Journal of Gastric Cancer最新文献

{"title":"Feasibility and Potential of Reduced Port Surgery for Total Gastrectomy With Overlap Esophagojejunal Anastomosis Method.","authors":"Ho Seok Seo, Sojung Kim, Kyo Young Song, Han Hong Lee","doi":"10.5230/jgc.2023.23.e26","DOIUrl":"10.5230/jgc.2023.23.e26","url":null,"abstract":"<p><strong>Purpose: </strong>Reduced port surgery (RPS) for gastric cancer has been frequently reported in distal gastrectomies but rarely in total gastrectomies. This study aimed to determine the feasibility of 3-port totally laparoscopic total gastrectomy (TLTG) with overlapping esophagojejunal (EJ) anastomosis.</p><p><strong>Materials and methods: </strong>A total of 81 patients who underwent curative TLTG for gastric cancer (36 and 45 patients with 3-port and 5-port TLTG, respectively) were evaluated. All 3-port TLTG procedures were performed with the same method as 5-port TLTG, including EJ anastomosis with the intracorporeal overlap method using a linear stapler, except for the number of ports and assistants. Short-term outcomes, including the number of lymph nodes (LNs) harvested by station and postoperative complications, were analyzed retrospectively.</p><p><strong>Results: </strong>Clinical characteristics were not significantly different among the groups, except that the 3-port TLTG group was younger and had a lower rate of pulmonary comorbidity. There were no cases of open conversion or additional port placement. All operative details and the number of harvested LNs did not differ between the groups, but the rate of suprapancreatic LN harvest was higher in the 3-port TLTG group. No significant differences were observed in the overall complication rates between the 2 groups.</p><p><strong>Conclusions: </strong>Three-port TLTG with overlapping EJ anastomoses using a linear stapler is a feasible RPS procedure for total gastrectomy to treat gastric cancer.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 3","pages":"487-498"},"PeriodicalIF":3.8,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/75/jgc-23-487.PMC10412980.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10032019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Surgery and Its Potential for Gastric Cancer.","authors":"Takahiro Kinoshita, Masaru Komatsu","doi":"10.5230/jgc.2023.23.e27","DOIUrl":"10.5230/jgc.2023.23.e27","url":null,"abstract":"<p><p>Artificial intelligence (AI) has made significant progress in recent years, and many medical fields are attempting to introduce AI technology into clinical practice. Currently, much research is being conducted to evaluate that AI can be incorporated into surgical procedures to make them safer and more efficient, subsequently to obtain better outcomes for patients. In this paper, we review basic AI research regarding surgery and discuss the potential for implementing AI technology in gastric cancer surgery. At present, research and development is focused on AI technologies that assist the surgeon's understandings and judgment during surgery, such as anatomical navigation. AI systems are also being developed to recognize in which the surgical phase is ongoing. Such a surgical phase recognition systems is considered for effective storage of surgical videos and education, in the future, for use in systems to objectively evaluate the skill of surgeons. At this time, it is not considered practical to let AI make intraoperative decisions or move forceps automatically from an ethical standpoint, too. At present, AI research on surgery has various limitations, and it is desirable to develop practical systems that will truly benefit clinical practice in the future.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 3","pages":"400-409"},"PeriodicalIF":3.8,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/03/1f/jgc-23-400.PMC10412972.