Effect of Sequential Early Enteral Nutrition on Postoperative Rehabilitation and Complications in Gastric Cancer Patients

Objective:To analyze the effect of sequential early enteral nutrition in patients with gastric cancer after surgery.Methods:A total of 139 gastric cancer patients,treated between October 2021 and October 2023,were randomly selected and divided into two groups:Group A(68 cases,receiving early enteral nutrition)and Group B(71 cases,receiving sequential early enteral nutrition),using computer randomization.The effects of the interventions on both groups were compared.Results:Seven days post-operation,the levels of nutritional indicators in Group B were significantly higher than those in Group A(P<0.05).Group B showed significantly better levels of inflammatory factors and immune factors compared to Group A seven days post-operation(P<0.05).The postoperative complication rate in Group B was 4.23%,2 significantly lower than that in Group A,which was 16.18%(χ=5.477,P=0.019).Conclusion:The utilization of sequential early enteral nutrition in gastric cancer patients after surgery demonstrated notable improvements in nutritional status and inflammation markers,along with enhanced immunity,effectively reducing postoperative complications.

Associate factors for endoscopic submucosal dissection operation time and postoperative delayed hemorrhage of early gastric cancer

BACKGROUND Endoscopic submucosal dissection(ESD)is a treatment for early gastric cancer with the advantages of small invasion,fewer complications,and a low local recurrence rate.However,there is a high risk of complications such as bleeding and perforation,and the operation time is also longer.ESD operation time is closely related to bleeding and perforation.AIM To investigate the influencing factors associated with ESD operation time and postoperative delayed hemorrhage to provide a reference for early planning,early identification,and prevention of complications.METHODS We conducted a retrospective study based on the clinical data of 520 patients with early gastric cancer in the Second Affiliated Hospital of Hainan Medical University from January 2019 to December 2021.The baseline data,clinical features,and endoscopic and pathological characteristics of patients were collected.The multivariate linear regression model was used to investigate the influencing factors of ESD operation time.Logistic regression analysis was carried out to evaluate the influencing factors of postoperative delayed hemorrhage.RESULTS The multivariate analysis of ESD operation time showed that the maximum lesion diameter could affect 8.815%of ESD operation time when other influencing factors remained unchanged.The operation time increased by 3.766%or 10.247%if the lesion was mixed or concave.The operation time increased by 4.417%if combined with an ulcer or scar.The operation time increased by 3.692%if combined with perforation.If infiltrated into the submucosa,it increased by 2.536%.Multivariate analysis of delayed hemorrhage after ESD showed that the maximum diameter of the lesion,lesion morphology,and ESD operation time were independent influencing factors for delayed hemorrhage after ESD.Patients with lesion≥3.0 cm(OR=3.785,95%CI:1.165-4.277),lesion morphology-concave(OR=10.985,95%CI:2.133-35.381),and ESD operation time≥60 min(OR=2.958,95%CI:1.117-3.526)were prone to delayed hemorrhage after ESD.CONCLUSION If the maximum diameter of the lesion in patients with early gastric cancer is≥3.0 cm,and the shape of the lesion is concave,or accompanied by an ulcer or scar,combined with perforation,and infiltrates into the submucosa,the ESD operation will take a longer time.When the maximum diameter of the lesion is≥3.0 cm,the shape of the lesion is concave in patients and the operation time of ESD takes longer time,the risk of delayed hemorrhage after ESD is higher.

Prognostic value of 11-factor modified frailty index in postoperative adverse outcomes of elderly gastric cancer patients in China

