Eleven-year experience with 3000 cases of laparoscopic gastric cancer surgery in a single institution: analysis of postoperative morbidities and long-term oncologic outcomes

Park, Young Suk; Son, Sang‐Yong; Oo, Aung Myint; Jung, Do Hyun; Shin, Dong Ju; Ahn, Sang Hoon; Park, Do Joong; Kim, Hyung‐Ho

doi:10.1007/s00464-015-4708-6

Cited by 15 publications

(8 citation statements)

References 34 publications

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“…We previously reported that obesity (BMI ! 27.5) is an independent risk factor for surgical complications from laparoscopic gastrectomy (29). In this study, we focused on the relationship between long-term outcomes and BMI loss as well as perioperative BMI in patients who underwent open and laparoscopic curative gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Roles of Perioperative Body Mass Index and Weight Loss in the Long-Term Survival of Gastric Cancer Patients

Park

Lee

et al. 2018

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Most patients with gastric cancer rapidly lose weight after gastrectomy. Therefore, analysis of the effect of body mass index (BMI) on patients with gastric cancer survival should include postoperative BMI and BMI loss and preoperative BMI. This retrospective cohort study analyzed the effect of three BMI variables and their interaction on long-term outcomes. Preoperative BMI analysis included 2,063 patients with gastric cancer who underwent curative gastrectomy between January 2009 and December 2013 at Seoul National University Bundang Hospital. BMI at postoperative 6 to 12 months was available in 1,845 of these cases. Patients with preoperative BMI 23.0 to <27.5 [HR, 0.63; 95% confidence interval (CI), 0.48-0.82 for BMI 23.0 to <25.0 and HR, 0.57; 95% CI, 0.42-0.78 for BMI 25.0 to <27.5] and postoperative BMI 23.0 to <25.0 (HR, 0.67; 95% CI, 0.46-0.98) showed significantly better overall survival (OS) than pre- and postoperative patients with BMI 18.5 to <23.0, respectively. Postoperative underweight (BMI <18.5; HR, 1.74; 95% CI, 1.27-2.37) and postoperative severe BMI loss (>4.5; HR, 1.79; 95% CI, 1.29-2.50) were associated with higher mortality. Severe BMI loss and preoperative BMI <23.0 had an adverse synergistic effect; patients with BMI <23.0 were more vulnerable to severe BMI loss than those with BMI ≥23.0. Associations with cancer-specific survival were similar. All three BMI variables were prognostic factors for survival of patients with gastric cancer. Preoperative BMI and severe BMI loss had an interaction. Perioperative BMI and weight loss should be analyzed collectively in patients with gastric cancer undergoing gastrectomy. .

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Section: Discussionmentioning

confidence: 99%

Prognostic Roles of Perioperative Body Mass Index and Weight Loss in the Long-Term Survival of Gastric Cancer Patients

Park

Lee

et al. 2018

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…This protocol serves to limit surgical stress and aid recovery, thus, mitigating some of the negative effects of frailty. Secondly, gastrectomy is a highly standardized procedure at our tertiary institution, which is a high-volume centre for gastrectomy for cancer, with all cases performed by 3 senior surgeons [15]. These factors may contribute to gastrectomy being a relatively “low-risk” procedure at our institution, the assumption being that frailty may have greater impact on “high-risk” procedures as compared to “low-risk” procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation of this study is that it may not be directly applicable to Western populations, where there are notable differences in gastric cancer and gastrectomy outcomes. Gastric cancer in “Western” populations tends to be located more proximally (with a larger proportion of total gastrectomies being performed) and present at a later stage, with resultant differences in morbidity and mortality outcomes [9, 15, 18]. It is interesting to note that there was a significant relationship between gastric cancer and frailty in a study with an overall 30-day mortality of 8.8%, where “frail” patients had a 30-day mortality rate of 23.3 versus 5.2% [9].…”

