Does N ratio affect survival in D1 and D2 lymph node dissection for gastric cancer?

AIM:To identify whether there could have been changes in survival if lymph node ratio (N ratio) had been used.METHODS:We assessed 334 gastric adenocarcinoma cases retrospectively between 2001 and 2009.Two hundred and sixteen patients out of 334 were included in the study.Patients were grouped according to disection1 (D1) or dissection 2 (D2) dissection.We compared the estimated survival and actual survival determined by Pathologic nodes (pN) class and N ratio,and SPSS 15.0 software was used for statistical analysis.RESULTS:Ninety-six (44.4%) patients underwent D1 dissection and 120 (55.6%) had D2 dissection.When groups were evaluated,23 (24.0%) patients in D1 and 21 (17.5%) in D2 had stage migration (P=0.001).When both D1 and D2 groups were evaluated for number of pathological lymph nodes,despite the fact that there was no difference in N ratio between D1 and D2 groups,a statistically significant difference was found between them with regard to pN1 and pN2 groups (P=0.047,P=0.044 respectively).In D1,pN0 had the longest survival while pN3 had the shortest.In D2,pN0 had the longest survival whereas pN3 had the shortest survival.CONCLUSION:N ratio is an accurate staging system for defining prognosis and treatment plan,thus decreasing methodological errors in gastric cancer staging.

Are stapler line reinforcement materials necessary in sleeve gastrectomy?

AIM: To investigate the effect of staple line reinforcement materials on decreasing complications related to sleeve gastrectomy.METHODS: In this retrospective study, we analyzed 84 patients who had sleeve gastrectomy due to obesity between April 2012 and April 2015. Sleeve gastrectomy procedure was performed in patients with a body mass index(BMI) more than 40 kg/m2, and the ones with a BMI between 32 and 40 kg/m2 in the presence of comorbid diseases. Reinforcement materials were used in 45 patients while they were not used in 39 patients. Materials such as Peristrip, 3/0 prolene, and V-lock were used for reinforcement in the reinforcement group(RG), and the materials used showed variations during the study period. The baseline characteristics, duration of surgery, hospital stay, comorbidities including hypertension, type 2 diabetes mellitus, hypertension, hepatosteatosis, gallstones, osteoarthritis, gastroesophageal reflux, sleep disorders, as well as the complications including leaks and bleeding after surgery were recorded and compared between the reinforcement and non-RGs(NRGs). RESULTS: There were no differences between the reinforcement and NRGs for baseline characteristics including age(P = 0.689), gender(P = 0.057), height(P = 0.483), weight(P = 0.889), BMI(P = 0.971), hospital stay(P = 0.888), or duration of surgery(P = 0.229). The most common comorbidities in the RG were hypertension(24.4%) and hepatosteatosis(24.4%), while type 2 diabetes mellitus(28.2%) and hepatosteatosis(28.2%) were the most frequent comorbidities in the NRG. There were no differences between the reinforcement and NRGs for the rates of comorbidities(P > 0.05). Leak was observed in one(2.2%) patient in the RG, and there was leak in 2(5.1%), and bleeding in 2(5.1%) patients in the NRG. There were no differences between the reinforcement and NRGs for the rate of staple line leaks(P = 0.446) or bleeding(P = 0.213). One of the patients with leak died in the NRG while there were no deaths in the RG.CONCLUSION: Although staple line reinforcement materials decreased morbidity and mortality, the differences between the two groups were not statistically significant.