Does the preoperative platelet-tolymphocyte ratio and neutrophil-tolymphocyte ratio predict morbidity after gastrectomy for gastric cancer?

Background:Gastric cancer is the 2 nd most common cause of cancer-related deaths,and the morbidity rate after surgery is reported to be as high as 46%.The estimation of possible complications,morbidity,and mortality and the ability to specify patients at high risk have become substantial for an intimate follow-up and for proper management in the intensive care unit.This study aimed to determine the prognostic value of the preoperative platelet-tolymphocyte ratio(PLR)and neutrophil-to-lymphocyte ratio(NLR)and their relations with clinical outcomes and complications after gastrectomy for gastric cancer.Methods:This single-center,retrospective cohort study evaluated the data of 292 patients who underwent gastrectomy with curative intent between January 2015 and June 2018 in a tertiary state hospital in Ankara,Turkey.A receiver operating characteristic curve was generated to evaluate the ability of laboratory values to predict clinically relevant postoperative complications.The area under the curve was computed to compare the predictive power of the NLR and PLR.Then,the cutoff points were selected as the stratifying values for the PLR and NLR.Results:The area under the curve values of the PLR(0.60,95%CI 0.542–0.657)and NLR(0.556,95%CI 0.497–0.614)were larger than those of the other preoperative laboratory values.For the PLR,the diagnostic sensitivity and specificity were 50.00%and 72.22%,respectively,whereas for the NLR,the diagnostic sensitivity and specificity were 37.50%and 80.16%,respectively.The PLR was related to morbidity,whereas the relation of the NLR with mortality was more prominent.This study demonstrated that the PLR and NLR may predict mortality and morbidity via the ClavienDindo classification in gastric cancer patients.The variable was grade≥3 in the Clavien-Dindo classification,including complications requiring surgical or endoscopic interventions,life-threatening complications,and death.Both the PLR and NLR differed significantly according to Clavien-Dindo grade≥3.In this analysis,the PLR was related to morbidity,while the NLR relation with mortality was more intense.Conclusion:Based on the results of the study,the PLR and NLR could be used as independent predictive factors for mortality and morbidity in patients with gastric cancer.

Risk factors for operative morbidity and mortality in gastric cancer patients undergoing total gastrectomy

AIM： To study the risk factors for morbidity and mortality following total gastrectomy. METHODS： We retrospectively reviewed the records of 125 consecutive patients who underwent total gastrectomy for gastric cancer at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2003 and March 2008. RESULTS： The overall morbidity rate was 20.8% （27 patients） and the mortality rate was 3.2% （4 patients）. Morbidity rates were higher in patients aged over 60 [odds ratio （OR） 4.23 （95% confidence interval （CI） 1.09 to 12.05）], with preoperative comorbidity [with vs without, OR 1.25 （95% CI 1.13 to 8.12）], when the combined resection was performed [combined resection vs total gastrectomy only, OR 2.67 （95% CI 1.58 to 5.06）]. CONCLUSION： Age, preoperative comorbidity and combined resection were with the rate of morbidity gastric cancer. independently associated after total gastrectomy for

Effects of age on survival and morbidity in gastric cancer patients undergoing gastrectomy

To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score. METHODSWe enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old (Group A), and 333 patients were aged < 79 years old (Group B). We compared the surgical outcomes and survival of the two groups after IPTW. RESULTSPostoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B (P < 0.05). Overall survival (OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage I disease, OS was significantly lower in Group A (P < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection were independent prognostic values for OS. CONCLUSIONWhen the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.