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10330668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Gastrectomy for Gastric Cancer in Patients Aged >80 Years: A Systematic Literature Review and Meta-Analysis.","authors":"Zelalem Chimdesa Merga,&nbsp;Ji Sung Lee,&nbsp;Chung-Sik Gong","doi":"10.5230/jgc.2023.23.e23","DOIUrl":"https://doi.org/10.5230/jgc.2023.23.e23","url":null,"abstract":"<p><p>This meta-analysis examined the surgical management of older patients (>80 years) with gastric cancer, who were often excluded from randomized controlled trials. We analyzed 23 retrospective cohort studies involving 18,372 patients and found that older patients had a higher in-hospital mortality rate (relative risk [RR], 3.23; 95% confidence interval [CI], 1.46-7.17; P<0.01) and more post-operative complications (RR, 1.36; 95% CI, 1.19-1.56; P<0.01) than did younger patients. However, the surgical complications were similar between the two groups. Older patients were more likely to undergo less extensive lymph node dissection and longer hospital stays. Although older patients had statistically significant post-operative medical complications, they were not deprived of surgery for gastric cancer. The comorbidities and potential risks of post-operative complications should be carefully evaluated in older patients, highlighting the importance of careful patient selection. Overall, this meta-analysis provides recommendations for the surgical management of older patients with gastric cancer. Careful patient selection and evaluation of comorbidities should be performed to minimize the risk of post-operative complications in older patients, while recognizing that they should not be deprived of surgery for gastric cancer.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 3","pages":"428-450"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dc/b1/jgc-23-428.PMC10412976.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10032021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Optimal Tumor Mutational Burden Cutoff Value as a Novel Marker for Predicting the Efficacy of Programmed Cell Death-1 Checkpoint Inhibitors in Advanced Gastric Cancer.","authors":"Jae Yeon Jang,&nbsp;Youngkyung Jeon,&nbsp;Sun Young Jeong,&nbsp;Sung Hee Lim,&nbsp;Won Ki Kang,&nbsp;Jeeyun Lee,&nbsp;Seung Tae Kim","doi":"10.5230/jgc.2023.23.e29","DOIUrl":"https://doi.org/10.5230/jgc.2023.23.e29","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal tumor mutational burden (TMB) value for predicting treatment response to programmed cell death-1 (PD-1) checkpoint inhibitors in advanced gastric cancer (AGC) remains unclear. We aimed to investigate the optimal TMB cutoff value that could predict the efficacy of PD-1 checkpoint inhibitors in AGC.</p><p><strong>Materials and methods: </strong>Patients with AGC who received pembrolizumab or nivolumab between October 1, 2020, and July 27, 2021, at Samsung Medical Center in Korea were retrospectively analyzed. The TMB levels were measured using a next-generation sequencing assay. Based on receiver operating characteristic curve analysis, the TMB cutoff value was determined.</p><p><strong>Results: </strong>A total 53 patients were analyzed. The TMB cutoff value for predicting the overall response rate (ORR) to PD-1 checkpoint inhibitors was defined as 13.31 mutations per megabase (mt/Mb) with 56% sensitivity and 95% specificity. Based on this definition, 7 (13.2%) patients were TMB-high (TMB-H). The ORR differed between the TMB-low (TMB-L) and TMB-H (8.7% vs. 71.4%, P=0.001). The progression-free survival and overall survival (OS) for 53 patients were 1.93 (95% confidence interval [CI], 1.600-2.268) and 4.26 months (95% CI, 2.992-5.532). The median OS was longer in the TMB-H (20.8 months; 95% CI, 2.292-39.281) than in the TMB-L (3.31 months; 95% CI, 1.604-5.019; P=0.049).</p><p><strong>Conclusions: </strong>The TMB cutoff value for predicting treatment response in AGC patients who received PD-1 checkpoint inhibitor monotherapy as salvage treatment was 13.31 mt/Mb. When applying the programmed death ligand-1 status to TMB-H, patients who would benefit from PD-1 checkpoint inhibitors can be selected.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 3","pages":"476-486"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/58/54/jgc-23-476.PMC10412974.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9978398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Artificial Intelligence in Gastric Cancer: Surgical and Therapeutic Perspectives: A Comprehensive Review.","authors":"JunHo Lee,&nbsp;Hanna Lee,&nbsp;Jun-Won Chung","doi":"10.5230/jgc.2023.23.e31","DOIUrl":"https://doi.org/10.5230/jgc.2023.23.e31","url":null,"abstract":"<p><p>Stomach cancer has a high annual mortality rate worldwide necessitating early detection and accurate treatment. Even experienced specialists can make erroneous judgments based on several factors. Artificial intelligence (AI) technologies are being developed rapidly to assist in this field. Here, we aimed to determine how AI technology is used in gastric cancer diagnosis and analyze how it helps patients and surgeons. Early detection and correct