Machine learning identifies the risk of complications after laparoscopic radical gastrectomy for gastric cancer

BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.

Harnessing interventions during the immediate perioperative period to improve the long-term survival of patients following radical gastrectomy

Although the incidence and mortality of gastric cancer(GC)have been decreasing steadily worldwide,especially in East Asia,the disease burden of this malignancy is still very heavy.Except for tremendous progress in the management of GC by multidisciplinary treatment,surgical excision of the primary tumor is still the cornerstone intervention in the curative-intent treatment of GC.During the relatively short perioperative period,patients undergoing radical gastrectomy will suffer from at least part of the following perioperative events:Surgery,anesthesia,pain,intraoperative blood loss,allogeneic blood transfusion,postoperative complications,and their related anxiety,depression and stress response,which have been shown to affect long-term outcomes.Therefore,in recent years,studies have been carried out to find and test interventions during the perioperative period to improve the long-term survival of patients following radical gastrectomy,which will be the aim of this review.

Influences of dexmedetomidine on stress responses and postoperative cognitive and coagulation functions in patients undergoing radical gastrectomy under general anesthesia

BACKGROUND Radical gastrectomy(RG)is commonly used in the treatment of patients with gastric cancer(GC),but this procedure may lead to stress responses,postoperative cognitive dysfunction,and blood coagulation abnormalities in patients.AIM To investigate the influences of dexmedetomidine(DEX)on stress responses and postoperative cognitive and coagulation functions in patients undergoing RG under general anesthesia(GA).METHODS One hundred and two patients undergoing RG for GC under GA from February 2020 to February 2022 were retrospectively reviewed.Of these,50 patients had received conventional anesthesia intervention[control group(CG)]and 52 patients had received DEX in addition to routine anesthesia intervention[observation group(OG)].Inflammatory factor(IFs;tumor necrosis factor-α,TNF-α;interleukin-6,IL-6),stress responses(cortisol,Cor;adrenocorticotropic hormone,ACTH),cognitive function(CF;Mini-Mental State Examination,MMSE),neurological function(neuron-specific enolase,NSE;S100 calciumbinding protein B,S100B),and coagulation function(prothrombin time,PT;thromboxane B2,TXB2;fibrinogen,FIB)were compared between the two groups before surgery(T0),as well as at 6 h(T1)and 24 h(T2)after surgery.RESULTS Compared with T0,TNF-α,IL-6,Cor,ACTH,NSE,S100B,PT,TXB2,and FIB showed a significant increase in both groups at T1 and T2,but with even lower levels in OG vs CG.Both groups showed a significant reduction in the MMSE score at T1 and T2 compared with T0,but the MMSE score was notably higher in OG compared with CG.CONCLUSION In addition to a potent inhibitory effect on postoperative IFs and stress responses in GC patients undergoing RG under GA,DEX may also alleviate the coagulation dysfunction and improve the postoperative CF of these patients.

Utilization of deep neuromuscular blockade combined with reduced abdominal pressure in laparoscopic radical gastrectomy for gastric cancer:An academic perspective