Spectrum of Bladder Cancer Patients Morbidity and Mortality in a Tertiary Hospital of Northwestern Nigeria: A 7-Year Review

Background: Bladder cancer is a common cause of morbidity and mortality in our institution due to the late presentation. Morbidity is defined as a development of complications that may lead to mortality. Uraemia is a common presentation that constitutes a management challenge in our patients. We study the spectrum of morbidity and mortality in bladder cancer patients in our institution. Materials and Methods: This is a retrospective study of patients with clinical, radiological, cytological and or histological features of bladder cancer that had a morbidity and or mortality managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from January 2011 to December, 2017. Data were retrieved from patients’ case notes via a proforma and analyzed using SPSS 20.0 version for windows. The results were presented in number percent, tables and chart. Results: There were morbidity and or mortality in 234 bladder cancer patients within the study period with a mean age of 48.4 ± 14.1 years and a range of 3 - 106 years. There were 219 males (91.5%) and 20 females (8.5%) with a male to female ratio of 11:1. There were haematuria and lower urinary tract symptoms (LUTS) in 230 patients (98.3%). There were necroturia ± weight loss and anorexia in 126 patients (53.8%). There was urinary tract infection (UTI) in 75 patients (32.1%), anaemia in 131 patients (56.0%) and uraemia in 161 patients (68.8%). Mortality was recorded in 84 patients (35.9%) which was due to uraemia in 52 patients (22.2%), urosepsis in 22 patients (9.4%) and anaemia in 8 patients (3.4%), intestinal obstruction and blood transfusion reaction in 1 patient each (0.4%). Conclusion: Anaemia, urosepsis and uraemia are the most common causes of morbidity and or mortality in bladder tumour patients in Sokoto. This poses great diagnostic and therapeutic dilemma to the urologist, patients and their relatives.

Risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years

Objective This study is to analyse the clinical feature and risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years. Methods The clinical records of 222 patients older than 70 years who had undergone pulmonary resection for their lung cancer were reviewed. The patients were divided into 3 groups,group I including the patients who had

Management of genitourinary syndrome of menopause in breast cancer survivors:An update

There is increasing attention about managing the adverse effects of adjuvant therapy(Chemotherapy and anti-estrogen treatment)for breast cancer survivors(BCSs).Vulvovaginal atrophy(VVA),caused by decreased levels of circulating estrogen to urogenital receptors,is commonly experienced by this patients.Women receiving antiestrogen therapy,specifically aromatase inhibitors,often suffer from vaginal dryness,itching,irritation,dyspareunia,and dysuria,collectively known as genitourinary syndrome of menopause(GSM),that it can in turn lead to pain,discomfort,impairment of sexual function and negatively impact on multiple domains of quality of life(QoL).The worsening of QoL in these patients due to GSM symptoms can lead to discontinuation of hormone adjuvant therapies and therefore must be addressed properly.The diagnosis of VVA is confirmed through patient-reported symptoms and gynecological examination of external structures,introitus,and vaginal mucosa.Systemic estrogen treatment is contraindicated in BCSs.In these patients,GSM may be prevented,reduced and managed in most cases but this requires early recognition and appropriate treatment,but it is normally undertreated by oncologists because of fear of cancer recurrence,specifically when considering treatment with vaginal estrogen therapy(VET)because of unknown levels of systemic absorption of estradiol.Lifestyle modifications and nonhormonal treatments(vaginal moisturizers,lubricants,and gels)are the first-line treatment for GSM both in healthy women as BCSs,but when these are not effective for symptom relief,other options can be considered,such as VET,ospemifene,local androgens,intravaginal dehydroepiandrosterone(prasterone),or laser therapy(erbium or CO2 Laser).The present data suggest that these therapies are effective for VVA in BCSs;however,safety remains controversial and a there is a major concern with all of these treatments.We review current evidence for various nonpharmacologic and pharmacologic therapeutic modalities for GSM in BCSs and highlight the substantial gaps in the evidence for safe and effective therapies and the need for future research.We include recommendations for an approach to the management of GSM in women at high risk for breast cancer,women with estrogen-receptor positive breast cancers,women with triplenegative breast cancers,and women with metastatic disease.

