Laparoscopic vs open total gastrectomy for gastric cancer:A meta-analysis

AIM:To conduct a meta-analysis comparing laparoscopic total gastrectomy(LTG)with open total gastrectomy(OTG)for the treatment of gastric cancer.METHODS:Major databases such as Medline(PubMed),Embase,Academic Search Premier(EBSCO),Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL)in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013.Evaluated endpoints were operative,postoperative and oncological outcomes.Operative outcomes included operative time and intraoperative blood loss.Postoperative recovery included time to first fatus,time to first oral intake,hospital stay and analgesics use.Postoperative complications comprised morbidity,anastomotic leakage,anastomotic stenosis,ileus,bleeding,abdominal abscess,wound problems and mortality.Oncological outcomes included positive resection margins,number of retrieved lymph nodes,and proximal and distal resection margins.The pooled effect was calculated using either a fixed effects or a random effects model.RESULTS:Fifteen non-randomized comparative studies with 2022 patients were included(LTG-811,OTG-1211).Both groups had similar short-term oncological outcomes,analgesic use(WMD-0.09;95%CI:-2.39-2.20;P=0.94)and mortality(OR=0.74;95%CI:0.24-2.31;P=0.61).However,LTG was associated with a lower intraoperative blood loss(WMD-201.19 mL;95%CI:-296.50--105.87 mL;P<0.0001)and overall complication rate(OR=0.73;95%CI:0.57-0.92;P=0.009);fewer wound-related complications(OR=0.39;95%CI:0.21-0.72;P=0.002);a quicker recovery of gastrointestinal motility with shorter time to frst fatus(WMD-0.82;95%CI:-1.18--0.45;P<0.0001)and oral intake(WMD-1.30;95%CI:-1.84--0.75;P<0.00001);and a shorter hospital stay(WMD-3.55;95%CI:-5.13--1.96;P<0.0001),albeit with a longer operation time(WMD 48.25 min;95%CI:31.15-65.35;P<0.00001),as compared with OTG.CONCLUSION:LTG is safe and effective,and may offer some advantages over OTG in the treatment of gastric cancer.

Clinical impact of preoperative acute pancreatitis in patients who undergo pancreaticoduodenectomy for periampullary tumors

AIM: To investigate the impact of preoperative acute pancreatitis(PAP) on the surgical management of periampullary tumors.METHODS: Fifty-eight patients with periampullary tumors and PAP were retrospectively analyzed. Thirtyfour patients who underwent pancreaticoduodenectomy(PD) and 4 patients who underwent total pancreatectomy were compared with a control group of 145 patients without PAP during the same period.RESULTS: The preoperative waiting time was significantly shorter for the concomitant PAP patients who underwent a resection(22.4 d vs 54.6 d, p < 0.001)compared to those who did not. The presence of PAP significantly increased the rate of severe complications(Clavien grade 3 or higher)(17.6% vs 4.8%, p = 0.019)and lengthened the hospital stay(19.5 d vs 14.5 d,p = 0.006). A multivariate logistic regression analysis revealed that PAP was an independent risk factor for postoperative pancreatic fistula(OR = 2.91; 95%CI:1.10-7.68; p = 0.032) and severe complications(OR =4.70; 95%CI: 1.48-14.96; p = 0.009) after PD. There was no perioperative mortality.CONCLUSION: PAP significantly increases the incidence of severe complications and lengthens thehospital stay following PD. PD could be safely performed in highly selective patients with PAP.

Functionality is not an independent prognostic factor for pancreatic neuroendocrine tumors

BACKGROUND Pancreatic neuroendocrine neoplasms(pNENs)that produce hormones leading to symptoms are classified as functional tumors,while others are classified as nonfunctional tumors.The traditional view is that functionality is a factor that affects the prognosis of pNEN patients.However,as the sample sizes of studies have increased,researches in recent years have proposed new viewpoints.AIM To assess whether functionality is an independent factor for predicting the prognosis of pNEN patients.METHODS From January 2004 to December 2016,data of patients who underwent surgery at the primary site for the treatment of pNENs from the Surveillance,Epidemiology,and End Results(SEER)database and West China Hospital database were retrospectively analyzed.RESULTS Contemporaneous data from the two databases were analyzed separately as two cohorts and then merged as the third cohort to create a large sample that was suitable for multivariate analysis.From the SEER database,age(P=0.006)and T stage(P<0.001)were independent risk factors affecting the survival.From the West China Hospital database,independent prognostic factors were age(P=0.034),sex(P=0.032),and grade(P=0.039).The result of the cohort consisting of the combined populations from the two databases showed that race(P=0.015),age(P=0.002),sex(P=0.032)and T stage(P<0.001)were independent prognostic factors.In the West China Hospital database and in the total population,nonfunctional pNETs and other functional pNETs tended to have poorer prognoses than insulinoma.However,functionality was not associated with the survival time of patients with pNETs in the multivariate analysis.CONCLUSION Functionality is not associated with prognosis.Race,age,sex,and T stage are independent factors for predicting the survival of patients with pNETs.