ObjectiveTo study the clinical significance of prognostic nutritional index (PNI) combined with neutrophil to lymphocyte ratio (NLR) in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.MethodsTo retrospectively analyze and collect the clinical data of 517 patients with gastric cancer who were diagnosed at the Third People’s Hospital of Shangqiu City from January 2016 to May 2020, all of the patients received radical gastrectomy. We explored the risk factors that affect the occurrence of postoperative anastomotic leakage, and explored the clinical significance of PNI combined with NLR on the third day after operation in predicting the occurrence of anastomotic leakage.ResultsAmong 517 patients undergoing radical gastrectomy, 61 had anastomotic leakage, and the incidence of anastomotic leakage was 11.8%. The results of multivariate logistic regression analysis showed that patients with preoperative diabetes and intraoperative blood loss ≥400 mL had a higher incidence of anastomotic leakage, and with the increase of NLR value on the 3rd and 5th day after operation, and the decrease of PNI value on the 3rd and 5th day after operation, the incidence of anastomotic leakage increased (P<0.05). The area under the curve of NLR, PNI, and NLR combined with PNI on the 3rd day after operation in predicting the occurrence of anastomotic leakage were 0.849, 0.581, and 0.949, respectively, and the differences were statistically significant (P<0.05), the sensitivity and specificity of NLR combined with PNI were higher than the individual indicator.ConclusionPNI combined with NLR on the 3rd day after operation has important clinical significance in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.
Objective To explore method of jejunum nutrition tube implantation in total laparoscopic radical gastrectomy for distal gastric cancer (GC). Methods The clinical data of 30 patients with distal GC underwent the total laparoscopic radical gastrectomy from October 2017 to March 2018 in the Departmeng of Tumor Surgery, Lanzhou University Second Hospital were retrospectively analyzed, the total laparoscopic radical distal gastrectomy were performed in all the patients and the jejunum nutrition tube were implanted during the operation. Results Thirty patients with distal GC were successfully treated with the total laparoscopic radical gastrectomy and the jejunum nutrition tubes were implanted into under the total laparoscopy through the intraoperative guidance by the gastric tube, firstly fastening the nutrition tube to the gastric tube in vitro, and then separating them in vivo, finally the nutrition tube was smoothly implanted into the jejunum under the direct vision. The implantation time was 10 to 15 min with an average of 13.5 min. The jejunal nutrition tube retention time was 5 to 7 d with an average of 6 d. There were no complications such as the bleeding, anastomotic leakage, anastomotic obstruction, stenosis, intestinal leakage, intestinal obstruction, and other complications after the operation in the 30 patients. Conclusions Method of jejunum nutrition tube implantation in total laparoscopic radical gastrectomy for distal GC is easy to be performed. Intraoperative and postoperative complications are few. It provides a favorable guarantee for improving postoperative nutritional status of patient with distal GC.
ObjectiveTo assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer.MethodsA total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups.ResultsThere was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05); the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months. There was no significant difference between the two groups (P>0.05).ConclusionsLaparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.
ObjectiveTo systematically review the methods, characteristics, and indications of technique for retraction of liver and evaluate their application effects during the laparoscopic radical gastrectomy for gastric cancer, so as to provide reference for clinicians to choose the most suitable liver retraction method. MethodThe relevant research literature on the application of liver retraction method both domestically and internationally during the laparoscopic radical gastrectomy was reviewed and compared. ResultsThe main liver retraction methods that were used both domestically and internationally included V-shaped retraction, W-shaped retraction, medical adhesive retraction, and liver dilator retraction. Among them, the V-shaped, W-shaped, and liver dilator retraction techniques had been improved according to the situation, but these retraction techniques had their own advantages and disadvantages and could not be completely replaced by each other. ConclusionsCurrently, there is no absolutely ideal retraction method that is simple, safe, and effective. The specific choice of liver retraction technology needs to be selected based on the patient’s specific physical conditions, considering the safety, effectiveness, and rationality of this method.
ObjectiveTo analyze the risk factors affecting delayed gastric emptying (DGE) after laparoscopic distal gastrectomy for gastric cancer. MethodsThe gastric cancer patients who underwent laparoscopic distal gastrectomy in the Jiaozuo People’s Hospital from January 1, 2013 to December 31, 2022 were retrospectively collected. The occurrence of DGE was recorded. Meanwhile, the multivariate binary logistic regression analysis was performed to screen the risk factors affecting the DGE. ResultsA total of 350 gastric cancer patients underwent laparoscopic distal gastrectomy and met the inclusion and exclusion criteria of this study were included, 17 (4.9%) of whom developed DGE. The multivariate binary logistic regression analysis results showed that the preoperative gastric outflow tract obstruction (OR=8.582, P=0.009), intraoperative jejunal nutrition tube indwelling (OR=14.317, P=0.010), more peritoneal drainage tube placement (OR=5.455, P=0.006), and intraoperative blood loss ≥140 mL (OR=4.912, P=0.018) increased the risk of DGE. ConclusionAccording to the results of this study, when patients undergoing laparoscopic distal radical gastrectomy for gastric cancer accompanied by preoperative gastric outflow tract obstruction, intraoperative jejunal nutrition tube indwelling, more peritoneal drainage tube placement, and more intraoperative blood loss, it should be paid more attention to prevention DGE, and early detection and treatment, so as to improve the prognosis of patients.
