Short-term outcomes of preoperative computed tomography angiography versus standard assessment in patients with BMI ≥ 25.0 kg/m² undergoing laparoscopic gastrectomy: the GISSG20-01 randomized clinical trial.

IF 6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gastric Cancer Pub Date : 2025-03-01 Epub Date: 2025-01-09 DOI:10.1007/s10120-024-01580-9

Cheng Meng, Shougen Cao, Leping Li, Lijian Xia, Xianqun Chu, Lixin Jiang, XinJian Wang, Hao Wang, Shusheng Huang, Quanhong Duan, Zuocheng Sun, Qingsi He, Xizeng Hui, Daogui Yang, Huanhu Zhang, Zequn Li, Xiaodong Liu, Yulong Tian, Yuqi Sun, Yu Li, Haitao Jiang, Zhaojian Niu, Jian Zhang, Yanbing Zhou

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引用次数: 0

Abstract

Background: Laparoscopic gastrectomy lacks hand-direct tactile sense and has a limited surgical field compared to laparotomy. Apart from textbook classification, there are anatomical variations in the gastric arteries. Laparoscopic gastrectomy presents technical difficulties and necessitates a more comprehensive comprehension of regional anatomy than open surgical procedures. We aimed to compare efficacy and safety of preoperative computed tomography angiography (CTA) associated with surgical decision-making for laparoscopic gastrectomy.

Methods: The GISSG 20-01 study was a multicenter, open-label, randomized clinical trial. The enrollment criteria mainly included histologically confirmed gastric cancer patients with BMI ≥ 25 kg/m². Eligible patients were randomly assigned to the CTA group or the non-CTA group in a 1:1 ratio. The primary endpoint was the volume of intraoperative blood loss.

Results: Between November 2020 and December 2021, 382 patients were enrolled and randomly assigned. After exclusion of 25 patients, 357 patients were included in the modified intention-to-treat population (179 in the CTA group and 178 in the non-CTA group). The mean intraoperative blood loss (CTA vs non-CTA; 74.2 vs 95.0 mL, P = 0.005) and operation time (215.4 vs 231.2 min, P = 0.004) was significantly lower in the CTA group. Total number of retrieved lymph nodes was similar in two groups (32.2 vs 30.2, P = 0.070). The CTA group had a significantly lower surgery task load index sore than the non-CTA group (36.6 vs 41.7, P < 0.001). There was no significant difference in postoperative complications rate of 14.5% in the CTA group and 22.5% in the non-CTA group (difference, - 8.0% [95% CI, - 16.0 to 0.1]; P = 0.053).

Conclusion: Preoperative CTA associated with surgical decision-making could relieve surgery burden and lead to a better surgical performance compared with non-CTA support, which including decreased blood loss volume, vessel damage and operation time.

Trial registration: NCT04636099.

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BMI≥25.0 kg/m2的腹腔镜胃切除术患者术前计算机断层血管造影与标准评估的短期结果：GISSG20-01随机临床试验

背景：与剖腹手术相比，腹腔镜胃切除术缺乏手直接触觉，手术范围有限。除了教科书上的分类，胃动脉也有解剖学上的差异。腹腔镜胃切除术存在技术上的困难，需要比开放手术更全面地理解区域解剖。我们的目的是比较术前计算机断层血管造影（CTA）与腹腔镜胃切除术手术决策相关的有效性和安全性。方法：GISSG 20-01研究是一项多中心、开放标签、随机临床试验。入选标准主要为组织学证实的BMI≥25 kg/m2的胃癌患者。符合条件的患者按1:1的比例随机分为CTA组和非CTA组。主要终点是术中出血量。结果：在2020年11月至2021年12月期间，382名患者入组并随机分配。在排除25例患者后，357例患者被纳入改良意向治疗人群（179例CTA组，178例非CTA组）。平均术中出血量(CTA vs非CTA；CTA组74.2 vs 95.0 mL, P = 0.005)，手术时间（215.4 vs 231.2 min, P = 0.004）显著缩短。两组淋巴结清扫总数相似（32.2 vs 30.2, P = 0.070）。CTA组的手术任务负荷指数明显低于非CTA组（36.6 vs 41.7）， P结论：术前CTA辅助手术决策可减轻手术负担，手术效果优于非CTA组，包括出血量减少、血管损伤减少、手术时间缩短等。试验注册：NCT04636099。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gastric Cancer 医学-胃肠肝病学

CiteScore

14.70

自引率

2.70%

发文量

审稿时长

6-12 weeks

期刊介绍： Gastric Cancer is an esteemed global forum that focuses on various aspects of gastric cancer research, treatment, and biology worldwide. The journal promotes a diverse range of content, including original articles, case reports, short communications, and technical notes. It also welcomes Letters to the Editor discussing published articles or sharing viewpoints on gastric cancer topics. Review articles are predominantly sought after by the Editor, ensuring comprehensive coverage of the field. With a dedicated and knowledgeable editorial team, the journal is committed to providing exceptional support and ensuring high levels of author satisfaction. In fact, over 90% of published authors have expressed their intent to publish again in our esteemed journal.