Better 5-Year Survival Rate Following Curative Gastrectomy in Overweight Patients

Background  

Westernization of lifestyle and diet has resulted in an increase in overweight patients in Japan. Although the adverse effects of higher body mass index (BMI) on early surgical outcomes are known, the relationship between BMI and long-term outcome is unclear.     

Surgical and Survival Outcome Following Truly Palliative Gastrectomy in Patients with Incurable Gastric Cancer

Background and objectives

Gastrectomy is sometimes performed even in patients with incurable factors, particularly when they have urgent symptoms. The aim of this study was to clarify the clinicopathological characteristics of patients undergoing palliative gastrectomy and to identify prognostic factors.

Methods

This study included consecutive 137 gastric cancer patients with urgent symptoms who underwent gastrectomy with macroscopic residual tumor at Shizuoka Cancer Center. Clinicopathological characteristics and surgical outcomes were investigated. In addition, we used the Cox proportional hazards model to identify independent prognostic factors.

Results

Of 137 patients, urgent symptoms were bleeding in 58 patients and stenosis in 112 patients. Postoperative complications were observed in 58 patients (42 %). Chemotherapy was given after surgery in 94 patients (70 %). Median survival time for all patients was 9.9 months, and was longer in patients receiving chemotherapy (11.1 months) than in those not receiving chemotherapy (6.8 months; p = 0.002). Multivariate analysis identified macroscopic type (hazard ratio, 0.471; 95 % confidence interval, 0.364–0.927) as an independent prognostic factor.

Conclusions

The postoperative complication rate was high and survival outcome was poor in patients undergoing palliative gastrectomy. Postoperative chemotherapy may carry a better survival outcome, so we should try to give chemotherapy after palliative gastrectomy.

     

Survival of Young Patients after Gastrectomy for Gastric Cancer

It has been suggested that gastric cancer has a worse prognosis in young patients, but the data are controversial. The aim of this study was to compare the 5-year survivals after gastrectomy for gastric cancer in two groups of patients (those ≤45 years of age and those (>45 years) and to determine some of the prognostic factors. The 5-year survival was significantly better for patients ≤45 years of age. Survival was also better for young patients with a curative resection and also for those with lymph node metastases. However, survival was not significantly different for the two groups when the resection was not curative and when the lymph nodes were not involved. Survival was no different for the two groups when compared at each stage, although a multivariate analysis showed that age >45 years, moderate or poor degree of differentiation of the tumor, advanced tumors, the presence of lymph node involvement, and a noncurative resection were independent negative prognostic factors. Long-term survival after gastrectomy for gastric cancer depends on the stage of the disease; the age of the patient is not a decisive factor.     

Association of Allogeneic Blood Transfusions and Long-Term Survival of Patients with Gastric Cancer after Curative Gastrectomy

Introduction  

The relationship between perioperative allogeneic blood transfusions and poor prognosis in patients with gastric cancer remains controversial. The aim of this study is to examine the effect of perioperative blood transfusions on long-term survival of patients undergoing curative gastric resection for gastric cancer.     

Tumors Arising at Previous Anastomotic Site may have Poor Prognosis in Patients with Gastric Stump Cancer Following Gastrectomy

Introduction  

We analyzed the clinicopathological characteristics and outcomes of patients with gastric stump cancer (GSC) to identify important prognostic factors.     

Sarcopenic Obesity Is Associated with Severe Postoperative Complications in Gastric Cancer Patients Undergoing Gastrectomy: a Prospective Study

Objective

This study aimed to determine the risk of severe postoperative complications (SPCs) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients.

Methods

We conducted a prospective study of 636 consecutive patients with gastric cancer who underwent radical gastrectomy. Degrees of sarcopenia and obesity were calculated before surgery. Factors contributing to SPCs were determined using univariate and multivariate analysis. A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs.

Results

Logistic analysis revealed that sarcopenic obesity, age, open surgery, and combined resection were independent prognostic factors for SPCs. Sarcopenic obese patients have the highest risk in all patients (sarcopenic obesity vs normal, OR?=?6.575 p?=?0.001; sarcopenic obesity vs obesity, OR?=?5.833 p?=?0.001; sarcopenic obesity vs sarcopenia, OR?=?2.571 p?=?0.032), while obese patients share the similar rate of SPCs with normal people (obesity vs normal, OR?=?1.056 p?=?0.723). The nomogram we constructed was able to quantify the risk of SPCs reliably (c-index, 0.737).