BACKGROUND Few studies have examined the specific efficacy of deep neuromuscular blockade(NMB)combined with pneumoperitoneal pressure reduction in laparoscopic radical gastrectomy(LRG)in the elderly.AIM To investigate the application effect of deep neuromuscular blockade(NMB)combined with reduced pneumoperitoneum pressure in LRG for gastric cancer(GC)in elderly patients and its influence on inflammation.METHODS Totally 103 elderly patients with GC treated in our hospital between January 2020 and January 2022 were retrospectively analyzed.Among them,45 patients treated with surgery based on deep NMB and conventional pneumoperitoneum pressure were assigned to the control group,while the rest of the 58 patients who underwent surgery based on deep NMB and reduced pneumoperitoneum pressure were assigned to the observation group.The two groups were compared in the changes of the Leiden-surgical rating scale score,serum tumor necrosis fact-α(TNF-α)and interleukin 6(IL-6)before and after therapy.The visual analogue scale(VAS)was adopted for evaluating the shoulder pain of patients at 8 h,24 h and 48 h after the operation.The driving pressure of the two groups at different time points was also compared.Additionally,the operation time,pneumoperitoneum time,infusion volume,blood loss,extubation time after surgery,residence time in the resuscitation room,TOF%=90%time and post-anesthetic recovery room(PACU)stay time were all recorded,and adverse PACU-associated respiratory events were also recorded.The postoperative hospitalization time and postoperative expenses of the two groups were counted and compared.RESULTS No significant difference was found between the two groups at the time of skin incision,60 minutes since the operation and abdominal closure after surgery(P>0.05).The observation group exhibited significantly lower VAS scores than the control group at 24 and 48h after surgery(P<0.05).Additionally,the observation group had significantly lower driving pressure than the control group at 5 min and 60 min after the establishment of pneumoperitoneum(P<0.05).Additionally,the two groups were similar in terms of the operation time,pneumoperitoneum time,infusion volume,blood loss,extubation time after surgery,residence time in the resuscitation room and TOF%=90%time(P>0.05),and the observation group showed significantly lower TNF-αand IL-6 Levels than the control group at 24 h after therapy(P<0.05).Moreover,the incidence of adverse events was not significantly different between the two groups(P>0.05),and the observation group experienced significantly less hospitalization time and postoperative expenses than the control group(P<0.05).CONCLUSION Deep NMB combined with reduced pneumoperitoneum pressure can decrease the VAS score of shoulder pain and inflammatory reaction,without hindering the surgical vision and increasing adverse PACU-associated respiratory events,and can thus shorten the hospitalization time and treatment cost for patient.

Emergency exploratory laparotomy and radical gastrectomy in patients with gastric cancer combined with acute upper gastrointestinal bleeding

BACKGROUND Gastric cancer(GC)is a prevalent malignant tumor worldwide and ranks as the fourth leading cause of cancer-related mortality.Upper gastrointestinal bleeding(UGIB)is a frequent complication of GC.Radical gastrectomy and palliative therapy are widely used surgical procedures in the clinical management of GC.This study intends to probe the clinical efficacy and safety of radical gastrectomy and palliative therapy on the basis of exploratory laparotomy in patients with GC combined with UGIB,hoping to provide valuable information to aid patients in selecting the appropriate surgical intervention.AIM To investigate the clinical efficacy and safety of exploratory laparotomy^(+)radical gastrectomy and palliative therapy in patients with GC and UGIB combined.METHODS A total of 89 GC patients admitted to the First Affiliated Hospital of the University of South China between July 2018 and July 2020 were selected as participants for this study.The 89 patients were divided into two groups:radical resection group(n=46)treated with exploratory laparotomy^(+)radical gastrectomy and Palliative group(n=43)treated with palliative therapy.The study compared several variables between the two groups,including surgical duration,intraoperative blood transfusion volume,postoperative anal exhaust time,off-bed activity time,length of hospitalization,and incidence of complications such as duodenal stump rupture,anastomotic obstruction,and postoperative incision.Additionally,postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),and CD3^(+)/HLADR^(+)),immunoglobulin(IgG and IgM),tumor markers(CEA,CA199,and CA125),and inflammatory factors(IL-6,IL-17,and TNF-α)were assessed.The surgical efficacy and postoperative quality of life recovery were also evaluated.The patients were monitored for survival and tumor recurrence at 6 mo,1 year,and 2 years post-surgery.RESULTS The results indicated that the duration of operation time and postoperative hospitalization did not differ between the two surgical procedures.However,patients in the radical resection group exhibited shorter intraoperative blood loss,anus exhaust time,off-bed activity time,and inpatient activity time than those in the Palliative group.Although there was no substantial difference in the occurrence of postoperative complications,such as duodenal stump rupture and anastomotic obstruction,between the radical resection group and Palliative group(P>0.05),the radical resection group exhibited higher postoperative immune function indicators(including CD3^(+),CD4^(+),CD8^(+),etc.)and immunoglobulin levels(IgG,IgM)than the Palliative group,while tumor markers and inflammatory factors levels were lower than those in the radical resection group.Additionally,surgical efficacy,postoperative quality of life,and postoperative survival rates were higher in patients who underwent radical gastrectomy than in those who underwent palliative therapy.Moreover,the probability of postoperative tumor recurrence was lower in the radical gastrectomy group compared to the palliative therapy group,and these differences were all statistically significant(P<0.05).CONCLUSION Compared to palliative therapy,exploratory laparotomy^(+)radical gastrectomy can improve immune function,reduce the levels of tumor markers and inflammatory factors,improve surgical efficacy,promote postoperative quality of life recovery,enhance survival rates,and attenuate the probability of tumor recurrence.

