Impact of the Number of Dissected Lymph Nodes on Survival for Gastric Cancer after Distal Subtotal Gastrectomy

Objectives. To investigate the prognostic impact of the number of dissected lymph nodes (LNs) in gastric cancer after curative distal gastrectomy. Methods. The survival of 634 patients who underwent curative distal gastrectomy from 1995 to 2004 was retrieved. Long-term surgical outcomes and associations between the number of dissected LNs and the 5-year survival rate were investigated. Results. The number of dissected LNs was one of the most important prognostic indicators. Among patients with comparable T category, the larger the number of dissected LNs was, the better the survival would be (P < 0.05). The linear regression showed that a significant survival improvement based on increasing retrieved LNs for stage II, III and IV (P < 0.05). A cut-point analysis yields the greatest variance of survival rate difference at the levels of 15 LNs (stage I), 25 LNs (stage II) and 30 LNs (stage III). Conclusion. The number of dissected LNs is an independent prognostic factor for gastric cancer. To improve the long-term survival of patients with gastric cancer, removing at least 15 LNs for stage I, 25 LNs for stage II, and 30 LNs for stage III patients during curative distal gastrectomy is recommended

Diagnostic value of two dimensional shear wave elastography combined with texture analysis in early liver fibrosis.

BACKGROUND: Staging diagnosis of liver fibrosis is a prerequisite for timely diagnosis and therapy in patients with chronic hepatitis B. In recent years, ultrasound elastography has become an important method for clinical noninvasive assessment of liver fibrosis stage, but its diagnostic value for early liver fibrosis still needs to be further improved. In this study, the texture analysis was carried out on the basis of two dimensional shear wave elastography (2D-SWE), and the feasibility of 2D-SWE plus texture analysis in the diagnosis of early liver fibrosis was discussed. AIM: To assess the diagnostic value of 2D-SWE combined with textural analysis in liver fibrosis staging. METHODS: This study recruited 46 patients with chronic hepatitis B. Patients underwent 2D-SWE and texture analysis; Young\u27s modulus values and textural patterns were obtained, respectively. Textural pattern was analyzed with regard to contrast, correlation, angular second moment (ASM), and homogeneity. Pathological results of biopsy specimens were the gold standard; comparison and assessment of the diagnosis efficiency were conducted for 2D-SWE, texture analysis and their combination. RESULTS: 2D-SWE displayed diagnosis efficiency in early fibrosis, significant fibrosis, severe fibrosis, and early cirrhosis (AUC \u3e 0.7, P \u3c 0.05) with respective AUC values of 0.823 (0.678-0.921), 0.808 (0.662-0.911), 0.920 (0.798-0.980), and 0.855 (0.716-0.943). Contrast and homogeneity displayed independent diagnosis efficiency in liver fibrosis stage (AUC \u3e 0.7, P \u3c 0.05), whereas correlation and ASM showed limited values. AUC of contrast and homogeneity were respectively 0.906 (0.779-0.973), 0.835 (0.693-0.930), 0.807 (0.660-0.910) and 0.925 (0.805-0.983), 0.789 (0.639-0.897), 0.736 (0.582-0.858), 0.705 (0.549-0.883) and 0.798 (0.650-0.904) in four liver fibrosis stages, which exhibited equivalence to 2D-SWE in diagnostic efficiency (P \u3e 0.05). Combined diagnosis (PRE) displayed diagnostic efficiency (AUC \u3e 0.7, P \u3c 0.01) for all fibrosis stages with respective AUC of 0.952 (0.841-0.994), 0.896 (0.766-0.967), 0.978 (0.881-0.999), 0.947 (0.835-0.992). The combined diagnosis showed higher diagnosis efficiency over 2D-SWE in early liver fibrosis (P \u3c 0.05), whereas no significant differences were observed in other comparisons (P \u3e 0.05). CONCLUSION: Texture analysis was capable of diagnosing liver fibrosis stage, combined diagnosis had obvious advantages in early liver fibrosis, liver fibrosis stage might be related to the hepatic tissue hardness distribution

Current Status of Indocyanine Green Tracer-Guided Lymph Node Dissection in Minimally Invasive Surgery for Gastric Cancer

With the rapid development and popularization of laparoscopic and robotic radical gastrectomy, gastric cancer surgery has gradually entered a new era of precise minimally invasive surgery. The era of precision medicine has put forth new requirements for minimally invasive surgical treatment of patients with gastric cancer at different disease stages. For patients with early gastric cancer, avoiding surgical trauma caused by excessive lymph node dissection improves quality of life while pursuing radical treatment of the tumor. In patients with advanced gastric cancer, systematic lymph node dissection can be achieved without increasing surgical complications. With the successful application of indocyanine green (ICG) fluorescence imaging technology in minimally invasive surgical instrumentation in recent years, researchers have found that ICG fluorescence imaging yields good tissue penetration and can identify lymph nodes in fat tissue better than other dyes. Therefore, whether ICG fluorescence imaging technology can guide surgeons in performing safe and effective lymph node dissection has attracted much attention. The present review discusses the clinical applications and research progress of ICG tracer-guided lymph node dissection in patients with gastric cancer

Laparoscopic resection for gastric GISTs: surgical and long-term outcomes of 133 cases