Conclusions

Sarcopenic obesity, together with age, open surgery, and combined resection are independent predictors of SPCs. Obesity will significantly increase the risk of SPCs in sarcopenic patient with gastric cancer, but it will not bring higher risk to normal patients. Our nomogram is a simple and practical instrument to identify patients at high risk of surgical complications.

     

Survival Benefit of Palliative Gastrectomy in Gastric Cancer Patients with Peritoneal Metastasis

Background

The survival benefit of palliative gastrectomy in patients with peritoneal metastasis as a single incurable factor remains unclear.

Methods

A total of 148 gastric cancer patients with peritoneal metastasis underwent gastrectomy or chemotherapy at the Shizuoka Cancer Center between September 2002 and December 2008 and were included in this study. The effects of gastrectomy and chemotherapy on their long-term outcome were investigated. Multivariate analysis was also performed to identify independent prognostic factors.

Results

Gastrectomy was performed in 82 patients and subsequent chemotherapy was administered to 55. Chemotherapy was selected as an initial treatment for 66 patients. Median survival time (MST) was identical between patients with and without gastrectomy (13.1 vs. 12.0?months; P?=?0.410). Conversely, MST was significantly longer in patients who received chemotherapy (13.7?months) than those who did not (7.1?months; P?=?0.048). According to the results of multivariate analysis, chemotherapy (hazards ratio [HR]?=?0.476; 95?% CI?=?0.288–0.787) was selected as an independent prognostic factor, while gastrectomy was not.

Conclusions

The results of the present study did not show a survival benefit of palliative gastrectomy in selected patients with peritoneal metastasis. Instead, chemotherapy has to be considered as an initial treatment for these patients.     

影响胃癌患者术后生存因素的Cox回归分析

目的探讨胃癌临床病理特征及治疗方法对患者生存率的影响。方法以1994年4月至2005年8月手术治疗和病理确诊且随访资料完整的759例胃癌患者为对象,对其外科治疗结果进行回顾性分析,用KaplanMeier计算3年和5年生存率,用Logrank单因素比较和Cox回归多因素分析比较,分析影响胃癌患者术后生存率的因素。随访时间为4～131个月,平均(62.3±6.7)个月。结果单因素分析表明,患者的年龄、肿瘤部位、肿瘤直径、Borrmann分型、组织学类型、TNM分期、肿瘤浸润深度、淋巴结转移、肝转移、腹腔种植、术中输血、根治范围及清扫方法均为影响胃癌患者术后生存的影响因素。经Cox回归多因素分析发现,肿瘤部位、直径、浸润深度、术中输血、淋巴结清扫范围、淋巴结转移、清扫方法、肝转移、腹腔种植及TNM分期为影响患者术后生存的独立预后因素。结论影响胃癌患者术后生存的独立因素有肿瘤部位、大小、淋巴结转移、肿瘤浸润深度、腹腔种植、肝转移、病理分期,根治手术范围、淋巴结清扫技术及术中输血是影响患者术后生存率的重要因素。     

Survival Benefit of Non-curative Gastrectomy for Gastric Cancer Patients with Synchronous Distant Metastasis

Background  

The prognosis for gastric cancer patients with distant metastasis is very poor. The purpose of this study was to evaluate the survival benefit of non-curative gastrectomy for gastric cancer patients with synchronous distant metastasis.     

Severity of Complications After Gastrectomy in Elderly Patients With Gastric Cancer

Background

The risk of surgery for gastric cancer has not been fully evaluated, and this study aimed to assess the severity of postoperative complications after D2 or modified D2 gastrectomy in elderly patients.

Methods

Eligible patients were retrospectively selected from the Kanagawa Cancer Center database between 1990 and 2009 based on the following criteria: age ≥80?years and D2 or modified D2 gastrectomy as a primary treatment for gastric cancer. The severity of complications was evaluated using the Clavien–Dindo classification.

Results

A total of 83 patients with a median age of 82?years (range 80–88?years) were entered in this study. Sixty (72?%) had at least one co-morbid condition. American Society of Anesthesiologists scores were 2 in 66 patients and 3 in 17 patients. The extent of gastrectomy was distal in 65 (78?%) and total in 18 (22?%) patients. The procedure used for lymphadenectomy was modified D2 in 38 (46?%) and D2 in 45 (54?%) patients. Altogether, 18 complications were observed in 15 patients. The overall morbidity rate was 18?% [95?% confidence interval (CI) 9.7–26.2?%], and the mortality rate was 3.6?% (95?% CI 0–7.6?%). Complications were classified as grade 2 (n?=?9), grade 3a (n?=?1), grade 3b (n?=?4), grade 4 (n?=?1), and grade 5 (n?=?3). Severe complications (≥ grade 3) occurred in 8.4?% (95?% CI 2.4–14.4?%).