treatment of early gastric cancer (EGC) can greatly increase survival rates. To determine this, it is important to accurately determine the diagnosis and depth of the lesion and the presence or absence of metastasis to the lymph nodes, and suggest an appropriate treatment method. The deep learning algorithm, which has learned gastric lesion endoscopyimages, morphological characteristics, and patient clinical information, detects gastric lesions with high accuracy, sensitivity, and specificity, and predicts morphological characteristics. Through this, AI assists the judgment of specialists to help select the correct treatment method among endoscopic procedures and radical resections and helps to predict the resection margins of lesions. Additionally, AI technology has increased the diagnostic rate of both relatively inexperienced and skilled endoscopic diagnosticians. However, there were limitations in the data used for learning, such as the amount of quantitatively insufficient data, retrospective study design, single-center design, and cases of non-various lesions. Nevertheless, this assisted endoscopic diagnosis technology that incorporates deep learning technology is sufficiently practical and future-oriented and can play an important role in suggesting accurate treatment plans to surgeons for resection of lesions in the treatment of EGC.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 3","pages":"375-387"},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/06/9c/jgc-23-375.PMC10412973.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10032016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in Gastric Cancer Imaging With Emphasis on Diagnostic Imaging and Body Morphometry.","authors":"Kyung Won Kim, Jimi Huh, Bushra Urooj, Jeongjin Lee, Jinseok Lee, In-Seob Lee, Hyesun Park, Seongwon Na, Yousun Ko","doi":"10.5230/jgc.2023.23.e30","DOIUrl":"10.5230/jgc.2023.23.e30","url":null,"abstract":"<p><p>Gastric cancer remains a significant global health concern, coercing the need for advancements in imaging techniques for ensuring accurate diagnosis and effective treatment planning. Artificial intelligence (AI) has emerged as a potent tool for gastric-cancer imaging, particularly for diagnostic imaging and body morphometry. This review article offers a comprehensive overview of the recent developments and applications of AI in gastric cancer imaging. We investigated the role of AI imaging in gastric cancer diagnosis and staging, showcasing its potential to enhance the accuracy and efficiency of these crucial aspects of patient management. Additionally, we explored the application of AI body morphometry specifically for assessing the clinical impact of gastrectomy. This aspect of AI utilization holds significant promise for understanding postoperative changes and optimizing patient outcomes. Furthermore, we examine the current state of AI techniques for the prognosis of patients with gastric cancer. These prognostic models leverage AI algorithms to predict long-term survival outcomes and assist clinicians in making informed treatment decisions. However, the implementation of AI techniques for gastric cancer imaging has several limitations. As AI continues to evolve, we hope to witness the translation of cutting-edge technologies into routine clinical practice, ultimately improving patient care and outcomes in the fight against gastric cancer.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 3","pages":"388-399"},"PeriodicalIF":3.8,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/b8/jgc-23-388.PMC10412978.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9978395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence in the Pathology of Gastric Cancer.","authors":"Sangjoon Choi, Seokhwi Kim","doi":"10.5230/jgc.2023.23.e25","DOIUrl":"10.5230/jgc.2023.23.e25","url":null,"abstract":"<p><p>Recent advances in artificial intelligence (AI) have provided novel tools for rapid and precise pathologic diagnosis. The introduction of digital pathology has enabled the acquisition of scanned slide images that are essential for the application of AI. The application of AI for improved pathologic diagnosis includes the error-free detection of potentially negligible lesions, such as a minute focus of metastatic tumor cells in lymph nodes, the accurate diagnosis of potentially controversial histologic findings, such as very well-differentiated carcinomas mimicking normal epithelial tissues, and the pathological subtyping of the