Effect of Subcostal Anterior Quadratus Lumborum Block vs.Oblique Subcostal Transversus Abdominis Plane Block after Laparoscopic Radical Gastrectomy

Objective:To evaluate the analgesic effect of ultrasound-guided subcostal anterior quadratus lumborum block(QLB)for laparoscopic radical gastrectomy surgery.Methods:Patients(aged 20-65 years,ASA Ⅰ-Ⅱ,and weighing 40-75 kg)scheduled for elective laparoscopic radical gastrectomy were enrolled in the current study.Sixty patients were randomly assigned to two groups by computer-generated randomization codes:an ultrasound-guided oblique subcostal transversus abdominis plane block(TAPB)group(group T,n=30)or an ultrasound-guided subcostal anterior QLB group(group Q,n=30).In both groups,bilateral ultrasound-guided oblique subcostal TAPB and subcostal anterior QLB were performed before general anesthesia with 0.25% ropivacaine 0.5 mL/kg.For postoperative management,all patients received patient-controlled intravenous analgesia(PCIA)with nalbuphine and sufentanil after surgery,maintaining visual analogue scale(VAS)scores<4 within 48 h.The intraoperative consumption of remifentanil,the requirement for sufentanil as a rescue analgesic,and the VAS scores at rest and coughing were recorded at 1,6,12,24 and 48 h after surgery.The recovery(extubation time after surgery,first ambulation time,first flatus time and length of postoperative hospital stay)and the adverse events(nausea and vomiting,skin pruritus,respiratory depression and nerve-block related complications)were observed and recorded.The primary outcome was the perioperative consumption of opioids.Results:Compared with group T,the intraoperative consumption of remifentanil,requirement for sufentanil and the frequency of PCIA were reduced in group Q.Meanwhile,VAS scores at all points of observation were significantly lower in group Q than in group T.Patients in group Q were also associated with shorter time to first out-of-bed activity and flatus,and shorter length of postoperative hospital stay than group T(P<0.05).There were no skin pruritus,respiratory depression or nerve-block related complications in both groups.Conclusion:Compared with ultrasound-guided oblique subcostal TAPB,ultrasound-guided subcostal anterior QLB provided greater opioid-sparing effect,lower visual analogue scores,and shorter postoperative hospital stay for laparoscopic radical gastrectomy.

Heterotopic ossification beneath the upper abdominal incision after radical gastrectomy:Two case reports

BACKGROUND Heterotopic ossification(HO)is a rare clinical phenomenon that refers to bone formation in nonossifying tissues.CASE SUMMARY This report presents two cases of HO beneath the upper abdominal median incision after radical gastrectomy.The first patient had postoperative pain below the incision area.There were no signs of anastomotic leakage,and the wound healed.Computed tomography(CT)findings 2 wk postoperatively were negative for HO,but the 6-wk CT showed HO beneath the incision.The patient refused reoperation,and after conservative therapy,the pain was gradually relieved after 2 wk.In the second case,postoperative recovery was uneventful,and HO was only detected on routine follow-up CT after 4 mo.An anti-adhesion membrane was applied beneath the peritoneum in both patients.Our findings suggest that HO beneath the abdominal incision might form at approximately 1 mo postoperatively.It may cause intractable pain;however,reoperation is usually not required.CONCLUSION In our cases,we suspect that HO may be related to the use of foreign materials beneath the peritoneum,which needs to be further investigated.

