Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer
Abstract Background This study aimed to determine the safety and feasibility of minimally invasive gastrectomy in patients who underwent preoperative chemotherapy for highly advanced gastric cancer. Methods Preoperative chemotherapy was indicated for patients with advanced large tumors (≥ cT3 and ≥ ...
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Gastroenterology |
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| Online Access: | https://doi.org/10.1186/s12876-024-03155-5 |
| _version_ | 1797274427713388544 |
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| author | Tsuyoshi Tanaka Koichi Suda Susumu Shibasaki Akiko Serizawa Shingo Akimoto Masaya Nakauchi Hiroshi Matsuoka Kazuki Inaba Ichiro Uyama |
| author_facet | Tsuyoshi Tanaka Koichi Suda Susumu Shibasaki Akiko Serizawa Shingo Akimoto Masaya Nakauchi Hiroshi Matsuoka Kazuki Inaba Ichiro Uyama |
| author_sort | Tsuyoshi Tanaka |
| collection | DOAJ |
| description | Abstract Background This study aimed to determine the safety and feasibility of minimally invasive gastrectomy in patients who underwent preoperative chemotherapy for highly advanced gastric cancer. Methods Preoperative chemotherapy was indicated for patients with advanced large tumors (≥ cT3 and ≥ 5 cm) and/or bulky node metastasis (≥ 3 cm × 1 or ≥ 1.5 cm × 2). Between January 2009 and March 2022, 150 patients underwent preoperative chemotherapy followed by gastrectomy with R0 resection, including conversion surgery (robotic, 62; laparoscopic, 88). The outcomes of these patients were retrospectively examined. Results Among them, 41 and 47 patients had stage IV disease and underwent splenectomy, respectively. Regarding operative outcomes, operative time was 475 min, blood loss was 72 g, morbidity (grade ≥ 3a) rate was 12%, local complication rate was 10.7%, and postoperative hospital stay was 14 days (Interquartile range: 11–18 days). Fifty patients (33.3%) achieved grade ≥ 2 histological responses. Regarding resection types, total/proximal gastrectomy plus splenectomy (29.8%) was associated with significantly higher morbidity than other types (distal gastrectomy, 3.2%; total/proximal gastrectomy, 4.9%; P < 0.001). Specifically, among splenectomy cases, the rate of postoperative complications associated with the laparoscopic approach was significantly higher than that associated with the robotic approach (40.0% vs. 0%, P = 0.009). In the multivariate analysis, splenectomy was an independent risk factor for postoperative complications [odds ratio, 8.574; 95% confidence interval (CI), 2.584–28.443; P < 0.001]. Conclusions Minimally invasive gastrectomy following preoperative chemotherapy was feasible and safe for patients with highly advanced gastric cancer. Robotic gastrectomy may improve surgical safety, particularly in the case of total/proximal gastrectomy combined with splenectomy. |
| first_indexed | 2024-03-07T14:58:11Z |
| format | Article |
| id | doaj.art-2959d80f6d0d4ed89728e01c6a6bc75a |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-03-07T14:58:11Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-2959d80f6d0d4ed89728e01c6a6bc75a2024-03-05T19:18:14ZengBMCBMC Gastroenterology1471-230X2024-02-0124111010.1186/s12876-024-03155-5Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancerTsuyoshi Tanaka0Koichi Suda1Susumu Shibasaki2Akiko Serizawa3Shingo Akimoto4Masaya Nakauchi5Hiroshi Matsuoka6Kazuki Inaba7Ichiro Uyama8Department of Surgery, Fujita Health UniversityDepartment of Surgery, Fujita Health UniversityDepartment of Surgery, Fujita Health UniversityDepartment of Surgery, Fujita Health UniversityDepartment of Surgery, Fujita Health UniversityDepartment of Advanced Robotic and Endoscopic Surgery, Fujita Health UniversityDepartment of Surgery, Fujita Health UniversityDepartment of Advanced Robotic and Endoscopic Surgery, Fujita Health UniversityDepartment of Advanced Robotic and Endoscopic Surgery, Fujita Health UniversityAbstract Background This study aimed to determine the safety and feasibility of minimally invasive gastrectomy in patients who underwent preoperative chemotherapy for highly advanced gastric cancer. Methods Preoperative chemotherapy was indicated for patients with advanced large tumors (≥ cT3 and ≥ 5 cm) and/or bulky node metastasis (≥ 3 cm × 1 or ≥ 1.5 cm × 2). Between January 2009 and March 2022, 150 patients underwent preoperative chemotherapy followed by gastrectomy with R0 resection, including conversion surgery (robotic, 62; laparoscopic, 88). The outcomes of these patients were retrospectively examined. Results Among them, 41 and 47 patients had stage IV disease and underwent splenectomy, respectively. Regarding operative outcomes, operative time was 475 min, blood loss was 72 g, morbidity (grade ≥ 3a) rate was 12%, local complication rate was 10.7%, and postoperative hospital stay was 14 days (Interquartile range: 11–18 days). Fifty patients (33.3%) achieved grade ≥ 2 histological responses. Regarding resection types, total/proximal gastrectomy plus splenectomy (29.8%) was associated with significantly higher morbidity than other types (distal gastrectomy, 3.2%; total/proximal gastrectomy, 4.9%; P < 0.001). Specifically, among splenectomy cases, the rate of postoperative complications associated with the laparoscopic approach was significantly higher than that associated with the robotic approach (40.0% vs. 0%, P = 0.009). In the multivariate analysis, splenectomy was an independent risk factor for postoperative complications [odds ratio, 8.574; 95% confidence interval (CI), 2.584–28.443; P < 0.001]. Conclusions Minimally invasive gastrectomy following preoperative chemotherapy was feasible and safe for patients with highly advanced gastric cancer. Robotic gastrectomy may improve surgical safety, particularly in the case of total/proximal gastrectomy combined with splenectomy.https://doi.org/10.1186/s12876-024-03155-5Stomach neoplasmsNeoadjuvant chemotherapyInduction chemotherapyMinimally invasive surgery |
| spellingShingle | Tsuyoshi Tanaka Koichi Suda Susumu Shibasaki Akiko Serizawa Shingo Akimoto Masaya Nakauchi Hiroshi Matsuoka Kazuki Inaba Ichiro Uyama Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer BMC Gastroenterology Stomach neoplasms Neoadjuvant chemotherapy Induction chemotherapy Minimally invasive surgery |
| title | Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer |
| title_full | Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer |
| title_fullStr | Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer |
| title_full_unstemmed | Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer |
| title_short | Safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer |
| title_sort | safety and feasibility of minimally invasive gastrectomy following preoperative chemotherapy for highly advanced gastric cancer |
| topic | Stomach neoplasms Neoadjuvant chemotherapy Induction chemotherapy Minimally invasive surgery |
| url | https://doi.org/10.1186/s12876-024-03155-5 |
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