Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction

Background. The frequency of tumors in the upper one-third of the stomach has been increasing. The standard operation for proximal gastric cancer has been total or proximal gastrectomy. The aim of this study was to present the pathologic and surgical results of 30 patients with early-stage proximal gastric cancer managed by proximal gastrectomy. Methods. A consecutive series of 30 patients who underwent proximal gastrectomy for early-stage proximal gastric cancer was studied. Sixteen patients underwent jejunal interposition, while 14 underwent gastric tube reconstruction, which consisted of a direct anastomosis between the esophagus and the remnant of the tube-like stomach. Results. Twenty patients (67%) had no abdominal symptoms and the lesions were detected by screening gastric fiberscopy. The tumors were mostly located along the lesser curvature (73%), were grossly depressed type (IIc) (70%), and histologically well differentiated type (63%). The depth of wall invasion was the mucosa in 12 patients, submucosa in 15, and muscularis propria in 3; lymph node metastasis was absent in 28 patients (93%). When compared with patients with jejunal interposition, patients with gastric tube reconstruction had a shorter operation time (327 vs 165 min), less blood loss (508 vs 151 g), and shorter hospital stay after operation (31 vs 17 days). Endoscopy and 24-h pH monitoring showed no evidence of reflux esophagitis, except in 1 patient with gastric tube reconstruction, and no patient died of recurrence. Conclusions. Early-stage proximal gastric cancer can be successfully treated by proximal gastrectomy. Since gastric tube reconstruction is a simple, easy, and safe procedure, proximal gastrectomy followed by gastric tube reconstruction is recommended for patients with early-stage proximal gastric cancer. Received for publication on Jan. 5, 1999; accepted on Feb. 10, 1999     

Total removal of the posterior mediastinal gastric conduit due to gastric cancer after esophagectomy

BACKGROUND: Total removal of the gastric conduit (TRGC) due to gastric cancer after esophagectomy often results in high operative morbidity and mortality rates, especially when done in the posterior mediastinum. This is one of the reasons for the retro-sternal or subcutaneous route being preferred for gastric conduit replacement in esophageal cancer operation. PATIENTS: Five out of 680 post-operative esophageal cancer patients underwent TRGC via thoracotomy and laparotomy due to posterior mediastinal gastric conduit cancers. RESULTS: In these patients, advanced gastric cancers were found at an average of 84 months (ranging 57-136 months) after esophageal cancer surgery and preoperative risk factors for TRGC were found in age, nutrition, and pulmonary function. The operative time for TRGC was long (average 670 min) but not associated with operative complications, while blood loss varied among patients, with one with the most operative blood loss dying after surgery due to pyothorax and renal failure. This case, and another early case subjected to TRGC first with thoracotomy then followed by laparotomy, showed more operative blood loss (10,895 and 3,260 ml) than the later three patients (2,370, 1,900, and 1,780 ml), who underwent laparotomy before thoracotomy with ligation of the blood supply of the gastric conduit and lysis of adhesion around gastric conduit in the lower mediastinum from the abdomen. CONCLUSION: TRGC in the posterior mediastinum would be safer if operative manipulation were started from laparotomy in order to reduce operative blood loss. J. Surg. Oncol. 2004;85:204-208.     

吲哚菁绿荧光成像在全腹腔镜远端胃癌根治术中的应用

目的:探讨吲哚菁绿(indocyanine green,ICG)荧光成像技术在全腹腔镜远端胃癌根治术中肿瘤定位及淋巴结清扫方面的应用价值。方法:回顾性收集2017年8月至2019年8月北京大学肿瘤医院收治的经胃镜及病理确诊的126例远端胃癌患者临床病理资料。其中62例患者在ICG标记近红外荧光腹腔镜下完成手术(观察组),64例行常规腹腔镜手术(对照组)。评估对比术前ICG标记与术中内镜定位的效果;对比两组淋巴结清扫与检获情况。结果:T1～2期观察组患者术中标本测量近端切缘距离(4.92±1.65)cm与对照组(4.76±1.66)cm相比差异无统计学意义(P=0.671)。T3～4期观察组患者第二站淋巴结清扫数目为(11.09±6.19)枚,高于对照组(8.89±4.35)枚(P=0.049);观察组破损淋巴结检出数量(0.74±0.46)枚少于对照组(1.27±1.22)枚(P=0.009)。结论:T1～2期胃癌患者行术前ICG标记可精准判断肿瘤边界,其肿瘤定位效果与术中胃镜相当,全腹腔镜手术时可指导选择合适的切除线。ICG在T3～4期胃癌的淋巴导航作用可指导术中更精细、完整、彻底地...     