ObjectiveTo explore the clinical effect of keeping the pancreatic capsule in radical gastrectomy for early stage of gastric cancer. MethodsTwo hundreds and seven patients with early stage of gastric cancer who were treated in our hospital from Jan 2011 to December 2011 were enrolled prospectively, and were divided into experimental group (n=95) and control group (n=112). Patients in experimental group kept the pancreatic capsule in radical gastrec-tomy, but patients in control group didn't keep the pancreatic capsule. Comparison of the clinical effect between the 2 groups was performed. ResultsThe blood loss[(134.1±5.3) mL vs. (150.3±3.7) mL] and operation time[(76.4±5.7) min vs. (87.5±9.1) min]of experimental group were all lower or shorter than those of control group (P<0.05), but there were no significant difference between the 2 groups in incidence of total complication[7.37% (7/95) vs. 10.71% (12/112)], stomal leak[3.16% (3/95) vs. 4.46% (5/112)], and anastomotic stenosis[4.21% (4/95) vs. 6.25% (7/112)], P>0.05. All of the 207 patients were followed-up for 1-36 months, with the median time of 17.5 months. During the follow-up period, in experimental group, there were 30 patients suffered from recurrence, 23 patients suffered from metastasis, and 44 patients died, and the 1-and 3-year survival rates was 84.21% (80/95) and 53.68% (51/95) respectively, 1- and 3-year disease free survival rates was 80.00% (76/95) and 48.42% (46/95) respectively; in control group, there were 37 patients suffered from recurrence, 23 patients suffered from metastasis, and 49 patients died, and the 1-and 3-year survival rates was 85.71% (96/112) and 56.25% (63/112) respectively, 1-and 3-year disease free survival rates was 81.25% (91/112) and 49.11% (55/112) respectively. There were no significant difference in the 1-and 3-year survival rate, 1-and 3-year disease free survival rate (P>0.05). In addition, there were no significant difference in the survival and disease free survival situation (P>0.05). ConclusionsSurvival and disease free survival situation of keeping the pancreatic capsule in radical gastrectomy is similar with traditionally radical gastrectomy, but surgery of keeping the pancreatic capsule in radical gastrectomy has the advantages of less bleeding and shorter operation time, which is worthy of further study.
ObjectiveTo investigate the risk factors affecting the occurrence of infectious complications after radical gastrectomy for gastric cancer, and to establish a risk prediction Nomogram model. MethodsThe clinicopathologic data of 429 primary gastric cancer patients who underwent radical resection for gastric cancer at the Second Department of General Surgery of Shaanxi Provincial People’s Hospital between January 2018 and December 2020 were retrospectively collected to explore the influencing factors of infectious complications using multivariate logistic regression analyses, and to construct a prediction model based on the results of the multivariate analysis, and then to further validate the differentiation, consistency, and clinical utility of the model. ResultsOf the 429 patients, infectious complications occurred in 86 cases (20.05%), including 53 cases (12.35%) of pulmonary infections, 16 cases (3.73%) of abdominal infections, 7 cases (1.63%) of incision infections, and 10 cases (2.33%) of urinary tract infections. The results of multivariate logistic analysis showed that low prognostic nutritional index [OR=0.951, 95%CI (0.905, 0.999), P=0.044], long surgery time [OR=1.274, 95%CI (1.069, 1.518), P=0.007], American Society of Anesthesiologists physical status classification (ASA) grade Ⅲ–Ⅳ [OR=9.607, 95%CI (4.484, 20.584), P＜0.001] and alcohol use [OR=3.116, 95%CI (1.696, 5.726), P＜0.001] were independent risk factors for the occurrence of infectious complications, and a Nomogram model was established based on these factors, with an area under the ROC of 0.802 [95%CI (0.746, 0.858)]; the calibration curves showed that the probability of occurrence of infectious complications after radical gastrectomy predicted by the Nomogram was in good agreement with the actual results; the decision curve analysis showed that the Nomogram model could obtain clinical benefits in a wide range of thresholds and had good practicality.ConclusionsClinicians need to pay attention to the perioperative management of gastric cancer patients, fully assess the patients’ own conditions through the prediction model established by prognostic nutritional index, surgery time, ASA grade and alcohol use, and take targeted interventions for the patients with higher risks, in order to reduce the risk of postoperative infectious complications.