BACKGROUND Preoperative evaluation of frailty is limited to a few surgical procedures.However,the evaluation in Chinese elderly gastric cancer(GC)patients remains blank.AIM To validate and estimate the prognostic value of the 11-index modified frailty index(mFI-11)for predicting postoperative anastomotic fistula,intensive care unit(ICU)admission,and long-term survival in elderly patients(over 65 years of age)undergoing radical GC.METHODS This study was a retrospective cohort study which included patients who underwent elective gastrectomy with D2 Lymph node dissection between April 1,2017 and April 1,2019.The primary outcome was 1-year all-cause mortality.The secondary outcomes were admission to ICU,anastomotic fistula,and 6-mo mortality.Patients were divided into two groups according to the optimal grouping cutoff of 0.27 points from previous studies:High risk of frailty marked as mFI-11High and low risk of frailty marked as mFI-11Low.Survival curves between the two groups were compared,and univariate and multivariate regression analyses were performed to explore the relationship between preoperative frailty and postoperative complications in elderly patients undergoing radical GC.The discrimination ability of the mFI-11,prognostic nutritional index,and tumornode-metastasis pathological stage to identify adverse postoperative outcomes was assessed by calculating the area under the receiver operating characteristic(ROC)curve.RESULTS A total of 1003 patients were included,of which 13.86%(139/1003)were defined as having mFI-11High and 86.14%(864/1003)as having mFI-11Low.By comparing the incidence of postoperative complications in the two groups of patients,it was found that mFI-11High patients had higher rates of 1-year postoperative mortality,admission to ICU,anastomotic fistula,and 6-mo mortality than the mFI-11Low group(18.0%vs 8.9%,P=0.001;31.7%vs 14.7%,P<0.001;7.9%vs 2.8%,P<0.001;and 12.2%vs 3.6%,P<0.001).Multivariate analysis revealed mFI-11 as an independent predictive indicator for postoperative outcome[1-year postoperative mortality:Adjusted odds ratio(aOR)=4.432,95%confidence interval(95%CI):2.599-6.343,P=0.003;admission to ICU:aOR=2.058,95%CI:1.188-3.563,P=0.010;anastomotic fistula:aOR=2.852,95%CI:1.357-5.994,P=0.006;6-mo mortality:aOR=2.438,95%CI:1.075-5.484,P=0.033].mFI-11 showed better prognostic efficacy in predicting 1-year postoperative mortality[area under the ROC curve(AUROC):0.731],admission to ICU(AUROC:0.776),anastomotic fistula(AUROC:0.877),and 6-mo mortality(AUROC:0.759).CONCLUSION Frailty as measured by mFI-11 could provide prognostic information for 1-year postoperative mortality,admission to ICU,anastomotic fistula,and 6-mo mortality in patients over 65 years old undergoing radical GC.

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer:A retrospective cohort study

BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory.Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant.AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer.METHODS A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric cancer.For each patient we calculated the Kattan’s score.We arbitrarily divided the study population of patients into two groups based on the nomogram score(<100 points or≥100 points).Prespecified subgroups in these analyses were defined according to age(≤65 years or>65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity.RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy.Perioperative mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a Kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).Surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUSION Mortality and morbidity rate are higher in N+and advanced gastric cancer patients.The removal of more than 35 lymph nodes does not lead to an increase in mortality.

Reoperation for early postoperative complications after gastric cancer surgery in a Chinese hospital

AIM:To investigate the occurrence of postoperative complications of gastric cancer surgery,and analyze the potential causes of reoperation for early postoperative complications. METHODS:A total of 1639 patients who underwent radical or palliative gastrectomies for gastric cancer were included in the study.The study endpoint was the analysis of postoperative complications in inpatients. RESULTS:About 31%of patients had early postoperative complications,and complications of infection occurred most frequently.Intra-abdominal hemorrhage and anastomotic leak were the main causes of reoperation,which accounted for about 2.2%.Mortality was 11.1%in the reoperation group,but was only 0.8%in other patients.The duration of postoperative stay in hospital was significantly longer and the total expenditure was markedly higher in the patients who underwent reoperation(P<0.001).There was no significant association of any available factors in this study with the high rate of reoperation.CONCLUSION:Reoperation significantly increases the mortality rate and raises the burden of the surgical unit.More prospective studies are required to explore the potential risk factors.

Postoperative decrease of serum albumin predicts shortterm complications in patients undergoing gastric cancer resection

AIM To find an accurate and simple predictor for postoperative short-term complications after gastrectomy. METHODS Two hundred and twenty-three patients undergoing gastric cancer resection between October 1,2015 and September 30,2016 were enrolled in this study. Univariate and multivariate analyses were used toidentify risk factors for complications after gastrectomy. The cutoff values and diagnostic accuracy were examined by receiver operating characteristic curves.RESULTS Sixty-two(27.8%) patients had short-term complications after gastric cancer resection. The postoperative decrease in serum albumin(?ALB) was an independent risk factor for complications(OR = 17.957,95%CI: 6.073-53.095,P < 0.001). The cutoff value was 14.0% and the area under the curve was higher than that of C-reactive protein on postoperative day 3(area under the curve: 0.806 vs 0.709). Patients with ?ALB ≥ 14.0% were more likely to have short-term complications after gastrectomy(46.7% vs 5.0%,P < 0.001),prolonged hospital stay(17.2 ± 10.8 d vs 14.1 ± 4.2 d,P = 0.007) and higher comprehensive complication index(P < 0.001) than those with ?ALB < 14.0%.CONCLUSION Postoperative ?ALB with a cutoff of 14.0% can be used to recognize patients who have high risk of short-term complications following gastric cancer resection.