长期禁食水可增加远端胃癌根治术后胃瘫的发生风险

目的:探讨围手术期长期禁食水与胃下部癌患者行远端胃癌根治术后发生胃瘫的相关性。方法:将76例确诊为胃癌的病人随机分成实验组及对照组,实验组术前不禁食水,术后在静脉营养支持治疗的同时第1天嘱患者少量多次饮水,第2~3天根据患者情况增加饮水量至500 ml,第4~5天经口行肠内营养等全流质饮食并根据患者情况逐步过渡到半流食。对照组术前1天禁食水,术后给予静脉营养及肠内营养支持,术后1周左右开始试行进食,并保证两组患者的术者、手术方式、营养支持、抗感染及抑酸等治疗方案一致。结果:实验组患者术后胃瘫发生例数（1例）明显少于对照组（6例）,差异有统计学意义（P=0.047）。而两组患者在术后营养状态、感染及吻合口瘘等并发症方面发生率无显著差异（P>0.05）。结论:围手术期长期禁食水可以增加胃下部癌根治术后胃瘫发生风险,术后早期经口进食可以降低胃下部癌术后胃瘫发生几率,不增加感染及吻合口瘘等并发症发生率,安全有效。     

Gastric stump cancer after distal gastrectomy for benign gastric ulcer in a population-based study

The risk of cancer in the gastric remnant after distal gastrectomy for benign ulcer disease has been assessed mainly in studies of small sample size, selected series and limited follow-up time. This was a population-based cohort study of patients who had undergone distal gastrectomy for benign ulcer disease in 1964-2008 in Sweden. Data for follow-up for cancer and censoring for death were obtained from nationwide registries of Cancer and Population, respectively. The number of observed cancer cases in the gastrectomy cohort was divided by the expected number, calculated from the cancer incidence of the Swedish population of corresponding age, sex and calendar year. Relative risks were presented as standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). The distal gastrectomy cohort included 18,912 patients and 323,676 person-years at risk. The observed total number of gastric stump cancers (n = 140) was not higher than expected (SIR 0.84, 95% CI 0.71-0.99). There was no increased SIR with latency periods shorter than 30 years; increase was seen only among patients who had undergone gastric resection over 30 years earlier (SIR 2.29, 95% CI 1.38-3.57). Sex, age, ulcer location and type of surgical reconstruction were not associated with any considerable differences in SIR. In conclusion, this large population-based study revealed an increased risk of cancer in the gastric remnant only 30 years or longer after gastric resection for benign disease, whereas other factors did not influence this risk.     

Analysis of safety and efficacy of laparoscopic radical gastrectomy combined with or without indocyanine green tracer fluorescence technique in treatment of gastric cancer: a retrospective cohort study

BackgroundAn adequate resection margin and lymph node dissection are important factors for successful radical gastrectomy. The presence of near-infrared camera imaging with indocyanine green (ICG) gives new insight into radical gastrectomy. Laparoscopic radical gastrectomy with ICG is still in its initial stages and requires more evidence-based medical research. The aim of the present study was to evaluate the safety and availability of lymph node dissection and precise gastrectomy for gastric cancer patients undergoing radical resection under laparoscope with ICG, in the hope of providing evidence of application of ICG tracer fluorescence technique in radical gastrectomy.MethodsA retrospective cohort study was performed with 56 patients who underwent laparoscopic radical gastrectomy. The patients were categorized into the ICG (n=18) or the non-ICG (n=38) group based on whether preoperative endoscopic mucosal ICG injection was performed. Their clinical characteristics (age, tumor size, location, TNM stage and so on) were compared as baseline data. Perioperative outcomes (blood loss, time of first intestinal exhaust, early or long-term complications and so on) were used to assess safety. The status of lymph node dissection and tumor localization were analyzed to testify efficacy. SPSS version 26.0 was used for the statistical analysis.ResultsThere was no difference in clinical data at baseline. From the safety point of view, there was no difference in perioperative outcomes (operative time, blood loss, time of first intestinal exhaust and so on) between the two groups (all P>0.05). From the efficacy point of view, the number of lymph nodes <5 mm (21.84±1.86 vs. 16.24±2.10, P<0.001), the total number of lymph nodes (34.61±5.87 vs. 29.92±5.27, P=0.004), the number of lymph nodes dissected in perigastric regions (groups 1–7, 22.89±3.64 vs. 20.29±3.00, P=0.007), and the number of lymph nodes in extraperigastric regions (groups 8–12, 11.72±3.06 vs. 9.61±3.18, P=0.022) were greater in ICG group compared with non-ICG group. In ICG group, the average vertical distances between the top and bottom of the fluorescent edge and neoplastic edge were 2.65±0.58 and 2.67±0.65 cm, respectively. Fluorescent edge pathology was negative.ConclusionsICG fluorescence could be conducive to lymph node dissection and precise gastrectomy in laparoscopic radical gastrectomy.     