cancers. Additionally, the utilization of AI algorithms enables the precise decision of the score of immunohistochemical markers for targeted therapies, such as human epidermal growth factor receptor 2 and programmed death-ligand 1. Studies have revealed that AI assistance can reduce the discordance of interpretation between pathologists and more accurately predict clinical outcomes. Several approaches have been employed to develop novel biomarkers from histologic images using AI. Moreover, AI-assisted analysis of the cancer microenvironment showed that the distribution of tumor-infiltrating lymphocytes was related to the response to the immune checkpoint inhibitor therapy, emphasizing its value as a biomarker. As numerous studies have demonstrated the significance of AI-assisted interpretation and biomarker development, the AI-based approach will advance diagnostic pathology.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 3","pages":"410-427"},"PeriodicalIF":3.8,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/f4/jgc-23-410.PMC10412971.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9978392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Phase III Study of Patients With Advanced Gastric Adenocarcinoma Without Progression After Six Cycles of XELOX (Capecitabine Plus Oxaliplatin) Followed by Capecitabine Maintenance or Clinical Observation.","authors":"Guk Jin Lee,&nbsp;Hyunho Kim,&nbsp;Sung Shim Cho,&nbsp;Hyung Soon Park,&nbsp;Ho Jung An,&nbsp;In Sook Woo,&nbsp;Jae Ho Byun,&nbsp;Ji Hyung Hong,&nbsp;Yoon Ho Ko,&nbsp;Der Sheng Sun,&nbsp;Hye Sung Won,&nbsp;Jong Youl Jin,&nbsp;Ji Chan Park,&nbsp;In-Ho Kim,&nbsp;Sang Young Roh,&nbsp;Byoung Yong Shim","doi":"10.5230/jgc.2023.23.e16","DOIUrl":"https://doi.org/10.5230/jgc.2023.23.e16","url":null,"abstract":"<p><strong>Purpose: </strong>Oxaliplatin, a component of the capecitabine plus oxaliplatin (XELOX) regimen, has a more favorable toxicity profile than cisplatin in patients with advanced gastric cancer (GC). However, oxaliplatin can induce sensory neuropathy and cumulative, dose-related toxicities. Thus, the capecitabine maintenance regimen may achieve the maximum treatment effect while reducing the cumulative neurotoxicity of oxaliplatin. This study aimed to compare the survival of patients with advanced GC between capecitabine maintenance and observation after 1st line XELOX chemotherapy.</p><p><strong>Materials and methods: </strong>Sixty-three patients treated with six cycles of XELOX for advanced GC in six hospitals of the Catholic University of Korea were randomized 1:1 to receive capecitabine maintenance or observation. The primary endpoint was progression-free survival (PFS), analyzed using a two-sided log-rank test stratified at a 5% significance level.</p><p><strong>Results: </strong>Between 2015 and 2020, 32 and 31 patients were randomized into the maintenance and observation groups, respectively. After randomization, the median number of capecitabine maintenance cycles was 6. The PFS was significantly higher in the maintenance group than the observation group (6.3 vs. 4.1 months, P=0.010). Overall survival was not significantly different between the 2 groups (18.2 vs. 16.5 months, P=0.624). Toxicities, such as hand-foot syndrome, were reported in some maintenance group patients. Maintenance treatment was a significant factor associated with PFS in multivariate analysis (hazard ratio, 0.472; 95% confidence interval, 0.250-0.890; P=0.020).</p><p><strong>Conclusions: </strong>After 6 cycles of XELOX chemotherapy, capecitabine maintenance significantly prolonged PFS compared with observation, and toxicity was manageable. Maintenance treatment was a significant prognostic factor associated with PFS.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT02289547.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 2","pages":"315-327"},"PeriodicalIF":2.5,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/f7/jgc-23-315.PMC10154142.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10659444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advantages of Function-Preserving Gastrectomy for Older Patients With Upper-Third Early Gastric Cancer: Maintenance of Nutritional Status and Favorable Survival.","authors":"Masayoshi Terayama, Manabu Ohashi, Satoshi Ida, Masaru Hayami, Rie Makuuchi, Koshi Kumagai, Takeshi Sano, Souya Nunobe","doi":"10.5230/jgc.2023.23.e9","DOIUrl":"10.5230/jgc.2023.23.e9","url":null,"abstract":"<p><strong>Purpose: </strong>The incidence of early gastric cancer is increasing in older patients alongside life expectancy. For early gastric cancer of the upper third of the stomach, laparoscopic function-preserving gastrectomy (LFPG), including laparoscopic proximal gastrectomy (LPG) and laparoscopic subtotal gastrectomy (LSTG), is expected to be an alternative to laparoscopic total gastrectomy (LTG). However, whether LFPG has advantages over LTG in older patients remains unknown.