Radical gastrectomy for D2 distal gastric cancer

Patient＇s information The patient is a 56-year-old man who visited our hospital for ＂repeated epigastric pain for more than two months.＂ Physical examination showed nearly pale appearance; abdomen was soft and no mass palpable; left supraclavicular lymph node （-）; and digital rectal examination （-）.

Superior pancreatic lymphadenectomy with portal vein priority via posterior common hepatic artery approach in laparoscopic radical gastrectomy

BACKGROUND D2 lymph node dissection for advanced gastric cancer is advocated,and station 8p lymph node should be considered in selected patients,which is,however,technically difficult.AIM To introduce a new and easy-to-perform procedure for dissection of the lymph nodes superior to the pancreas.METHODS A series of patients who underwent laparoscopic gastrectomy for gastric cancer were retrospectively included with utilization of a new procedure for superior pancreatic lymphadenectomy(LND)with portal vein priority via the posterior common hepatic artery approach(SPLD-PPPH)based on a newly defined portal triangle.The surgical outcome of the patients,as well as the efficacy and safety of SPLD-PPPH are reported.RESULTS A total of 51 patients were included with most of them being male(n=34,66.7%).According to the 8th edition of AJCC TNM staging,there were four(7.8%)patients in stage I,13(25.5%)in stage II,33(64.7%)in stage III and one(2.0%)in stage IV.The average duration for LND was about 1 h(67.7±6.9 min).After surgery,four patients developed morbidities,but all were treated successfully with no perioperative mortality.Among the 51 patients included,the percentage of patients who had lymph node metastasis at station 8p was 9.8%.Of note,with a total of 14 lymph nodes harvested at station 8p,the incidence of nodal metastasis was 14.3%.CONCLUSION About one in 10 patients with advanced gastric cancer had nodal metastasis at station 8p.The new approach of SPLD-PPPH is safe and effective for D2+LND during laparoscopic radical gastrectomy.

How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks

BACKGROUND Intraoperative methylene blue testing(IMBT),air leak testing,or endoscopy is used to assess the anastomotic integrity of esophagojejunostomy during open total gastrectomy for gastric cancer.Totally laparoscopic radical gastrectomy has been widely used to treat gastric cancer in the last few decades.However,reports on testing anastomotic integrity in totally laparoscopic radical gastrectomy are limited.AIM To explore the effects of IMBT on the incidence of postoperative anastomotic leaks(PALs)and identify the risk factors for PALs in totally laparoscopic radical gastrectomy.METHODS From January 2017 to December 2019,patients who underwent totally laparoscopic radical gastrectomy at the Shaanxi Provincial People's Hospital were retrospectively analyzed.According to whether or not they experienced an IMBT,the patients were divided into an IMBT group and a control group.If the IMBT was positive,an intraoperative suture was required to reinforce the anastomosis.The difference in the incidence of PALs was compared,and the risk factors were investigated.RESULTS This study consisted of 513 patients,211 in the IMBT group and 302 in the control group.Positive IMBT was shown in seven patients(3.3%)in the IMBT group,and no PAL occurred in these patients after suture reinforcement.Multivariate analysis showed that risk factors for predicting positive IMBT were body mass index(BMI)>25 kg/m2(hazard ratio[HR]=8.357,P=0.009),operation time>4 h(HR=55.881,P=0.002),and insufficient surgical experience(HR=15.286,P=0.010).Moreover,15 patients(2.9%)developed PALs in 513 patients,and the rates of PALs were significantly lower in the IMBT group than in the control group[2 of 211 patients(0.9%)vs 13 of 302 patients(4.3%),P=0.0026].Further analysis demonstrated that preoperative complications(HR=13.128,P=0.017),totally laparoscopic total gastrectomy(HR=9.075,P=0.043),and neoadjuvant chemotherapy(HR=7.150,P=0.008)were independent risk factors for PALs.CONCLUSION IMBT is an effective method to evaluate the integrity of anastomosis during totally laparoscopic radical gastrectomy,thus preventing technical defect-related anastomotic leaks.Preoperative complications,totally laparoscopic total gastrectomy,and neoadjuvant chemotherapy are independent risk factors for PALs.

