BackgroundLittle data are available supporting the feasibility and safety of early oral feeding in patients after total gastrectomy. The aim of this study was to analyze the potential applicability of early provision of oral diet in these settings.MethodsMedical records of 353 patients who underwent total gastrectomy for gastric cancer between 2006 and 2012 were retrospectively analyzed. Early oral feeding was defined as clear liquid diet on postoperative day (POD) 1 followed by gradual introduction of solid diet on POD 2 to 3. Late oral feeding was defined as initiation of liquid diet from POD 4 to 6 and gradually advancing to solid diets.ResultsEarly oral feeding was implemented in 185 of 353 (52 %) patients. Prompt provision of food did not increase the risk of anastomotic failure (odds ratio 0.924, 95 % confidence interval 0.609–1.402, P = 0.709). The number of reoperations and in-hospital mortality rates was unaffected by the timing of nutritional intervention. Early feeding tended to be associated with fewer surgical (15 vs 24 %, P = 0.027) and general (8 vs 23 %, P < 0.001) complications. However, subsequent multivariate regression models failed to confirm significant correlations between timing of oral meals and postoperative morbidity.ConclusionOur findings suggested that early oral feeding is feasible and safe after total gastrectomy for gastric cancer. However, benefits of such early nutritional interventions require further studies.

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BackgroundLittle data are available for non-abscess abdominal fluid collections (AFCs) after pancreatic surgery and their clinical implications. We sought to analyze the natural history of such collections in a population of patients subject to routine postoperative imaging.MethodsFrom 1995 to 2011, 709 patients underwent pancreatic resections and routine postoperative monitoring with abdominal ultrasound according to a unit protocol. AFCs were classified as asymptomatic (no interventional treatment), symptomatic (need for percutaneous drainage of sterile, amylase-poor fluid), and pancreatic fistula (drainage of amylase-rich fluid).ResultsNinety-seven of 149 AFCs (65 %) were asymptomatic and resolved spontaneously after a median follow-up of 22 days (interquartile range, 9–52 days). Among 52 (35 %) AFCs requiring percutaneous drainage, there were 20 pancreatic fistulas and 32 symptomatic collections. A stepwise logistic regression model identified three factors associated with the need for interventional treatment, i.e., body mass index ≥25 (odds ratio, 3.23; 95 % confidence interval (CI), 1.32 to 7.91), pancreatic fistula (odds ratio, 2.93; 95 % CI, 1.20 to 7.17), and biliary fistula (odds ratio, 3.92; 95 % CI, 1.35 to 11.31).ConclusionsOne fourth of patients develop various types of non-abscess AFCs after pancreatic surgery. Around half of them are asymptomatic and resolve spontaneously.

Expression of hENT, RRM1, and dCK genes provides important prognostic information for PDAC patients treated with adjuvant gemcitabine.

Background: The aim of this study was the analysis of the influence of prognostic factors on short-and long-term outcomes of gastric cancer resection. Patients and Methods: A database of 709 patients who had gastric cancer resection between 2007 and 2015 was compiled. Results: Total gastrectomy (TG) and subtotal proximal gastrectomy (SPG) significantly increased the risk of overall complications (p=0.0015 and 0.0173, respectively) and surgical complications (p=0.0141 and 0.0035, respectively). Moreover the resection of an additional organ was an independent prognostic factor of overall complications (p<0.0001), systemic complications (p=0.0503), surgical complications (p<0.0001) and relaparotomy (p=0.0259). T stage (p<0.0001), N stage (p<0.0001), M stage (p<0.0001) and radical resection (p<0.0001) significantly affected 5year survival rates. Conclusion: Early diagnosis and radical resection was crucial in 5-year survival rates. However, the type of gastrectomy and the resection of an additional organ were the most important factors in short-term outcomes of treatment for such patients.Gastric cancer is the second most common cancer of the gastrointestinal tract in the world. In 2020, the incidence of new cases of gastric cancer was estimated at 1,089,103, with a mortality rate of 768,793 people globally. Unlike East Asia, gastric cancer is a relatively rare neoplasm in North America and some highly developed countries in Western Europe. However, even there it is one of the most common causes of death from malignant neoplasms (1). In Poland, the number of deaths from gastric cancer reaches 5000 per year. In 2018, 3155 men and 1745 women died from this in our country (2).Currently, the majority of publications concern aspects of multimodal therapy with pre-and perioperative chemotherapy, even in the presence of oligometastasis. Nevertheless, surgical resection is still the most effective treatment for such patients, and the principles of surgery of gastric cancer are usually well established (3)(4)(5).Although data from a large number of articles reveals the impact of prognostic factors on the prognosis of patients with gastric cancer resection, survival is significantly improved by the effectiveness of surgical treatment measured by short-term outcomes. Most reports involving prognostic factors for patients after gastric cancer resection focus on the 5-year survival rate. There are no in detail articles on the influence of prognostic factors on short-term outcomes of treatment such as overall complications, systemic complications, surgical complications, relaparotomy and perioperative mortality (6-30). There are many prognostic factors that could affect the short-term outcomes of gastric cancer resection including gender, age, location, histologic type, tumour staging, type of gastrectomy, number of retrieved lymph nodes or resection of an additional organ.In this study we carried out univariate and multivariate analysis of prognostic factors which, in addition to long-term outcomes (5-year survival), also affecte...