Genitourinary function and defecation after colorectal cancer surgery with low-and high-ligation of the inferior mesenteric artery:A meta-analysis

BACKGROUND The effect of low ligation(LL)vs high ligation(HL)of the inferior mesenteric artery(IMA)on functional outcomes during sigmoid colon and rectal cancer surgery,including urinary,sexual,and bowel function,is still controversial.AIM To assess the effect of LL of the IMA on genitourinary function and defecation after colorectal cancer(CRC)surgery.METHODS EMBASE,PubMed,Web of Science,and the Cochrane Library were systematically searched to retrieve studies describing sigmoid colon and rectal cancer surgery in order to compare outcomes following LL and HL.A total of 14 articles,including 4750 patients,were analyzed using Review Manager 5.3 software.Dichotomous results are expressed as odds ratios(ORs)with 95%confidence intervals(CIs)and continuous outcomes are expressed as weighted mean differences(WMDs)with 95%CIs.RESULTS LL resulted in a significantly lower incidence of nocturnal bowel movement(OR=0.73,95%CI:0.55 to 0.97,P=0.03)and anastomotic stenosis(OR=0.31,95%CI:0.16 to 0.62,P=0.0009)compared with HL.The risk of postoperative urinary dysfunction,however,did not differ significantly between the two techniques.The meta-analysis also showed no significant differences between LL and HL in terms of anastomotic leakage,postoperative complications,total lymph nodes harvested,blood loss,operation time,tumor recurrence,mortality,5-year overall survival rate,or 5-year disease-free survival rate.CONCLUSION Since LL may result in better bowel function and a reduced rate of anastomotic stenosis following CRC surgeries,we suggest that LL be preferred over HL.

Exploring the role of natural bioactive molecules in genitourinary cancers:how far has research progressed?

The primary approaches to treat cancerous diseases include drug treatment,surgical procedures,biotherapy,and radiation therapy.Chemotherapy has been the primary treatment for cancer for a long time,but its main drawback is that it kills cancerous cells along with healthy ones,leading to deadly adverse health effects.However,genitourinary cancer has become a concern in recent years as it is more common in middle-aged people.So,researchers are trying to find possible therapeutic options from natural small molecules due to the many drawbacks associated with chemotherapy and other radiation-based therapies.Plenty of research was conducted regarding genitourinary cancer to determine the promising role of natural small molecules.So,this review focused on natural small molecules along with their potential therapeutic targets in the case of genitourinary cancers such as prostate cancer,renal cancer,bladder cancer,testicular cancer,and so on.Also,this review states some ongoing or completed clinical evidence in this regard.

An integrated analysis of mRNA-miRNA transcriptome data revealed hub regulatory networks in three genitourinary cancers

Bladder,kidney,prostate and testicular carcinoma are the top four genitourinary cancers in China.Here we analyzed mRNA and miRNA expression profiles of carcinomas of the bladder(TCC),kidney(ccRCC)and testis(TGCT)to uncover their specific regulatory mechanisms.The gene expression profiles of GSE31617 were downloaded from GEO database,which contained 27 samples,including 10 TCC,7 TGCT and 10 ccRCC.Specific up-and downregulated differentially expressed genes(DEGs)and differentially expressed microRNAs(DEmiRNAs)of each cancer were selected and target genes of DEmiRNAs were predicted.Gene interaction network of the shared genes and target genes of DEmiRNAs of each cancer was predicted by STRING and constructed by Cytoscape.In each cancer,we build regulatory networks of hub genes selected and conducted GO analysis of enriched genes.Furthermore,we chose four hub genes(SALL4,RHEB,CDC42 and TNN)for survival analysis in OncoLnc database,and they all had effects on the survival rate of another genitourinary cancer-kidney renal clear cell carcinoma(KIRC).In conclusion,the present study indicated that the identified hub genes promote our understanding of molecular mechanisms underlying the development of three genitourinary cancers,and might be used as molecular targets and diagnostic biomarkers for the treatment of them.

Genitourinary tumors and liver transplantation: A comprehensive review

Liver transplantation is as a crucial therapeutic option for patients with end-stage liver disease,but the persistent organ shortage emphasizes a need to explore unconventional donor sources,including individuals with a history of malignan-cies.This review investigates the viability of liver donation from individuals with current or past genitourinary malignancies,focusing on renal,prostate and urinary bladder cancers.The rising incidence of urogenital malignancies among potential donors is thought to result from increasing donor age.Analysis of transmission risks reveals low rates of donor-derived cancer transmission,partic-ularly for early-stage renal and prostate cancers.Recipients with a history of genitourinary malignancy pose complex challenges regarding post-transplant immunosuppression and cancer recurrence.Nonetheless,the evidence suggests acceptable outcomes can be achieved with careful patient selection and tailored management strategies.Recommendations for pre-transplant evaluation and post-transplant surveillance are discussed,highlighting the need for individualized approaches in this patient population.Further prospective studies are warranted to refine guidelines and optimize outcomes in liver transplantation for patients with genitourinary malignancies.

