Duration of Postoperative Fever as a Simple and Useful Prognostic Indicator in Gastric Cancer Patients

[Background] Postoperative inflammation is associated with cancer progression in several cancers. However, the prognostic significance of postoperative fever remains unclear in gastric cancer patients. [Methods] We enrolled 442 patients with a histopathological diagnosis of gastric adenocarcinoma who underwent curative surgery. [Results] The mean duration of postoperative fever ≥ 37°C was 8.7 days (range: 0–186 days) and significantly longer in patients with advanced gastric cancer, venous invasion, and open or total gastrectomy vs. patients with early gastric cancer (P = 0.0072), no venous invasion (P = 0.025), laparoscopic gastrectomy (P = 0.027), and either proximal or distal partial gastrectomy (P = 0.0015). Five-year overall survival rates were 69.5% vs. 83.6% in the prolonged postoperative fever group (≥ 6 days of ≥ 37°C) vs. the nonprolonged group (< 6 days of ≥ 37°C), respectively (P = 0.0008). In patients without Clavien-Dindo classification postoperative infectious complications grade ≥ 2, 5-year overall survival was 69.7% vs. 84.0% in patients with prolonged postoperative fever vs. those without, respectively (P = 0.0067). Five-year disease-specific survival was 85.9% vs. 93.1% in patients with prolonged fever vs. those without, respectively (P = 0.041). Multivariate analysis indicated that postoperative fever was an independent prognostic indicator. [Conclusion] Postoperative fever ≥ 37°C duration may be useful in predicting prognosis in gastric cancer patients

Operative Procedure for Laparoscopy-Assisted Vagus Nerve and Pylorus-Preserving Gastrectomy (LAVNPPG) for Early Gastric Cancer

Laparosocpy-assisted pylorus-preserving gastrectomy (LAPPG) is a widely accepted surgical procedure for the treatment of early gastric cancer in the middle third of the stomach. We have been performing this operation since 2007. Compared with traditional distal gastrectomy, LAPPG has postoperative nutritional benefits for patients. However, this procedure preserves only the pyloric branch of the vagus nerve and not the celiac branch. We found that patients retain a large amount of residual food in the gastric remnant, which interferes with the detection of secondary cancer on endoscopic follow-up. To improve the pyloric function and postoperative gastrointestinal motility, we changed our procedure during 2009 to preserve both the pyloric and celiac branches of the vagus nerve, and we named this new procedure laparoscopy-assisted vagus nerve and pylorus-preserving gastrectomy (LAVNPPG). From 2009 to 2011, 11 patients underwent LAVNPPG at our hospital. Retrospective comparison of the safety of operation, postoperative complications, and condition of the gastric remnant between LAPPG (n = 13) and LAVNPPG (n = 11) found that the occurrence of postprandial stasis and food residue in the gastric remnant tended to be lower following LAVNPPG, though the differences were not significant. These findings indicate that LAVNPPG may be an operative procedure that could replace LAPPG

Gross Appearance and Curability Are Predictive Factors of a Better Prognosis After Gastrectomy in Gastric Cancer Patients with Metastasis to the Adjacent Peritoneum of the Stomach

[Background] Gastric cancer patients with peritoneal metastasis have an extremely poor prognosis. The aim of the current study was to clarify the predictive factors of a better outcome in gastric cancer patients with peritoneal metastasis. [Methods] We analyzed the records of 2262 gastric adenocarcinoma patients who underwent gastrectomies at our institution between January 1980 and December 2010. [Results] The 5-year survival rates for advanced gastric cancer patients with P1 (n = 43), P2 (n = 56), and P3 (n = 36) metastasis were 16.3%, 0%, and 0%, respectively. The prognosis of P1 gastric cancer patients was significantly better than that of either P2 (P = 0.0003) or P3 patients (P < 0.0001). A multivariate analysis identified gross appearance and curability as independent prognostic indicators in P1 gastric cancer patients. In fact, the prognosis was good for patients in whom an R0/1 resection had been performed and with tumors having a gross appearance of other than type 4, with a 40% 5-year survival rate and a 29-month median survival time. [Conclusion] Our data indicated a good prognosis for P1 patients in whom an R0/1 resection could be performed and with tumors having a gross appearance of other than type 4. Therefore, radical surgery and adequate adjuvant chemotherapy should be performed in these patients