ObjectiveTo develop altering intake managing symptoms (AIMS) dietary intervention and evaluate its effects on nutritional status and dietary compliance for patients after gastrectomy.MethodsFrom April 2017 to July 2018, 176 patients underwent the gastrectomy in the Xijing Hospital of Air Force Military Medical University were selected, then were divided into an AIMS group and a control group by the Excel 2007 random function method. The AIMS group was intervened by the AIMS dietary intervention, the control group was given the routine diet management. The body mass, body mass index (BMI), albumin, and dietary intake at the admission, on the 2nd week and the 3rd month after the discharge were compared between the two groups. The nutritional status of the two groups was assessed by the PG-SGA scale. The diet-related symptoms and dietary compliance of the two groups were assessed by the dietary related symptoms scale and the dietary compliance scale.ResultsA total of 176 eligible patients were enrolled in this study, including 92 patients in the AIMS group and 84 patients in the control group. There were no significant differences in the baseline data such as the gender, age, educational level, occupation, disease type, surgical method, tumor TNM stage, and pathological differentiated type between the two groups (P>0.050). There were no significant differences in the body mass, BMI, and albumin between the AIMS group and the control group before and after the dietary intervention (P>0.050). The PG-SGA score, diet-related symptom score, and dietary compliance score had significant differences between on the 2nd week or the 3rd month after the discharge and at the admission in the AIMS group and the control group (P<0.050), which had significant differences on the 2nd week or the 3rd month after the discharge between the AIMS group and the control group (P<0.001). The dietary intake of the AIMS group was significantly higher than that of the control group on the 3rd month after the discharge (P<0.001). The complications incidences of total diet-related symptoms was 5.5% (5/91) and 14.6% (12/82) in the AIMS group and the control group, respectively, the difference was statistically significant (P=0.047).ConclusionUsing AIMS dietary intervention for patients after radical gastrectomy can significantly improve their overall nutritional status and improve dietary compliance.
ObjectiveTo evaluate the significance of the accessory left hepatic artery during the procedure of laparoscopic radical gastrectomy for gastric cancer. MethodsClinical data and imaging data of 120 patients with gastric cancer who underwent laparoscopic radical gastrectomy between January 2014 and June 2015 were retrospectively collected, to summarize the significance of accessory left hepatic artery in laparoscopic radical gastrectomy for gastric cancer, and to summarize the main points during the operation. ResultsNine patients (7.5%) had the accessory left hepatic artery in the whole group of 120 patients. Ligation was performed at the beginning of the distal left gastric artery or each branch near the stomach. All patients recovered well postoperatively. There was no significant difference in the total bilirubin, glutamic-pyruvic transaminase, and glutamic-oxalacetic transaminase on 3 days before surgery, 1, 3, and 7 days after surgery (P > 0.05). In addition, there was no occurrence of liver abscesses and intrahepatic biloma. ConclusionsThe incidence of accessory left hepatic artery variation is at a high incidence rate in clinical patients. It needs to be paid attention to protect the accessory left hepatic artery during the laparoscopic radical gastrectomy for gastric cancer, in order to avoid the occurrence of liver abscess and intrahepatic biloma.
ObjectiveTo investigate the research progress of assisted techniques for lymph node dissection in gastric cancer. Method The literatures on the applications of assisted techniques of lymph node dissection in the gastric cancer radical gastrectomy in recent years were reviewed. ResultsAt present, the assisted techniques used for lymph node dissection in the radical gastrectomy mainly included the lymphatic tracing technology and laparoscopic and robotic surgeries. The lymphatic tracing technology mainly included the use of dye tracers, indocyanine green, gamma probe, intraoperative radiation technology, etc. Among which gamma probe and intraoperative radiation technology were expensive and not suitable for clinical application, and intraoperative radiation technology had a radiation risk, so it was rarely used currently. At present, the dye tracers and indocyanine green were mainly used in the clinical lymph node tracing, both of which could improve the detection rate and increase the number of lymph node dissection, and improve the prognosis of patients. The laparoscopic radical gastrectomy was not inferior to traditional radical gastrectomy in terms of lymph node dissection, and had been more widely used in the clinical practice due to its advantages of visualization, minimally invasive, quickly postoperative recovery, and good short-term efficacy. Compared with the conventional laparoscopic system, the robotic surgical system was more precise, dexterous, stable, and had a better feedback feeling, which was more conducive to the lymph node dissection of special location. ConclusionUse of lymphatic tracers, laparoscopy and robotics could increase lymph node detection rate and improve prognosis of patients.