Surgical outcome after docetaxel-based neoadjuvant chemotherapy in locally-advanced gastric cancer

AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric cancer.METHODS:Patients suffering from locally-advanced(T3-4 any N M0 or any T N1-3 M0)gastric carcinoma,staged with endoscopic ultrasound,bone scan,computed tomography,and laparoscopy,were assigned to receive four 21 d/cycles of TCF(docetaxel 75 mg/m 2 day 1,cisplatin 75 mg/m 2 day 1,and fluorouracil 300 mg/m 2 per day for days 1-14),either before(Arm A)or after(Arm B)gastrectomy.Operative morbidity,overall mortality,and severe adverse events were compared by intention-to-treat analysis.RESULTS:From November 1999 to November 2005,70 patients were treated.After preoperative TCF(Arm A),thirty-two(94%)resections were performed,85% of which were R0.Pathological response was complete in 4 patients(11.7%),and partial in 18(55%).No surgical mortality and 28.5%morbidity rate were observed,similar to those of immediate surgery arm(P= 0.86).Serious chemotherapy adverse events tended to be more frequent in arm B(23%vs 11%,P=0.07),with a single death per arm.CONCLUSION:Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.

Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

Laparoscopic resection for colon and rectal cancer is associated with quicker return of bowel function, reduced postoperative morbidity rates and shorter length of hospital stay compared to open surgery, with no differences in long-term survival. Conversion to open surgery is reported in up to 30% of patients enrolled in randomized control trials comparing open and laparoscopic colorectal resection for cancer. In this review, reasons for conversion are anatomical-related factors, disease-related-factors and surgeon-related factors. Body mass index, local tumour extension and co-morbidities are independent predictors of conversion. The current evidence has shown that patients with converted resection for colon cancer have similar outcomes compared to patients undergoing a laparoscopic completed or open resection. The few studies that have assessed the outcomes after conversion of laparoscopic rectal resection reported significantly higher rates of complications and longer length of hospital stay in converted patients compared to laparoscopically treated patients. No definitive conclusions can be drawn when converted and open rectal resections are compared. Early and pre-emptive conversion appears to have more favourable outcomes than reactive conversion; however, further large studies are needed to better define the optimal timing of conversion. With regard to long-term oncologic outcome, overall and disease-free survival in the case of conversion in laparoscopic colorectal cancer surgery seems to be worse than those achieved in patients in whom resection was successfully completed by laparoscopy. Although a worse long-term oncologic outcome has been suggested, it remains difficult to draw a proper conclusion due to the heterogeneity of the long-term outcomes as well as the inclusion of both colon and rectal cancer patients in most of the studies. Therefore, we discuss the currently available evidence of the impact of conversion in laparoscopic resection for colon and rectal cancer on both short-term outcomes and long-term survival.

Primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery for patients with advanced ovarian cancer

Objectives： To compare the survival and perioperafive morbidity between primary debulking surgery （PDS） and neoadjuvant chemotherapy followed by interval debulking surgery （NAC/IDS） in treating patients with advanced epithelial ovarian cancer （EOC）. Methods： We retrospectively reviewed 67 patients with stage IIIC or iV EOC treated at Peking University Cancer Hospital from January 2006 to June 2009. VVherein, 37 and 30 patients underwent PDS and NAC/ IDS, respectively. Results： No difference in overall survival （OS） or progression-free survival （PFS） was observed between NAC/IDS group and PDS group （OS： 41.2 vs. 39.1 months, P=0.23; PFS： 27.1 vs. 24.3 months, P=0.37）. The optimal debulking rate was 60% in the NAC/IDS group, which was significantly higher than that in the PDS group （32.4%） （P=0.024）. The NAC/IDS group had significantly less intraoperative estimated blood loss and transfusion, lower nasogastric intubation rate, and earlier ambulation and recovery of intestinal function than the PDS group （P〈0.05）. Conclusions： NAC/IDS is less invasive than PDS, and offers the advantages regarding optimal cytoreduction rate, intraoperative blood loss, and postoperative recovery, without significantly impairing the survival compared with PDS in treating patients with stage IIIC or IV EOC. Therefore, NAC/IDS may be a valuable treatment alternative for EOC patients.