Impact of a Low Preoperative Body Mass Index on the Postoperative Complications and Overall Survival of Gastric Cancer Patients: a Systematic Review and Meta-analysis

Objective Obesity is related to various diseases and the risk of cancer.However,most studies overemphasize the risk of obesity,while ignoring the impact of underweight.In this study,we carried out a metaanalysis to assess the impact of a low preoperative body mass index on the postoperative complication and overall survival rates of gastric cancer patients.Methods We identified and selected relevant studies through PubMed,Embase,the Cochrane Library databases,the web of science,China National Knowledge Infrastructure and Wanfang electronic databases up to February 2019.The relative risk and 95%confidence interval were used to assess the association between the BMI and outcomes of gastric cancer patients.Results Seventeen publications were included in the final meta-analysis.There was a significant increase in the risk of postoperative complications(RR:1.30,95%CI:1.07-1.57,P<0.05;I2=61.1%)in the patients with a low body mass index.Conclusion Further research,including larger-scale prospective studies,is needed to confirm this finding.For underweight patients with poor nutritional status,preoperative nutritional support and BMI adjustment may be helpful to improve the postoperative outcomes.

Nomogram to predict prolonged postoperative ileus after gastrectomy in gastric cancer

BACKGROUND Prolonged postoperative ileus(PPOI)is one of the common complications in gastric cancer patients who underwent gastrectomy.Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI.We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.AIM To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.METHODS Between June 2016 and March 2017,the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database.Clinical data of patients who fulfilled the criteria were obtained.Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI.A nomogram for PPOI was developed and verified by bootstrap resampling.The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve.The clinical usefulness of our model was evaluated using the net benefit curve.RESULTS This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy.The incidence of PPOI was 19.75%in patients with gastrectomy.Age older than 60 years,open surgery,advanced stage(III–IV),and postoperative use of opioid analgesic were independent risk factors for PPOI.We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy.This nomogram had an excellent diagnostic performance[area under the curve(AUC)=0.836,sensitivity=84.4%,and specificity=75.4%].This nomogram was further validated by bootstrapping for 500 repetitions.The AUC of the bootstrap model was 0.832(95%CI:0.741–0.924).This model showed a good fitting and calibration and positive net benefits in decision curve analysis.CONCLUSION We have developed a prediction nomogram of PPOI for gastric cancer.This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.

Clinical observation of radical total gastrectomy without postoperative gastrointestinal decompression in elderly patients with gastric cancer

Purpose:To investigate the safety and feasibility of radical total gastrectomy without postoperative gastrointestinal decompression in elderly patients with gastric cancer.Methods:Elderly patients(65e80 years of age)hospitalized with gastric cancer from May 2009 to August 2012 were selected to receive radical total gastrectomy with(controls,n=39)or without(n=37)postoperative gastrointestinal decompression.Postoperative recovery conditions and associated complications were observed and compared.Results:In the group without decompression,the first passage of flatus post-operation was significantly earlier,and scores of nausea,pharyngitis,insomnia,and postoperative ambulation limitation were significantly reduced compared to controls(all p<0.01).However,there were no differences in the degree of abdominal distension,time to first anal defecation,or incidence of postoperative complications between the groups.Conclusion:Gastrointestinal decompression is not necessary after total gastrectomy in elderly gastric cancer patients,and may improve patient comfort and recovery.

Postoperative chemotherapy with S-1 plus oxaliplatin versus S-1alone in locally advanced gastric cancer(RESCUE-GC study): a protocol for a phase Ⅲ randomized controlled trial

Background： The ACTS-GC study had shown postoperative adiuvant therapy with S-1 improved survival of patients with locally advanced gastric cancer. Addition of oxaliplatin to S-1 is considered to be acceptable as one of the treatment options for gastric cancer patients after radical gastrectomy with D2 lymph node excision. Methods： We have commenced a randomized phase III trial in December 2016 to evaluate S-I plus oxaliplatin compared with S-1 alone in the adjuvant setting for locally advanced gastric cancer. A total of 564 patients will be accrued from 13 Chinese institutions in two years. The primary endpoint is 3-year relapse-free survival. The secondary endpoints are 5-year overall survival, proportion of patients who complete the postoperative chemotherapy and incidence of adverse events. Ethic and dissemination： The trial has been approved by the institutional review board of each participating institution and it was activated on December, 2016. The enrollment will be finished in December, 2018. Patient＇s follow-up will be ended until December, 2023. Trial registration： ClinicalTrials.gov, identifier： NCT02867839. Registered on August 4, 2016.

