Improving the outcomes in gastric cancer surgery

Tegels, Juul J. W.; Maat, Michiel F.G. de; Hulsewé, Karel W. E.; Hoofwijk, A. G. M.; Stoot, Jan H.M.B.

doi:10.3748/wjg.v20.i38.13692

Cited by 75 publications

(52 citation statements)

References 110 publications

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“…A lthough with decreasing incidence and mortality in many countries in the last decades, gastric cancer is still common worldwide and its prognosis is poor [1][2][3][4] . Gastrectomy is the only potentially curative treatment, but it is associated with increased postoperative catabolism and metabolic, endocrine, neuroendocrine and immune changes that contribute to high postoperative morbidity rates [5][6] .…”

Section: Introductionmentioning

confidence: 99%

Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

Poziomyck

Cavazzola

Coelho

et al. 2017

Rev. Col. Bras. Cir.

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Objectives: to determine the nutritional evaluation method that best predicts mortality in 90 days of patients submitted to gastrectomy for gastric cancer. Methods: we conducted a prospective study with 44 patients with gastric cancer, stages II to IIIa, of whom nine were submitted to partial gastrectomy, 34 to total gastrectomy, and one to esophago-gastrectomy. All patients were nutritionally evaluated through the same protocol, up to 72h after hospital admission. The parameters used were Patient-Generated Subjective Global Assessment (PGSGA), classical anthropometry, current weight and height, percentage of weight loss (%WL) and body mass index (BMI). We also measured the thickness of the thumb adductor muscle (TAM) in both hands, dominant hand (TAMD) and non-dominant hand (TAMND), as well as the calculated the prognostic nutritional index (PNI). The laboratory profile included serum levels of albumin, erythrocytes, hemoglobin, hematocrit, leukocytes, and total lymphocytes count (TLC). Results: of the 44 patients studied, 29 (66%) were malnourished by the subjective method, 15 being grade A, 18 grade B and 11 grade C. Cases with PGSGA grade B and TAMD 10.2±2.9 mm were significantly associated with higher mortality. The ROC curves (95% confidence interval) of both PGSGA and TAMD thickness reliably predicted mortality at 30 and 90 days. No laboratory method allowed predicting mortality at 90 days. Conclusion: PGSGA and the TAMD thickness can be used as preoperative parameters for risk of death in patients undergoing gastrectomy for gastric cancer.

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Section: Introductionmentioning

confidence: 99%

Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

Poziomyck

Cavazzola

Coelho

et al. 2017

Rev. Col. Bras. Cir.

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“…Invasive forms of gastric cancer continue to have a poor prognosis -this is why each potentially prognostic factor in this disease requires a thorough analysis. A potentially better prognosis is guaranteed by treatment in a highly specialised centre [7][8][9][10]. The annual number of gastrectomies, which would allow for a facility to be characterised as 'highly specialised' still remains disputable.…”

Section: Discussionmentioning

confidence: 99%

Surgical department profile focused on surgical oncology improves significantly the outcomes of major surgery for gastric cancer

Ciesielski

Kruszewski²,

Walczak³

et al. 2016

Nowotwory. Journal of Oncology

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Introduction. Gastrectomy for cancer remains a challenge for both the patient and the surgical team. It is regarded as a high-risk surgery with extensive postoperative trauma and significant morbidity and mortality. The experience in the preparation and selection for operative treatment and surgery itself are important factors affecting the outcome. The aim of the study was to analyse, on the basis of the first 6 years of departmental functioning, whether the change in surgical department profile from general to oncological surgery affects the outcome of major surgery for gastric cancer. Materials and methods. Data collected from 114 consecutive patients that underwent major surgery for gastric cancer in the first 6 years of activity of our department were retrospectively reviewed. The department was created on the basis of a previously existing general surgery unit. There were 87 radical and 27 palliative resections. Total gastrectomy was the most common procedure (84%). The material was divided into 2 groups: patients who underwent surgery during first 3 years of the department's existence (group I, n = 47) and patients who underwent surgery in the second 3-year period (group II, n = 67). Results. In the second three-year period we found: a higher mean age of patients (67.7 vs 63.1 years), a higher rate of artificial feeding applied (94% vs 66%), a higher mean number of harvested lymph nodes (21.3 vs 15.9), a lower rate of oesophageal anastomosis leak (0 vs 8.5%) and an improved 2-year survival rate (62.7% vs 44.7%). All of the mentioned differences exceeded the level of statistical significance. Postoperative mortality was 1.5% in group II and 8.5% in group I (p > 0.05). Conclusion. A surgical department profile focused on surgical oncology improves the outcome of major surgery for gastric cancer.

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“…The American College of Surgeons highlighted the importance of incorporating both sarcopenia and frailty in the preoperative risk assessment of older GC patients [28]. Tegels et al [29] described a strong correlation between these two factors and postoperative mortality after gastric surgery. Additionally, preoperative hypolbuminemia and poor nutritional status, low hemoglobin levels, and the presence of comorbidities such as diabetes were associated with sarcopenia, frailty, and consequently poor short-term and long-term outcomes [22,30,31].…”

Section: Impact Of Sarcopenia On the Surgical Management Of Gcmentioning

confidence: 99%

Sarcopenia in gastric cancer: when the loss costs too much

et al. 2017

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Sarcopenia is a complex syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. Malignancy is a major determinant of sarcopenia, and gastric cancer (GC) is among the most common causes of this phenomenon. As sarcopenia is a well-recognized poor prognostic feature in GC and has been associated with worse tolerance of surgical and medical treatments, members of the multidisciplinary team should be aware of the clinical relevance, pathogenic mechanisms, and potential treatments for this syndrome. The importance of sarcopenia is often underestimated in everyday practice and clinical trials, particularly among elderly or fragile patients. As treatment options are improving in all disease stages, deeper knowledge and greater attention to the metabolic balance in GC patients could further increase the benefit of novel therapeutic strategies and dramatically impact on quality of life. In this review, we describe the role of sarcopenia in different phases of GC progression. Our aim is to provide oncologists and surgeons dealing with GC patients with a useful tool for comprehensive assessment and timely management of this potentially life-threatening condition.

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Improving the outcomes in gastric cancer surgery

Cited by 75 publications

References 110 publications

Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

Nutritional assessment methods as predictors of postoperative mortality in gastric cancer patients submitted to gastrectomy

Surgical department profile focused on surgical oncology improves significantly the outcomes of major surgery for gastric cancer

Sarcopenia in gastric cancer: when the loss costs too much

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