Background Preoperative sarcopenia is associated with a poor long‐term prognosis in patients with gastric cancer (GC). Most GC patients rapidly lose muscle mass after gastrectomy. This retrospective cohort study analysed the effect of postoperative muscle loss and surgery‐induced sarcopenia on the long‐term outcomes of patients with GC. Methods Preoperative and postoperative 1 year abdominal computed tomography scans were available for 1801 GC patients who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. The patients were categorized into normal, presarcopenia, and sarcopenia groups according to the skeletal muscle index (SMI) measured on computed tomography scans. Patients who were not sarcopenic prior to gastrectomy but became sarcopenic after surgery were defined as the surgery‐induced sarcopenia group. Results There were 1227 men and 574 women included in the study. The mean age of the patients was 59.5 ± 12.3 years. Multivariable Cox‐regression analyses showed that preoperative SMI was not associated with overall survival (OS). However, postoperative sarcopenia was associated with significantly worse OS only in men [hazard ratio (HR), 1.75; 95% confidence interval (CI), 1.08–2.85]. SMI loss was an independent risk factor for OS in the entire cohort and in men (HR, 1.01; 95% CI, 1.00–1.02, for the entire cohort; HR, 1.02; 95% CI, 1.01–1.04, for men). The surgery‐induced sarcopenia group was associated with significantly higher mortality (HR, 1.84; 95% CI, 1.16–2.90, for the cohort; HR, 2.73; 95% CI, 1.54–4.82, for men), although SMI loss and surgery‐induced sarcopenia were not risk factors in women. Similar results were obtained for relapse‐free survival. Conclusions Postoperative muscle mass loss and surgery‐induced sarcopenia are prognostic factors for survival in patients with GC. Impact of postoperative muscle mass loss and surgery‐induced sarcopenia on survival outcomes is dependent on the sex.

<b><i>Introduction:</i></b> There is a dearth of literature on frailty specifically in elderly (aged ≥65 years) gastric cancer patients undergoing gastrectomy. We aim to assess the effects of frailty on postoperative outcomes. <b><i>Methods:</i></b> A review of a prospective database was performed from November 2011 to April 2019. Frailty was assessed by multidimensional frailty score (MFS). Outcomes assessed were early postoperative complications and mortality, and length of stay. <b><i>Results:</i></b> 289 patients were included. The mean age was 77.3 (range 66–94) years. 183 (63.3%) were males and 172 (59.5%) had early cancer. 275 (95.2%) underwent minimally invasive gastrectomy. 79 (27.3%) patients suffered early postoperative complications, with 47 (16.3%) suffering from Clavien-Dindo grade ≥2 complications. One-year, 90-day, 30-day, and inhospital mortality were 6.6, 1.4, 0.7, and 0%, respectively. 111 (38.4%) of patients were classified as “frail” based on MFS &#x3e; 5. “Frail” patients were associated with higher 1-year mortality (odds ratio (OR) 4.51, 95% CI 1.57–12.98, <i>p</i> = 0.005) on univariate analysis. On multivariate analysis, “frail” patients did not have significantly increased 1-year mortality. However, when definition of “frail” was changed from MFS &#x3e; 5 to MFS &#x3e; 6, frailty was significantly associated with increased 1-year mortality (OR 3.73, 95% CI 1.11–12.53, <i>p</i> = 0.033). <b><i>Conclusions:</i></b> Elderly gastric cancer patients undergoing gastrectomy with MFS &#x3e; 5 do not have increased mortality risk. The influence of frailty on postoperative outcomes may vary based on the risk of the surgical procedure.

Purpose: Conventional straight-shaped laparoscopic surgical instruments have limitations that, unlike robotic surgery, the wrist joint cannot be used. This study aimed to analyze the short-term safety and feasibility of ArtiSential (Livsmed), a new articulating laparoscopic instrument, which obviates the limitations of conventional laparoscopic surgery and allows the wrist joint to be used freely over 360° as in robotic surgery. Methods:The study included patients who underwent conventional laparoscopy or laparoscopy with the ArtiSential instrument. Patients who underwent laparoscopic gastrectomy for primary gastric adenocarcinoma in our institution were retrospectively reviewed. The groups were propensity score matched in a 1:1 ratio. Primary endpoint was incidence of early postoperative complication (postoperative 30-day morbidity and mortality) and secondary endpoints were operative outcomes.Results: A total of 327 patients (147 of the conventional group and 180 of the ArtiSential group) were propensity score matched. After propensity score matching was performed, each group comprised of 122 patients. Both groups were comparable with regard to operation time, estimated blood loss, number of retrieved lymph nodes, and length of hospital stay. The ArtiSential group had a faster time to a fluid diet (2.6 ± 1.3 days vs. 2.3 ± 0.6 days, p = 0.015). There was no statistically significant difference in early postoperative complications between the two groups (the conventional group, 23.0%; the ArtiSential group, 26.2%; p = 0.656). Conclusion:The current study showed that the use of ArtiSential is a safe and feasible option without increasing operation time, length of hospital stay, and intraoperative bleeding.

Objective To investigate the quality of life (QOL) of patients after laparoscopic sentinel node navigation surgery (SNNS) compared to conventional laparoscopy-assisted distal gastrectomy (LADG) in early gastric cancer patients. Methods Patients recruited for laparoscopic SNNS surgery between July 2010 and April 2013 were assessed for their QOL. A historical control group was established, consisting of patients who underwent conventional LADG with radical lymphadenectomy from the same institution. QOL questionnaire was taken serially from preoperative week 1 until 12 months postoperatively (1, 3, 6, and 12 months) using the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) QOL questionnaire-core (QLQ-C30) and gastric cancer-specific questionnaire (STO22). Results A total of 80 prospectively gathered patients who received SNNS were categorized into the comparison group (SNNS group). The QOL was compared with 78 patients identified to have received LADG from the gastric cancer database of our institution and were sorted into the control group (LADG group). In QLQ-C30, SNNS group showed better functioning scales in all except role functioning and better scores from the symptom scales in fatigue, insomnia, and diarrhea compared to the LADG group. In QLQ-STO22, scores on dysphagia, eating restriction, anxiety, and body image disturbance were better in SNNS group. Conclusions Postoperative QOL in laparoscopic gastrectomy combined with SNNS is superior compared to conventional laparoscopic distal gastrectomy in patients with stage I gastric cancer.

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