胃癌远端胃大部切除术后两种消化道重建方式的配比分析

目的:探讨胃癌远端胃大部切除后行B-II+Braun或Roux-en-Y两种消化道重建方式的优缺点。方法:回顾性分析我院2010年1月至2013年1月间接受远端胃大部切除并行上述消化道重建的胃癌患者临床及随访资料,据消化道重建方式分为B-II+Braun和Roux-en-Y两组,按性别、年龄、肿瘤大小、肿瘤分期进行配比,比较两组患者手术相关指标（手术时间、术中出血量、术后首次排气时间、术后住院时间）、术后近、远期并发症、术后1年以上胃镜复查结果及术后生存率。 结果:两组手术相关指标、术后近期并发症、术后1年和3年生存率差异均无统计学意义（均P>0.05）。远期并发症中,B-II+Braun组烧心/返流、倾倒综合征的发生率（分别为20.83%、16.67%）显著高于Roux-en-Y组（均为4.17%）,差异有统计学意义（P<0.05）。术后1年以上内镜检查结果显示Roux-en-Y组反流性胃炎、胆汁反流及反流性食管炎发生率（分别为31.25%、18.75%、9.38%）显著低于B-II+Braun组（分别为72.22%、61.11%、36.11%）,差异有统计学意义（P<0.05）;食物潴留方面,两组差异无统计学意义（P>0.05）。结论:胃癌远端胃大部切除术后行Roux-en-Y重建术后抗返流效果显著优于B-II+Braun,且在手术安全性及术后生存率方面无明显劣势。前者可替代后者,值得在临床推广应用。     

Surgical and oncological outcomes of distal gastrectomy compared to total gastrectomy for middle-third gastric cancer: A systematic review and meta-analysis

Distal gastrectomy (DG) and total gastrectomy (TG) are the most common types of radical surgery for patients with middle-third gastric cancer (MTGC). However, the indications and benefits of the two procedures still remain controversial. The present meta-analysis aimed to compare the surgical and oncological outcomes of DG and TG in the treatment of MTGC. A rigorous literature review was performed in the databases of PubMed, Embase, Web of Science, China National Knowledge Infrastructure and Chinese BioMedical Literature to retrieve studies published up to February 2022. The Newcastle-Ottawa Scale was used to assess the quality of included studies and a meta-analysis was performed using RevMan 5.3 software. A total of 12 retrospective studies performing comparisons of DG and TG were included in the present meta-analysis. For patients who underwent DG, a lower rate of overall post-operative complications, anastomosis leakage and intro-abdominal infection was determined. No significant difference was observed between DG and TG in the 5-year overall survival when the proximal resection margin ranged from 3 to 5 cm. Although DG was associated with a higher 5-year overall survival rate when compared to TG, there was no significant difference in the stratified analyses by TNM stage. In conclusion, the prognosis of MTGC did not depend on the extent of gastrectomy. With lower complications and acceptable oncological outcomes, DG was a safe and feasible surgical procedure for MTGC when a negative proximal margin was confirmed.     