Genitourinary small-cell carcinoma： 11-year treatment experience

The predictive factors of prognosis and treatment strategies for small-cell carcinoma （SCC） of the urinary tract are controversial. This study was aimed to investigate the clinical experience and management of patients with SCC of the urinary tract. We collected data of patients who were diagnosed with genitourinary SCC （GSCC） between 2002 and 2013 and were treated in the Fudan University Shanghai Cancer Center. A total of 18 patients were diagnosed with GSCC of which 10 originated from the prostate, seven from the bladder and one from the adrenal gland. The mean follow-up time was 15.5 months and progression-free survival （PFS） was 9.3 months. Primary tumor resection was attempted in 13 of 18 patients （72.2%） in whom radical surgery was performed in six of 14 （42.9%） limited disease patients. Most of the patients （13, 72.2%） received cisplatin-based chemotherapy. Patients who had normal lactic dehydrogenase （LDH） levels showed a significantly higher median PFS and overall survival （OS） compared with patients with high LDH levels （P = 0,030, P = 0.010）. Patients with limited disease treated with a radical operation experienced a non-significant （P = 0,211） longer PFS compared with patients who were not treated, but this reached statistical significance after analyzing OS （P = 0.211, P = 0.039）. Our patients showed a poor prognosis as reported previously. Serum LDH levels beyond the normal range indicate a poor prognosis. For GSCC patients who are diagnosed with limited disease, radical surgery is strongly recommended along with cisplatin-based chemotherapy,

Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery

AIM:To determine the relationship between pre-operative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay. METHODS:The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed. RESULTS:The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm;P < 0.001 and 21.9 vs 23.2 kg/m2;P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%;P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22,95% CI 1.17-4.23;P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups. CONCLUSION:Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.

Gastric cancer surgery in cirrhotic patients: Result of gastrectomy with D2 lymph node dissection

AIM： To explore the feasibility of performing gastrectomy with D2 lymphadenectomy in gastric cancer patients with liver cirrhosis. METHODS： A total of 7 178 patients were admitted with a diagnosis of liver cirrhosis from January 1993 to December 2003. We reviewed the records of 142 patients who were diagnosed with liver cirrhosis and gastric adenocarcinoma during the same period. Gastrectomy with D2 lymph node dissection for carcinoma of the stomach was performed in 94 patients with histologically proven hepatic cirrhosis. RESULTS： All but 12 patients were dassified as Child＇s class A. Only 35 patients （37.2%） were diagnosed with cirrhosis before operation. Seventy-three patients underwent a subtotal gastrectomy （77.7%） and 21 patients （22.3%） underwent a total gastrectomy, each with D2 or more lymph node dissection. Two patients （3.8%） who had prophylactic intra-operative drain placement, died of postoperative complications from hepatorenal failure with intractable ascites. Thirty-seven patients （39.4%） experienced postoperative complications. The extent of gastric resection did not influence the morbidity whereas serum aspartate aminotransferase level （P = 0.011） and transfusion did （P = 0.008）. The most common postoperative complication was ascites （13.9%） followed by wound infection （10.6%）. CONCLUSION： We concluded that the presence of compensated cirrhosis, i.e. Child class A, is not a contraindication against gastrectomy with D2 or more lymph node dissection, when curative resection for gastric cancer is possible. Hepatic reserve and meticulous hemostasis are the likely determinants of operative prognosis.