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed data of consecutive patients aged ≥75 years who underwent LTG, LPG, or LSTG for cT1N0M0 gastric cancer between 2005 and 2019. Surgical and nutritional outcomes, including blood parameters, percentage body weight (%BW) and percentage skeletal muscle index (%SMI) were compared between LTG and LPG or LSTG. Survival outcomes were also compared between LTG and LFPG groups.</p><p><strong>Results: </strong>A total of 111 patients who underwent LTG (n=39), LPG (n=48), and LSTG (n=24) were enrolled in this study. To match the surgical indications, LTG was further categorized into \"LTG for LPG\" (LTG-P) and \"LTG for LSTG\" (LTG-S). No significant differences were identified in the incidence of postoperative complications among the procedures. Postoperative nutritional parameters, %BW and %SMI were better after LPG and LSTG than after LTG-P and LTG-S, respectively. The survival outcomes of LFPG were better than those of LTG.</p><p><strong>Conclusions: </strong>LFPG is safe for older patients and has advantages over LTG in terms of postoperative nutritional parameters, body weight, skeletal muscle-sparing, and survival. Therefore, LFPG for upper early gastric cancer should be considered in older patients.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 2","pages":"303-314"},"PeriodicalIF":3.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/0e/jgc-23-303.PMC10154138.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9411365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chylous Ascites After Gastric Cancer Surgery: Risk Factors and Treatment Results.","authors":"Sung Hyun Park, Ki-Yoon Kim, Minah Cho, Hyoung-Il Kim, Woo Jin Hyung, Yoo Min Kim","doi":"10.5230/jgc.2023.23.e2","DOIUrl":"10.5230/jgc.2023.23.e2","url":null,"abstract":"<p><strong>Purpose: </strong>Although chylous ascites is a frequent complication of radical gastrectomy for gastric cancer, proper diagnostic criteria and optimal treatment strategies have not been established. This study aimed to identify the clinical features of chylous ascites and evaluate the treatment outcomes.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed the data of patients who underwent radical gastrectomy between 2013 and 2019. Diagnosis was made when milky fluid or elevated triglyceride levels (≥100 mg/dL) appeared in the drains without a preceding infection. The clinical features, risk factors, and treatment outcomes were assessed according to the initial treatment modalities for fasting and non-fasting groups.</p><p><strong>Results: </strong>Among the 7,388 patients who underwent radical gastrectomy for gastric cancer, 156 (2.1%) experienced chylous ascites. The median length of hospital stay was longer in patients with chylous ascites than in those without (median [interquartile range]: 8.0 [6.0-12.0] vs. 6.0 [5.0-8.0], P<0.001). Low body mass index (adjusted odds ratio [aOR]=0.9; P<0.001), advanced gastric cancer (aOR=1.51, P=0.024), open surgery (reference: laparoscopic surgery; aOR=1.87, P=0.003), and extent of surgical resection (reference: subtotal gastrectomy, total gastrectomy, aOR=1.5, P=0.029; proximal gastrectomy, aOR=2.93, P=0.002) were associated with the occurrence of chylous ascites. The fasting group (n=12) was hospitalized for a longer period than the non-fasting group (n=144) (15.0 [12.5-19.5] vs. 8.0 [6.0-10.0], P<0.001). There was no difference in grade III complication rate (16.7% vs. 4.2%, P=0.117) or readmission rate (16.7% vs. 11.1%, P=0.632) between the groups.</p><p><strong>Conclusions: </strong>A fat-controlled diet and medication without fasting provided adequate initial treatment for chylous ascites after radical gastrectomy for gastric cancer.</p>","PeriodicalId":56072,"journal":{"name":"Journal of Gastric Cancer","volume":"23 2","pages":"253-263"},"PeriodicalIF":3.8,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/64/dc/jgc-23-253.PMC10154137.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9411363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}