Background It aims to evaluate the surgical efficacy and long-term survival of different laparoscopic surgeries for gastric GISTs. Methods From a prospectively collected database, 133 patients with primary gastric GISTs undergoing laparoscopic surgery were selected from January 2008 to December 2014. They were divided into three groups according to the different operations that were performed, including laparoscopic gastric wedge resection (LWR Group, n=103), laparoscopic subtotal gastrectomy (LSG Group, n=18) and laparoscopic total gastrectomy (LTG group, n=12). Clinicopathological features and short- and long-term outcomes were analyzed retrospectively. Results All patients had received R0 resection. There were no differences among the three groups in age, BMI or NIH risk classification. Compared with the LSG group and LTG group, the LWR group had a shorter operative time, less blood loss, fewer operative complications and shorter time to ground activities, semi-liquid diet and hospital stay (P&lt;0.05). There was no statistically significant difference in time to first flatus and liquid diet or in the rate of postoperative complications (P&lt;0.05). In the patients with a large tumor (size≥5 cm), LWR was significantly associated with shorter operative time, less blood loss and shorter hospital stay compared with the laparoscopic gastric non-wedge resection (N-LWR) (P&lt;0.05). The median follow-up was 30 months, with 4 cases of recurrence and 3 deaths. The 5-year cumulative survival rate was similar among the three groups (P&gt;0.05). Conclusions Compared with LSG and LTG, more favorable minimally invasive results can be achieved from LWR for gastric GISTs, which may be the optimal surgical procedure

Left gastric vein on the dorsal side of the splenic artery: a rare anatomic variant revealed during gastric surgery

PURPOSE: The left gastric vein (LGV) is an important blood vessel requiring dissection during gastric surgery. We describe a rare anatomic variant of the LGV. METHODS: The LGV drainage pattern was analyzed relative to intraoperative vascular anatomy in 2,111 patients with gastric cancer who underwent radical resection from May 2007 to September 2012. The incidence of the anatomic variant was determined, and the diameter and length of the LGV and the distances from the end of the LGV to the splenoportal confluence and the root of the left gastric artery (LGA) were measured by abdominal CT reconstruction. RESULTS: In 6 of the 2,111 (0.28 %) gastric cancer patients who underwent radical resection, the LGV descended on the left side of the gastropancreatic fold, ran across the dorsal side of the splenic artery and drained into the splenic vein. The mean diameter and length of the LGV were 5.10 ± 0.40 and 37.40 ± 5.19 mm, respectively, and the mean distance from the end of the LGV to the splenoportal confluence was 13.05 ± 0.86 mm. The closer the LGV and LGA were to the root, the greater the distance between them, with a mean 13.85 ± 1.02 mm between the end of the LGV and the root of the LGA. CONCLUSIONS: In this rare anatomic variant, the LGV descends along the gastropancreatic fold, runs across the dorsal side of the splenic artery and drains into the splenic vein. Knowledge of this rare anatomic variant will help avoid damage to the LGV during gastric surgery

Long-term proton pump inhibitor use and the incidence of gastric cancer: A systematic review and meta-analysis

Background: There are controverted whether the long-term use of proton pump inhibitors (PPI) will increase the risk of gastric cancer. We performed a meta-analysis to assess the risk of gastric cancer in PPI users compared with non-PPI users. Methods: The main inclusion criteria were original studies reporting the incidence of gastric cancer in PPI users compared with non-PPI users. Key outcomes were the risk ratios (RR) for gastric cancer in association with PPI users or non-PPI users. Results: We analyzed data from 8 studies, comprising more than 927,684 patients. The risk of gastric cancer in PPI users was significantly higher than in non-PPI users [RR= 2.10, 95% CI (1.17-3.97)]. The risk of gastric cancer was similar between the 2 groups when the duration was ≤1 year [RR= 2.18, 95% CI (0.66-7.11)]. While the risk of gastric cancer for PPI users was higher than in non-PPI users when the duration was between 1-3 years, ≥1 year, ≥3 years and ≥5 years. The risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users [RR= 2.66, 95% CI (1.66 -4.27)], and the risk of non-cardiac gastric cancer for PPI users was higher than for non-PPI users when the duration ≥1 year [RR= 1.99, 95% CI (1.03-3.83)], but the risk for cardiac gastric cancer was similar between the 2 groups [RR= 1.86, 95% CI (0.71-4.89)]. Conclusions: We found the long-term use of PPI (duration ≥1 year) was significantly associated with a higher risk of non-cardiac gastric cancer

A protocol for cooperation to establish an International Gastric Cancer Unit (IGCU)

The following text shows the terms of a protocol for cooperation recently signed between the Department of Digestive Surgery - St. Mary’s Hospital (Terni, Italy; hereinafter&nbsp;“SMH”), the Department of Surgical Sciences - “La Sapienza” University (Rome, Italy;&nbsp;hereinafter “SUR”) and the Department of Gastric Surgery - Fujian Medical University&nbsp;Union Hospital (Fuzhou, Fujian Province, PRC; hereinafter “FMU”)

A protocol for cooperation to establish an International Gastric Cancer Unit (IGCU)

The following text shows the terms of a protocol for cooperation recently signed between The Department of Digestive Surgery - St. Mary’s Hospital (Terni, Italy; hereinafter “SMH”), the Department of Surgical Sciences - “La Sapienza” University (Rome, Italy; hereinafter “SUR”) and the Department of Gastric Surgery - Fujian Medical University Union Hospital (Fuzhou, Fujian Province, PRC; hereinafter “FMU”)

2,2,7,7-Tetra­methyl-2,3,6,7-tetra­hydro­benzofuro[7,6-b]furan

The title compound, C14H18O2, was obtained as a by-product during the preparation of carbofuran phenol. The two dihydro­furan rings are in envelope conformations