Anesthetic Effect of Sufentanil Combined with Remifentanil in Patients Undergoing Radical Gastrectomy

Objective:To explore and analyze the anesthetic effect of sufentanil combined with remifentanil in patients undergoing radical gastrectomy for gastric cancer.Methods:In this study,100 patients receiving radical gastrectomy for gastric cancer in our hospital were selected as the research subjects,and the period from June 2019 to February 2021 was divided into different anesthesia regimens.Fifty patients receiving remifentanil anesthesia were used as the control group,and 50 patients receiving remifentanil combined with sufentanil anesthesia were used as the research group.The anesthetic effect of the two groups of patients was analyzed and compared.Results:The HR and MAP of the study group at different time after intubation were lower than those of the control group(P<0.05).The changes of HR and MAP before and after intubation in two groups were significant compared with those before intubation(P<0.05).The postoperative VAS score of the study group was significantly better than that of the control group(P<0.05).Conclusions:In radical gastrectomy for gastric cancer,the choice of sufentanil and remifentanil as the anesthesia scheme can effectively stabilize the hemodynamics of patients,relieve the degree of postoperative pain,with obvious clinical value.

Effect of Pressure-Controlled Inverse Ratio Ventilation on WBC,PCT and CRP in Rats Undergoing Radical Gastrectomy and Related Mechanism

Objective:To explore the effect of pressure-controlled inverse ratio ventilation on partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaC O2),dynamic lung compliance(Cdyn),white blood cell(WBC),procalcitonin(PCT),C-reactive protein(CRP),and other indicators.Methods:A total of 100 healthy Wistar rats,aged 6-8 weeks and weighing 300-356 g,were used to establish gastric cancer models with 1-methyl-3-nitro-1-nitrosoguanidine(MNNG).60 gastric cancer rats were randomly divided into three groups and treated with laparoscopic radical gastrectomy after anesthesia.Rats in the VCV group were given volume control ventilation,rats in the PCV group were given pressure control ventilation,and rats in the PC-IRV group were given pressure control inverse ratio ventilation.The levels of WBC,PCT and CRP in the three groups were observed and compared on the 1st,3rd and 5th day after operation.Results:There were significant differences in PaO_(2)levels at 15 min after ventilation mode change and at the time of pneumoperitoneum closure,and in PaCO_(2)and Cdyn levels at 10 min after induction and at 15 min after ventilation mode change among the three groups(P<0.05).The PaO_(2)levels in PC-IRV group were higher than those in VCV group and PCV group at 15 min after the ventilation mode was changed and at the time of closing the pneumoperitoneum.The level of PaCO_(2)in PC-IRV group was lower than that in VCV group and PCV group 10 min after induction and 15 min after ventilation mode change,and the level of PaCO_(2)in PC-IRV group was lower than that in VCV group when pneumoperitoneum was turned off.The level of Cdyn in PC-IRV group was higher than that in VCV group and PCV group at 10 min after induction and 15 min after ventilation mode change.The level of Cdyn in PC-IRV group was higher than that in PCV group at the time of closing pneumoperitoneum.The Cdyn level in PCV group was lower than that in VCV group at 15 min after ventilation mode change.There were significant differences in WBC levels among the three groups on the 1st day after operation(P<0.05),and there were no significant differences in PCT and CRP levels among the three groups on the 1st day after operation(P>0.05).There were significant differences in WBC,PCT and CRP levels in the three groups of rats on the 3rd and 5th days after surgery(P<0.05).Except for PCT and CRP on the 1st day after operation,the WBC on the 1st,3rd and 5th days after operation,PCT and CRP on the 3rd and 5th days after operation in PCV group and PC-IRV group were lower than those in VCV group(P<0.05).Except for WBC,PCT and CRP on 1st day after operation,the levels of WBC,PCT and CRP on the 3rd and 5th days after operation in PC-IRV group were lower than those in PCV group(P<0.05).Conclusion:During laparoscopic radical gastrectomy for gastric cancer,pressure-controlled inverse ratio ventilation can help rats maintain good respiratory status and lung compliance during the operation,which can effectively alleviate the postoperative inflammatory response.