术中置入空肠营养管在防治胃癌术后胃瘫中的应用分析

目的 探讨术中置入空肠营养管对防治胃癌术后胃瘫的作用.方法 回顾性分析进行胃癌手术治疗的125例患者的临床资料,将术中置入空肠营养管者82例作为观察组,未置入营养管者43例作为对照组,观察两组患者胃瘫发生情况、胃瘫治愈时间、胃管引流量、胃管拔管时间以及胃功能指标.结果 观察组患者术后胃瘫发生率和治愈时间分别为2.44%和(15.38±4.03)d,低于对照组的18.60%和(25.93±3.27)d,差异有统计学意义(P﹤0.05);观察组胃功能指标中的最大耐受压力、耐受容积和顺应性分别为(23.83±7.54)kPa、(5.29±0.92)ml和(30.35±1.34),明显高于对照组,差异有统计学意义(P﹤0.05);观察组胃管平均引流量和拔除时间分别为(284.28±7.17)ml/d和(6.14±0.48)d,明显低于对照组的(394.16±4.28)ml/d和(7.64±0.36)d,而血清白蛋白浓度为(34.28±0.87)g/L,高于对照组的(23.12±0.79)g/L,差异有统计学意义(P﹤0.05).结论 术中置入空肠营养管对胃癌术后发生胃瘫起到防治作用,且可缩短胃瘫治愈时间,促进胃功能恢复.     

Prognostic impact of resection margin involvement after extended (D2/D3) gastrectomy for advanced gastric cancer: a 15-year experience at a single institute

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate whether microscopic positive margins are detrimental to the outcome of gastric cancer patients treated with extended (D2/3) gastrectomy. METHODS: Among 2,740 consecutive patients who had undergone extended gastrectomy for advanced gastric cancer between January 1987 and December 2002, 49 patients (1.8%) had positive resection margins on final histology. RESULTS: Among 49 patients, 29 (59.2%) had proximal involved margins and 20 (40.8%) had distal involved margins. The median survival time of the positive margin group was 34 months. The negative margin group had a significantly longer median survival time of 69 months (P = 0.025). When both groups of patients were stratified according to nodal stage, a positive resection margin determined a worse prognosis only in patients with node-negative disease (174 months vs. 37 months, P = 0.0001). In patients with nodal metastasis, the median survival time was similar in both groups. CONCLUSIONS: Our results suggest that a positive microscopic margin is associated with a worse outcome in patients with node-negative disease. Therefore, a more aggressive treatment, such as re-operation, is needed in node-negative patients with a positive microscopic disease.     

加速康复外科理念在胃癌根治术中应用效果的Meta分析

目的:评价加速康复外科理念在胃癌根治术围手术期应用的有效性与安全性。方法:检索Pubmed、Embase、Cochrane Library、中国生物医学文献数据库（SinoMed）、中国知网（CNKI）、维普、万方等数据库中关于加速康复外科在胃癌根治术中应用的随机对照试验,检索时间为1995年1月至 2018年2月。两位研究人员独立进行质量评价与资料提取,采用RevMan5.2软件进行Meta分析。结果:纳入14篇文献,共1 340例患者,包括加速康复外科组669例,对照组671例。相较于对照组,加速康复外科术后首次排气时间［SMD=-1.38,95%CI（-1.89,-0.87）,P＜0.000 01］、首次排便时间［SMD=-1.62,95%CI（-2.62,-0.63）,P=0.001］缩短;住院时间［WMD=-2.26,95%CI（-2.67,-1.84）,P＜0.000 01］、住院费用［SMD=-0.65,95%CI（-1.04,-0.26）,P=0.001］减少;总并发症发生率降低［OR=0.65,95%CI（0.46,0.93）,P=0.02］。但再入院［RR=1.01,95%CI（0.24～4.36）,P=0.99］并没有明显差异。结论:加速康复外科在胃癌根治术围手术期中应用是安全有效的,有利于促进患者的康复,具有临床应用价值,但需要更多高质量的循证证据支持。     

Increased risk of laryngeal and pharyngeal cancer after gastrectomy for ulcer disease in a population-based cohort study

Background:

Gastrectomy has been indicated as a risk factor for laryngeal cancer, and possibly also for pharyngeal cancer, but few studies are available. The postulated mechanism is increased bile reflux following gastrectomy.

Methods:

This was a population-based cohort study of patients who underwent gastrectomy for peptic ulcer disease between 1964 and 2008 in Sweden. Follow-up data for cancer was obtained from the Swedish Cancer Register. Relative risk was calculated as standardised incidence ratios (SIRs) with 95% confidence intervals (CIs).

Results:

The gastrectomy cohort comprises 19 767 patients, contributing 348 231 person-years at risk. The observed number of patients with laryngeal (n=56) and pharyngeal cancer (n=28) was two-fold higher than the expected (SIR: 2.0, 95% CI: 1.5–2.6 and SIR: 2.4, 95% CI: 1.6–3.5, respectively). After exclusion of 5536 cohort members with tobacco- or alcohol-related disease, the point SIRs remained increased (SIR: 1.6, 95% CI: 1.1–2.2 and SIR: 1.7, 95% CI: 0.9–2.8, respectively). The SIRs of laryngeal and pharyngeal cancer increased with time after gastrectomy (P for trend <0.0001), and were particularly increased ⩾30 years after gastrectomy (SIR: 4.8, 95% CI: 2.1–9.5 and SIR: 10.2, 95% CI: 3.7–22.3, respectively).