Short-term clinical outcomes of laparoscopic vs open rectal excision for rectal cancer: A systematic review and metaanalysis

AIM To review evidence on the short-term clinical outcomes of laparoscopic(LRR) vs open rectal resection(ORR) for rectal cancer.METHODS A systematic literature search was performed using Cochrane Central Register, MEDLINE, EMBASE, Scopus, Open Grey and Clinical Trials.gov register for randomized clinical trials(RCTs) comparing LRR vs ORR for rectal cancer and reporting short-term clinical outcomes. Articles published in English from January 1, 1995 to June, 30 2016 that met the selection criteria were retrieved and reviewed. The Preferred Reporting Items for Systematic reviews and Meta-Analysis(PRISMA) statements checklist for reporting a systematic review was followed. Random-effect models were used to estimate mean differences and risk ratios. The robustness and heterogeneity of the results were explored by performing sensitivity analyses. The pooledeffect was considered significant when P < 0.05.RESULTS Overall, 14 RCTs were included. No differences were found in postoperative mortality(P = 0.19) and morbidity(P = 0.75) rates. The mean operative time was 36.67 min longer(95%CI: 27.22-46.11, P < 0.00001), the mean estimated blood loss was 88.80 ml lower(95%CI:-117.25 to-60.34, P < 0.00001), and the mean incision length was 11.17 cm smaller(95%CI:-13.88 to-8.47, P < 0.00001) for LRR than ORR. These results were confirmed by sensitivity analyses that focused on the four major RCTs. The mean length of hospital stay was 1.71 d shorter(95%CI:-2.84 to-0.58, P < 0.003) for LRR than ORR. Similarly, bowel recovery(i.e., day of the first bowel movement) was 0.68 d shorter(95%CI:-1.00 to-0.36, P < 0.00001) for LRR. The sensitivity analysis did not confirm a significant difference between LRR and ORR for these latter two parameters. The overall quality of the evidence was rated as high. CONCLUSION LRR is associated with lesser blood loss, smaller incision length, and longer operative times compared to ORR. No differences are observed for postoperative morbidity and mortality.

Current role of hepatopancreatoduodenectomy for the management of gallbladder cancer and extrahepatic cholangiocarcinoma:A systematic review

BACKGROUND Hepatopancreatoduodenectomy(HPD)is the simultaneous combination of hepatic resection,pancreaticoduodenectomy,and resection of the entire extrahepatic biliary system.HPD is not a universally accepted due to high mortality and morbidity rates,as well as to controversial survival benefits.AIM To evaluate the current role of HPD for curative treatment of gallbladder cancer(GC)or extrahepatic cholangiocarcinoma(ECC)invading both the hepatic hilum and the intrapancreatic common bile duct.METHODS A systematic literature search using the PubMed,Web of Science,and Scopus databases was performed to identify studies reporting on HPD,using the following keywords:‘Hepatopancreaticoduodenectomy’,‘hepatopancreatoduodenectomy’,‘hepatopancreatectomy’,‘pancreaticoduodenectomy’,‘hepatectomy’,‘hepatic resection’,‘liver resection’,‘Whipple procedure’,‘bile duct cancer’,‘gallbladder cancer’,and‘cholangiocarcinoma’.RESULTS This updated systematic review,focusing on 13 papers published between 2015 and 2020,found that rates of morbidity for HPD have remained high,ranging between 37.0%and 97.4%,while liver failure and pancreatic fistula are the most serious complications.However,perioperative mortality for HPD has decreased compared to initial experiences,and varies between 0%and 26%,although in selected center it is well below 10%.Long term survival outcomes can be achieved in selected patients with R0 resection,although 5–year survival is better for ECC than GC.CONCLUSION The present review supports the role of HPD in patients with GC and ECC with horizontal spread involving the hepatic hilum and the intrapancreatic bile duct,provided that it is performed in centers with high experience in hepatobiliarypancreatic surgery.Extensive use of preoperative portal vein embolization,and preoperative biliary drainage in patients with obstructive jaundice,represent strategies for decreasing the occurrence and severity of postoperative complications.It is advisable to develop internationally-accepted protocols for patient selection,preoperative assessment,operative technique,and perioperative care,in order to better define which patients would benefit from HPD.