Section: Discussionmentioning

confidence: 99%

Frailty in Elderly Gastric Cancer Patients Undergoing Gastrectomy

et al. 2020

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Introduction: There is a dearth of literature on frailty specifically in elderly (aged ≥65 years) gastric cancer patients undergoing gastrectomy. We aim to assess the effects of frailty on postoperative outcomes. Methods: A review of a prospective database was performed from November 2011 to April 2019. Frailty was assessed by multidimensional frailty score (MFS). Outcomes assessed were early postoperative complications and mortality, and length of stay. Results: 289 patients were included. The mean age was 77.3 (range 66–94) years. 183 (63.3%) were males and 172 (59.5%) had early cancer. 275 (95.2%) underwent minimally invasive gastrectomy. 79 (27.3%) patients suffered early postoperative complications, with 47 (16.3%) suffering from Clavien-Dindo grade ≥2 complications. One-year, 90-day, 30-day, and inhospital mortality were 6.6, 1.4, 0.7, and 0%, respectively. 111 (38.4%) of patients were classified as “frail” based on MFS > 5. “Frail” patients were associated with higher 1-year mortality (odds ratio (OR) 4.51, 95% CI 1.57–12.98, p = 0.005) on univariate analysis. On multivariate analysis, “frail” patients did not have significantly increased 1-year mortality. However, when definition of “frail” was changed from MFS > 5 to MFS > 6, frailty was significantly associated with increased 1-year mortality (OR 3.73, 95% CI 1.11–12.53, p = 0.033). Conclusions: Elderly gastric cancer patients undergoing gastrectomy with MFS > 5 do not have increased mortality risk. The influence of frailty on postoperative outcomes may vary based on the risk of the surgical procedure.

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“…During such procedures, carbon dioxide (CO 2 ) pneumoperitoneum is applied in order to create a working space. This working space allows for the safe placement of access ports through the abdominal wall [50], visualization of organs [48,51] and completion of complex interventions [52,53]. Twenty years ago, we developed a first-generation device suitable for minimally invasive surgery procedures that allowed microdroplets of a therapeutic substance to be distributed into the pneumoperitoneum (CO 2 ), creating a "therapeutic pneumoperitoneum" [54].…”

Section: Pressurized Intraperitoneal Aerosol Chemotherapy (Pipac)mentioning

confidence: 99%

Overcoming Drug Resistance by Taking Advantage of Physical Principles: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)

Nadiradze

Horvath

Sautkin

et al. 2019

Cancers

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Theoretical considerations as well as comprehensive preclinical and clinical data suggest that optimizing physical parameters of intraperitoneal drug delivery might help to circumvent initial or acquired resistance of peritoneal metastasis (PM) to chemotherapy. Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is a novel minimally invasive drug delivery system systematically addressing the current limitations of intraperitoneal chemotherapy. The rationale behind PIPAC is: (1) optimizing homogeneity of drug distribution by applying an aerosol rather than a liquid solution; (2) applying increased intraperitoneal hydrostatic pressure to counteract elevated intratumoral interstitial fluid pressure; (3) limiting blood outflow during drug application; (4) steering environmental parameters (temperature, pH, electrostatic charge etc.) in the peritoneal cavity for best tissue target effect. In addition, PIPAC allows repeated application and objective assessment of tumor response by comparing biopsies between chemotherapy cycles. Although incompletely understood, the reasons that allow PIPAC to overcome established chemoresistance are probably linked to local dose intensification. All pharmacological data published so far show a superior therapeutic ratio (tissue concentration/dose applied) of PIPAC vs. systemic administration, of PIPAC vs. intraperitoneal liquid chemotherapy, of PIPAC vs. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) or PIPAC vs. laparoscopic HIPEC. In the initial introduction phase, PIPAC has been used in patients who were quite ill and had already failed multiple treatment regimes, but it may not be limited to that group of patients in the future. Rapid diffusion of PIPAC in clinical practice worldwide supports its potential to become a game changer in the treatment of chemoresistant isolated PM of various origins.

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Eleven-year experience with 3000 cases of laparoscopic gastric cancer surgery in a single institution: analysis of postoperative morbidities and long-term oncologic outcomes

Abstract: Our results indicate the trends toward the expansion of laparoscopic approaches to technically demanding procedures and an increased use of laparoscopic function-preserving surgeries for patients with EGC with acceptable outcomes.

Cited by 15 publications

References 34 publications

Prognostic Roles of Perioperative Body Mass Index and Weight Loss in the Long-Term Survival of Gastric Cancer Patients

Prognostic Roles of Perioperative Body Mass Index and Weight Loss in the Long-Term Survival of Gastric Cancer Patients

Frailty in Elderly Gastric Cancer Patients Undergoing Gastrectomy

Overcoming Drug Resistance by Taking Advantage of Physical Principles: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC)

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