Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer

Kunisaki, Chikara; Matsubara, Hiroaki; Konno, Hiroyuki; Saze, Zenichiro; Hirahara, Norimichi; Kikuchi, Hirotoshi; Wakabayashi, Go; Gotoh, Mitsukazu; Mori, Masaki

doi:10.1007/s10120-016-0634-0

Cited by 51 publications

(60 citation statements)

References 26 publications

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“…The overall rate of postoperative morbidity was similar with those in the prospective JCOG0110, and the current study clarified that splenectomy was associated with significantly higher rate of pancreas-related complications ( p = 0.003) such as pancreatic fistula/abdominal abscess [13, 14]. Mobilization of the pancreas from the retroperitoneum and extensive lymphadenectomy along the splenic vessels may be associated with these clinical results in the splenectomy group [15, 16].…”

Section: Discussionsupporting

confidence: 73%

Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature

et al. 2017

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BackgroundFor proximal gastric cancer invading the greater curvature, concomitant splenectomy is frequently performed to secure the clearance of lymph node metastases. However, prognostic impact of prophylactic splenectomy remains unclear. The aim of this study was to clarify the oncological significance of prophylactic splenectomy for advanced proximal gastric cancer invading the greater curvature.MethodsRetrospective review of 108 patients who underwent total or subtotal gastrectomy for advanced proximal gastric cancer involving the greater curvature was performed. Short-term and long-term outcomes were compared between the patients who underwent splenectomy (n = 63) and those who did not (n = 45).ResultsPatients who underwent splenectomy showed higher amount of blood loss (538 vs. 450 mL, p = 0.016) and morbidity rate (30.2 vs. 13.3, p = 0.041) compared with those who did not undergo splenectomy. In particular, pancreas-related complications were frequently observed among patients who received splenectomy (17.4 vs. 0%, p = 0.003). However, no significant improvement of long-term outcomes were confirmed in the cases with splenectomy (5-year recurrence-free rate, 60.2 vs. 67.3%; p = 0.609 and 5-year overall survival rates, 63.7 vs. 73.6%; p = 0.769). On the other hand, splenectomy was correlated with marginally better survival in patients with Borrmann type 1 or 2 gastric cancer (p = 0.072).ConclusionsFor advanced proximal gastric cancer involving the greater curvature, prophylactic splenectomy may have no significant prognostic impact despite the increased morbidity rate after surgery. Such surgical procedure should be avoided as long as lymph node involvement is not evident.

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Section: Discussionsupporting

confidence: 73%

Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature

et al. 2017

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“…The conclusion has often been reached, based on relatively large‐scale reports, that obesity negatively influences the postoperative complication rate. This negative influence might account for the high risks of complications such as incision infection, leakage, postoperative pneumonia, and intra‐abdominal abscess . In contrast, although BMI routinely serves as an obesity index, the visceral fat area (VFA) is reportedly a more appropriate predictor of complications .…”

Section: Gastric Cancer Surgerymentioning

confidence: 99%

Obesity as a surgical risk factor

Aikou

Seto

2017

Annals of Gastroent Surgery

143

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In recent years, both the actual number of overweight/obese individuals and their proportion of the population have steadily been rising worldwide and obesity‐related diseases have become major health concerns. In addition, as obesity is associated with an increased incidence of gastroenterological cancer, the number of obese patients has also been increasing in the field of gastroenterological surgery. While the influence of obesity on gastroenterological surgery has been widely studied, very few reports have focused on individual organs or surgical procedures, using a cross‐sectional study design. In the present review, we aimed to summarize the impacts of obesity on surgeries for the esophagus, stomach, colorectum, liver and pancreas. In general, obesity prolongs operative time. As to short‐term postoperative outcomes, obesity might be a risk for certain complications, depending on the procedure carried out. In contrast, it is possible that obesity doesn't adversely impact long‐term surgical outcomes. The influences of obesity on surgery are made even more complex by various categories of operative outcomes, surgical procedures, and differences in obesity among races. Therefore, it is important to appropriately evaluate perioperative risk factors, including obesity.

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“…Better or worse outcomes can be detected by the monitoring report. Furthermore, we are proceeding with papers on complications related to each of the eight operative methods for the evaluation of medical standards using data from 2011 and 2012 . To assure collection of high‐quality data, the Japanese Society of Gastroenterological Surgery (JSGS) have started data verification activities for a gastroenterological session in NCD in 2016.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011–2016

Kakeji

Takahashi

Udagawa

et al. 2017

Annals of Gastroent Surgery

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The National Clinical Database (NCD) of Japan started its registration in 2011 and over 9 000 000 cases from more than 5000 facilities were registered over a 6‐year period. This is the report of NCD based upon gastrointestinal surgery information in excess of 3 200 000 cases from 2011 to 2016 adding data of complications. About 70% of all gastrointestinal surgeries were carried out at certified institutions, and the percentage of surgeries done at certified institutions was particularly high for the esophagus (92.4% in 2016), liver (88.4%), pancreas (89.8%), and spleen (86.8%). The percentage of anesthesiologist participation was more than 90% for almost all organs, except 85.7% for the rectum and anus. Approximately, more than two‐thirds of the surgeries were carried out with the participation of a board‐certified surgeon. Although patients have been getting older, mortalities have not been increasing. There were differences in the incidence of complications according to organ site and procedure. Remarkably, mortality rates of low anterior resection were very low, and those of hepatectomy and acute diffuse peritonitis surgery have been gradually decreasing. Although the complication rates were gradually increasing for esophagectomy or pancreaticoduodenectomy, the mortality rates for these procedures were decreasing. Nationwide, this database is expected to ensure the quality of the board‐certification system and surgical outcomes in gastroenterological surgery.

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Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer

Cited by 51 publications

References 26 publications

Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature

Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature

Obesity as a surgical risk factor

Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011–2016

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