Extent of lymphadenectomy has no impact on postoperative complications after gastric cancer surgery in Sweden

Objective： Curative gastric cancer surgery entails removal of the primary tumor with adequate margins including regional lymph nodes. European randomized controlled trials with recruitment in the 1990＇s reported increased morbidity and mortality for D2 compared to D 1. Here, we examined the extent of lymphadenectomy during gastric cancer surgery and the associated risk for postoperative complications and mortality using the strengths of a population-based study. Methods： A prospective nationwide study conducted within the National Register of Esophageal and Gastric Cancer. All patients in Sweden from 2006 to 2013 who underwent gastric cancer resections with curative intent were included. Patients were categorized into DO, D I, or D I ＋/D2, and analyzed regarding postoperative morbidity and mortality using multivariable logistic regression. Results： In total, 349 （31.7%） patients had a DO, 494 （44.9%） DI, and 258 （23.4%） DI＋/D2 lymphadenectomy. The 30-d postoperative complication rates were 25.5%, 25.1% and 32.2 % （DO, D I and D1 ＋/D2, respectively）, and 90-d mortality rates were 8.3%, 4.3 % and 5.8%. After adjustment for confounders, in mukivariable analysis, there were no significant differences in risk for postoperative complications between the lymphadenectomy groups. For 90-d mortality, there was a lower risk for D1 vs. DO. Conclusions： The majority of gastric cancer resections in Sweden have included only a limited lymphadenectomy （DO and DI）. More extensive lymphadenectomy （DI＋/D2） seemed to have no impact on postoperative morbidity or mortality.

Prospective study of the effect of ERAS on postoperative recovery and complications in patients with gastric cancer

Objective:To study the efficacy of the enhanced recovery after surgery(ERAS)program on postoperative recovery and complications in patients with gastric cancer.Methods:Eighty patients in the perioperative period with radical gastrectomy were enrolled and randomly divided into 2 groups,the ERAS group and the non-ERAS group.The differences between the 2 groups in terms of postoperative recoveries and complications rate were determined.According to the body mass index(BMI)level,the ERAS group was divided into 2 subgroups,namely group A(BMI<28 kg/m2,n=16)and group B(BMI≥28 kg/m2,n=24).The non-ERAS group was also divided into group C(BMI<28 kg/m2,n=18)and group D(BMI≥28 kg/m2,n=22).The recovery and complications of each group were then determined.Results:The postoperative length of stay and visual analogue scale pain score were less in the ERAS group than the non-ERAS group(P<0.05).Time to first postoperative exhaustion,first postoperative defecation,returning leukocyte count to normal,and stopping intravenous nutrition were significantly shorter in the ERAS group(n=40),compared to the non-ERAS group(n=40,all P<0.05).The incidence of postoperative lower extremity intramuscular venous thrombosis was significantly higher in group D than in group B(χ2=4.800,P=0.028).In addition,the incidence of lower extremity intermuscular venous thrombosis and lung infection in group D was higher than those in other groups.Conclusions:The perioperative ERAS program was associated with faster recovery in patients undergoing radical gastrectomy.For patients with higher BMI(BMI≥28 kg/m2),the use of the perioperative ERAS program was more advantageous.

Prognostic significance of ERCC1 expression in postoperative patients with gastric cancer

Aim： This study explored the correlation between the expression of excision repair cross-complementation group 1 （ERCC1） and the prognosis of gastric cancer patients. Methods： From January 2005 to December 2008, 605 patients who underwent radical surgery in The First Affiliated Hospital of Nanjing Medical University were enrolled. We conducted the follow-up every 6 months and its contents included a comprehensive medical history, tumor markers and abdominal ultrasound or CT and other imaging findings. Deadline was April 30, 2013 and follow-up time between 51 to 91 months. Survival time is calculated from the date of diagnosis to death or last follow-up date. Immunohistochemistry （IHC） was used to assess the expression of ERCCI in resected samples. The relationship between ERCCI expression and survival of patients was investigated. The comparison of count data were analyzed by Chi-square test. Median survival time （MST） and the 5-year survival rate were calculated by life table analysis. The Kaplan-Meier curves were used for survival analysis. Results： ERCC1 expression was positive in 412 patients （68.1%）. There is no significant difference between ERCCl-positive group and ERCCl-negative group in terms of the MST and 5-year survival rate （P=0.455）. The MST and 5-year survival rate have no significant difference （P=0.162） between group with chemotherapy and group with no chemotherapy in patients with ERCCl-positive expression. However, the MST and 5-year survival rate in patients with ERCCl-negative expression benefited more from with chemotherapy （P=0.019）. The ERCCl-positive patients survived longer than those ERCCl-negative patients （P=0.183） in subgroup with no adjuvant chemotherapy. In the subgroup analysis, ERCC 1 expression had no significant relationship with overall survival in patients with stage II or llI gastric cancer （P〉0.05）. Conclusions： ERCC1 might be a good prognostic factor for the patients of gastric cancer after radical resection. Patients with ERCCl-negative expression could benefit more from adjuvant chemotherapy.