Risk factors for surgical-site infections after radical gastrectomy for gastric cancer:a study in China

Background:About 10%of patients get a surgical-site infection(SSI)after radical gastrectomy for gastric cancer,but SSI remains controversial among surgeons.The aim of this study was to explore the risk factors for SSIs after radical gastrectomy in patients with gastric cancer to guide clinical therapies and reduce the incidence of SSI.Methods:The study was a retrospective cohort study in patients who underwent radical gastrectomy for gastric cancer.SSI was defined in accordance with the National Nosocomial Infection Surveillance System.We evaluated patient-related and peri-operative variables that could be risk factors for SSIs.The Chi-squared test and logistic regression analysis were used to assess the association between these risk factors and SSI.Results:Among the 590 patients,386 were men and 204 were women.The mean age was 56.6(28-82)years and 14.2%(84/590)of these patients had an SSI.Among them,incisional SSI was observed in 23 patients(3.9%)and organ/space SSI in 61 patients(10.3%).Multivariate logistic regression analysis identified sex(odds ratios[ORs]=2.548,and 95%confidence interval[CI]:1.268-5.122,P=0.009),total gastrectomy(OR=2.327,95%CI:1.352-4.004,P=0.002),albumin level(day 3 after surgery)<30 g/L(OR=1.868,95%CI:1.066-3.274,P=0.029),and post-operative total parenteral nutrition(OR=2.318,95%CI:1.026-5.237,P=0.043)as independent risk factors for SSI.Conclusions:SSI was common among patients after radical gastrectomy for gastric cancer.The method supporting post-operative nutrition and the duration of prophylactic antibiotics may be important modifiable influencing factors for SSI.

Prognostic Significance of MiR-34a Expression in Patients with Gastric Cancer after Radical Gastrectomy

Background： MiR-34a dysregulation has been implicated in tumorigenesis and progression of gastric cancer, but its role in prognosis of patients with gastric cancer remains unknown. The aim of this study was to investigate the expression and prognostic significance of miR-34a in gastric cancer patients after radical gastrectomy. Methods： Quantitative real-time polymerase chain reaction was performed to detect the expression of miR-34a in human gastric cancer cell lines and tissues in 76 patients with gastric adenocarcinoma from China. Results are assessed for association with clinical features and overall survival （OS） using Kaplan-Meier analysis. Prognostic values of miR-34a expression and clinical outcomes were evaluated by Cox regression analysis. A molecular prognostic stratification scheme incorporating miR-34a expression was determined using receiver operating characteristic analysis. Results： The results show that the expression level of miR-34a was decreased in human gastric cancer cell lines and tissues, and down-regulated expression of miR-34a was associated with Lauren classification （P = 0.034）. Decreased miR-34a expression in gastric cancer tissues was positively correlated with poor OS of gastric cancer patients （P = 0.0 l 3）. Further multivariate Cox regression analysis suggested that miR-34a expression was an independent prognostic indicator for gastric cancer （P = 0.027）. Applying the prognostic value of miR-34a expression to tumor node metastasis （TNM） stage system showed a better prognostic value in patients with gastric cancer than miR-34a expression （P = 0.0435） or TNM stage （P = 0.0249） alone. Conclusion： The results reinforce the critical role for the down-regulated miR-34a expression in gastric cancer and suggest that miR-34a could be a prognostic indicator for this disease.

Laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer (Billroth Ⅱ anastomosis)

Laparoscopic radical gastrectomy has been increasingly applied in China. However, how to reduce surgery-related trauma, shorten operative time and achieve the long-term prognosis equal to the conventional open surgery is still hot research topics. Along with the change in learning curve and the optimization of endoscopic techniques, laparoscopic lymph node dissection can achieve or even exceed the extent that can be achieved in open surgery. Therefore, it has gradually replaced the conventional digestive tract reconstruction using an auxiliary incision. By completing the laparoscopic digestive tract reconstruction with EndoGIA, we describe the laparoscopy-assisted D2 radical distal gastrectomy for gastric cancer （Billroth Ⅱ anastomosis）.

Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer:A prospective case–control study

BACKGROUND Gastric cancer is the most common cause of cancer-related deaths,and is classified according to its location in the proximal,middle,or distal stomach.Surgical resection is the primary approach for treating gastric cancer.This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.AIM To explore the efficacy of different staplers and digestive tract reconstruction(DTR)methods after radical gastrectomy and their influence on prognosis.METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study,with a follow-up period of 12-26 mo.The patients were assigned to four groups based on the stapler and DTR plan as follows:BillrothⅠ(B-I)reconstruction+linear stapler group(group A,22 cases),B-I reconstruction+circular stapler group(group B,22 cases),Billroth II(B-II)reconstruction+linear stapler group(group C,22 cases),and B-II reconstruction+circular stapler group(group D,21 cases).The pathological parameters,postoperative gastrointestinal function recovery,postoperative complications,and quality of life(QOL)were compared among the four groups.RESULTS No significant differences in the maximum diameter of the gastric tumors,total number of lymph nodes dissected,drainage tube removal time,QLQ(QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively,and incidence of complications were observed among the four groups(P>0.05).However,groups A and C(linear stapler)had significantly lower intraoperative blood loss and significantly shorter anastomosis time,operation time,first fluid diet intake time,first exhaust time,and length of postoperative hospital stay(P<0.05)than groups B and D(circular stapler).CONCLUSION Linear staplers offer several advantages for postoperative recovery.B-I and B-II reconstruction methods had similar effects on QOL.The optimal solution can be selected according to individual conditions and postoperative convenience.

Laparoscopic gastrectomy for distal gastric cancer

This video presents a standard D2 laparoscopic-assisted gastrectomy for distal gastric cancer. The lymph node dissection of each station is performed as required in the standardized procedure of distal gastrectomy, followed by the Billroth II anastomosis through a small incision.

Multifactor analysis of the technique in total laparoscopic gastric cancer

BACKGROUND Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy.However,using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration.In order to overcome these issues and improve patient prognosis,muscle flap reconstruction technique has emerged.Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue.By covering the anastomotic site with muscle tissue,it not only enhances the stability of the anastomosis site but also increases blood supply,promoting healing and recovery of the anastomosis.Therefore,the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied.AIM To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients’prognosis.METHODS The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022.All patients underwent esopha-gogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy.Perioperative indicators were determined,and INTRODUCTION Gastric cancer is one of the most common tumors of the digestive system worldwide.Although gastric cancer may not have significant manifestations in the early stage,as the disease progresses,systemic symptoms such as emaciation,anemia,and gastric perforation are observed[1].Surgery is the main treatment strategy for gastric cancer.With recent advances in total laparoscopy,total laparoscopic radical resection has gradually become an important treatment strategy for gastric cancer.Conventional laparoscopic surgery may require at least 5-6 incisions,whereas total laparoscopic surgery requires only 3-4 small incisions,decreasing surgical trauma and postoperative pain[2].Furthermore,because total laparoscopic surgery is less invasive than conventional laparoscopic surgery,patients can generally return to normal living and working conditions more quickly[3].Moreover,total laparoscopic surgery does not leave obvious surgical scars;therefore,it is advantageous for patients who pay attention to appearance[4].Esophagogastrostomy is a method used to repair gastrointestinal anastomosis,called the“double muscle valve”.This technique requires folding the fundus of the stomach,followed by sealing it with two layers of tissue,forming a structure similar to a valve.The application of esophagogastrostomy to total laparoscopic radical resection for gastric cancer can effectively decrease the incidence of complications such as anastomotic incontinence and bile reflux and improve the surgical cure rate and postoperative quality of life,which is a recent topic of interest for surgeons.At present,systematic multivariate analyses of the application effects of esophagogastrostomy in total laparoscopic surgery for gastric cancer and their effects on prognosis remain scarce[5].In the present study,we conducted surgery and postoperative follow-up of patients with gastric cancer and collected relevant clinical data for esophagogastric anastomosis during postoperative resection for gastric cancer to ACKNOWLEDGEMENTS I would like to express my sincere thanks to all those who participated in the manuscript.