Conclusion:

Gastrectomy for peptic ulcer disease might entail a long-term increased risk of laryngeal and pharyngeal cancer.     

Laparoscopic distal gastrectomy and hyperthermic intraperitoneal chemotherapy in the treatment of advanced gastric cancer: a retrospective case-matched study on perioperative outcomes

BackgroundThis study aimed to assess the safety and efficacy of laparoscopic distal gastrectomy (LDG) with intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gastric cancer (AGC).MethodsIn this case-matched study, we retrospectively reviewed the database of 223 patients with AGC who underwent LDG in Tangdu Hospital from April 2016 to February 2019. Among all participants, 177 patients underwent LDG alone and 46 underwent LDG with HIPEC. We matched total of 138 (1:2) patients from the LDG + HIPEC group (n 46) and the LDG group (n 92) for gender, age, date of operation, and tumor-node-metastasis (TNM) stage of tumor.ResultsThere was no significant difference in the Clavien-Dindo classification of complications between LDG alone and LDG + HIPEC patients. Further analysis showed the morbidity of gastroparesis to be significantly increased in LDG + HIPEC patients. At the same time, we found that the operation time, the time to 1st flatus, and hospital stay were longer in LDG + HIPEC patients and the incidence of abdominal recurrence 2 years after operation was significantly higher in the LDG group than the LDG + HIPEC group.ConclusionsThe combination of LDG with intraoperative HIPEC is a safe and feasible method for AGC and HIPEC will limit the recovery of gastrointestinal functions. In addition, during the follow-up of our study, although there was no statistical difference between the two groups in abdominal recurrence at 2 years after surgery, a decreasing trend of abdominal recurrence in LDG + HIPEC patients could be seen in comparison to LDG patients.     

The assessment of intraoperative technique-related risk factors and the treatment of anastomotic leakage after esophagectomy: a narrative review

Anastomotic leakage, including cervical anastomotic leakage and intrathoracic anastomotic leakage, is a serious complication of esophageal cancer and a leading cause of death after esophagectomy. In fact, anastomotic leakage after esophagectomy can be caused by numerous factors in the preoperative, intraoperative, and postoperative periods. Intraoperative technique-related risk factors, including surgical methods, anastomosis sites, anastomosis methods, the type of gastric tube, and reconstruction routes, are the key causes of its occurrence. Anastomotic leakage treatments include both surgical and non-surgical treatments, while surgical treatment has high risks, many complications, and high mortality. Actually, non-surgical methods including naso-leakage drainage, stent, negative pressure therapy, and so on, are also very critical in the treatment of anastomotic leakage. So, the selection of correct and appropriate treatment methods plays an important role in alleviating the suffering of patients, shortening hospitalization time, and reducing mortality. This study undertook a systematic review in which data in the PubMed database were searched and analyzed to assess the safety and efficacy of surgical technique-related factors in esophagectomy, and appropriate treatment of anastomotic leakage after esophagectomy. In conclusion, gastric tube, posterior mediastinal route and stapled anastomosis are safe among esophagectomy surgical techniques, and non-surgical treatment of anastomotic leakage such as naso-leakage drainage is feasible in the majority of cases.     

Quality of life after curative gastrectomy for gastric cancer in a randomised controlled trial

Quality of life (QOL) was studied in gastric cancer patients treated on a randomised, controlled trial comparing D1 (level 1) with D3 (levels 1, 2 and 3) lymphadenectomy. A total of 221 patients were randomly assigned to D1 (n=110) and D3 (n=111) surgery. Quality-of-life assessments included functional outcomes (a 14-item survey about treatment-specific symptoms) and health perception (Spitzer QOL Index) was performed before and after surgery at disease-free status. Patients suffered from irrelative events such as loss of partners was excluded thereafter. Main analyses were done by intention-to-treat. Thus, 214 D1 (106/110=96.4%) and D3 (108/111=97.3%) R0 patients were assessed. Longitudinal analysis showed that functional outcomes decreased at 6 months after surgery and increased over time thereafter, while health perceptions increased over time in general. On the basis of linear mixed model analyses, patients having total gastrectomy, advanced cancer and hemipancreaticosplenectomy, but not complications had poorer QOL than those without. D1 and D3 patients showed no significant difference in QOL. The results suggest that changes of QOL were largely due to scope of gastric resection, disease status and distal pancreaticosplenectomy, rather than the extent of lymph node dissection. This indicates that nodal dissection can be performed for a potentially curable gastric cancer.     

