Gastric cancer(GC)remains a substantial health burden worldwide,ranking fifth in incidence and third in mortality among all cancer types.Surgeons have persistently attempted to address this growing burden through surg...Gastric cancer(GC)remains a substantial health burden worldwide,ranking fifth in incidence and third in mortality among all cancer types.Surgeons have persistently attempted to address this growing burden through surgical management of GC encompassing various aspects of surgery,including advances in surgical techniques and tools for minimally invasive surgery,novel technology for real-time image-guided surgery,and function-preserving and oncometabolic surgeries,aimed at improving patients’quality of life.The current perspective discusses the five most critical dimensions of the recent technical improvements and conceptual changes in GC surgery.We recommend further exploration of long-term benefits of these advancements,identification of breakthrough solutions to address current challenges,and delivery of the best quality of care.展开更多
Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the id...Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.Methods:A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed.The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries.Finally,intraoperative and postoperative outcomes were compared among the shorter,ideal,and longer operative time groups.Results:The statistically calculated ideal operative time was 135.4-165.4 min.The longer operative time(LOT)group had a lower rate of uneventful,perfect surgery than the ideal or shorter operative time(IOT/SOT)group(2.8%vs.8.8%and 2.2%vs.13.4%,all P<0.05).Longer operative time increased bleeding,postoperative morbidities,and delayed diet and discharge(all P<0.05).Particularly,an uneventful,perfect surgery could not be achieved when the operative time exceeded 240 min.Regardless of ideal time range,SOT group achieved the highest percentage of uneventful surgery(13.4%),which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform≥150 gastrectomies annually.Conclusions:Operative time longer than the ideal time range(especially≥240 min)should be avoided.If the essential operative procedure were faithfully conducted without compromising oncological safety,an operative time shorter than the ideal range leaded to a better prognosis.Efforts to minimize operative time should be attempted with sufficient surgical experience.展开更多
Studies on morbid obesity have shown remarkable improvement of diabetes in patients who have undergone bariatric operations.It was subsequently shown that these operations induce diabetes remission independent of the ...Studies on morbid obesity have shown remarkable improvement of diabetes in patients who have undergone bariatric operations.It was subsequently shown that these operations induce diabetes remission independent of the resultant weight loss;as a result,surgeons began to investigate whether operations for gastric cancer(GC)could have the same beneficial effect on diabetes as bariatric operations.It was then shown in multiple reports that followed that certain operations for GC were able to improve or even cure type 2 diabetes mellitus(T2 DM)in GC patients.This finding gave rise to the concept of"oncometabolic surgery",in which a patient diagnosed with both GC and T2 DM undergo a single operation with the purpose of treating both diseases.With the increasing incidence of T2 DM,oncometabolic surgery has the potential to improve the quality of life and even extend survival of many GC patients.However,because the GC patient population and the bariatric patient population are wildly different and because different GC operations have different properties,the effect of oncometabolic surgery must be carefully assessed and engineered in order to maximize benefit and avoid harm.This manuscript aims to summarize the findings made so far in the field of oncometabolic surgery and to provide an outlook regarding the possibility of oncometabolic surgery being incorporated into standard clinical practice.展开更多
文摘Gastric cancer(GC)remains a substantial health burden worldwide,ranking fifth in incidence and third in mortality among all cancer types.Surgeons have persistently attempted to address this growing burden through surgical management of GC encompassing various aspects of surgery,including advances in surgical techniques and tools for minimally invasive surgery,novel technology for real-time image-guided surgery,and function-preserving and oncometabolic surgeries,aimed at improving patients’quality of life.The current perspective discusses the five most critical dimensions of the recent technical improvements and conceptual changes in GC surgery.We recommend further exploration of long-term benefits of these advancements,identification of breakthrough solutions to address current challenges,and delivery of the best quality of care.
文摘Objective:While a rushed operation can omit essential procedures,prolonged operative time results in higher morbidity.Nevertheless,the optimal operative time range remains uncertain.This study aimed to estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.Methods:A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed.The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries.Finally,intraoperative and postoperative outcomes were compared among the shorter,ideal,and longer operative time groups.Results:The statistically calculated ideal operative time was 135.4-165.4 min.The longer operative time(LOT)group had a lower rate of uneventful,perfect surgery than the ideal or shorter operative time(IOT/SOT)group(2.8%vs.8.8%and 2.2%vs.13.4%,all P<0.05).Longer operative time increased bleeding,postoperative morbidities,and delayed diet and discharge(all P<0.05).Particularly,an uneventful,perfect surgery could not be achieved when the operative time exceeded 240 min.Regardless of ideal time range,SOT group achieved the highest percentage of uneventful surgery(13.4%),which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform≥150 gastrectomies annually.Conclusions:Operative time longer than the ideal time range(especially≥240 min)should be avoided.If the essential operative procedure were faithfully conducted without compromising oncological safety,an operative time shorter than the ideal range leaded to a better prognosis.Efforts to minimize operative time should be attempted with sufficient surgical experience.
文摘Studies on morbid obesity have shown remarkable improvement of diabetes in patients who have undergone bariatric operations.It was subsequently shown that these operations induce diabetes remission independent of the resultant weight loss;as a result,surgeons began to investigate whether operations for gastric cancer(GC)could have the same beneficial effect on diabetes as bariatric operations.It was then shown in multiple reports that followed that certain operations for GC were able to improve or even cure type 2 diabetes mellitus(T2 DM)in GC patients.This finding gave rise to the concept of"oncometabolic surgery",in which a patient diagnosed with both GC and T2 DM undergo a single operation with the purpose of treating both diseases.With the increasing incidence of T2 DM,oncometabolic surgery has the potential to improve the quality of life and even extend survival of many GC patients.However,because the GC patient population and the bariatric patient population are wildly different and because different GC operations have different properties,the effect of oncometabolic surgery must be carefully assessed and engineered in order to maximize benefit and avoid harm.This manuscript aims to summarize the findings made so far in the field of oncometabolic surgery and to provide an outlook regarding the possibility of oncometabolic surgery being incorporated into standard clinical practice.