Barrett's esophagus with high grade dysplasia is associated with non-esophageal cancer

AIM To study factors associated with esophageal and nonesophageal cancer morbidity among Barrett's esophagus(BE) patients. METHODS A cohort study within a single tertiary center included 386 consecutive patients with biopsy proven BE, who were recruited between 2004-2014. Endoscopic and histologic data were prospectively recorded. Cancer morbidity was obtained from the national cancer registry. Main outcomes were BE related(defined as esophagus and cardia) and non-BE related cancers(all other cancers). Cancer incidence and all-causemortality were compared between patients with highgrade dysplasia(HGD) and with low-grade or no dysplasia(non-HGD) using Kaplan-Meier curves and cox regression models.RESULTS Of the 386 patients, 12 had HGD, 7 had a BE related cancer. There were 75(19.4%) patients with 86 cases of lifetime cancers, 76 of these cases were non-BE cancers. Seven(1.8%) and 18(4.7%) patients had BE and non-BE incident cancers, respectively. Twelve(3.1%) patients had HGD as worst histologic result. Two(16.7%) and 16(4.4%) incident non-BE cancers occurred in the HGD and non-HGD group, respectively. Ten-year any cancer and non-BE cancer free survival was 63% and 82% in the HGD group compared to 93% and 95% at the non-HGD group, respectively. Log-rank test for patients with more than one endoscopy, assuring longer follow up, showed a significant difference(P < 0.001 and P = 0.017 respectively). All-cause mortality was not significantly associated with BE HGD.CONCLUSION Patients with BE and HGD, may have a higher risk for all-cause cancer morbidity. The implications on cancer prevention recommendations should be further studied.

Feasibility and nutritional impact of laparoscopic assisted tailored subtotal gastrectomy for middle-third gastric cancer

BACKGROUND Laparoscopic assisted total gastrectomy(LaTG)is associated with reduced nutritional status,and the procedure is not easily carried out without extensive expertise.A small remnant stomach after near-total gastrectomy confers no significant nutritional benefits over total gastrectomy.In this study,we developed a modified laparoscopic subtotal gastrectomy procedure,termed laparoscopicassisted tailored subtotal gastrectomy(LaTSG).AIM To evaluate the feasibility and nutritional impact of LaTSG compared to those of LaTG in patients with advanced middle-third gastric cancer(GC).METHODS We retrospectively analyzed surgical and oncological outcomes and postoperative nutritional status in 92 consecutive patients with middle-third GC who underwent radical laparoscopic gastrectomy at Department of Pancreatic Stomach Surgery,National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences,and Peking Union Medical College between 2013 and 2017.Of these 92 patients,47 underwent LaTSG(LaTSG group),and the remaining underwent LaTG(LaTG group).RESULTS Operation time(210±49.8 min vs 208±50.0 min,P>0.05)and intraoperative blood loss(152.3±166.1 mL vs 188.9±167.8 mL,P>0.05)were similar between the groups.The incidence of postoperative morbidities was lower in the LaTSG group than in the LaTG group(4.2%vs 17.8%,P<0.05).Postoperatively,nutritional indices did not significantly differ,until postoperative 12 mo.Albumin,prealbumin,total protein,hemoglobin levels,and red blood cell counts were significantly higher in the LaTSG group than in the LaTG group(P<0.05).No significant differences in Fe or C-reaction protein levels were found between the two groups.Endoscopic examination demonstrated that reflux oesophagitis was more common in the LaTG group(0%vs 11.1%,P<0.05).Kaplan–Meier analysis showed a significant improvement in the overall survival(OS)and disease free survival(DFS)in the LaTSG group.Multivariate analysis showed that LaTSG was an independent prognostic factor for OS(P=0.048)but not for DFS(P=0.054).Subgroup analysis showed that compared to LaTG,LaTSG improved the survival of patients with stage III cancers,but not for other stages.CONCLUSION For advanced GC involving the middle third stomach,LaTSG can be a good option with reduced morbidity and favorable nutritional status and oncological outcomes.