管状胃与全胃代食管术治疗食管癌的疗效比较

目的 比较管状胃代食管术与全胃代食管术治疗食管癌的临床疗效。方法 回顾性分析2007年1月至2012年1月在我院接受食管癌手术患者的病例资料;比较管状胃组（n=53）和全胃代食管组(n=48)患者在术中吻合口位置、术中出血量、手术时间、术后胃肠减压时间、胃肠减压量、胸腔闭式引流管拔除时间、胸腔引流液量、术后并发症发生情况及术后1个月的肺功能等临床指标上的差异。结果 管状胃组患者术后反流性食管炎的发生率为5.7％（3／53）,低于全胃组的25.0％（12／48）,差异具有统计学意义（P=0.01）;管状胃组无术后胸胃综合征,全胃组的发生率为8.3％（4／48）;管状胃组术后1个月的肺活量占预计值的百分比、最大通气量占预计值的百分比及第一秒用力呼气容积占预计值的百分比均显著高于全胃组,差异均有统计学意义（P＜0.01）。结论 管状胃代食管术较全胃代食管术可降低术后反流、胸胃综合征的发生率,且对患者术后呼吸功能影响较小。     

早期胃癌ESD治疗后腹腔镜补救手术3例并文献复习

目的 探讨早期胃癌患者行内镜黏膜下剥离术(ESD)后未达治愈标准的补救方式的选择及行腹腔镜补救手术的安全性和可行性.方法 收集3例早期胃癌ESD治疗后未达治愈标准再行腹腔镜补救手术患者的病例资料,分析其临床病理特征及补救手术指征,并对手术效果进行评价.结果 3例行腹腔镜补救根治性手术的早期胃癌患者ESD治疗均整块切除,术后病理示3例患者的病变黏膜下浸润均超过500μm,其中垂直切缘阳性患者1例,有静脉浸润患者1例,病变直径大于3 cm的患者2例;3例患者行腹腔镜补救手术均无中转开腹,术后均未发现有癌残留及淋巴结转移;手术时间111~151 min,术中出血量50~100 ml,无术中输血.术后排气时间为3~5 d,拔除胃管时间为4~6 d,拔除引流管时间为6~7 d,术后住院天数为8~13 d;3例患者均无手术相关并发症.结论 腹腔镜补救根治性手术是非治愈性ESD后一种安全有效的补救方式.     

Effects of perioperative eicosapentaenoic acid-enriched oral nutritional supplement on the long-term oncological outcomes after total gastrectomy for gastric cancer

Basic and clinical reports have suggested that eicosapentaenoic acid (EPA) exhibits anti-tumor activity. The present study evaluated whether perioperative EPA could improve the survival of patients with localized gastric cancer as a key secondary endpoint of a randomized clinical study. The present study was designed as multicenter, open-label, superiority, randomized trial to confirm the preventive effect of EPA on body weight loss after total gastrectomy for gastric cancer. Eligible patients were randomized to either the standard-diet group (EPA-off group) or EPA-on group by a centralized dynamic method. An EPA-enriched supplement (ProSure^®) was given to the EPA-on group in addition to their standard diet. This supplement included 600 kcal with 2.2 g/day of EPA. Among the 126 patients who were randomized, 123 patients (EPA-off group, n=60; EPA-on group, n=63) were examined in the survival analyses. All background factors were well balanced between the two groups. The 3-year and 5-year overall survival rates were 74.6 and 67.8%, respectively, in the EPA-off group, and 77.8 and 76.2% in the EPA-on group. There was no significant difference between the EPA-off and EPA-on groups (hazard ratio, 0.77; P=0.424). In the subgroup analysis, the hazard ratio was 0.39 in patients who received neoadjuvant chemotherapy and 0.57 in patients with nodal metastasis. In conclusion, a clear survival benefit of perioperative EPA was not observed in localized gastric cancer. The value of EPA should be further tested in a future study in patients with unfavorable advanced gastric cancer. Clinical trial number: UMIN000006380; date of registration, September 21, 2011.