Conclusions

The morbidity rate was acceptable, but that of severe complications was high, suggesting that surgery for gastric cancer in elderly patients is risky and should be limited.     

远端胃癌术后胃瘫多因素分析

目的:探讨分析引起远端胃癌术后胃瘫综合征的可能因素。方法:回顾分析行远端胃癌根治术的1046例患者的临床资料,通过多因素Logistic回归分析和单因素χ2检验分析12个可能引起胃瘫发生的危险因素。结果:性别、围手术期高血糖、术前营养不良、焦虑、术前幽门梗阻、毕II式吻合、术后第2天低蛋白血症与胃瘫发生有关;术中迷走神经干保留是术后胃瘫的保护性因素。结论:远端胃癌根治术后胃瘫由多种因素共同作用,积极处理这些因素有助于预防和减少术后胃瘫的发生。     

Predictive Factors Improving Survival After Gastrectomy in Gastric Cancer Patients with Peritoneal Carcinomatosis

Background  

The aim of this study was to review prognosis following gastrectomy for gastric cancer patients with synchronous peritoneal carcinomatosis and to identify predictive factors for improving survival after gastrectomy in this setting.     

Impact of Postoperative Complication and Completion of Multimodality Therapy on Survival in Patients Undergoing Gastrectomy for Advanced Gastric Cancer

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The Impact of Postoperative Complications on Long-Term Outcomes Following Curative Resection for Colorectal Cancer

Background This study aimed to investigate the impact of postoperative complications on long-term survival and disease recurrence in patients who underwent curative resection for colorectal cancer. Method Patients who underwent radical resection for colorectal cancer with curative intent from January 1996 to December 2004 were included. Operative mortality and morbidity were documented prospectively. Factors that might affect long-term outcome were analyzed with multivariate analysis. Results Curative resection was performed in 1657 patients (943 men), and the median age was 70 years (range: 24–94 years). The 30-day mortality was 2.4%, and the complication rate was 27.3%. Age over 70 years (P < .001, odds ratio: 2.06, 95% CI: 1.63–2.61), male gender (P = .001, odds ratio: 1.49, 95% CI: 1.19–1.88), emergency operation (P < .001, odds ratio: 3.14, 95% CI: 2.26–4.35) and rectal cancer (P < .001, odds ratio: 1.41, 95% CI: 1.25–1.61) were associated with a significantly higher complication rate. With exclusion of patients who died within 30 days, the median follow-up of the surviving patients was 45.3 months. The 5-year overall survival was 64.9%, and the overall recurrence rate was 29.1%. The presence of postoperative complications was an independent factor associated with a worse overall survival (P = .023, hazard ratio: 1.26; 95% CI: 1.03–1.52) and a higher overall recurrence rate (P = .04, hazard ratio: 1.26; 95% CI: 1.01–1.57). Conclusion The presence of postoperative complication not only affects the short-term results of resection of colorectal cancer, but the long-term oncologic outcomes are also adversely affected. Long-term outcomes can be improved with efforts to reduce postoperative complications.     

肥胖患者的腹腔镜辅助胃癌根治术

目的探讨肥胖因素对腹腔镜辅助胃癌根治术近期疗效的影响。方法回顾性分析我科2006年3月-2011年10月412例腹腔镜辅助胃癌根治术的临床资料,其中体重指数（body mass index,BMI）92594例（肥胖组）,BMI〈25318例（非肥胖组）,比较2组患者术中情况、术后恢复、手术并发症等指标。结果肥胖组手术时间明显长于非肥胖组[（220．7±40．4）min vs．（185．5±29．1）min,t=9．365,P=0．000],术中出血量明显多于非肥胖组[（132．1±34．1）mlvs．（106．2±18．6）ml,t=9．572,P=0．000],2组肛门排气时间虽有统计学差异,但无实际临床意义[（3．6±1．0）dVB．（3．4±0．8）d,t=2．005,P=0．046]。肥胖组淋巴结清扫数目为（20．8±7．5）枚,明显少于非肥胖组（27．1±8．7）枚（t=-6．356,P=0．000）。肥胖组与非肥胖组术后并发症发生率分别为19．1％（18／94）和13．2％（42／318）,无统计学差异（χ2=2．058,P=0．151）。2组围手术期死亡率分别为2．1％（2／94）和0．3％（1／318）,无统计学差异（P=0．132）。结论肥胖会延长腹腔镜辅助胃癌根治术的手术时间,影响淋巴结清扫,但不增加术后并发症发生率,开展初期应选择BMI〈25的非肥胖病例。