Macroscopic appearance of TypeⅣand giant Type Ⅲ is a high risk for a poor prognosis in pathological stage Ⅱ/Ⅲ advanced gastric cancer with postoperative adjuvant chemotherapy

AIM To evaluate whether a high risk macroscopic appearance(Type Ⅳ and giant Type Ⅲ) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage Ⅱ/Ⅲ(p Stage Ⅱ/Ⅲ) gastric cancer.METHODS One hundred and seventy-two advanced gastric cancer(defined as pT2 or beyond) patients with p Stage Ⅱ/Ⅲ who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival(RFS)(35.7%) and overall survival(OS)(34%) than an average risk appearance(P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13^(th) Japanese Gastric Cancer Association(JGCA) pT(P = 0.01), but not with the 13^(th) JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13^(th) JGCA p Stage(P < 0.0001)and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified highrisk macroscopic appearance(P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13^(th) JGCA stage in p Stage Ⅱ/Ⅲ advanced gastric cancer.

Relationship of the preoperative NRS 2002 score,PG-SGA score,and serum indices with postoperative complications in patients with gastric cancer

Objective To examine the utility of the Nutrition Risk Screening 2002(NRS 2002),Patient-Generated Subjective Global Assessment(PG-SGA)and serum factors for the preoperative evaluation of gastric cancer patients.Methods We examined 181 gastric cancer patients treated at the First Affiliated Hospital of Guangxi Medical University from January 2015 to January 2018.Nutritional assessments were administered within 48 h of admission.The body mass index(BMI)and serum factors were measured,and information on preoperative nutritional support and postoperative complications was recorded.Results Both the NRS 2002 and PG-SGA had positive correlations with age(P<0.05),and negative correlations with albumin,prealbumin,transferrin,hemoglobin,BMI,and bodyweight(P<0.05).The NRS 2002 and PG-SGA scores were positively correlated with each other(r=0.683,P<0.01),but had poor consistency(κ=0.357,P<0.01).During the preoperative period,33.2%of patients received nutritional support,mainly enteral nutrition.The nutritional risk group(NRS 2002≥3)received more support than the group without nutritional risk(NRS 2002<3;P<0.05).Patients with nutritional risk or malnutrition who received preoperative nutritional support had fewer postoperative complications than unsupported patients.The overall rate of complications was 12.2%,and the rate of severe complications(gradeⅢor above)was 5.5%.The malnutrition and nutritional risk groups had higher rates of severe complications.Conclusions The combined application of the NRS 2002,PG-SGA,BMI,and serum nutritional indices was useful for the nutritional screening and assessment of preoperative gastric cancer patients.The NRS 2002 and PG-SGA provided guidance on the need for nutritional support during the preoperative period.

Catheter-related Complications in Postoperative Intraperitoneal Chemotherapy for Gastric Cancer

Objective： To analyze catheter-related complications during postoperative Intraperitoneal chemotherapy （IPCT） for gastric cancer. Methods： From December 2003 to April 2007, 80 patients with gastric cancer were treated with postoperative IPCT using central venous catheters （CVCs）, during which the complications that occurred in association with CVCs were documented and analyzed. Results： Catheter-related complications were seen in 10 out of the 80 patients, yielding a total complication rate of 12.5%. Main complications included abdominal pain （3.8%）, local infection （1.3%）, catheter obstruction （2.5%）, leakage （2.5%） and dislocation （2.5%）. All patients successfully finished their IPCT, the success rate was 100%. There occurred no severe complications or treatment-related deaths. Conclusion： It is convenient and safe to carry out postoperative IPCT for gastric cancer using CVCs, which, with a low catheter-related complication rate, should be recommended for more clinic use.