Analgesic effect of ultrasound-guided bilateral transversus abdominis plane block in laparoscopic gastric cancer

BACKGROUND Postoperative complications are important factors affecting the survival time and quality of life of patients undergoing radical gastrectomy.AIM To investigate and compare the anesthetic effects of intravenous general anesthesia combined with epidural anesthesia or ultrasound-guided bilateral transversus abdominal plane block(TAPB)in gastric cancer patients undergoing laparoscopic radical gastrectomy.METHODS The clinical data of 85 patients who underwent laparoscopic radical gastrectomy in our hospital from December 2020 to January 2023 were retrospectively collected and divided into a TAPB group(n=45)and epidural anesthesia group(n=40)according to the different anesthesia and analgesia programs used.The TAPB group received general anesthesia combined with TAPB,and the epidural anesthesia group received general anesthesia combined with epidural anesthesia.The pain status,cognitive status,intestinal barrier indicators,recovery quality,and incidence of complications were compared between the two groups.RESULTS Compared with the epidural anesthesia group,the TAPB group’s visual analog scale scores were significantly lower 6 h,12 h,24 h and 48 h after surgery(P<0.05).The incidence of postoperative cognitive dysfunction(POCD)in the TAPB group was significantly lower than that in the epidural anesthesia group,and the Mini-mental State Examination score 24 h after surgery was significantly higher in the TAPB group than the epidural anesthesia group(P<0.05).The levels of diamine oxidase and plasma D-lactate were significantly lower in the TAPB group than the epidural anesthesia group 24 h after surgery(P<0.05).The agitation score and the incidence of agitation during recovery were significantly lower in the TAPB group than epidural anesthesia group(P<0.05).The total incidence of postoperative complications in the TAPB group was 4.44%,significantly lower than the 20.00%in the epidural anesthesia group(P<0.05).CONCLUSION Compared with epidural anesthesia combined with general anesthesia,TAPB combined with general anesthesia had a good analgesic effect in laparoscopic radical gastrectomy and can further reduce the incidence of POCD and postoperative complications,improve the levels of intestinal barrier indicators,and improve postoperative recovery quality.

Clinical value of regional lymph node sorting in gastric cancer

BACKGROUND Increasing evidence have shown that regional lymph node metastasis is a critical prognostic factor in gastric cancer(GC).In addition,lymph node dissection is a key factor in determining the appropriate treatment for GC.However,the association between the number of positive lymph nodes and area of lymph node metastasis in GC remains unclear.AIM To investigate the clinical value of regional lymph node sorting after radical gastrectomy for GC.METHODS This study included 661 patients with GC who underwent radical gastrectomy at Tianjin Medical University General Hospital between January 2012 and June 2020.The patients were divided into regional sorting and non-sorting groups.Clinicopathological data were collected and retrospectively reviewed to determine the differences in the total number of lymph nodes and number of positive lymph nodes between the groups.Independent sample t-tests were used for intergroup comparisons.Continuous variables that did not conform to a normal distribution were expressed as median(interquartile range),and the Mann-Whitney U test was used for inter-group comparisons.RESULTS There were no significant differences between the groups in terms of the surgical method,tumor site,immersion depth,and degree of differentiation.The total number of lymph nodes was significantly higher in the regional sorting group(n=324)than in the non-sorting group(n=337)(32.5 vs 21.2,P<0.001).There was no significant difference in the number of positive lymph nodes between the two groups.A total of 212 patients with GC had lymph node metastasis in the lymph node regional sorting group,including 89(41.98%)cases in the first dissection station and 123(58.02%)cases in the second dissection station.Binary and multivariate logistic regression results showed that the number of positive lymph nodes(P<0.001)was an independent risk factor for lymph node metastases at the second dissection station.CONCLUSION Regional sorting of lymph nodes after radical gastrectomy may increase the number of detected lymph nodes,thereby improving the reliability and accuracy of lymph node staging in clinical practice.