medicine.medical_specialty, medicine.medical_treatment, Adenocarcinoma, Krukenberg tumor, Krukenberg Tumor, Metastasis, Heart Neoplasms, Neoplasms, Multiple Primary, Pericarditis, Fatal Outcome, Gastrectomy, Stomach Neoplasms, Surgical oncology, Biopsy, medicine, Humans, Ovarian Neoplasms, medicine.diagnostic_test, business.industry, Radical Lymph Node Dissection, Gastroenterology, General Medicine, Middle Aged, medicine.disease, digestive system diseases, Cardiac Tamponade, Oncology, Lymphatic Metastasis, Female, Tomography, X-Ray Computed, business, Pericardium
الوصف: A 53-year-old Japanese woman with bilateral ovarian tumors consulted our department. Gastroendoscopy disclosed 16 superficial depressed gastric lesions, and the histopathological diagnosis of the biopsy specimens was poorly differentiated adenocarcinoma and signet-ring cell carcinoma. Computed tomography (CT), ultrasonography (US), and positron emission tomography (PET) examinations revealed no other metastasis except for that observed in the ovaries. We performed a total gastrectomy with radical lymph node dissection and bilateral ovarian resection. A postoperative histological examination revealed 43 isolated gastric lesions which were scattered over the entire resected stomach; they were all confined to the mucosa. Cancer cell invasion in the lymphatics was detected only in the submucosal region beneath the main tumor. Both ovarian tumors were diagnosed as metastasis of signet-ring cell carcinoma (Krukenberg tumor). Adjuvant chemotherapy with irinotecan (CPT-11) and low-dose cisplatin (CDDP) was given on an outpatient basis, but 1 year after the surgery, carcinomatous pericarditis occurred. Administration of mitomycin C (MMC) into the pericardial space was performed twice; however, unfortunately, the patient died 13 months after surgery.
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