Postoperative functional evaluation of gastrectomy for gastric cancer

To improve the quality of surgical procedures for gastric cancer,it is essential to consider many components comprehensively,including gastric motility,small intestinal absorption,hormones that affect gastric motility and appetite,presence or absence of vagus nerve preservation,esophageal regurgitation on endoscopic findings,in addition to whether or not there is a physiological route for food passage through the duodenum.Furthermore,proper functional evaluation cannot be performed without considering the form and amount of energy in the nutritional supplement to be loaded,and the posture at the time of investigation.The results of functional evaluation vary according to the method selected from many available options,but we believe that use of the most physiologically accurate,appropriate and selectable option will enable us to arrive at the best resection/reconstruction technique.We have reported that it is important to consider the preservation of three elements when performing gastrectomy:1)reduction of the extent of gastrectomy,2)preservation of the pylorus,and 3)preservation of the vagus nerve;among which preservation of the remnant stomach is the most important.Furthermore,the selection of a reconstruction method that maintains secretion of hormones beneficial to gastric motility preserves the energy balance inherent in the human body,and also provides better quality of life.

Significance of preoperative fibrinogen levels,neutrophils-to-lymphocyte ratio and its combined scores in evaluating the prognosis of postoperative patients with gastric cancer

Objective:To investigate the clinic significance of the combined detection of peripheral fibrinogen(Fbg)and neutrophils-to-lymphocyte ratio(NLR)(F-NLR)on the prognosis of postoperative gastric cancer patients.Methods:The clinical and pathological characteristics of 70 gastric cancer patients who were diagnosed by gastroscopy and surgically resected were collected,and the relationship between Fbg,NLR and F-NLR scores and pathological characteristics and prognosis of gastric cancer patients was retrospectively analyzed.Results:There were statistically significant differences in the levels of NLR in gastric cancer patients of different genders(P<0.05),while there were no significant differences in the levels of NLR and Fbg in other pathological factors such as age,T stage,lymph node metastasis and TNM stage(P>0.05).The f-NLR score of gastric cancer patients with different gender,T stage and TNM stage had statistical significance(P<0.05),but there was no statistical significance in the F-NLR score of gastric cancer patients with different age and whether lymph node metastasis(P>0.05).Univariate analysis showed that Fbg,NLR,F-NLR score,and TNM stage had an effect on recurrence and survival of patients with gastric cancer after surgery(P<0.05);multivariate COX regression analysis showed that only F-NLR score and TNM stage were independent risk factors for relapse and survival of patients with gastric cancer(P<0.05).Conclusion:The F-NLR scores about the combined detection of Fbg and NLR may guide clinical prediction of the prognosis of gastric cancer patients.

Difference in the effects of three nutritional pathways on postoperative rehabilitation in patients with gastric cancer and type 2 diabetes mellitus

Objective To explore the difference in the effects of three nutritional pathways on the rehabilitation of patients with gastric cancer and diabetes mellitus after operation.Methods Overall,120 patients were randomly divided into the partial parenteral nutrition(PPN),early enteral nutrition(EEN),and diabetes mellitus special enteral nutritional emulsion(DEN)groups.The differences in the effects of three nutritional modes were compared.Results(1)On postoperative day four,the total protein level in the EEN and DEN groups was significantly higher than that in the PPN group(P<0.05).On postoperative day ten,body mass index,lymphocyte count,total protein level,and pre-albumin level in the DEN group were significantly higher than those in the PPN group(P<0.05).(2)On postoperative day four,there was no significant difference in the fasting blood glucose level between the EEN and DEN groups(P>0.05),but this level was significantly lower than that in the PPN group(P<0.05).On postoperative day ten,fasting and postprandial blood glucose levels in the DEN group were significantly lower than those in the PPN group.(3)On postoperative day four,the C-reactive protein level in the DEN group was significantly lower than that in the other groups(P<0.05).(4)The incidence rates of complications in the PPN,EEN,and DEN groups were 25.0%,10.0%,and 5.0%,respectively.The incidence of complications in the PPN group was significantly higher than that in the other groups.However,there was no significant difference in perioperative indexes among the three groups(P>0.05).Conclusion Enteral nutrition is more conducive to the recovery of patients with gastric cancer and type 2 diabetes mellitus after operation;the special enteral nutrition emulsion for diabetes mellitus is more effective than the conventional nutrition solution in stabilizing blood sugar levels and reducing the degree of inflammation.

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.