Optimal Management of Gastric Cancer

Coburn, Natalie; Seevaratnam, Rajini; Paszat, Lawrence; Helyer, Lucy; Law, Calvin; Swallow, Carol J.; Cardosa, Roberta; Mahar, Alyson; Lourenço, Laércio Gomes; Dixon, Matthew; Bekaii‐Saab, Tanios; Chau, Ian; Church, Neal; Coit, Daniel G.; Crane, Christopher H.; Earle, Craig C.; Mansfield, Paul F.; Marcon, Norman E.; Miner, Thomas J.; Noh, Sung Hoon; Porter, Geoff; Posner, Mitchell C.; Prachand, Vivek N.; Sano, Takeshi; Velde, Cornelis van de; Wong, Sandra L.; McLeod, Robin S.

doi:10.1097/sla.0b013e318288dd2b

Cited by 47 publications

(19 citation statements)

References 93 publications

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“…Laparoscopic surgery has been proposed as a promising method for the therapy of gastric cancer [41, 42]. Another fact is that people around the world are getting fatter.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

et al. 2017

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BackgroundObesity is a growing epidemic around the world, and obese patients are generally regarded as high risk for surgery compared with normal weight patients. The purpose of this study was to evaluate the influence of obesity on the surgical outcomes of laparoscopic gastrectomy (LG) for gastric cancer.MethodsWe reviewed data for all patients undergoing LG for gastric cancer at our institute between October 2004 and December 2016. Patients were divided into non-obese and obese groups and the perioperative outcomes were compared. Furthermore, a subgroup analysis was conducted to evaluate which of the two commonly used methods of LG, laparoscopic-assisted gastrectomy (LAG) and totally laparoscopic gastrectomy (TLG), is more suitable for obese patients.ResultsA total of 1691 patients, 1255 non-obese and 436 obese or overweight patients, underwent LG during the study period. The mean operation time was significantly longer in the obese group than in the non-obese group (209.9 ± 29.7 vs. 227.2 ± 25.7 min, P < 0.01), and intraoperative blood loss was significantly lower in the non-obese group (113.4 ± 34.1 vs. 136.9 ± 36.7 ml, P < 0.01). Time to first flatus, time to oral intake, and postoperative hospital stay were significantly shorter in the non-obese group than in the obese group (3.3 ± 0.8 vs. 3.6 ± 0.9 days; 4.3 ± 1.0 vs. 4.6 ± 1.0 days; and 9.0 ± 2.2 vs. 9.6 ± 2.2 days, respectively; P < 0.01). 119 (9.5%) of the non-obese patients had postoperative complications as compared to 44 (10.1%) of the obese patients (P = 0.71). In the subgroup analysis of all patients, TLG showed improved results for early surgical outcomes compared to LAG, mainly due to its advantages in obese patients.ConclusionsObesity is associated with long operation time, increased blood loss, and slow recovery after laparoscopic gastric resection but does not affect intraoperative security or effectiveness. TLG may have less negative results in obese patients than LAG due to a variety of reasons. Our analysis shows that TLG is more advantageous, with regard to early surgical outcomes, for obese patients.

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“…Laparoscopic surgery has been proposed as a promising method for the therapy of gastric cancer [41, 42]. Another fact is that people around the world are getting fatter.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

et al. 2017

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“…It remains controversial in the treatment of gastric cancer between West and East [ 27 ]. In the West, although D2 lymphadenectomy is recommended, most surgeons are still adopting D1 lymphadenectomy [ 17 , 28 , 29 ]. In the East, however, surgeons routinely perform D2 lymphadenectomy for patients with gastric cancer [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Hospital Readmission after Radical Gastrectomy for Gastric Cancer: A Prospective Study

et al. 2015

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BackgroundHospital readmission is gathering increasing attention as a measure of health care quality and a potential cost-saving target. The purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer.MethodsWe conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. The incidence, cause and risk factors for 30-day readmission were determined.ResultsA total of 376 patients were included in our analysis without loss in follow-up. The 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Factors not associated with a higher readmission rate included a history of a major postoperative complication during the index hospitalization, prolonged primary length of hospital stay after surgery, a history of previous abdominal surgery, advanced age, body mass index, pre-existing cardiopulmonary comorbidities, American Society of Anesthesiology grade, type of resection, extent of node dissection and discharge disposition.ConclusionsReadmission within 30 days of discharge after radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission. Preoperative optimization of nutritional status of patients at nutritional risk may effectively decrease readmission rates.

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“…Until recently, endoscopic radiography was regarded as the best method of preoperative staging to determine the degree of tumor invasion (category T) ( 7 ) . The most recent international consensus corroborated the necessity of preoperative TNM staging and pointed out multidetector-row computed tomography as the best staging method ( 8 , 9 ) , which has demonstrated similar or superior accuracy as compared with endoscopic ultrasonography for T-staging and a clear advantage in relation to other methods for N- and M-staging.…”

Section: Introductionmentioning

confidence: 97%

Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma

et al. 2015

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ObjectiveTo evaluate the role of multidetector computed tomography in the preoperative investigation of tumor invasion depth and lymph node and metastatic involvement according to the TNM classification, in patients with gastric adenocarcinoma.Materials and MethodsFifty-four patients with biopsy-confirmed gastric cancer underwent preoperative staging with 64-channel multidetector computed tomography. Two independent radiologists analyzed the images and classified the findings. Sensitivity, specificity, accuracy and overall accuracy were calculated for each observer. The interobserver agreement was also evaluated.ResultsThe accuracy in the classification of categories T ranged from 74% to 96% for observer 1 and from 80% to 92% for observer 2. The overall accuracy was 70% for both observers. The weighted kappa index was 0.75, consistent with a significant interobserver agreement. The accuracy in the classification of lymph node involvement (category N) ranged from 55% to 79% for observer 1 and from 73% to 82% for observer 2. The evaluation of metastatic involvement showed an overall accuracy of 89.6% for both observers.Conclusion64-channel multidetector computed tomography demonstrated clinically relevant accuracy in the preoperative staging of gastric adenocarcinoma as regards invasion depth (T category) and metastatic involvement (M category).

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Optimal Management of Gastric Cancer

Abstract: The expert panel has created 22 statements for the perioperative management of GC patients, to provide guidance to clinicians and improve the care received by patients.

Cited by 47 publications

References 93 publications

Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

Laparoscopic gastrectomy in obese gastric cancer patients: a comparative study with non-obese patients and evaluation of difference in laparoscopic methods

Risk Factors for Hospital Readmission after Radical Gastrectomy for Gastric Cancer: A Prospective Study

Multidetector computed tomography in the preoperative staging of gastric adenocarcinoma

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